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ML2884A Medco Maintenance Drug List Effective September 1, 2011 The Medco Maintenance Drug List contains medications that are generally taken on a long-term or maintenance basis for conditions such as high blood pressure or high cholesterol. Through the Medco Pharmacy ® mail order service, you can get up to a 90-day supply of your medications for the same cost as two 30-day fills at a participating retail pharmacy. For the PPO Plan only:You may purchase maintenance medications from a participating retail pharmacy three times, after which you must use the mail order pharmacy for the medications to be covered under the PPO Plan. If you continue to purchase your maintenance medications at a retail pharmacy after the third fill, you will be responsible for the entire cost of the medication. Note: This list (1) does not include all maintenance medications, (2) is subject to change, (3) may include medications not covered by your health plan and (4) may include medications that are subject to additional coverage rules as determined by your health plan.

Medco Maintenance Drug List Effective September … Maintenance Drug List Effective September 1, ... CITALOPRAM HBR CITRACAL PRENATAL + DHA CITRACAL PRENATAL RX

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ML2884A

Medco Maintenance Drug ListEffective September 1, 2011

The Medco Maintenance Drug List contains medications that are generally taken on a long-term ormaintenance basis for conditions such as high blood pressure or high cholesterol. Through theMedco Pharmacy® mail order service, you can get up to a 90-day supply of your medications for thesame cost as two 30-day fills at a participating retail pharmacy.

For the PPO Plan only: You may purchase maintenance medications from a participating retail pharmacy three times, after which you must use the mail order pharmacy for the medications to becovered under the PPO Plan. If you continue to purchase your maintenance medications at a retailpharmacy after the third fill, you will be responsible for the entire cost of the medication.

Note: This list (1) does not include all maintenance medications, (2) is subject to change, (3) mayinclude medications not covered by your health plan and (4) may include medications that are subject to additional coverage rules as determined by your health plan.

ML2884A

Medco Maintenance Drug List

1ST CHOICE LANCETS1ST TIER UNIFINE PENTIPS3 STEP SKIN CARE3M NEXCARE STOMASEAL

AACARBOSEACCESS SETACCOLATEACCU-CHEKACCU-CHEK ACTIVEACCU-CHEK ADVANTAGEACCU-CHEK AVIVAACCU-CHEK COMFORT CURVEACCU-CHEK COMPACTACCU-CHEK COMPACT BLUE CONTROLACCU-CHEK D-TRON PLUSACCU-CHEK IIACCU-CHEK IIIACCU-CHEK INSTANTACCU-CHEK INSTANTPLUSACCU-CHEK RAPID DACCU-CHEK SIMPLICITYACCU-CHEK SOFTCLIXACCU-CHEK SPIRITACCU-CHEK TENDER 1ACCU-CHEK TENDER 2ACCU-CHEK ULTRAFLEX-1ACCU-CHEK ULTRAFLEX-2ACCU-CHEK VOICEMATEACCU-DROPACCUPRILACCURETICACCUSUREACCUTREND GLUCOSEACEBUTOLOL HCLACEONACETAZOLAMIDEACETEST REAGENTACIPHEXACTIGALLACTI-LANCEACTI-LANCE LITEACTI-LANCE SPECIALACTIVE LIFE

ACTIVE LIFE CLOSED-END POUCHACTIVE LIFE CONVEXACTIVE LIFE DRAINABLE POUCHACTIVE LIFE ONE-PIECEACTIVE LIFE POUCHACTIVE LIFE STOMA CAPACTIVE LIFE UROSTOMY POUCHACTIVELLAACTONELACTOPLUS METACTOPLUS MET XRACTOSACURA CONTROL SOLUTIONACURA CONTROL SOLUTION LOWACURA CONTROL SOLUTION NORMALACURA METER KITACURA PLUSACURA STARTER KITACURA TEST STRIPSADALATADALAT CCADAPTADAPT BARRIERADAPT BARRIER RINGADAPT CONVEX BARRIERADAPT PASTEADAPT STOMA POWDERADENOCARDADENOSINEADHESIVE BARRIERSADHESIVE REMOVERADJUSTABLE LANCING DEVICEADVAIR DISKUSADVAIR HFAADVANCEADVANCE INTUITIONADVANCE MICRO-DRAWADVANCED AM/PMADVANCED CARE PLUSADVANCED LANCING DEVICEADVANCED NATALCAREADVANCED TRAVEL LANCETSADVANCED-RF NATALCAREADVICORADVOCATE BLOOD GLUCOSE MONITORADVOCATE CONTROL SOLUTIONADVOCATE DUO

ADVOCATE LANCETADVOCATE LANCING DEVICEADVOCATE REDI-CODEADVOCATE TEST STRIPAEROBIDAEROBID-MAFEDITAB CRAGGRASTATAGGRENOXAGRYLINAIMSCO ULTRA THIN IIAIRAVITEALBAFORTALBAFORT SALBA-LYBEALBATUSSIN NNALBERTSONS STARTERALBUTEROL SULFATEALCOHOLALCOHOL PREPALDACTAZIDEALDACTONEALDOMETALDORILALENDRONATE SODIUMALESSEALKALINE BATTERIESALLANFOL RXALLANTEXALLKARE PROTECT BARRIER WIPEALORAALPHAGANALPHAGAN PALPROSTADILALTACEALTERNATE SITE LANCETALTERNATE SITE LANCING DEVICEALTOPREVALUPENTALVESCOAMANTADINE HCLAMARYLAMILORIDE HCLAMILORIDE HCL W/HCTZAMINATE WITH 90MG IRONAMINOBENZOATE POTASSIUMAMINOPHYLLINE

ML2884A

AMIODARONE HCLAMITRIPTYLINE HCLAMITRIPTYLINE-PERPHENAZINEAMLODIPINE BESYLATEAMLODIPINE BESYLATE-BENAZEPRILAMOXAPINEAMYL NITRITEANAFRANILANAGRELIDE HYDROCHLORIDEANAPROXANAPROX DSANASTROZOLEANEMAGENANEMAGEN FORTEANSAIDANTARAANTI-STICK INSULINANTI-STICK TUBERCULINAPIDRAAPIDRA SOLOSTARAPLENZINAPPBUTAMONEAPPBUTAMONE-DAPPFORMINAPPFORMIN-DAPPLIANCE COVER DRAINABLEAPRACLONIDINE HCLAPRESAZIDEAPRESOLINEAPRIAPTIVUSAQUASOL AAQUATENSENARANELLEAREDIAARICEPTARICEPT ODTARIMIDEXARM BELTARMOUR THYROIDAROMASINARTANEARTHROTECASCENSIA AUTODISCASCENSIA BREEZE 2ASCENSIA BRIOASCENSIA ELITE

ASCENSIA ELITE XLASCOR LASCOR L NCASCORBIC ACIDASENDINASMANEXASPIRIN E.C.ASPIRIN SRASSURAASSURA 2PC DRAINABLEASSURA 2PC IRRIGATION SLEEVEASSURA ACASSURA CONVEXASSURA CUT-TO-FITASSURA EASICLOSE DRAINABLEASSURA EXTRAASSURA FLANGEASSURA FLANGE CONVEXASSURA IRRIGATION FACE PLATEASSURA LIGHT EASICLOSE DRAINASSURA NON-CONVEX DRAINABLEASSURA OSTOMY BELTASSURA PEDIATRIC POUCHASSURA POUCHASSURA STANDARD WEARASSURA TWO-PIECE URO MINICAPASSURA WOUND MANAGERASSURE 3ASSURE 4ASSURE DOSEASSURE IIASSURE LANCEASSURE PLATINUMASSURE PROATABEXATABEX ECATACANDATACAND HCTATENOLOLATENOLOL W/CHLORTHALIDONEATROPENATROVENTATROVENT HFAAURORA HEALTHCARE LANCETSAUTOJECT 2AUTO-LANCETAUTOLANCET DEVICE W-LANCETS

AUTOLET IMPRESSIONAUTOLET LITEAUTOLET LITE CLINISAFEAUTOLET MINIAUTOLET MKII CLINISAFEAUTOLET PLATFORMSAUTOPENAVANDARYLAVANDIAAVAPROAVENTYL HCLAVIANEAVODARTAXID ORAL SOLUTIONAXID PULVULEAYGESTINAZASANAZATHIOPRINEAZILECTAZOPTAZORAZULFIDINEAZURETTE

BBACMINBALZIVABANISH IIBANZELBARACLUDEBARDIC ADAPTER-TUBINGB-D AUTO INJECTORBD AUTOSHIELD PEN NEEDLEBD ECLIPSEBD GENIE LANCETBD INSULIN PEN NEEDLE UF MINIBD INSULIN PEN NEEDLE UF ORIGBD INSULIN PEN NEEDLE UF SHORTB-D INSULIN SYRINGEBD INSULIN SYRINGE MFBD INTEGRA NEEDLEBD INTEGRA SYRINGEB-D MAGNI-GUIDE MAGNIFIERBD MICROTAINER LANCETB-D NEEDLES

