ESSENTIAL FORMULARY2018 Comprehensive Medication List
Effective Date: June 1, 2018
This document has information about the drugs covered in your plan. Please read carefully.
1711 CR 011_01 6/2018
How We Develop Our FormularyQualChoice uses a Pharmacy and Therapeutics Committee made up of practicing doctors, pharmacists, and nurses to make sure our drug list is clinically sound and gives the best value to our members. This committee reviews FDA-approved drugs that are newly approved and those thatare currently on the market. Drugs are chosen based on safety, effectiveness, and cost in comparison to other drugs in their class.
Formulary DesignOur Essential formulary includes generic drugs, preferred and non-preferred drugs, specialty drugs and ACA (Affordable Care Act) preventive drugs. Our Essential formulary is a closed formulary. This means that coverage is limited to those products listed in the different tiers. There are 4 tiers on the formulary, along with the preventive drugs.
Tier 1 This tier has the lowest member cost share. Most, but not all, generic medications are in Tier 1.
Tier 2 This tier contains some higher cost generic drugs and preferred brand-name drugs. Preferred brand-name drugs generally have lower co-payments than non-preferredbrand-name drugs.
Tier 3 This tier may contain some higher cost generic drugs but is mostly non-preferred brand drugs. Non-preferred drugs generally have higher co-payments than preferred brand-name drugs.
Tier 5 This tier contains specialty drugs and has the highest co-payment and cost. These drugs are used to treat complex or rare health problems.
ACA Preventive Drugs – Drugs listed as ‘Preventive’ may have coverage and no co-payment when health care reform requirements are met for age, gender, and/or risk factors.
Medical ManagementWe use reasonable medical and utilization management to determine whether a medication is medically necessary. These may include prior authorization, quantity limits, and step therapy as described below. Those drugs are listed as:
PA – Prior Authorization QL – Quantity Limits ST – Step Therapy
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
morgidox 1X100MG
morgidox 1X50MG
morgidox 2X100MG
okebo
June 2018
Doxycycline Hyclate
TIER 02 tetracycline hydrochloride
ANTI-INFECTIVES
tetracycline HCL
Tetracycline HCL
PENICILLINS
TIER 03 Vibramycin
TIER 01 amoxicillin
amoxicillin/clavulanate potassium
QUINOLONES
amoxicillin/clavulanate potassium ER
TIER 01 ciprofloxacin
dicloxacillin sodium
ciprofloxacin ER
penicillin v potassium
ciprofloxacin HCL
Amoxicillin
levofloxacin
Amoxicillin/Clavulanate Potassium
moxifloxacin HCL
Ampicillin
ofloxacin
Penicillin V Potassium
Ciprofloxacin HCL
TIER 03 Augmentin
Levofloxacin
Moxatag
TIER 03 Baxdela
Cipro
CEPHALOSPORIN
FIRST GENERATION
AMINOGLYCOSIDES
TIER 01 cefadroxil
TIER 01 amikacin sulfate
cephalexin
gentamicin sulfate
Cefazolin Sodium
gentamicin sulfate pediatric
SECOND GENERATION
neomycin sulfate
TIER 01 cefaclor
paromomycin sulfate
cefprozil
tobramycin sulfate
cefuroxime axetil
Tobramycin Sulfate
Cefaclor
TIER 03 Streptomycin Sulfate
Cefaclor ER
TIER 05 tobramycin
THIRD GENERATION
Kitabis PAK
TIER 01 cefdinir
Tobramycin
cefixime
cefpodoxime proxetil
SULFONAMIDES
ceftriaxone sodium
TIER 01 Sulfadiazine
TIER 03 Cefditoren Pivoxil
Suprax
ANTIMYCOBACTERIAL AGENTS
MACROLIDES
TIER 01 ethambutol HCL
isoniazid
TIER 01 azithromycin
pyrazinamide
clarithromycin
rifabutin
clarithromycin ER
rifampin
erythromycin
Isoniazid
erythromycin base
TIER 03 Cycloserine
erythromycin ethylsuccinate
Paser
Azithromycin
Priftin
Clarithromycin
Rifamate
E.e.s. 400
Rifater
Erythrocin Stearate
Trecator
