MEMBER 2020 PERFORMANCE DRUG LIST · 2020-03-20 · While extensive, this is not an exhaustive list of all available medications and this list is subject to change. See the most current

MEMBER

PERFORMANCE DRUG LIST2020

For group HMO, PPO and EPO members with an insurance plan that includes a prescription drug benefit

Effective January 1, 2020

Blue Cross and Blue Shield of Kansas City 2020 Performance Drug List

IntroductionThe Prescription Drug List (PDL) has been developed and is maintained by the Medical and Pharmacy Management Committee of Blue Cross and Blue Shield of Kansas City (Blue KC). The committee is composed of practicing doctors and pharmacists within the Kansas City area. Quarterly meetings are held to evaluate new drug therapies and review drug utilization issues.

Medications are evaluated on the basis of safety, effectiveness, adverse events, proven advantages over existing agents and cost. Tier 1 medications are typically generic drugs that contain the same active ingredients as brand name drugs and have the lowest copay. New drugs will require an exception or prior authorization until they are reviewed by the committee.

While extensive, this is not an exhaustive list of all available medications and this list is subject to change. See the most current PDL by visiting your member portal at MyBlueKC.com. If you require additional information or clarification, contact our Clinical Pharmacy unit at 816-395-2176 or 800-228-1436.

Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in the PDL status may occur. The committee may also implement prior authorization or other utilization management processes as deemed necessary. Doctors and pharmacists will be notified of any such changes via direct mailings.

How to use this list:1 Find the page number for your drug by searching the alphabetical index at the end.

2 Locate your drug and identify the Drug Tier. You will also want to note restrictions and preferred alternatives if applicable.

3 Refer to the Drug Tier description tables at the end of this introduction to identify the tier copay for your drug (based on the benefit schedule described in your member certificate or in your Blue KC benefit summary.

Prior Authorization/Drug Utilization ManagementSome drugs have coverage rules or have limits on the amount dispensed. In some cases, the prescriber must do something in order to obtain the drug. For example:

• Prior approval (or prior authorization): For some drugs, the prescriber must get approval from BlueKC before the prescription can be filled. Without that approval, the drug may not be covered.

• Quantity limits: For some drugs, there are limits to the amount of drug that may be obtained.

• Step Therapy: For some drugs, BlueKC requires step therapy. This means that drugs will have to be tried in a certain order for a medical condition. If the doctor feels that the first drugs are not appropriate, the prescriber will have to submit a prior authorization request.

Prescribers may request exceptions to these coverage rules or limits by submitting an electronic prior authorization request form. www.BlueKC.com > Providers > Forms > Prior Authorizations for Medications.

HOW TO REACH USBlue Cross and Blue Shield of Kansas City Pharmacy Services P.O. Box 419169 Kansas City, MO 64141-2735

816-395-2176 or 800-228-1436

www.BlueKC.com

Frequently asked questionsWhat is the difference between brand name drugs and generic drugs?When a drug company develops a new medication they apply for a patent. This patent protects the drug from being copied by other drug companies for a certain period of time. These drugs are brand name drugs. Once the patent period expires, other manufacturers can produce the same drug as long as they follow strict guidelines established by the Food and Drug Administration's (FDA) guidelines. These same drugs are generic drugs. Generic drugs are less expensive versions of those brand name drugs whose patents have expired. They are made with the same active ingredients of the brand name drug, but they may have a different color, shape or filler material. The cost of a generic drug is typically less than a brand name drug. All generic medications are approved by the FDA before they are released on the market.

What is the difference between a generic equivalent and a generic alternative?A generic equivalent is a medication that contains the same active ingredient and works the same way as the original brand name drug. A generic alternative is a generic medication that may not have the same active ingredient, but works in the same way as another drug.

What is a maintenance drug?A maintenance drug is a medication used to treat a chronic condition like diabetes or high blood pressure. The FDA must approve maintenance drugs as safe for long-term use. Blue KC uses a national drug information database called Medispan to determine which medications are included on the maintenance drug list. If your prescription is a maintenance drug, you can have it filled for several months instead of just one prescription at a time.

Does Blue KC cover all prescription drugs?Blue KC covers most prescription drugs. However, some drug classes require an additional benefit be added to your health insurance plan in order to be covered. This additional benefit is referred to as a ‘rider.’ Examples of such drug classes are fertility, birth control, impotency, and weight loss.

How is the tier level status determined for medications?The PDL is a list of prescription medications that have been reviewed and recommended by the Blue KC Medical and Pharmacy Management Committee.

The list has a combination of brand name and generic medications. Each of these medications has been reviewed for its safety, effectiveness, clinical outcomes, and cost. Doctors and pharmacists on the committee look at drug utilization issues, the number of adverse events, and any proven advantages over other drugs on the PDL. The most efficient and cost-effective drugs are on Tier 1 of the PDL.

Why does Blue KC require prior authorization for some drugs before they are covered?Blue KC may require prior authorization for some drugs or a class. Medications on the prior authorization list may have safety concerns or have FDA approval, only for a certain use. Some of the prior authorization medications may also have a lower-cost alternative that should be considered first or the drug may not be as effective as something else in the same drug class. Some medications are also on the prior authorization list because they have the potential to be misused. Your doctor and Blue KC will work together to get prior authorization and approval for your prescription when needed.

Do I need to show my member ID card at the pharmacy?Yes, show your member ID card to your pharmacist whenever you have a prescription filled. Your prescription claim is electronically transmitted to Blue KC when you fill your prescription. Please make sure the pharmacy has your most current health insurance information and correct birth date so there won’t be any delays or claim denials when we process your claim.

What do I do if I need to refill my prescription early (i.e., leaving on vacation, the doctor increased my dosage)? To have a prescription refilled early, have your pharmacist call the Pharmacy Customer Service unit at 816-395- 2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

What if I am out of town and need to have a prescription filled?Blue KC contracts with most major pharmacy chains and has a network of over 44,000 pharmacies nationwide. If the pharmacy you are using has difficulty in processing your prescription claim, have them contact the Pharmacy Customer Service unit for assistance at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

Why must some drugs be purchased through a Specialty Pharmacy?Specialty drugs are those that require special ordering, handling, clinical monitoring and/or customer service. These drugs are best purchased through a Specialty Pharmacy. Blue KC has a network of Specialty Pharmacies available to provide specialized care for patients with complex chronic health conditions to obtain

their medications and manage their health conditions. Specialty medications are limited to a 34 day supply.

What if I have questions about my prescription drug coverage?For more information on your prescription drug coverage, call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

Miscellaneous Information

Specialty PharmacyA Specialty Pharmacy is one that provides specialized care for patients with complex chronic health conditions such as Rheumatoid Arthritis, Multiple Sclerosis or Psoriasis. Specialty drugs may be oral or injectable medications that can either be self-administered or administered by a health care professional. These pharmacies do everything from dispense the specialty medication to help patients manage their health condition. Most specialty medications are covered under the pharmacy benefit. Specialty medications are limited to a 34 day supply. The following is a list of other services provided by the Specialty Pharmacies:

• Assigns a Patient Care Coordinator who serves as a personal advocate and point of contact

• Offers access to a dedicated clinical staff of nurses and pharmacists who are knowledgeable about the medications and conditions

• Provides the necessary supplies to administer the medications — at no additional cost

• Offers care management programs to help patients get the most from their medications

• Provides patients with refill reminder calls

• Allows the medications to be delivered to either the physician’s office or patients home

• Works directly with patients to arrange a convenient shipment date

• Ships all medications overnight

• Coordinates with Blue KC to take care of billing issues

These services are provided to you at no additional cost. Prescriptions for a specialty medication will need to be filled at the Specialty Pharmacy listed below.

Optum Specialty Pharmacy Phone: 1-855-427-4682

Drug Tier DescriptionsTo find out what prescription drug tier is on your plan, please see the benefit schedule in your member certificate or in your Blue KC benefit summary.

2-Tier Benefit Drug Tier

Tier 1 copayG

G-S

Tier 2 copayPB

PB-S

List of AbbreviationsG Generic Drug.

G-S Generic Specialty Drug.

PB Preferred Brand Drug.

PB-S Preferred Brand Specialty Drug.

ACA Affordable Care Act. These preventative drugs may be covered at no cost (check your benefits to confirm).

M Maintenance Drug.

OTC Over the Counter. An OTC drug is a non-prescription drug.

PA Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescription. If you don’t get approval, your plan may not cover the drug.

QL Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

ST ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

Discrimination is Against the LawBlue KC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue KC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Blue KC:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as: › Qualified sign language interpreters › Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as: › Qualified interpreters › Information written in other languages

If you need these services, contact Customer Service, 844-395-7126 (Toll free), [email protected].

If you believe that Blue KC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the Appeals Department, PO Box 419169, Kansas City, MO 64141-6169, 816-395-3537, TTY: 816-842-5607, [email protected]. You can file a grievance in person or by mail, or email. If you need help filing a grievance, the Appeals Department is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 202011-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

If you, or someone you’re helping, has questions about Blue KC, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-844-395-7126.

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German: Falls Sie oder jemand, dem Sie helfen, Fragen zum Blue KC haben, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer 1-844-395-7126 an.

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M57313-E 10/19

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للتحدث مع مترجم اتصل ب. 7126 -1-844-395.

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Tagalog: Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Blue KC, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa1-844-395-7126.

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Pennsylvanian Dutch: Wann du hoscht en Froog, odder ebber, wu du helfscht, hot en Froog baut Blue KC, hoscht du es Recht fer Hilf un Information in deinre eegne Schprooch griege, un die Hilf koschtet nix. Wann du mit me Interpreter schwetze witt, kannscht du 1-844-395-7126 uffrufe.

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رايگان دريافت مناييد 7126-395-844-1.متاس حاصل مناييد.

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Table of Contents

Analgesics - Drugs for Pain...............................................................................................................................10Analgesics - Drugs for Pain and Inflammation.................................................................................................. 11Anesthetics........................................................................................................................................................12Anti-Addiction / Substance Abuse Treatment Agents....................................................................................... 13Antibacterials.....................................................................................................................................................13Anticoagulants...................................................................................................................................................15Anticonvulsants - Drugs for Seizures................................................................................................................ 15Antidementia Agents - Drugs for Alzheimer's Disease and Dementia.............................................................. 16Antidepressants.................................................................................................................................................16Antiemetics - Drugs for Nausea and Vomiting.................................................................................................. 18Antifungals.........................................................................................................................................................18Antigout Agents................................................................................................................................................. 19Antimigraine Agents.......................................................................................................................................... 19Antimyasthenic Agents......................................................................................................................................19Antimycobacterials............................................................................................................................................ 19Antineoplastics - Drugs for Cancer....................................................................................................................20Antiparasitics..................................................................................................................................................... 23Antiparkinson Agents........................................................................................................................................ 24Antiplatelets.......................................................................................................................................................24Antipsychotics - Drugs for Mood Disorders....................................................................................................... 25Antivirals............................................................................................................................................................25Anxiolytics - Drugs for Anxiety...........................................................................................................................27Bipolar Agents - Drugs for Mood Disorders.......................................................................................................28Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders..............................................28Cardiovascular Agents - Drugs for Heart and Circulation Conditions............................................................... 28Central Nervous System Agents - Drugs for Attention Deficit Disorder........................................................... 32Central Nervous System Agents - Drugs for Multiple Sclerosis........................................................................ 33Central Nervous System Agents - Miscellaneous............................................................................................. 33Dental and Oral Agents - Drugs for Mouth and Throat Conditions....................................................................33Dermatological Agents - Drugs for Skin Conditions.......................................................................................... 34Diabetes - Antidiabetic Agents.......................................................................................................................... 38Diabetes - Glucose Monitoring.......................................................................................................................... 39Diabetes - Glycemic Agents.............................................................................................................................. 39Diabetes - Insulins.............................................................................................................................................39Electrolytes / Minerals / Metals / Vitamins.........................................................................................................40Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer................................................................................43Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions.................................................43Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment............................................. 45Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions.......................................................45Genitourinary Agents - Drugs for Prostate Conditions...................................................................................... 46Hormonal Agents - Adrenal............................................................................................................................... 46Hormonal Agents - Men's Health.......................................................................................................................46Hormonal Agents - Osteoporosis...................................................................................................................... 47Hormonal Agents - Pituitary.............................................................................................................................. 47Hormonal Agents - Sex Hormones and Birth Control........................................................................................47Hormonal Agents - Thyroid............................................................................................................................... 53Immunological Agents - Drugs for Immune System Stimulation or Suppression.............................................. 53Immunological Agents - Drugs for Vaccination................................................................................................. 54Inflammatory Bowel Disease Agents.................................................................................................................56Metabolic Bone Disease Agents - Drugs for Osteoporosis............................................................................... 56Metabolic Bone Disease Agents - Other........................................................................................................... 57

8

Miscellaneous Therapeutic Agents................................................................................................................... 57Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation...........................................................57Ophthalmic Agents - Drugs for Glaucoma.........................................................................................................58Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions......................................................................... 58Otic Agents - Drugs for Ear Conditions............................................................................................................. 59Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold........................................................60Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions................................... 61Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis.................................................................... 62Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension.................................................... 62Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm...................................................................... 62Sleep Disorder Agents...................................................................................................................................... 63

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Drug Name Drug Tier Restrictions / Limits

Analgesics - Drugs for Pain

acetaminophen-codeine G QL

acetaminophen-codeine #2 G QL



apap-caff-dihydrocodeine oral capsule G QL

ascomp-codeine G

BELBUCA PB PA; QL

buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr

G PA; QL

butalbital-acetaminophen oral capsule G

butalbital-acetaminophen oral tablet 50-300 mg, 50-325 mg

G

butalbital-apap-caff-cod G

butalbital-apap-caffeine G

butalbital-asa-caff-codeine G

butalbital-aspirin-caffeine G

butorphanol tartrate nasal G QL

carisoprodol-aspirin-codeine G

codeine sulfate G QL

DOLOPHINE G PA

duraxin G

endocet G QL

fentanyl G PA; QL

fentanyl citrate buccal lozenge on a handle G PA; QL

hydrocodone bitartrate er G PA; QL

hydrocodone-acetaminophen G QL

hydrocodone-ibuprofen G QL

hydromorphone hcl er G PA; QL

hydromorphone hcl oral G QL

hydromorphone hcl rectal G QL

HYSINGLA ER PB PA; QL

lorcet G QL

lorcet hd G QL

lorcet plus G QL

meperidine hcl oral G QL

methadone hcl intensol G

methadone hcl oral concentrate G

methadone hcl oral solution G

Last Updated 3/16/20

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methadone hcl oral tablet G PA

methadone hcl oral tablet soluble G

methadose oral concentrate 10 mg/ml G

methadose oral tablet soluble G

methadose sugar-free G

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml

G QL

morphine sulfate er G PA; QL

morphine sulfate er beads G PA; QL

morphine sulfate oral G QL

morphine sulfate rectal G QL

oxycodone hcl oral capsule G QL

oxycodone hcl oral concentrate 100 mg/5ml G QL

oxycodone hcl oral solution G QL

oxycodone hcl oral tablet G QL

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

G QL

oxycodone-aspirin G QL

oxycodone-ibuprofen G QL

OXYCONTIN PB PA; QL

oxymorphone hcl G QL

oxymorphone hcl er G PA; QL

pentazocine-naloxone hcl G QL

tencon G

tramadol hcl er (biphasic) G QL

tramadol hcl er oral capsule extended release 24 hour 150 mg

G PA; QL

tramadol hcl er oral tablet extended release 24 hour

G QL

tramadol hcl ir G QL

tramadol-acetaminophen G QL

vicodin hp G QL

Analgesics - Drugs for Pain and Inflammation

celecoxib oral G QL

choline-mag trisalicylate G

diclofenac potassium G

diclofenac sodium er G

diclofenac sodium oral G


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diclofenac sodium transdermal gel 1 % G QL

