PrimeChoice Accord Formulary - Prime Therapeutics

2060-B © Prime Therapeutics LLC 01/21

PrimeChoice Accord Formulary January 2021

Please consider talking to your doctor about prescribing one of the formulary medications that are indicated as covered under your plan; which may help reduce your out-of-pocket costs. This list may help guide you and your doctor in selecting an appropriate medication for you.

The drug list, also known as a formulary, is regularly updated. You can view the most up-to-date list, or the specialty drug list, at MyPrime.com.

Contents Introduction .................................................................. I Coverage considerations ............................................. I Abbreviation key .......................................................... I

Preferred Medication List Anti-Infective Drugs .................................................... 1 Biologicals .................................................................. 5 Antineoplastic Agents................................................. 5 Endocrine and Metabolic Drugs ................................. 8 Cardiovascular Agents ............................................. 14 Respiratory Agents................................................... 20 Gastrointestinal Agents ............................................ 22 Genitourinary Agents ............................................... 24 Central Nervous System Drugs ............................... 25 Analgesics and Anesthetics ..................................... 31 Neuromuscular Drugs .............................................. 34 Nutritional Products .................................................. 36 Hematological Agents .............................................. 37 Topical Products ...................................................... 40 Miscellaneous Products ........................................... 43 Index ........................................................................ 45

To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.

https://www.myprime.com/

PrimeChoice Accord Formulary, January 2021 I

Introduction The PrimeChoice Accord Formulary contains covered drugs for a broad range of diseases.

Generics drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand drug in (parentheses). Some generic products have no reference brand.

Brand prescription drugs are shown in capital letters followed by the generic name.

The PrimeChoice Accord Formulary is organized into broad categories (e.g. Anti-Infective drugs). Within most categories, drugs are sub-grouped by drug class (e.g. Penicillins) or by use for a specific medical condition (e.g. Diabetes).

To save the most money on prescription drugs, take this drug list with you each time you visit your physician. Consider asking your physician to prescribe generic and formulary drugs, if appropriate. Any and all decisions that require or pertain to independent professional medical judgment or training, or the need for, and dosage of, a prescription drug must be made solely by you and your physician in accordance with the patient/physician relationship.

Coverage considerations Most prescription drug benefit plans provide coverage for up to a 30-day supply of medication, with some exceptions. Your plan may also provide coverage for up to a 90-day supply of maintenance medications. Maintenance medications are those drugs you may take on an ongoing basis for conditions such as high blood pressure, diabetes or high cholesterol. Some plans may exclude coverage for certain agents or drug categories, like those used for erectile dysfunction or weight loss.

Over-the-counter exclusions: Your benefit plan may not provide coverage for prescription medications that have an over-the-counter version. You should refer to your benefit plan material for details about your particular benefits.

Compounded medications: Your benefit plan may not provide coverage for compounded medications. Please see your plan materials or call the number on the back of your ID card to determine whether compounded medications are covered and/or verify your payment amount.

Repackaged medications: Repackaged versions of medications already available on the market are not covered.

Abbreviation/acronym key aer..................................................................... aerosol cap ................................................................. capsules chew ............................................................. chewable conc .......................................................... concentrate cr...................................................... controlled release dr ........................................................ delayed release ec ........................................................... enteric coated equiv ........................................................... equivalent er....................................................... extended release gm........................................................................ gram inhal .................................................................. inhaler inj .................................................................... injection liqd....................................................................... liquid mg.................................................................. milligram ml ..................................................................... milliliter nebu .............................................................. nebulizer

odt. ........................................ orally disintegrating tabs oint ................................................................. ointment ophth .......................................................... ophthalmic osm ..................................................... osmotic release pack ................................................................. packets powd ................................................................ powder pttw ................................................ twice-weekly patch sl .................................................................. sublingual soln .................................................................. solution suppos ................................................... suppositories susp ........................................................... suspension tab ..................................................................... tablets td ............................................................... transdermal w/ ............................................................................ with

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PrimeChoice Accord Formulary, January 2021 1

Drug Name

ANTI-INFECTIVE AGENTSPENICILLINSAMOXICILLIN – amoxicillin (trihydrate) chew tab 125 mgAMOXICILLIN – amoxicillin (trihydrate) chew tab 250 mgamoxicillin (trihydrate) cap 250 mgamoxicillin (trihydrate) cap 500 mgamoxicillin (trihydrate) for susp 125 mg/5mlamoxicillin (trihydrate) for susp 200 mg/5mlamoxicillin (trihydrate) for susp 250 mg/5mlamoxicillin (trihydrate) for susp 400 mg/5mlamoxicillin (trihydrate) tab 500 mgamoxicillin (trihydrate) tab 875 mgamoxicillin & k clavulanate for susp 200-28.5 mg/5mlamoxicillin & k clavulanate for susp 250-62.5 mg/5ml

(Augmentin)amoxicillin & k clavulanate for susp 400-57 mg/5mlamoxicillin & k clavulanate for susp 600-42.9 mg/5ml

(Augmentin es-600)amoxicillin & k clavulanate tab 250-125 mgamoxicillin & k clavulanate tab 500-125 mg

(Augmentin)amoxicillin & k clavulanate tab 875-125 mg

(Augmentin)AMOXICILLIN/CLAVULANATE P – amoxicillin & k

clavulanate tab er 12hr 1000-62.5 mgAMOXICILLIN/CLAVULANATE P – amoxicillin & k

clavulanate chew tab 200-28.5 mgAMOXICILLIN/CLAVULANATE P – amoxicillin & k

clavulanate chew tab 400-57 mgAMPICILLIN – ampicillin cap 500 mgAUGMENTIN – amoxicillin & k clavulanate for susp

125-31.25 mg/5mldicloxacillin sodium cap 250 mgdicloxacillin sodium cap 500 mgPENICILLIN V POTASSIUM – penicillin v potassium for

soln 125 mg/5mlPENICILLIN V POTASSIUM – penicillin v potassium for

soln 250 mg/5mlpenicillin v potassium tab 250 mgpenicillin v potassium tab 500 mgCEPHALOSPORINScefaclor cap 250 mg

Drug Name

cefaclor cap 500 mgcefadroxil cap 500 mgcefadroxil for susp 250 mg/5mlcefadroxil for susp 500 mg/5mlcefadroxil tab 1 gmcefdinir cap 300 mgcefdinir for susp 125 mg/5mlcefdinir for susp 250 mg/5mlcefixime cap 400 mg (Suprax)cefixime for susp 100 mg/5ml (Suprax)cefixime for susp 200 mg/5ml (Suprax)cefpodoxime proxetil for susp 50 mg/5mlcefpodoxime proxetil for susp 100 mg/5mlcefpodoxime proxetil tab 100 mgcefpodoxime proxetil tab 200 mgcefprozil for susp 125 mg/5mlcefprozil for susp 250 mg/5mlcefprozil tab 250 mgcefprozil tab 500 mgceftriaxone sodium for inj 250 mgceftriaxone sodium for inj 500 mg (Rocephin)ceftriaxone sodium for inj 1 gm (Rocephin)ceftriaxone sodium for inj 2 gmcefuroxime axetil tab 250 mg (Ceftin)cefuroxime axetil tab 500 mg (Ceftin)cephalexin cap 250 mg (Keflex)cephalexin cap 500 mg (Keflex)cephalexin for susp 125 mg/5mlcephalexin for susp 250 mg/5mlSUPRAX – cefixime for susp 500 mg/5mlSUPRAX – cefixime chew tab 100 mgSUPRAX – cefixime chew tab 200 mgMACROLIDESAZITHROMYCIN – azithromycin powd pack for susp 1

gmazithromycin for susp 100 mg/5ml (Zithromax)azithromycin for susp 200 mg/5ml (Zithromax)azithromycin tab 250 mg (Zithromax)azithromycin tab 500 mg (Zithromax)azithromycin tab 600 mg (Zithromax)

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Drug Name

CLARITHROMYCIN – clarithromycin for susp 125mg/5ml

CLARITHROMYCIN – clarithromycin for susp 250mg/5ml

clarithromycin tab er 24hr 500 mgclarithromycin tab 250 mg (Biaxin)clarithromycin tab 500 mg (Biaxin)TETRACYCLINESdemeclocycline hcl tab 150 mgdemeclocycline hcl tab 300 mgdoxycycline hyclate cap 50 mgdoxycycline hyclate cap 100 mg (Vibramycin)doxycycline hyclate tab 20 mgdoxycycline hyclate tab 100 mgdoxycycline monohydrate cap 50 mgdoxycycline monohydrate cap 100 mg (Monodox)doxycycline monohydrate tab 50 mg (Adoxa)doxycycline monohydrate tab 75 mg (Adoxa)doxycycline monohydrate tab 100 mg (Adoxa pak

1/100)doxycycline monohydrate tab 150 mg (Adoxa pak

1/150)minocycline hcl cap 50 mg (Minocin)minocycline hcl cap 75 mg (Minocin)minocycline hcl cap 100 mg (Minocin)tetracycline hcl cap 250 mg (Tetracycline hcl)tetracycline hcl cap 500 mg (Tetracycline hcl)FLUOROQUINOLONESCIPRO – ciprofloxacin for oral susp 500 mg/5ml (10%)

(10 gm/100ml)CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg

(base equiv)ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)ciprofloxacin hcl tab 750 mg (base equiv)levofloxacin oral soln 25 mg/ml (Levaquin)levofloxacin tab 250 mg (Levaquin)levofloxacin tab 500 mg (Levaquin)levofloxacin tab 750 mg (Levaquin)ofloxacin tab 400 mgAMINOGLYCOSIDES

Drug Name

neomycin sulfate tab 500 mgPAROMOMYCIN SULFATE – paromomycin sulfate cap

250 mgtobramycin nebu soln 300 mg/5ml (Tobi)SULFADIAZINE – sulfadiazine tab 500 mgANTIMYCOBACTERIAL AGENTSethambutol hcl tab 100 mg (Myambutol)ethambutol hcl tab 400 mg (Myambutol)ISONIAZID – isoniazid tab 100 mgISONIAZID – isoniazid syrup 50 mg/5mlisoniazid tab 300 mgPRIFTIN – rifapentine tab 150 mgpyrazinamide tab 500 mgrifabutin cap 150 mg (Mycobutin)rifampin cap 150 mg (Rifadin)rifampin cap 300 mg (Rifadin)ANTIFUNGALSfluconazole for susp 10 mg/ml (Diflucan)fluconazole for susp 40 mg/ml (Diflucan)fluconazole tab 50 mg (Diflucan)fluconazole tab 100 mg (Diflucan)fluconazole tab 150 mg (Diflucan)fluconazole tab 200 mg (Diflucan)flucytosine cap 250 mg (Ancobon)flucytosine cap 500 mg (Ancobon)griseofulvin microsize susp 125 mg/5mlgriseofulvin microsize tab 500 mg (Grifulvin v)itraconazole cap 100 mg (Sporanox)itraconazole oral soln 10 mg/ml (Sporanox)NOXAFIL – posaconazole susp 40 mg/mlnystatin tab 500000 unitposaconazole tab delayed release 100 mg (Noxafil)terbinafine hcl tab 250 mg (Lamisil)voriconazole for susp 40 mg/ml (Vfend)voriconazole tab 50 mg (Vfend)voriconazole tab 200 mg (Vfend)ANTIVIRALSabacavir sulfate soln 20 mg/ml (base equiv) (Ziagen)abacavir sulfate tab 300 mg (base equiv) (Ziagen)abacavir sulfate-lamivudine tab 600-300 mg (Epzicom)

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Drug Name

abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg (Trizivir)

acyclovir cap 200 mg (Zovirax)acyclovir susp 200 mg/5ml (Zovirax)acyclovir tab 400 mg (Zovirax)acyclovir tab 800 mg (Zovirax)adefovir dipivoxil tab 10 mg (Hepsera)atazanavir sulfate cap 150 mg (base equiv) (Reyataz)atazanavir sulfate cap 200 mg (base equiv) (Reyataz)atazanavir sulfate cap 300 mg (base equiv) (Reyataz)ATRIPLA – efavirenz-emtricitabine-tenofovir df tab

600-200-300 mgBARACLUDE – entecavir oral soln 0.05 mg/mlBIKTARVY – bictegravir-emtricitabine-tenofovir af tab

50-200-25 mgCIMDUO – lamivudine-tenofovir disoproxil fumarate tab

300-300 mgDELSTRIGO – doravirine-lamivudine-tenofovir df tab

100-300-300 mgDESCOVY – emtricitabine-tenofovir alafenamide

fumarate tab 200-25 mgDIDANOSINE – didanosine delayed release capsule 200

mgDIDANOSINE – didanosine delayed release capsule 250

mgDIDANOSINE – didanosine delayed release capsule 400

mgDOVATO – dolutegravir sodium-lamivudine tab 50-300

mg (base eq)efavirenz cap 50 mg (Sustiva)efavirenz cap 200 mg (Sustiva)efavirenz tab 600 mg (Sustiva)efavirenz-emtricitabine-tenofovir df tab

600-200-300 mg (Atripla)efavirenz-lamivudine-tenofovir df tab 400-300-300 mg

(Symfi lo)efavirenz-lamivudine-tenofovir df tab 600-300-300 mg

(Symfi)entecavir tab 0.5 mg (Baraclude)entecavir tab 1 mg (Baraclude)EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mgEPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv)

Drug Name

EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg(base equiv)

famciclovir tab 125 mg (Famvir)famciclovir tab 250 mg (Famvir)famciclovir tab 500 mg (Famvir)GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mgHARVONI – ledipasvir-sofosbuvir tab 45-200 mgHARVONI – ledipasvir-sofosbuvir tab 90-400 mgHARVONI – ledipasvir-sofosbuvir pellet pack 33.75-150

mgHARVONI – ledipasvir-sofosbuvir pellet pack 45-200 mgINTELENCE – etravirine tab 25 mgINTELENCE – etravirine tab 100 mgINTELENCE – etravirine tab 200 mgISENTRESS – raltegravir potassium packet for susp 100

mg (base equiv)ISENTRESS – raltegravir potassium tab 400 mg (base

equiv)ISENTRESS – raltegravir potassium chew tab 25 mg

(base equiv)ISENTRESS – raltegravir potassium chew tab 100 mg

(base equiv)ISENTRESS HD – raltegravir potassium tab 600 mg

(base equiv)JULUCA – dolutegravir sodium-rilpivirine hcl tab 50-25

mg (base eq)KALETRA – lopinavir-ritonavir tab 100-25 mgKALETRA – lopinavir-ritonavir tab 200-50 mglamivudine oral soln 10 mg/ml (Epivir)lamivudine tab 100 mg (hbv) (Epivir hbv)lamivudine tab 150 mg (Epivir)lamivudine tab 300 mg (Epivir)lamivudine-zidovudine tab 150-300 mg (Combivir)LEDIPASVIR/SOFOSBUVIR – ledipasvir-sofosbuvir tab

90-400 mglopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

(Kaletra)MAVYRET – glecaprevir-pibrentasvir tab 100-40 mgNEVIRAPINE ER – nevirapine tab er 24hr 100 mgnevirapine susp 50 mg/5ml (Viramune)nevirapine tab er 24hr 400 mg (Viramune xr)

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Drug Name

nevirapine tab 200 mg (Viramune)NORVIR – ritonavir oral soln 80 mg/mlNORVIR – ritonavir powder packet 100 mgODEFSEY – emtricitabine-rilpivirine-tenofovir af tab

200-25-25 mgoseltamivir phosphate cap 30 mg (base equiv)

(Tamiflu)oseltamivir phosphate cap 45 mg (base equiv)

(Tamiflu)oseltamivir phosphate cap 75 mg (base equiv)

(Tamiflu)oseltamivir phosphate for susp 6 mg/ml (base equiv)

(Tamiflu)PEGASYS – peginterferon alfa-2a inj 180 mcg/mlPEGASYS – peginterferon alfa-2a inj 180 mcg/0.5mlPEGASYS PROCLICK – peginterferon alfa-2a inj 180

mcg/0.5mlPREZCOBIX – darunavir-cobicistat tab 800-150 mgPREZISTA – darunavir ethanolate susp 100 mg/ml (base

equiv)PREZISTA – darunavir ethanolate tab 75 mg (base




equiv)ribavirin cap 200 mg (Rebetol)ribavirin tab 200 mg (Copegus)ritonavir tab 100 mg (Norvir)SOFOSBUVIR/VELPATASVIR – sofosbuvir-velpatasvir

tab 400-100 mgSOVALDI – sofosbuvir tab 200 mgSOVALDI – sofosbuvir tab 400 mgSOVALDI – sofosbuvir pellet pack 150 mgSOVALDI – sofosbuvir pellet pack 200 mgstavudine cap 15 mg (Zerit)stavudine cap 20 mg (Zerit)stavudine cap 30 mg (Zerit)stavudine cap 40 mg (Zerit)SYMFI – efavirenz-lamivudine-tenofovir df tab

600-300-300 mg

Drug Name

SYMFI LO – efavirenz-lamivudine-tenofovir df tab400-300-300 mg

TEMIXYS – lamivudine-tenofovir disoproxil fumarate tab300-300 mg

tenofovir disoproxil fumarate tab 300 mg (Viread)TIVICAY – dolutegravir sodium tab 10 mg (base equiv)TIVICAY – dolutegravir sodium tab 25 mg (base equiv)TIVICAY – dolutegravir sodium tab 50 mg (base equiv)TIVICAY PD – dolutegravir sodium tab for oral susp 5 mg

(base equiv)TRIUMEQ – abacavir-dolutegravir-lamivudine tab

600-50-300 mgTRUVADA – emtricitabine-tenofovir disoproxil fumarate

tab 100-150 mgTRUVADA – emtricitabine-tenofovir disoproxil fumarate



tab 200-300 mgvalacyclovir hcl tab 500 mg (Valtrex)valacyclovir hcl tab 1 gm (Valtrex)valganciclovir hcl for soln 50 mg/ml (base equiv)

(Valcyte)valganciclovir hcl tab 450 mg (base equivalent)

(Valcyte)VIREAD – tenofovir disoproxil fumarate oral powder 40

mg/gmVIREAD – tenofovir disoproxil fumarate tab 150 mgVIREAD – tenofovir disoproxil fumarate tab 200 mgVIREAD – tenofovir disoproxil fumarate tab 250 mgVOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab

400-100-100 mgzidovudine cap 100 mg (Retrovir)zidovudine syrup 10 mg/ml (Retrovir)zidovudine tab 300 mgANTIMALARIALSatovaquone-proguanil hcl tab 62.5-25 mg (Malarone)atovaquone-proguanil hcl tab 250-100 mg (Malarone)CHLOROQUINE PHOSPHATE – chloroquine phosphate

tab 500 mgchloroquine phosphate tab 250 mgCOARTEM – artemether-lumefantrine tab 20-120 mg

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Drug Name

hydroxychloroquine sulfate tab 200 mg (Plaquenil)MEFLOQUINE HCL – mefloquine hcl tab 250 mgprimaquine phosphate tab 26.3 mg (15 mg base)

(Primaquine phosphate)pyrimethamine tab 25 mg (Daraprim)SOLOSEC – secnidazole granules packet 2 gmANTHELMINTICSalbendazole tab 200 mg (Albenza)BENZNIDAZOLE – benznidazole tab 12.5 mgBENZNIDAZOLE – benznidazole tab 100 mgivermectin tab 3 mg (Stromectol)praziquantel tab 600 mg (Biltricide)ANTI-INFECTIVE AGENTS - MISC.ALINIA – nitazoxanide tab 500 mgALINIA – nitazoxanide for susp 100 mg/5mlclindamycin hcl cap 75 mg (Cleocin)clindamycin hcl cap 150 mg (Cleocin)clindamycin hcl cap 300 mg (Cleocin)clindamycin palmitate hcl for soln 75 mg/5ml (base

equiv) (Cleocin pediatric gr)dapsone tab 25 mgdapsone tab 100 mgIMPAVIDO – miltefosine cap 50 mglinezolid for susp 100 mg/5ml (Zyvox)linezolid tab 600 mg (Zyvox)metronidazole tab 250 mg (Flagyl)metronidazole tab 500 mg (Flagyl)nitrofurantoin macrocrystalline cap 25 mg

(Macrodantin)nitrofurantoin macrocrystalline cap 50 mg

(Macrodantin)nitrofurantoin macrocrystalline cap 100 mg

(Macrodantin)nitrofurantoin monohydrate macrocrystalline cap

100 mg (Macrobid)nitrofurantoin susp 25 mg/5mlpentamidine isethionate for nebulization soln 300 mg

(Nebupent)SIVEXTRO – tedizolid phosphate tab 200 mgsulfamethoxazole-trimethoprim susp 200-40 mg/5mlsulfamethoxazole-trimethoprim tab 400-80 mg

(Bactrim)

Drug Name

sulfamethoxazole-trimethoprim tab 800-160 mg(Bactrim ds)

trimethoprim tab 100 mgvancomycin hcl cap 125 mg (base equivalent)

(Vancocin hcl)vancomycin hcl cap 250 mg (base equivalent)

(Vancocin hcl)XIFAXAN – rifaximin tab 550 mgBIOLOGICALSPASSIVE IMMUNIZING AGENTSSYNAGIS – palivizumab im soln 50 mg/0.5mlSYNAGIS – palivizumab im soln 100 mg/mlANTINEOPLASTIC AGENTSANTINEOPLASTICSabiraterone acetate tab 250 mg (Zytiga)ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml

(2000000 unit/0.5ml)AFINITOR – everolimus tab 10 mgAFINITOR DISPERZ – everolimus tab for oral susp 2 mgAFINITOR DISPERZ – everolimus tab for oral susp 3 mgAFINITOR DISPERZ – everolimus tab for oral susp 5 mgALECENSA – alectinib hcl cap 150 mg (base equivalent)ALUNBRIG – brigatinib tab initiation therapy pack 90 mg

& 180 mgALUNBRIG – brigatinib tab 30 mgALUNBRIG – brigatinib tab 90 mgALUNBRIG – brigatinib tab 180 mganastrozole tab 1 mg (Arimidex)AYVAKIT – avapritinib tab 100 mgAYVAKIT – avapritinib tab 200 mgAYVAKIT – avapritinib tab 300 mgbexarotene cap 75 mg (Targretin)bicalutamide tab 50 mg (Casodex)BOSULIF – bosutinib tab 100 mgBOSULIF – bosutinib tab 400 mgBOSULIF – bosutinib tab 500 mgCABOMETYX – cabozantinib s-malate tab 20 mg (base

equivalent)CABOMETYX – cabozantinib s-malate tab 40 mg (base

equivalent)CABOMETYX – cabozantinib s-malate tab 60 mg (base

equivalent)

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Drug Name

capecitabine tab 150 mg (Xeloda)capecitabine tab 500 mg (Xeloda)CAPRELSA – vandetanib tab 100 mgCAPRELSA – vandetanib tab 300 mgCOMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60

mg dose) kitCOMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20

mg (100 dose) kitCOMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20

mg (140 dose) kitCOTELLIC – cobimetinib fumarate tab 20 mg (base

equivalent)cyclophosphamide cap 25 mg (Cyclophosphamide)cyclophosphamide cap 50 mg (Cyclophosphamide)EMCYT – estramustine phosphate sodium cap 140 mgERIVEDGE – vismodegib cap 150 mgERLEADA – apalutamide tab 60 mgerlotinib hcl tab 25 mg (base equivalent) (Tarceva)erlotinib hcl tab 100 mg (base equivalent) (Tarceva)erlotinib hcl tab 150 mg (base equivalent) (Tarceva)ETOPOSIDE – etoposide cap 50 mgeverolimus tab 2.5 mg (Afinitor)everolimus tab 5 mg (Afinitor)everolimus tab 7.5 mg (Afinitor)exemestane tab 25 mg (Aromasin)FARYDAK – panobinostat lactate cap 10 mg (base

equivalent)FARYDAK – panobinostat lactate cap 20 mg (base

equivalent)flutamide cap 125 mgGILOTRIF – afatinib dimaleate tab 20 mg (base

equivalent)GILOTRIF – afatinib dimaleate tab 30 mg (base

equivalent)GILOTRIF – afatinib dimaleate tab 40 mg (base

equivalent)GLEOSTINE – lomustine cap 10 mgGLEOSTINE – lomustine cap 40 mgGLEOSTINE – lomustine cap 100 mgHYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)HYCAMTIN – topotecan hcl cap 1 mg (base equiv)hydroxyurea cap 500 mg (Hydrea)

Drug Name

IBRANCE – palbociclib cap 75 mgIBRANCE – palbociclib cap 100 mgIBRANCE – palbociclib cap 125 mgIBRANCE – palbociclib tab 75 mgIBRANCE – palbociclib tab 100 mgIBRANCE – palbociclib tab 125 mgICLUSIG – ponatinib hcl tab 15 mg (base equiv)ICLUSIG – ponatinib hcl tab 45 mg (base equiv)imatinib mesylate tab 100 mg (base equivalent)

(Gleevec)imatinib mesylate tab 400 mg (base equivalent)

(Gleevec)IMBRUVICA – ibrutinib cap 70 mgIMBRUVICA – ibrutinib cap 140 mgIMBRUVICA – ibrutinib tab 140 mgIMBRUVICA – ibrutinib tab 280 mgIMBRUVICA – ibrutinib tab 420 mgIMBRUVICA – ibrutinib tab 560 mgINLYTA – axitinib tab 1 mgINLYTA – axitinib tab 5 mgIRESSA – gefitinib tab 250 mgJAKAFI – ruxolitinib phosphate tab 5 mg (base

equivalent)JAKAFI – ruxolitinib phosphate tab 10 mg (base




equivalent)KISQALI – ribociclib succinate tab pack 200 mg daily

doseKISQALI – ribociclib succinate tab pack 400 mg daily

dose (200 mg tab)KISQALI – ribociclib succinate tab pack 600 mg daily

dose (200 mg tab)KISQALI FEMARA 200 DOSE – ribociclib 200 mg dose

(200 mg tab) & letrozole 2.5 mg tbpkKISQALI FEMARA 400 DOSE – ribociclib 400 mg dose

(200 mg tab) & letrozole 2.5 mg tbpkKISQALI FEMARA 600 DOSE – ribociclib 600 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk

2021


Drug Name

lapatinib ditosylate tab 250 mg (base equiv) (Tykerb)LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapy

pack 10 mg (10 mg daily dose)LENVIMA 12MG DAILY DOSE – lenvatinib cap therapy

pack 3 x 4 mg (12 mg daily dose)LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapy

pack 10 & 4 mg (14 mg daily dose)LENVIMA 18 MG DAILY DOSE – lenvatinib cap ther pack

10 mg & 2 x 4 mg (18 mg daily dose)LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapy

pack 2 x 10 mg (20 mg daily dose)LENVIMA 24 MG DAILY DOSE – lenvatinib cap ther pack

2 x 10 mg & 4 mg (24 mg daily dose)LENVIMA 4 MG DAILY DOSE – lenvatinib cap therapy

pack 4 mg (4 mg daily dose)LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapy

pack 2 x 4 mg (8 mg daily dose)letrozole tab 2.5 mg (Femara)leucovorin calcium tab 5 mgleucovorin calcium tab 10 mgleucovorin calcium tab 15 mgleucovorin calcium tab 25 mgLEUKERAN – chlorambucil tab 2 mgLONSURF – trifluridine-tipiracil tab 15-6.14 mgLONSURF – trifluridine-tipiracil tab 20-8.19 mgLYNPARZA – olaparib tab 100 mgLYNPARZA – olaparib tab 150 mgLYSODREN – mitotane tab 500 mgMATULANE – procarbazine hcl cap 50 mgmegestrol acetate susp 40 mg/ml (Megace oral)megestrol acetate tab 20 mgmegestrol acetate tab 40 mgMEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg

(base equivalent)MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (base

equivalent)melphalan tab 2 mg (Alkeran)mercaptopurine tab 50 mg (Purinethol)MESNEX – mesna tab 400 mgmethotrexate sodium tab 2.5 mg (base equiv)MYLERAN – busulfan tab 2 mg

Drug Name

NEXAVAR – sorafenib tosylate tab 200 mg (baseequivalent)

nilutamide tab 150 mg (Nilandron)NINLARO – ixazomib citrate cap 2.3 mg (base

equivalent)NINLARO – ixazomib citrate cap 3 mg (base equivalent)NINLARO – ixazomib citrate cap 4 mg (base equivalent)NUBEQA – darolutamide tab 300 mgODOMZO – sonidegib phosphate cap 200 mg (base

equivalent)PIQRAY 200MG DAILY DOSE – alpelisib tab therapy

pack 200 mg daily dosePIQRAY 250MG DAILY DOSE – alpelisib tab pack 250

mg daily dose (200 mg & 50 mg tabs)PIQRAY 300MG DAILY DOSE – alpelisib tab pack 300

mg daily dose (2x150 mg tab)POMALYST – pomalidomide cap 1 mgPOMALYST – pomalidomide cap 2 mgPOMALYST – pomalidomide cap 3 mgPOMALYST – pomalidomide cap 4 mgPURIXAN – mercaptopurine susp 2000 mg/100ml (20

mg/ml)ROZLYTREK – entrectinib cap 100 mgROZLYTREK – entrectinib cap 200 mgRUBRACA – rucaparib camsylate tab 200 mg (base

equivalent)RUBRACA – rucaparib camsylate tab 250 mg (base

equivalent)RUBRACA – rucaparib camsylate tab 300 mg (base

equivalent)RYDAPT – midostaurin cap 25 mgSOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml

(base equivalent)SPRYCEL – dasatinib tab 20 mgSPRYCEL – dasatinib tab 50 mgSPRYCEL – dasatinib tab 70 mgSPRYCEL – dasatinib tab 80 mgSPRYCEL – dasatinib tab 100 mgSPRYCEL – dasatinib tab 140 mgSTIVARGA – regorafenib tab 40 mgSUTENT – sunitinib malate cap 12.5 mg (base

equivalent)SUTENT – sunitinib malate cap 25 mg (base equivalent)

2021


Drug Name

SUTENT – sunitinib malate cap 37.5 mg (baseequivalent)

SUTENT – sunitinib malate cap 50 mg (base equivalent)TABLOID – thioguanine tab 40 mgTABRECTA – capmatinib hcl tab 150 mgTABRECTA – capmatinib hcl tab 200 mgTAFINLAR – dabrafenib mesylate cap 50 mg (base

equivalent)TAFINLAR – dabrafenib mesylate cap 75 mg (base

equivalent)TAGRISSO – osimertinib mesylate tab 40 mg (base

equivalent)TAGRISSO – osimertinib mesylate tab 80 mg (base

equivalent)TALZENNA – talazoparib tosylate cap 0.25 mg (base

equivalent)TALZENNA – talazoparib tosylate cap 1 mg (base

equivalent)tamoxifen citrate tab 10 mg (base equivalent)tamoxifen citrate tab 20 mg (base equivalent)TASIGNA – nilotinib hcl cap 50 mg (base equivalent)TASIGNA – nilotinib hcl cap 150 mg (base equivalent)TASIGNA – nilotinib hcl cap 200 mg (base equivalent)temozolomide cap 5 mg (Temodar)temozolomide cap 20 mg (Temodar)temozolomide cap 100 mg (Temodar)temozolomide cap 140 mg (Temodar)temozolomide cap 180 mg (Temodar)temozolomide cap 250 mg (Temodar)toremifene citrate tab 60 mg (base equivalent)

(Fareston)tretinoin cap 10 mgTYKERB – lapatinib ditosylate tab 250 mg (base equiv)VENCLEXTA – venetoclax tab 10 mgVENCLEXTA – venetoclax tab 50 mgVENCLEXTA – venetoclax tab 100 mgVENCLEXTA STARTING PACK – venetoclax tab therapy

starter pack 10 & 50 & 100 mgVERZENIO – abemaciclib tab 50 mgVERZENIO – abemaciclib tab 100 mgVERZENIO – abemaciclib tab 150 mgVERZENIO – abemaciclib tab 200 mg

Drug Name

VITRAKVI – larotrectinib sulfate oral soln 20 mg/ml (baseequivalent)

VITRAKVI – larotrectinib sulfate cap 25 mg (baseequivalent)

VITRAKVI – larotrectinib sulfate cap 100 mg (baseequivalent)

VOTRIENT – pazopanib hcl tab 200 mg (base equiv)XALKORI – crizotinib cap 200 mgXALKORI – crizotinib cap 250 mgXTANDI – enzalutamide cap 40 mgYONSA – abiraterone acetate tab 125 mgZELBORAF – vemurafenib tab 240 mgZOLINZA – vorinostat cap 100 mgZYDELIG – idelalisib tab 100 mgZYDELIG – idelalisib tab 150 mgZYKADIA – ceritinib tab 150 mgZYTIGA – abiraterone acetate tab 500 mgENDOCRINE AND METABOLIC DRUGSCORTICOSTEROIDSbudesonide delayed release particles cap 3 mg

(Entocort ec)CORTISONE ACETATE – cortisone acetate tab 25 mgDEXAMETHASONE – dexamethasone soln 0.5 mg/5mlDEXAMETHASONE – dexamethasone tab 1 mgDEXAMETHASONE – dexamethasone tab 2 mgdexamethasone elixir 0.5 mg/5mlDEXAMETHASONE INTENSOL – dexamethasone conc

1 mg/mldexamethasone tab 0.5 mgdexamethasone tab 0.75 mgdexamethasone tab 1.5 mgdexamethasone tab 4 mgdexamethasone tab 6 mgfludrocortisone acetate tab 0.1 mghydrocortisone tab 5 mg (Cortef)hydrocortisone tab 10 mg (Cortef)hydrocortisone tab 20 mg (Cortef)methylprednisolone tab therapy pack 4 mg (21)

(Medrol dosepak)methylprednisolone tab 4 mg (Medrol)methylprednisolone tab 8 mg (Medrol)

2021


Drug Name

methylprednisolone tab 16 mg (Medrol)methylprednisolone tab 32 mg (Medrol)PREDNISOLONE – prednisolone syrup 15 mg/5ml (usp

solution equivalent)prednisolone sod phosph oral soln 6.7 mg/5ml

(5 mg/5ml base) (Pediapred)prednisolone sod phosphate oral soln 15 mg/5ml

(base equiv) (Orapred)PREDNISONE – prednisone oral soln 5 mg/5mlprednisone tab therapy pack 5 mg (21)prednisone tab therapy pack 5 mg (48)prednisone tab therapy pack 10 mg (21)prednisone tab therapy pack 10 mg (48)prednisone tab 1 mgprednisone tab 2.5 mgprednisone tab 5 mgprednisone tab 10 mgprednisone tab 20 mgprednisone tab 50 mgANDROGEN-ANABOLICdanazol cap 50 mgdanazol cap 100 mgdanazol cap 200 mgtestosterone cypionate im inj in oil 100 mg/ml (Depo-

testosterone)testosterone cypionate im inj in oil 200 mg/ml (Depo-

testosterone)TESTOSTERONE ENANTHATE – testosterone

enanthate im inj in oil 200 mg/mltestosterone td gel 25 mg/2.5gm (1%) (Androgel)testosterone td gel 50 mg/5gm (1%) (Androgel)testosterone td gel 12.5 mg/act (1%) (Androgel pump)testosterone td gel 20.25 mg/1.25gm (1.62%)

(Androgel)testosterone td gel 40.5 mg/2.5gm (1.62%) (Androgel)testosterone td gel 20.25 mg/act (1.62%) (Androgel

pump)testosterone td soln 30 mg/act (Axiron)ESTROGENSCLIMARA PRO – estradiol-levonorgestrel td patch

weekly 0.045-0.015 mg/dayDIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%)

Drug Name

DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%)DIVIGEL – estradiol td gel 0.75 mg/0.75gm (0.1%)DIVIGEL – estradiol td gel 1 mg/gm (0.1%)DIVIGEL – estradiol td gel 1.25 mg/1.25gm (0.1%)DUAVEE – conjugated estrogens-bazedoxifene tab

0.45-20 mgestradiol & norethindrone acetate tab 0.5-0.1 mg

(Activella)estradiol & norethindrone acetate tab 1-0.5 mg

(Activella)estradiol tab 0.5 mg (Estrace)estradiol tab 1 mg (Estrace)estradiol tab 2 mg (Estrace)estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-

dot)estradiol td patch twice weekly 0.0375 mg/24hr

(Vivelle-dot)estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-

dot)estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-

dot)estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-

dot)estradiol td patch weekly 0.025 mg/24hr (Climara)estradiol td patch weekly 0.0375 mg/24hr

(37.5 mcg/24hr) (Climara)estradiol td patch weekly 0.05 mg/24hr (Climara)estradiol td patch weekly 0.06 mg/24hr (Climara)estradiol td patch weekly 0.075 mg/24hr (Climara)estradiol td patch weekly 0.1 mg/24hr (Climara)ESTROGEL – estradiol gel 0.06% (0.75 mg/1.25 gm

metered-dose pump)norethindrone acetate-ethinyl estradiol tab

0.5 mg-2.5 mcg (Femhrt low dose)norethindrone acetate-ethinyl estradiol tab

1 mg-5 mcgORIAHNN – elagolix-estrad-noreth 300-1-0.5mg &

elagolix 300mg cap packPREMARIN – estrogens, conjugated tab 0.3 mgPREMARIN – estrogens, conjugated tab 0.45 mgPREMARIN – estrogens, conjugated tab 0.625 mgPREMARIN – estrogens, conjugated tab 0.9 mgPREMARIN – estrogens, conjugated tab 1.25 mg

2021


Drug Name

PREMPHASE – conj est 0.625(14)/conj est-medroxyproac tab 0.625-5mg(14)

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.3-1.5 mg



PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-5 mg

CONTRACEPTIVESdesogest-eth estrad & eth estrad tab

0.15-0.02/0.01 mg(21/5) (Mircette)desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg

(Desogen)drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz)drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin

28)ELLA – ulipristal acetate tab 30 mgethynodiol diacetate & ethinyl estradiol tab

1 mg-35 mcgethynodiol diacetate & ethinyl estradiol tab

1 mg-50 mcg (Zovia 1/50e)levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) (Loseasonique)levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7) (Seasonique)levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mglevonorgestrel & ethinyl estradiol tab 0.1 mg-20 mcglevonorgestrel & ethinyl estradiol tab 0.15 mg-30 mcglevonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcgmedroxyprogesterone acetate im susp prefilled syr

150 mg/ml (Depo-provera contrac)medroxyprogesterone acetate im susp 150 mg/ml

(Depo-provera contrac)MIRENA – levonorgestrel releasing iud 20 mcg/day (52

mg total)norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

(Ovcon-35)norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

(Brevicon-28)

Drug Name

norethindrone & ethinyl estradiol tab 1 mg-35 mcg(Norinyl 1+35)

norethindrone & ethinyl estradiol-fe chew tab0.4 mg-35 mcg (Femcon fe)

norethindrone ac-ethinyl estrad-fe tab1-20/1-30/1-35 mg-mcg (Estrostep fe)

norethindrone ace & ethinyl estradiol tab1 mg-20 mcg (Loestrin 1/20-21)

norethindrone ace & ethinyl estradiol tab1.5 mg-30 mcg (Loestrin 1.5/30-21)

norethindrone ace & ethinyl estradiol-fe tab1 mg-20 mcg (Loestrin fe 1/20)

norethindrone ace & ethinyl estradiol-fe tab1.5 mg-30 mcg (Loestrin fe 1.5/30)

norethindrone tab 0.35 mg (Nor-qd)norethindrone-eth estradiol tab

0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-

mcg (Tri-norinyl 28)norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

(Ortho-cyclen)norgestimate-eth estrad tab

0.18-25/0.215-25/0.25-25 mg-mcg (Ortho tri-cyclen lo)norgestimate-eth estrad tab

0.18-35/0.215-35/0.25-35 mg-mcg (Ortho tri-cyclen)norgestrel & ethinyl estradiol tab 0.3 mg-30 mcgNUVARING – etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hrSKYLA – levonorgestrel releasing iud 14 mcg/day (13.5

mg total)XULANE – norelgestromin-ethinyl estradiol td ptwk

150-35 mcg/24hrPROGESTINSmedroxyprogesterone acetate tab 2.5 mg (Provera)medroxyprogesterone acetate tab 5 mg (Provera)medroxyprogesterone acetate tab 10 mg (Provera)norethindrone acetate tab 5 mg (Aygestin)progesterone micronized cap 100 mg (Prometrium)progesterone micronized cap 200 mg (Prometrium)ANTIDIABETICSacarbose tab 25 mg (Precose)acarbose tab 50 mg (Precose)acarbose tab 100 mg (Precose)

2021


Drug Name

BAQSIMI ONE PACK – glucagon nasal powder 3 mg/dose

BAQSIMI TWO PACK – glucagon nasal powder 3 mg/dose

diazoxide susp 50 mg/ml (Proglycem)FARXIGA – dapagliflozin propanediol tab 5 mg (base

equivalent)FARXIGA – dapagliflozin propanediol tab 10 mg (base

equivalent)glimepiride tab 1 mg (Amaryl)glimepiride tab 2 mg (Amaryl)glimepiride tab 4 mg (Amaryl)glipizide tab er 24hr 2.5 mg (Glucotrol xl)glipizide tab er 24hr 5 mg (Glucotrol xl)glipizide tab er 24hr 10 mg (Glucotrol xl)glipizide tab 5 mg (Glucotrol)glipizide tab 10 mg (Glucotrol)glipizide-metformin hcl tab 2.5-250 mgglipizide-metformin hcl tab 2.5-500 mgglipizide-metformin hcl tab 5-500 mgGLUCAGON EMERGENCY KIT – glucagon (rdna) for inj

kit 1 mgGLUCAGON EMERGENCY KIT FO – glucagon hcl for inj

1 mgglyburide micronized tab 1.5 mg (Glynase)glyburide micronized tab 3 mg (Glynase)glyburide micronized tab 6 mg (Glynase)glyburide tab 1.25 mgglyburide tab 2.5 mgglyburide tab 5 mgglyburide-metformin tab 1.25-250 mg (Glucovance)glyburide-metformin tab 2.5-500 mg (Glucovance)glyburide-metformin tab 5-500 mg (Glucovance)GLYXAMBI – empagliflozin-linagliptin tab 10-5 mgGLYXAMBI – empagliflozin-linagliptin tab 25-5 mgGVOKE HYPOPEN 1-PACK – glucagon subcutaneous

solution auto-injector 0.5 mg/0.1mlGVOKE HYPOPEN 1-PACK – glucagon subcutaneous

solution auto-injector 1 mg/0.2mlGVOKE HYPOPEN 2-PACK – glucagon subcutaneous

solution auto-injector 0.5 mg/0.1ml

Drug Name

GVOKE HYPOPEN 2-PACK – glucagon subcutaneoussolution auto-injector 1 mg/0.2ml

GVOKE PFS – glucagon subcutaneous soln pref syringe0.5 mg/0.1ml

GVOKE PFS – glucagon subcutaneous soln pref syringe1 mg/0.2ml

INVOKAMET – canagliflozin-metformin hcl tab 50-500mg




INVOKAMET XR – canagliflozin-metformin hcl tab er24hr 50-500 mg




INVOKANA – canagliflozin tab 100 mgINVOKANA – canagliflozin tab 300 mgJANUMET – sitagliptin-metformin hcl tab 50-500 mgJANUMET – sitagliptin-metformin hcl tab 50-1000 mgJANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-500 mgJANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-1000 mgJANUMET XR – sitagliptin-metformin hcl tab er 24hr