Erythromycin Ethylsuccinate
TIER 03 DificidQL,PA
ANTIFUNGALS
Ery-TAB
Eryped 400
TIER 01 fluconazole
Zmax
flucytosine
griseofulvin microsize
TETRACYCLINES
griseofulvin ultramicrosize
itraconazole
TIER 01 avidoxy
ketoconazolePA
demeclocycline hydrochloride
nystatin
demeclocycline HCL
terbinafine HCL
doxycycline
voriconazole
doxycycline hyclate
TIER 03 Bio-statin
doxycycline monohydrate
NoxafilPA
minocycline hydrochloride
Sporanox
minocycline HCL
TIER 05 CresembaPA
mondoxyne nl
ANTIVIRALS
TIER 01
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 1
abacavir
Moderiba
abacavir sulfate/lamivudine/zidovudine
Moderiba 1200 Dose Pack
abacavir/lamivudine
Moderiba 800 Dose Pack
acyclovir
Pegasys
atazanavir
Pegasys Proclick
atazanavir sulfate
Pegintron
didanosine
Prevymis
efavirenz
Rebetol
famciclovir
Ribasphere
fosamprenavir calcium
Ribasphere Ribapak
lamivudine/zidovudine
Vemlidy
lopinavir/ritonavir
VoseviPA
nevirapine
nevirapine ERST
ANTIMALARIALS
oseltamivir phosphate
TIER 01 atovaquone/proguanil HCL
rimantadine HCL
chloroquine phosphate
ritonavir
hydroxychloroquine sulfate
stavudine
quinine sulfate
tenofovir disoproxil fumarate
Chloroquine Phosphate
valacyclovir HCL
Mefloquine HCL
valganciclovir
Primaquine Phosphate
valganciclovir hydrochlorde
TIER 03 Coartem
zidovudine
Daraprim
TIER 02 Atripla
Intelence
ANTHELMINTICS
Invirase
TIER 01 ivermectin
Kaletra
praziquantel
Norvir
TIER 03 AlbenzaQL
Prezista
BenznidazolePA
Reyataz
Emverm
Truvada
Viramune
MISC. ANTI-INFECTIVES
Viread
TIER 01 atovaquone
TIER 03 Aptivus
baciim
Biktarvy
bacitracin
Complera
clindamycin palmitate HCL
Crixivan
clindamycin HCL
Descovy
dapsone
Edurant
linezolid
Emtriva
metronidazole
Evotaz
polymyxin b sulfate
Genvoya
sulfamethoxazole/trimethoprim
Isentress
sulfamethoxazole/trimethoprim DS
Isentress HD
sulfatrim pediatric
Lexiva
tinidazole
Odefsey
trimethoprim
Prezcobix
vancomycin HCL
Relenza Diskhaler
TIER 03 Alinia
Rescriptor
Nebupent
Selzentry
Primsol
Stribild
Sivextro
Symfi
Trimpex
Symfi LO
Xifaxan
Tivicay
TIER 05 colistimethate sodium
Triumeq
Cayston
Tybost
Videx Pediatric
ANTINEOPLASTICS, ETC
Viracept
ALKYLATING AGENTS
TIER 05 adefovir dipivoxil
TIER 01 melphalan
entecavir
TIER 03 Hexalen
lamivudine
Leukeran
moderiba
Myleran
ribasphere
TIER 05 cyclophosphamide
ribavirin
temozolomide
Baraclude
Cyclophosphamide
EpclusaPA
Gleostine
Epivir HBV
Fuzeon
ANTIMETABOLITES
MavyretPA
TIER 01
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 2
mercaptopurine
GilotrifPA
methotrexate
IbrancePA
methotrexate sodium
IclusigPA
Methotrexate Sodium
IdhifaPA
TIER 03 Trexall
ImbruvicaPA
TIER 05 capecitabinePA
InlytaPA
Tabloid
IressaPA
JakafiPA
HORMONAL AGENTS
KisqaliPA
Lenvima 10 MG Daily DosePA
TIER 01 anastrozole
Lenvima 14 MG Daily DosePA
letrozole
Lenvima 18 MG Daily DosePA
megestrol acetate
Lenvima 20 MG Daily DosePA
tamoxifen citrate
Lenvima 24 MG Daily DosePA
TIER 03 Lysodren
Lenvima 8 MG Daily DosePA
Soltamox
LynparzaPA
TIER 05 bicalutamide
MekinistPA
exemestane
NerlynxPA
flutamide
NexavarPA
leuprolide acetate
NinlaroPA
nilutamide
RubracaPA
Eligard
RydaptPA
Emcyt
SprycelPA
Fareston
StivargaPA
Faslodex
SutentPA
Hydroxyprogesterone Caproate
TafinlarPA
Lupron Depot (1-month)
TagrissoPA
Lupron Depot (3-month)
TarcevaPA
Lupron Depot (4-month)
TasignaPA
Lupron Depot (6-month)
ToriselPA
Trelstar Mixject
TykerbPA
XtandiPA
VerzenioPA
ZytigaPA
Votrient
XalkoriPA
IMMUNOMODULATORS
ZejulaPA
TIER 01 azathioprine
ZelborafPA
cyclosporine
ZolinzaPA
cyclosporine modified
ZydeligPA
gengraf
ZykadiaPA
mycophenolate mofetil
mycophenolic acid DR
TOPOISOMERASE I INHIBITOR
sirolimus
TIER 03 Hycamtin
tacrolimus
Cyclosporine Modified
ANTINEOPLASTICS MISC.