diclofenac sodium transdermal solution G PA

diclofenac-misoprostol G

diflunisal oral G

ec-naproxen G

etodolac G

etodolac er G

flurbiprofen oral G

ibu G

ibuprofen oral tablet 400 mg, 600 mg, 800 mg G

indomethacin er G

indomethacin oral capsule 25 mg, 50 mg G

ketoprofen er G

ketoprofen oral capsule 25 mg G

ketorolac tromethamine oral G QL

meclofenamate sodium oral G

meloxicam oral G

nabumetone oral G

naproxen dr G

naproxen oral tablet G

naproxen sodium oral tablet 275 mg, 550 mg G

oxaprozin G

piroxicam oral G

salsalate oral G

sulindac oral G

tolmetin sodium G

Anesthetics

c-topical G

ethyl chloride G

glydo G

lidocaine external ointment G

lidocaine external patch 5 % G

lidocaine hcl external solution G

lidocaine hcl urethral/mucosal G

lidocaine-prilocaine external cream G

marlido G


12


Anti-Addiction / Substance Abuse Treatment Agents

acamprosate calcium G

BUNAVAIL G QL

buprenorphine hcl sublingual G QL

buprenorphine hcl-naloxone hcl G QL

bupropion hcl er (smoking det) G M; ACA; QL

CHANTIX PB ACA; QL

CHANTIX CONTINUING MONTH PAK PB ACA; QL

CHANTIX STARTING MONTH PAK PB ACA; QL

disulfiram oral G

EVZIO G ST

naloxone hcl injection solution G

naloxone hcl injection solution cartridge G

naloxone hcl injection solution prefilled syringe G

naltrexone hcl oral G

NARCAN G

NICOTROL PB M; ACA; QL

NICOTROL NS PB M; ACA; QL

ZUBSOLV G QL

Antibacterials

amoxicillin G

amoxicillin-potassium clavulanate er G

amoxicillin-potassium clavulanate oral G

ampicillin G

avidoxy G

azithromycin oral G

cefaclor G

cefaclor er G

cefadroxil G

cefdinir G

cefditoren pivoxil G

cefixime G

cefpodoxime proxetil G

cefprozil G

cefuroxime axetil G

cephalexin G

ciprofloxacin hcl oral G


13


clarithromycin er G

clarithromycin oral G

CLEOCIN VAGINAL SUPPOSITORY PB

clindamycin hcl oral G

clindamycin palmitate hcl G

clindamycin phosphate vaginal G

colistimethate sodium (cba) G

demeclocycline hcl G

dicloxacillin sodium G

doxycycline hyclate oral capsule G

doxycycline hyclate oral tablet 100 mg, 20 mg G

doxycycline monohydrate oral G

erythromycin base G

erythromycin ethylsuccinate oral G

erythromycin oral G

gentamicin sulfate external G

levofloxacin oral G

linezolid oral G QL

mafenide acetate external G

methenamine hippurate G

methenamine mandelate oral G

metronidazole oral G

metronidazole vaginal G

minocycline hcl oral G

mondoxyne nl G

morgidox oral G

moxifloxacin hcl oral G

mupirocin external G

neomycin sulfate oral G

nitrofurantoin G

nitrofurantoin macrocrystal oral G

nitrofurantoin monohydrate macrocrystals G

ofloxacin oral G

okebo G

paromomycin sulfate oral G

penicillin v potassium G

silver nitrate external G

silver sulfadiazine external G


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ssd G

sulfadiazine oral G

sulfamethoxazole-trimethoprim oral G

sulfatrim pediatric G

tetracycline hcl oral G

tinidazole oral G

trimethoprim oral G

vancomycin hcl oral capsule G

vandazole G

Anticoagulants

ELIQUIS PB M; QL

ELIQUIS DVT/PE STARTER PACK PB M; QL

enoxaparin sodium subcutaneous G QL

fondaparinux sodium G QL

heparin sodium (porcine) G

heparin sodium (porcine) pf G

jantoven G

PRADAXA PB M; QL

warfarin sodium oral G

XARELTO PB M; QL

XARELTO STARTER PACK PB M; QL

Anticonvulsants - Drugs for Seizures

carbamazepine er G

carbamazepine oral G

clobazam G PA

diazepam rectal G QL

divalproex sodium er G

divalproex sodium oral G

epitol G

ethosuximide oral G

felbamate G

gabapentin oral G

lamotrigine er G

lamotrigine oral G

lamotrigine starter kit-blue G

lamotrigine starter kit-green G

lamotrigine starter kit-orange G

levetiracetam er G


15


levetiracetam oral G

oxcarbazepine G

phenobarbital oral G

phenytoin infatabs G

phenytoin oral G

phenytoin sodium extended G

primidone oral G

roweepra G

roweepra xr G

subvenite G

subvenite starter kit-blue G

subvenite starter kit-green G

subvenite starter kit-orange G

tiagabine hcl G

topiramate er G

topiramate oral G

valproic acid oral G

vigabatrin G-S PA

vigadrone G-S PA

zonisamide oral G

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia

donepezil hcl G M

galantamine hydrobromide G M

galantamine hydrobromide er G M

memantine hcl er G M; QL

memantine hcl oral G M

NAMZARIC PB QL

rivastigmine G M

rivastigmine tartrate G M

Antidepressants

amitriptyline hcl oral G

amoxapine G

bupropion hcl er (sr) G M; QL

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

G M; QL

BUPROPION HCL ER (XL) ORAL TABLET EXTENDED RELEASE 24 HOUR 450 MG

PB M; QL

bupropion hcl oral G M


16


chlordiazepoxide-amitriptyline G

citalopram hydrobromide G M

clomipramine hcl oral G

desipramine hcl oral G

desvenlafaxine succinate er G M; QL

doxepin hcl oral capsule G

doxepin hcl oral concentrate G

duloxetine hcl oral G M; QL

escitalopram oxalate G M

fluoxetine hcl (pmdd) G M

fluoxetine hcl oral capsule G M

fluoxetine hcl oral capsule delayed release G M; QL

fluoxetine hcl oral solution G M

fluoxetine hcl oral tablet G M

fluvoxamine maleate G M

fluvoxamine maleate er G M; QL

imipramine hcl oral G

imipramine pamoate G

maprotiline hcl G

mirtazapine oral G

nefazodone hcl G M

nortriptyline hcl oral G

olanzapine-fluoxetine hcl G QL

paroxetine hcl G M

paroxetine hcl er G M

paroxetine mesylate G M; QL

PAXIL ORAL SUSPENSION PB ST; M

perphenazine-amitriptyline G

phenelzine sulfate oral G

protriptyline hcl G

sertraline hcl oral G M

tranylcypromine sulfate G

trazodone hcl oral G

trimipramine maleate oral G

venlafaxine hcl G M

venlafaxine hcl er oral capsule extended release 24 hour

G M

venlafaxine hcl er oral tablet extended release 24 hour 225 mg

G M


17


Antiemetics - Drugs for Nausea and Vomiting

aprepitant G QL

compro G

dimenhydrinate injection G

doxylamine-pyridoxine G PA; QL

dronabinol G PA; QL

granisetron hcl oral G QL

metoclopramide hcl oral G

ondansetron hcl oral solution G QL

ondansetron hcl oral tablet 24 mg G QL

ondansetron hcl oral tablet 4 mg, 8 mg G

ondansetron odt G

perphenazine oral G

prochlorperazine G

prochlorperazine maleate oral G

scopolamine G

trimethobenzamide hcl oral G

Antifungals

bio-statin oral powder G

ciclodan G

ciclopirox G

ciclopirox olamine external G

clotrimazole mouth/throat G

clotrimazole-betamethasone G

econazole nitrate external G

exoderm external lotion G

fluconazole oral G

flucytosine oral G

griseofulvin microsize oral G

griseofulvin ultramicrosize G

itraconazole oral G PA

ketoconazole external cream G

ketoconazole external shampoo G

ketoconazole oral G

miconazole 3 vaginal suppository G

naftifine hcl G

nyamyc G

nystatin external G


18


nystatin mouth/throat G

nystatin oral G

nystatin-triamcinolone G

nystop G

posaconazole G

terbinafine hcl oral G QL

terconazole G

voriconazole oral G

Antigout Agents

allopurinol oral G M

colchicine oral tablet G

colchicine-probenecid G

COLCRYS PB

febuxostat G ST; M

probenecid G M

Antimigraine Agents

AIMOVIG PB PA; M; QL

almotriptan malate G QL

dihydroergotamine mesylate injection G

dihydroergotamine mesylate nasal G QL

eletriptan hydrobromide G QL

EMGALITY PB PA; M; QL

EMGALITY (300 MG DOSE) PB PA; M; QL

ergotamine-caffeine G

naratriptan hcl G QL

rizatriptan benzoate G QL

sumatriptan nasal G QL

sumatriptan succinate oral G QL

sumatriptan succinate refill G QL

sumatriptan succinate subcutaneous G QL

zolmitriptan oral G QL

Antimyasthenic Agents

pyridostigmine bromide er G M

pyridostigmine bromide oral tablet G M

Antimycobacterials

cycloserine oral G

dapsone oral G

ethambutol hcl oral G


19


isoniazid oral G

pyrazinamide oral G

rifabutin G

rifampin oral G

Antineoplastics - Drugs for Cancer

abiraterone acetate G-S PA

AFINITOR PB-S PA; QL

AFINITOR DISPERZ PB-S PA

ALECENSA PB-S PA

ALKERAN ORAL PB

ALUNBRIG PB-S PA; QL

anastrozole oral G

AROMASIN PB

BALVERSA PB PA

bexarotene G-S PA

bicalutamide G

BOSULIF PB-S PA

BRAFTOVI PB-S PA

CABOMETYX PB-S PA

CALQUENCE PB-S PA

capecitabine G-S PA

CAPRELSA ORAL TABLET 100 MG PB-S PA; QL

CAPRELSA ORAL TABLET 300 MG PB-S PA

CASODEX PB

COMETRIQ (100 MG DAILY DOSE) PB-S PA



COPIKTRA PB-S PA

COTELLIC PB-S PA

cyclophosphamide oral G

DAURISMO PB-S PA

EMCYT PB-S

ERIVEDGE PB-S PA

ERLEADA PB-S PA

erlotinib hcl oral tablet 100 mg, 150 mg G-S PA

erlotinib hcl oral tablet 25 mg G-S PA; QL

etoposide oral G-S

everolimus oral tablet 2.5 mg, 5 mg, 7.5 mg G-S PA; QL


20


exemestane G

FARESTON PB-S

FARYDAK PB-S PA

FEMARA PB

flutamide G

GILOTRIF PB-S PA; QL

GLEOSTINE PB-S

HYCAMTIN ORAL PB-S

HYDREA PB

hydroxyurea oral G

IBRANCE ORAL CAPSULE PB-S PA

IBRANCE ORAL TABLET PB

ICLUSIG ORAL TABLET 15 MG PB-S PA; QL

ICLUSIG ORAL TABLET 45 MG PB-S PA

IDHIFA PB-S PA; QL

imatinib mesylate G-S PA

IMBRUVICA PB-S PA

INLYTA PB-S PA

INREBIC PB-S PA

IRESSA PB-S PA

JAKAFI ORAL TABLET 10 MG PB-S PA; QL

JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

PB-S PA

KISQALI (200 MG DOSE) PB-S PA



KISQALI FEMARA (400 MG DOSE) PB-S PA

KISQALI FEMARA (600 MG DOSE) PB-S PA

KISQALI FEMARA(200 MG DOSE) PB-S PA

LENVIMA (10 MG DAILY DOSE) PB-S PA








letrozole oral G


21


leucovorin calcium oral G

LEUKERAN PB

LONSURF PB-S PA

LORBRENA PB-S PA

LYNPARZA PB-S PA

LYSODREN PB-S

MATULANE PB-S

MEKINIST PB-S PA

MEKTOVI PB-S PA

melphalan G

mercaptopurine oral G

MESNEX ORAL PB

MYLERAN PB-S

NERLYNX PB-S PA; QL

NEXAVAR PB-S PA

NILANDRON PB-S

nilutamide G-S

NINLARO PB-S PA

NUBEQA PB-S PA

ODOMZO PB-S PA

PIQRAY (200 MG DAILY DOSE) PB-S PA



POMALYST PB-S PA

PURIXAN PB-S

REVLIMID PB-S PA

ROZLYTREK PB-S PA

RUBRACA PB-S PA

RYDAPT PB-S PA

SOLTAMOX PB ACA

SPRYCEL PB-S PA

STIVARGA PB-S PA

SUTENT PB-S PA

TABLOID PB-S

TAFINLAR PB-S PA

TAGRISSO ORAL TABLET 40 MG PB-S PA; QL

TAGRISSO ORAL TABLET 80 MG PB-S PA

TALZENNA PB-S PA


22


tamoxifen citrate oral G ACA

TARCEVA ORAL TABLET 100 MG, 150 MG PB-S PA

TARCEVA ORAL TABLET 25 MG PB-S PA; QL

TASIGNA PB-S PA

TEMODAR ORAL PB-S PA

temozolomide G-S PA

THALOMID PB-S PA

TIBSOVO PB-S PA

toremifene citrate G-S

tretinoin oral G-S

TURALIO PB PA

TYKERB PB-S PA

VENCLEXTA PB-S PA

VENCLEXTA STARTING PACK PB-S PA

VERZENIO PB-S PA

VITRAKVI PB-S PA

VIZIMPRO PB-S PA

VOTRIENT PB-S PA

XALKORI PB-S PA

XELODA PB-S PA

XOSPATA PB-S PA

XPOVIO (100 MG ONCE WEEKLY) PB-S PA



XPOVIO (80 MG TWICE WEEKLY) PB-S PA

XTANDI PB-S PA

YONSA PB-S PA

ZEJULA PB-S PA

ZELBORAF PB-S PA

ZOLINZA PB-S PA

ZYDELIG PB-S PA

ZYKADIA PB-S PA

ZYTIGA PB-S PA

Antiparasitics

albendazole oral G PA

ALINIA PB

atovaquone oral G

atovaquone-proguanil hcl G


23


chloroquine phosphate oral G

crotan G

EMVERM PB

hydroxychloroquine sulfate oral G M

ivermectin oral G

lindane G

malathion G

mefloquine hcl G

pentamidine isethionate inhalation G

permethrin external G

praziquantel oral G

primaquine phosphate G

quinine sulfate oral G PA

spinosad G

sulfurated lime G

Antiparkinson Agents

amantadine hcl oral G M

APOKYN PB-S PA; QL

benztropine mesylate oral G

bromocriptine mesylate oral G

carbidopa oral G M

carbidopa-levodopa G M

carbidopa-levodopa er G M

carbidopa-levodopa-entacapone G M

entacapone G M

pramipexole dihydrochloride G M

pramipexole dihydrochloride er G M

rasagiline mesylate oral G M

