Kaiser Permanente Senior Advantage de Medicare y Medicaid …info.kaiserpermanente.org/info_assets/directory/pdf/codb... · 2017-10-01 · Por lo general, tiene que usar las farmacias

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Kaiser Permanente Senior Advantage de Medicare y

Medicaid (HMO SNP)

Lista de medicamentos aprobados de 2017

(Lista de medicamentos cubiertos) POR FAVOR, LEER: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS MEDICAMENTOS QUE CUBRIMOS EN ESTE PLAN Esta lista de medicamentos recetados disponibles se actualizó el 1 de septiembre de 2017. Para obtener información más reciente o si tiene alguna pregunta, comuníquese con el Servicio a los Miembros al 1-800-476-2167 o bien, para los usuarios de TTY, al 711, siete días a la semana, de 8 a. m. a 8 p. m., o visite kp.org/seniormedrx.

Nota para los miembros actuales: Esta lista de medicamentos recetados disponibles ha cambiado desde el año pasado. Revise este documento para asegurarse de que todavía incluye los medicamentos que está tomando.

Cuando en esta lista de medicamentos (lista de medicamentos recetados disponibles) se utilizan los términos “nosotros”, “nuestros/as” o “-nos”, se hace referencia a Kaiser Foundation Health Plan, Inc. de Colorado. Cuando se habla del “plan” o de “nuestro plan”, se hace referencia al plan Kaiser Permanente Senior Advantage de Medicare y Medicaid.

En este documento se incluye una lista de los medicamentos (lista de medicamentos recetados disponibles) de nuestro plan, la cual está actualizada al 1 de septiembre de 2017. Para obtener una lista de medicamentos recetados disponibles actualizada, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización de la lista de medicamentos recetados disponibles, aparece en la portada y la contraportada.

http://kp.org/seniormedrx

Por lo general, tiene que usar las farmacias de la red para utilizar su beneficio de medicamentos recetados. Los beneficios, la lista de medicamentos recetados disponibles, la red de farmacias o los copagos y coseguros podrían cambiar el 1 de enero de 2018 y en forma ocasional durante el año. Kaiser Permanente es un plan de la Organización para el mantenimiento de la salud (HMO) SNP con un contrato con Medicare y con el programa Medicaid del estado. La inscripción en Kaiser Permanente depende de la renovación del contrato. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-476-2167 (línea TTY: 711).

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-476-2167 (TTY: 711).

Lista de medicamentos aprobados de 2017 para Senior Advantage de Medicare y Medicaid • 1

¿Qué es la lista de medicamentos recetados disponibles de Kaiser Permanente? Una lista de medicamentos recetados disponibles es una lista de los medicamentos cubiertos, seleccionados por Kaiser Permanente junto con un equipo de proveedores de atención médica, que representa las farmacoterapias que se consideran parte necesaria de un programa de tratamiento de calidad. Por lo general, nuestro plan cubrirá los medicamentos que figuran en nuestra lista de medicamentos recetados disponibles, siempre y cuando el medicamento sea necesario desde el punto de vista médico, la receta médica se surta en una farmacia de la red de Kaiser Permanente y se cumpla con otras reglas del plan. Para obtener más información sobre cómo surtir sus recetas médicas, consulte su Evidencia de Cobertura. ¿Puede cambiar la lista de medicamentos recetados disponibles? En general, si está tomando un medicamento incluido en nuestra lista de medicamentos recetados disponibles de 2017 que estaba cubierto al principio del año, no suspenderemos ni reduciremos la cobertura del medicamento durante el año de cobertura de 2017, excepto en casos en los que surja un medicamento genérico nuevo menos caro o se publique información adversa nueva sobre la seguridad o eficacia de un medicamento. Otros tipos de cambios en la lista de medicamentos recetados disponibles, tal como la retirada de un medicamento de nuestra lista, no afectarán a los miembros que actualmente estén usando dicho medicamento. Seguirá estando disponible al mismo costo compartido para aquellos miembros que

continúen usándolo durante el resto del año de la cobertura. Consideramos que es importante que tenga acceso continuo durante el resto del año de la cobertura a los medicamentos de la lista que estaban disponibles cuando seleccionó nuestro plan, excepto en casos en los que pueda ahorrar más dinero o en los que nosotros podamos garantizar su seguridad. Si retiramos medicamentos de nuestra lista de medicamentos recetados disponibles, agregamos el requisito de autorización previa, límites a las cantidades o restricciones en el tratamiento escalonado de un medicamento, tenemos que notificarles a los miembros que se verán afectados por dicho cambio por lo menos 60 días antes de la fecha en que entre en vigor el cambio o cuando el miembro solicite resurtir el medicamento, momento en el cual se le dará al miembro un suministro de 60 días del medicamento. Si la Administración de Fármacos y Alimentos de los Estados Unidos considera que un medicamento de nuestra lista de medicamentos recetados disponibles es peligroso o si el fabricante del medicamento lo retira del mercado, retiraremos inmediatamente el medicamento de nuestra lista e informaremos este hecho a los miembros que usan el medicamento. La lista de medicamentos recetados disponibles adjunta está actualizada al 1 de septiembre de 2017. Por favor comuníquese con nosotros si desea obtener información actualizada sobre los medicamentos que cubre nuestro plan. En la portada y la contraportada encontrará nuestra información de contacto. Si a mediados de año se realiza un cambio que no es de mantenimiento en la lista de medicamentos recetados disponibles, detallaremos esto en la Explicación de beneficios de Medicare Parte D que le enviamos o en la Notificación

2 • Lista de medicamentos aprobados de 2017 para Senior Advantage de Medicare y Medicaid

(Provision of Notice) publicada en el sitio kp.org/seniormedrx. ¿Cómo uso la lista de medicamentos recetados disponibles? Hay dos maneras de buscar su medicamento en la lista de medicamentos recetados disponibles: Afecciones médicas La lista de medicamentos recetados disponible empieza en la página 6. Los medicamentos de esta lista de medicamentos recetados disponibles están agrupados en categorías según el tipo de afección médica para la cual se use el medicamento. Por ejemplo, los medicamentos que se usan para tratar afecciones del corazón figuran bajo la categoría “Cardiovascular Drugs” (Medicamentos cardiovasculares). Si sabe para qué se usa su medicamento, busque el nombre de la categoría en la lista que comienza en la página 7. Luego busque en esta categoría el nombre de su medicamento. Listado en orden alfabético Si no está seguro de en qué categoría debe buscar, busque su medicamento en el índice que comienza en la página 67. El índice ofrece una lista en orden alfabético de todos los medicamentos que figuran en este documento. En el índice se incluyen tanto medicamentos de marca como medicamentos genéricos. Consulte el índice y busque su medicamento. Seguido del nombre del medicamento, verá el número de la página donde encontrará información sobre la cobertura. Pase a la página señalada en el índice y busque el nombre de su medicamento en la primera columna de la lista.

¿Qué son los medicamentos genéricos? Nuestro plan cubre los medicamentos de marca y los genéricos. Un medicamento genérico está aprobado por la Administración de Fármacos y Alimentos de los Estados Unidos como un medicamento que contiene el mismo principio activo que el medicamento de marca. Por lo general, los medicamentos genéricos cuestan menos que los de marca. ¿Tiene alguna restricción mi cobertura? Algunos medicamentos cubiertos pueden tener requisitos o límites de cobertura adicionales. Estos requisitos y límites pueden incluir:

• Autorización previa: Nuestro plan requiere que usted o su médico obtenga autorización previa para ciertos medicamentos. Esto significa que necesitará obtener nuestra autorización antes de surtir sus recetas médicas. Es posible que Kaiser Permanente no cubra el medicamento si no obtiene la autorización.

Puede averiguar si su medicamento tiene algún requisito o límite adicional consultando la lista de medicamentos recetados disponibles que empieza en la página 7. También puede visitar nuestro sitio web para obtener más información sobre las restricciones correspondientes a ciertos medicamentos cubiertos. Hemos publicado un documento en línea que explica nuestra restricción de autorización previa. También puede pedirnos que le enviemos una copia. Nuestra información de contacto, junto con la fecha de la última actualización de la lista de medicamentos recetados disponibles, aparece en la portada y la contraportada.



Nos puede pedir que hagamos una excepción de estas restricciones o límites o una lista de otros medicamentos semejantes que pueden usarse para tratar su afección médica. Consulte la sección “¿Cómo pido una excepción a la Lista de medicamentos recetados disponibles de Kaiser Permanente?” en la página 3 para obtener información sobre cómo solicitar una excepción. ¿Qué sucede si mi medicamento no está en la lista de medicamentos recetados disponibles? Si su medicamento no figura en esta lista de medicamentos recetados disponibles (lista de medicamentos cubiertos), deberá comunicarse primero con Servicio a los Miembros y preguntar si su medicamento está cubierto. Si se le informa que Kaiser Permanente no cubre su medicamento, tiene dos opciones:

• Puede pedir una lista de medicamentos similares cubiertos por nosotros en Servicio a los Miembros. Cuando reciba la lista, muéstresela a su médico y pídale que le recete un medicamento similar que esté cubierto en nuestro plan.

• Puede pedirnos que hagamos una excepción y cubramos su medicamento. Consulte a continuación la información sobre cómo pedir una excepción.

¿Cómo pido una excepción a la Lista de medicamentos recetados disponibles de Kaiser Permanente? Puede pedirnos que hagamos una excepción a nuestras reglas de cobertura. Hay varios tipos de excepciones que puede pedirnos que hagamos.

• Nos puede pedir que cubramos un medicamento aunque no esté incluido en nuestra Lista completa de medicamentos recetados disponibles. Si obtiene la autorización, este medicamento tendrá cobertura a un nivel de costo compartido predeterminado y no podrá pedirnos que proveamos el medicamento a un nivel de costo compartido más bajo.

• Nos puede pedir que no apliquemos restricciones o límites de cobertura en su medicamento. Por ejemplo, para ciertos medicamentos, Kaiser Permanente limita la cantidad de medicamento cubierto. Si su medicamento tiene un límite de cantidad, puede pedirnos que eliminemos el límite y cubramos una cantidad mayor.

Por lo general, solo aprobaremos su solicitud de una excepción si los medicamentos alternativos incluidos en la Lista de medicamentos recetados disponibles del plan o las restricciones adicionales en su utilización no fueran igual de eficaces para tratar su afección o si le causaran efectos médicos adversos.


Deberá comunicarse con nosotros para pedirnos una decisión de cobertura inicial para una excepción de la restricción de la Lista de medicamentos recetados disponibles o de la utilización. Cuando solicite una excepción de la restricción de la Lista de medicamentos recetados disponibles, deberá entregar una declaración de la persona que le haya recetado el medicamento o del médico, en la que apoye su solicitud. Por lo general, debemos tomar nuestra decisión en el transcurso de 72 horas después de haber recibido la declaración de respaldo de la persona que recetó su medicamento. Puede pedir una excepción acelerada (rápida) si usted o su médico cree que su salud podría verse gravemente afectada al esperar hasta 72 horas para que se tome una decisión. Si aprobamos su solicitud para acelerar la decisión, debemos tomar una decisión a más tardar 24 horas después de que hayamos recibido una declaración de respaldo de su médico o de otra persona que le haya recetado el medicamento. ¿Qué debo hacer antes de hablar con mi médico acerca de cambiar mis medicamentos o solicitar una excepción? Como un miembro nuevo o continuo de nuestro plan, es posible que esté tomando medicamentos que no se encuentren en nuestra Lista de medicamentos recetados disponibles. o que esté usando un medicamento que sí está incluido en nuestra lista, pero que su capacidad para obtenerlo es limitada. Por ejemplo, es posible que necesite nuestra autorización previa para poder surtir su receta médica. Debe hablar con su médico para decidir si debe cambiar a un medicamento apropiado que nosotros

cubramos o solicitar una excepción a la Lista de medicamentos recetados disponibles para que cubramos el medicamento que usa. Mientras habla con su médico para determinar cuál sería la mejor forma de proceder en su caso, es posible que cubramos su medicamento, en ciertos casos, durante los primeros 90 días que sea miembro de nuestro plan. Para cada uno de sus medicamentos que no esté en nuestra Lista de medicamentos recetados disponibles, o si su capacidad para obtenerlos es limitada, cubriremos un suministro temporal de 30 días (a menos que su receta médica indique menos días) cuando acuda a una farmacia de la red. Después de su primer suministro de 30 días, no cubriremos estos medicamentos aunque haya sido miembro del clan menos de 90 días. Si es residente de un centro de atención a largo plazo, le permitiremos resurtir su receta médica hasta que le hayamos proporcionado un suministro de transición de hasta 98 días que concuerde con el incremento del suministro (a menos que su receta médica indique menos días). Cubriremos más de un resurtido de estos medicamentos durante los primeros 90 días que sea miembro de nuestro plan. Si necesita un medicamento que no está en nuestra Lista de medicamentos recetados disponibles o si su capacidad para obtener sus medicamentos es limitada, y ya transcurrieron los primeros 90 días de su afiliación a nuestro plan, cubriremos un suministro de emergencia de 31 días para ese medicamento (a menos que su receta médica indique menos días) mientras solicita una excepción a la Lista de medicamentos recetados disponibles. Como miembro activo de nuestro plan, si tiene una estancia con cobertura en un hospital o un centro de atención de


enfermería especializada como paciente hospitalizado, los medicamentos que reciba durante su estancia estarán cubiertos conforme a su beneficio médico y no a su cobertura de medicamentos recetados de la Parte D de Medicare. Cuando se le dé de alta del hospital para que regrese a su casa o para que se traslade a un nivel de atención de custodia en un centro de atención a largo plazo, es posible que muchos de los medicamentos recetados para pacientes ambulatorios que obtenga en una farmacia estén bajo la cobertura de la Parte D de Medicare. Debido a que su cobertura de medicamentos es distinta según el contexto en el que se obtiene el medicamento, es posible que un medicamento que haya estado usando y que haya tenido cobertura con su beneficio médico no tenga cobertura con la Parte D de Medicare (por ejemplo, medicamentos de venta sin receta o medicamentos para la tos). Si esto ocurre, tendrá que pagar el precio total de dicho medicamento, a menos que tenga otra cobertura (por ejemplo, cobertura de grupo patrocinada por su empleador).

Más información Para obtener información más detallada sobre su cobertura de medicamentos recetados de Kaiser Permanente, consulte su Evidencia de Cobertura y los demás documentos del plan. Si tiene alguna pregunta sobre nuestro plan, por favor comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización de la lista de medicamentos recetados disponibles, aparece en la portada y la contraportada. Si tiene preguntas generales sobre la cobertura de Medicare para medicamentos recetados, por favor llame a Medicare al 1-800-MEDICARE (1-800-633-4227), 24 horas al día, siete días a la semana. Los usuarios de TTY deben llamar al 1-877-486-2048. O visite http://www.medicare.gov.

http://www.medicare.gov/


Lista de medicamentos recetados disponibles de Kaiser Permanente La lista de medicamentos recetados disponibles que comienza en la siguiente página ofrece información de cobertura sobre los medicamentos cubiertos por nuestro plan. Si tiene dificultades para encontrar su medicamento en la lista, consulte el índice que comienza en la página 67. La primera columna de la tabla contiene el nombre del medicamento. Los medicamentos de marca aparecen con letras mayúsculas (por ejemplo, ALBENZA) y los genéricos con letras minúsculas y en cursiva (por ejemplo, amoxicillin). La información que se muestra en la columna Requisitos/Límites le indica si nuestro plan tiene algún requisito especial en la cobertura de su medicamento. HI = Los medicamentos de infusión intravenosa domiciliaria pueden estar cubiertos por nuestro beneficio médico y obtenerse en las farmacias de infusión intravenosa domiciliaria. Si desea más información, consulte su directorio de farmacias o llame a nuestro plan al número que aparece en la portada y la contraportada. LD = Los medicamentos de distribución limitada solo se pueden obtener en ciertas farmacias especializadas. Si desea más información, consulte su directorio de farmacias o llame a nuestro plan al número que aparece en la portada y la contraportada. MO = Medicamentos de pedido por correo. Puede pedir en línea el resurtido de ciertos medicamentos recetados por medio de nuestro servicio de pedidos por correo en kp.org/refill o por teléfono o aplicación móvil. Comuníquese con nosotros 10 días antes de que se le terminen los medicamentos. Por lo general, deberá recibirlos en el transcurso de 10 días. De lo contrario, comuníquese a la farmacia de venta por correo de Kaiser Permanente al 1-866-523-6059 (línea TTY: 711), de lunes a viernes, de 8 a. m. a 6 p. m., o al número que aparece en la etiqueta de su medicamento recetado para pedir ayuda. No todos los medicamentos pueden enviarse por correo; hay restricciones y limitaciones. Si desea más información, visite el sitio kp.org/seniormedrx. NDS = Medicamentos con suministro diario no extendido que se entregan en suministros de hasta 30 días para vigilar si se presentan posibles efectos adversos y para evitar que se desperdicie medicamento.

PA = Los medicamentos con autorización previa pueden estar cubiertos por la Parte D de Medicare o la Parte B de Medicare, dependiendo de la manera en que se administran (por ejemplo, por bomba de infusión, nebulizador u otro dispositivo de equipos médicos duraderos), el lugar en donde se administran (por ejemplo, en casa o en un centro de atención a largo plazo) y el tipo de afección médica que se busca tratar con ellos. Es posible que también se requiera autorización previa para los medicamentos en los que el tratamiento de la afección médica es el que determina si el medicamento no está incluido en la Parte D (excluido) o si tiene cobertura.

http://kp.org/refill


Al inicio o al final de esta tabla encontrará información sobre el significado de las abreviaturas que aparecen en esta tabla.


Nombre del medicamento

Nivel del medica-mento

Requisitos/Límites

ANTI-INFECTIVE AGENTS ANTHELMINTICS ALBENZA 1 BILTRICIDE 1 ivermectin 1 mebendazole 1 SKLICE 1 STROMECTOL 1 ANTIBACTERIALS amikacin sulfate soln 500 mg/2ml 1 HI

amoxicillin 1 amoxicillin & pot clavulanate 1

ampicillin 1 ampicillin sodium solr 1 gm 1 HI

ampicillin sodium solr 10 gm 1 HI

ampicillin sodium solr 125 mg 1 HI

ampicillin-sulbactam sodium solr 1.5 (1-0.5) gm

1 HI

ampicillin-sulbactam sodium solr 15 (10-5) gm

1 HI

ampicillin-sulbactam sodium solr 3 (2-1) gm 1 HI

AUGMENTIN 1 AVELOX 1 AVELOX ABC PACK 1 AVELOX SOLN 400 MG/250ML 1 HI

AVYCAZ SOLR 2.5 (2-0.5) GM 1 HI

AZACTAM IN DEXTROSE SOLN 1 GM

1 HI

AZACTAM IN DEXTROSE SOLN 2 GM

1 HI

azithromycin 1 MO



Requisitos/Límites

AZITHROMYCIN PACK 1 GM 1 MO

azithromycin solr 500 mg 1 HI

aztreonam solr 1 gm 1 HI AZULFIDINE 1 AZULFIDINE EN-TABS 1

bacitracin 1 BACTOCILL IN DEXTROSE SOLN 1 GM/50ML

1 HI

BACTOCILL IN DEXTROSE SOLN 2 GM/50ML

1 HI

BACTRIM 1 MO BACTRIM DS 1 MO BETHKIS 1 PA BIAXIN 1 BICILLIN C-R 1 BICILLIN C-R 900/300 1 BICILLIN L-A 1 CAYSTON 1 LD CEDAX 1 cefaclor 1 cefaclor monohydrate 1 cefadroxil 1 cefazolin sodium solr 1 gm 1 HI

cefazolin sodium solr 10 gm 1 HI

cefazolin sodium solr 500 mg 1 HI

cefdinir 1 cefepime hcl solr 1 gm 1 HI cefepime hcl solr 2 gm 1 HI cefixime 1 cefotaxime sodium solr 1 gm 1 HI

cefotaxime sodium solr 2 gm 1 HI

cefotaxime sodium solr 500 mg 1 HI





Requisitos/Límites

cefotetan disodium solr 1 gm 1 HI

cefotetan disodium solr 2 gm 1 HI

cefoxitin sodium solr 1 gm 1 HI



CEFOXITIN SODIUM-DEXTROSE SOLR 1-4 GM-%

1 HI

CEFOXITIN SODIUM-DEXTROSE SOLR 2-2.2 GM-%

1 HI

cefpodoxime proxetil 1 cefprozil 1 CEFTAZIDIME AND DEXTROSE SOLR 1 GM/50ML

1 HI

CEFTAZIDIME AND DEXTROSE SOLR 2 GM/50ML

1 HI

ceftazidime solr 1 gm 1 HI ceftazidime solr 2 gm 1 HI ceftazidime solr 6 gm 1 HI CEFTIN SUSR 125 MG/5ML 1

CEFTIN SUSR 250 MG/5ML 1

CEFTIN TABS 250 MG 1

CEFTIN TABS 500 MG 1

ceftriaxone sodium solr 1 gm 1 HI



ceftriaxone sodium solr 250 mg 1 HI

ceftriaxone sodium solr 500 mg 1 HI



Requisitos/Límites

cefuroxime axetil 1 cefuroxime sodium solr 1.5 gm 1 HI

cefuroxime sodium solr 7.5 gm 1 HI

cefuroxime sodium solr 750 mg 1 HI

CEFUROXIME-DEXTROSE SOLR 1.5-2.9 GM-%

1 HI

cephalexin 1 chloramphenicol sod succinate solr 1 gm 1 HI

CIPRO 1 CIPRO IN D5W SOLN 400 MG/200ML 1 HI

ciprofloxacin 1 ciprofloxacin hcl 1 ciprofloxacin in d5w soln 200 mg/100ml 1 HI

ciprofloxacin soln 400 mg/40ml 1 HI

ciprofloxacin-ciprofloxacin hcl 1

claforan solr 1 gm 1 HI CLAFORAN SOLR 10 GM 1 HI

claforan solr 2 gm 1 HI CLAFORAN SOLR 500 MG 1 HI

clarithromycin 1 CLEOCIN 1 CLEOCIN IN D5W SOLN 300 MG/50ML 1 HI

CLEOCIN IN D5W SOLN 600 MG/50ML 1 HI

CLEOCIN IN D5W SOLN 900 MG/50ML 1 HI

CLEOCIN PHOSPHATE SOLN 900 MG/6ML

1 HI

clindamycin hcl 1 clindamycin palmitate hydrochloride 1





Requisitos/Límites

clindamycin phosphate in d5w soln 300 mg/50ml

1 HI


1 HI


1 HI

clindamycin phosphate soln 300 mg/2ml

1 HI


1 HI


1 HI

colistimethate sodium solr 150 mg 1 HI

CUBICIN SOLR 500 MG 1 HI

DALVANCE 1 daptomycin solr 500 mg 1 HI

demeclocycline hcl 1 dicloxacillin sodium 1 DIFICID 1 NDS DORIBAX SOLR 500 MG 1 HI

DORYX 1 MO DORYX MPC 1 MO doxy 100 solr 100 mg 1 HI doxycycline (monohydrate) 1 MO

doxycycline hyclate 1 MO doxycycline hyclate solr 100 mg 1 HI

E.E.S. GRANULES 1 ERYPED 200 1 ERYPED 400 1 erythrocin lactobionate solr 500 mg

1 HI



Requisitos/Límites

erythromycin base 1 MO erythromycin ethylsuccinate 1

erythromycin stearate 1 FORTAZ SOLR 1 GM 1 HI FORTAZ SOLR 2 GM 1 HI FORTAZ SOLR 6 GM 1 HI gentamicin in saline soln 0.8-0.9 mg/ml-% 1 HI

gentamicin in saline soln 1-0.9 mg/ml-% 1 HI

gentamicin in saline soln 1.2-0.9 mg/ml-% 1 HI

gentamicin in saline soln 1.6-0.9 mg/ml-% 1 HI

gentamicin sulfate soln 10 mg/ml 1 HI

gentamicin sulfate soln 40 mg/ml 1 HI

imipenem-cilastatin solr 250 mg 1 HI

imipenem-cilastatin solr 500 mg 1 HI

INVANZ SOLR 1 GM 1 HI KETEK 1 KITABIS PAK 1 PA LEVAQUIN 1 levofloxacin 1 levofloxacin in d5w soln 500 mg/100ml 1 HI

levofloxacin in d5w soln 750 mg/150ml 1 HI

levofloxacin soln 25 mg/ml 1 HI

LINCOCIN SOLN 300 MG/ML 1 HI

lincomycin hcl soln 300 mg/ml 1 HI

linezolid 1 NDS LINEZOLID IN SODIUM CHLORIDE SOLN 600-0.9 MG/300ML-%

1 HI,NDS





Requisitos/Límites

linezolid soln 600 mg/300ml 1 HI,NDS

MAXIPIME SOLR 1 GM 1 HI

MAXIPIME SOLR 2 GM 1 HI

meropenem solr 500 mg 1 HI

MERREM SOLR 500 MG 1 HI

MINOCIN 1 MO minocycline hcl 1 MO moxifloxacin hcl 1 MOXIFLOXACIN HCL SOLN 400 MG/250ML 1 HI

NAFCILLIN SODIUM IN DEXTROSE SOLN 1 GM/50ML

1 HI

NAFCILLIN SODIUM IN DEXTROSE SOLN 2 GM/100ML

1 HI

nafcillin sodium solr 1 gm 1 HI

nafcillin sodium solr 10 gm 1 HI

neomycin sulfate 1 ofloxacin 1 ORBACTIV 1 oxacillin sodium solr 10 gm 1 HI

oxacillin sodium solr 2 gm 1 HI

PCE 1 PENICILLIN G POT IN DEXTROSE SOLN 20000 UNIT/ML

1 HI

PENICILLIN G POT IN DEXTROSE SOLN 40000 UNIT/ML

1 HI

PENICILLIN G POT IN DEXTROSE SOLN 60000 UNIT/ML

1 HI

penicillin g potassium solr 5000000 unit 1 HI



Requisitos/Límites

penicillin g procaine 1 penicillin g sodium solr 5000000 unit 1 HI

penicillin v potassium 1 piperacillin sod-tazobactam so solr 3.375 (3-0.375) gm

1 HI

piperacillin sod-tazobactam so solr 4.5 (4-0.5) gm

1 HI

piperacillin sod-tazobactam so solr 40.5 (36-4.5) gm

1 HI

polymyxin b sulfate solr 500000 unit 1 HI

PRIMAXIN IV SOLR 250-250 MG 1 HI

PRIMAXIN IV SOLR 500-500 MG 1 HI

SIVEXTRO 1 NDS SOLODYN 1 MO streptomycin sulfate 1 sulfadiazine 1 sulfamethoxazole-trimethoprim 1 MO

sulfamethoxazole-trimethoprim soln 400-80 mg/5ml

1 HI

sulfasalazine 1 SUPRAX 1 SYNERCID SOLR 150-350 MG 1 HI

tazicef solr 1 gm 1 HI tazicef solr 2 gm 1 HI tazicef solr 6 gm 1 HI TEFLARO SOLR 400 MG 1 HI

TEFLARO SOLR 600 MG 1 HI

tetracycline hcl 1 MO TETRACYCLINE HCL 1 MO TIGECYCLINE SOLR 50 MG 1 HI

TOBI 1 PA





Requisitos/Límites

TOBI PODHALER 1 tobramycin 1 PA tobramycin sulfate soln 10 mg/ml 1 HI

tobramycin sulfate soln 80 mg/2ml 1 HI

TYGACIL SOLR 50 MG 1 HI

UNASYN SOLR 15 (10-5) GM 1 HI

UNASYN SOLR 3 (2-1) GM 1 HI

VANCOCIN HCL 1 NDS vancomycin hcl 1 VANCOMYCIN HCL IN DEXTROSE SOLN 1-5 GM/200ML-%

1 HI

VANCOMYCIN HCL IN DEXTROSE SOLN 500-5 MG/100ML-%

1 HI

vancomycin hcl solr 10 gm 1 HI

vancomycin hcl solr 1000 mg 1 HI

vancomycin hcl solr 500 mg 1 HI

VIBATIV 1 VIBRAMYCIN 1 MO XIFAXAN 1 NDS ZERBAXA 1 ZINACEF IN STERILE WATER SOLN 1.5 GM

1 HI

ZINACEF SOLR 1.5 GM 1 HI

ZINACEF SOLR 7.5 GM 1 HI

ZINACEF SOLR 750 MG 1 HI

ZITHROMAX PACK 1 GM 1 MO

ZITHROMAX SOLR 500 MG 1 HI



Requisitos/Límites

ZITHROMAX SUSR 100 MG/5ML 1 MO

ZITHROMAX SUSR 200 MG/5ML 1 MO

ZITHROMAX TABS 250 MG 1 MO



ZITHROMAX TRI-PAK TABS 500 MG 1 MO

ZITHROMAX Z-PAK TABS 250 MG 1 MO

ZMAX SUSR 2 GM 1 MO ZOSYN SOLN 2-0.25 GM/50ML 1 HI

ZOSYN SOLN 3-0.375 GM/50ML 1 HI

ZOSYN SOLR 40.5 (36-4.5) GM 1 HI

ZYVOX 1 NDS ZYVOX SOLN 200 MG/100ML 1 HI,NDS

ZYVOX SOLN 600 MG/300ML 1 HI,NDS

ANTIFUNGALS ABELCET SUSP 5 MG/ML 1 HI

AMBISOME SUSR 50 MG 1 HI

amphotericin b solr 50 mg 1 HI

ANCOBON 1 CANCIDAS SOLR 50 MG 1 HI

CANCIDAS SOLR 70 MG 1 HI

CRESEMBA 1 NDS DIFLUCAN 1 ERAXIS SOLR 100 MG 1 HI

ERAXIS SOLR 50 MG 1 HI fluconazole 1





Requisitos/Límites

fluconazole in sodium chloride soln 200-0.9 mg/100ml-%

1 HI

fluconazole in sodium chloride soln 400-0.9 mg/200ml-%

1 HI

flucytosine 1 GRIS-PEG 1 griseofulvin microsize 1 griseofulvin ultramicrosize 1

itraconazole 1 ketoconazole 1 LAMISIL 1 MYCAMINE SOLR 100 MG 1 HI

MYCAMINE SOLR 50 MG 1 HI

NOXAFIL 1 nystatin 1 nystatin (mouth-throat) 1

ONMEL TABS 200 MG 1

SPORANOX CAPS 100 MG 1

SPORANOX SOLN 10 MG/ML 1

terbinafine hcl 1 VFEND IV SOLR 200 MG 1 HI

VFEND SUSR 40 MG/ML 1

VFEND TABS 200 MG 1

VFEND TABS 50 MG 1 voriconazole 1 voriconazole solr 200 mg 1 HI

ANTIMYCOBACTERIALS aminosalicylic acid 1 MO CAPASTAT SULFATE SOLR 1 GM

1 HI



Requisitos/Límites

dapsone 1 MO ethambutol hcl 1 MO isoniazid 1 MO isoniazid & rifampin 1 MO MYAMBUTOL 1 MO MYCOBUTIN 1 MO PRIFTIN 1 MO pyrazinamide 1 MO rifabutin 1 MO RIFADIN 1 MO RIFADIN SOLR 600 MG 1 HI

rifampin 1 MO rifampin solr 600 mg 1 HI RIFATER 1 MO SIRTURO 1 NDS TRECATOR 1 MO ANTIPROTOZOALS ALINIA 1 atovaquone 1 NDS atovaquone-proguanil hcl 1

chloroquine phosphate 1

COARTEM 1 DARAPRIM 1 FLAGYL 1 hydroxychloroquine sulfate 1

IMPAVIDO 1 NDS MALARONE 1 mefloquine hcl 1 MEPRON 1 NDS METRO SOLN 500-0.74 MG/100ML-% 1 HI

metronidazole 1 metronidazole in nacl soln 500-0.79 mg/100ml-%

1 HI

NEBUPENT SOLR 300 MG 1 PA

paromomycin sulfate 1





Requisitos/Límites

PENTAM SOLR 300 MG 1

PLAQUENIL 1 MO primaquine phosphate 1 PRIMAQUINE PHOSPHATE 1

QUALAQUIN 1 NDS quinine sulfate 1 NDS TINDAMAX 1 tinidazole 1 ANTIVIRALS abacavir sulfate 1 MO abacavir sulfate-lamivudine 1 MO

abacavir sulfate-lamivudine-zidovudine 1 MO

acyclovir 1 MO acyclovir sodium soln 50 mg/ml 1 HI

adefovir dipivoxil 1 NDS APTIVUS 1 MO ATRIPLA 1 MO BARACLUDE SOLN 0.05 MG/ML 1 MO

BARACLUDE TABS 0.5 MG 1

BARACLUDE TABS 1 MG 1

cidofovir soln 75 mg/ml 1 HI

COMBIVIR 1 MO COMPLERA 1 MO COPEGUS 1 MO CRIXIVAN 1 MO CYTOVENE SOLR 500 MG 1 HI

DAKLINZA 1 PA,NDS DESCOVY 1 MO didanosine 1 MO EDURANT 1 MO EMTRIVA 1 MO entecavir 1 MO EPCLUSA 1 PA,NDS



Requisitos/Límites

EPIVIR HBV SOLN 5 MG/ML 1 MO

EPIVIR HBV TABS 100 MG 1 MO

EPIVIR SOLN 10 MG/ML 1 MO

EPIVIR TABS 150 MG 1 MO EPIVIR TABS 300 MG 1 MO EPZICOM 1 MO EVOTAZ 1 MO famciclovir 1 MO FAMVIR 1 MO FLUMADINE 1 MO FUZEON 1 NDS ganciclovir sodium solr 500 mg 1 HI

GENVOYA 1 MO HARVONI 1 PA,NDS HEPSERA 1 NDS INCIVEK 1 NDS INFERGEN 1 NDS INTELENCE 1 MO INVIRASE 1 MO ISENTRESS 1 MO KALETRA 1 MO lamivudine 1 MO lamivudine (hbv) 1 MO lamivudine-zidovudine 1 MO LEXIVA SUSP 50 MG/ML 1 MO

LEXIVA TABS 700 MG 1 MO

lopinavir-ritonavir 1 MO nevirapine 1 MO NORVIR 1 MO ODEFSEY 1 MO OLYSIO 1 PA,NDS oseltamivir phosphate 1 MO PEG-INTRON 1 NDS PEG-INTRON REDIPEN 1 NDS





Requisitos/Límites

PEG-INTRON REDIPEN PAK 4 1 NDS

PEGASYS 1 NDS PEGASYS PROCLICK 1 NDS

PEGINTRON 1 NDS PLEGRIDY 1 NDS PLEGRIDY STARTER PACK 1 NDS

PREZCOBIX 1 MO PREZISTA 1 MO RAPIVAB 1 REBETOL 1 MO RELENZA DISKHALER 1 MO

RESCRIPTOR 1 MO RETROVIR CAPS 100 MG 1 MO

RETROVIR SOLN 10 MG/ML 1 HI

RETROVIR SYRP 50 MG/5ML 1 MO

REYATAZ 1 MO ribavirin (hepatitis c) 1 MO rimantadine hydrochloride 1 MO

SELZENTRY 1 MO SOVALDI 1 PA,NDS stavudine 1 MO STRIBILD 1 MO SUSTIVA 1 MO SYNAGIS 1 TAMIFLU 1 MO TECHNIVIE 1 PA,NDS TIVICAY 1 MO TRIUMEQ 1 MO TRIZIVIR 1 MO TRUVADA TABS 100-150 MG 1 MO

TRUVADA TABS 133-200 MG 1 MO




Requisitos/Límites


TYZEKA 1 NDS valacyclovir hcl 1 MO VALCYTE SOLR 50 MG/ML 1 NDS

VALCYTE TABS 450 MG 1 NDS

valganciclovir hcl 1 NDS VALTREX 1 MO VEMLIDY 1 NDS VICTRELIS 1 NDS VIDEX EC CPDR 125 MG 1 MO

VIDEX EC CPDR 200 MG 1 MO



VIDEX SOLR 2 GM 1 MO VIEKIRA PAK 1 PA,NDS VIEKIRA XR 1 PA,NDS VIRACEPT 1 MO VIRAMUNE 1 MO VIRAMUNE XR 1 MO VIRAZOLE 1 MO VIREAD POWD 40 MG/GM 1 MO

VIREAD TABS 150 MG 1 MO




VISTIDE SOLN 75 MG/ML 1 HI

VITEKTA 1 MO VOSEVI 1 PA,NDS ZEPATIER 1 PA,NDS ZERIT 1 MO





Requisitos/Límites

ZIAGEN SOLN 20 MG/ML 1 MO

ZIAGEN TABS 300 MG 1 MO

zidovudine 1 MO ZOVIRAX 1 MO URINARY ANTI-INFECTIVES FURADANTIN 1 HIPREX 1 MACROBID 1 MACRODANTIN 1 methenamine hippurate 1

MONUROL 1 nitrofurantoin 1 nitrofurantoin macrocrystal 1

nitrofurantoin monohyd macro 1

PRIMSOL 1 MO trimethoprim 1 MO ANTIHISTAMINE DRUGS ANTIHISTAMINE DRUGS carbinoxamine maleate 1

cetirizine hcl 1 CLARINEX 1 CLARINEX-D 12 HOUR 1

clemastine fumarate 1 cyproheptadine hcl 1 desloratadine 1 diphenhydramine hcl 1 KARBINAL ER 1 levocetirizine dihydrochloride 1

promethazine & phenylephrine 1

promethazine hcl 1 SEMPREX-D 1 XYZAL 1 ANTINEOPLASTIC AGENTS ANTINEOPLASTIC AGENTS



Requisitos/Límites

ABRAXANE 1 adrucil soln 500 mg/10ml 1 HI

AFINITOR 1 NDS AFINITOR DISPERZ 1 NDS ALECENSA 1 NDS ALIMTA 1 ALKERAN SOLR 50 MG 1

ALUNBRIG 1 NDS anastrozole 1 ARIMIDEX 1 AROMASIN 1 ARRANON 1 ARZERRA 1 AVASTIN 1 azacitidine 1 BAVENCIO 1 NDS BCG VACCINE 1 BELEODAQ 1 BENDEKA SOLN 100 MG/4ML 1