TIER 03 Astagraf XLPA
Azasan
TIER 01 hydroxyurea
Envarsus XRPA
TIER 05 bexarotenePA
Rapamune
tretinoin
Sandimmune
ActimmunePA
Zortress
Alferon NPA
TIER 05 PomalystPA
Intron A
Revlimid
Matulane
Thalomid
SylatronPA
MITOTIC INHIBITORS
CHEMOTHERAPY RESCUE
TIER 05 Etoposide
TIER 01 leucovorin calcium
Leucovorin Calcium
ENZYME INHIBITORS
TIER 03 Mesnex
TIER 05 imatinib mesylatePA
ANTINEOPLASTIC COMBO
AfinitorPA
Afinitor DisperzPA
TIER 05 Kisqali Femara 200 DosePA
AlecensaPA
Kisqali Femara 400 DosePA
AlunbrigPA
Kisqali Femara 600 DosePA
BosulifPA
LonsurfPA
CalquencePA
CaprelsaPA
CARDIOVASCULAR DRUGS
CometriqPA
CARDIAC GLYCOSIDES
CotellicPA
TIER 01 digitek
FarydakPA
digox
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 3
digoxin
verapamil HCL SR
Digoxin
Nisoldipine ER
TIER 03 Nymalize
ANTIANGINAL AGENTS
ANTIARRHYTHMICS
TIER 01 isosorbide dinitrate
isosorbide mononitrate
TIER 01 amiodarone hydrochloride
isosorbide mononitrate ER
amiodarone hydrocloride
minitran
amiodarone HCL
nitro-time
disopyramide phosphate
nitroglycerin
dofetilide
nitroglycerin lingual
flecainide acetate
nitroglycerin transdermal
mexiletine HCL
nitroglycerin ER
pacerone
Isosorbide Dinitrate ER
propafenone hydrochloride ER
TIER 02 Ranexa
propafenone hydrochlorideer
TIER 03 Dilatrate SR
propafenone HCL
Isordil Titradose
propafenone HCL ER
Nitro-bid
quinidine gluconate CR
Nitro-dur
quinidine gluconate ER
Nitromist
Quinidine Sulfate
TIER 03 Multaq
BETA BLOCKERS
Norpace CR
TIER 01 acebutolol hydrochloride
ACE INHIBITORS
acebutolol HCL
atenolol
TIER 01 benazepril HCL
betaxolol HCL
captopril
bisoprolol fumarate
enalapril maleate
carvedilol
fosinopril sodium
carvedilol phosphate
lisinopril
labetalol hydrochloride
moexipril HCL
labetalol HCL
perindopril erbumine
metoprolol succinate ER
quinapril hydrochloride
metoprolol tartrate
quinapril HCL
nadolol
ramipril
pindolol
trandolapril
propranolol hydrochloride
propranolol HCL
ANGIOTENSIN RCPTR BLOCKER
propranolol HCL ER
TIER 01 candesartan cilexetil
sorine
irbesartan
sotalol hydrochloride
losartan potassium
sotalol hydrochloride (AF)
olmesartan medoxomilQL,PA,ST
sotalol hydrocholride
telmisartanQL
sotalol HCL
valsartan
sotalol HCL (AF)
Eprosartan Mesylate
Propranolol HCL
TIER 03 EdarbiQL,PA
Timolol Maleate
TIER 03 Bystolic
DIRECT RENIN INHIBITORS
TIER 03 TekturnaQL
CALCIUM CHANNEL BLOCKERS
TIER 01 afeditab CR
ANTIHYPERTENSIVES MISC.