ropinirole hcl G M

ropinirole hcl er G M

selegiline hcl oral G M

tolcapone G M

trihexyphenidyl hcl G

Antiplatelets

aspirin-dipyridamole er G M

BRILINTA PB M

cilostazol G M

clopidogrel bisulfate oral G M


24


dipyridamole oral G M

prasugrel hcl G M

Antipsychotics - Drugs for Mood Disorders

aripiprazole G QL

chlorpromazine hcl injection G

chlorpromazine hcl oral G

clozapine G QL

fluphenazine hcl G

haloperidol decanoate intramuscular G

haloperidol lactate oral G

haloperidol oral G

loxapine succinate G

molindone hcl G

olanzapine oral G QL

paliperidone er G QL

pimozide G

quetiapine fumarate G QL

quetiapine fumarate er G QL

risperidone G QL

SAPHRIS PB QL

thioridazine hcl oral G

thiothixene G

trifluoperazine hcl G

ziprasidone hcl G QL

ziprasidone mesylate G

Antivirals

abacavir sulfate G

abacavir sulfate-lamivudine G

abacavir-lamivudine-zidovudine G

acyclovir external G

acyclovir oral G

adefovir dipivoxil G

APTIVUS PB

atazanavir sulfate G

CIMDUO PB

COMPLERA PB

CRIXIVAN PB

didanosine G


25


DOVATO PB

EDURANT PB

efavirenz G

EMTRIVA PB

entecavir G QL

EPIVIR HBV ORAL SOLUTION PB

EVOTAZ PB

famciclovir G

fosamprenavir calcium G

FUZEON PB

HARVONI ORAL TABLET 45-200 MG PB-S PA; QL

INTELENCE PB

INVIRASE PB

ISENTRESS PB

ISENTRESS HD PB

JULUCA PB

KALETRA ORAL TABLET PB

lamivudine G

lamivudine-zidovudine G

LEXIVA ORAL SUSPENSION PB

lopinavir-ritonavir G

MAVYRET PB-S PA; QL

nevirapine G

nevirapine er G

NORVIR ORAL PACKET PB

NORVIR ORAL SOLUTION PB

oseltamivir phosphate oral G QL

PEGASYS PB-S PA

PEGASYS PROCLICK PB-S PA

PREZCOBIX PB

PREZISTA PB

REYATAZ ORAL PACKET PB

ribavirin inhalation G-S

ribavirin oral G-S

rimantadine hcl G

ritonavir G

SELZENTRY PB PA

stavudine G


26


SYMFI PB

SYMFI LO PB

tenofovir disoproxil fumarate G

TIVICAY PB

TRIUMEQ PB

TRUVADA PB

TYBOST PB

valacyclovir hcl oral G QL

valganciclovir hcl G

VIDEX PB

VIRACEPT PB

VIREAD ORAL POWDER PB

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

PB

VOSEVI PB-S PA; QL

zidovudine G

Anxiolytics - Drugs for Anxiety

alprazolam er G QL

alprazolam intensol G QL

alprazolam oral tablet G QL

alprazolam xr G QL

buspirone hcl oral G M

chlordiazepoxide hcl G QL

clonazepam oral G QL

clorazepate dipotassium G QL

diazepam intensol G

diazepam oral G

estazolam G QL

hydroxyzine hcl oral G

hydroxyzine pamoate oral G

lorazepam intensol G QL

lorazepam oral concentrate 2 mg/ml G QL

lorazepam oral tablet G QL

meprobamate G

oxazepam G QL

quazepam G QL

triazolam G QL


27


Bipolar Agents - Drugs for Mood Disorders

lithium G

lithium carbonate er G

lithium carbonate oral G

Blood Products / Modifiers / Volume Expanders - Drugs for Bleeding Disorders

aminocaproic acid oral G

anagrelide hcl G M

MULPLETA PB-S PA

NPLATE SUBCUTANEOUS SOLUTION RECONSTITUTED 125 MCG

PB PA

tranexamic acid oral G

Cardiovascular Agents - Drugs for Heart and Circulation Conditions

acebutolol hcl oral G M

aliskiren fumarate G M

amiloride hcl oral G M

amiloride-hydrochlorothiazide G M

amiodarone hcl oral G M

amlodipine besylate oral G M

amlodipine besylate-benazepril hcl G M

amlodipine besylate-valsartan G M

amlodipine-atorvastatin G M

amlodipine-olmesartan G M

amlodipine-valsartan-hctz G M

atenolol oral G M

atenolol-chlorthalidone G M

atorvastatin calcium oral tablet 10 mg, 20 mg G M; ACA

atorvastatin calcium oral tablet 40 mg, 80 mg G M

benazepril hcl oral G M

benazepril-hydrochlorothiazide G M

betaxolol hcl oral G M

bisoprolol fumarate G M

bisoprolol-hydrochlorothiazide G M

bumetanide oral G M

BYSTOLIC PB M

candesartan cilexetil G M

candesartan cilexetil-hctz G M

captopril oral G M


28


captopril-hydrochlorothiazide G M

cartia xt G M

carvedilol G M

carvedilol phosphate er G M

chlorothiazide oral G M

chlorthalidone G M

cholestyramine light G M

cholestyramine oral G M

clonidine G M

clonidine hcl oral G M

colesevelam hcl G M

colestipol hcl G M

digitek G M

digox G M

digoxin oral G M

diltiazem hcl er beads G M

diltiazem hcl er coated beads G M

diltiazem hcl er oral capsule extended release 12 hour

G M

diltiazem hcl oral G M

dilt-xr G M

disopyramide phosphate G M

dofetilide G

doxazosin mesylate oral G M

enalapril maleate oral G M

enalapril-hydrochlorothiazide G M

ENTRESTO PB M; QL

eplerenone G M

eprosartan mesylate G M

ethacrynic acid G M

ezetimibe G M

ezetimibe-simvastatin G M

felodipine er G M

fenofibrate micronized G M

fenofibrate oral capsule G M

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg

G M

fenofibric acid oral capsule delayed release G M

flecainide acetate G M


29


fosinopril sodium G M

fosinopril sodium-hctz G M

furosemide oral G M

gemfibrozil oral G M

guanfacine hcl G M

hydralazine hcl oral G M

hydrochlorothiazide oral G M

indapamide G M

irbesartan G M

irbesartan-hydrochlorothiazide G M

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

G M

isosorbide mononitrate G M

isosorbide mononitrate er G M

isoxsuprine hcl oral G M

isradipine G M

labetalol hcl oral G M

LANOXIN ORAL PB M

lisinopril oral G M

lisinopril-hydrochlorothiazide G M

losartan potassium G M

losartan potassium-hctz G M

lovastatin G M; ACA

matzim la G M

methyldopa G M

methyldopa-hydrochlorothiazide G M

metolazone G M

metoprolol succinate er G M

metoprolol tartrate oral G M

metoprolol-hydrochlorothiazide G M

mexiletine hcl oral G M

midodrine hcl G

minitran G M

minoxidil oral G M

moexipril hcl G M

niacin er (antihyperlipidemic) G M

niacor G M

nicardipine hcl oral G M


30


nifedipine er G M

nifedipine er osmotic release G M

nifedipine oral G M

nimodipine oral G

nisoldipine er G M

nitroglycerin sublingual G M

nitroglycerin transdermal G M

nitroglycerin translingual G M

nitro-time G M

NORPACE CR PB M

olmesartan medoxomil oral G M

olmesartan medoxomil-hctz G M

olmesartan-amlodipine-hctz G M

omega-3-acid ethyl esters G PA; M

pacerone oral tablet 200 mg G M

papaverine hcl injection G

pentoxifylline er G M

perindopril erbumine G M

phenoxybenzamine hcl oral G

pindolol G M

PRALUENT SUBCUTANEOUS SOLUTION AUTO-INJECTOR 75 MG/ML

PB PA; QL

pravastatin sodium G M; ACA

prazosin hcl oral G M

prevalite G M

propafenone hcl G M

propafenone hcl er G M

propranolol hcl er G M

propranolol hcl oral G M

propranolol-hctz G M

quinapril hcl G M

quinapril-hydrochlorothiazide G M

quinidine gluconate er G M

quinidine sulfate G M

ramipril G M

ranolazine er G M

REPATHA PB PA; QL

REPATHA PUSHTRONEX SYSTEM PB PA; QL


31


REPATHA SURECLICK PB PA; QL

rosuvastatin calcium oral tablet 10 mg, 5 mg G M; ACA

rosuvastatin calcium oral tablet 20 mg, 40 mg G M

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

G M; ACA

simvastatin oral tablet 80 mg G M

sorine G M

sotalol hcl (af) G M

sotalol hcl oral G M

sotalol hydrochloride oral tablet 120 mg, 160 mg, 80 mg

G M

spironolactone oral G M

spironolactone-hctz G M

taztia xt G M

TEKTURNA PB M

TEKTURNA HCT PB ST; M

telmisartan G M

telmisartan-amlodipine G M

telmisartan-hctz G M

tiadylt er G M

timolol maleate oral G M

torsemide G M

trandolapril G M

trandolapril-verapamil hcl er G M

triamterene oral G M

triamterene-hctz G M

valsartan G M

valsartan-hydrochlorothiazide G M

VASCEPA PB PA; M

verapamil hcl er G M

verapamil hcl oral G M

Central Nervous System Agents - Drugs for Attention Deficit Disorder

amphetamine sulfate G PA; QL

amphetamine-dextroamphetamine G PA; QL

amphetamine-dextroamphetamine er G PA; QL

atomoxetine hcl G QL

clonidine hcl er G

dexmethylphenidate hcl G PA; QL


32


dexmethylphenidate hcl er G PA; QL

dextroamphetamine sulfate G PA; QL

dextroamphetamine sulfate er G PA; QL

guanfacine hcl er G

metadate er G PA; QL

methylphenidate hcl er G PA; QL

methylphenidate hcl er (cd) G PA; QL

methylphenidate hcl er (la) G PA; QL

methylphenidate hcl oral G PA; QL

relexxii G PA; QL

VYVANSE PB PA; QL

Central Nervous System Agents - Drugs for Multiple Sclerosis

AVONEX PEN PB-S PA; QL

AVONEX PREFILLED PB-S PA; QL

BETASERON PB-S PA; QL

COPAXONE PB-S PA; QL

dalfampridine er G-S PA; QL

glatiramer acetate G-S PA; QL

glatopa G-S PA; QL

TECFIDERA PB-S PA; QL

Central Nervous System Agents - Miscellaneous

caffeine citrate oral G

pregabalin oral G QL

riluzole G PA; QL

tetrabenazine G-S PA

Dental and Oral Agents - Drugs for Mouth and Throat Conditions

cavarest G M

cevimeline hcl G M

chlorhexidine gluconate mouth/throat G

clinpro 5000 G M

denta 5000 plus G M

dentagel G M

easygel G M

fluoridex G M

fluoridex daily renewal G M

fluoridex enhanced whitening G M


33


fluoridex sensitivity relief G M

lidocaine hcl mouth/throat G

lidocaine viscous hcl G

neutral sodium fluoride G M

oralone G

paroex G

periogard G

pilocarpine hcl oral G

prevident mouth/throat G M

sf G M

sf 5000 plus G M

sodium fluoride 5000 plus G M

sodium fluoride 5000 ppm G M

sodium fluoride dental G M

triamcinolone acetonide mouth/throat G

Dermatological Agents - Drugs for Skin Conditions

acitretin G

ACZONE EXTERNAL GEL 7.5 % PB

adapalene external cream G PA

adapalene external gel 0.3 % G PA

adapalene-benzoyl peroxide G

ala-cort external cream 2.5 % G

alclometasone dipropionate G

amcinonide external lotion G

amcinonide external ointment G

ammonium lactate external lotion G

amnesteem G PA

arzol silver nit applicators G

avar cleanser G

avita G PA

azelaic acid external G

benzepro creamy wash G

benzepro external foam 5.3 % G

benzepro foaming cloths G

benzoyl peroxide external foam 9.8 % G

benzoyl peroxide-erythromycin G

beser external lotion G


34


betamethasone dipropionate aug G

betamethasone dipropionate external G

betamethasone valerate external G

bp cleansing wash G

bp wash external liquid 2.5 %, 7 % G

calcipotriene external cream G

calcipotriene external ointment G

calcipotriene external solution G

calcitriol external G

cerovel G

claravis G PA

clindacin etz external swab G

clindacin-p G

clindamycin phosphate-benzoyl peroxide G

clindamycin phosphate external G

clindamycin-tretinoin G

clobetasol prop emollient base G

clobetasol propionate e G

clobetasol propionate emulsion G

clobetasol propionate external G

clocortolone pivalate G

clodan external shampoo G

coal tar external G

dapsone external G

desonide external G

desoximetasone external cream 0.25 % G

desoximetasone external gel G

desoximetasone external liquid G

desoximetasone external ointment 0.25 % G

diclofenac sodium transdermal gel 3 % G ST; QL

doxycycline G

DUPIXENT PB-S PA; QL

ery G

erythromycin external G

EUCRISA PB ST

fluocinolone acetonide body G

fluocinolone acetonide external G

fluocinolone acetonide scalp G


35


fluocinonide emulsified base G

fluocinonide external cream 0.05 % G

fluocinonide external gel G

fluocinonide external ointment G

fluocinonide external solution G

FLUOROURACIL EXTERNAL CREAM 0.5 % PB

fluorouracil external cream 5 % G

fluorouracil external solution G

fluticasone propionate external G

grafco silver nit applicator G

halcinonide G

halobetasol propionate external cream G

halobetasol propionate external ointment G

hydrocortisone ace-pramoxine external cream 2.5-1 %

G

hydrocortisone butyrate external cream G

hydrocortisone butyrate external ointment G