100-1000 mgJANUVIA – sitagliptin phosphate tab 25 mg (base equiv)JANUVIA – sitagliptin phosphate tab 50 mg (base equiv)JANUVIA – sitagliptin phosphate tab 100 mg (base equiv)JARDIANCE – empagliflozin tab 10 mgJARDIANCE – empagliflozin tab 25 mgmetformin hcl tab er 24hr 500 mg (Glucophage xr)metformin hcl tab er 24hr 750 mg (Glucophage xr)metformin hcl tab 500 mg (Glucophage)metformin hcl tab 850 mg (Glucophage)metformin hcl tab 1000 mg (Glucophage)nateglinide tab 60 mg (Starlix)

2021


Drug Name

nateglinide tab 120 mg (Starlix)OZEMPIC – semaglutide soln pen-inj 0.25 or 0.5 mg/

dose (2 mg/1.5ml)OZEMPIC – semaglutide soln pen-inj 1 mg/dose (2

mg/1.5ml)pioglitazone hcl tab 15 mg (base equiv) (Actos)pioglitazone hcl tab 30 mg (base equiv) (Actos)pioglitazone hcl tab 45 mg (base equiv) (Actos)pioglitazone hcl-metformin hcl tab 15-500 mg

(Actoplus met)pioglitazone hcl-metformin hcl tab 15-850 mg

(Actoplus met)repaglinide tab 0.5 mg (Prandin)repaglinide tab 1 mg (Prandin)repaglinide tab 2 mg (Prandin)RYBELSUS – semaglutide tab 3 mgRYBELSUS – semaglutide tab 7 mgRYBELSUS – semaglutide tab 14 mgSOLIQUA 100/33 – insulin glargine-lixisenatide sol pen-

inj 100-33 unit-mcg/mlSYNJARDY – empagliflozin-metformin hcl tab 5-500 mgSYNJARDY – empagliflozin-metformin hcl tab 5-1000 mgSYNJARDY – empagliflozin-metformin hcl tab 12.5-500

mgSYNJARDY – empagliflozin-metformin hcl tab 12.5-1000

mgSYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

5-1000 mgSYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

10-1000 mgSYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

12.5-1000 mgSYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

25-1000 mgTRIJARDY XR – empagliflozin-linagliptin-metformin tab

er 24hr 5-2.5-1000mgTRIJARDY XR – empagliflozin-linagliptin-metformin tab

er 24hr 10-5-1000 mgTRIJARDY XR – empagliflozin-linaglip-metformin tab er

24hr 12.5-2.5-1000mgTRIJARDY XR – empagliflozin-linagliptin-metformin tab

er 24hr 25-5-1000 mgTRULICITY – dulaglutide soln pen-injector 0.75 mg/0.5ml

Drug Name

TRULICITY – dulaglutide soln pen-injector 1.5 mg/0.5mlTRULICITY – dulaglutide soln pen-injector 3 mg/0.5mlTRULICITY – dulaglutide soln pen-injector 4.5 mg/0.5mlVICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/

ml)XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

2.5-1000 mgXIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

5-500 mgXIGDUO XR – dapagliflozin-metformin hcl tab er 24hr



10-1000 mgXULTOPHY 100/3.6 – insulin degludec-liraglutide sol

pen-inj 100-3.6 unit-mg/mlRapid-Acting InsulinsFIASP – insulin aspart (with niacinamide) inj 100 unit/mlFIASP FLEXTOUCH – insulin aspart (with niacinamide)

sol pen-inj 100 unit/mlFIASP PENFILL – insulin aspart (with niacinamide) soln

cartridge 100 unit/mlINSULIN ASPART – insulin aspart inj 100 unit/mlINSULIN ASPART FLEXPEN – insulin aspart soln pen-

injector 100 unit/mlINSULIN ASPART PENFILL – insulin aspart soln

cartridge 100 unit/mlNOVOLOG – insulin aspart inj 100 unit/mlNOVOLOG FLEXPEN – insulin aspart soln pen-injector

100 unit/mlNOVOLOG PENFILL – insulin aspart soln cartridge 100

unit/mlShort-Acting InsulinsHUMULIN R U-500 (CONCENTR – insulin regular

(human) inj 500 unit/mlHUMULIN R U-500 KWIKPEN – insulin regular (human)

soln pen-injector 500 unit/mlNOVOLIN R – insulin regular (human) inj 100 unit/mlNOVOLIN R FLEXPEN – insulin regular (human) soln

pen-injector 100 unit/mlIntermediate-Acting InsulinsINSULIN ASPART PROTAMINE/ – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)

2021


Drug Name

INSULIN ASPART PROTAMINE/ – insulin aspart prot &aspart (human) inj 100 unit/ml (70-30)

NOVOLIN N – insulin nph (human) (isophane) inj 100unit/ml

NOVOLIN N FLEXPEN – insulin nph (human) (isophane)susp pen-injector 100 unit/ml

NOVOLIN 70/30 – insulin nph isophane & regular humaninj 100 unit/ml (70-30)

NOVOLIN 70/30 FLEXPEN – insulin nph & regular susppen-inj 100 unit/ml (70-30)

NOVOLOG MIX 70/30 – insulin aspart prot & aspart(human) inj 100 unit/ml (70-30)

NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &aspart sus pen-inj 100 unit/ml (70-30)

Basal InsulinsLANTUS – insulin glargine inj 100 unit/mlLANTUS SOLOSTAR – insulin glargine soln pen-injector

100 unit/mlLEVEMIR – insulin detemir inj 100 unit/mlLEVEMIR FLEXTOUCH – insulin detemir soln pen-

injector 100 unit/mlTOUJEO MAX SOLOSTAR – insulin glargine soln pen-

injector 300 unit/ml (2 unit dial)TOUJEO SOLOSTAR – insulin glargine soln pen-injector

300 unit/ml (1 unit dial)TRESIBA – insulin degludec inj 100 unit/mlTRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 100 unit/mlTRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 200 unit/mlTHYROID AGENTSlevothyroxine sodium tab 25 mcg (Synthroid)levothyroxine sodium tab 50 mcg (Synthroid)levothyroxine sodium tab 75 mcg (Synthroid)levothyroxine sodium tab 88 mcg (Synthroid)levothyroxine sodium tab 100 mcg (Synthroid)levothyroxine sodium tab 112 mcg (Synthroid)levothyroxine sodium tab 125 mcg (Synthroid)levothyroxine sodium tab 137 mcg (Synthroid)levothyroxine sodium tab 150 mcg (Synthroid)levothyroxine sodium tab 175 mcg (Synthroid)levothyroxine sodium tab 200 mcg (Synthroid)levothyroxine sodium tab 300 mcg (Synthroid)

Drug Name

liothyronine sodium tab 5 mcg (Cytomel)liothyronine sodium tab 25 mcg (Cytomel)liothyronine sodium tab 50 mcg (Cytomel)methimazole tab 5 mg (Tapazole)methimazole tab 10 mg (Tapazole)propylthiouracil tab 50 mgOXYTOCICSmethylergonovine maleate tab 0.2 mgENDOCRINE and METABOLIC AGENTS - MISC.ALENDRONATE SODIUM – alendronate sodium tab 5

mgalendronate sodium tab 10 mgalendronate sodium tab 35 mgalendronate sodium tab 70 mg (Fosamax)cabergoline tab 0.5 mgcalcitonin (salmon) nasal soln 200 unit/act (Miacalcin)calcitriol cap 0.25 mcg (Rocaltrol)calcitriol cap 0.5 mcg (Rocaltrol)calcitriol oral soln 1 mcg/ml (Rocaltrol)CHORIONIC GONADOTROPIN – chorionic gonadotropin

for im inj 10000 unitcinacalcet hcl tab 30 mg (base equiv) (Sensipar)cinacalcet hcl tab 60 mg (base equiv) (Sensipar)cinacalcet hcl tab 90 mg (base equiv) (Sensipar)CLOMIPHENE CITRATE – clomiphene citrate tab 50 mgCYSTADANE – betaine powder for oral solutiondesmopressin acetate nasal spray soln 0.01%

(Ddavp)desmopressin acetate nasal spray soln 0.01%

(refrigerated)desmopressin acetate tab 0.1 mg (Ddavp)desmopressin acetate tab 0.2 mg (Ddavp)FOLLISTIM AQ – follitropin beta inj 300 unit/0.36mlFOLLISTIM AQ – follitropin beta inj 600 unit/0.72mlFOLLISTIM AQ – follitropin beta inj 900 unit/1.08mlganirelix acetate soln prefilled syringe 250 mcg/0.5ml

(Ganirelix acetate)ibandronate sodium tab 150 mg (base equivalent)

(Boniva)INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml)levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)

2021


Drug Name

levocarnitine tab 330 mg (Carnitor)MENOPUR – menotropins for subcutaneous inj 75 unitnitisinone cap 2 mg (Orfadin)nitisinone cap 5 mg (Orfadin)nitisinone cap 10 mg (Orfadin)NITYR – nitisinone tab 2 mgNITYR – nitisinone tab 5 mgNITYR – nitisinone tab 10 mgNORDITROPIN FLEXPRO – somatropin solution pen-

injector 5 mg/1.5mlNORDITROPIN FLEXPRO – somatropin solution pen-



injector 30 mg/3mlNOVAREL – chorionic gonadotropin for im inj 5000 unitNOVAREL – chorionic gonadotropin for im inj 10000 unitoctreotide acetate inj 50 mcg/ml (0.05 mg/ml)

(Sandostatin)octreotide acetate inj 100 mcg/ml (0.1 mg/ml)



(Sandostatin)octreotide acetate inj 1000 mcg/ml (1 mg/ml)

(Sandostatin)ORFADIN – nitisinone cap 20 mgORFADIN – nitisinone susp 4 mg/mlORILISSA – elagolix sodium tab 150 mg (base equiv)ORILISSA – elagolix sodium tab 200 mg (base equiv)paricalcitol cap 1 mcg (Zemplar)paricalcitol cap 2 mcg (Zemplar)paricalcitol cap 4 mcg (Zemplar)PREGNYL W/DILUENT BENZYL – chorionic

gonadotropin for im inj 10000 unitPROLIA – denosumab inj soln prefilled syringe 60 mg/mlraloxifene hcl tab 60 mg (Evista)REVCOVI – elapegademase-lvlr im soln 2.4 mg/1.5ml

(1.6 mg/ml)risedronate sodium tab 5 mg (Actonel)

Drug Name

risedronate sodium tab 30 mg (Actonel)risedronate sodium tab 35 mg (Actonel)risedronate sodium tab 150 mg (Actonel)SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 10 mgSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 20 mgSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 30 mgSTIMATE – desmopressin acetate nasal soln 1.5 mg/mlSTRENSIQ – asfotase alfa subcutaneous inj 18

mg/0.45mlSTRENSIQ – asfotase alfa subcutaneous inj 28 mg/0.7mlSTRENSIQ – asfotase alfa subcutaneous inj 40 mg/mlSTRENSIQ – asfotase alfa subcutaneous inj 80 mg/0.8mlTYMLOS – abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56mlCARDIOVASCULAR AGENTSCARDIOTONICSdigoxin oral soln 0.05 mg/ml (Digoxin)digoxin tab 125 mcg (0.125 mg) (Lanoxin)digoxin tab 250 mcg (0.25 mg) (Lanoxin)ANTIANGINAL AGENTSisosorbide dinitrate tab 5 mg (Isordil titradose)isosorbide dinitrate tab 10 mgisosorbide dinitrate tab 20 mgisosorbide dinitrate tab 30 mgisosorbide mononitrate tab er 24hr 30 mgisosorbide mononitrate tab er 24hr 60 mgisosorbide mononitrate tab er 24hr 120 mgisosorbide mononitrate tab 10 mgisosorbide mononitrate tab 20 mgNITRO-BID – nitroglycerin oint 2%nitroglycerin sl tab 0.3 mg (Nitrostat)nitroglycerin sl tab 0.4 mg (Nitrostat)nitroglycerin sl tab 0.6 mg (Nitrostat)nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)BETA BLOCKERS

2021


Drug Name

acebutolol hcl cap 200 mg (Sectral)acebutolol hcl cap 400 mg (Sectral)atenolol tab 25 mg (Tenormin)atenolol tab 50 mg (Tenormin)atenolol tab 100 mg (Tenormin)bisoprolol fumarate tab 5 mg (Zebeta)bisoprolol fumarate tab 10 mg (Zebeta)carvedilol tab 3.125 mg (Coreg)carvedilol tab 6.25 mg (Coreg)carvedilol tab 12.5 mg (Coreg)carvedilol tab 25 mg (Coreg)labetalol hcl tab 100 mg (Trandate)labetalol hcl tab 200 mg (Trandate)labetalol hcl tab 300 mg (Trandate)metoprolol succinate tab er 24hr 25 mg (tartrate

equiv) (Toprol xl)metoprolol succinate tab er 24hr 50 mg (tartrate



equiv) (Toprol xl)metoprolol tartrate tab 25 mgmetoprolol tartrate tab 50 mg (Lopressor)metoprolol tartrate tab 100 mg (Lopressor)nadolol tab 20 mg (Corgard)nadolol tab 40 mg (Corgard)nadolol tab 80 mg (Corgard)pindolol tab 5 mgpindolol tab 10 mgPROPRANOLOL HCL – propranolol hcl oral soln 20

mg/5mlPROPRANOLOL HCL – propranolol hcl oral soln 40

mg/5mlpropranolol hcl cap er 24hr 60 mg (Inderal la)propranolol hcl cap er 24hr 80 mg (Inderal la)propranolol hcl cap er 24hr 120 mg (Inderal la)propranolol hcl cap er 24hr 160 mg (Inderal la)propranolol hcl tab 10 mgpropranolol hcl tab 20 mgpropranolol hcl tab 40 mg

Drug Name

propranolol hcl tab 60 mgpropranolol hcl tab 80 mgsotalol hcl (afib/afl) tab 80 mg (Betapace af)sotalol hcl (afib/afl) tab 120 mg (Betapace af)sotalol hcl (afib/afl) tab 160 mg (Betapace af)sotalol hcl tab 80 mg (Betapace)sotalol hcl tab 120 mg (Betapace)sotalol hcl tab 160 mg (Betapace)sotalol hcl tab 240 mgtimolol maleate tab 5 mgtimolol maleate tab 10 mgtimolol maleate tab 20 mgCALCIUM CHANNEL BLOCKERSamlodipine besylate tab 2.5 mg (base equivalent)

(Norvasc)amlodipine besylate tab 5 mg (base equivalent)

(Norvasc)amlodipine besylate tab 10 mg (base equivalent)

(Norvasc)diltiazem hcl cap er 24hr 120 mgdiltiazem hcl cap er 24hr 180 mgdiltiazem hcl cap er 24hr 240 mgdiltiazem hcl coated beads cap er 24hr 120 mg

(Cardizem cd)diltiazem hcl coated beads cap er 24hr 180 mg

(Cardizem cd)diltiazem hcl coated beads cap er 24hr 240 mg

(Cardizem cd)diltiazem hcl coated beads cap er 24hr 300 mgdiltiazem hcl coated beads cap er 24hr 360 mg

(Cardizem cd)diltiazem hcl extended release beads cap er 24hr

120 mg (Tiazac)diltiazem hcl extended release beads cap er 24hr





420 mg (Tiazac)

2021


Drug Name

diltiazem hcl tab 30 mg (Cardizem)diltiazem hcl tab 60 mg (Cardizem)diltiazem hcl tab 90 mgdiltiazem hcl tab 120 mg (Cardizem)felodipine tab er 24hr 2.5 mgfelodipine tab er 24hr 5 mgfelodipine tab er 24hr 10 mgnifedipine tab er 24hr 30 mg (Adalat cc)nifedipine tab er 24hr 60 mg (Adalat cc)nifedipine tab er 24hr 90 mg (Adalat cc)nifedipine tab er 24hr osmotic release 30 mg

(Procardia xl)nifedipine tab er 24hr osmotic release 60 mg

(Procardia xl)nifedipine tab er 24hr osmotic release 90 mg

(Procardia xl)nimodipine cap 30 mgverapamil hcl cap er 24hr 120 mg (Verelan)verapamil hcl cap er 24hr 180 mg (Verelan)verapamil hcl cap er 24hr 240 mg (Verelan)VERAPAMIL HCL SR – verapamil hcl cap er 24hr 360

mgverapamil hcl tab er 120 mg (Calan sr)verapamil hcl tab er 180 mg (Calan sr)verapamil hcl tab er 240 mg (Calan sr)verapamil hcl tab 40 mgverapamil hcl tab 80 mg (Calan)verapamil hcl tab 120 mg (Calan)ANTIARRHYTHMICSamiodarone hcl tab 100 mgamiodarone hcl tab 200 mg (Cordarone)amiodarone hcl tab 400 mgdisopyramide phosphate cap 100 mg (Norpace)disopyramide phosphate cap 150 mg (Norpace)flecainide acetate tab 50 mgflecainide acetate tab 100 mgflecainide acetate tab 150 mgmexiletine hcl cap 150 mgmexiletine hcl cap 200 mgmexiletine hcl cap 250 mg

Drug Name

MULTAQ – dronedarone hcl tab 400 mg (baseequivalent)

propafenone hcl cap er 12hr 225 mg (Rythmol sr)propafenone hcl cap er 12hr 325 mg (Rythmol sr)propafenone hcl cap er 12hr 425 mg (Rythmol sr)propafenone hcl tab 150 mg (Rythmol)propafenone hcl tab 225 mg (Rythmol)propafenone hcl tab 300 mgquinidine gluconate tab er 324 mgQUINIDINE SULFATE – quinidine sulfate tab 200 mgQUINIDINE SULFATE – quinidine sulfate tab 300 mgANTIHYPERTENSIVESamlodipine besylate-benazepril hcl cap 2.5-10 mg

(Lotrel)amlodipine besylate-benazepril hcl cap 5-10 mg





(Lotrel)amlodipine besylate-valsartan tab 5-160 mg (Exforge)amlodipine besylate-valsartan tab 5-320 mg (Exforge)amlodipine besylate-valsartan tab 10-160 mg

(Exforge)amlodipine besylate-valsartan tab 10-320 mg

(Exforge)amlodipine-valsartan-hydrochlorothiazide tab

5-160-12.5 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

5-160-25 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

10-160-12.5 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

10-160-25 mg (Exforge hct)amlodipine-valsartan-hydrochlorothiazide tab

10-320-25 mg (Exforge hct)atenolol & chlorthalidone tab 50-25 mg (Tenoretic 50)atenolol & chlorthalidone tab 100-25 mg (Tenoretic

100)

2021


Drug Name

benazepril & hydrochlorothiazide tab 5-6.25 mgbenazepril & hydrochlorothiazide tab 10-12.5 mg

(Lotensin hct)benazepril & hydrochlorothiazide tab 20-12.5 mg

(Lotensin hct)benazepril & hydrochlorothiazide tab 20-25 mg

(Lotensin hct)benazepril hcl tab 5 mgbenazepril hcl tab 10 mg (Lotensin)benazepril hcl tab 20 mg (Lotensin)benazepril hcl tab 40 mg (Lotensin)bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

(Ziac)bisoprolol & hydrochlorothiazide tab 5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide tab 10-6.25 mg

(Ziac)candesartan cilexetil tab 4 mg (Atacand)candesartan cilexetil tab 8 mg (Atacand)candesartan cilexetil tab 16 mg (Atacand)candesartan cilexetil tab 32 mg (Atacand)candesartan cilexetil-hydrochlorothiazide tab

16-12.5 mg (Atacand hct)candesartan cilexetil-hydrochlorothiazide tab

32-12.5 mg (Atacand hct)candesartan cilexetil-hydrochlorothiazide tab

32-25 mg (Atacand hct)captopril tab 12.5 mgcaptopril tab 25 mgcaptopril tab 50 mgcaptopril tab 100 mgCAPTOPRIL/HYDROCHLOROTHIA – captopril &

hydrochlorothiazide tab 25-15 mgCAPTOPRIL/HYDROCHLOROTHIA – captopril &



hydrochlorothiazide tab 50-25 mgclonidine hcl tab 0.1 mg (Catapres)clonidine hcl tab 0.2 mg (Catapres)clonidine hcl tab 0.3 mg (Catapres)clonidine td patch weekly 0.1 mg/24hr (Catapres-tts-1)clonidine td patch weekly 0.2 mg/24hr (Catapres-tts-2)

Drug Name

clonidine td patch weekly 0.3 mg/24hr (Catapres-tts-3)doxazosin mesylate tab 1 mg (Cardura)doxazosin mesylate tab 2 mg (Cardura)doxazosin mesylate tab 4 mg (Cardura)doxazosin mesylate tab 8 mg (Cardura)enalapril maleate & hydrochlorothiazide tab

5-12.5 mgenalapril maleate & hydrochlorothiazide tab 10-25 mg

(Vaseretic)enalapril maleate tab 2.5 mg (Vasotec)enalapril maleate tab 5 mg (Vasotec)enalapril maleate tab 10 mg (Vasotec)enalapril maleate tab 20 mg (Vasotec)eplerenone tab 25 mg (Inspra)eplerenone tab 50 mg (Inspra)fosinopril sodium & hydrochlorothiazide tab

10-12.5 mgfosinopril sodium & hydrochlorothiazide tab

20-12.5 mgfosinopril sodium tab 10 mgfosinopril sodium tab 20 mgfosinopril sodium tab 40 mgguanfacine hcl tab 1 mg (Tenex)guanfacine hcl tab 2 mg (Tenex)hydralazine hcl tab 10 mghydralazine hcl tab 25 mghydralazine hcl tab 50 mghydralazine hcl tab 100 mgirbesartan tab 75 mg (Avapro)irbesartan tab 150 mg (Avapro)irbesartan tab 300 mg (Avapro)irbesartan-hydrochlorothiazide tab 150-12.5 mg

(Avalide)irbesartan-hydrochlorothiazide tab 300-12.5 mg

(Avalide)lisinopril & hydrochlorothiazide tab 10-12.5 mg

(Zestoretic)lisinopril & hydrochlorothiazide tab 20-12.5 mg

(Zestoretic)lisinopril & hydrochlorothiazide tab 20-25 mg

(Zestoretic)lisinopril tab 2.5 mg (Zestril)

2021


Drug Name

lisinopril tab 5 mg (Prinivil)lisinopril tab 10 mg (Prinivil)lisinopril tab 20 mg (Prinivil)lisinopril tab 30 mg (Zestril)lisinopril tab 40 mg (Zestril)losartan potassium & hydrochlorothiazide tab

50-12.5 mg (Hyzaar)losartan potassium & hydrochlorothiazide tab

100-12.5 mg (Hyzaar)losartan potassium & hydrochlorothiazide tab

100-25 mg (Hyzaar)losartan potassium tab 25 mg (Cozaar)losartan potassium tab 50 mg (Cozaar)losartan potassium tab 100 mg (Cozaar)methyldopa tab 250 mgmethyldopa tab 500 mgmetoprolol & hydrochlorothiazide tab 50-25 mg

(Lopressor hct)metoprolol & hydrochlorothiazide tab 100-25 mg

(Lopressor hct)METOPROLOL/HYDROCHLOROTHI – metoprolol &

hydrochlorothiazide tab 100-50 mgminoxidil tab 2.5 mgminoxidil tab 10 mgmoexipril hcl tab 7.5 mg (Univasc)moexipril hcl tab 15 mg (Univasc)olmesartan medoxomil tab 5 mg (Benicar)olmesartan medoxomil tab 20 mg (Benicar)olmesartan medoxomil tab 40 mg (Benicar)olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)olmesartan medoxomil-hydrochlorothiazide tab

40-25 mg (Benicar hct)perindopril erbumine tab 2 mgperindopril erbumine tab 4 mg (Aceon)perindopril erbumine tab 8 mg (Aceon)phenoxybenzamine hcl cap 10 mg (Dibenzyline)prazosin hcl cap 1 mg (Minipress)prazosin hcl cap 2 mg (Minipress)prazosin hcl cap 5 mg (Minipress)

Drug Name

PROPRANOLOL/HYDROCHLOROTH – propranolol &hydrochlorothiazide tab 40-25 mg

PROPRANOLOL/HYDROCHLOROTH – propranolol &hydrochlorothiazide tab 80-25 mg

quinapril hcl tab 5 mg (Accupril)quinapril hcl tab 10 mg (Accupril)quinapril hcl tab 20 mg (Accupril)quinapril hcl tab 40 mg (Accupril)quinapril-hydrochlorothiazide tab 10-12.5 mg

(Accuretic)quinapril-hydrochlorothiazide tab 20-12.5 mg

(Accuretic)quinapril-hydrochlorothiazide tab 20-25 mg

(Accuretic)ramipril cap 1.25 mg (Altace)ramipril cap 2.5 mg (Altace)ramipril cap 5 mg (Altace)ramipril cap 10 mg (Altace)telmisartan tab 20 mg (Micardis)telmisartan tab 40 mg (Micardis)telmisartan tab 80 mg (Micardis)telmisartan-hydrochlorothiazide tab 40-12.5 mg

(Micardis hct)telmisartan-hydrochlorothiazide tab 80-12.5 mg

(Micardis hct)telmisartan-hydrochlorothiazide tab 80-25 mg

(Micardis hct)terazosin hcl cap 1 mg (base equivalent)terazosin hcl cap 2 mg (base equivalent)terazosin hcl cap 5 mg (base equivalent)terazosin hcl cap 10 mg (base equivalent)trandolapril tab 1 mg (Mavik)trandolapril tab 2 mg (Mavik)trandolapril tab 4 mg (Mavik)valsartan tab 40 mg (Diovan)valsartan tab 80 mg (Diovan)valsartan tab 160 mg (Diovan)valsartan tab 320 mg (Diovan)valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan

hct)valsartan-hydrochlorothiazide tab 160-12.5 mg

(Diovan hct)

2021


Drug Name

valsartan-hydrochlorothiazide tab 160-25 mg (Diovanhct)

valsartan-hydrochlorothiazide tab 320-12.5 mg(Diovan hct)

valsartan-hydrochlorothiazide tab 320-25 mg (Diovanhct)

DIURETICSacetazolamide cap er 12hr 500 mg (Diamox)acetazolamide tab 125 mgacetazolamide tab 250 mgamiloride & hydrochlorothiazide tab 5-50 mgamiloride hcl tab 5 mgbumetanide tab 0.5 mgbumetanide tab 1 mgbumetanide tab 2 mgchlorthalidone tab 25 mgchlorthalidone tab 50 mgfurosemide oral soln 10 mg/mlfurosemide tab 20 mg (Lasix)furosemide tab 40 mg (Lasix)furosemide tab 80 mg (Lasix)hydrochlorothiazide cap 12.5 mg (Microzide)hydrochlorothiazide tab 12.5 mghydrochlorothiazide tab 25 mghydrochlorothiazide tab 50 mgindapamide tab 1.25 mgindapamide tab 2.5 mgmethazolamide tab 25 mg (Neptazane)methazolamide tab 50 mg (Neptazane)metolazone tab 2.5 mg (Zaroxolyn)metolazone tab 5 mg (Zaroxolyn)metolazone tab 10 mgspironolactone & hydrochlorothiazide tab 25-25 mg

(Aldactazide)spironolactone tab 25 mg (Aldactone)spironolactone tab 50 mg (Aldactone)spironolactone tab 100 mg (Aldactone)torsemide tab 5 mg (Demadex)torsemide tab 10 mg (Demadex)torsemide tab 20 mg (Demadex)

Drug Name

torsemide tab 100 mg (Demadex)triamterene & hydrochlorothiazide cap 37.5-25 mg

(Dyazide)triamterene & hydrochlorothiazide tab 37.5-25 mg

(Maxzide-25)triamterene & hydrochlorothiazide tab 75-50 mg

(Maxzide)VASOPRESSORSepinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000) (Epipen-jr 2-pak)epinephrine solution auto-injector 0.3 mg/0.3ml

(1:1000) (Epipen 2-pak)midodrine hcl tab 2.5 mgmidodrine hcl tab 5 mgmidodrine hcl tab 10 mgSYMJEPI – epinephrine soln prefilled syringe 0.15

mg/0.3ml (1:2000)SYMJEPI – epinephrine solution prefilled syringe 0.3

mg/0.3ml (1:1000)ANTIHYPERLIPIDEMICSatorvastatin calcium tab 10 mg (base equivalent)

(Lipitor)atorvastatin calcium tab 20 mg (base equivalent)



(Lipitor)cholestyramine light powder packets 4 gmcholestyramine light powder 4 gm/dose (Questran

light)cholestyramine powder packets 4 gm (Questran)cholestyramine powder 4 gm/dose (Questran)choline fenofibrate cap dr 45 mg (fenofibric acid

equiv) (Trilipix)colesevelam hcl packet for susp 3.75 gm (Welchol)colesevelam hcl tab 625 mg (Welchol)colestipol hcl granule packets 5 gm (Colestid flavored)colestipol hcl granules 5 gm (Colestid flavored)colestipol hcl tab 1 gm (Colestid)ezetimibe tab 10 mg (Zetia)ezetimibe-simvastatin tab 10-10 mg (Vytorin)ezetimibe-simvastatin tab 10-20 mg (Vytorin)

2021


Drug Name

ezetimibe-simvastatin tab 10-40 mg (Vytorin)ezetimibe-simvastatin tab 10-80 mg (Vytorin)fenofibrate micronized cap 67 mg (Lofibra)fenofibrate micronized cap 134 mg (Lofibra)fenofibrate micronized cap 200 mg (Lofibra)fenofibrate tab 48 mg (Tricor)fenofibrate tab 54 mg (Lofibra)fenofibrate tab 145 mg (Tricor)fenofibrate tab 160 mg (Lofibra)gemfibrozil tab 600 mg (Lopid)lovastatin tab 10 mglovastatin tab 20 mg (Mevacor)lovastatin tab 40 mg (Mevacor)NEXLETOL – bempedoic acid tab 180 mgNEXLIZET – bempedoic acid-ezetimibe tab 180-10 mgniacin tab er 500 mg (antihyperlipidemic) (Niaspan)niacin tab er 750 mg (antihyperlipidemic) (Niaspan)niacin tab er 1000 mg (antihyperlipidemic) (Niaspan)pravastatin sodium tab 10 mgpravastatin sodium tab 20 mg (Pravachol)pravastatin sodium tab 40 mg (Pravachol)pravastatin sodium tab 80 mg (Pravachol)REPATHA – evolocumab subcutaneous soln prefilled

syringe 140 mg/mlREPATHA PUSHTRONEX SYSTEM – evolocumab

subcutaneous soln cartridge/infusor 420 mg/3.5mlREPATHA SURECLICK – evolocumab subcutaneous

soln auto-injector 140 mg/mlrosuvastatin calcium tab 5 mg (Crestor)rosuvastatin calcium tab 10 mg (Crestor)rosuvastatin calcium tab 20 mg (Crestor)rosuvastatin calcium tab 40 mg (Crestor)simvastatin tab 5 mg (Zocor)simvastatin tab 10 mg (Zocor)simvastatin tab 20 mg (Zocor)simvastatin tab 40 mg (Zocor)simvastatin tab 80 mg (Zocor)CARDIOVASCULAR AGENTS - MISC.ambrisentan tab 5 mg (Letairis)ambrisentan tab 10 mg (Letairis)

Drug Name

bosentan tab 62.5 mg (Tracleer)bosentan tab 125 mg (Tracleer)CORLANOR – ivabradine hcl oral soln 5 mg/5ml (base

equiv)CORLANOR – ivabradine hcl tab 5 mg (base equiv)CORLANOR – ivabradine hcl tab 7.5 mg (base equiv)ENTRESTO – sacubitril-valsartan tab 24-26 mgENTRESTO – sacubitril-valsartan tab 49-51 mgENTRESTO – sacubitril-valsartan tab 97-103 mgOPSUMIT – macitentan tab 10 mgsildenafil citrate tab 20 mg (Revatio)tadalafil tab 20 mg (pah) (Adcirca)tadalafil tab 2.5 mg (Cialis)tadalafil tab 5 mg (Cialis)tadalafil tab 10 mg (Cialis)tadalafil tab 20 mg (Cialis)TRACLEER – bosentan tab for oral susp 32 mgUPTRAVI – selexipag tab therapy pack 200 mcg (140) &

800 mcg (60)UPTRAVI – selexipag tab 200 mcgUPTRAVI – selexipag tab 400 mcgUPTRAVI – selexipag tab 600 mcgUPTRAVI – selexipag tab 800 mcgUPTRAVI – selexipag tab 1000 mcgUPTRAVI – selexipag tab 1200 mcgUPTRAVI – selexipag tab 1400 mcgUPTRAVI – selexipag tab 1600 mcgVYNDAMAX – tafamidis cap 61 mgVYNDAQEL – tafamidis meglumine (cardiac) cap 20 mgRESPIRATORY AGENTSANTIHISTAMINEScetirizine hcl oral soln 1 mg/ml (5 mg/5ml)cyproheptadine hcl syrup 2 mg/5mlcyproheptadine hcl tab 4 mgDESLORATADINE ODT – desloratadine tab orally

disintegrating 2.5 mgDESLORATADINE ODT – desloratadine tab orally

disintegrating 5 mgdesloratadine tab 5 mg (Clarinex)levocetirizine dihydrochloride soln 2.5 mg/5ml

(0.5 mg/ml) (Xyzal)

2021


Drug Name

levocetirizine dihydrochloride tab 5 mg (Xyzal)promethazine hcl suppos 12.5 mgpromethazine hcl suppos 25 mgpromethazine hcl syrup 6.25 mg/5mlpromethazine hcl tab 12.5 mgpromethazine hcl tab 25 mgpromethazine hcl tab 50 mgPROMETHEGAN – promethazine hcl suppos 50 mgNASAL AGENTS - SYSTEMIC and TOPICALazelastine hcl nasal spray 0.1% (137 mcg/spray)azelastine hcl nasal spray 0.15% (205.5 mcg/spray)

(Astepro)FLUNISOLIDE – flunisolide nasal soln 25 mcg/act

(0.025%)fluticasone propionate nasal susp 50 mcg/act

(Flonase)ipratropium bromide nasal soln 0.03% (21 mcg/spray)

(Atrovent)ipratropium bromide nasal soln 0.06% (42 mcg/spray)

(Atrovent)mometasone furoate nasal susp 50 mcg/act

(Nasonex)COUGH/COLD/ALLERGYacetylcysteine inhal soln 10%acetylcysteine inhal soln 20%sodium chloride soln nebu 3%sodium chloride soln nebu 7% (Hyper-sal)ANTIASTHMATIC and BRONCHODILATOR AGENTSADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21

mcg/actADVAIR HFA – fluticasone-salmeterol inhal aerosol

115-21 mcg/actADVAIR HFA – fluticasone-salmeterol inhal aerosol

230-21 mcg/actalbuterol sulfate inhal aero 108 mcg/act (90mcg base

equiv) (Proventil hfa)albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)albuterol sulfate soln nebu 0.5% (5 mg/ml)albuterol sulfate soln nebu 0.63 mg/3ml (base equiv)albuterol sulfate soln nebu 1.25 mg/3ml (base equiv)albuterol sulfate syrup 2 mg/5mlalbuterol sulfate tab 2 mg

Drug Name

albuterol sulfate tab 4 mgANORO ELLIPTA – umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inhARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 50 mcg/actARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 100 mcg/actARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 200 mcg/actASMANEX HFA – mometasone furoate inhal aerosol

suspension 50 mcg/actASMANEX HFA – mometasone furoate inhal aerosol

suspension 100 mcg/actASMANEX HFA – mometasone furoate inhal aerosol

suspension 200 mcg/actASMANEX TWISTHALER 120 ME – mometasone

furoate inhal powd 220 mcg/inh (breath activated)ASMANEX TWISTHALER 30 MET – mometasone



furoate inhal powd 220 mcg/inh (breath activated)ATROVENT HFA – ipratropium bromide hfa inhal aerosol

17 mcg/actBREO ELLIPTA – fluticasone furoate-vilanterol aero

powd ba 100-25 mcg/inhBREO ELLIPTA – fluticasone furoate-vilanterol aero

powd ba 200-25 mcg/inhBREZTRI AEROSPHERE – budesonide-glycopyrrolate-

formoterol aers 160-9-4.8 mcg/actbudesonide inhalation susp 0.25 mg/2ml (Pulmicort)budesonide inhalation susp 0.5 mg/2ml (Pulmicort)budesonide inhalation susp 1 mg/2ml (Pulmicort)COMBIVENT RESPIMAT – ipratropium-albuterol inhal

aerosol soln 20-100 mcg/actcromolyn sodium soln nebu 20 mg/2mlDULERA – mometasone furoate-formoterol fumarate

aerosol 50-5 mcg/actDULERA – mometasone furoate-formoterol fumarate

aerosol 100-5 mcg/actDULERA – mometasone furoate-formoterol fumarate

aerosol 200-5 mcg/actFLOVENT DISKUS – fluticasone propionate aer pow ba

50 mcg/blister

2021


Drug Name

FLOVENT DISKUS – fluticasone propionate aer pow ba100 mcg/blister

FLOVENT DISKUS – fluticasone propionate aer pow ba250 mcg/blister

FLOVENT HFA – fluticasone propionate hfa inhal aero 44mcg/act (50/valve)

FLOVENT HFA – fluticasone propionate hfa inhal aer 110mcg/act (125/valve)

FLOVENT HFA – fluticasone propionate hfa inhal aer 220mcg/act (250/valve)

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 55-14 mcg/act



INCRUSE ELLIPTA – umeclidinium br aero powd breathact 62.5 mcg/inh (base eq)

ipratropium bromide inhal soln 0.02%ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

(Duoneb)levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base

equiv)levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

(Xopenex)levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv)

(Xopenex)levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv)

(Xopenex)montelukast sodium chew tab 4 mg (base equiv)

(Singulair)montelukast sodium chew tab 5 mg (base equiv)

(Singulair)montelukast sodium oral granules packet 4 mg (base

equiv) (Singulair)montelukast sodium tab 10 mg (base equiv)

(Singulair)QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 40 mcg/actQVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 80 mcg/actSEREVENT DISKUS – salmeterol xinafoate aer pow ba

50 mcg/dose (base equiv)SPIRIVA HANDIHALER – tiotropium bromide

monohydrate inhal cap 18 mcg (base equiv)

Drug Name

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act

STIOLTO RESPIMAT – tiotropium br-olodaterol inhalaero soln 2.5-2.5 mcg/act

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act

terbutaline sulfate tab 2.5 mgterbutaline sulfate tab 5 mgTHEOPHYLLINE ER – theophylline tab er 12hr 300 mgTHEOPHYLLINE ER – theophylline tab er 12hr 450 mgtheophylline tab er 24hr 400 mgtheophylline tab er 24hr 600 mgTRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 100-62.5-25 mcg/inhTRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 200-62.5-25 mcg/inhVENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/

act (90mcg base equiv)zafirlukast tab 10 mg (Accolate)zafirlukast tab 20 mg (Accolate)RESPIRATORY AGENTS - MISC.KALYDECO – ivacaftor tab 150 mgKALYDECO – ivacaftor packet 25 mgKALYDECO – ivacaftor packet 50 mgKALYDECO – ivacaftor packet 75 mgPULMOZYME – dornase alfa inhal soln 1 mg/mlSYMDEKO – tezacaftor-ivacaftor 50-75 mg & ivacaftor 75

mg tab tbpkSYMDEKO – tezacaftor-ivacaftor 100-150 mg & ivacaftor

150 mg tab tbpkTRIKAFTA – elexacaf-tezacaf-ivacaf 100-50-75 mg

&ivacaftor 150 mg tbpkGASTROINTESTINAL AGENTSLAXATIVESGAVILYTE-C – peg 3350-kcl-na bicarb-nacl-na sulfate for

soln 240 gmlactulose solution 10 gm/15mlpeg 3350-kcl-sod bicarb-nacl for soln 420 gm

(Nulytely/flavor pack)

2021


Drug Name

peg 3350-kcl-na bicarb-nacl-na sulfate for soln236 gm (Golytely)

ANTIDIARRHEALSdiphenoxylate w/ atropine tab 2.5-0.025 mg (Lomotil)DIPHENOXYLATE/ATROPINE – diphenoxylate w/

atropine liq 2.5-0.025 mg/5mlloperamide hcl cap 2 mgULCER DRUGSCIMETIDINE HCL – cimetidine hcl soln 300 mg/5mlcimetidine tab 300 mgcimetidine tab 400 mgcimetidine tab 800 mgdicyclomine hcl cap 10 mg (Bentyl)dicyclomine hcl oral soln 10 mg/5mldicyclomine hcl tab 20 mg (Bentyl)esomeprazole magnesium cap delayed release 20 mg