amlodipine besylate
TIER 01 clonidine HCL
cartia XT
doxazosin
dilt-XR
doxazosin mesylate
diltiazem CD
eplerenone
diltiazem HCL
guanfacine HCL
diltiazem HCL CD
hydralazine hydrochloride
diltiazem HCL ER
hydralazine HCL
felodipine ER
methyldopa
isradipine
minoxidil
matzim LA
phenoxybenzamine hydrochloride
nicardipine HCL
prazosin HCL
nifedipine
terazosin HCL
nifedipine ER
TIER 03 Demser
nimodipine
nisoldipine ER
ANTIHYPERTENSIVE COMBO
taztia XT
TIER 01 amlodipine besylate/benazepril hydrochloride
verapamil HCL
amlodipine besylate/benazepril HCL
verapamil HCL ER
amlodipine besylate/valsartan
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 4
amlodipine/olmesartan medoxomil
ANTIHYPERLIPIDEMICS
amlodipine/valsartan/hctz
TIER 01 atorvastatin calcium
atenolol/chlorthalidone
cholestyramine
benazepril HCL/hydrochlorothiazide
cholestyramine light
bisoprolol fumarate/hydrochlorothiazide
colesevelam hydrochlori DE
candesartan cilexetil/hydrochlorothiazide
colestipol HCL
enalapril maleate/hydrochlorothiazide
ezetimibe
fosinopril sodium/hydrochlorothiazide
ezetimibe/simvastatinPA
irbesartan/hydrochlorothiazide
fenofibrate
lisinopril/hydrochlorothiazide
fenofibrate micronized
losartan potassium/hydrochlorothiazide
fluvastatin
metoprolol/hydrochlorothiazide
fluvastatin sodium ER
moexipril/hydrochlorothiazide
gemfibrozil
nadolol/bendroflumethiazide
lovastatin
olmesartan medoxomil/amlodipine/hydrochlorothiazide
niacin ER
olmesartan medoxomil/hydrochlorothiazideQL,PA,ST
omega-3-acid ethyl esters
quinapril/hydrochlorothiazide
pravastatin sodium
telmisartan/amlodipine
prevalite
telmisartan/hydrochlorothiazideQL
simvastatin
trandolapril/verapamil HCL ER
triklo
valsartan/hydrochlorothiazide
Fenofibrate
Captopril/Hydrochlorothiazide
Fenofibric Acid
Methyldopa/Hydrochlorothiazide
TIER 02 fenofibric acid DR
Metoprolol/Hydrochlorothiazide
rosuvastatin calcium
Propranolol/Hydrochlorothiazide
TIER 03 LivaloPA
Trandolapril/Verapamil HCL ER
Welchol
TIER 03 Dutoprol
TIER 05 RepathaPA
EdarbyclorPA
Repatha Pushtronex SystemPA
Metoprolol Succinate ER/Hydrochlorothiazide
Repatha SureclickPA
Tekturna HCTQL
CARDIOVASCULAR - MISC.
DIURETICS
TIER 01 amlodipine besylate/atorvastatin calcium
TIER 01 acetazolamide
isoxsuprine HCL
acetazolamide sodium
sildenafil citrateQL,PA
acetazolamide ER
TIER 03 BidilQL
amiloride HCL
CaverjectQL,PA
amiloride/hydrochlorothiazide
Caverject ImpulseQL,PA
bumetanide
CialisQL,PA
chlorothiazide
EdexQL,PA
chlorthalidone
Entresto
ethacrynic acid
MuseQL,PA
furosemide
TIER 05 sildenafilPA
hydrochlorothiazide
AdcircaPA
indapamide
AdempasPA
methazolamide
LetairisPA
metolazone
OpsumitPA
spironolactone
RevatioPA
spironolactone/hydrochlorothiazide
TracleerPA
torsemide
TyvasoPA
triamterene/hydrochlorothiazide
Tyvaso RefillPA
Chlorothiazide
Tyvaso StarterPA
Furosemide
UptraviQL,PA
Methyclothiazide
VentavisPA
TIER 03 Aldactazide
Amiloride HCL
DERMATOLOGICALS
Diuril
ACNE PRODUCTS
Dyrenium
TIER 01 adapalene
adapalene and benzoyl peroxide
VASOPRESSORS
adapalene P.M.
TIER 01 ephedrine sulfate
amnesteem
epinephrine HCL
avar cleanser
midodrine HCL
avar-e emollient
Phenylephrine HCL
avar-e green
TIER 02 Auvi-q
avita
Epinephrine
benzepro
Epipen 2-PAK
benzepro creamy wash
Epipen-JR 2-PAK
benzepro foaming cloths
benzepro SHORT contact
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 5
benzoyl peroxide
ciclopirox treatment
bp foam
clotrimazole
bp wash
clotrimazole/betamethasone dipropionate
bp 10-1
econazole nitrate
bpo foaming cloths
ketoconazole
claravis
nystatin
clindacin etz pledgets
nystatin/triamcinolone
clindacin-p
nystatin/triamcinolone acetonide
clindamycin phosphate
oxiconazole nitrate
clindamycin phosphate/tretinoin
TIER 03 Ertaczo
clindamycin/benzoyl peroxide
Exelderm
dapsone
Halotin
ery
Mentax
erythromycin
Naftin
erythromycin/benzoyl peroxide
Oxistat
isotretinoin
Xolegel
myorisan
neuac
ANTIVIRALS - TOPICAL
pr benzoyl peroxide wash
TIER 01 acyclovir
rosanil cleanser
TIER 02 Denavir
sodium sulfacetamide
TIER 03 Xerese
sodium sulfacetamide/sulfur
Zovirax
sodium sulfacetamide/sulfur cleanser
sodium sulfacetamide/sulfur green
ANTI-INFLAMMATORY AGENTS
sodium sulfacetamide/sulfur wash
TIER 01 diclofenac sodium
sss 10%-5%
klofensaid II
sulfacetamide sodium
TIER 03 FlectorPA
sulfacetamide sodium/sulfur
sulfacetamide sodium/sulfur cleanser
ANTIPRURITICS
sulfamez wash
TIER 03 Camphor
tretinoin
Doxepin HydrochlorideQL,PA
tretinoin microsphere
tretinoin microsphere P.M.