hydrocortisone butyrate external solution G

hydrocortisone external cream 2.5 % G

hydrocortisone external lotion 2.5 % G

hydrocortisone external ointment 2.5 % G

hydrocortisone valerate G

imiquimod external G

isotretinoin oral G PA

ivermectin external G

lactic acid e G

lactic acid external G

latrix xm G

methoxsalen rapid G

methyl salicylate external liquid G

metronidazole external G

MIRVASO PB

mometasone furoate external G

myorisan G PA

neuac external gel G

pimecrolimus G

podocon G

podofilox external G


36


pr benzoyl peroxide wash G

PRAMOSONE EXTERNAL CREAM 1-1 % PB

prednicarbate G

RETIN-A MICRO PUMP EXTERNAL GEL 0.06 %, 0.08 %

PB PA

rosadan external cream G

rosadan external gel G

salicylic acid er G

salicylic acid external foam G

salicylic acid external gel G

salicylic acid external lotion G

salicylic acid external shampoo G

salicylic acid-cleanser external kit 6 % (lotion) G

selenium sulfide external G

sodium hyaluronate external G

sodium sulfacetamide G

SOOLANTRA PB

sss 10-5 G

sulfacetamide sodium (acne) G

sulfacetamide sodium external gel G

sulfacetamide sodium-sulfur external cream 10-2 %, 10-5 %

G

sulfacetamide sodium-sulfur external emulsion G

sulfacetamide sodium-sulfur external liquid 10-2 %, 9-4 %, 9.8-4.8 %

G

sulfacetamide sodium-sulfur external lotion 10-5 %

G

sulfacetamide sodium-sulfur external pad G

sulfacetamide sodium-sulfur external suspension

G

sulfacetamide-sulfur in urea G

sulfacleanse 8/4 G

tacrolimus external ointment G

tazarotene external G

tovet external foam G

tretinoin external G PA

tretinoin microsphere G PA

tretinoin microsphere pump G PA

triamcinolone acetonide external cream G


37


triamcinolone acetonide external lotion G

triamcinolone acetonide external ointment G

trianex G

triderm G

turpentine external G

urea external cream 39 %, 45 % G

urea external lotion G

urea hydrating G

urea nail G

urea-c40 G

zaclir cleansing G

zenatane G PA

Diabetes - Antidiabetic Agents

acarbose oral G M

BYDUREON PB ST; M; QL

BYDUREON BCISE AUTOINJECTOR PB ST; M; QL

BYETTA 10 MCG PEN PB ST; M; QL

BYETTA 5 MCG PEN PB ST; M; QL

glimepiride G M

glipizide er G M

glipizide ir G M

glipizide xl G M

glipizide-metformin hcl G M

glyburide micronized G M

glyburide oral G M

glyburide-metformin G M

GLYXAMBI PB ST; M

INVOKAMET PB ST; M

INVOKAMET XR PB ST; M

INVOKANA PB ST; M

JANUMET PB ST; M

JANUMET XR PB ST; M

JANUVIA PB ST; M

JARDIANCE PB ST; M

JENTADUETO PB ST; M

JENTADUETO XR PB ST; M

metformin hcl er G M

metformin hcl oral tablet G M


38


miglitol G M

nateglinide G M

OZEMPIC PB ST; M; QL

pioglitazone hcl G M

pioglitazone hcl-glimepiride G M

pioglitazone hcl-metformin hcl G M

repaglinide G M

RYBELSUS PB M; QL

SOLIQUA PB ST; M; QL

SYNJARDY PB ST; M

SYNJARDY XR PB ST; M

tolbutamide G M

TRADJENTA PB ST

TRULICITY PB ST; M; QL

VICTOZA PB ST; M; QL

Diabetes - Glucose Monitoring

ONETOUCH ULTRA 2 KIT W/DEVICE PB OTC

ONETOUCH ULTRA BLUE TEST STRIPS PB OTC; QL

ONETOUCH ULTRA MINI KIT W/DEVICE PB OTC

ONETOUCH VERIO KIT W/DEVICE PB OTC

ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

PB OTC

ONETOUCH VERIO TEST STRIPS PB OTC; QL

ONETOUCH VERIO IQ SYSTEM PB OTC

ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE

PB OTC

Diabetes - Glycemic Agents

BAQSIMI ONE PACK PB

BAQSIMI TWO PACK PB

GLUCAGEN HYPOKIT PB

GLUCAGON EMERGENCY KIT PB

GVOKE PFS PB

PROGLYCEM PB M

Diabetes - Insulins

DROPLET MICRON PB ST; M; OTC

HUMALOG PB M

HUMALOG KWIKPEN PB M

HUMALOG MIX 50/50 KWIKPEN PB M

HUMALOG MIX 50/50 VIAL PB M


39


HUMALOG MIX 75/25 KWIKPEN PB M

HUMALOG MIX 75/25 VIAL PB M

HUMALOG U-100 JUNIOR KWIKPEN PB M

HUMULIN 70/30 KWIKPEN PB M; OTC

HUMULIN 70/30 VIAL PB M; OTC

HUMULIN N KWIKPEN PB M; OTC

HUMULIN N VIAL PB M; OTC

HUMULIN R U-500 KWIKPEN PB M

HUMULIN R U-500 VIAL (CONCENTRATED) PB M

HUMULIN R VIAL PB M; OTC

LANTUS SOLOSTAR PB M

LANTUS U-100 VIAL PB M

TOUJEO MAX SOLOSTAR PB M

TOUJEO SOLOSTAR PB M

Electrolytes / Minerals / Metals / Vitamins

adc/f (0.5mg/ml) G ACA

aminobenzoate potassium G M

ATABEX OB PB

calcium-folic acid plus d G

CARBAGLU PB-S

chromagen G

CITRANATAL BLOOM PB

clovique G PA

cyanocobalamin injection solution 1000 mcg/ml G M

cytra k crystals G

deferasirox G-S PA

effer-k oral tablet effervescent 25 meq G M

ELITE-OB PB

ENBRACE HR PB

ergocalciferol oral capsule G

ferotrinsic G

ferraplus 90 G

FLORIVA ORAL LIQUID PB M; ACA

FLORIVA PLUS PB ACA

FLUORABON PB M; ACA

fluoritab oral solution G M; ACA

fluoritab oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

G M; ACA


40


fluoritab oral tablet chewable 2.2 (1 f) mg G M

FLURA-DROPS PB M; ACA

folic acid oral tablet 1 mg G M

foltrin G

hemocyte-plus G

hydroxocobalamin acetate G

iodine strong oral G

kionex G

klor-con G M

klor-con 10 G M

klor-con m10 G M

klor-con m20 G M

klor-con sprinkle G M

klor-con/ef G M

k-prime G M

k-tan plus G

levocarnitine oral solution G M

levocarnitine oral tablet G M

levocarnitine sf G M

ludent oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

G M; ACA

ludent oral tablet chewable 2.2 (1 f) mg G M

multigen G

multi-vit/iron/fluoride G ACA

multi-vitamin/fluoride G ACA

multivitamin/fluoride oral solution G ACA

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg

G ACA

multivitamin/fluoride oral tablet chewable 1 mg G

multivitamin/fluoride/iron G ACA

multi-vitamin/fluoride/iron G ACA

multivitamins/fluoride G ACA

mvc-fluoride oral tablet chewable 0.25 mg, 0.5 mg

G ACA

mvc-fluoride oral tablet chewable 1 mg G

nafrinse G M

nafrinse drops G M; ACA

NESTABS PB

phospho-trin 250 neutral G


41


phytonadione oral G

pnv prenatal plus multivit+dha G

polysaccharide iron forte G

POLY-VI-FLOR PB

POLY-VI-FLOR FS PB

POLY-VI-FLOR/IRON PB

pot bicarb-pot chloride G M

potassium bicarbonate oral G M

potassium chloride crys er G M

potassium chloride er G M

potassium chloride oral G M

potassium citrate er G M

potassium citrate-citric acid G

PRENARA PB

PRENATA PB

prenatal plus iron G

PRENATE ELITE PB

PRENATVITE PLUS PB

PRENATVITE RX PB

PRIMACARE PB

QUFLORA FE PEDIATRIC PB ACA

QUFLORA PEDIATRIC ORAL SOLUTION PB ACA

QUFLORA PEDIATRIC ORAL TABLET CHEWABLE 0.25 MG, 0.5 MG

PB ACA

RELNATE DHA PB

SAMSCA PB-S QL

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG

PB

sodium chloride (pf) G

sodium fluoride oral solution G M; ACA

sodium fluoride oral tablet 1.1 (0.5 f) mg G M; ACA

sodium fluoride oral tablet 2.2 (1 f) mg G M

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

G M; ACA

sodium fluoride oral tablet chewable 2.2 (1 f) mg G M

sodium polystyrene sulfonate G

sps G

taron-crystals G

tl-hem 150 G


42


TRICARE PRENATAL DHA ONE PB

trientine hcl G PA

trinate G

TRI-VI-FLOR PB

TRI-VI-FLORO PB

tri-vitamin/fluoride G ACA

tri-vite/fluoride G ACA

tryptophan oral G

vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

G

vitamins acd-fluoride G ACA

vp-pnv-dha G

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer

cimetidine hcl G M

cimetidine oral tablet 300 mg, 400 mg, 800 mg G M

DEXILANT PB M; QL

famotidine oral suspension reconstituted G M

famotidine oral tablet 40 mg G M

lansoprazole oral capsule delayed release G M; QL

lansoprazole tablet delayed release dispersible 15 mg oral (rx)

G M; QL

misoprostol oral G M

nizatidine G M

omeprazole oral capsule delayed release G M; QL

pantoprazole sodium oral G M; QL

rabeprazole sodium oral tablet delayed release G M; QL

ranitidine hcl oral capsule G M

ranitidine hcl oral syrup G M

ranitidine hcl oral tablet 300 mg G M

ranitidine hcl tablet 150 mg oral (rx) G M

sucralfate oral G M

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions

alosetron hcl G PA

amoxicill-clarithro-lansopraz G

belladonna alkaloids-opium G

cascara sagrada oral fluid extract G

chlordiazepoxide-clidinium G


43


CLENPIQ PB ACA

constulose G

cromolyn sodium oral G

dicyclomine hcl oral G

diphenoxylate-atropine G

ed-spaz G

enulose G

gavilyte-c G ACA

gavilyte-g G ACA

gavilyte-n with flavor pack G ACA

generlac G

glycopyrrolate oral tablet 1 mg, 2 mg G

hyoscyamine sulfate er G

hyoscyamine sulfate injection G

hyoscyamine sulfate oral G

hyoscyamine sulfate sl G

hyoscyamine sulfate sublingual G

hyosyne G

lactulose encephalopathy G

lactulose oral solution G

LINZESS PB ST; QL

methscopolamine bromide oral G

mineral oil heavy oral G

nulev G

OMECLAMOX-PAK PB

oscimin G

oscimin sr G

OSMOPREP PB ACA

peg 3350-kcl-na bicarb-nacl G ACA

peg-3350/electrolytes G ACA

phenobarbital-belladonna alk G

phenohytro G

PLENVU PB ACA

PREPOPIK PB ACA

propantheline bromide oral G

PYLERA PB

SUPREP BOWEL PREP KIT PB ACA

symax-sl G


44


symax-sr G

SYMPROIC PB ST; QL

trilyte G ACA

ursodiol oral G M

Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment

CREON PB

KUVAN PB-S PA

miglustat G-S PA

nitisinone G-S PA

sodium phenylbutyrate oral tablet G

STRENSIQ PB-S PA

ZENPEP PB

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions

bethanechol chloride oral G

calcium acetate (phos binder) G

calcium acetate oral tablet 667 mg G

darifenacin hydrobromide er G M

DEPEN TITRATABS PB M

ELMIRON PB

flavoxate hcl G M

hyophen G

lanthanum carbonate G

me/naphos/mb/hyo1 G

MYRBETRIQ PB

oxybutynin chloride er G M

oxybutynin chloride oral G M

penicillamine oral capsule G PA; M

penicillamine oral tablet G M

phenazo oral tablet 200 mg G

phenazopyridine hcl oral tablet 100 mg, 200 mg G

phosphasal G

sevelamer carbonate G

sevelamer hcl G

solifenacin succinate G M

tolterodine tartrate G M

tolterodine tartrate er G M

trospium chloride G M


45


trospium chloride er G M

uretron d/s G

urin ds G

ustell G

uticap G

utira-c G

utrona-c G

Genitourinary Agents - Drugs for Prostate Conditions

alfuzosin hcl er G M

dutasteride oral G M

dutasteride-tamsulosin hcl G M

finasteride oral tablet 5 mg G M

silodosin G M

tamsulosin hcl G M

terazosin hcl G M

Hormonal Agents - Adrenal

cortisone acetate oral G

dexamethasone intensol G

dexamethasone oral G

fludrocortisone acetate oral G M

hydrocortisone oral G

lidolog G

MEDROL ORAL TABLET 2 MG PB

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

G

methylprednisolone oral G

MILLIPRED PB

prednisolone oral solution G

prednisolone sodium phosphate oral G

prednisone intensol G

prednisone oral G

Hormonal Agents - Men's Health

ANDRODERM PB PA

danazol oral G

methyltestosterone oral G PA

testosterone cypionate intramuscular G PA

testosterone enanthate intramuscular G PA

testosterone transdermal G PA


46


Hormonal Agents - Osteoporosis

raloxifene hcl G M

Hormonal Agents - Pituitary

cabergoline G M

DDAVP RHINAL TUBE PB M

desmopressin ace spray refrig G M

desmopressin acetate oral G M

desmopressin acetate spray G M

INCRELEX PB-S PA

leuprolide acetate injection G-S PA

LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT 7.5 MG

PB-S PA

LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT 22.5 MG

PB-S PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

PB-S PA

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG

PB-S PA

LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 15 MG, 7.5 MG

PB-S PA

LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT 30 MG (PED)