BEXAROTENE 1 NDS bicalutamide 1 BICNU 1 bleomycin sulfate 1 BLINCYTO 1 BOSULIF 1 NDS busulfan 1 BUSULFEX 1 CABOMETYX 1 NDS CAMPTOSAR 1 CAPRELSA 1 LD,NDS carboplatin 1 CASODEX 1 cisplatin 1 CISPLATIN 1 cladribine 1 clofarabine 1 CLOLAR 1 COMETRIQ (100 MG DAILY DOSE) 1 LD,NDS





Requisitos/Límites

COMETRIQ (140 MG DAILY DOSE) 1 LD,NDS

COMETRIQ (60 MG DAILY DOSE) 1 LD,NDS

COSMEGEN 1 COTELLIC 1 NDS CYCLOPHOSPHAMIDE 1 PA

CYRAMZA 1 cytarabine 1 dacarbazine 1 DACOGEN 1 DARZALEX 1 daunorubicin hcl 1 decitabine 1 DOCEFREZ SOLR 20 MG 1

DOCETAXEL (NON-ALCOHOL) SOLN 160 MG/8ML

1

DOCETAXEL (NON-ALCOHOL) SOLN 20 MG/ML

1

DOCETAXEL (NON-ALCOHOL) SOLN 80 MG/4ML

1

DOCETAXEL CONC 20 MG/0.5ML 1

DOCETAXEL CONC 80 MG/2ML 1

DOCETAXEL CONC 80 MG/4ML 1

DOCETAXEL SOLN 80 MG/8ML 1

DOXIL 1 doxorubicin hcl 1 doxorubicin hcl liposomal 1

DROXIA 1 ELIGARD KIT 22.5 MG 1

ELIGARD KIT 30 MG 1 ELIGARD KIT 45 MG 1 ELIGARD KIT 7.5 MG 1



Requisitos/Límites

ELLENCE 1 ELSPAR 1 EMCYT 1 NDS EMPLICITI 1 epirubicin hcl 1 ERBITUX 1 ERIVEDGE 1 NDS ERWINAZE 1 ETOPOPHOS 1 etoposide 1 EVOMELA SOLR 50 MG 1 NDS

exemestane 1 FARESTON 1 FARYDAK 1 LD,NDS FASLODEX 1 NDS FEMARA 1 FIRMAGON 1 fludarabine phosphate 1 fluorouracil soln 2.5 gm/50ml 1 HI

flutamide 1 FOLOTYN 1 GAZYVA 1 gemcitabine hcl 1 GEMZAR 1 GILOTRIF 1 NDS GLEEVEC 1 NDS GLEOSTINE CAPS 10 MG 1

GLEOSTINE CAPS 100 MG 1



HALAVEN 1 HERCEPTIN SOLR 150 MG 1 NDS

HERCEPTIN SOLR 440 MG 1

HEXALEN 1





Requisitos/Límites

HYCAMTIN 1 HYDREA 1 hydroxyurea 1 IBRANCE 1 NDS ICLUSIG 1 LD,NDS IDAMYCIN PFS 1 idarubicin hcl 1 IFEX 1 ifosfamide 1 imatinib mesylate 1 NDS IMBRUVICA 1 NDS IMFINZI 1 NDS INLYTA 1 NDS INTRON A 1 NDS IRESSA 1 NDS irinotecan hcl 1 ISTODAX 1 ISTODAX (OVERFILL) 1

IXEMPRA KIT 1 JAKAFI 1 NDS JEVTANA 1 KADCYLA 1 KEYTRUDA 1 KYPROLIS 1 NDS LARTRUVO 1 NDS LENVIMA 10 MG DAILY DOSE 1 LD,NDS

LENVIMA 14 MG DAILY DOSE 1 LD,NDS





letrozole 1 LEUKERAN 1 leuprolide acetate 1



Requisitos/Límites

LOMUSTINE CAPS 10 MG 1



LONSURF 1 NDS LUPANETA PACK 1 LUPRON DEPOT (1-MONTH) KIT 3.75 MG 1

LUPRON DEPOT (1-MONTH) KIT 7.5 MG 1

LUPRON DEPOT (3-MONTH) KIT 11.25 MG

1

LUPRON DEPOT (3-MONTH) KIT 22.5 MG 1

LUPRON DEPOT (4-MONTH) KIT 30 MG 1

LUPRON DEPOT (6-MONTH) KIT 45 MG 1

LUPRON DEPOT-PED (1-MONTH) 1

LUPRON DEPOT-PED (3-MONTH) 1

LYNPARZA 1 NDS LYSODREN 1 NDS MARQIBO 1 MATULANE 1 NDS MEGACE ORAL 1 megestrol acetate 1 MEKINIST 1 NDS melphalan hcl 1 mercaptopurine 1 methotrexate sodium 1 PA mitomycin 1 mitoxantrone hcl 1 MUSTARGEN 1 NERLYNX 1 NDS NEXAVAR 1 NDS NILANDRON 1 nilutamide 1 NINLARO 1 NDS





Requisitos/Límites

NIPENT 1 ODOMZO 1 NDS ONCASPAR 1 ONIVYDE 1 OPDIVO 1 oxaliplatin 1 paclitaxel 1 PERJETA 1 POMALYST 1 NDS PORTRAZZA 1 PROLEUKIN 1 PURIXAN 1 NDS REVLIMID 1 NDS RHEUMATREX 1 PA RITUXAN 1 RITUXAN HYCELA 1 NDS RUBRACA 1 NDS RYDAPT 1 NDS SOLTAMOX 1 SPRYCEL 1 NDS STIVARGA 1 NDS SUTENT 1 NDS SYLATRON 1 SYLVANT 1 SYNRIBO 1 NDS TABLOID 1 TAFINLAR 1 NDS TAGRISSO 1 NDS tamoxifen citrate 1 TARCEVA 1 NDS TARGRETIN 1 NDS TASIGNA 1 NDS TAXOTERE CONC 80 MG/4ML 1

TECENTRIQ 1 NDS TENIPOSIDE 1 TEPADINA 1 NDS thiotepa 1 TICE BCG 1 topotecan hcl 1 TORISEL 1



Requisitos/Límites

TREANDA SOLR 100 MG 1

TREANDA SOLR 25 MG 1

TRELSTAR MIXJECT 1 tretinoin (chemotherapy) 1 NDS

TRISENOX 1 TYKERB 1 NDS UNITUXIN 1 VALSTAR 1 VANTAS 1 VECTIBIX 1 VELCADE 1 VENCLEXTA STARTING PACK TBPK 10 & 50 & 100 MG

1 NDS

VENCLEXTA TABS 10 MG 1 NDS



VIDAZA 1 vinblastine sulfate 1 vincristine sulfate 1 vinorelbine tartrate 1 VOTRIENT 1 NDS XALKORI 1 NDS XATMEP 1 PA,NDS XERMELO 1 NDS XTANDI 1 NDS YERVOY 1 YONDELIS 1 ZALTRAP 1 ZANOSAR 1 ZEJULA 1 NDS ZELBORAF 1 NDS ZOLINZA 1 NDS ZYDELIG 1 NDS ZYKADIA 1 NDS





Requisitos/Límites

ZYTIGA 1 NDS AUTONOMIC DRUGS ANTICHOLINERGIC AGENTS ANORO ELLIPTA 1 MO atropine sulfate 1 ATROPINE SULFATE 1 ATROVENT 1 MO ATROVENT HFA 1 MO BENTYL 1 MO BEVESPI AEROSPHERE 1 MO

CUVPOSA SOLN 1 MG/5ML 1 MO

dicyclomine hcl 1 MO glycopyrrolate 1 MO INCRUSE ELLIPTA 1 MO ipratropium bromide 1 PA,MO ipratropium bromide (nasal) 1 MO

methscopolamine bromide 1 MO

propantheline bromide 1 MO ROBINUL SOLN 0.4 MG/2ML 1

ROBINUL TABS 1 MG 1 MO

ROBINUL-FORTE TABS 2 MG 1 MO

SPIRIVA HANDIHALER CAPS 18 MCG

1 MO

SPIRIVA RESPIMAT AERS 1.25 MCG/ACT 1 MO

SPIRIVA RESPIMAT AERS 2.5 MCG/ACT 1 MO

STIOLTO RESPIMAT 1 MO TUDORZA PRESSAIR 1 MO

AUTONOMIC DRUGS, MISCELLANEOUS CHANTIX 1 MO CHANTIX CONTINUING MONTH PAK

1 MO



Requisitos/Límites

CHANTIX STARTING MONTH PAK 1 MO

NICOTROL INHA 10 MG 1 MO

NICOTROL NS SOLN 10 MG/ML 1 MO

PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS ARICEPT 1 MO bethanechol chloride 1 MO cevimeline hcl 1 MO donepezil hydrochloride 1 MO

EVOXAC 1 MO EXELON 1 MO galantamine hydrobromide 1 MO

GUANIDINE HCL 1 MO MESTINON SYRP 60 MG/5ML 1 MO

MESTINON TABS 60 MG 1 MO

MESTINON TBCR 180 MG 1 MO

pilocarpine hcl (oral) 1 MO pyridostigmine bromide 1 MO

RAZADYNE 1 MO RAZADYNE ER 1 MO REGONOL SOLN 10 MG/2ML 1 MO

rivastigmine 1 MO rivastigmine tartrate 1 MO SALAGEN 1 MO SKELETAL MUSCLE RELAXANTS AMRIX 1 PA baclofen 1 MO carisoprodol 1 PA,NDS carisoprodol w/ aspirin 1 PA,NDS carisoprodol w/ aspirin & codeine 1 PA,NDS

chlorzoxazone 1 cyclobenzaprine hcl 1 PA





Requisitos/Límites

DANTRIUM 1 dantrolene sodium 1 GABLOFEN SOLN 10000 MCG/20ML 1 PA

GABLOFEN SOLN 20000 MCG/20ML 1 PA

GABLOFEN SOLN 40000 MCG/20ML 1 PA

GABLOFEN SOSY 50 MCG/ML 1 PA

LIORESAL SOLN 0.05 MG/ML 1 PA

LIORESAL SOLN 10 MG/20ML 1 PA



metaxalone 1 methocarbamol 1 orphenadrine citrate 1 SKELAXIN 1 SOMA 1 PA,NDS tizanidine hcl 1 ZANAFLEX 1 SYMPATHOLYTIC (ADRENERGIC BLOCKING) AGENTS alfuzosin hcl 1 MO D.H.E. 45 SOLN 1 MG/ML 1 NDS

DIBENZYLINE 1 MO dihydroergotamine mesylate 1 NDS

ergoloid mesylates 1 MO ergotamine tartrate 1 FLOMAX 1 MO MIGRANAL SOLN 4 MG/ML 1 NDS

phenoxybenzamine hcl 1 MO

RAPAFLO 1 MO tamsulosin hcl 1 MO UROXATRAL 1 MO



Requisitos/Límites

SYMPATHOMIMETIC (ADRENERGIC) AGENTS ADRENACLICK SOAJ 0.15 MG/0.15ML 1

ADRENACLICK SOAJ 0.3 MG/0.3ML 1

ADRENALIN SOLN 1 MG/ML 1

ADVAIR DISKUS AEPB 100-50 MCG/DOSE

1 MO


1 MO


1 MO

ADVAIR HFA AERO 115-21 MCG/ACT 1 MO



albuterol sulfate er tb12 4 mg 1 MO

albuterol sulfate er tb12 8 mg 1 MO

albuterol sulfate nebu (2.5 mg/3ml) 0.083% 1 PA,MO

albuterol sulfate nebu (5 mg/ml) 0.5% 1 PA,MO,ND

S albuterol sulfate nebu 0.63 mg/3ml 1 PA,MO

albuterol sulfate nebu 1.25 mg/3ml 1 PA,MO

albuterol sulfate syrp 2 mg/5ml 1 MO

albuterol sulfate tabs 2 mg 1 MO

albuterol sulfate tabs 4 mg 1 MO

ARCAPTA NEOHALER 1 MO

AUVI-Q SOAJ 0.15 MG/0.15ML 1 NDS





Requisitos/Límites

AUVI-Q SOAJ 0.3 MG/0.3ML 1 NDS

BROVANA 1 PA,MO COMBIVENT RESPIMAT AERS 20-100 MCG/ACT

1 MO

DUONEB SOLN 0.5-2.5 (3) MG/3ML 1 PA,MO

epinephrine (anaphylaxis) 1

EPINEPHRINE SOAJ 0.15 MG/0.3ML 1

EPINEPHRINE SOAJ 0.3 MG/0.3ML 1

EPIPEN JR 2-PAK SOAJ 0.15 MG/0.3ML 1

FORADIL AEROLIZER 1 MO

ipratropium-albuterol 1 PA,MO levalbuterol hcl 1 PA,MO levalbuterol tartrate 1 MO MAXAIR AUTOHALER 1 MO

metaproterenol sulfate 1 MO midodrine hcl 1 MO NORTHERA 1 NDS PERFOROMIST 1 PA,MO PROAIR HFA AERS 108 (90 BASE) MCG/ACT

1 MO

PROAIR RESPICLICK AEPB 108 (90 BASE) MCG/ACT

1 MO

PROVENTIL HFA AERS 108 (90 BASE) MCG/ACT

1 MO

SEREVENT DISKUS 1 MO STRIVERDI RESPIMAT 1 MO

terbutaline sulfate 1 MO VENTOLIN HFA AERS 108 (90 BASE) MCG/ACT

1 MO



Requisitos/Límites

vospire er tb12 4 mg 1 MO vospire er tb12 8 mg 1 MO XOPENEX 1 PA,MO XOPENEX CONCENTRATE 1 PA,MO

XOPENEX HFA 1 MO BLOOD FORMATION, COAGULATION, AND THROMBOSIS COAGULANTS AND ANTICOAGULANTS AGGRENOX 1 MO AGRYLIN 1 MO AMICAR 1 MO anagrelide hcl 1 MO ARGATROBAN SOLN 125 MG/125ML 1 HI

argatroban soln 250 mg/2.5ml 1 HI

ARIXTRA 1 NDS aspirin-dipyridamole 1 MO BRILINTA 1 MO cilostazol 1 MO clopidogrel bisulfate 1 MO COUMADIN 1 MO CYKLOKAPRON SOLN 1000 MG/10ML 1 HI

DURLAZA 1 MO EFFIENT 1 MO ELIQUIS 1 MO enoxaparin sodium 1 NDS fondaparinux sodium 1 NDS FRAGMIN 1 NDS heparin (porcine) in d5w soln 40-5 unit/ml-%

1 HI

heparin (porcine) in d5w soln 50-5 unit/ml-%

1 HI

heparin sod (porcine) in d5w soln 100 unit/ml

1 HI

heparin sodium (porcine) 1





Requisitos/Límites

heparin sodium (porcine) soln 1000 unit/ml

1 HI

heparin sodium (porcine) soln 5000 unit/ml

1 HI

INTEGRILIN SOLN 20 MG/10ML 1 HI

INTEGRILIN SOLN 75 MG/100ML 1 HI

LOVENOX 1 NDS LYSTEDA 1 MO pentoxifylline 1 MO PLAVIX 1 MO PRADAXA 1 MO SAVAYSA 1 MO tranexamic acid 1 MO tranexamic acid soln 1000 mg/10ml 1 HI

warfarin sodium 1 MO XARELTO 1 MO XARELTO STARTER PACK 1 MO

YOSPRALA 1 MO ZONTIVITY 1 MO HEMATOPOIETIC AGENTS ARANESP (ALBUMIN FREE) 1 PA,NDS

EPOGEN 1 PA,NDS GRANIX 1 LEUKINE SOLR 250 MCG 1 HI,NDS

MIRCERA 1 PA MOZOBIL 1 NEULASTA 1 NDS NEULASTA ONPRO 1 NDS NEUMEGA 1 NEUPOGEN 1 NDS NPLATE 1 NDS PROCRIT 1 PA,NDS PROMACTA 1 NDS ZARXIO 1 NDS



Requisitos/Límites

CARDIOVASCULAR DRUGS A-ADRENERGIC BLOCKING AGENTS CARDURA 1 MO CARDURA XL 1 MO doxazosin mesylate 1 MO MINIPRESS 1 MO prazosin hcl 1 MO terazosin hcl 1 MO ANTILIPEMIC AGENTS ALTOPREV 1 MO ANTARA 1 MO atorvastatin calcium 1 MO cholestyramine 1 MO cholestyramine light 1 MO choline fenofibrate 1 MO COLESTID 1 MO colestipol hcl 1 MO CRESTOR 1 MO ezetimibe 1 MO ezetimibe-simvastatin 1 MO fenofibrate 1 MO FENOFIBRATE 1 MO fenofibrate micronized 1 MO fenofibric acid 1 MO FENOFIBRIC ACID 1 MO FENOGLIDE 1 MO FIBRICOR 1 MO fluvastatin sodium 1 MO gemfibrozil 1 MO JUXTAPID 1 PA,LD,NDS KYNAMRO 1 PA,LD,NDS LESCOL XL 1 MO LIPITOR 1 MO LIPOFEN 1 MO LIVALO 1 MO LOPID 1 MO lovastatin 1 MO LOVAZA 1 MO niacin (antihyperlipidemic) 1 MO

NIASPAN 1 MO





Requisitos/Límites

omega-3-acid ethyl esters 1 MO

PRALUENT 1 PA,NDS PRAVACHOL 1 MO pravastatin sodium 1 MO REPATHA 1 PA,NDS REPATHA PUSHTRONEX SYSTEM

1 PA,NDS

REPATHA SURECLICK 1 PA,NDS

rosuvastatin calcium 1 MO simvastatin 1 MO TRICOR 1 MO TRIGLIDE 1 MO TRILIPIX 1 MO VASCEPA 1 MO VYTORIN 1 MO WELCHOL 1 MO ZETIA 1 MO ZOCOR 1 MO CALCIUM-CHANNEL BLOCKING AGENTS ADALAT CC 1 MO amlodipine besylate 1 MO amlodipine besylate-atorvastatin calcium 1 MO

amlodipine besylate-benazepril hcl 1 MO

amlodipine besylate-olmesartan medoxomil

1 MO

amlodipine besylate-valsartan 1 MO

amlodipine-valsartan-hydrochlorothiazide 1 MO

AZOR 1 MO CADUET 1 MO CALAN 1 MO CALAN SR 1 MO CARDENE IV SOLN 20-0.86 MG/200ML-% 1 HI

CARDENE IV SOLN 40-0.83 MG/200ML-% 1 HI



Requisitos/Límites

CARDIZEM 1 MO CARDIZEM CD 1 MO CARDIZEM LA 1 MO CLEVIPREX 1 diltiazem hcl 1 MO diltiazem hcl coated beads 1 MO

diltiazem hcl extended release beads 1 MO

diltiazem hcl soln 50 mg/10ml 1 HI

diltiazem hcl solr 100 mg 1 HI

EXFORGE 1 MO EXFORGE HCT 1 MO felodipine 1 MO isradipine 1 MO LOTREL 1 MO nicardipine hcl 1 MO nicardipine hcl soln 2.5 mg/ml 1 HI

nifedipine 1 MO nimodipine 1 MO nisoldipine 1 MO NORVASC 1 MO olmesartan medoxomil-amlodipine-hydrochlorothiazide

1 MO

PROCARDIA 1 MO PROCARDIA XL 1 MO SULAR 1 MO TARKA 1 MO telmisartan-amlodipine 1 MO

TIAZAC 1 MO trandolapril-verapamil hcl 1 MO

TRIBENZOR 1 MO TWYNSTA 1 MO verapamil hcl 1 MO verapamil hcl soln 2.5 mg/ml 1 HI





Requisitos/Límites

VERELAN 1 MO VERELAN PM 1 MO CARDIAC DRUGS amiodarone hcl 1 MO amiodarone hcl soln 150 mg/3ml 1 HI

CORLANOR 1 MO digoxin 1 MO DIGOXIN SOLN 0.05 MG/ML 1 MO

disopyramide phosphate 1 MO

dofetilide 1 MO flecainide acetate 1 MO LANOXIN PEDIATRIC SOLN 0.1 MG/ML 1

LANOXIN SOLN 0.25 MG/ML 1

LANOXIN TABS 125 MCG 1 MO

LANOXIN TABS 187.5 MCG 1 MO

LANOXIN TABS 250 MCG 1 MO

LANOXIN TABS 62.5 MCG 1 MO

mexiletine hcl 1 MO MULTAQ 1 MO NEXTERONE SOLN 150-4.21 MG/100ML-%

1 HI

NEXTERONE SOLN 360-4.14 MG/200ML-%

1 HI

NORPACE CAPS 100 MG 1 MO

NORPACE CAPS 150 MG 1 MO

NORPACE CR CP12 100 MG 1 MO

NORPACE CR CP12 150 MG 1 MO

procainamide hcl 1 propafenone hcl 1 MO



Requisitos/Límites

quinidine gluconate 1 MO QUINIDINE GLUCONATE 1 MO

quinidine sulfate 1 MO RANEXA 1 MO RYTHMOL 1 MO RYTHMOL SR 1 MO TIKOSYN 1 MO HYPOTENSIVE AGENTS CATAPRES 1 MO CATAPRES-TTS-1 1 MO CATAPRES-TTS-2 1 MO CATAPRES-TTS-3 1 MO clonidine & chlorthalidone 1 MO

clonidine hcl 1 MO clonidine hcl (adhd) 1 MO guanfacine hcl 1 MO hydralazine hcl soln 20 mg/ml 1

hydralazine hcl tabs 10 mg 1 MO




KAPVAY 1 MO mecamylamine hcl 1 NDS methyldopa 1 MO methyldopa & hydrochlorothiazide 1 MO

methyldopate hcl soln 250 mg/5ml 1 HI

minoxidil 1 MO PROGLYCEM 1 MO RESERPINE 1 MO TENEX 1 MO RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS ACCUPRIL 1 MO ACCURETIC 1 MO





Requisitos/Límites

ALDACTAZIDE 1 MO ALDACTONE 1 MO ALTACE 1 MO ATACAND 1 MO ATACAND HCT 1 MO AVALIDE 1 MO AVAPRO 1 MO benazepril & hydrochlorothiazide 1 MO

benazepril hcl 1 MO BENICAR 1 MO BENICAR HCT 1 MO BYVALSON 1 MO candesartan cilexetil 1 MO candesartan cilexetil-hydrochlorothiazide 1 MO

captopril 1 MO captopril & hydrochlorothiazide 1 MO

COZAAR 1 MO DIOVAN 1 MO DIOVAN HCT 1 MO EDARBI 1 MO EDARBYCLOR 1 MO enalapril maleate 1 MO enalapril maleate & hydrochlorothiazide 1 MO

ENTRESTO 1 MO EPANED 1 MO eplerenone 1 MO eprosartan mesylate 1 MO fosinopril sodium 1 MO fosinopril sodium & hydrochlorothiazide 1 MO

HYZAAR 1 MO INSPRA 1 MO irbesartan 1 MO irbesartan-hydrochlorothiazide 1 MO

lisinopril & hydrochlorothiazide 1 MO

lisinopril tabs 10 mg 1 MO



Requisitos/Límites

lisinopril tabs 2.5 mg 1 MO lisinopril tabs 20 mg 1 MO lisinopril tabs 30 mg 1 MO lisinopril tabs 40 mg 1 MO lisinopril tabs 5 mg 1 MO losartan potassium 1 MO losartan potassium & hydrochlorothiazide 1 MO

LOTENSIN 1 MO MAVIK 1 MO MICARDIS 1 MO MICARDIS HCT 1 MO moexipril hcl 1 MO moexipril-hydrochlorothiazide 1 MO

olmesartan medoxomil 1 MO

olmesartan medoxomil-hydrochlorothiazide

1 MO

perindopril erbumine 1 MO PRINIVIL 1 MO QBRELIS 1 quinapril hcl 1 MO quinapril-hydrochlorothiazide 1 MO

ramipril 1 MO spironolactone & hydrochlorothiazide 1 MO

spironolactone tabs 100 mg 1 MO



TEKTURNA 1 MO TEKTURNA HCT 1 MO telmisartan 1 MO telmisartan-hydrochlorothiazide 1 MO

trandolapril 1 MO valsartan 1 MO





Requisitos/Límites

valsartan-hydrochlorothiazide 1 MO

VASERETIC 1 MO VASOTEC 1 MO ZESTORETIC 1 MO ZESTRIL 1 MO VASODILATING AGENTS ADCIRCA 1 PA BIDIL 1 MO CIALIS 1 PA,NDS dipyridamole 1 MO GONITRO PACK 400 MCG 1 MO

ISORDIL TITRADOSE 1 MO isosorbide dinitrate 1 MO isosorbide mononitrate er tb24 120 mg

1 MO

isosorbide mononitrate er tb24 30 mg

1 MO

isosorbide mononitrate er tb24 60 mg

1 MO

isosorbide mononitrate tabs 10 mg

1 MO

isosorbide mononitrate tabs 20 mg

1 MO

NITRO-DUR PT24 0.1 MG/HR 1 MO






nitroglycerin 1 MO



Requisitos/Límites

nitroglycerin soln 5 mg/ml 1 HI

NITROLINGUAL SOLN 0.4 MG/SPRAY 1 MO

NITROMIST AERS 400 MCG/SPRAY 1 MO

NITROSTAT SUBL 0.3 MG 1 MO



PERSANTINE 1 MO REVATIO SOLN 10 MG/12.5ML 1

REVATIO SUSR 10 MG/ML 1 PA,NDS

REVATIO TABS 20 MG 1 PA,NDS

sildenafil citrate (pulmonary hypertension)

1 PA,MO

ß-ADRENERGIC BLOCKING AGENTS acebutolol hcl 1 MO atenolol 1 MO atenolol & chlorthalidone 1 MO

BETAPACE 1 MO BETAPACE AF 1 MO betaxolol hcl 1 MO bisoprolol & hydrochlorothiazide 1 MO

bisoprolol fumarate 1 MO BYSTOLIC 1 MO carvedilol 1 MO COREG 1 MO COREG CR 1 MO CORGARD 1 MO CORZIDE 1 MO DUTOPROL 1 MO INDERAL LA 1 MO INNOPRAN XL 1 MO labetalol hcl 1 MO





Requisitos/Límites

labetalol hcl soln 5 mg/ml 1 HI

LOPRESSOR 1 MO LOPRESSOR HCT 1 MO metoprolol & hydrochlorothiazide 1 MO

metoprolol succinate 1 MO metoprolol tartrate soct 5 mg/5ml 1

metoprolol tartrate soln 5 mg/5ml 1

metoprolol tartrate tabs 100 mg 1 MO



nadolol & bendroflumethiazide 1 MO

nadolol tabs 20 mg 1 MO nadolol tabs 40 mg 1 MO nadolol tabs 80 mg 1 MO pindolol 1 MO propranolol & hydrochlorothiazide 1 MO

propranolol hcl er cp24 120 mg 1 MO




propranolol hcl soln 1 mg/ml 1 HI

propranolol hcl soln 20 mg/5ml 1 MO

propranolol hcl soln 40 mg/5ml 1 MO

propranolol hcl tabs 10 mg 1 MO




Requisitos/Límites




SECTRAL 1 MO sotalol hcl 1 MO sotalol hcl (afib/afl) 1 MO SOTYLIZE 1 MO TENORETIC 100 1 MO TENORETIC 50 1 MO TENORMIN 1 MO timolol maleate 1 MO TOPROL XL 1 MO ZEBETA 1 MO ZIAC 1 MO CENTRAL NERVOUS SYSTEM AGENTS ANALGESICS AND ANTIPYRETICS ABSTRAL 1 PA,NDS acetaminophen w/ codeine 1 NDS

acetaminophen-caff-dihydrocod 1 NDS

ACTIQ 1 PA,NDS ANAPROX DS 1 ARTHROTEC 1 ARYMO ER TBEA 15 MG 1 NDS

ARYMO ER TBEA 30 MG 1 NDS

ARYMO ER TBEA 60 MG 1 NDS

AVINZA 1 NDS BELBUCA 1 NDS BUPRENEX 1 NDS buprenorphine 1 NDS buprenorphine hcl 1 NDS butalbital-acetaminophen 1

butalbital-acetaminophen-caffeine

1





Requisitos/Límites

butalbital-acetaminophen-caffeine w/ codeine

1 NDS

butalbital-aspirin-caffeine 1

butalbital-aspirin-caffeine w/cod 1 NDS

butorphanol tartrate 1 NDS BUTRANS 1 NDS CAMBIA 1 CELEBREX 1 celecoxib 1 codeine sulfate 1 NDS CODEINE SULFATE 1 NDS CONZIP 1 NDS DAYPRO 1 DEMEROL 1 PA,NDS diclofenac potassium 1 diclofenac sodium 1 diclofenac w/ misoprostol 1

diflunisal 1 DILAUDID 1 NDS DOLOPHINE TABS 10 MG 1 NDS

DOLOPHINE TABS 5 MG 1 NDS

DUEXIS 1 DURAGESIC-100 1 NDS DURAGESIC-12 1 NDS DURAGESIC-25 1 NDS DURAGESIC-50 1 NDS DURAGESIC-75 1 NDS EC-NAPROSYN 1 EMBEDA 1 NDS etodolac 1 EXALGO 1 NDS FELDENE 1 NDS fenoprofen calcium 1 FENOPROFEN CALCIUM 1

fentanyl 1 NDS



Requisitos/Límites

fentanyl citrate 1 PA,NDS FENTORA 1 PA,NDS FIORINAL 1 FIORINAL/CODEINE #3 1 NDS

flurbiprofen 1 GRALISE 1 GRALISE STARTER 1 hydrocodone-acetaminophen 1 NDS

hydrocodone-ibuprofen 1 NDS

hydromorphone hcl 1 NDS HYSINGLA ER 1 NDS ibuprofen 1 ILARIS 1 NDS ILARIS (150MG DELIVERED) 1 NDS

INDOCIN 1 indomethacin 1 KADIAN CP24 10 MG 1 NDS KADIAN CP24 100 MG 1 NDS

KADIAN CP24 20 MG 1 NDS KADIAN CP24 200 MG 1 NDS

KADIAN CP24 30 MG 1 NDS KADIAN CP24 40 MG 1 NDS KADIAN CP24 50 MG 1 NDS KADIAN CP24 60 MG 1 NDS KADIAN CP24 80 MG 1 NDS ketoprofen 1 ketorolac tromethamine 1

LAZANDA 1 PA,NDS levorphanol tartrate 1 NDS meclofenamate sodium 1

mefenamic acid 1 meloxicam 1 meperidine hcl 1 PA,NDS methadone hcl 1 NDS





Requisitos/Límites

METHADONE HCL SOLN 10 MG/ML 1 NDS

MOBIC 1 MORPHABOND ER T12A 100 MG 1 NDS

MORPHABOND ER T12A 15 MG 1 NDS



morphine sulfate 1 NDS MORPHINE SULFATE (PF) SOLN 10 MG/ML

1 NDS

MORPHINE SULFATE (PF) SOLN 2 MG/ML

1 NDS


1 NDS


1 NDS

morphine sulfate beads 1 NDS

MORPHINE SULFATE TABS 15 MG

1 NDS

MORPHINE SULFATE TABS 30 MG

1 NDS

MS CONTIN TBCR 100 MG 1 NDS





nabumetone 1 nalbuphine hcl 1 NDS NAPRELAN 1



Requisitos/Límites

NAPROSYN 1 naproxen 1 naproxen sodium 1 NUCYNTA 1 NDS NUCYNTA ER 1 NDS OPANA 1 NDS OPANA ER 1 NDS oxaprozin 1 oxycodone hcl 1 NDS oxycodone w/ acetaminophen 1 NDS

oxycodone-aspirin 1 NDS oxycodone-ibuprofen 1 NDS OXYCONTIN 1 NDS oxymorphone hcl 1 NDS pentazocine w/ naloxone 1 NDS

PERCODAN 1 NDS piroxicam 1 NDS PONSTEL 1 ROXICODONE 1 NDS SUBSYS 1 PA,NDS sulindac 1 SYNALGOS-DC 1 NDS TALWIN 1 NDS TIVORBEX 1 tolmetin sodium 1 tramadol hcl 1 NDS tramadol-acetaminophen 1 NDS

ULTRACET 1 NDS ULTRAM 1 NDS ULTRAM ER 1 NDS VICOPROFEN 1 NDS VIMOVO 1 NDS VIVLODEX 1 XARTEMIS XR 1 NDS XTAMPZA ER 1 NDS ZIPSOR 1 ZOHYDRO ER 1 NDS ZORVOLEX 1





Requisitos/Límites

ANOREXIGENIC AGENTS AND RESPIRATORY AND CEREBRAL STIMULANTS ADDERALL TABS 10 MG 1 NDS

ADDERALL TABS 15 MG 1 NDS

ADDERALL TABS 30 MG 1 NDS

ADDERALL XR CP24 10 MG 1 NDS






ADZENYS XR-ODT 1 NDS amphetamine sulfate 1 NDS amphetamine-dextroamphetamine 1 NDS

APTENSIO XR CP24 10 MG 1 NDS







armodafinil 1 PA ATIVAN 1 NDS CONCERTA TBCR 18 MG 1 NDS

CONCERTA TBCR 27 MG 1 NDS



Requisitos/Límites



DAYTRANA 1 NDS DESOXYN 1 PA,NDS DEXEDRINE 1 NDS dexmethylphenidate hcl 1 NDS

dextroamphetamine sulfate 1 NDS

DIAZEPAM 1 NDS DYANAVEL XR 1 NDS FOCALIN 1 NDS FOCALIN XR 1 NDS METADATE CD CPCR 10 MG 1 NDS

METADATE CD CPCR 20 MG 1 NDS





methamphetamine hcl 1 PA,NDS METHYLIN CHEW 10 MG 1 NDS

METHYLIN CHEW 2.5 MG 1 NDS

METHYLIN CHEW 5 MG 1 NDS

METHYLIN SOLN 10 MG/5ML 1 NDS

METHYLIN SOLN 5 MG/5ML 1 NDS

methylphenidate hcl 1 NDS midazolam hcl 1 NDS modafinil 1 PA,NDS MYDAYIS CP24 12.5 MG 1 NDS





Requisitos/Límites

MYDAYIS CP24 25 MG 1 NDS

MYDAYIS CP24 37.5 MG 1 NDS

MYDAYIS CP24 50 MG 1 NDS

NUVIGIL 1 PA PROVIGIL 1 PA,NDS QUAZEPAM 1 NDS QUILLICHEW ER CHER 20 MG 1 NDS

QUILLICHEW ER CHER 30 MG 1 NDS

QUILLICHEW ER CHER 40 MG 1 NDS

QUILLIVANT XR SUSR 25 MG/5ML 1 NDS

RITALIN LA CP24 10 MG 1 NDS





RITALIN TABS 10 MG 1 NDS RITALIN TABS 20 MG 1 NDS RITALIN TABS 5 MG 1 NDS VYVANSE CAPS 10 MG 1 NDS

VYVANSE CAPS 20 MG 1 NDS








Requisitos/Límites

VYVANSE CHEW 10 MG 1 NDS






ANTICONVULSANTS APTIOM 1 MO BANZEL 1 MO BRIVIACT SOLN 10 MG/ML 1

BRIVIACT SOLN 50 MG/5ML 1

BRIVIACT TABS 10 MG 1





carbamazepine 1 MO CARBATROL 1 MO CELONTIN 1 MO CEREBYX 1 clonazepam 1 NDS DEPACON SOLN 100 MG/ML 1 HI

DEPAKENE 1 MO DEPAKOTE 1 MO DEPAKOTE ER 1 MO DEPAKOTE SPRINKLES 1 MO

DILANTIN 1 MO divalproex sodium 1 MO EQUETRO 1 MO





Requisitos/Límites

ethosuximide 1 MO felbamate 1 MO FELBATOL 1 fosphenytoin sodium 1 FYCOMPA 1 gabapentin 1 MO GABITRIL 1 MO HORIZANT 1 MO KEPPRA SOLN 100 MG/ML 1 MO

KEPPRA TABS 1000 MG 1 MO




KEPPRA XR TB24 500 MG 1 MO

KEPPRA XR TB24 750 MG 1 MO

KLONOPIN 1 NDS LAMICTAL CHEW 25 MG 1 MO

LAMICTAL CHEW 5 MG 1 MO

LAMICTAL ODT TBDP 100 MG 1 MO




LAMICTAL STARTER KIT 25 (35) MG 1 MO

LAMICTAL STARTER KIT 25 (42)-100 (7) MG

1 MO

LAMICTAL STARTER KIT 25 (84)-100(14) MG

1 MO



Requisitos/Límites

LAMICTAL TABS 100 MG 1 MO




LAMICTAL XR KIT 25 & 50 & 100 MG 1 MO

LAMICTAL XR KIT 25 (21)-50 (7) MG 1 MO

LAMICTAL XR KIT 50 & 100 & 200 MG 1 MO

LAMICTAL XR TB24 100 MG 1 MO






lamotrigine 1 MO levetiracetam 1 MO LEVETIRACETAM IN NACL 1

levetiracetam in sodium chloride 1

levetiracetam soln 500 mg/5ml 1 HI

LYRICA 1 MO MAGNESIUM SULFATE SOLN 2 GM/50ML

1 HI

MAGNESIUM SULFATE SOLN 20 GM/500ML

1 HI


1 HI





Requisitos/Límites


1 HI

magnesium sulfate soln 50 % 1 HI

MYSOLINE 1 MO NEURONTIN 1 MO ONFI 1 MO oxcarbazepine 1 MO OXTELLAR XR 1 MO PEGANONE 1 MO phenytoin 1 MO phenytoin sodium 1 phenytoin sodium extended 1 MO

POTIGA 1 MO primidone 1 MO QUDEXY XR 1 MO SABRIL 1 LD SPRITAM TB3D 1000 MG 1

SPRITAM TB3D 250 MG 1 MO

SPRITAM TB3D 500 MG 1 MO

SPRITAM TB3D 750 MG 1

TEGRETOL 1 MO TEGRETOL-XR 1 MO tiagabine hcl 1 MO TOPAMAX 1 MO TOPAMAX SPRINKLE 1 MO

topiramate 1 MO TRILEPTAL 1 MO TROKENDI XR 1 MO valproate sodium 1 MO valproate sodium soln 500 mg/5ml 1 HI

valproic acid 1 MO VIMPAT 1 MO VIMPAT SOLN 200 MG/20ML 1 HI



Requisitos/Límites

ZARONTIN 1 MO ZONEGRAN 1 MO zonisamide 1 MO ANTIMIGRAINE AGENTS almotriptan malate 1 AMERGE 1 AXERT 1 ergotamine w/ caffeine 1

