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Whirlpool Corporation
PDL—Medication Categories Guide Effective August 2014
You can make the most of your pharmacy benefit plan and control your prescription medication costs by using this
Preferred Drug List. Be sure to share this list with your doctor to select cost-effective medications that are
clinically appropriate to treat your condition or maintain your health.
This Preferred Drug List (PDL) was developed by Whirlpool’s Formulary Review Committee, under the direction of a committee of doctors and pharmacists.
Understanding Your Tiered Copays Your pharmacy benefit plan offers five categories— or tiers—of medications that determine your costs (copays):
Tier 0: Value-Based Medications. Select value-based medications for controlling cholesterol, blood pressure, diabetes, asthma, chronic obstructive pulmonary disease and coronary artery disease are included in Tier 0. The co-insurance is 0%, which means they are available at no cost to you.
Tier 1: Generics. Most generic medications are included in Tier 1. Generics contain the same active ingredient as their brand-name equivalents and offer the same effectiveness and safety. These drugs are clinically proven and typically available at a lower cost. The co-insurance is 10%.
Tier 2: Preferred. Clinically proven and cost-effective preferred-brand medications and some generic medications are included in Tier 2. They have higher copays than generics but are less costly than nonpreferred medications on the third tier. The co-insurance is 20%.
Tier 3: Nonpreferred. Mostly non-preferred-brand medications are included in Tier 3. These drugs are not as clinically or cost-effective compared to other drugs available. Because a generic version or a second-tier alternative is available, the co-insurance is 50%. Tier 4: Brand and generic drugs considered to have minimal or no clinical and cost-effective value are in Tier 4. The co-insurance is 100%.
How to Use This Guide Whenever possible, you and your doctor should consult this guide for the lowest cost brand name and generic medications available for your therapy. Some tips to keep in mind when using this guide:
Therapeutic categories are listed alphabetically in all UPPERCASE letters in black boxes. Therapeutic classes in each category are printed in all UPPERCASE letters in bold.
Generic medications are listed in lowercase letters below the word GENERIC. Brand-name generic medications have the first letter in Uppercase.
Some medications treat more than one condition. Check different categories for your medication.
All medications on the PDL have been approved by the FDA. Additional Information Not all medications are listed in this PDL. Medication coverage and copays may vary from plan to plan. For more information specific to your plan, log on to healthscopebenefits.com and click on the Walgreens tab. For additional assistance, please call 877-WHIRL50 (877-944-7550). Please note: The PDL is subject to change without notice.
Drug names are the property of their respective o wners. ©2014 Catamaran Inc. All rights reserved. Catamaran is a registered trademark of C atamaran Inc.
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
RADIOPHARMACEUTICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CELLULAR IMMUNOTHERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CALCIUM REGULATORS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Cefaclor ER
Cefotetan
Cefotetan/Dextrose
Cefuroxime/Dextrose
August 2014
TIER 03 NON PREFERRED
Cefoxitin Sodium
ANTI-INFECTIVES
Ceftin
Cefuroxime Sodium
PENICILLINS
Mefoxin
TIER 01 GENERIC
Zinacef
amoxicillin
Zinacef IN Iso-osmotic Dextrose
amoxicillin/clavulanate potassium
Zinacef IN Iso-osmotic Diluent
amoxicillin/clavulanate potassium ER
THIRD GENERATION
ampicillin
TIER 01 GENERIC
ampicillin sodium
cefdinir
ampicillin-sulbactam
cefotaxime sodium
dicloxacillin sodium
cefpodoxime proxetil
nafcillin sodium
ceftazidime
oxacillin sodium
ceftriaxone sodium
penicillin v potassium
Cefditoren Pivoxil
penicillin G potassium
Ceftazidime/Dextrose
piperacillin sodium/ tazobactam sodium
Ceftriaxone IN Iso-osmotic Dextrose
piperacillin sodium/tazobactam sodium
Ceftriaxone/Dextrose
piperacillin/tazobactam
TIER 03 NON PREFERRED
Amoxicillin
Cedax
Ampicillin
Ceftazidime
Ampicillin Sodium
Ceftibuten
Penicillin G Potassium IN Iso-osmotic Dextrose
Claforan
Penicillin G Sodium
Claforan/D5W
Pfizerpen-G
Fortaz
TIER 03 NON PREFERRED
Rocephin
Amoxicillin ER
Spectracef
Ampicillin-sulbactam
Suprax
Augmentin
Tazicef
Augmentin ES-600
FOURTH GENERATION
Augmentin XR
TIER 01 GENERIC
Bactocill IN Dextrose
cefepime
Bicillin C-R
TIER 03 NON PREFERRED
Bicillin L-a
Cefepime
Moxatag
Maxipime
Nafcillin Sodium
Nallpen Iso-osmotic IN Dextrose
MACROLIDES
Nallpen/Dextrose
TIER 01 GENERIC
Penicillin G Procaine
azithromycin
Timentin
clarithromycin
Unasyn
clarithromycin ER
Unasyn Bulk Pack
erythromycin
Zosyn
Azithromycin
E.e.s. 400
CEPHALOSPORIN
Erythrocin Stearate
FIRST GENERATION
Erythromycin Base
TIER 01 GENERIC
Erythromycin Ethylsuccinate
cefadroxil
TIER 03 NON PREFERRED
cefazolin sodium
Biaxin
cephalexin
Biaxin XL
Cefazolin Sodium
Biaxin XL PAC
Cephalexin
Dificid
TIER 03 NON PREFERRED
E.e.s. Granules
Ancef
Ery-TAB
Cefazolin Sodium/Dextrose
Eryped 200
Keflex
Eryped 400
SECOND GENERATION
Erythrocin Lactobionate
TIER 01 GENERIC
PCE
cefaclor
Zithromax
cefoxitin sodium
Zithromax Tri-PAK
cefprozil
Zithromax Z-PAK
cefuroxime axetil
Zmax
cefuroxime sodium
Cefaclor
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 1
TETRACYCLINES
PREFERRED
tobramycinPA
TIER 01 GENERIC
Tobi Podhaler
demeclocycline HCL
TIER 03 NON PREFERRED
doxycycline
BethkisPA
doxycycline hyclate
Gentamicin Sulfate/0.9% Sodium Chloride
doxycycline monohydrate
Streptomycin Sulfate
minocycline HCL
TobiPA
Morgidox 1X100MG
Tobramycin Sulfate/Sodium Chloride
Morgidox 2X100MG
Tetracycline HCL
SULFONAMIDES
TIER 03 NON PREFERRED
Acticlate
TIER 01 GENERIC
Adoxa
Sulfadiazine
Adoxa PAK 1/100
Adoxa PAK 1/150
ANTIMYCOBACTERIAL AGENTS
Adoxa PAK 2/100
TIER 01 GENERIC
Alodox Convenience Kit
ethambutol HCL
Avidoxy DK
isoniazid
Dynacin
pyrazinamide
Minocin
rifampin
Minocin Kit
Cycloserine
Monodox
Isoniazid
Nutridox
TIER 02 PREFERRED
Ocudox
rifabutin
Oraxyl
TIER 03 NON PREFERRED
Vibramycin
Capastat Sulfate
TIER 04 100% COPAY
Myambutol
doxycycline hyclate DR
Mycobutin
minocycline HCL ER
Paser
Doryx
Priftin
Nicazeldoxy 30 Kit
Rifadin
Nicazeldoxy 60 Kit
Rifamate
Solodyn
Rifater
Seromycin
QUINOLONES
Sirturo
TIER 01 GENERIC
Trecator
ciprofloxacin
ciprofloxacin ER
ANTIFUNGALS
ciprofloxacin HCL
TIER 01 GENERIC
ciprofloxacin I.V.-IN D5W
fluconazole
levofloxacin
fluconazole IN dextrose
levofloxacin IN D5W
fluconazole IN NACL
moxifloxacin HCL
griseofulvin microsize
ofloxacin
griseofulvin ultramicrosize
TIER 02 PREFERRED
itraconazole
Noroxin
ketoconazole
TIER 03 NON PREFERRED
nystatin
Avelox
terbinafine HCL
Avelox Abc Pack
voriconazole
Cipro
Amphotericin B
Cipro I.V.-IN D5W
Fluconazole IN NACL
Cipro XR
TIER 02 PREFERRED
Factive
flucytosine
Levaquin
Noxafil
Ofloxacin
TIER 03 NON PREFERRED
Abelcet
AMINOGLYCOSIDES
Ambisome
TIER 01 GENERIC
Amphotec
amikacin sulfate
Ancobon
gentamicin sulfate
Cancidas
gentamicin sulfate pediatric
Diflucan
gentamicin sulfate/sodium chloride
Eraxis
gentamicin sulfate/0.9% sodium chloride
Grifulvin V
isotonic gentamicin
Gris-peg
neomycin sulfate
Lamisil
paromomycin sulfate
Mycamine
tobramycin sulfate
Onmel
Isotonic Gentamicin
Sporanox
TIER 02
Sporanox Pulsepak
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 2
Terbinex
Famvir
Vfend
Flumadine
Vfend IV
Foscavir
HepseraPA
ANTIVIRALS
IncivekPA
InfergenPA
TIER 01 GENERIC
Moderiba
abacavir
Moderiba 1200 Dose Pack
abacavir sulfate/lamivudine/zidovudine
Moderiba 800 Dose Pack
acyclovir
OlysioPA
acyclovir sodium
Rebetol
cidofovir
Retrovir
didanosine
Retrovir IV Infusion
famciclovir
Ribatab
ganciclovir
Rimantalist
lamivudine/zidovudine
Sitavig
nevirapine
SovaldiPA
nevirapine ER
Stribild
ribavirin
Trizivir
rimantadine HCL
TyzekaPA
stavudine
Valtrex
valacyclovir HCL
VictrelisPA
zidovudine
Videx EC
Acyclovir Sodium
Viramune
Foscarnet Sodium
Viramune XR
Nevirapine
Virazole
Ribasphere
Vistide
Ribasphere Ribapak
Zerit
TIER 02 PREFERRED
Ziagen
adefovir dipivoxilPA
Zovirax
lamivudine
Aptivus
ANTIMALARIALS
Atripla
BaracludePA
TIER 01 GENERIC
Complera
atovaquone/proguanil HCL
Crixivan
chloroquine phosphate
Emtriva
hydroxychloroquine sulfate
Epzicom
mefloquine HCL
FuzeonPA
quinine sulfate
Intelence
TIER 02 PREFERRED
Invirase
Daraprim
Isentress
Primaquine Phosphate
Kaletra
TIER 03 NON PREFERRED
Lexiva
Aralen
Norvir
Coartem
Peg-intronPA
Malarone
Peg-intron RedipenPA
Plaquenil
Peg-intron Redipen PAK 4PA
Qualaquin
PegasysPA
Pegasys ProclickPA
AMEBICIDES
Prezista
TIER 02 PREFERRED
Relenza Diskhaler
Yodoxin
Rescriptor
Reyataz
ANTHELMINTICS
SelzentryPA
TIER 02 PREFERRED
Sustiva
Albenza
Tamiflu
Biltricide
Tivicay
Stromectol
TruvadaPA
Valcyte
MISC. ANTI-INFECTIVES
Videx Pediatric
TIER 01 GENERIC
Viracept
aztreonam
Viread
bacitracin
TIER 03 NON PREFERRED
clindamycin palmitate HCL
Combivir
clindamycin phosphate
Copegus
clindamycin phosphate add-vantage
Cytovene
clindamycin phosphate pharmacy bulk package
Edurant
clindamycin phosphate IN D5W
Epivir
clindamycin HCL
Epivir HBV
colistimethate sodium
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 3
imipenem/cilastatin
Cisplatin
meropenem
Cyclophosphamide
metronidazole
Ifosfamide
metronidazole IN NACL 0.79%
TIER 02 PREFERRED
polymyxin b sulfate
Alkeran
sulfamethoxazole/trimethoprim
Hexalen
sulfamethoxazole/trimethoprim DS
Leukeran
tinidazole
Lomustine
trimethoprim
MyleranPA
vancomycin HCL
Treanda
Chloramphenicol Sodium Succinate
ValchlorPA
Dapsone
TIER 03 NON PREFERRED
Metro IV
Bicnu
Sulfamethoxazole/Trimethoprim
Busulfex
Vancomycin HCL
Ceenu
TIER 02 PREFERRED
Eloxatin
atovaquone
Gliadel Wafer
Alinia
Ifex
Nebupent
Mustargen
Zyvox
TemodarPA
TIER 03 NON PREFERRED
Zanosar
Azactam
Azactam IN Iso-osmotic Dextrose
ANTIBIOTICS
Bacitracin
TIER 01 GENERIC
Bactrim
bleomycin sulfate
Bactrim DS
daunorubicin HCL
CaystonPA
doxorubicin HCL
Cleocin
doxorubicin HCL liposome
Cleocin IN D5W
epirubicin HCL
Cleocin Pediatric Granules
idarubicin HCL
Cleocin Phosphate
mitomycin
Clindamycin Phosphate
mitoxantrone HCLPA
Coly-mycin M
Adriamycin
Cubicin
Epirubicin HCL
Dalvance
TIER 03 NON PREFERRED
Doribax
Cosmegen
First-vancomycin 25
Daunoxome
First-vancomycin 50
Doxil
Flagyl
Ellence
Flagyl ER
Idamycin PFS
Invanz
Ketek
ANTINEOPLASTIC ENZYMES
Lincocin
TIER 03 NON PREFERRED
Mepron
Elspar
Merrem
ErwinazePA
Neutrexin
Oncaspar
Pentam 300
Primaxin IV
ANTIMETABOLITES
Primaxin IV Add-vantage
TIER 01 GENERIC
Primsol
azacitidinePA
Sivextro
cladribine
Synercid
cytarabine
Tindamax
cytarabine aqueous
Tygacil
decitabinePA
Vancocin HCL
floxuridine
Vancomycin HCL IN Dextrose
fludarabine phosphate
Vibativ
fluorouracil
Xifaxan
gemcitabine HCL
mercaptopurine
ANTINEOPLASTICS, ETC
methotrexate
ALKYLATING AGENTS
methotrexate sodium
TIER 01 GENERIC
Cytarabine
carboplatin
Fludarabine Phosphate
cisplatin
Gemcitabine
ifosfamide
TIER 02 PREFERRED
melphalan hydrochloride
capecitabinePA
oxaliplatin
Folotyn
temozolomidePA
Trexall
Carboplatin
TIER 03
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 4
NON PREFERRED
Trelstar MixjectPA
Alimta
ZytigaPA
Arranon
Clolar
IMMUNOMODULATORS
DacogenPA
TIER 01 GENERIC
Fludara
azathioprine
Gemzar
cyclosporine
Purinethol
cyclosporine modified
Purixan
mycophenolate mofetil
Tabloid
mycophenolic acid DR
VidazaPA
sirolimus
XelodaPA
tacrolimus
Cyclosporine Modified
ANGIOGENESIS INHIBITORS
TIER 02 PREFERRED
TIER 02 PREFERRED
Atgam
Avastin
Azasan
CyramzaPA
Neoral
ZaltrapPA
PomalystPA
Rapamune
ANTIBODIES
RevlimidPA
Sandimmune
TIER 02 PREFERRED
ThalomidPA
Erbitux
Thymoglobulin
GazyvaPA
TIER 03 NON PREFERRED
HerceptinPA
Astagraf XL
KadcylaPA
Cellcept
RituxanPA
Cellcept Intravenous
TIER 03 NON PREFERRED
Imuran
AdcetrisPA
Myfortic
ArzerraPA
NulojixPA
Bexxar
Prograf
PerjetaPA
Simulect
Vectibix
ZortressPA
YervoyPA
Zevalin Y-90
MITOTIC INHIBITORS
HORMONAL AGENTS
TIER 01 GENERIC
etoposide
TIER 01 GENERIC
paclitaxel
anastrozole
vincristine sulfate
bicalutamide
vinorelbine tartrate
exemestane
Etoposide
flutamide
Paclitaxel
letrozole
Vinblastine Sulfate
leuprolide acetatePA
TIER 02 PREFERRED
megestrol acetate
Ixempra Kit
tamoxifen citrate
JevtanaPA
TIER 02 PREFERRED
TIER 03 NON PREFERRED
Depo-provera
Abraxane
Emcyt
Docefrez
FirmagonPA
Docetaxel
Lupron DepotPA
Etopophos
Lysodren
HalavenPA
VantasPA
Marqibo
XtandiPA
Navelbine
ZoladexPA
Taxotere
TIER 03 NON PREFERRED
Teniposide
Arimidex
Vumon
Aromasin
Casodex
ENZYME INHIBITORS
EligardPA
Fareston
TIER 02 PREFERRED
Faslodex
AfinitorPA
Femara
Afinitor DisperzPA
Megace Oral
BosulifPA
Nilandron
GleevecPA
Soltamox
JakafiPA
Trelstar DepotPA
MekinistPA
Trelstar Depot MixjectPA
NexavarPA
Trelstar LAPA
SprycelPA
Trelstar LA MixjectPA
SutentPA
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 5
TafinlarPA
GENERIC
TarcevaPA
amifostine
TasignaPA
dexrazoxane
Torisel
leucovorin calcium
TykerbPA
mesna
VelcadePA
Calcium Folinate
VotrientPA
Leucovorin Calcium
XalkoriPA
TIER 03 NON PREFERRED
ZelborafPA
Ethyol
TIER 03 NON PREFERRED
Fusilev
Beleodaq
Mesnex
CaprelsaPA
Totect
CometriqPA
Zinecard
GilotrifPA
TIER 04 100% COPAY
IclusigPA
Voraxaze
IstodaxPA
KyprolisPA
CHEMOTHERAPY ADJUNCTS
StivargaPA
TIER 02 PREFERRED
ZolinzaPA
Kepivance
Zydelig
TIER 03 NON PREFERRED
ZykadiaPA
Elitek
TOPOISOMERASE I INHIBITOR
ANTINEOPLASTIC COMBO
TIER 01 GENERIC
TIER 01 GENERIC
irinotecan
Ifosfamide/Mesna
topotecan HCL
Topotecan HCL
CARDIOVASCULAR DRUGS
TIER 03 NON PREFERRED
PHOSPHODIESTERASE INHBTR
Camptosar
TIER 01 GENERIC
Hycamtin
milrinone lactate
Irinotecan
milrinone IN dextrose
RADIOPHARMACEUTICALS
CARDIAC GLYCOSIDES
TIER 03 NON PREFERRED
TIER 01 GENERIC
Bexxar 131 Iodine
digoxin
Metastron
Digoxin
Quadramet
TIER 03 NON PREFERRED
TIER 04 100% COPAY
Lanoxin
Xofigo
Lanoxin Pediatric
CELLULAR IMMUNOTHERAPY
ANTIANGINAL AGENTS
TIER 03 NON PREFERRED
TIER 00 VALUE BASED BENEFIT
Provenge
Nitrostat
TIER 01 GENERIC
ANTINEOPLASTICS MISC.
isosorbide dinitrate
TIER 01 GENERIC
isosorbide dinitrate ER
dacarbazine
isosorbide mononitrate
hydroxyurea
isosorbide mononitrate ER
tretinoin
nitroglycerin
Dacarbazine
nitroglycerin lingual
TIER 02 PREFERRED
nitroglycerin transdermal
Actimmune
nitroglycerin IN dextrose 5%
Intron-aPA
nitroglycerin IN 5% dextrose
Intron-a W/DiluentPA
Isosorbide Dinitrate
Matulane
Nitroglycerin
Proleukin
Nitroglycerin IN Dextrose 5%
SynriboPA
Nitroglycerin Lingual
TIER 03 NON PREFERRED
TIER 02 PREFERRED
Alferon N
Dilatrate SR
Hydrea
RanexaPA
Nipent
TIER 03 NON PREFERRED
Photofrin
Imdur
SylatronPA
Isordil Titradose
TargretinPA
Nitro-bid
Trisenox
Nitro-dur
Uvadex
Nitrolingual Pumpspray
Nitromist
CHEMOTHERAPY RESCUE
Nitronal
TIER 01
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 6
BETA BLOCKERS
Calan
Calan SR
TIER 00 VALUE BASED BENEFIT
Cardene I.v.
carvedilol
Cardene IV
TIER 01 GENERIC
Cardene SR
acebutolol HCL
Cardizem
atenolol
Cardizem CD
betaxolol HCL
Cleviprex
bisoprolol fumarate
Dilacor XR
esmolol HCL
Hypertenipine-2.5
labetalol HCL
Isoptin SR
metoprolol succinate ER
Norvasc
metoprolol tartrate
Nymalize
nadolol
Procardia
pindolol
Procardia XL
propranolol HCL
Sular
propranolol HCL ER
Tiazac
sotalol HCL
Verelan
sotalol HCL (AF)
Verelan PM
Propranolol HCL
Timolol Maleate
ANTIARRHYTHMICS
TIER 02 PREFERRED
Coreg CR
TIER 01 GENERIC
TIER 03 NON PREFERRED
adenosine
Betapace
amiodarone HCL
Betapace AF
disopyramide phosphate
Brevibloc
flecainide acetate
Bystolic
ibutilide fumarate
Coreg
lidocaine HCL
Corgard
lidocaine HCL IN D5W
Hemangeol
lidocaine HCL/dextrose
Hypertenevide-12.5
mexiletine HCL
Inderal LA
propafenone HCL
Inderal XL
propafenone HCL ER
Innopran XL
quinidine gluconate CR
Kerlone
quinidine gluconate ER
Levatol
quinidine sulfate
Lopressor
Amiodarone HCL
Sectral
Lidocaine HCL
Sotalol Hydrochloride
Procainamide HCL
Tenormin
Quinidine Sulfate ER
Toprol XL
TIER 02 PREFERRED
Trandate
Tikosyn
Zebeta
TIER 03 NON PREFERRED
Adenocard
CALCIUM CHANNEL BLOCKERS
Cordarone
Corvert
TIER 00 VALUE BASED BENEFIT
Multaq
amlodipine besylate
Nexterone
diltiazem HCL
Norpace
verapamil HCL
Norpace CR
TIER 01 GENERIC
Quinidine Gluconate
diltiazem CD
Quinidine Sulfate
diltiazem HCL ER
Rythmol
felodipine ER
Rythmol SR
nicardipine HCL
Tambocor
nifedipine
Xylocaine
nifedipine ER
nimodipine
ACE INHIBITORS
nisoldipine
verapamil HCL ER
TIER 00 VALUE BASED BENEFIT
verapamil HCL SR
benazepril HCL
Diltiazem HCL
captopril
Isradipine
enalapril maleate
Nisoldipine
fosinopril sodium
Nisoldipine ER
lisinopril
Verapamil HCL
moexipril HCL
TIER 02 PREFERRED
perindopril erbumine
Cardizem LA
quinapril HCL
TIER 03 NON PREFERRED
ramipril
Adalat CC
trandolapril
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 7
TIER 01 GENERIC
ANTIHYPERTENSIVE COMBO
enalaprilat
TIER 00 VALUE BASED BENEFIT
TIER 03 NON PREFERRED
benazepril HCL/hydrochlorothiazide
Accupril
enalapril maleate/hydrochlorothiazide
Aceon
lisinopril/hydrochlorothiazide
Altace
losartan potassium/hydrochlorothiazide
Epaned
Captopril/Hydrochlorothiazide
Lotensin
TIER 01 GENERIC
Mavik
amlodipine besylate/benazepril hydrochloride
Prinivil
amlodipine besylate/benazepril HCL
Univasc
atenolol/chlorthalidone
Vasotec
bisoprolol fumarate/hydrochlorothiazide
Zestril
candesartan cilexetil/hydrochlorothiazide
fosinopril sodium/hydrochlorothiazide
ANGIOTENSIN RCPTR BLOCKER
irbesartan/hydrochlorothiazide
TIER 00 VALUE BASED BENEFIT
metoprolol/hydrochlorothiazide
losartan potassium
moexipril/hydrochlorothiazide
TIER 01 GENERIC
nadolol/bendroflumethiazide
candesartan cilexetil
quinapril/hydrochlorothiazide
eprosartan mesylate
telmisartan/amlodipine
irbesartan
telmisartan/hydrochloroth
telmisartan
telmisartan/hydrochlorothiazide
valsartan
valsartan/hydrochlorothiazide
TIER 03 NON PREFERRED
Clorpres
AtacandST
Methyldopa/Hydrochlorothiazide
AvaproST
Propranolol/Hydrochlorothiazide
BenicarST
TIER 03 NON PREFERRED
CozaarST
Accuretic
DiovanST
Atacand HCTST
Edarbi
AvalideST
MicardisST
AzorST
TevetenST
Benicar HCTST
Corzide
DIRECT RENIN INHIBITORS
Diovan HCTST
Dutoprol
TIER 03 NON PREFERRED
ExforgeST
TekturnaST
Exforge HCTST
Hypertensolol
ANTIHYPERTENSIVES MISC.