Medco Maintenance Drug List

ML2884A

B-D PRECISIONGLIDE NEEDLEB-D SAFE CLIPB-D SAFETYGLIDEB-D ULTRA FINE LANCETSBECONASE AQBENAZEPRIL HCLBENAZEPRIL HCL-HCTZBENICARBENICAR HCTBENZTROPINE MESYLATEBEROCCABETAGANBETAPACEBETAPACE AFBETAXOLOL HCLBETIMOLBETOPTIC SBICALUTAMIDEBIDILBIFERA RXBI-FILIN GBIOCELBIONIME RIGHTEST GM300 SYSTEMBIOSCANNER GLUCOSE TESTBIOSCANNER KETONE TESTBISOPROLOL FUMARATEBISOPROLOL FUMARATE/HCTZBLOCADRENBLOOD GLUCOSEBLOOD GLUCOSE MONITORINGBLOOD GLUCOSE MTR START KITBLOOD GLUCOSE TESTBLOOD SUGAR DIAGNOSTICBONIVAB-PLEXB-PLEX PLUSBREEZE 2BRETHINEBRETYLIUM TOSYLATEBREVIBLOCBREVICONBRIMONIDINE TARTRATEBRITE LIFE STARTERBROMOCRIPTINE MESYLATEBRONCAPBRONCODURBRONCOMAR-1

BRONDILBUDEPRION SRBUDEPRION XLBUDESONIDEBUMETANIDEBUMEXBUPROPION HCLBUPROPION HCL XLBUPROPION SRBYETTABYSTOLIC

CCADUETCAFFEINE & SODIUM BENZOATECALAFOL RXCALANCALAN SRCALCIJEXCALCITONIN-SALMONCALCITRIOLCALDOLORCAL-NATECALOMISTCAMBIACAMILACAPASTAT SULFATECAPOTENCAPOZIDECAPTOPRILCAPTOPRIL/HYDROCHLOROTHIAZIDECARAFATECARBAMAZEPINECARBAMAZEPINE XRCARBATROLCARBIDOPA/LEVODOPACARDENECARDENE SRCARDIOTEK RXCARDIZEMCARDIZEM CDCARDIZEM LACARDIZEM SRCARDURACARDURA XL

CARENATAL DHACAREONECARESENS NCAROMEGACARRA SCENTCARTEOLOL HCLCARTIA XTCARTRIDGE FILLING AIDCARTRIDGE PUMPCARTRIDGE STAMPEDCARVEDILOLCASODEXCATAFLAMCATAPRESCATAPRES-TTSCATHETER W-CAIR CLAMP NON-VENTCAVAN ONE OMEGACAVAN-ALPHA KITCAVAN-EC SOD DHACAVAN-FOLATE DHACAVAN-HEME OBCAVERJECTCAZIANTCEFOLCELEBREXCELEXACELLCEPTCELONTINCENESTINCENOGEN ULTRACENOGEN-OBCENOLATECENTRATEXCEREBYXCEREFOLINCEREFOLIN NACCESIACETIRIZINE HCLCHEMSTRIPCHEMSTRIP 10 WITH SGCHEMSTRIP 2 GPCHEMSTRIP 50BCHEMSTRIP 7CHEMSTRIP 9CHEMSTRIP BG DIARYCHEMSTRIP BG TEST KITCHEMSTRIP K

Medco Maintenance Drug List

CHEMSTRIP UGCHEMSTRIP UGKCHILDREN’S ADVILCHLOROTHIAZIDECHLORPROPAMIDECHLORTHALIDONECHOLESTYRAMINECHOLESTYRAMINE LIGHTCHOLINE MAG TRISALICYLATECHROMAGENCHROMAGEN FACHROMAGEN FORTECIALISCILOSTAZOLCIMETIDINECIMETIDINE IN SODIUM CHLORIDECITALOPRAM HBRCITRACAL PRENATAL + DHACITRACAL PRENATAL RXCITRANATAL 90 DHACITRANATAL ASSURECITRANATAL B-CALMCITRANATAL DHACITRANATAL HARMONYCITRANATAL RXCLARINEXCLARINEX-D 12 HOURCLARINEX-D 24 HOURCLEANLET KIDSCLEANLET LANCETCLEANLET XLCLEVER CHEK BLOOD GLUCOSE SYSTCLEVER CHEK CONTROL SOLUTIONCLEVER CHEK LANCETSCLEVER CHEK TEST STRIPSCLEVER CHOICECLEVER CHOICE PROCLEVIPREXCLICKFINECLIMARACLIMARA PROCLINISTIX REAGENTCLINITEST REAGENTCLINORILCLIP & STORCLOMIPRAMINE HCLCLONIDINE HCL

CLORPRESCLOSED POUCH/DEODOR FILM/FLNGCLOSED-END POUCHCOAGUCHEKCOBAL-1000COGENTINCOLESTIDCOLESTIPOL HCLCOLOPLASTCOLOPLAST PASTECOLOPLAST RINGCOLOPLAST SKIN BARRIERCOLOSTOKIT IRRIGATORCOLOSTOMY BARIUM ENEMA KITCOLOSTOPADSCOLOSTOTIPCOLOSTOTIP W-QUICK DISCONNECTCOMBGENCOMBI RXCOMBIGANCOMBIPATCHCOMBIPRESCOMBISTIX REAGENTCOMBIVENTCOMBIVIRCOMFORTCOMFORT LANCETSCOMFORT SHORTCOMFORT WEAR POUCH COVERCOMPACT IRRIGATORCOMPLETE NATAL DHACOMPLETENATECOMPLETE-RF PRENATALCOMTANCO-NATAL FACONCEPT DHACONCEPT OBCONE TIPCONISONCONTACT DETACH INFUSION SETCONTINUOUS GLUCOSE SENSORCONTOURCONTOUR ICONTOUR USBCONTROLCONTROL SOLUTIONCONVEX SYN BARR W-FLOAT FLANGE

COPDCORDARONECOREGCOREG CRCORGARDCORLOPAMCORVERTCORVITACORVITECORZIDECOSOPTCOVARYXCOVARYX H.S.COVERA-HSCOZAARCPL DRAINABLE POUCHCREONCRESTORCRIXIVANCRNATALCROMOLYN SODIUMCRYSELLECUPRIMINECURITYCURITY ALCOHOL PREPSCYANOCOBALAMINCYCLESSACYCLOSERINECYCLOSPORINCYCLOSETCYCRINCYMBALTACYMED SEALCYSTOSCOPY-IRRIGATION SETCYTOMELCYTOTEC

DDAILYVITEDAYPRODAYTO-HIMBINDDAVPDECADRON TURBINAIREDELESTROGENDEMADEXDEMSER

Medco Maintenance Drug List

ML2884A

DEMULENDEPACONDEPAKENEDEPAKOTEDEPAKOTE ERDEPAKOTE SPRINKLEDEPENDEPLINDEPO-ESTRADIOLDEPO-PROVERADEPO-SUBQ PROVERADEPRIZINEDERMA-GUARDDESIPRAMINE HCLDESMOPRESSIN ACETATEDESOGENDESYRELDETROLDETROL LADEX4 GLUCOSEDEX4 GLUCOSE BITSDEXFERRUMDEXFOLDEXILANTDEXTROSE-LACT RINGERS-KCLDIABETADIABETIC.COM STARTERDIABINESEDIAL-A-FLO MICRODRIP SETDIALYVITEDIALYVITE 800 WITH IRONDIAMOXDIAMOX SEQUELSDIASCREEN 10DIASCREEN 1B REAGENTDIASCREEN 1G REAGENTDIASCREEN 1K REAGENTDIASCREEN 2GK REAGENTDIASCREEN 2GPDIASCREEN 3 REAGENTDIASCREEN 4NL REAGENTDIASCREEN 4OBLDIASCREEN 4PHDIASCREEN 5DIASCREEN 6DIASCREEN 7DIASCREEN 8