PB PA

NORDITROPIN FLEXPRO PB-S PA

NUTROPIN AQ NUSPIN 10 PB-S PA



octreotide acetate G-S PA

OMNITROPE PB-S PA

ORILISSA PB PA; QL

SYNAREL PB

Hormonal Agents - Sex Hormones and Birth Control

afirmelle G M; ACA

altavera G M; ACA

alyacen 1/35 G M; ACA

alyacen 7/7/7 G M; ACA

amabelz G M

amethia G M; ACA; QL

amethia lo G M; ACA; QL

amethyst G M; ACA


47


apri G M; ACA

aranelle G M; ACA

ashlyna G M; ACA; QL

aubra G M; ACA

aubra eq G M; ACA

aurovela 1.5/30 G M; ACA

aurovela 1/20 G M; ACA

aurovela 24 fe G M; ACA

aurovela fe 1.5/30 G M; ACA

aurovela fe 1/20 G M; ACA

aviane G M; ACA

ayuna G M; ACA

azurette G M; ACA

BALCOLTRA PB M; ACA

balziva G M; ACA

bekyree G M; ACA

blisovi 24 fe G M; ACA

blisovi fe 1.5/30 G M; ACA

blisovi fe 1/20 G M; ACA

briellyn G M; ACA

camila G M; ACA

camrese G M; ACA; QL

camrese lo G M; ACA; QL

caziant G M; ACA

chateal G M; ACA

chateal eq G M; ACA

CLIMARA PRO PB M

covaryx G

covaryx hs G

cryselle-28 G M; ACA

cyclafem 1/35 G M; ACA

cyclafem 7/7/7 G M; ACA

cyred G M; ACA

cyred eq G M; ACA

dasetta 1/35 G M; ACA

dasetta 7/7/7 G M; ACA

daysee G M; ACA; QL

deblitane G M; ACA


48


delyla G M; ACA

desogestrel-ethinyl estradiol G M; ACA

dotti G M

drospiren-eth estrad-levomefol G M; ACA

drospirenone-ethinyl estradiol G M; ACA

DUAVEE PB

eemt G

eemt hs G

elinest G M; ACA

ELLA PB ACA

emoquette G M; ACA

ENDOMETRIN PB

enpresse-28 G M; ACA

enskyce G M; ACA

errin G M; ACA

est estrogens-methyltest G

est estrogens-methyltest ds G

est estrogens-methyltest hs G

estarylla G M; ACA

estradiol oral G M

estradiol transdermal G M

estradiol vaginal G M

estradiol valerate intramuscular G

estradiol-norethindrone acet G M

ethynodiol diac-eth estradiol G M; ACA

FALESSA PB ACA

falmina G M; ACA

fayosim G M; ACA; QL

femynor G M; ACA

fyavolv G M

gianvi G M; ACA

hailey 1.5/30 G M; ACA

hailey 24 fe G M; ACA

heather G M; ACA

incassia G M; ACA

introvale G M; ACA; QL

isibloom G M; ACA

jaimiess G M; ACA; QL


49


jasmiel G M; ACA

jencycla G M; ACA

jinteli G M

jolessa G M; ACA; QL

juleber G M; ACA

junel 1.5/30 G M; ACA

junel 1/20 G M; ACA

junel fe 1.5/30 G M; ACA

junel fe 1/20 G M; ACA

junel fe 24 G M; ACA

kaitlib fe G M; ACA

kalliga G M; ACA

kariva G M; ACA

kelnor 1/35 G M; ACA

kelnor 1/50 G M; ACA

kurvelo G M; ACA

larin 1.5/30 G M; ACA

larin 1/20 G M; ACA

larin 24 fe G M; ACA

larin fe 1.5/30 G M; ACA

larin fe 1/20 G M; ACA

larissia G M; ACA

layolis fe G M; ACA

leena G M; ACA

lessina G M; ACA

levonest G M; ACA

levonorgest-eth est & eth est G M; ACA; QL

levonorgest-eth estrad 91-day G M; ACA; QL

levonorgestrel-ethinyl estrad G M; ACA

levonorg-eth estrad triphasic G M; ACA

levora 0.15/30 (28) G M; ACA

lillow G M; ACA

lojaimiess G M; ACA; QL

lopreeza G M

loryna G M; ACA

low-ogestrel G M; ACA

lo-zumandimine G M; ACA

lutera G M; ACA


50


lyza G M; ACA

marlissa G M; ACA

medroxyprogesterone acetate oral G M

megestrol acetate oral suspension G

megestrol acetate oral tablet G-S

melodetta 24 fe G M; ACA

MENEST PB M

mibelas 24 fe G M; ACA

microgestin 1.5/30 G M; ACA

microgestin 1/20 G M; ACA

microgestin fe 1.5/30 G M; ACA

microgestin fe 1/20 G M; ACA

mili G M; ACA

mimvey G M

mono-linyah G M; ACA

NATAZIA PB M; ACA

necon 0.5/35 (28) G M; ACA

nikki G M; ACA

nora-be G M; ACA

norethin ace-eth estrad-fe G M; ACA

norethindrone acetate oral G M

norethindrone acet-ethinyl est G M; ACA

norethindrone oral G M; ACA

norethindrone-eth estradiol G M

norethin-eth estradiol-fe G M; ACA

norgestimate-eth estradiol G M; ACA

norgestimate-ethinyl estradiol triphasic G M; ACA

norlyda G M; ACA

norlyroc G M; ACA

nortrel 0.5/35 (28) G M; ACA

nortrel 1/35 (21) G M; ACA

nortrel 1/35 (28) G M; ACA

nortrel 7/7/7 G M; ACA

ocella G M; ACA

ogestrel G M; ACA

orsythia G M; ACA

philith G M; ACA

pimtrea G M; ACA


51


pirmella 1/35 G M; ACA

pirmella 7/7/7 G M; ACA

portia-28 G M; ACA

PREMARIN ORAL PB M

PREMARIN VAGINAL PB M

PREMPHASE PB M

PREMPRO PB M

previfem G M; ACA

progesterone intramuscular G

progesterone micronized oral G

reclipsen G M; ACA

rivelsa G M; ACA; QL

setlakin G M; ACA; QL

sharobel G M; ACA

simliya G M; ACA

simpesse G M; ACA; QL

sprintec 28 G M; ACA

sronyx G M; ACA

syeda G M; ACA

tarina 24 fe G M; ACA

tarina fe 1/20 G M; ACA

tarina fe 1/20 eq G M; ACA

TAYTULLA PB M; ACA

tilia fe G M; ACA

tri femynor G M; ACA

tri-estarylla G M; ACA

tri-legest fe G M; ACA

tri-linyah G M; ACA

tri-lo-estarylla G M; ACA

tri-lo-marzia G M; ACA

tri-lo-mili G M; ACA

tri-lo-sprintec G M; ACA

tri-mili G M; ACA

tri-previfem G M; ACA

tri-sprintec G M; ACA

trivora (28) G M; ACA

tri-vylibra G M; ACA

tri-vylibra lo G M; ACA


52


tulana G M; ACA

tydemy G M; ACA

velivet G M; ACA

vienva G M; ACA

viorele G M; ACA

volnea G M; ACA

vyfemla G M; ACA

vylibra G M; ACA

wera G M; ACA

wymzya fe G M; ACA

yuvafem G M

zarah G M; ACA

zovia 1/35e (28) G M; ACA

zumandimine G M; ACA

Hormonal Agents - Thyroid

euthyrox oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 88 mcg

G M

levo-t oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 88 mcg

G M

levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 88 mcg

G M

levoxyl oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 50 mcg, 88 mcg

G M

liothyronine sodium oral G M

methimazole oral G M

np thyroid G M

propylthiouracil oral G M

thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

G M

unithroid oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 88 mcg

G M

Immunological Agents - Drugs for Immune System Stimulation or Suppression

azathioprine oral G

CIMZIA PB-S PA

CIMZIA PREFILLED KIT PB-S PA


53


CIMZIA STARTER KIT PB-S PA

cyclosporine modified G

cyclosporine oral G

everolimus oral tablet 0.25 mg, 0.5 mg, 0.75 mg G PA

FIRAZYR PB-S PA

gengraf G

HUMIRA PB-S PA

HUMIRA PEDIATRIC CROHNS START PB-S PA

HUMIRA PEN PB-S PA

HUMIRA PEN-CD/UC/HS STARTER PB-S PA

HUMIRA PEN-PS/UV/ADOL HS START PB-S PA

icatibant acetate PB-S PA

leflunomide oral G M

methotrexate oral G

methotrexate sodium oral G

mycophenolate mofetil G

mycophenolate sodium G

OTEZLA PB-S PA

RASUVO PB-S PA; QL

RINVOQ PB-S PA

SANDIMMUNE ORAL SOLUTION PB

SIMPONI PB-S PA

sirolimus oral G

SKYRIZI (150 MG DOSE) PB-S PA

STELARA SUBCUTANEOUS PB-S PA

tacrolimus oral G

TREMFYA PB-S PA

TREXALL PB

XATMEP PB-S

XELJANZ PB-S PA

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 11 MG

PB-S PA

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR 22 MG

PB PA

Immunological Agents - Drugs for Vaccination

ACTHIB PB ACA

ADACEL PB ACA

AFLURIA QUADRIVALENT PB ACA


54


BEXSERO PB ACA

BOOSTRIX PB ACA

DAPTACEL PB ACA

DIPHTHERIA-TETANUS TOXOIDS DT PB ACA

ENGERIX-B PB ACA

FLUAD PB ACA

FLUARIX QUADRIVALENT PB ACA

FLUBLOK QUADRIVALENT PB ACA

FLUCELVAX QUADRIVALENT PB ACA

FLULAVAL QUADRIVALENT PB ACA

FLUZONE HIGH-DOSE PB ACA

FLUZONE QUADRIVALENT PB ACA

GARDASIL 9 PB ACA

HAVRIX PB ACA

HEPLISAV-B PB ACA

HIBERIX PB ACA

INFANRIX PB ACA

IPOL PB ACA

KINRIX PB ACA

MENACTRA PB ACA

MENVEO PB ACA

M-M-R II PB ACA

PEDIARIX PB ACA

PEDVAX HIB PB ACA

PENTACEL PB ACA

PNEUMOVAX 23 PB ACA

PREVNAR 13 PB ACA

PROQUAD PB ACA

QUADRACEL PB ACA

RECOMBIVAX HB PB ACA

ROTARIX PB ACA

ROTATEQ PB ACA

SHINGRIX PB ACA

TDVAX PB ACA

TENIVAC PB ACA

TRUMENBA PB ACA

TWINRIX PB ACA

VAQTA PB ACA


55


VARIVAX PB ACA

ZOSTAVAX PB ACA

Inflammatory Bowel Disease Agents

anucort-hc G

anusol-hc rectal G

APRISO PB M

balsalazide disodium G

budesonide er G

budesonide oral G

colocort G

hemmorex-hc G

hydrocortisone ace-pramoxine rectal cream 1-1 %, 2.5-1 %

G

hydrocortisone acetate rectal G

hydrocortisone rectal G

hydrocortisone rectal cream 1 %, 2.5 % G

mesalamine er G M

mesalamine oral G M

mesalamine rectal G M

mesalamine-cleanser G

PROCTOFOAM HC RECTAL FOAM 1-1 % PB

procto-med hc rectal cream 2.5 % G

procto-pak rectal cream 1 % G

proctosol hc rectal cream 2.5 % G

proctozone-hc rectal cream 2.5 % G

SFROWASA PB M

sulfasalazine oral G M

Metabolic Bone Disease Agents - Drugs for Osteoporosis

alendronate sodium oral solution G M

alendronate sodium oral tablet 10 mg, 5 mg G M

alendronate sodium oral tablet 35 mg, 70 mg G M; QL

calcitonin (salmon) G M; QL

FORTEO SUBCUTANEOUS SOLUTION 600 MCG/2.4ML

PB-S PA

ibandronate sodium oral G M; QL

risedronate sodium oral tablet 150 mg, 35 mg G M; QL

risedronate sodium oral tablet 30 mg, 5 mg G M

risedronate sodium oral tablet delayed release G M; QL


56


TYMLOS PB-S PA

Metabolic Bone Disease Agents - Other

calcitriol oral G M

cinacalcet hcl G PA

paricalcitol oral G M

Miscellaneous Therapeutic Agents

ergoloid mesylates oral G M

methergine G

methylergonovine maleate oral G

mlk f1 G

mlk f2 G

mlk f3 G

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation

azelastine hcl ophthalmic G

bacitracin ophthalmic G

bromfenac sodium (once-daily) G QL

ciprofloxacin hcl ophthalmic G

cromolyn sodium ophthalmic G

dexamethasone sodium phosphate ophthalmic G

diclofenac sodium ophthalmic G

epinastine hcl G

erythromycin ophthalmic G

fluorometholone G

flurbiprofen sodium G

FML PB

gatifloxacin ophthalmic G

gentak G

gentamicin sulfate ophthalmic G

ketorolac tromethamine ophthalmic G

levofloxacin ophthalmic G

loteprednol etabonate G

MOXEZA PB

moxifloxacin hcl (2x day) G

moxifloxacin hcl ophthalmic G

NATACYN PB

ofloxacin ophthalmic G

olopatadine hcl ophthalmic G


57


prednisolone acetate ophthalmic G

prednisolone acetate p-f G

prednisolone sodium phosphate ophthalmic G

PROLENSA PB QL

sulfacetamide sodium ophthalmic G

tobramycin ophthalmic G

trifluridine G

Ophthalmic Agents - Drugs for Glaucoma

acetazolamide er G M

acetazolamide oral G M

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 % PB M

apraclonidine hcl G

AZOPT PB M

betaxolol hcl ophthalmic G M

bimatoprost ophthalmic G M; QL

brimonidine tartrate ophthalmic G M

carteolol hcl G M

COMBIGAN PB M

dorzolamide hcl ophthalmic G M

dorzolamide hcl-timolol mal G M

dorzolamide hcl-timolol mal pf G M

latanoprost ophthalmic G M

levobunolol hcl G M

LUMIGAN PB M; QL

methazolamide oral G M

PHOSPHOLINE IODIDE PB M

pilocarpine hcl ophthalmic G M

RHOPRESSA PB M

ROCKLATAN PB M; QL

SIMBRINZA PB M

timolol maleate ophthalmic G M

travoprost (bak free) G M; QL

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions

ak-poly-bac G

altacaine G

altafrin G

atropine sulfate ophthalmic ointment G M


58


atropine sulfate ophthalmic solution 1 % G M

bacitracin-polymyxin b ophthalmic G

bacitra-neomycin-polymyxin-hc G

cyclopentolate hcl ophthalmic G M

homatropaire G M

homatropine hbr G M

neomycin-bacitracin zn-polymyx G

neomycin-polymyxin-dexameth ophthalmic ointment

G

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

G

neomycin-polymyxin-gramicidin G

neomycin-polymyxin-hc ophthalmic G

neo-polycin G

neo-polycin hc G

phenylephrine hcl ophthalmic G

polycin G

polymyxin b-trimethoprim G

proparacaine hcl ophthalmic G

RESTASIS PB PA; M

RESTASIS MULTIDOSE PB PA; M

sulfacetamide-prednisolone ophthalmic solution G

tetcaine G

tetracaine hcl ophthalmic G

tetravisc G

tetravisc forte G

tobramycin-dexamethasone G

XIIDRA PB PA; M

Otic Agents - Drugs for Ear Conditions

acetic acid otic G

CIPRODEX PB

ciprofloxacin hcl otic G ST

cortic-nd G

exotic-hc G

flac G

fluocinolone acetonide otic G

hydrocortisone-acetic acid G

neomycin-polymyxin-hc otic G

ofloxacin otic G


59


Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold

azelastine hcl nasal G QL

azelastine-fluticasone G QL

benzonatate G

bromfed dm G

brompheniramine tannate G

carbinoxamine maleate oral solution G

carbinoxamine maleate oral tablet 4 mg G

clemastine fumarate oral tablet 2.68 mg G

cyproheptadine hcl oral G

desloratadine G

diphenhydramine hcl oral elixir G

flunisolide nasal G QL

fluticasone propionate nasal G

guaiatussin ac G PA; OTC; QL

guaifenesin ac G PA; OTC; QL

hydrocodone polst-cpm polst er G PA; QL

hydrocodone-homatropine G PA; QL

hydromet G PA; QL

ipratropium bromide nasal G

mometasone furoate nasal G QL

nebusal inhalation nebulization solution 3 % G

NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

PB-S PA; QL

NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

PB-S PA; QL

NUCALA SUBCUTANEOUS SOLUTION RECONSTITUTED

PB PA; QL

olopatadine hcl nasal G QL

phenadoz G

promethazine hcl oral G

promethazine hcl rectal G

promethazine-codeine G PA; QL

promethazine-dm G

promethazine-dm oral solution 6.25-15 mg/5ml G

promethazine-phenyleph-codeine G PA; QL

promethazine-phenylephrine G

promethegan G


60


pseudoephedrine-bromphen-dm G

pulmosal G

ryvent G

sodium chloride inhalation G

virtussin ac w/alc G PA; OTC; QL

Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions

acetylcysteine inhalation G

ADVAIR DISKUS PB M; QL

ADVAIR HFA PB M; QL

albuterol sulfate er G M

albuterol sulfate hfa aerosol solution 108 (90 base) mcg/act inhalation

G M; QL

ALBUTEROL SULFATE HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION

G-S M; QL

albuterol sulfate inhalation G M; QL

albuterol sulfate oral G M

ANORO ELLIPTA PB M; QL

ARNUITY ELLIPTA PB M; QL

BREO ELLIPTA PB M; QL

budesonide inhalation G M; QL

COMBIVENT RESPIMAT PB QL

cromolyn sodium inhalation G M

difil-g forte G

ELIXOPHYLLIN PB M

epinephrine injection solution auto-injector G

FLOVENT DISKUS PB M; QL

FLOVENT HFA PB M; QL

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

G M; QL

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14 MCG/ACT

G M; QL

INCRUSE ELLIPTA PB M; QL

ipratropium bromide inhalation G M; QL

ipratropium-albuterol G QL

levalbuterol hcl inhalation G QL


61


metaproterenol sulfate oral G M

montelukast sodium oral G M

PROAIR HFA G M; QL

PROAIR RESPICLICK G M; QL

PULMICORT FLEXHALER PB M; QL

SEREVENT DISKUS PB M; QL

SPIRIVA HANDIHALER PB M; QL

SPIRIVA RESPIMAT PB M; QL

STIOLTO RESPIMAT PB M; QL

SYMBICORT PB M; QL

terbutaline sulfate oral G M

theophylline G M

theophylline er G M

TRELEGY ELLIPTA PB M; QL

VENTOLIN HFA G-S M; QL

wixela inhub G M; QL

zafirlukast G M

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis

BETHKIS PB-S

PULMOZYME PB PA

tobramycin inhalation G-S

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension

ADEMPAS PB-S PA; QL

alyq G-S PA; QL

ambrisentan G-S PA; QL

bosentan G-S PA; QL

OPSUMIT PB-S PA; QL

sildenafil citrate oral suspension reconstituted G-S PA; QL

sildenafil citrate oral tablet 20 mg G-S PA; QL

tadalafil (pah) G-S PA; QL

TRACLEER 32 MG PB-S PA; QL

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm

baclofen external G

baclofen oral G

carisoprodol oral G

carisoprodol-aspirin G


62


chlorzoxazone oral tablet 375 mg, 500 mg, 750 mg

G

cyclobenzaprine hcl oral G

dantrolene sodium oral G

enovarx-cyclobenzaprine hcl G

metaxalone G

methocarbamol oral G

orphenadrine citrate er G

orphenadrine-aspirin-caffeine G

tizanidine hcl oral G

Sleep Disorder Agents

armodafinil G PA; QL

doxepin hcl oral tablet G QL

eszopiclone G QL

flurazepam hcl G PA; QL

modafinil G PA; QL

ramelteon G QL

SUNOSI PB PA; QL

temazepam G QL

zaleplon G QL

zolpidem tartrate oral G QL


63

Index of Drugs

abacavir sulfate.........................25abacavir sulfate-lamivudine...... 25abacavir-lamivudine-zidovudine.................................25abiraterone acetate................... 20acamprosate calcium................ 13acarbose................................... 38acebutolol hcl............................ 28acetaminophen-codeine............10acetaminophen-codeine #2.......10acetaminophen-codeine #3.......10acetaminophen-codeine #4.......10acetazolamide...........................58acetazolamide er.......................58acetic acid................................. 59acetylcysteine........................... 61acitretin..................................... 34ACTHIB.....................................54acyclovir.................................... 25ACZONE................................... 34ADACEL....................................54adapalene................................. 34adapalene-benzoyl peroxide.....34adc/f (0.5mg/ml)........................ 40adefovir dipivoxil ....................... 25ADEMPAS................................ 62ADVAIR DISKUS...................... 61ADVAIR HFA............................ 61AFINITOR................................. 20AFINITOR DISPERZ.................20afirmelle.................................... 47AFLURIA QUADRIVALENT......54AIMOVIG...................................19ak-poly-bac............................... 58ala-cort...................................... 34albendazole...............................23albuterol sulfate.........................61albuterol sulfate er.................... 61albuterol sulfate hfa...................61ALBUTEROL SULFATE HFA... 61alclometasone dipropionate...... 34ALECENSA...............................20alendronate sodium.................. 56alfuzosin hcl er.......................... 46ALINIA.......................................23aliskiren fumarate......................28ALKERAN................................. 20allopurinol..................................19almotriptan malate.................... 19alosetron hcl..............................43ALPHAGAN P........................... 58alprazolam................................ 27

alprazolam er............................ 27alprazolam intensol................... 27alprazolam xr............................ 27altacaine....................................58altafrin....................................... 58altavera..................................... 47ALUNBRIG................................20alyacen 1/35..............................47alyacen 7/7/7.............................47alyq........................................... 62amabelz.................................... 47amantadine hcl..........................24ambrisentan.............................. 62amcinonide................................34amethia..................................... 47amethia lo................................. 47amethyst................................... 47amiloride hcl..............................28amiloride-hydrochlorothiazide... 28aminobenzoate potassium........ 40aminocaproic acid..................... 28amiodarone hcl......................... 28amitriptyline hcl......................... 16amlodipine besylate.................. 28amlodipine besylate-benazepril hcl............................................. 28amlodipine besylate-valsartan.. 28amlodipine-atorvastatin.............28amlodipine-olmesartan..............28amlodipine-valsartan-hctz......... 28ammonium lactate.....................34amnesteem............................... 34amoxapine................................ 16amoxicill-clarithro-lansopraz..... 43amoxicillin................................. 13amoxicillin-potassium clavulanate................................13amoxicillin-potassium clavulanate er............................13amphetamine sulfate.................32amphetamine-dextroamphetamine.................. 32amphetamine-dextroamphetamine er.............. 32ampicillin................................... 13anagrelide hcl............................28anastrozole............................... 20ANDRODERM.......................... 46ANORO ELLIPTA..................... 61anucort-hc................................. 56anusol-hc.................................. 56apap-caff-dihydrocodeine......... 10

APOKYN................................... 24apraclonidine hcl....................... 58aprepitant.................................. 18apri............................................ 48APRISO.................................... 56APTIVUS...................................25aranelle..................................... 48aripiprazole............................... 25armodafinil ................................ 63ARNUITY ELLIPTA...................61AROMASIN...............................20arzol silver nit applicators..........34ascomp-codeine........................10ashlyna......................................48aspirin-dipyridamole er..............24ATABEX OB..............................40atazanavir sulfate......................25atenolol..................................... 28atenolol-chlorthalidone..............28atomoxetine hcl.........................32atorvastatin calcium.................. 28atovaquone............................... 23atovaquone-proguanil hcl..........23atropine sulfate................... 58, 59aubra.........................................48aubra eq....................................48aurovela 1.5/30......................... 48aurovela 1/20............................ 48aurovela 24 fe........................... 48aurovela fe 1.5/30..................... 48aurovela fe 1/20........................ 48avar cleanser............................ 34aviane....................................... 48avidoxy......................................13avita.......................................... 34AVONEX PEN...........................33AVONEX PREFILLED.............. 33ayuna........................................ 48azathioprine.............................. 53azelaic acid............................... 34azelastine hcl...................... 57, 60azelastine-fluticasone............... 60azithromycin..............................13AZOPT...................................... 58azurette..................................... 48bacitracin...................................57bacitracin-polymyxin b.............. 59bacitra-neomycin-polymyxin-hc 59baclofen.................................... 62BALCOLTRA.............................48balsalazide disodium.................56BALVERSA............................... 20