FROVA 1 frovatriptan succinate 1 IMITREX 1 IMITREX STATDOSE REFILL 1

MAXALT 1 MAXALT-MLT 1 naratriptan hcl 1 ONZETRA XSAIL 1 RELPAX 1 rizatriptan benzoate 1 sumatriptan 1 sumatriptan succinate 1 SUMAVEL DOSEPRO 1

TREXIMET 1 ZEMBRACE SYMTOUCH 1

zolmitriptan 1 ZOMIG 1 ZOMIG ZMT 1 ANTIPARKINSONIAN AGENTS amantadine hcl 1 MO APOKYN 1 NDS AZILECT 1 MO benztropine mesylate 1 MO bromocriptine mesylate 1 MO

cabergoline 1 MO carbidopa 1 MO carbidopa-levodopa 1 MO carbidopa-levodopa-entacapone 1 MO





Requisitos/Límites

COGENTIN 1 COMTAN 1 MO DUOPA 1 LD ELDEPRYL 1 MO EMSAM 1 MO entacapone 1 MO LODOSYN 1 MO MIRAPEX 1 MO MIRAPEX ER 1 MO NEUPRO 1 MO PARLODEL 1 MO pramipexole dihydrochloride 1 MO

rasagiline mesylate 1 MO REQUIP 1 MO REQUIP XL 1 MO ropinirole hydrochloride 1 MO

RYTARY 1 MO selegiline hcl 1 MO SINEMET 1 MO SINEMET CR 1 MO STALEVO 100 1 MO STALEVO 125 1 MO STALEVO 150 1 MO STALEVO 200 1 MO STALEVO 50 1 MO STALEVO 75 1 MO TASMAR 1 MO tolcapone 1 MO trihexyphenidyl hcl 1 MO XADAGO 1 MO ZELAPAR 1 MO ANXIOLYTICS, SEDATIVES, AND HYPNOTICS alprazolam 1 NDS AMBIEN 1 NDS AMBIEN CR 1 NDS ATIVAN 1 NDS BELSOMRA 1 buspirone hcl 1 BUTISOL SODIUM 1



Requisitos/Límites

chlordiazepoxide hcl 1 NDS clorazepate dipotassium 1 NDS

DIASTAT ACUDIAL 1 NDS DIASTAT PEDIATRIC 1 NDS diazepam 1 NDS diazepam (anticonvulsant) 1 NDS

EDLUAR 1 NDS estazolam 1 NDS eszopiclone 1 NDS flurazepam hcl 1 NDS HALCION 1 NDS HETLIOZ 1 NDS hydroxyzine hcl 1 hydroxyzine pamoate 1 INTERMEZZO 1 NDS lorazepam 1 NDS LUNESTA 1 NDS meprobamate 1 midazolam hcl 1 NDS oxazepam 1 NDS phenobarbital 1 PHENOBARBITAL 1 RESTORIL 1 NDS ROZEREM 1 SILENOR 1 SONATA 1 NDS temazepam 1 NDS TRANXENE-T 1 NDS triazolam 1 NDS VALIUM 1 NDS VISTARIL 1 XANAX 1 NDS XANAX XR 1 NDS zaleplon 1 NDS zolpidem tartrate 1 NDS ZOLPIMIST 1 NDS CENTRAL NERVOUS SYSTEM AGENTS, MISCELLANEOUS acamprosate calcium 1 MO atomoxetine hcl 1 MO





Requisitos/Límites

AUSTEDO 1 NDS guanfacine hcl (adhd) 1 MO INGREZZA 1 NDS INTUNIV 1 MO memantine hcl 1 MO NAMENDA 1 MO NAMENDA TITRATION PAK 1 MO

NAMENDA XR 1 MO NAMENDA XR TITRATION PACK 1 MO

NAMZARIC 1 MO,NDS NUEDEXTA 1 NDS RADICAVA SOLN 30 MG/100ML 1 HI,NDS

RILUTEK 1 riluzole 1 MO SAVELLA 1 MO SAVELLA TITRATION PACK 1 MO

STRATTERA 1 MO tetrabenazine 1 NDS XENAZINE 1 NDS XYREM 1 LD,NDS OPIATE ANTAGONISTS BUNAVAIL 1 NDS buprenorphine hcl-naloxone hcl dihydrate 1 NDS

EVZIO SOAJ 0.4 MG/0.4ML 1

EVZIO SOAJ 2 MG/0.4ML 1

naloxone hcl 1 naltrexone hcl 1 NARCAN LIQD 4 MG/0.1ML 1

SUBOXONE 1 NDS VIVITROL 1 NDS ZUBSOLV 1 NDS PSYCHOTHERAPEUTIC AGENTS ABILIFY 1 MO ABILIFY MAINTENA 1



Requisitos/Límites

amitriptyline hcl 1 MO amoxapine 1 MO ANAFRANIL 1 MO APLENZIN 1 MO aripiprazole 1 MO ARISTADA 1 NDS BRINTELLIX 1 MO BRISDELLE 1 MO bupropion hcl 1 MO bupropion hcl (smoking deterrent) 1 MO

CELEXA 1 MO chlordiazepoxide-amitriptyline 1

chlorpromazine hcl 1 MO citalopram hydrobromide soln 10 mg/5ml

1 MO

citalopram hydrobromide tabs 10 mg

1 MO


1 MO


1 MO

clomipramine hcl 1 MO clozapine 1 NDS CLOZARIL 1 NDS CYMBALTA 1 MO desipramine hcl 1 MO DESVENLAFAXINE ER 1 MO

desvenlafaxine succinate 1 MO

doxepin hcl 1 MO duloxetine hcl 1 MO EFFEXOR XR 1 MO escitalopram oxalate 1 MO FANAPT 1 MO FANAPT TITRATION PACK 1 MO





Requisitos/Límites

FAZACLO 1 NDS FETZIMA 1 MO FETZIMA TITRATION 1 MO FLUOXETINE HCL 1 MO fluoxetine hcl caps 10 mg 1 MO

fluoxetine hcl caps 20 mg 1 MO

fluoxetine hcl caps 40 mg 1 MO

fluoxetine hcl cpdr 90 mg 1 MO

fluoxetine hcl soln 20 mg/5ml 1 MO

fluoxetine hcl tabs 10 mg 1 MO

fluoxetine hcl tabs 20 mg 1 MO

fluphenazine decanoate 1

fluphenazine hcl 1 MO fluvoxamine maleate 1 MO FORFIVO XL 1 MO GEODON 1 MO GEODON 1 MO HALDOL 1 HALDOL DECANOATE 1

haloperidol 1 MO haloperidol decanoate 1 haloperidol lactate 1 MO imipramine hcl 1 MO imipramine pamoate 1 MO INVEGA 1 MO INVEGA SUSTENNA 1 NDS INVEGA TRINZA 1 KHEDEZLA 1 MO LATUDA 1 LEXAPRO 1 MO LITHIUM 1 MO lithium carbonate 1 MO LITHOBID 1 MO loxapine succinate 1 MO



Requisitos/Límites

maprotiline hcl 1 MO MARPLAN 1 MO mirtazapine 1 MO molindone hcl 1 MO NARDIL 1 MO nefazodone hcl 1 MO NORPRAMIN 1 MO nortriptyline hcl 1 MO NUPLAZID 1 NDS olanzapine 1 MO olanzapine-fluoxetine hcl 1 MO

ORAP 1 MO paliperidone 1 MO PAMELOR 1 MO PARNATE 1 MO paroxetine hcl er tb24 12.5 mg 1 MO

paroxetine hcl er tb24 25 mg 1 MO

paroxetine hcl er tb24 37.5 mg 1 MO

paroxetine hcl tabs 10 mg 1 MO




PAXIL 1 MO PAXIL CR 1 MO perphenazine 1 MO perphenazine-amitriptyline 1 MO

PEXEVA 1 MO phenelzine sulfate 1 MO pimozide 1 MO PRISTIQ 1 MO prochlorperazine 1 MO prochlorperazine edisylate 1





Requisitos/Límites

prochlorperazine maleate 1

protriptyline hcl 1 MO PROZAC 1 MO PROZAC WEEKLY 1 MO quetiapine fumarate 1 MO REMERON 1 MO REMERON SOLTAB 1 MO REXULTI 1 NDS RISPERDAL 1 MO RISPERDAL CONSTA 1 NDS

RISPERDAL M-TAB 1 MO risperidone 1 MO SAPHRIS 1 MO SARAFEM 1 MO SEROQUEL 1 MO SEROQUEL XR 1 MO sertraline hcl 1 MO SURMONTIL 1 MO SYMBYAX 1 MO thioridazine hcl 1 MO thiothixene 1 MO tranylcypromine sulfate 1 MO

trazodone hcl tabs 100 mg 1 MO




trifluoperazine hcl 1 MO trimipramine maleate 1 MO TRINTELLIX 1 MO venlafaxine hcl 1 MO VENLAFAXINE HCL ER 1 MO

VERSACLOZ 1 NDS VIIBRYD 1 MO VIIBRYD STARTER PACK 1 MO



Requisitos/Límites

VRAYLAR CAPS 1.5 MG 1 NDS

VRAYLAR CAPS 3 MG 1 NDS

VRAYLAR CAPS 4.5 MG 1 NDS

VRAYLAR CAPS 6 MG 1 NDS

VRAYLAR CPPK 1.5 & 3 MG 1 NDS

WELLBUTRIN 1 MO WELLBUTRIN SR 1 MO WELLBUTRIN XL 1 MO ziprasidone hcl 1 MO ZOLOFT 1 MO ZYBAN 1 MO ZYPREXA 1 MO ZYPREXA RELPREVV 1

ZYPREXA ZYDIS 1 MO DIABETIC SUPPLIES DIABETIC SUPPLIES alcohol swabs 1 MO gauze pads & dressings 1 MO

insulin pen needle 1 MO insulin syringe/needle u-100 1 MO

ELECTROLYTIC, CALORIC, AND WATER BALANCE ACIDIFYING AND ALKALINIZING AGENTS ammonium chloride soln 5 meq/ml 1 HI

potassium citrate (alkalinizer) 1 MO

SODIUM LACTATE SOLN 5 MEQ/ML 1 HI

UROCIT-K 10 1 MO UROCIT-K 15 1 MO UROCIT-K 5 1 MO AMMONIA DETOXICANTS BUPHENYL 1 NDS CARBAGLU 1 LD





Requisitos/Límites

lactulose 1 MO lactulose (encephalopathy) 1 MO

LITHOSTAT 1 MO RAVICTI 1 NDS sodium phenylbutyrate 1 NDS

CALORIC AGENTS AMINOSYN II SOLN 10 % 1 HI

AMINOSYN II SOLN 15 % 1 HI

AMINOSYN II SOLN 7 % 1 HI

AMINOSYN II SOLN 8.5 % 1 HI

aminosyn ii/electrolytes soln 8.5 %

1 HI

AMINOSYN-HBC SOLN 7 % 1 HI

AMINOSYN-PF SOLN 10 % 1 HI

AMINOSYN-PF SOLN 7 % 1 HI

AMINOSYN-RF SOLN 5.2 % 1 HI

AMINOSYN/ELECTROLYTES SOLN 7 % 1 HI

aminosyn/electrolytes soln 8.5 % 1 HI

CLINIMIX E/DEXTROSE (2.75/10) SOLN 2.75 %

1 HI


1 HI


1 HI

CLINIMIX E/DEXTROSE 1 HI



Requisitos/Límites

(4.25/25) SOLN 4.25 % CLINIMIX E/DEXTROSE (4.25/5) SOLN 4.25 %

1 HI

CLINIMIX E/DEXTROSE (5/15) SOLN 5 %

1 HI


1 HI


1 HI

CLINIMIX/DEXTROSE (2.75/5) SOLN 2.75 %

1 HI


1 HI


1 HI


1 HI


1 HI

CLINIMIX/DEXTROSE (5/15) SOLN 5 % 1 HI



clinisol sf soln 15 % 1 HI dextrose soln 10 % 1 HI dextrose soln 5 % 1 HI FREAMINE HBC SOLN 6.9 % 1 HI

HEPATAMINE SOLN 8 % 1 HI

intralipid emul 20 % 1 HI INTRALIPID EMUL 30 % 1 HI





Requisitos/Límites

LIPOSYN III EMUL 10 % 1 HI

NEPHRAMINE SOLN 5.4 % 1 HI

nutrilipid emul 20 % 1 HI plenamine soln 15 % 1 HI premasol soln 10 % 1 HI premasol soln 6 % 1 HI PROCALAMINE SOLN 3 % 1 HI

PROSOL SOLN 20 % 1 HI TRAVASOL SOLN 10 % 1 HI

TROPHAMINE SOLN 10 % 1 HI

TROPHAMINE SOLN 6 % 1 HI

DIURETICS amiloride & hydrochlorothiazide 1 MO

amiloride hcl 1 MO bumetanide soln 0.25 mg/ml 1

bumetanide tabs 0.5 mg 1 MO

bumetanide tabs 1 mg 1 MO bumetanide tabs 2 mg 1 MO chlorothiazide 1 MO chlorothiazide sodium solr 500 mg 1 HI

chlorthalidone 1 MO DEMADEX 1 MO DIURIL 1 MO DYAZIDE 1 MO DYRENIUM 1 MO EDECRIN 1 MO ethacrynate sodium solr 50 mg 1 HI

ethacrynic acid 1 MO furosemide soln 10 mg/ml 1 HI

furosemide soln 8 mg/ml 1 MO



Requisitos/Límites

furosemide tabs 20 mg 1 MO



hydrochlorothiazide caps 12.5 mg 1 MO

hydrochlorothiazide tabs 12.5 mg 1 MO

hydrochlorothiazide tabs 25 mg 1 MO

hydrochlorothiazide tabs 50 mg 1 MO

indapamide 1 MO LASIX 1 MO MAXZIDE 1 MO MAXZIDE-25 1 MO methyclothiazide 1 MO metolazone 1 MO MICROZIDE 1 MO SAMSCA 1 NDS SODIUM DIURIL SOLR 500 MG 1 HI

SODIUM EDECRIN SOLR 50 MG 1 HI

torsemide 1 MO triamterene-hctz caps 37.5-25 mg 1 MO

triamterene-hctz caps 50-25 mg 1 MO

triamterene-hctz tabs 37.5-25 mg 1 MO

triamterene-hctz tabs 75-50 mg 1 MO

ION-REMOVING AGENTS AURYXIA 1 MO FOSRENOL CHEW 1000 MG 1 MO

FOSRENOL CHEW 500 MG 1 MO

FOSRENOL CHEW 750 MG 1 MO





Requisitos/Límites

FOSRENOL PACK 1000 MG 1

FOSRENOL PACK 750 MG 1

KAYEXALATE 1 MO RENAGEL 1 MO RENVELA 1 MO sevelamer carbonate 1 MO sodium polystyrene sulfonate 1 MO

VELPHORO 1 MO VELTASSA 1 NDS IRRIGATING SOLUTIONS irrigation solutions, physiological 1 MO

lactated ringer's (irrigation) 1 MO

ringer's irrigation 1 MO sodium chloride (gu irrigant) 1 MO

water for irrigation, sterile 1 MO

REPLACEMENT PREPARATIONS calcium acetate (phosphate binder) 1 MO

DEXTROSE 5%/ELECTROLYTE #48 SOLN

1 HI

dextrose in lactated ringers soln 5 % 1 HI

DEXTROSE-NACL SOLN 10-0.2 % 1 HI


dextrose-nacl soln 2.5-0.45 % 1 HI

dextrose-nacl soln 5-0.2 % 1 HI






Requisitos/Límites


IONOSOL-B IN D5W SOLN 1 HI

IONOSOL-MB IN D5W SOLN 1 HI

ISOLYTE-P IN D5W SOLN 1 HI

ISOLYTE-S SOLN 1 HI K-TAB TBCR 10 MEQ 1 MO K-TAB TBCR 20 MEQ 1 MO K-TAB TBCR 8 MEQ 1 MO kcl in dextrose-nacl soln 10-5-0.45 meq/l-%-%

1 HI

kcl in dextrose-nacl soln 20-5-0.2 meq/l-%-%

1 HI

KCL IN DEXTROSE-NACL SOLN 20-5-0.225 MEQ/L-%-%

1 HI


1 HI


1 HI


1 HI


1 HI


1 HI

KCL IN DEXTROSE-NACL SOLN 40-5-0.9 MEQ/L-%-%

1 HI

KCL-LACTATED RINGERS-D5W SOLN 20 MEQ/L

1 HI

lactated ringers soln 1 HI MAGNESIUM SULFATE IN D5W 1 HI





Requisitos/Límites

SOLN 1-5 GM/100ML-% NORMOSOL-M IN D5W SOLN 1 HI

NORMOSOL-R IN D5W SOLN 1 HI

NORMOSOL-R PH 7.4 SOLN 1 HI

PHOSLO CAPS 667 MG 1 MO

PHOSLYRA SOLN 667 MG/5ML 1 MO

PLASMA-LYTE 148 SOLN 1 HI

PLASMA-LYTE A SOLN 1 HI

PLASMA-LYTE-56 IN D5W SOLN 1 HI

potassium chloride 1 MO potassium chloride in dextrose soln 20-5 meq/l-%

1 HI

potassium chloride in dextrose soln 40-5 meq/l-%

1 HI

potassium chloride in nacl soln 20-0.45 meq/l-%

1 HI


1 HI


1 HI

potassium chloride microencapsulated crystals cr

1 MO

potassium chloride soln 10 meq/100ml 1 HI

potassium chloride soln 2 meq/ml 1 HI





Requisitos/Límites

ringers soln 1 HI sodium chloride soln 0.45 % 1 HI

sodium chloride soln 0.9 % 1 HI

sodium chloride soln 2.5 meq/ml 1 HI

sodium chloride soln 3 % 1 HI

sodium chloride soln 5 % 1 HI

tpn electrolytes soln 1 HI ZINC TRACE METAL SOLN 1 MG/ML 1 HI

URICOSURIC AGENTS colchicine w/ probenecid 1 MO

probenecid 1 MO ZURAMPIC 1 MO ENZYMES ENZYMES ADAGEN 1 LD ALDURAZYME SOLN 2.9 MG/5ML 1 HI

CEREZYME SOLR 400 UNIT 1 HI,NDS

ELAPRASE 1 ELELYSO 1 NDS ELITEK SOLR 1.5 MG 1 HI ELITEK SOLR 7.5 MG 1 HI FABRAZYME 1 FABRAZYME SOLR 5 MG 1 HI

KANUMA 1 LUMIZYME 1 MYOZYME 1 NAGLAZYME 1 PULMOZYME 1 PA STRENSIQ 1 NDS SUCRAID 1 LD VIMIZIM SOLN 5 MG/5ML 1 HI

VPRIV 1 NDS





Requisitos/Límites

EYE, EAR, NOSE, AND THROAT (EENT) PREPARATIONS ANTI-INFECTIVES AZASITE 1 bacitracin (ophthalmic) 1

bacitracin-polymyxin b (ophth) 1

BESIVANCE 1 BLEPH-10 1 chlorhexidine gluconate (mouth-throat)

1

CILOXAN OINT 0.3 % 1 CILOXAN SOLN 0.3 % 1

ciprofloxacin hcl (ophth) 1

erythromycin (ophth) 1 gatifloxacin (ophth) 1 gentamicin sulfate (ophth) 1

levofloxacin (ophth) 1 MOXEZA 1 NATACYN 1 neomycin-bacitracin zn-polymyxin 1

neomycin-polymyxin-gramicidin 1

OCUFLOX 1 ofloxacin (ophth) 1 ofloxacin (otic) 1 OTOVEL 1 polymyxin b-trimethoprim 1

POLYTRIM 1 sulfacetamide sodium (ophth) 1

tobramycin (ophth) 1 TOBREX OINT 0.3 % 1 TOBREX SOLN 0.3 % 1 trifluridine 1 VIGAMOX 1



Requisitos/Límites

VIROPTIC 1 ZIRGAN 1 ZYMAXID 1 ANTI-INFLAMMATORY AGENTS ACULAR 1 MO ACULAR LS 1 MO ACUVAIL 1 MO ALREX 1 MO bacitracin-poly-neomycin-hc 1 MO

BECONASE AQ 1 MO BLEPHAMIDE 1 MO bromfenac sodium (ophth) 1 MO

budesonide (nasal) 1 MO CIPRO HC 1 MO CIPRODEX 1 MO COLY-MYCIN S 1 MO CORTISPORIN-TC 1 MO dexamethasone sodium phosphate (ophth)

1 MO

diclofenac sodium (ophth) 1 MO

DUREZOL 1 MO FLAREX 1 MO flunisolide (nasal) 1 MO fluocinolone acetonide (otic) 1 MO

fluorometholone (ophth) 1 MO

flurbiprofen sodium 1 MO fluticasone propionate (nasal) 1 MO

FML FORTE SUSP 0.25 % 1 MO

FML LIQUIFILM SUSP 0.1 % 1 MO

FML OINT 0.1 % 1 MO hydrocortisone w/acetic acid 1 MO

ILEVRO 1 MO





Requisitos/Límites

ketorolac tromethamine (ophth) 1 MO

LOTEMAX 1 MO MAXIDEX 1 MO MAXITROL 1 MO mometasone furoate (nasal) 1 MO

NASONEX 1 MO neomycin-polymy-dexameth 1 MO

neomycin-polymyxin-hc (ophth) 1 MO

neomycin-polymyxin-hc (otic) 1 MO

NEVANAC 1 MO OCUFEN 1 MO OMNARIS 1 MO OMNIPRED SUSP 1 % 1 MO

PRED FORTE SUSP 1 % 1 MO

PRED MILD SUSP 0.12 % 1 MO

PRED-G 1 MO PRED-G S.O.P. 1 MO prednisolone acetate (ophth) 1 MO

prednisolone sodium phosphate (ophth) 1 MO

PROLENSA 1 MO QNASL 1 MO QNASL CHILDRENS 1 MO RESTASIS 1 MO RHINOCORT AQUA 1 MO sulfacetamide sod-prednisolone 1 MO

TOBRADEX OINT 0.3-0.1 % 1 MO

TOBRADEX ST SUSP 0.3-0.05 % 1 MO

TOBRADEX SUSP 0.3-0.1 % 1 MO

tobramycin-dexamethasone 1 MO



Requisitos/Límites

triamcinolone acetonide (nasal) 1 MO

VERAMYST 1 MO VEXOL 1 MO XIIDRA 1 ZETONNA 1 MO ZYLET 1 MO ANTIALLERGIC AGENTS ALOCRIL 1 MO ALOMIDE 1 MO ASTEPRO 1 MO azelastine hcl 1 MO azelastine hcl (ophth) 1 MO BEPREVE 1 MO cromolyn sodium (ophth) 1 MO

DYMISTA 1 MO ELESTAT 1 MO EMADINE 1 MO epinastine hcl (ophth) 1 MO LASTACAFT 1 MO olopatadine hcl 1 MO olopatadine hcl (nasal) 1 MO

PATADAY 1 MO PATANASE 1 MO PATANOL 1 MO PAZEO 1 MO ANTIGLAUCOMA AGENTS acetazolamide 1 MO acetazolamide sodium solr 500 mg 1 HI

ALPHAGAN P 1 MO AZOPT 1 MO BETAGAN 1 MO betaxolol hcl (ophth) 1 MO BETIMOL 1 MO BETOPTIC-S 1 MO bimatoprost 1 MO brimonidine tartrate 1 MO carteolol hcl (ophth) 1 MO COMBIGAN 1 MO





Requisitos/Límites

COSOPT 1 MO COSOPT PF 1 MO DIAMOX SEQUELS 1 MO dorzolamide hcl 1 MO dorzolamide hcl-timolol maleate 1 MO

ISOPTO CARPINE 1 MO ISTALOL 1 MO latanoprost 1 MO levobunolol hcl 1 MO LUMIGAN 1 MO methazolamide 1 MO metipranolol 1 MO PHOSPHOLINE IODIDE 1 MO

pilocarpine hcl 1 MO SIMBRINZA 1 MO timolol maleate (ophth) 1 MO

TIMOPTIC OCUDOSE 1 MO

TIMOPTIC-XE 1 MO TRAVATAN Z 1 MO travoprost 1 MO TRUSOPT 1 MO XALATAN 1 MO ZIOPTAN 1 MO EENT DRUGS, MISCELLANEOUS acetic acid (otic) 1 MO apraclonidine hcl 1 MO atropine sulfate (ophthalmic) 1 MO

CYSTARAN 1 IOPIDINE SOLN 0.5 % 1 MO

IOPIDINE SOLN 1 % 1 MO LACRISERT 1 MO naphazoline hcl 1 MO LOCAL ANESTHETICS lidocaine hcl (mouth-throat) 1 MO

proparacaine hcl 1 MO



Requisitos/Límites

GASTROINTESTINAL DRUGS ANTI-INFLAMMATORY AGENTS alosetron hcl 1 NDS APRISO CP24 0.375 GM 1 MO

ASACOL HD TBEC 800 MG 1 MO

balsalazide disodium 1 MO CANASA SUPP 1000 MG 1 MO

DELZICOL CPDR 400 MG 1 MO

DIPENTUM 1 GIAZO 1 MO LIALDA TBEC 1.2 GM 1 MO LOTRONEX 1 NDS mesalamine 1 MO mesalamine w/ cleanser 1 MO

PENTASA CPCR 250 MG 1 MO

PENTASA CPCR 500 MG 1 MO

SFROWASA ENEM 4 GM/60ML 1 MO

ANTIDIARRHEA AGENTS diphenoxylate w/ atropine 1

LOMOTIL 1 loperamide hcl 1 MO ANTIEMETICS AKYNZEO 1 PA,NDS ALOXI SOLN 0.25 MG/5ML 1 HI

ANZEMET 1 PA,NDS ANZEMET SOLN 20 MG/ML 1 HI,NDS

aprepitant 1 PA,NDS CESAMET 1 PA dronabinol 1 PA EMEND 1 PA,NDS EMEND CAPS 125 MG 1 PA,NDS





Requisitos/Límites

EMEND CAPS 40 MG 1 PA,NDS EMEND CAPS 80 MG 1 PA,NDS EMEND SUSR 125 MG 1 PA,NDS

EMEND TRI-PACK CAPS 80 & 125 MG 1 PA,NDS

granisetron hcl 1 PA granisetron hcl soln 0.1 mg/ml 1 HI

granisetron hcl soln 1 mg/ml 1 HI

granisetron hcl soln 4 mg/4ml 1 HI

MARINOL CAPS 10 MG 1 PA

MARINOL CAPS 2.5 MG 1 PA

MARINOL CAPS 5 MG 1 PA

meclizine hcl 1 ondansetron 1 PA ondansetron hcl 1 PA ondansetron hcl soln 4 mg/2ml 1 HI

SANCUSO 1 NDS SYNDROS SOLN 5 MG/ML 1 PA,NDS

TIGAN 1 PA TRANSDERM-SCOP (1.5 MG) 1

trimethobenzamide hcl 1 PA

VARUBI 1 PA,NDS ZOFRAN 1 PA ZOFRAN ODT 1 PA ZOFRAN SOLN 40 MG/20ML 1 HI

ZUPLENZ 1 PA ANTIULCER AGENTS AND ACID SUPPRESSANTS ACIPHEX 1 MO ACIPHEX SPRINKLE 1 MO



Requisitos/Límites

amoxicillin-clarithromycin w/ lansoprazole

1 MO

CARAFATE SUSP 1 GM/10ML 1 MO

CARAFATE TABS 1 GM 1 MO

cimetidine 1 MO cimetidine hcl 1 MO CYTOTEC 1 MO DEXILANT 1 MO esomeprazole magnesium 1 MO

esomeprazole sodium solr 20 mg 1 HI

esomeprazole sodium solr 40 mg 1 HI

famotidine 1 MO famotidine premixed soln 20-0.9 mg/50ml-%

1 HI

famotidine soln 20 mg/2ml 1 HI

lansoprazole 1 MO misoprostol 1 MO NEXIUM 1 MO NEXIUM I.V. SOLR 40 MG 1 HI

nizatidine 1 MO OMECLAMOX-PAK 1 MO omeprazole 1 MO omeprazole-sodium bicarbonate 1 MO

pantoprazole sodium 1 MO pantoprazole sodium solr 40 mg 1 HI

PEPCID 1 MO PREVACID 1 MO PREVACID SOLUTAB 1 MO

PREVPAC 1 MO PRILOSEC 1 MO PROTONIX PACK 40 MG 1 MO





Requisitos/Límites

PROTONIX SOLR 40 MG 1 HI

PROTONIX TBEC 20 MG 1 MO

PROTONIX TBEC 40 MG 1 MO

PYLERA 1 MO rabeprazole sodium 1 MO ranitidine hcl 1 MO ranitidine hcl soln 150 mg/6ml 1 HI

ranitidine hcl soln 50 mg/2ml 1 HI

sucralfate 1 MO ZANTAC 1 MO ZANTAC SOLN 1000 MG/40ML 1 HI

ZEGERID 1 MO CATHARTICS AND LAXATIVES bisacodyl-peg 3350-pot chloride-sod bicarb-sod chloride

1 MO

COLYTE WITH FLAVOR PACKS 1 MO

GOLYTELY 1 MO MOVIPREP 1 MO NULYTELY WITH FLAVOR PACKS 1 MO

OSMOPREP 1 MO peg 3350-kcl-sod bicarb-sod chloride-sod sulfate

1 MO

peg 3350-potassium chloride-sod bicarbonate-sod chloride

1 MO

polyethylene glycol 3350 1 MO

PREPOPIK 1 MO SUPREP BOWEL PREP KIT 1 MO

DIGESTANTS CREON CPEP 12000 UNIT 1 MO



Requisitos/Límites

CREON CPEP 24000 UNIT 1 MO

CREON CPEP 3000-9500 UNIT 1 MO



PANCREAZE CPEP 10500 UNIT 1 MO





PERTZYE CPEP 16000 UNIT 1 MO



VIOKACE TABS 10440 UNIT 1 MO

VIOKACE TABS 20880 UNIT 1 MO

ZENPEP CPEP 10000 UNIT 1 MO




ZENPEP CPEP 3000-10000 UNIT 1 MO



GI DRUGS, MISCELLANEOUS ACTIGALL 1 MO AMITIZA 1 MO





Requisitos/Límites

chenodiol 1 MO CHOLBAM 1 NDS ENTYVIO 1 GATTEX 1 NDS LINZESS 1 MO metoclopramide hcl 1 MO metoclopramide hcl soln 5 mg/ml 1 HI

METOZOLV ODT 1 MO MOVANTIK 1 MO MYTESI 1 MO NUTRESTORE 1 MO OCALIVA 1 NDS REGLAN 1 MO RELISTOR SOLN 12 MG/0.6ML 1

RELISTOR SOLN 8 MG/0.4ML 1

RELISTOR TABS 150 MG 1 NDS

URSO 250 1 MO URSO FORTE 1 MO ursodiol 1 MO VIBERZI 1 NDS GOLD COMPOUNDS GOLD COMPOUNDS RIDAURA 1 MO HEAVY METAL ANTAGONISTS HEAVY METAL ANTAGONISTS CHEMET 1 CUPRIMINE CAPS 250 MG 1

DEPEN TITRATABS TABS 250 MG 1

EXJADE TBSO 125 MG 1 NDS



FERRIPROX 1 LD,NDS JADENU SPRINKLE PACK 180 MG 1 NDS



Requisitos/Límites

JADENU SPRINKLE PACK 360 MG 1 NDS

JADENU SPRINKLE PACK 90 MG 1 NDS

JADENU TABS 180 MG 1 NDS



SYPRINE 1 NDS HORMONES AND SYNTHETIC SUBSTITUTES ADRENALS ARISTOSPAN INTRA-ARTICULAR 1

ARISTOSPAN INTRALESIONAL 1

BREO ELLIPTA 1 MO budesonide 1 MO CELESTONE 1 MO CORTEF 1 MO cortisone acetate 1 MO DEPO-MEDROL SUSP 20 MG/ML 1

DEPO-MEDROL SUSP 40 MG/ML 1

DEPO-MEDROL SUSP 80 MG/ML 1

dexamethasone 1 PA,MO dexamethasone sodium phosphate 1 MO

dexamethasone sodium phosphate soln 10 mg/ml

1 HI

EMFLAZA 1 NDS ENTOCORT EC 1 fludrocortisone acetate 1 MO

hydrocortisone 1 MO hydrocortisone sod succinate 1

KENALOG 1 MO





Requisitos/Límites

MEDROL TABS 16 MG 1 MO

MEDROL TABS 2 MG 1 MO MEDROL TABS 32 MG 1 MO

MEDROL TABS 4 MG 1 MO MEDROL TABS 8 MG 1 MO MEDROL TBPK 4 MG 1 MO methylprednisolone 1 MO methylprednisolone acetate 1

methylprednisolone sod succ 1

ORAPRED ODT 1 MO prednisolone 1 MO prednisolone sodium phosphate 1 MO

prednisone 1 PA,MO RAYOS 1 PA,MO SOLU-CORTEF 1 SOLU-MEDROL SOLR 125 MG 1

SOLU-MEDROL SOLR 2 GM 1

SOLU-MEDROL SOLR 40 MG 1

SOLU-MEDROL SOLR 500 MG 1

UCERIS 1 MO,NDS ANDROGENS ANADROL-50 1 MO ANDRODERM PT24 2 MG/24HR 1 MO

ANDRODERM PT24 4 MG/24HR 1 MO

ANDROGEL GEL 20.25 MG/1.25GM (1.62%)

1 MO

ANDROGEL GEL 25 MG/2.5GM (1%) 1 MO

ANDROGEL GEL 40.5 MG/2.5GM (1.62%)

1 MO



Requisitos/Límites

ANDROGEL GEL 50 MG/5GM (1%) 1 MO

ANDROGEL PUMP GEL 20.25 MG/ACT (1.62%)

1 MO

AVEED 1 MO AXIRON SOLN 30 MG/ACT 1 MO

danazol 1 MO FORTESTA GEL 10 MG/ACT (2%) 1 MO

methyltestosterone 1 MO NATESTO GEL 5.5 MG/ACT 1 MO

oxandrolone 1 MO STRIANT MISC 30 MG 1 MO

TESTIM GEL 50 MG/5GM (1%) 1 MO

testosterone 1 MO testosterone cypionate 1 MO

testosterone enanthate 1 MO

TESTOSTERONE GEL 25 MG/2.5GM (1%)

1 MO

VOGELXO GEL 50 MG/5GM (1%) 1 MO

VOGELXO PUMP GEL 12.5 MG/ACT (1%)

1 MO

CONTRACEPTIVES BEYAZ 1 MO BREVICON (28) 1 MO CYCLESSA 1 MO DESOGEN 1 MO desogestrel & ethinyl estradiol 1 MO

desogestrel-ethinyl estradiol (biphasic) 1 MO

desogestrel-ethinyl estradiol (triphasic) 1 MO





Requisitos/Límites

drospirenone-ethinyl estradiol 1 MO

drospirenone-ethinyl estradiol-levomefolate calcium

1 MO

ELLA 1 MO ethynodiol diacet & eth estrad 1 MO

FEMCON FE 1 MO GENERESS FE 1 MO levonorgestrel & eth estradiol 1 MO

levonorgestrel-eth estradiol (triphasic) 1 MO

levonorgestrel-ethinyl estradiol (91-day) 1 MO

levonorgestrel-ethinyl estradiol (continuous) 1 MO

LO LOESTRIN FE 1 MO LOSEASONIQUE 1 MO MINASTRIN 24 FE 1 MO MODICON (28) 1 MO NATAZIA 1 MO NECON 1/50 (28) 1 MO NOR-QD 1 MO norelgestromin-ethinyl estradiol 1 MO

norethin acet & estrad-fe 1 MO

norethindrone & eth estradiol 1 MO

norethindrone & ethinyl estradiol-fe 1 MO

norethindrone (contraceptive) 1 MO

norethindrone acet & eth estra 1 MO

norethindrone acetate-ethinyl estradiol-fe

1 MO

norethindrone-eth estradiol (biphasic) 1 MO

norethindrone-eth estradiol (triphasic) 1 MO



Requisitos/Límites

norgestimate-ethinyl estradiol 1 MO

norgestimate-ethinyl estradiol (triphasic) 1 MO

norgestrel & ethinyl estradiol 1 MO

NORINYL 1+35 (28) 1 MO NORINYL 1+50 (28) 1 MO NUVARING 1 MO ORTHO MICRONOR 1 MO ORTHO TRI-CYCLEN (28) 1 MO

ORTHO TRI-CYCLEN LO 1 MO

ORTHO-CYCLEN (28) 1 MO

ORTHO-NOVUM 1/35 (28) 1 MO

ORTHO-NOVUM 7/7/7 (28) 1 MO

PLAN B ONE-STEP 1 QUARTETTE 1 MO SAFYRAL 1 MO SEASONIQUE 1 MO TRI-NORINYL (28) 1 MO YASMIN 28 1 MO YAZ 1 MO DIABETIC AGENTS acarbose 1 MO ACTOPLUS MET 1 MO ACTOPLUS MET XR 1 MO ACTOS 1 MO ADLYXIN 1 MO ADLYXIN STARTER PACK 1 MO

AFREZZA POWD 12 UNIT 1 MO

AFREZZA POWD 4 & 8 & 12 UNIT 1 MO

AFREZZA POWD 4 (30) & 8 (60) UNIT 1 MO






Requisitos/Límites



AFREZZA POWD 8 (60)& 12 (30) UNIT 1 MO


alogliptin benzoate 1 MO ALOGLIPTIN-METFORMIN HCL 1 MO

alogliptin-pioglitazone 1 MO AMARYL 1 MO APIDRA 1 PA,MO APIDRA SOLOSTAR 1 MO AVANDIA 1 MO BASAGLAR KWIKPEN SOPN 100 UNIT/ML

1 MO

BYDUREON 1 MO BYETTA 10 MCG PEN 1 MO

BYETTA 5 MCG PEN 1 MO chlorpropamide 1 MO CYCLOSET 1 MO DUETACT 1 MO FARXIGA 1 MO FORTAMET 1 MO glimepiride 1 MO glipizide er tb24 10 mg 1 MO

glipizide er tb24 2.5 mg 1 MO

glipizide er tb24 5 mg 1 MO glipizide tabs 10 mg 1 MO glipizide tabs 5 mg 1 MO glipizide-metformin hcl 1 MO GLUCAGEN HYPOKIT 1