(base eq) (Nexium)esomeprazole magnesium cap delayed release 40 mg

(base eq) (Nexium)esomeprazole magnesium for delayed release susp

packet 10 mg (Nexium)esomeprazole magnesium for delayed release susp

packet 20 mg (Nexium)esomeprazole magnesium for delayed release susp

packet 40 mg (Nexium)famotidine for susp 40 mg/5mlfamotidine tab 20 mg (Pepcid)famotidine tab 40 mg (Pepcid)glycopyrrolate tab 1 mg (Robinul)glycopyrrolate tab 2 mg (Robinul forte)lansoprazole cap delayed release 15 mg (Prevacid)lansoprazole cap delayed release 30 mg (Prevacid)methscopolamine bromide tab 2.5 mg (Pamine)methscopolamine bromide tab 5 mg (Pamine forte)misoprostol tab 100 mcg (Cytotec)misoprostol tab 200 mcg (Cytotec)NEXIUM – esomeprazole magnesium for delayed release

susp pack 2.5 mgNEXIUM – esomeprazole magnesium for delayed release

susp packet 5 mgomeprazole cap delayed release 10 mg (Prilosec)omeprazole cap delayed release 20 mg (Prilosec)

Drug Name

omeprazole cap delayed release 40 mg (Prilosec)pantoprazole sodium ec tab 20 mg (base equiv)

(Protonix)pantoprazole sodium ec tab 40 mg (base equiv)

(Protonix)PROPANTHELINE BROMIDE – propantheline bromide

tab 15 mgsucralfate tab 1 gm (Carafate)ANTIEMETICSaprepitant capsule therapy pack 80 & 125 mg (Emend)aprepitant capsule 40 mg (Emend)aprepitant capsule 80 mg (Emend)aprepitant capsule 125 mg (Emend)EMEND – aprepitant for oral susp 125 mg (125 mg/5ml)fosaprepitant dimeglumine for iv infusion 150 mg

(base eq) (Emend)granisetron hcl tab 1 mgmeclizine hcl tab 12.5 mgmeclizine hcl tab 25 mgONDANSETRON HCL – ondansetron hcl tab 24 mgondansetron hcl oral soln 4 mg/5ml (Zofran)ondansetron hcl tab 4 mg (Zofran)ondansetron hcl tab 8 mg (Zofran)ondansetron orally disintegrating tab 4 mg (Zofran

odt)ondansetron orally disintegrating tab 8 mg (Zofran

odt)scopolamine td patch 72hr 1 mg/3days (Transderm-

scop)trimethobenzamide hcl cap 300 mg (Tigan)DIGESTIVE AIDSCREON – pancrelipase (lip-prot-amyl) dr cap

3000-9500-15000 unitCREON – pancrelipase (lip-prot-amyl) dr cap




36000-114000-180000 unitZENPEP – pancrelipase (lip-prot-amyl) dr cap

3000-10000-14000 unit

2021


Drug Name

ZENPEP – pancrelipase (lip-prot-amyl) dr cap5000-17000-24000 unit






GASTROINTESTINAL AGENTS- MISC.balsalazide disodium cap 750 mg (Colazal)calcium acetate (phosphate binder) cap 667 mg

(169 mg ca) (Phoslo)calcium acetate (phosphate binder) tab 667 mg

(Eliphos)CHENODAL – chenodiol tab 250 mglactulose (encephalopathy) solution 10 gm/15mlmesalamine cap dr 400 mg (Delzicol)mesalamine cap er 24hr 0.375 gm (Apriso)mesalamine enema 4 gmmesalamine suppos 1000 mg (Canasa)mesalamine tab delayed release 800 mg (Asacol hd)mesalamine tab delayed release 1.2 gm (Lialda)metoclopramide hcl soln 5 mg/5ml (10 mg/10ml)

(base equiv)metoclopramide hcl tab 5 mg (base equivalent)

(Reglan)metoclopramide hcl tab 10 mg (base equivalent)

(Reglan)sevelamer carbonate packet 0.8 gm (Renvela)sevelamer carbonate packet 2.4 gm (Renvela)sevelamer carbonate tab 800 mg (Renvela)sulfasalazine tab delayed release 500 mg (Azulfidine

en-tabs)sulfasalazine tab 500 mg (Azulfidine)SYMPROIC – naldemedine tosylate tab 0.2 mg (base

equivalent)TRULANCE – plecanatide tab 3 mgursodiol cap 300 mg (Actigall)ursodiol tab 250 mg (Urso 250)

Drug Name

ursodiol tab 500 mg (Urso forte)VELPHORO – sucroferric oxyhydroxide chew tab 500 mgVIBERZI – eluxadoline tab 75 mgVIBERZI – eluxadoline tab 100 mgGENITOURINARY AGENTSURINARY ANTISPASMODICSoxybutynin chloride syrup 5 mg/5mloxybutynin chloride tab er 24hr 5 mg (Ditropan xl)oxybutynin chloride tab er 24hr 10 mg (Ditropan xl)oxybutynin chloride tab er 24hr 15 mg (Ditropan xl)oxybutynin chloride tab 5 mgsolifenacin succinate tab 5 mg (Vesicare)solifenacin succinate tab 10 mg (Vesicare)tolterodine tartrate cap er 24hr 2 mg (Detrol la)tolterodine tartrate cap er 24hr 4 mg (Detrol la)tolterodine tartrate tab 1 mg (Detrol)tolterodine tartrate tab 2 mg (Detrol)VAGINAL PRODUCTSclindamycin phosphate vaginal cream 2% (Cleocin)ENDOMETRIN – progesterone vaginal insert 100 mgestradiol vaginal cream 0.1 mg/gm (Estrace)metronidazole vaginal gel 0.75% (Metrogel-vaginal)TERCONAZOLE – terconazole vaginal cream 0.8%terconazole vaginal cream 0.4% (Terazol 7)terconazole vaginal suppos 80 mg (Terazol 3)VAGIFEM – estradiol vaginal tab 10 mcgGENITOURINARY AGENTS - MISC.alfuzosin hcl tab er 24hr 10 mg (Uroxatral)CYSTAGON – cysteamine bitartrate cap 50 mgCYSTAGON – cysteamine bitartrate cap 150 mgdutasteride cap 0.5 mg (Avodart)finasteride tab 5 mg (Proscar)K-PHOS NO 2 – potassium & sodium acid phosphates

tab 305-700 mgpotassium citrate tab er 5 meq (540 mg) (Urocit-k 5)potassium citrate tab er 10 meq (1080 mg) (Urocit-k

10)potassium citrate tab er 15 meq (1620 mg) (Urocit-k

15)

2021


Drug Name

sodium citrate & citric acid soln 500-334 mg/5ml(Shohls solution modi)

tamsulosin hcl cap 0.4 mg (Flomax)CENTRAL NERVOUS SYSTEM DRUGSANTIANXIETY AGENTSalprazolam tab er 24hr 0.5 mg (Xanax xr)alprazolam tab er 24hr 1 mg (Xanax xr)alprazolam tab er 24hr 2 mg (Xanax xr)alprazolam tab er 24hr 3 mg (Xanax xr)alprazolam tab 0.25 mg (Xanax)alprazolam tab 0.5 mg (Xanax)alprazolam tab 1 mg (Xanax)alprazolam tab 2 mg (Xanax)buspirone hcl tab 5 mgbuspirone hcl tab 10 mgbuspirone hcl tab 15 mgbuspirone hcl tab 30 mgDIAZEPAM – diazepam oral soln 1 mg/mldiazepam tab 2 mg (Valium)diazepam tab 5 mg (Valium)diazepam tab 10 mg (Valium)hydroxyzine hcl syrup 10 mg/5mlhydroxyzine hcl tab 10 mghydroxyzine hcl tab 25 mghydroxyzine hcl tab 50 mgHYDROXYZINE PAMOATE – hydroxyzine pamoate cap

100 mghydroxyzine pamoate cap 25 mg (Vistaril)hydroxyzine pamoate cap 50 mg (Vistaril)lorazepam conc 2 mg/ml (Lorazepam intensol)lorazepam tab 0.5 mg (Ativan)lorazepam tab 1 mg (Ativan)lorazepam tab 2 mg (Ativan)ANTIDEPRESSANTSamitriptyline hcl tab 10 mgamitriptyline hcl tab 25 mgamitriptyline hcl tab 50 mgamitriptyline hcl tab 75 mgamitriptyline hcl tab 100 mgamitriptyline hcl tab 150 mg

Drug Name

bupropion hcl tab er 12hr 100 mg (Wellbutrin sr)bupropion hcl tab er 12hr 150 mg (Wellbutrin sr)bupropion hcl tab er 12hr 200 mg (Wellbutrin sr)bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)bupropion hcl tab 75 mg (Wellbutrin)bupropion hcl tab 100 mg (Wellbutrin)citalopram hydrobromide oral soln 10 mg/5mlcitalopram hydrobromide tab 10 mg (base equiv)

(Celexa)citalopram hydrobromide tab 20 mg (base equiv)

(Celexa)citalopram hydrobromide tab 40 mg (base equiv)

(Celexa)clomipramine hcl cap 25 mg (Anafranil)clomipramine hcl cap 50 mg (Anafranil)clomipramine hcl cap 75 mg (Anafranil)desipramine hcl tab 10 mg (Norpramin)desipramine hcl tab 25 mg (Norpramin)desipramine hcl tab 50 mg (Norpramin)desipramine hcl tab 75 mg (Norpramin)desipramine hcl tab 100 mg (Norpramin)desipramine hcl tab 150 mg (Norpramin)desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) (Pristiq)desvenlafaxine succinate tab er 24hr 50 mg (base

equiv) (Pristiq)desvenlafaxine succinate tab er 24hr 100 mg (base

equiv) (Pristiq)doxepin hcl cap 10 mgdoxepin hcl cap 25 mgdoxepin hcl cap 50 mgdoxepin hcl cap 75 mgdoxepin hcl cap 100 mgdoxepin hcl conc 10 mg/mlduloxetine hcl enteric coated pellets cap 20 mg (base

eq) (Cymbalta)duloxetine hcl enteric coated pellets cap 30 mg (base

eq) (Cymbalta)duloxetine hcl enteric coated pellets cap 60 mg (base

eq) (Cymbalta)

2021


Drug Name

escitalopram oxalate soln 5 mg/5ml (base equiv)(Lexapro)

escitalopram oxalate tab 5 mg (base equiv) (Lexapro)escitalopram oxalate tab 10 mg (base equiv) (Lexapro)escitalopram oxalate tab 20 mg (base equiv) (Lexapro)fluoxetine hcl cap 10 mg (Prozac)fluoxetine hcl cap 20 mg (Prozac)fluoxetine hcl cap 40 mg (Prozac)fluoxetine hcl solution 20 mg/5mlfluvoxamine maleate tab 25 mgfluvoxamine maleate tab 50 mgfluvoxamine maleate tab 100 mgimipramine hcl tab 10 mg (Tofranil)imipramine hcl tab 25 mg (Tofranil)imipramine hcl tab 50 mg (Tofranil)mirtazapine tab 7.5 mgmirtazapine tab 15 mg (Remeron)mirtazapine tab 30 mg (Remeron)mirtazapine tab 45 mg (Remeron)NORTRIPTYLINE HCL – nortriptyline hcl soln 10 mg/5mlnortriptyline hcl cap 10 mg (Pamelor)nortriptyline hcl cap 25 mg (Pamelor)nortriptyline hcl cap 50 mg (Pamelor)nortriptyline hcl cap 75 mg (Pamelor)paroxetine hcl tab er 24hr 12.5 mg (Paxil cr)paroxetine hcl tab er 24hr 25 mg (Paxil cr)paroxetine hcl tab er 24hr 37.5 mg (Paxil cr)paroxetine hcl tab 10 mg (Paxil)paroxetine hcl tab 20 mg (Paxil)paroxetine hcl tab 30 mg (Paxil)paroxetine hcl tab 40 mg (Paxil)phenelzine sulfate tab 15 mg (Nardil)sertraline hcl oral concentrate for solution 20 mg/ml

(Zoloft)sertraline hcl tab 25 mg (Zoloft)sertraline hcl tab 50 mg (Zoloft)sertraline hcl tab 100 mg (Zoloft)tranylcypromine sulfate tab 10 mg (Parnate)trazodone hcl tab 50 mgtrazodone hcl tab 100 mg

Drug Name

trazodone hcl tab 150 mgtrazodone hcl tab 300 mgvenlafaxine hcl cap er 24hr 37.5 mg (base equivalent)

(Effexor xr)venlafaxine hcl cap er 24hr 75 mg (base equivalent)

(Effexor xr)venlafaxine hcl cap er 24hr 150 mg (base equivalent)

(Effexor xr)venlafaxine hcl tab 25 mg (base equivalent)venlafaxine hcl tab 37.5 mg (base equivalent)venlafaxine hcl tab 50 mg (base equivalent)venlafaxine hcl tab 75 mg (base equivalent)venlafaxine hcl tab 100 mg (base equivalent)ANTIPSYCHOTICSaripiprazole tab 2 mg (Abilify)aripiprazole tab 5 mg (Abilify)aripiprazole tab 10 mg (Abilify)aripiprazole tab 15 mg (Abilify)aripiprazole tab 20 mg (Abilify)aripiprazole tab 30 mg (Abilify)chlorpromazine hcl tab 10 mgchlorpromazine hcl tab 25 mgchlorpromazine hcl tab 50 mgchlorpromazine hcl tab 100 mgchlorpromazine hcl tab 200 mgclozapine tab 25 mg (Clozaril)clozapine tab 50 mgclozapine tab 100 mg (Clozaril)clozapine tab 200 mgfluphenazine decanoate inj 25 mg/mlFLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/

mlfluphenazine hcl tab 1 mgfluphenazine hcl tab 2.5 mgfluphenazine hcl tab 5 mgfluphenazine hcl tab 10 mgFLUPHENAZINE HYDROCHLORID – fluphenazine hcl

elixir 2.5 mg/5mlhaloperidol decanoate im soln 50 mg/ml (Haldol

decanoate 50)

2021


Drug Name

haloperidol decanoate im soln 100 mg/ml (Haldoldecanoate 100)

haloperidol lactate oral conc 2 mg/mlhaloperidol tab 0.5 mghaloperidol tab 1 mghaloperidol tab 2 mghaloperidol tab 5 mghaloperidol tab 10 mghaloperidol tab 20 mgLITHIUM – lithium oral solution 8 meq/5mlLITHIUM CARBONATE – lithium carbonate cap 150 mglithium carbonate cap 150 mg (Lithium carbonate)lithium carbonate cap 300 mglithium carbonate cap 600 mg (Lithium carbonate)lithium carbonate tab er 300 mg (Lithobid)lithium carbonate tab er 450 mglithium carbonate tab 300 mgloxapine succinate cap 5 mg (Loxitane)loxapine succinate cap 10 mgloxapine succinate cap 25 mgloxapine succinate cap 50 mgolanzapine orally disintegrating tab 5 mg (Zyprexa

zydis)olanzapine orally disintegrating tab 10 mg (Zyprexa



zydis)olanzapine tab 2.5 mg (Zyprexa)olanzapine tab 5 mg (Zyprexa)olanzapine tab 7.5 mg (Zyprexa)olanzapine tab 10 mg (Zyprexa)olanzapine tab 15 mg (Zyprexa)olanzapine tab 20 mg (Zyprexa)perphenazine tab 2 mgperphenazine tab 4 mgperphenazine tab 8 mgperphenazine tab 16 mgprochlorperazine maleate tab 5 mg (base equivalent)

(Compazine)

Drug Name

prochlorperazine maleate tab 10 mg (base equivalent)(Compazine)

prochlorperazine suppos 25 mgquetiapine fumarate tab er 24hr 50 mg (Seroquel xr)quetiapine fumarate tab er 24hr 150 mg (Seroquel xr)quetiapine fumarate tab er 24hr 200 mg (Seroquel xr)quetiapine fumarate tab er 24hr 300 mg (Seroquel xr)quetiapine fumarate tab er 24hr 400 mg (Seroquel xr)quetiapine fumarate tab 25 mg (Seroquel)quetiapine fumarate tab 50 mg (Seroquel)quetiapine fumarate tab 100 mg (Seroquel)quetiapine fumarate tab 200 mg (Seroquel)quetiapine fumarate tab 300 mg (Seroquel)quetiapine fumarate tab 400 mg (Seroquel)RISPERIDONE ODT – risperidone orally disintegrating

tab 0.25 mgrisperidone orally disintegrating tab 0.5 mg (Risperdal

m-tab)risperidone orally disintegrating tab 1 mg (Risperdal




m-tab)risperidone soln 1 mg/ml (Risperdal)risperidone tab 0.25 mg (Risperdal)risperidone tab 0.5 mg (Risperdal)risperidone tab 1 mg (Risperdal)risperidone tab 2 mg (Risperdal)risperidone tab 3 mg (Risperdal)risperidone tab 4 mg (Risperdal)thiothixene cap 1 mgthiothixene cap 2 mgthiothixene cap 5 mgthiothixene cap 10 mgtrifluoperazine hcl tab 1 mg (base equivalent)trifluoperazine hcl tab 2 mg (base equivalent)trifluoperazine hcl tab 5 mg (base equivalent)trifluoperazine hcl tab 10 mg (base equivalent)

2021


Drug Name

ziprasidone hcl cap 20 mg (Geodon)ziprasidone hcl cap 40 mg (Geodon)ziprasidone hcl cap 60 mg (Geodon)ziprasidone hcl cap 80 mg (Geodon)HYPNOTICSBELSOMRA – suvorexant tab 5 mgBELSOMRA – suvorexant tab 10 mgBELSOMRA – suvorexant tab 15 mgBELSOMRA – suvorexant tab 20 mgestazolam tab 1 mgestazolam tab 2 mgeszopiclone tab 1 mg (Lunesta)eszopiclone tab 2 mg (Lunesta)eszopiclone tab 3 mg (Lunesta)phenobarbital elixir 20 mg/5mlphenobarbital tab 15 mgphenobarbital tab 16.2 mgphenobarbital tab 30 mgphenobarbital tab 32.4 mgphenobarbital tab 60 mgphenobarbital tab 100 mgtemazepam cap 7.5 mg (Restoril)temazepam cap 15 mg (Restoril)temazepam cap 22.5 mg (Restoril)temazepam cap 30 mg (Restoril)zaleplon cap 5 mg (Sonata)zaleplon cap 10 mg (Sonata)zolpidem tartrate tab er 6.25 mg (Ambien cr)zolpidem tartrate tab er 12.5 mg (Ambien cr)zolpidem tartrate tab 5 mg (Ambien)zolpidem tartrate tab 10 mg (Ambien)ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTSADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 5 mgADDERALL XR – amphetamine-dextroamphetamine cap



er 24hr 20 mg

Drug Name

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 25 mg

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 30 mg

amphetamine-dextroamphetamine cap er 24hr 5 mg(Adderall xr)






amphetamine-dextroamphetamine tab 5 mg (Adderall)amphetamine-dextroamphetamine tab 7.5 mg

(Adderall)amphetamine-dextroamphetamine tab 10 mg

(Adderall)amphetamine-dextroamphetamine tab 12.5 mg




(Adderall)armodafinil tab 50 mg (Nuvigil)armodafinil tab 150 mg (Nuvigil)armodafinil tab 200 mg (Nuvigil)armodafinil tab 250 mg (Nuvigil)atomoxetine hcl cap 10 mg (base equiv) (Strattera)atomoxetine hcl cap 18 mg (base equiv) (Strattera)atomoxetine hcl cap 25 mg (base equiv) (Strattera)atomoxetine hcl cap 40 mg (base equiv) (Strattera)atomoxetine hcl cap 60 mg (base equiv) (Strattera)atomoxetine hcl cap 80 mg (base equiv) (Strattera)atomoxetine hcl cap 100 mg (base equiv) (Strattera)caffeine citrate oral soln 60 mg/3ml (10 mg/ml base

equiv) (Cafcit)CONCERTA – methylphenidate hcl tab er osmotic

release (osm) 18 mg

2021


Drug Name

CONCERTA – methylphenidate hcl tab er osmoticrelease (osm) 27 mg



dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin xr)dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin

xr)dexmethylphenidate hcl cap er 24 hr 15 mg (Focalin






xr)dexmethylphenidate hcl tab 2.5 mg (Focalin)dexmethylphenidate hcl tab 5 mg (Focalin)dexmethylphenidate hcl tab 10 mg (Focalin)dextroamphetamine sulfate cap er 24hr 5 mg

(Dexedrine)dextroamphetamine sulfate cap er 24hr 10 mg

(Dexedrine)dextroamphetamine sulfate cap er 24hr 15 mg

(Dexedrine)dextroamphetamine sulfate tab 5 mgdextroamphetamine sulfate tab 10 mgguanfacine hcl tab er 24hr 1 mg (base equiv) (Intuniv)guanfacine hcl tab er 24hr 2 mg (base equiv) (Intuniv)guanfacine hcl tab er 24hr 3 mg (base equiv) (Intuniv)guanfacine hcl tab er 24hr 4 mg (base equiv) (Intuniv)methylphenidate hcl tab er osmotic release (osm)

18 mg (Concerta)methylphenidate hcl tab er osmotic release (osm)



54 mg (Concerta)

Drug Name

methylphenidate hcl tab er 10 mgmethylphenidate hcl tab er 20 mgmethylphenidate hcl tab 5 mg (Ritalin)methylphenidate hcl tab 10 mg (Ritalin)methylphenidate hcl tab 20 mg (Ritalin)modafinil tab 100 mg (Provigil)modafinil tab 200 mg (Provigil)SUNOSI – solriamfetol hcl tab 75 mg (base equiv)SUNOSI – solriamfetol hcl tab 150 mg (base equiv)VYVANSE – lisdexamfetamine dimesylate cap 10 mgVYVANSE – lisdexamfetamine dimesylate cap 20 mgVYVANSE – lisdexamfetamine dimesylate cap 30 mgVYVANSE – lisdexamfetamine dimesylate cap 40 mgVYVANSE – lisdexamfetamine dimesylate cap 50 mgVYVANSE – lisdexamfetamine dimesylate cap 60 mgVYVANSE – lisdexamfetamine dimesylate cap 70 mgVYVANSE – lisdexamfetamine dimesylate chew tab 10

mgVYVANSE – lisdexamfetamine dimesylate chew tab 20





mgPSYCHOTHERAPEUTIC and NEUROLOGICALAGENTS - MISC.acamprosate calcium tab delayed release 333 mg

(Campral)AUBAGIO – teriflunomide tab 7 mgAUBAGIO – teriflunomide tab 14 mgAVONEX – interferon beta-1a im prefilled syringe kit 30

mcg/0.5mlAVONEX PEN – interferon beta-1a im auto-injector kit 30

mcg/0.5mlBETASERON – interferon beta-1b for inj kit 0.3 mgbupropion hcl (smoking deterrent) tab er 12hr 150 mg

(Zyban)CHANTIX – varenicline tartrate tab 0.5 mg (base equiv)

2021


Drug Name

CHANTIX – varenicline tartrate tab 1 mg (base equiv)CHANTIX CONTINUING MONTH – varenicline tartrate

tab 1 mg (base equiv)CHANTIX STARTING MONTH PA – varenicline tartrate

tab 0.5 mg x 11 & tab 1 mg x 42 packCOPAXONE – glatiramer acetate soln prefilled syringe 20

mg/mlCOPAXONE – glatiramer acetate soln prefilled syringe 40

mg/mldimethyl fumarate capsule delayed release 120 mg

(Tecfidera)dimethyl fumarate capsule delayed release 240 mg

(Tecfidera)dimethyl fumarate capsule dr starter pack 120 mg &

240 mg (Tecfidera starter pa)disulfiram tab 250 mg (Antabuse)disulfiram tab 500 mg (Antabuse)donepezil hydrochloride orally disintegrating tab

5 mg (Aricept odt)donepezil hydrochloride orally disintegrating tab

10 mg (Aricept odt)donepezil hydrochloride tab 5 mg (Aricept)donepezil hydrochloride tab 10 mg (Aricept)GALANTAMINE HYDROBROMIDE – galantamine

hydrobromide oral soln 4 mg/mlgalantamine hydrobromide cap er 24hr 8 mg

(Razadyne er)galantamine hydrobromide cap er 24hr 16 mg

(Razadyne er)galantamine hydrobromide cap er 24hr 24 mg

(Razadyne er)galantamine hydrobromide tab 4 mg (Razadyne)galantamine hydrobromide tab 8 mg (Razadyne)galantamine hydrobromide tab 12 mg (Razadyne)GILENYA – fingolimod hcl cap 0.5 mg (base equiv)glatiramer acetate soln prefilled syringe 20 mg/ml

(Copaxone)glatiramer acetate soln prefilled syringe 40 mg/ml

(Copaxone)MAVENCLAD – cladribine tab therapy pack 10 mg (4

tabs)MAVENCLAD – cladribine tab therapy pack 10 mg (5

tabs)

Drug Name

MAVENCLAD – cladribine tab therapy pack 10 mg (6tabs)





MAYZENT – siponimod fumarate tab 0.25 mg (baseequiv)

MAYZENT – siponimod fumarate tab 2 mg (base equiv)memantine hcl oral solution 2 mg/ml (Namenda)memantine hcl tab 5 mg (Namenda)memantine hcl tab 10 mg (Namenda)memantine hcl tab 28 x 5 mg & 21 x 10 mg titration

pack (Namenda titration pa)NICOTROL INHALER – nicotine inhaler system 10 mg (4

mg delivered)NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/

spray)PIMOZIDE – pimozide tab 1 mgPIMOZIDE – pimozide tab 2 mgPLEGRIDY – peginterferon beta-1a soln pen-injector 125

mcg/0.5mlPLEGRIDY – peginterferon beta-1a soln prefilled syringe

125 mcg/0.5mlPLEGRIDY STARTER PACK – peginterferon beta-1a

soln pen-inj 63 & 94 mcg/0.5ml packPLEGRIDY STARTER PACK – peginterferon beta-1a

soln pref syr 63 & 94 mcg/0.5ml packREBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml

(12mu/ml)REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml

(24mu/ml)REBIF REBIDOSE – interferon beta-1a soln auto-inj 22

mcg/0.5ml (12mu/ml)REBIF REBIDOSE – interferon beta-1a soln auto-inj 44

mcg/0.5ml (24mu/ml)REBIF REBIDOSE TITRATION – interferon beta-1a auto-

inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5mlREBIF TITRATION PACK – interferon beta-1a pref syr

6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml

2021


Drug Name

rivastigmine tartrate cap 1.5 mg (base equivalent)rivastigmine tartrate cap 3 mg (base equivalent)rivastigmine tartrate cap 4.5 mg (base equivalent)rivastigmine tartrate cap 6 mg (base equivalent)tetrabenazine tab 12.5 mg (Xenazine)tetrabenazine tab 25 mg (Xenazine)ZEPOSIA – ozanimod hcl cap 0.92 mgZEPOSIA STARTER KIT – ozanimod cap pack 4 x 0.23

mg & 3 x 0.46 mg & 30 x 0.92 mgZEPOSIA 7-DAY STARTER PAC – ozanimod cap pack 4

x 0.23 mg & 3 x 0.46 mgANALGESICS AND ANESTHETICSANALGESICS - NON-NARCOTICbutalbital-acetaminophen tab 50-325 mgbutalbital-acetaminophen-caffeine tab 50-325-40 mg

(Esgic)butalbital-aspirin-caffeine cap 50-325-40 mg (Fiorinal)TENCON – butalbital-acetaminophen tab 50-325 mgANALGESICS - NARCOTICacetaminophen w/ codeine soln 120-12 mg/5mlacetaminophen w/ codeine tab 300-15 mg (Tylenol/

codeine)acetaminophen w/ codeine tab 300-30 mg (Tylenol/

codeine #3)acetaminophen w/ codeine tab 300-60 mg (Tylenol/

codeine #4)buprenorphine hcl sl tab 2 mg (base equiv)buprenorphine hcl sl tab 8 mg (base equiv)butalbital-aspirin-caff w/ codeine cap

50-325-40-30 mg (Fiorinal/codeine #3)codeine sulfate tab 30 mgfentanyl citrate lozenge on a handle 200 mcg (Actiq)fentanyl citrate lozenge on a handle 400 mcg (Actiq)fentanyl citrate lozenge on a handle 600 mcg (Actiq)fentanyl citrate lozenge on a handle 800 mcg (Actiq)fentanyl citrate lozenge on a handle 1200 mcg (Actiq)fentanyl citrate lozenge on a handle 1600 mcg (Actiq)fentanyl td patch 72hr 12 mcg/hr (Duragesic)fentanyl td patch 72hr 25 mcg/hr (Duragesic)fentanyl td patch 72hr 50 mcg/hr (Duragesic)fentanyl td patch 72hr 75 mcg/hr (Duragesic)

Drug Name

fentanyl td patch 72hr 100 mcg/hr (Duragesic)hydrocodone-acetaminophen soln 7.5-325 mg/15ml

(Hycet)hydrocodone-acetaminophen tab 10-325 mg (Norco)hydrocodone-acetaminophen tab 5-325 mg (Norco)hydrocodone-acetaminophen tab 7.5-325 mg (Norco)hydrocodone-ibuprofen tab 5-200 mg (Reprexain)hydrocodone-ibuprofen tab 7.5-200 mg (Vicoprofen)hydrocodone-ibuprofen tab 10-200 mg (Ibudone)hydromorphone hcl liqd 1 mg/ml (Dilaudid)hydromorphone hcl tab 2 mg (Dilaudid)hydromorphone hcl tab 4 mg (Dilaudid)hydromorphone hcl tab 8 mg (Dilaudid)methadone hcl conc 10 mg/ml (Methadose)methadone hcl soln 5 mg/5ml (Methadone hcl)methadone hcl soln 10 mg/5ml (Methadone hcl)methadone hcl tab for oral susp 40 mgmethadone hcl tab 5 mg (Dolophine hcl)methadone hcl tab 10 mg (Dolophine)MORPHINE SULFATE ER – morphine sulfate beads cap

er 24hr 30 mgMORPHINE SULFATE ER – morphine sulfate beads cap





er 24hr 120 mgmorphine sulfate oral soln 10 mg/5mlmorphine sulfate oral soln 20 mg/5mlmorphine sulfate oral soln 100 mg/5ml (20 mg/ml)morphine sulfate tab er 15 mg (Ms contin)morphine sulfate tab er 30 mg (Ms contin)morphine sulfate tab er 60 mg (Ms contin)morphine sulfate tab er 100 mg (Ms contin)morphine sulfate tab er 200 mg (Ms contin)morphine sulfate tab 15 mg (Morphine sulfate)morphine sulfate tab 30 mg (Morphine sulfate)

2021


Drug Name

NUCYNTA ER – tapentadol hcl tab er 12hr 50 mgNUCYNTA ER – tapentadol hcl tab er 12hr 100 mgNUCYNTA ER – tapentadol hcl tab er 12hr 150 mgNUCYNTA ER – tapentadol hcl tab er 12hr 200 mgNUCYNTA ER – tapentadol hcl tab er 12hr 250 mgoxycodone hcl cap 5 mgoxycodone hcl conc 100 mg/5ml (20 mg/ml)

(Oxycodone hcl)oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)oxycodone hcl tab 5 mg (Roxicodone)oxycodone hcl tab 10 mgoxycodone hcl tab 15 mg (Roxicodone)oxycodone hcl tab 20 mgoxycodone hcl tab 30 mg (Roxicodone)oxycodone w/ acetaminophen tab 5-325 mg (Percocet)oxycodone w/ acetaminophen tab 7.5-325 mg

(Percocet)oxycodone w/ acetaminophen tab 10-325 mg

(Percocet)OXYCODONE/ASPIRIN – oxycodone-aspirin tab

4.8355-325 mgtramadol hcl tab er 24hr 100 mgtramadol hcl tab er 24hr 200 mgtramadol hcl tab er 24hr 300 mgtramadol hcl tab 50 mg (Ultram)tramadol-acetaminophen tab 37.5-325 mg (Ultracet)XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

9 mgXTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

13.5 mgXTAMPZA ER – oxycodone cap er 12hr abuse-deterrent



36 mgANALGESICS - ANTI-INFLAMMATORYACTEMRA – tocilizumab subcutaneous soln prefilled

syringe 162 mg/0.9mlACTEMRA ACTPEN – tocilizumab subcutaneous soln

auto-injector 162 mg/0.9mlcelecoxib cap 50 mg (Celebrex)

Drug Name

celecoxib cap 100 mg (Celebrex)celecoxib cap 200 mg (Celebrex)celecoxib cap 400 mg (Celebrex)diclofenac potassium tab 50 mg (Cataflam)diclofenac sodium tab delayed release 25 mgdiclofenac sodium tab delayed release 50 mgdiclofenac sodium tab delayed release 75 mgENBREL – etanercept subcutaneous inj 25 mg/0.5mlENBREL – etanercept for subcutaneous inj 25 mgENBREL – etanercept subcutaneous soln prefilled

syringe 25 mg/0.5mlENBREL – etanercept subcutaneous soln prefilled

syringe 50 mg/mlENBREL MINI – etanercept subcutaneous solution

cartridge 50 mg/mlENBREL SURECLICK – etanercept subcutaneous

solution auto-injector 50 mg/mletodolac cap 200 mgetodolac cap 300 mgetodolac tab er 24hr 400 mgetodolac tab er 24hr 500 mgetodolac tab er 24hr 600 mgetodolac tab 400 mgetodolac tab 500 mgFLURBIPROFEN – flurbiprofen tab 50 mgflurbiprofen tab 100 mgHUMIRA – adalimumab prefilled syringe kit 10 mg/0.1mlHUMIRA – adalimumab prefilled syringe kit 10 mg/0.2mlHUMIRA – adalimumab prefilled syringe kit 20 mg/0.2mlHUMIRA – adalimumab prefilled syringe kit 20 mg/0.4mlHUMIRA – adalimumab prefilled syringe kit 40 mg/0.8mlHUMIRA – adalimumab prefilled syringe kit 40 mg/0.4mlHUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8mlHUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8ml & 40 mg/0.4mlHUMIRA PEN – adalimumab pen-injector kit 40 mg/0.8mlHUMIRA PEN – adalimumab pen-injector kit 40 mg/0.4mlHUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 40 mg/0.8mlHUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 80 mg/0.8ml

2021


Drug Name

HUMIRA PEN-PS/UV STARTER – adalimumab pen-injector kit 40 mg/0.8ml

HUMIRA PEN-PS/UV STARTER – adalimumab pen-injector kit 80 mg/0.8ml & 40 mg/0.4ml

ibuprofen susp 100 mg/5mlibuprofen tab 400 mgibuprofen tab 600 mgibuprofen tab 800 mgILARIS – canakinumab subcutaneous inj 150 mg/mlindomethacin cap 25 mgindomethacin cap 50 mgleflunomide tab 10 mg (Arava)leflunomide tab 20 mg (Arava)meloxicam tab 7.5 mg (Mobic)meloxicam tab 15 mg (Mobic)nabumetone tab 500 mgnabumetone tab 750 mgnaproxen sodium tab 275 mg (Anaprox)naproxen sodium tab 550 mg (Anaprox ds)naproxen tab ec 375 mg (Ec-naprosyn)naproxen tab ec 500 mg (Ec-naprosyn)naproxen tab 250 mg (Naprosyn)naproxen tab 375 mg (Naprosyn)naproxen tab 500 mg (Naprosyn)OTEZLA – apremilast tab starter therapy pack 10 mg &

20 mg & 30 mgOTEZLA – apremilast tab 30 mgOTREXUP – methotrexate soln pf auto-injector 10

mg/0.4mlOTREXUP – methotrexate soln pf auto-injector 12.5

mg/0.4mlOTREXUP – methotrexate soln pf auto-injector 15





mg/0.4mloxaprozin tab 600 mg (Daypro)

Drug Name

piroxicam cap 10 mg (Feldene)piroxicam cap 20 mg (Feldene)RINVOQ – upadacitinib tab er 24hr 15 mgSIMPONI – golimumab subcutaneous soln auto-injector

100 mg/mlSIMPONI – golimumab subcutaneous soln prefilled

syringe 100 mg/mlsulindac tab 150 mgsulindac tab 200 mgXELJANZ – tofacitinib citrate tab 5 mg (base equivalent)XELJANZ – tofacitinib citrate tab 10 mg (base equivalent)XELJANZ XR – tofacitinib citrate tab er 24hr 11 mg (base

equivalent)XELJANZ XR – tofacitinib citrate tab er 24hr 22 mg (base

equivalent)MIGRAINE PRODUCTSAIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 70 mg/mlAIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 140 mg/mldihydroergotamine mesylate inj 1 mg/ml (D.h.e. 45)dihydroergotamine mesylate nasal spray 4 mg/ml

(Migranal)eletriptan hydrobromide tab 20 mg (base equivalent)

(Relpax)eletriptan hydrobromide tab 40 mg (base equivalent)

(Relpax)EMGALITY – galcanezumab-gnlm subcutaneous soln

auto-injector 120 mg/mlEMGALITY – galcanezumab-gnlm subcutaneous soln

prefilled syr 100 mg/mlEMGALITY – galcanezumab-gnlm subcutaneous soln

prefilled syr 120 mg/mlnaratriptan hcl tab 1 mg (base equiv) (Amerge)naratriptan hcl tab 2.5 mg (base equiv) (Amerge)rizatriptan benzoate oral disintegrating tab 5 mg

(base eq) (Maxalt-mlt)rizatriptan benzoate oral disintegrating tab 10 mg

(base eq) (Maxalt-mlt)rizatriptan benzoate tab 5 mg (base equivalent)

(Maxalt)rizatriptan benzoate tab 10 mg (base equivalent)

(Maxalt)sumatriptan nasal spray 5 mg/act (Imitrex)

2021


Drug Name

sumatriptan nasal spray 20 mg/act (Imitrex)SUMATRIPTAN SUCCINATE – sumatriptan succinate

solution prefilled syringe 6 mg/0.5mlsumatriptan succinate inj 6 mg/0.5ml (Imitrex statdose

ref)sumatriptan succinate solution auto-injector

4 mg/0.5ml (Imitrex statdose sys)sumatriptan succinate solution auto-injector

6 mg/0.5ml (Imitrex statdose sys)sumatriptan succinate solution cartridge 4 mg/0.5ml

(Imitrex statdose ref)sumatriptan succinate solution cartridge 6 mg/0.5ml

(Imitrex statdose ref)sumatriptan succinate tab 25 mg (Imitrex)sumatriptan succinate tab 50 mg (Imitrex)sumatriptan succinate tab 100 mg (Imitrex)GOUT AGENTSallopurinol tab 100 mg (Zyloprim)allopurinol tab 300 mg (Zyloprim)colchicine w/ probenecid tab 0.5-500 mgMITIGARE – colchicine cap 0.6 mgprobenecid tab 500 mgNEUROMUSCULAR DRUGSANTICONVULSANTSBANZEL – rufinamide tab 200 mgBANZEL – rufinamide tab 400 mgcarbamazepine cap er 12hr 100 mg (Carbatrol)carbamazepine cap er 12hr 200 mg (Carbatrol)carbamazepine cap er 12hr 300 mg (Carbatrol)carbamazepine chew tab 100 mgcarbamazepine susp 100 mg/5ml (Tegretol)carbamazepine tab er 12hr 100 mg (Tegretol-xr)carbamazepine tab er 12hr 200 mg (Tegretol-xr)carbamazepine tab er 12hr 400 mg (Tegretol-xr)carbamazepine tab 200 mg (Tegretol)CELONTIN – methsuximide cap 300 mgclonazepam tab 0.5 mg (Klonopin)clonazepam tab 1 mg (Klonopin)clonazepam tab 2 mg (Klonopin)DIASTAT ACUDIAL – diazepam rectal gel delivery

system 10 mg

Drug Name

DIASTAT ACUDIAL – diazepam rectal gel deliverysystem 20 mg

DIASTAT PEDIATRIC – diazepam rectal gel deliverysystem 2.5 mg

DILANTIN – phenytoin sodium extended cap 30 mgDILANTIN – phenytoin sodium extended cap 100 mgDILANTIN-125 – phenytoin susp 125 mg/5mldivalproex sodium cap delayed release sprinkle

125 mg (Depakote sprinkles)divalproex sodium tab delayed release 125 mg

(Depakote)divalproex sodium tab delayed release 250 mg

(Depakote)divalproex sodium tab delayed release 500 mg

(Depakote)divalproex sodium tab er 24 hr 250 mg (Depakote er)divalproex sodium tab er 24 hr 500 mg (Depakote er)EPIDIOLEX – cannabidiol soln 100 mg/mlethosuximide cap 250 mg (Zarontin)ethosuximide soln 250 mg/5ml (Zarontin)gabapentin cap 100 mg (Neurontin)gabapentin cap 300 mg (Neurontin)gabapentin cap 400 mg (Neurontin)gabapentin oral soln 250 mg/5ml (Neurontin)gabapentin tab 600 mg (Neurontin)gabapentin tab 800 mg (Neurontin)lamotrigine tab chewable dispersible 5 mg (Lamictal

chewable di)lamotrigine tab chewable dispersible 25 mg (Lamictal

chewable di)lamotrigine tab 25 mg (Lamictal)lamotrigine tab 100 mg (Lamictal)lamotrigine tab 150 mg (Lamictal)lamotrigine tab 200 mg (Lamictal)levetiracetam oral soln 100 mg/ml (Keppra)levetiracetam tab er 24hr 500 mg (Keppra xr)levetiracetam tab er 24hr 750 mg (Keppra xr)levetiracetam tab 250 mg (Keppra)levetiracetam tab 500 mg (Keppra)levetiracetam tab 750 mg (Keppra)levetiracetam tab 1000 mg (Keppra)oxcarbazepine susp 300 mg/5ml (60 mg/ml) (Trileptal)

2021


Drug Name

oxcarbazepine tab 150 mg (Trileptal)oxcarbazepine tab 300 mg (Trileptal)oxcarbazepine tab 600 mg (Trileptal)phenytoin chew tab 50 mg (Dilantin infatabs)phenytoin sodium extended cap 100 mg (Dilantin)phenytoin sodium extended cap 200 mg (Phenytek)phenytoin sodium extended cap 300 mg (Phenytek)phenytoin susp 125 mg/5ml (Dilantin)pregabalin cap 25 mg (Lyrica)pregabalin cap 50 mg (Lyrica)pregabalin cap 75 mg (Lyrica)pregabalin cap 100 mg (Lyrica)pregabalin cap 150 mg (Lyrica)pregabalin cap 200 mg (Lyrica)pregabalin cap 225 mg (Lyrica)pregabalin cap 300 mg (Lyrica)pregabalin soln 20 mg/ml (Lyrica)primidone tab 50 mg (Mysoline)primidone tab 250 mg (Mysoline)topiramate sprinkle cap 15 mg (Topamax sprinkle)topiramate sprinkle cap 25 mg (Topamax sprinkle)topiramate tab 25 mg (Topamax)topiramate tab 50 mg (Topamax)topiramate tab 100 mg (Topamax)topiramate tab 200 mg (Topamax)valproate sodium oral soln 250 mg/5ml (base equiv)