HyzaarST
TIER 01 GENERIC
Lopressor HCT
clonidine HCL
Lotensin HCT
doxazosin mesylate
Lotrel
eplerenone
Lytensopril Kit
fenoldopam mesylate
Lytensopril-90
guanfacine HCL
Lytensopril-90 Kit
hydralazine HCL
Micardis HCTST
methyldopa
Tarka
minoxidil
Tekturna HCTST
prazosin HCL
Tenoretic 100
terazosin HCL
Tenoretic 50
Methyldopate HCL
Teveten HCTST
Nitropress
Twynsta
Phentolamine Mesylate
Uniretic
Reserpine
Vaseretic
TIER 02 PREFERRED
Zestoretic
Demser
Ziac
Dibenzyline
TIER 04 100% COPAY
TIER 03 NON PREFERRED
Amturnide
Cardura
Edarbyclor
Catapres
Tekamlo
Catapres-tts-1
Tribenzor
Catapres-tts-2
Catapres-tts-3
DIURETICS
Corlopam
TIER 00 VALUE BASED BENEFIT
Inspra
hydrochlorothiazide
Minipress
Chlorthalidone
Tenex
TIER 01 GENERIC
Vecamyl
acetazolamide
acetazolamide sodium
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 8
acetazolamide ER
VALUE BASED BENEFIT
amiloride HCL
atorvastatin calcium
amiloride/hydrochlorothiazide
lovastatin
bumetanide
pravastatin sodium
chlorothiazide
simvastatin
chlorothiazide sodium
TIER 01 GENERIC
furosemide
cholestyramine
indapamide
cholestyramine light
mannitol
colestipol HCL
methazolamide
colestipol HCL for oral suspension
metolazone
fenofibrate
spironolactone
fenofibrate micronized
spironolactone/hydrochlorothiazide
fluvastatin
torsemide
gemfibrozil
triamterene/hydrochlorothiazide
niacin ER
Acetazolamide
Fenofibric AcidST
Furosemide
TIER 02 PREFERRED
Methyclothiazide
omega-3-acid ethyl esters
Torsemide
JuxtapidPA
TIER 03 NON PREFERRED
KynamroPA
Aldactazide
Welchol
Aldactone
Zetia
Chlorothiazide
TIER 03 NON PREFERRED
Demadex
Advicor
Diamox
AltoprevST
Diuril
Colestid
Dyazide
Colestid Flavored
Dyrenium
CrestorST
Edecrin
Fenofibrate
Introl
FibricorST
Lasix
Lescol
Maxzide
Lescol XLST
Maxzide-25
Lipitor
Microzide
LivaloST
Neptazane
Lopid
Sodium Diuril
Lovaza
Sodium Edecrin
Mevacor
Triamterene/Hydrochlorothiazide
Niacor
Zaroxolyn
Niaspan
Pravachol
VASOPRESSORS
Questran
Questran Light
TIER 01 GENERIC
Simcor
dobutamine HCL
Zocor
dobutamine HCL/D5W
TIER 04 100% COPAY
dobutamine/dextrose 5%
fenofibric acid DR
dopamine HCL
AntaraST
dopamine HCL-dextrose 5%
FenoglideST
dopamine HCL/dextrose 5%
Lipofen
dopamine/D5W
Lofibra
ephedrine sulfate
Tricor
midodrine HCL
TriglideST
norepinephrine bitartrate
Trilipix
phenylephrine HCL
Vytorin
Adrenaclick
Auvi-q
CARDIOVASCULAR - MISC.
Dopamine HCL
Epinephrine
TIER 01 GENERIC
Epipen 2-PAK
amlodipine besylate/atorvastatin calcium
Epipen-JR 2-PAK
epoprostenol sodium
TIER 03 NON PREFERRED
papaverine HCL
Adrenalin
VeletriPA
Dobutamine/Dextrose 5%
TIER 02 PREFERRED
Levophed
sildenafilPA
Neo-synephrine
sildenafil citratePA
Northera
AdempasPA
Phenylephrine HCL
Bidil
Cialis
ANTIHYPERLIPIDEMICS
FlolanPA
LetairisPA
TIER 00
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 9
Muse
Nuox
RemodulinPA
Plexion
RevatioPA
Plexion Cleanser
TracleerPA
Plexion Cleansing Cloths
VentavisPA
Retin-aPA
Viagra
Retin-a MicroPA
TIER 03 NON PREFERRED
Retin-a Micro P.M.PA
AdcircaPA
Rosanil
Caduet
Sulfoam
Levitra
Sumadan Wash
Natrecor
Sumadan XLT
OrenitramPA
Sumaxin
Staxyn
Sumaxin CP Kit
Stendra
Sumaxin Ts
TyvasoPA
Sumaxin Wash
Tyvaso RefillPA
Tretin-xPA
Tyvaso StarterPA
VeltinPA
TIER 04 100% COPAY
ZianaPA
OpsumitPA
TIER 04 100% COPAY
Benzaclin With P.M.
DERMATOLOGICALS
EpiduoPA
Sumadan Kit
ACNE PRODUCTS
TIER 01 GENERIC
ROSACEA AGENTS
adapalenePA
TIER 01 GENERIC
clindamycin phosphate
metronidazole
clindamycin/benzoyl peroxide
TIER 02 PREFERRED
erythromycin
Finacea
erythromycin/benzoyl peroxide
Oracea
sodium sulfacetamide
TIER 03 NON PREFERRED
sodium sulfacetamide/sulfur
Metrocream
sodium sulfacetamide/sulfur cleanser
Metrogel
sodium sulfacetamide/sulfur cleansing cloths
Metrolotion
sodium sulfacetamide/sulfur green
Noritate
sodium sulfacetamide/sulfur wash
Rosadan Kit
sulfacetamide sodium
sulfacetamide sodium/sulfur cleanser
ANTIBIOTICS - TOPICAL
tretinoinPA
TIER 01 GENERIC
tretinoin microspherePA
mupirocin
tretinoin microsphere P.M.PA
mupirocin calcium
Claravis
Gentamicin Sulfate
Clindacin PAC
TIER 03 NON PREFERRED
Sodium Sulfacetamide/Sulfur
Altabax
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
Bactroban
Sodium Sulfacetamide/Sulfur IN Urea
Centany
TIER 03 NON PREFERRED
Centany AT
Absorica
Cortisporin
Acanya
Neo-synalar
Aczone
Neo-synalar Kit
Akne-mycin
AtralinPA
ANTIFUNGALS - TOPICAL
Avar
Avar LS
TIER 01 GENERIC
Avar LS Cleanser
ciclopirox
Avar-e LS
ciclopirox nail lacquer
Azelex
ciclopirox olamine
Benzaclin
clotrimazole
Benzamycin
clotrimazole/betamethasone dipropionate
Benzamycinpak
econazole nitrate
Clarifoam EF
ketoconazole
Cleocin-t
nystatin
Clindacin Etz
nystatin/triamcinolone
Clindagel
Ciclodan Solution Kit
DifferinPA
Ciclopirox Topical Solution Kit
Duac
TIER 02 PREFERRED
Erygel
Ertaczo
Evoclin
Mentax
Fabior
TIER 03 NON PREFERRED
Klaron
Cnl8 Nail Kit
Neuac Kit
Exelderm
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 10
Extina
8-mop
Halotin
TIER 04 100% COPAY
Jublia
Sorilux
Lamisil Spray
Loprox
ANTISEBORRHEIC AGENTS
Loprox Shampoo
TIER 01 GENERIC
Lotrisone
selenium sulfide
Luzu
sodium sulfacetamide
Naftin
sodium sulfacetamide wash
Nizoral
Seb-prev
Oxistat
Selenium Sulfide
Pediaderm AF Complete Kit
Sodium Sulfacetamide/Urea
Pedipirox-4 Nail
TIER 03 NON PREFERRED
Penlac Nail Lacquer
Glycolic Acid
Vusion
Glycolic Acid 70% High Purity
Xolegel
Ovace Plus
Xolegel Corepak
Ovace Plus Wash
Xolegel Duo/Head & Shoulders
Ovace Wash
Xolegel Duo/Xolex
Promiseb
TIER 04 100% COPAY
Selrx
Ciclodan Cream Kit
Selsun Shampoo
Ecoza
Tersi Foam
Ketodan Kit
TL Triseb
TIER 04 100% COPAY
ANTIVIRALS - TOPICAL
Promiseb Complete
TIER 02 PREFERRED
acyclovir
CORTICOSTEROIDS - TOPICAL
TIER 03 NON PREFERRED
TIER 01 GENERIC
Denavir
alclometasone dipropionate
Xerese
amcinonide
Zovirax
augmented betamethasone dipropionate
TIER 04 100% COPAY
betamethasone dipropionate
Lidovir
betamethasone valerate
clobetasol propionate
ANTI-INFLAMMATORY AGENTS
clobetasol propionate emollient
TIER 01 GENERIC
desonide
diclofenac sodium
desoximetasone
TIER 03 NON PREFERRED
diflorasone diacetate
Flector
fluocinolone acetonide
Lidoprofen
fluocinonide
Pennsaid
fluocinonide emollient base
Voltaren
fluocinonide-e
Vopac
fluticasone propionate
Vopac GB
halobetasol propionate
Vopac Kt
hydrocortisone
hydrocortisone acetate/aloe
ANTIPRURITICS
hydrocortisone butyrate
hydrocortisone valerate
TIER 01 GENERIC
hydrocortisone IN absorbase
Prudoxin
mometasone furoate
TIER 03 NON PREFERRED
prednicarbate
Zonalon
triamcinolone acetonide
Amcinonide
ANTIPSORIATICS
Apexicon E
TIER 01 GENERIC
Desoximetasone
calcipotriene
Diflorasone Diacetate
Calcitriol
Triamcinolone Acetonide
TIER 02 PREFERRED
Trianex
acitretin
U-cort
methoxsalen
TIER 02 PREFERRED
StelaraPA
hydrocortisone butyrate (lipid)
TIER 03 NON PREFERRED
hydrocortisone butyrate (lipophilic)
Dovonex
Capex
Dritho-creme HP
Cordran Tape
Oxsoralen Ultra
TIER 03 NON PREFERRED
Soriatane
Aclovate
Tazorac
Ala Scalp
Vectical
Carmol-HC
Zithranol
Clobex
Zithranol-rr
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 11
Clodan Kit
lactic acid e
Cordran
lactic acid w/vitamin e
Cutivate
lidocaine
Derma-smoothe/FS Body
lidocaine HCL
Derma-smoothe/FS Body Oil
lidocaine HCL jelly
Derma-smoothe/FS Scalp
lidocaine/prilocaine
Derma-smoothe/FS Scalp Oil
lindane
Dermasorb HC
malathion
Dermasorb Ta
permethrin
Dermatop
podofilox
Desonate
salicylic acid
Desowen
sodium hyaluronate
Desowen Cream/Cetaphil Lotion
urea
Desowen Lotion/Cetaphil Cream
urea topical
Desowen Ointment/Cetaphil Lotion
urea IN zinc undecylenate/lactic acid vehicle
Diprolene
urea 40% nail film
Diprolene AF
Aluminum Acetate
Elocon
Benzoin Compound Tincture
Epifoam
Cocaine HCL
First-hydrocortisone
Ethyl Chloride/Fine Pinpoint
Halog
Ethyl Chloride/Fine Stream
Halonate
Ethyl Chloride/Medium Jet Stream
Kenalog
Ethyl Chloride/Medium Stream
Locoid
Ethyl Chloride/Mist
Locoid Lipocream
Hylira
Luxiq
Latrix XM
Nucort
Lidocaine HCL
Nuzon
Lidocaine/Prilocaine
Olux
Mb Hydrogel
Olux-e
Pr Cream
Pandel
Pruclair
Pediaderm HC
Prumyx
Pediaderm Ta
Salicylic Acid
Pramosone
Salicylic Acid IN Ammonium Lactate Vehicle
Scalacort DK
TL-cermide
Synalar
TIER 02 PREFERRED
Temovate
Condylox
Temovate E
Eurax
Texacort
Oxsoralen
Topicort
TIER 03 NON PREFERRED
Ultravate
Aluvea
Ultravate PAC
Anacaine
Vanos
Arnica Flower
Verdeso
Atopiclair
Westcort
Aurstat
TIER 04 100% COPAY
Aurstat Anti-itch Hydrogel
calcipotriene/betamethasone dipropionate
Aurstat Anti-itch Hydrogel Kit
Synalar Cream Kit
Benzoin Tincture
Synalar Ointment Kit
Boric Acid
Synalar Ts
Cem-urea
Taclonex
Coal TAR
Ultravate X
Dermasorb XM
Drysol
IMMUNOMODULATING AGENTS
Elenzapatch
Eletone
TIER 01 GENERIC
Eletone Twinpack
imiquimod
Elimite
TIER 02 PREFERRED
Emla
ElidelPA
Emulsion SB
ProtopicPA
Epiceram
TIER 03 NON PREFERRED
Ethyl Chloride
Aldara
Gebauers Pain Ease
Zyclara
Gebauers Spray And Stretch
Zyclara P.M.
Genadur
Gordofilm
DERMATOLOGICALS - MISC.
Gordons Urea
TIER 01 GENERIC
Hydro 35
ammonium lactate
Hydro 40 Foam
episone CRE
Kerafoam
lactic acid
Kerafoam 42
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 12
Keralac
TIER 03 NON PREFERRED
Lac-hydrin
A-hydrocort
Lidoderm
Aristospan Intra-articular
Lycelle
Aristospan Intralesional
Natroba
Celestone
Neosalus
Celestone-soluspan
Neosalus CP
Cortef
Nivatopic Plus
Depo-medrol
Ovide
Dexamethasone Sodium Phosphate
Pliaglis
Dexpak 10 Day
Presera
Dexpak 13 Day
Pyrogallic Acid
Dexpak 6 Day
Qutenza
Entocort EC
Radigel
FLO-pred
Salkera
Interarticular Joint Kit
Salvax Duo Plus
Kenalog-10
Sklice
Kenalog-40
Spinosad
Medrol
Sulfurated Lime
Medrol Dosepak
Synera
Millipred
Tetrix
Millipred DP
Tropazone
Orapred
Ulesfia
Orapred Odt
Umecta
Pediapred
Umecta Nail Film
Prelone
Umecta PD
Rayos
Uramaxin
Solu-cortef
Uramaxin GT
Solu-medrol
Uramaxin GT Kit
Uceris
Utopic
Veripred 20
Veregen
Vexa
ANDROGENS-ANABOLIC
Witch Hazel
TIER 01 GENERIC
Xclair
danazol
Xerac Ac
oxandrolonePA
Xylocaine
testosterone cypionatePA
TIER 04 100% COPAY
testosterone enanthatePA
Hylatopic
AndroxyPA
Hylatopic Plus
TIER 02 PREFERRED
HPR
AndrodermPA
HPR Plus
AndrogelPA
HPR Plus/Mb Hydrogel
Androgel P.M.PA
Nuvail
TIER 03 NON PREFERRED
Ultrasal-ER
Anadrol-50PA
Virasal
AndroidPA
Aveed
ENDOCRINE AND METABOLIC
AxironPA
Depo-testosteronePA
CORTICOSTEROIDS
First-testosterone
TIER 01 GENERIC
First-testosterone Mc Compounding KitPA
betamethasone sodium phosphate/betamethasone acetate
FortestaPA
budesonide
OxandrinPA
dexamethasone
StriantPA
dexamethasone sodium phosphate
TestimPA
fludrocortisone acetate
Testopel
hydrocortisone
TestosteronePA
methylprednisolone
Testosterone P.M.PA
methylprednisolone acetate
TestredPA
methylprednisolone dose pack
VogelxoPA
methylprednisolone sodiumsuccinate
Vogelxo P.M.PA
prednisolone
prednisolone sodium phosphate
ESTROGENS
prednisone
TIER 01 GENERIC
Cortisone Acetate
estradiol
Dexamethasone
estradiol valerate
Dexamethasone Intensol
estradiol/norethindrone acetate
Prednisolone Sodium Phosphate
estropipate
Prednisone
Estropipate
Prednisone Intensol
Jinteli
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 13
TIER 02 PREFERRED
Nordette-28
Cenestin
Norinyl 1+50
Climara
Ortho Micronor
Combipatch
Ortho Tri-cyclen
Divigel
Ortho-cept
Enjuvia
Ortho-cyclen
Evamist
Ortho-novum 1/35
Premphase
Ovcon-35
Prempro
Plan B
Vivelle-dot
Plan B One-step
TIER 03 NON PREFERRED
Quartette
Activella
Tri-norinyl 28
Alora
Yasmin 28
Angeliq
Yaz
Climara Pro
TIER 04 100% COPAY
Delestrogen
Cyclessa
Depo-estradiol
Femcon FE
Duavee
Loestrin FE 1.5/30
Elestrin
Loestrin FE 1/20
Estrace
Loestrin 24 FE
Estrasorb
Minastrin 24 FE
Estrogel
Seasonique
Femhrt Low Dose
Menest
PROGESTINS
Menostar
TIER 00 GENERIC
Minivelle
medroxyprogesterone acetate
Prefest
TIER 01 GENERIC
Premarin
norethindrone acetate
progesterone
CONTRACEPTIVES
TIER 03 NON PREFERRED
TIER 00 GENERIC
Aygestin
drospirenone/ethinyl estradiol
MakenaPA
levonorgestrel and ethinyl estradiol
Megace ES
levonorgestrel/ethinyl estradiol
Prometrium
norethindrone
Provera
norgestimate/ethinyl estradiol
Amethyst
ANTIDIABETIC AGENTS
Beyaz
INSULIN
Generess FE
TIER 00 VALUE BASED BENEFIT
Loseasonique
Humalog
Natazia
Humalog Mix 50/50
Necon 1/50-28
Humalog Mix 75/25
Necon 10/11-28
Humulin R U-500 (concentrated)
Norinyl 1+35
Lantus
Ogestrel
Levemir
Ortho Tri-cyclen LO
Novolog
Ortho-novum 7/7/7
Novolog Mix 70/30
Safyral
TIER 02 PREFERRED
Zovia 1/50e
Apidra
TIER 01 GENERIC
Apidra Solostar
desogestrel/ethinyl estradiol
Humalog Kwikpen
levonorgestrel
Humalog Mix 50/50 Kwikpen
norethindrone acetate/ethinyl estradiol
Humalog Mix 75/25 Kwikpen
norethindrone acetate/ethinyl estradiol/ferrous fumarate
Lantus Solostar
Brevicon-28
Levemir Flexpen
TIER 02 PREFERRED
Novolog Flexpen
Desogen
Novolog Mix 70/30 Prefilled Flexpen
TIER 03 NON PREFERRED
Novolog Penfill
Ella
TIER 03 NON PREFERRED
Estrostep FE
Levemir Flextouch
Falessa
AMYLIN ANALOGS
Loestrin 1.5/30-21
TIER 02 PREFERRED
Loestrin 1/20-21
Symlinpen 120PA
Lomedia 24 FE
Symlinpen 60PA
LO Loestrin FE
INCRETIN MIMETIC AGENTS
LO Minastrin FE
TIER 02 PREFERRED
Mircette
ByettaPA
Modicon
TIER 03 NON PREFERRED
Nor-QD
Bydureon
Tanzeum
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 14
VictozaPA
TIER 01 GENERIC
SULFONYLUREAS
glipizide/metformin HCL
TIER 00 VALUE BASED BENEFIT
pioglitazone HCL/metformin HCL
glimepiride
TIER 02 PREFERRED
glipizide
pioglitazone HCL-glimepiride
glipizide ER
TIER 03 NON PREFERRED
glyburide
Actoplus Met
glyburide micronized
Actoplus Met XR
Glyburide
Appformin
TIER 01 GENERIC
Appformin-d
tolazamide
Duetact
Chlorpropamide
Glucovance
Tolazamide
Invokamet
Tolbutamide
Janumet
TIER 03 NON PREFERRED
Janumet XR
Amaryl
Juvisync
Diabeta
Kombiglyze XR
Glucotrol
Prandimet
Glucotrol XL
TIER 04 100% COPAY
Glynase
Avandamet
BIGUANIDES
Avandaryl
TIER 00 VALUE BASED BENEFIT
Kazano
metformin HCL
Oseni
metformin HCL ER
TIER 03 NON PREFERRED
BISPHOSPHONATES
Fortamet
TIER 01 GENERIC
Glucophage
alendronate sodiumQL
Glucophage XR
pamidronate disodium
Glumetza
risedronate sodiumQL
Riomet
Alendronate SodiumQL
MEGLITINIDE ANALOGUES
Etidronate Disodium
TIER 01 GENERIC
TIER 02 PREFERRED
nateglinide
ActonelQL,ST
TIER 02 PREFERRED
Zoledronic AcidPA
repaglinide
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
ibandronate sodiumQL
Prandin
zoledronic acidPA
Starlix
Didronel
DIABETIC OTHER
FosamaxQL
TIER 02 PREFERRED
Pamidronate Disodium
Glucagon Emergency Kit
ReclastPA
Korlym
ZometaPA
TIER 03 NON PREFERRED
TIER 04 100% COPAY
Farxiga
BinostoQL
Glucagen
BonivaQL
Glucagen Hypokit
InvokanaPA
CALCITONINS
Jardiance
TIER 01 GENERIC
Proglycem
calcitonin salmon
ALPHA-GLUCOSIDASE INHIBIT
calcitonin-salmon
TIER 01 GENERIC
TIER 03 NON PREFERRED
acarbose
Fortical
TIER 03 NON PREFERRED
Miacalcin
Glyset
Precose
PARATHYROID HORMONE
DPP-4 INHIBITORS
TIER 02 PREFERRED
TIER 03 NON PREFERRED
Forteo
Januvia
Nesina
RANK LIGAND INHIBITORS
Onglyza
TIER 03 NON PREFERRED
Tradjenta
ProliaPA
INSULIN SENSITIZING AGENT
XgevaPA
TIER 01 GENERIC
pioglitazone HCL
CALCIUM REGULATORS - MISC
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
Actos
Ganite
Avandia
ANTIDIABETIC COMBINATIONS
HORMONE RECEPTOR MDLTR
TIER 00 VALUE BASED BENEFIT
TIER 02
glyburide/metformin HCL
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 15
PREFERRED
TIER 02 PREFERRED
raloxifene hydrochloride
Sandostatin Lar DepotPA
TIER 03 NON PREFERRED
Somatuline DepotPA
Evista
TIER 03 NON PREFERRED
Osphena
SandostatinPA
SigniforPA
FERTILITY REGULATORS
GH RECEPTOR ANTAGONISTS
TIER 01 GENERIC
chorionic gonadotropin
TIER 02 PREFERRED
clomiphene citrate
SomavertPA
TIER 02 PREFERRED
Bravelle
POSTERIOR PITUITARY
Gonal-f
TIER 01 GENERIC
Gonal-f RFF
desmopressin acetate
Gonal-f RFF Pen
vasopressin
Ovidrel
TIER 02 PREFERRED
Repronex
Stimate
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
Follistim AQ
Ddavp
Gonal-f RFF Rediject
Pitressin Synthetic
Menopur
CORTICOTROPIN
LHRH/GNRH AGONIST
TIER 03 NON PREFERRED
TIER 02 PREFERRED
Acthar HPPA
Lupron Depot-PEDPA
Supprelin LAPA
PROLACTIN INHIBITORS
Synarel
TIER 01 GENERIC
TIER 03 NON PREFERRED
cabergoline
Lupaneta PackPA
VASOPRESSIN ANTAGONISTS
GNRH/LHRH ANTAGONISTS
TIER 03 NON PREFERRED
TIER 02 PREFERRED
Samsca
Cetrotide
Vaprisol
TIER 03 NON PREFERRED
Ganirelix Acetate
PROGESTERONE ANTAGONISTS
TIER 03 NON PREFERRED
GROWTH HORMONES
Mifeprex
TIER 02 PREFERRED
GenotropinPA
METABOLIC MODIFIERS
Genotropin MiniquickPA
TIER 01 GENERIC
HumatropePA
calcitriol
Humatrope Combo PackPA
levocarnitine
TIER 03 NON PREFERRED
TIER 02 PREFERRED
Norditropin CartridgePA
doxercalciferol
Norditropin FlexproPA
paricalcitol
Norditropin Nordiflex PenPA
sodium phenylbutyrate
NutropinPA
AldurazymePA
Nutropin AQ Nuspin 10PA
Cystadane
Nutropin AQ Nuspin 20PA
ElaprasePA
Nutropin AQ Nuspin 5PA
FabrazymePA
Nutropin AQ PenPA
KuvanPA
OmnitropePA
MyaleptPA
SaizenPA
NaglazymePA
Saizen Click.easyPA
Orfadin
SerostimPA
RavictiPA
Tev-tropinPA
Sensipar
ZorbtivePA
TIER 03 NON PREFERRED
Ammonul
GHRH
Buphenyl
TIER 03 NON PREFERRED
CarbagluPA
EgriftaPA
Carnitor
Carnitor SF
SOMATOMEDINS
Hectorol
TIER 03 NON PREFERRED
LumizymePA
IncrelexPA
MyozymePA
Rocaltrol
SOMATOSTATIC AGENTS
VimizimPA
TIER 01 GENERIC
Zemplar
octreotide acetatePA
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 16
THYROID AGENTS
ULCER DRUGS
TIER 01 GENERIC
TIER 01 GENERIC
levothyroxine sodium
atropine sulfate
liothyronine sodium
cimetidine
methimazole
cimetidine HCL
propylthiouracil
dicyclomine HCL
Levothyroxine Sodium
famotidine
TIER 03 NON PREFERRED
glycopyrrolate
Armour Thyroid
hyoscyamine sulfate
Cytomel
hyoscyamine sulfate odt
Nature-throid
hyoscyamine sulfate ER
Nature-throid Nt-2.5
hyoscyamine sulfate SR
Synthroid
methscopolamine bromide
Tapazole
misoprostol
Thyrolar-1
nizatidine
Thyrolar-1/2
ranitidine HCL
Thyrolar-1/4
sucralfate
Thyrolar-2
Anaspaz
Thyrolar-3
Belladonna & Opium
Tirosint
Belladonna Alkaloids & Opium
Triostat
Dicyclomine HCL
Westhroid
Famotidine Premixed
Westhroid-p
Propantheline Bromide
Wp Thyroid
Scopolamine Hydrobromide
TIER 02 PREFERRED
GASTROINTESTINAL
Pylera
TIER 03 NON PREFERRED
LAXATIVES
Atropen
TIER 01 GENERIC
Atropine Sulfate
lactulose
Axid
peg 3350/electrolytes
Bentyl
peg-3350/electrolytes
Cantil
peg-3350/NACL/NA bicarbonate/KCL
Carafate
polyethylene glycol 3350
Cuvposa
TIER 03 NON PREFERRED
Cytotec
Cascara Sagrada
Digex NF
Colyte-flavor Packs
Famotidine
Golytely
Gabitidine
Halflytely Bowel Prep/Flavor Packs
Gastrinex NF
Kristalose
Glycate
Mineral Oil Heavy
Helidac
Moviprep
Levbid
Nulytely/Flavor Packs
Levsin
Osmoprep
Levsin/SL
Prepopik
Pamine
Senna Leaves
Pamine Forte
Suclear
Pamine FQ
Suprep Bowel Prep
Pepcid
Robinul
ANTIDIARRHEALS
Robinul Forte
TIER 01 GENERIC
Sentradine
diphenoxylate/atropine
Symax Duotab
loperamide HCL
Zantac
opium
opium tincture
ANTIEMETICS
Diphenoxylate/Atropine
TIER 01 GENERIC
Opium Tincture (paregoric)
dronabinol
TIER 02 PREFERRED
granisetron HCLQL
Motofen
meclizine HCL
TIER 03 NON PREFERRED
ondansetron odtQL
FulyzaqPA
ondansetron HCLQL
Lomotil
trimethobenzamide HCL
Restora RX
Dimenhydrinate
Rezyst IM
GranisolQL
Rezyst SB
TIER 02 PREFERRED
Vsl#3 DS
AnzemetQL
DiclegisPA
ANTACIDS
EmendQL
TIER 03 NON PREFERRED
Transderm-scop
Sodium Bicarbonate
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 17
TIER 03 NON PREFERRED
Dipentum
Aloxi
Entereg
Cesamet
Gastrocrom
Marinol
GattexPA
SancusoQL
Giazo
Tigan
Lialda
ZofranQL
Lidocaine HCL-hydrocortisone Acetate With Aloe
Zofran OdtQL
Linzess
TIER 04 100% COPAY
Metozolv Odt
ZuplenzQL
Phoslo
Phoslyra
DIGESTIVE AIDS
Procort
Proctocort
TIER 02 PREFERRED
Reglan
Creon
Renvela
Pancreaze
Rowasa
Pancrelipase
Sevelamer Carbonate
Zenpep
Sfrowasa
TIER 03 NON PREFERRED
Urso Forte
Pertzye
Urso 250
Sucraid
Velphoro
Ultresa
Viokace
GENITOURINARY
GASTROINTESTINAL - MISC.