ANTIPSORIATICS
zenatane
TIER 01 acitretin
Sodium Sulfacetamide/Sulfur
calcipotriene
TIER 03 benzoyl peroxide- HC
calcitrene
vanoxide-HC
methoxsalen
Aczone
tazarotene
Azelex
Calcitriol
Benziq
TIER 03 Dritho-creme HP
Benziq LS
Tazorac
Benzoyl Peroxide 8%
TIER 05 CosentyxPA
Clindagel
Cosentyx Sensoready PenPA
Fabior
StelaraPA
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
TaltzPA
Sumaxin CP Kit
TremfyaPA
Zaclir Cleansing
ANTISEBORRHEIC AGENTS
ROSACEA AGENTS
TIER 01 seb-prev wash
TIER 01 metronidazole
selenium sulfide
rosadan
selenium sulfide shampoo
TIER 03 Finacea
sodium sulfacetamide
Noritate
sodium sulfacetamide wash
Rosadan Kit
TIER 03 Glycolic Acid
Soolantra
Glycolic Acid 70% High Purity
Loutrex
ANTIBIOTICS - TOPICAL
Ovace Plus
TIER 01 gentamicin sulfate
Promiseb
mupirocin
TIER 03 Altabax
CORTICOSTEROIDS - TOPICAL
Cortisporin
TIER 01 ala-cort
Neo-synalar
alclometasone dipropionate
augmented betamethasone dipropionate
ANTIFUNGALS - TOPICAL
betamethasone dipropionate
TIER 01 ciclodan
betamethasone valerate
ciclopirox
calcipotriene/betamethasone dipropionate
ciclopirox nail lacquer
clobetasol propionate
ciclopirox olamine
clobetasol propionate e
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 6
clobetasol propionate emollient
lidocaine-prilocaine-cream base
clodan
lidocaine/prilocaine
desonide
lidopin
desoximetasone
lidopril
fluocinolone acetonide
lidopril XR
fluocinolone acetonide body
liprozonepak
fluocinolone acetonide scalp
livixil PAK
fluocinonide
malathion
fluocinonide emulsified base
medolor PAK
flurandrenolide
permethrin
fluticasone propionate
podofilox
halobetasol propionate
port-prep
hydrocortisone
pramox gel
hydrocortisone butyrate
prikaan
hydrocortisone butyrate (lipid)
prikaan lite
hydrocortisone butyrate (lipophilic)
prilolid
hydrocortisone valerate
priloxx LP
hydrocortisone 1% IN absorbase
rea LO 40
mometasone furoate
relador PAK
nolix
relador PAK plus
scalacort
salicylic acid
triamcinolone acetonide
salicylic acid cream
triderm
salicylic acid lotion
Amcinonide
salimez
Apexicon E
salisol forte
Augmented Betamethasone Dipropionate
salitech forte
Clocortolone Pivalate
sodium hyaluronate
Clocortolone Pivalate P.M.
soluline
Diflorasone Diacetate
solupicc
Prednicarbate
umecta mousse
Psorcon
ure-k
Trianex
urea
TIER 03 Capex
urea hydrating
Cordran
urea nail
Desonate
urea-c40
Enstilar
uremez-40
Epifoam
Cem-urea
Halog
Ethyl Chloride
Nucort
Ethyl Chloride/Fine Pinpoint
Pramosone
Ethyl Chloride/Fine Stream
Pramosone E
Ethyl Chloride/Medium Jet Stream
Taclonex
Ethyl Chloride/Medium Stream
Texacort
Ethyl Chloride/Mist
Lindane
IMMUNOMODULATING AGENTS
Podocon 25 IN Benzoin Tincture
Tretinoin Emollient
TIER 01 imiquimod
Urea
tacrolimus
Urea IN Zinc Undecylenate/Lactic Acid Vehicle
TIER 02 Elidel
Urea Topical
TIER 03 lidocaineQL
DERMATOLOGICALS - MISC.