GLUCAGON EMERGENCY 1

GLUCOPHAGE 1 MO GLUCOPHAGE XR 1 MO



Requisitos/Límites

GLUCOTROL 1 MO GLUCOTROL XL 1 MO GLUCOVANCE 1 MO GLUMETZA 1 MO glyburide 1 MO glyburide micronized 1 MO glyburide-metformin 1 MO GLYNASE 1 MO GLYSET 1 MO GLYXAMBI 1 MO HUMALOG KWIKPEN SOPN 100 UNIT/ML 1 MO

HUMALOG KWIKPEN SOPN 200 UNIT/ML 1 MO

HUMALOG MIX 50/50 1 MO HUMALOG MIX 50/50 KWIKPEN 1 MO

HUMALOG MIX 75/25 1 MO HUMALOG MIX 75/25 KWIKPEN 1 MO

HUMALOG SOCT 100 UNIT/ML 1 MO

HUMALOG SOLN 100 UNIT/ML 1 MO

HUMULIN 70/30 1 MO HUMULIN 70/30 KWIKPEN 1 MO

HUMULIN N KWIKPEN SUPN 100 UNIT/ML

1 MO

HUMULIN N SUSP 100 UNIT/ML 1 MO

HUMULIN R SOLN 100 UNIT/ML 1 PA,MO

HUMULIN R U-500 (CONCENTRATED) SOLN 500 UNIT/ML

1 MO

HUMULIN R U-500 KWIKPEN SOPN 500 UNIT/ML

1 MO

INVOKAMET 1 MO INVOKAMET XR 1 MO INVOKANA 1 MO





Requisitos/Límites

JANUMET 1 MO JANUMET XR 1 MO JANUVIA 1 MO JARDIANCE 1 MO JENTADUETO 1 MO JENTADUETO XR 1 MO KAZANO 1 MO KOMBIGLYZE XR 1 MO KORLYM 1 LD,NDS LANTUS SOLN 100 UNIT/ML 1 MO

LANTUS SOLOSTAR SOPN 100 UNIT/ML 1 MO

LEVEMIR 1 MO LEVEMIR FLEXTOUCH 1 MO

metformin hcl er (mod) tb24 1000 mg 1 MO

metformin hcl er (mod) tb24 500 mg 1 MO

metformin hcl er (osm) tb24 1000 mg 1 MO

metformin hcl er (osm) tb24 500 mg 1 MO

metformin hcl er tb24 500 mg 1 MO

metformin hcl er tb24 750 mg 1 MO

metformin hcl tabs 1000 mg 1 MO



miglitol 1 MO nateglinide 1 MO NESINA 1 MO NOVOLIN 70/30 1 MO NOVOLIN N RELION SUSP 100 UNIT/ML 1 MO

NOVOLIN N SUSP 100 UNIT/ML 1 MO

NOVOLIN R RELION SOLN 100 UNIT/ML 1 PA,MO



Requisitos/Límites

NOVOLIN R SOLN 100 UNIT/ML 1 PA,MO

NOVOLOG 1 PA,MO NOVOLOG FLEXPEN 1 MO NOVOLOG MIX 70/30 1 MO NOVOLOG MIX 70/30 FLEXPEN 1 MO

NOVOLOG PENFILL 1 MO ONGLYZA 1 MO OSENI 1 MO pioglitazone hcl 1 MO pioglitazone hcl-glimepiride 1 MO

pioglitazone hcl-metformin hcl 1 MO

PRANDIN 1 MO PRECOSE 1 MO repaglinide 1 MO repaglinide-metformin hcl 1 MO

RIOMET 1 SOLIQUA 1 MO STARLIX 1 MO SYMLINPEN 120 1 MO SYMLINPEN 60 1 MO SYNJARDY 1 MO TANZEUM 1 MO tolazamide 1 MO tolbutamide 1 MO TOUJEO SOLOSTAR SOPN 300 UNIT/ML 1 MO

TRADJENTA 1 MO TRESIBA FLEXTOUCH 1 MO

TRULICITY 1 MO VICTOZA 1 MO XIGDUO XR 1 MO XULTOPHY 1 NDS ESTROGENS AND ANTIESTROGENS ACTIVELLA 1 MO ALORA PTTW 0.025 MG/24HR 1 MO





Requisitos/Límites

ALORA PTTW 0.05 MG/24HR 1 MO



ANGELIQ 1 MO CLIMARA PRO 1 MO CLIMARA PTWK 0.025 MG/24HR 1 MO

CLIMARA PTWK 0.0375 MG/24HR 1 MO





COMBIPATCH 1 MO DELESTROGEN 1 DIVIGEL GEL 0.5 MG/0.5GM 1 MO

DUAVEE 1 MO ELESTRIN GEL 0.52 MG/0.87 GM (0.06%) 1 MO

esterified estrogens 1 MO estradiol 1 MO estradiol & norethindrone acetate 1 MO

estradiol cypionate 1 estradiol vaginal 1 MO estradiol valerate 1 estradiol-norgestimate 1 MO ESTRING 1 MO estropipate 1 MO EVAMIST SOLN 1.53 MG/SPRAY 1 MO

EVISTA 1 MO FEMHRT LOW DOSE 1 MO FEMRING 1 MO



Requisitos/Límites

MENOSTAR PTWK 14 MCG/24HR 1 MO

MINIVELLE PTTW 0.025 MG/24HR 1 MO





norethindrone acetate-ethinyl estradiol

1 MO

PREMARIN 1 MO PREMARIN SOLR 25 MG 1

PREMARIN TABS 0.3 MG 1 MO





PREMPHASE 1 MO PREMPRO 1 MO raloxifene hcl 1 MO VAGIFEM 1 MO VIVELLE-DOT PTTW 0.025 MG/24HR 1 MO

VIVELLE-DOT PTTW 0.0375 MG/24HR 1 MO




GONADOTROPINS





Requisitos/Límites

chorionic gonadotropin 1 PA

SYNAREL 1 MO PARATHYROID calcitonin (salmon) 1 MO FORTEO 1 PA,NDS FORTICAL SOLN 200 UNIT/ACT 1 MO

MIACALCIN SOLN 200 UNIT/ACT 1 MO

MIACALCIN SOLN 200 UNIT/ML 1

NATPARA 1 LD,NDS TYMLOS 1 NDS PITUITARY DDAVP 1 MO DDAVP RHINAL TUBE 1 MO

DDAVP SOLN 4 MCG/ML 1 MO

DDAVP TABS 0.1 MG 1 MO DDAVP TABS 0.2 MG 1 MO desmopressin acetate 1 MO desmopressin acetate refrigerated 1 MO

desmopressin acetate spray refrigerated 1 MO

HP ACTHAR 1 PA,NDS STIMATE SOLN 1.5 MG/ML 1 MO

PROGESTINS CRINONE 1 PA,MO DEPO-PROVERA 1 DEPO-PROVERA SUSP 150 MG/ML 1

DEPO-SUBQ PROVERA 104 SUSY 104 MG/0.65ML

1

hydroxyprogesterone caproate (antineoplastic)

1

MAKENA 1 medroxyprogesterone acetate 1 MO



Requisitos/Límites

medroxyprogesterone acetate (contraceptive)

1

MEGACE ES 1 MO megestrol acetate (appetite) 1 MO

norethindrone acetate 1 MO progesterone micronized 1 MO

PROMETRIUM 1 MO PROVERA 1 MO SOMATOTROPIN AGONISTS AND ANTAGONISTS EGRIFTA 1 NDS GENOTROPIN MINIQUICK SOLR 0.2 MG

1 PA,NDS

GENOTROPIN MINIQUICK SOLR 0.4 MG

1 PA,NDS


1 PA,NDS


1 PA,NDS

GENOTROPIN MINIQUICK SOLR 1 MG

1 PA,NDS


1 PA,NDS


1 PA,NDS


1 PA,NDS


1 PA,NDS

GENOTROPIN MINIQUICK SOLR 2 MG

1 PA,NDS





Requisitos/Límites

GENOTROPIN SOLR 12 MG 1 PA,NDS

GENOTROPIN SOLR 5 MG 1 PA,NDS

HUMATROPE SOLR 12 MG 1 PA,NDS




INCRELEX 1 NDS NORDITROPIN FLEXPRO SOLN 10 MG/1.5ML

1 PA,NDS

NORDITROPIN FLEXPRO SOLN 15 MG/1.5ML

1 PA,NDS

NORDITROPIN FLEXPRO SOLN 30 MG/3ML

1 PA,NDS

NORDITROPIN FLEXPRO SOLN 5 MG/1.5ML

1 PA,NDS

NUTROPIN AQ NUSPIN 10 SOLN 10 MG/2ML

1 PA,NDS


1 PA,NDS


1 PA,NDS

NUTROPIN AQ PEN SOLN 10 MG/2ML 1 PA,NDS

NUTROPIN AQ PEN SOLN 20 MG/2ML 1 PA,NDS

OMNITROPE SOLN 10 MG/1.5ML 1 PA,NDS

OMNITROPE SOLN 5 MG/1.5ML 1 PA,NDS

OMNITROPE SOLR 5.8 MG 1 PA,NDS

SAIZEN 1 PA,NDS



Requisitos/Límites

SAIZEN CLICK.EASY 1 PA,NDS SAIZENPREP 1 PA,NDS SEROSTIM 1 PA,NDS SIGNIFOR 1 NDS SIGNIFOR LAR 1 NDS SOMAVERT 1 LD,NDS TEV-TROPIN SOLR 5 MG 1 PA,NDS

ZOMACTON SOLR 10 MG 1 PA,NDS

ZOMACTON SOLR 5 MG 1 PA,NDS

ZORBTIVE 1 PA,NDS THYROID AND ANTITHYROID AGENTS CYTOMEL 1 MO levothyroxine sodium 1 MO LEVOTHYROXINE SODIUM 1 MO

liothyronine sodium 1 MO liothyronine sodium soln 10 mcg/ml 1 HI

methimazole 1 MO propylthiouracil 1 MO SYNTHROID 1 MO THYROLAR-1 1 THYROLAR-1/2 1 THYROLAR-1/4 1 THYROLAR-2 1 THYROLAR-3 1 TIROSINT 1 MO TRIOSTAT SOLN 10 MCG/ML 1 HI

MISCELLANEOUS THERAPEUTIC AGENTS MISCELLANEOUS THERAPEUTIC AGENTS acetylcysteine 1 PA,MO ACTEMRA SOLN 200 MG/10ML 1 HI,NDS

ACTEMRA SOLN 400 MG/20ML 1 HI,NDS

ACTEMRA SOLN 80 MG/4ML 1 HI,NDS

ACTEMRA SOSY 162 MG/0.9ML 1 NDS





Requisitos/Límites

ACTIMMUNE 1 LD,NDS ACTONEL 1 MO alendronate sodium soln 70 mg/75ml 1 MO

alendronate sodium tabs 10 mg 1 MO





allopurinol 1 MO allopurinol sodium solr 500 mg 1 HI

ALOPRIM SOLR 500 MG 1 HI

amifostine solr 500 mg 1 HI

AMPYRA 1 NDS ARAVA 1 MO ARCALYST 1 NDS ASTAGRAF XL CP24 0.5 MG 1 PA,MO

ASTAGRAF XL CP24 1 MG 1 PA,MO

ASTAGRAF XL CP24 5 MG 1 PA

ATELVIA 1 MO ATGAM INJ 50 MG/ML 1 HI

AUBAGIO 1 PA,NDS AVODART 1 MO AVONEX 1 NDS AVONEX PEN 1 NDS AVONEX PREFILLED 1 NDS azathioprine 1 PA,MO azathioprine sodium 1 PA,MO BENLYSTA 1 NDS BERINERT 1



Requisitos/Límites

BETASERON KIT 0.3 MG 1 NDS

BINOSTO 1 MO BONIVA 1 PA,MO BONIVA SOLN 3 MG/3ML 1 HI

BOTOX 1 PA CARNITOR 1 PA,MO CARNITOR SOLN 200 MG/ML 1 HI

CELLCEPT 1 PA,MO CELLCEPT INTRAVENOUS SOLR 500 MG

1 HI

CERDELGA 1 NDS CIMZIA 1 NDS CIMZIA PREFILLED 1 NDS CINRYZE SOLR 500 UNIT 1 HI,NDS

colchicine 1 MO COLCHICINE CAPS 0.6 MG 1 MO

COLCRYS TABS 0.6 MG 1 MO

COPAXONE 1 NDS cyclosporine 1 PA,MO cyclosporine modified (for microemulsion) 1 PA,MO

cyclosporine soln 50 mg/ml 1 HI

CYSTADANE 1 LD,NDS CYSTAGON CAPS 150 MG 1 LD,NDS

CYSTAGON CAPS 50 MG 1 LD,NDS

DEMSER 1 MO dexrazoxane solr 250 mg 1 HI

disulfiram 1 MO dutasteride 1 MO dutasteride-tamsulosin hcl 1 MO

DYSPORT 1 PA





Requisitos/Límites

ELMIRON 1 MO ENBREL 1 NDS ENBREL SURECLICK 1 NDS ENVARSUS XR TB24 0.75 MG 1 PA,MO

ENVARSUS XR TB24 1 MG 1 PA,MO

ENVARSUS XR TB24 4 MG 1 PA,MO

etidronate disodium 1 MO EXONDYS 51 1 NDS EXTAVIA KIT 0.3 MG 1 NDS finasteride 1 MO FIRAZYR 1 NDS fomepizole soln 1 gm/ml 1 HI

FOSAMAX 1 MO FOSAMAX PLUS D 1 MO FUSILEV SOLR 50 MG 1 HI

GILENYA 1 NDS glatiramer acetate 1 NDS GRASTEK 1 MO HAEGARDA 1 NDS HEMABATE 1 HUMIRA 1 NDS HUMIRA PEDIATRIC CROHNS START 1 NDS

HUMIRA PEN 1 NDS HUMIRA PEN-CROHNS STARTER 1 NDS

HUMIRA PEN-PSORIASIS STARTER

1 NDS

ibandronate sodium 1 PA,MO ibandronate sodium soln 3 mg/3ml 1 HI

IMURAN 1 PA,MO INFLECTRA 1 NDS JALYN 1 MO KEVEYIS 1 NDS KEVZARA 1 NDS KINERET 1 NDS



Requisitos/Límites

KUVAN 1 NDS leflunomide 1 MO LEMTRADA 1 leucovorin calcium 1 MO leucovorin calcium solr 100 mg 1 HI

leucovorin calcium solr 350 mg 1 HI

levocarnitine (metabolic modifiers) 1 PA,MO

levocarnitine soln 200 mg/ml 1 HI

levoleucovorin calcium 1 MO

levoleucovorin calcium solr 50 mg 1 HI

lidocaine hcl (local anesth.) 1

mesna soln 100 mg/ml 1 HI

MESNEX SOLN 100 MG/ML 1 HI

MESNEX TABS 400 MG 1 NDS

methylergonovine maleate 1

MIFEPREX 1 MITIGARE CAPS 0.6 MG 1 MO

MYALEPT 1 NDS mycophenolate mofetil 1 PA,MO mycophenolate mofetil hcl solr 500 mg 1 HI

mycophenolate sodium 1 PA,MO

MYFORTIC 1 PA,MO NEORAL CAPS 100 MG 1 PA,MO

NEORAL CAPS 25 MG 1 PA,MO

NEORAL SOLN 100 MG/ML 1 PA,MO

NULOJIX SOLR 250 MG 1 HI





Requisitos/Límites

OCREVUS 1 octreotide acetate 1 ORALAIR 1 MO ORENCIA 1 NDS ORENCIA CLICKJECT 1 NDS

ORFADIN 1 LD,NDS OTEZLA 1 PA,NDS OTREXUP SOAJ 10 MG/0.4ML 1

OTREXUP SOAJ 12.5 MG/0.4ML 1

OTREXUP SOAJ 15 MG/0.4ML 1






pamidronate disodium soln 30 mg/10ml 1 HI

pamidronate disodium soln 6 mg/ml 1 HI

pamidronate disodium soln 90 mg/10ml 1 HI

PROCYSBI CPDR 25 MG 1 NDS

PROCYSBI CPDR 75 MG 1 NDS

PROGRAF CAPS 0.5 MG 1 PA,MO

PROGRAF CAPS 1 MG 1 PA,MO

PROGRAF CAPS 5 MG 1 PA,MO

PROGRAF SOLN 5 MG/ML 1 HI

PROLIA SOLN 60 MG/ML 1 NDS



Requisitos/Límites

PROSCAR 1 MO RAGWITEK 1 MO RAPAMUNE 1 PA,MO RASUVO SOAJ 10 MG/0.2ML 1

RASUVO SOAJ 12.5 MG/0.25ML 1

RASUVO SOAJ 15 MG/0.3ML 1








REBIF 1 NDS REBIF REBIDOSE 1 NDS REBIF REBIDOSE TITRATION PACK 1 NDS

REBIF TITRATION PACK 1 NDS

RECLAST SOLN 5 MG/100ML 1 HI

REMICADE 1 RENFLEXIS 1 NDS RIMSO-50 1 risedronate sodium 1 MO RUCONEST 1 NDS SANDIMMUNE 1 PA,MO SANDIMMUNE SOLN 50 MG/ML 1 HI

SANDOSTATIN LAR DEPOT KIT 10 MG 1 NDS






Requisitos/Límites


SANDOSTATIN SOLN 100 MCG/ML 1





SENSIPAR TABS 30 MG 1 NDS



SIMPONI 1 NDS SIMPONI ARIA 1 NDS SIMULECT SOLR 10 MG 1 HI

SIMULECT SOLR 20 MG 1 HI

sirolimus 1 PA,MO SODIUM FLUORIDE 1 MO SOMATULINE DEPOT 1

tacrolimus 1 PA,MO TECFIDERA 1 NDS THALOMID 1 NDS THIOLA 1 MO THYMOGLOBULIN SOLR 25 MG 1 HI

TYBOST 1 MO TYSABRI 1 ULORIC 1 MO VISTOGARD 1 VORAXAZE 1 XELJANZ 1 NDS XELJANZ XR 1 NDS XEOMIN SOLR 100 UNIT 1 PA



Requisitos/Límites

XEOMIN SOLR 200 UNIT 1 PA

XEOMIN SOLR 50 UNIT 1 PA

XGEVA SOLN 120 MG/1.7ML 1 NDS

XURIDEN 1 XYLOCAINE 1 ZAVESCA 1 LD,NDS ZINBRYTA 1 NDS ZINECARD SOLR 250 MG 1 HI

zoledronic acid conc 4 mg/5ml 1 HI

zoledronic acid soln 5 mg/100ml 1 HI

ZOMETA CONC 4 MG/5ML 1 HI

ZOMETA SOLN 4 MG/100ML 1 HI

ZORTRESS TABS 0.25 MG 1 PA,MO

ZORTRESS TABS 0.5 MG 1 PA

ZORTRESS TABS 0.75 MG 1 PA

ZYLOPRIM 1 MO RESPIRATORY TRACT AGENTS ANTI-INFLAMMATORY AGENTS ACCOLATE 1 MO AIRDUO RESPICLICK 113/14 1 MO

AIRDUO RESPICLICK 232/14 1 MO

AIRDUO RESPICLICK 55/14 1 MO

CINQAIR 1 NDS cromolyn sodium 1 PA,MO cromolyn sodium (mastocytosis) 1 MO

fluticasone-salmeterol 1 MO GASTROCROM 1 MO montelukast sodium 1 MO NUCALA 1 NDS





Requisitos/Límites

SINGULAIR 1 MO zafirlukast 1 MO zileuton 1 MO ZYFLO CR TB12 600 MG 1

ZYFLO TABS 600 MG 1 MO RESPIRATORY AGENTS, MISCELLANEOUS AEROSPAN 1 MO ALVESCO 1 MO ARALAST NP 1 ARNUITY ELLIPTA 1 MO ASMANEX 120 METERED DOSES AEPB 220 MCG/INH

1 MO

ASMANEX 30 METERED DOSES AEPB 110 MCG/INH

1 MO


1 MO


1 MO

ASMANEX HFA AERO 100 MCG/ACT 1 MO

ASMANEX HFA AERO 200 MCG/ACT 1 MO

budesonide (inhalation) 1 PA,MO

DALIRESP 1 MO DULERA 1 MO ESBRIET 1 PA,NDS FLOVENT DISKUS 1 MO FLOVENT HFA AERO 110 MCG/ACT 1 MO

FLOVENT HFA AERO 220 MCG/ACT 1 MO

FLOVENT HFA AERO 44 MCG/ACT 1 MO

GLASSIA 1 KALYDECO 1 PA,NDS OFEV 1 NDS ORKAMBI 1 NDS



Requisitos/Límites

PROLASTIN-C 1 PULMICORT FLEXHALER AEPB 180 MCG/ACT

1 MO

PULMICORT FLEXHALER AEPB 90 MCG/ACT

1 MO

PULMICORT SUSP 0.25 MG/2ML 1 PA,MO

PULMICORT SUSP 0.5 MG/2ML 1 PA,MO

PULMICORT SUSP 1 MG/2ML 1 PA,MO

QVAR 1 MO SYMBICORT 1 MO XOLAIR 1 NDS ZEMAIRA 1 VASODILATING AGENTS ADEMPAS 1 NDS LETAIRIS 1 NDS OPSUMIT 1 NDS ORENITRAM TBCR 0.125 MG 1 LD,NDS

ORENITRAM TBCR 0.25 MG 1 LD,NDS

ORENITRAM TBCR 1 MG 1 LD,NDS

ORENITRAM TBCR 2.5 MG 1 LD,NDS

ORENITRAM TBCR 5 MG 1 LD,NDS

REMODULIN 1 LD TRACLEER 1 NDS TYVASO 1 PA,LD UPTRAVI 1 NDS VENTAVIS 1 PA,LD,NDS SERUMS, TOXOIDS, AND VACCINES SERUMS BIVIGAM SOLN 10 GM/100ML 1 HI

CARIMUNE NF SOLR 12 GM 1 HI

CARIMUNE NF SOLR 6 GM 1 HI





Requisitos/Límites

CYTOGAM INJ 50 MG/ML 1 HI

FLEBOGAMMA DIF SOLN 0.5 GM/10ML 1 HI

FLEBOGAMMA DIF SOLN 10 GM/100ML 1 HI


FLEBOGAMMA DIF SOLN 2.5 GM/50ML 1 HI





GAMASTAN S/D 1 PA GAMMAGARD S/D LESS IGA SOLR 10 GM

1 HI

GAMMAGARD S/D LESS IGA SOLR 5 GM

1 HI

GAMMAGARD S/D SOLR 10 GM 1 HI

GAMMAGARD SOLN 2.5 GM/25ML 1 HI

GAMMAKED SOLN 1 GM/10ML 1 HI

GAMMAPLEX SOLN 10 GM/100ML 1 HI




GAMUNEX-C SOLN 1 GM/10ML 1 HI


GAMUNEX-C SOLN 2.5 GM/25ML 1 HI



Requisitos/Límites




HYPERRAB S/D 1 HYPERRHO S/D 1 HYQVIA 1 PA,NDS IMOGAM RABIES-HT 1 NABI-HB 1 OCTAGAM SOLN 1 GM/20ML 1 HI

OCTAGAM SOLN 2 GM/20ML 1 HI



PRIVIGEN SOLN 20 GM/200ML 1 HI

PRIVIGEN SOLN 40 GM/400ML 1 HI

RHOPHYLAC 1 VARIZIG 1 ZINPLAVA 1 TOXOIDS DIPHTHERIA-TETANUS TOXOIDS DT

1

KINRIX 1 QUADRACEL 1 TENIVAC 1 TETANUS-DIPHTHERIA TOXOIDS TD

1

VACCINES ACTHIB 1 ADACEL 1 BEXSERO 1 BOOSTRIX 1 CERVARIX 1 COMVAX 1





Requisitos/Límites

DAPTACEL 1 ENGERIX-B 1 PA GARDASIL 1 GARDASIL 9 1 HAVRIX 1 HIBERIX 1 IMOVAX RABIES 1 INFANRIX 1 IPOL 1 IXIARO 1 M-M-R II 1 MENACTRA 1 MENHIBRIX 1 MENOMUNE 1 MENVEO 1 PEDIARIX 1 PEDVAX HIB 1 PROQUAD 1 RABAVERT 1 RECOMBIVAX HB 1 PA ROTARIX 1 ROTATEQ 1 TRUMENBA 1 TWINRIX 1 TYPHIM VI 1 VAQTA 1 VARIVAX 1 YF-VAX 1 ZOSTAVAX 1 SKIN AND MUCOUS MEMBRANE AGENTS ANTI-INFECTIVES (SKIN AND MUCOUS MEMBRANE) ACANYA 1 MO acyclovir topical 1 AKNE-MYCIN OINT 2 % 1 MO

ALTABAX 1 AVC VAGINAL 1 BACTROBAN 1 BACTROBAN NASAL 1 BENZACLIN 1 MO



Requisitos/Límites

BENZAMYCIN 1 MO benzoyl peroxide-erythromycin 1 MO

butoconazole nitrate (one dose) 1

ciclopirox 1 ciclopirox olamine 1 CLEOCIN CREA 2 % 1 CLEOCIN SUPP 100 MG 1

CLEOCIN-T 1 MO CLINDAGEL 1 MO clindamycin phosphate & cleanser 1 MO

clindamycin phosphate (topical) 1 MO

clindamycin phosphate vaginal 1

clindamycin phosphate-benzoyl peroxide

1 MO

clindamycin phosphate-benzoyl peroxide (refrigerate)

1 MO

CLINDESSE 1 clotrimazole 1 clotrimazole (topical) 1 clotrimazole w/ betamethasone 1

DENAVIR 1 DUAC 1 MO econazole nitrate 1 ELIMITE 1 ERTACZO 1 ERYGEL GEL 2 % 1 MO erythromycin (acne aid) 1 MO

EURAX 1 EVOCLIN 1 MO EXELDERM 1 EXTINA 1 gentamicin sulfate (topical) 1





Requisitos/Límites

JUBLIA 1 KERYDIN 1 ketoconazole (topical) 1 KLARON 1 MO lindane 1 LOPROX 1 LOTRISONE 1 LUZU 1 malathion 1 MENTAX 1 METROCREAM 1 METROGEL 1 METROGEL-VAGINAL 1

METROLOTION 1 metronidazole (topical) 1

metronidazole vaginal 1 miconazole nitrate vaginal 1

mupirocin 1 mupirocin calcium (topical) 1

naftifine hcl 1 NAFTIN 1 neomycin/polymyxin b gu 1

NIZORAL 1 NORITATE 1 NUVESSA 1 nystatin (topical) 1 ONEXTON 1 MO ORAVIG 1 oxiconazole nitrate 1 OXISTAT 1 permethrin 1 selenium sulfide 1 SILVADENE 1 silver sulfadiazine 1 SOOLANTRA 1 sulfacetamide sodium (acne) 1 MO



Requisitos/Límites

SULFAMYLON CREA 85 MG/GM 1

SULFAMYLON PACK 5 % 1

TERAZOL 3 1 TERAZOL 7 1 terconazole vaginal 1 XERESE 1 ZOVIRAX 1 MO ANTI-INFLAMMATORY AGENTS (SKIN AND MUCOUS MEMBRANE) alclometasone dipropionate 1 MO

amcinonide 1 MO betamethasone dipropionate (topical) 1 MO

betamethasone dipropionate augmented

1 MO

betamethasone valerate 1 MO

calcipotriene-betamethasone dipropionate

1 MO

CAPEX SHAM 0.01 % 1 MO clobetasol propionate 1 MO clobetasol propionate emollient base 1 MO

CLOBEX LOTN 0.05 % 1 MO

CLOBEX SHAM 0.05 % 1 MO

CLOBEX SPRAY LIQD 0.05 % 1 MO

CLODERM PUMP 1 MO CORDRAN 1 MO CORTISPORIN 1 MO CUTIVATE 1 MO DERMATOP 1 MO DESONATE GEL 0.05 % 1 MO

desonide 1 MO DESOWEN CREA 0.05 % 1 MO





Requisitos/Límites

desoximetasone 1 MO diflorasone diacetate 1 MO diflorasone diacetate emollient base 1 MO

DIPROLENE 1 MO DIPROLENE AF 1 MO ELOCON 1 MO ENSTILAR FOAM 0.005-0.064 % 1 MO

EUCRISA 1 MO fluocinolone acetonide 1 MO fluocinonide 1 MO fluocinonide emulsified base 1 MO

flurandrenolide 1 MO fluticasone propionate 1 MO halobetasol propionate 1 MO

HALOG 1 MO hydrocortisone (intrarectal) 1 MO

hydrocortisone (rectal) 1 MO hydrocortisone (topical) 1 MO

hydrocortisone acetate (topical) 1 MO

hydrocortisone butyrate 1 MO

hydrocortisone butyrate hydrophilic lipo base

1 MO

hydrocortisone valerate 1 MO

KENALOG 1 MO LOCOID 1 MO mometasone furoate 1 MO neomycin sulfate-fluocinolone acetonide 1 MO

nystatin-triamcinolone 1 MO OLUX FOAM 0.05 % 1 MO PANDEL 1 MO prednicarbate 1 MO SYNALAR (CREAM) 1 MO



Requisitos/Límites

SYNALAR CREA 0.025 % 1 MO

TACLONEX OINT 0.005-0.064 % 1

TACLONEX SUSP 0.005-0.064 % 1 MO

TOPICORT 1 MO TOPICORT SPRAY 1 MO triamcinolone acetonide (mouth) 1 MO

triamcinolone acetonide (topical) 1 MO

TRIDESILON CREA 0.05 % 1 MO

UCERIS 1 MO,NDS ULTRAVATE CREA 0.05 % 1 MO

ULTRAVATE LOTN 0.05 % 1 NDS

ULTRAVATE OINT 0.05 % 1 MO

VANOS 1 MO ANTIPRURITICS AND LOCAL ANESTHETICS doxepin hcl (antipruritic) 1 MO

EMLA 1 PA,MO lidocaine 1 PA,MO lidocaine hcl 1 MO lidocaine-prilocaine 1 PA,MO LIDOCAINE-TETRACAINE 1 PA

LIDODERM 1 PA,MO PLIAGLIS 1 PA PRUDOXIN 1 MO SYNERA 1 PA XYLOCAINE 1 ZONALON 1 MO CELL STIMULANTS AND PROLIFERANTS ATRALIN GEL 0.05 % 1 PA,MO KEPIVANCE SOLR 6.25 MG 1 HI

RETIN-A CREA 0.025 % 1 PA,MO





Requisitos/Límites

RETIN-A CREA 0.05 % 1 PA,MO

RETIN-A CREA 0.1 % 1 PA,MO RETIN-A GEL 0.01 % 1 PA,MO RETIN-A GEL 0.025 % 1 PA,MO

RETIN-A MICRO GEL 0.04 % 1 PA,MO

RETIN-A MICRO GEL 0.1 % 1 PA,MO

RETIN-A MICRO PUMP GEL 0.04 % 1 PA,MO



tretinoin 1 PA,MO tretinoin microsphere 1 PA,MO SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS 8-MOP 1 MO ABSORICA 1 NDS acitretin 1 MO ACZONE 1 MO adapalene 1 MO ALDARA 1 MO AZELEX 1 MO calcipotriene 1 MO CALCITRIOL 1 PA,MO CARAC CREA 0.5 % 1 MO clindamycin phosphate-tretinoin 1 MO

CONDYLOX 1 MO COSENTYX 1 NDS COSENTYX SENSOREADY PEN 1 NDS

diclofenac sodium (actinic keratoses) 1 MO

diclofenac sodium (topical) 1 MO

DIFFERIN CREA 0.1 % 1 MO

DIFFERIN GEL 0.1 % 1 MO



Requisitos/Límites

DIFFERIN GEL 0.3 % 1 MO DIFFERIN LOTN 0.1 % 1 MO

DOVONEX 1 MO DUPIXENT 1 NDS EFUDEX CREA 5 % 1 MO ELIDEL 1 MO EPIDUO 1 MO EPIDUO FORTE 1 MO FABIOR 1 MO FINACEA FOAM 15 % 1 MO

FINACEA GEL 15 % 1 MO FLECTOR 1 PA,MO FLUOROPLEX CREA 1 % 1 MO

fluorouracil (topical) 1 MO imiquimod 1 MO isotretinoin 1 NDS lactic acid (ammonium lactate) 1 MO

methoxsalen rapid 1 MO MIRVASO 1 MO ORACEA 1 OXSORALEN 1 MO OXSORALEN ULTRA 1 MO PANRETIN 1 PENNSAID 1 MO PICATO 1 MO podofilox 1 MO PROTOPIC 1 MO RECTIV 1 MO REGRANEX 1 RYNODERM 1 NDS SANTYL 1 MO SILIQ 1 NDS SOLARAZE 1 MO SORIATANE 1 SORILUX 1 MO STELARA 1 PA tacrolimus (topical) 1 MO TALTZ 1 NDS





Requisitos/Límites

TARGRETIN 1 NDS tazarotene 1 PA,MO TAZORAC 1 PA,MO TOLAK CREA 4 % 1 TREMFYA 1 UVADEX 1 VALCHLOR 1 NDS VECTICAL 1 MO VELTIN 1 MO VEREGEN 1 MO VOLTAREN 1 MO ZIANA 1 MO ZYCLARA 1 MO ZYCLARA PUMP 1 MO SMOOTH MUSCLE RELAXANTS SMOOTH MUSCLE RELAXANTS aminophylline soln 25 mg/ml 1 HI

darifenacin hydrobromide 1 MO

DETROL 1 MO DETROL LA 1 MO DITROPAN XL 1 MO ENABLEX 1 MO flavoxate hcl 1 MO GELNIQUE 1 MO MYRBETRIQ 1 MO oxybutynin chloride 1 MO OXYTROL 1 MO theophylline 1 MO tolterodine tartrate 1 MO TOVIAZ 1 MO trospium chloride 1 MO VESICARE 1 MO VITAMINS VITAMINS calcitriol 1 PA,MO calcitriol soln 1 mcg/ml 1 PA,HI

doxercalciferol 1 PA,MO doxercalciferol soln 4 mcg/2ml 1 HI



Requisitos/Límites

HECTOROL 1 PA,MO HECTOROL SOLN 4 MCG/2ML 1 HI

paricalcitol 1 PA,MO paricalcitol soln 2 mcg/ml 1 HI

paricalcitol soln 5 mcg/ml 1 HI

RAYALDEE 1 NDS ROCALTROL 1 PA,MO VINATE CALCIUM 1 MO VP-PNV-DHA 1 MO ZEMPLAR 1 PA,MO ZEMPLAR SOLN 2 MCG/ML 1 HI

ZEMPLAR SOLN 5 MCG/ML 1 HI


La información que se muestra en la columna Requisitos/Límites le indica si nuestro plan tiene algún requisito especial en la cobertura de su medicamento. HI = Los medicamentos de infusión intravenosa domiciliaria pueden estar cubiertos por nuestro beneficio médico y obtenerse en las farmacias de infusión intravenosa domiciliaria. Si desea más información, consulte su directorio de farmacias o llame a nuestro plan al número que aparece en la portada y la contraportada. LD = Los medicamentos de distribución limitada solo se pueden obtener en ciertas farmacias especializadas. Si desea más información, consulte su directorio de farmacias o llame a nuestro plan al número que aparece en la portada y la contraportada. MO = Medicamentos de pedido por correo. Puede pedir en línea el resurtido de ciertos medicamentos recetados por medio de nuestro servicio de pedidos por correo en kp.org/refill o por teléfono o aplicación móvil, lo cual podría reducir los costos de un suministro de tres meses. Comuníquese con nosotros 10 días antes de que se le terminen los medicamentos. Por lo general, deberá recibirlos en el transcurso de 10 días. De lo contrario, comuníquese con la farmacia de venta por correo de Kaiser Permanente al 1-866-523-6059 (línea TTY: 711), de lunes a viernes, de 8 a. m. a 6 p. m., o al número que aparece en la etiqueta de su medicamento recetado para pedir ayuda. Es posible que otros medicamentos estén disponibles para envío por correo. No todos los medicamentos pueden enviarse por correo; hay restricciones y limitaciones. Si desea más información, visite el sitio kp.org/seniormedrx. NDS = Medicamentos con suministro diario no extendido que se entregan en suministros de hasta 30 días para vigilar si se presentan posibles efectos adversos y para evitar que se desperdicie medicamento.