URINARY ANTI-INFECTIVES
TIER 01 GENERIC
TIER 01 GENERIC
balsalazide disodium
methenamine hippurate
calcium acetate
methenamine mandelate
cromolyn sodium
nitrofurantoin
hydrocort ene 100MG
nitrofurantoin macrocrystals
hydrocortisone
nitrofurantoin monohydrate
hydrocortisone acetate/lidocaine HCL
nitrofurantoin monohydrate/macrocrystals
hydrocortisone acetate/pramoxine
Methenamine Mandelate
lactulose
Uretron D/S
lidocaine HCL/hydrocortisone acetate
Urex
mesalamine
Urogesic-blue
metoclopramide HCL
TIER 03 NON PREFERRED
sulfasalazine
Furadantin
ursodiol
Hiprex
Dexpanthenol
Macrobid
Eliphos
Macrodantin
TIER 02 PREFERRED
Monurol
Amitiza
Prosed/DS
Anusol-HC
Urelle
Apriso
Uribel
Asacol
Urimar-t
Asacol HD
Uroqid #2
Canasa
CimziaPA
URINARY ANTISPASMODICS
Cimzia Starter KitPA
TIER 01 GENERIC
Cortifoam
bethanechol chloride
Delzicol
flavoxate HCL
EntyvioPA
oxybutynin chloride
Fosrenol
oxybutynin chloride ER
Lotronex
tolterodine tartrate
Pentasa
tolterodine tartrate ER
Proctofoam HC
trospium chloride
RelistorPA
trospium chloride ER
RemicadePA
TIER 03 NON PREFERRED
Renagel
Detrol
TIER 03 NON PREFERRED
Detrol LA
Actigall
Ditropan XL
Analpram Advanced
Enablex
Analpram-HC
Gelnique
Analpram-HC Singles
Myrbetriq
Azulfidine
Oxytrol
Azulfidine EN-TABS
Sanctura
Chenodal
Sanctura XR
Colazal
Toviaz
Cortenema
Urecholine
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 18
Vesicare
HEMATOPOIETIC AGENTS
TIER 01 GENERIC
VAGINAL PRODUCTS
cyanocobalamin
TIER 01 GENERIC
folic acid
clindamycin phosphate
folic acid/vitamin b-6/vitamin b-12
metronidazole vaginal
sodium ferric gluconate complex/sucrose
terconazole
Animi-3
Relagard
Centratex
TIER 02 PREFERRED
Ferrex 150 Forte Plus
Avc
Ferrex 28
Estring
Folic Acid
Premarin
Folivane-f
Vagifem
Folivane-plus
TIER 03 NON PREFERRED
Hematogen Fa
Cleocin
Hydroxocobalamin
Clindesse
Icar-c Plus
CrinonePA
Multigen
Endometrin
Multigen Folic
Estrace
Multigen Plus
Fem PH
TIER 02 PREFERRED
Femring
Aranesp Albumin FreePA
First-progesterone VGS 100 Compounding Kit
Droxia
First-progesterone VGS 200 Compounding Kit
ElelysoPA
First-progesterone VGS 25 Compounding Kit
Foltrate
First-progesterone VGS 400 Compounding Kit
LeukinePA
First-progesterone VGS 50 Compounding Kit
MozobilPA
Gynazole-1
NeulastaPA
Metrogel-vaginal
NeumegaPA
Terazol 3
NeupogenPA
Terazol 7
NplatePA
ProcritPA
GENITOURINARY - MISC.
PromactaPA
TIER 03 NON PREFERRED
TIER 01 GENERIC
Albafort
alfuzosin HCL ER
Animi-3/Vitamin D
citric acid/sodium citrate
B-6 Folic Acid
finasteride
Biferarx
hydrochloric acid
Cenfol
phenazopyridine HCL
CerezymePA
potassium citrate-citric acid crystals
Corvite 150
tamsulosin HCL
Divista
Cytra-3
Ed Cyte F
Potassium Citrate
EpogenPA
Tricitrates
Feraheme
TIER 02 PREFERRED
Feriva
Cystagon
Ferivafa
Elmiron
Ferralet 90
TIER 03 NON PREFERRED
Ferrlecit
Avodart
Ferro-plex Hematinic
Cardura XL
Ferrotrin
Citrolith
Folgard RX
Flomax
Fusion Plus
K-phos NO 2
GranixPA
Lithostat
Hematron-AF
Oracit
Hemocyte Plus
Potassium Citrate ER
Hemocyte-f
ProcysbiPA
Injectafer
Proscar
Integra F
Pyridium
Integra Plus
Shohls Solution Modified
Iron
Thiola
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc
Urocit-k 10
Urocit-k 15
Irospan 24/6
Urocit-k 5
Is 24/6
Uroxatral
Maxaron Forte
TIER 04 100% COPAY
Maxfe
Jalyn
MV FE Asparto Gly/FE Fum/Succ Acid/Vit C/Threonic Acd/B12/Fa
Rapaflo
MV FE Asparto Gly/Vit C/Vit B12/CA Threonate/Succ Acd/Stomac
HEMATOLOGICAL
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 19
Nascobal
Recothrom Spray Kit
Natalvirt Flt
Thrombogen
Nephron Fa
Tisseel
Novaferrum
Trasylol
OmontysPA
Pre-folic
HEMATOLOGICAL - MISC.
Proferrin-forte
TIER 00 VALUE BASED BENEFIT
Protectiron
clopidogrel
Tandem F
TIER 01 GENERIC
Tandem Plus
anagrelide hydrochloride
Venofer
cilostazol
VprivPA
dipyridamole
ZavescaPA
hetastarch 6%/NACL
pentoxifylline ER
ANTICOAGULANTS
ticlopidine HCL
TIER 00 VALUE BASED BENEFIT
LMD 10% Dextrose 5%
warfarin sodium
LMD 10% Sodium Chloride 0.9%
TIER 01 GENERIC
Protamine Sulfate
enoxaparin sodium
Voluven
fondaparinux sodium
TIER 02 PREFERRED
heparin lock
Aggrenox
heparin lock flush
Effient
heparin lock flush for flushing vascular access devices
SolirisPA
heparin lock flush/NACL for flushing vascular access devices
TIER 03 NON PREFERRED
Activase
heparin sodium
Aggrastat
heparin sodium dcu
Agrylin
heparin sodium lock flush
Brilinta
heparin sodium/sodium chloride 0.9% premix
Cathflo Activase
heparin sodium/D5W
Firazyr
heparin sodium/NACL 0.9%
Hespan
Heparin Sodium/D5W
Hextend
Heparin Sodium/NACL 0.45%
Integrilin
Heparin Sodium/Sodium Chloride 0.9%
Kalbitor
TIER 02 PREFERRED
Kinlytic
Fragmin
Persantine
TIER 03 NON PREFERRED
Plavix
argatroban
Pletal
Angiomax
Reopro
Argatroban
Retavase
Arixtra
Retavase Half-kit
Coumadin
Tnkase
Eliquis
Trental
Heparin Lock Flush
Zontivity
Heparin Sodium
Iprivask
MOUTH/THROAT/DENTAL AGENT
Lovenox
Pradaxa
TIER 01 GENERIC
Xarelto
chlorhexidine gluconate
chlorhexidine gluconate oral rinse
HEMOSTATICS
clotrimazole
TIER 01 GENERIC
lidocaine viscous
aminocaproic acid
lidocaine HCL
Thrombin-jmi Diluent
nystatin
Thrombin-jmi Epistaxis
pilocarpine hydrochloride
Thrombin-jmi Syringe Spray Kit
pilocarpine HCL
Thrombin-jmi W/Dil Spray P.M. Actuator
stannous fluoride oral rinse
TIER 02 PREFERRED
triamcinolone acetonide
tranexamic acid
triamcinolone IN orabase
Aminocaproic Acid
Nafrinse Daily/Acidulated
TIER 03 NON PREFERRED
Nafrinse Daily/Neutral
Amicar
Nafrinse Weekly
Artiss
TIER 02 PREFERRED
Astringyn
cevimeline HCL
Cyklokapron
TIER 03 NON PREFERRED
Evicel
Aquoral
Evithrom
Caphosol
Lysteda
Debacterol
Recothrom
Evoxac
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 20
First-bxn Mouthwash
imipramine pamoate
First-dukes Mouthwash
imipramine HCL
First-marys Mouthwash
mirtazapine
First-mouthwash Blm
mirtazapine odt
Gel-kam Oral Care Rinse
nefazodone HCL
Gelclair
nortriptyline HCL
Lta 360 Kit
paroxetine HCLQL
Neutrasal
paroxetine HCL ERQL
Numoisyn
phenelzine sulfate
Peridex
protriptyline HCL
Prevident
sertraline HCLQL
Salagen
tranylcypromine sulfate
TIER 04 100% COPAY
trazodone HCL
Oravig
trimipramine maleate
venlafaxine HCLQL
NEUROLOGY, CNS, PSYCH
venlafaxine HCL ERQL
Amoxapine
ANTIANXIETY AGENTS
Doxepin HCL
TIER 01 GENERIC
Maprotiline HCL
alprazolam
Nefazodone HCL
alprazolam odt
Nortriptyline HCL
alprazolam ER
Venlafaxine HCL ERQL
buspirone HCL
TIER 02 PREFERRED
chlordiazepoxide HCL
duloxetine HCLQL
clorazepate dipotassium
PristiqQL
diazepam
TIER 03 NON PREFERRED
droperidol
Anafranil
gene-xene TAB 15MG
AplenzinQL
gene-xene TAB 3.75MG
Appbutamone
gene-xene TAB 7.5MG
Appbutamone-d
hydroxyzine pamoate
CelexaQL
hydroxyzine HCL
CymbaltaQL
lorazepam
Desvenlafaxine ERST
meprobamate
Effexor XRQL
oxazepam
Emsam
Diazepam
Fluoxetine HCL
Diazepam Intensol
Gaboxetine
Hydroxyzine HCL
KhedezlaST
Hydroxyzine Pamoate
LexaproQL
Lorazepam Intensol
Luvox CRQL,ST
TIER 03 NON PREFERRED
Marplan
Alprazolam Intensol
Nardil
Ativan
Norpramin
Gabavale-5
Oleptro
Gabazolamine
Pamelor
Gabazolamine-0.5
Parnate
Niravam
PaxilQL
Sentrazolam AM 0.25
Paxil CRQL
Tranxene T
PexevaQL,ST
Valium
ProzacQL
Vistaril
Prozac WeeklyQL
Xanax
Remeron
Xanax XR
Remeron Soltab
Sentraflox AM-10
ANTIDEPRESSANTS
Sentralopram AM-10
TIER 01 GENERIC
Sentravil PM-25
amitriptyline HCL
Sentroxatine
bupropion HCL
Surmontil
bupropion HCL ERQL
Tofranil
bupropion HCL SRQL
Tofranil-PM
bupropion HCL XLQL
Trazamine
citalopram hydrobromideQL
ViibrydQL,ST
clomipramine HCL
Vivactil
desipramine HCL
Wellbutrin
doxepin HCL
Wellbutrin SRQL
escitalopram oxalateQL
Wellbutrin XLQL
fluoxetine DRQL
ZoloftQL
fluoxetine HCLQL
TIER 04 100% COPAY
fluvoxamine maleateQL
BrintellixST
fluvoxamine maleate ERQL
FetzimaST
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 21
Fetzima Titration PackST
estazolam
Forfivo XLQL
eszopiclone
flurazepam HCL
ANTIPSYCHOTICS
phenobarbital
temazepam
TIER 01 GENERIC
triazolam
chlorpromazine HCL
zaleplon
clozapine
zolpidem tartrate
fluphenazine decanoate
zolpidem tartrate ER
fluphenazine HCL
Phenobarbital Sodium
haloperidol
TIER 03 NON PREFERRED
haloperidol decanoate
Ambien
haloperidol lactate
Ambien CR
lithium carbonate
Amytal Sodium
lithium carbonate ER
Butisol Sodium
loxapine
Doral
loxapine succinate
Gabazolpidem-5
olanzapine
Halcion
olanzapine odt
HetliozPA
perphenazine
Lunesta
prochlorperazine
Nembutal Sodium
prochlorperazine edisylate
Phenobarbital
prochlorperazine maleate
Precedex
quetiapine fumarate
Quazepam
risperidone
Restoril
risperidone odt
RozeremST
thioridazine HCL
Seconal
thiothixene
Sentrazolpidem PM-5
trifluoperazine HCL
Sonata
ziprasidone HCL
Strazepam
Chlorpromazine HCL
TIER 04 100% COPAY
Clozapine Odt
EdluarST
Fluphenazine HCL
IntermezzoST
Lithium Carbonate
Silenor
Lithium Citrate
ZolpimistST
TIER 02 PREFERRED
Seroquel XR
ADHD, NARCOLEPSY, ETC.
TIER 03 NON PREFERRED
Abilify
TIER 01 GENERIC
Abilify Discmelt
amphetamine/dextroamphetamineQL
Abilify Maintena
caffeine citrate
Adasuve
clonidine HCL ER
Clozaril
dexmethylphenidate HCLQL
Compazine
dexmethylphenidate HCL ERQL
Equetro
dextroamphetamine sulfateQL
Fanapt
dextroamphetamine sulfate ERQL
Fanapt Titration Pack
doxapram HCL
Fazaclo
methamphetamine HCLQL
Geodon
methylphenidate hydrochloride
Haldol
methylphenidate HCLQL
Haldol Decanoate 100
methylphenidate HCL CDQL
Haldol Decanoate 50
methylphenidate HCL ERQL
Invega
methylphenidate HCL SRQL
Invega Sustenna
modafinilPA
Latuda
Caffeine/Sodium Benzoate
Lithobid
Methylphenidate HCL ERQL
Loxitane
TIER 02 PREFERRED
Risperdal
DaytranaQL
Risperdal Consta
StratteraQL,ST
Risperdal M-TAB
VyvanseQL
Saphris
TIER 03 NON PREFERRED
Seroquel
AdderallQL
Versacloz
Adderall XRQL
Zyprexa
Cafcit
Zyprexa Relprevv
ConcertaQL
Zyprexa Zydis
DesoxynQL
DexedrineQL
HYPNOTICS
Dopram
FocalinQL
TIER 01 GENERIC
Focalin XRQL
dexmedetomidine HCL
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 22
Intuniv
Felbatol
Kapvay
Keppra
Kapvay Dose Pack
Keppra XR
Metadate CDQL
Klonopin
Methylin
Lamictal
NuvigilPA,QL
Lamictal Chewable Dispersible
ProcentraQL
Lamictal Odt
ProvigilPA
Lamictal Starter/Taking Valproate
Quillivant XRQL
Lamictal XR
RitalinQL
Mysoline
Ritalin LAQL
Neurontin
Ritalin SRQL
Oxtellar XR
Sentramodafin AM-100
Phenytek
Qudexy XR
ANTICONVULSANTS
SabrilPA
Stavzor
TIER 01 GENERIC
Tegretol
carbamazepine
Therapentin-60
carbamazepine ER
Therapentin-90
clonazepam
Topamax
clonazepam odt
Topamax Sprinkle
divalproex sodium
Topiramate ER
divalproex sodium DR
Trileptal
divalproex sodium ER
Trokendi XR
ethosuximide
Vimpat
felbamate
Zarontin
fosphenytoin sodium
Zonegran
gabapentin
lamotrigine
ANTIPARKINSON AGENTS
lamotrigine ER
levetiracetam
TIER 01 GENERIC
levetiracetam ER
amantadine HCL
oxcarbazepine
benztropine mesylate
phenytoin sodium
bromocriptine mesylate
phenytoin sodium extended
carbidopa/levodopa
primidone
carbidopa/levodopa odt
topiramate
carbidopa/levodopa ER
valproate sodium
entacapone
valproic acid
pramipexole dihydrochloride
zonisamide
ropinirole HCL
Diazepam
selegiline HCL
Levetiracetam
trihexyphenidyl HCL
TIER 02 PREFERRED
Amantadine HCL
phenytoin
TIER 02 PREFERRED
tiagabine hydrochloride
carbidopa
Banzel
ropinirole ER
Celontin
ApokynPA
Dilantin Infatabs
Azilect
Fycompa
Carbidopa/Levodopa/Entacapone
Gabitril
TIER 03 NON PREFERRED
Lamictal Starter/Not Taking Carbamazepine
Cogentin
Lamictal Starter/Taking Carbamazepine/Not Taking Valproate
Comtan
Eldepryl
Lyrica
Lodosyn
Onfi
Mirapex
Peganone
Mirapex ER
Potiga
Neupro
Tegretol-XR
Parcopa
TIER 03 NON PREFERRED
Parlodel
Aptiom
Requip
Carbatrol
Requip XL
Cerebyx
Sinemet
Depacon
Sinemet CR
Depakene
Stalevo 100
Depakote
Stalevo 125
Depakote ER
Stalevo 150
Depakote Sprinkles
Stalevo 200
Diastat Acudial
Stalevo 50
Diastat Pediatric
Stalevo 75
Dilantin
Tasmar
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 23
Zelapar
TIER 03 NON PREFERRED
cisatracurium besylate
NEUROLOGY, PSYCH - MISC.
BotoxPA
DysportPA
TIER 01 GENERIC
Nimbex
acamprosate calcium DR
Rilutek
disulfiram
XeominPA
donepezil HCL
Zemuron
fluoxetineQL
galantamine
MUSCULOSKELETAL AGENTS
galantamine hydrobromide
olanzapine/fluoxetine
TIER 01 GENERIC
rivastigmine tartrate
baclofen
Chlordiazepoxide/Amitriptyline
carisoprodol
Ergoloid Mesylates
carisoprodol/aspirin
Perphenazine/Amitriptyline
carisoprodol/aspirin/codeine
TIER 02 PREFERRED
chlorzoxazone
AvonexPA
cyclobenzaprine HCL
Avonex PenPA
dantrolene sodium
BetaseronPA
metaxalone
CopaxonePA
methocarbamol
Orap
orphenadrine citrate
RebifPA
orphenadrine citrate ER
Rebif Titration PackPA
orphenadrine/asa/caffeine
XenazinePA
tizanidine HCL
XyremPA
Carisoprodol
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
AmpyraPA
Amrix
Antabuse
Cyclobenzaprine Comfort PAC
Aricept
Dantrium
Aricept Odt
Dantrium IV
AubagioPA
Dantrolene Sodium
Brisdelle
Fexmid
Campral
Flexeril
Exelon
Lorzone
ExtaviaPA
Norflex
GilenyaPA
Parafon Forte DSC
Gralise Starter
Prazolamine
Namenda
Robaxin
Namenda Titration PAK
Robaxin-750
Nuedexta
Ryanodex
Razadyne
Skelaxin
Razadyne ER
Soma
Rebif RebidosePA
Therabenzaprine-60
Rebif Rebidose Titration PackPA
Therabenzaprine-90
SarafemQL
Therabenzaprine-90-5
Savella
Tizanidine Comfort PAC
Savella Titration Pack
Zanaflex
Symbyax
TecfideraPA
ANTIMYASTHENIC AGENTS
Tecfidera Starter PackPA
TIER 01 GENERIC
TysabriPA
neostigmine methylsulfate
TIER 04 100% COPAY
pyridostigmine bromide
Gralise
Enlon
Horizant
Guanidine HCL
Namenda XR
TIER 02 PREFERRED
Namenda XR Titration Pack
Mestinon Timespan
Prostigmin
NEUROMUSCULAR AGENTS
TIER 03 NON PREFERRED
TIER 01 GENERIC
Bloxiverz
atracurium besylate
Enlon-plus
pancuronium bromide
Mestinon
riluzole
Regonol
rocuronium bromide
vecuronium bromide
OPHTHALMOLOGY AND OTIC
Anectine
ANTI-INFECTIVES
Quelicin
TIER 01 GENERIC
Quelicin 1000
bacitracin/polymyxin b
TIER 02 PREFERRED
ciprofloxacin HCL
MyoblocPA
erythromycin
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 24
gatifloxacin
sulfacetamide sodium/prednisolone sodium phosphate
gentamicin sulfate
tobramycin/dexamethasone
levofloxacin
Neomycin/Polymyxin/Hydrocortisone
neomycin/bacitracin/polymyxin
Prednisolone Sodium Phosphate
neomycin/polymyxin/bacitracin zinc
TIER 02 PREFERRED
neomycin/polymyxin/gramicidin
Alrex
ofloxacin
Blephamide S.o.p.
polymyxin b sulfate/trimethoprim sulfate
Lotemax
sodium sulfacetamide
Pred Mild
sulfacetamide sodium
Zylet
tobramycin sulfate
TIER 03 NON PREFERRED
trifluridine
Blephamide
trimethoprim sulfate/polymyxin b sulfate
Durezol
TIER 02 PREFERRED
Flarex
Ciloxan
FML
Natacyn
FML Forte
Vigamox
FML Liquifilm
TIER 03 NON PREFERRED
Maxidex
Azasite
Maxitrol
Bacitracin
Omnipred
Besivance
Pred Forte
Betadine Ophthalmic Prep
Pred-G
Bleph-10
Pred-G S.o.p.