(Depakene)valproic acid cap 250 mg (Depakene)vigabatrin powd pack 500 mg (Sabril)vigabatrin tab 500 mg (Sabril)zonisamide cap 25 mg (Zonegran)zonisamide cap 50 mgzonisamide cap 100 mg (Zonegran)ANTIPARKINSON AGENTSamantadine hcl cap 100 mgamantadine hcl syrup 50 mg/5mlbenztropine mesylate tab 0.5 mgbenztropine mesylate tab 1 mgbenztropine mesylate tab 2 mg

Drug Name

carbidopa & levodopa orally disintegrating tab10-100 mg (Parcopa)



carbidopa & levodopa tab er 25-100 mg (Sinemet cr)carbidopa & levodopa tab er 50-200 mg (Sinemet cr)carbidopa & levodopa tab 10-100 mg (Sinemet)carbidopa & levodopa tab 25-100 mg (Sinemet)carbidopa & levodopa tab 25-250 mg (Sinemet)CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 12.5-50-200 mgCARBIDOPA/LEVODOPA/ENTACA – carbidopa-


levodopa-entacapone tabs 25-100-200 mgCARBIDOPA/LEVODOPA/ENTACA – carbidopa-



levodopa-entacapone tabs 50-200-200 mgentacapone tab 200 mg (Comtan)INBRIJA – levodopa inhal powder cap 42 mgKYNMOBI – apomorphine hydrochloride film 10 mgKYNMOBI – apomorphine hydrochloride film 15 mgKYNMOBI – apomorphine hydrochloride film 20 mgKYNMOBI – apomorphine hydrochloride film 25 mgKYNMOBI – apomorphine hydrochloride film 30 mgpramipexole dihydrochloride tab 0.125 mg (Mirapex)pramipexole dihydrochloride tab 0.25 mg (Mirapex)pramipexole dihydrochloride tab 0.5 mg (Mirapex)pramipexole dihydrochloride tab 0.75 mg (Mirapex)pramipexole dihydrochloride tab 1 mg (Mirapex)pramipexole dihydrochloride tab 1.5 mg (Mirapex)rasagiline mesylate tab 0.5 mg (base equiv) (Azilect)rasagiline mesylate tab 1 mg (base equiv) (Azilect)ropinirole hydrochloride tab 0.25 mg (Requip)ropinirole hydrochloride tab 0.5 mg (Requip)ropinirole hydrochloride tab 1 mg (Requip)ropinirole hydrochloride tab 2 mg (Requip)

2021


Drug Name

ropinirole hydrochloride tab 3 mg (Requip)ropinirole hydrochloride tab 4 mg (Requip)ropinirole hydrochloride tab 5 mg (Requip)SELEGILINE HCL – selegiline hcl tab 5 mgselegiline hcl cap 5 mg (Eldepryl)trihexyphenidyl hcl oral soln 0.4 mg/mltrihexyphenidyl hcl tab 2 mgtrihexyphenidyl hcl tab 5 mgNEUROMUSCULAR AGENTSriluzole tab 50 mg (Rilutek)MUSCULOSKELETAL THERAPY AGENTSbaclofen tab 10 mgbaclofen tab 20 mgchlorzoxazone tab 500 mgcyclobenzaprine hcl tab 5 mgcyclobenzaprine hcl tab 10 mgdantrolene sodium cap 25 mg (Dantrium)dantrolene sodium cap 50 mg (Dantrium)dantrolene sodium cap 100 mg (Dantrolene sodium)EUFLEXXA – sodium hyaluronate intra-articular soln pref

syr 20 mg/2mlmethocarbamol tab 500 mg (Robaxin)methocarbamol tab 750 mg (Robaxin-750)orphenadrine citrate tab er 12hr 100 mgSYNVISC – hylan intra-articular solution prefilled syringe

16 mg/2mlSYNVISC ONE – hylan intra-articular solution prefilled

syringe 48 mg/6mltizanidine hcl tab 2 mg (base equivalent)tizanidine hcl tab 4 mg (base equivalent) (Zanaflex)ANTIMYASTHENIC AGENTSpyridostigmine bromide tab 60 mg (Mestinon)NUTRITIONAL PRODUCTSVITAMINSergocalciferol cap 1.25 mg (50000 unit) (Drisdol)phytonadione tab 5 mg (Mephyton)MULTIVITAMINSKOSHER PRENATAL PLUS IRON – prenatal vit w/ iron

carbonyl-fa tab 30-1 mgPRENATABS RX – prenatal vit w/ iron carbonyl-fa tab

29-1 mg

Drug Name

PRENATAL PLUS IRON – prenatal vit w/ iron carbonyl-fatab 29-1 mg

PRENATAL VITAMINS PLUS LO – prenatal vit w/ fefumarate-fa tab 27-1 mg

PRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg

PRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab29-1 mg

PRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap106.5-1 mg

SE-NATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg

SE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab29-1 mg

TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1 mgVINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab

29-1 mgVINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1 mgMINERALS and ELECTROLYTESFLURA-DROPS – sodium fluoride soln 0.25 mg/drop f

(from 0.55 mg/drop naf)K-PHOS – potassium phosphate monobasic tab 500 mgpot phos monobasic w/sod phos di & monobas tab

155-852-130mg (K-phos neutral)potassium chloride cap er 8 meq (Micro-k)potassium chloride cap er 10 meq (Micro-k)POTASSIUM CHLORIDE ER – potassium chloride tab er

8 meq (600 mg)potassium chloride microencapsulated crys er tab 10

meqpotassium chloride microencapsulated crys er tab 20

meqpotassium chloride oral soln 10% (20 meq/15ml)potassium chloride oral soln 20% (40 meq/15ml)potassium chloride powder packet 20 meq (K-lor

hospital pack)potassium chloride tab er 8 meq (600 mg)potassium chloride tab er 10 meq (K-tab)SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from

1.1 mg naf)SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from

2.2 mg naf)sodium fluoride chew tab 0.25 mg f (from 0.55 mg

naf) (Luride)

2021


Drug Name

sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)(Luride)

sodium fluoride chew tab 1 mg f (from 2.2 mg naf)(Luride)

sodium fluoride soln 0.125 mg/drop f (0.275 mg/dropnaf)

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)(Luride)

HEMATOLOGICAL AGENTSHEMATOPOIETIC AGENTSARANESP ALBUMIN FREE – darbepoetin alfa soln

prefilled syringe 10 mcg/0.4mlARANESP ALBUMIN FREE – darbepoetin alfa soln








prefilled syringe 500 mcg/mlARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25

mcg/mlARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40

mcg/mlARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60

mcg/mlARANESP ALBUMIN FREE – darbepoetin alfa soln inj

100 mcg/mlARANESP ALBUMIN FREE – darbepoetin alfa soln inj

200 mcg/mlARANESP ALBUMIN FREE – darbepoetin alfa soln inj

300 mcg/mlCERDELGA – eliglustat tartrate cap 84 mg (base

equivalent)cyanocobalamin inj 1000 mcg/mlfolic acid tab 1 mg

Drug Name

FULPHILA – pegfilgrastim-jmdb soln prefilled syringe 6mg/0.6ml

GRANIX – tbo-filgrastim soln prefilled syringe 300mcg/0.5ml

GRANIX – tbo-filgrastim soln prefilled syringe 480mcg/0.8ml

GRANIX – tbo-filgrastim subcutaneous inj 300 mcg/mlGRANIX – tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml)NEULASTA – pegfilgrastim soln prefilled syringe 6

mg/0.6mlNEULASTA ONPRO KIT – pegfilgrastim soln prefilled

syringe kit 6 mg/0.6mlNEUPOGEN – filgrastim soln prefilled syringe 300

mcg/0.5mlNEUPOGEN – filgrastim soln prefilled syringe 480

mcg/0.8ml (600 mcg/ml)NEUPOGEN – filgrastim inj 300 mcg/mlNEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/ml)NIVESTYM – filgrastim-aafi soln prefilled syringe 300

mcg/0.5mlNIVESTYM – filgrastim-aafi soln prefilled syringe 480

mcg/0.8mlNIVESTYM – filgrastim-aafi inj 300 mcg/mlNIVESTYM – filgrastim-aafi inj 480 mcg/1.6ml (300 mcg/

ml)PROCRIT – epoetin alfa inj 2000 unit/mlPROCRIT – epoetin alfa inj 3000 unit/mlPROCRIT – epoetin alfa inj 4000 unit/mlPROCRIT – epoetin alfa inj 10000 unit/mlPROCRIT – epoetin alfa inj 20000 unit/mlPROCRIT – epoetin alfa inj 40000 unit/mlRETACRIT – epoetin alfa-epbx inj 2000 unit/mlRETACRIT – epoetin alfa-epbx inj 3000 unit/mlRETACRIT – epoetin alfa-epbx inj 4000 unit/mlRETACRIT – epoetin alfa-epbx inj 10000 unit/mlRETACRIT – epoetin alfa-epbx inj 40000 unit/mlUDENYCA – pegfilgrastim-cbqv soln prefilled syringe 6

mg/0.6mlZARXIO – filgrastim-sndz soln prefilled syringe 300

mcg/0.5mlZARXIO – filgrastim-sndz soln prefilled syringe 480

mcg/0.8ml

2021


Drug Name

ZIEXTENZO – pegfilgrastim-bmez soln prefilled syringe 6mg/0.6ml

ANTICOAGULANTSELIQUIS – apixaban tab 2.5 mgELIQUIS – apixaban tab 5 mgELIQUIS STARTER PACK – apixaban tab starter pack 5

mgenoxaparin sodium inj 30 mg/0.3ml (Lovenox)enoxaparin sodium inj 40 mg/0.4ml (Lovenox)enoxaparin sodium inj 60 mg/0.6ml (Lovenox)enoxaparin sodium inj 80 mg/0.8ml (Lovenox)enoxaparin sodium inj 100 mg/ml (Lovenox)enoxaparin sodium inj 120 mg/0.8ml (Lovenox)enoxaparin sodium inj 150 mg/ml (Lovenox)enoxaparin sodium inj 300 mg/3ml (Lovenox)warfarin sodium tab 1 mg (Coumadin)warfarin sodium tab 2 mg (Coumadin)warfarin sodium tab 2.5 mg (Coumadin)warfarin sodium tab 3 mg (Coumadin)warfarin sodium tab 4 mg (Coumadin)warfarin sodium tab 5 mg (Coumadin)warfarin sodium tab 6 mg (Coumadin)warfarin sodium tab 7.5 mg (Coumadin)warfarin sodium tab 10 mg (Coumadin)XARELTO – rivaroxaban tab 2.5 mgXARELTO – rivaroxaban tab 10 mgXARELTO – rivaroxaban tab 15 mgXARELTO – rivaroxaban tab 20 mgXARELTO STARTER PACK – rivaroxaban tab starter

therapy pack 15 mg & 20 mgHEMATOLOGICAL AGENTS - MISC.ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

250 unitADVATE – antihemophilic factor recomb (rahf-pfm) for inj




2000 unit

Drug Name

ADVATE – antihemophilic factor recomb (rahf-pfm) for inj3000 unit

ADVATE – antihemophilic factor recomb (rahf-pfm) for inj4000 unit

AFSTYLA – antihemophilic fact rcmb single chain for injkit 250 unit







anagrelide hcl cap 0.5 mg (Agrylin)anagrelide hcl cap 1 mgBENEFIX – coagulation factor ix (recombinant) for inj kit

250 unitBENEFIX – coagulation factor ix (recombinant) for inj kit




3000 unitBRILINTA – ticagrelor tab 60 mgBRILINTA – ticagrelor tab 90 mgcilostazol tab 50 mg (Pletal)cilostazol tab 100 mg (Pletal)CINRYZE – c1 esterase inhibitor (human) for iv inj 500

unitclopidogrel bisulfate tab 75 mg (base equiv) (Plavix)COAGADEX – coagulation factor x (human) for inj 250

unitCOAGADEX – coagulation factor x (human) for inj 500

unitCORIFACT – factor xiii concentrate (human) for inj kit

1000-1600 unitdipyridamole tab 25 mg (Persantine)

2021


Drug Name

dipyridamole tab 50 mg (Persantine)dipyridamole tab 75 mg (Persantine)ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for

inj 250 unitELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for









inj 6000 unitESPEROCT – antihemophilic factor recomb glycopeg-

exei for inj 500 unitESPEROCT – antihemophilic factor recomb glycopeg-




exei for inj 3000 unitFEIBA – antiinhibitor coagulant complex for iv soln 500

unitFEIBA – antiinhibitor coagulant complex for iv soln 1000

unitFEIBA – antiinhibitor coagulant complex for iv soln 2500

unitHAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 2000 unitHAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 3000 unitHUMATE-P – antihemophilic factor/vwf (human) for inj

250-600 unit

Drug Name

HUMATE-P – antihemophilic factor/vwf (human) for inj500-1200 unit

HUMATE-P – antihemophilic factor/vwf (human) for inj1000-2400 unit

icatibant acetate inj 30 mg/3ml (base equivalent)(Firazyr)

JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl) for inj500 unit

JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj1000 unit



KOGENATE FS – antihemophilic factor (recombinant) forinj kit 250 unit





KOVALTRY – antihemophilic factor recomb (rahf-pfm) forinj 250 unit





NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii)for inj 250 unit





2021


Drug Name


NOVOSEVEN RT – coagulation factor viia (recomb) forinj 1 mg (1000 mcg)




OBIZUR – antihemophilic factor (recomb porc) rpfviii forinj 500 unit

pentoxifylline tab er 400 mgprasugrel hcl tab 5 mg (base equiv) (Effient)prasugrel hcl tab 10 mg (base equiv) (Effient)TRETTEN – coagulation factor xiii a-subunit for inj

2000-3125 unitVONVENDI – von willebrand factor (recombinant) for inj

650 unitVONVENDI – von willebrand factor (recombinant) for inj

1300 unitTOPICAL PRODUCTSOPHTHALMIC AGENTSALPHAGAN P – brimonidine tartrate ophth soln 0.1%ALREX – loteprednol etabonate ophth susp 0.2%ATROPINE SULFATE – atropine sulfate ophth soln 1%azelastine hcl ophth soln 0.05% (Optivar)AZOPT – brinzolamide ophth susp 1%BACITRACIN – bacitracin ophth oint 500 unit/gmbacitracin-polymyxin b ophth ointbacitracin-polymyxin-neomycin-hc ophth oint 1%brimonidine tartrate ophth soln 0.15% (Alphagan p)brimonidine tartrate ophth soln 0.2%CARTEOLOL HCL – carteolol hcl ophth soln 1%CILOXAN – ciprofloxacin hcl ophth oint 0.3%ciprofloxacin hcl ophth soln 0.3% (base equivalent)

(Ciloxan)cromolyn sodium ophth soln 4%cyclopentolate hcl ophth soln 1% (Cyclogyl)DEXAMETHASONE SODIUM PHOS – dexamethasone

sodium phosphate ophth soln 0.1%diclofenac sodium ophth soln 0.1%

Drug Name

dorzolamide hcl ophth soln 2% (Trusopt)dorzolamide hcl-timolol maleate ophth soln

22.3-6.8 mg/ml (Cosopt)erythromycin ophth oint 5 mg/gmfluorometholone ophth susp 0.1% (Fml liquifilm)FLURBIPROFEN SODIUM – flurbiprofen sodium ophth

soln 0.03%GENTAK – gentamicin sulfate ophth oint 0.3%gentamicin sulfate ophth soln 0.3% (Garamycin)ketorolac tromethamine ophth soln 0.4% (Acular ls)ketorolac tromethamine ophth soln 0.5% (Acular)latanoprost ophth soln 0.005% (Xalatan)LEVOBUNOLOL HCL – levobunolol hcl ophth soln 0.5%LOTEMAX – loteprednol etabonate ophth oint 0.5%LOTEMAX – loteprednol etabonate ophth gel 0.5%LOTEMAX SM – loteprednol etabonate ophth gel 0.38%loteprednol etabonate ophth susp 0.5% (Lotemax)LUMIGAN – bimatoprost ophth soln 0.01%moxifloxacin hcl ophth soln 0.5% (base equiv)

(Vigamox)NATACYN – natamycin ophth susp 5%neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oinneomycin-polymyxin-dexamethasone ophth oint

0.1% (Maxitrol)neomycin-polymyxin-dexamethasone ophth susp

0.1% (Maxitrol)NEOMYCIN/POLYMYXIN/GRAMIC – neomycin-polymy-

gramicid op sol 1.75-10000-0.025mg-unt-mg/mlofloxacin ophth soln 0.3% (Ocuflox)PAZEO – olopatadine hcl ophth soln 0.7% (base

equivalent)pilocarpine hcl ophth soln 1% (Isopto carpine)pilocarpine hcl ophth soln 2% (Isopto carpine)pilocarpine hcl ophth soln 4% (Isopto carpine)polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1% (Polytrim)PREDNISOLONE ACETATE – prednisolone acetate

ophth susp 1%SIMBRINZA – brinzolamide-brimonidine tartrate ophth

susp 1-0.2%sulfacetamide sodium ophth soln 10% (Bleph-10)

2021


Drug Name

SULFACETAMIDE SODIUM/PRED – sulfacetamidesodium-prednisolone ophth soln 10-0.23(0.25)%

timolol maleate ophth soln 0.25% (Timoptic)timolol maleate ophth soln 0.5% (Timoptic)tobramycin ophth soln 0.3% (Tobrex)tobramycin-dexamethasone ophth susp 0.3-0.1%

(Tobradex)travoprost ophth soln 0.004% (benzalkonium free)

(bak free) (Travatan z)TRIFLURIDINE – trifluridine ophth soln 1%tropicamide ophth soln 0.5%tropicamide ophth soln 1% (Mydriacyl)ZYLET – loteprednol etabonate-tobramycin ophth susp

0.5-0.3%OTIC AGENTSacetic acid otic soln 2%CIPRO HC – ciprofloxacin-hydrocortisone otic susp

0.2-1%CIPRODEX – ciprofloxacin-dexamethasone otic susp

0.3-0.1%ciprofloxacin-dexamethasone otic susp 0.3-0.1%

(Ciprodex)hydrocortisone w/ acetic acid otic soln 1-2% (Vosol

hc)neomycin-polymyxin-hc otic soln 1% (Cortisporin)neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%ofloxacin otic soln 0.3%MOUTH/THROAT/DENTAL AGENTScevimeline hcl cap 30 mg (Evoxac)chlorhexidine gluconate soln 0.12% (Peridex)clotrimazole troche 10 mglidocaine hcl viscous soln 2%nystatin susp 100000 unit/mlpilocarpine hcl tab 5 mg (Salagen)pilocarpine hcl tab 7.5 mg (Salagen)sodium fluoride cream 1.1% (Prevident 5000 plus)sodium fluoride gel 1.1% (0.5% f) (Prevident fluoride)triamcinolone acetonide dental paste 0.1%ANORECTAL AGENTSCORTIFOAM – hydrocortisone acetate perianal foam

10% (90 mg/dose)

Drug Name

hydrocortisone acetate suppos 25 mghydrocortisone enema 100 mg/60ml (Cortenema)hydrocortisone perianal cream 2.5% (Anusol-hc)DERMATOLOGICALSacitretin cap 10 mg (Soriatane)acitretin cap 17.5 mg (Soriatane)acitretin cap 25 mg (Soriatane)adapalene cream 0.1% (Differin)adapalene gel 0.1% (Differin)adapalene gel 0.3% (Differin)adapalene-benzoyl peroxide gel 0.1-2.5% (Epiduo)alclometasone dipropionate cream 0.05% (Aclovate)alclometasone dipropionate oint 0.05%AMCINONIDE – amcinonide cream 0.1%AUGMENTED BETAMETHASONE D – betamethasone

dipropionate augmented gel 0.05%azelaic acid gel 15% (Finacea)benzoyl peroxide-erythromycin gel 5-3%

(Benzamycin)betamethasone dipropionate augmented cream

0.05% (Diprolene af)betamethasone dipropionate augmented lotion 0.05%

(Diprolene)betamethasone dipropionate augmented oint 0.05%

(Diprolene)betamethasone dipropionate cream 0.05%betamethasone dipropionate lotion 0.05%betamethasone dipropionate oint 0.05%betamethasone valerate cream 0.1% (base

equivalent)betamethasone valerate lotion 0.1% (base equivalent)betamethasone valerate oint 0.1% (base equivalent)calcipotriene cream 0.005% (Dovonex)calcipotriene oint 0.005%calcipotriene soln 0.005% (50 mcg/ml)CARAC – fluorouracil cream 0.5%ciclopirox gel 0.77% (Loprox)ciclopirox olamine cream 0.77% (base equiv)ciclopirox olamine susp 0.77% (base equiv)ciclopirox shampoo 1% (Loprox shampoo)ciclopirox solution 8% (Penlac nail lacquer)

2021


Drug Name

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2(1)-5% (Duac)

clindamycin phosphate gel 1% (Cleocin-t)clindamycin phosphate lotion 1% (Cleocin-t)clindamycin phosphate soln 1% (Cleocin-t)clindamycin phosphate swab 1% (Cleocin-t)clindamycin phosphate-benzoyl peroxide gel 1-5%

(Benzaclin)clobetasol propionate cream 0.05% (Temovate)clobetasol propionate emollient base cream 0.05%

(Temovate e)clobetasol propionate foam 0.05% (Olux)clobetasol propionate gel 0.05% (Temovate)clobetasol propionate oint 0.05% (Temovate)clobetasol propionate soln 0.05% (Temovate)COSENTYX – secukinumab subcutaneous soln prefilled

syringe 150 mg/mlCOSENTYX – secukinumab subcutaneous pref syr 150

mg/ml (300 mg dose)COSENTYX SENSOREADY PEN – secukinumab

subcutaneous soln auto-injector 150 mg/mlCOSENTYX SENSOREADY PEN – secukinumab

subcutaneous auto-inj 150 mg/ml (300 mg dose)desonide cream 0.05% (Desowen)desonide lotion 0.05% (Desowen)desonide oint 0.05% (Desowen)desoximetasone cream 0.25% (Topicort)desoximetasone oint 0.25% (Topicort)diclofenac sodium (actinic keratoses) gel 3%

(Solaraze)DIFFERIN – adapalene lotion 0.1%econazole nitrate cream 1%ENSTILAR – calcipotriene-betamethasone dipropionate

foam 0.005-0.064%EPIDUO FORTE – adapalene-benzoyl peroxide gel

0.3-2.5%ERY – erythromycin pads 2%erythromycin gel 2% (Erygel)erythromycin soln 2%FINACEA – azelaic acid foam 15%fluocinolone acetonide cream 0.01%fluocinolone acetonide cream 0.025% (Synalar)

Drug Name

fluocinolone acetonide oil 0.01% (body oil) (Derma-smoothe/fs bod)

fluocinolone acetonide oil 0.01% (scalp oil) (Derma-smoothe/fs sca)

fluocinolone acetonide oint 0.025% (Synalar)fluocinolone acetonide soln 0.01% (Synalar)fluocinonide cream 0.05%fluocinonide emulsified base cream 0.05%fluocinonide gel 0.05%fluocinonide oint 0.05%fluocinonide soln 0.05%FLUOROPLEX – fluorouracil cream 1%FLUOROURACIL – fluorouracil soln 2%FLUOROURACIL – fluorouracil soln 5%fluorouracil cream 5% (Efudex)fluticasone propionate cream 0.05% (Cutivate)fluticasone propionate oint 0.005% (Cutivate)gentamicin sulfate cream 0.1%gentamicin sulfate oint 0.1%halobetasol propionate cream 0.05% (Ultravate)halobetasol propionate oint 0.05% (Ultravate)hydrocortisone cream 2.5%hydrocortisone lotion 2.5%hydrocortisone oint 2.5%hydrocortisone valerate cream 0.2%hydrocortisone valerate oint 0.2% (Westcort)imiquimod cream 5% (Aldara)isotretinoin cap 10 mgisotretinoin cap 20 mgisotretinoin cap 30 mg (Claravis)isotretinoin cap 40 mgketoconazole cream 2%ketoconazole shampoo 2% (Nizoral)lidocaine hcl gel 2%lidocaine hcl soln 4% (Xylocaine)lidocaine oint 5%lidocaine patch 5% (Lidoderm)lidocaine-prilocaine cream 2.5-2.5% (Emla)LINDANE – lindane shampoo 1%malathion lotion 0.5% (Ovide)

2021


Drug Name

metronidazole cream 0.75% (Metrocream)metronidazole gel 0.75%metronidazole gel 1% (Metrogel)metronidazole lotion 0.75% (Metrolotion)mometasone furoate cream 0.1% (Elocon)mometasone furoate oint 0.1% (Elocon)mometasone furoate solution 0.1% (lotion) (Elocon)mupirocin oint 2% (Bactroban)nystatin cream 100000 unit/gmnystatin oint 100000 unit/gmnystatin topical powder 100000 unit/gmnystatin-triamcinolone cream 100000-0.1 unit/gm-%nystatin-triamcinolone oint 100000-0.1 unit/gm-%ORACEA – doxycycline (rosacea) cap delayed release

40 mgpermethrin cream 5% (Elimite)PICATO – ingenol mebutate gel 0.015%PICATO – ingenol mebutate gel 0.05%pimecrolimus cream 1% (Elidel)podofilox soln 0.5% (Condylox)selenium sulfide lotion 2.5%silver sulfadiazine cream 1% (Silvadene)SKYRIZI – risankizumab-rzaa sol prefilled syringe 2 x 75

mg/0.83ml kitSOOLANTRA – ivermectin cream 1%STELARA – ustekinumab inj 45 mg/0.5mlSTELARA – ustekinumab soln prefilled syringe 45

mg/0.5mlSTELARA – ustekinumab soln prefilled syringe 90 mg/mlsulfacetamide sodium lotion 10% (acne) (Klaron)tacrolimus oint 0.03% (Protopic)tacrolimus oint 0.1% (Protopic)tazarotene cream 0.1% (Tazorac)TAZORAC – tazarotene cream 0.05%TAZORAC – tazarotene gel 0.05%TAZORAC – tazarotene gel 0.1%TREMFYA – guselkumab soln pen-injector 100 mg/mlTREMFYA – guselkumab soln prefilled syringe 100 mg/

mltretinoin cream 0.025% (Retin-a)

Drug Name

tretinoin cream 0.05% (Retin-a)tretinoin cream 0.1% (Retin-a)tretinoin gel 0.01% (Retin-a)tretinoin gel 0.025%, NF = Avita (Retin-a)tretinoin microsphere gel 0.04% (Retin-a micro)tretinoin microsphere gel 0.1% (Retin-a micro)triamcinolone acetonide cream 0.025%triamcinolone acetonide cream 0.1%triamcinolone acetonide cream 0.5%triamcinolone acetonide lotion 0.025%triamcinolone acetonide lotion 0.1%triamcinolone acetonide oint 0.025%triamcinolone acetonide oint 0.1%triamcinolone acetonide oint 0.5%VALCHLOR – mechlorethamine hcl gel 0.016% (base

equivalent)ZYCLARA – imiquimod cream 3.75%ZYCLARA PUMP – imiquimod cream 2.5%ZYCLARA PUMP – imiquimod cream 3.75%MISCELLANEOUS PRODUCTSANTIDOTESCHEMET – succimer cap 100 mgNALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/mlnaloxone hcl inj 0.4 mg/mlnaloxone hcl inj 4 mg/10mlnaltrexone hcl tab 50 mg (Revia)NARCAN – naloxone hcl nasal spray 4 mg/0.1mlDIABETIC SUPPLIESASCENCIA CONTOUR, CONTOUR NEXT calibration

liquid; test stripsASCENSIA CONTOUR, CONTOUR NEXT/EZ/LINK/ONE

blood glucose meterASCENSIA DIASTIX, KETO-DIASTIX, KETOSTIX urine

test productsDEXCOM G5/G6 RECEIVER/SENSOR/TRANSMITTER

– continuous blood glucose systemFREESTYLE LIBRE/2, 14 READER/SENSOR/FLASH –

continuous blood glucose systemINSULIN PEN NEEDLES - variousINSULIN SYRINGES - variousLANCET DEVICES - various

2021


Drug Name

LANCETS - variousMEDICAL DEVICESINHALER ASSIST DEVICES - SPACERSASSORTED CLASSESazathioprine tab 50 mg (Imuran)buprenorphine hcl-naloxone hcl sl film 2-0.5 mg

(base equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl film 4-1 mg (base

equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl film 8-2 mg (base

equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl film 12-3 mg (base

equiv) (Suboxone)buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (base

equiv)buprenorphine hcl-naloxone hcl sl tab 8-2 mg (base

equiv)cyclosporine cap 25 mg (Sandimmune)cyclosporine cap 100 mg (Sandimmune)cyclosporine modified cap 25 mg (Neoral)cyclosporine modified cap 50 mg (Cyclosporine

modifie)cyclosporine modified cap 100 mg (Neoral)cyclosporine modified oral soln 100 mg/ml (Neoral)everolimus tab 0.25 mg (Zortress)everolimus tab 0.5 mg (Zortress)everolimus tab 0.75 mg (Zortress)LOKELMA – sodium zirconium cyclosilicate for susp

packet 5 gmLOKELMA – sodium zirconium cyclosilicate for susp

packet 10 gmmycophenolate mofetil cap 250 mg (Cellcept)mycophenolate mofetil for oral susp 200 mg/ml

(Cellcept)mycophenolate mofetil tab 500 mg (Cellcept)mycophenolate sodium tab dr 180 mg (mycophenolic

acid equiv) (Myfortic)mycophenolate sodium tab dr 360 mg (mycophenolic

acid equiv) (Myfortic)penicillamine tab 250 mg (Depen titratabs)REVLIMID – lenalidomide caps 2.5 mgREVLIMID – lenalidomide cap 5 mgREVLIMID – lenalidomide cap 10 mg

Drug Name

REVLIMID – lenalidomide cap 15 mgREVLIMID – lenalidomide cap 20 mgREVLIMID – lenalidomide cap 25 mgsirolimus oral soln 1 mg/ml (Rapamune)sirolimus tab 0.5 mg (Rapamune)sirolimus tab 1 mg (Rapamune)sirolimus tab 2 mg (Rapamune)sodium polystyrene sulfonate oral susp 15 gm/60ml

(Sps)sodium polystyrene sulfonate powder (Kayexalate)tacrolimus cap 0.5 mg (Prograf)tacrolimus cap 1 mg (Prograf)tacrolimus cap 5 mg (Prograf)THALOMID – thalidomide cap 50 mgTHALOMID – thalidomide cap 100 mgTHALOMID – thalidomide cap 150 mgTHALOMID – thalidomide cap 200 mgVELTASSA – patiromer sorbitex calcium for susp packet

8.4 gm (base eq)VELTASSA – patiromer sorbitex calcium for susp packet

16.8 gm (base eq)VELTASSA – patiromer sorbitex calcium for susp packet

25.2 gm (base eq)ZORTRESS – everolimus tab 1 mg

2021


INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg

(Epzicom)...........................................................................2abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg (Trizivir).................................................3abacavir sulfate soln 20 mg/ml (base equiv)

(Ziagen)..............................................................................2abacavir sulfate tab 300 mg (base equiv) (Ziagen).........2abiraterone acetate tab 250 mg (Zytiga).......................... 5acamprosate calcium tab delayed release 333 mg

(Campral).........................................................................29acarbose tab 25 mg (Precose)........................................ 10acarbose tab 50 mg (Precose)........................................ 10acarbose tab 100 mg (Precose)...................................... 10acebutolol hcl cap 200 mg (Sectral)...............................15acebutolol hcl cap 400 mg (Sectral)...............................15acetaminophen w/ codeine soln 120-12 mg/5ml........... 31acetaminophen w/ codeine tab 300-15 mg (Tylenol/

codeine)...........................................................................31acetaminophen w/ codeine tab 300-30 mg (Tylenol/

codeine #3)..................................................................... 31acetaminophen w/ codeine tab 300-60 mg (Tylenol/

codeine #4)..................................................................... 31acetazolamide cap er 12hr 500 mg (Diamox)................ 19acetazolamide tab 125 mg............................................... 19acetazolamide tab 250 mg............................................... 19acetic acid otic soln 2%...................................................41acetylcysteine inhal soln 10%.........................................21acetylcysteine inhal soln 20%.........................................21acitretin cap 10 mg (Soriatane).......................................41acitretin cap 17.5 mg (Soriatane)....................................41acitretin cap 25 mg (Soriatane).......................................41ACTEMRA ACTPEN – tocilizumab subcutaneous soln

auto-injector 162 mg/0.9ml..............................................32ACTEMRA – tocilizumab subcutaneous soln prefilled

syringe 162 mg/0.9ml...................................................... 32ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml

(2000000 unit/0.5ml)..........................................................5acyclovir cap 200 mg (Zovirax).........................................3acyclovir susp 200 mg/5ml (Zovirax)............................... 3acyclovir tab 400 mg (Zovirax)..........................................3acyclovir tab 800 mg (Zovirax)..........................................3adapalene-benzoyl peroxide gel 0.1-2.5% (Epiduo)......41adapalene cream 0.1% (Differin).....................................41adapalene gel 0.1% (Differin).......................................... 41adapalene gel 0.3% (Differin).......................................... 41ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 5 mg.................................................................... 28ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 10 mg.................................................................. 28ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 15 mg.................................................................. 28

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 20 mg.................................................................. 28



adefovir dipivoxil tab 10 mg (Hepsera)............................3ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21

mcg/act............................................................................. 21ADVAIR HFA – fluticasone-salmeterol inhal aerosol 115-21

mcg/act............................................................................. 21ADVAIR HFA – fluticasone-salmeterol inhal aerosol

230-21 mcg/act................................................................ 21ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

250 unit.............................................................................38ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

500 unit.............................................................................38ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

1000 unit...........................................................................38ADVATE – antihemophilic factor recomb (rahf-pfm) for inj




4000 unit...........................................................................38AFINITOR DISPERZ – everolimus tab for oral susp 2

mg....................................................................................... 5AFINITOR DISPERZ – everolimus tab for oral susp 3

mg....................................................................................... 5AFINITOR DISPERZ – everolimus tab for oral susp 5

mg....................................................................................... 5AFINITOR – everolimus tab 10 mg......................................5AFSTYLA – antihemophilic fact rcmb single chain for inj kit

250 unit.............................................................................38AFSTYLA – antihemophilic fact rcmb single chain for inj kit

500 unit.............................................................................38AFSTYLA – antihemophilic fact rcmb single chain for inj kit

1000 unit...........................................................................38AFSTYLA – antihemophilic fact rcmb single chain for inj kit




3000 unit...........................................................................38AIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 70 mg/ml............................................................. 33AIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 140 mg/ml........................................................... 33albendazole tab 200 mg (Albenza)....................................5albuterol sulfate inhal aero 108 mcg/act (90mcg base

equiv) (Proventil hfa).....................................................21albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)..........21

2021


albuterol sulfate soln nebu 0.5% (5 mg/ml)...................21albuterol sulfate soln nebu 0.63 mg/3ml (base

equiv)............................................................................... 21albuterol sulfate soln nebu 1.25 mg/3ml (base

equiv)............................................................................... 21albuterol sulfate syrup 2 mg/5ml....................................21albuterol sulfate tab 2 mg................................................21albuterol sulfate tab 4 mg................................................21alclometasone dipropionate cream 0.05%

(Aclovate)........................................................................ 41alclometasone dipropionate oint 0.05%.........................41ALECENSA – alectinib hcl cap 150 mg (base

equivalent).......................................................................... 5ALENDRONATE SODIUM – alendronate sodium tab 5

mg.....................................................................................13alendronate sodium tab 10 mg....................................... 13alendronate sodium tab 35 mg....................................... 13alendronate sodium tab 70 mg (Fosamax)....................13alfuzosin hcl tab er 24hr 10 mg (Uroxatral)................... 24ALINIA – nitazoxanide for susp 100 mg/5ml........................5ALINIA – nitazoxanide tab 500 mg...................................... 5allopurinol tab 100 mg (Zyloprim).................................. 34allopurinol tab 300 mg (Zyloprim).................................. 34ALPHAGAN P – brimonidine tartrate ophth soln 0.1%...... 40alprazolam tab er 24hr 0.5 mg (Xanax xr)......................25alprazolam tab er 24hr 1 mg (Xanax xr).........................25alprazolam tab er 24hr 2 mg (Xanax xr).........................25alprazolam tab er 24hr 3 mg (Xanax xr).........................25alprazolam tab 0.25 mg (Xanax)......................................25alprazolam tab 0.5 mg (Xanax)........................................25alprazolam tab 1 mg (Xanax)...........................................25alprazolam tab 2 mg (Xanax)...........................................25ALREX – loteprednol etabonate ophth susp 0.2%.............40ALUNBRIG – brigatinib tab initiation therapy pack 90 mg &

180 mg............................................................................... 5ALUNBRIG – brigatinib tab 30 mg.......................................5ALUNBRIG – brigatinib tab 90 mg.......................................5ALUNBRIG – brigatinib tab 180 mg.....................................5amantadine hcl cap 100 mg............................................ 35amantadine hcl syrup 50 mg/5ml....................................35ambrisentan tab 5 mg (Letairis)......................................20ambrisentan tab 10 mg (Letairis)....................................20AMCINONIDE – amcinonide cream 0.1%......................... 41amiloride & hydrochlorothiazide tab 5-50 mg............... 19amiloride hcl tab 5 mg..................................................... 19amiodarone hcl tab 100 mg.............................................16amiodarone hcl tab 400 mg.............................................16amiodarone hcl tab 200 mg (Cordarone).......................16amitriptyline hcl tab 10 mg..............................................25amitriptyline hcl tab 25 mg..............................................25amitriptyline hcl tab 50 mg..............................................25amitriptyline hcl tab 75 mg..............................................25amitriptyline hcl tab 100 mg............................................25amitriptyline hcl tab 150 mg............................................25amlodipine besylate-benazepril hcl cap 2.5-10 mg

(Lotrel)............................................................................. 16

amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)............................................................................. 16





amlodipine besylate tab 2.5 mg (base equivalent)(Norvasc)......................................................................... 15

amlodipine besylate tab 5 mg (base equivalent)(Norvasc)......................................................................... 15

amlodipine besylate tab 10 mg (base equivalent)(Norvasc)......................................................................... 15

amlodipine besylate-valsartan tab 5-160 mg(Exforge)..........................................................................16




amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)......................................... 16

amlodipine-valsartan-hydrochlorothiazide tab 5-160-25mg (Exforge hct)............................................................ 16

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct)....................................... 16

amlodipine-valsartan-hydrochlorothiazide tab10-160-25 mg (Exforge hct).......................................... 16

amlodipine-valsartan-hydrochlorothiazide tab10-320-25 mg (Exforge hct).......................................... 16

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 200-28.5 mg................................... 1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 400-57 mg...................................... 1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate tab er 12hr 1000-62.5 mg..............................1

amoxicillin & k clavulanate for susp 200-28.5mg/5ml............................................................................... 1

amoxicillin & k clavulanate for susp 400-57 mg/5ml...... 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml

(Augmentin)...................................................................... 1amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

(Augmentin es-600)..........................................................1amoxicillin & k clavulanate tab 250-125 mg.................... 1amoxicillin & k clavulanate tab 500-125 mg

(Augmentin)...................................................................... 1amoxicillin & k clavulanate tab 875-125 mg

(Augmentin)...................................................................... 1AMOXICILLIN – amoxicillin (trihydrate) chew tab 125

mg....................................................................................... 1AMOXICILLIN – amoxicillin (trihydrate) chew tab 250

mg....................................................................................... 1

2021


amoxicillin (trihydrate) cap 250 mg..................................1amoxicillin (trihydrate) cap 500 mg..................................1amoxicillin (trihydrate) for susp 125 mg/5ml...................1amoxicillin (trihydrate) for susp 200 mg/5ml...................1amoxicillin (trihydrate) for susp 250 mg/5ml...................1amoxicillin (trihydrate) for susp 400 mg/5ml...................1amoxicillin (trihydrate) tab 500 mg...................................1amoxicillin (trihydrate) tab 875 mg...................................1amphetamine-dextroamphetamine cap er 24hr 5 mg

(Adderall xr)....................................................................28amphetamine-dextroamphetamine cap er 24hr 10 mg





(Adderall xr)....................................................................28amphetamine-dextroamphetamine tab 5 mg

(Adderall).........................................................................28amphetamine-dextroamphetamine tab 7.5 mg

(Adderall).........................................................................28amphetamine-dextroamphetamine tab 10 mg

(Adderall).........................................................................28amphetamine-dextroamphetamine tab 12.5 mg




(Adderall).........................................................................28AMPICILLIN – ampicillin cap 500 mg.................................. 1anagrelide hcl cap 1 mg.................................................. 38anagrelide hcl cap 0.5 mg (Agrylin)............................... 38anastrozole tab 1 mg (Arimidex).......................................5ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inh............................................................... 21aprepitant capsule 40 mg (Emend).................................23aprepitant capsule 80 mg (Emend).................................23aprepitant capsule 125 mg (Emend)...............................23aprepitant capsule therapy pack 80 & 125 mg

(Emend)........................................................................... 23ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25

mcg/ml.............................................................................. 37ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40

mcg/ml.............................................................................. 37ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60

mcg/ml.............................................................................. 37ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

100 mcg/ml.......................................................................37ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

200 mcg/ml.......................................................................37

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj300 mcg/ml.......................................................................37

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 10 mcg/0.4ml........................................ 37

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 25 mcg/0.42ml...................................... 37







ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 500 mcg/ml........................................... 37

aripiprazole tab 2 mg (Abilify).........................................26aripiprazole tab 5 mg (Abilify).........................................26aripiprazole tab 10 mg (Abilify).......................................26aripiprazole tab 15 mg (Abilify).......................................26aripiprazole tab 20 mg (Abilify).......................................26aripiprazole tab 30 mg (Abilify).......................................26armodafinil tab 50 mg (Nuvigil).......................................28armodafinil tab 150 mg (Nuvigil).....................................28armodafinil tab 200 mg (Nuvigil).....................................28armodafinil tab 250 mg (Nuvigil).....................................28ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 50 mcg/act................................................... 21ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 100 mcg/act................................................. 21ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 200 mcg/act................................................. 21ASCENCIA CONTOUR, CONTOUR NEXTcalibration

liquid; test strips...............................................................43ASCENSIA CONTOUR, CONTOUR NEXT/EZ/LINK/