lidocaine PAKQL
TIER 01 agoneaze
lidozion
ammonium lactate
premium lidocaineQL
anodyne lpt
Aluminum Chloride Hexahydrate
benzoin compound tincture
Anacaine
cerovel
Arnica Flower
dermacinrx empricaine
Avage
dermacinrx prizopak
Bensal HP
episone CRE
Benzoin Tincture
glydo
Boric Acid
lactic acid
Coal TAR
lactic acid e
Cocaine HCL
lactic acid w/vitamin e
Condylox
lido bdk
Eurax
lido-k
Gebauers Pain Ease
lido-prilo caine pack
Gebauers Spray And Stretch
lidocaine hydrochloride
Genadur
lidocaine HCL
Gordofilm
lidocaine HCL jelly
Gordons Urea
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 7
Hylira
norethindrone acetate/ethinyl estradiol
Keralyt Scalp
Estropipate
Latrix XM
TIER 02 Climara Pro
Neosalus
Premarin
Pyrogallic Acid
Premphase
Sulfurated Lime
Prempro
Synera
TIER 03 Combipatch
Ulesfia
Depo-estradiol
Urea Nail
Divigel
Veregen
DuaveePA
Elestrin
ENDOCRINE AND METABOLIC
Estrogel
Evamist
CORTICOSTEROIDS
Menest
TIER 01 betamethasone sodium phosphate/betamethasone acetate
Menostar
Prefest
budesonide
deltasone
CONTRACEPTIVES
dexamethasone
dexamethasone sodium phosphate
TIER 01 aftera
fludrocortisone acetate
altavera
hydrocortisone
alyacen 1/35
methylprednisolone
alyacen 7/7/7
methylprednisolone acetate
amethia
methylprednisolone dose pack
amethia LO
prednisolone sodium phosphate
amethyst
prednisolone sodium phosphate odt
apri
prednisone
aranelle
triamcinolone acetonide
ashlyna
Dexamethasone
aubra
Dexamethasone Intensol
aviane
Dexamethasone Sodium Phosphate
azurette
Prednisolone
balziva
Prednisolone Sodium Phosphate
bekyree
Prednisone
blisovi FE 1.5/30
Prednisone Intensol
blisovi FE 1/20
TIER 03 Cortisone Acetate
blisovi 24 FE
Medrol
briellyn
camila
ANDROGENS-ANABOLIC
camrese
camrese LO
TIER 01 danazol
caziant
oxandrolone
chateal
testosteronePA
cryselle-28
testosterone topical solutionPA
cyclafem 1/35
Methyltestosterone
cyclafem 7/7/7
TIER 02 testosterone cypionatePA
cyred
testosterone enanthatePA
dasetta 1/35
AndrogelPA
dasetta 7/7/7
Androgel P.M.PA
daysee
TIER 03 Anadrol-50
deblitane
delyla
ESTROGENS
desogestrel/ethinyl estradiol
TIER 01 amabelz
drospirenone/ethinyl estradiol
covaryx
drospirenone/ethinyl estradiol/levomefolate calcium
covaryx HS
econtra one-step
eemt
econtra EZ
eemt HS
elinest
esterified estrogens/methyltestosterone
emoquette
esterified estrogens/methyltestosterone DS
enpresse-28
esterified estrogens/methyltestosterone HS
enskyce
estradiol
errin
estradiol valerate
estarylla
estradiol/norethindrone acetate
ethynodiol diacetate/ethinyl estradiol
fyavolv
falmina
jevantique LO
fayosim
jinteli
femynor
lopreeza
gianvi
mimvey
heather
mimvey LO
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 8
introvale
pimtrea
isibloom
pirmella 1/35
jencycla
pirmella 7/7/7
jolessa
portia-28
jolivette
previfem
juleber
quasense
junel FE 1.5/30
rajani
junel FE 1/20
react
junel FE 24
reclipsen
junel 1.5/30
rivelsa
junel 1/20
setlakin
kaitlib FE
sharobel
kariva
sprintec 28
kelnor 1/35
sronyx
kelnor 1/50
syeda
kimidess
take action
kurvelo
tarina FE 1/20
larin FE 1.5/30
tilia FE
larin FE 1/20
tri femynor
larin 1.5/30
tri-estarylla
larin 1/20
tri-legest FE
larin 24 FE
tri-linyah
larissia
tri-mili
layolis FE
tri-sprintec
leena
tri-vylibra