Garamycin
Tobradex
Mitosol
Tobradex ST
Moxeza
Vexol
Neosporin
Ocuflox
PROSTAGLANDINS
Polytrim
TIER 01 GENERIC
Sulfacetamide Sodium
latanoprost
Tobrex
TIER 02 PREFERRED
Viroptic
Travatan Z
Zirgan
Travoprost
Zymaxid
TIER 03 NON PREFERRED
Lumigan
ARTIFICIAL TEAR/LUBRICANT
Rescula
TIER 02 PREFERRED
Xalatan
Lacrisert
Zioptan
BETA-BLOCKERS
CYCLOPLEGIC MYDRIATICS
TIER 01 GENERIC
TIER 01 GENERIC
betaxolol HCL
atropine sulfate
carteolol HCL
homatropine HBR
dorzolamide HCL/timolol maleate
Atropine Sulfate
levobunolol HCL
TIER 02 PREFERRED
timolol maleate
cyclopentolate HCL
timolol maleate ophthalmic gel forming
TIER 03 NON PREFERRED
Levobunolol HCL
Cyclogyl
TIER 02 PREFERRED
Cyclomydril
Betimol
Isopto Atropine
Betoptic-s
Isopto Homatropine
TIER 03 NON PREFERRED
Isopto Hyoscine
Betagan
Combigan
DECONGESTANTS
Cosopt
TIER 01 GENERIC
Cosopt PF
phenylephrine HCL
Istalol
Mydfrin
Metipranolol
Naphazoline HCL
Timoptic
Timoptic Ocudose
MIOTICS
Timoptic-xe
TIER 01 GENERIC
pilocarpine HCL
OPHTHALMIC STEROIDS
TIER 02 PREFERRED
TIER 01 GENERIC
Isopto Carbachol
dexamethasone sodium phosphate
Phospholine Iodide
fluorometholone
Pilopine HS
neomycin/polymyxin/bacitracin/hydrocortisone
TIER 03 NON PREFERRED
neomycin/polymyxin/dexamethasone
Isopto Carpine
prednisolone acetate
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 25
ADRENERGIC AGENTS
Otozin
TIER 02 PREFERRED
TIER 01 GENERIC
Cipro HC
apraclonidine
Ciprodex
brimonidine tartrate
TIER 03 NON PREFERRED
TIER 03 NON PREFERRED
Cetraxal
Alphagan P
Coly-mycin S
Iopidine
Cortisporin
Simbrinza
Cortisporin-tc
Cresylate
IMMUNOMODULATORS
Dermotic
TIER 02 PREFERRED
Pramotic
RestasisPA
Vosol HC
TIER 04 100% COPAY
LOCAL ANESTHETICS
Auralgan
TIER 01 GENERIC
proparacaine HCL
OXYTOCICS
tetracaine HCL
TIER 03 NON PREFERRED
TIER 01 GENERIC
Akten
methylergonovine maleate
Alcaine
oxytocin
TIER 03 NON PREFERRED
OPHTHALMICS - MISC.
Cervidil
TIER 01 GENERIC
Hemabate
azelastine HCL
Pitocin
bromfenac
Prepidil
cromolyn sodium
Prostin E2
diclofenac sodium
dorzolamide HCL
PAIN MANAGEMENT
epinastine HCL
flurbiprofen sodium
ANALGESICS - NONNARCOTIC
ketorolac tromethamine
TIER 01 GENERIC
Bromfenac
butal/asa/caff
TIER 02 PREFERRED
butalbital/acetaminophen
Azopt
butalbital/acetaminophen/caffeine
CystaranPA
butalbital/apap/caffeine
Pataday
butalbital/asa/caffeine
Patanol
choline magnesium trisalicylate
TIER 03 NON PREFERRED
diflunisal
Acular
salsalate
Acular LS
Alagesic LQ
Acuvail
Butalbital/Aspirin/Caffeine
Alocril
Mst 600
Alomide
Rhinoflex-650
Bepreve
Tencon
Bromday
TIER 02 PREFERRED
Elestat
Ofirmev
Emadine
Phrenilin Forte
Ilevro
TIER 03 NON PREFERRED
Lastacaft
Bupap
Nevanac
Dolgic Plus
Ocufen
Dologesic
Optivar
Equagesic
Prolensa
Esgic
Trusopt
Esgic-plus
Fioricet
OTIC AGENTS
Fiorinal
TIER 01 GENERIC
Levacet
acetic acid
Orbivan
antipyrine/benzocaine
Staflex
fluocinolone acetonide
TIER 04 100% COPAY
fluocinolone acetonide ear drops
Orbivan CF
hydrocortisone/acetic acid
neomycin/polymyxin/hydrocortisone
ANALGESICS - OPIOID
neomycin/polymyxin/HC
TIER 01 GENERIC
ofloxacin
acetaminophen/codeine
Acetic Acid/Aluminum Acetate
acetaminophen/codeine #2
Antipyrine/Benzocaine
acetaminophen/codeine #3
Ciprofloxacin
acetaminophen/codeine #4
Myoxin
acetaminophen/codeine phosphate
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 26
alfentanil
Infumorph 500
buprenorphine HCL
Kadian
butalbital/acetaminophen/caffeine/codeine
Liquicet
butalbital/aspirin/caffeine/codeine
Lorcet Plus
butorphanol tartrateQL
Lorcet 10/650
fentanylQL
Lortab
fentanyl citrate oral transmucosalQL
Magnacet
hydrocodone bitartrate/acetaminophen
Morphine Sulfate Add-vantage
hydrocodone/acetaminophen
MS Contin
hydrocodone/ibuprofen
Norco
hydromorphone HCL
Nucynta
hydromorphone HCL ER
Nucynta ER
meperidine HCL
Opana
methadone HCL
Opana ER (crush Resistant)
morphine sulfate
Percocet
nalbuphine HCL
Percodan
oxycodone HCL
Primlev
oxycodone/acetaminophen
Reprexain
oxycodone/aspirin
Roxicet
oxycodone/ibuprofen
Roxicodone
oxymorphone hydrochloride
Rybix Odt
oxymorphone hydrochloride ER
Suboxone
pentazocine/acetaminophen
Subsys
pentazocine/naloxone HCL
Synalgos-dc
tramadol hydrochloride/acetaminophen
Talwin
tramadol HCL
Theracodeine-300
tramadol HCL ER
Theracodophen-low-90
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate
Theracodophen-325
Codeine Sulfate
Theracodophen-650
Hydrocodone Bitartrate/Acetaminophen
Theracodophen-750
Hydrocodone/Acetaminophen
Theratramadol-60
Hydromorphone HCL
Theratramadol-90
Hydromorphone HCL Dosette
Tylenol/Codeine #3
Levorphanol Tartrate
Tylenol/Codeine #4
Maxidone
Ultiva
Meperidine HCL
Ultracet
Methadone HCL
Ultram
Methadose
Ultram ER
Methadose Sugar-free
Vicoprofen
Morphine Sulfate
Xartemis XR
Oxycodone HCL
Xodol
Tramadol HCL ER
Zohydro ER
Trezix
Zolvit
Xolox
Zydone
TIER 02 PREFERRED
TIER 04 100% COPAY
buprenorphine HCL/naloxone HCL
Butrans
morphine sulfate ER
Conzip
OxycontinQL
Lazanda
TIER 03 NON PREFERRED
AbstralQL
ANTI-INFLAMMATORY
ActiqQL
TIER 01 GENERIC
Alfenta
diclofenac potassium
Aspirin-caffeine-dihydrocodeine
diclofenac sodium DR
Avinza
diclofenac sodium ER
Buprenex
diclofenac sodium/misoprostol
Capital/Codeine
etodolac
Demerol
etodolac ER
Dilaudid
flurbiprofen
Dilaudid-HP
ibuprofen
Dolophine
indomethacin
Dolophine HCL
indomethacin sodium
DuragesicQL
indomethacin ER
Exalgo
ketoprofen
FentoraQL
ketorolac tromethamine
Fioricet/Codeine
leflunomide
Fiorinal/Codeine #3
mefenamic acid
Hycet
meloxicam
Hydromorphone HCL ER
nabumetone
Ibudone
naproxen
Infumorph 200
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 27
naproxen sodium
100% COPAY
oxaprozin
Ketorolac Tromethamine
piroxicam
Sprix
sulindac
tolmetin sodium
MIGRAINE PRODUCTS
Fenoprofen Calcium
TIER 01 GENERIC
Indomethacin
dihydroergotamine mesylatePA
Ketoprofen ER
naratriptan HCLQL
Meclofenamate Sodium
rizatriptan benzoatePA
Meloxicam
rizatriptan benzoate odtPA
Tolmetin Sodium
sumatriptan succinateQL
TIER 02 PREFERRED
sumatriptan succinate refill
ArcalystPA
zolmitriptanPA
CelebrexST
zolmitriptan odtPA
EnbrelPA
Migergot
Enbrel SureclickPA
SumatriptanPA
HumiraPA
TIER 02 PREFERRED
Humira PenPA
Ergomar
Humira Pen-crohns DiseasestarterPA
RelpaxQL
Humira Pen-psoriasis StarterPA
TIER 03 NON PREFERRED
OrenciaPA
Alsuma
Ridaura
AmergePA
TIER 03 NON PREFERRED
AxertPA
ActemraPA
Cafergot
Anaprox
D.h.e. 45PA
Anaprox DS
Dihydroergotamine MesylatePA
Arava
FrovaPA
Arthrotec 50
ImitrexPA
Arthrotec 75
Imitrex Statdose Refill
Caldolor
Imitrex Statdose System
Cataflam
MaxaltPA
Daypro
Maxalt-MLTPA
Duexis
Migral
EC-naprosyn
MigranalPA
Feldene
Sumatriptan SuccinatePA
Ibuprofen Comfort PAC
Sumavel Dosepro
IlarisPA
TreximetPA
Indocin
ZomigPA
Indocin IV
Zomig Nasal SprayPA
IC 400
Zomig ZMTPA
IC 800
TIER 04 100% COPAY
KineretPA
Cambia
Meloxicam Comfort PAC
Mobic
GOUT AGENTS
Nalfon
TIER 01 GENERIC
Naprelan
allopurinol
Naprosyn
probenecid
Naproxen Comfort PAC
probenecid/colchicine
Neoprofen
TIER 03 NON PREFERRED
OtezlaPA
Aloprim
Ponstel
Colcrys
Rasuvo
KrystexxaPA
Rheumatrex
Uloric
SimponiPA
Zyloprim
Simponi AriaPA
Therafeldamine
LOCAL ANESTHETICS-INJ
Theraprofen-60
TIER 01 GENERIC
Theraprofen-800
bupivacaine HCL
Theraprofen-90
chloroprocaine HCL
Theraproxen-500
lidocaine HCL
Theraproxen-60
lidocaine/epinephrine
Theraproxen-90
ropivacaine HCL
Trepadiclofen-25
Carbocaine
Trepoxen-250
Marcaine
Trepoxicam-7.5
Marcaine W/O Epi
Vimovo
Marcaine/Epinephrine
Voltaren-XR
Mepivacaine HCL
XeljanzPA
TIER 03 NON PREFERRED
Zipsor
bupivacaine/epinephrine
TIER 04
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 28
BD Pudendal/Local Block Tray 1% Lidocaine
Astelin
Duocaine
Astepro
Durasafe Spinal/Epidural Tray/1% Xylocaine/19GX36"close CATH
Atrovent
Bactroban Nasal
Durasafe Spinal/Epidural Tray/1% Xylocaine/19GX36"open CATH
Patanase
Qnasl
Durasafe Spinal/Epidural Tray/1% Xylocaine/20GX36"close CATH
Tyzine
Tyzine Pediatric Nasal Drops
Durasafe Spinal/Epidural Tray/1% Xylocaine/20GX36"open CATH
TIER 04 100% COPAY
Beconase AQ
Exparel
Dymista
Lidocaine HCL/Dextrose
Flonase
Monoject Bone Marrow Biopsy Prepping Tray
Nasacort AQ
Monoject Bone Marrow Biopsy Tray/Biop Aspir Needle 11GX4"
Nasonex
Monoject Bone Marrow Biopsy Tray/Biop Aspir Needle 8GX4"
Omnaris
Rhinocort Aqua
Monoject Bone Marrow Biopsy Tray/Sternal-iliac Needle 16G
Veramyst
Zetonna
Naropin
Nesacaine
COUGH/COLD/ALLERGY
Nesacaine-mpf
TIER 01 GENERIC
Sensorcaine-mpf/Epinephrine
acetylcysteine
Tetracaine HCL
benzonatate
Turkel Paracentesis Procedure Tray/8french
bromphen/pseudoephedrine HCL/dextromethorphan HBR
Xylocaine
hydrocodone bitartrate/chlorpheniramine maleate/PSE
Xylocaine-mpf
hydrocodone bitartrate/homatropine methylbromide
Xylocaine-mpf/Epinephrine
hydrocodone/homatropine
Xylocaine/Epinephrine
phenylephrine/guaifenesin
promethazine-DM
RESPIRATORY, ALLERGY, ETC
promethazine/codeine
ANTIHISTAMINES
promethazine/dextromethorphan
TIER 01 GENERIC
sodium chloride
carbinoxamine maleate
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine HCL
clemastine fumarate
cyproheptadine HCL
Pediatex TD
desloratadine odt
Relhist
diphenhydramine HCL
Suttar-SF
promethazine HCL
Suttar-2
promethazine HCL plain
TIER 02 PREFERRED
Brompheniramine Tannate
hydrocodone polistirex/chlorpheniramine polistirex
Clemastine Fumarate
Tussicaps
Dexchlorpheniramine Maleate
TIER 03 NON PREFERRED
Doxytex
Alahist Ac
Ed-chlor-tan
Alahist DHC
TIER 03 NON PREFERRED
Allfen CD
Karbinal ER
Allfen CDX
Palgic
Ambifed CD
Phenergan
Ambifed CDX
Respa-BR
Ambifed-G CD
TIER 04 100% COPAY
Ambifed-G CDX
cetirizine HCL
Carbaphen 12
desloratadine
Carbaphen 12 PED
levocetirizine dihydrochloride
Cotab A
Clarinex
Cotab AX
Clarinex Reditabs
Cotabflu
Xyzal
Cpb Wc
Decon-a
NASAL AGENTS
Donatuss Dc
Exactuss
TIER 01 GENERIC
Gilphex TR
budesonide
Giltuss
flunisolide
Giltuss PED-c
fluticasone propionate
Giltuss TR
ipratropium bromide
Hyper-sal
Flunisolide
Hypersal
TIER 02 PREFERRED
J-cof DHC
azelastine HCL
J-max DHC
TIER 03 NON PREFERRED
Maxifed CD
triamcinolone acetonide
Maxifed CDX
Adrenalin
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 29
Maxifed-G CD
Perforomist
Maxifed-G CDX
Serevent Diskus
Maxiflu CD
Spiriva Handihaler
Maxiflu CDX
Xopenex HFA
Maxiphen CD
TIER 03 NON PREFERRED
Maxiphen CDX
Accolate
Nebusal
Accuneb
Neotuss Plus
Adrenalin
Panatuss Dxp
Aerospan
Pediatex TDM
Alvesco
Phenflu CD
Anoro Ellipta
Phenflu CDX
Arcapta Neohaler
Poly-tussin DHC
Breo Ellipta
Rescon-JR
Brondil
Rescon-MX
Brovana
Rezira
Daliresp
Tessalon Perles
Duoneb
Tussionex Pennkinetic Extended Release
Isuprel
Vituz
Lufyllin
Zonatuss
Proventil HFA
Zutripro
Pulmicort
TIER 04 100% COPAY
Pulmophylline
Clarinex-d 12 HOUR
Senophylline
Clarinex-d 24 HOUR
Singulair
Semprex-d
Striverdi Respimat
Theo-24
ANTIASTHMATIC/COPD AGENTS
Tudorza Pressair
Ventolin HFA
TIER 00 VALUE BASED BENEFIT
Vospire ER
budesonide
XolairPA
Advair Diskus
Xopenex
Advair HFA
Xopenex Concentrate
Asmanex 120 Metered Doses
Zyflo
Asmanex 14 Metered Doses
Zyflo CR
Asmanex 30 Metered Doses
TIER 04 100% COPAY
Asmanex 60 Metered Doses
Combivent Respimat
Asmanex 7 Metered Doses
Dulera
RESPIRATORY AGENTS - MISC
Flovent Diskus
Flovent HFA
TIER 02 PREFERRED
Proair HFA
PulmozymePA
Pulmicort Flexhaler
TIER 03 NON PREFERRED
Qvar
Aralast NPPA
Symbicort
Curosurf
TIER 01 GENERIC
GlassiaPA
albuterol sulfate
Infasurf
albuterol sulfate ER
KalydecoPA
albuterol TAB 4MG
Prolastin-cPA
aminophylline
Surfaxin
cromolyn sodium
Survanta Intratracheal
epinephrine HCL
ZemairaPA
ipratropium bromide
ipratropium bromide/albuterol sulfate
TOXOIDS
montelukast sodium
terbutaline sulfate
TIER 01 GENERIC
theophylline
Adacel
theophylline CR
TIER 02 PREFERRED
theophylline ER
Boostrix
theophylline/D5W
Daptacel
zafirlukast
Infanrix
Metaproterenol Sulfate
Tenivac
Theophylline/D5W
Tetanus/Diphtheria Toxoids-adsorbed Adult
TIER 02 PREFERRED
TIER 03 NON PREFERRED
levalbuterol
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
levalbuterol HCL
Kinrix
Atrovent HFA
Pediarix
Combivent
Pentacel
Elixophyllin
Tetanus Toxoid Adsorbed
Foradil Aerolizer
Maxair Autohaler
VACCINES
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 30
Prevnar 13
TIER 02 PREFERRED
Proquad
Acthib
Rabavert
Comvax
Recombivax HB
Hiberix
Rotarix
Imovax Rabies (h.d.c.v.)
Rotateq
Ipol Inactivated IPV
Twinrix
M-m-r II W/Diluent 10 Dose
Vaqta
Menomune-a/C/Y/W-135
Vivotif Berna
Pedvax HIB
Zostavax
Pneumovax 23
Pneumovax 23/1 Dose
VITAMINS
Pneumovax 23/5 Dose
VITAMINS
Typhim VI
TIER 01 GENERIC
Varivax
ascorbic acid
Yf-vax
ergocalciferol
TIER 03 NON PREFERRED
phytonadione
Afluria PF 2012-2013
thiamine HCL
Afluria PF 2013-2014
vitamin c 222MG
Afluria PF 2014-2015
vitamin d
Afluria 2012-2013
vitamin k1
Afluria 2013-2014
Pyridoxine HCL
Afluria 2014-2015
Vitamin K1
Bcg Vaccine
Wheat Germ
Biothrax
TIER 02 PREFERRED
Cervarix
Mephyton
Engerix-b
TIER 03 NON PREFERRED
Fluarix Quadrivalent 2013-2014
Aquasol A Parenteral
Fluarix Quadrivalent 2014-2015
Decara
Fluarix 2012-2013
Drisdol
Fluarix 2013-2014
Flublok 2013-2014
MULTIVITAMINS
Flucelvax 2012-2013
TIER 01 GENERIC
Flucelvax 2013-2014
b-complex
Flucelvax 2014-2015
b-complex 100
Flulaval Quadrivalent 2013-2014
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper
Flulaval Quadrivalent 2014-2015
Albafort
Flulaval 2012-2013
Cavan-alpha Kit
Flulaval 2013-2014
Cod Liver Oil
Flulaval 2014-2015
Crnatal
Flumist Nasal Vaccine 2012-2013
CO-natal Fa
Flumist Quadrivalent
Elite-OB
Fluvirin PF 2012-2013
Folbecal
Fluvirin PF 2013-2014
Folcaps Omega 3
Fluvirin PF 2014-2015
Folivane-prx DHA NF
Fluvirin 2012-2013
Folivane-OB
Fluvirin 2013-2014
Inatal Advance
Fluvirin 2014-2015
Inatal GT
Fluzone High-dose PF 2012-2013
Inatal Ultra
Fluzone High-dose PF 2013-2014
M.v.i. Adult
Fluzone High-dose PF 2014-2015
Macnatal CN DHA
Fluzone Pediatric PF 2012-2013
Mynatal
Fluzone Pediatric PF 2013-2014
Mynatal Advance
Fluzone Pediatric PF 2014-2015
Mynatal Ultracaplet
Fluzone PF 2012-2013
Natalvit
Fluzone PF 2013-2014
OB-natal One
Fluzone Quadrivalent 2013-2014
Pr Natal 400
Fluzone Quadrivalent 2014-2015
Pr Natal 400 EC
Fluzone Split 2012-2013
Pr Natal 430
Fluzone Split 2013-2014
Pr Natal 430 EC
Fluzone Split 2014-2015
Prenatabs RX
Gardasil
Prenatal Ad
Havrix
Strovite
Influenza A (h1n1) Monovalent 2009
Taron-bc
Ixiaro
Taron-c DHA
Medical Provider EZ Flu Shot 2014-2015
Taron-duo EC
Menactra
Taron-prex
Menhibrix
Tricare
Menveo
Trinate
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 31
Triveen-duo DHA
Natelle One
Triveen-prx RNF
Neevo DHA
Triveen-ten
Nephplex RX
Triveen-u
Nephro-vite RX
TL G-FOL OS
Nephrocaps
Vemavite-prx 2
Nephrocaps QT
Vinacal
Nestabs
Vinate AZ Extra
Nestabs Abc
Vinate C
Nestabs DHA
Vinate Calcium
Newgen
Vinate Care
Nexa Plus
Vinate GT
Nexa Select
Vinate IC
Nicadan
Vinate II
Nicazel
Vinate M
Nicazel Forte
Vinate One
Nicomide
Vinate Pn Care
Nutricap
Vitaroca Plus
Nutrivit
Zatean-pn
O-CAL Fa
Zatean-pn DHA
O-CAL Prenatal
Zatean-pn Plus
Obstetrix DHA
Zatean-CH
Obstetrix EC
TIER 02 PREFERRED
OB Complete
Bal-care DHA
OB Complete One
TIER 03 NON PREFERRED
OB Complete Petite
Adrenal C Formula
OB Complete Premier
Atabex EC
OB Complete 400
Atabex Prenatal
OB Complete/DHA
B-nexa
Paire OB
Bacmin
Poly-VI-flor
Bal-care DHA Essential
Poly-VI-flor/Iron
Citranatal Assure
Prefera OB
Citranatal B-calm
Prefera OB + DHA
Citranatal DHA
Preferaob One
Citranatal Harmony
Prefol-DHA
Citranatal RX
Prenata
Citranatal 90 DHA
Prenatal-u
Concept DHA
Prenate
Concept OB
Prenate AM
Corvite
Prenate DHA
Dialyvite Supreme D
Prenate Elite
Dialyvite 3000
Prenate Enhance
Dialyvite 5000
Prenate Essential
Dialyvite/Zinc
Prenate Mini
Diatx ZN
Prenate Pixie
Duet DHA
Prenate Restore
Duet DHA Balanced
Prenate Star
Duet DHA EC
Prenexa
Duet DHA 400
Preque 10
Duet DHA 400EC
Protect Plus
Duet DHA 430
Protectbone
Duet DHA 430EC
Protectnatal
Escavite
Provida OB
Escavite D
Quflora Pediatric
Folet DHA
R-natal OB
Folet One
Renatabs
Folgard OS
Renatabs With Iron
Fortavit
Renax
Gesticare DHA
Req 49+
M.v.i. Pediatric
Select-ob+dha
M.v.i.-12 Without Vitamin K
Select-OB
M-vit
Siderol
Marnatal-f
Strovite Forte
Maxinate
Strovite One
Moms Choice RX
Supervite
Mykidz Iron Fl
Supervite EC
Natachew
Support-500
Natafort
Synagex
Natalvirt CA
Synatek
Natalvirt 90 DHA
Tri-VI-flor
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 32
Tricare Prenatal Compleat
Tricare Prenatal DHA One
Udamin
Udamin SP
Vinacal B
Vinate DHA
Vinate DHA RF
Vita-pren
Vitafol
Vitafol Ultra
Vitafol-nano
Vitafol-ob+dha
Vitafol-one
Vitafol-plus
Vitafol-pn
Vitafol-OB
Vital-d RX