ONEblood glucose meter................................................ 43ASCENSIA DIASTIX, KETO-DIASTIX, KETOSTIXurine

test products.....................................................................43ASMANEX HFA – mometasone furoate inhal aerosol

suspension 50 mcg/act....................................................21ASMANEX HFA – mometasone furoate inhal aerosol

suspension 100 mcg/act..................................................21ASMANEX HFA – mometasone furoate inhal aerosol

suspension 200 mcg/act..................................................21ASMANEX TWISTHALER 120 ME – mometasone furoate

inhal powd 220 mcg/inh (breath activated).....................21ASMANEX TWISTHALER 30 MET – mometasone furoate

inhal powd 110 mcg/inh (breath activated)..................... 21ASMANEX TWISTHALER 30 MET – mometasone furoate

inhal powd 220 mcg/inh (breath activated).....................21ASMANEX TWISTHALER 60 MET – mometasone furoate

inhal powd 220 mcg/inh (breath activated).....................21

2021


atazanavir sulfate cap 150 mg (base equiv)(Reyataz)............................................................................3



atenolol & chlorthalidone tab 50-25 mg (Tenoretic50).....................................................................................16

atenolol & chlorthalidone tab 100-25 mg (Tenoretic100)...................................................................................16

atenolol tab 25 mg (Tenormin)........................................ 15atenolol tab 50 mg (Tenormin)........................................ 15atenolol tab 100 mg (Tenormin)...................................... 15atomoxetine hcl cap 10 mg (base equiv) (Strattera).....28atomoxetine hcl cap 18 mg (base equiv) (Strattera).....28atomoxetine hcl cap 25 mg (base equiv) (Strattera).....28atomoxetine hcl cap 40 mg (base equiv) (Strattera).....28atomoxetine hcl cap 60 mg (base equiv) (Strattera).....28atomoxetine hcl cap 80 mg (base equiv) (Strattera).....28atomoxetine hcl cap 100 mg (base equiv)

(Strattera)........................................................................ 28atorvastatin calcium tab 10 mg (base equivalent)

(Lipitor)............................................................................ 19atorvastatin calcium tab 20 mg (base equivalent)



(Lipitor)............................................................................ 19atovaquone-proguanil hcl tab 62.5-25 mg

(Malarone)......................................................................... 4atovaquone-proguanil hcl tab 250-100 mg

(Malarone)......................................................................... 4ATRIPLA – efavirenz-emtricitabine-tenofovir df tab

600-200-300 mg.................................................................3ATROPINE SULFATE – atropine sulfate ophth soln

1%.....................................................................................40ATROVENT HFA – ipratropium bromide hfa inhal aerosol

17 mcg/act........................................................................21AUBAGIO – teriflunomide tab 7 mg...................................29AUBAGIO – teriflunomide tab 14 mg.................................29AUGMENTED BETAMETHASONE D – betamethasone

dipropionate augmented gel 0.05%................................ 41AUGMENTIN – amoxicillin & k clavulanate for susp

125-31.25 mg/5ml.............................................................. 1AVONEX – interferon beta-1a im prefilled syringe kit 30

mcg/0.5ml......................................................................... 29AVONEX PEN – interferon beta-1a im auto-injector kit 30

mcg/0.5ml......................................................................... 29AYVAKIT – avapritinib tab 100 mg.......................................5AYVAKIT – avapritinib tab 200 mg.......................................5AYVAKIT – avapritinib tab 300 mg.......................................5azathioprine tab 50 mg (Imuran).....................................44azelaic acid gel 15% (Finacea)........................................41azelastine hcl nasal spray 0.1% (137 mcg/spray)......... 21

azelastine hcl nasal spray 0.15% (205.5 mcg/spray)(Astepro)..........................................................................21

azelastine hcl ophth soln 0.05% (Optivar)..................... 40AZITHROMYCIN – azithromycin powd pack for susp 1

gm....................................................................................... 1azithromycin for susp 100 mg/5ml (Zithromax).............. 1azithromycin for susp 200 mg/5ml (Zithromax).............. 1azithromycin tab 250 mg (Zithromax).............................. 1azithromycin tab 500 mg (Zithromax).............................. 1azithromycin tab 600 mg (Zithromax).............................. 1AZOPT – brinzolamide ophth susp 1%..............................40

BBACITRACIN – bacitracin ophth oint 500 unit/gm............. 40bacitracin-polymyxin b ophth oint..................................40bacitracin-polymyxin-neomycin-hc ophth oint 1%.......40baclofen tab 10 mg...........................................................36baclofen tab 20 mg...........................................................36balsalazide disodium cap 750 mg (Colazal).................. 24BANZEL – rufinamide tab 200 mg..................................... 34BANZEL – rufinamide tab 400 mg..................................... 34BAQSIMI ONE PACK – glucagon nasal powder 3 mg/

dose.................................................................................. 11BAQSIMI TWO PACK – glucagon nasal powder 3 mg/

dose.................................................................................. 11BARACLUDE – entecavir oral soln 0.05 mg/ml...................3BELSOMRA – suvorexant tab 5 mg.................................. 28BELSOMRA – suvorexant tab 10 mg................................ 28BELSOMRA – suvorexant tab 15 mg................................ 28BELSOMRA – suvorexant tab 20 mg................................ 28benazepril & hydrochlorothiazide tab 5-6.25 mg.......... 17benazepril & hydrochlorothiazide tab 10-12.5 mg

(Lotensin hct)................................................................. 17benazepril & hydrochlorothiazide tab 20-12.5 mg

(Lotensin hct)................................................................. 17benazepril & hydrochlorothiazide tab 20-25 mg

(Lotensin hct)................................................................. 17benazepril hcl tab 5 mg................................................... 17benazepril hcl tab 10 mg (Lotensin)...............................17benazepril hcl tab 20 mg (Lotensin)...............................17benazepril hcl tab 40 mg (Lotensin)...............................17BENEFIX – coagulation factor ix (recombinant) for inj kit

250 unit.............................................................................38BENEFIX – coagulation factor ix (recombinant) for inj kit

500 unit.............................................................................38BENEFIX – coagulation factor ix (recombinant) for inj kit

1000 unit...........................................................................38BENEFIX – coagulation factor ix (recombinant) for inj kit

2000 unit...........................................................................38BENEFIX – coagulation factor ix (recombinant) for inj kit

3000 unit...........................................................................38BENZNIDAZOLE – benznidazole tab 12.5 mg.................... 5BENZNIDAZOLE – benznidazole tab 100 mg..................... 5benzoyl peroxide-erythromycin gel 5-3%

(Benzamycin).................................................................. 41benztropine mesylate tab 0.5 mg....................................35

2021


benztropine mesylate tab 1 mg.......................................35benztropine mesylate tab 2 mg.......................................35betamethasone dipropionate augmented cream 0.05%

(Diprolene af)..................................................................41betamethasone dipropionate augmented lotion 0.05%

(Diprolene).......................................................................41betamethasone dipropionate augmented oint 0.05%

(Diprolene).......................................................................41betamethasone dipropionate cream 0.05%................... 41betamethasone dipropionate lotion 0.05%....................41betamethasone dipropionate oint 0.05%....................... 41betamethasone valerate cream 0.1% (base

equivalent).......................................................................41betamethasone valerate lotion 0.1% (base

equivalent).......................................................................41betamethasone valerate oint 0.1% (base

equivalent).......................................................................41BETASERON – interferon beta-1b for inj kit 0.3 mg.......... 29bexarotene cap 75 mg (Targretin).....................................5bicalutamide tab 50 mg (Casodex)...................................5BIKTARVY – bictegravir-emtricitabine-tenofovir af tab

50-200-25 mg.....................................................................3bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

(Ziac)................................................................................ 17bisoprolol & hydrochlorothiazide tab 5-6.25 mg

(Ziac)................................................................................ 17bisoprolol & hydrochlorothiazide tab 10-6.25 mg

(Ziac)................................................................................ 17bisoprolol fumarate tab 5 mg (Zebeta)...........................15bisoprolol fumarate tab 10 mg (Zebeta).........................15bosentan tab 62.5 mg (Tracleer)..................................... 20bosentan tab 125 mg (Tracleer)...................................... 20BOSULIF – bosutinib tab 100 mg........................................ 5BOSULIF – bosutinib tab 400 mg........................................ 5BOSULIF – bosutinib tab 500 mg........................................ 5BREO ELLIPTA – fluticasone furoate-vilanterol aero powd

ba 100-25 mcg/inh...........................................................21BREO ELLIPTA – fluticasone furoate-vilanterol aero powd

ba 200-25 mcg/inh...........................................................21BREZTRI AEROSPHERE – budesonide-glycopyrrolate-

formoterol aers 160-9-4.8 mcg/act..................................21BRILINTA – ticagrelor tab 60 mg....................................... 38BRILINTA – ticagrelor tab 90 mg....................................... 38brimonidine tartrate ophth soln 0.2%.............................40brimonidine tartrate ophth soln 0.15% (Alphagan

p).......................................................................................40budesonide delayed release particles cap 3 mg

(Entocort ec)..................................................................... 8budesonide inhalation susp 0.25 mg/2ml

(Pulmicort).......................................................................21budesonide inhalation susp 0.5 mg/2ml

(Pulmicort).......................................................................21budesonide inhalation susp 1 mg/2ml (Pulmicort).......21bumetanide tab 0.5 mg.................................................... 19bumetanide tab 1 mg........................................................19bumetanide tab 2 mg........................................................19

buprenorphine hcl-naloxone hcl sl film 2-0.5 mg (baseequiv) (Suboxone)..........................................................44

buprenorphine hcl-naloxone hcl sl film 4-1 mg (baseequiv) (Suboxone)..........................................................44



buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (baseequiv)............................................................................... 44

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv)............................................................................... 44

buprenorphine hcl sl tab 2 mg (base equiv)................. 31buprenorphine hcl sl tab 8 mg (base equiv)................. 31bupropion hcl (smoking deterrent) tab er 12hr 150 mg

(Zyban).............................................................................29bupropion hcl tab er 12hr 100 mg (Wellbutrin sr).........25bupropion hcl tab er 12hr 150 mg (Wellbutrin sr).........25bupropion hcl tab er 12hr 200 mg (Wellbutrin sr).........25bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)......... 25bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)......... 25bupropion hcl tab 75 mg (Wellbutrin)............................ 25bupropion hcl tab 100 mg (Wellbutrin).......................... 25buspirone hcl tab 5 mg....................................................25buspirone hcl tab 10 mg..................................................25buspirone hcl tab 15 mg..................................................25buspirone hcl tab 30 mg..................................................25butalbital-acetaminophen-caffeine tab 50-325-40 mg

(Esgic)..............................................................................31butalbital-acetaminophen tab 50-325 mg.......................31butalbital-aspirin-caffeine cap 50-325-40 mg

(Fiorinal).......................................................................... 31butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg

(Fiorinal/codeine #3)......................................................31

Ccabergoline tab 0.5 mg.................................................... 13CABOMETYX – cabozantinib s-malate tab 20 mg (base

equivalent).......................................................................... 5CABOMETYX – cabozantinib s-malate tab 40 mg (base

equivalent).......................................................................... 5CABOMETYX – cabozantinib s-malate tab 60 mg (base

equivalent).......................................................................... 5caffeine citrate oral soln 60 mg/3ml (10 mg/ml base

equiv) (Cafcit)................................................................. 28calcipotriene cream 0.005% (Dovonex)..........................41calcipotriene oint 0.005%.................................................41calcipotriene soln 0.005% (50 mcg/ml).......................... 41calcitonin (salmon) nasal soln 200 unit/act

(Miacalcin)....................................................................... 13calcitriol cap 0.25 mcg (Rocaltrol)..................................13calcitriol cap 0.5 mcg (Rocaltrol)....................................13calcitriol oral soln 1 mcg/ml (Rocaltrol).........................13calcium acetate (phosphate binder) cap 667 mg (169

mg ca) (Phoslo)..............................................................24

2021


calcium acetate (phosphate binder) tab 667 mg(Eliphos).......................................................................... 24

candesartan cilexetil-hydrochlorothiazide tab 16-12.5mg (Atacand hct)........................................................... 17

candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg (Atacand hct)........................................................... 17

candesartan cilexetil-hydrochlorothiazide tab 32-25mg (Atacand hct)........................................................... 17

candesartan cilexetil tab 4 mg (Atacand)...................... 17candesartan cilexetil tab 8 mg (Atacand)...................... 17candesartan cilexetil tab 16 mg (Atacand).................... 17candesartan cilexetil tab 32 mg (Atacand).................... 17capecitabine tab 150 mg (Xeloda).................................... 6capecitabine tab 500 mg (Xeloda).................................... 6CAPRELSA – vandetanib tab 100 mg................................. 6CAPRELSA – vandetanib tab 300 mg................................. 6CAPTOPRIL/HYDROCHLOROTHIA – captopril &

hydrochlorothiazide tab 25-15 mg...................................17CAPTOPRIL/HYDROCHLOROTHIA – captopril &



hydrochlorothiazide tab 50-25 mg...................................17captopril tab 12.5 mg........................................................17captopril tab 25 mg...........................................................17captopril tab 50 mg...........................................................17captopril tab 100 mg.........................................................17CARAC – fluorouracil cream 0.5%.....................................41carbamazepine cap er 12hr 100 mg (Carbatrol)............34carbamazepine cap er 12hr 200 mg (Carbatrol)............34carbamazepine cap er 12hr 300 mg (Carbatrol)............34carbamazepine chew tab 100 mg................................... 34carbamazepine susp 100 mg/5ml (Tegretol)..................34carbamazepine tab er 12hr 100 mg (Tegretol-xr).......... 34carbamazepine tab er 12hr 200 mg (Tegretol-xr).......... 34carbamazepine tab er 12hr 400 mg (Tegretol-xr).......... 34carbamazepine tab 200 mg (Tegretol)............................34CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 12.5-50-200 mg................................... 35CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 18.75-75-200 mg................................. 35CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 25-100-200 mg.................................... 35CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 31.25-125-200 mg............................... 35CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 37.5-150-200 mg................................. 35CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-

entacapone tabs 50-200-200 mg.................................... 35carbidopa & levodopa orally disintegrating tab 10-100

mg (Parcopa).................................................................. 35carbidopa & levodopa orally disintegrating tab 25-100

mg (Parcopa).................................................................. 35carbidopa & levodopa orally disintegrating tab 25-250

mg (Parcopa).................................................................. 35

carbidopa & levodopa tab er 25-100 mg (Sinemetcr)..................................................................................... 35

carbidopa & levodopa tab er 50-200 mg (Sinemetcr)..................................................................................... 35

carbidopa & levodopa tab 10-100 mg (Sinemet)...........35carbidopa & levodopa tab 25-100 mg (Sinemet)...........35carbidopa & levodopa tab 25-250 mg (Sinemet)...........35CARTEOLOL HCL – carteolol hcl ophth soln 1%..............40carvedilol tab 3.125 mg (Coreg)......................................15carvedilol tab 6.25 mg (Coreg)........................................15carvedilol tab 12.5 mg (Coreg)........................................15carvedilol tab 25 mg (Coreg)...........................................15cefaclor cap 250 mg........................................................... 1cefaclor cap 500 mg........................................................... 1cefadroxil cap 500 mg........................................................1cefadroxil for susp 250 mg/5ml........................................ 1cefadroxil for susp 500 mg/5ml........................................ 1cefadroxil tab 1 gm.............................................................1cefdinir cap 300 mg............................................................1cefdinir for susp 125 mg/5ml............................................ 1cefdinir for susp 250 mg/5ml............................................ 1cefixime cap 400 mg (Suprax)...........................................1cefixime for susp 100 mg/5ml (Suprax)........................... 1cefixime for susp 200 mg/5ml (Suprax)........................... 1cefpodoxime proxetil for susp 50 mg/5ml.......................1cefpodoxime proxetil for susp 100 mg/5ml.....................1cefpodoxime proxetil tab 100 mg..................................... 1cefpodoxime proxetil tab 200 mg..................................... 1cefprozil for susp 125 mg/5ml...........................................1cefprozil for susp 250 mg/5ml...........................................1cefprozil tab 250 mg...........................................................1cefprozil tab 500 mg...........................................................1ceftriaxone sodium for inj 2 gm........................................1ceftriaxone sodium for inj 1 gm (Rocephin)....................1ceftriaxone sodium for inj 250 mg....................................1ceftriaxone sodium for inj 500 mg (Rocephin)................1cefuroxime axetil tab 250 mg (Ceftin).............................. 1cefuroxime axetil tab 500 mg (Ceftin).............................. 1celecoxib cap 50 mg (Celebrex)......................................32celecoxib cap 100 mg (Celebrex)....................................32celecoxib cap 200 mg (Celebrex)....................................32celecoxib cap 400 mg (Celebrex)....................................32CELONTIN – methsuximide cap 300 mg...........................34cephalexin cap 250 mg (Keflex)........................................1cephalexin cap 500 mg (Keflex)........................................1cephalexin for susp 125 mg/5ml.......................................1cephalexin for susp 250 mg/5ml.......................................1CERDELGA – eliglustat tartrate cap 84 mg (base

equivalent)........................................................................ 37cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)................... 20cevimeline hcl cap 30 mg (Evoxac)................................41CHANTIX CONTINUING MONTH – varenicline tartrate tab

1 mg (base equiv)............................................................30CHANTIX STARTING MONTH PA – varenicline tartrate

tab 0.5 mg x 11 & tab 1 mg x 42 pack............................30

2021


CHANTIX – varenicline tartrate tab 0.5 mg (baseequiv)................................................................................ 29

CHANTIX – varenicline tartrate tab 1 mg (base equiv)......30CHEMET – succimer cap 100 mg......................................43CHENODAL – chenodiol tab 250 mg.................................24chlorhexidine gluconate soln 0.12% (Peridex)..............41CHLOROQUINE PHOSPHATE – chloroquine phosphate

tab 500 mg.........................................................................4chloroquine phosphate tab 250 mg..................................4chlorpromazine hcl tab 10 mg........................................ 26chlorpromazine hcl tab 25 mg........................................ 26chlorpromazine hcl tab 50 mg........................................ 26chlorpromazine hcl tab 100 mg...................................... 26chlorpromazine hcl tab 200 mg...................................... 26chlorthalidone tab 25 mg.................................................19chlorthalidone tab 50 mg.................................................19chlorzoxazone tab 500 mg...............................................36cholestyramine light powder 4 gm/dose (Questran

light)................................................................................. 19cholestyramine light powder packets 4 gm.................. 19cholestyramine powder 4 gm/dose (Questran).............19cholestyramine powder packets 4 gm (Questran)........19choline fenofibrate cap dr 45 mg (fenofibric acid

equiv) (Trilipix)................................................................19CHORIONIC GONADOTROPIN – chorionic gonadotropin

for im inj 10000 unit.........................................................13ciclopirox gel 0.77% (Loprox)......................................... 41ciclopirox olamine cream 0.77% (base equiv)...............41ciclopirox olamine susp 0.77% (base equiv).................41ciclopirox shampoo 1% (Loprox shampoo).................. 41ciclopirox solution 8% (Penlac nail lacquer).................41cilostazol tab 50 mg (Pletal)............................................38cilostazol tab 100 mg (Pletal)..........................................38CILOXAN – ciprofloxacin hcl ophth oint 0.3%................... 40CIMDUO – lamivudine-tenofovir disoproxil fumarate tab

300-300 mg........................................................................ 3CIMETIDINE HCL – cimetidine hcl soln 300 mg/5ml.........23cimetidine tab 300 mg......................................................23cimetidine tab 400 mg......................................................23cimetidine tab 800 mg......................................................23cinacalcet hcl tab 30 mg (base equiv) (Sensipar).........13cinacalcet hcl tab 60 mg (base equiv) (Sensipar).........13cinacalcet hcl tab 90 mg (base equiv) (Sensipar).........13CINRYZE – c1 esterase inhibitor (human) for iv inj 500

unit.................................................................................... 38CIPRO – ciprofloxacin for oral susp 500 mg/5ml (10%) (10

gm/100ml)...........................................................................2CIPRODEX – ciprofloxacin-dexamethasone otic susp

0.3-0.1%........................................................................... 41ciprofloxacin-dexamethasone otic susp 0.3-0.1%

(Ciprodex)........................................................................41CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg

(base equiv)....................................................................... 2ciprofloxacin hcl ophth soln 0.3% (base equivalent)

(Ciloxan).......................................................................... 40ciprofloxacin hcl tab 750 mg (base equiv).......................2

ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)..........2ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)..........2CIPRO HC – ciprofloxacin-hydrocortisone otic susp

0.2-1%.............................................................................. 41citalopram hydrobromide oral soln 10 mg/5ml............. 25citalopram hydrobromide tab 10 mg (base equiv)

(Celexa)............................................................................25citalopram hydrobromide tab 20 mg (base equiv)

(Celexa)............................................................................25citalopram hydrobromide tab 40 mg (base equiv)

(Celexa)............................................................................25CLARITHROMYCIN – clarithromycin for susp 125

mg/5ml................................................................................ 2CLARITHROMYCIN – clarithromycin for susp 250

mg/5ml................................................................................ 2clarithromycin tab er 24hr 500 mg................................... 2clarithromycin tab 250 mg (Biaxin).................................. 2clarithromycin tab 500 mg (Biaxin).................................. 2CLIMARA PRO – estradiol-levonorgestrel td patch weekly

0.045-0.015 mg/day...........................................................9clindamycin hcl cap 75 mg (Cleocin)...............................5clindamycin hcl cap 150 mg (Cleocin).............................5clindamycin hcl cap 300 mg (Cleocin).............................5clindamycin palmitate hcl for soln 75 mg/5ml (base

equiv) (Cleocin pediatric gr)...........................................5clindamycin phosphate-benzoyl peroxide gel 1-5%

(Benzaclin)...................................................................... 42clindamycin phosphate gel 1% (Cleocin-t)....................42clindamycin phosphate lotion 1% (Cleocin-t)............... 42clindamycin phosphate soln 1% (Cleocin-t)..................42clindamycin phosphate swab 1% (Cleocin-t)................ 42clindamycin phosphate vaginal cream 2%

(Cleocin).......................................................................... 24clindamycin phosph-benzoyl peroxide (refrig) gel 1.2

(1)-5% (Duac).................................................................. 42clobetasol propionate cream 0.05% (Temovate)...........42clobetasol propionate emollient base cream 0.05%

(Temovate e)................................................................... 42clobetasol propionate foam 0.05% (Olux)......................42clobetasol propionate gel 0.05% (Temovate)................ 42clobetasol propionate oint 0.05% (Temovate)...............42clobetasol propionate soln 0.05% (Temovate).............. 42CLOMIPHENE CITRATE – clomiphene citrate tab 50

mg.....................................................................................13clomipramine hcl cap 25 mg (Anafranil)........................25clomipramine hcl cap 50 mg (Anafranil)........................25clomipramine hcl cap 75 mg (Anafranil)........................25clonazepam tab 0.5 mg (Klonopin).................................34clonazepam tab 1 mg (Klonopin)....................................34clonazepam tab 2 mg (Klonopin)....................................34clonidine hcl tab 0.1 mg (Catapres)............................... 17clonidine hcl tab 0.2 mg (Catapres)............................... 17clonidine hcl tab 0.3 mg (Catapres)............................... 17clonidine td patch weekly 0.1 mg/24hr (Catapres-

tts-1)................................................................................. 17

2021


clonidine td patch weekly 0.2 mg/24hr (Catapres-tts-2)................................................................................. 17

clonidine td patch weekly 0.3 mg/24hr (Catapres-tts-3)................................................................................. 17

clopidogrel bisulfate tab 75 mg (base equiv)(Plavix).............................................................................38

clotrimazole troche 10 mg............................................... 41clozapine tab 50 mg......................................................... 26clozapine tab 200 mg....................................................... 26clozapine tab 25 mg (Clozaril).........................................26clozapine tab 100 mg (Clozaril).......................................26COAGADEX – coagulation factor x (human) for inj 250

unit.................................................................................... 38COAGADEX – coagulation factor x (human) for inj 500

unit.................................................................................... 38COARTEM – artemether-lumefantrine tab 20-120 mg........ 4codeine sulfate tab 30 mg............................................... 31colchicine w/ probenecid tab 0.5-500 mg...................... 34colesevelam hcl packet for susp 3.75 gm

(Welchol)..........................................................................19colesevelam hcl tab 625 mg (Welchol).......................... 19colestipol hcl granule packets 5 gm (Colestid

flavored)...........................................................................19colestipol hcl granules 5 gm (Colestid flavored).......... 19colestipol hcl tab 1 gm (Colestid)...................................19COMBIVENT RESPIMAT – ipratropium-albuterol inhal

aerosol soln 20-100 mcg/act...........................................21COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60

mg dose) kit....................................................................... 6COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20

mg (100 dose) kit...............................................................6COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20

mg (140 dose) kit...............................................................6CONCERTA – methylphenidate hcl tab er osmotic release

(osm) 18 mg.....................................................................28CONCERTA – methylphenidate hcl tab er osmotic release



(osm) 54 mg.....................................................................29COPAXONE – glatiramer acetate soln prefilled syringe 20

mg/ml................................................................................ 30COPAXONE – glatiramer acetate soln prefilled syringe 40

mg/ml................................................................................ 30CORIFACT – factor xiii concentrate (human) for inj kit

1000-1600 unit................................................................. 38CORLANOR – ivabradine hcl oral soln 5 mg/5ml (base

equiv)................................................................................ 20CORLANOR – ivabradine hcl tab 5 mg (base equiv).........20CORLANOR – ivabradine hcl tab 7.5 mg (base equiv)......20CORTIFOAM – hydrocortisone acetate perianal foam 10%

(90 mg/dose)....................................................................41CORTISONE ACETATE – cortisone acetate tab 25 mg...... 8COSENTYX – secukinumab subcutaneous pref syr 150

mg/ml (300 mg dose)...................................................... 42

COSENTYX – secukinumab subcutaneous soln prefilledsyringe 150 mg/ml........................................................... 42

COSENTYX SENSOREADY PEN – secukinumabsubcutaneous auto-inj 150 mg/ml (300 mg dose)...........42

COSENTYX SENSOREADY PEN – secukinumabsubcutaneous soln auto-injector 150 mg/ml................... 42

COTELLIC – cobimetinib fumarate tab 20 mg (baseequivalent).......................................................................... 6

CREON – pancrelipase (lip-prot-amyl) dr cap3000-9500-15000 unit......................................................23

CREON – pancrelipase (lip-prot-amyl) dr cap6000-19000-30000 unit....................................................23

CREON – pancrelipase (lip-prot-amyl) dr cap12000-38000-60000 unit..................................................23

CREON – pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit................................................23

CREON – pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit..............................................23

cromolyn sodium ophth soln 4%....................................40cromolyn sodium soln nebu 20 mg/2ml........................ 21cyanocobalamin inj 1000 mcg/ml................................... 37cyclobenzaprine hcl tab 5 mg.........................................36cyclobenzaprine hcl tab 10 mg.......................................36cyclopentolate hcl ophth soln 1% (Cyclogyl)................40cyclophosphamide cap 25 mg (Cyclophosphamide)..... 6cyclophosphamide cap 50 mg (Cyclophosphamide)..... 6cyclosporine cap 25 mg (Sandimmune)........................ 44cyclosporine cap 100 mg (Sandimmune)...................... 44cyclosporine modified cap 50 mg (Cyclosporine

modifie)............................................................................44cyclosporine modified cap 25 mg (Neoral)....................44cyclosporine modified cap 100 mg (Neoral)..................44cyclosporine modified oral soln 100 mg/ml

(Neoral)............................................................................ 44cyproheptadine hcl syrup 2 mg/5ml...............................20cyproheptadine hcl tab 4 mg.......................................... 20CYSTADANE – betaine powder for oral solution...............13CYSTAGON – cysteamine bitartrate cap 50 mg................24CYSTAGON – cysteamine bitartrate cap 150 mg..............24

Ddanazol cap 50 mg..............................................................9danazol cap 100 mg............................................................9danazol cap 200 mg............................................................9dantrolene sodium cap 25 mg (Dantrium)..................... 36dantrolene sodium cap 50 mg (Dantrium)..................... 36dantrolene sodium cap 100 mg (Dantrolene

sodium)............................................................................36dapsone tab 25 mg.............................................................5dapsone tab 100 mg...........................................................5DELSTRIGO – doravirine-lamivudine-tenofovir df tab

100-300-300 mg.................................................................3demeclocycline hcl tab 150 mg........................................ 2demeclocycline hcl tab 300 mg........................................ 2DESCOVY – emtricitabine-tenofovir alafenamide fumarate

tab 200-25 mg....................................................................3

2021


desipramine hcl tab 10 mg (Norpramin)........................ 25desipramine hcl tab 25 mg (Norpramin)........................ 25desipramine hcl tab 50 mg (Norpramin)........................ 25desipramine hcl tab 75 mg (Norpramin)........................ 25desipramine hcl tab 100 mg (Norpramin)...................... 25desipramine hcl tab 150 mg (Norpramin)...................... 25DESLORATADINE ODT – desloratadine tab orally

disintegrating 2.5 mg....................................................... 20DESLORATADINE ODT – desloratadine tab orally

disintegrating 5 mg.......................................................... 20desloratadine tab 5 mg (Clarinex).................................. 20desmopressin acetate nasal spray soln 0.01%

(Ddavp)............................................................................ 13desmopressin acetate nasal spray soln 0.01%

(refrigerated)................................................................... 13desmopressin acetate tab 0.1 mg (Ddavp)....................13desmopressin acetate tab 0.2 mg (Ddavp)....................13desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5) (Mircette).........................................................10desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg(Cyclessa)........................................................................10

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg(Desogen)........................................................................ 10

desonide cream 0.05% (Desowen)................................. 42desonide lotion 0.05% (Desowen).................................. 42desonide oint 0.05% (Desowen)......................................42desoximetasone cream 0.25% (Topicort).......................42desoximetasone oint 0.25% (Topicort)...........................42desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) (Pristiq)................................................................25desvenlafaxine succinate tab er 24hr 50 mg (base

equiv) (Pristiq)................................................................25desvenlafaxine succinate tab er 24hr 100 mg (base

equiv) (Pristiq)................................................................25DEXAMETHASONE – dexamethasone soln 0.5

mg/5ml................................................................................ 8DEXAMETHASONE – dexamethasone tab 1 mg................8DEXAMETHASONE – dexamethasone tab 2 mg................8dexamethasone elixir 0.5 mg/5ml..................................... 8DEXAMETHASONE INTENSOL – dexamethasone conc 1

mg/ml.................................................................................. 8DEXAMETHASONE SODIUM PHOS – dexamethasone

sodium phosphate ophth soln 0.1%................................40dexamethasone tab 0.5 mg............................................... 8dexamethasone tab 0.75 mg............................................. 8dexamethasone tab 1.5 mg............................................... 8dexamethasone tab 4 mg.................................................. 8dexamethasone tab 6 mg.................................................. 8DEXCOM G5/G6 RECEIVER/SENSOR/TRANSMITTER –

continuous blood glucose system................................... 43dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin

xr)..................................................................................... 29dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin

xr)..................................................................................... 29

dexmethylphenidate hcl cap er 24 hr 15 mg (Focalinxr)..................................................................................... 29






dexmethylphenidate hcl tab 2.5 mg (Focalin)............... 29dexmethylphenidate hcl tab 5 mg (Focalin).................. 29dexmethylphenidate hcl tab 10 mg (Focalin)................ 29dextroamphetamine sulfate cap er 24hr 5 mg

(Dexedrine)......................................................................29dextroamphetamine sulfate cap er 24hr 10 mg

(Dexedrine)......................................................................29dextroamphetamine sulfate cap er 24hr 15 mg

(Dexedrine)......................................................................29dextroamphetamine sulfate tab 5 mg.............................29dextroamphetamine sulfate tab 10 mg...........................29DIASTAT ACUDIAL – diazepam rectal gel delivery system

10 mg............................................................................... 34DIASTAT ACUDIAL – diazepam rectal gel delivery system

20 mg............................................................................... 34DIASTAT PEDIATRIC – diazepam rectal gel delivery

system 2.5 mg................................................................. 34DIAZEPAM – diazepam oral soln 1 mg/ml.........................25diazepam tab 2 mg (Valium)............................................25diazepam tab 5 mg (Valium)............................................25diazepam tab 10 mg (Valium)..........................................25diazoxide susp 50 mg/ml (Proglycem)...........................11diclofenac potassium tab 50 mg (Cataflam)..................32diclofenac sodium (actinic keratoses) gel 3%

(Solaraze)........................................................................ 42diclofenac sodium ophth soln 0.1%...............................40diclofenac sodium tab delayed release 25 mg..............32diclofenac sodium tab delayed release 50 mg..............32diclofenac sodium tab delayed release 75 mg..............32dicloxacillin sodium cap 250 mg...................................... 1dicloxacillin sodium cap 500 mg...................................... 1dicyclomine hcl cap 10 mg (Bentyl)...............................23dicyclomine hcl oral soln 10 mg/5ml............................. 23dicyclomine hcl tab 20 mg (Bentyl)................................23DIDANOSINE – didanosine delayed release capsule 200

mg....................................................................................... 3DIDANOSINE – didanosine delayed release capsule 250

mg....................................................................................... 3DIDANOSINE – didanosine delayed release capsule 400

mg....................................................................................... 3DIFFERIN – adapalene lotion 0.1%...................................42digoxin oral soln 0.05 mg/ml (Digoxin).......................... 14digoxin tab 125 mcg (0.125 mg) (Lanoxin).................... 14digoxin tab 250 mcg (0.25 mg) (Lanoxin)...................... 14

2021


dihydroergotamine mesylate inj 1 mg/ml (D.h.e.45).....................................................................................33

dihydroergotamine mesylate nasal spray 4 mg/ml(Migranal)........................................................................ 33

DILANTIN – phenytoin sodium extended cap 30 mg.........34DILANTIN – phenytoin sodium extended cap 100 mg.......34DILANTIN-125 – phenytoin susp 125 mg/5ml................... 34diltiazem hcl cap er 24hr 120 mg....................................15diltiazem hcl cap er 24hr 180 mg....................................15diltiazem hcl cap er 24hr 240 mg....................................15diltiazem hcl coated beads cap er 24hr 300 mg............15diltiazem hcl coated beads cap er 24hr 120 mg

(Cardizem cd)................................................................. 15diltiazem hcl coated beads cap er 24hr 180 mg



(Cardizem cd)................................................................. 15diltiazem hcl extended release beads cap er 24hr 120

mg (Tiazac)..................................................................... 15diltiazem hcl extended release beads cap er 24hr 180





mg (Tiazac)..................................................................... 15diltiazem hcl tab 90 mg....................................................16diltiazem hcl tab 30 mg (Cardizem)................................16diltiazem hcl tab 60 mg (Cardizem)................................16diltiazem hcl tab 120 mg (Cardizem)..............................16dimethyl fumarate capsule delayed release 120 mg

(Tecfidera)....................................................................... 30dimethyl fumarate capsule delayed release 240 mg

(Tecfidera)....................................................................... 30dimethyl fumarate capsule dr starter pack 120 mg &

240 mg (Tecfidera starter pa)....................................... 30DIPHENOXYLATE/ATROPINE – diphenoxylate w/

atropine liq 2.5-0.025 mg/5ml..........................................23diphenoxylate w/ atropine tab 2.5-0.025 mg

(Lomotil).......................................................................... 23dipyridamole tab 25 mg (Persantine)............................. 38dipyridamole tab 50 mg (Persantine)............................. 39dipyridamole tab 75 mg (Persantine)............................. 39disopyramide phosphate cap 100 mg (Norpace).......... 16disopyramide phosphate cap 150 mg (Norpace).......... 16disulfiram tab 250 mg (Antabuse).................................. 30disulfiram tab 500 mg (Antabuse).................................. 30divalproex sodium cap delayed release sprinkle 125

mg (Depakote sprinkles)...............................................34divalproex sodium tab delayed release 125 mg

(Depakote)....................................................................... 34

divalproex sodium tab delayed release 250 mg(Depakote)....................................................................... 34

divalproex sodium tab delayed release 500 mg(Depakote)....................................................................... 34

divalproex sodium tab er 24 hr 250 mg (Depakoteer)..................................................................................... 34

divalproex sodium tab er 24 hr 500 mg (Depakoteer)..................................................................................... 34

DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%).............9DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%).................9DIVIGEL – estradiol td gel 0.75 mg/0.75gm (0.1%).............9DIVIGEL – estradiol td gel 1 mg/gm (0.1%).........................9DIVIGEL – estradiol td gel 1.25 mg/1.25gm (0.1%).............9donepezil hydrochloride orally disintegrating tab 5 mg

(Aricept odt)....................................................................30donepezil hydrochloride orally disintegrating tab 10

mg (Aricept odt).............................................................30donepezil hydrochloride tab 5 mg (Aricept)..................30donepezil hydrochloride tab 10 mg (Aricept)................30dorzolamide hcl ophth soln 2% (Trusopt)..................... 40dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml (Cosopt)...............................................................40DOVATO – dolutegravir sodium-lamivudine tab 50-300 mg

(base eq)............................................................................ 3doxazosin mesylate tab 1 mg (Cardura)........................17doxazosin mesylate tab 2 mg (Cardura)........................17doxazosin mesylate tab 4 mg (Cardura)........................17doxazosin mesylate tab 8 mg (Cardura)........................17doxepin hcl cap 10 mg.....................................................25doxepin hcl cap 25 mg.....................................................25doxepin hcl cap 50 mg.....................................................25doxepin hcl cap 75 mg.....................................................25doxepin hcl cap 100 mg...................................................25doxepin hcl conc 10 mg/ml............................................. 25doxycycline hyclate cap 50 mg.........................................2doxycycline hyclate cap 100 mg (Vibramycin)................2doxycycline hyclate tab 20 mg......................................... 2doxycycline hyclate tab 100 mg....................................... 2doxycycline monohydrate cap 50 mg.............................. 2doxycycline monohydrate cap 100 mg (Monodox).........2doxycycline monohydrate tab 50 mg (Adoxa)................ 2doxycycline monohydrate tab 75 mg (Adoxa)................ 2doxycycline monohydrate tab 100 mg (Adoxa pak

1/100)..................................................................................2doxycycline monohydrate tab 150 mg (Adoxa pak

1/150)..................................................................................2drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin

28).....................................................................................10drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz)......10DUAVEE – conjugated estrogens-bazedoxifene tab

0.45-20 mg......................................................................... 9DULERA – mometasone furoate-formoterol fumarate

aerosol 50-5 mcg/act.......................................................21DULERA – mometasone furoate-formoterol fumarate

aerosol 100-5 mcg/act.....................................................21

2021


DULERA – mometasone furoate-formoterol fumarateaerosol 200-5 mcg/act.....................................................21

duloxetine hcl enteric coated pellets cap 20 mg (baseeq) (Cymbalta)................................................................ 25



dutasteride cap 0.5 mg (Avodart)................................... 24

Eeconazole nitrate cream 1%............................................ 42efavirenz cap 50 mg (Sustiva)...........................................3efavirenz cap 200 mg (Sustiva).........................................3efavirenz-emtricitabine-tenofovir df tab 600-200-300

mg (Atripla)....................................................................... 3efavirenz-lamivudine-tenofovir df tab 600-300-300 mg

(Symfi)................................................................................3efavirenz-lamivudine-tenofovir df tab 400-300-300 mg

(Symfi lo)...........................................................................3efavirenz tab 600 mg (Sustiva)..........................................3eletriptan hydrobromide tab 20 mg (base equivalent)

(Relpax)............................................................................33eletriptan hydrobromide tab 40 mg (base equivalent)

(Relpax)............................................................................33ELIQUIS – apixaban tab 2.5 mg........................................ 38ELIQUIS – apixaban tab 5 mg........................................... 38ELIQUIS STARTER PACK – apixaban tab starter pack 5

mg.....................................................................................38ELLA – ulipristal acetate tab 30 mg...................................10ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for

inj 250 unit....................................................................... 39ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for



inj 1000 unit..................................................................... 39ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for






inj 6000 unit..................................................................... 39EMCYT – estramustine phosphate sodium cap 140 mg......6EMEND – aprepitant for oral susp 125 mg (125

mg/5ml).............................................................................23EMGALITY – galcanezumab-gnlm subcutaneous soln

auto-injector 120 mg/ml...................................................33

EMGALITY – galcanezumab-gnlm subcutaneous solnprefilled syr 100 mg/ml.................................................... 33

EMGALITY – galcanezumab-gnlm subcutaneous solnprefilled syr 120 mg/ml.................................................... 33

enalapril maleate & hydrochlorothiazide tab 5-12.5mg.....................................................................................17

enalapril maleate & hydrochlorothiazide tab 10-25 mg(Vaseretic)....................................................................... 17

enalapril maleate tab 2.5 mg (Vasotec)..........................17enalapril maleate tab 5 mg (Vasotec).............................17enalapril maleate tab 10 mg (Vasotec)...........................17enalapril maleate tab 20 mg (Vasotec)...........................17ENBREL – etanercept for subcutaneous inj 25 mg........... 32ENBREL – etanercept subcutaneous inj 25 mg/0.5ml.......32ENBREL – etanercept subcutaneous soln prefilled syringe

25 mg/0.5ml..................................................................... 32ENBREL – etanercept subcutaneous soln prefilled syringe