DIASCREEN 9DIASTIX REAGENTDIATX ZNDIBENZYLINEDICLOFENAC POTASSIUMDICLOFENAC SODIUMDIDANOSINEDIDGETDIDRONELDIETHYLSTILBESTROLDIFIL-GDIFIL-G FORTEDIFLUNISALDIGESPLEN PLUSDIGEXDIGITEKDIGOXINDILACOR XRDILANTINDILATRATE-SRDILEX-GDILT-CDDILTIA XTDILTIAZEM ERDILTIAZEM HCLDILTIAZEM-D5WDILT-XRDILTZAC ERDIOVANDIOVAN HCTDIPYRIDAMOLEDISETRONIC BELTDISOPYRAMIDE PHOSPHATEDITROPANDITROPAN XLDIURILDIURIL SODIUMDIVALPROEX SODIUMDIVALPROEX SODIUM ERDIVIGELDOCOSAVITDOLOBIDDORZOLAMIDE HCLDORZOLAMIDE-TIMOLOLDOUBLE-HESIVEDOXAZOSIN MESYLATEDOXEPIN HCL

DRAIN POUCH/REPLACE DEODOR FLTDRAINABLE ADHESIVE POUCHDRAINABLE MINI-POUCH W-FLANGEDRAINABLE POUCHDRAINABLE POUCH CLAMPDRAINABLE POUCH W/FILTR&FLANGEDRAINABLE POUCH WITH FLANGEDRISDOLDROPLET LANCETSDROPLET LANCING DEVICED-TRON CARTRIDGED-TRON FILLING SETD-TRON POWER PACKD-TRONPLUS ADAPTERD-TRONPLUS POWER PACKDUALVIT FDUALVIT OBDUALVIT PLUSDUANE READE STARTERDUET DHADUET DHA COMPLETEDUET DHA ECDUET DHA EC STUARTNADUET DHA EC STUARTNATALDUET DHA STUARTNATALDUET DHA WITH FERRAZONEDUET STUARTNATALDUETACTDULEEK-DP 15DULEEK-DP 7.5DULEEK-MET NEWDULERADUO-CAREDUOLOCK CURVED TAIL CLOSUREDUONEBDUOVIT DHADURAHESIVE MOLDABLE CONVEXDYAZIDEDYFLEX-GDY-G LIQUIDDYGASEDYLIXDYNACIRCDYNACIRC CRDY-O-DERMDYPHYLLINE GG ESDYPHYLLINE-GG

Medco Maintenance Drug List

ML2884A

DYRENIUM

EEAKIN COHESIVE SEALSEAKIN FISTULA & WOUND POUCHEAKIN SKIN BARRIEREASICLOSE WIDE OUTLETEASPRINEASY CHECKEASY CHECK TEST STRIPEASY CLICKEASY COMFORT INSULIN SYRINGEEASY PRO PLUSEASY TALKEASY TOUCHEASY TRAKEASYGLUCOEASYMAXEASYMAX NEASYMAX SPEAKINGEASYMAX VEASYPROECKERD STARTERECLIPSEECLIPSE CONTROL SOLUTIONEC-NAPROSYNECONOMY POUCHED CYTE FED-BRON GEDECRINEDECRIN SODIUMEDEXEDGE OBEFFER-KEFFEXOREFFEXOR XREFFIENTELASTIC BELTELAVILELDEPRYLELDERCAPSELEMENT BLOOD GLUCOSE METERELEMENT CONTROL SOLUTIONELEMENT TEST STRIPSELESTRIN

ELITE OBELITE-OBELIXOPHYLLINEMBRACEEMBRACE GLUCOSE CONTROL LOWEMTRIVAENABLEXENALAPRIL MALEATEENALAPRIL MALEATE/HCTZENALAPRILATENCORAENDURONENEMA BAGENEMA BAG WITH CATHETERENFOLASTENFOLAST-NENJUVIAENPRESSEENVISIONENZYCAPENZYMAXEPIFLUREPIKLOREPITOLEPIVIREPIVIR HBVEPZICOMEPLERENONEEQUATEEQUETROERITROGENERRINESIDRIXESMOLOL HCLESSIANESSIAN H.S.ESTEEM DRAINABLE POUCHESTEEM SYNERGYESTRACEESTRADERMESTRADIOLESTRADIOL VALERATEESTRADIOL-NORETHINDRONE ACETATESTRASORBESTRINGESTROGELESTROGEN & METHYLTESTOSTERONE

ESTROPIPATEESTROSTEP FEETHAMBUTOL HCLETHEDENTETHMOZINEETHOSUXIMIDEETIDRONATE DISODIUMETODOLACEULEXINEVAMISTEVENCAREEVISTAEVOLUTION BLOOD GLUCOSE METEREVOLUTION CONTROL SOLUTIONEVOLUTION TEST STRIPSEXACTECHEXACTECH RSGEXEL HUBER NEEDLEEXEL HYPODERMIC NEEDLEEXEL INSULIN SYRINGEEXEL MTI DRAWING NEEDLEEXELONEXFORGEEXFORGE HCTEXPRESS MED STARTEREXTRA COLOSTOMY POUCHEXTRA OPEN-END DRAINEXTRA SECURITY POUCHEXUBERA CHAMBEREXUBERA INHALEREXUBERA RELEASE UNITE-Z JECT ALCOHOL SWABE-Z JECT BLOOD LANCETE-Z JECT LANCETSE-Z SET WINGED INFUSION SETEZ SMARTEZ SMART PLUSEZ-LETS

FFABBFAC-XFAMOTIDINEFAMOTIDINE-NSFANATREX

Medco Maintenance Drug List

ML2884A

FAST TAKEFAT EMULSION IV SETFE CFECAL COLLECTORFECAL COLLECTOR, DRAINABLEFELDENEFELODIPINE ERFEMARAFEMCON FEFEMECAL OBFEMECAL OB PLUS DHAFEMHRTFEMRINGFEMTABSFEMTRACEFENOFIBRATEFENOFIBRIC ACIDFENOGLIDEFENOLDOPAM MESYLATEFENOPROFEN CALCIUMFEOCYTE FAFERAHEMEFEROCONFERO-FOLICFEROTRINFEROTRINSICFERRALET 90FERRAPLUS 90FERREX 150 FORTEFERREX 150 FORTE PLUSFERREX 28FERRLECITFERROCITE PLUSFERROCITE-FFERROFLEX 150 FORTEFERROGELS FORTEFERROMARFERRO-PLEX HEMATINICFERROVITEFERROVITE FAFERROVITE FORTEFE-TINIC 150 FORTEFETRINFEXOFENADINE HCLFEXOFENADINE-PSE ERFIBRICORFIFTY50 RESERVOIR

FIFTY50 TEST STRIPFILTER NEEDLEFILTER REPLACEMENTFILTER SECURITY CLOSED POUCHFILTRODOR POUCH FILTERFINASTERIDEFINGERSTIXFIRSTCHOICE DRAINABLE POUCHFIRSTCHOICE POSTOP DRAIN POUCHFIRSTCHOICE UROSTOMY POUCHFISTULA POUCHFLAVOXATE HCLFLECAINIDE ACETATEFLEXI-SEALFLEXI-SEAL FMSFLEXI-TRAK ANCHORING DEVICEFLEXTEND SKIN BARRIERFLOMAXFLONASEFLOVENT DISKUSFLOVENT HFAFLOW-EZEFLUNISOLIDEFLUOR-A-DAYFLUOXETINE DRFLUOXETINE HCLFLURBIPROFENFLUTAMIDEFLUTICASONE PROPIONATEFLUVOXAMINE MALEATEFOLAMINFOLASTFOLBALIN PLUSFOLBECALFOLBEEFOLBEE PLUSFOLBICFOLCAL DHAFOLCAPSFOLCAPS CARE ONEFOLCAPS OMEGA-3FOLEVEFOLEVE PLUSFOLGARD RXFOLIC ACIDFOLIC ACID-CYANCOBAL-PYRIDOXINFOLINATAL PLUS B

FOLITABFOLIVANE-EC CALCIUM DHA NFFOLIVANE-FFOLIVANE-OBFOLIVANE-PLUSFOLIVANE-PRX DHA NFFOLMORFOLNATEFOLNATE PLUSFOLPACE RXFOLPLEXFOLPLEX 2.2FOLTABSFOLTABS 90 PLUS DHAFOLTABS PRENATAL PLUS DHAFOLTRATEFOLTRINFOLTXFOLVITEFORA D10FORA D15FORA D15CFORA D15GFORA D15ZFORA D20FORA G20FORA G71AFORA LANCETSFORA LANCING DEVICEFORA V10FORA V12FORA V20FORMULA B PLUSFORMULA-BFORTAMETFORTAVITFORTICALFOSAMAXFOSAMAX-DFOSINOPRIL SODIUMFOSINOPRIL-HYDROCHLOROTHIAZIDEFOSPHENYTOIN SODIUMFREESTYLE CONTROL SOLUTIONFREESTYLE FLASH SYSTEMFREESTYLE FREEDOMFREESTYLE FREEDOM LITEFREESTYLE LANCETS