PA = Los medicamentos con autorización previa pueden estar cubiertos por Medicare Parte D o Medicare Parte B, dependiendo de la manera en que se administran (por ejemplo, por bomba de infusión, nebulizador u otro dispositivo de equipos médicos duraderos), el lugar en donde se administran (por ejemplo, en casa o en un centro de atención a largo plazo) y el tipo de afección médica que se busca tratar con ellos. Es posible que también se requiera autorización previa para los medicamentos en los que el tratamiento de la afección médica es el que determina si el medicamento no está incluido en la Parte D (excluido) o si tiene cobertura.

http://kp.org/refill



Índice de medicamentos

8

8-MOP ..................................................... 64

A

abacavir sulfate ....................................... 13 abacavir sulfate-lamivudine ..................... 13 abacavir sulfate-lamivudine-zidovudine ... 13 ABELCET SUSP 5 MG/ML ...................... 11 ABILIFY ................................................... 35 ABILIFY MAINTENA ................................ 35 ABRAXANE ............................................. 15 ABSORICA .............................................. 64 ABSTRAL ................................................ 27 acamprosate calcium ............................... 34 ACANYA .................................................. 61 acarbose .................................................. 49 ACCOLATE ............................................. 58 ACCUPRIL .............................................. 24 ACCURETIC ............................................ 24 acebutolol hcl ........................................... 26 acetaminophen w/ codeine ...................... 27 acetaminophen-caff-dihydrocod ............... 27 acetazolamide ......................................... 43 acetazolamide sodium solr 500 mg ......... 43 acetic acid (otic) ....................................... 44 acetylcysteine .......................................... 54 ACIPHEX ................................................. 45 ACIPHEX SPRINKLE .............................. 45 acitretin .................................................... 64 ACTEMRA SOLN 200 MG/10ML ............. 54 ACTEMRA SOLN 400 MG/20ML ............. 54 ACTEMRA SOLN 80 MG/4ML ................. 54 ACTEMRA SOSY 162 MG/0.9ML ............ 54 ACTHIB ................................................... 60 ACTIGALL ............................................... 46 ACTIMMUNE ........................................... 55 ACTIQ ..................................................... 27 ACTIVELLA ............................................. 51 ACTONEL................................................ 55 ACTOPLUS MET ..................................... 49 ACTOPLUS MET XR ............................... 49 ACTOS .................................................... 49 ACULAR .................................................. 42 ACULAR LS ............................................. 42

ACUVAIL .................................................. 42 acyclovir ............................................. 13, 61 acyclovir sodium soln 50 mg/ml ............... 13 acyclovir topical ........................................ 61 ACZONE .................................................. 64 ADACEL................................................... 60 ADAGEN .................................................. 41 ADALAT CC ............................................. 23 adapalene ................................................ 64 ADCIRCA ................................................. 26 ADDERALL TABS 10 MG ........................ 30 ADDERALL TABS 15 MG ........................ 30 ADDERALL TABS 30 MG ........................ 30 ADDERALL XR CP24 10 MG ................... 30 ADDERALL XR CP24 15 MG ................... 30 ADDERALL XR CP24 20 MG ................... 30 ADDERALL XR CP24 25 MG ................... 30 ADDERALL XR CP24 30 MG ................... 30 ADDERALL XR CP24 5 MG ..................... 30 adefovir dipivoxil ...................................... 13 ADEMPAS ............................................... 59 ADLYXIN .................................................. 49 ADLYXIN STARTER PACK ..................... 49 ADRENACLICK SOAJ 0.15 MG/0.15ML .. 20 ADRENACLICK SOAJ 0.3 MG/0.3ML ...... 20 ADRENALIN SOLN 1 MG/ML .................. 20 adrucil soln 500 mg/10ml ......................... 15 ADVAIR DISKUS AEPB 100-50

MCG/DOSE .......................................... 20 ADVAIR DISKUS AEPB 250-50

MCG/DOSE .......................................... 20 ADVAIR DISKUS AEPB 500-50

MCG/DOSE .......................................... 20 ADVAIR HFA AERO 115-21 MCG/ACT ... 20 ADVAIR HFA AERO 230-21 MCG/ACT ... 20 ADVAIR HFA AERO 45-21 MCG/ACT ..... 20 ADZENYS XR-ODT ................................. 30 AEROSPAN ............................................. 59 AFINITOR ................................................ 15 AFINITOR DISPERZ ................................ 15 AFREZZA POWD 12 UNIT ...................... 49 AFREZZA POWD 4 & 8 & 12 UNIT .......... 49 AFREZZA POWD 4 (30) & 8 (60) UNIT ... 49 AFREZZA POWD 4 (60) & 8 (30) UNIT ... 49 AFREZZA POWD 4 (90) & 8 (90) UNIT ... 50 AFREZZA POWD 4 UNIT ........................ 50


AFREZZA POWD 8 (60)& 12 (30) UNIT .. 50 AFREZZA POWD 8 UNIT ........................ 50 AGGRENOX ............................................ 21 AGRYLIN ................................................. 21 AIRDUO RESPICLICK 113/14 ................. 58 AIRDUO RESPICLICK 232/14 ................. 58 AIRDUO RESPICLICK 55/14................... 58 AKNE-MYCIN OINT 2 % ......................... 61 AKYNZEO ............................................... 44 ALBENZA .................................................. 7 albuterol sulfate er tb12 4 mg .................. 20 albuterol sulfate er tb12 8 mg .................. 20 albuterol sulfate nebu (2.5 mg/3ml) 0.083%

............................................................. 20 albuterol sulfate nebu (5 mg/ml) 0.5% ..... 20 albuterol sulfate nebu 0.63 mg/3ml .......... 20 albuterol sulfate nebu 1.25 mg/3ml .......... 20 albuterol sulfate syrp 2 mg/5ml ................ 20 albuterol sulfate tabs 2 mg ....................... 20 albuterol sulfate tabs 4 mg ....................... 20 alclometasone dipropionate ..................... 62 alcohol swabs .......................................... 37 ALDACTAZIDE ........................................ 25 ALDACTONE ........................................... 25 ALDARA .................................................. 64 ALDURAZYME SOLN 2.9 MG/5ML ......... 41 ALECENSA ............................................. 15 alendronate sodium soln 70 mg/75ml ...... 55 alendronate sodium tabs 10 mg ............... 55 alendronate sodium tabs 35 mg ............... 55 alendronate sodium tabs 40 mg ............... 55 alendronate sodium tabs 5 mg................. 55 alendronate sodium tabs 70 mg ............... 55 alfuzosin hcl ............................................. 20 ALIMTA ................................................... 15 ALINIA ..................................................... 12 ALKERAN SOLR 50 MG ......................... 15 allopurinol ................................................ 55 allopurinol sodium solr 500 mg ................ 55 almotriptan malate ................................... 33 ALOCRIL ................................................. 43 alogliptin benzoate ................................... 50 ALOGLIPTIN-METFORMIN HCL ............. 50 alogliptin-pioglitazone .............................. 50 ALOMIDE ................................................ 43 ALOPRIM SOLR 500 MG ........................ 55 ALORA PTTW 0.025 MG/24HR ............... 51 ALORA PTTW 0.05 MG/24HR ................. 52 ALORA PTTW 0.075 MG/24HR ............... 52 ALORA PTTW 0.1 MG/24HR................... 52

alosetron hcl ............................................. 44 ALOXI SOLN 0.25 MG/5ML ..................... 44 ALPHAGAN P .......................................... 43 alprazolam ............................................... 34 ALREX ..................................................... 42 ALTABAX ................................................. 61 ALTACE ................................................... 25 ALTOPREV .............................................. 22 ALUNBRIG ............................................... 15 ALVESCO ................................................ 59 amantadine hcl ......................................... 33 AMARYL .................................................. 50 AMBIEN ................................................... 34 AMBIEN CR ............................................. 34 AMBISOME SUSR 50 MG ....................... 11 amcinonide ............................................... 62 AMERGE ................................................. 33 AMICAR ................................................... 21 amifostine solr 500 mg ............................. 55 amikacin sulfate soln 500 mg/2ml .............. 7 amiloride & hydrochlorothiazide ............... 39 amiloride hcl ............................................. 39 aminophylline soln 25 mg/ml .................... 65 aminosalicylic acid ................................... 12 AMINOSYN II SOLN 10 % ....................... 38 AMINOSYN II SOLN 15 % ....................... 38 AMINOSYN II SOLN 7 % ......................... 38 AMINOSYN II SOLN 8.5 % ...................... 38 aminosyn ii/electrolytes soln 8.5 % .......... 38 AMINOSYN/ELECTROLYTES SOLN 7 %

............................................................. 38 aminosyn/electrolytes soln 8.5 % ............. 38 AMINOSYN-HBC SOLN 7 % ................... 38 AMINOSYN-PF SOLN 10 % .................... 38 AMINOSYN-PF SOLN 7 % ...................... 38 AMINOSYN-RF SOLN 5.2 % ................... 38 amiodarone hcl ........................................ 24 amiodarone hcl soln 150 mg/3ml ............. 24 AMITIZA ................................................... 46 amitriptyline hcl ........................................ 35 amlodipine besylate ................................. 23 amlodipine besylate-atorvastatin calcium . 23 amlodipine besylate-benazepril hcl .......... 23 amlodipine besylate-olmesartan medoxomil

............................................................. 23 amlodipine besylate-valsartan .................. 23 amlodipine-valsartan-hydrochlorothiazide 23 ammonium chloride soln 5 meq/ml ........... 37 amoxapine ............................................... 35 amoxicillin ............................................ 7, 45


amoxicillin & pot clavulanate ...................... 7 amoxicillin-clarithromycin w/ lansoprazole 45 amphetamine sulfate ............................... 30 amphetamine-dextroamphetamine .......... 30 amphotericin b solr 50 mg ....................... 11 ampicillin .................................................... 7 ampicillin sodium solr 1 gm ........................ 7 ampicillin sodium solr 10 gm ...................... 7 ampicillin sodium solr 125 mg .................... 7 ampicillin-sulbactam sodium solr 1.5 (1-0.5)

gm .......................................................... 7 ampicillin-sulbactam sodium solr 15 (10-5)

gm .......................................................... 7 ampicillin-sulbactam sodium solr 3 (2-1) gm

............................................................... 7 AMPYRA ................................................. 55 AMRIX ..................................................... 19 ANADROL-50 .......................................... 48 ANAFRANIL ............................................ 35 anagrelide hcl .......................................... 21 ANAPROX DS ......................................... 27 anastrozole .............................................. 15 ANCOBON .............................................. 11 ANDRODERM PT24 2 MG/24HR ............ 48 ANDRODERM PT24 4 MG/24HR ............ 48 ANDROGEL GEL 20.25 MG/1.25GM

(1.62%) ................................................ 48 ANDROGEL GEL 25 MG/2.5GM (1%)..... 48 ANDROGEL GEL 40.5 MG/2.5GM (1.62%)

............................................................. 48 ANDROGEL GEL 50 MG/5GM (1%) ....... 48 ANDROGEL PUMP GEL 20.25 MG/ACT

(1.62%) ................................................ 48 ANGELIQ................................................. 52 ANORO ELLIPTA .................................... 19 ANTARA .................................................. 22 ANZEMET ............................................... 44 ANZEMET SOLN 20 MG/ML ................... 44 APIDRA ................................................... 50 APIDRA SOLOSTAR ............................... 50 APLENZIN ............................................... 35 APOKYN.................................................. 33 apraclonidine hcl ...................................... 44 aprepitant................................................. 44 APRISO CP24 0.375 GM ........................ 44 APTENSIO XR CP24 10 MG ................... 30 APTENSIO XR CP24 15 MG ................... 30 APTENSIO XR CP24 20 MG ................... 30 APTENSIO XR CP24 30 MG ................... 30 APTENSIO XR CP24 40 MG ................... 30

APTENSIO XR CP24 50 MG ................... 30 APTENSIO XR CP24 60 MG ................... 30 APTIOM ................................................... 31 APTIVUS .................................................. 13 ARALAST NP ........................................... 59 ARANESP (ALBUMIN FREE) .................. 22 ARAVA ..................................................... 55 ARCALYST .............................................. 55 ARCAPTA NEOHALER ........................... 20 ARGATROBAN SOLN 125 MG/125ML .... 21 argatroban soln 250 mg/2.5ml .................. 21 ARICEPT ................................................. 19 ARIMIDEX ................................................ 15 aripiprazole .............................................. 35 ARISTADA ............................................... 35 ARISTOSPAN INTRA-ARTICULAR ......... 47 ARISTOSPAN INTRALESIONAL ............. 47 ARIXTRA ................................................. 21 armodafinil ............................................... 30 ARNUITY ELLIPTA .................................. 59 AROMASIN .............................................. 15 ARRANON ............................................... 15 ARTHROTEC ........................................... 27 ARYMO ER TBEA 15 MG ........................ 27 ARYMO ER TBEA 30 MG ........................ 27 ARYMO ER TBEA 60 MG ........................ 27 ARZERRA ................................................ 15 ASACOL HD TBEC 800 MG .................... 44 ASMANEX 120 METERED DOSES AEPB

220 MCG/INH ....................................... 59 ASMANEX 30 METERED DOSES AEPB



220 MCG/INH ....................................... 59 ASMANEX HFA AERO 100 MCG/ACT .... 59 ASMANEX HFA AERO 200 MCG/ACT .... 59 aspirin-dipyridamole ................................. 21 ASTAGRAF XL CP24 0.5 MG .................. 55 ASTAGRAF XL CP24 1 MG ..................... 55 ASTAGRAF XL CP24 5 MG ..................... 55 ASTEPRO ................................................ 43 ATACAND ................................................ 25 ATACAND HCT ....................................... 25 ATELVIA .................................................. 55 atenolol .................................................... 26 atenolol & chlorthalidone .......................... 26 ATGAM INJ 50 MG/ML ............................ 55 ATIVAN .............................................. 30, 34


atomoxetine hcl ....................................... 34 atorvastatin calcium ........................... 22, 23 atovaquone .............................................. 12 atovaquone-proguanil hcl ........................ 12 ATRALIN GEL 0.05 % ............................. 63 ATRIPLA.................................................. 13 atropine sulfate .................................. 19, 44 ATROPINE SULFATE ............................. 19 atropine sulfate (ophthalmic).................... 44 ATROVENT ............................................. 19 ATROVENT HFA ..................................... 19 AUBAGIO ................................................ 55 AUGMENTIN ............................................. 7 AURYXIA ................................................. 39 AUSTEDO ............................................... 35 AUVI-Q SOAJ 0.15 MG/0.15ML .............. 20 AUVI-Q SOAJ 0.3 MG/0.3ML .................. 21 AVALIDE ................................................. 25 AVANDIA ................................................. 50 AVAPRO.................................................. 25 AVASTIN ................................................. 15 AVC VAGINAL ......................................... 61 AVEED .................................................... 48 AVELOX .................................................... 7 AVELOX ABC PACK ................................. 7 AVELOX SOLN 400 MG/250ML ................ 7 AVINZA ................................................... 27 AVODART ............................................... 55 AVONEX.................................................. 55 AVONEX PEN ......................................... 55 AVONEX PREFILLED ............................. 55 AVYCAZ SOLR 2.5 (2-0.5) GM ................. 7 AXERT .................................................... 33 AXIRON SOLN 30 MG/ACT .................... 48 azacitidine................................................ 15 AZACTAM IN DEXTROSE SOLN 1 GM .... 7 AZACTAM IN DEXTROSE SOLN 2 GM .... 7 AZASITE.................................................. 42 azathioprine ............................................. 55 azathioprine sodium................................. 55 azelastine hcl ........................................... 43 azelastine hcl (ophth) ............................... 43 AZELEX ................................................... 64 AZILECT .................................................. 33 azithromycin .............................................. 7 AZITHROMYCIN PACK 1 GM ................... 7 azithromycin solr 500 mg ........................... 7 AZOPT .................................................... 43 AZOR ...................................................... 23 aztreonam solr 1 gm .................................. 7

AZULFIDINE .............................................. 7 AZULFIDINE EN-TABS .............................. 7

B

bacitracin .............................................. 7, 42 bacitracin (ophthalmic) ............................. 42 bacitracin-polymyxin b (ophth) ................. 42 bacitracin-poly-neomycin-hc ..................... 42 baclofen ................................................... 19 BACTOCILL IN DEXTROSE SOLN 1

GM/50ML ................................................ 7 BACTOCILL IN DEXTROSE SOLN 2

GM/50ML ................................................ 7 BACTRIM ................................................... 7 BACTRIM DS ............................................. 7 BACTROBAN ........................................... 61 BACTROBAN NASAL .............................. 61 balsalazide disodium ................................ 44 BANZEL ................................................... 31 BARACLUDE SOLN 0.05 MG/ML ............ 13 BARACLUDE TABS 0.5 MG .................... 13 BARACLUDE TABS 1 MG ....................... 13 BASAGLAR KWIKPEN SOPN 100

UNIT/ML ............................................... 50 BAVENCIO .............................................. 15 BCG VACCINE ........................................ 15 BECONASE AQ ....................................... 42 BELBUCA ................................................ 27 BELEODAQ ............................................. 15 BELSOMRA ............................................. 34 benazepril & hydrochlorothiazide ............. 25 benazepril hcl ..................................... 23, 25 BENDEKA SOLN 100 MG/4ML ................ 15 BENICAR ................................................. 25 BENICAR HCT ......................................... 25 BENLYSTA .............................................. 55 BENTYL ................................................... 19 BENZACLIN ............................................. 61 BENZAMYCIN ......................................... 61 benzoyl peroxide-erythromycin ................ 61 benztropine mesylate ............................... 33 BEPREVE ................................................ 43 BERINERT ............................................... 55 BESIVANCE ............................................ 42 BETAGAN ................................................ 43 betamethasone dipropionate (topical) ...... 62 betamethasone dipropionate augmented . 62 betamethasone valerate ........................... 62 BETAPACE .............................................. 26


BETAPACE AF ........................................ 26 BETASERON KIT 0.3 MG ....................... 55 betaxolol hcl ....................................... 26, 43 betaxolol hcl (ophth) ................................ 43 bethanechol chloride................................ 19 BETHKIS ................................................... 7 BETIMOL ................................................. 43 BETOPTIC-S ........................................... 43 BEVESPI AEROSPHERE ....................... 19 BEXAROTENE ........................................ 15 BEXSERO ............................................... 60 BEYAZ ..................................................... 48 BIAXIN ....................................................... 7 bicalutamide ............................................ 15 BICILLIN C-R ............................................. 7 BICILLIN C-R 900/300 ............................... 7 BICILLIN L-A ............................................. 7 BICNU ..................................................... 15 BIDIL ....................................................... 26 BILTRICIDE ............................................... 7 bimatoprost .............................................. 43 BINOSTO ................................................ 55 bisacodyl-peg 3350-pot chloride-sod bicarb-

sod chloride .......................................... 46 bisoprolol & hydrochlorothiazide .............. 26 bisoprolol fumarate .................................. 26 BIVIGAM SOLN 10 GM/100ML ............... 59 bleomycin sulfate ..................................... 15 BLEPH-10................................................ 42 BLEPHAMIDE ......................................... 42 BLINCYTO ............................................... 15 BONIVA ................................................... 55 BONIVA SOLN 3 MG/3ML ....................... 55 BOOSTRIX .............................................. 60 BOSULIF ................................................. 15 BOTOX .................................................... 55 BREO ELLIPTA ....................................... 47 BREVICON (28) ...................................... 48 BRILINTA ................................................ 21 brimonidine tartrate .................................. 43 BRINTELLIX ............................................ 35 BRISDELLE ............................................. 35 BRIVIACT SOLN 10 MG/ML .................... 31 BRIVIACT SOLN 50 MG/5ML .................. 31 BRIVIACT TABS 10 MG .......................... 31 BRIVIACT TABS 100 MG ........................ 31 BRIVIACT TABS 25 MG .......................... 31 BRIVIACT TABS 50 MG .......................... 31 BRIVIACT TABS 75 MG .......................... 31 bromfenac sodium (ophth) ....................... 42

bromocriptine mesylate ............................ 33 BROVANA ............................................... 21 budesonide .................................. 42, 47, 59 budesonide (inhalation) ............................ 59 budesonide (nasal) ................................... 42 bumetanide soln 0.25 mg/ml .................... 39 bumetanide tabs 0.5 mg ........................... 39 bumetanide tabs 1 mg .............................. 39 bumetanide tabs 2 mg .............................. 39 BUNAVAIL ............................................... 35 BUPHENYL .............................................. 37 BUPRENEX ............................................. 27 buprenorphine .................................... 27, 35 buprenorphine hcl .............................. 27, 35 buprenorphine hcl-naloxone hcl dihydrate 35 bupropion hcl ........................................... 35 bupropion hcl (smoking deterrent) ............ 35 buspirone hcl ............................................ 34 busulfan ................................................... 15 BUSULFEX .............................................. 15 butalbital-acetaminophen ................... 27, 28 butalbital-acetaminophen-caffeine ..... 27, 28 butalbital-acetaminophen-caffeine w/

codeine ................................................. 28 butalbital-aspirin-caffeine ......................... 28 butalbital-aspirin-caffeine w/cod ............... 28 BUTISOL SODIUM .................................. 34 butoconazole nitrate (one dose) ............... 61 butorphanol tartrate .................................. 28 BUTRANS ................................................ 28 BYDUREON ............................................. 50 BYETTA 10 MCG PEN ............................ 50 BYETTA 5 MCG PEN .............................. 50 BYSTOLIC ............................................... 26 BYVALSON .............................................. 25

C

cabergoline .............................................. 33 CABOMETYX .......................................... 15 CADUET .................................................. 23 CALAN ..................................................... 23 CALAN SR ............................................... 23 calcipotriene ....................................... 62, 64 calcipotriene-betamethasone dipropionate

............................................................. 62 calcitonin (salmon) ................................... 53 calcitriol .................................................... 65 CALCITRIOL ............................................ 64 calcitriol soln 1 mcg/ml ............................. 65


calcium acetate (phosphate binder) ......... 40 CAMBIA ................................................... 28 CAMPTOSAR .......................................... 15 CANASA SUPP 1000 MG ....................... 44 CANCIDAS SOLR 50 MG ........................ 11 CANCIDAS SOLR 70 MG ........................ 11 candesartan cilexetil ................................ 25 candesartan cilexetil-hydrochlorothiazide 25 CAPASTAT SULFATE SOLR 1 GM ........ 12 CAPEX SHAM 0.01 % ............................. 62 CAPRELSA ............................................. 15 captopril ................................................... 25 captopril & hydrochlorothiazide ................ 25 CARAC CREA 0.5 % ............................... 64 CARAFATE SUSP 1 GM/10ML ............... 45 CARAFATE TABS 1 GM ......................... 45 CARBAGLU ............................................. 37 carbamazepine ........................................ 31 CARBATROL ........................................... 31 carbidopa ................................................. 33 carbidopa-levodopa ................................. 33 carbidopa-levodopa-entacapone ............. 33 carbinoxamine maleate ............................ 15 carboplatin ............................................... 15 CARDENE IV SOLN 20-0.86 MG/200ML-%

............................................................. 23 CARDENE IV SOLN 40-0.83 MG/200ML-%

............................................................. 23 CARDIZEM .............................................. 23 CARDIZEM CD ........................................ 23 CARDIZEM LA ........................................ 23 CARDURA ............................................... 22 CARDURA XL ......................................... 22 CARIMUNE NF SOLR 12 GM ................. 59 CARIMUNE NF SOLR 6 GM ................... 59 carisoprodol ............................................. 19 carisoprodol w/ aspirin ............................. 19 carisoprodol w/ aspirin & codeine ............ 19 CARNITOR .............................................. 55 CARNITOR SOLN 200 MG/ML ................ 55 carteolol hcl (ophth) ................................. 43 carvedilol ................................................. 26 CASODEX ............................................... 15 CATAPRES ............................................. 24 CATAPRES-TTS-1 .................................. 24 CATAPRES-TTS-2 .................................. 24 CATAPRES-TTS-3 .................................. 24 CAYSTON ................................................. 7 CEDAX ...................................................... 7 cefaclor ...................................................... 7

cefaclor monohydrate ................................. 7 cefadroxil .................................................... 7 cefazolin sodium solr 1 gm ......................... 7 cefazolin sodium solr 10 gm ....................... 7 cefazolin sodium solr 500 mg ..................... 7 cefdinir ....................................................... 7 cefepime hcl solr 1 gm ............................... 7 cefepime hcl solr 2 gm ............................... 7 cefixime ...................................................... 7 cefotaxime sodium solr 1 gm ...................... 7 cefotaxime sodium solr 2 gm ...................... 7 cefotaxime sodium solr 500 mg .................. 7 cefotetan disodium solr 1 gm ..................... 8 cefotetan disodium solr 2 gm ..................... 8 cefoxitin sodium solr 1 gm .......................... 8 cefoxitin sodium solr 10 gm ........................ 8 cefoxitin sodium solr 2 gm .......................... 8 CEFOXITIN SODIUM-DEXTROSE SOLR

1-4 GM-% ............................................... 8 CEFOXITIN SODIUM-DEXTROSE SOLR

2-2.2 GM-% ............................................ 8 cefpodoxime proxetil .................................. 8 cefprozil...................................................... 8 CEFTAZIDIME AND DEXTROSE SOLR 1

GM/50ML ................................................ 8 CEFTAZIDIME AND DEXTROSE SOLR 2

GM/50ML ................................................ 8 ceftazidime solr 1 gm ................................. 8 ceftazidime solr 2 gm ................................. 8 ceftazidime solr 6 gm ................................. 8 CEFTIN SUSR 125 MG/5ML ...................... 8 CEFTIN SUSR 250 MG/5ML ...................... 8 CEFTIN TABS 250 MG .............................. 8 CEFTIN TABS 500 MG .............................. 8 ceftriaxone sodium solr 1 gm ..................... 8 ceftriaxone sodium solr 10 gm ................... 8 ceftriaxone sodium solr 2 gm ..................... 8 ceftriaxone sodium solr 250 mg ................. 8 ceftriaxone sodium solr 500 mg ................. 8 cefuroxime axetil ........................................ 8 cefuroxime sodium solr 1.5 gm .................. 8 cefuroxime sodium solr 7.5 gm .................. 8 cefuroxime sodium solr 750 mg ................. 8 CEFUROXIME-DEXTROSE SOLR 1.5-2.9

GM-% ..................................................... 8 CELEBREX .............................................. 28 celecoxib .................................................. 28 CELESTONE ........................................... 47 CELEXA ................................................... 35 CELLCEPT .............................................. 55


CELLCEPT INTRAVENOUS SOLR 500 MG ............................................................. 55

CELONTIN .............................................. 31 cephalexin ................................................. 8 CERDELGA ............................................. 55 CEREBYX ............................................... 31 CEREZYME SOLR 400 UNIT .................. 41 CERVARIX .............................................. 60 CESAMET ............................................... 44 cetirizine hcl ............................................. 15 cevimeline hcl .......................................... 19 CHANTIX ................................................. 19 CHANTIX CONTINUING MONTH PAK ... 19 CHANTIX STARTING MONTH PAK ........ 19 CHEMET ................................................. 47 chenodiol ................................................. 47 chloramphenicol sod succinate solr 1 gm .. 8 chlordiazepoxide hcl ................................ 34 chlordiazepoxide-amitriptyline .................. 35 chlorhexidine gluconate (mouth-throat).... 42 chloroquine phosphate ............................ 12 chlorothiazide .......................................... 39 chlorothiazide sodium solr 500 mg .......... 39 chlorpromazine hcl................................... 35 chlorpropamide ........................................ 50 chlorthalidone .............................. 24, 26, 39 chlorzoxazone ......................................... 19 CHOLBAM ............................................... 47 cholestyramine ........................................ 22 cholestyramine light ................................. 22 choline fenofibrate ................................... 22 chorionic gonadotropin ............................ 53 CIALIS ..................................................... 26 ciclopirox.................................................. 61 ciclopirox olamine .................................... 61 cidofovir soln 75 mg/ml ............................ 13 cilostazol .................................................. 21 CILOXAN OINT 0.3 % ............................. 42 CILOXAN SOLN 0.3 % ............................ 42 cimetidine ................................................ 45 cimetidine hcl ........................................... 45 CIMZIA .................................................... 55 CIMZIA PREFILLED ................................ 55 CINQAIR.................................................. 58 CINRYZE SOLR 500 UNIT ...................... 55 CIPRO ................................................. 8, 42 CIPRO HC ............................................... 42 CIPRO IN D5W SOLN 400 MG/200ML...... 8 CIPRODEX .............................................. 42 ciprofloxacin ......................................... 8, 42

ciprofloxacin hcl ................................... 8, 42 ciprofloxacin hcl (ophth) ........................... 42 ciprofloxacin in d5w soln 200 mg/100ml ..... 8 ciprofloxacin soln 400 mg/40ml .................. 8 ciprofloxacin-ciprofloxacin hcl ..................... 8 cisplatin .................................................... 15 CISPLATIN .............................................. 15 citalopram hydrobromide soln 10 mg/5ml . 35 citalopram hydrobromide tabs 10 mg ....... 35 citalopram hydrobromide tabs 20 mg ....... 35 citalopram hydrobromide tabs 40 mg ....... 35 cladribine .................................................. 15 claforan solr 1 gm....................................... 8 CLAFORAN SOLR 10 GM ......................... 8 claforan solr 2 gm....................................... 8 CLAFORAN SOLR 500 MG ....................... 8 CLARINEX ............................................... 15 CLARINEX-D 12 HOUR ........................... 15 clarithromycin ....................................... 8, 45 clemastine fumarate ................................. 15 CLEOCIN ............................................. 8, 61 CLEOCIN CREA 2 % ............................... 61 CLEOCIN IN D5W SOLN 300 MG/50ML ... 8 CLEOCIN IN D5W SOLN 600 MG/50ML ... 8 CLEOCIN IN D5W SOLN 900 MG/50ML ... 8 CLEOCIN PHOSPHATE SOLN 900

MG/6ML .................................................. 8 CLEOCIN SUPP 100 MG ......................... 61 CLEOCIN-T .............................................. 61 CLEVIPREX ............................................. 23 CLIMARA PRO ........................................ 52 CLIMARA PTWK 0.025 MG/24HR ........... 52 CLIMARA PTWK 0.0375 MG/24HR ......... 52 CLIMARA PTWK 0.05 MG/24HR ............. 52 CLIMARA PTWK 0.06 MG/24HR ............. 52 CLIMARA PTWK 0.075 MG/24HR ........... 52 CLIMARA PTWK 0.1 MG/24HR ............... 52 CLINDAGEL ............................................. 61 clindamycin hcl ........................................... 8 clindamycin palmitate hydrochloride........... 8 clindamycin phosphate & cleanser ........... 61 clindamycin phosphate (topical) ............... 61 clindamycin phosphate in d5w soln 300

mg/50ml .................................................. 9 clindamycin phosphate in d5w soln 600

mg/50ml .................................................. 9 clindamycin phosphate in d5w soln 900

mg/50ml .................................................. 9 clindamycin phosphate soln 300 mg/2ml .... 9 clindamycin phosphate soln 600 mg/4ml .... 9


clindamycin phosphate soln 900 mg/6ml ... 9 clindamycin phosphate vaginal ................ 61 clindamycin phosphate-benzoyl peroxide 61 clindamycin phosphate-benzoyl peroxide

(refrigerate) .......................................... 61 clindamycin phosphate-tretinoin .............. 64 CLINDESSE ............................................ 61 CLINIMIX E/DEXTROSE (2.75/10) SOLN

2.75 % .................................................. 38 CLINIMIX E/DEXTROSE (2.75/5) SOLN




4.25 % .................................................. 38 CLINIMIX E/DEXTROSE (5/15) SOLN 5 %

............................................................. 38 CLINIMIX E/DEXTROSE (5/20) SOLN 5 %

............................................................. 38 CLINIMIX E/DEXTROSE (5/25) SOLN 5 %

............................................................. 38 CLINIMIX/DEXTROSE (2.75/5) SOLN 2.75

% .......................................................... 38 CLINIMIX/DEXTROSE (4.25/10) SOLN

4.25 % .................................................. 38 CLINIMIX/DEXTROSE (4.25/20) SOLN

4.25 % .................................................. 38 CLINIMIX/DEXTROSE (4.25/25) SOLN

4.25 % .................................................. 38 CLINIMIX/DEXTROSE (4.25/5) SOLN 4.25

% .......................................................... 38 CLINIMIX/DEXTROSE (5/15) SOLN 5 % 38 CLINIMIX/DEXTROSE (5/20) SOLN 5 % 38 CLINIMIX/DEXTROSE (5/25) SOLN 5 % 38 clinisol sf soln 15 % ................................. 38 clobetasol propionate ............................... 62 clobetasol propionate emollient base ....... 62 CLOBEX LOTN 0.05 % ........................... 62 CLOBEX SHAM 0.05 % ........................... 62 CLOBEX SPRAY LIQD 0.05 % ................ 62 CLODERM PUMP ................................... 62 clofarabine ............................................... 15 CLOLAR .................................................. 15 clomipramine hcl ...................................... 35 clonazepam ............................................. 31 clonidine & chlorthalidone ........................ 24 clonidine hcl ............................................. 24 clonidine hcl (adhd).................................. 24

clopidogrel bisulfate ................................. 21 clorazepate dipotassium .......................... 34 clotrimazole .............................................. 61 clotrimazole (topical) ................................ 61 clotrimazole w/ betamethasone ................ 61 clozapine .................................................. 35 CLOZARIL ............................................... 35 COARTEM ............................................... 12 codeine sulfate ......................................... 28 CODEINE SULFATE ................................ 28 COGENTIN .............................................. 34 colchicine ........................................... 41, 55 COLCHICINE CAPS 0.6 MG .................... 55 colchicine w/ probenecid .......................... 41 COLCRYS TABS 0.6 MG ......................... 55 COLESTID ............................................... 22 colestipol hcl ............................................ 22 colistimethate sodium solr 150 mg ............. 9 COLY-MYCIN S ....................................... 42 COLYTE WITH FLAVOR PACKS ............ 46 COMBIGAN ............................................. 43 COMBIPATCH ......................................... 52 COMBIVENT RESPIMAT AERS 20-100

MCG/ACT ............................................. 21 COMBIVIR ............................................... 13 COMETRIQ (100 MG DAILY DOSE) ....... 15 COMETRIQ (140 MG DAILY DOSE) ....... 16 COMETRIQ (60 MG DAILY DOSE) ......... 16 COMPLERA ............................................. 13 COMTAN ................................................. 34 COMVAX ................................................. 60 CONCERTA TBCR 18 MG ....................... 30 CONCERTA TBCR 27 MG ....................... 30 CONCERTA TBCR 36 MG ....................... 30 CONCERTA TBCR 54 MG ....................... 30 CONDYLOX ............................................. 64 CONZIP ................................................... 28 COPAXONE ............................................. 55 COPEGUS ............................................... 13 CORDRAN ............................................... 62 COREG .................................................... 26 COREG CR .............................................. 26 CORGARD ............................................... 26 CORLANOR ............................................. 24 CORTEF ............................................ 47, 48 cortisone acetate ...................................... 47 CORTISPORIN .................................. 42, 62 CORTISPORIN-TC .................................. 42 CORZIDE ................................................. 26 COSENTYX ............................................. 64


COSENTYX SENSOREADY PEN ........... 64 COSMEGEN ............................................ 16 COSOPT ................................................. 44 COSOPT PF ............................................ 44 COTELLIC ............................................... 16 COUMADIN ............................................. 21 COZAAR.................................................. 25 CREON CPEP 12000 UNIT ..................... 46 CREON CPEP 24000 UNIT ..................... 46 CREON CPEP 3000-9500 UNIT .............. 46 CREON CPEP 36000 UNIT ..................... 46 CREON CPEP 6000 UNIT ....................... 46 CRESEMBA ............................................ 11 CRESTOR ............................................... 22 CRINONE ................................................ 53 CRIXIVAN................................................ 13 cromolyn sodium ............................... 43, 58 cromolyn sodium (mastocytosis) .............. 58 cromolyn sodium (ophth) ......................... 43 CUBICIN SOLR 500 MG ........................... 9 CUPRIMINE CAPS 250 MG .................... 47 CUTIVATE ............................................... 62 CUVPOSA SOLN 1 MG/5ML ................... 19 CYCLESSA ............................................. 48 cyclobenzaprine hcl ................................. 19 CYCLOPHOSPHAMIDE .......................... 16 CYCLOSET ............................................. 50 cyclosporine ............................................. 55 cyclosporine modified (for microemulsion)55 cyclosporine soln 50 mg/ml ..................... 55 CYKLOKAPRON SOLN 1000 MG/10ML . 21 CYMBALTA ............................................. 35 cyproheptadine hcl .................................. 15 CYRAMZA ............................................... 16 CYSTADANE ........................................... 55 CYSTAGON CAPS 150 MG .................... 55 CYSTAGON CAPS 50 MG ...................... 55 CYSTARAN ............................................. 44 cytarabine ................................................ 16 CYTOGAM INJ 50 MG/ML ...................... 60 CYTOMEL ............................................... 54 CYTOTEC ............................................... 45 CYTOVENE SOLR 500 MG..................... 13

D

D.H.E. 45 SOLN 1 MG/ML ....................... 20 dacarbazine ............................................. 16 DACOGEN .............................................. 16 DAKLINZA ............................................... 13

DALIRESP ............................................... 59 DALVANCE ................................................ 9 danazol .................................................... 48 DANTRIUM .............................................. 20 dantrolene sodium.................................... 20 dapsone ................................................... 12 DAPTACEL .............................................. 61 daptomycin solr 500 mg ............................. 9 DARAPRIM .............................................. 12 darifenacin hydrobromide ......................... 65 DARZALEX .............................................. 16 daunorubicin hcl ....................................... 16 DAYPRO .................................................. 28 DAYTRANA ............................................. 30 DDAVP..................................................... 53 DDAVP RHINAL TUBE ............................ 53 DDAVP SOLN 4 MCG/ML ........................ 53 DDAVP TABS 0.1 MG .............................. 53 DDAVP TABS 0.2 MG .............................. 53 decitabine ................................................. 16 DELESTROGEN ...................................... 52 DELZICOL CPDR 400 MG ....................... 44 DEMADEX ............................................... 39 demeclocycline hcl ..................................... 9 DEMEROL ............................................... 28 DEMSER .................................................. 55 DENAVIR ................................................. 61 DEPACON SOLN 100 MG/ML ................. 31 DEPAKENE ............................................. 31 DEPAKOTE ............................................. 31 DEPAKOTE ER ....................................... 31 DEPAKOTE SPRINKLES ........................ 31 DEPEN TITRATABS TABS 250 MG ........ 47 DEPO-MEDROL SUSP 20 MG/ML .......... 47 DEPO-MEDROL SUSP 40 MG/ML .......... 47 DEPO-MEDROL SUSP 80 MG/ML .......... 47 DEPO-PROVERA .................................... 53 DEPO-PROVERA SUSP 150 MG/ML ...... 53 DEPO-SUBQ PROVERA 104 SUSY 104

MG/0.65ML ........................................... 53 DERMATOP ............................................. 62 DESCOVY ............................................... 13 desipramine hcl ........................................ 35 desloratadine ........................................... 15 desmopressin acetate .............................. 53 desmopressin acetate refrigerated ........... 53 desmopressin acetate spray refrigerated . 53 DESOGEN ............................................... 48 desogestrel & ethinyl estradiol ................. 48 desogestrel-ethinyl estradiol (biphasic) .... 48


desogestrel-ethinyl estradiol (triphasic).... 48 DESONATE GEL 0.05 % ......................... 62 desonide .................................................. 62 DESOWEN CREA 0.05 % ....................... 62 desoximetasone ...................................... 63 DESOXYN ............................................... 30 DESVENLAFAXINE ER ........................... 35 desvenlafaxine succinate ......................... 35 DETROL .................................................. 65 DETROL LA ............................................. 65 dexamethasone ........................... 42, 43, 47 dexamethasone sodium phosphate ... 42, 47 dexamethasone sodium phosphate (ophth)

............................................................. 42 dexamethasone sodium phosphate soln 10

mg/ml ................................................... 47 DEXEDRINE ............................................ 30 DEXILANT ............................................... 45 dexmethylphenidate hcl ........................... 30 dexrazoxane solr 250 mg ........................ 55 dextroamphetamine sulfate ..................... 30 DEXTROSE 5%/ELECTROLYTE #48