50 mg/ml...........................................................................32ENBREL MINI – etanercept subcutaneous solution

cartridge 50 mg/ml...........................................................32ENBREL SURECLICK – etanercept subcutaneous

solution auto-injector 50 mg/ml....................................... 32ENDOMETRIN – progesterone vaginal insert 100 mg...... 24enoxaparin sodium inj 30 mg/0.3ml (Lovenox)............. 38enoxaparin sodium inj 40 mg/0.4ml (Lovenox)............. 38enoxaparin sodium inj 60 mg/0.6ml (Lovenox)............. 38enoxaparin sodium inj 80 mg/0.8ml (Lovenox)............. 38enoxaparin sodium inj 100 mg/ml (Lovenox)................ 38enoxaparin sodium inj 120 mg/0.8ml (Lovenox)........... 38enoxaparin sodium inj 150 mg/ml (Lovenox)................ 38enoxaparin sodium inj 300 mg/3ml (Lovenox).............. 38ENSTILAR – calcipotriene-betamethasone dipropionate

foam 0.005-0.064%..........................................................42entacapone tab 200 mg (Comtan)...................................35entecavir tab 0.5 mg (Baraclude)......................................3entecavir tab 1 mg (Baraclude).........................................3ENTRESTO – sacubitril-valsartan tab 24-26 mg............... 20ENTRESTO – sacubitril-valsartan tab 49-51 mg............... 20ENTRESTO – sacubitril-valsartan tab 97-103 mg............. 20EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg........... 3EPIDIOLEX – cannabidiol soln 100 mg/ml........................ 34EPIDUO FORTE – adapalene-benzoyl peroxide gel

0.3-2.5%........................................................................... 42epinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000) (Epipen-jr 2-pak)............................................. 19epinephrine solution auto-injector 0.3 mg/0.3ml

(1:1000) (Epipen 2-pak)................................................. 19EPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv)..............3eplerenone tab 25 mg (Inspra)........................................17eplerenone tab 50 mg (Inspra)........................................17ergocalciferol cap 1.25 mg (50000 unit) (Drisdol).........36ERIVEDGE – vismodegib cap 150 mg................................ 6ERLEADA – apalutamide tab 60 mg....................................6erlotinib hcl tab 25 mg (base equivalent) (Tarceva)........6erlotinib hcl tab 100 mg (base equivalent) (Tarceva)......6erlotinib hcl tab 150 mg (base equivalent) (Tarceva)......6

2021


ERY – erythromycin pads 2%............................................ 42erythromycin gel 2% (Erygel)..........................................42erythromycin ophth oint 5 mg/gm..................................40erythromycin soln 2%...................................................... 42escitalopram oxalate soln 5 mg/5ml (base equiv)

(Lexapro)......................................................................... 26escitalopram oxalate tab 5 mg (base equiv)



(Lexapro)......................................................................... 26esomeprazole magnesium cap delayed release 20 mg

(base eq) (Nexium)........................................................ 23esomeprazole magnesium cap delayed release 40 mg

(base eq) (Nexium)........................................................ 23esomeprazole magnesium for delayed release susp

packet 10 mg (Nexium)................................................. 23esomeprazole magnesium for delayed release susp

packet 20 mg (Nexium)................................................. 23esomeprazole magnesium for delayed release susp

packet 40 mg (Nexium)................................................. 23ESPEROCT – antihemophilic factor recomb glycopeg-exei

for inj 500 unit..................................................................39ESPEROCT – antihemophilic factor recomb glycopeg-exei

for inj 1000 unit................................................................39ESPEROCT – antihemophilic factor recomb glycopeg-exei



for inj 3000 unit................................................................39estazolam tab 1 mg.......................................................... 28estazolam tab 2 mg.......................................................... 28estradiol & norethindrone acetate tab 0.5-0.1 mg

(Activella)...........................................................................9estradiol & norethindrone acetate tab 1-0.5 mg

(Activella)...........................................................................9estradiol tab 0.5 mg (Estrace)...........................................9estradiol tab 1 mg (Estrace)..............................................9estradiol tab 2 mg (Estrace)..............................................9estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch twice weekly 0.0375 mg/24hr

(Vivelle-dot)....................................................................... 9estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-

dot)..................................................................................... 9estradiol td patch weekly 0.025 mg/24hr (Climara).........9estradiol td patch weekly 0.05 mg/24hr (Climara)...........9estradiol td patch weekly 0.06 mg/24hr (Climara)...........9estradiol td patch weekly 0.075 mg/24hr (Climara).........9estradiol td patch weekly 0.1 mg/24hr (Climara).............9

estradiol td patch weekly 0.0375 mg/24hr (37.5mcg/24hr) (Climara)......................................................... 9

estradiol vaginal cream 0.1 mg/gm (Estrace)................24ESTROGEL – estradiol gel 0.06% (0.75 mg/1.25 gm

metered-dose pump)..........................................................9eszopiclone tab 1 mg (Lunesta)......................................28eszopiclone tab 2 mg (Lunesta)......................................28eszopiclone tab 3 mg (Lunesta)......................................28ethambutol hcl tab 100 mg (Myambutol)......................... 2ethambutol hcl tab 400 mg (Myambutol)......................... 2ethosuximide cap 250 mg (Zarontin)..............................34ethosuximide soln 250 mg/5ml (Zarontin)..................... 34ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg...................................................................................10ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg (Zovia 1/50e).......................................................... 10etodolac cap 200 mg........................................................ 32etodolac cap 300 mg........................................................ 32etodolac tab er 24hr 400 mg........................................... 32etodolac tab er 24hr 500 mg........................................... 32etodolac tab er 24hr 600 mg........................................... 32etodolac tab 400 mg.........................................................32etodolac tab 500 mg.........................................................32ETOPOSIDE – etoposide cap 50 mg...................................6EUFLEXXA – sodium hyaluronate intra-articular soln pref

syr 20 mg/2ml.................................................................. 36everolimus tab 2.5 mg (Afinitor)....................................... 6everolimus tab 5 mg (Afinitor).......................................... 6everolimus tab 7.5 mg (Afinitor)....................................... 6everolimus tab 0.25 mg (Zortress)..................................44everolimus tab 0.5 mg (Zortress)....................................44everolimus tab 0.75 mg (Zortress)..................................44EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg

(base equiv)....................................................................... 3exemestane tab 25 mg (Aromasin)...................................6ezetimibe-simvastatin tab 10-10 mg (Vytorin)...............19ezetimibe-simvastatin tab 10-20 mg (Vytorin)...............19ezetimibe-simvastatin tab 10-40 mg (Vytorin)...............20ezetimibe-simvastatin tab 10-80 mg (Vytorin)...............20ezetimibe tab 10 mg (Zetia)............................................. 19

Ffamciclovir tab 125 mg (Famvir)....................................... 3famciclovir tab 250 mg (Famvir)....................................... 3famciclovir tab 500 mg (Famvir)....................................... 3famotidine for susp 40 mg/5ml....................................... 23famotidine tab 20 mg (Pepcid)........................................23famotidine tab 40 mg (Pepcid)........................................23FARXIGA – dapagliflozin propanediol tab 5 mg (base

equivalent)........................................................................ 11FARXIGA – dapagliflozin propanediol tab 10 mg (base

equivalent)........................................................................ 11FARYDAK – panobinostat lactate cap 10 mg (base

equivalent).......................................................................... 6FARYDAK – panobinostat lactate cap 20 mg (base

equivalent).......................................................................... 6

2021


FEIBA – antiinhibitor coagulant complex for iv soln 500unit.................................................................................... 39



felodipine tab er 24hr 2.5 mg.......................................... 16felodipine tab er 24hr 5 mg............................................. 16felodipine tab er 24hr 10 mg........................................... 16fenofibrate micronized cap 67 mg (Lofibra).................. 20fenofibrate micronized cap 134 mg (Lofibra)................ 20fenofibrate micronized cap 200 mg (Lofibra)................ 20fenofibrate tab 54 mg (Lofibra)....................................... 20fenofibrate tab 160 mg (Lofibra)..................................... 20fenofibrate tab 48 mg (Tricor)......................................... 20fenofibrate tab 145 mg (Tricor)....................................... 20fentanyl citrate lozenge on a handle 200 mcg

(Actiq).............................................................................. 31fentanyl citrate lozenge on a handle 400 mcg





(Actiq).............................................................................. 31fentanyl td patch 72hr 12 mcg/hr (Duragesic)...............31fentanyl td patch 72hr 25 mcg/hr (Duragesic)...............31fentanyl td patch 72hr 50 mcg/hr (Duragesic)...............31fentanyl td patch 72hr 75 mcg/hr (Duragesic)...............31fentanyl td patch 72hr 100 mcg/hr (Duragesic).............31FIASP FLEXTOUCH – insulin aspart (with niacinamide)

sol pen-inj 100 unit/ml..................................................... 12FIASP – insulin aspart (with niacinamide) inj 100 unit/

ml...................................................................................... 12FIASP PENFILL – insulin aspart (with niacinamide) soln

cartridge 100 unit/ml........................................................ 12FINACEA – azelaic acid foam 15%................................... 42finasteride tab 5 mg (Proscar)........................................ 24flecainide acetate tab 50 mg........................................... 16flecainide acetate tab 100 mg......................................... 16flecainide acetate tab 150 mg......................................... 16FLOVENT DISKUS – fluticasone propionate aer pow ba

50 mcg/blister...................................................................21FLOVENT DISKUS – fluticasone propionate aer pow ba

100 mcg/blister.................................................................22FLOVENT DISKUS – fluticasone propionate aer pow ba

250 mcg/blister.................................................................22FLOVENT HFA – fluticasone propionate hfa inhal aer 110

mcg/act (125/valve)..........................................................22FLOVENT HFA – fluticasone propionate hfa inhal aer 220

mcg/act (250/valve)..........................................................22FLOVENT HFA – fluticasone propionate hfa inhal aero 44

mcg/act (50/valve)............................................................22

fluconazole for susp 10 mg/ml (Diflucan)........................2fluconazole for susp 40 mg/ml (Diflucan)........................2fluconazole tab 50 mg (Diflucan)......................................2fluconazole tab 100 mg (Diflucan)....................................2fluconazole tab 150 mg (Diflucan)....................................2fluconazole tab 200 mg (Diflucan)....................................2flucytosine cap 250 mg (Ancobon)...................................2flucytosine cap 500 mg (Ancobon)...................................2fludrocortisone acetate tab 0.1 mg...................................8FLUNISOLIDE – flunisolide nasal soln 25 mcg/act

(0.025%)........................................................................... 21fluocinolone acetonide cream 0.01%............................. 42fluocinolone acetonide cream 0.025% (Synalar)...........42fluocinolone acetonide oil 0.01% (body oil) (Derma-

smoothe/fs bod)............................................................. 42fluocinolone acetonide oil 0.01% (scalp oil) (Derma-

smoothe/fs sca)..............................................................42fluocinolone acetonide oint 0.025% (Synalar)...............42fluocinolone acetonide soln 0.01% (Synalar)................42fluocinonide cream 0.05%............................................... 42fluocinonide emulsified base cream 0.05%...................42fluocinonide gel 0.05%.....................................................42fluocinonide oint 0.05%....................................................42fluocinonide soln 0.05%...................................................42fluorometholone ophth susp 0.1% (Fml liquifilm)........ 40FLUOROPLEX – fluorouracil cream 1%............................ 42fluorouracil cream 5% (Efudex)...................................... 42FLUOROURACIL – fluorouracil soln 2%........................... 42FLUOROURACIL – fluorouracil soln 5%........................... 42fluoxetine hcl cap 10 mg (Prozac)..................................26fluoxetine hcl cap 20 mg (Prozac)..................................26fluoxetine hcl cap 40 mg (Prozac)..................................26fluoxetine hcl solution 20 mg/5ml.................................. 26fluphenazine decanoate inj 25 mg/ml.............................26FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/

ml...................................................................................... 26fluphenazine hcl tab 1 mg............................................... 26fluphenazine hcl tab 2.5 mg............................................ 26fluphenazine hcl tab 5 mg............................................... 26fluphenazine hcl tab 10 mg............................................. 26FLUPHENAZINE HYDROCHLORID – fluphenazine hcl

elixir 2.5 mg/5ml...............................................................26FLURA-DROPS – sodium fluoride soln 0.25 mg/drop f

(from 0.55 mg/drop naf).................................................. 36FLURBIPROFEN – flurbiprofen tab 50 mg........................ 32FLURBIPROFEN SODIUM – flurbiprofen sodium ophth

soln 0.03%....................................................................... 40flurbiprofen tab 100 mg................................................... 32flutamide cap 125 mg.........................................................6FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 55-14 mcg/act....................... 22FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 113-14 mcg/act......................22FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 232-14 mcg/act..................... 22fluticasone propionate cream 0.05% (Cutivate)............ 42

2021


fluticasone propionate nasal susp 50 mcg/act(Flonase)..........................................................................21

fluticasone propionate oint 0.005% (Cutivate).............. 42fluvoxamine maleate tab 25 mg......................................26fluvoxamine maleate tab 50 mg......................................26fluvoxamine maleate tab 100 mg....................................26folic acid tab 1 mg............................................................37FOLLISTIM AQ – follitropin beta inj 300 unit/0.36ml..........13FOLLISTIM AQ – follitropin beta inj 600 unit/0.72ml..........13FOLLISTIM AQ – follitropin beta inj 900 unit/1.08ml..........13fosaprepitant dimeglumine for iv infusion 150 mg

(base eq) (Emend)......................................................... 23fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg.....................................................................................17fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg.....................................................................................17fosinopril sodium tab 10 mg........................................... 17fosinopril sodium tab 20 mg........................................... 17fosinopril sodium tab 40 mg........................................... 17FREESTYLE LIBRE/2, 14 READER/SENSOR/FLASH –

continuous blood glucose system................................... 43FULPHILA – pegfilgrastim-jmdb soln prefilled syringe 6

mg/0.6ml...........................................................................37furosemide oral soln 10 mg/ml....................................... 19furosemide tab 20 mg (Lasix)......................................... 19furosemide tab 40 mg (Lasix)......................................... 19furosemide tab 80 mg (Lasix)......................................... 19

Ggabapentin cap 100 mg (Neurontin)...............................34gabapentin cap 300 mg (Neurontin)...............................34gabapentin cap 400 mg (Neurontin)...............................34gabapentin oral soln 250 mg/5ml (Neurontin)...............34gabapentin tab 600 mg (Neurontin)................................34gabapentin tab 800 mg (Neurontin)................................34galantamine hydrobromide cap er 24hr 8 mg

(Razadyne er)..................................................................30galantamine hydrobromide cap er 24hr 16 mg

(Razadyne er)..................................................................30galantamine hydrobromide cap er 24hr 24 mg

(Razadyne er)..................................................................30GALANTAMINE HYDROBROMIDE – galantamine

hydrobromide oral soln 4 mg/ml......................................30galantamine hydrobromide tab 4 mg (Razadyne).........30galantamine hydrobromide tab 8 mg (Razadyne).........30galantamine hydrobromide tab 12 mg (Razadyne).......30ganirelix acetate soln prefilled syringe 250 mcg/0.5ml

(Ganirelix acetate)..........................................................13GAVILYTE-C – peg 3350-kcl-na bicarb-nacl-na sulfate for

soln 240 gm..................................................................... 22gemfibrozil tab 600 mg (Lopid).......................................20GENTAK – gentamicin sulfate ophth oint 0.3%................. 40gentamicin sulfate cream 0.1%.......................................42gentamicin sulfate oint 0.1%...........................................42gentamicin sulfate ophth soln 0.3% (Garamycin).........40

GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg........................................................... 3

GILENYA – fingolimod hcl cap 0.5 mg (base equiv)..........30GILOTRIF – afatinib dimaleate tab 20 mg (base

equivalent).......................................................................... 6GILOTRIF – afatinib dimaleate tab 30 mg (base

equivalent).......................................................................... 6GILOTRIF – afatinib dimaleate tab 40 mg (base

equivalent).......................................................................... 6glatiramer acetate soln prefilled syringe 20 mg/ml

(Copaxone)......................................................................30glatiramer acetate soln prefilled syringe 40 mg/ml

(Copaxone)......................................................................30GLEOSTINE – lomustine cap 10 mg................................... 6GLEOSTINE – lomustine cap 40 mg................................... 6GLEOSTINE – lomustine cap 100 mg................................. 6glimepiride tab 1 mg (Amaryl).........................................11glimepiride tab 2 mg (Amaryl).........................................11glimepiride tab 4 mg (Amaryl).........................................11glipizide-metformin hcl tab 2.5-250 mg..........................11glipizide-metformin hcl tab 2.5-500 mg..........................11glipizide-metformin hcl tab 5-500 mg.............................11glipizide tab er 24hr 2.5 mg (Glucotrol xl)..................... 11glipizide tab er 24hr 5 mg (Glucotrol xl)........................ 11glipizide tab er 24hr 10 mg (Glucotrol xl)...................... 11glipizide tab 5 mg (Glucotrol)..........................................11glipizide tab 10 mg (Glucotrol)........................................11GLUCAGON EMERGENCY KIT FO – glucagon hcl for inj

1 mg................................................................................. 11GLUCAGON EMERGENCY KIT – glucagon (rdna) for inj

kit 1 mg............................................................................ 11glyburide-metformin tab 1.25-250 mg

(Glucovance)...................................................................11glyburide-metformin tab 2.5-500 mg (Glucovance)...... 11glyburide-metformin tab 5-500 mg (Glucovance)......... 11glyburide micronized tab 1.5 mg (Glynase)...................11glyburide micronized tab 3 mg (Glynase)......................11glyburide micronized tab 6 mg (Glynase)......................11glyburide tab 1.25 mg.......................................................11glyburide tab 2.5 mg.........................................................11glyburide tab 5 mg............................................................11glycopyrrolate tab 1 mg (Robinul)..................................23glycopyrrolate tab 2 mg (Robinul forte).........................23GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg........... 11GLYXAMBI – empagliflozin-linagliptin tab 25-5 mg........... 11granisetron hcl tab 1 mg................................................. 23GRANIX – tbo-filgrastim soln prefilled syringe 300

mcg/0.5ml......................................................................... 37GRANIX – tbo-filgrastim soln prefilled syringe 480

mcg/0.8ml......................................................................... 37GRANIX – tbo-filgrastim subcutaneous inj 300 mcg/ml.....37GRANIX – tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml).................................................................... 37griseofulvin microsize susp 125 mg/5ml......................... 2griseofulvin microsize tab 500 mg (Grifulvin v)..............2

2021


guanfacine hcl tab er 24hr 1 mg (base equiv)(Intuniv)............................................................................29




guanfacine hcl tab 1 mg (Tenex).................................... 17guanfacine hcl tab 2 mg (Tenex).................................... 17GVOKE HYPOPEN 1-PACK – glucagon subcutaneous

solution auto-injector 0.5 mg/0.1ml................................. 11GVOKE HYPOPEN 1-PACK – glucagon subcutaneous

solution auto-injector 1 mg/0.2ml.................................... 11GVOKE HYPOPEN 2-PACK – glucagon subcutaneous

solution auto-injector 0.5 mg/0.1ml................................. 11GVOKE HYPOPEN 2-PACK – glucagon subcutaneous

solution auto-injector 1 mg/0.2ml.................................... 11GVOKE PFS – glucagon subcutaneous soln pref syringe

0.5 mg/0.1ml.................................................................... 11GVOKE PFS – glucagon subcutaneous soln pref syringe 1

mg/0.2ml...........................................................................11

HHAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 2000 unit............................................. 39HAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 3000 unit............................................. 39halobetasol propionate cream 0.05% (Ultravate)..........42halobetasol propionate oint 0.05% (Ultravate)..............42haloperidol decanoate im soln 50 mg/ml (Haldol

decanoate 50)................................................................. 26haloperidol decanoate im soln 100 mg/ml (Haldol

decanoate 100)............................................................... 27haloperidol lactate oral conc 2 mg/ml............................27haloperidol tab 0.5 mg..................................................... 27haloperidol tab 1 mg........................................................ 27haloperidol tab 2 mg........................................................ 27haloperidol tab 5 mg........................................................ 27haloperidol tab 10 mg...................................................... 27haloperidol tab 20 mg...................................................... 27HARVONI – ledipasvir-sofosbuvir pellet pack 33.75-150

mg....................................................................................... 3HARVONI – ledipasvir-sofosbuvir pellet pack 45-200

mg....................................................................................... 3HARVONI – ledipasvir-sofosbuvir tab 45-200 mg................3HARVONI – ledipasvir-sofosbuvir tab 90-400 mg................3HUMATE-P – antihemophilic factor/vwf (human) for inj

250-600 unit..................................................................... 39HUMATE-P – antihemophilic factor/vwf (human) for inj

500-1200 unit................................................................... 39HUMATE-P – antihemophilic factor/vwf (human) for inj

1000-2400 unit................................................................. 39HUMIRA – adalimumab prefilled syringe kit 10

mg/0.1ml...........................................................................32

HUMIRA – adalimumab prefilled syringe kit 10mg/0.2ml...........................................................................32





HUMIRA PEDIATRIC CROHNS D – adalimumab prefilledsyringe kit 80 mg/0.8ml................................................... 32

HUMIRA PEDIATRIC CROHNS D – adalimumab prefilledsyringe kit 80 mg/0.8ml & 40 mg/0.4ml.......................... 32

HUMIRA PEN – adalimumab pen-injector kit 40mg/0.8ml...........................................................................32

HUMIRA PEN – adalimumab pen-injector kit 40mg/0.4ml...........................................................................32

HUMIRA PEN-CD/UC/HS START – adalimumab pen-injector kit 40 mg/0.8ml................................................... 32

HUMIRA PEN-CD/UC/HS START – adalimumab pen-injector kit 80 mg/0.8ml................................................... 32

HUMIRA PEN-PS/UV STARTER – adalimumab pen-injector kit 40 mg/0.8ml................................................... 33

HUMIRA PEN-PS/UV STARTER – adalimumab pen-injector kit 80 mg/0.8ml & 40 mg/0.4ml.......................... 33

HUMULIN R U-500 (CONCENTR – insulin regular(human) inj 500 unit/ml....................................................12

HUMULIN R U-500 KWIKPEN – insulin regular (human)soln pen-injector 500 unit/ml........................................... 12

HYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)....... 6HYCAMTIN – topotecan hcl cap 1 mg (base equiv)............ 6hydralazine hcl tab 10 mg............................................... 17hydralazine hcl tab 25 mg............................................... 17hydralazine hcl tab 50 mg............................................... 17hydralazine hcl tab 100 mg............................................. 17hydrochlorothiazide cap 12.5 mg (Microzide)............... 19hydrochlorothiazide tab 12.5 mg.................................... 19hydrochlorothiazide tab 25 mg....................................... 19hydrochlorothiazide tab 50 mg....................................... 19hydrocodone-acetaminophen soln 7.5-325 mg/15ml

(Hycet)..............................................................................31hydrocodone-acetaminophen tab 7.5-325 mg

(Norco).............................................................................31hydrocodone-acetaminophen tab 5-325 mg

(Norco).............................................................................31hydrocodone-acetaminophen tab 10-325 mg

(Norco).............................................................................31hydrocodone-ibuprofen tab 10-200 mg (Ibudone)........ 31hydrocodone-ibuprofen tab 5-200 mg (Reprexain).......31hydrocodone-ibuprofen tab 7.5-200 mg

(Vicoprofen).................................................................... 31hydrocortisone acetate suppos 25 mg.......................... 41hydrocortisone cream 2.5%.............................................42hydrocortisone enema 100 mg/60ml (Cortenema)........41hydrocortisone lotion 2.5%............................................. 42

2021


hydrocortisone oint 2.5%.................................................42hydrocortisone perianal cream 2.5% (Anusol-hc)........ 41hydrocortisone tab 5 mg (Cortef)..................................... 8hydrocortisone tab 10 mg (Cortef)................................... 8hydrocortisone tab 20 mg (Cortef)................................... 8hydrocortisone valerate cream 0.2%..............................42hydrocortisone valerate oint 0.2% (Westcort)...............42hydrocortisone w/ acetic acid otic soln 1-2% (Vosol

hc).....................................................................................41hydromorphone hcl liqd 1 mg/ml (Dilaudid)..................31hydromorphone hcl tab 2 mg (Dilaudid)........................31hydromorphone hcl tab 4 mg (Dilaudid)........................31hydromorphone hcl tab 8 mg (Dilaudid)........................31hydroxychloroquine sulfate tab 200 mg (Plaquenil).......5hydroxyurea cap 500 mg (Hydrea)................................... 6hydroxyzine hcl syrup 10 mg/5ml...................................25hydroxyzine hcl tab 10 mg.............................................. 25hydroxyzine hcl tab 25 mg.............................................. 25hydroxyzine hcl tab 50 mg.............................................. 25hydroxyzine pamoate cap 25 mg (Vistaril).................... 25hydroxyzine pamoate cap 50 mg (Vistaril).................... 25HYDROXYZINE PAMOATE – hydroxyzine pamoate cap

100 mg............................................................................. 25

Iibandronate sodium tab 150 mg (base equivalent)

(Boniva)........................................................................... 13IBRANCE – palbociclib cap 75 mg...................................... 6IBRANCE – palbociclib cap 100 mg.................................... 6IBRANCE – palbociclib cap 125 mg.................................... 6IBRANCE – palbociclib tab 75 mg....................................... 6IBRANCE – palbociclib tab 100 mg..................................... 6IBRANCE – palbociclib tab 125 mg..................................... 6ibuprofen susp 100 mg/5ml.............................................33ibuprofen tab 400 mg....................................................... 33ibuprofen tab 600 mg....................................................... 33ibuprofen tab 800 mg....................................................... 33icatibant acetate inj 30 mg/3ml (base equivalent)

(Firazyr)............................................................................39ICLUSIG – ponatinib hcl tab 15 mg (base equiv)................ 6ICLUSIG – ponatinib hcl tab 45 mg (base equiv)................ 6ILARIS – canakinumab subcutaneous inj 150 mg/ml........ 33imatinib mesylate tab 100 mg (base equivalent)

(Gleevec)............................................................................6imatinib mesylate tab 400 mg (base equivalent)

(Gleevec)............................................................................6IMBRUVICA – ibrutinib cap 70 mg.......................................6IMBRUVICA – ibrutinib cap 140 mg.....................................6IMBRUVICA – ibrutinib tab 140 mg..................................... 6IMBRUVICA – ibrutinib tab 280 mg..................................... 6IMBRUVICA – ibrutinib tab 420 mg..................................... 6IMBRUVICA – ibrutinib tab 560 mg..................................... 6imipramine hcl tab 10 mg (Tofranil)............................... 26imipramine hcl tab 25 mg (Tofranil)............................... 26imipramine hcl tab 50 mg (Tofranil)............................... 26imiquimod cream 5% (Aldara).........................................42

IMPAVIDO – miltefosine cap 50 mg.....................................5INBRIJA – levodopa inhal powder cap 42 mg................... 35INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml).........13INCRUSE ELLIPTA – umeclidinium br aero powd breath

act 62.5 mcg/inh (base eq)............................................. 22indapamide tab 1.25 mg...................................................19indapamide tab 2.5 mg.....................................................19indomethacin cap 25 mg................................................. 33indomethacin cap 50 mg................................................. 33INHALER ASSIST DEVICES -........................................... 44INLYTA – axitinib tab 1 mg...................................................6INLYTA – axitinib tab 5 mg...................................................6INSULIN ASPART FLEXPEN – insulin aspart soln pen-

injector 100 unit/ml.......................................................... 12INSULIN ASPART – insulin aspart inj 100 unit/ml............. 12INSULIN ASPART PENFILL – insulin aspart soln cartridge

100 unit/ml........................................................................12INSULIN ASPART PROTAMINE/ – insulin aspart prot &

aspart (human) inj 100 unit/ml (70-30)............................13INSULIN ASPART PROTAMINE/ – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)............................ 12INSULIN PEN NEEDLES - various....................................43INSULIN SYRINGES - various...........................................43INTELENCE – etravirine tab 25 mg.....................................3INTELENCE – etravirine tab 100 mg...................................3INTELENCE – etravirine tab 200 mg...................................3INVOKAMET – canagliflozin-metformin hcl tab 50-500

mg.....................................................................................11INVOKAMET – canagliflozin-metformin hcl tab 50-1000



mg.....................................................................................11INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

50-500 mg........................................................................ 11INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

50-1000 mg......................................................................11INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

150-500 mg......................................................................11INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr

150-1000 mg....................................................................11INVOKANA – canagliflozin tab 100 mg..............................11INVOKANA – canagliflozin tab 300 mg..............................11ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

(Duoneb)..........................................................................22ipratropium bromide inhal soln 0.02%...........................22ipratropium bromide nasal soln 0.03% (21 mcg/spray)

(Atrovent)........................................................................ 21ipratropium bromide nasal soln 0.06% (42 mcg/spray)

(Atrovent)........................................................................ 21irbesartan-hydrochlorothiazide tab 150-12.5 mg

(Avalide)...........................................................................17irbesartan-hydrochlorothiazide tab 300-12.5 mg

(Avalide)...........................................................................17irbesartan tab 75 mg (Avapro)........................................ 17

2021


irbesartan tab 150 mg (Avapro)...................................... 17irbesartan tab 300 mg (Avapro)...................................... 17IRESSA – gefitinib tab 250 mg............................................ 6ISENTRESS HD – raltegravir potassium tab 600 mg (base

equiv).................................................................................. 3ISENTRESS – raltegravir potassium chew tab 25 mg

(base equiv)....................................................................... 3ISENTRESS – raltegravir potassium chew tab 100 mg

(base equiv)....................................................................... 3ISENTRESS – raltegravir potassium packet for susp 100

mg (base equiv).................................................................3ISENTRESS – raltegravir potassium tab 400 mg (base

equiv).................................................................................. 3ISONIAZID – isoniazid syrup 50 mg/5ml............................. 2ISONIAZID – isoniazid tab 100 mg......................................2isoniazid tab 300 mg.......................................................... 2isosorbide dinitrate tab 10 mg........................................14isosorbide dinitrate tab 20 mg........................................14isosorbide dinitrate tab 30 mg........................................14isosorbide dinitrate tab 5 mg (Isordil titradose)........... 14isosorbide mononitrate tab er 24hr 30 mg.................... 14isosorbide mononitrate tab er 24hr 60 mg.................... 14isosorbide mononitrate tab er 24hr 120 mg.................. 14isosorbide mononitrate tab 10 mg................................. 14isosorbide mononitrate tab 20 mg................................. 14isotretinoin cap 10 mg..................................................... 42isotretinoin cap 20 mg..................................................... 42isotretinoin cap 40 mg..................................................... 42isotretinoin cap 30 mg (Claravis)....................................42itraconazole cap 100 mg (Sporanox)................................2itraconazole oral soln 10 mg/ml (Sporanox)................... 2ivermectin tab 3 mg (Stromectol)..................................... 5

JJAKAFI – ruxolitinib phosphate tab 5 mg (base

equivalent).......................................................................... 6JAKAFI – ruxolitinib phosphate tab 10 mg (base




equivalent).......................................................................... 6JANUMET – sitagliptin-metformin hcl tab 50-500 mg........11JANUMET – sitagliptin-metformin hcl tab 50-1000 mg......11JANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-500 mg........................................................................ 11JANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-1000 mg......................................................................11JANUMET XR – sitagliptin-metformin hcl tab er 24hr

100-1000 mg....................................................................11JANUVIA – sitagliptin phosphate tab 25 mg (base

equiv)................................................................................ 11JANUVIA – sitagliptin phosphate tab 50 mg (base

equiv)................................................................................ 11

JANUVIA – sitagliptin phosphate tab 100 mg (baseequiv)................................................................................ 11

JARDIANCE – empagliflozin tab 10 mg.............................11JARDIANCE – empagliflozin tab 25 mg.............................11JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj

1000 unit...........................................................................39JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj

2000 unit...........................................................................39JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj

3000 unit...........................................................................39JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl) for inj

500 unit.............................................................................39JULUCA – dolutegravir sodium-rilpivirine hcl tab 50-25 mg

(base eq)............................................................................ 3

KKALETRA – lopinavir-ritonavir tab 100-25 mg.....................3KALETRA – lopinavir-ritonavir tab 200-50 mg.....................3KALYDECO – ivacaftor packet 25 mg............................... 22KALYDECO – ivacaftor packet 50 mg............................... 22KALYDECO – ivacaftor packet 75 mg............................... 22KALYDECO – ivacaftor tab 150 mg................................... 22ketoconazole cream 2%................................................... 42ketoconazole shampoo 2% (Nizoral)..............................42ketorolac tromethamine ophth soln 0.5% (Acular)....... 40ketorolac tromethamine ophth soln 0.4% (Acular

ls)......................................................................................40KISQALI FEMARA 200 DOSE – ribociclib 200 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk............................... 6KISQALI FEMARA 400 DOSE – ribociclib 400 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk............................... 6KISQALI FEMARA 600 DOSE – ribociclib 600 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk............................... 6KISQALI – ribociclib succinate tab pack 200 mg daily

dose.................................................................................... 6KISQALI – ribociclib succinate tab pack 400 mg daily dose

(200 mg tab)...................................................................... 6KISQALI – ribociclib succinate tab pack 600 mg daily dose

(200 mg tab)...................................................................... 6KOGENATE FS – antihemophilic factor (recombinant) for

inj kit 250 unit.................................................................. 39KOGENATE FS – antihemophilic factor (recombinant) for

inj kit 500 unit.................................................................. 39KOGENATE FS – antihemophilic factor (recombinant) for

inj kit 1000 unit................................................................ 39KOGENATE FS – antihemophilic factor (recombinant) for

inj kit 2000 unit................................................................ 39KOGENATE FS – antihemophilic factor (recombinant) for

inj kit 3000 unit................................................................ 39KOSHER PRENATAL PLUS IRON – prenatal vit w/ iron

carbonyl-fa tab 30-1 mg.................................................. 36KOVALTRY – antihemophilic factor recomb (rahf-pfm) for

inj 250 unit....................................................................... 39KOVALTRY – antihemophilic factor recomb (rahf-pfm) for

inj 500 unit....................................................................... 39

2021


KOVALTRY – antihemophilic factor recomb (rahf-pfm) forinj 1000 unit..................................................................... 39



K-PHOS NO 2 – potassium & sodium acid phosphates tab305-700 mg......................................................................24

K-PHOS – potassium phosphate monobasic tab 500mg.....................................................................................36

KYNMOBI – apomorphine hydrochloride film 10 mg......... 35KYNMOBI – apomorphine hydrochloride film 15 mg......... 35KYNMOBI – apomorphine hydrochloride film 20 mg......... 35KYNMOBI – apomorphine hydrochloride film 25 mg......... 35KYNMOBI – apomorphine hydrochloride film 30 mg......... 35

Llabetalol hcl tab 100 mg (Trandate)................................15labetalol hcl tab 200 mg (Trandate)................................15labetalol hcl tab 300 mg (Trandate)................................15lactulose (encephalopathy) solution 10 gm/15ml......... 24lactulose solution 10 gm/15ml........................................ 22lamivudine oral soln 10 mg/ml (Epivir)............................ 3lamivudine tab 150 mg (Epivir)......................................... 3lamivudine tab 300 mg (Epivir)......................................... 3lamivudine tab 100 mg (hbv) (Epivir hbv)........................3lamivudine-zidovudine tab 150-300 mg (Combivir)........ 3lamotrigine tab chewable dispersible 5 mg (Lamictal

chewable di)....................................................................34lamotrigine tab chewable dispersible 25 mg (Lamictal

chewable di)....................................................................34lamotrigine tab 25 mg (Lamictal)....................................34lamotrigine tab 100 mg (Lamictal)..................................34lamotrigine tab 150 mg (Lamictal)..................................34lamotrigine tab 200 mg (Lamictal)..................................34LANCET DEVICES - various..............................................43LANCETS - various............................................................ 44lansoprazole cap delayed release 15 mg

(Prevacid)........................................................................ 23lansoprazole cap delayed release 30 mg

(Prevacid)........................................................................ 23LANTUS – insulin glargine inj 100 unit/ml......................... 13LANTUS SOLOSTAR – insulin glargine soln pen-injector

100 unit/ml........................................................................13lapatinib ditosylate tab 250 mg (base equiv)

(Tykerb)..............................................................................7latanoprost ophth soln 0.005% (Xalatan).......................40LEDIPASVIR/SOFOSBUVIR – ledipasvir-sofosbuvir tab

90-400 mg.......................................................................... 3leflunomide tab 10 mg (Arava)........................................33leflunomide tab 20 mg (Arava)........................................33LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapy

pack 10 & 4 mg (14 mg daily dose)..................................7LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapy

pack 10 mg (10 mg daily dose)........................................ 7

LENVIMA 4 MG DAILY DOSE – lenvatinib cap therapypack 4 mg (4 mg daily dose)............................................ 7

LENVIMA 12MG DAILY DOSE – lenvatinib cap therapypack 3 x 4 mg (12 mg daily dose).................................... 7

LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapypack 2 x 10 mg (20 mg daily dose).................................. 7

LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapypack 2 x 4 mg (8 mg daily dose)...................................... 7

LENVIMA 18 MG DAILY DOSE – lenvatinib cap ther pack10 mg & 2 x 4 mg (18 mg daily dose).............................. 7

LENVIMA 24 MG DAILY DOSE – lenvatinib cap ther pack2 x 10 mg & 4 mg (24 mg daily dose).............................. 7

letrozole tab 2.5 mg (Femara)........................................... 7leucovorin calcium tab 5 mg.............................................7leucovorin calcium tab 10 mg...........................................7leucovorin calcium tab 15 mg...........................................7leucovorin calcium tab 25 mg...........................................7LEUKERAN – chlorambucil tab 2 mg.................................. 7levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base

equiv)............................................................................... 22levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

(Xopenex)........................................................................ 22levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv)

(Xopenex)........................................................................ 22levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv)

(Xopenex)........................................................................ 22LEVEMIR FLEXTOUCH – insulin detemir soln pen-injector

100 unit/ml........................................................................13LEVEMIR – insulin detemir inj 100 unit/ml.........................13levetiracetam oral soln 100 mg/ml (Keppra)..................34levetiracetam tab er 24hr 500 mg (Keppra xr)...............34levetiracetam tab er 24hr 750 mg (Keppra xr)...............34levetiracetam tab 250 mg (Keppra).................................34levetiracetam tab 500 mg (Keppra).................................34levetiracetam tab 750 mg (Keppra).................................34levetiracetam tab 1000 mg (Keppra)...............................34LEVOBUNOLOL HCL – levobunolol hcl ophth soln

0.5%..................................................................................40levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)...... 13levocarnitine tab 330 mg (Carnitor)................................14levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/

ml) (Xyzal)....................................................................... 20levocetirizine dihydrochloride tab 5 mg (Xyzal)............21levofloxacin oral soln 25 mg/ml (Levaquin).................... 2levofloxacin tab 250 mg (Levaquin)................................. 2levofloxacin tab 500 mg (Levaquin)................................. 2levofloxacin tab 750 mg (Levaquin)................................. 2levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg....................................................................10levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg...................................................................................10levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg...................................................................................10levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg................................10

2021


levonorg-eth est tab 0.1-0.02mg(84) & eth est tab0.01mg(7) (Loseasonique)............................................ 10

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab0.01mg(7) (Seasonique)................................................ 10

levothyroxine sodium tab 25 mcg (Synthroid)..............13levothyroxine sodium tab 50 mcg (Synthroid)..............13levothyroxine sodium tab 75 mcg (Synthroid)..............13levothyroxine sodium tab 88 mcg (Synthroid)..............13levothyroxine sodium tab 100 mcg (Synthroid)............13levothyroxine sodium tab 112 mcg (Synthroid)............ 13levothyroxine sodium tab 125 mcg (Synthroid)............13levothyroxine sodium tab 137 mcg (Synthroid)............13levothyroxine sodium tab 150 mcg (Synthroid)............13levothyroxine sodium tab 175 mcg (Synthroid)............13levothyroxine sodium tab 200 mcg (Synthroid)............13levothyroxine sodium tab 300 mcg (Synthroid)............13lidocaine hcl gel 2%......................................................... 42lidocaine hcl soln 4% (Xylocaine)...................................42lidocaine hcl viscous soln 2%........................................ 41lidocaine oint 5%...............................................................42lidocaine patch 5% (Lidoderm)....................................... 42lidocaine-prilocaine cream 2.5-2.5% (Emla).................. 42LINDANE – lindane shampoo 1%......................................42linezolid for susp 100 mg/5ml (Zyvox).............................5linezolid tab 600 mg (Zyvox)............................................. 5liothyronine sodium tab 5 mcg (Cytomel)..................... 13liothyronine sodium tab 25 mcg (Cytomel)................... 13liothyronine sodium tab 50 mcg (Cytomel)................... 13lisinopril & hydrochlorothiazide tab 10-12.5 mg

(Zestoretic)......................................................................17lisinopril & hydrochlorothiazide tab 20-12.5 mg

(Zestoretic)......................................................................17lisinopril & hydrochlorothiazide tab 20-25 mg

(Zestoretic)......................................................................17lisinopril tab 5 mg (Prinivil)............................................. 18lisinopril tab 10 mg (Prinivil)...........................................18lisinopril tab 20 mg (Prinivil)...........................................18lisinopril tab 2.5 mg (Zestril)........................................... 17lisinopril tab 30 mg (Zestril)............................................ 18lisinopril tab 40 mg (Zestril)............................................ 18lithium carbonate cap 300 mg.........................................27lithium carbonate cap 150 mg (Lithium carbonate)......27lithium carbonate cap 600 mg (Lithium carbonate)......27LITHIUM CARBONATE – lithium carbonate cap 150

mg.....................................................................................27lithium carbonate tab er 450 mg.....................................27lithium carbonate tab er 300 mg (Lithobid)................... 27lithium carbonate tab 300 mg......................................... 27LITHIUM – lithium oral solution 8 meq/5ml........................27LOKELMA – sodium zirconium cyclosilicate for susp

packet 5 gm..................................................................... 44LOKELMA – sodium zirconium cyclosilicate for susp

packet 10 gm................................................................... 44LONSURF – trifluridine-tipiracil tab 15-6.14 mg...................7LONSURF – trifluridine-tipiracil tab 20-8.19 mg...................7loperamide hcl cap 2 mg................................................. 23

lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)(Kaletra)............................................................................. 3

lorazepam conc 2 mg/ml (Lorazepam intensol)............ 25lorazepam tab 0.5 mg (Ativan)........................................ 25lorazepam tab 1 mg (Ativan)........................................... 25lorazepam tab 2 mg (Ativan)........................................... 25losartan potassium & hydrochlorothiazide tab 50-12.5

mg (Hyzaar).....................................................................18losartan potassium & hydrochlorothiazide tab 100-12.5

mg (Hyzaar).....................................................................18losartan potassium & hydrochlorothiazide tab 100-25

mg (Hyzaar).....................................................................18losartan potassium tab 25 mg (Cozaar).........................18losartan potassium tab 50 mg (Cozaar).........................18losartan potassium tab 100 mg (Cozaar).......................18LOTEMAX – loteprednol etabonate ophth gel 0.5%..........40LOTEMAX – loteprednol etabonate ophth oint 0.5%.........40LOTEMAX SM – loteprednol etabonate ophth gel