Medco Maintenance Drug List

ML2884A

FREESTYLE LITE METERFREESTYLE LITE STRIPSFREESTYLE NAVIGATORFREESTYLE SIDEKICK IIFREESTYLE SYSTEMFREESTYLE TEST STRIPSFREESTYLE UNISTIK 2FUMATINICFUROSEMIDE

GG-4GABAPENTINGABITRILGABOXETINEGALANTAMINEGANITEGASTRINEXGASTROCROMGDRIVEGELNIQUEGEMFIBROZILGENESUPP-500GENETECT PLUSGENGRAFGENHEMATGENTEX ADEGENTLE DRAWGENTLE TOUCH LOOP OSTOMY SYSGENTLE TOUCH SYSTEMGESTICAREGESTICARE DHAGIANVIGILDESS FEGLIMEPIRIDEGLIPIZIDEGLIPIZIDE ERGLIPIZIDE XLGLIPIZIDE-METFORMINGLUCO BURSTGLUCO SHOTGLUCOCARD 01GLUCOCARD 01 CONTROLGLUCOCARD 01 SENSORGLUCOCARD 01-MINI

GLUCOCARD VITALGLUCOCARD VITAL SENSORGLUCOCARD X-METERGLUCOCARD X-METER CONTROLGLUCOCARD X-SENSORGLUCOCOM AUTOLINKGLUCOCOM BLOOD GLUCOSEGLUCOCOM CONTROL SOLUTIONGLUCOCOM GLUCOSEGLUCOCOM LANCETSGLUCOLABGLUCOLAB CONTROLGLUCOLEADERGLUCOLET 2GLUCOMETER DEXGLUCOMETER ELITEGLUCOPHAGEGLUCOPHAGE XRGLUCOPROGLUCOSEGLUCOSE BITSGLUCOSE CONTROL SOLUTIONGLUCOSE GELGLUCOSE TEST STRIPGLUCOSOURCEGLUCOSTIX REAGENTGLUCOTROLGLUCOTROL XLGLUCOVANCEGLUCOWATCHGLUMETZAGLUTOFAC-ZXGLUTOSEGLYBURIDEGLYBURIDE MICRONIZEDGLYBURIDE-METFORMIN HCLGLYNASEGLYSETGOLD SODIUM THIOMALATEGOOD NEIGH STARTERGUANABENZ ACETATEGUANFACINE HCLGUARDIAN 2PC SYSTEM MINI-POUCHGUARDIAN REAL-TIMEGUARDIAN RT CHARGERGUARDIAN RT STARTER KITGUARDIAN RT SYSTEM

GUARDIAN TEST PLUGGUARDIAN TRANSMITTER TAPEGYNODIOL

HHAEMOLANCEHAEMOLANCE PLUSHAEMOLANCE, RETRACTABLEHEATHERHEMA-COMBISTIXHEMATINIC PLUSHEMATINIC WITH FOLIC ACIDHEMATOGENHEMATOGEN FAHEMATOGEN FORTEHEMATRONHEMATRON-AFHEMAXHEMOCYTE PLUSHEMOCYTE-FHEPSERAHIP PRENATALHOLLIHESIVE PASTE 2OZ TUBEHOLLIHESIVE SKIN BARRIERHOLLISTER SKIN CLEANSERHOLLISTER SKIN COND CREAMHOLLISTER SKIN MOISTURE BARRIRHOSPITAL PACK IRRIGATORHOSPITAL QUALITY CONTROL LOGHOSPITAL TEST STATION KITH-TRON PLUS-PISTON RODH-TRON POWER PACKH-TRONPLUS ADAPTERHUMALOGHUMALOG MIX 50-50HUMALOG MIX 75-25HUMAPEN LUXURA HDHUMAPEN MEMOIRHUMULIN 50-50HUMULIN 70-30HUMULIN NHUMULIN RHYDRALAZINE HCLHYDRA-ZIDEHYDROCHLORIC ACID

Medco Maintenance Drug List

ML2884A

HYDROCHLOROTHIAZIDEHYDRODIURILHYDROXOCOBALAMINHYDROXYCHLOROQUINE SULFATEHYGROTONHYPODERMIC NEEDLEHYPOLANCEHYTRINHYZAAR

IIBC W/FOLICIBERET-FOLIC 500IBUPROFENIBUTILIDE FUMARATEICAR PRENATALICAR-C PLUSICAR-C PLUS SRIFEREX 150 FORTEI-FOL PLUSILE-SORBILETIN II LENTE (PORK)IMDURIMIPRAMINE HCLIMIPRAMINE PAMOATEIMURANIN CONTROL PEN NEEDLEINATAL ADVANCEINATAL GTINATAL ULTRAINDAPAMIDEINDERALINDERAL LAINDERIDEINDOCININDOCIN I.V.INDOCIN SRINDOMETHACININFEDINFINITYINFINITY CONTROL SOLUTIONINFINITY TEST STRIPSINFUSION SETINFUVITEINFUVITE ADULT

INNOPRAN XLINNOVOINOMAXINPATIENT LOGBOOKINSERTION TUBE CATHETERINSET 30 INFUSION SETINSET 30 TUBINGINSET INFUSION SETINSPRAINSTACLEANINSTA-GLUCOSEINSULIN CARTRIDGEINSULIN PEN NEEDLEINSULIN- SYRINGEINSUL-TOTEINSUMEDINSUPENINTALINTEGRA FINTEGRA PLUSINTEGRILININTELENCEINTRAVENOUS, ARTERIAL & BLOODINVIRASEIODOPENIOPIDINEIPRATROPIUM BROMIDEIPRATROPIUM-ALBUTEROLIROFOLIRONIRON DEXTRAN COMPLEXIRON-CIRO-PLEXIRRIGATION SETIRRIGATION SLEEVEISMOISOCHRONISONARIFISONIAZIDISOPROPYL ALCOHOLISOPTIN S.R.ISOPTO CARBACHOLISOPTO CARPINEISORDILISOSORBIDE DINITRATEISOSORBIDE MONONITRATEISOXSUPRINE HCL

ISRADIPINEISTALOLIV ADMINISTRATION SETIV PREP ANTISEPTICIV PREP WIPESIVITES RX

JJALYNJANUMETJANUVIAJAY-PHYLJOLESSAJOLIVETTEJUNELJUNEL FE

KK EFFERVESCENTKALETRAKAOCHLOR-EFFKAON-CLKAPIDEXKAR C PLUSKARAYAKARAYA DRAINABLE OSTOMY POUCHKARAYA GUMKARAYA PASTE TUBEKARAYA SEAL CLOSED STOMA POUCHKARIVAKAY CIELK-DURKELNOR 1-35KEMADRINKEPPRAKEPPRA XRKERR STARTERKETOCAREKETO-DIASTIX REAGENTKETONEKETOPROFENKETOSTIX REAGENTKEYNOTEKINRAY

Medco Maintenance Drug List

ML2884A

K-LORKLOR-CONKLOR-CON MKLOR-CON-EFK-LYTEK-LYTE-CLKOLNATAL DHAK-PRIMEK-TABKUTRASEKU-ZYMEKU-ZYME HP

LLABETALOL HCLLABSTIX REAGENT STRIPSLACTOCAL-FLADY LITELAIRD TIPLAMICTALLAMICTAL ODTLAMICTAL XRLAMOTRIGINELANCETLANCET DEVICELANCETS, THINLANCING DEVICELANCING SYSTEMLANOXICAPSLANOXINLANOXIN PEDIATRICLANSOPRAZOLELANTUSLANTUS SOLOSTARLAPASELASIXLEENALESCOLLESCOL XLLESSINALEVACETLEVATOLLEVEMIRLEVETIRACETAMLEVITRA

LEVLENLEVLITELEVOBUNOLOL HCLLEVORALEVOTHYROXINE SODIUMLEVOXYLLEXAPROLEXIVALEXXELLIBERTY CONTROL SOLUTIONLIBERTY MONITORLIBERTY TEST STRIPLIDOCAINE HCLLIDOCAINE HCL IN DEXTROSELIFE MEDICAL STARTERLIFESCANLIFESHIELD BLUNT CANNULALINEARITY TEST KITLIOTHYRONINE SODIUMLIPITORLIPOFENLIPRAMLIPRAM-PN20LISINOPRILLISINOPRIL-HCTZLITE TOUCHLITE TOUCH INSULIN PEN NEEDLESLITTLE ONES ACTIVE LIFE POUCHLITTLE ONES CLOSED-END POUCHLITTLE ONES DRAINABLE POUCHLITTLE ONES SKIN BARRIERLITTLE ONES SUR-FIT PED BELTLITTLE ONES UROSTOMY POUCHLIVALOL-METHYLFOLATE CALCIUMLO/OVRALLOCHOLESTLOCHOLEST LIGHTLODINELODINE XLLODOSYNLOESTRINLOESTRIN 24 FELOESTRIN FELOFIBRALONG STARTERLONITEN