64

balziva.......................................48BAQSIMI ONE PACK............... 39BAQSIMI TWO PACK...............39bekyree..................................... 48BELBUCA................................. 10belladonna alkaloids-opium...... 43benazepril hcl............................28benazepril-hydrochlorothiazide. 28benzepro................................... 34benzepro creamy wash.............34benzepro foaming cloths...........34benzonatate.............................. 60benzoyl peroxide.......................34benzoyl peroxide-erythromycin. 34benztropine mesylate................24beser......................................... 34betamethasone dipropionate.... 35betamethasone dipropionate aug............................................ 35betamethasone valerate........... 35BETASERON............................33betaxolol hcl........................ 28, 58bethanechol chloride.................45BETHKIS...................................62bexarotene................................ 20BEXSERO.................................55bicalutamide..............................20bimatoprost............................... 58bio-statin................................... 18bisoprolol fumarate................... 28bisoprolol-hydrochlorothiazide.. 28blisovi 24 fe............................... 48blisovi fe 1.5/30......................... 48blisovi fe 1/20............................ 48BOOSTRIX............................... 55bosentan................................... 62BOSULIF...................................20bp cleansing wash.................... 35bp wash.....................................35BRAFTOVI................................ 20BREO ELLIPTA........................ 61briellyn.......................................48BRILINTA..................................24brimonidine tartrate................... 58bromfed dm...............................60bromfenac sodium (once-daily).57bromocriptine mesylate.............24brompheniramine tannate......... 60budesonide......................... 56, 61budesonide er........................... 56bumetanide............................... 28BUNAVAIL................................ 13buprenorphine...........................10

buprenorphine hcl..................... 13buprenorphine hcl-naloxone hcl............................................. 13bupropion hcl............................ 16bupropion hcl er (smoking det). 13bupropion hcl er (sr)..................16bupropion hcl er (xl).................. 16BUPROPION HCL ER (XL)...... 16buspirone hcl.............................27butalbital-acetaminophen..........10butalbital-apap-caff-cod............ 10butalbital-apap-caffeine.............10butalbital-asa-caff-codeine........10butalbital-aspirin-caffeine.......... 10butorphanol tartrate...................10BYDUREON..............................38BYDUREON BCISE AUTOINJECTOR...................... 38BYETTA 10 MCG PEN............. 38BYETTA 5 MCG PEN............... 38BYSTOLIC................................ 28cabergoline............................... 47CABOMETYX........................... 20caffeine citrate...........................33calcipotriene..............................35calcitonin (salmon).................... 56calcitriol ............................... 35, 57calcium acetate......................... 45calcium acetate (phos binder)...45calcium-folic acid plus d............ 40CALQUENCE............................20camila........................................48camrese.................................... 48camrese lo................................ 48candesartan cilexetil ................. 28candesartan cilexetil-hctz..........28capecitabine..............................20CAPRELSA...............................20captopril .................................... 28captopril-hydrochlorothiazide.... 29CARBAGLU.............................. 40carbamazepine......................... 15carbamazepine er..................... 15carbidopa.................................. 24carbidopa-levodopa.................. 24carbidopa-levodopa er.............. 24carbidopa-levodopa-entacapone............................... 24carbinoxamine maleate.............60carisoprodol.............................. 62carisoprodol-aspirin...................62carisoprodol-aspirin-codeine.....10carteolol hcl...............................58

cartia xt..................................... 29carvedilol...................................29carvedilol phosphate er.............29cascara sagrada....................... 43CASODEX................................ 20cavarest.................................... 33caziant.......................................48cefaclor..................................... 13cefaclor er................................. 13cefadroxil ...................................13cefdinir...................................... 13cefditoren pivoxil ....................... 13cefixime.....................................13cefpodoxime proxetil ................. 13cefprozil .....................................13cefuroxime axetil ....................... 13celecoxib................................... 11cephalexin.................................13cerovel...................................... 35cevimeline hcl........................... 33CHANTIX.................................. 13CHANTIX CONTINUING MONTH PAK.............................13CHANTIX STARTING MONTH PAK...........................................13chateal...................................... 48chateal eq................................. 48chlordiazepoxide hcl................. 27chlordiazepoxide-amitriptyline...17chlordiazepoxide-clidinium........43chlorhexidine gluconate............ 33chloroquine phosphate..............24chlorothiazide............................29chlorpromazine hcl....................25chlorthalidone............................29chlorzoxazone...........................63cholestyramine..........................29cholestyramine light.................. 29choline-mag trisalicylate............11chromagen................................ 40ciclodan.....................................18ciclopirox................................... 18ciclopirox olamine..................... 18cilostazol................................... 24CIMDUO................................... 25cimetidine..................................43cimetidine hcl............................ 43CIMZIA......................................53CIMZIA PREFILLED KIT...........53CIMZIA STARTER KIT............. 54cinacalcet hcl............................ 57CIPRODEX............................... 59ciprofloxacin hcl............ 13, 57, 59

65

citalopram hydrobromide.......... 17CITRANATAL BLOOM..............40claravis......................................35clarithromycin............................14clarithromycin er........................14clemastine fumarate..................60CLENPIQ.................................. 44CLEOCIN.................................. 14CLIMARA PRO......................... 48clindacin etz.............................. 35clindacin-p.................................35clindamycin hcl..........................14clindamycin palmitate hcl.......... 14clindamycin phosphate....... 14, 35clindamycin phosphate-benzoyl peroxide.......................35clindamycin-tretinoin................. 35clinpro 5000.............................. 33clobazam...................................15clobetasol prop emollient base. 35clobetasol propionate................35clobetasol propionate e.............35clobetasol propionate emulsion 35clocortolone pivalate................. 35clodan....................................... 35clomipramine hcl....................... 17clonazepam...............................27clonidine....................................29clonidine hcl.............................. 29clonidine hcl er.......................... 32clopidogrel bisulfate.................. 24clorazepate dipotassium........... 27clotrimazole...............................18clotrimazole-betamethasone.....18clovique.....................................40clozapine...................................25coal tar...................................... 35codeine sulfate..........................10colchicine.................................. 19colchicine-probenecid............... 19COLCRYS.................................19colesevelam hcl........................ 29colestipol hcl............................. 29colistimethate sodium (cba)...... 14colocort..................................... 56COMBIGAN.............................. 58COMBIVENT RESPIMAT......... 61COMETRIQ (100 MG DAILY DOSE).......................................20COMETRIQ (140 MG DAILY DOSE).......................................20COMETRIQ (60 MG DAILY DOSE).......................................20

COMPLERA..............................25compro...................................... 18constulose.................................44COPAXONE..............................33COPIKTRA................................20cortic-nd.................................... 59cortisone acetate.......................46COTELLIC................................ 20covaryx......................................48covaryx hs.................................48CREON..................................... 45CRIXIVAN................................. 25cromolyn sodium...........44, 57, 61crotan........................................ 24cryselle-28.................................48c-topical.....................................12cyanocobalamin........................ 40cyclafem 1/35............................48cyclafem 7/7/7...........................48cyclobenzaprine hcl.................. 63cyclopentolate hcl..................... 59cyclophosphamide.................... 20cycloserine................................ 19cyclosporine.............................. 54cyclosporine modified............... 54cyproheptadine hcl....................60cyred......................................... 48cyred eq.................................... 48cytra k crystals.......................... 40dalfampridine er........................ 33danazol..................................... 46dantrolene sodium.................... 63dapsone.............................. 19, 35DAPTACEL............................... 55darifenacin hydrobromide er..... 45dasetta 1/35.............................. 48dasetta 7/7/7............................. 48DAURISMO...............................20daysee...................................... 48DDAVP RHINAL TUBE.............47deblitane................................... 48deferasirox................................ 40delyla.........................................49demeclocycline hcl....................14denta 5000 plus........................ 33dentagel.................................... 33DEPEN TITRATABS.................45desipramine hcl.........................17desloratadine............................ 60desmopressin ace spray refrig..47desmopressin acetate...............47desmopressin acetate spray..... 47desogestrel-ethinyl estradiol..... 49

desonide................................... 35desoximetasone........................35desvenlafaxine succinate er......17dexamethasone........................ 46dexamethasone intensol........... 46dexamethasone sodium phosphate................................. 57DEXILANT................................ 43dexmethylphenidate hcl............ 32dexmethylphenidate hcl er........ 33dextroamphetamine sulfate.......33dextroamphetamine sulfate er.. 33diazepam............................ 15, 27diazepam intensol..................... 27diclofenac potassium................ 11diclofenac sodium... 11, 12, 35, 57diclofenac sodium er................. 11diclofenac-misoprostol.............. 12dicloxacillin sodium................... 14dicyclomine hcl..........................44didanosine.................................25difil-g forte................................. 61diflunisal.................................... 12digitek........................................29digox......................................... 29digoxin.......................................29dihydroergotamine mesylate.....19diltiazem hcl.............................. 29diltiazem hcl er.......................... 29diltiazem hcl er beads............... 29diltiazem hcl er coated beads... 29dilt-xr......................................... 29dimenhydrinate......................... 18diphenhydramine hcl.................60diphenoxylate-atropine..............44DIPHTHERIA-TETANUS TOXOIDS DT............................ 55dipyridamole..............................25disopyramide phosphate...........29disulfiram...................................13divalproex sodium..................... 15divalproex sodium er.................15dofetilide....................................29DOLOPHINE.............................10donepezil hcl............................. 16dorzolamide hcl.........................58dorzolamide hcl-timolol mal...... 58dorzolamide hcl-timolol mal pf.. 58dotti ........................................... 49DOVATO...................................26doxazosin mesylate.................. 29doxepin hcl..........................17, 63doxycycline............................... 35

66

doxycycline hyclate................... 14doxycycline monohydrate......... 14doxylamine-pyridoxine.............. 18dronabinol................................. 18DROPLET MICRON................. 39drospiren-eth estrad-levomefol. 49drospirenone-ethinyl estradiol...49DUAVEE................................... 49duloxetine hcl............................ 17DUPIXENT................................35duraxin...................................... 10dutasteride................................ 46dutasteride-tamsulosin hcl........ 46easygel......................................33ec-naproxen.............................. 12econazole nitrate.......................18ed-spaz..................................... 44EDURANT.................................26eemt.......................................... 49eemt hs..................................... 49efavirenz................................... 26effer-k........................................40eletriptan hydrobromide............ 19elinest........................................49ELIQUIS....................................15ELIQUIS DVT/PE STARTER PACK........................................ 15ELITE-OB..................................40ELIXOPHYLLIN........................ 61ELLA......................................... 49ELMIRON..................................45EMCYT..................................... 20EMGALITY................................19EMGALITY (300 MG DOSE).... 19emoquette................................. 49EMTRIVA.................................. 26EMVERM.................................. 24enalapril maleate.......................29enalapril-hydrochlorothiazide.... 29ENBRACE HR.......................... 40endocet..................................... 10ENDOMETRIN..........................49ENGERIX-B.............................. 55enovarx-cyclobenzaprine hcl.... 63enoxaparin sodium....................15enpresse-28.............................. 49enskyce.....................................49entacapone............................... 24entecavir................................... 26ENTRESTO.............................. 29enulose..................................... 44epinastine hcl............................ 57epinephrine............................... 61

epitol......................................... 15EPIVIR HBV..............................26eplerenone................................ 29eprosartan mesylate................. 29ergocalciferol.............................40ergoloid mesylates.................... 57ergotamine-caffeine.................. 19ERIVEDGE............................... 20ERLEADA................................. 20erlotinib hcl................................20errin...........................................49ery............................................. 35erythromycin................. 14, 35, 57erythromycin base.....................14erythromycin ethylsuccinate......14escitalopram oxalate................. 17est estrogens-methyltest...........49est estrogens-methyltest ds...... 49est estrogens-methyltest hs...... 49estarylla.....................................49estazolam..................................27estradiol.................................... 49estradiol valerate.......................49estradiol-norethindrone acet..... 49eszopiclone............................... 63ethacrynic acid.......................... 29ethambutol hcl...........................19ethosuximide.............................15ethyl chloride.............................12ethynodiol diac-eth estradiol..... 49etodolac.................................... 12etodolac er................................ 12etoposide.................................. 20EUCRISA.................................. 35euthyrox.................................... 53everolimus...........................20, 54EVOTAZ....................................26EVZIO....................................... 13exemestane.............................. 21exoderm.................................... 18exotic-hc....................................59ezetimibe...................................29ezetimibe-simvastatin............... 29FALESSA..................................49falmina...................................... 49famciclovir................................. 26famotidine................................. 43FARESTON.............................. 21FARYDAK................................. 21fayosim......................................49febuxostat................................. 19felbamate.................................. 15felodipine er.............................. 29

FEMARA................................... 21femynor..................................... 49fenofibrate................................. 29fenofibrate micronized...............29fenofibric acid............................29fentanyl..................................... 10fentanyl citrate...........................10ferotrinsic.................................. 40ferraplus 90............................... 40finasteride................................. 46FIRAZYR...................................54flac............................................ 59flavoxate hcl.............................. 45flecainide acetate...................... 29FLORIVA...................................40FLORIVA PLUS........................ 40FLOVENT DISKUS................... 61FLOVENT HFA......................... 61FLUAD...................................... 55FLUARIX QUADRIVALENT......55FLUBLOK QUADRIVALENT.....55FLUCELVAX QUADRIVALENT...................... 55fluconazole................................18flucytosine................................. 18fludrocortisone acetate..............46FLULAVAL QUADRIVALENT... 55flunisolide.................................. 60fluocinolone acetonide........ 35, 59fluocinolone acetonide body..... 35fluocinolone acetonide scalp.....35fluocinonide...............................36fluocinonide emulsified base.....36FLUORABON............................40fluoridex.................................... 33fluoridex daily renewal.............. 33fluoridex enhanced whitening... 33fluoridex sensitivity relief........... 34fluoritab............................... 40, 41fluorometholone........................ 57FLUOROURACIL......................36fluorouracil ................................ 36fluoxetine hcl............................. 17fluoxetine hcl (pmdd).................17fluphenazine hcl........................ 25FLURA-DROPS........................ 41flurazepam hcl...........................63flurbiprofen................................ 12flurbiprofen sodium................... 57flutamide................................... 21fluticasone propionate.........36, 60fluticasone-salmeterol............... 61