0.38%................................................................................40loteprednol etabonate ophth susp 0.5% (Lotemax)......40lovastatin tab 10 mg.........................................................20lovastatin tab 20 mg (Mevacor).......................................20lovastatin tab 40 mg (Mevacor).......................................20loxapine succinate cap 10 mg........................................ 27loxapine succinate cap 25 mg........................................ 27loxapine succinate cap 50 mg........................................ 27loxapine succinate cap 5 mg (Loxitane)........................27LUMIGAN – bimatoprost ophth soln 0.01%.......................40LYNPARZA – olaparib tab 100 mg.......................................7LYNPARZA – olaparib tab 150 mg.......................................7LYSODREN – mitotane tab 500 mg.....................................7

Mmalathion lotion 0.5% (Ovide).........................................42MATULANE – procarbazine hcl cap 50 mg......................... 7MAVENCLAD – cladribine tab therapy pack 10 mg (4

tabs)..................................................................................30MAVENCLAD – cladribine tab therapy pack 10 mg (5






tabs)..................................................................................30MAVYRET – glecaprevir-pibrentasvir tab 100-40 mg.......... 3MAYZENT – siponimod fumarate tab 0.25 mg (base

equiv)................................................................................ 30MAYZENT – siponimod fumarate tab 2 mg (base

equiv)................................................................................ 30meclizine hcl tab 12.5 mg................................................23meclizine hcl tab 25 mg...................................................23

2021


medroxyprogesterone acetate im susp 150 mg/ml(Depo-provera contrac).................................................10

medroxyprogesterone acetate im susp prefilled syr150 mg/ml (Depo-provera contrac)..............................10

medroxyprogesterone acetate tab 2.5 mg(Provera)..........................................................................10

medroxyprogesterone acetate tab 5 mg (Provera).......10medroxyprogesterone acetate tab 10 mg (Provera).....10MEFLOQUINE HCL – mefloquine hcl tab 250 mg...............5megestrol acetate susp 40 mg/ml (Megace oral)............ 7megestrol acetate tab 20 mg.............................................7megestrol acetate tab 40 mg.............................................7MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg

(base equivalent)............................................................... 7MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (base

equivalent).......................................................................... 7meloxicam tab 7.5 mg (Mobic)........................................33meloxicam tab 15 mg (Mobic).........................................33melphalan tab 2 mg (Alkeran)...........................................7memantine hcl oral solution 2 mg/ml (Namenda)......... 30memantine hcl tab 5 mg (Namenda).............................. 30memantine hcl tab 10 mg (Namenda)............................ 30memantine hcl tab 28 x 5 mg & 21 x 10 mg titration

pack (Namenda titration pa).........................................30MENOPUR – menotropins for subcutaneous inj 75

unit.................................................................................... 14mercaptopurine tab 50 mg (Purinethol)...........................7mesalamine cap dr 400 mg (Delzicol)............................ 24mesalamine cap er 24hr 0.375 gm (Apriso)...................24mesalamine enema 4 gm................................................. 24mesalamine suppos 1000 mg (Canasa)......................... 24mesalamine tab delayed release 1.2 gm (Lialda)..........24mesalamine tab delayed release 800 mg (Asacol

hd).................................................................................... 24MESNEX – mesna tab 400 mg............................................7metformin hcl tab er 24hr 500 mg (Glucophage xr)......11metformin hcl tab er 24hr 750 mg (Glucophage xr)......11metformin hcl tab 500 mg (Glucophage)....................... 11metformin hcl tab 850 mg (Glucophage)....................... 11metformin hcl tab 1000 mg (Glucophage)..................... 11methadone hcl conc 10 mg/ml (Methadose)................. 31methadone hcl soln 5 mg/5ml (Methadone hcl)............31methadone hcl soln 10 mg/5ml (Methadone hcl)..........31methadone hcl tab for oral susp 40 mg.........................31methadone hcl tab 10 mg (Dolophine)...........................31methadone hcl tab 5 mg (Dolophine hcl).......................31methazolamide tab 25 mg (Neptazane)..........................19methazolamide tab 50 mg (Neptazane)..........................19methimazole tab 5 mg (Tapazole)................................... 13methimazole tab 10 mg (Tapazole).................................13methocarbamol tab 750 mg (Robaxin-750)....................36methocarbamol tab 500 mg (Robaxin)...........................36methotrexate sodium tab 2.5 mg (base equiv)................7methscopolamine bromide tab 2.5 mg (Pamine).......... 23methscopolamine bromide tab 5 mg (Pamine

forte).................................................................................23

methyldopa tab 250 mg................................................... 18methyldopa tab 500 mg................................................... 18methylergonovine maleate tab 0.2 mg...........................13methylphenidate hcl tab er 10 mg..................................29methylphenidate hcl tab er 20 mg..................................29methylphenidate hcl tab er osmotic release (osm) 18

mg (Concerta).................................................................29methylphenidate hcl tab er osmotic release (osm) 27



mg (Concerta).................................................................29methylphenidate hcl tab 5 mg (Ritalin).......................... 29methylphenidate hcl tab 10 mg (Ritalin)........................ 29methylphenidate hcl tab 20 mg (Ritalin)........................ 29methylprednisolone tab 4 mg (Medrol)............................8methylprednisolone tab 8 mg (Medrol)............................8methylprednisolone tab 16 mg (Medrol)..........................9methylprednisolone tab 32 mg (Medrol)..........................9methylprednisolone tab therapy pack 4 mg (21)

(Medrol dosepak)............................................................. 8metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base

equiv)............................................................................... 24metoclopramide hcl tab 5 mg (base equivalent)

(Reglan)........................................................................... 24metoclopramide hcl tab 10 mg (base equivalent)

(Reglan)........................................................................... 24metolazone tab 10 mg......................................................19metolazone tab 2.5 mg (Zaroxolyn)................................19metolazone tab 5 mg (Zaroxolyn)...................................19METOPROLOL/HYDROCHLOROTHI – metoprolol &

hydrochlorothiazide tab 100-50 mg.................................18metoprolol & hydrochlorothiazide tab 50-25 mg

(Lopressor hct)...............................................................18metoprolol & hydrochlorothiazide tab 100-25 mg

(Lopressor hct)...............................................................18metoprolol succinate tab er 24hr 25 mg (tartrate equiv)

(Toprol xl)........................................................................15metoprolol succinate tab er 24hr 50 mg (tartrate equiv)

(Toprol xl)........................................................................15metoprolol succinate tab er 24hr 100 mg (tartrate

equiv) (Toprol xl)............................................................15metoprolol succinate tab er 24hr 200 mg (tartrate

equiv) (Toprol xl)............................................................15metoprolol tartrate tab 25 mg......................................... 15metoprolol tartrate tab 50 mg (Lopressor).................... 15metoprolol tartrate tab 100 mg (Lopressor).................. 15metronidazole cream 0.75% (Metrocream).................... 43metronidazole gel 0.75%..................................................43metronidazole gel 1% (Metrogel).................................... 43metronidazole lotion 0.75% (Metrolotion)......................43metronidazole tab 250 mg (Flagyl)................................... 5metronidazole tab 500 mg (Flagyl)................................... 5metronidazole vaginal gel 0.75% (Metrogel-

vaginal)............................................................................ 24

2021


mexiletine hcl cap 150 mg...............................................16mexiletine hcl cap 200 mg...............................................16mexiletine hcl cap 250 mg...............................................16midodrine hcl tab 2.5 mg.................................................19midodrine hcl tab 5 mg....................................................19midodrine hcl tab 10 mg..................................................19minocycline hcl cap 50 mg (Minocin).............................. 2minocycline hcl cap 75 mg (Minocin).............................. 2minocycline hcl cap 100 mg (Minocin)............................ 2minoxidil tab 2.5 mg.........................................................18minoxidil tab 10 mg..........................................................18MIRENA – levonorgestrel releasing iud 20 mcg/day (52

mg total)........................................................................... 10mirtazapine tab 7.5 mg.....................................................26mirtazapine tab 15 mg (Remeron).................................. 26mirtazapine tab 30 mg (Remeron).................................. 26mirtazapine tab 45 mg (Remeron).................................. 26misoprostol tab 100 mcg (Cytotec)................................ 23misoprostol tab 200 mcg (Cytotec)................................ 23MITIGARE – colchicine cap 0.6 mg...................................34modafinil tab 100 mg (Provigil).......................................29modafinil tab 200 mg (Provigil).......................................29moexipril hcl tab 7.5 mg (Univasc).................................18moexipril hcl tab 15 mg (Univasc)..................................18mometasone furoate cream 0.1% (Elocon)................... 43mometasone furoate nasal susp 50 mcg/act

(Nasonex)........................................................................ 21mometasone furoate oint 0.1% (Elocon)........................43mometasone furoate solution 0.1% (lotion)

(Elocon)........................................................................... 43montelukast sodium chew tab 4 mg (base equiv)

(Singulair)........................................................................22montelukast sodium chew tab 5 mg (base equiv)

(Singulair)........................................................................22montelukast sodium oral granules packet 4 mg (base

equiv) (Singulair)............................................................22montelukast sodium tab 10 mg (base equiv)

(Singulair)........................................................................22MORPHINE SULFATE ER – morphine sulfate beads cap

er 24hr 30 mg.................................................................. 31MORPHINE SULFATE ER – morphine sulfate beads cap





er 24hr 120 mg................................................................ 31morphine sulfate oral soln 10 mg/5ml........................... 31morphine sulfate oral soln 20 mg/5ml........................... 31morphine sulfate oral soln 100 mg/5ml (20 mg/ml)...... 31morphine sulfate tab er 15 mg (Ms contin)................... 31morphine sulfate tab er 30 mg (Ms contin)................... 31morphine sulfate tab er 60 mg (Ms contin)................... 31

morphine sulfate tab er 100 mg (Ms contin)................. 31morphine sulfate tab er 200 mg (Ms contin)................. 31morphine sulfate tab 15 mg (Morphine sulfate)............31morphine sulfate tab 30 mg (Morphine sulfate)............31moxifloxacin hcl ophth soln 0.5% (base equiv)

(Vigamox)........................................................................ 40MULTAQ – dronedarone hcl tab 400 mg (base

equivalent)........................................................................ 16mupirocin oint 2% (Bactroban).......................................43mycophenolate mofetil cap 250 mg (Cellcept)..............44mycophenolate mofetil for oral susp 200 mg/ml

(Cellcept)......................................................................... 44mycophenolate mofetil tab 500 mg (Cellcept)...............44mycophenolate sodium tab dr 180 mg (mycophenolic

acid equiv) (Myfortic).................................................... 44mycophenolate sodium tab dr 360 mg (mycophenolic

acid equiv) (Myfortic).................................................... 44MYLERAN – busulfan tab 2 mg...........................................7

Nnabumetone tab 500 mg.................................................. 33nabumetone tab 750 mg.................................................. 33nadolol tab 20 mg (Corgard)........................................... 15nadolol tab 40 mg (Corgard)........................................... 15nadolol tab 80 mg (Corgard)........................................... 15naloxone hcl inj 0.4 mg/ml.............................................. 43naloxone hcl inj 4 mg/10ml............................................. 43NALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/

ml...................................................................................... 43naltrexone hcl tab 50 mg (Revia)....................................43naproxen sodium tab 275 mg (Anaprox)....................... 33naproxen sodium tab 550 mg (Anaprox ds)..................33naproxen tab ec 375 mg (Ec-naprosyn).........................33naproxen tab ec 500 mg (Ec-naprosyn).........................33naproxen tab 250 mg (Naprosyn)................................... 33naproxen tab 375 mg (Naprosyn)................................... 33naproxen tab 500 mg (Naprosyn)................................... 33naratriptan hcl tab 1 mg (base equiv) (Amerge)........... 33naratriptan hcl tab 2.5 mg (base equiv) (Amerge)........ 33NARCAN – naloxone hcl nasal spray 4 mg/0.1ml............. 43NATACYN – natamycin ophth susp 5%............................. 40nateglinide tab 60 mg (Starlix)........................................11nateglinide tab 120 mg (Starlix)......................................12NEOMYCIN/POLYMYXIN/GRAMIC – neomycin-polymy-

gramicid op sol 1.75-10000-0.025mg-unt-mg/ml............ 40neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin................................ 40neomycin-polymyxin-dexamethasone ophth oint 0.1%

(Maxitrol)......................................................................... 40neomycin-polymyxin-dexamethasone ophth susp

0.1% (Maxitrol)................................................................40neomycin-polymyxin-hc otic soln 1% (Cortisporin)..... 41neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%....................................................................... 41neomycin sulfate tab 500 mg............................................2

2021


NEULASTA ONPRO KIT – pegfilgrastim soln prefilledsyringe kit 6 mg/0.6ml..................................................... 37

NEULASTA – pegfilgrastim soln prefilled syringe 6mg/0.6ml...........................................................................37

NEUPOGEN – filgrastim inj 300 mcg/ml............................37NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/

ml).....................................................................................37NEUPOGEN – filgrastim soln prefilled syringe 300

mcg/0.5ml......................................................................... 37NEUPOGEN – filgrastim soln prefilled syringe 480

mcg/0.8ml (600 mcg/ml)..................................................37NEVIRAPINE ER – nevirapine tab er 24hr 100 mg............. 3nevirapine susp 50 mg/5ml (Viramune)........................... 3nevirapine tab er 24hr 400 mg (Viramune xr)..................3nevirapine tab 200 mg (Viramune)....................................4NEXAVAR – sorafenib tosylate tab 200 mg (base

equivalent).......................................................................... 7NEXIUM – esomeprazole magnesium for delayed release

susp packet 5 mg............................................................ 23NEXIUM – esomeprazole magnesium for delayed release

susp pack 2.5 mg............................................................ 23NEXLETOL – bempedoic acid tab 180 mg........................20NEXLIZET – bempedoic acid-ezetimibe tab 180-10

mg.....................................................................................20niacin tab er 500 mg (antihyperlipidemic)

(Niaspan)......................................................................... 20niacin tab er 750 mg (antihyperlipidemic)

(Niaspan)......................................................................... 20niacin tab er 1000 mg (antihyperlipidemic)

(Niaspan)......................................................................... 20NICOTROL INHALER – nicotine inhaler system 10 mg (4

mg delivered)................................................................... 30NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/

spray)................................................................................30nifedipine tab er 24hr 30 mg (Adalat cc)........................16nifedipine tab er 24hr 60 mg (Adalat cc)........................16nifedipine tab er 24hr 90 mg (Adalat cc)........................16nifedipine tab er 24hr osmotic release 30 mg

(Procardia xl).................................................................. 16nifedipine tab er 24hr osmotic release 60 mg

(Procardia xl).................................................................. 16nifedipine tab er 24hr osmotic release 90 mg

(Procardia xl).................................................................. 16nilutamide tab 150 mg (Nilandron)................................... 7nimodipine cap 30 mg......................................................16NINLARO – ixazomib citrate cap 2.3 mg (base

equivalent).......................................................................... 7NINLARO – ixazomib citrate cap 3 mg (base

equivalent).......................................................................... 7NINLARO – ixazomib citrate cap 4 mg (base

equivalent).......................................................................... 7nitisinone cap 2 mg (Orfadin)......................................... 14nitisinone cap 5 mg (Orfadin)......................................... 14nitisinone cap 10 mg (Orfadin)....................................... 14NITRO-BID – nitroglycerin oint 2%.................................... 14

nitrofurantoin macrocrystalline cap 25 mg(Macrodantin)....................................................................5



nitrofurantoin monohydrate macrocrystalline cap 100mg (Macrobid).................................................................. 5

nitrofurantoin susp 25 mg/5ml..........................................5nitroglycerin sl tab 0.3 mg (Nitrostat)............................ 14nitroglycerin sl tab 0.4 mg (Nitrostat)............................ 14nitroglycerin sl tab 0.6 mg (Nitrostat)............................ 14nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)..........14nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)..........14nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)..........14nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)..........14NITYR – nitisinone tab 2 mg..............................................14NITYR – nitisinone tab 5 mg..............................................14NITYR – nitisinone tab 10 mg............................................14NIVESTYM – filgrastim-aafi inj 300 mcg/ml.......................37NIVESTYM – filgrastim-aafi inj 480 mcg/1.6ml (300 mcg/

ml).....................................................................................37NIVESTYM – filgrastim-aafi soln prefilled syringe 300

mcg/0.5ml......................................................................... 37NIVESTYM – filgrastim-aafi soln prefilled syringe 480

mcg/0.8ml......................................................................... 37NORDITROPIN FLEXPRO – somatropin solution pen-

injector 5 mg/1.5ml.......................................................... 14NORDITROPIN FLEXPRO – somatropin solution pen-

injector 10 mg/1.5ml........................................................ 14NORDITROPIN FLEXPRO – somatropin solution pen-

injector 15 mg/1.5ml........................................................ 14NORDITROPIN FLEXPRO – somatropin solution pen-

injector 30 mg/3ml........................................................... 14norethindrone & ethinyl estradiol-fe chew tab 0.4

mg-35 mcg (Femcon fe)................................................10norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg

(Brevicon-28).................................................................. 10norethindrone & ethinyl estradiol tab 1 mg-35 mcg

(Norinyl 1+35)................................................................. 10norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg

(Ovcon-35).......................................................................10norethindrone ace & ethinyl estradiol-fe tab 1 mg-20

mcg (Loestrin fe 1/20)................................................... 10norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30

mcg (Loestrin fe 1.5/30)................................................ 10norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg

(Loestrin 1/20-21)........................................................... 10norethindrone ace & ethinyl estradiol tab 1.5 mg-30

mcg (Loestrin 1.5/30-21)............................................... 10norethindrone acetate-ethinyl estradiol tab 1 mg-5

mcg.....................................................................................9norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5

mcg (Femhrt low dose)...................................................9norethindrone acetate tab 5 mg (Aygestin)...................10

2021


norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35mg-mcg (Estrostep fe).................................................. 10

norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)..............................................10

norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl 28)....................................................... 10

norethindrone tab 0.35 mg (Nor-qd)...............................10norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

(Ortho-cyclen).................................................................10norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35

mg-mcg (Ortho tri-cyclen)............................................ 10norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25

mg-mcg (Ortho tri-cyclen lo)........................................10norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg.........10nortriptyline hcl cap 10 mg (Pamelor)............................26nortriptyline hcl cap 25 mg (Pamelor)............................26nortriptyline hcl cap 50 mg (Pamelor)............................26nortriptyline hcl cap 75 mg (Pamelor)............................26NORTRIPTYLINE HCL – nortriptyline hcl soln 10

mg/5ml..............................................................................26NORVIR – ritonavir oral soln 80 mg/ml................................4NORVIR – ritonavir powder packet 100 mg.........................4NOVAREL – chorionic gonadotropin for im inj 5000

unit.................................................................................... 14NOVAREL – chorionic gonadotropin for im inj 10000

unit.................................................................................... 14NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii) for

inj 250 unit....................................................................... 39NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii) for

inj 500 unit....................................................................... 39NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii) for

inj 1000 unit..................................................................... 39NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii) for



inj 3000 unit..................................................................... 40NOVOLIN 70/30 FLEXPEN – insulin nph & regular susp

pen-inj 100 unit/ml (70-30).............................................. 13NOVOLIN 70/30 – insulin nph isophane & regular human

inj 100 unit/ml (70-30)......................................................13NOVOLIN N FLEXPEN – insulin nph (human) (isophane)

susp pen-injector 100 unit/ml.......................................... 13NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/

ml...................................................................................... 13NOVOLIN R FLEXPEN – insulin regular (human) soln

pen-injector 100 unit/ml................................................... 12NOVOLIN R – insulin regular (human) inj 100 unit/ml....... 12NOVOLOG FLEXPEN – insulin aspart soln pen-injector

100 unit/ml........................................................................12NOVOLOG – insulin aspart inj 100 unit/ml........................ 12NOVOLOG MIX 70/30 – insulin aspart prot & aspart

(human) inj 100 unit/ml (70-30).......................................13NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)............................ 13

NOVOLOG PENFILL – insulin aspart soln cartridge 100unit/ml............................................................................... 12

NOVOSEVEN RT – coagulation factor viia (recomb) for inj1 mg (1000 mcg)............................................................. 40




NOXAFIL – posaconazole susp 40 mg/ml...........................2NUBEQA – darolutamide tab 300 mg..................................7NUCYNTA ER – tapentadol hcl tab er 12hr 50 mg............32NUCYNTA ER – tapentadol hcl tab er 12hr 100 mg..........32NUCYNTA ER – tapentadol hcl tab er 12hr 150 mg..........32NUCYNTA ER – tapentadol hcl tab er 12hr 200 mg..........32NUCYNTA ER – tapentadol hcl tab er 12hr 250 mg..........32NUVARING – etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hr....................................................... 10nystatin cream 100000 unit/gm.......................................43nystatin oint 100000 unit/gm...........................................43nystatin susp 100000 unit/ml.......................................... 41nystatin tab 500000 unit.....................................................2nystatin topical powder 100000 unit/gm........................43nystatin-triamcinolone cream 100000-0.1 unit/gm-

%.......................................................................................43nystatin-triamcinolone oint 100000-0.1 unit/gm-%....... 43

OOBIZUR – antihemophilic factor (recomb porc) rpfviii for inj

500 unit.............................................................................40octreotide acetate inj 50 mcg/ml (0.05 mg/ml)

(Sandostatin)...................................................................14octreotide acetate inj 100 mcg/ml (0.1 mg/ml)



(Sandostatin)...................................................................14octreotide acetate inj 1000 mcg/ml (1 mg/ml)

(Sandostatin)...................................................................14ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab

200-25-25 mg.....................................................................4ODOMZO – sonidegib phosphate cap 200 mg (base

equivalent).......................................................................... 7ofloxacin ophth soln 0.3% (Ocuflox)..............................40ofloxacin otic soln 0.3%...................................................41ofloxacin tab 400 mg..........................................................2olanzapine orally disintegrating tab 5 mg (Zyprexa

zydis)................................................................................27olanzapine orally disintegrating tab 10 mg (Zyprexa



zydis)................................................................................27

2021


olanzapine tab 2.5 mg (Zyprexa).....................................27olanzapine tab 5 mg (Zyprexa)........................................27olanzapine tab 7.5 mg (Zyprexa).....................................27olanzapine tab 10 mg (Zyprexa)......................................27olanzapine tab 15 mg (Zyprexa)......................................27olanzapine tab 20 mg (Zyprexa)......................................27olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)...............................................18olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)...............................................18olmesartan medoxomil-hydrochlorothiazide tab 40-25

mg (Benicar hct)............................................................ 18olmesartan medoxomil tab 5 mg (Benicar)................... 18olmesartan medoxomil tab 20 mg (Benicar)................. 18olmesartan medoxomil tab 40 mg (Benicar)................. 18omeprazole cap delayed release 10 mg (Prilosec)....... 23omeprazole cap delayed release 20 mg (Prilosec)....... 23omeprazole cap delayed release 40 mg (Prilosec)....... 23ONDANSETRON HCL – ondansetron hcl tab 24 mg........ 23ondansetron hcl oral soln 4 mg/5ml (Zofran)................23ondansetron hcl tab 4 mg (Zofran).................................23ondansetron hcl tab 8 mg (Zofran).................................23ondansetron orally disintegrating tab 4 mg (Zofran

odt)................................................................................... 23ondansetron orally disintegrating tab 8 mg (Zofran

odt)................................................................................... 23OPSUMIT – macitentan tab 10 mg....................................20ORACEA – doxycycline (rosacea) cap delayed release 40

mg.....................................................................................43ORFADIN – nitisinone cap 20 mg......................................14ORFADIN – nitisinone susp 4 mg/ml................................. 14ORIAHNN – elagolix-estrad-noreth 300-1-0.5mg & elagolix

300mg cap pack................................................................ 9ORILISSA – elagolix sodium tab 150 mg (base equiv)......14ORILISSA – elagolix sodium tab 200 mg (base equiv)......14orphenadrine citrate tab er 12hr 100 mg....................... 36oseltamivir phosphate cap 30 mg (base equiv)

(Tamiflu).............................................................................4oseltamivir phosphate cap 45 mg (base equiv)

(Tamiflu).............................................................................4oseltamivir phosphate cap 75 mg (base equiv)

(Tamiflu).............................................................................4oseltamivir phosphate for susp 6 mg/ml (base equiv)

(Tamiflu).............................................................................4OTEZLA – apremilast tab 30 mg....................................... 33OTEZLA – apremilast tab starter therapy pack 10 mg & 20

mg & 30 mg..................................................................... 33OTREXUP – methotrexate soln pf auto-injector 10

mg/0.4ml...........................................................................33OTREXUP – methotrexate soln pf auto-injector 12.5

mg/0.4ml...........................................................................33OTREXUP – methotrexate soln pf auto-injector 15

mg/0.4ml...........................................................................33OTREXUP – methotrexate soln pf auto-injector 17.5

mg/0.4ml...........................................................................33

OTREXUP – methotrexate soln pf auto-injector 20mg/0.4ml...........................................................................33

OTREXUP – methotrexate soln pf auto-injector 22.5mg/0.4ml...........................................................................33

OTREXUP – methotrexate soln pf auto-injector 25mg/0.4ml...........................................................................33

oxaprozin tab 600 mg (Daypro).......................................33oxcarbazepine susp 300 mg/5ml (60 mg/ml)

(Trileptal)......................................................................... 34oxcarbazepine tab 150 mg (Trileptal)............................. 35oxcarbazepine tab 300 mg (Trileptal)............................. 35oxcarbazepine tab 600 mg (Trileptal)............................. 35oxybutynin chloride syrup 5 mg/5ml..............................24oxybutynin chloride tab er 24hr 5 mg (Ditropan xl)......24oxybutynin chloride tab er 24hr 10 mg (Ditropan

xl)......................................................................................24oxybutynin chloride tab er 24hr 15 mg (Ditropan

xl)......................................................................................24oxybutynin chloride tab 5 mg......................................... 24OXYCODONE/ASPIRIN – oxycodone-aspirin tab

4.8355-325 mg.................................................................32oxycodone hcl cap 5 mg................................................. 32oxycodone hcl conc 100 mg/5ml (20 mg/ml)

(Oxycodone hcl).............................................................32oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)............32oxycodone hcl tab 10 mg................................................ 32oxycodone hcl tab 20 mg................................................ 32oxycodone hcl tab 5 mg (Roxicodone).......................... 32oxycodone hcl tab 15 mg (Roxicodone)........................ 32oxycodone hcl tab 30 mg (Roxicodone)........................ 32oxycodone w/ acetaminophen tab 5-325 mg

(Percocet)........................................................................ 32oxycodone w/ acetaminophen tab 7.5-325 mg

(Percocet)........................................................................ 32oxycodone w/ acetaminophen tab 10-325 mg

(Percocet)........................................................................ 32OZEMPIC – semaglutide soln pen-inj 1 mg/dose (2

mg/1.5ml)..........................................................................12OZEMPIC – semaglutide soln pen-inj 0.25 or 0.5 mg/dose

(2 mg/1.5ml).....................................................................12

Ppantoprazole sodium ec tab 20 mg (base equiv)

(Protonix).........................................................................23pantoprazole sodium ec tab 40 mg (base equiv)

(Protonix).........................................................................23paricalcitol cap 1 mcg (Zemplar).................................... 14paricalcitol cap 2 mcg (Zemplar).................................... 14paricalcitol cap 4 mcg (Zemplar).................................... 14PAROMOMYCIN SULFATE – paromomycin sulfate cap

250 mg............................................................................... 2paroxetine hcl tab er 24hr 12.5 mg (Paxil cr)................ 26paroxetine hcl tab er 24hr 25 mg (Paxil cr)................... 26paroxetine hcl tab er 24hr 37.5 mg (Paxil cr)................ 26paroxetine hcl tab 10 mg (Paxil).....................................26paroxetine hcl tab 20 mg (Paxil).....................................26

2021


paroxetine hcl tab 30 mg (Paxil).....................................26paroxetine hcl tab 40 mg (Paxil).....................................26PAZEO – olopatadine hcl ophth soln 0.7% (base

equivalent)........................................................................ 40PEGASYS – peginterferon alfa-2a inj 180 mcg/ml.............. 4PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml......... 4PEGASYS PROCLICK – peginterferon alfa-2a inj 180

mcg/0.5ml........................................................................... 4peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm

(Golytely)......................................................................... 23peg 3350-kcl-sod bicarb-nacl for soln 420 gm

(Nulytely/flavor pack).................................................... 22penicillamine tab 250 mg (Depen titratabs)...................44PENICILLIN V POTASSIUM – penicillin v potassium for

soln 125 mg/5ml................................................................ 1PENICILLIN V POTASSIUM – penicillin v potassium for

soln 250 mg/5ml................................................................ 1penicillin v potassium tab 250 mg....................................1penicillin v potassium tab 500 mg....................................1pentamidine isethionate for nebulization soln 300 mg

(Nebupent).........................................................................5pentoxifylline tab er 400 mg............................................40perindopril erbumine tab 2 mg....................................... 18perindopril erbumine tab 4 mg (Aceon).........................18perindopril erbumine tab 8 mg (Aceon).........................18permethrin cream 5% (Elimite)........................................43perphenazine tab 2 mg.................................................... 27perphenazine tab 4 mg.................................................... 27perphenazine tab 8 mg.................................................... 27perphenazine tab 16 mg.................................................. 27phenelzine sulfate tab 15 mg (Nardil)............................ 26phenobarbital elixir 20 mg/5ml........................................28phenobarbital tab 15 mg..................................................28phenobarbital tab 16.2 mg...............................................28phenobarbital tab 30 mg..................................................28phenobarbital tab 32.4 mg...............................................28phenobarbital tab 60 mg..................................................28phenobarbital tab 100 mg................................................28phenoxybenzamine hcl cap 10 mg (Dibenzyline)......... 18phenytoin chew tab 50 mg (Dilantin infatabs)...............35phenytoin sodium extended cap 100 mg (Dilantin)...... 35phenytoin sodium extended cap 200 mg

(Phenytek)....................................................................... 35phenytoin sodium extended cap 300 mg

(Phenytek)....................................................................... 35phenytoin susp 125 mg/5ml (Dilantin)........................... 35phytonadione tab 5 mg (Mephyton)............................... 36PICATO – ingenol mebutate gel 0.015%........................... 43PICATO – ingenol mebutate gel 0.05%............................. 43pilocarpine hcl ophth soln 1% (Isopto carpine)............ 40pilocarpine hcl ophth soln 2% (Isopto carpine)............ 40pilocarpine hcl ophth soln 4% (Isopto carpine)............ 40pilocarpine hcl tab 5 mg (Salagen).................................41pilocarpine hcl tab 7.5 mg (Salagen)..............................41pimecrolimus cream 1% (Elidel)..................................... 43PIMOZIDE – pimozide tab 1 mg........................................ 30

PIMOZIDE – pimozide tab 2 mg........................................ 30pindolol tab 5 mg..............................................................15pindolol tab 10 mg............................................................15pioglitazone hcl-metformin hcl tab 15-500 mg

(Actoplus met)................................................................12pioglitazone hcl-metformin hcl tab 15-850 mg

(Actoplus met)................................................................12pioglitazone hcl tab 15 mg (base equiv) (Actos)...........12pioglitazone hcl tab 30 mg (base equiv) (Actos)...........12pioglitazone hcl tab 45 mg (base equiv) (Actos)...........12PIQRAY 250MG DAILY DOSE – alpelisib tab pack 250 mg

daily dose (200 mg & 50 mg tabs)....................................7PIQRAY 300MG DAILY DOSE – alpelisib tab pack 300 mg

daily dose (2x150 mg tab).................................................7PIQRAY 200MG DAILY DOSE – alpelisib tab therapy pack

200 mg daily dose............................................................. 7piroxicam cap 10 mg (Feldene).......................................33piroxicam cap 20 mg (Feldene).......................................33PLEGRIDY – peginterferon beta-1a soln pen-injector 125

mcg/0.5ml......................................................................... 30PLEGRIDY – peginterferon beta-1a soln prefilled syringe

125 mcg/0.5ml..................................................................30PLEGRIDY STARTER PACK – peginterferon beta-1a soln

pen-inj 63 & 94 mcg/0.5ml pack..................................... 30PLEGRIDY STARTER PACK – peginterferon beta-1a soln

pref syr 63 & 94 mcg/0.5ml pack.................................... 30podofilox soln 0.5% (Condylox)......................................43polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1% (Polytrim)..........................................................40POMALYST – pomalidomide cap 1 mg............................... 7POMALYST – pomalidomide cap 2 mg............................... 7POMALYST – pomalidomide cap 3 mg............................... 7POMALYST – pomalidomide cap 4 mg............................... 7posaconazole tab delayed release 100 mg (Noxafil)...... 2potassium chloride cap er 8 meq (Micro-k)...................36potassium chloride cap er 10 meq (Micro-k).................36POTASSIUM CHLORIDE ER – potassium chloride tab er

8 meq (600 mg)...............................................................36potassium chloride microencapsulated crys er tab 10

meq...................................................................................36potassium chloride microencapsulated crys er tab 20

meq...................................................................................36potassium chloride oral soln 10% (20 meq/15ml).........36potassium chloride oral soln 20% (40 meq/15ml).........36potassium chloride powder packet 20 meq (K-lor

hospital pack).................................................................36potassium chloride tab er 10 meq (K-tab)..................... 36potassium chloride tab er 8 meq (600 mg)....................36potassium citrate tab er 5 meq (540 mg) (Urocit-k

5).......................................................................................24potassium citrate tab er 10 meq (1080 mg) (Urocit-k

10).....................................................................................24potassium citrate tab er 15 meq (1620 mg) (Urocit-k

15).....................................................................................24pot phos monobasic w/sod phos di & monobas tab

155-852-130mg (K-phos neutral)..................................36

2021


pramipexole dihydrochloride tab 0.125 mg(Mirapex)..........................................................................35

pramipexole dihydrochloride tab 0.25 mg(Mirapex)..........................................................................35

pramipexole dihydrochloride tab 0.5 mg (Mirapex)......35pramipexole dihydrochloride tab 0.75 mg

(Mirapex)..........................................................................35pramipexole dihydrochloride tab 1 mg (Mirapex).........35pramipexole dihydrochloride tab 1.5 mg (Mirapex)......35prasugrel hcl tab 5 mg (base equiv) (Effient)................40prasugrel hcl tab 10 mg (base equiv) (Effient)..............40pravastatin sodium tab 10 mg........................................ 20pravastatin sodium tab 20 mg (Pravachol)....................20pravastatin sodium tab 40 mg (Pravachol)....................20pravastatin sodium tab 80 mg (Pravachol)....................20praziquantel tab 600 mg (Biltricide)................................. 5prazosin hcl cap 1 mg (Minipress)................................. 18prazosin hcl cap 2 mg (Minipress)................................. 18prazosin hcl cap 5 mg (Minipress)................................. 18PREDNISOLONE ACETATE – prednisolone acetate ophth

susp 1%............................................................................40PREDNISOLONE – prednisolone syrup 15 mg/5ml (usp

solution equivalent)............................................................9prednisolone sod phosphate oral soln 15 mg/5ml

(base equiv) (Orapred).................................................... 9prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base) (Pediapred)...............................................9PREDNISONE – prednisone oral soln 5 mg/5ml.................9prednisone tab 1 mg.......................................................... 9prednisone tab 2.5 mg....................................................... 9prednisone tab 5 mg.......................................................... 9prednisone tab 10 mg........................................................ 9prednisone tab 20 mg........................................................ 9prednisone tab 50 mg........................................................ 9prednisone tab therapy pack 5 mg (21)........................... 9prednisone tab therapy pack 5 mg (48)........................... 9prednisone tab therapy pack 10 mg (21)......................... 9prednisone tab therapy pack 10 mg (48)......................... 9pregabalin cap 25 mg (Lyrica)........................................ 35pregabalin cap 50 mg (Lyrica)........................................ 35pregabalin cap 75 mg (Lyrica)........................................ 35pregabalin cap 100 mg (Lyrica)...................................... 35pregabalin cap 150 mg (Lyrica)...................................... 35pregabalin cap 200 mg (Lyrica)...................................... 35pregabalin cap 225 mg (Lyrica)...................................... 35pregabalin cap 300 mg (Lyrica)...................................... 35pregabalin soln 20 mg/ml (Lyrica).................................. 35PREGNYL W/DILUENT BENZYL – chorionic gonadotropin

for im inj 10000 unit.........................................................14PREMARIN – estrogens, conjugated tab 0.3 mg.................9PREMARIN – estrogens, conjugated tab 0.45 mg...............9PREMARIN – estrogens, conjugated tab 0.625 mg.............9PREMARIN – estrogens, conjugated tab 0.9 mg.................9PREMARIN – estrogens, conjugated tab 1.25 mg...............9PREMPHASE – conj est 0.625(14)/conj est-medroxypro

ac tab 0.625-5mg(14)...................................................... 10

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.3-1.5 mg.................................................... 10

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.45-1.5 mg.................................................. 10

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-2.5 mg................................................ 10

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-5 mg................................................... 10

PRENATABS RX – prenatal vit w/ iron carbonyl-fa tab 29-1mg.....................................................................................36

PRENATAL PLUS IRON – prenatal vit w/ iron carbonyl-fatab 29-1 mg......................................................................36

PRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab29-1 mg............................................................................ 36

PRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg............................................................................ 36

PRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap106.5-1 mg....................................................................... 36

PRENATAL VITAMINS PLUS LO – prenatal vit w/ fefumarate-fa tab 27-1 mg..................................................36

PREZCOBIX – darunavir-cobicistat tab 800-150 mg...........4PREZISTA – darunavir ethanolate susp 100 mg/ml (base

equiv).................................................................................. 4PREZISTA – darunavir ethanolate tab 75 mg (base




equiv).................................................................................. 4PRIFTIN – rifapentine tab 150 mg....................................... 2primaquine phosphate tab 26.3 mg (15 mg base)

(Primaquine phosphate)..................................................5primidone tab 50 mg (Mysoline)..................................... 35primidone tab 250 mg (Mysoline)................................... 35probenecid tab 500 mg.................................................... 34prochlorperazine maleate tab 5 mg (base equivalent)

(Compazine)....................................................................27prochlorperazine maleate tab 10 mg (base equivalent)

(Compazine)....................................................................27prochlorperazine suppos 25 mg.....................................27PROCRIT – epoetin alfa inj 2000 unit/ml...........................37PROCRIT – epoetin alfa inj 3000 unit/ml...........................37PROCRIT – epoetin alfa inj 4000 unit/ml...........................37PROCRIT – epoetin alfa inj 10000 unit/ml.........................37PROCRIT – epoetin alfa inj 20000 unit/ml.........................37PROCRIT – epoetin alfa inj 40000 unit/ml.........................37progesterone micronized cap 100 mg

(Prometrium)...................................................................10progesterone micronized cap 200 mg

(Prometrium)...................................................................10PROLIA – denosumab inj soln prefilled syringe 60 mg/

ml...................................................................................... 14promethazine hcl suppos 12.5 mg................................. 21promethazine hcl suppos 25 mg.................................... 21

2021


promethazine hcl syrup 6.25 mg/5ml............................. 21promethazine hcl tab 12.5 mg.........................................21promethazine hcl tab 25 mg............................................21promethazine hcl tab 50 mg............................................21PROMETHEGAN – promethazine hcl suppos 50 mg........21propafenone hcl cap er 12hr 225 mg (Rythmol sr)....... 16propafenone hcl cap er 12hr 325 mg (Rythmol sr)....... 16propafenone hcl cap er 12hr 425 mg (Rythmol sr)....... 16propafenone hcl tab 300 mg........................................... 16propafenone hcl tab 150 mg (Rythmol)......................... 16propafenone hcl tab 225 mg (Rythmol)......................... 16PROPANTHELINE BROMIDE – propantheline bromide

tab 15 mg.........................................................................23PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 40-25 mg...................................18PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 80-25 mg...................................18propranolol hcl cap er 24hr 60 mg (Inderal la)..............15propranolol hcl cap er 24hr 80 mg (Inderal la)..............15propranolol hcl cap er 24hr 120 mg (Inderal la)............15propranolol hcl cap er 24hr 160 mg (Inderal la)............15PROPRANOLOL HCL – propranolol hcl oral soln 20

mg/5ml..............................................................................15PROPRANOLOL HCL – propranolol hcl oral soln 40

mg/5ml..............................................................................15propranolol hcl tab 10 mg............................................... 15propranolol hcl tab 20 mg............................................... 15propranolol hcl tab 40 mg............................................... 15propranolol hcl tab 60 mg............................................... 15propranolol hcl tab 80 mg............................................... 15propylthiouracil tab 50 mg.............................................. 13PULMOZYME – dornase alfa inhal soln 1 mg/ml.............. 22PURIXAN – mercaptopurine susp 2000 mg/100ml (20 mg/

ml)....................................................................................... 7pyrazinamide tab 500 mg...................................................2pyridostigmine bromide tab 60 mg (Mestinon)............. 36pyrimethamine tab 25 mg (Daraprim)...............................5Qquetiapine fumarate tab er 24hr 50 mg (Seroquel

xr)..................................................................................... 27quetiapine fumarate tab er 24hr 150 mg (Seroquel




xr)..................................................................................... 27quetiapine fumarate tab 25 mg (Seroquel).................... 27quetiapine fumarate tab 50 mg (Seroquel).................... 27quetiapine fumarate tab 100 mg (Seroquel).................. 27quetiapine fumarate tab 200 mg (Seroquel).................. 27quetiapine fumarate tab 300 mg (Seroquel).................. 27quetiapine fumarate tab 400 mg (Seroquel).................. 27quinapril hcl tab 5 mg (Accupril)....................................18

quinapril hcl tab 10 mg (Accupril)..................................18quinapril hcl tab 20 mg (Accupril)..................................18quinapril hcl tab 40 mg (Accupril)..................................18quinapril-hydrochlorothiazide tab 10-12.5 mg

(Accuretic).......................................................................18quinapril-hydrochlorothiazide tab 20-12.5 mg