SOLN ................................................... 40 dextrose in lactated ringers soln 5 % ....... 40 dextrose soln 10 % .................................. 38 dextrose soln 5 % .................................... 38 DEXTROSE-NACL SOLN 10-0.2 % ........ 40 DEXTROSE-NACL SOLN 10-0.45 % ...... 40 dextrose-nacl soln 2.5-0.45 % ................. 40 dextrose-nacl soln 5-0.2 % ...................... 40 DEXTROSE-NACL SOLN 5-0.225 % ...... 40 dextrose-nacl soln 5-0.33 % .................... 40 dextrose-nacl soln 5-0.45 % .................... 40 dextrose-nacl soln 5-0.9 % ...................... 40 DIAMOX SEQUELS ................................. 44 DIASTAT ACUDIAL ................................. 34 DIASTAT PEDIATRIC ............................. 34 diazepam ................................................. 34 DIAZEPAM .............................................. 30 diazepam (anticonvulsant) ....................... 34 DIBENZYLINE ......................................... 20 diclofenac potassium ............................... 28 diclofenac sodium ........................ 28, 42, 64 diclofenac sodium (actinic keratoses) ...... 64 diclofenac sodium (ophth) ........................ 42 diclofenac sodium (topical) ...................... 64 diclofenac w/ misoprostol ......................... 28 dicloxacillin sodium .................................... 9 dicyclomine hcl ........................................ 19 didanosine ............................................... 13

DIFFERIN CREA 0.1 % ........................... 64 DIFFERIN GEL 0.1 % .............................. 64 DIFFERIN GEL 0.3 % .............................. 64 DIFFERIN LOTN 0.1 % ............................ 64 DIFICID ...................................................... 9 diflorasone diacetate ................................ 63 diflorasone diacetate emollient base ........ 63 DIFLUCAN ............................................... 11 diflunisal ................................................... 28 digoxin ..................................................... 24 DIGOXIN SOLN 0.05 MG/ML ................... 24 dihydroergotamine mesylate .................... 20 DILANTIN ................................................. 31 DILAUDID ................................................ 28 diltiazem hcl ............................................. 23 diltiazem hcl coated beads ....................... 23 diltiazem hcl extended release beads ...... 23 diltiazem hcl soln 50 mg/10ml .................. 23 diltiazem hcl solr 100 mg .......................... 23 DIOVAN ................................................... 25 DIOVAN HCT ........................................... 25 DIPENTUM .............................................. 44 diphenhydramine hcl ................................ 15 diphenoxylate w/ atropine ........................ 44 DIPHTHERIA-TETANUS TOXOIDS DT ... 60 DIPROLENE ............................................ 63 DIPROLENE AF ....................................... 63 dipyridamole ....................................... 21, 26 disopyramide phosphate .......................... 24 disulfiram .................................................. 55 DITROPAN XL ......................................... 65 DIURIL ..................................................... 39 divalproex sodium .................................... 31 DIVIGEL GEL 0.5 MG/0.5GM .................. 52 DOCEFREZ SOLR 20 MG ....................... 16 DOCETAXEL (NON-ALCOHOL) SOLN 160

MG/8ML ................................................ 16 DOCETAXEL (NON-ALCOHOL) SOLN 20

MG/ML .................................................. 16 DOCETAXEL (NON-ALCOHOL) SOLN 80

MG/4ML ................................................ 16 DOCETAXEL CONC 20 MG/0.5ML ......... 16 DOCETAXEL CONC 80 MG/2ML ............ 16 DOCETAXEL CONC 80 MG/4ML ............ 16 DOCETAXEL SOLN 80 MG/8ML ............. 16 dofetilide................................................... 24 DOLOPHINE TABS 10 MG ...................... 28 DOLOPHINE TABS 5 MG ........................ 28 donepezil hydrochloride ........................... 19 DORIBAX SOLR 500 MG .......................... 9


DORYX ...................................................... 9 DORYX MPC ............................................. 9 dorzolamide hcl ....................................... 44 dorzolamide hcl-timolol maleate .............. 44 DOVONEX ............................................... 64 doxazosin mesylate ................................. 22 doxepin hcl ........................................ 35, 63 doxepin hcl (antipruritic) ........................... 63 doxercalciferol ......................................... 65 doxercalciferol soln 4 mcg/2ml ................. 65 DOXIL ...................................................... 16 doxorubicin hcl ......................................... 16 doxorubicin hcl liposomal ......................... 16 doxy 100 solr 100 mg ................................ 9 doxycycline (monohydrate) ........................ 9 doxycycline hyclate .................................... 9 doxycycline hyclate solr 100 mg ................ 9 dronabinol ................................................ 44 drospirenone-ethinyl estradiol .................. 49 drospirenone-ethinyl estradiol-levomefolate

calcium ................................................. 49 DROXIA ................................................... 16 DUAC ...................................................... 61 DUAVEE .................................................. 52 DUETACT................................................ 50 DUEXIS ................................................... 28 DULERA .................................................. 59 duloxetine hcl ........................................... 35 DUONEB SOLN 0.5-2.5 (3) MG/3ML ...... 21 DUOPA .................................................... 34 DUPIXENT .............................................. 64 DURAGESIC-100 .................................... 28 DURAGESIC-12 ...................................... 28 DURAGESIC-25 ...................................... 28 DURAGESIC-50 ...................................... 28 DURAGESIC-75 ...................................... 28 DUREZOL ............................................... 42 DURLAZA ................................................ 21 dutasteride ............................................... 55 dutasteride-tamsulosin hcl ....................... 55 DUTOPROL ............................................. 26 DYANAVEL XR ....................................... 30 DYAZIDE ................................................. 39 DYMISTA................................................. 43 DYRENIUM ............................................. 39 DYSPORT ............................................... 55

E

E.E.S. GRANULES .................................... 9

EC-NAPROSYN ....................................... 28 econazole nitrate ...................................... 61 EDARBI.................................................... 25 EDARBYCLOR ........................................ 25 EDECRIN ................................................. 39 EDLUAR .................................................. 34 EDURANT ................................................ 13 EFFEXOR XR .......................................... 35 EFFIENT .................................................. 21 EFUDEX CREA 5 % ................................ 64 EGRIFTA ................................................. 53 ELAPRASE .............................................. 41 ELDEPRYL .............................................. 34 ELELYSO ................................................. 41 ELESTAT ................................................. 43 ELESTRIN GEL 0.52 MG/0.87 GM (0.06%)

............................................................. 52 ELIDEL..................................................... 64 ELIGARD KIT 22.5 MG ............................ 16 ELIGARD KIT 30 MG ............................... 16 ELIGARD KIT 45 MG ............................... 16 ELIGARD KIT 7.5 MG .............................. 16 ELIMITE ................................................... 61 ELIQUIS ................................................... 21 ELITEK SOLR 1.5 MG ............................. 41 ELITEK SOLR 7.5 MG ............................. 41 ELLA ........................................................ 49 ELLENCE ................................................. 16 ELMIRON ................................................. 56 ELOCON .................................................. 63 ELSPAR ................................................... 16 EMADINE ................................................. 43 EMBEDA .................................................. 28 EMCYT .................................................... 16 EMEND .............................................. 44, 45 EMEND CAPS 125 MG ............................ 44 EMEND CAPS 40 MG .............................. 45 EMEND CAPS 80 MG .............................. 45 EMEND SUSR 125 MG ........................... 45 EMEND TRI-PACK CAPS 80 & 125 MG .. 45 EMFLAZA ................................................ 47 EMLA ....................................................... 63 EMPLICITI ............................................... 16 EMSAM .................................................... 34 EMTRIVA ................................................. 13 ENABLEX ................................................ 65 enalapril maleate ...................................... 25 enalapril maleate & hydrochlorothiazide ... 25 ENBREL................................................... 56 ENBREL SURECLICK ............................. 56


ENGERIX-B ............................................. 61 enoxaparin sodium .................................. 21 ENSTILAR FOAM 0.005-0.064 % ............ 63 entacapone ........................................ 33, 34 entecavir .................................................. 13 ENTOCORT EC ...................................... 47 ENTRESTO ............................................. 25 ENTYVIO ................................................. 47 ENVARSUS XR TB24 0.75 MG ............... 56 ENVARSUS XR TB24 1 MG .................... 56 ENVARSUS XR TB24 4 MG .................... 56 EPANED .................................................. 25 EPCLUSA ................................................ 13 EPIDUO ................................................... 64 EPIDUO FORTE ...................................... 64 epinastine hcl (ophth) .............................. 43 epinephrine (anaphylaxis) ........................ 21 EPINEPHRINE SOAJ 0.15 MG/0.3ML..... 21 EPINEPHRINE SOAJ 0.3 MG/0.3ML ...... 21 EPIPEN JR 2-PAK SOAJ 0.15 MG/0.3ML 21 epirubicin hcl ............................................ 16 EPIVIR HBV SOLN 5 MG/ML .................. 13 EPIVIR HBV TABS 100 MG..................... 13 EPIVIR SOLN 10 MG/ML ........................ 13 EPIVIR TABS 150 MG ............................. 13 EPIVIR TABS 300 MG ............................. 13 eplerenone............................................... 25 EPOGEN ................................................. 22 eprosartan mesylate ................................ 25 EPZICOM ................................................ 13 EQUETRO ............................................... 31 ERAXIS SOLR 100 MG ........................... 11 ERAXIS SOLR 50 MG ............................. 11 ERBITUX ................................................. 16 ergoloid mesylates ................................... 20 ergotamine tartrate .................................. 20 ergotamine w/ caffeine ............................. 33 ERIVEDGE .............................................. 16 ERTACZO ............................................... 61 ERWINAZE .............................................. 16 ERYGEL GEL 2 % ................................... 61 ERYPED 200 ............................................. 9 ERYPED 400 ............................................. 9 erythrocin lactobionate solr 500 mg ........... 9 erythromycin (acne aid) ........................... 61 erythromycin (ophth) ................................ 42 erythromycin base ..................................... 9 erythromycin ethylsuccinate ...................... 9 erythromycin stearate ................................ 9 ESBRIET ................................................. 59

escitalopram oxalate ................................ 35 esomeprazole magnesium ....................... 45 esomeprazole sodium solr 20 mg ............ 45 esomeprazole sodium solr 40 mg ............ 45 estazolam ................................................. 34 esterified estrogens .................................. 52 estradiol ....................................... 48, 49, 52 estradiol & norethindrone acetate ............ 52 estradiol cypionate ................................... 52 estradiol vaginal ....................................... 52 estradiol valerate ...................................... 52 estradiol-norgestimate .............................. 52 ESTRING ................................................. 52 estropipate ............................................... 52 eszopiclone .............................................. 34 ethacrynate sodium solr 50 mg ................ 39 ethacrynic acid ......................................... 39 ethambutol hcl .......................................... 12 ethosuximide ............................................ 32 ethynodiol diacet & eth estrad .................. 49 etidronate disodium .................................. 56 etodolac ................................................... 28 ETOPOPHOS .......................................... 16 etoposide ................................................. 16 EUCRISA ................................................. 63 EURAX..................................................... 61 EVAMIST SOLN 1.53 MG/SPRAY ........... 52 EVISTA .................................................... 52 EVOCLIN ................................................. 61 EVOMELA SOLR 50 MG ......................... 16 EVOTAZ ................................................... 13 EVOXAC .................................................. 19 EVZIO SOAJ 0.4 MG/0.4ML .................... 35 EVZIO SOAJ 2 MG/0.4ML ....................... 35 EXALGO .................................................. 28 EXELDERM ............................................. 61 EXELON .................................................. 19 exemestane ............................................. 16 EXFORGE ............................................... 23 EXFORGE HCT ....................................... 23 EXJADE TBSO 125 MG ........................... 47 EXJADE TBSO 250 MG ........................... 47 EXJADE TBSO 500 MG ........................... 47 EXONDYS 51 .......................................... 56 EXTAVIA KIT 0.3 MG ............................... 56 EXTINA .................................................... 61 ezetimibe .................................................. 22 ezetimibe-simvastatin ............................... 22


F

FABIOR ................................................... 64 FABRAZYME ........................................... 41 FABRAZYME SOLR 5 MG ...................... 41 famciclovir................................................ 13 famotidine ................................................ 45 famotidine premixed soln 20-0.9 mg/50ml-%

............................................................. 45 famotidine soln 20 mg/2ml ....................... 45 FAMVIR ................................................... 13 FANAPT .................................................. 35 FANAPT TITRATION PACK .................... 35 FARESTON ............................................. 16 FARXIGA ................................................. 50 FARYDAK................................................ 16 FASLODEX ............................................. 16 FAZACLO ................................................ 36 felbamate ................................................. 32 FELBATOL .............................................. 32 FELDENE ................................................ 28 felodipine ................................................. 23 FEMARA.................................................. 16 FEMCON FE ........................................... 49 FEMHRT LOW DOSE ............................. 52 FEMRING ................................................ 52 fenofibrate................................................ 22 FENOFIBRATE ....................................... 22 fenofibrate micronized ............................. 22 fenofibric acid .......................................... 22 FENOFIBRIC ACID ................................. 22 FENOGLIDE ............................................ 22 fenoprofen calcium .................................. 28 FENOPROFEN CALCIUM ....................... 28 fentanyl .................................................... 28 fentanyl citrate ......................................... 28 FENTORA ............................................... 28 FERRIPROX ............................................ 47 FETZIMA ................................................. 36 FETZIMA TITRATION ............................. 36 FIBRICOR ............................................... 22 FINACEA FOAM 15 % ............................. 64 FINACEA GEL 15 % ................................ 64 finasteride ................................................ 56 FIORINAL ................................................ 28 FIORINAL/CODEINE #3 .......................... 28 FIRAZYR ................................................. 56 FIRMAGON ............................................. 16 FLAGYL ................................................... 12 FLAREX .................................................. 42

flavoxate hcl ............................................. 65 FLEBOGAMMA DIF SOLN 0.5 GM/10ML 60 FLEBOGAMMA DIF SOLN 10 GM/100ML

............................................................. 60 FLEBOGAMMA DIF SOLN 10 GM/200ML

............................................................. 60 FLEBOGAMMA DIF SOLN 2.5 GM/50ML 60 FLEBOGAMMA DIF SOLN 20 GM/200ML

............................................................. 60 FLEBOGAMMA DIF SOLN 20 GM/400ML

............................................................. 60 FLEBOGAMMA DIF SOLN 5 GM/100ML . 60 FLEBOGAMMA DIF SOLN 5 GM/50ML ... 60 flecainide acetate ..................................... 24 FLECTOR ................................................ 64 FLOMAX .................................................. 20 FLOVENT DISKUS .................................. 59 FLOVENT HFA AERO 110 MCG/ACT ..... 59 FLOVENT HFA AERO 220 MCG/ACT ..... 59 FLOVENT HFA AERO 44 MCG/ACT ....... 59 fluconazole ......................................... 11, 12 fluconazole in sodium chloride soln 200-0.9

mg/100ml-% ......................................... 12 fluconazole in sodium chloride soln 400-0.9

mg/200ml-% ......................................... 12 flucytosine ................................................ 12 fludarabine phosphate .............................. 16 fludrocortisone acetate ............................. 47 FLUMADINE ............................................ 13 flunisolide (nasal) ..................................... 42 fluocinolone acetonide ....................... 42, 63 fluocinolone acetonide (otic) ..................... 42 fluocinonide .............................................. 63 fluocinonide emulsified base .................... 63 fluorometholone (ophth) ........................... 42 FLUOROPLEX CREA 1 % ....................... 64 fluorouracil (topical) .................................. 64 fluorouracil soln 2.5 gm/50ml ................... 16 FLUOXETINE HCL .................................. 36 fluoxetine hcl caps 10 mg ......................... 36 fluoxetine hcl caps 20 mg ......................... 36 fluoxetine hcl caps 40 mg ......................... 36 fluoxetine hcl cpdr 90 mg ......................... 36 fluoxetine hcl soln 20 mg/5ml ................... 36 fluoxetine hcl tabs 10 mg ......................... 36 fluoxetine hcl tabs 20 mg ......................... 36 fluphenazine decanoate ........................... 36 fluphenazine hcl ....................................... 36 flurandrenolide ......................................... 63 flurazepam hcl .......................................... 34


flurbiprofen ......................................... 28, 42 flurbiprofen sodium .................................. 42 flutamide .................................................. 16 fluticasone propionate ........................ 42, 63 fluticasone propionate (nasal) .................. 42 fluticasone-salmeterol .............................. 58 fluvastatin sodium .................................... 22 fluvoxamine maleate ................................ 36 FML FORTE SUSP 0.25 % ..................... 42 FML LIQUIFILM SUSP 0.1 % .................. 42 FML OINT 0.1 % ...................................... 42 FOCALIN ................................................. 30 FOCALIN XR ........................................... 30 FOLOTYN................................................ 16 fomepizole soln 1 gm/ml .......................... 56 fondaparinux sodium ............................... 21 FORADIL AEROLIZER ............................ 21 FORFIVO XL ........................................... 36 FORTAMET ............................................. 50 FORTAZ SOLR 1 GM ................................ 9 FORTAZ SOLR 2 GM ................................ 9 FORTAZ SOLR 6 GM ................................ 9 FORTEO.................................................. 53 FORTESTA GEL 10 MG/ACT (2%) ......... 48 FORTICAL SOLN 200 UNIT/ACT ............ 53 FOSAMAX ............................................... 56 FOSAMAX PLUS D ................................. 56 fosinopril sodium ...................................... 25 fosinopril sodium & hydrochlorothiazide... 25 fosphenytoin sodium ................................ 32 FOSRENOL CHEW 1000 MG ................. 39 FOSRENOL CHEW 500 MG ................... 39 FOSRENOL CHEW 750 MG ................... 39 FOSRENOL PACK 1000 MG ................... 40 FOSRENOL PACK 750 MG..................... 40 FRAGMIN ................................................ 21 FREAMINE HBC SOLN 6.9 % ................. 38 FROVA .................................................... 33 frovatriptan succinate ............................... 33 FURADANTIN ......................................... 15 furosemide soln 10 mg/ml ........................ 39 furosemide soln 8 mg/ml .......................... 39 furosemide tabs 20 mg ............................ 39 furosemide tabs 40 mg ............................ 39 furosemide tabs 80 mg ............................ 39 FUSILEV SOLR 50 MG ........................... 56 FUZEON .................................................. 13 FYCOMPA ............................................... 32

G

gabapentin ............................................... 32 GABITRIL ................................................. 32 GABLOFEN SOLN 10000 MCG/20ML ..... 20 GABLOFEN SOLN 20000 MCG/20ML ..... 20 GABLOFEN SOLN 40000 MCG/20ML ..... 20 GABLOFEN SOSY 50 MCG/ML .............. 20 galantamine hydrobromide ....................... 19 GAMASTAN S/D ...................................... 60 GAMMAGARD S/D LESS IGA SOLR 10

GM ....................................................... 60 GAMMAGARD S/D LESS IGA SOLR 5 GM

............................................................. 60 GAMMAGARD S/D SOLR 10 GM ............ 60 GAMMAGARD SOLN 2.5 GM/25ML ........ 60 GAMMAKED SOLN 1 GM/10ML .............. 60 GAMMAPLEX SOLN 10 GM/100ML ........ 60 GAMMAPLEX SOLN 10 GM/200ML ........ 60 GAMMAPLEX SOLN 20 GM/200ML ........ 60 GAMMAPLEX SOLN 5 GM/50ML ............ 60 GAMUNEX-C SOLN 1 GM/10ML ............. 60 GAMUNEX-C SOLN 10 GM/100ML ......... 60 GAMUNEX-C SOLN 2.5 GM/25ML .......... 60 GAMUNEX-C SOLN 20 GM/200ML ......... 60 GAMUNEX-C SOLN 40 GM/400ML ......... 60 GAMUNEX-C SOLN 5 GM/50ML ............. 60 ganciclovir sodium solr 500 mg ................ 13 GARDASIL ............................................... 61 GARDASIL 9 ............................................ 61 GASTROCROM ....................................... 58 gatifloxacin (ophth) ................................... 42 GATTEX ................................................... 47 gauze pads & dressings ........................... 37 GAZYVA .................................................. 16 GELNIQUE .............................................. 65 gemcitabine hcl ........................................ 16 gemfibrozil ................................................ 22 GEMZAR .................................................. 16 GENERESS FE ....................................... 49 GENOTROPIN MINIQUICK SOLR 0.2 MG

............................................................. 53 GENOTROPIN MINIQUICK SOLR 0.4 MG



............................................................. 53 GENOTROPIN MINIQUICK SOLR 1 MG . 53


GENOTROPIN MINIQUICK SOLR 1.2 MG ............................................................. 53




GENOTROPIN MINIQUICK SOLR 2 MG 53 GENOTROPIN SOLR 12 MG .................. 54 GENOTROPIN SOLR 5 MG .................... 54 gentamicin in saline soln 0.8-0.9 mg/ml-% . 9 gentamicin in saline soln 1.2-0.9 mg/ml-% . 9 gentamicin in saline soln 1.6-0.9 mg/ml-% . 9 gentamicin in saline soln 1-0.9 mg/ml-% .... 9 gentamicin sulfate (ophth) ....................... 42 gentamicin sulfate (topical) ...................... 61 gentamicin sulfate soln 10 mg/ml ............... 9 gentamicin sulfate soln 40 mg/ml ............... 9 GENVOYA ............................................... 13 GEODON................................................. 36 GIAZO ..................................................... 44 GILENYA ................................................. 56 GILOTRIF ................................................ 16 GLASSIA ................................................. 59 glatiramer acetate .................................... 56 GLEEVEC................................................ 16 GLEOSTINE CAPS 10 MG ...................... 16 GLEOSTINE CAPS 100 MG .................... 16 GLEOSTINE CAPS 40 MG ...................... 16 GLEOSTINE CAPS 5 MG ........................ 16 glimepiride ......................................... 50, 51 glipizide er tb24 10 mg ............................. 50 glipizide er tb24 2.5 mg ............................ 50 glipizide er tb24 5 mg ............................... 50 glipizide tabs 10 mg ................................. 50 glipizide tabs 5 mg ................................... 50 glipizide-metformin hcl ............................. 50 GLUCAGEN HYPOKIT ............................ 50 GLUCAGON EMERGENCY .................... 50 GLUCOPHAGE ....................................... 50 GLUCOPHAGE XR ................................. 50 GLUCOTROL .......................................... 50 GLUCOTROL XL ..................................... 50 GLUCOVANCE ....................................... 50 GLUMETZA ............................................. 50 glyburide .................................................. 50 glyburide micronized ................................ 50 glyburide-metformin ................................. 50 glycopyrrolate .......................................... 19

GLYNASE ................................................ 50 GLYSET ................................................... 50 GLYXAMBI ............................................... 50 GOLYTELY .............................................. 46 GONITRO PACK 400 MCG ..................... 26 GRALISE ................................................. 28 GRALISE STARTER ................................ 28 granisetron hcl ......................................... 45 granisetron hcl soln 0.1 mg/ml ................. 45 granisetron hcl soln 1 mg/ml .................... 45 granisetron hcl soln 4 mg/4ml .................. 45 GRANIX ................................................... 22 GRASTEK ................................................ 56 griseofulvin microsize ............................... 12 griseofulvin ultramicrosize ........................ 12 GRIS-PEG ............................................... 12 guanfacine hcl .................................... 24, 35 guanfacine hcl (adhd) ............................... 35 GUANIDINE HCL ..................................... 19

H

HAEGARDA ............................................. 56 HALAVEN ................................................ 16 HALCION ................................................. 34 HALDOL................................................... 36 HALDOL DECANOATE ........................... 36 halobetasol propionate ............................. 63 HALOG .................................................... 63 haloperidol ............................................... 36 haloperidol decanoate .............................. 36 haloperidol lactate .................................... 36 HARVONI ................................................. 13 HAVRIX.................................................... 61 HECTOROL ............................................. 65 HECTOROL SOLN 4 MCG/2ML .............. 65 HEMABATE ............................................. 56 heparin (porcine) in d5w soln 40-5 unit/ml-%

............................................................. 21 heparin (porcine) in d5w soln 50-5 unit/ml-%

............................................................. 21 heparin sod (porcine) in d5w soln 100

unit/ml ................................................... 21 heparin sodium (porcine) ................... 21, 22 heparin sodium (porcine) soln 1000 unit/ml

............................................................. 22 heparin sodium (porcine) soln 5000 unit/ml

............................................................. 22 HEPATAMINE SOLN 8 % ........................ 38 HEPSERA ................................................ 13


HERCEPTIN SOLR 150 MG.................... 16 HERCEPTIN SOLR 440 MG.................... 16 HETLIOZ ................................................. 34 HEXALEN ................................................ 16 HIBERIX .................................................. 61 HIPREX ................................................... 15 HORIZANT .............................................. 32 HP ACTHAR ............................................ 53 HUMALOG KWIKPEN SOPN 100 UNIT/ML

............................................................. 50 HUMALOG KWIKPEN SOPN 200 UNIT/ML

............................................................. 50 HUMALOG MIX 50/50 ............................. 50 HUMALOG MIX 50/50 KWIKPEN ............ 50 HUMALOG MIX 75/25 ............................. 50 HUMALOG MIX 75/25 KWIKPEN ............ 50 HUMALOG SOCT 100 UNIT/ML ............. 50 HUMALOG SOLN 100 UNIT/ML .............. 50 HUMATROPE SOLR 12 MG ................... 54 HUMATROPE SOLR 24 MG ................... 54 HUMATROPE SOLR 5 MG ..................... 54 HUMATROPE SOLR 6 MG ..................... 54 HUMIRA .................................................. 56 HUMIRA PEDIATRIC CROHNS START . 56 HUMIRA PEN .......................................... 56 HUMIRA PEN-CROHNS STARTER ........ 56 HUMIRA PEN-PSORIASIS STARTER .... 56 HUMULIN 70/30 ...................................... 50 HUMULIN 70/30 KWIKPEN ..................... 50 HUMULIN N KWIKPEN SUPN 100

UNIT/ML ............................................... 50 HUMULIN N SUSP 100 UNIT/ML ............ 50 HUMULIN R SOLN 100 UNIT/ML ............ 50 HUMULIN R U-500 (CONCENTRATED)

SOLN 500 UNIT/ML ............................. 50 HUMULIN R U-500 KWIKPEN SOPN 500

UNIT/ML ............................................... 50 HYCAMTIN .............................................. 17 hydralazine hcl soln 20 mg/ml.................. 24 hydralazine hcl tabs 10 mg ...................... 24 hydralazine hcl tabs 100 mg .................... 24 hydralazine hcl tabs 25 mg ...................... 24 hydralazine hcl tabs 50 mg ...................... 24 HYDREA.................................................. 17 hydrochlorothiazide caps 12.5 mg ........... 39 hydrochlorothiazide tabs 12.5 mg ............ 39 hydrochlorothiazide tabs 25 mg ............... 39 hydrochlorothiazide tabs 50 mg ............... 39 hydrocodone-acetaminophen .................. 28 hydrocodone-ibuprofen ............................ 28

hydrocortisone ............................. 42, 47, 63 hydrocortisone (intrarectal)....................... 63 hydrocortisone (rectal) ............................. 63 hydrocortisone (topical) ............................ 63 hydrocortisone acetate (topical) ............... 63 hydrocortisone butyrate ............................ 63 hydrocortisone butyrate hydrophilic lipo

base ..................................................... 63 hydrocortisone sod succinate ................... 47 hydrocortisone valerate ............................ 63 hydrocortisone w/acetic acid .................... 42 hydromorphone hcl .................................. 28 hydroxychloroquine sulfate....................... 12 hydroxyprogesterone caproate

(antineoplastic) ..................................... 53 hydroxyurea ............................................. 17 hydroxyzine hcl ........................................ 34 hydroxyzine pamoate ............................... 34 HYPERRAB S/D ...................................... 60 HYPERRHO S/D ...................................... 60 HYQVIA ................................................... 60 HYSINGLA ER ......................................... 28 HYZAAR .................................................. 25

I ibandronate sodium .................................. 56 ibandronate sodium soln 3 mg/3ml .......... 56 IBRANCE ................................................. 17 ibuprofen ............................................ 28, 29 ICLUSIG ................................................... 17 IDAMYCIN PFS ....................................... 17 idarubicin hcl ............................................ 17 IFEX ......................................................... 17 ifosfamide ................................................. 17 ILARIS ..................................................... 28 ILARIS (150MG DELIVERED) ................. 28 ILEVRO .................................................... 42 imatinib mesylate ..................................... 17 IMBRUVICA ............................................. 17 IMFINZI .................................................... 17 imipenem-cilastatin solr 250 mg ................. 9 imipenem-cilastatin solr 500 mg ................. 9 imipramine hcl .......................................... 36 imipramine pamoate ................................. 36 imiquimod ................................................. 64 IMITREX .................................................. 33 IMITREX STATDOSE REFILL ................. 33 IMOGAM RABIES-HT .............................. 60 IMOVAX RABIES ..................................... 61


IMPAVIDO ............................................... 12 IMURAN .................................................. 56 INCIVEK .................................................. 13 INCRELEX ............................................... 54 INCRUSE ELLIPTA ................................. 19 indapamide .............................................. 39 INDERAL LA ............................................ 26 INDOCIN ................................................. 28 indomethacin ........................................... 28 INFANRIX ................................................ 61 INFERGEN .............................................. 13 INFLECTRA ............................................. 56 INGREZZA .............................................. 35 INLYTA .................................................... 17 INNOPRAN XL ........................................ 26 INSPRA ................................................... 25 insulin pen needle .................................... 37 insulin syringe/needle u-100 .................... 37 INTEGRILIN SOLN 20 MG/10ML ............ 22 INTEGRILIN SOLN 75 MG/100ML .......... 22 INTELENCE ............................................ 13 INTERMEZZO ......................................... 34 intralipid emul 20 % ................................. 38 INTRALIPID EMUL 30 % ......................... 38 INTRON A ............................................... 17 INTUNIV .................................................. 35 INVANZ SOLR 1 GM ................................. 9 INVEGA ................................................... 36 INVEGA SUSTENNA ............................... 36 INVEGA TRINZA ..................................... 36 INVIRASE ................................................ 13 INVOKAMET ........................................... 50 INVOKAMET XR ..................................... 50 INVOKANA .............................................. 50 IONOSOL-B IN D5W SOLN..................... 40 IONOSOL-MB IN D5W SOLN .................. 40 IOPIDINE SOLN 0.5 % ............................ 44 IOPIDINE SOLN 1 % ............................... 44 IPOL ........................................................ 61 ipratropium bromide ................................. 19 ipratropium bromide (nasal) ..................... 19 ipratropium-albuterol ................................ 21 irbesartan................................................. 25 irbesartan-hydrochlorothiazide................. 25 IRESSA ................................................... 17 irinotecan hcl ........................................... 17 irrigation solutions, physiological ............. 40 ISENTRESS ............................................ 13 ISOLYTE-P IN D5W SOLN ...................... 40 ISOLYTE-S SOLN ................................... 40

isoniazid ................................................... 12 isoniazid & rifampin .................................. 12 ISOPTO CARPINE ................................... 44 ISORDIL TITRADOSE ............................. 26 isosorbide dinitrate ................................... 26 isosorbide mononitrate er tb24 120 mg .... 26 isosorbide mononitrate er tb24 30 mg ...... 26 isosorbide mononitrate er tb24 60 mg ...... 26 isosorbide mononitrate tabs 10 mg .......... 26 isosorbide mononitrate tabs 20 mg .......... 26 isotretinoin ................................................ 64 isradipine .................................................. 23 ISTALOL .................................................. 44 ISTODAX ................................................. 17 ISTODAX (OVERFILL) ............................. 17 itraconazole .............................................. 12 ivermectin ................................................... 7 IXEMPRA KIT .......................................... 17 IXIARO ..................................................... 61

J

JADENU SPRINKLE PACK 180 MG ........ 47 JADENU SPRINKLE PACK 360 MG ........ 47 JADENU SPRINKLE PACK 90 MG .......... 47 JADENU TABS 180 MG ........................... 47 JADENU TABS 360 MG ........................... 47 JADENU TABS 90 MG ............................. 47 JAKAFI ..................................................... 17 JALYN ...................................................... 56 JANUMET ................................................ 51 JANUMET XR .......................................... 51 JANUVIA .................................................. 51 JARDIANCE ............................................. 51 JENTADUETO ......................................... 51 JENTADUETO XR ................................... 51 JEVTANA ................................................. 17 JUBLIA ..................................................... 62 JUXTAPID ................................................ 22

K

KADCYLA ................................................ 17 KADIAN CP24 10 MG .............................. 28 KADIAN CP24 100 MG ............................ 28 KADIAN CP24 20 MG .............................. 28 KADIAN CP24 200 MG ............................ 28 KADIAN CP24 30 MG .............................. 28 KADIAN CP24 40 MG .............................. 28 KADIAN CP24 50 MG .............................. 28 KADIAN CP24 60 MG .............................. 28


KADIAN CP24 80 MG .............................. 28 KALETRA ................................................ 13 KALYDECO ............................................. 59 KANUMA ................................................. 41 KAPVAY .................................................. 24 KARBINAL ER ......................................... 15 KAYEXALATE ......................................... 40 KAZANO .................................................. 51 kcl in dextrose-nacl soln 10-5-0.45 meq/l-%-

% .......................................................... 40 kcl in dextrose-nacl soln 20-5-0.2 meq/l-%-

% .......................................................... 40 KCL IN DEXTROSE-NACL SOLN 20-5-

0.225 MEQ/L-%-% ............................... 40 kcl in dextrose-nacl soln 20-5-0.33 meq/l-%-





% .......................................................... 40 KCL IN DEXTROSE-NACL SOLN 40-5-0.9

MEQ/L-%-% ......................................... 40 KCL-LACTATED RINGERS-D5W SOLN 20

MEQ/L .................................................. 40 KENALOG ......................................... 47, 63 KEPIVANCE SOLR 6.25 MG ................... 63 KEPPRA SOLN 100 MG/ML .................... 32 KEPPRA TABS 1000 MG ........................ 32 KEPPRA TABS 250 MG .......................... 32 KEPPRA TABS 500 MG .......................... 32 KEPPRA TABS 750 MG .......................... 32 KEPPRA XR TB24 500 MG ..................... 32 KEPPRA XR TB24 750 MG ..................... 32 KERYDIN................................................. 62 KETEK ....................................................... 9 ketoconazole ..................................... 12, 62 ketoconazole (topical) .............................. 62 ketoprofen................................................ 28 ketorolac tromethamine ..................... 28, 43 ketorolac tromethamine (ophth) ............... 43 KEVEYIS ................................................. 56 KEVZARA ................................................ 56 KEYTRUDA ............................................. 17 KHEDEZLA .............................................. 36 KINERET ................................................. 56 KINRIX .................................................... 60

KITABIS PAK ............................................. 9 KLARON .................................................. 62 KLONOPIN .............................................. 32 KOMBIGLYZE XR .................................... 51 KORLYM .................................................. 51 K-TAB TBCR 10 MEQ .............................. 40 K-TAB TBCR 20 MEQ .............................. 40 K-TAB TBCR 8 MEQ ................................ 40 KUVAN..................................................... 56 KYNAMRO ............................................... 22 KYPROLIS ............................................... 17

L

labetalol hcl ........................................ 26, 27 labetalol hcl soln 5 mg/ml ......................... 27 LACRISERT ............................................. 44 lactated ringer's (irrigation) ....................... 40 lactated ringers soln ................................. 40 lactic acid (ammonium lactate) ................. 64 lactulose ................................................... 38 lactulose (encephalopathy) ...................... 38 LAMICTAL CHEW 25 MG ........................ 32 LAMICTAL CHEW 5 MG .......................... 32 LAMICTAL ODT TBDP 100 MG ............... 32 LAMICTAL ODT TBDP 200 MG ............... 32 LAMICTAL ODT TBDP 25 MG ................. 32 LAMICTAL ODT TBDP 50 MG ................. 32 LAMICTAL STARTER KIT 25 (35) MG .... 32 LAMICTAL STARTER KIT 25 (42)-100 (7)

MG ....................................................... 32 LAMICTAL STARTER KIT 25 (84)-100(14)

MG ....................................................... 32 LAMICTAL TABS 100 MG........................ 32 LAMICTAL TABS 150 MG........................ 32 LAMICTAL TABS 200 MG........................ 32 LAMICTAL TABS 25 MG ......................... 32 LAMICTAL XR KIT 25 & 50 & 100 MG ..... 32 LAMICTAL XR KIT 25 (21)-50 (7) MG ...... 32 LAMICTAL XR KIT 50 & 100 & 200 MG ... 32 LAMICTAL XR TB24 100 MG .................. 32 LAMICTAL XR TB24 200 MG .................. 32 LAMICTAL XR TB24 25 MG .................... 32 LAMICTAL XR TB24 250 MG .................. 32 LAMICTAL XR TB24 300 MG .................. 32 LAMICTAL XR TB24 50 MG .................... 32 LAMISIL ................................................... 12 lamivudine ................................................ 13 lamivudine (hbv) ....................................... 13 lamivudine-zidovudine .............................. 13


lamotrigine ............................................... 32 LANOXIN PEDIATRIC SOLN 0.1 MG/ML 24 LANOXIN SOLN 0.25 MG/ML .................. 24 LANOXIN TABS 125 MCG ...................... 24 LANOXIN TABS 187.5 MCG ................... 24 LANOXIN TABS 250 MCG ...................... 24 LANOXIN TABS 62.5 MCG ..................... 24 lansoprazole ............................................ 45 LANTUS SOLN 100 UNIT/ML .................. 51 LANTUS SOLOSTAR SOPN 100 UNIT/ML