lessina
tri-LO-estarylla
levonest
tri-LO-marzia
levonorgestrel
tri-LO-sprintec
levonorgestrel and ethinyl estradiol
trinessa
levonorgestrel/ethinyl estradiol
trinessa LO
levora 0.15/30-28
trivora-28
lillow
tulana
loryna
tydemy
low-ogestrel
velivet
lutera
vienva
lyza
viorele
marlissa
vyfemla
medroxyprogesterone acetateQL
vylibra
melodetta 24 FE
wera
mibelas 24 FE
wymzya FE
microgestin FE
zarah
microgestin FE 1.5/30
zenchent
microgestin 1.5/30
zovia 1/35e
microgestin 1/20
Ogestrel
mili
TIER 02 Nuvaring
mono-linyah
Xulane
mononessa
TIER 03 Depo-subq Provera 104QL
my choice
Ella
my way
LO Loestrin FE
myzilra
necon 0.5/35-28
PROGESTINS
necon 7/7/7
TIER 01 medroxyprogesterone acetate
nikki
megestrol acetate
nora-be
norethindrone acetate
norethindrone
progesterone
norethindrone & ethinyl estradiol ferrous fumarate
TIER 05 MakenaPA
norethindrone acetate/ethinyl estradiol
norethindrone acetate/ethinyl estradiol/ferrous fumarate
ANTIDIABETIC AGENTS
norethindrone/ethinyl estradiol/ferrous fumarate
INSULIN
norgestimate/ethinyl estradiol
TIER 02 Fiasp
norlyda
Fiasp Flextouch
norlyroc
Lantus
nortrel 0.5/35 (28)
Lantus Solostar
nortrel 1/35
Levemir
nortrel 7/7/7
Levemir Flextouch
ocella
Novolin N
opcicon one-step
Novolin N Relion
option 2
Novolin R
orsythia
Novolin R Relion
philith
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 9
Novolin 70/30
INSULIN SENSITIZING AGENT
Novolin 70/30 Relion
TIER 01 pioglitazone HCL
Novolog
TIER 03 AvandiaPA
Novolog Flexpen
ANTIDIABETIC COMBINATIONS
Novolog Mix 70/30
TIER 01 glipizide/metformin HCL
Novolog Mix 70/30 Prefilled Flexpen
glyburide/metformin HCL
Novolog Penfill
pioglitazone HCL-glimepiride
Relion R
pioglitazone HCL/metformin HCL
Toujeo Max Solostar
Repaglinide/Metformin Hydrochloride
Toujeo Solostar
TIER 02 InvokametPA
TIER 03 Admelog
Invokamet XR
Apidra
Janumet
Apidra Solostar
Janumet XRST
Humalog
JentaduetoST
Humalog Junior Kwikpen
Jentadueto XRST
Humalog Kwikpen
SynjardyPA
Humalog Mix 50/50
Synjardy XRPA
Humalog Mix 50/50 Kwikpen
TIER 03 Actoplus Met XR
Humalog Mix 75/25
Humalog Mix 75/25 Kwikpen
BISPHOSPHONATES
Humulin N
TIER 01 alendronate sodium
Humulin N Kwikpen
risedronate sodium
Humulin R
risedronate sodium DR
Humulin R U-500 (concentrated)
Alendronate Sodium
Humulin R U-500 Kwikpen
Etidronate Disodium
Humulin 70/30
TIER 03 ibandronate sodiumST
Humulin 70/30 Kwikpen
AMYLIN ANALOGS
CALCITONINS
TIER 03 Symlinpen 120
TIER 01 calcitonin salmon
Symlinpen 60
calcitonin-salmon
INCRETIN MIMETIC AGENTS
TIER 02 VictozaPA
PARATHYROID HORMONE
TIER 03 BydureonPA
TIER 05 ForteoPA
Bydureon PenPA
NatparaPA
ByettaPA
TymlosPA
SULFONYLUREAS
TIER 01 glimepiride
RANK LIGAND INHIBITORS
glipizide
TIER 05 ProliaPA
glipizide ER
glipizide XL
HORMONE RECEPTOR MDLTR
glyburide
TIER 01 raloxifene hydrochloride
glyburide micronized
TIER 03 OsphenaPA
Chlorpropamide
Tolazamide
FERTILITY REGULATORS
Tolbutamide
TIER 05 BravellePA
TIER 03 Glyburide
Chorionic GonadotropinPA
BIGUANIDES
Follistim AQPA
TIER 01 metformin hydrochloride
Gonal-fPA
metformin hydrochloride ER
Gonal-f RFFPA
metformin HCL
Gonal-f RFF RedijectPA
metformin HCL ER
MenopurPA
TIER 03 Riomet
NovarelPA
MEGLITINIDE ANALOGUES
OvidrelPA
TIER 01 nateglinide