Vitamedmd One RX/Quatrefolic
Vitamedmd Plus RX/Quatre Folic
Vitamedmd Redichew RX
Vitamedmd Redichew RX/Quatrefolic
Vitapearl
Viva CT Prenatal
Viva DHA
MEDICAL DEVICES
DIABETIC SUPPLIES
TIER 00 VALUE BASED BENEFIT
Insulin Syringe/0.5ML/30G X 5/16"
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"
MISCELLANEOUS
TIER 02 PREFERRED
Chemet
ExjadePA
TIER 03 NON PREFERRED
FerriproxPA
Pentetate Calcium Trisodium
Pentetate Zinc Trisodium
Effective August 2014
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 33
Index
A
Adempas, 9
alprazolam odt, 21
Adenocard, 7
Alrex, 25
A-hydrocort, 13
adenosine, 7
Alsuma, 28
abacavir, 3
Adoxa, 2
Altabax, 10
abacavir sulfate/lamivudine/zidovudine, 3
Adoxa PAK 1/100, 2
Altace, 8
Abelcet, 2
Adoxa PAK 1/150, 2
Altoprev, 9
Abilify, 22
Adoxa PAK 2/100, 2
Aluminum Acetate, 12
Abilify Discmelt, 22
Adrenaclick, 9
Aluvea, 12
Abilify Maintena, 22
Adrenal C Formula, 32
Alvesco, 30
Abraxane, 5
Adrenalin, 9, 29, 30
amantadine HCL, 23
Absorica, 10
Adriamycin, 4
Amantadine HCL, 23
Abstral, 27
Advair Diskus, 30
Amaryl, 15
acamprosate calcium DR, 24
Advair HFA, 30
Ambien, 22
Acanya, 10
Advicor, 9
Ambien CR, 22
acarbose, 15
Aerospan, 30
Ambifed CD, 29
Accolate, 30
Afinitor, 5
Ambifed CDX, 29
Accuneb, 30
Afinitor Disperz, 5
Ambifed-G CD, 29
Accupril, 8
Afluria 2012-2013, 31
Ambifed-G CDX, 29
Accuretic, 8
Afluria 2013-2014, 31
Ambisome, 2
acebutolol HCL, 7
Afluria 2014-2015, 31
amcinonide, 11
Aceon, 8
Afluria PF 2012-2013, 31
Amcinonide, 11
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate, 27
Afluria PF 2013-2014, 31
Amerge, 28
Afluria PF 2014-2015, 31
Amethyst, 14
acetaminophen/codeine, 26
Aggrastat, 20
Amicar, 20
acetaminophen/codeine #2, 26
Aggrenox, 20
amifostine, 6
acetaminophen/codeine #3, 26
Agrylin, 20
amikacin sulfate, 2
acetaminophen/codeine #4, 26
Akne-mycin, 10
amiloride HCL, 9
acetaminophen/codeine phosphate, 26
Akten, 26
amiloride/hydrochlorothiazide, 9
acetazolamide, 8
Ala Scalp, 11
aminocaproic acid, 20
Acetazolamide, 9
Alagesic LQ, 26
Aminocaproic Acid, 20
acetazolamide ER, 9
Alahist Ac, 29
aminophylline, 30
acetazolamide sodium, 8
Alahist DHC, 29
amiodarone HCL, 7
acetic acid, 26
Albafort, 19, 31
Amiodarone HCL, 7
Acetic Acid/Aluminum Acetate, 26
Albenza, 3
Amitiza, 18
acetylcysteine, 29
albuterol sulfate, 30
amitriptyline HCL, 21
acitretin, 11
albuterol sulfate ER, 30
amlodipine besylate, 7
Aclovate, 11
albuterol TAB 4MG, 30
amlodipine besylate/atorvastatin calcium, 9
Actemra, 28
Alcaine, 26
Acthar HP, 16
alclometasone dipropionate, 11
amlodipine besylate/benazepril HCL, 8
Acthib, 31
Aldactazide, 9
amlodipine besylate/benazepril hydrochloride, 8
Acticlate, 2
Aldactone, 9
Actigall, 18
Aldara, 12
ammonium lactate, 12
Actimmune, 6
Aldurazyme, 16
Ammonul, 16
Actiq, 27
alendronate sodium, 15
Amoxapine, 21
Activase, 20
Alendronate Sodium, 15
amoxicillin, 1
Activella, 14
Alfenta, 27
Amoxicillin, 1
Actonel, 15
alfentanil, 27
Amoxicillin ER, 1
Actoplus Met, 15
Alferon N, 6
amoxicillin/clavulanate potassium, 1
Actoplus Met XR, 15
alfuzosin HCL ER, 19
amoxicillin/clavulanate potassium ER, 1
Actos, 15
Alimta, 5
amphetamine/dextroamphetamine, 22
Acular, 26
Alinia, 4
Amphotec, 2
Acular LS, 26
Alkeran, 4
Amphotericin B, 2
Acuvail, 26
Allfen CD, 29
ampicillin, 1
acyclovir, 3, 11
Allfen CDX, 29
Ampicillin, 1
acyclovir sodium, 3
allopurinol, 28
ampicillin sodium, 1
Acyclovir Sodium, 3
Alocril, 26
Ampicillin Sodium, 1
Aczone, 10
Alodox Convenience Kit, 2
ampicillin-sulbactam, 1
Adacel, 30
Alomide, 26
Ampicillin-sulbactam, 1
Adalat CC, 7
Aloprim, 28
Ampyra, 24
adapalene, 10
Alora, 14
Amrix, 24
Adasuve, 22
Aloxi, 18
Amturnide, 8
Adcetris, 5
Alphagan P, 26
Amytal Sodium, 22
Adcirca, 10
alprazolam, 21
Anacaine, 12
Adderall, 22
alprazolam ER, 21
Anadrol-50, 13
Adderall XR, 22
Alprazolam Intensol, 21
Anafranil, 21
adefovir dipivoxil, 3
anagrelide hydrochloride, 20
Asmanex 14 Metered Doses, 30
azathioprine, 5
Analpram Advanced, 18
Asmanex 30 Metered Doses, 30
azelastine HCL, 26, 29
Analpram-HC, 18
Asmanex 60 Metered Doses, 30
Azelex, 10
Analpram-HC Singles, 18
Asmanex 7 Metered Doses, 30
Azilect, 23
Anaprox, 28
Aspirin-caffeine-dihydrocodeine, 27
azithromycin, 1
Anaprox DS, 28
Astagraf XL, 5
Azithromycin, 1
Anaspaz, 17
Astelin, 29
Azopt, 26
anastrozole, 5
Astepro, 29
Azor, 8
Ancef, 1
Astringyn, 20
aztreonam, 3
Ancobon, 2
Atabex EC, 32
Azulfidine, 18
Androderm, 13
Atabex Prenatal, 32
Azulfidine EN-TABS, 18
Androgel, 13
Atacand, 8
B
Androgel P.M., 13
Atacand HCT, 8
B-6 Folic Acid, 19
Android, 13
atenolol, 7
b-complex, 31
Androxy, 13
atenolol/chlorthalidone, 8
b-complex 100, 31
Anectine, 24
Atgam, 5
B-nexa, 32
Angeliq, 14
Ativan, 21
bacitracin, 3
Angiomax, 20
Atopiclair, 12
Bacitracin, 4, 25
Animi-3, 19
atorvastatin calcium, 9
bacitracin/polymyxin b, 24
Animi-3/Vitamin D, 19
atovaquone, 4
baclofen, 24
Anoro Ellipta, 30
atovaquone/proguanil HCL, 3
Bacmin, 32
Antabuse, 24
atracurium besylate, 24
Bactocill IN Dextrose, 1
Antara, 9
Atralin, 10
Bactrim, 4
antipyrine/benzocaine, 26
Atripla, 3
Bactrim DS, 4
Antipyrine/Benzocaine, 26
Atropen, 17
Bactroban, 10
Anusol-HC, 18
atropine sulfate, 17, 25
Bactroban Nasal, 29
Anzemet, 17
Atropine Sulfate, 17, 25
Bal-care DHA, 32
Apexicon E, 11
Atrovent, 29
Bal-care DHA Essential, 32
Apidra, 14
Atrovent HFA, 30
balsalazide disodium, 18
Apidra Solostar, 14
Aubagio, 24
Banzel, 23
Aplenzin, 21
augmented betamethasone dipropionate, 11
Baraclude, 3
Apokyn, 23
Bcg Vaccine, 31
Appbutamone, 21
Augmentin, 1
BD Pudendal/Local Block Tray 1% Lidocaine, 29
Appbutamone-d, 21
Augmentin ES-600, 1
Appformin, 15
Augmentin XR, 1
Beconase AQ, 29
Appformin-d, 15
Auralgan, 26
Beleodaq, 6
apraclonidine, 26
Aurstat, 12
Belladonna & Opium, 17
Apriso, 18
Aurstat Anti-itch Hydrogel, 12
Belladonna Alkaloids & Opium, 17
Aptiom, 23
Aurstat Anti-itch Hydrogel Kit, 12
benazepril HCL, 7
Aptivus, 3
Auvi-q, 9
benazepril HCL/hydrochlorothiazide, 8
Aquasol A Parenteral, 31
Avalide, 8
Benicar, 8
Aquoral, 20
Avandamet, 15
Benicar HCT, 8
Aralast NP, 30
Avandaryl, 15
Bentyl, 17
Aralen, 3
Avandia, 15
Benzaclin, 10
Aranesp Albumin Free, 19
Avapro, 8
Benzaclin With P.M., 10
Arava, 28
Avar, 10
Benzamycin, 10
Arcalyst, 28
Avar LS, 10
Benzamycinpak, 10
Arcapta Neohaler, 30
Avar LS Cleanser, 10
Benzoin Compound Tincture, 12
argatroban, 20
Avar-e LS, 10
Benzoin Tincture, 12
Argatroban, 20
Avastin, 5
benzonatate, 29
Aricept, 24
Avc, 19
benztropine mesylate, 23
Aricept Odt, 24
Aveed, 13
Bepreve, 26
Arimidex, 5
Avelox, 2
Besivance, 25
Aristospan Intra-articular, 13
Avelox Abc Pack, 2
Betadine Ophthalmic Prep, 25
Aristospan Intralesional, 13
Avidoxy DK, 2
Betagan, 25
Arixtra, 20
Avinza, 27
betamethasone dipropionate, 11
Armour Thyroid, 17
Avodart, 19
betamethasone sodium phosphate/betamethasone acetate, 13
Arnica Flower, 12
Avonex, 24
Aromasin, 5
Avonex Pen, 24
betamethasone valerate, 11
Arranon, 5
Axert, 28
Betapace, 7
Arthrotec 50, 28
Axid, 17
Betapace AF, 7
Arthrotec 75, 28
Axiron, 13
Betaseron, 24
Artiss, 20
Aygestin, 14
betaxolol HCL, 7, 25
Arzerra, 5
azacitidine, 4
bethanechol chloride, 18
Asacol, 18
Azactam, 4
Bethkis, 2
Asacol HD, 18
Azactam IN Iso-osmotic Dextrose, 4
Betimol, 25
ascorbic acid, 31
Azasan, 5
Betoptic-s, 25
Asmanex 120 Metered Doses, 30
Azasite, 25
Bexxar, 5
Bexxar 131 Iodine, 6
Butisol Sodium, 22
carisoprodol/aspirin, 24
Beyaz, 14
butorphanol tartrate, 27
carisoprodol/aspirin/codeine, 24
Biaxin, 1
Butrans, 27
Carmol-HC, 11
Biaxin XL, 1
Bydureon, 14
Carnitor, 16
Biaxin XL PAC, 1
Byetta, 14
Carnitor SF, 16
bicalutamide, 5
Bystolic, 7
carteolol HCL, 25
Bicillin C-R, 1
C
carvedilol, 7
Bicillin L-a, 1
Cascara Sagrada, 17
cabergoline, 16
Bicnu, 4
Casodex, 5
Caduet, 10
Bidil, 9
Cataflam, 28
Cafcit, 22
Biferarx, 19
Catapres, 8
Cafergot, 28
Biltricide, 3
Catapres-tts-1, 8
caffeine citrate, 22
Binosto, 15
Catapres-tts-2, 8
Caffeine/Sodium Benzoate, 22
Biothrax, 31
Catapres-tts-3, 8
Calan, 7
bisoprolol fumarate, 7
Cathflo Activase, 20
Calan SR, 7
bisoprolol fumarate/hydrochlorothiazide, 8
Cavan-alpha Kit, 31
calcipotriene, 11
Cayston, 4
calcipotriene/betamethasone dipropionate, 12
bleomycin sulfate, 4
Cedax, 1
Bleph-10, 25
Ceenu, 4
calcitonin salmon, 15
Blephamide, 25
cefaclor, 1
calcitonin-salmon, 15
Blephamide S.o.p., 25
Cefaclor, 1
Calcitriol, 11
Bloxiverz, 24
Cefaclor ER, 1
calcitriol, 16
Boniva, 15
cefadroxil, 1
calcium acetate, 18
Boostrix, 30
cefazolin sodium, 1
Calcium Folinate, 6
Boric Acid, 12
Cefazolin Sodium, 1
Caldolor, 28
Bosulif, 5
Cefazolin Sodium/Dextrose, 1
Cambia, 28
Botox, 24
cefdinir, 1
Campral, 24
Bravelle, 16
Cefditoren Pivoxil, 1
Camptosar, 6
Breo Ellipta, 30
cefepime, 1
Canasa, 18
Brevibloc, 7
Cefepime, 1
Cancidas, 2
Brevicon-28, 14
cefotaxime sodium, 1
candesartan cilexetil, 8
Brilinta, 20
Cefotetan, 1
candesartan cilexetil/hydrochlorothiazide, 8
brimonidine tartrate, 26
Cefotetan/Dextrose, 1
Brintellix, 21
cefoxitin sodium, 1
Cantil, 17
Brisdelle, 24
Cefoxitin Sodium, 1
Capastat Sulfate, 2
Bromday, 26
cefpodoxime proxetil, 1
capecitabine, 4
bromfenac, 26
cefprozil, 1
Capex, 11
Bromfenac, 26
ceftazidime, 1
Caphosol, 20
bromocriptine mesylate, 23
Ceftazidime, 1
Capital/Codeine, 27
bromphen/pseudoephedrine HCL/dextromethorphan HBR, 29
Ceftazidime/Dextrose, 1
Caprelsa, 6
Ceftibuten, 1
captopril, 7
Brompheniramine Tannate, 29
Ceftin, 1
Captopril/Hydrochlorothiazide, 8
Brondil, 30
Ceftriaxone IN Iso-osmotic Dextrose, 1
Carafate, 17
Brovana, 30
ceftriaxone sodium, 1
Carbaglu, 16
budesonide, 13, 29, 30
Ceftriaxone/Dextrose, 1
carbamazepine, 23
bumetanide, 9
cefuroxime axetil, 1
carbamazepine ER, 23
Bupap, 26
cefuroxime sodium, 1
Carbaphen 12, 29
Buphenyl, 16
Cefuroxime Sodium, 1
Carbaphen 12 PED, 29
bupivacaine HCL, 28
Cefuroxime/Dextrose, 1
Carbatrol, 23
bupivacaine/epinephrine, 28
Celebrex, 28
carbidopa, 23
Buprenex, 27
Celestone, 13
carbidopa/levodopa, 23
buprenorphine HCL, 27
Celestone-soluspan, 13
carbidopa/levodopa ER, 23
buprenorphine HCL/naloxone HCL, 27
Celexa, 21
carbidopa/levodopa odt, 23
bupropion HCL, 21
Cellcept, 5
Carbidopa/Levodopa/Entacapone, 23
bupropion HCL ER, 21
Cellcept Intravenous, 5
carbinoxamine maleate, 29
bupropion HCL SR, 21
Celontin, 23
Carbocaine, 28
bupropion HCL XL, 21
Cem-urea, 12
carboplatin, 4
buspirone HCL, 21
Cenestin, 14
Carboplatin, 4
Busulfex, 4
Cenfol, 19
Cardene I.v., 7
butal/asa/caff, 26
Centany, 10
Cardene IV, 7
butalbital/acetaminophen, 26
Centany AT, 10
Cardene SR, 7
butalbital/acetaminophen/caffeine, 26
Centratex, 19
Cardizem, 7
butalbital/acetaminophen/caffeine/codeine, 27
cephalexin, 1
Cardizem CD, 7
Cephalexin, 1
Cardizem LA, 7
butalbital/apap/caffeine, 26
Cerebyx, 23
Cardura, 8
butalbital/asa/caffeine, 26
Cerezyme, 19
Cardura XL, 19
Butalbital/Aspirin/Caffeine, 26
Cervarix, 31
carisoprodol, 24
butalbital/aspirin/caffeine/codeine, 27
Cervidil, 26
Carisoprodol, 24
Cesamet, 18
Clarinex Reditabs, 29
Combivent, 30
cetirizine HCL, 29
Clarinex-d 12 HOUR, 30
Combivent Respimat, 30
Cetraxal, 26
Clarinex-d 24 HOUR, 30
Combivir, 3
Cetrotide, 16
clarithromycin, 1
Cometriq, 6
cevimeline HCL, 20
clarithromycin ER, 1
Compazine, 22
Chemet, 33
clemastine fumarate, 29
Complera, 3
Chenodal, 18
Clemastine Fumarate, 29
Comtan, 23
Chloramphenicol Sodium Succinate, 4
Cleocin, 4, 19
Comvax, 31
chlordiazepoxide HCL, 21
Cleocin IN D5W, 4
Concept DHA, 32
Chlordiazepoxide/Amitriptyline, 24
Cleocin Pediatric Granules, 4
Concept OB, 32
chlorhexidine gluconate, 20
Cleocin Phosphate, 4
Concerta, 22
chlorhexidine gluconate oral rinse, 20
Cleocin-t, 10
Condylox, 12
chloroprocaine HCL, 28
Cleviprex, 7
Conzip, 27
chloroquine phosphate, 3
Climara, 14
Copaxone, 24
chlorothiazide, 9
Climara Pro, 14
Copegus, 3
Chlorothiazide, 9
Clindacin Etz, 10
Cordarone, 7
chlorothiazide sodium, 9
Clindacin PAC, 10
Cordran, 12
chlorpromazine HCL, 22
Clindagel, 10
Cordran Tape, 11
Chlorpromazine HCL, 22
clindamycin HCL, 3
Coreg, 7
Chlorpropamide, 15
clindamycin palmitate HCL, 3
Coreg CR, 7
Chlorthalidone, 8
clindamycin phosphate, 3, 10, 19
Corgard, 7
chlorzoxazone, 24
Clindamycin Phosphate, 4
Corlopam, 8
cholestyramine, 9
clindamycin phosphate add-vantage, 3
Cortef, 13
cholestyramine light, 9
clindamycin phosphate IN D5W, 3
Cortenema, 18
choline magnesium trisalicylate, 26
clindamycin phosphate pharmacy bulk package, 3
Cortifoam, 18
chorionic gonadotropin, 16
Cortisone Acetate, 13
Cialis, 9
clindamycin/benzoyl peroxide, 10
Cortisporin, 10, 26
Ciclodan Cream Kit, 11
Clindesse, 19
Cortisporin-tc, 26
Ciclodan Solution Kit, 10
clobetasol propionate, 11
Corvert, 7
ciclopirox, 10
clobetasol propionate emollient, 11
Corvite, 32
ciclopirox nail lacquer, 10
Clobex, 11
Corvite 150, 19
ciclopirox olamine, 10
Clodan Kit, 12
Corzide, 8
Ciclopirox Topical Solution Kit, 10
Clolar, 5
Cosmegen, 4
cidofovir, 3
clomiphene citrate, 16
Cosopt, 25
cilostazol, 20
clomipramine HCL, 21
Cosopt PF, 25
Ciloxan, 25
clonazepam, 23
Cotab A, 29
cimetidine, 17
clonazepam odt, 23
Cotab AX, 29
cimetidine HCL, 17
clonidine HCL, 8
Cotabflu, 29
Cimzia, 18
clonidine HCL ER, 22
Coumadin, 20
Cimzia Starter Kit, 18
clopidogrel, 20
Cozaar, 8
Cipro, 2
clorazepate dipotassium, 21
Cpb Wc, 29
Cipro HC, 26
Clorpres, 8
Creon, 18
Cipro I.V.-IN D5W, 2
clotrimazole, 10, 20
Crestor, 9
Cipro XR, 2
clotrimazole/betamethasone dipropionate, 10
Cresylate, 26
Ciprodex, 26
Crinone, 19
ciprofloxacin, 2
clozapine, 22
Crixivan, 3
Ciprofloxacin, 26
Clozapine Odt, 22
Crnatal, 31
ciprofloxacin ER, 2
Clozaril, 22
cromolyn sodium, 18, 26, 30
ciprofloxacin HCL, 2, 24
Cnl8 Nail Kit, 10
Cubicin, 4
ciprofloxacin I.V.-IN D5W, 2
CO-natal Fa, 31
Curosurf, 30
cisatracurium besylate, 24
Coal TAR, 12
Cutivate, 12
cisplatin, 4
Coartem, 3
Cuvposa, 17
Cisplatin, 4
Cocaine HCL, 12
cyanocobalamin, 19
citalopram hydrobromide, 21
Cod Liver Oil, 31
Cyclessa, 14
Citranatal 90 DHA, 32
Codeine Sulfate, 27
Cyclobenzaprine Comfort PAC, 24
Citranatal Assure, 32
Cogentin, 23
cyclobenzaprine HCL, 24
Citranatal B-calm, 32
Colazal, 18
Cyclogyl, 25
Citranatal DHA, 32
Colcrys, 28
Cyclomydril, 25
Citranatal Harmony, 32
Colestid, 9
cyclopentolate HCL, 25
Citranatal RX, 32
Colestid Flavored, 9
Cyclophosphamide, 4
citric acid/sodium citrate, 19
colestipol HCL, 9
Cycloserine, 2
Citrolith, 19
colestipol HCL for oral suspension, 9
cyclosporine, 5
cladribine, 4
colistimethate sodium, 3
cyclosporine modified, 5
Claforan, 1
Coly-mycin M, 4
Cyclosporine Modified, 5
Claforan/D5W, 1
Coly-mycin S, 26
Cyklokapron, 20
Claravis, 10
Colyte-flavor Packs, 17
Cymbalta, 21
Clarifoam EF, 10
Combigan, 25
cyproheptadine HCL, 29
Clarinex, 29
Combipatch, 14
Cyramza, 5
Cystadane, 16
Desowen Cream/Cetaphil Lotion, 12
Dilatrate SR, 6
Cystagon, 19
Desowen Lotion/Cetaphil Cream, 12
Dilaudid, 27
Cystaran, 26
Desowen Ointment/Cetaphil Lotion, 12
Dilaudid-HP, 27
cytarabine, 4
desoximetasone, 11
diltiazem CD, 7
Cytarabine, 4
Desoximetasone, 11
diltiazem HCL, 7
cytarabine aqueous, 4
Desoxyn, 22
Diltiazem HCL, 7
Cytomel, 17
Desvenlafaxine ER, 21
diltiazem HCL ER, 7
Cytotec, 17
Detrol, 18
Dimenhydrinate, 17
Cytovene, 3
Detrol LA, 18
Diovan, 8
Cytra-3, 19
dexamethasone, 13
Diovan HCT, 8
D
Dexamethasone, 13
Dipentum, 18
Dexamethasone Intensol, 13
diphenhydramine HCL, 29
D.h.e. 45, 28
dexamethasone sodium phosphate, 13, 25
diphenoxylate/atropine, 17
dacarbazine, 6
Diphenoxylate/Atropine, 17
Dacarbazine, 6
Dexamethasone Sodium Phosphate, 13
Diphtheria/Tetanus Toxoids Adsorbed Pediatric, 30
Dacogen, 5
Dexchlorpheniramine Maleate, 29
Daliresp, 30
Dexedrine, 22
Diprolene, 12
Dalvance, 4
dexmedetomidine HCL, 22
Diprolene AF, 12
danazol, 13
dexmethylphenidate HCL, 22
dipyridamole, 20
Dantrium, 24
dexmethylphenidate HCL ER, 22
disopyramide phosphate, 7
Dantrium IV, 24
Dexpak 10 Day, 13
disulfiram, 24
dantrolene sodium, 24
Dexpak 13 Day, 13
Ditropan XL, 18
Dantrolene Sodium, 24
Dexpak 6 Day, 13
Diuril, 9
Dapsone, 4
Dexpanthenol, 18
divalproex sodium, 23
Daptacel, 30
dexrazoxane, 6
divalproex sodium DR, 23
Daraprim, 3
dextroamphetamine sulfate, 22
divalproex sodium ER, 23
daunorubicin HCL, 4
dextroamphetamine sulfate ER, 22
Divigel, 14
Daunoxome, 4
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine HCL, 29
Divista, 19
Daypro, 28
dobutamine HCL, 9
Daytrana, 22
dobutamine HCL/D5W, 9
Ddavp, 16
dobutamine/dextrose 5%, 9
Diabeta, 15
Debacterol, 20
Dobutamine/Dextrose 5%, 9
Dialyvite 3000, 32
Decara, 31
Docefrez, 5
Dialyvite 5000, 32
decitabine, 4
Docetaxel, 5
Dialyvite Supreme D, 32
Decon-a, 29
Dolgic Plus, 26
Dialyvite/Zinc, 32
Delestrogen, 14