............................................................. 51 LARTRUVO ............................................. 17 LASIX ...................................................... 39 LASTACAFT ............................................ 43 latanoprost ............................................... 44 LATUDA .................................................. 36 LAZANDA ................................................ 28 leflunomide .............................................. 56 LEMTRADA ............................................. 56 LENVIMA 10 MG DAILY DOSE ............... 17 LENVIMA 14 MG DAILY DOSE ............... 17 LENVIMA 18 MG DAILY DOSE ............... 17 LENVIMA 20 MG DAILY DOSE ............... 17 LENVIMA 24 MG DAILY DOSE ............... 17 LENVIMA 8 MG DAILY DOSE ................. 17 LESCOL XL ............................................. 22 LETAIRIS................................................. 59 letrozole ................................................... 17 leucovorin calcium ................................... 56 leucovorin calcium solr 100 mg ................ 56 leucovorin calcium solr 350 mg ................ 56 LEUKERAN ............................................. 17 LEUKINE SOLR 250 MCG ...................... 22 leuprolide acetate .................................... 17 levalbuterol hcl ......................................... 21 levalbuterol tartrate .................................. 21 LEVAQUIN ................................................ 9 LEVEMIR ................................................. 51 LEVEMIR FLEXTOUCH .......................... 51 levetiracetam ........................................... 32 LEVETIRACETAM IN NACL .................... 32 levetiracetam in sodium chloride .............. 32 levetiracetam soln 500 mg/5ml ................ 32 levobunolol hcl ......................................... 44 levocarnitine (metabolic modifiers) .......... 56 levocarnitine soln 200 mg/ml ................... 56 levocetirizine dihydrochloride ................... 15 levofloxacin .......................................... 9, 42 levofloxacin (ophth).................................. 42 levofloxacin in d5w soln 500 mg/100ml...... 9

levofloxacin in d5w soln 750 mg/150ml ...... 9 levofloxacin soln 25 mg/ml ......................... 9 levoleucovorin calcium ............................. 56 levoleucovorin calcium solr 50 mg ........... 56 levonorgestrel & eth estradiol ................... 49 levonorgestrel-eth estradiol (triphasic) ..... 49 levonorgestrel-ethinyl estradiol (91-day) .. 49 levonorgestrel-ethinyl estradiol (continuous)

............................................................. 49 levorphanol tartrate .................................. 28 levothyroxine sodium ............................... 54 LEVOTHYROXINE SODIUM ................... 54 LEXAPRO ................................................ 36 LEXIVA SUSP 50 MG/ML ........................ 13 LEXIVA TABS 700 MG ............................ 13 LIALDA TBEC 1.2 GM ............................. 44 lidocaine ....................................... 44, 56, 63 lidocaine hcl ................................. 44, 56, 63 lidocaine hcl (local anesth.) ...................... 56 lidocaine hcl (mouth-throat) ...................... 44 lidocaine-prilocaine .................................. 63 LIDOCAINE-TETRACAINE ...................... 63 LIDODERM .............................................. 63 LINCOCIN SOLN 300 MG/ML .................... 9 lincomycin hcl soln 300 mg/ml .................... 9 lindane ..................................................... 62 linezolid ................................................ 9, 10 LINEZOLID IN SODIUM CHLORIDE SOLN

600-0.9 MG/300ML-% ............................ 9 linezolid soln 600 mg/300ml ..................... 10 LINZESS .................................................. 47 LIORESAL SOLN 0.05 MG/ML ................ 20 LIORESAL SOLN 10 MG/20ML ............... 20 LIORESAL SOLN 10 MG/5ML ................. 20 LIORESAL SOLN 40 MG/20ML ............... 20 liothyronine sodium .................................. 54 liothyronine sodium soln 10 mcg/ml ......... 54 LIPITOR ................................................... 22 LIPOFEN .................................................. 22 LIPOSYN III EMUL 10 % ......................... 39 lisinopril & hydrochlorothiazide ................. 25 lisinopril tabs 10 mg ................................. 25 lisinopril tabs 2.5 mg ................................ 25 lisinopril tabs 20 mg ................................. 25 lisinopril tabs 30 mg ................................. 25 lisinopril tabs 40 mg ................................. 25 lisinopril tabs 5 mg ................................... 25 LITHIUM ................................................... 36 lithium carbonate ...................................... 36 LITHOBID ................................................ 36


LITHOSTAT ............................................. 38 LIVALO .................................................... 22 LO LOESTRIN FE ................................... 49 LOCOID ................................................... 63 LODOSYN ............................................... 34 LOMOTIL ................................................. 44 LOMUSTINE CAPS 10 MG ..................... 17 LOMUSTINE CAPS 100 MG ................... 17 LOMUSTINE CAPS 40 MG ..................... 17 LONSURF ............................................... 17 loperamide hcl ......................................... 44 LOPID ...................................................... 22 lopinavir-ritonavir ..................................... 13 LOPRESSOR .......................................... 27 LOPRESSOR HCT .................................. 27 LOPROX.................................................. 62 lorazepam ................................................ 34 losartan potassium................................... 25 losartan potassium & hydrochlorothiazide 25 LOSEASONIQUE .................................... 49 LOTEMAX ............................................... 43 LOTENSIN ............................................... 25 LOTREL .................................................. 23 LOTRISONE ............................................ 62 LOTRONEX ............................................. 44 lovastatin ................................................. 22 LOVAZA .................................................. 22 LOVENOX ............................................... 22 loxapine succinate ................................... 36 LUMIGAN ................................................ 44 LUMIZYME .............................................. 41 LUNESTA ................................................ 34 LUPANETA PACK ................................... 17 LUPRON DEPOT (1-MONTH) KIT 3.75 MG

............................................................. 17 LUPRON DEPOT (1-MONTH) KIT 7.5 MG

............................................................. 17 LUPRON DEPOT (3-MONTH) KIT 11.25

MG ....................................................... 17 LUPRON DEPOT (3-MONTH) KIT 22.5 MG

............................................................. 17 LUPRON DEPOT (4-MONTH) KIT 30 MG

............................................................. 17 LUPRON DEPOT (6-MONTH) KIT 45 MG

............................................................. 17 LUPRON DEPOT-PED (1-MONTH) ........ 17 LUPRON DEPOT-PED (3-MONTH) ........ 17 LUZU ....................................................... 62 LYNPARZA .............................................. 17 LYRICA ................................................... 32

LYSODREN ............................................. 17 LYSTEDA ................................................. 22

M

MACROBID .............................................. 15 MACRODANTIN ...................................... 15 MAGNESIUM SULFATE IN D5W SOLN 1-5

GM/100ML-% ....................................... 40 MAGNESIUM SULFATE SOLN 2 GM/50ML

............................................................. 32 MAGNESIUM SULFATE SOLN 20

GM/500ML ............................................ 32 MAGNESIUM SULFATE SOLN 4

GM/100ML ............................................ 32 MAGNESIUM SULFATE SOLN 40

GM/1000ML .......................................... 33 magnesium sulfate soln 50 % .................. 33 MAKENA .................................................. 53 MALARONE ............................................. 12 malathion ................................................. 62 maprotiline hcl .......................................... 36 MARINOL CAPS 10 MG .......................... 45 MARINOL CAPS 2.5 MG ......................... 45 MARINOL CAPS 5 MG ............................ 45 MARPLAN ................................................ 36 MARQIBO ................................................ 17 MATULANE ............................................. 17 MAVIK ...................................................... 25 MAXAIR AUTOHALER ............................ 21 MAXALT ................................................... 33 MAXALT-MLT .......................................... 33 MAXIDEX ................................................. 43 MAXIPIME SOLR 1 GM ........................... 10 MAXIPIME SOLR 2 GM ........................... 10 MAXITROL ............................................... 43 MAXZIDE ................................................. 39 MAXZIDE-25 ............................................ 39 mebendazole ............................................. 7 mecamylamine hcl ................................... 24 meclizine hcl ............................................ 45 meclofenamate sodium ............................ 28 MEDROL TABS 16 MG ............................ 48 MEDROL TABS 2 MG .............................. 48 MEDROL TABS 32 MG ............................ 48 MEDROL TABS 4 MG .............................. 48 MEDROL TABS 8 MG .............................. 48 MEDROL TBPK 4 MG .............................. 48 medroxyprogesterone acetate .................. 53


medroxyprogesterone acetate (contraceptive) ..................................... 53

mefenamic acid ....................................... 28 mefloquine hcl ......................................... 12 MEGACE ES ........................................... 53 MEGACE ORAL ...................................... 17 megestrol acetate .............................. 17, 53 megestrol acetate (appetite) .................... 53 MEKINIST................................................ 17 meloxicam ............................................... 28 melphalan hcl .......................................... 17 memantine hcl ......................................... 35 MENACTRA ............................................ 61 MENHIBRIX ............................................. 61 MENOMUNE ........................................... 61 MENOSTAR PTWK 14 MCG/24HR ......... 52 MENTAX.................................................. 62 MENVEO ................................................. 61 meperidine hcl ......................................... 28 meprobamate .......................................... 34 MEPRON ................................................. 12 mercaptopurine ........................................ 17 meropenem solr 500 mg .......................... 10 MERREM SOLR 500 MG ........................ 10 mesalamine ............................................. 44 mesalamine w/ cleanser .......................... 44 mesna soln 100 mg/ml ............................. 56 MESNEX SOLN 100 MG/ML ................... 56 MESNEX TABS 400 MG ......................... 56 MESTINON SYRP 60 MG/5ML ............... 19 MESTINON TABS 60 MG ........................ 19 MESTINON TBCR 180 MG ..................... 19 METADATE CD CPCR 10 MG ................ 30 METADATE CD CPCR 20 MG ................ 30 METADATE CD CPCR 30 MG ................ 30 METADATE CD CPCR 40 MG ................ 30 METADATE CD CPCR 50 MG ................ 30 METADATE CD CPCR 60 MG ................ 30 metaproterenol sulfate ............................. 21 metaxalone .............................................. 20 metformin hcl er (mod) tb24 1000 mg ...... 51 metformin hcl er (mod) tb24 500 mg ........ 51 metformin hcl er (osm) tb24 1000 mg ...... 51 metformin hcl er (osm) tb24 500 mg ........ 51 metformin hcl er tb24 500 mg .................. 51 metformin hcl er tb24 750 mg .................. 51 metformin hcl tabs 1000 mg .................... 51 metformin hcl tabs 500 mg ...................... 51 metformin hcl tabs 850 mg ...................... 51 methadone hcl ......................................... 28

METHADONE HCL SOLN 10 MG/ML ...... 29 methamphetamine hcl .............................. 30 methazolamide ......................................... 44 methenamine hippurate ........................... 15 methimazole ............................................. 54 methocarbamol ........................................ 20 methotrexate sodium ................................ 17 methoxsalen rapid .................................... 64 methscopolamine bromide ....................... 19 methyclothiazide ...................................... 39 methyldopa .............................................. 24 methyldopa & hydrochlorothiazide ........... 24 methyldopate hcl soln 250 mg/5ml ........... 24 methylergonovine maleate ....................... 56 METHYLIN CHEW 10 MG ....................... 30 METHYLIN CHEW 2.5 MG ...................... 30 METHYLIN CHEW 5 MG ......................... 30 METHYLIN SOLN 10 MG/5ML ................. 30 METHYLIN SOLN 5 MG/5ML ................... 30 methylphenidate hcl ................................. 30 methylprednisolone .................................. 48 methylprednisolone acetate ..................... 48 methylprednisolone sod succ ................... 48 methyltestosterone ................................... 48 metipranolol ............................................. 44 metoclopramide hcl .................................. 47 metoclopramide hcl soln 5 mg/ml ............. 47 metolazone .............................................. 39 metoprolol & hydrochlorothiazide ............. 27 metoprolol succinate ................................ 27 metoprolol tartrate soct 5 mg/5ml ............. 27 metoprolol tartrate soln 5 mg/5ml ............. 27 metoprolol tartrate tabs 100 mg ............... 27 metoprolol tartrate tabs 25 mg ................. 27 metoprolol tartrate tabs 50 mg ................. 27 METOZOLV ODT ..................................... 47 METRO SOLN 500-0.74 MG/100ML-% ... 12 METROCREAM ....................................... 62 METROGEL ............................................. 62 METROGEL-VAGINAL ............................ 62 METROLOTION ....................................... 62 metronidazole .................................... 12, 62 metronidazole (topical) ............................. 62 metronidazole in nacl soln 500-0.79

mg/100ml-% ......................................... 12 metronidazole vaginal .............................. 62 mexiletine hcl ........................................... 24 MIACALCIN SOLN 200 UNIT/ACT .......... 53 MIACALCIN SOLN 200 UNIT/ML ............. 53 MICARDIS ............................................... 25


MICARDIS HCT ....................................... 25 miconazole nitrate vaginal ....................... 62 MICROZIDE ............................................ 39 midazolam hcl .................................... 30, 34 midodrine hcl ........................................... 21 MIFEPREX .............................................. 56 miglitol ..................................................... 51 MIGRANAL SOLN 4 MG/ML.................... 20 MINASTRIN 24 FE .................................. 49 MINIPRESS ............................................. 22 MINIVELLE PTTW 0.025 MG/24HR ........ 52 MINIVELLE PTTW 0.0375 MG/24HR ...... 52 MINIVELLE PTTW 0.05 MG/24HR .......... 52 MINIVELLE PTTW 0.075 MG/24HR ........ 52 MINIVELLE PTTW 0.1 MG/24HR ............ 52 MINOCIN ................................................. 10 minocycline hcl ........................................ 10 minoxidil .................................................. 24 MIRAPEX ................................................ 34 MIRAPEX ER .......................................... 34 MIRCERA ................................................ 22 mirtazapine .............................................. 36 MIRVASO ................................................ 64 misoprostol ........................................ 28, 45 MITIGARE CAPS 0.6 MG ........................ 56 mitomycin ................................................ 17 mitoxantrone hcl ...................................... 17 M-M-R II .................................................. 61 MOBIC ..................................................... 29 modafinil .................................................. 30 MODICON (28) ........................................ 49 moexipril hcl ............................................. 25 moexipril-hydrochlorothiazide .................. 25 molindone hcl .......................................... 36 mometasone furoate .......................... 43, 63 mometasone furoate (nasal) .................... 43 montelukast sodium ................................. 58 MONUROL .............................................. 15 MORPHABOND ER T12A 100 MG ......... 29 MORPHABOND ER T12A 15 MG ........... 29 MORPHABOND ER T12A 30 MG ........... 29 MORPHABOND ER T12A 60 MG ........... 29 morphine sulfate ...................................... 29 MORPHINE SULFATE (PF) SOLN 10

MG/ML ................................................. 29 MORPHINE SULFATE (PF) SOLN 2

MG/ML ................................................. 29 MORPHINE SULFATE (PF) SOLN 4

MG/ML ................................................. 29

MORPHINE SULFATE (PF) SOLN 8 MG/ML .................................................. 29

morphine sulfate beads ............................ 29 MORPHINE SULFATE TABS 15 MG ....... 29 MORPHINE SULFATE TABS 30 MG ....... 29 MOVANTIK .............................................. 47 MOVIPREP .............................................. 46 MOXEZA .................................................. 42 moxifloxacin hcl ........................................ 10 MOXIFLOXACIN HCL SOLN 400

MG/250ML ............................................ 10 MOZOBIL ................................................. 22 MS CONTIN TBCR 100 MG ..................... 29 MS CONTIN TBCR 15 MG ....................... 29 MS CONTIN TBCR 200 MG ..................... 29 MS CONTIN TBCR 30 MG ....................... 29 MS CONTIN TBCR 60 MG ....................... 29 MULTAQ .................................................. 24 mupirocin ................................................. 62 mupirocin calcium (topical) ....................... 62 MUSTARGEN .......................................... 17 MYALEPT ................................................ 56 MYAMBUTOL .......................................... 12 MYCAMINE SOLR 100 MG ..................... 12 MYCAMINE SOLR 50 MG ....................... 12 MYCOBUTIN ........................................... 12 mycophenolate mofetil ............................. 56 mycophenolate mofetil hcl solr 500 mg .... 56 mycophenolate sodium ............................ 56 MYDAYIS CP24 12.5 MG ........................ 30 MYDAYIS CP24 25 MG ........................... 31 MYDAYIS CP24 37.5 MG ........................ 31 MYDAYIS CP24 50 MG ........................... 31 MYFORTIC .............................................. 56 MYOZYME ............................................... 41 MYRBETRIQ ............................................ 65 MYSOLINE .............................................. 33 MYTESI.................................................... 47

N

NABI-HB .................................................. 60 nabumetone ............................................. 29 nadolol & bendroflumethiazide ................. 27 nadolol tabs 20 mg ................................... 27 nadolol tabs 40 mg ................................... 27 nadolol tabs 80 mg ................................... 27 NAFCILLIN SODIUM IN DEXTROSE SOLN

1 GM/50ML ........................................... 10


NAFCILLIN SODIUM IN DEXTROSE SOLN 2 GM/100ML ........................................ 10

nafcillin sodium solr 1 gm ........................ 10 nafcillin sodium solr 10 gm ...................... 10 naftifine hcl .............................................. 62 NAFTIN ................................................... 62 NAGLAZYME .......................................... 41 nalbuphine hcl ......................................... 29 naloxone hcl ............................................ 35 naltrexone hcl .......................................... 35 NAMENDA ............................................... 35 NAMENDA TITRATION PAK ................... 35 NAMENDA XR ......................................... 35 NAMENDA XR TITRATION PACK .......... 35 NAMZARIC .............................................. 35 naphazoline hcl ........................................ 44 NAPRELAN ............................................. 29 NAPROSYN ...................................... 28, 29 naproxen ................................................. 29 naproxen sodium ..................................... 29 naratriptan hcl .......................................... 33 NARCAN LIQD 4 MG/0.1ML.................... 35 NARDIL ................................................... 36 NASONEX ............................................... 43 NATACYN ............................................... 42 NATAZIA ................................................. 49 nateglinide ............................................... 51 NATESTO GEL 5.5 MG/ACT ................... 48 NATPARA................................................ 53 NEBUPENT SOLR 300 MG ..................... 12 NECON 1/50 (28) .................................... 49 nefazodone hcl ........................................ 36 neomycin sulfate ................................ 10, 63 neomycin sulfate-fluocinolone acetonide . 63 neomycin/polymyxin b gu ........................ 62 neomycin-bacitracin zn-polymyxin ........... 42 neomycin-polymy-dexameth .................... 43 neomycin-polymyxin-gramicidin ............... 42 neomycin-polymyxin-hc (ophth) ............... 43 neomycin-polymyxin-hc (otic) .................. 43 NEORAL CAPS 100 MG ......................... 56 NEORAL CAPS 25 MG ........................... 56 NEORAL SOLN 100 MG/ML.................... 56 NEPHRAMINE SOLN 5.4 % .................... 39 NERLYNX................................................ 17 NESINA ................................................... 51 NEULASTA .............................................. 22 NEULASTA ONPRO ................................ 22 NEUMEGA .............................................. 22 NEUPOGEN ............................................ 22

NEUPRO .................................................. 34 NEURONTIN ............................................ 33 NEVANAC ................................................ 43 nevirapine ................................................ 13 NEXAVAR ................................................ 17 NEXIUM ................................................... 45 NEXIUM I.V. SOLR 40 MG ...................... 45 NEXTERONE SOLN 150-4.21 MG/100ML-

% .......................................................... 24 NEXTERONE SOLN 360-4.14 MG/200ML-

% .......................................................... 24 niacin (antihyperlipidemic) ........................ 22 NIASPAN ................................................. 22 nicardipine hcl .......................................... 23 nicardipine hcl soln 2.5 mg/ml .................. 23 NICOTROL INHA 10 MG ......................... 19 NICOTROL NS SOLN 10 MG/ML ............ 19 nifedipine .................................................. 23 NILANDRON ............................................ 17 nilutamide ................................................. 17 nimodipine ................................................ 23 NINLARO ................................................. 17 NIPENT .................................................... 18 nisoldipine ................................................ 23 NITRO-DUR PT24 0.1 MG/HR ................. 26 NITRO-DUR PT24 0.2 MG/HR ................. 26 NITRO-DUR PT24 0.3 MG/HR ................. 26 NITRO-DUR PT24 0.4 MG/HR ................. 26 NITRO-DUR PT24 0.6 MG/HR ................. 26 NITRO-DUR PT24 0.8 MG/HR ................. 26 nitrofurantoin ............................................ 15 nitrofurantoin macrocrystal ....................... 15 nitrofurantoin monohyd macro .................. 15 nitroglycerin .............................................. 26 nitroglycerin soln 5 mg/ml......................... 26 NITROLINGUAL SOLN 0.4 MG/SPRAY .. 26 NITROMIST AERS 400 MCG/SPRAY ..... 26 NITROSTAT SUBL 0.3 MG ...................... 26 NITROSTAT SUBL 0.4 MG ...................... 26 NITROSTAT SUBL 0.6 MG ...................... 26 nizatidine .................................................. 45 NIZORAL ................................................. 62 NORDITROPIN FLEXPRO SOLN 10

MG/1.5ML ............................................. 54 NORDITROPIN FLEXPRO SOLN 15

MG/1.5ML ............................................. 54 NORDITROPIN FLEXPRO SOLN 30

MG/3ML ................................................ 54 NORDITROPIN FLEXPRO SOLN 5

MG/1.5ML ............................................. 54


norelgestromin-ethinyl estradiol ............... 49 norethin acet & estrad-fe ......................... 49 norethindrone & eth estradiol ................... 49 norethindrone & ethinyl estradiol-fe ......... 49 norethindrone (contraceptive) .................. 49 norethindrone acet & eth estra ................. 49 norethindrone acetate .................. 49, 52, 53 norethindrone acetate-ethinyl estradiol ... 49,

52 norethindrone acetate-ethinyl estradiol-fe 49 norethindrone-eth estradiol (biphasic)...... 49 norethindrone-eth estradiol (triphasic) ..... 49 norgestimate-ethinyl estradiol .................. 49 norgestimate-ethinyl estradiol (triphasic) . 49 norgestrel & ethinyl estradiol.................... 49 NORINYL 1+35 (28) ................................ 49 NORINYL 1+50 (28) ................................ 49 NORITATE .............................................. 62 NORMOSOL-M IN D5W SOLN ............... 41 NORMOSOL-R IN D5W SOLN ................ 41 NORMOSOL-R PH 7.4 SOLN ................. 41 NORPACE CAPS 100 MG ...................... 24 NORPACE CAPS 150 MG ...................... 24 NORPACE CR CP12 100 MG ................. 24 NORPACE CR CP12 150 MG ................. 24 NORPRAMIN ........................................... 36 NOR-QD .................................................. 49 NORTHERA ............................................ 21 nortriptyline hcl ........................................ 36 NORVASC ............................................... 23 NORVIR .................................................. 13 NOVOLIN 70/30 ...................................... 51 NOVOLIN N RELION SUSP 100 UNIT/ML

............................................................. 51 NOVOLIN N SUSP 100 UNIT/ML ............ 51 NOVOLIN R RELION SOLN 100 UNIT/ML

............................................................. 51 NOVOLIN R SOLN 100 UNIT/ML ............ 51 NOVOLOG .............................................. 51 NOVOLOG FLEXPEN ............................. 51 NOVOLOG MIX 70/30 ............................. 51 NOVOLOG MIX 70/30 FLEXPEN ............ 51 NOVOLOG PENFILL ............................... 51 NOXAFIL ................................................. 12 NPLATE .................................................. 22 NUCALA .................................................. 58 NUCYNTA ............................................... 29 NUCYNTA ER ......................................... 29 NUEDEXTA ............................................. 35 NULOJIX SOLR 250 MG ......................... 56

NULYTELY WITH FLAVOR PACKS ........ 46 NUPLAZID ............................................... 36 NUTRESTORE ........................................ 47 nutrilipid emul 20 % .................................. 39 NUTROPIN AQ NUSPIN 10 SOLN 10

MG/2ML ................................................ 54 NUTROPIN AQ NUSPIN 20 SOLN 20

MG/2ML ................................................ 54 NUTROPIN AQ NUSPIN 5 SOLN 5

MG/2ML ................................................ 54 NUTROPIN AQ PEN SOLN 10 MG/2ML .. 54 NUTROPIN AQ PEN SOLN 20 MG/2ML .. 54 NUVARING .............................................. 49 NUVESSA ................................................ 62 NUVIGIL ................................................... 31 nystatin......................................... 12, 62, 63 nystatin (mouth-throat) ............................. 12 nystatin (topical) ....................................... 62 nystatin-triamcinolone .............................. 63

O

OCALIVA ................................................. 47 OCREVUS ............................................... 57 OCTAGAM SOLN 1 GM/20ML ................. 60 OCTAGAM SOLN 2 GM/20ML ................. 60 OCTAGAM SOLN 25 GM/500ML ............. 60 OCTAGAM SOLN 5 GM/100ML ............... 60 octreotide acetate..................................... 57 OCUFEN .................................................. 43 OCUFLOX ................................................ 42 ODEFSEY ................................................ 13 ODOMZO ................................................. 18 OFEV ....................................................... 59 ofloxacin ............................................. 10, 42 ofloxacin (ophth) ...................................... 42 ofloxacin (otic) .......................................... 42 olanzapine ................................................ 36 olanzapine-fluoxetine hcl .......................... 36 olmesartan medoxomil ....................... 23, 25 olmesartan medoxomil-amlodipine-

hydrochlorothiazide .............................. 23 olmesartan medoxomil-hydrochlorothiazide

............................................................. 25 olopatadine hcl ......................................... 43 olopatadine hcl (nasal) ............................. 43 OLUX FOAM 0.05 % ................................ 63 OLYSIO.................................................... 13 OMECLAMOX-PAK ................................. 45 omega-3-acid ethyl esters ........................ 23


omeprazole .............................................. 45 omeprazole-sodium bicarbonate .............. 45 OMNARIS ................................................ 43 OMNIPRED SUSP 1 % ........................... 43 OMNITROPE SOLN 10 MG/1.5ML .......... 54 OMNITROPE SOLN 5 MG/1.5ML ............ 54 OMNITROPE SOLR 5.8 MG.................... 54 ONCASPAR ............................................ 18 ondansetron ............................................. 45 ondansetron hcl ....................................... 45 ondansetron hcl soln 4 mg/2ml ................ 45 ONEXTON ............................................... 62 ONFI ........................................................ 33 ONGLYZA ............................................... 51 ONIVYDE ................................................ 18 ONMEL TABS 200 MG ............................ 12 ONZETRA XSAIL .................................... 33 OPANA .................................................... 29 OPANA ER .............................................. 29 OPDIVO .................................................. 18 OPSUMIT ................................................ 59 ORACEA ................................................. 64 ORALAIR ................................................. 57 ORAP ...................................................... 36 ORAPRED ODT ...................................... 48 ORAVIG .................................................. 62 ORBACTIV .............................................. 10 ORENCIA ................................................ 57 ORENCIA CLICKJECT ............................ 57 ORENITRAM TBCR 0.125 MG ................ 59 ORENITRAM TBCR 0.25 MG .................. 59 ORENITRAM TBCR 1 MG ....................... 59 ORENITRAM TBCR 2.5 MG .................... 59 ORENITRAM TBCR 5 MG ....................... 59 ORFADIN ................................................ 57 ORKAMBI ................................................ 59 orphenadrine citrate ................................. 20 ORTHO MICRONOR ............................... 49 ORTHO TRI-CYCLEN (28) ...................... 49 ORTHO TRI-CYCLEN LO ....................... 49 ORTHO-CYCLEN (28) ............................. 49 ORTHO-NOVUM 1/35 (28) ...................... 49 ORTHO-NOVUM 7/7/7 (28) ..................... 49 oseltamivir phosphate .............................. 13 OSENI ..................................................... 51 OSMOPREP ............................................ 46 OTEZLA .................................................. 57 OTOVEL .................................................. 42 OTREXUP SOAJ 10 MG/0.4ML .............. 57 OTREXUP SOAJ 12.5 MG/0.4ML ........... 57

OTREXUP SOAJ 15 MG/0.4ML ............... 57 OTREXUP SOAJ 17.5 MG/0.4ML ............ 57 OTREXUP SOAJ 20 MG/0.4ML ............... 57 OTREXUP SOAJ 22.5 MG/0.4ML ............ 57 OTREXUP SOAJ 25 MG/0.4ML ............... 57 OTREXUP SOAJ 7.5 MG/0.4ML .............. 57 oxacillin sodium solr 10 gm ...................... 10 oxacillin sodium solr 2 gm ........................ 10 oxaliplatin ................................................. 18 oxandrolone ............................................. 48 oxaprozin ................................................. 29 oxazepam ................................................ 34 oxcarbazepine .......................................... 33 oxiconazole nitrate ................................... 62 OXISTAT .................................................. 62 OXSORALEN ........................................... 64 OXSORALEN ULTRA .............................. 64 OXTELLAR XR ........................................ 33 oxybutynin chloride .................................. 65 oxycodone hcl .......................................... 29 oxycodone w/ acetaminophen .................. 29 oxycodone-aspirin .................................... 29 oxycodone-ibuprofen ................................ 29 OXYCONTIN ............................................ 29 oxymorphone hcl ...................................... 29 OXYTROL ................................................ 65

P

paclitaxel .................................................. 18 paliperidone ............................................. 36 PAMELOR ............................................... 36 pamidronate disodium soln 30 mg/10ml ... 57 pamidronate disodium soln 6 mg/ml ......... 57 pamidronate disodium soln 90 mg/10ml ... 57 PANCREAZE CPEP 10500 UNIT ............ 46 PANCREAZE CPEP 16800 UNIT ............ 46 PANCREAZE CPEP 21000 UNIT ............ 46 PANCREAZE CPEP 2600 UNIT .............. 46 PANCREAZE CPEP 4200 UNIT .............. 46 PANDEL................................................... 63 PANRETIN ............................................... 64 pantoprazole sodium ................................ 45 pantoprazole sodium solr 40 mg .............. 45 paricalcitol ................................................ 65 paricalcitol soln 2 mcg/ml ......................... 65 paricalcitol soln 5 mcg/ml ......................... 65 PARLODEL .............................................. 34 PARNATE ................................................ 36 paromomycin sulfate ................................ 12


paroxetine hcl er tb24 12.5 mg ................ 36 paroxetine hcl er tb24 25 mg ................... 36 paroxetine hcl er tb24 37.5 mg ................ 36 paroxetine hcl tabs 10 mg ........................ 36 paroxetine hcl tabs 20 mg ........................ 36 paroxetine hcl tabs 30 mg ........................ 36 paroxetine hcl tabs 40 mg ........................ 36 PATADAY ................................................ 43 PATANASE ............................................. 43 PATANOL ................................................ 43 PAXIL ...................................................... 36 PAXIL CR ................................................ 36 PAZEO .................................................... 43 PCE ......................................................... 10 PEDIARIX ................................................ 61 PEDVAX HIB ........................................... 61 peg 3350-kcl-sod bicarb-sod chloride-sod

sulfate .................................................. 46 peg 3350-potassium chloride-sod

bicarbonate-sod chloride ...................... 46 PEGANONE ............................................ 33 PEGASYS ............................................... 14 PEGASYS PROCLICK ............................ 14 PEGINTRON ........................................... 14 PEG-INTRON .................................... 13, 14 PEG-INTRON REDIPEN ................... 13, 14 PEG-INTRON REDIPEN PAK 4 .............. 14 PENICILLIN G POT IN DEXTROSE SOLN

20000 UNIT/ML .................................... 10 PENICILLIN G POT IN DEXTROSE SOLN

40000 UNIT/ML .................................... 10 PENICILLIN G POT IN DEXTROSE SOLN

60000 UNIT/ML .................................... 10 penicillin g potassium solr 5000000 unit .. 10 penicillin g procaine ................................. 10 penicillin g sodium solr 5000000 unit ....... 10 penicillin v potassium ............................... 10 PENNSAID .............................................. 64 PENTAM SOLR 300 MG ......................... 13 PENTASA CPCR 250 MG ....................... 44 PENTASA CPCR 500 MG ....................... 44 pentazocine w/ naloxone ......................... 29 pentoxifylline ............................................ 22 PEPCID ................................................... 45 PERCODAN ............................................ 29 PERFOROMIST ...................................... 21 perindopril erbumine ................................ 25 PERJETA ................................................ 18 permethrin ............................................... 62 perphenazine ........................................... 36

perphenazine-amitriptyline ....................... 36 PERSANTINE .......................................... 26 PERTZYE CPEP 16000 UNIT .................. 46 PERTZYE CPEP 4000 UNIT .................... 46 PERTZYE CPEP 8000 UNIT .................... 46 PEXEVA................................................... 36 phenelzine sulfate .................................... 36 phenobarbital ........................................... 34 PHENOBARBITAL ................................... 34 phenoxybenzamine hcl ............................ 20 phenytoin ................................................. 33 phenytoin sodium ..................................... 33 phenytoin sodium extended ..................... 33 PHOSLO CAPS 667 MG .......................... 41 PHOSLYRA SOLN 667 MG/5ML ............. 41 PHOSPHOLINE IODIDE .......................... 44 PICATO.................................................... 64 pilocarpine hcl .................................... 19, 44 pilocarpine hcl (oral) ................................. 19 pimozide................................................... 36 pindolol..................................................... 27 pioglitazone hcl ........................................ 51 pioglitazone hcl-glimepiride ...................... 51 pioglitazone hcl-metformin hcl .................. 51 piperacillin sod-tazobactam so solr 3.375

(3-0.375) gm ......................................... 10 piperacillin sod-tazobactam so solr 4.5 (4-

0.5) gm ................................................. 10 piperacillin sod-tazobactam so solr 40.5

(36-4.5) gm ........................................... 10 piroxicam .................................................. 29 PLAN B ONE-STEP ................................. 49 PLAQUENIL ............................................. 13 PLASMA-LYTE 148 SOLN ....................... 41 PLASMA-LYTE A SOLN .......................... 41 PLASMA-LYTE-56 IN D5W SOLN ........... 41 PLAVIX .................................................... 22 PLEGRIDY ............................................... 14 PLEGRIDY STARTER PACK ................... 14 plenamine soln 15 % ................................ 39 PLIAGLIS ................................................. 63 podofilox................................................... 64 polyethylene glycol 3350 .......................... 46 polymyxin b sulfate solr 500000 unit ........ 10 polymyxin b-trimethoprim ......................... 42 POLYTRIM ............................................... 42 POMALYST ............................................. 18 PONSTEL ................................................ 29 PORTRAZZA ........................................... 18 potassium chloride ............................. 41, 46


potassium chloride in dextrose soln 20-5 meq/l-% ................................................ 41

potassium chloride in dextrose soln 40-5 meq/l-% ................................................ 41

potassium chloride in nacl soln 20-0.45 meq/l-% ................................................ 41



potassium chloride microencapsulated crystals cr ............................................. 41

potassium chloride soln 10 meq/100ml .... 41 potassium chloride soln 2 meq/ml ............ 41 potassium chloride soln 20 meq/100ml .... 41 potassium chloride soln 40 meq/100ml .... 41 potassium citrate (alkalinizer) .................. 37 POTIGA ................................................... 33 PRADAXA ............................................... 22 PRALUENT ............................................. 23 pramipexole dihydrochloride .................... 34 PRANDIN ................................................ 51 PRAVACHOL .......................................... 23 pravastatin sodium................................... 23 prazosin hcl ............................................. 22 PRECOSE ............................................... 51 PRED FORTE SUSP 1 % ........................ 43 PRED MILD SUSP 0.12 % ...................... 43 PRED-G .................................................. 43 PRED-G S.O.P. ....................................... 43 prednicarbate ........................................... 63 prednisolone ...................................... 43, 48 prednisolone acetate (ophth) ................... 43 prednisolone sodium phosphate ........ 43, 48 prednisolone sodium phosphate (ophth) .. 43 prednisone ............................................... 48 PREMARIN .............................................. 52 PREMARIN SOLR 25 MG ....................... 52 PREMARIN TABS 0.3 MG ....................... 52 PREMARIN TABS 0.45 MG ..................... 52 PREMARIN TABS 0.625 MG ................... 52 PREMARIN TABS 0.9 MG ....................... 52 PREMARIN TABS 1.25 MG ..................... 52 premasol soln 10 % ................................. 39 premasol soln 6 % ................................... 39 PREMPHASE .......................................... 52 PREMPRO .............................................. 52 PREPOPIK .............................................. 46 PREVACID .............................................. 45 PREVACID SOLUTAB ............................. 45

PREVPAC ................................................ 45 PREZCOBIX ............................................ 14 PREZISTA ............................................... 14 PRIFTIN ................................................... 12 PRILOSEC ............................................... 45 primaquine phosphate .............................. 13 PRIMAQUINE PHOSPHATE ................... 13 PRIMAXIN IV SOLR 250-250 MG ............ 10 PRIMAXIN IV SOLR 500-500 MG ............ 10 primidone ................................................. 33 PRIMSOL ................................................. 15 PRINIVIL .................................................. 25 PRISTIQ ................................................... 36 PRIVIGEN SOLN 20 GM/200ML .............. 60 PRIVIGEN SOLN 40 GM/400ML .............. 60 PROAIR HFA AERS 108 (90 BASE)

MCG/ACT ............................................. 21 PROAIR RESPICLICK AEPB 108 (90

BASE) MCG/ACT ................................. 21 probenecid ............................................... 41 procainamide hcl ...................................... 24 PROCALAMINE SOLN 3 % ..................... 39 PROCARDIA ............................................ 23 PROCARDIA XL ...................................... 23 prochlorperazine ................................ 36, 37 prochlorperazine edisylate ....................... 36 prochlorperazine maleate ......................... 37 PROCRIT ................................................. 22 PROCYSBI CPDR 25 MG ........................ 57 PROCYSBI CPDR 75 MG ........................ 57 progesterone micronized .......................... 53 PROGLYCEM .......................................... 24 PROGRAF CAPS 0.5 MG ........................ 57 PROGRAF CAPS 1 MG ........................... 57 PROGRAF CAPS 5 MG ........................... 57 PROGRAF SOLN 5 MG/ML ..................... 57 PROLASTIN-C ......................................... 59 PROLENSA ............................................. 43 PROLEUKIN ............................................ 18 PROLIA SOLN 60 MG/ML........................ 57 PROMACTA ............................................. 22 promethazine & phenylephrine ................. 15 promethazine hcl ...................................... 15 PROMETRIUM ........................................ 53 propafenone hcl ....................................... 24 propantheline bromide ............................. 19 proparacaine hcl ...................................... 44 propranolol & hydrochlorothiazide ............ 27 propranolol hcl er cp24 120 mg ................ 27 propranolol hcl er cp24 160 mg ................ 27


propranolol hcl er cp24 60 mg ................. 27 propranolol hcl er cp24 80 mg ................. 27 propranolol hcl soln 1 mg/ml .................... 27 propranolol hcl soln 20 mg/5ml ................ 27 propranolol hcl soln 40 mg/5ml ................ 27 propranolol hcl tabs 10 mg ...................... 27 propranolol hcl tabs 20 mg ...................... 27 propranolol hcl tabs 40 mg ...................... 27 propranolol hcl tabs 60 mg ...................... 27 propranolol hcl tabs 80 mg ...................... 27 propylthiouracil ........................................ 54 PROQUAD .............................................. 61 PROSCAR ............................................... 57 PROSOL SOLN 20 % .............................. 39 PROTONIX PACK 40 MG ....................... 45 PROTONIX SOLR 40 MG ....................... 46 PROTONIX TBEC 20 MG ........................ 46 PROTONIX TBEC 40 MG ........................ 46 PROTOPIC .............................................. 64 protriptyline hcl ........................................ 37 PROVENTIL HFA AERS 108 (90 BASE)