(Accuretic).......................................................................18quinapril-hydrochlorothiazide tab 20-25 mg

(Accuretic).......................................................................18quinidine gluconate tab er 324 mg.................................16QUINIDINE SULFATE – quinidine sulfate tab 200 mg.......16QUINIDINE SULFATE – quinidine sulfate tab 300 mg.......16QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 40 mcg/act.....................................................22QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 80 mcg/act.....................................................22

Rraloxifene hcl tab 60 mg (Evista)....................................14ramipril cap 1.25 mg (Altace).......................................... 18ramipril cap 2.5 mg (Altace)............................................ 18ramipril cap 5 mg (Altace)............................................... 18ramipril cap 10 mg (Altace)............................................. 18rasagiline mesylate tab 0.5 mg (base equiv)

(Azilect)............................................................................35rasagiline mesylate tab 1 mg (base equiv) (Azilect)..... 35REBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml

(12mu/ml)......................................................................... 30REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml

(24mu/ml)......................................................................... 30REBIF REBIDOSE – interferon beta-1a soln auto-inj 22

mcg/0.5ml (12mu/ml)....................................................... 30REBIF REBIDOSE – interferon beta-1a soln auto-inj 44

mcg/0.5ml (24mu/ml)....................................................... 30REBIF REBIDOSE TITRATION – interferon beta-1a auto-

inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml...........................30REBIF TITRATION PACK – interferon beta-1a pref syr

6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml................................30repaglinide tab 0.5 mg (Prandin).................................... 12repaglinide tab 1 mg (Prandin)....................................... 12repaglinide tab 2 mg (Prandin)....................................... 12REPATHA – evolocumab subcutaneous soln prefilled

syringe 140 mg/ml........................................................... 20REPATHA PUSHTRONEX SYSTEM – evolocumab

subcutaneous soln cartridge/infusor 420 mg/3.5ml........ 20REPATHA SURECLICK – evolocumab subcutaneous soln

auto-injector 140 mg/ml...................................................20RETACRIT – epoetin alfa-epbx inj 2000 unit/ml................ 37RETACRIT – epoetin alfa-epbx inj 3000 unit/ml................ 37RETACRIT – epoetin alfa-epbx inj 4000 unit/ml................ 37RETACRIT – epoetin alfa-epbx inj 10000 unit/ml.............. 37RETACRIT – epoetin alfa-epbx inj 40000 unit/ml.............. 37REVCOVI – elapegademase-lvlr im soln 2.4 mg/1.5ml (1.6

mg/ml)...............................................................................14REVLIMID – lenalidomide cap 5 mg..................................44REVLIMID – lenalidomide cap 10 mg................................44

2021


REVLIMID – lenalidomide cap 15 mg................................44REVLIMID – lenalidomide cap 20 mg................................44REVLIMID – lenalidomide cap 25 mg................................44REVLIMID – lenalidomide caps 2.5 mg............................. 44ribavirin cap 200 mg (Rebetol)..........................................4ribavirin tab 200 mg (Copegus)........................................ 4rifabutin cap 150 mg (Mycobutin).....................................2rifampin cap 150 mg (Rifadin)...........................................2rifampin cap 300 mg (Rifadin)...........................................2riluzole tab 50 mg (Rilutek)............................................. 36RINVOQ – upadacitinib tab er 24hr 15 mg........................33risedronate sodium tab 5 mg (Actonel)......................... 14risedronate sodium tab 30 mg (Actonel)....................... 14risedronate sodium tab 35 mg (Actonel)....................... 14risedronate sodium tab 150 mg (Actonel)..................... 14RISPERIDONE ODT – risperidone orally disintegrating tab

0.25 mg............................................................................ 27risperidone orally disintegrating tab 0.5 mg (Risperdal

m-tab)...............................................................................27risperidone orally disintegrating tab 1 mg (Risperdal




m-tab)...............................................................................27risperidone soln 1 mg/ml (Risperdal).............................27risperidone tab 0.25 mg (Risperdal)...............................27risperidone tab 0.5 mg (Risperdal).................................27risperidone tab 1 mg (Risperdal)....................................27risperidone tab 2 mg (Risperdal)....................................27risperidone tab 3 mg (Risperdal)....................................27risperidone tab 4 mg (Risperdal)....................................27ritonavir tab 100 mg (Norvir).............................................4rivastigmine tartrate cap 1.5 mg (base equivalent)...... 31rivastigmine tartrate cap 3 mg (base equivalent)......... 31rivastigmine tartrate cap 4.5 mg (base equivalent)...... 31rivastigmine tartrate cap 6 mg (base equivalent)......... 31rizatriptan benzoate oral disintegrating tab 5 mg (base

eq) (Maxalt-mlt).............................................................. 33rizatriptan benzoate oral disintegrating tab 10 mg

(base eq) (Maxalt-mlt)....................................................33rizatriptan benzoate tab 5 mg (base equivalent)

(Maxalt)............................................................................ 33rizatriptan benzoate tab 10 mg (base equivalent)

(Maxalt)............................................................................ 33ropinirole hydrochloride tab 0.25 mg (Requip)............. 35ropinirole hydrochloride tab 0.5 mg (Requip)............... 35ropinirole hydrochloride tab 1 mg (Requip).................. 35ropinirole hydrochloride tab 2 mg (Requip).................. 35ropinirole hydrochloride tab 3 mg (Requip).................. 36ropinirole hydrochloride tab 4 mg (Requip).................. 36ropinirole hydrochloride tab 5 mg (Requip).................. 36rosuvastatin calcium tab 5 mg (Crestor)....................... 20rosuvastatin calcium tab 10 mg (Crestor)..................... 20

rosuvastatin calcium tab 20 mg (Crestor)..................... 20rosuvastatin calcium tab 40 mg (Crestor)..................... 20ROZLYTREK – entrectinib cap 100 mg............................... 7ROZLYTREK – entrectinib cap 200 mg............................... 7RUBRACA – rucaparib camsylate tab 200 mg (base

equivalent).......................................................................... 7RUBRACA – rucaparib camsylate tab 250 mg (base

equivalent).......................................................................... 7RUBRACA – rucaparib camsylate tab 300 mg (base

equivalent).......................................................................... 7RYBELSUS – semaglutide tab 3 mg................................. 12RYBELSUS – semaglutide tab 7 mg................................. 12RYBELSUS – semaglutide tab 14 mg............................... 12RYDAPT – midostaurin cap 25 mg...................................... 7

SSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 10 mg..................................................................... 14SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 20 mg..................................................................... 14SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 30 mg..................................................................... 14scopolamine td patch 72hr 1 mg/3days (Transderm-

scop)................................................................................ 23selegiline hcl cap 5 mg (Eldepryl).................................. 36SELEGILINE HCL – selegiline hcl tab 5 mg......................36selenium sulfide lotion 2.5%........................................... 43SE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab 29-1

mg.....................................................................................36SE-NATAL 19 – prenatal vit w/ fe fumarate-fa chew tab

29-1 mg............................................................................ 36SEREVENT DISKUS – salmeterol xinafoate aer pow ba

50 mcg/dose (base equiv)...............................................22sertraline hcl oral concentrate for solution 20 mg/ml

(Zoloft)............................................................................. 26sertraline hcl tab 25 mg (Zoloft)..................................... 26sertraline hcl tab 50 mg (Zoloft)..................................... 26sertraline hcl tab 100 mg (Zoloft)................................... 26sevelamer carbonate packet 0.8 gm (Renvela)............. 24sevelamer carbonate packet 2.4 gm (Renvela)............. 24sevelamer carbonate tab 800 mg (Renvela).................. 24sildenafil citrate tab 20 mg (Revatio)............................. 20silver sulfadiazine cream 1% (Silvadene)...................... 43SIMBRINZA – brinzolamide-brimonidine tartrate ophth

susp 1-0.2%..................................................................... 40SIMPONI – golimumab subcutaneous soln auto-injector

100 mg/ml........................................................................ 33SIMPONI – golimumab subcutaneous soln prefilled

syringe 100 mg/ml........................................................... 33simvastatin tab 5 mg (Zocor).......................................... 20simvastatin tab 10 mg (Zocor)........................................ 20simvastatin tab 20 mg (Zocor)........................................ 20simvastatin tab 40 mg (Zocor)........................................ 20simvastatin tab 80 mg (Zocor)........................................ 20sirolimus oral soln 1 mg/ml (Rapamune).......................44sirolimus tab 0.5 mg (Rapamune)...................................44

2021


sirolimus tab 1 mg (Rapamune)......................................44sirolimus tab 2 mg (Rapamune)......................................44SIVEXTRO – tedizolid phosphate tab 200 mg.....................5SKYLA – levonorgestrel releasing iud 14 mcg/day (13.5

mg total)........................................................................... 10SKYRIZI – risankizumab-rzaa sol prefilled syringe 2 x 75

mg/0.83ml kit....................................................................43sodium chloride soln nebu 3%....................................... 21sodium chloride soln nebu 7% (Hyper-sal)................... 21sodium citrate & citric acid soln 500-334 mg/5ml

(Shohls solution modi)..................................................25sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)

(Luride)............................................................................ 36sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)

(Luride)............................................................................ 37sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

(Luride)............................................................................ 37sodium fluoride cream 1.1% (Prevident 5000 plus)...... 41sodium fluoride gel 1.1% (0.5% f) (Prevident

fluoride)........................................................................... 41SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from

1.1 mg naf).......................................................................36SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from

2.2 mg naf).......................................................................36sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop

naf)................................................................................... 37sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

(Luride)............................................................................ 37sodium polystyrene sulfonate oral susp 15 gm/60ml

(Sps).................................................................................44sodium polystyrene sulfonate powder

(Kayexalate).................................................................... 44SOFOSBUVIR/VELPATASVIR – sofosbuvir-velpatasvir tab

400-100 mg........................................................................ 4solifenacin succinate tab 5 mg (Vesicare).....................24solifenacin succinate tab 10 mg (Vesicare)...................24SOLIQUA 100/33 – insulin glargine-lixisenatide sol pen-inj

100-33 unit-mcg/ml.......................................................... 12SOLOSEC – secnidazole granules packet 2 gm................. 5SOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml (base

equivalent).......................................................................... 7SOOLANTRA – ivermectin cream 1%............................... 43sotalol hcl (afib/afl) tab 80 mg (Betapace af).................15sotalol hcl (afib/afl) tab 120 mg (Betapace af)...............15sotalol hcl (afib/afl) tab 160 mg (Betapace af)...............15sotalol hcl tab 240 mg......................................................15sotalol hcl tab 80 mg (Betapace)....................................15sotalol hcl tab 120 mg (Betapace)..................................15sotalol hcl tab 160 mg (Betapace)..................................15SOVALDI – sofosbuvir pellet pack 150 mg..........................4SOVALDI – sofosbuvir pellet pack 200 mg..........................4SOVALDI – sofosbuvir tab 200 mg...................................... 4SOVALDI – sofosbuvir tab 400 mg...................................... 4SPIRIVA HANDIHALER – tiotropium bromide

monohydrate inhal cap 18 mcg (base equiv)..................22

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act.............................................. 22

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act................................................ 22

spironolactone & hydrochlorothiazide tab 25-25 mg(Aldactazide)................................................................... 19

spironolactone tab 25 mg (Aldactone)...........................19spironolactone tab 50 mg (Aldactone)...........................19spironolactone tab 100 mg (Aldactone).........................19SPRYCEL – dasatinib tab 20 mg.........................................7SPRYCEL – dasatinib tab 50 mg.........................................7SPRYCEL – dasatinib tab 70 mg.........................................7SPRYCEL – dasatinib tab 80 mg.........................................7SPRYCEL – dasatinib tab 100 mg.......................................7SPRYCEL – dasatinib tab 140 mg.......................................7stavudine cap 15 mg (Zerit)...............................................4stavudine cap 20 mg (Zerit)...............................................4stavudine cap 30 mg (Zerit)...............................................4stavudine cap 40 mg (Zerit)...............................................4STELARA – ustekinumab inj 45 mg/0.5ml.........................43STELARA – ustekinumab soln prefilled syringe 45

mg/0.5ml...........................................................................43STELARA – ustekinumab soln prefilled syringe 90 mg/

ml...................................................................................... 43STIMATE – desmopressin acetate nasal soln 1.5 mg/

ml...................................................................................... 14STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aero

soln 2.5-2.5 mcg/act........................................................ 22STIVARGA – regorafenib tab 40 mg....................................7STRENSIQ – asfotase alfa subcutaneous inj 18

mg/0.45ml.........................................................................14STRENSIQ – asfotase alfa subcutaneous inj 28

mg/0.7ml...........................................................................14STRENSIQ – asfotase alfa subcutaneous inj 40 mg/

ml...................................................................................... 14STRENSIQ – asfotase alfa subcutaneous inj 80

mg/0.8ml...........................................................................14sucralfate tab 1 gm (Carafate).........................................23SULFACETAMIDE SODIUM/PRED – sulfacetamide

sodium-prednisolone ophth soln 10-0.23(0.25)%........... 41sulfacetamide sodium lotion 10% (acne) (Klaron)........43sulfacetamide sodium ophth soln 10% (Bleph-10)....... 40SULFADIAZINE – sulfadiazine tab 500 mg......................... 2sulfamethoxazole-trimethoprim susp 200-40

mg/5ml............................................................................... 5sulfamethoxazole-trimethoprim tab 400-80 mg

(Bactrim)............................................................................5sulfamethoxazole-trimethoprim tab 800-160 mg

(Bactrim ds)...................................................................... 5sulfasalazine tab delayed release 500 mg (Azulfidine

en-tabs)............................................................................24sulfasalazine tab 500 mg (Azulfidine)............................ 24sulindac tab 150 mg......................................................... 33sulindac tab 200 mg......................................................... 33sumatriptan nasal spray 5 mg/act (Imitrex)...................33sumatriptan nasal spray 20 mg/act (Imitrex).................34

2021


sumatriptan succinate inj 6 mg/0.5ml (Imitrex statdoseref).................................................................................... 34

sumatriptan succinate solution auto-injector 4mg/0.5ml (Imitrex statdose sys)...................................34

sumatriptan succinate solution auto-injector 6mg/0.5ml (Imitrex statdose sys)...................................34

sumatriptan succinate solution cartridge 4 mg/0.5ml(Imitrex statdose ref).....................................................34

sumatriptan succinate solution cartridge 6 mg/0.5ml(Imitrex statdose ref).....................................................34

SUMATRIPTAN SUCCINATE – sumatriptan succinatesolution prefilled syringe 6 mg/0.5ml...............................34

sumatriptan succinate tab 25 mg (Imitrex)....................34sumatriptan succinate tab 50 mg (Imitrex)....................34sumatriptan succinate tab 100 mg (Imitrex)..................34SUNOSI – solriamfetol hcl tab 75 mg (base equiv)........... 29SUNOSI – solriamfetol hcl tab 150 mg (base equiv)......... 29SUPRAX – cefixime chew tab 100 mg................................ 1SUPRAX – cefixime chew tab 200 mg................................ 1SUPRAX – cefixime for susp 500 mg/5ml........................... 1SUTENT – sunitinib malate cap 12.5 mg (base

equivalent).......................................................................... 7SUTENT – sunitinib malate cap 25 mg (base

equivalent).......................................................................... 7SUTENT – sunitinib malate cap 37.5 mg (base

equivalent).......................................................................... 8SUTENT – sunitinib malate cap 50 mg (base

equivalent).......................................................................... 8SYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 80-4.5 mcg/act....................................................22SYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 160-4.5 mcg/act..................................................22SYMDEKO – tezacaftor-ivacaftor 50-75 mg & ivacaftor 75

mg tab tbpk...................................................................... 22SYMDEKO – tezacaftor-ivacaftor 100-150 mg & ivacaftor

150 mg tab tbpk...............................................................22SYMFI – efavirenz-lamivudine-tenofovir df tab

600-300-300 mg.................................................................4SYMFI LO – efavirenz-lamivudine-tenofovir df tab

400-300-300 mg.................................................................4SYMJEPI – epinephrine soln prefilled syringe 0.15

mg/0.3ml (1:2000)............................................................19SYMJEPI – epinephrine solution prefilled syringe 0.3

mg/0.3ml (1:1000)............................................................19SYMPROIC – naldemedine tosylate tab 0.2 mg (base

equivalent)........................................................................ 24SYNAGIS – palivizumab im soln 50 mg/0.5ml.....................5SYNAGIS – palivizumab im soln 100 mg/ml........................5SYNJARDY – empagliflozin-metformin hcl tab 5-500

mg.....................................................................................12SYNJARDY – empagliflozin-metformin hcl tab 5-1000

mg.....................................................................................12SYNJARDY – empagliflozin-metformin hcl tab 12.5-500

mg.....................................................................................12SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000

mg.....................................................................................12

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr5-1000 mg........................................................................ 12

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr10-1000 mg......................................................................12

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr12.5-1000 mg...................................................................12

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr25-1000 mg......................................................................12

SYNVISC – hylan intra-articular solution prefilled syringe16 mg/2ml........................................................................ 36

SYNVISC ONE – hylan intra-articular solution prefilledsyringe 48 mg/6ml........................................................... 36

TTABLOID – thioguanine tab 40 mg...................................... 8TABRECTA – capmatinib hcl tab 150 mg............................ 8TABRECTA – capmatinib hcl tab 200 mg............................ 8tacrolimus cap 0.5 mg (Prograf)..................................... 44tacrolimus cap 1 mg (Prograf)........................................ 44tacrolimus cap 5 mg (Prograf)........................................ 44tacrolimus oint 0.03% (Protopic).................................... 43tacrolimus oint 0.1% (Protopic)...................................... 43tadalafil tab 2.5 mg (Cialis)..............................................20tadalafil tab 5 mg (Cialis).................................................20tadalafil tab 10 mg (Cialis)...............................................20tadalafil tab 20 mg (Cialis)...............................................20tadalafil tab 20 mg (pah) (Adcirca)................................. 20TAFINLAR – dabrafenib mesylate cap 50 mg (base

equivalent).......................................................................... 8TAFINLAR – dabrafenib mesylate cap 75 mg (base

equivalent).......................................................................... 8TAGRISSO – osimertinib mesylate tab 40 mg (base

equivalent).......................................................................... 8TAGRISSO – osimertinib mesylate tab 80 mg (base

equivalent).......................................................................... 8TALZENNA – talazoparib tosylate cap 0.25 mg (base

equivalent).......................................................................... 8TALZENNA – talazoparib tosylate cap 1 mg (base

equivalent).......................................................................... 8tamoxifen citrate tab 10 mg (base equivalent)................8tamoxifen citrate tab 20 mg (base equivalent)................8tamsulosin hcl cap 0.4 mg (Flomax).............................. 25TASIGNA – nilotinib hcl cap 50 mg (base equivalent)......... 8TASIGNA – nilotinib hcl cap 150 mg (base equivalent)....... 8TASIGNA – nilotinib hcl cap 200 mg (base equivalent)....... 8tazarotene cream 0.1% (Tazorac)....................................43TAZORAC – tazarotene cream 0.05%...............................43TAZORAC – tazarotene gel 0.05%.................................... 43TAZORAC – tazarotene gel 0.1%...................................... 43telmisartan-hydrochlorothiazide tab 40-12.5 mg

(Micardis hct)..................................................................18telmisartan-hydrochlorothiazide tab 80-12.5 mg

(Micardis hct)..................................................................18telmisartan-hydrochlorothiazide tab 80-25 mg

(Micardis hct)..................................................................18telmisartan tab 20 mg (Micardis).................................... 18

2021


telmisartan tab 40 mg (Micardis).................................... 18telmisartan tab 80 mg (Micardis).................................... 18temazepam cap 7.5 mg (Restoril)................................... 28temazepam cap 15 mg (Restoril).................................... 28temazepam cap 22.5 mg (Restoril)................................. 28temazepam cap 30 mg (Restoril).................................... 28TEMIXYS – lamivudine-tenofovir disoproxil fumarate tab

300-300 mg........................................................................ 4temozolomide cap 5 mg (Temodar).................................. 8temozolomide cap 20 mg (Temodar)................................8temozolomide cap 100 mg (Temodar)..............................8temozolomide cap 140 mg (Temodar)..............................8temozolomide cap 180 mg (Temodar)..............................8temozolomide cap 250 mg (Temodar)..............................8TENCON – butalbital-acetaminophen tab 50-325 mg....... 31tenofovir disoproxil fumarate tab 300 mg (Viread)......... 4terazosin hcl cap 1 mg (base equivalent)......................18terazosin hcl cap 2 mg (base equivalent)......................18terazosin hcl cap 5 mg (base equivalent)......................18terazosin hcl cap 10 mg (base equivalent)....................18terbinafine hcl tab 250 mg (Lamisil).................................2terbutaline sulfate tab 2.5 mg......................................... 22terbutaline sulfate tab 5 mg............................................ 22TERCONAZOLE – terconazole vaginal cream 0.8%.........24terconazole vaginal cream 0.4% (Terazol 7).................. 24terconazole vaginal suppos 80 mg (Terazol 3)..............24testosterone cypionate im inj in oil 100 mg/ml (Depo-

testosterone).....................................................................9testosterone cypionate im inj in oil 200 mg/ml (Depo-

testosterone).....................................................................9TESTOSTERONE ENANTHATE – testosterone enanthate

im inj in oil 200 mg/ml....................................................... 9testosterone td gel 12.5 mg/act (1%) (Androgel

pump).................................................................................9testosterone td gel 20.25 mg/act (1.62%) (Androgel

pump).................................................................................9testosterone td gel 25 mg/2.5gm (1%) (Androgel).......... 9testosterone td gel 50 mg/5gm (1%) (Androgel)............. 9testosterone td gel 20.25 mg/1.25gm (1.62%)

(Androgel)..........................................................................9testosterone td gel 40.5 mg/2.5gm (1.62%)

(Androgel)..........................................................................9testosterone td soln 30 mg/act (Axiron).......................... 9tetrabenazine tab 12.5 mg (Xenazine)............................ 31tetrabenazine tab 25 mg (Xenazine)............................... 31tetracycline hcl cap 250 mg (Tetracycline hcl)................2tetracycline hcl cap 500 mg (Tetracycline hcl)................2THALOMID – thalidomide cap 50 mg................................ 44THALOMID – thalidomide cap 100 mg.............................. 44THALOMID – thalidomide cap 150 mg.............................. 44THALOMID – thalidomide cap 200 mg.............................. 44THEOPHYLLINE ER – theophylline tab er 12hr 300

mg.....................................................................................22THEOPHYLLINE ER – theophylline tab er 12hr 450

mg.....................................................................................22theophylline tab er 24hr 400 mg.....................................22

theophylline tab er 24hr 600 mg.....................................22thiothixene cap 1 mg........................................................27thiothixene cap 2 mg........................................................27thiothixene cap 5 mg........................................................27thiothixene cap 10 mg......................................................27timolol maleate ophth soln 0.25% (Timoptic)................41timolol maleate ophth soln 0.5% (Timoptic)..................41timolol maleate tab 5 mg................................................. 15timolol maleate tab 10 mg............................................... 15timolol maleate tab 20 mg............................................... 15TIVICAY – dolutegravir sodium tab 10 mg (base equiv)...... 4TIVICAY – dolutegravir sodium tab 25 mg (base equiv)...... 4TIVICAY – dolutegravir sodium tab 50 mg (base equiv)...... 4TIVICAY PD – dolutegravir sodium tab for oral susp 5 mg

(base equiv)....................................................................... 4tizanidine hcl tab 2 mg (base equivalent)......................36tizanidine hcl tab 4 mg (base equivalent)

(Zanaflex).........................................................................36tobramycin-dexamethasone ophth susp 0.3-0.1%

(Tobradex)....................................................................... 41tobramycin nebu soln 300 mg/5ml (Tobi)........................ 2tobramycin ophth soln 0.3% (Tobrex)............................41tolterodine tartrate cap er 24hr 2 mg (Detrol la)............24tolterodine tartrate cap er 24hr 4 mg (Detrol la)............24tolterodine tartrate tab 1 mg (Detrol)............................. 24tolterodine tartrate tab 2 mg (Detrol)............................. 24topiramate sprinkle cap 15 mg (Topamax sprinkle)..... 35topiramate sprinkle cap 25 mg (Topamax sprinkle)..... 35topiramate tab 25 mg (Topamax).................................... 35topiramate tab 50 mg (Topamax).................................... 35topiramate tab 100 mg (Topamax)..................................35topiramate tab 200 mg (Topamax)..................................35toremifene citrate tab 60 mg (base equivalent)

(Fareston).......................................................................... 8torsemide tab 5 mg (Demadex).......................................19torsemide tab 10 mg (Demadex).....................................19torsemide tab 20 mg (Demadex).....................................19torsemide tab 100 mg (Demadex)...................................19TOUJEO MAX SOLOSTAR – insulin glargine soln pen-

injector 300 unit/ml (2 unit dial).......................................13TOUJEO SOLOSTAR – insulin glargine soln pen-injector

300 unit/ml (1 unit dial)....................................................13TRACLEER – bosentan tab for oral susp 32 mg...............20tramadol-acetaminophen tab 37.5-325 mg

(Ultracet)..........................................................................32tramadol hcl tab er 24hr 100 mg.....................................32tramadol hcl tab er 24hr 200 mg.....................................32tramadol hcl tab er 24hr 300 mg.....................................32tramadol hcl tab 50 mg (Ultram).....................................32trandolapril tab 1 mg (Mavik).......................................... 18trandolapril tab 2 mg (Mavik).......................................... 18trandolapril tab 4 mg (Mavik).......................................... 18tranylcypromine sulfate tab 10 mg (Parnate)................26travoprost ophth soln 0.004% (benzalkonium free)

(bak free) (Travatan z)................................................... 41trazodone hcl tab 50 mg.................................................. 26

2021


trazodone hcl tab 100 mg................................................26trazodone hcl tab 150 mg................................................26trazodone hcl tab 300 mg................................................26TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 100-62.5-25 mcg/inh.............................................. 22TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 200-62.5-25 mcg/inh.............................................. 22TREMFYA – guselkumab soln pen-injector 100 mg/ml..... 43TREMFYA – guselkumab soln prefilled syringe 100 mg/

ml...................................................................................... 43TRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 100 unit/ml.......................................................... 13TRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 200 unit/ml.......................................................... 13TRESIBA – insulin degludec inj 100 unit/ml...................... 13tretinoin cap 10 mg.............................................................8tretinoin cream 0.025% (Retin-a).....................................43tretinoin cream 0.05% (Retin-a).......................................43tretinoin cream 0.1% (Retin-a).........................................43tretinoin gel 0.025%, NF = Avita (Retin-a)......................43tretinoin gel 0.01% (Retin-a)............................................ 43tretinoin microsphere gel 0.04% (Retin-a micro).......... 43tretinoin microsphere gel 0.1% (Retin-a micro)............ 43TRETTEN – coagulation factor xiii a-subunit for inj

2000-3125 unit................................................................. 40triamcinolone acetonide cream 0.025%......................... 43triamcinolone acetonide cream 0.1%............................. 43triamcinolone acetonide cream 0.5%............................. 43triamcinolone acetonide dental paste 0.1%.................. 41triamcinolone acetonide lotion 0.025%..........................43triamcinolone acetonide lotion 0.1%..............................43triamcinolone acetonide oint 0.025%............................. 43triamcinolone acetonide oint 0.1%................................. 43triamcinolone acetonide oint 0.5%................................. 43triamterene & hydrochlorothiazide cap 37.5-25 mg

(Dyazide)..........................................................................19triamterene & hydrochlorothiazide tab 37.5-25 mg

(Maxzide-25)....................................................................19triamterene & hydrochlorothiazide tab 75-50 mg

(Maxzide)......................................................................... 19trifluoperazine hcl tab 1 mg (base equivalent)..............27trifluoperazine hcl tab 2 mg (base equivalent)..............27trifluoperazine hcl tab 5 mg (base equivalent)..............27trifluoperazine hcl tab 10 mg (base equivalent)............27TRIFLURIDINE – trifluridine ophth soln 1%.......................41trihexyphenidyl hcl oral soln 0.4 mg/ml.........................36trihexyphenidyl hcl tab 2 mg...........................................36trihexyphenidyl hcl tab 5 mg...........................................36TRIJARDY XR – empagliflozin-linaglip-metformin tab er

24hr 12.5-2.5-1000mg..................................................... 12TRIJARDY XR – empagliflozin-linagliptin-metformin tab er

24hr 5-2.5-1000mg.......................................................... 12TRIJARDY XR – empagliflozin-linagliptin-metformin tab er

24hr 10-5-1000 mg.......................................................... 12TRIJARDY XR – empagliflozin-linagliptin-metformin tab er

24hr 25-5-1000 mg.......................................................... 12

TRIKAFTA – elexacaf-tezacaf-ivacaf 100-50-75 mg&ivacaftor 150 mg tbpk................................................... 22

trimethobenzamide hcl cap 300 mg (Tigan).................. 23trimethoprim tab 100 mg................................................... 5TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1 mg...... 36TRIUMEQ – abacavir-dolutegravir-lamivudine tab

600-50-300 mg...................................................................4tropicamide ophth soln 0.5%.......................................... 41tropicamide ophth soln 1% (Mydriacyl)......................... 41TRULANCE – plecanatide tab 3 mg.................................. 24TRULICITY – dulaglutide soln pen-injector 0.75

mg/0.5ml...........................................................................12TRULICITY – dulaglutide soln pen-injector 1.5

mg/0.5ml...........................................................................12TRULICITY – dulaglutide soln pen-injector 3 mg/0.5ml.....12TRULICITY – dulaglutide soln pen-injector 4.5

mg/0.5ml...........................................................................12TRUVADA – emtricitabine-tenofovir disoproxil fumarate

tab 100-150 mg..................................................................4TRUVADA – emtricitabine-tenofovir disoproxil fumarate



tab 200-300 mg..................................................................4TYKERB – lapatinib ditosylate tab 250 mg (base equiv)..... 8TYMLOS – abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56ml............................................................. 14

UUDENYCA – pegfilgrastim-cbqv soln prefilled syringe 6

mg/0.6ml...........................................................................37UPTRAVI – selexipag tab 200 mcg....................................20UPTRAVI – selexipag tab 400 mcg....................................20UPTRAVI – selexipag tab 600 mcg....................................20UPTRAVI – selexipag tab 800 mcg....................................20UPTRAVI – selexipag tab 1000 mcg..................................20UPTRAVI – selexipag tab 1200 mcg..................................20UPTRAVI – selexipag tab 1400 mcg..................................20UPTRAVI – selexipag tab 1600 mcg..................................20UPTRAVI – selexipag tab therapy pack 200 mcg (140) &

800 mcg (60)....................................................................20ursodiol cap 300 mg (Actigall)........................................24ursodiol tab 250 mg (Urso 250)...................................... 24ursodiol tab 500 mg (Urso forte).................................... 24

VVAGIFEM – estradiol vaginal tab 10 mcg.......................... 24valacyclovir hcl tab 1 gm (Valtrex)................................... 4valacyclovir hcl tab 500 mg (Valtrex)............................... 4VALCHLOR – mechlorethamine hcl gel 0.016% (base

equivalent)........................................................................ 43valganciclovir hcl for soln 50 mg/ml (base equiv)

(Valcyte).............................................................................4valganciclovir hcl tab 450 mg (base equivalent)

(Valcyte).............................................................................4

2021


valproate sodium oral soln 250 mg/5ml (base equiv)(Depakene)...................................................................... 35

valproic acid cap 250 mg (Depakene)............................35valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan

hct)................................................................................... 18valsartan-hydrochlorothiazide tab 160-12.5 mg (Diovan

hct)................................................................................... 18valsartan-hydrochlorothiazide tab 160-25 mg (Diovan

hct)................................................................................... 19valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovan

hct)................................................................................... 19valsartan-hydrochlorothiazide tab 320-25 mg (Diovan

hct)................................................................................... 19valsartan tab 40 mg (Diovan).......................................... 18valsartan tab 80 mg (Diovan).......................................... 18valsartan tab 160 mg (Diovan)........................................ 18valsartan tab 320 mg (Diovan)........................................ 18vancomycin hcl cap 125 mg (base equivalent)

(Vancocin hcl)...................................................................5vancomycin hcl cap 250 mg (base equivalent)

(Vancocin hcl)...................................................................5VELPHORO – sucroferric oxyhydroxide chew tab 500

mg.....................................................................................24VELTASSA – patiromer sorbitex calcium for susp packet

8.4 gm (base eq)............................................................. 44VELTASSA – patiromer sorbitex calcium for susp packet

16.8 gm (base eq)........................................................... 44VELTASSA – patiromer sorbitex calcium for susp packet

25.2 gm (base eq)........................................................... 44VENCLEXTA STARTING PACK – venetoclax tab therapy

starter pack 10 & 50 & 100 mg.........................................8VENCLEXTA – venetoclax tab 10 mg..................................8VENCLEXTA – venetoclax tab 50 mg..................................8VENCLEXTA – venetoclax tab 100 mg................................8venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)

(Effexor xr)...................................................................... 26venlafaxine hcl cap er 24hr 75 mg (base equivalent)

(Effexor xr)...................................................................... 26venlafaxine hcl cap er 24hr 150 mg (base equivalent)

(Effexor xr)...................................................................... 26venlafaxine hcl tab 25 mg (base equivalent).................26venlafaxine hcl tab 37.5 mg (base equivalent)..............26venlafaxine hcl tab 50 mg (base equivalent).................26venlafaxine hcl tab 75 mg (base equivalent).................26venlafaxine hcl tab 100 mg (base equivalent)...............26VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/act

(90mcg base equiv)......................................................... 22verapamil hcl cap er 24hr 120 mg (Verelan).................. 16verapamil hcl cap er 24hr 180 mg (Verelan).................. 16verapamil hcl cap er 24hr 240 mg (Verelan).................. 16VERAPAMIL HCL SR – verapamil hcl cap er 24hr 360

mg.....................................................................................16verapamil hcl tab er 120 mg (Calan sr)..........................16verapamil hcl tab er 180 mg (Calan sr)..........................16verapamil hcl tab er 240 mg (Calan sr)..........................16verapamil hcl tab 40 mg.................................................. 16

verapamil hcl tab 80 mg (Calan).....................................16verapamil hcl tab 120 mg (Calan)...................................16VERZENIO – abemaciclib tab 50 mg...................................8VERZENIO – abemaciclib tab 100 mg.................................8VERZENIO – abemaciclib tab 150 mg.................................8VERZENIO – abemaciclib tab 200 mg.................................8VIBERZI – eluxadoline tab 75 mg......................................24VIBERZI – eluxadoline tab 100 mg....................................24VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/

ml).....................................................................................12vigabatrin powd pack 500 mg (Sabril)........................... 35vigabatrin tab 500 mg (Sabril).........................................35VINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab

29-1 mg............................................................................ 36VINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1

mg.....................................................................................36VIREAD – tenofovir disoproxil fumarate oral powder 40

mg/gm.................................................................................4VIREAD – tenofovir disoproxil fumarate tab 150 mg........... 4VIREAD – tenofovir disoproxil fumarate tab 200 mg........... 4VIREAD – tenofovir disoproxil fumarate tab 250 mg........... 4VITRAKVI – larotrectinib sulfate cap 25 mg (base

equivalent).......................................................................... 8VITRAKVI – larotrectinib sulfate cap 100 mg (base

equivalent).......................................................................... 8VITRAKVI – larotrectinib sulfate oral soln 20 mg/ml (base

equivalent).......................................................................... 8VONVENDI – von willebrand factor (recombinant) for inj

650 unit.............................................................................40VONVENDI – von willebrand factor (recombinant) for inj

1300 unit...........................................................................40voriconazole for susp 40 mg/ml (Vfend)..........................2voriconazole tab 50 mg (Vfend)........................................2voriconazole tab 200 mg (Vfend)......................................2VOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab

400-100-100 mg.................................................................4VOTRIENT – pazopanib hcl tab 200 mg (base equiv).........8VYNDAMAX – tafamidis cap 61 mg...................................20VYNDAQEL – tafamidis meglumine (cardiac) cap 20

mg.....................................................................................20VYVANSE – lisdexamfetamine dimesylate cap 10 mg...... 29VYVANSE – lisdexamfetamine dimesylate cap 20 mg...... 29VYVANSE – lisdexamfetamine dimesylate cap 30 mg...... 29VYVANSE – lisdexamfetamine dimesylate cap 40 mg...... 29VYVANSE – lisdexamfetamine dimesylate cap 50 mg...... 29VYVANSE – lisdexamfetamine dimesylate cap 60 mg...... 29VYVANSE – lisdexamfetamine dimesylate cap 70 mg...... 29VYVANSE – lisdexamfetamine dimesylate chew tab 10

mg.....................................................................................29VYVANSE – lisdexamfetamine dimesylate chew tab 20



mg.....................................................................................29

2021


VYVANSE – lisdexamfetamine dimesylate chew tab 50mg.....................................................................................29

VYVANSE – lisdexamfetamine dimesylate chew tab 60mg.....................................................................................29

Wwarfarin sodium tab 1 mg (Coumadin).......................... 38warfarin sodium tab 2 mg (Coumadin).......................... 38warfarin sodium tab 2.5 mg (Coumadin)....................... 38warfarin sodium tab 3 mg (Coumadin).......................... 38warfarin sodium tab 4 mg (Coumadin).......................... 38warfarin sodium tab 5 mg (Coumadin).......................... 38warfarin sodium tab 6 mg (Coumadin).......................... 38warfarin sodium tab 7.5 mg (Coumadin)....................... 38warfarin sodium tab 10 mg (Coumadin)........................ 38

XXALKORI – crizotinib cap 200 mg....................................... 8XALKORI – crizotinib cap 250 mg....................................... 8XARELTO – rivaroxaban tab 2.5 mg..................................38XARELTO – rivaroxaban tab 10 mg...................................38XARELTO – rivaroxaban tab 15 mg...................................38XARELTO – rivaroxaban tab 20 mg...................................38XARELTO STARTER PACK – rivaroxaban tab starter

therapy pack 15 mg & 20 mg..........................................38XELJANZ – tofacitinib citrate tab 5 mg (base

equivalent)........................................................................ 33XELJANZ – tofacitinib citrate tab 10 mg (base

equivalent)........................................................................ 33XELJANZ XR – tofacitinib citrate tab er 24hr 11 mg (base

equivalent)........................................................................ 33XELJANZ XR – tofacitinib citrate tab er 24hr 22 mg (base

equivalent)........................................................................ 33XIFAXAN – rifaximin tab 550 mg......................................... 5XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

2.5-1000 mg.....................................................................12XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

5-500 mg.......................................................................... 12XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

5-1000 mg........................................................................ 12XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

10-500 mg........................................................................ 12XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

10-1000 mg......................................................................12XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent 9

mg.....................................................................................32XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

13.5 mg............................................................................ 32XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

18 mg............................................................................... 32XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

27 mg............................................................................... 32XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

36 mg............................................................................... 32XTANDI – enzalutamide cap 40 mg.....................................8

XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr...........................................................................10

XULTOPHY 100/3.6 – insulin degludec-liraglutide sol pen-inj 100-3.6 unit-mg/ml......................................................12

YYONSA – abiraterone acetate tab 125 mg.......................... 8

Zzafirlukast tab 10 mg (Accolate)..................................... 22zafirlukast tab 20 mg (Accolate)..................................... 22zaleplon cap 5 mg (Sonata).............................................28zaleplon cap 10 mg (Sonata)...........................................28ZARXIO – filgrastim-sndz soln prefilled syringe 300

mcg/0.5ml......................................................................... 37ZARXIO – filgrastim-sndz soln prefilled syringe 480

mcg/0.8ml......................................................................... 37ZELBORAF – vemurafenib tab 240 mg............................... 8ZENPEP – pancrelipase (lip-prot-amyl) dr cap

3000-10000-14000 unit....................................................23ZENPEP – pancrelipase (lip-prot-amyl) dr cap

5000-17000-24000 unit....................................................24ZENPEP – pancrelipase (lip-prot-amyl) dr cap

10000-32000-42000 unit..................................................24ZENPEP – pancrelipase (lip-prot-amyl) dr cap



25000-79000-105000 unit................................................24ZENPEP – pancrelipase (lip-prot-amyl) dr cap

40000-126000-168000 unit............................................. 24ZEPOSIA 7-DAY STARTER PAC – ozanimod cap pack 4 x

0.23 mg & 3 x 0.46 mg................................................... 31ZEPOSIA – ozanimod hcl cap 0.92 mg............................. 31ZEPOSIA STARTER KIT – ozanimod cap pack 4 x 0.23

mg & 3 x 0.46 mg & 30 x 0.92 mg..................................31zidovudine cap 100 mg (Retrovir).....................................4zidovudine syrup 10 mg/ml (Retrovir)..............................4zidovudine tab 300 mg.......................................................4ZIEXTENZO – pegfilgrastim-bmez soln prefilled syringe 6

mg/0.6ml...........................................................................38ziprasidone hcl cap 20 mg (Geodon)............................. 28ziprasidone hcl cap 40 mg (Geodon)............................. 28ziprasidone hcl cap 60 mg (Geodon)............................. 28ziprasidone hcl cap 80 mg (Geodon)............................. 28ZOLINZA – vorinostat cap 100 mg...................................... 8zolpidem tartrate tab er 6.25 mg (Ambien cr)................28zolpidem tartrate tab er 12.5 mg (Ambien cr)................28zolpidem tartrate tab 5 mg (Ambien)..............................28zolpidem tartrate tab 10 mg (Ambien)............................28zonisamide cap 50 mg..................................................... 35zonisamide cap 25 mg (Zonegran)................................. 35zonisamide cap 100 mg (Zonegran)............................... 35ZORTRESS – everolimus tab 1 mg................................... 44ZYCLARA – imiquimod cream 3.75%................................43

2021


ZYCLARA PUMP – imiquimod cream 2.5%...................... 43ZYCLARA PUMP – imiquimod cream 3.75%.................... 43ZYDELIG – idelalisib tab 100 mg.........................................8ZYDELIG – idelalisib tab 150 mg.........................................8ZYKADIA – ceritinib tab 150 mg.......................................... 8ZYLET – loteprednol etabonate-tobramycin ophth susp

0.5-0.3%........................................................................... 41ZYTIGA – abiraterone acetate tab 500 mg..........................8

Documents

PrimeChoice Accord Formulary - Prime Therapeutics