LOOP OSTOMY BRIDGE, STERILELOPIDLOPRESSORLOPRESSOR HCTLO-PROFILE UROSTOMY POUCHLOSARTAN POTASSIUMLOSARTAN-HYDROCHLOROTHIAZIDELOSEASONIQUELOTENSINLOTENSIN HCTLOTRELLOVASTATINLOVAZALOW-OGESTRELLOZI-FLURLOZOLLS PLUM PRIMARY SET-OLLUDENT FLUORIDELUDIOMILLUER-LOK SYRINGELUFYLLINLUFYLLIN-GGLUMIGANLUTERALUVOXLUVOX CRLYBRELLYTENSOPRIL

MM.V.I. ADULTM.V.I. PEDIATRICM.V.I.-12M9CLEANER-DECRYSTALLIZERMACUTEKMAGELLAN INSULIN SAFETY SYRNGMAJOR COMFORTMANIFOLD 111-SLMANNITOLMANUVITE SPMAPROTILINE HCLMARNATAL-FMARNATAL-F PLUSMARTINICMATERNA

Medco Maintenance Drug List

ML2884A

MATERNITYMAVIKMAX BLOOD GLUCOSE METERMAX GLUCOSE CONTROL SOLUTIONMAX GLUCOSE TEST STRIPSMAXARON FORTEMAXIMAMAXINATEMAXZIDEMECLOFENAMATE SODIUMMEDICAL ADHESIVEMEDI-JECTOR ADAPTERMEDI-JECTOR VISIONMEDI-LANCEMEDISENSEMEDISENSE CONTROLMEDISENSE GLUCOSE KETONE CONTRMEDLANCE PLUSMEDROXYPROGESTERONE ACETATEMEDTRONIC REMOTE CONTROLMEFENAMIC ACIDMEGA C-A PLUSMEGAVITE RXMEIJER STARTERMELOXICAMMENESTMENOSTARMEPHYTONMESTINONMETAGLIPMETANXMETAPROTERENOL SULFATEMETFORMIN HCLMETFORMIN HCL ERMETHAZOLAMIDEMETHIMAZOLEMETHYCLOTHIAZIDEMETHYL SALICYLATEMETHYLDOPAMETHYLDOPA/HYDROCHLOROTHIAZIDEMETHYLDOPATE HCLMETIPRANOLOLMETOLAZONEMETOPROLOL SUCCINATEMETOPROLOL TARTRATEMETOPROLOL-HYDROCHLOROTHIAZIDEMEVACOR

MEXILETINE HCLMEXITILMIACALCINMICARDISMICARDIS HCTMICROMICRO THIN LANCETSMICRODERMMICRODERM PLUSMICRODOTMICROGESTINMICROGESTIN FEMICROHESIVE STOMA PASTEMICRO-KMICROLETMICROLET VACULANCEMICRONASEMICROSKIN BARRIERMICROZIDEMIDAMORMIMVEYMINI UROSTOMY POUCHMINI-DRAIN OPEN END POUCHMINILINK REAL-TIME TRANSMITTERMINIMEDMINIMED RESERVOIRMINIPRESSMINOXIDILMIO INFUSION SETMIOCHOL-EMIOSTATMIRAPEXMIRAPEX ERMIRCETTEMIRTAZAPINEMISOPROSTOLMOBICMODICONMODURETICMOEXIPRIL HCLMOEXIPRIL-HYDROCHLOROTHIAZIDEMONOJECTMONOJECT INSULIN SYRINGEMONOJECT SYRINGEMONOJECTOR LANCET DEVICEMONOKETMONOLET LANCETS

MONOLET THIN LANCETSMONONESSAMONOPRILMONOPRIL HCTMOTRINMST 600MULTAQMULTI-B-PLUSMULTICHEWMULTIFOLMULTIFOL PLUSMULTIGENMULTIGEN FOLICMULTIGEN PLUSMULTI-LANCET DEVICEMULTINATAL PLUSMULTI-NATE 30MULTI-NATE 30 DHAMULTI-NATE DHA EXTRAMULTI-RET FOLIC 500MULTISTIXMULTISTIX 10 SGMULTISTIX 5MULTISTIX 7MULTISTIX 8 SGMULTISTIX 9MULTISTIX 9 SGMULTIVITAMIN W/FLUORIDE & IRONMULTIVITAMIN W/MINERALSMULTIVITAMIN WITH FLUORIDEMUSEMVC-FLUORIDEM-VITMYAMBUTOLMYCI BRON-GMYCOBUTINMYCOPHENOLATE MOFETILMYFERON-150 FORTEMYFORTICMYGLUCOHEALTHMYKIDZ IRON FLMYNATALMYNATAL ADVANCEMYNATAL PLUSMYNATAL-ZMYNATE 90 PLUSMYO VYT

Medco Maintenance Drug List

ML2884A

MYOCHRYSINEMYSOLINE

NNABUMETONENADOLOLNADOLOL-BENDROFLUMETHIAZIDENAFRINSENALFONNAMENDANANO PEN NEEDLENAPRELANNAPRELAN CR DOSEPAKNAPROSYNNAPROXENNAPROXEN SODIUMNASACORT AQNASALIDENASARELNASCOBALNASONEXNATACAPSNATACHEWNATAFORTNATALCARENATALCARE PICNATALCARE PIC FORTENATALCARE PLUSNATALCARE RXNATALCARE THREENATALVITNATATABNATATAB CFENATATAB FANATAZIANATELLENATELLE CNATELLE ONENATELLE PLUSNATELLE PREFERNATELLE-EZNATRECORNATURE-THROIDNAVARRO STARTERNECON

NEEDLE FREE SYRINGE KITNEEDLE-PRO EDGENEEDLESNEEVONEEVO DHANEFAZODONE HCLNEOPROFENNEOSTIGMINE BROMIDENEOSTIGMINE METHYLSULFATENEORALNEPHPLEX RXNEPHROCAPSNEPHRON FANEPHRONEXNEPHRO-VITE RXNEPTAZANENERVIDOXNERVIDOX SNERVIDOX-6 NRNERVIDOX-6 SNESTABS CBFNESTABS FANESTABS RXNEUPRONEURIN-SLNEURO B12NEURO B12 FORTENEURO B-12 FORTE SNEURO B-12 SNEURO-B12NEURO-B12 FORTE NRNEURODEP NRNEURONTINNEURPATH-BNEW IMAGENEW IMAGE CLOSED MINI-POUCHNEW IMAGE CLOSED POUCHNEW IMAGE COLOSTOMY-ILEO KITNEW IMAGE DRAINABLE KITNEW IMAGE DRAINABLE MINI-POUCHNEW IMAGE DRAINABLE POUCHNEW IMAGE FLEXTENDNEW IMAGE FLEXWEARNEW IMAGE IRRIGATION SLEEVENEW IMAGE KITNEW IMAGE SKIN BARRIERNEW IMAGE SKIN BARRIER-FLANGE

NEW IMAGE UROSTOMYNEW IMAGE UROSTOMY KITNEW IMAGE UROSTOMY POUCHNEWTEKNEXIUMNIACORNIASPANNIC 750NICARDIPINE HCLNICOMIDENICOTINAMIDENICOTINAMIDE ZCFNIFEDIAC CCNIFEDICAL XLNIFEDIPINENIFEDIPINE ERNIFEREX GOLDNIFEREX-150 FORTENIFEREX-PN FORTENIGHT DRAIN ADAPTERNILANDRONNIMODIPINENIMOTOPNISOLDIPINENITROGLYCERIN MICRO PUMP SETNITROPRESSNIZATIDINENO STING SKIN PREPNOKOR ADMIX NEEDLENOKOR NEEDLENOLVADEXNONVENTED T-U-R SETNORA-BENORDETTENORETHINDRONE ACETATENORGESTREL-ETHINY ESTRANORINYLNORMODYNENORPACENORPACE CRNORPRAMINNOR-Q-DNORTHYXNORTRELNORTRIPTYLINE HCLNORVASCNORVIR

Medco Maintenance Drug List

ML2884A

NOVA MAX BLOOD GLUCOSE METERNOVA SUREFLEXNOVAFERRUMNOVAMAX PLUSNOVANATALNOVASTARTNOVOFINENOVOFINE AUTOCOVERNOVOLIN 70-30NOVOLIN 70-30 INNOLETNOVOLIN LNOVOLIN NNOVOLIN N INNOLETNOVOLIN RNOVOLIN R INNOLETNOVOLOGNOVOLOG MIX 70-30NOVOPEN 3NOVOPEN JRNUFOLNU-NATAL ADVANCEDNUTRAVANCENUTRICAPNUTRINATENUTRIPORT BALLOONNUTRISPIRENUVARING