MCG/ACT ............................................ 21 PROVERA ............................................... 53 PROVIGIL................................................ 31 PROZAC.................................................. 37 PROZAC WEEKLY .................................. 37 PRUDOXIN .............................................. 63 PULMICORT FLEXHALER AEPB 180

MCG/ACT ............................................ 59 PULMICORT FLEXHALER AEPB 90

MCG/ACT ............................................ 59 PULMICORT SUSP 0.25 MG/2ML .......... 59 PULMICORT SUSP 0.5 MG/2ML ............ 59 PULMICORT SUSP 1 MG/2ML ............... 59 PULMOZYME .......................................... 41 PURIXAN................................................. 18 PYLERA .................................................. 46 pyrazinamide ........................................... 12 pyridostigmine bromide ............................ 19

Q

QBRELIS ................................................. 25 QNASL .................................................... 43 QNASL CHILDRENS ............................... 43 QUADRACEL .......................................... 60 QUALAQUIN ........................................... 13 QUARTETTE ........................................... 49 QUAZEPAM ............................................ 31 QUDEXY XR ........................................... 33

quetiapine fumarate ................................. 37 QUILLICHEW ER CHER 20 MG .............. 31 QUILLICHEW ER CHER 30 MG .............. 31 QUILLICHEW ER CHER 40 MG .............. 31 QUILLIVANT XR SUSR 25 MG/5ML ........ 31 quinapril hcl .............................................. 25 quinapril-hydrochlorothiazide ................... 25 quinidine gluconate .................................. 24 QUINIDINE GLUCONATE ....................... 24 quinidine sulfate ....................................... 24 quinine sulfate .......................................... 13 QVAR ....................................................... 59

R

RABAVERT .............................................. 61 rabeprazole sodium .................................. 46 RADICAVA SOLN 30 MG/100ML ............ 35 RAGWITEK .............................................. 57 raloxifene hcl ............................................ 52 ramipril ..................................................... 25 RANEXA .................................................. 24 ranitidine hcl ............................................. 46 ranitidine hcl soln 150 mg/6ml .................. 46 ranitidine hcl soln 50 mg/2ml .................... 46 RAPAFLO ................................................ 20 RAPAMUNE ............................................. 57 RAPIVAB ................................................. 14 rasagiline mesylate .................................. 34 RASUVO SOAJ 10 MG/0.2ML ................. 57 RASUVO SOAJ 12.5 MG/0.25ML ............ 57 RASUVO SOAJ 15 MG/0.3ML ................. 57 RASUVO SOAJ 17.5 MG/0.35ML ............ 57 RASUVO SOAJ 20 MG/0.4ML ................. 57 RASUVO SOAJ 22.5 MG/0.45ML ............ 57 RASUVO SOAJ 25 MG/0.5ML ................. 57 RASUVO SOAJ 27.5 MG/0.55ML ............ 57 RASUVO SOAJ 30 MG/0.6ML ................. 57 RASUVO SOAJ 7.5 MG/0.15ML .............. 57 RAVICTI ................................................... 38 RAYALDEE .............................................. 65 RAYOS .................................................... 48 RAZADYNE ............................................. 19 RAZADYNE ER ....................................... 19 REBETOL ................................................ 14 REBIF ...................................................... 57 REBIF REBIDOSE ................................... 57 REBIF REBIDOSE TITRATION PACK ..... 57 REBIF TITRATION PACK ........................ 57 RECLAST SOLN 5 MG/100ML ................ 57


RECOMBIVAX HB ................................... 61 RECTIV ................................................... 64 REGLAN .................................................. 47 REGONOL SOLN 10 MG/2ML ................ 19 REGRANEX ............................................ 64 RELENZA DISKHALER ........................... 14 RELISTOR SOLN 12 MG/0.6ML ............. 47 RELISTOR SOLN 8 MG/0.4ML ............... 47 RELISTOR TABS 150 MG ....................... 47 RELPAX .................................................. 33 REMERON .............................................. 37 REMERON SOLTAB ............................... 37 REMICADE .............................................. 57 REMODULIN ........................................... 59 RENAGEL ............................................... 40 RENFLEXIS ............................................. 57 RENVELA ................................................ 40 repaglinide ............................................... 51 repaglinide-metformin hcl ........................ 51 REPATHA................................................ 23 REPATHA PUSHTRONEX SYSTEM ...... 23 REPATHA SURECLICK .......................... 23 REQUIP ................................................... 34 REQUIP XL ............................................. 34 RESCRIPTOR ......................................... 14 RESERPINE ............................................ 24 RESTASIS ............................................... 43 RESTORIL ............................................... 34 RETIN-A CREA 0.025 % ......................... 63 RETIN-A CREA 0.05 % ........................... 64 RETIN-A CREA 0.1 % ............................. 64 RETIN-A GEL 0.01 % .............................. 64 RETIN-A GEL 0.025 % ............................ 64 RETIN-A MICRO GEL 0.04 % ................. 64 RETIN-A MICRO GEL 0.1 % ................... 64 RETIN-A MICRO PUMP GEL 0.04 % ...... 64 RETIN-A MICRO PUMP GEL 0.08 % ...... 64 RETIN-A MICRO PUMP GEL 0.1 % ........ 64 RETROVIR CAPS 100 MG ...................... 14 RETROVIR SOLN 10 MG/ML .................. 14 RETROVIR SYRP 50 MG/5ML ................ 14 REVATIO SOLN 10 MG/12.5ML .............. 26 REVATIO SUSR 10 MG/ML .................... 26 REVATIO TABS 20 MG ........................... 26 REVLIMID................................................ 18 REXULTI ................................................. 37 REYATAZ ................................................ 14 RHEUMATREX ....................................... 18 RHINOCORT AQUA ................................ 43 RHOPHYLAC .......................................... 60

ribavirin (hepatitis c) ................................. 14 RIDAURA ................................................. 47 rifabutin .................................................... 12 RIFADIN ................................................... 12 RIFADIN SOLR 600 MG .......................... 12 rifampin .................................................... 12 rifampin solr 600 mg ................................. 12 RIFATER .................................................. 12 RILUTEK .................................................. 35 riluzole ..................................................... 35 rimantadine hydrochloride ........................ 14 RIMSO-50 ................................................ 57 ringers soln ........................................ 40, 41 RIOMET ................................................... 51 risedronate sodium ................................... 57 RISPERDAL ............................................. 37 RISPERDAL CONSTA ............................. 37 RISPERDAL M-TAB ................................. 37 risperidone ............................................... 37 RITALIN LA CP24 10 MG ........................ 31 RITALIN LA CP24 20 MG ........................ 31 RITALIN LA CP24 30 MG ........................ 31 RITALIN LA CP24 40 MG ........................ 31 RITALIN LA CP24 60 MG ........................ 31 RITALIN TABS 10 MG ............................. 31 RITALIN TABS 20 MG ............................. 31 RITALIN TABS 5 MG ............................... 31 RITUXAN ................................................. 18 RITUXAN HYCELA .................................. 18 rivastigmine .............................................. 19 rivastigmine tartrate .................................. 19 rizatriptan benzoate .................................. 33 ROBINUL SOLN 0.4 MG/2ML .................. 19 ROBINUL TABS 1 MG ............................. 19 ROBINUL-FORTE TABS 2 MG ................ 19 ROCALTROL ........................................... 65 ropinirole hydrochloride ............................ 34 rosuvastatin calcium ................................. 23 ROTARIX ................................................. 61 ROTATEQ ................................................ 61 ROXICODONE ........................................ 29 ROZEREM ............................................... 34 RUBRACA ............................................... 18 RUCONEST ............................................. 57 RYDAPT .................................................. 18 RYNODERM ............................................ 64 RYTARY .................................................. 34 RYTHMOL ............................................... 24 RYTHMOL SR ......................................... 24


S

SABRIL .................................................... 33 SAFYRAL ................................................ 49 SAIZEN ................................................... 54 SAIZEN CLICK.EASY .............................. 54 SAIZENPREP .......................................... 54 SALAGEN................................................ 19 SAMSCA ................................................. 39 SANCUSO ............................................... 45 SANDIMMUNE ........................................ 57 SANDIMMUNE SOLN 50 MG/ML ............ 57 SANDOSTATIN LAR DEPOT KIT 10 MG 57 SANDOSTATIN LAR DEPOT KIT 20 MG 57 SANDOSTATIN LAR DEPOT KIT 30 MG 58 SANDOSTATIN SOLN 100 MCG/ML ...... 58 SANDOSTATIN SOLN 1000 MCG/ML .... 58 SANDOSTATIN SOLN 200 MCG/ML ...... 58 SANDOSTATIN SOLN 50 MCG/ML ........ 58 SANDOSTATIN SOLN 500 MCG/ML ...... 58 SANTYL .................................................. 64 SAPHRIS ................................................. 37 SARAFEM ............................................... 37 SAVAYSA ................................................ 22 SAVELLA................................................. 35 SAVELLA TITRATION PACK .................. 35 SEASONIQUE ......................................... 49 SECTRAL ................................................ 27 selegiline hcl ............................................ 34 selenium sulfide ....................................... 62 SELZENTRY ........................................... 14 SEMPREX-D ........................................... 15 SENSIPAR TABS 30 MG ........................ 58 SENSIPAR TABS 60 MG ........................ 58 SENSIPAR TABS 90 MG ........................ 58 SEREVENT DISKUS ............................... 21 SEROQUEL ............................................. 37 SEROQUEL XR ....................................... 37 SEROSTIM .............................................. 54 sertraline hcl ............................................ 37 sevelamer carbonate ............................... 40 SFROWASA ENEM 4 GM/60ML ............. 44 SIGNIFOR ............................................... 54 SIGNIFOR LAR ....................................... 54 sildenafil citrate (pulmonary hypertension)

............................................................. 26 SILENOR ................................................. 34 SILIQ ....................................................... 64 SILVADENE ............................................ 62 silver sulfadiazine .................................... 62

SIMBRINZA ............................................. 44 SIMPONI .................................................. 58 SIMPONI ARIA ........................................ 58 SIMULECT SOLR 10 MG ........................ 58 SIMULECT SOLR 20 MG ........................ 58 simvastatin ......................................... 22, 23 SINEMET ................................................. 34 SINEMET CR ........................................... 34 SINGULAIR .............................................. 59 sirolimus ................................................... 58 SIRTURO ................................................. 12 SIVEXTRO ............................................... 10 SKELAXIN ............................................... 20 SKLICE ...................................................... 7 sodium chloride (gu irrigant) ..................... 40 sodium chloride soln 0.45 % .................... 41 sodium chloride soln 0.9 % ...................... 41 sodium chloride soln 2.5 meq/ml .............. 41 sodium chloride soln 3 % ......................... 41 sodium chloride soln 5 % ......................... 41 SODIUM DIURIL SOLR 500 MG .............. 39 SODIUM EDECRIN SOLR 50 MG ........... 39 SODIUM FLUORIDE ................................ 58 SODIUM LACTATE SOLN 5 MEQ/ML ..... 37 sodium phenylbutyrate ............................. 38 sodium polystyrene sulfonate ................... 40 SOLARAZE .............................................. 64 SOLIQUA ................................................. 51 SOLODYN ............................................... 10 SOLTAMOX ............................................. 18 SOLU-CORTEF ....................................... 48 SOLU-MEDROL SOLR 125 MG .............. 48 SOLU-MEDROL SOLR 2 GM .................. 48 SOLU-MEDROL SOLR 40 MG ................ 48 SOLU-MEDROL SOLR 500 MG .............. 48 SOMA ...................................................... 20 SOMATULINE DEPOT ............................ 58 SOMAVERT ............................................. 54 SONATA .................................................. 34 SOOLANTRA ........................................... 62 SORIATANE ............................................ 64 SORILUX ................................................. 64 sotalol hcl ................................................. 27 sotalol hcl (afib/afl) ................................... 27 SOTYLIZE ................................................ 27 SOVALDI ................................................. 14 SPIRIVA HANDIHALER CAPS 18 MCG .. 19 SPIRIVA RESPIMAT AERS 1.25 MCG/ACT

............................................................. 19


SPIRIVA RESPIMAT AERS 2.5 MCG/ACT ............................................................. 19

spironolactone & hydrochlorothiazide ...... 25 spironolactone tabs 100 mg ..................... 25 spironolactone tabs 25 mg ....................... 25 spironolactone tabs 50 mg ....................... 25 SPORANOX CAPS 100 MG .................... 12 SPORANOX SOLN 10 MG/ML ................ 12 SPRITAM TB3D 1000 MG ....................... 33 SPRITAM TB3D 250 MG ......................... 33 SPRITAM TB3D 500 MG ......................... 33 SPRITAM TB3D 750 MG ......................... 33 SPRYCEL ................................................ 18 STALEVO 100 ......................................... 34 STALEVO 125 ......................................... 34 STALEVO 150 ......................................... 34 STALEVO 200 ......................................... 34 STALEVO 50 ........................................... 34 STALEVO 75 ........................................... 34 STARLIX.................................................. 51 stavudine ................................................. 14 STELARA ................................................ 64 STIMATE SOLN 1.5 MG/ML .................... 53 STIOLTO RESPIMAT .............................. 19 STIVARGA .............................................. 18 STRATTERA ........................................... 35 STRENSIQ .............................................. 41 streptomycin sulfate ................................. 10 STRIANT MISC 30 MG ............................ 48 STRIBILD ................................................ 14 STRIVERDI RESPIMAT .......................... 21 STROMECTOL .......................................... 7 SUBOXONE ............................................ 35 SUBSYS .................................................. 29 SUCRAID ................................................ 41 sucralfate ................................................. 46 SULAR .................................................... 23 sulfacetamide sodium (acne) ................... 62 sulfacetamide sodium (ophth) .................. 42 sulfacetamide sod-prednisolone .............. 43 sulfadiazine ........................................ 10, 62 sulfamethoxazole-trimethoprim ................ 10 sulfamethoxazole-trimethoprim soln 400-80

mg/5ml ................................................. 10 SULFAMYLON CREA 85 MG/GM ........... 62 SULFAMYLON PACK 5 % ...................... 62 sulfasalazine ............................................ 10 sulindac ................................................... 29 sumatriptan .............................................. 33 sumatriptan succinate .............................. 33

SUMAVEL DOSEPRO ............................. 33 SUPRAX .................................................. 10 SUPREP BOWEL PREP KIT ................... 46 SURMONTIL ............................................ 37 SUSTIVA .................................................. 14 SUTENT ................................................... 18 SYLATRON .............................................. 18 SYLVANT ................................................. 18 SYMBICORT ............................................ 59 SYMBYAX ................................................ 37 SYMLINPEN 120 ..................................... 51 SYMLINPEN 60 ....................................... 51 SYNAGIS ................................................. 14 SYNALAR (CREAM) ................................ 63 SYNALAR CREA 0.025 % ....................... 63 SYNALGOS-DC ....................................... 29 SYNAREL ................................................ 53 SYNDROS SOLN 5 MG/ML ..................... 45 SYNERA .................................................. 63 SYNERCID SOLR 150-350 MG ............... 10 SYNJARDY .............................................. 51 SYNRIBO ................................................. 18 SYNTHROID ............................................ 54 SYPRINE ................................................. 47

T

TABLOID .................................................. 18 TACLONEX OINT 0.005-0.064 % ............ 63 TACLONEX SUSP 0.005-0.064 % ........... 63 tacrolimus ........................................... 58, 64 tacrolimus (topical) ................................... 64 TAFINLAR ................................................ 18 TAGRISSO .............................................. 18 TALTZ ...................................................... 64 TALWIN ................................................... 29 TAMIFLU .................................................. 14 tamoxifen citrate ....................................... 18 tamsulosin hcl .................................... 20, 55 TANZEUM ................................................ 51 TARCEVA ................................................ 18 TARGRETIN ...................................... 18, 65 TARKA ..................................................... 23 TASIGNA ................................................. 18 TASMAR .................................................. 34 TAXOTERE CONC 80 MG/4ML ............... 18 tazarotene ................................................ 65 tazicef solr 1 gm ....................................... 10 tazicef solr 2 gm ....................................... 10 tazicef solr 6 gm ....................................... 10


TAZORAC ............................................... 65 TECENTRIQ ............................................ 18 TECFIDERA ............................................ 58 TECHNIVIE ............................................. 14 TEFLARO SOLR 400 MG ........................ 10 TEFLARO SOLR 600 MG ........................ 10 TEGRETOL ............................................. 33 TEGRETOL-XR ....................................... 33 TEKTURNA ............................................. 25 TEKTURNA HCT ..................................... 25 telmisartan ......................................... 23, 25 telmisartan-amlodipine ............................. 23 telmisartan-hydrochlorothiazide ............... 25 temazepam .............................................. 34 TENEX .................................................... 24 TENIPOSIDE ........................................... 18 TENIVAC ................................................. 60 TENORETIC 100 ..................................... 27 TENORETIC 50 ....................................... 27 TENORMIN ............................................. 27 TEPADINA ............................................... 18 TERAZOL 3 ............................................. 62 TERAZOL 7 ............................................. 62 terazosin hcl ............................................ 22 terbinafine hcl .......................................... 12 terbutaline sulfate .................................... 21 terconazole vaginal .................................. 62 TESTIM GEL 50 MG/5GM (1%) .............. 48 testosterone ............................................. 48 testosterone cypionate ............................. 48 testosterone enanthate ............................ 48 TESTOSTERONE GEL 25 MG/2.5GM (1%)

............................................................. 48 TETANUS-DIPHTHERIA TOXOIDS TD .. 60 tetrabenazine ........................................... 35 tetracycline hcl ......................................... 10 TETRACYCLINE HCL ............................. 10 TEV-TROPIN SOLR 5 MG ...................... 54 THALOMID .............................................. 58 theophylline ............................................. 65 THIOLA ................................................... 58 thioridazine hcl ......................................... 37 thiotepa .................................................... 18 thiothixene ............................................... 37 THYMOGLOBULIN SOLR 25 MG ........... 58 THYROLAR-1 .......................................... 54 THYROLAR-1/2 ....................................... 54 THYROLAR-1/4 ....................................... 54 THYROLAR-2 .......................................... 54 THYROLAR-3 .......................................... 54

tiagabine hcl ............................................. 33 TIAZAC .................................................... 23 TICE BCG ................................................ 18 TIGAN ...................................................... 45 TIGECYCLINE SOLR 50 MG ................... 10 TIKOSYN ................................................. 24 timolol maleate ................................... 27, 44 timolol maleate (ophth) ............................. 44 TIMOPTIC OCUDOSE ............................. 44 TIMOPTIC-XE .......................................... 44 TINDAMAX .............................................. 13 tinidazole .................................................. 13 TIROSINT ................................................ 54 TIVICAY ................................................... 14 TIVORBEX ............................................... 29 tizanidine hcl ............................................ 20 TOBI .................................................. 10, 11 TOBI PODHALER .................................... 11 TOBRADEX OINT 0.3-0.1 % .................... 43 TOBRADEX ST SUSP 0.3-0.05 % ........... 43 TOBRADEX SUSP 0.3-0.1 % .................. 43 tobramycin ................................... 11, 42, 43 tobramycin (ophth) ................................... 42 tobramycin sulfate soln 10 mg/ml ............. 11 tobramycin sulfate soln 80 mg/2ml ........... 11 tobramycin-dexamethasone ..................... 43 TOBREX OINT 0.3 % ............................... 42 TOBREX SOLN 0.3 % ............................. 42 TOLAK CREA 4 % ................................... 65 tolazamide ................................................ 51 tolbutamide .............................................. 51 tolcapone ................................................. 34 tolmetin sodium ........................................ 29 tolterodine tartrate .................................... 65 TOPAMAX ............................................... 33 TOPAMAX SPRINKLE ............................. 33 TOPICORT .............................................. 63 TOPICORT SPRAY ................................. 63 topiramate ................................................ 33 topotecan hcl ............................................ 18 TOPROL XL ............................................. 27 TORISEL .................................................. 18 torsemide ................................................. 39 TOUJEO SOLOSTAR SOPN 300 UNIT/ML

............................................................. 51 TOVIAZ .................................................... 65 tpn electrolytes soln ................................. 41 TRACLEER .............................................. 59 TRADJENTA ............................................ 51 tramadol hcl ............................................. 29


tramadol-acetaminophen ......................... 29 trandolapril ......................................... 23, 25 trandolapril-verapamil hcl ......................... 23 tranexamic acid ....................................... 22 tranexamic acid soln 1000 mg/10ml ........ 22 TRANSDERM-SCOP (1.5 MG) ................ 45 TRANXENE-T .......................................... 34 tranylcypromine sulfate ............................ 37 TRAVASOL SOLN 10 % .......................... 39 TRAVATAN Z .......................................... 44 travoprost................................................. 44 trazodone hcl tabs 100 mg ...................... 37 trazodone hcl tabs 150 mg ...................... 37 trazodone hcl tabs 300 mg ...................... 37 trazodone hcl tabs 50 mg ........................ 37 TREANDA SOLR 100 MG ....................... 18 TREANDA SOLR 25 MG ......................... 18 TRECATOR ............................................. 12 TRELSTAR MIXJECT .............................. 18 TREMFYA ............................................... 65 TRESIBA FLEXTOUCH ........................... 51 tretinoin .............................................. 18, 64 tretinoin (chemotherapy) .......................... 18 tretinoin microsphere ............................... 64 TREXIMET .............................................. 33 triamcinolone acetonide (mouth) .............. 63 triamcinolone acetonide (nasal) ............... 43 triamcinolone acetonide (topical) ............. 63 triamterene-hctz caps 37.5-25 mg ........... 39 triamterene-hctz caps 50-25 mg .............. 39 triamterene-hctz tabs 37.5-25 mg ............ 39 triamterene-hctz tabs 75-50 mg ............... 39 triazolam .................................................. 34 TRIBENZOR ............................................ 23 TRICOR ................................................... 23 TRIDESILON CREA 0.05 % .................... 63 trifluoperazine hcl .................................... 37 trifluridine ................................................. 42 TRIGLIDE ................................................ 23 trihexyphenidyl hcl ................................... 34 TRILEPTAL ............................................. 33 TRILIPIX .................................................. 23 trimethobenzamide hcl ............................. 45 trimethoprim ................................. 10, 15, 42 trimipramine maleate ............................... 37 TRI-NORINYL (28) .................................. 49 TRINTELLIX ............................................ 37 TRIOSTAT SOLN 10 MCG/ML ................ 54 TRISENOX .............................................. 18 TRIUMEQ ................................................ 14

TRIZIVIR .................................................. 14 TROKENDI XR ........................................ 33 TROPHAMINE SOLN 10 % ..................... 39 TROPHAMINE SOLN 6 % ....................... 39 trospium chloride ...................................... 65 TRULICITY .............................................. 51 TRUMENBA ............................................. 61 TRUSOPT ................................................ 44 TRUVADA TABS 100-150 MG ................. 14 TRUVADA TABS 133-200 MG ................. 14 TRUVADA TABS 167-250 MG ................. 14 TRUVADA TABS 200-300 MG ................. 14 TUDORZA PRESSAIR ............................. 19 TWINRIX .................................................. 61 TWYNSTA ............................................... 23 TYBOST ................................................... 58 TYGACIL SOLR 50 MG ........................... 11 TYKERB ................................................... 18 TYMLOS .................................................. 53 TYPHIM VI ............................................... 61 TYSABRI .................................................. 58 TYVASO .................................................. 59 TYZEKA ................................................... 14

U

UCERIS ............................................. 48, 63 ULORIC ................................................... 58 ULTRACET .............................................. 29 ULTRAM .................................................. 29 ULTRAM ER ............................................ 29 ULTRAVATE CREA 0.05 % ..................... 63 ULTRAVATE LOTN 0.05 % ..................... 63 ULTRAVATE OINT 0.05 % ...................... 63 UNASYN SOLR 15 (10-5) GM ................. 11 UNASYN SOLR 3 (2-1) GM ..................... 11 UNITUXIN ................................................ 18 UPTRAVI ................................................. 59 UROCIT-K 10 ........................................... 37 UROCIT-K 15 ........................................... 37 UROCIT-K 5 ............................................. 37 UROXATRAL ........................................... 20 URSO 250 ................................................ 47 URSO FORTE ......................................... 47 ursodiol .................................................... 47 UVADEX .................................................. 65

V

VAGIFEM ................................................. 52 valacyclovir hcl ......................................... 14


VALCHLOR ............................................. 65 VALCYTE SOLR 50 MG/ML .................... 14 VALCYTE TABS 450 MG ........................ 14 valganciclovir hcl ..................................... 14 VALIUM ................................................... 34 valproate sodium ..................................... 33 valproate sodium soln 500 mg/5ml .......... 33 valproic acid ............................................. 33 valsartan ...................................... 23, 25, 26 valsartan-hydrochlorothiazide ............ 23, 26 VALSTAR ................................................ 18 VALTREX ................................................ 14 VANCOCIN HCL ..................................... 11 vancomycin hcl ........................................ 11 VANCOMYCIN HCL IN DEXTROSE SOLN

1-5 GM/200ML-% ................................. 11 VANCOMYCIN HCL IN DEXTROSE SOLN

500-5 MG/100ML-% ............................. 11 vancomycin hcl solr 10 gm ...................... 11 vancomycin hcl solr 1000 mg................... 11 vancomycin hcl solr 500 mg .................... 11 VANOS .................................................... 63 VANTAS .................................................. 18 VAQTA .................................................... 61 VARIVAX ................................................. 61 VARIZIG .................................................. 60 VARUBI ................................................... 45 VASCEPA................................................ 23 VASERETIC ............................................ 26 VASOTEC ............................................... 26 VECTIBIX ................................................ 18 VECTICAL ............................................... 65 VELCADE ................................................ 18 VELPHORO ............................................. 40 VELTASSA .............................................. 40 VELTIN .................................................... 65 VEMLIDY ................................................. 14 VENCLEXTA STARTING PACK TBPK 10 &

50 & 100 MG ........................................ 18 VENCLEXTA TABS 10 MG ..................... 18 VENCLEXTA TABS 100 MG ................... 18 VENCLEXTA TABS 50 MG ..................... 18 venlafaxine hcl ......................................... 37 VENLAFAXINE HCL ER .......................... 37 VENTAVIS ............................................... 59 VENTOLIN HFA AERS 108 (90 BASE)

MCG/ACT ............................................ 21 VERAMYST ............................................. 43 verapamil hcl ........................................... 23 verapamil hcl soln 2.5 mg/ml ................... 23

VEREGEN ............................................... 65 VERELAN ................................................ 24 VERELAN PM .......................................... 24 VERSACLOZ ........................................... 37 VESICARE ............................................... 65 VEXOL ..................................................... 43 VFEND IV SOLR 200 MG ........................ 12 VFEND SUSR 40 MG/ML ........................ 12 VFEND TABS 200 MG ............................. 12 VFEND TABS 50 MG ............................... 12 VIBATIV ................................................... 11 VIBERZI ................................................... 47 VIBRAMYCIN ........................................... 11 VICOPROFEN ......................................... 29 VICTOZA ................................................. 51 VICTRELIS .............................................. 14 VIDAZA .................................................... 18 VIDEX EC CPDR 125 MG........................ 14 VIDEX EC CPDR 200 MG........................ 14 VIDEX EC CPDR 250 MG........................ 14 VIDEX EC CPDR 400 MG........................ 14 VIDEX SOLR 2 GM .................................. 14 VIEKIRA PAK ........................................... 14 VIEKIRA XR ............................................. 14 VIGAMOX ................................................ 42 VIIBRYD ................................................... 37 VIIBRYD STARTER PACK ...................... 37 VIMIZIM SOLN 5 MG/5ML ....................... 41 VIMOVO ................................................... 29 VIMPAT.................................................... 33 VIMPAT SOLN 200 MG/20ML ................. 33 VINATE CALCIUM ................................... 65 vinblastine sulfate..................................... 18 vincristine sulfate...................................... 18 vinorelbine tartrate ................................... 18 VIOKACE TABS 10440 UNIT ................... 46 VIOKACE TABS 20880 UNIT ................... 46 VIRACEPT ............................................... 14 VIRAMUNE .............................................. 14 VIRAMUNE XR ........................................ 14 VIRAZOLE ............................................... 14 VIREAD POWD 40 MG/GM ..................... 14 VIREAD TABS 150 MG ............................ 14 VIREAD TABS 200 MG ............................ 14 VIREAD TABS 250 MG ............................ 14 VIREAD TABS 300 MG ............................ 14 VIROPTIC ................................................ 42 VISTARIL ................................................. 34 VISTIDE SOLN 75 MG/ML ....................... 14 VISTOGARD ............................................ 58


VITEKTA.................................................. 14 VIVELLE-DOT PTTW 0.025 MG/24HR .... 52 VIVELLE-DOT PTTW 0.0375 MG/24HR .. 52 VIVELLE-DOT PTTW 0.05 MG/24HR...... 52 VIVELLE-DOT PTTW 0.075 MG/24HR .... 52 VIVELLE-DOT PTTW 0.1 MG/24HR ....... 52 VIVITROL ................................................ 35 VIVLODEX ............................................... 29 VOGELXO GEL 50 MG/5GM (1%) .......... 48 VOGELXO PUMP GEL 12.5 MG/ACT (1%)

............................................................. 48 VOLTAREN ............................................. 65 VORAXAZE ............................................. 58 voriconazole ............................................ 12 voriconazole solr 200 mg ......................... 12 VOSEVI ................................................... 14 vospire er tb12 4 mg ................................ 21 vospire er tb12 8 mg ................................ 21 VOTRIENT .............................................. 18 VP-PNV-DHA .......................................... 65 VPRIV ...................................................... 41 VRAYLAR CAPS 1.5 MG ........................ 37 VRAYLAR CAPS 3 MG ........................... 37 VRAYLAR CAPS 4.5 MG ........................ 37 VRAYLAR CAPS 6 MG ........................... 37 VRAYLAR CPPK 1.5 & 3 MG .................. 37 VYTORIN................................................. 23 VYVANSE CAPS 10 MG ......................... 31 VYVANSE CAPS 20 MG ......................... 31 VYVANSE CAPS 30 MG ......................... 31 VYVANSE CAPS 40 MG ......................... 31 VYVANSE CAPS 50 MG ......................... 31 VYVANSE CAPS 60 MG ......................... 31 VYVANSE CAPS 70 MG ......................... 31 VYVANSE CHEW 10 MG ........................ 31 VYVANSE CHEW 20 MG ........................ 31 VYVANSE CHEW 30 MG ........................ 31 VYVANSE CHEW 40 MG ........................ 31 VYVANSE CHEW 50 MG ........................ 31 VYVANSE CHEW 60 MG ........................ 31

W

warfarin sodium ....................................... 22 water for irrigation, sterile ........................ 40 WELCHOL ............................................... 23 WELLBUTRIN ......................................... 37 WELLBUTRIN SR.................................... 37 WELLBUTRIN XL .................................... 37

X

XADAGO .................................................. 34 XALATAN ................................................. 44 XALKORI ................................................. 18 XANAX ..................................................... 34 XANAX XR ............................................... 34 XARELTO ................................................ 22 XARELTO STARTER PACK .................... 22 XARTEMIS XR ......................................... 29 XATMEP .................................................. 18 XELJANZ ................................................. 58 XELJANZ XR ........................................... 58 XENAZINE ............................................... 35 XEOMIN SOLR 100 UNIT ........................ 58 XEOMIN SOLR 200 UNIT ........................ 58 XEOMIN SOLR 50 UNIT .......................... 58 XERESE .................................................. 62 XERMELO ............................................... 18 XGEVA SOLN 120 MG/1.7ML ................. 58 XIFAXAN .................................................. 11 XIGDUO XR ............................................. 51 XIIDRA ..................................................... 43 XOLAIR .................................................... 59 XOPENEX ................................................ 21 XOPENEX CONCENTRATE .................... 21 XOPENEX HFA ....................................... 21 XTAMPZA ER .......................................... 29 XTANDI .................................................... 18 XULTOPHY .............................................. 51 XURIDEN ................................................. 58 XYLOCAINE ...................................... 58, 63 XYREM .................................................... 35 XYZAL ..................................................... 15

Y

YASMIN 28 .............................................. 49 YAZ .......................................................... 49 YERVOY .................................................. 18 YF-VAX .................................................... 61 YONDELIS ............................................... 18 YOSPRALA .............................................. 22

Z

zafirlukast ................................................. 59 zaleplon.................................................... 34 ZALTRAP ................................................. 18 ZANAFLEX .............................................. 20 ZANOSAR ................................................ 18 ZANTAC ................................................... 46


ZANTAC SOLN 1000 MG/40ML .............. 46 ZARONTIN .............................................. 33 ZARXIO ................................................... 22 ZAVESCA ................................................ 58 ZEBETA .................................................. 27 ZEGERID................................................. 46 ZEJULA ................................................... 18 ZELAPAR ................................................ 34 ZELBORAF .............................................. 18 ZEMAIRA................................................. 59 ZEMBRACE SYMTOUCH ....................... 33 ZEMPLAR................................................ 65 ZEMPLAR SOLN 2 MCG/ML ................... 65 ZEMPLAR SOLN 5 MCG/ML ................... 65 ZENPEP CPEP 10000 UNIT ................... 46 ZENPEP CPEP 15000 UNIT ................... 46 ZENPEP CPEP 20000 UNIT ................... 46 ZENPEP CPEP 25000 UNIT ................... 46 ZENPEP CPEP 3000-10000 UNIT .......... 46 ZENPEP CPEP 40000 UNIT ................... 46 ZENPEP CPEP 5000 UNIT ..................... 46 ZEPATIER ............................................... 14 ZERBAXA ................................................ 11 ZERIT ...................................................... 14 ZESTORETIC .......................................... 26 ZESTRIL .................................................. 26 ZETIA ...................................................... 23 ZETONNA ............................................... 43 ZIAC ........................................................ 27 ZIAGEN SOLN 20 MG/ML ....................... 15 ZIAGEN TABS 300 MG ........................... 15 ZIANA ...................................................... 65 zidovudine ......................................... 13, 15 zileuton .................................................... 59 ZINACEF IN STERILE WATER SOLN 1.5

GM ....................................................... 11 ZINACEF SOLR 1.5 GM .......................... 11 ZINACEF SOLR 7.5 GM .......................... 11 ZINACEF SOLR 750 MG ......................... 11 ZINBRYTA ............................................... 58 ZINC TRACE METAL SOLN 1 MG/ML .... 41 ZINECARD SOLR 250 MG ...................... 58 ZINPLAVA ............................................... 60 ZIOPTAN ................................................. 44 ziprasidone hcl ......................................... 37 ZIPSOR ................................................... 29 ZIRGAN ................................................... 42 ZITHROMAX PACK 1 GM ....................... 11 ZITHROMAX SOLR 500 MG ................... 11 ZITHROMAX SUSR 100 MG/5ML ........... 11

ZITHROMAX SUSR 200 MG/5ML ........... 11 ZITHROMAX TABS 250 MG .................... 11 ZITHROMAX TABS 500 MG .................... 11 ZITHROMAX TABS 600 MG .................... 11 ZITHROMAX TRI-PAK TABS 500 MG ..... 11 ZITHROMAX Z-PAK TABS 250 MG ......... 11 ZMAX SUSR 2 GM .................................. 11 ZOCOR .................................................... 23 ZOFRAN .................................................. 45 ZOFRAN ODT .......................................... 45 ZOFRAN SOLN 40 MG/20ML .................. 45 ZOHYDRO ER ......................................... 29 zoledronic acid conc 4 mg/5ml ................. 58 zoledronic acid soln 5 mg/100ml .............. 58 ZOLINZA .................................................. 18 zolmitriptan ............................................... 33 ZOLOFT ................................................... 37 zolpidem tartrate ...................................... 34 ZOLPIMIST .............................................. 34 ZOMACTON SOLR 10 MG ...................... 54 ZOMACTON SOLR 5 MG ........................ 54 ZOMETA CONC 4 MG/5ML ..................... 58 ZOMETA SOLN 4 MG/100ML .................. 58 ZOMIG ..................................................... 33 ZOMIG ZMT ............................................. 33 ZONALON ................................................ 63 ZONEGRAN ............................................. 33 zonisamide ............................................... 33 ZONTIVITY .............................................. 22 ZORBTIVE ............................................... 54 ZORTRESS TABS 0.25 MG ..................... 58 ZORTRESS TABS 0.5 MG ....................... 58 ZORTRESS TABS 0.75 MG ..................... 58 ZORVOLEX ............................................. 29 ZOSTAVAX .............................................. 61 ZOSYN SOLN 2-0.25 GM/50ML .............. 11 ZOSYN SOLN 3-0.375 GM/50ML ............ 11 ZOSYN SOLR 40.5 (36-4.5) GM .............. 11 ZOVIRAX ........................................... 15, 62 ZUBSOLV ................................................ 35 ZUPLENZ ................................................. 45 ZURAMPIC .............................................. 41 ZYBAN ..................................................... 37 ZYCLARA ................................................ 65 ZYCLARA PUMP ..................................... 65 ZYDELIG .................................................. 18 ZYFLO CR TB12 600 MG ........................ 59 ZYFLO TABS 600 MG ............................. 59 ZYKADIA .................................................. 18 ZYLET ...................................................... 43


ZYLOPRIM .............................................. 58 ZYMAXID................................................. 42 ZYPREXA ................................................ 37 ZYPREXA RELPREVV ............................ 37 ZYPREXA ZYDIS .................................... 37

ZYTIGA .................................................... 19 ZYVOX ..................................................... 11 ZYVOX SOLN 200 MG/100ML ................. 11 ZYVOX SOLN 600 MG/300ML ................. 11

09/2017

Esta lista de medicamentos recetados disponibles se actualizó el 1 de septiembre de 2017. Para obtener información más reciente o si tiene alguna pregunta, comuníquese con el Servicio a los Miembros al 1-800-476-2167 o bien, para los usuarios de TTY, al 711, siete días a la semana, de 8 a. m. a 8 p. m., o visite kp.org/seniormedrx.

kp.org/seniormedrx Please recycle.



Documents

Kaiser Permanente Senior Advantage de Medicare y Medicaid …info.kaiserpermanente.org/info_assets/directory/pdf/codb... · 2017-10-01 · Por lo general, tiene que usar las farmacias