Dologesic, 26
Diamox, 9
Delzicol, 18
Dolophine, 27
Diastat Acudial, 23
Demadex, 9
Dolophine HCL, 27
Diastat Pediatric, 23
demeclocycline HCL, 2
Donatuss Dc, 29
Diatx ZN, 32
Demerol, 27
donepezil HCL, 24
diazepam, 21
Demser, 8
dopamine HCL, 9
Diazepam, 21, 23
Denavir, 11
Dopamine HCL, 9
Diazepam Intensol, 21
Depacon, 23
dopamine HCL-dextrose 5%, 9
Dibenzyline, 8
Depakene, 23
dopamine HCL/dextrose 5%, 9
Diclegis, 17
Depakote, 23
dopamine/D5W, 9
diclofenac potassium, 27
Depakote ER, 23
Dopram, 22
diclofenac sodium, 11, 26
Depakote Sprinkles, 23
Doral, 22
diclofenac sodium DR, 27
Depo-estradiol, 14
Doribax, 4
diclofenac sodium ER, 27
Depo-medrol, 13
Doryx, 2
diclofenac sodium/misoprostol, 27
Depo-provera, 5
dorzolamide HCL, 26
dicloxacillin sodium, 1
Depo-testosterone, 13
dorzolamide HCL/timolol maleate, 25
dicyclomine HCL, 17
Derma-smoothe/FS Body, 12
Dovonex, 11
Dicyclomine HCL, 17
Derma-smoothe/FS Body Oil, 12
doxapram HCL, 22
didanosine, 3
Derma-smoothe/FS Scalp, 12
doxazosin mesylate, 8
Didronel, 15
Derma-smoothe/FS Scalp Oil, 12
doxepin HCL, 21
Differin, 10
Dermasorb HC, 12
Doxepin HCL, 21
Dificid, 1
Dermasorb Ta, 12
doxercalciferol, 16
diflorasone diacetate, 11
Dermasorb XM, 12
Doxil, 4
Diflorasone Diacetate, 11
Dermatop, 12
doxorubicin HCL, 4
Diflucan, 2
Dermotic, 26
doxorubicin HCL liposome, 4
diflunisal, 26
desipramine HCL, 21
doxycycline, 2
Digex NF, 17
desloratadine, 29
doxycycline hyclate, 2
digoxin, 6
desloratadine odt, 29
doxycycline hyclate DR, 2
Digoxin, 6
desmopressin acetate, 16
doxycycline monohydrate, 2
dihydroergotamine mesylate, 28
Desogen, 14
Doxytex, 29
Dihydroergotamine Mesylate, 28
desogestrel/ethinyl estradiol, 14
Drisdol, 31
Dilacor XR, 7
Desonate, 12
Dritho-creme HP, 11
Dilantin, 23
desonide, 11
dronabinol, 17
Dilantin Infatabs, 23
Desowen, 12
droperidol, 21
Ellence, 4
Escavite D, 32
drospirenone/ethinyl estradiol, 14
Elmiron, 19
escitalopram oxalate, 21
Droxia, 19
Elocon, 12
Esgic, 26
Drysol, 12
Eloxatin, 4
Esgic-plus, 26
Duac, 10
Elspar, 4
esmolol HCL, 7
Duavee, 14
Emadine, 26
estazolam, 22
Duet DHA, 32
Emcyt, 5
Estrace, 14, 19
Duet DHA 400, 32
Emend, 17
estradiol, 13
Duet DHA 400EC, 32
Emla, 12
estradiol valerate, 13
Duet DHA 430, 32
Emsam, 21
estradiol/norethindrone acetate, 13
Duet DHA 430EC, 32
Emtriva, 3
Estrasorb, 14
Duet DHA Balanced, 32
Emulsion SB, 12
Estring, 19
Duet DHA EC, 32
Enablex, 18
Estrogel, 14
Duetact, 15
enalapril maleate, 7
estropipate, 13
Duexis, 28
enalapril maleate/hydrochlorothiazide, 8
Estropipate, 13
Dulera, 30
enalaprilat, 8
Estrostep FE, 14
duloxetine HCL, 21
Enbrel, 28
eszopiclone, 22
Duocaine, 29
Enbrel Sureclick, 28
ethambutol HCL, 2
Duoneb, 30
Endometrin, 19
ethosuximide, 23
Duragesic, 27
Engerix-b, 31
Ethyl Chloride, 12
Durasafe Spinal/Epidural Tray/1% Xylocaine/19GX36"close CATH, 29
Enjuvia, 14
Ethyl Chloride/Fine Pinpoint, 12
Enlon, 24
Ethyl Chloride/Fine Stream, 12
Durasafe Spinal/Epidural Tray/1% Xylocaine/19GX36"open CATH, 29
Enlon-plus, 24
Ethyl Chloride/Medium Jet Stream, 12
enoxaparin sodium, 20
Ethyl Chloride/Medium Stream, 12
Durasafe Spinal/Epidural Tray/1% Xylocaine/20GX36"close CATH, 29
entacapone, 23
Ethyl Chloride/Mist, 12
Entereg, 18
Ethyol, 6
Durasafe Spinal/Epidural Tray/1% Xylocaine/20GX36"open CATH, 29
Entocort EC, 13
Etidronate Disodium, 15
Entyvio, 18
etodolac, 27
Durezol, 25
Epaned, 8
etodolac ER, 27
Dutoprol, 8
ephedrine sulfate, 9
Etopophos, 5
Dyazide, 9
Epiceram, 12
etoposide, 5
Dymista, 29
Epiduo, 10
Etoposide, 5
Dynacin, 2
Epifoam, 12
Eurax, 12
Dyrenium, 9
epinastine HCL, 26
Evamist, 14
Dysport, 24
Epinephrine, 9
Evicel, 20
E
epinephrine HCL, 30
Evista, 16
Epipen 2-PAK, 9
Evithrom, 20
E.e.s. 400, 1
Epipen-JR 2-PAK, 9
Evoclin, 10
E.e.s. Granules, 1
epirubicin HCL, 4
Evoxac, 20
EC-naprosyn, 28
Epirubicin HCL, 4
Exactuss, 29
econazole nitrate, 10
episone CRE, 12
Exalgo, 27
Ecoza, 11
Epivir, 3
Exelderm, 10
Ed Cyte F, 19
Epivir HBV, 3
Exelon, 24
Ed-chlor-tan, 29
eplerenone, 8
exemestane, 5
Edarbi, 8
Epogen, 19
Exforge, 8
Edarbyclor, 8
epoprostenol sodium, 9
Exforge HCT, 8
Edecrin, 9
eprosartan mesylate, 8
Exjade, 33
Edluar, 22
Epzicom, 3
Exparel, 29
Edurant, 3
Equagesic, 26
Extavia, 24
Effexor XR, 21
Equetro, 22
Extina, 11
Effient, 20
Eraxis, 2
F
Egrifta, 16
Erbitux, 5
Elaprase, 16
Fabior, 10
ergocalciferol, 31
Eldepryl, 23
Fabrazyme, 16
Ergoloid Mesylates, 24
Elelyso, 19
Factive, 2
Ergomar, 28
Elenzapatch, 12
Falessa, 14
Ertaczo, 10
Elestat, 26
famciclovir, 3
Erwinaze, 4
Elestrin, 14
famotidine, 17
Ery-TAB, 1
Eletone, 12
Famotidine, 17
Erygel, 10
Eletone Twinpack, 12
Famotidine Premixed, 17
Eryped 200, 1
Elidel, 12
Famvir, 3
Eryped 400, 1
Eligard, 5
Fanapt, 22
Erythrocin Lactobionate, 1
Elimite, 12
Fanapt Titration Pack, 22
Erythrocin Stearate, 1
Eliphos, 18
Fareston, 5
erythromycin, 1, 10, 24
Eliquis, 20
Farxiga, 15
Erythromycin Base, 1
Elite-OB, 31
Faslodex, 5
Erythromycin Ethylsuccinate, 1
Elitek, 6
Fazaclo, 22
erythromycin/benzoyl peroxide, 10
Elixophyllin, 30
felbamate, 23
Escavite, 32
Ella, 14
Felbatol, 23
Feldene, 28
Flolan, 9
Fluzone PF 2013-2014, 31
felodipine ER, 7
Flomax, 19
Fluzone Quadrivalent 2013-2014, 31
Fem PH, 19
Flonase, 29
Fluzone Quadrivalent 2014-2015, 31
Femara, 5
Flovent Diskus, 30
Fluzone Split 2012-2013, 31
Femcon FE, 14
Flovent HFA, 30
Fluzone Split 2013-2014, 31
Femhrt Low Dose, 14
floxuridine, 4
Fluzone Split 2014-2015, 31
Femring, 19
Fluarix 2012-2013, 31
FML, 25
fenofibrate, 9
Fluarix 2013-2014, 31
FML Forte, 25
Fenofibrate, 9
Fluarix Quadrivalent 2013-2014, 31
FML Liquifilm, 25
fenofibrate micronized, 9
Fluarix Quadrivalent 2014-2015, 31
Focalin, 22
Fenofibric Acid, 9
Flublok 2013-2014, 31
Focalin XR, 22
fenofibric acid DR, 9
Flucelvax 2012-2013, 31
Folbecal, 31
Fenoglide, 9
Flucelvax 2013-2014, 31
Folcaps Omega 3, 31
fenoldopam mesylate, 8
Flucelvax 2014-2015, 31
Folet DHA, 32
Fenoprofen Calcium, 28
fluconazole, 2
Folet One, 32
fentanyl, 27
fluconazole IN dextrose, 2
Folgard OS, 32
fentanyl citrate oral transmucosal, 27
fluconazole IN NACL, 2
Folgard RX, 19
Fentora, 27
Fluconazole IN NACL, 2
folic acid, 19
Feraheme, 19
flucytosine, 2
Folic Acid, 19
Feriva, 19
Fludara, 5
folic acid/vitamin b-6/vitamin b-12, 19
Ferivafa, 19
fludarabine phosphate, 4
Folivane-f, 19
Ferralet 90, 19
Fludarabine Phosphate, 4
Folivane-OB, 31
Ferrex 150 Forte Plus, 19
fludrocortisone acetate, 13
Folivane-plus, 19
Ferrex 28, 19
Flulaval 2012-2013, 31
Folivane-prx DHA NF, 31
Ferriprox, 33
Flulaval 2013-2014, 31
Follistim AQ, 16
Ferrlecit, 19
Flulaval 2014-2015, 31
Folotyn, 4
Ferro-plex Hematinic, 19
Flulaval Quadrivalent 2013-2014, 31
Foltrate, 19
Ferrotrin, 19
Flulaval Quadrivalent 2014-2015, 31
fondaparinux sodium, 20
Fetzima, 21
Flumadine, 3
Foradil Aerolizer, 30
Fetzima Titration Pack, 22
Flumist Nasal Vaccine 2012-2013, 31
Forfivo XL, 22
Fexmid, 24
Flumist Quadrivalent, 31
Fortamet, 15
Fibricor, 9
flunisolide, 29
Fortavit, 32
Finacea, 10
Flunisolide, 29
Fortaz, 1
finasteride, 19
fluocinolone acetonide, 11, 26
Forteo, 15
Fioricet, 26
fluocinolone acetonide ear drops, 26
Fortesta, 13
Fioricet/Codeine, 27
fluocinonide, 11
Fortical, 15
Fiorinal, 26
fluocinonide emollient base, 11
Fosamax, 15
Fiorinal/Codeine #3, 27
fluocinonide-e, 11
Foscarnet Sodium, 3
Firazyr, 20
fluorometholone, 25
Foscavir, 3
Firmagon, 5
fluorouracil, 4
fosinopril sodium, 7
First-bxn Mouthwash, 21
fluoxetine, 24
fosinopril sodium/hydrochlorothiazide, 8
First-dukes Mouthwash, 21
fluoxetine DR, 21
fosphenytoin sodium, 23
First-hydrocortisone, 12
fluoxetine HCL, 21
Fosrenol, 18
First-marys Mouthwash, 21
Fluoxetine HCL, 21
Fragmin, 20
First-mouthwash Blm, 21
fluphenazine decanoate, 22
Frova, 28
First-progesterone VGS 100 Compounding Kit, 19
fluphenazine HCL, 22
Fulyzaq, 17
Fluphenazine HCL, 22
Furadantin, 18
First-progesterone VGS 200 Compounding Kit, 19
flurazepam HCL, 22
furosemide, 9
flurbiprofen, 27
Furosemide, 9
First-progesterone VGS 25 Compounding Kit, 19
flurbiprofen sodium, 26
Fusilev, 6
flutamide, 5
Fusion Plus, 19
First-progesterone VGS 400 Compounding Kit, 19
fluticasone propionate, 11, 29
Fuzeon, 3
fluvastatin, 9
Fycompa, 23
First-progesterone VGS 50 Compounding Kit, 19
Fluvirin 2012-2013, 31
G
Fluvirin 2013-2014, 31
gabapentin, 23
First-testosterone, 13
Fluvirin 2014-2015, 31
Gabavale-5, 21
First-testosterone Mc Compounding Kit, 13
Fluvirin PF 2012-2013, 31
Gabazolamine, 21
Fluvirin PF 2013-2014, 31
Gabazolamine-0.5, 21
First-vancomycin 25, 4
Fluvirin PF 2014-2015, 31
Gabazolpidem-5, 22
First-vancomycin 50, 4
fluvoxamine maleate, 21
Gabitidine, 17
Flagyl, 4
fluvoxamine maleate ER, 21
Gabitril, 23
Flagyl ER, 4
Fluzone High-dose PF 2012-2013, 31
Gaboxetine, 21
Flarex, 25
Fluzone High-dose PF 2013-2014, 31
galantamine, 24
flavoxate HCL, 18
Fluzone High-dose PF 2014-2015, 31
galantamine hydrobromide, 24
flecainide acetate, 7
Fluzone Pediatric PF 2012-2013, 31
ganciclovir, 3
Flector, 11
Fluzone Pediatric PF 2013-2014, 31
Ganirelix Acetate, 16
Flexeril, 24
Fluzone Pediatric PF 2014-2015, 31
Ganite, 15
FLO-pred, 13
Fluzone PF 2012-2013, 31
Garamycin, 25
Gardasil, 31
Gonal-f RFF Pen, 16
Horizant, 24
Gastrinex NF, 17
Gonal-f RFF Rediject, 16
HPR, 13
Gastrocrom, 18
Gordofilm, 12
HPR Plus, 13
gatifloxacin, 25
Gordons Urea, 12
HPR Plus/Mb Hydrogel, 13
Gattex, 18
Gralise, 24
Humalog, 14
Gazyva, 5
Gralise Starter, 24
Humalog Kwikpen, 14
Gebauers Pain Ease, 12
granisetron HCL, 17
Humalog Mix 50/50, 14
Gebauers Spray And Stretch, 12
Granisol, 17
Humalog Mix 50/50 Kwikpen, 14
Gel-kam Oral Care Rinse, 21
Granix, 19
Humalog Mix 75/25, 14
Gelclair, 21
Grifulvin V, 2
Humalog Mix 75/25 Kwikpen, 14
Gelnique, 18
Gris-peg, 2
Humatrope, 16
Gemcitabine, 4
griseofulvin microsize, 2
Humatrope Combo Pack, 16
gemcitabine HCL, 4
griseofulvin ultramicrosize, 2
Humira, 28
gemfibrozil, 9
guanfacine HCL, 8
Humira Pen, 28
Gemzar, 5
Guanidine HCL, 24
Humira Pen-crohns Diseasestarter, 28
Genadur, 12
Gynazole-1, 19
Humira Pen-psoriasis Starter, 28
gene-xene TAB 15MG, 21
H
Humulin R U-500 (concentrated), 14
gene-xene TAB 3.75MG, 21
Hycamtin, 6
Halaven, 5
gene-xene TAB 7.5MG, 21
Hycet, 27
Halcion, 22
Generess FE, 14
hydralazine HCL, 8
Haldol, 22
Genotropin, 16
Hydrea, 6
Haldol Decanoate 100, 22
Genotropin Miniquick, 16
Hydro 35, 12
Haldol Decanoate 50, 22
gentamicin sulfate, 2, 25
Hydro 40 Foam, 12
Halflytely Bowel Prep/Flavor Packs, 17
Gentamicin Sulfate, 10
hydrochloric acid, 19
halobetasol propionate, 11
gentamicin sulfate pediatric, 2
hydrochlorothiazide, 8
Halog, 12
gentamicin sulfate/0.9% sodium chloride, 2
hydrocodone bitartrate/acetaminophen, 27
Halonate, 12
haloperidol, 22
Gentamicin Sulfate/0.9% Sodium Chloride, 2
Hydrocodone Bitartrate/Acetaminophen, 27
haloperidol decanoate, 22
haloperidol lactate, 22
gentamicin sulfate/sodium chloride, 2
hydrocodone bitartrate/chlorpheniramine maleate/PSE, 29
Halotin, 11
Geodon, 22
Havrix, 31
Gesticare DHA, 32
hydrocodone bitartrate/homatropine methylbromide, 29
Hectorol, 16
Giazo, 18
Helidac, 17
Gilenya, 24
hydrocodone polistirex/chlorpheniramine polistirex, 29
Hemabate, 26
Gilotrif, 6
Hemangeol, 7
Gilphex TR, 29
hydrocodone/acetaminophen, 27
Hematogen Fa, 19
Giltuss, 29
Hydrocodone/Acetaminophen, 27
Hematron-AF, 19
Giltuss PED-c, 29
hydrocodone/homatropine, 29
Hemocyte Plus, 19
Giltuss TR, 29
hydrocodone/ibuprofen, 27
Hemocyte-f, 19
Glassia, 30
hydrocort ene 100MG, 18
heparin lock, 20
Gleevec, 5
hydrocortisone, 11, 13, 18
heparin lock flush, 20
Gliadel Wafer, 4
hydrocortisone acetate/aloe, 11
Heparin Lock Flush, 20
glimepiride, 15
hydrocortisone acetate/lidocaine HCL, 18
heparin lock flush for flushing vascular access devices, 20
glipizide, 15
hydrocortisone acetate/pramoxine, 18
glipizide ER, 15
hydrocortisone butyrate, 11
heparin lock flush/NACL for flushing vascular access devices, 20
glipizide/metformin HCL, 15
hydrocortisone butyrate (lipid), 11
Glucagen, 15
hydrocortisone butyrate (lipophilic), 11
heparin sodium, 20
Glucagen Hypokit, 15
hydrocortisone IN absorbase, 11
Heparin Sodium, 20
Glucagon Emergency Kit, 15
hydrocortisone valerate, 11
heparin sodium dcu, 20
Glucophage, 15
hydrocortisone/acetic acid, 26
heparin sodium lock flush, 20
Glucophage XR, 15
hydromorphone HCL, 27
heparin sodium/D5W, 20
Glucotrol, 15
Hydromorphone HCL, 27
Heparin Sodium/D5W, 20
Glucotrol XL, 15
Hydromorphone HCL Dosette, 27
Heparin Sodium/NACL 0.45%, 20
Glucovance, 15
hydromorphone HCL ER, 27
heparin sodium/NACL 0.9%, 20
Glumetza, 15
Hydromorphone HCL ER, 27
Heparin Sodium/Sodium Chloride 0.9%, 20
glyburide, 15
Hydroxocobalamin, 19
Glyburide, 15
hydroxychloroquine sulfate, 3
heparin sodium/sodium chloride 0.9% premix, 20
glyburide micronized, 15
hydroxyurea, 6
glyburide/metformin HCL, 15
hydroxyzine HCL, 21
Hepsera, 3
Glycate, 17
Hydroxyzine HCL, 21
Herceptin, 5
Glycolic Acid, 11
hydroxyzine pamoate, 21
Hespan, 20
Glycolic Acid 70% High Purity, 11
Hydroxyzine Pamoate, 21
hetastarch 6%/NACL, 20
glycopyrrolate, 17
Hylatopic, 13
Hetlioz, 22
Glynase, 15
Hylatopic Plus, 13
Hexalen, 4
Glyset, 15
Hylira, 12
Hextend, 20
Golytely, 17
hyoscyamine sulfate, 17
Hiberix, 31
Gonal-f, 16
hyoscyamine sulfate ER, 17
Hiprex, 18
Gonal-f RFF, 16
hyoscyamine sulfate odt, 17
homatropine HBR, 25
hyoscyamine sulfate SR, 17
Intuniv, 23
Kapvay Dose Pack, 23
Hyper-sal, 29
Invanz, 4
Karbinal ER, 29
Hypersal, 29
Invega, 22
Kazano, 15
Hypertenevide-12.5, 7
Invega Sustenna, 22
Keflex, 1
Hypertenipine-2.5, 7
Invirase, 3
Kenalog, 12
Hypertensolol, 8
Invokamet, 15
Kenalog-10, 13
Hyzaar, 8
Invokana, 15
Kenalog-40, 13
I
Iopidine, 26
Kepivance, 6
Ipol Inactivated IPV, 31
Keppra, 23
ibandronate sodium, 15
ipratropium bromide, 29, 30
Keppra XR, 23
Ibudone, 27
ipratropium bromide/albuterol sulfate, 30
Kerafoam, 12
ibuprofen, 27
Iprivask, 20
Kerafoam 42, 12
Ibuprofen Comfort PAC, 28
irbesartan, 8
Keralac, 13
ibutilide fumarate, 7
irbesartan/hydrochlorothiazide, 8
Kerlone, 7
IC 400, 28
irinotecan, 6
Ketek, 4
IC 800, 28
Irinotecan, 6
ketoconazole, 2, 10
Icar-c Plus, 19
Iron, 19
Ketodan Kit, 11
Iclusig, 6
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc, 19
ketoprofen, 27
Idamycin PFS, 4
Ketoprofen ER, 28
idarubicin HCL, 4
Irospan 24/6, 19
ketorolac tromethamine, 26, 27
Ifex, 4
Is 24/6, 19
Ketorolac Tromethamine, 28
ifosfamide, 4
Isentress, 3
Khedezla, 21
Ifosfamide, 4
isoniazid, 2
Kineret, 28
Ifosfamide/Mesna, 6
Isoniazid, 2
Kinlytic, 20
Ilaris, 28
Isoptin SR, 7
Kinrix, 30
Ilevro, 26
Isopto Atropine, 25
Klaron, 10
Imdur, 6
Isopto Carbachol, 25
Klonopin, 23
imipenem/cilastatin, 4
Isopto Carpine, 25
Kombiglyze XR, 15
imipramine HCL, 21
Isopto Homatropine, 25
Korlym, 15
imipramine pamoate, 21
Isopto Hyoscine, 25
Kristalose, 17
imiquimod, 12
Isordil Titradose, 6
Krystexxa, 28
Imitrex, 28
isosorbide dinitrate, 6
Kuvan, 16
Imitrex Statdose Refill, 28
Isosorbide Dinitrate, 6
Kynamro, 9
Imitrex Statdose System, 28
isosorbide dinitrate ER, 6
Kyprolis, 6
Imovax Rabies (h.d.c.v.), 31
isosorbide mononitrate, 6
L
Imuran, 5
isosorbide mononitrate ER, 6
Inatal Advance, 31
labetalol HCL, 7
isotonic gentamicin, 2
Inatal GT, 31
Lac-hydrin, 13
Isotonic Gentamicin, 2
Inatal Ultra, 31
Lacrisert, 25
Isradipine, 7
Incivek, 3
lactic acid, 12
Istalol, 25
Increlex, 16
lactic acid e, 12
Istodax, 6
indapamide, 9
lactic acid w/vitamin e, 12
Isuprel, 30
Inderal LA, 7
lactulose, 17, 18
itraconazole, 2
Inderal XL, 7
Lamictal, 23
Ixempra Kit, 5
Indocin, 28
Lamictal Chewable Dispersible, 23
Ixiaro, 31
Indocin IV, 28
Lamictal Odt, 23
J
indomethacin, 27
Lamictal Starter/Not Taking Carbamazepine, 23
Indomethacin, 28
J-cof DHC, 29
indomethacin ER, 27
J-max DHC, 29
Lamictal Starter/Taking Carbamazepine/Not Taking Valproate, 23
indomethacin sodium, 27
Jakafi, 5
Infanrix, 30
Jalyn, 19
Infasurf, 30
Janumet, 15
Lamictal Starter/Taking Valproate, 23
Infergen, 3
Janumet XR, 15
Lamictal XR, 23
Influenza A (h1n1) Monovalent 2009, 31
Januvia, 15
Lamisil, 2
Infumorph 200, 27
Jardiance, 15
Lamisil Spray, 11
Infumorph 500, 27
Jevtana, 5
lamivudine, 3
Injectafer, 19
Jinteli, 13
lamivudine/zidovudine, 3
Innopran XL, 7
Jublia, 11
lamotrigine, 23
Inspra, 8
Juvisync, 15
lamotrigine ER, 23
Insulin Syringe/0.5ML/30G X 5/16", 33
Juxtapid, 9
Lanoxin, 6
Integra F, 19
K
Lanoxin Pediatric, 6
Integra Plus, 19
Lantus, 14
K-phos NO 2, 19
Integrilin, 20
Lantus Solostar, 14
Kadcyla, 5
Intelence, 3
Lasix, 9
Kadian, 27
Interarticular Joint Kit, 13
Lastacaft, 26
Kalbitor, 20
Intermezzo, 22
latanoprost, 25
Kaletra, 3
Introl, 9
Latrix XM, 12