OO.A.D.OB + DHAOB COMPLETEOB COMPLETE DHAOB-NATAL ONEOBSTETRIX DHAOBSTETRIX ECOBTREXOBTREX DHAO-CAL FAO-CAL PRENATALOCELLAOCTRONOCUPRESSODOR ELIMINATOROGEN

OGESTRELOLEPTRO EROMEPRAZOLEOMEPRAZOLE-SODIUM BICARBONATEOMNARISOMNIPODONE TOUCH BASIC SYSTEMONE TOUCH DELICAONE TOUCH GLUCOSE CONTROL SOLNONE TOUCH II TEST STRIPSONE TOUCH LANCETSONE TOUCH SURESOFTONE TOUCH TEST STRIPSONE TOUCH ULTRA 2ONE TOUCH ULTRA CONTROL SOLNONE TOUCH ULTRA SMARTONE TOUCH ULTRA SYSTEMONE TOUCH ULTRA TEST STRIPSONE TOUCH ULTRALINKONE TOUCH ULTRAMINIONE-PIECE DRAINABLE POUCHONE-PIECE UROSTOMY POUCHONGLYZAOPTINATEOPTIPRANOLOLOPTIUMOPTIUM EZORETICORINASEORSINI INSULIN SYRINGEORTHO EVRAORTHO MICRONORORTHO TRI-CYCLENORTHO TRI-CYCLEN LOORTHO-CEPTORTHO-CYCLENORTHO-ESTORTHO-NOVUMORTHO-PREFESTORUDISOSMITROLOSTOMY BELTOSTOMY PASTEOVCONOVRALOXAPROZINOXCARBAZEPINE

OXYBUTYNIN CHLORIDEOXYBUTYNIN CHLORIDE EROXYTROL

PPACERONEPALCAPS 10PALCAPS 20PAMELORPAMIDRONATE DISODIUMPANCREASEPANCREASE MTPANCREAZEPANCRECARB MS-16PANCRECARB MS-4PANCRECARB MS-8PANCRELIPASEPANFIL GPANGESTYME CNPANGESTYME ECPANGESTYME MT 16PANGESTYME ULPANOCAPSPANOCAPS MT 16PANOCAPS MT 20PANOKASEPANTOPRAZOLE SODIUMPAPAVERINE HCLPARADIGMPARADIGM INFUSIONPARADIGM INSULIN PUMP PATHWAYPARADIGM LINK BLOOD GLUCOSEPARADIGM REAL-TIMEPARADIGM REMOTE CONTROLPARADIGM SILHOUETTEPARA-TIMEPARCOPAPARLODELPAROXETINE HCLPASERPAXILPAXIL CRPCA CONT INF MINI-BOREPCA MINI-BOREPCA SET

Medco Maintenance Drug List

ML2884A

P-D NATAL PLUSPEGANONEPEN- NEEDLEPENICILLAMINE(D-)PENLET PLUS BLOOD SAMPLERPEPCIDPERINDOPRIL ERBUMINEPERSANTINEPEXEVAPHARMACIST CHOICEPHENOXYBENZAMINE HCLPHENYTEKPHENYTOINPHENYTOIN SODIUMPHYTONADIONEPILOCARPINE HCLPILOPINE HSPINDOLOLPIROXICAMPISTON RODPLAQUENILPLARETASEPLAVIXPLENDILPLETALPLUM LC 5000 NITROGLY SETPLUM LC 5000 PRIMARY SETPLUMSET MICRODRIP PUMP SET-OLPLUMSET PRIMARY SET-OLPLUMSET SPECIALITY PUMP SET-OLPNV-DHAPNV-DHA PLUSPNV-IRONPNV-OMEGAPNV-SELECTPOCKETCHEM EZPOLY IRON PNPOLY IRON PN FORTEPOLYFINPOLYFIN QRPOLY-IRON 150 FORTEPOLYSACCHARIDE IRON FORTEPOLY-VI-FLORPOLY-VI-FLOR W/IRONPOLY-VITAMIN WITH FLUORIDEPOLYVITAMIN WITH FLUORIDE-IRONPOLYVITAMIN WITH IRON-FLUORIDE

PONSTELPORTIAPOT CHLORIDE/DEXTROSE/NSPOTABAPOTASSIUM ACETATEPOTASSIUM BICARBONATEPOTASSIUM CHL-NORMAL SALINEPOTASSIUM CHLORIDEPOTASSIUM CHLORIDE/DEXTROSEPOTASSIUM CHLORIDE-DW5-LRPOUCH CLAMPPOUCHKINS DRAIN TUBEPOUCHKINS DRAINABLE POUCHPOUCHKINS PEDIATRIC 1PC POUCHPOUCHKINS PEDIATRIC 2PC POUCHPOUCHKINS PEDIATRIC BELTPOUCHKINS PREMIE POUCHPOUCHKINS SKIN BARRIERPOUCHKINS UROSTOMY POUCHPR NATAL 400PR NATAL 400 ECPR NATAL 430PR NATAL 430 ECPR NATAL 440 ECPRAMIPEXOLE DI-HCLPRANDIMETPRANDINPRAVACHOLPRAVASTATIN SODIUMPRAZOSIN HCLPRECAREPRECARE CONCEIVEPRECARE PREMIERPRECISIONPRECISION GLUCOSE CONTROLPRECISION LINKPRECISION PCXPRECISION PCX PLUSPRECISION POINT OF CAREPRECISION Q-I-DPRECISION SOF-TACTPRECISION XTRAPRECISIONGLIDEPRECOSEPREFERA-OBPREFERA-OB ONEPREFERA-OB PLUS DHA

PREFESTPREMARINPREMESIS RXPREMIER CLOSED MINI-POUCHPREMIER CLOSED POUCHPREMIER COLOSTOMY-ILEOSTOMYPREMIER DRAINABLE MINI-POUCHPREMIER DRAINABLE POUCHPREMIER LOCK N ROLLPREMIER PRE-SIZED MINI-POUCHPREMIER SKN BARR W-FLOAT FLANGPREMIER UROSTOMYPREMIER UROSTOMY POUCHPREMIER UROSTOMY POUCH/FLANGEPREMIUM CLOSED OSTOMY POUCHPREMIUM DRAINABLE POUCHPREMIUM SKIN BARRIERPREMIUM SKIN BARRIER PASTEPREMPHASEPREMPROPRENA-CAPPRENACAREPRENAFIRSTPRENAPLUSPRENATABS CBFPRENATABS FAPRENATABS OBNPRENATABS RXPRENATALPRENATAL 1 + 1PRENATAL 19PRENATAL ADPRENATAL ADVANTAGEPRENATAL FORMULAPRENATAL FORMULA 3PRENATAL LOW IRONPRENATAL MR 90 FEPRENATAL MTRPRENATAL MULTIVITAMIN W-IRONPRENATAL PLUSPRENATAL RXPRENATAL W/FOLIC ACIDPRENATAL ZPRENATAL-HPRENATAL-UPRENATEPRENATE DHA

Medco Maintenance Drug List

ML2884A

PRENATE ELITEPRENATE ESSENTIALPRENATE PLUSPRENEXAPREQUE 10PRESTIGEPRESTIGE LANCETSPRESTIGE METERPRESTIGE SMART SYSTEMPRESTIGE SMART SYSTEM IQPRETERNAPREVACID NAPRAPACPREVACID RXPREVALITEPREVIFEMPREVIT+DHAPREVITE RXPREZISTAPRIFTINPRILOSEC RXPRIMACAREPRIMACARE ADVANTAGEPRIMACARE ONEPRIMARY PUMP SETPRIMIDONEPRINIVILPRINZIDEPRISTIQPROBARIMIN QTPROCAINAMIDE HCLPROCANBIDPROCARDIAPROCARDIA XLPROCHIEVEPRODIGYPRODIGY AUTOCODEPRODIGY CONTROL SOLUTIONPRODIGY DUOPRODIGY EJECTPRODIGY INSULIN SYRINGEPRODIGY LANCETSPRODIGY LANCING DEVICEPRODIGY NO CODINGPRODIGY PEN NEEDLEPRODIGY POCKETPRODIGY PREFERREDPRODIGY TWIST TOP LANCET

PRODIGY VOICEPROFERRIN-FORTEPROGRAFPROMARPROMETRIUMPROPAFENONE HCLPROPRANOLOL HCLPROPRANOLOL HCL-HCTZPROPYLTHIOURACILPROSCARPROSTIGMINPROSTIN VR PEDIATRICPROTECT CARDIOPROTECT PLUSPROTECT PLUS NRPROTECTIVE BARRIER FILMPROTONIXPROTONIX IVPROTRIPTYLINE HCLPROVENTILPROVERAPROVIDER PUMP SETPROZACPROZAC WEEKLYPRUET DHAPRUET DHA ECPRUVATE 21-7PSV SETPTS PANELSPUBLIX LANCETPULMICORTPULMICORT FLEXHALERPULMOPHYLLINEPYRAZINAMIDEPYRIDOSTIGMINE BROMIDEPYRIDOXINE HCL