67

FLUTICASONE-SALMETEROL..........................61fluvoxamine maleate................. 17fluvoxamine maleate er.............17FLUZONE HIGH-DOSE............55FLUZONE QUADRIVALENT.... 55FML...........................................57folic acid.................................... 41foltrin......................................... 41fondaparinux sodium.................15FORTEO................................... 56fosamprenavir calcium.............. 26fosinopril sodium....................... 30fosinopril sodium-hctz............... 30furosemide................................ 30FUZEON................................... 26fyavolv.......................................49gabapentin................................ 15galantamine hydrobromide....... 16galantamine hydrobromide er... 16GARDASIL 9.............................55gatifloxacin................................ 57gavilyte-c...................................44gavilyte-g...................................44gavilyte-n with flavor pack.........44gemfibrozil .................................30generlac.................................... 44gengraf......................................54gentak....................................... 57gentamicin sulfate............... 14, 57gianvi.........................................49GILOTRIF................................. 21glatiramer acetate..................... 33glatopa...................................... 33GLEOSTINE............................. 21glimepiride.................................38glipizide er.................................38glipizide ir.................................. 38glipizide xl................................. 38glipizide-metformin hcl.............. 38GLUCAGEN HYPOKIT............. 39GLUCAGON EMERGENCY KIT............................................ 39glyburide................................... 38glyburide micronized................. 38glyburide-metformin.................. 38glycopyrrolate............................44glydo......................................... 12GLYXAMBI................................38grafco silver nit applicator......... 36granisetron hcl.......................... 18griseofulvin microsize................18griseofulvin ultramicrosize.........18

guaiatussin ac........................... 60guaifenesin ac...........................60guanfacine hcl...........................30guanfacine hcl er.......................33GVOKE PFS............................. 39hailey 1.5/30..............................49hailey 24 fe................................49halcinonide................................36halobetasol propionate..............36haloperidol................................ 25haloperidol decanoate...............25haloperidol lactate.....................25HARVONI..................................26HAVRIX.....................................55heather......................................49hemmorex-hc............................ 56hemocyte-plus...........................41heparin sodium (porcine).......... 15heparin sodium (porcine) pf...... 15HEPLISAV-B.............................55HIBERIX....................................55homatropaire.............................59homatropine hbr........................59HUMALOG................................39HUMALOG KWIKPEN.............. 39HUMALOG MIX 50/50 KWIKPEN................................. 39HUMALOG MIX 50/50 VIAL......39HUMALOG MIX 75/25 KWIKPEN................................. 40HUMALOG MIX 75/25 VIAL......40HUMALOG U-100 JUNIOR KWIKPEN................................. 40HUMIRA....................................54HUMIRA PEDIATRIC CROHNS START......................54HUMIRA PEN........................... 54HUMIRA PEN-CD/UC/HS STARTER................................. 54HUMIRA PEN-PS/UV/ADOL HS START................................ 54HUMULIN 70/30 KWIKPEN...... 40HUMULIN 70/30 VIAL...............40HUMULIN N KWIKPEN............ 40HUMULIN N VIAL..................... 40HUMULIN R U-500 KWIKPEN..40HUMULIN R U-500 VIAL (CONCENTRATED)..................40HUMULIN R VIAL..................... 40HYCAMTIN............................... 21hydralazine hcl.......................... 30HYDREA................................... 21hydrochlorothiazide...................30

hydrocodone bitartrate er..........10hydrocodone polst-cpm polst er...............................................60hydrocodone-acetaminophen... 10hydrocodone-homatropine........ 60hydrocodone-ibuprofen............. 10hydrocortisone.............. 36, 46, 56hydrocortisone ace-pramoxine............................................ 36, 56hydrocortisone acetate..............56hydrocortisone butyrate............ 36hydrocortisone valerate.............36hydrocortisone-acetic acid........ 59hydromet................................... 60hydromorphone hcl................... 10hydromorphone hcl er............... 10hydroxocobalamin acetate........ 41hydroxychloroquine sulfate....... 24hydroxyurea.............................. 21hydroxyzine hcl......................... 27hydroxyzine pamoate................27hyophen.................................... 45hyoscyamine sulfate................. 44hyoscyamine sulfate er............. 44hyoscyamine sulfate sl..............44hyosyne.....................................44HYSINGLA ER..........................10ibandronate sodium.................. 56IBRANCE.................................. 21ibu............................................. 12ibuprofen................................... 12icatibant acetate........................54ICLUSIG....................................21IDHIFA...................................... 21imatinib mesylate...................... 21IMBRUVICA.............................. 21imipramine hcl...........................17imipramine pamoate................. 17imiquimod..................................36incassia..................................... 49INCRELEX................................ 47INCRUSE ELLIPTA.................. 61indapamide............................... 30indomethacin.............................12indomethacin er........................ 12INFANRIX................................. 55INLYTA..................................... 21INREBIC................................... 21INTELENCE..............................26introvale.................................... 49INVIRASE................................. 26INVOKAMET.............................38INVOKAMET XR.......................38

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INVOKANA............................... 38iodine strong............................. 41IPOL..........................................55ipratropium bromide............ 60, 61ipratropium-albuterol................. 61irbesartan.................................. 30irbesartan-hydrochlorothiazide..30IRESSA.....................................21ISENTRESS..............................26ISENTRESS HD....................... 26isibloom.....................................49isoniazid.................................... 20isosorbide dinitrate....................30isosorbide mononitrate..............30isosorbide mononitrate er......... 30isotretinoin.................................36isoxsuprine hcl.......................... 30isradipine...................................30itraconazole...............................18ivermectin............................24, 36jaimiess..................................... 49JAKAFI......................................21jantoven.................................... 15JANUMET................................. 38JANUMET XR........................... 38JANUVIA...................................38JARDIANCE..............................38jasmiel.......................................50jencycla..................................... 50JENTADUETO.......................... 38JENTADUETO XR.................... 38jinteli ..........................................50jolessa.......................................50juleber....................................... 50JULUCA.................................... 26junel 1.5/30............................... 50junel 1/20.................................. 50junel fe 1.5/30........................... 50junel fe 1/20.............................. 50junel fe 24................................. 50kaitlib fe.....................................50KALETRA..................................26kalliga........................................50kariva........................................ 50kelnor 1/35................................ 50kelnor 1/50................................ 50ketoconazole.............................18ketoprofen................................. 12ketoprofen er.............................12ketorolac tromethamine...... 12, 57KINRIX...................................... 55kionex........................................41KISQALI (200 MG DOSE).........21

KISQALI (400 MG DOSE).........21KISQALI (600 MG DOSE).........21KISQALI FEMARA (400 MG DOSE).......................................21KISQALI FEMARA (600 MG DOSE).......................................21KISQALI FEMARA(200 MG DOSE).......................................21klor-con..................................... 41klor-con 10................................ 41klor-con m10............................. 41klor-con m20............................. 41klor-con sprinkle........................41klor-con/ef................................. 41k-prime...................................... 41k-tan plus.................................. 41kurvelo...................................... 50KUVAN......................................45labetalol hcl............................... 30lactic acid.................................. 36lactic acid e............................... 36lactulose....................................44lactulose encephalopathy......... 44lamivudine.................................26lamivudine-zidovudine.............. 26lamotrigine................................ 15lamotrigine er............................ 15lamotrigine starter kit-blue.........15lamotrigine starter kit-green...... 15lamotrigine starter kit-orange.... 15LANOXIN.................................. 30lansoprazole..............................43lanthanum carbonate................ 45LANTUS SOLOSTAR............... 40LANTUS U-100 VIAL................ 40larin 1.5/30................................ 50larin 1/20................................... 50larin 24 fe.................................. 50larin fe 1.5/30............................ 50larin fe 1/20............................... 50larissia.......................................50latanoprost................................ 58latrix xm.....................................36layolis fe.................................... 50leena......................................... 50leflunomide................................54LENVIMA (10 MG DAILY DOSE).......................................21LENVIMA (12 MG DAILY DOSE).......................................21LENVIMA (14 MG DAILY DOSE).......................................21

LENVIMA (18 MG DAILY DOSE).......................................21LENVIMA (20 MG DAILY DOSE).......................................21LENVIMA (24 MG DAILY DOSE).......................................21LENVIMA (4 MG DAILY DOSE).......................................21LENVIMA (8 MG DAILY DOSE).......................................21lessina.......................................50letrozole.................................... 21leucovorin calcium.................... 22LEUKERAN...............................22leuprolide acetate......................47levalbuterol hcl.......................... 61levetiracetam.............................16levetiracetam er........................ 15levobunolol hcl.......................... 58levocarnitine..............................41levocarnitine sf.......................... 41levofloxacin......................... 14, 57levonest.....................................50levonorgest-eth est & eth est.... 50levonorgest-eth estrad 91-day.. 50levonorgestrel-ethinyl estrad.....50levonorg-eth estrad triphasic.....50levora 0.15/30 (28)....................50levo-t......................................... 53levothyroxine sodium................ 53levoxyl....................................... 53LEXIVA..................................... 26lidocaine....................................12lidocaine hcl........................ 12, 34lidocaine hcl urethral/mucosal...12lidocaine viscous hcl................. 34lidocaine-prilocaine................... 12lidolog........................................46lillow.......................................... 50lindane...................................... 24linezolid..................................... 14LINZESS................................... 44liothyronine sodium................... 53lisinopril ..................................... 30lisinopril-hydrochlorothiazide.....30lithium........................................28lithium carbonate.......................28lithium carbonate er.................. 28lojaimiess.................................. 50LONSURF.................................22lopinavir-ritonavir.......................26lopreeza.................................... 50lorazepam................................. 27

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lorazepam intensol....................27LORBRENA.............................. 22lorcet......................................... 10lorcet hd.................................... 10lorcet plus..................................10loryna........................................ 50losartan potassium....................30losartan potassium-hctz............ 30loteprednol etabonate............... 57lovastatin...................................30low-ogestrel...............................50loxapine succinate.................... 25lo-zumandimine.........................50ludent........................................ 41LUMIGAN..................................58LUPRON DEPOT (1-MONTH)..47LUPRON DEPOT (3-MONTH)..47LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG..47LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG..47LUPRON DEPOT-PED (1-MONTH)....................................47LUPRON DEPOT-PED (3-MONTH)....................................47lutera......................................... 50LYNPARZA............................... 22LYSODREN.............................. 22lyza............................................51mafenide acetate...................... 14malathion.................................. 24maprotiline hcl...........................17marlido...................................... 12marlissa.....................................51MATULANE.............................. 22matzim la...................................30MAVYRET.................................26me/naphos/mb/hyo1................. 45meclofenamate sodium.............12MEDROL...................................46medroxyprogesterone acetate.. 51mefloquine hcl...........................24megestrol acetate..................... 51MEKINIST................................. 22MEKTOVI..................................22melodetta 24 fe......................... 51meloxicam.................................12melphalan................................. 22memantine hcl...........................16memantine hcl er...................... 16MENACTRA..............................55MENEST................................... 51MENVEO.................................. 55

meperidine hcl...........................10meprobamate............................27mercaptopurine......................... 22mesalamine...............................56mesalamine er.......................... 56mesalamine-cleanser................56MESNEX...................................22metadate er...............................33metaproterenol sulfate.............. 62metaxalone............................... 63metformin hcl er........................ 38metformin hcl ir ......................... 38methadone hcl.................... 10, 11methadone hcl intensol............. 10methadose................................ 11methadose sugar-free...............11methazolamide..........................58methenamine hippurate............ 14methenamine mandelate.......... 14methergine................................ 57methimazole..............................53methocarbamol......................... 63methotrexate............................. 54methotrexate sodium................ 54methoxsalen rapid.....................36methscopolamine bromide........44methyl salicylate........................36methyldopa............................... 30methyldopa-hydrochlorothiazide...................30methylergonovine maleate........57methylphenidate hcl.................. 33methylphenidate hcl er..............33methylphenidate hcl er (cd).......33methylphenidate hcl er (la)........33methylprednisolone...................46methylprednisolone acetate...... 46methyltestosterone....................46metoclopramide hcl...................18metolazone............................... 30metoprolol succinate er.............30metoprolol tartrate.....................30metoprolol-hydrochlorothiazide.30metronidazole..................... 14, 36mexiletine hcl............................ 30mibelas 24 fe.............................51miconazole 3.............................18microgestin 1.5/30.....................51microgestin 1/20........................51microgestin fe 1.5/30.................51microgestin fe 1/20....................51midodrine hcl.............................30miglitol.......................................39

miglustat....................................45mili .............................................51MILLIPRED............................... 46mimvey......................................51mineral oil heavy....................... 44minitran..................................... 30minocycline hcl..........................14minoxidil .................................... 30mirtazapine............................... 17MIRVASO................................. 36misoprostol................................43mlk f1........................................ 57mlk f2........................................ 57mlk f3........................................ 57M-M-R II.................................... 55modafinil ....................................63moexipril hcl.............................. 30molindone hcl............................25mometasone furoate........... 36, 60mondoxyne nl............................14mono-linyah.............................. 51montelukast sodium.................. 62morgidox................................... 14morphine sulfate....................... 11morphine sulfate (concentrate). 11morphine sulfate er................... 11morphine sulfate er beads........ 11MOXEZA...................................57moxifloxacin hcl...................14, 57moxifloxacin hcl (2x day)...........57MULPLETA............................... 28multigen.................................... 41multi-vit/iron/fluoride..................41multivitamin/fluoride.................. 41multi-vitamin/fluoride................. 41multivitamin/fluoride/iron........... 41multi-vitamin/fluoride/iron.......... 41multivitamins/fluoride................ 41mupirocin.................................. 14mvc-fluoride.............................. 41mycophenolate mofetil .............. 54mycophenolate sodium............. 54MYLERAN.................................22myorisan................................... 36MYRBETRIQ.............................45nabumetone.............................. 12nafrinse..................................... 41nafrinse drops........................... 41naftifine hcl................................18naloxone hcl..............................13naltrexone hcl............................13NAMZARIC............................... 16naproxen................................... 12

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naproxen dr...............................12naproxen sodium...................... 12naratriptan hcl........................... 19NARCAN...................................13NATACYN.................................57NATAZIA...................................51nateglinide.................................39nebusal..................................... 60necon 0.5/35 (28)......................51nefazodone hcl..........................17neomycin sulfate....................... 14neomycin-bacitracin zn-polymyx.....................................59neomycin-polymyxin-dexameth 59neomycin-polymyxin-gramicidin..................................59neomycin-polymyxin-hc............ 59neo-polycin................................59neo-polycin hc...........................59NERLYNX................................. 22NESTABS................................. 41neuac........................................ 36neutral sodium fluoride..............34nevirapine................................. 26nevirapine er............................. 26NEXAVAR.................................22niacin er (antihyperlipidemic).... 30niacor........................................ 30nicardipine hcl........................... 30NICOTROL............................... 13NICOTROL NS......................... 13nifedipine...................................31nifedipine er.............................. 31nifedipine er osmotic release.... 31nikki...........................................51NILANDRON.............................22nilutamide..................................22nimodipine.................................31NINLARO.................................. 22nisoldipine er.............................31nitisinone...................................45nitrofurantoin............................. 14nitrofurantoin macrocrystal........14nitrofurantoin monohydrate macrocrystals............................14nitroglycerin...............................31nitro-time................................... 31nizatidine...................................43nora-be......................................51NORDITROPIN FLEXPRO....... 47norethin ace-eth estrad-fe.........51norethindrone............................51norethindrone acetate............... 51

norethindrone acet-ethinyl est...51norethindrone-eth estradiol....... 51norethin-eth estradiol-fe............ 51norgestimate-eth estradiol........ 51norgestimate-ethinyl estradiol triphasic.....................................51norlyda...................................... 51norlyroc..................................... 51NORPACE CR.......................... 31nortrel 0.5/35 (28)..................... 51nortrel 1/35 (21)........................ 51nortrel 1/35 (28)........................ 51nortrel 7/7/7...............................51nortriptyline hcl..........................17NORVIR.................................... 26np thyroid.................................. 53NPLATE.................................... 28NUBEQA...................................22NUCALA................................... 60nulev......................................... 44NUTROPIN AQ NUSPIN 10..... 47NUTROPIN AQ NUSPIN 20..... 47NUTROPIN AQ NUSPIN 5....... 47nyamyc......................................18nystatin................................18, 19nystatin-triamcinolone............... 19nystop....................................... 19ocella.........................................51octreotide acetate..................... 47ODOMZO..................................22ofloxacin........................14, 57, 59ogestrel..................................... 51okebo........................................ 14olanzapine.................................25olanzapine-fluoxetine hcl.......... 17olmesartan medoxomil..............31olmesartan medoxomil-hctz...... 31olmesartan-amlodipine-hctz......31olopatadine hcl....................57, 60OMECLAMOX-PAK.................. 44omega-3-acid ethyl esters.........31omeprazole............................... 43OMNITROPE............................ 47ondansetron hcl........................ 18ondansetron odt........................ 18ONETOUCH ULTRA 2 KIT W/DEVICE................................ 39ONETOUCH ULTRA BLUE TEST STRIPS...........................39ONETOUCH ULTRA MINI KIT W/DEVICE................................ 39ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE..........39

ONETOUCH VERIO IQ SYSTEM................................... 39ONETOUCH VERIO KIT W/DEVICE................................ 39ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE..........39OPSUMIT..................................62oralone...................................... 34ORILISSA................................. 47orphenadrine citrate er..............63orphenadrine-aspirin-caffeine... 63orsythia..................................... 51oscimin......................................44oscimin sr..................................44oseltamivir phosphate............... 26OSMOPREP............................. 44OTEZLA.................................... 54oxaprozin.................................. 12oxazepam................................. 27oxcarbazepine...........................16oxybutynin chloride................... 45oxybutynin chloride er............... 45oxycodone hcl........................... 11oxycodone-acetaminophen.......11oxycodone-aspirin.....................11oxycodone-ibuprofen................ 11OXYCONTIN.............................11oxymorphone hcl.......................11oxymorphone hcl er.................. 11OZEMPIC..................................39pacerone................................... 31paliperidone er.......................... 25pantoprazole sodium.................43papaverine hcl...........................31paricalcitol................................. 57paroex....................................... 34paromomycin sulfate.................14paroxetine hcl............................17paroxetine hcl er....................... 17paroxetine mesylate..................17PAXIL........................................17PEDIARIX................................. 55PEDVAX HIB............................ 55peg 3350-kcl-na bicarb-nacl......44peg-3350/electrolytes................44PEGASYS.................................26PEGASYS PROCLICK............. 26penicillamine............................. 45penicillin v potassium................ 14PENTACEL............................... 55pentamidine isethionate............ 24pentazocine-naloxone hcl......... 11pentoxifylline er......................... 31