Kalydeco, 30
Intron-a, 6
Latuda, 22
Kapvay, 23
Intron-a W/Diluent, 6
Lazanda, 27
leflunomide, 27
Lithium Carbonate, 22
M
Lescol, 9
lithium carbonate ER, 22
M-m-r II W/Diluent 10 Dose, 31
Lescol XL, 9
Lithium Citrate, 22
M-vit, 32
Letairis, 9
Lithobid, 22
M.v.i. Adult, 31
letrozole, 5
Lithostat, 19
M.v.i. Pediatric, 32
leucovorin calcium, 6
Livalo, 9
M.v.i.-12 Without Vitamin K, 32
Leucovorin Calcium, 6
LMD 10% Dextrose 5%, 20
Macnatal CN DHA, 31
Leukeran, 4
LMD 10% Sodium Chloride 0.9%, 20
Macrobid, 18
Leukine, 19
LO Loestrin FE, 14
Macrodantin, 18
leuprolide acetate, 5
LO Minastrin FE, 14
Magnacet, 27
Levacet, 26
Locoid, 12
Makena, 14
levalbuterol, 30
Locoid Lipocream, 12
Malarone, 3
levalbuterol HCL, 30
Lodosyn, 23
malathion, 12
Levaquin, 2
Loestrin 1.5/30-21, 14
mannitol, 9
Levatol, 7
Loestrin 1/20-21, 14
Maprotiline HCL, 21
Levbid, 17
Loestrin 24 FE, 14
Marcaine, 28
Levemir, 14
Loestrin FE 1.5/30, 14
Marcaine W/O Epi, 28
Levemir Flexpen, 14
Loestrin FE 1/20, 14
Marcaine/Epinephrine, 28
Levemir Flextouch, 14
Lofibra, 9
Marinol, 18
levetiracetam, 23
Lomedia 24 FE, 14
Marnatal-f, 32
Levetiracetam, 23
Lomotil, 17
Marplan, 21
levetiracetam ER, 23
Lomustine, 4
Marqibo, 5
Levitra, 10
loperamide HCL, 17
Matulane, 6
levobunolol HCL, 25
Lopid, 9
Mavik, 8
Levobunolol HCL, 25
Lopressor, 7
Maxair Autohaler, 30
levocarnitine, 16
Lopressor HCT, 8
Maxalt, 28
levocetirizine dihydrochloride, 29
Loprox, 11
Maxalt-MLT, 28
levofloxacin, 2, 25
Loprox Shampoo, 11
Maxaron Forte, 19
levofloxacin IN D5W, 2
lorazepam, 21
Maxfe, 19
levonorgestrel, 14
Lorazepam Intensol, 21
Maxidex, 25
levonorgestrel and ethinyl estradiol, 14
Lorcet 10/650, 27
Maxidone, 27
levonorgestrel/ethinyl estradiol, 14
Lorcet Plus, 27
Maxifed CD, 29
Levophed, 9
Lortab, 27
Maxifed CDX, 29
Levorphanol Tartrate, 27
Lorzone, 24
Maxifed-G CD, 30
levothyroxine sodium, 17
losartan potassium, 8
Maxifed-G CDX, 30
Levothyroxine Sodium, 17
losartan potassium/hydrochlorothiazide, 8
Maxiflu CD, 30
Levsin, 17
Maxiflu CDX, 30
Levsin/SL, 17
Loseasonique, 14
Maxinate, 32
Lexapro, 21
Lotemax, 25
Maxiphen CD, 30
Lexiva, 3
Lotensin, 8
Maxiphen CDX, 30
Lialda, 18
Lotensin HCT, 8
Maxipime, 1
lidocaine, 12
Lotrel, 8
Maxitrol, 25
lidocaine HCL, 7, 12, 20, 28
Lotrisone, 11
Maxzide, 9
Lidocaine HCL, 7, 12
Lotronex, 18
Maxzide-25, 9
lidocaine HCL IN D5W, 7
lovastatin, 9
Mb Hydrogel, 12
lidocaine HCL jelly, 12
Lovaza, 9
meclizine HCL, 17
Lidocaine HCL-hydrocortisone Acetate With Aloe, 18
Lovenox, 20
Meclofenamate Sodium, 28
loxapine, 22
Medical Provider EZ Flu Shot 2014-2015, 31
lidocaine HCL/dextrose, 7
loxapine succinate, 22
Lidocaine HCL/Dextrose, 29
Loxitane, 22
Medrol, 13
lidocaine HCL/hydrocortisone acetate, 18
Lta 360 Kit, 21
Medrol Dosepak, 13
lidocaine viscous, 20
Lufyllin, 30
medroxyprogesterone acetate, 14
lidocaine/epinephrine, 28
Lumigan, 25
mefenamic acid, 27
lidocaine/prilocaine, 12
Lumizyme, 16
mefloquine HCL, 3
Lidocaine/Prilocaine, 12
Lunesta, 22
Mefoxin, 1
Lidoderm, 13
Lupaneta Pack, 16
Megace ES, 14
Lidoprofen, 11
Lupron Depot, 5
Megace Oral, 5
Lidovir, 11
Lupron Depot-PED, 16
megestrol acetate, 5
Lincocin, 4
Luvox CR, 21
Mekinist, 5
lindane, 12
Luxiq, 12
meloxicam, 27
Linzess, 18
Luzu, 11
Meloxicam, 28
liothyronine sodium, 17
Lycelle, 13
Meloxicam Comfort PAC, 28
Lipitor, 9
Lyrica, 23
melphalan hydrochloride, 4
Lipofen, 9
Lysodren, 5
Menactra, 31
Liquicet, 27
Lysteda, 20
Menest, 14
lisinopril, 7
Lytensopril Kit, 8
Menhibrix, 31
lisinopril/hydrochlorothiazide, 8
Lytensopril-90, 8
Menomune-a/C/Y/W-135, 31
lithium carbonate, 22
Lytensopril-90 Kit, 8
Menopur, 16
Menostar, 14
metronidazole vaginal, 19
Mst 600, 26
Mentax, 10
Mevacor, 9
Multaq, 7
Menveo, 31
mexiletine HCL, 7
Multigen, 19
meperidine HCL, 27
Miacalcin, 15
Multigen Folic, 19
Meperidine HCL, 27
Micardis, 8
Multigen Plus, 19
Mephyton, 31
Micardis HCT, 8
mupirocin, 10
Mepivacaine HCL, 28
Microzide, 9
mupirocin calcium, 10
meprobamate, 21
midodrine HCL, 9
Muse, 10
Mepron, 4
Mifeprex, 16
Mustargen, 4
mercaptopurine, 4
Migergot, 28
MV FE Asparto Gly/FE Fum/Succ Acid/Vit C/Threonic Acd/B12/Fa, 19
meropenem, 4
Migral, 28
Merrem, 4
Migranal, 28
MV FE Asparto Gly/Vit C/Vit B12/CA Threonate/Succ Acd/Stomac, 19
mesalamine, 18
Millipred, 13
mesna, 6
Millipred DP, 13
Myalept, 16
Mesnex, 6
milrinone IN dextrose, 6
Myambutol, 2
Mestinon, 24
milrinone lactate, 6
Mycamine, 2
Mestinon Timespan, 24
Minastrin 24 FE, 14
Mycobutin, 2
Metadate CD, 23
Mineral Oil Heavy, 17
mycophenolate mofetil, 5
Metaproterenol Sulfate, 30
Minipress, 8
mycophenolic acid DR, 5
Metastron, 6
Minivelle, 14
Mydfrin, 25
metaxalone, 24
Minocin, 2
Myfortic, 5
metformin HCL, 15
Minocin Kit, 2
Mykidz Iron Fl, 32
metformin HCL ER, 15
minocycline HCL, 2
Myleran, 4
methadone HCL, 27
minocycline HCL ER, 2
Mynatal, 31
Methadone HCL, 27
minoxidil, 8
Mynatal Advance, 31
Methadose, 27
Mirapex, 23
Mynatal Ultracaplet, 31
Methadose Sugar-free, 27
Mirapex ER, 23
Myobloc, 24
methamphetamine HCL, 22
Mircette, 14
Myoxin, 26
methazolamide, 9
mirtazapine, 21
Myozyme, 16
methenamine hippurate, 18
mirtazapine odt, 21
Myrbetriq, 18
methenamine mandelate, 18
misoprostol, 17
Mysoline, 23
Methenamine Mandelate, 18
mitomycin, 4
N
methimazole, 17
Mitosol, 25
nabumetone, 27
methocarbamol, 24
mitoxantrone HCL, 4
nadolol, 7
methotrexate, 4
Mobic, 28
nadolol/bendroflumethiazide, 8
methotrexate sodium, 4
modafinil, 22
nafcillin sodium, 1
methoxsalen, 11
Moderiba, 3
Nafcillin Sodium, 1
methscopolamine bromide, 17
Moderiba 1200 Dose Pack, 3
Nafrinse Daily/Acidulated, 20
Methyclothiazide, 9
Moderiba 800 Dose Pack, 3
Nafrinse Daily/Neutral, 20
methyldopa, 8
Modicon, 14
Nafrinse Weekly, 20
Methyldopa/Hydrochlorothiazide, 8
moexipril HCL, 7
Naftin, 11
Methyldopate HCL, 8
moexipril/hydrochlorothiazide, 8
Naglazyme, 16
methylergonovine maleate, 26
mometasone furoate, 11
nalbuphine HCL, 27
Methylin, 23
Moms Choice RX, 32
Nalfon, 28
methylphenidate HCL, 22
Monodox, 2
Nallpen Iso-osmotic IN Dextrose, 1
methylphenidate HCL CD, 22
Monoject Bone Marrow Biopsy Prepping Tray, 29
Nallpen/Dextrose, 1
methylphenidate HCL ER, 22
Namenda, 24
Methylphenidate HCL ER, 22
Monoject Bone Marrow Biopsy Tray/Biop Aspir Needle 11GX4", 29
Namenda Titration PAK, 24
methylphenidate HCL SR, 22
Namenda XR, 24
methylphenidate hydrochloride, 22
Monoject Bone Marrow Biopsy Tray/Biop Aspir Needle 8GX4", 29
Namenda XR Titration Pack, 24
methylprednisolone, 13
Naphazoline HCL, 25
methylprednisolone acetate, 13
Monoject Bone Marrow Biopsy Tray/Sternal-iliac Needle 16G, 29
Naprelan, 28
methylprednisolone dose pack, 13
Naprosyn, 28
methylprednisolone sodiumsuccinate, 13
montelukast sodium, 30
naproxen, 27
Metipranolol, 25
Monurol, 18
Naproxen Comfort PAC, 28
metoclopramide HCL, 18
Morgidox 1X100MG, 2
naproxen sodium, 28
metolazone, 9
Morgidox 2X100MG, 2
naratriptan HCL, 28
metoprolol succinate ER, 7
morphine sulfate, 27
Nardil, 21
metoprolol tartrate, 7
Morphine Sulfate, 27
Naropin, 29
metoprolol/hydrochlorothiazide, 8
Morphine Sulfate Add-vantage, 27
Nasacort AQ, 29
Metozolv Odt, 18
morphine sulfate ER, 27
Nascobal, 20
Metro IV, 4
Motofen, 17
Nasonex, 29
Metrocream, 10
Moviprep, 17
Natachew, 32
Metrogel, 10
Moxatag, 1
Natacyn, 25
Metrogel-vaginal, 19
Moxeza, 25
Natafort, 32
Metrolotion, 10
moxifloxacin HCL, 2
Natalvirt 90 DHA, 32
metronidazole, 4, 10
Mozobil, 19
Natalvirt CA, 32
metronidazole IN NACL 0.79%, 4
MS Contin, 27
Natalvirt Flt, 20
Natalvit, 31
ox/copper, 31
Norvasc, 7
Natazia, 14
Niacor, 9
Norvir, 3
nateglinide, 15
Niaspan, 9
Novaferrum, 20
Natelle One, 32
Nicadan, 32
Novolog, 14
Natrecor, 10
nicardipine HCL, 7
Novolog Flexpen, 14
Natroba, 13
Nicazel, 32
Novolog Mix 70/30, 14
Nature-throid, 17
Nicazel Forte, 32
Novolog Mix 70/30 Prefilled Flexpen, 14
Nature-throid Nt-2.5, 17
Nicazeldoxy 30 Kit, 2
Novolog Penfill, 14
Navelbine, 5
Nicazeldoxy 60 Kit, 2
Noxafil, 2
Nebupent, 4
Nicomide, 32
Nplate, 19
Nebusal, 30
nifedipine, 7
Nucort, 12
Necon 1/50-28, 14
nifedipine ER, 7
Nucynta, 27
Necon 10/11-28, 14
Nilandron, 5
Nucynta ER, 27
Neevo DHA, 32
Nimbex, 24
Nuedexta, 24
nefazodone HCL, 21
nimodipine, 7
Nulojix, 5
Nefazodone HCL, 21
Nipent, 6
Nulytely/Flavor Packs, 17
Nembutal Sodium, 22
Niravam, 21
Numoisyn, 21
Neo-synalar, 10
nisoldipine, 7
Nuox, 10
Neo-synalar Kit, 10
Nisoldipine, 7
Nutricap, 32
Neo-synephrine, 9
Nisoldipine ER, 7
Nutridox, 2
neomycin sulfate, 2
Nitro-bid, 6
Nutrivit, 32
neomycin/bacitracin/polymyxin, 25
Nitro-dur, 6
Nutropin, 16
neomycin/polymyxin/bacitracin zinc, 25
nitrofurantoin, 18
Nutropin AQ Nuspin 10, 16
neomycin/polymyxin/bacitracin/hydrocortisone, 25
nitrofurantoin macrocrystals, 18
Nutropin AQ Nuspin 20, 16
nitrofurantoin monohydrate, 18
Nutropin AQ Nuspin 5, 16
neomycin/polymyxin/dexamethasone, 25
nitrofurantoin monohydrate/macrocrystals, 18
Nutropin AQ Pen, 16
neomycin/polymyxin/gramicidin, 25
Nuvail, 13
neomycin/polymyxin/HC, 26
nitroglycerin, 6
Nuvigil, 23
Neomycin/Polymyxin/Hydrocortisone, 25
Nitroglycerin, 6
Nuzon, 12
neomycin/polymyxin/hydrocortisone, 26
nitroglycerin IN 5% dextrose, 6
Nymalize, 7
Neoprofen, 28
nitroglycerin IN dextrose 5%, 6
nystatin, 2, 10, 20
Neoral, 5
Nitroglycerin IN Dextrose 5%, 6
nystatin/triamcinolone, 10
Neosalus, 13
nitroglycerin lingual, 6
O
Neosalus CP, 13
Nitroglycerin Lingual, 6
O-CAL Fa, 32
Neosporin, 25
nitroglycerin transdermal, 6
O-CAL Prenatal, 32
neostigmine methylsulfate, 24
Nitrolingual Pumpspray, 6
OB Complete, 32
Neotuss Plus, 30
Nitromist, 6
OB Complete 400, 32
Nephplex RX, 32
Nitronal, 6
OB Complete One, 32
Nephro-vite RX, 32
Nitropress, 8
OB Complete Petite, 32
Nephrocaps, 32
Nitrostat, 6
OB Complete Premier, 32
Nephrocaps QT, 32
Nivatopic Plus, 13
OB Complete/DHA, 32
Nephron Fa, 20
nizatidine, 17
OB-natal One, 31
Neptazane, 9
Nizoral, 11
Obstetrix DHA, 32
Nesacaine, 29
Nor-QD, 14
Obstetrix EC, 32
Nesacaine-mpf, 29
Norco, 27
octreotide acetate, 16
Nesina, 15
Nordette-28, 14
Ocudox, 2
Nestabs, 32
Norditropin Cartridge, 16
Ocufen, 26
Nestabs Abc, 32
Norditropin Flexpro, 16
Ocuflox, 25
Nestabs DHA, 32
Norditropin Nordiflex Pen, 16
Ofirmev, 26
Neuac Kit, 10
norepinephrine bitartrate, 9
ofloxacin, 2, 25, 26
Neulasta, 19
norethindrone, 14
Ofloxacin, 2
Neumega, 19
norethindrone acetate, 14
Ogestrel, 14
Neupogen, 19
norethindrone acetate/ethinyl estradiol, 14
olanzapine, 22
Neupro, 23
olanzapine odt, 22
Neurontin, 23
norethindrone acetate/ethinyl estradiol/ferrous fumarate, 14
olanzapine/fluoxetine, 24
Neutrasal, 21
Oleptro, 21
Neutrexin, 4
Norflex, 24
Olux, 12
Nevanac, 26
norgestimate/ethinyl estradiol, 14
Olux-e, 12
nevirapine, 3
Norinyl 1+35, 14
Olysio, 3
Nevirapine, 3
Norinyl 1+50, 14
omega-3-acid ethyl esters, 9
nevirapine ER, 3
Noritate, 10
Omnaris, 29
Newgen, 32
Noroxin, 2
Omnipred, 25
Nexa Plus, 32
Norpace, 7
Omnitrope, 16
Nexa Select, 32
Norpace CR, 7
Omontys, 20
Nexavar, 5
Norpramin, 21
Oncaspar, 4
Nexterone, 7
Northera, 9
ondansetron HCL, 17
niacin ER, 9
nortriptyline HCL, 21
ondansetron odt, 17
niacinamide/azelaic ac/ turmer/fa/b6/zinc
Nortriptyline HCL, 21
Onfi, 23
Onglyza, 15
Paire OB, 32
perindopril erbumine, 7
Onmel, 2
Palgic, 29
Perjeta, 5
Opana, 27
Pamelor, 21
permethrin, 12
Opana ER (crush Resistant), 27
pamidronate disodium, 15
perphenazine, 22
opium, 17
Pamidronate Disodium, 15
Perphenazine/Amitriptyline, 24
opium tincture, 17
Pamine, 17
Persantine, 20
Opium Tincture (paregoric), 17
Pamine Forte, 17
Pertzye, 18
Opsumit, 10
Pamine FQ, 17
Pexeva, 21
Optivar, 26
Panatuss Dxp, 30
Pfizerpen-G, 1
Oracea, 10
Pancreaze, 18
phenazopyridine HCL, 19
Oracit, 19
Pancrelipase, 18
phenelzine sulfate, 21
Orap, 24
pancuronium bromide, 24
Phenergan, 29
Orapred, 13
Pandel, 12
Phenflu CD, 30
Orapred Odt, 13
papaverine HCL, 9
Phenflu CDX, 30
Oravig, 21
Parafon Forte DSC, 24
phenobarbital, 22
Oraxyl, 2
Parcopa, 23
Phenobarbital, 22
Orbivan, 26
paricalcitol, 16
Phenobarbital Sodium, 22
Orbivan CF, 26
Parlodel, 23
Phentolamine Mesylate, 8
Orencia, 28
Parnate, 21
phenylephrine HCL, 9, 25
Orenitram, 10
paromomycin sulfate, 2
Phenylephrine HCL, 9
Orfadin, 16
paroxetine HCL, 21
phenylephrine/guaifenesin, 29
orphenadrine citrate, 24
paroxetine HCL ER, 21
Phenytek, 23
orphenadrine citrate ER, 24
Paser, 2
phenytoin, 23
orphenadrine/asa/caffeine, 24
Pataday, 26
phenytoin sodium, 23
Ortho Micronor, 14
Patanase, 29
phenytoin sodium extended, 23
Ortho Tri-cyclen, 14
Patanol, 26
Phoslo, 18
Ortho Tri-cyclen LO, 14
Paxil, 21
Phoslyra, 18
Ortho-cept, 14
Paxil CR, 21
Phospholine Iodide, 25
Ortho-cyclen, 14
PCE, 1
Photofrin, 6
Ortho-novum 1/35, 14
Pediaderm AF Complete Kit, 11
Phrenilin Forte, 26
Ortho-novum 7/7/7, 14
Pediaderm HC, 12
phytonadione, 31
Oseni, 15
Pediaderm Ta, 12
pilocarpine HCL, 20, 25
Osmoprep, 17
Pediapred, 13
pilocarpine hydrochloride, 20
Osphena, 16
Pediarix, 30
Pilopine HS, 25
Otezla, 28
Pediatex TD, 29
pindolol, 7
Otozin, 26
Pediatex TDM, 30
pioglitazone HCL, 15
Ovace Plus, 11
Pedipirox-4 Nail, 11
pioglitazone HCL-glimepiride, 15
Ovace Plus Wash, 11
Pedvax HIB, 31
pioglitazone HCL/metformin HCL, 15
Ovace Wash, 11
peg 3350/electrolytes, 17
piperacillin sodium/ tazobactam sodium, 1
Ovcon-35, 14
peg-3350/electrolytes, 17
Ovide, 13
peg-3350/NACL/NA bicarbonate/KCL, 17
piperacillin sodium/tazobactam sodium, 1
Ovidrel, 16
Peg-intron, 3
piperacillin/tazobactam, 1
oxacillin sodium, 1
Peg-intron Redipen, 3
piroxicam, 28
oxaliplatin, 4
Peg-intron Redipen PAK 4, 3
Pitocin, 26
Oxandrin, 13
Peganone, 23
Pitressin Synthetic, 16
oxandrolone, 13
Pegasys, 3
Plan B, 14
oxaprozin, 28
Pegasys Proclick, 3
Plan B One-step, 14
oxazepam, 21
penicillin G potassium, 1
Plaquenil, 3
oxcarbazepine, 23
Penicillin G Potassium IN Iso-osmotic Dextrose, 1
Plavix, 20
Oxistat, 11
Pletal, 20
Oxsoralen, 12
Penicillin G Procaine, 1
Plexion, 10
Oxsoralen Ultra, 11
Penicillin G Sodium, 1
Plexion Cleanser, 10
Oxtellar XR, 23
penicillin v potassium, 1
Plexion Cleansing Cloths, 10
oxybutynin chloride, 18
Penlac Nail Lacquer, 11
Pliaglis, 13
oxybutynin chloride ER, 18
Pennsaid, 11
Pneumovax 23, 31
oxycodone HCL, 27
Pentacel, 30
Pneumovax 23/1 Dose, 31
Oxycodone HCL, 27
Pentam 300, 4
Pneumovax 23/5 Dose, 31
oxycodone/acetaminophen, 27
Pentasa, 18
podofilox, 12
oxycodone/aspirin, 27
pentazocine/acetaminophen, 27
Poly-tussin DHC, 30
oxycodone/ibuprofen, 27
pentazocine/naloxone HCL, 27
Poly-VI-flor, 32
Oxycontin, 27
Pentetate Calcium Trisodium, 33
Poly-VI-flor/Iron, 32
oxymorphone hydrochloride, 27
Pentetate Zinc Trisodium, 33
polyethylene glycol 3350, 17
oxymorphone hydrochloride ER, 27
pentoxifylline ER, 20
polymyxin b sulfate, 4
oxytocin, 26
Pepcid, 17
polymyxin b sulfate/trimethoprim sulfate, 25
Oxytrol, 18
Percocet, 27
P
Percodan, 27
Polytrim, 25
Perforomist, 30
Pomalyst, 5
paclitaxel, 5
Peridex, 21
Ponstel, 28
Paclitaxel, 5
Potassium Citrate, 19
Primaxin IV Add-vantage, 4
Prumyx, 12
Potassium Citrate ER, 19
primidone, 23
Pulmicort, 30
potassium citrate-citric acid crystals, 19
Primlev, 27
Pulmicort Flexhaler, 30
Potiga, 23
Primsol, 4
Pulmophylline, 30
Pr Cream, 12
Prinivil, 8
Pulmozyme, 30
Pr Natal 400, 31
Pristiq, 21
Purinethol, 5
Pr Natal 400 EC, 31
Proair HFA, 30
Purixan, 5
Pr Natal 430, 31
probenecid, 28
Pylera, 17
Pr Natal 430 EC, 31
probenecid/colchicine, 28
pyrazinamide, 2
Pradaxa, 20
Procainamide HCL, 7
Pyridium, 19
pramipexole dihydrochloride, 23
Procardia, 7
pyridostigmine bromide, 24
Pramosone, 12
Procardia XL, 7
Pyridoxine HCL, 31
Pramotic, 26
Procentra, 23
Pyrogallic Acid, 13
Prandimet, 15
prochlorperazine, 22
Q
Prandin, 15
prochlorperazine edisylate, 22
Qnasl, 29
Pravachol, 9
prochlorperazine maleate, 22
Quadramet, 6
pravastatin sodium, 9
Procort, 18
Qualaquin, 3
Prazolamine, 24
Procrit, 19
Quartette, 14
prazosin HCL, 8
Proctocort, 18
Quazepam, 22
Pre-folic, 20
Proctofoam HC, 18
Qudexy XR, 23
Precedex, 22
Procysbi, 19
Quelicin, 24
Precose, 15
Proferrin-forte, 20
Quelicin 1000, 24
Pred Forte, 25
progesterone, 14
Questran, 9
Pred Mild, 25
Proglycem, 15
Questran Light, 9
Pred-G, 25
Prograf, 5
quetiapine fumarate, 22
Pred-G S.o.p., 25
Prolastin-c, 30
Quflora Pediatric, 32
prednicarbate, 11
Prolensa, 26
Quillivant XR, 23
prednisolone, 13
Proleukin, 6
quinapril HCL, 7
prednisolone acetate, 25
Prolia, 15
quinapril/hydrochlorothiazide, 8
prednisolone sodium phosphate, 13
Promacta, 19
Quinidine Gluconate, 7
Prednisolone Sodium Phosphate, 13, 25
promethazine HCL, 29
quinidine gluconate CR, 7
prednisone, 13
promethazine HCL plain, 29
quinidine gluconate ER, 7
Prednisone, 13
promethazine-DM, 29