QQUASENSEQUESTRANQUESTRAN LIGHTQUICK DISCONNECT-CONNECTORQUICK-CHECK FILMQUICK-CHECK IIQUICK-CHECK ONE

QUICK-SET PARADIGMQUICKTEKQUINAPRILQUINAPRIL-HYDROCHLOROTHIAZIDEQUINARETICQUINIDEXQUINIDINE GLUCONATEQUINIDINE SULFATEQVAR

RRAMIPRILRANEXARANITIDINE HCLRAPAFLORAPID D INFUSION SETRAPIFLUXRAZADYNERAZADYNE ERREAL-TIME STARTER KITRECLASTRECLIPSENREFUAH PLUSREFUAH PLUS GLUCOSE CONTROLREGONOLREGULAR COLOSTOMY POUCHRELAFENRELIASEAL DISCRELIEF PLUSRELIONRELION CONFIRMRELION ULTRA THIN PLUSREMERONRENAFRENAL CAPSRENAL SOFTGELRENALPRENRE-NATA 29RE-NATA 29 OBRENATABSRENATABS WITH IRONRENATERENATE DHARENATE DHA EXTRARENA-VITE RX

Medco Maintenance Drug List

ML2884A

RENAXRENEW ADVANCED LANCING SYSTEMRENEW ADVANCED MICRO-LANCETSRENO CAPSREOCYTE PLUSREOPROREPLACEMENT PEDIATRIC MONITORREPLIVA 21-7REQ49+REQUIPREQUIP XLRESECTISOLRESERPINERESERVOIRRESTORE CLEAN ‘N MOISTRESTORE WOUND CLEANSERREXAVITE 150REXAVITE 150 FORTEREYATAZRHINOCORT AQUARIDAURARIFADINRIFAMATERIFAMPINRIFATERRIGHTEST CONTROL SOLUTIONRIGHTEST GD500RIGHTEST GM100 SYSTEMRIGHTEST GM300 SYSTEMRIGHTEST GM550 SYSTEMRIGHTEST GS100 TEST STRIPSRIGHTEST GS300 TEST STRIPSRIGHTEST GS550 TEST STRIPSRIMACTANERIOMETRIVASTIGMINEROCALTROLROPINIROLE HCLROVIN-CF OFROVIN-NVROVIN-NV DHARYTHMOLRYTHMOL SR

SSAFESNAP INSULIN SYRINGESAFETY-LETSAF-T E-Z SETSALFLEXSALSALATESANCTURASANCTURA XRSANDIMMUNESARAFEMSEASONALESEASONIQUESE-CARESE-CARE CONCEIVESE-CARE GESTURESECONDARY IRRIGATION SETSECTRALSELECT-LITESELECT-OBSELECT-OB + DHASELEGILINE HCLSELFEMRASE-NATAL 19SE-NATAL 90SE-NATAL ONESENETONICSENILEZOLSENOPHYLLINESENSURA CLICK OSTOMY POUCHSENSURA EASICLOSE WIDE OUTLETSENSURA FLEX OSTOMY BASE PLATESENSURA FLEX OSTOMY POUCHESENSURA OSTOMY BASE PLATESENTROXATINESE-PLETE DHASEROMYCINSERTRALINE HCLSERZONESE-TAN DHASE-TAN PLUSSETONETSETONET-ECSE-VATE 21-7SEVEN PLUSSEW-IN POCKET

SHIELD FOR INSERTION TUBESHOPRITE VALUE PACKSHUT OFF FOR 5000 ENEMA BAGSHUT OFF FOR TUBINGSIDEKICKSIDEROLSILHOUETTESIL-SERTERSIMCORSIMPLECHOICESIMVASTATINSINEMETSINEMET CRSINEQUANSINGLE USE SWABSINGLE-LETSINGULAIRSKELIDSKIN BARRIER W-FLOATING FLANGESKIN GEL PROTECTIVE DRESSINGSKIN GEL PUMP SPRAYSKIN-BOND CEMENTSKIN-PREPSLEEVE CLOSURE CLAMPSLO-BIDSLOW-KSMART CARESENS NSMARTESTSMARTEST EJECTSMARTEST LANCETSMARTEST PERSONASMARTEST PRONTOSMARTEST PROTEGESMARTEST SMART CODESMARTEST TALKINGSMARTEST TESTSOF-SENSORSOF-SERTERSOFT TOUCHSOF-TACTSOFTCLIXSOFTFLEX SKIN BARRIERSOLIASOLO V2SOLO V2 CONTROL SOLUTIONSOLO V2 LANCETSSOLO V2 LANCING DEVICE

Medco Maintenance Drug List

ML2884A

SOLO V2 TEST STRIPSSOLTAMOXSOLUSET 150X15 I.V. SET-SLSOLUSET IV PUMP SETSORBITRATESORINESOTALOLSOTALOL AFSOTALOL HCLSPECIAL NEEDLESPIRIVASPIRONOLACTONESPIRONOLACTONE W/HCTZSPORT BELTSPRINTECSRONYXSTALEVOSTARLIXSTARTER KITSTAT-LETSTAVZORSTAVUDINESTEP 1-INCONTINENT CLEANSERSTEP 2-MOISTURE CREAMSTEP 3-MOISTURE BARRIERSTERILE TWO-FER NEEDLESTOMA CAP W-DEODOR FLTR-FLANGESTOMA CAP W-MICROPORE ADHESIVESTOMA CONE W-CONNECTOR UNITSTOMA IRRIGATOR DRAIN W-FLANGESTOMA LUBRICANTSTOMA URINE BAGSTOMAHESIVESTOMAHESIVE PROTECTIVESTOMAHESIVE STERILE WAFERSTOMASEALSTRONGSTARTSTROVITESTROVITE ADVANCESTROVITE ADVANCE + DSTROVITE FORTESTROVITE ONESTROVITE PLUSSTUARTNATAL PLUS 3SUB-Q SETSUCRALFATESULAR

SULFASALAZINESULFASALAZINE DRSULFAZINESULFAZINE ECSULINDACSUPER THIN LANCETSSUPERVITESUPPORTSUPREME GLUCOSE CONTROLSUPREME METERSURE COMFORTSURE COMFORT ALCOHOL PREP PADSSURE COMFORT LANCETSSURE COMFORT LANCING PENSURE EDGE BLOOD GLUCOSE METERSURE EDGE GLUCOSE CONTROL SOLNSURE EDGE TEST STRIPSSURECHEK GLUCOSE CONTROLSURECHEK TEST STRIPSSURE-FINE PEN NEEDLESSUREFLEXSURE-JECT INSULIN SYRINGESURE-LANCESURELETSURELITESURELITE XLSURE-PENSURE-PREP ALCOHOL PREP PADSSURESHARP MULTI-SAMPLE NEEDLESURESTEPSURESTEP PROSURE-TSURE-T PARADIGMSURE-TEST EASYPLUS MINISUR-FIT AUTOLOCKSUR-FIT AUTOLOCK DRAIN POUCHSUR-FIT AUTOLOCK DURAHESIVESUR-FIT AUTOLOCK INSERTSSUR-FIT AUTOLOCK POUCHSUR-FIT AUTOLOCK STOMAHESIVESUR-FIT DRAINABLE POUCHSUR-FIT DRAINAGE CONTAINERSUR-FIT FLANGE CAPSUR-FIT LOOP OSTOMY RODSUR-FIT NAT IRRIG FACEPLATESUR-FIT NATURASUR-FIT NATURA ADAPTOR

SUR-FIT NATURA CLOSED-END PCHSUR-FIT NATURA CONVEX INSERTSSUR-FIT NATURA DRAINABLE POUCHSUR-FIT NATURA DURAHESIVESUR-FIT NATURA FLANGE CAPSUR-FIT NATURA IRRIG SLEEVESUR-FIT NATURA LITTLE ONESSUR-FIT NATURA LOW-PRESSURESUR-FIT NATURA POST OPSUR-FIT NATURA POUCHSUR-FIT NATURA STOMAHESIVESUR-FIT NATURA UROSTOMY POUCHSUR-FIT NIGHT DRAINAGE TUBINGSUR-FIT TAIL CLOSURESSUR-FIT-ACT LIFE-TAIL CLOSURESSURGILANCE LANCETSSURMONTILSUSTIVASYMBICORTSYMLINSYMLINPEN 120SYMLINPEN 60SYMMETRELSYNTHETIC SKIN BARR W/FLANGESYNTHROIDSYSTEM POUCH