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perindopril erbumine................. 31periogard...................................34permethrin.................................24perphenazine............................ 18perphenazine-amitriptyline........17phenadoz.................................. 60phenazo.................................... 45phenazopyridine hcl.................. 45phenelzine sulfate..................... 17phenobarbital............................ 16phenobarbital-belladonna alk....44phenohytro................................ 44phenoxybenzamine hcl............. 31phenylephrine hcl......................59phenytoin.................................. 16phenytoin infatabs.....................16phenytoin sodium extended...... 16philith.........................................51phosphasal................................45PHOSPHOLINE IODIDE...........58phospho-trin 250 neutral........... 41phytonadione............................ 42pilocarpine hcl..................... 34, 58pimecrolimus.............................36pimozide....................................25pimtrea...................................... 51pindolol......................................31pioglitazone hcl......................... 39pioglitazone hcl-glimepiride.......39pioglitazone hcl-metformin hcl.. 39PIQRAY (200 MG DAILY DOSE).......................................22PIQRAY (250 MG DAILY DOSE).......................................22PIQRAY (300 MG DAILY DOSE).......................................22pirmella 1/35............................. 52pirmella 7/7/7............................ 52piroxicam...................................12PLENVU....................................44PNEUMOVAX 23...................... 55pnv prenatal plus multivit+dha.. 42podocon.................................... 36podofilox....................................36polycin.......................................59polymyxin b-trimethoprim..........59polysaccharide iron forte...........42POLY-VI-FLOR......................... 42POLY-VI-FLOR FS................... 42POLY-VI-FLOR/IRON............... 42POMALYST.............................. 22portia-28....................................52posaconazole............................19

pot bicarb-pot chloride.............. 42potassium bicarbonate..............42potassium chloride.................... 42potassium chloride crys er........ 42potassium chloride er................42potassium citrate er...................42potassium citrate-citric acid.......42pr benzoyl peroxide wash......... 37PRADAXA.................................15PRALUENT...............................31pramipexole dihydrochloride..... 24pramipexole dihydrochloride er.24PRAMOSONE...........................37prasugrel hcl............................. 25pravastatin sodium....................31praziquantel.............................. 24prazosin hcl...............................31prednicarbate............................ 37prednisolone............................. 46prednisolone acetate.................58prednisolone acetate p-f........... 58prednisolone sodium phosphate........................... 46, 58prednisone................................ 46prednisone intensol...................46pregabalin................................. 33PREMARIN............................... 52PREMPHASE........................... 52PREMPRO................................52PRENARA.................................42PRENATA................................. 42prenatal plus iron...................... 42PRENATE ELITE...................... 42PRENATVITE PLUS................. 42PRENATVITE RX..................... 42PREPOPIK................................44prevalite.................................... 31prevident................................... 34previfem.................................... 52PREVNAR 13............................55PREZCOBIX............................. 26PREZISTA................................ 26PRIMACARE.............................42primaquine phosphate.............. 24primidone.................................. 16PROAIR HFA............................ 62PROAIR RESPICLICK..............62probenecid................................ 19prochlorperazine....................... 18prochlorperazine maleate......... 18PROCTOFOAM HC.................. 56procto-med hc........................... 56procto-pak................................. 56

proctosol hc...............................56proctozone-hc........................... 56progesterone.............................52progesterone micronized.......... 52PROGLYCEM........................... 39PROLENSA.............................. 58promethazine hcl.......................60promethazine-codeine.............. 60promethazine-dm...................... 60promethazine-phenyleph-codeine..................................... 60promethazine-phenylephrine.... 60promethegan.............................60propafenone hcl........................ 31propafenone hcl er.................... 31propantheline bromide.............. 44proparacaine hcl....................... 59propranolol hcl.......................... 31propranolol hcl er...................... 31propranolol-hctz........................ 31propylthiouracil ..........................53PROQUAD................................55protriptyline hcl..........................17pseudoephedrine-bromphen-dm............................................. 61PULMICORT FLEXHALER.......62pulmosal....................................61PULMOZYME........................... 62PURIXAN.................................. 22PYLERA....................................44pyrazinamide.............................20pyridostigmine bromide.............19pyridostigmine bromide er.........19QUADRACEL............................55quazepam................................. 27quetiapine fumarate.................. 25quetiapine fumarate er.............. 25QUFLORA FE PEDIATRIC.......42QUFLORA PEDIATRIC............ 42quinapril hcl...............................31quinapril-hydrochlorothiazide.... 31quinidine gluconate er...............31quinidine sulfate........................ 31quinine sulfate...........................24rabeprazole sodium.................. 43raloxifene hcl.............................47ramelteon.................................. 63ramipril ...................................... 31ranitidine hcl..............................43ranolazine er............................. 31rasagiline mesylate................... 24RASUVO...................................54reclipsen....................................52

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RECOMBIVAX HB.................... 55relexxii .......................................33RELNATE DHA.........................42repaglinide................................ 39REPATHA................................. 31REPATHA PUSHTRONEX SYSTEM................................... 31REPATHA SURECLICK........... 32RESTASIS................................ 59RESTASIS MULTIDOSE.......... 59RETIN-A MICRO PUMP........... 37REVLIMID................................. 22REYATAZ................................. 26RHOPRESSA........................... 58ribavirin..................................... 26rifabutin..................................... 20rifampin..................................... 20riluzole.......................................33rimantadine hcl..........................26RINVOQ....................................54risedronate sodium................... 56risperidone................................ 25ritonavir..................................... 26rivastigmine...............................16rivastigmine tartrate.................. 16rivelsa........................................52rizatriptan benzoate.................. 19ROCKLATAN............................ 58ropinirole hcl..............................24ropinirole hcl er......................... 24rosadan..................................... 37rosuvastatin calcium................. 32ROTARIX.................................. 55ROTATEQ.................................55roweepra................................... 16roweepra xr............................... 16ROZLYTREK............................ 22RUBRACA................................ 22RYBELSUS...............................39RYDAPT................................... 22ryvent........................................ 61salicylic acid.............................. 37salicylic acid er..........................37salicylic acid-cleanser............... 37salsalate....................................12SAMSCA...................................42SANDIMMUNE......................... 54SAPHRIS.................................. 25scopolamine..............................18SELECT-OB..............................42selegiline hcl............................. 24selenium sulfide........................ 37SELZENTRY.............................26

SEREVENT DISKUS................ 62sertraline hcl..............................17setlakin......................................52sevelamer carbonate................ 45sevelamer hcl............................45sf............................................... 34sf 5000 plus...............................34SFROWASA............................. 56sharobel.................................... 52SHINGRIX.................................55sildenafil citrate......................... 62silodosin.................................... 46silver nitrate...............................14silver sulfadiazine......................14SIMBRINZA.............................. 58simliya....................................... 52simpesse...................................52SIMPONI...................................54simvastatin................................ 32sirolimus....................................54SKYRIZI (150 MG DOSE).........54sodium chloride.........................61sodium chloride (pf).................. 42sodium fluoride....................34, 42sodium fluoride 5000 plus......... 34sodium fluoride 5000 ppm.........34sodium hyaluronate...................37sodium phenylbutyrate..............45sodium polystyrene sulfonate... 42sodium sulfacetamide............... 37solifenacin succinate.................45SOLIQUA.................................. 39SOLTAMOX.............................. 22SOOLANTRA............................37sorine........................................ 32sotalol hcl.................................. 32sotalol hcl (af)............................32sotalol hydrochloride................. 32spinosad....................................24SPIRIVA HANDIHALER............62SPIRIVA RESPIMAT................ 62spironolactone...........................32spironolactone-hctz...................32sprintec 28................................ 52SPRYCEL................................. 22sps............................................ 42sronyx....................................... 52ssd............................................ 15sss 10-5.................................... 37stavudine...................................26STELARA..................................54STIOLTO RESPIMAT............... 62STIVARGA................................22

STRENSIQ................................45subvenite...................................16subvenite starter kit-blue...........16subvenite starter kit-green........ 16subvenite starter kit-orange...... 16sucralfate.................................. 43sulfacetamide sodium......... 37, 58sulfacetamide sodium (acne).... 37sulfacetamide sodium-sulfur..... 37sulfacetamide-prednisolone...... 59sulfacetamide-sulfur in urea......37sulfacleanse 8/4........................ 37sulfadiazine............................... 15sulfamethoxazole-trimethoprim.15sulfasalazine............................. 56sulfatrim pediatric......................15sulfurated lime...........................24sulindac.....................................12sumatriptan............................... 19sumatriptan succinate............... 19sumatriptan succinate refill ....... 19SUNOSI.................................... 63SUPREP BOWEL PREP KIT....44SUTENT....................................22syeda........................................ 52symax-sl....................................44symax-sr................................... 45SYMBICORT.............................62SYMFI....................................... 27SYMFI LO................................. 27SYMPROIC...............................45SYNAREL................................. 47SYNJARDY...............................39SYNJARDY XR.........................39TABLOID...................................22tacrolimus............................37, 54tadalafil (pah)............................ 62TAFINLAR.................................22TAGRISSO............................... 22TALZENNA............................... 22tamoxifen citrate........................23tamsulosin hcl........................... 46TARCEVA................................. 23tarina 24 fe................................ 52tarina fe 1/20............................. 52tarina fe 1/20 eq........................ 52taron-crystals............................ 42TASIGNA.................................. 23TAYTULLA................................52tazarotene................................. 37taztia xt......................................32TDVAX...................................... 55TECFIDERA..............................33

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TEKTURNA...............................32TEKTURNA HCT...................... 32telmisartan................................ 32telmisartan-amlodipine..............32telmisartan-hctz.........................32temazepam............................... 63TEMODAR................................ 23temozolomide............................23tencon....................................... 11TENIVAC.................................. 55tenofovir disoproxil fumarate.....27terazosin hcl..............................46terbinafine hcl............................19terbutaline sulfate......................62terconazole............................... 19testosterone.............................. 46testosterone cypionate..............46testosterone enanthate............. 46tetcaine..................................... 59tetrabenazine............................ 33tetracaine hcl.............................59tetracycline hcl.......................... 15tetravisc.....................................59tetravisc forte............................ 59THALOMID............................... 23theophylline...............................62theophylline er...........................62thioridazine hcl.......................... 25thiothixene.................................25thyroid....................................... 53tiadylt er.................................... 32tiagabine hcl..............................16TIBSOVO.................................. 23tilia fe.........................................52timolol maleate....................32, 58tinidazole...................................15TIVICAY.................................... 27tizanidine hcl............................. 63tl-hem 150................................. 42tobramycin.......................... 58, 62tobramycin-dexamethasone......59tolbutamide............................... 39tolcapone.................................. 24tolmetin sodium.........................12tolterodine tartrate.....................45tolterodine tartrate er.................45topiramate................................. 16topiramate er.............................16toremifene citrate...................... 23torsemide.................................. 32TOUJEO MAX SOLOSTAR...... 40TOUJEO SOLOSTAR...............40tovet.......................................... 37

TRACLEER...............................62TRADJENTA.............................39tramadol hcl er.......................... 11tramadol hcl er (biphasic)..........11tramadol hcl ir ........................... 11tramadol-acetaminophen.......... 11trandolapril ................................ 32trandolapril-verapamil hcl er......32tranexamic acid.........................28tranylcypromine sulfate............. 17travoprost (bak free)..................58trazodone hcl............................ 17TRELEGY ELLIPTA..................62TREMFYA.................................54tretinoin............................... 23, 37tretinoin microsphere................ 37tretinoin microsphere pump...... 37TREXALL.................................. 54tri femynor................................. 52triamcinolone acetonide 34, 37, 38triamterene................................32triamterene-hctz........................ 32trianex....................................... 38triazolam................................... 27TRICARE PRENATAL DHA ONE.......................................... 43triderm.......................................38trientine hcl................................43tri-estarylla................................ 52trifluoperazine hcl......................25trifluridine.................................. 58trihexyphenidyl hcl.................... 24tri-legest fe................................ 52tri-linyah.................................... 52tri-lo-estarylla............................ 52tri-lo-marzia............................... 52tri-lo-mili .................................... 52tri-lo-sprintec............................. 52trilyte......................................... 45trimethobenzamide hcl..............18trimethoprim.............................. 15tri-mili ........................................ 52trimipramine maleate................ 17trinate........................................ 43tri-previfem................................ 52tri-sprintec................................. 52TRIUMEQ................................. 27TRI-VI-FLOR.............................43TRI-VI-FLORO.......................... 43tri-vitamin/fluoride......................43tri-vite/fluoride........................... 43trivora (28).................................52tri-vylibra................................... 52

tri-vylibra lo................................52trospium chloride.......................45trospium chloride er.................. 46TRULICITY............................... 39TRUMENBA..............................55TRUVADA.................................27tryptophan................................. 43tulana........................................ 53TURALIO.................................. 23turpentine.................................. 38TWINRIX...................................55TYBOST....................................27tydemy...................................... 53TYKERB....................................23TYMLOS................................... 57unithroid.................................... 53urea...........................................38urea hydrating........................... 38urea nail .................................... 38urea-c40....................................38uretron d/s.................................46urin ds....................................... 46ursodiol..................................... 45ustell ..........................................46uticap........................................ 46utira-c........................................ 46utrona-c.....................................46valacyclovir hcl..........................27valganciclovir hcl.......................27valproic acid.............................. 16valsartan................................... 32valsartan-hydrochlorothiazide... 32vancomycin hcl......................... 15vandazole..................................15VAQTA......................................55VARIVAX.................................. 56VASCEPA................................. 32velivet........................................53VENCLEXTA.............................23VENCLEXTA STARTING PACK........................................ 23venlafaxine hcl.......................... 17venlafaxine hcl er...................... 17VENTOLIN HFA........................62verapamil hcl.............................32verapamil hcl er.........................32VERZENIO................................23vicodin hp..................................11VICTOZA.................................. 39VIDEX....................................... 27vienva........................................53vigabatrin.................................. 16vigadrone.................................. 16

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viorele....................................... 53VIRACEPT................................ 27VIREAD.....................................27virtussin ac w/alc.......................61vitamin d (ergocalciferol)...........43vitamins acd-fluoride................. 43VITRAKVI..................................23VIZIMPRO.................................23volnea....................................... 53voriconazole..............................19VOSEVI.....................................27VOTRIENT................................23vp-pnv-dha................................ 43vyfemla......................................53vylibra........................................53VYVANSE................................. 33warfarin sodium.........................15wera.......................................... 53wixela inhub.............................. 62wymzya fe................................. 53XALKORI.................................. 23XARELTO................................. 15XARELTO STARTER PACK.....15XATMEP................................... 54XELJANZ.................................. 54XELJANZ XR............................ 54XELODA................................... 23XIIDRA...................................... 59XOSPATA................................. 23XPOVIO (100 MG ONCE WEEKLY)..................................23XPOVIO (60 MG ONCE WEEKLY)..................................23XPOVIO (80 MG ONCE WEEKLY)..................................23XPOVIO (80 MG TWICE WEEKLY)..................................23XTANDI.....................................23YONSA..................................... 23yuvafem.................................... 53zaclir cleansing......................... 38zafirlukast..................................62zaleplon.....................................63zarah......................................... 53ZEJULA.....................................23ZELBORAF............................... 23zenatane................................... 38ZENPEP....................................45zidovudine.................................27ziprasidone hcl.......................... 25ziprasidone mesylate................ 25ZOLINZA...................................23zolmitriptan................................19

zolpidem tartrate....................... 63zonisamide................................16ZOSTAVAX...............................56zovia 1/35e (28)........................ 53ZUBSOLV................................. 13zumandimine.............................53ZYDELIG...................................23ZYKADIA...................................23ZYTIGA..................................... 23

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MEMBER 2020 PERFORMANCE DRUG LIST · 2020-03-20 · While extensive, this is not an exhaustive list of all available medications and this list is subject to change. See the most current