quinidine sulfate, 7
Prednisone Intensol, 13
promethazine/codeine, 29
Quinidine Sulfate, 7
Prefera OB, 32
promethazine/dextromethorphan, 29
Quinidine Sulfate ER, 7
Prefera OB + DHA, 32
Prometrium, 14
quinine sulfate, 3
Preferaob One, 32
Promiseb, 11
Qutenza, 13
Prefest, 14
Promiseb Complete, 11
Qvar, 30
Prefol-DHA, 32
propafenone HCL, 7
R
Prelone, 13
propafenone HCL ER, 7
Premarin, 14, 19
Propantheline Bromide, 17
R-natal OB, 32
Premphase, 14
proparacaine HCL, 26
Rabavert, 31
Prempro, 14
propranolol HCL, 7
Radigel, 13
Prenata, 32
Propranolol HCL, 7
raloxifene hydrochloride, 16
Prenatabs RX, 31
propranolol HCL ER, 7
ramipril, 7
Prenatal Ad, 31
Propranolol/Hydrochlorothiazide, 8
Ranexa, 6
Prenatal-u, 32
propylthiouracil, 17
ranitidine HCL, 17
Prenate, 32
Proquad, 31
Rapaflo, 19
Prenate AM, 32
Proscar, 19
Rapamune, 5
Prenate DHA, 32
Prosed/DS, 18
Rasuvo, 28
Prenate Elite, 32
Prostigmin, 24
Ravicti, 16
Prenate Enhance, 32
Prostin E2, 26
Rayos, 13
Prenate Essential, 32
Protamine Sulfate, 20
Razadyne, 24
Prenate Mini, 32
Protect Plus, 32
Razadyne ER, 24
Prenate Pixie, 32
Protectbone, 32
Rebetol, 3
Prenate Restore, 32
Protectiron, 20
Rebif, 24
Prenate Star, 32
Protectnatal, 32
Rebif Rebidose, 24
Prenexa, 32
Protopic, 12
Rebif Rebidose Titration Pack, 24
Prepidil, 26
protriptyline HCL, 21
Rebif Titration Pack, 24
Prepopik, 17
Provenge, 6
Reclast, 15
Preque 10, 32
Proventil HFA, 30
Recombivax HB, 31
Presera, 13
Provera, 14
Recothrom, 20
Prevident, 21
Provida OB, 32
Recothrom Spray Kit, 20
Prevnar 13, 31
Provigil, 23
Reglan, 18
Prezista, 3
Prozac, 21
Regonol, 24
Priftin, 2
Prozac Weekly, 21
Relagard, 19
Primaquine Phosphate, 3
Pruclair, 12
Relenza Diskhaler, 3
Primaxin IV, 4
Prudoxin, 11
Relhist, 29
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2", 33
Ritalin SR, 23
Sensipar, 16
Rituxan, 5
Sensorcaine-mpf/Epinephrine, 29
Relistor, 18
rivastigmine tartrate, 24
Sentradine, 17
Relpax, 28
rizatriptan benzoate, 28
Sentraflox AM-10, 21
Remeron, 21
rizatriptan benzoate odt, 28
Sentralopram AM-10, 21
Remeron Soltab, 21
Robaxin, 24
Sentramodafin AM-100, 23
Remicade, 18
Robaxin-750, 24
Sentravil PM-25, 21
Remodulin, 10
Robinul, 17
Sentrazolam AM 0.25, 21
Renagel, 18
Robinul Forte, 17
Sentrazolpidem PM-5, 22
Renatabs, 32
Rocaltrol, 16
Sentroxatine, 21
Renatabs With Iron, 32
Rocephin, 1
Serevent Diskus, 30
Renax, 32
rocuronium bromide, 24
Seromycin, 2
Renvela, 18
ropinirole ER, 23
Seroquel, 22
Reopro, 20
ropinirole HCL, 23
Seroquel XR, 22
repaglinide, 15
ropivacaine HCL, 28
Serostim, 16
Reprexain, 27
Rosadan Kit, 10
sertraline HCL, 21
Repronex, 16
Rosanil, 10
Sevelamer Carbonate, 18
Req 49+, 32
Rotarix, 31
Sfrowasa, 18
Requip, 23
Rotateq, 31
Shohls Solution Modified, 19
Requip XL, 23
Rowasa, 18
Siderol, 32
Rescon-JR, 30
Roxicet, 27
Signifor, 16
Rescon-MX, 30
Roxicodone, 27
sildenafil, 9
Rescriptor, 3
Rozerem, 22
sildenafil citrate, 9
Rescula, 25
Ryanodex, 24
Silenor, 22
Reserpine, 8
Rybix Odt, 27
Simbrinza, 26
Respa-BR, 29
Rythmol, 7
Simcor, 9
Restasis, 26
Rythmol SR, 7
Simponi, 28
Restora RX, 17
S
Simponi Aria, 28
Restoril, 22
Simulect, 5
Sabril, 23
Retavase, 20
simvastatin, 9
Safyral, 14
Retavase Half-kit, 20
Sinemet, 23
Saizen, 16
Retin-a, 10
Sinemet CR, 23
Saizen Click.easy, 16
Retin-a Micro, 10
Singulair, 30
Salagen, 21
Retin-a Micro P.M., 10
sirolimus, 5
salicylic acid, 12
Retrovir, 3
Sirturo, 2
Salicylic Acid, 12
Retrovir IV Infusion, 3
Sitavig, 3
Salicylic Acid IN Ammonium Lactate Vehicle, 12
Revatio, 10
Sivextro, 4
Revlimid, 5
Skelaxin, 24
Salkera, 13
Reyataz, 3
Sklice, 13
salsalate, 26
Rezira, 30
Sodium Bicarbonate, 17
Salvax Duo Plus, 13
Rezyst IM, 17
sodium chloride, 29
Samsca, 16
Rezyst SB, 17
Sodium Diuril, 9
Sanctura, 18
Rheumatrex, 28
Sodium Edecrin, 9
Sanctura XR, 18
Rhinocort Aqua, 29
sodium ferric gluconate complex/sucrose, 19
Sancuso, 18
Rhinoflex-650, 26
Sandimmune, 5
Ribasphere, 3
sodium hyaluronate, 12
Sandostatin, 16
Ribasphere Ribapak, 3
sodium phenylbutyrate, 16
Sandostatin Lar Depot, 16
Ribatab, 3
sodium sulfacetamide, 10, 11, 25
Saphris, 22
ribavirin, 3
sodium sulfacetamide wash, 11
Sarafem, 24
Ridaura, 28
sodium sulfacetamide/sulfur, 10
Savella, 24
rifabutin, 2
Sodium Sulfacetamide/Sulfur, 10
Savella Titration Pack, 24
Rifadin, 2
sodium sulfacetamide/sulfur cleanser, 10
Scalacort DK, 12
Rifamate, 2
Sodium Sulfacetamide/Sulfur Cleanser IN Urea, 10
Scopolamine Hydrobromide, 17
rifampin, 2
Seasonique, 14
Rifater, 2
sodium sulfacetamide/sulfur cleansing cloths, 10
Seb-prev, 11
Rilutek, 24
Seconal, 22
riluzole, 24
sodium sulfacetamide/sulfur green, 10
Sectral, 7
rimantadine HCL, 3
Sodium Sulfacetamide/Sulfur IN Urea, 10
Select-OB, 32
Rimantalist, 3
sodium sulfacetamide/sulfur wash, 10
Select-ob+dha, 32
Riomet, 15
Sodium Sulfacetamide/Urea, 11
selegiline HCL, 23
risedronate sodium, 15
Soliris, 20
selenium sulfide, 11
Risperdal, 22
Solodyn, 2
Selenium Sulfide, 11
Risperdal Consta, 22
Soltamox, 5
Selrx, 11
Risperdal M-TAB, 22
Solu-cortef, 13
Selsun Shampoo, 11
risperidone, 22
Solu-medrol, 13
Selzentry, 3
risperidone odt, 22
Soma, 24
Semprex-d, 30
Ritalin, 23
Somatuline Depot, 16
Senna Leaves, 17
Ritalin LA, 23
Somavert, 16
Senophylline, 30
Sonata, 22
Sumavel Dosepro, 28
Tekturna HCT, 8
Soriatane, 11
Sumaxin, 10
telmisartan, 8
Sorilux, 11
Sumaxin CP Kit, 10
telmisartan/amlodipine, 8
sotalol HCL, 7
Sumaxin Ts, 10
telmisartan/hydrochloroth, 8
sotalol HCL (AF), 7
Sumaxin Wash, 10
telmisartan/hydrochlorothiazide, 8
Sotalol Hydrochloride, 7
Supervite, 32
temazepam, 22
Sovaldi, 3
Supervite EC, 32
Temodar, 4
Spectracef, 1
Support-500, 32
Temovate, 12
Spinosad, 13
Supprelin LA, 16
Temovate E, 12
Spiriva Handihaler, 30
Suprax, 1
temozolomide, 4
spironolactone, 9
Suprep Bowel Prep, 17
Tencon, 26
spironolactone/hydrochlorothiazide, 9
Surfaxin, 30
Tenex, 8
Sporanox, 2
Surmontil, 21
Teniposide, 5
Sporanox Pulsepak, 2
Survanta Intratracheal, 30
Tenivac, 30
Sprix, 28
Sustiva, 3
Tenoretic 100, 8
Sprycel, 5
Sutent, 5
Tenoretic 50, 8
Staflex, 26
Suttar-2, 29
Tenormin, 7
Stalevo 100, 23
Suttar-SF, 29
Terazol 3, 19
Stalevo 125, 23
Sylatron, 6
Terazol 7, 19
Stalevo 150, 23
Symax Duotab, 17
terazosin HCL, 8
Stalevo 200, 23
Symbicort, 30
terbinafine HCL, 2
Stalevo 50, 23
Symbyax, 24
Terbinex, 3
Stalevo 75, 23
Symlinpen 120, 14
terbutaline sulfate, 30
stannous fluoride oral rinse, 20
Symlinpen 60, 14
terconazole, 19
Starlix, 15
Synagex, 32
Tersi Foam, 11
stavudine, 3
Synalar, 12
Tessalon Perles, 30
Stavzor, 23
Synalar Cream Kit, 12
Testim, 13
Staxyn, 10
Synalar Ointment Kit, 12
Testopel, 13
Stelara, 11
Synalar Ts, 12
Testosterone, 13
Stendra, 10
Synalgos-dc, 27
testosterone cypionate, 13
Stimate, 16
Synarel, 16
testosterone enanthate, 13
Stivarga, 6
Synatek, 32
Testosterone P.M., 13
Strattera, 22
Synera, 13
Testred, 13
Strazepam, 22
Synercid, 4
Tetanus Toxoid Adsorbed, 30
Streptomycin Sulfate, 2
Synribo, 6
Tetanus/Diphtheria Toxoids-adsorbed Adult, 30
Striant, 13
Synthroid, 17
Stribild, 3
T
tetracaine HCL, 26
Striverdi Respimat, 30
Tetracaine HCL, 29
Tabloid, 5
Stromectol, 3
Tetracycline HCL, 2
Taclonex, 12
Strovite, 31
Tetrix, 13
tacrolimus, 5
Strovite Forte, 32
Tev-tropin, 16
Tafinlar, 6
Strovite One, 32
Teveten, 8
Talwin, 27
Suboxone, 27
Teveten HCT, 8
Tambocor, 7
Subsys, 27
Texacort, 12
Tamiflu, 3
Suclear, 17
Thalomid, 5
tamoxifen citrate, 5
Sucraid, 18
Theo-24, 30
tamsulosin HCL, 19
sucralfate, 17
theophylline, 30
Tandem F, 20
Sular, 7
theophylline CR, 30
Tandem Plus, 20
sulfacetamide sodium, 10, 25
theophylline ER, 30
Tanzeum, 14
Sulfacetamide Sodium, 25
theophylline/D5W, 30
Tapazole, 17
sulfacetamide sodium/prednisolone sodium phosphate, 25
Theophylline/D5W, 30
Tarceva, 6
Therabenzaprine-60, 24
Targretin, 6
sulfacetamide sodium/sulfur cleanser, 10
Therabenzaprine-90, 24
Tarka, 8
Sulfadiazine, 2
Therabenzaprine-90-5, 24
Taron-bc, 31
sulfamethoxazole/trimethoprim, 4
Theracodeine-300, 27
Taron-c DHA, 31
Sulfamethoxazole/Trimethoprim, 4
Theracodophen-325, 27
Taron-duo EC, 31
sulfamethoxazole/trimethoprim DS, 4
Theracodophen-650, 27
Taron-prex, 31
sulfasalazine, 18
Theracodophen-750, 27
Tasigna, 6
Sulfoam, 10
Theracodophen-low-90, 27
Tasmar, 23
Sulfurated Lime, 13
Therafeldamine, 28
Taxotere, 5
sulindac, 28
Therapentin-60, 23
Tazicef, 1
Sumadan Kit, 10
Therapentin-90, 23
Tazorac, 11
Sumadan Wash, 10
Theraprofen-60, 28
Tecfidera, 24
Sumadan XLT, 10
Theraprofen-800, 28
Tecfidera Starter Pack, 24
Sumatriptan, 28
Theraprofen-90, 28
Tegretol, 23
sumatriptan succinate, 28
Theraproxen-500, 28
Tegretol-XR, 23
Sumatriptan Succinate, 28
Theraproxen-60, 28
Tekamlo, 8
sumatriptan succinate refill, 28
Theraproxen-90, 28
Tekturna, 8
Theratramadol-60, 27
Torisel, 6
Triostat, 17
Theratramadol-90, 27
torsemide, 9
Trisenox, 6
thiamine HCL, 31
Torsemide, 9
Triveen-duo DHA, 32
Thiola, 19
Totect, 6
Triveen-prx RNF, 32
thioridazine HCL, 22
Toviaz, 18
Triveen-ten, 32
thiothixene, 22
Tracleer, 10
Triveen-u, 32
Thrombin-jmi Diluent, 20
Tradjenta, 15
Trizivir, 3
Thrombin-jmi Epistaxis, 20
tramadol HCL, 27
Trokendi XR, 23
Thrombin-jmi Syringe Spray Kit, 20
tramadol HCL ER, 27
Tropazone, 13
Thrombin-jmi W/Dil Spray P.M. Actuator, 20
Tramadol HCL ER, 27
trospium chloride, 18
tramadol hydrochloride/acetaminophen, 27
trospium chloride ER, 18
Thrombogen, 20
Trusopt, 26
Thymoglobulin, 5
Trandate, 7
Truvada, 3
Thyrolar-1, 17
trandolapril, 7
Tudorza Pressair, 30
Thyrolar-1/2, 17
tranexamic acid, 20
Turkel Paracentesis Procedure Tray/8french, 29
Thyrolar-1/4, 17
Transderm-scop, 17
Thyrolar-2, 17
Tranxene T, 21
Tussicaps, 29
Thyrolar-3, 17
tranylcypromine sulfate, 21
Tussionex Pennkinetic Extended Release, 30
tiagabine hydrochloride, 23
Trasylol, 20
Tiazac, 7
Travatan Z, 25
Twinrix, 31
ticlopidine HCL, 20
Travoprost, 25
Twynsta, 8
Tigan, 18
Trazamine, 21
Tygacil, 4
Tikosyn, 7
trazodone HCL, 21
Tykerb, 6
Timentin, 1
Treanda, 4
Tylenol/Codeine #3, 27
Timolol Maleate, 7
Trecator, 2
Tylenol/Codeine #4, 27
timolol maleate, 25
Trelstar Depot, 5
Typhim VI, 31
timolol maleate ophthalmic gel forming, 25
Trelstar Depot Mixject, 5
Tysabri, 24
Trelstar LA, 5
Tyvaso, 10
Timoptic, 25
Trelstar LA Mixject, 5
Tyvaso Refill, 10
Timoptic Ocudose, 25
Trelstar Mixject, 5
Tyvaso Starter, 10
Timoptic-xe, 25
Trental, 20
Tyzeka, 3
Tindamax, 4
Trepadiclofen-25, 28
Tyzine, 29
tinidazole, 4
Trepoxen-250, 28
Tyzine Pediatric Nasal Drops, 29
Tirosint, 17
Trepoxicam-7.5, 28
U
Tisseel, 20
Tretin-x, 10
U-cort, 11
Tivicay, 3
tretinoin, 6, 10
Uceris, 13
Tizanidine Comfort PAC, 24
tretinoin microsphere, 10
Udamin, 33
tizanidine HCL, 24
tretinoin microsphere P.M., 10
Udamin SP, 33
TL G-FOL OS, 32
Trexall, 4
Ulesfia, 13
TL Triseb, 11
Treximet, 28
Uloric, 28
TL-cermide, 12
Trezix, 27
Ultiva, 27
Tnkase, 20
Tri-norinyl 28, 14
Ultracet, 27
Tobi, 2
Tri-VI-flor, 32
Ultram, 27
Tobi Podhaler, 2
triamcinolone acetonide, 11, 20, 29
Ultram ER, 27
Tobradex, 25
Triamcinolone Acetonide, 11
Ultrasal-ER, 13
Tobradex ST, 25
triamcinolone IN orabase, 20
Ultravate, 12
tobramycin, 2
triamterene/hydrochlorothiazide, 9
Ultravate PAC, 12
tobramycin sulfate, 2, 25
Triamterene/Hydrochlorothiazide, 9
Ultravate X, 12
Tobramycin Sulfate/Sodium Chloride, 2
Trianex, 11
Ultresa, 18
tobramycin/dexamethasone, 25
triazolam, 22
Umecta, 13
Tobrex, 25
Tribenzor, 8
Umecta Nail Film, 13
Tofranil, 21
Tricare, 31
Umecta PD, 13
Tofranil-PM, 21
Tricare Prenatal Compleat, 33
Unasyn, 1
tolazamide, 15
Tricare Prenatal DHA One, 33
Unasyn Bulk Pack, 1
Tolazamide, 15
Tricitrates, 19
Uniretic, 8
Tolbutamide, 15
Tricor, 9
Univasc, 8
tolmetin sodium, 28
trifluoperazine HCL, 22
Uramaxin, 13
Tolmetin Sodium, 28
trifluridine, 25
Uramaxin GT, 13
tolterodine tartrate, 18
Triglide, 9
Uramaxin GT Kit, 13
tolterodine tartrate ER, 18
trihexyphenidyl HCL, 23
urea, 12
Topamax, 23
Trileptal, 23
urea 40% nail film, 12
Topamax Sprinkle, 23
Trilipix, 9
urea IN zinc undecylenate/lactic acid vehicle, 12
Topicort, 12
trimethobenzamide HCL, 17
topiramate, 23
trimethoprim, 4
urea topical, 12
Topiramate ER, 23
trimethoprim sulfate/polymyxin b sulfate, 25
Urecholine, 18
topotecan HCL, 6
Urelle, 18
Topotecan HCL, 6
trimipramine maleate, 21
Uretron D/S, 18
Toprol XL, 7
Trinate, 31
Urex, 18
Uribel, 18
Vibativ, 4
Voltaren, 11
Urimar-t, 18
Vibramycin, 2
Voltaren-XR, 28
Urocit-k 10, 19
Vicoprofen, 27
Voluven, 20
Urocit-k 15, 19
Victoza, 15
Vopac, 11
Urocit-k 5, 19
Victrelis, 3
Vopac GB, 11
Urogesic-blue, 18
Vidaza, 5
Vopac Kt, 11
Uroqid #2, 18
Videx EC, 3
Voraxaze, 6
Uroxatral, 19
Videx Pediatric, 3
voriconazole, 2
Urso 250, 18
Vigamox, 25
Vosol HC, 26
Urso Forte, 18
Viibryd, 21
Vospire ER, 30
ursodiol, 18
Vimizim, 16
Votrient, 6
Utopic, 13
Vimovo, 28
Vpriv, 20
Uvadex, 6
Vimpat, 23
Vsl#3 DS, 17
V
Vinacal, 32
Vumon, 5
Vinacal B, 33
Vusion, 11
Vagifem, 19
Vinate AZ Extra, 32
Vytorin, 9
valacyclovir HCL, 3
Vinate C, 32
Vyvanse, 22
Valchlor, 4
Vinate Calcium, 32
W
Valcyte, 3
Vinate Care, 32
Valium, 21
warfarin sodium, 20
Vinate DHA, 33
valproate sodium, 23
Welchol, 9
Vinate DHA RF, 33
valproic acid, 23
Wellbutrin, 21
Vinate GT, 32
valsartan, 8
Wellbutrin SR, 21
Vinate IC, 32
valsartan/hydrochlorothiazide, 8
Wellbutrin XL, 21
Vinate II, 32
Valtrex, 3
Westcort, 12
Vinate M, 32
Vancocin HCL, 4
Westhroid, 17
Vinate One, 32
vancomycin HCL, 4
Westhroid-p, 17
Vinate Pn Care, 32
Vancomycin HCL, 4
Wheat Germ, 31
Vinblastine Sulfate, 5
Vancomycin HCL IN Dextrose, 4
Witch Hazel, 13
vincristine sulfate, 5
Vanos, 12
Wp Thyroid, 17
vinorelbine tartrate, 5
Vantas, 5
X
Viokace, 18
Vaprisol, 16
Viracept, 3
Xalatan, 25
Vaqta, 31
Viramune, 3
Xalkori, 6
Varivax, 31
Viramune XR, 3
Xanax, 21
Vaseretic, 8
Virasal, 13
Xanax XR, 21
vasopressin, 16
Virazole, 3
Xarelto, 20
Vasotec, 8
Viread, 3
Xartemis XR, 27
Vecamyl, 8
Viroptic, 25
Xclair, 13
Vectibix, 5
Vistaril, 21
Xeljanz, 28
Vectical, 11
Vistide, 3
Xeloda, 5
vecuronium bromide, 24
Vita-pren, 33
Xenazine, 24
Velcade, 6
Vitafol, 33
Xeomin, 24
Veletri, 9
Vitafol Ultra, 33
Xerac Ac, 13
Velphoro, 18
Vitafol-nano, 33
Xerese, 11
Veltin, 10
Vitafol-OB, 33
Xgeva, 15
Vemavite-prx 2, 32
Vitafol-ob+dha, 33
Xifaxan, 4
venlafaxine HCL, 21
Vitafol-one, 33
Xodol, 27
venlafaxine HCL ER, 21
Vitafol-plus, 33
Xofigo, 6
Venlafaxine HCL ER, 21
Vitafol-pn, 33
Xolair, 30
Venofer, 20
Vital-d RX, 33
Xolegel, 11
Ventavis, 10
Vitamedmd One RX/Quatrefolic, 33
Xolegel Corepak, 11
Ventolin HFA, 30
Vitamedmd Plus RX/Quatre Folic, 33
Xolegel Duo/Head & Shoulders, 11
Veramyst, 29
Vitamedmd Redichew RX, 33
Xolegel Duo/Xolex, 11
verapamil HCL, 7
Vitamedmd Redichew RX/Quatrefolic, 33
Xolox, 27
Verapamil HCL, 7
vitamin c 222MG, 31
Xopenex, 30
verapamil HCL ER, 7
vitamin d, 31
Xopenex Concentrate, 30
verapamil HCL SR, 7
vitamin k1, 31
Xopenex HFA, 30
Verdeso, 12
Vitamin K1, 31
Xtandi, 5
Veregen, 13
Vitapearl, 33
Xylocaine, 7, 13, 29
Verelan, 7
Vitaroca Plus, 32
Xylocaine-mpf, 29
Verelan PM, 7
Vituz, 30
Xylocaine-mpf/Epinephrine, 29
Veripred 20, 13
Viva CT Prenatal, 33
Xylocaine/Epinephrine, 29
Versacloz, 22
Viva DHA, 33
Xyrem, 24
Vesicare, 19
Vivactil, 21
Xyzal, 29
Vexa, 13
Vivelle-dot, 14
Y
Vexol, 25
Vivotif Berna, 31
Vfend, 3
Yasmin 28, 14
Vogelxo, 13
Vfend IV, 3
Yaz, 14
Vogelxo P.M., 13
Viagra, 10
Yervoy, 5
Yf-vax, 31
Zonegran, 23
Yodoxin, 3
zonisamide, 23
Z
Zontivity, 20
Zorbtive, 16
zafirlukast, 30
Zortress, 5
zaleplon, 22
Zostavax, 31
Zaltrap, 5
Zosyn, 1
Zanaflex, 24
Zovia 1/50e, 14
Zanosar, 4
Zovirax, 3, 11
Zantac, 17
Zuplenz, 18
Zarontin, 23
Zutripro, 30
Zaroxolyn, 9
Zyclara, 12
Zatean-CH, 32
Zyclara P.M., 12
Zatean-pn, 32
Zydelig, 6
Zatean-pn DHA, 32
Zydone, 27
Zatean-pn Plus, 32
Zyflo, 30
Zavesca, 20
Zyflo CR, 30
Zebeta, 7
Zykadia, 6
Zelapar, 24
Zylet, 25
Zelboraf, 6
Zyloprim, 28
Zemaira, 30
Zymaxid, 25
Zemplar, 16
Zyprexa, 22
Zemuron, 24
Zyprexa Relprevv, 22
Zenpep, 18
Zyprexa Zydis, 22
Zerit, 3
Zytiga, 5
Zestoretic, 8
Zyvox, 4
Zestril, 8
8
Zetia, 9
Zetonna, 29
8-mop, 11
Zevalin Y-90, 5
Ziac, 8
Ziagen, 3
Ziana, 10
zidovudine, 3
Zinacef, 1
Zinacef IN Iso-osmotic Dextrose, 1
Zinacef IN Iso-osmotic Diluent, 1
Zinecard, 6
Zioptan, 25
ziprasidone HCL, 22
Zipsor, 28
Zirgan, 25
Zithranol, 11
Zithranol-rr, 11
Zithromax, 1
Zithromax Tri-PAK, 1
Zithromax Z-PAK, 1
Zmax, 1
Zocor, 9
Zofran, 18
Zofran Odt, 18
Zohydro ER, 27
Zoladex, 5
Zoledronic Acid, 15
zoledronic acid, 15
Zolinza, 6
zolmitriptan, 28
zolmitriptan odt, 28
Zoloft, 21
zolpidem tartrate, 22
zolpidem tartrate ER, 22
Zolpimist, 22
Zolvit, 27
Zometa, 15
Zomig, 28
Zomig Nasal Spray, 28
Zomig ZMT, 28
Zonalon, 11
Zonatuss, 30