TTACROLLIMUSTAGAMETTALADINETAMBOCORTAMOXIFEN CITRATETAMSULOSIN HCLTANDEM DHATANDEM FTANDEM OBTANDEM PLUSTAPAZOLETARKATARON A PRENATALTARON EC CALCIUMTARON FORTETARON PRENATALTARON-C DHA

Medco Maintenance Drug List

ML2884A

TAZTIA XTTECHLITE BLOOD LANCETTEGRETOLTEGRETOL XRTEKAMLOTEKTURNATEKTURNA HCTTENDERLETTTENDERLETT JUNIORTENDERLETT TODDLERTENEXTENORETICTENORMINTERAZOSIN HCLTERBUTALINE SULFATETERUMO INSULIN SYRINGETERUMO SURGUARDTEST STRIPSTETRA-MAGTEVETENTEVETEN HCTTHALASETTHALITONETHEO-24THEOCHRONTHEO-DURTHEOPHYLLINE ANHYDROUSTHEOPHYLLINE IN 5% DEXTROSETHERAPEUTIC HEMATINICTHERAPEUTIC VITAMIN W-MINERALSTHEROBECTHEROBEC PLUSTHIAMINE HCLTHINPRO INSULIN SYRINGETHINSETTHYROIDTIA DOCETIA DOCE STIAZACTICLIDTICLOPIDINE HCLTIKOSYNTILADETILIA FETIMOLOL MALEATETIMOPTICTIMOPTIC-XE

TIROSINTTL GARD RXTL ICONTOFRANILTOFRANIL-PMTOLAZAMIDETOLBUTAMIDETOLECTINTOLECTIN 600TOLECTIN DSTOLINASETOLMETIN SODIUMTOPAMAXTOPCARE ULTRA COMFORTTOPCARE UNIVERSAL1 THIN LANCETTOPIRAGENTOPIRAMATETOPROL XLTORSEMIDETOVIAZTRACER BGTRANDATETRANDOLAPRILTRANDOLAPRIL-VERAPAMILTRANSFER NEEDLETRAVATANTRAVATAN ZTRAZAMINETRAZODONE HCLTRECATORTRI RXTRIADVANCETRIAMTERENE W/HCTZTRIAVILTRIBENZORTRICARETRICARE DHATRICARE PRENATAL DHA ONETRICONTRICORTRICOSALTRIFERA OBTRIFEREX 150 FORTETRIGELS-F FORTETRIGLIDETRIHEXYPHENIDYL HCLTRI-LEGEST FE

TRILEPTALTRI-LEVLENTRILIPIXTRILISATETRI-LO-SPRINTECTRIMAGENTRIMAGEN FATRIMAGEN FORTETRIMESIS RXTRIMIPRAMINE MALEATETRINATAL RX 1TRINATETRINESSATRI-NORINYLTRINSICONTRIOSTATTRIPHASILTRIPHROCAPSTRI-PREVIFEMTRI-SPRINTECTRIVEEN-CF NACTRIVEEN-ONETRIVEEN-PRX RNFTRIVEEN-UTRI-VI-FLORTRI-VITAMIN WITH FLUORIDETRI-VITAMIN WITH IRON-FLUORIDETRIVORATROSPIUM CHLORIDETRUE CARE STARTERTRUE2GO BLOOD GLUCOSE SYSTEMTRUECONTROLTRUERESULT BLOOD GLUCOSE SYSTMTRUETEST GLUCOSE CONTROLTRUETEST TEST STRIPSTRUETRACKTRUETRACK BLOOD GLUCOSE SYSTEMTRUETRACK SMART SYSTEMTRUSOPTTRUST NATAL DHATUBEGUARDTUBING FOR IRRIGATORT-U-R SYSTEM W-FLOW POUCH 2000TWO-PIECE STOMA CAPSTWYNSTA

Medco Maintenance Drug List

ML2884A

UUDAMINUDAMIN SPULTICAREULTIGUARDULTI-LANCEULTILETULTILET ALCOHOL SWABULTILET CLASSICULTILET INSULIN SYRINGEULTILET PEN NEEDLEULTIMAULTIMATE COMFORTULTIMATECARE ADVANTAGEULTIMATECARE COMBOULTIMATECARE ONEULTIMATECARE ONE NFULTRA COMFORTULTRA NATALCAREULTRA THIN PLUS LANCETSULTRACAPS MT 20ULTRA-FRESHULTRA-KLENZULTRA-NATALULTRASEULTRATHIN LANCETSULTRATLC LANCETSULTRATLC LANCETS-DEVICEULTRATRAK PROUNI-CHECKUNIFINE PENTIPSUNILET COMFORTOUCHUNILET EXCELITEUNILET EXCELITE IIUNILET GP LANCETUNILET LANCETUNIPHYLUNIRETICUNISTIKUNISTIK 2UNISTIK 2 EXTRAUNISTIK 2 NORMALUNISTIK 3UNISTIK 3 EXTRAUNISTIK CZT

UNITHROIDUNIVASCURI-KLEENURISPASURISTIX 4URISTIX REAGENTUROSEXUROSTOMY DRAIN TUBE ADAPTERUROSTOMY MICRO-POUCHUROSTOMY MULTI-CHAMBERUROSTOMY MULTI-CHAMBER POUCHUROSTOMY POUCHUROSTOMY POUCH WITH FLANGEUROXATRALURSOURSO FORTEURSODIOL

VVALPROATE SODIUMVALPROIC ACIDVALTURNAVALUE PLUS LANCETSVALUSTRIP TEST STRIPSVANISHPOINTVARIDINVASERETICVASODILANVASOTECV-C FORTEVELIVETVENATAL-FAVENLAFAXINE HCLVENLAFAXINE HCL ERVENLAFAXINE HCL ER BRANDVENOFERVENOSETVENOSET 100 SOLUSETVENTOLINVERAMYSTVERAPAMIL ERVERAPAMIL HCLVERELANVERELAN PMVEROTIN-BY

VEROTIN-GRVESICAREVGVIAGRAVI-C FORTEVICA-FORTEVICAP FORTEVICON FORTEVICTORYVICTOZAVIDEXVIDEX ECVIMOVOVINACALVINATAL FORTEVINATEVINATE AZVINATE CVINATE CALCIUMVINATE GTVINATE ICVINATE IIVINATE IIIVINATE ONEVINATE ULTRAVINATE-MVIRAMUNEVIRAMUNE XRVIREADVISI-FLOW IRRIG STARTER SETVISI-FLOW IRRIGATION SLEEVEVISI-FLOW IRRIGATOR STOMA CONEVISI-FLOW SLEEVE TAIL CLOSURESVISI-FLOW STOMA CONEVISKENVITA S FORTEVITACELVITACON FORTEVITAFOLVITAFOL-OBVITAFOL-OB+DHAVITAFOL-PNVITAGEN ADVANCEVITAGEN FORTEVITAJECTVITAL-D RXVITAMAX

Medco Maintenance Drug List

ML2884A

VITAMIN B COMPLEXVITAMIN B-12VITAMIN DVITAMIN D2VITAMIN KVITANATAL OB + DHAVITAPHILVITAPHIL + DHAVITAPHIL AIDEVITAPLEXVITAPLEX PLUSVITA-RESPAVITASPIREVITATAB MVVIVA DHAVIVACTILVIVELLEVIVELLE- DOTVOL-CARE RXVOL-NATEVOL-PLUSVOL-TAB RXVOLTARENVOLTAREN-XRVOSPIRE ERVYNATAL-FAVYTORIN

WWAVESENSE AMPWAVESENSE CONTROL SOLUTIONWAVESENSE JAZZWAVESENSE LANCETSWAVESENSE PRESTOW-D STARTERWEBCOL ALCOHOL PREPSWELCHOLWELLBUTRINWELLBUTRIN SRWELLBUTRIN XL

WHEAT GERM OILWINN DIXIE MEDICWOUND MANAGERWYTENSIN

XXALATANXYLOCAINEXYZAL

YYALE NEEDLEYASMINYAZYOCONYOHIMBINE HCL

ZZANTAC RXZARAHZARONTINZAROXOLYNZATEAN-PNZATEAN-PN DHAZATEAN-PN PLUSZEBETAZEGERID RXZELAPARZENCHENTZENPEPZERITZERVALXZESTORETICZESTRILZETIAZIACZIAGEN

ZIDOVUDINEZIPSORZOCORZOLOFTZOMETAZONEGRANZONISAMIDEZORPRINZOVIAZYCOSEZYFLOZYFLO CRZYRTEC RXZYRTEC-D RX

Medco Maintenance Drug List

ML2884A

ML2884A

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