Pregnyl W/Diluent Benzyl Alcohol/NACLPA
repaglinide
DIABETIC OTHER
LHRH/GNRH AGONIST
TIER 02 InvokanaPA
TIER 05 Lupaneta Pack
JardiancePA
Lupron Depot-PED (1-month)PA
TIER 03 CyclosetPA
Lupron Depot-PED (3-month)PA
Glucagen Hypokit
Supprelin LAPA
Glucagon Emergency Kit
Synarel
Proglycem
TIER 05 KorlymPA
GNRH/LHRH ANTAGONISTS
ALPHA-GLUCOSIDASE INHIBIT
TIER 05 CetrotidePA
TIER 01 acarbose
Ganirelix AcetatePA
miglitol
DPP-4 INHIBITORS
GROWTH HORMONES
TIER 02 JanuviaPA
TIER 05
TradjentaPA
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 10
Norditropin CartridgePA
Wp Thyroid
Norditropin FlexproPA
GASTROINTESTINAL
GHRH
LAXATIVES
TIER 05 EgriftaPA
TIER 01 constulose
gavilyte-c
SOMATOMEDINS
gavilyte-h
TIER 05 IncrelexPA
gavilyte-n/flavor pack
gavilyte-G
SOMATOSTATIC AGENTS
lactulose
TIER 05 octreotide acetate
peg 3350/electrolytes
Sandostatin Lar Depot
peg-prep
Signifor
peg-3350/electrolytes
Somatuline Depot
peg-3350/NACL/NA bicarbonate/KCL
pegylax
GH RECEPTOR ANTAGONISTS
polyethylene glycol 3350
trilyte
TIER 05 Somavert
TIER 03 Cascara Sagrada
Colyte-flavor Packs
POSTERIOR PITUITARY
Gialax
TIER 01 desmopressin acetate
Golytely
TIER 03 Stimate
Kristalose
Moviprep
PROLACTIN INHIBITORS
Osmoprep
TIER 01 cabergoline
Prepopik
Suprep Bowel Prep Kit
VASOPRESSIN ANTAGONISTS
TIER 03 Samsca
ANTIDIARRHEALS
TIER 01 diphenoxylate/atropine
PROGESTERONE ANTAGONISTS
loperamide HCL
TIER 03 Mifeprex
Diphenoxylate/Atropine
TIER 03 Motofen
METABOLIC MODIFIERS
TIER 01 calcitriol
ULCER DRUGS
doxercalciferol
TIER 01 atropine sulfate
levocarnitine
belladonna alkaloids/phenobarbital
paricalcitol
cimetidine
sodium phenylbutyrate
dicyclomine HCL
TIER 03 Cystadane
ed-spaz
TIER 05 CarbagluPA
famotidine
KuvanPA
glycopyrrolate
NityrPA
hyoscyamine sulfate
Sensipar
hyoscyamine sulfate odt
hyoscyamine sulfate ER
THYROID AGENTS
hyoscyamine sulfate SR
TIER 01 levo-t
hyosyne
levothyroxine sodium
lansoprazole
levothyroxine/liothyronine
lansoprazole/amoxicillin/clarithromycin
levoxyl
methscopolamine bromide
liothyronine sodium
misoprostol
methimazole
nulev
propylthiouracil
omeprazole
unithroid
omeprazole DR
unithroid direct
oscimin
NP thyroid 120
oscimin SR
NP thyroid 15
pantoprazole sodium
NP thyroid 30
pantoprazole sodium DR
NP thyroid 60
phenohytro
NP thyroid 90
ranitidine HCL
TIER 02 Armour Thyroid
sucralfate
Nature-throid
symax-SL
Nature-throid Nt-2.5
symax-SR
Thyrolar-1
Atropine Sulfate
Thyrolar-1/2
Belladonna & Opium
Thyrolar-1/4
Belladonna Alkaloids & Opium
Thyrolar-2
Cimetidine HCL
Thyrolar-3
Propantheline Bromide
Westhroid
TIER 02 esomeprazole magnesiumQL,PA
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 11
nizatidine
Chenodal
rabeprazole sodium
Dipentum
Nizatidine
Entereg
TIER 03 Carafate
Movantik
Cuvposa
Pentasa
DexilantQL,PA
Phoslyra
Levsin
Procort
Pylera
Rectiv
Symax DuotabQL
Renagel
Symproic
ANTIEMETICS
Uceris
TIER 05 CholbamPA
TIER 01 aprepitantQL
CimziaPA
dronabinol
Cimzia Starter KitPA
granisetron HCLQL
RelistorQL,PA
meclizine HCL
XermeloPA
ondansetron odt
ondansetron HCLQL
GENITOURINARY
scopolamine
trimethobenzamide HCL
URINARY ANTI-INFECTIVES
TIER 03 Akynzeo
TIER 01 me/naphos/mb/hyo 1
AnzemetQL
methenamine hippurate
Cesamet
methenamine mandelate
Emend
nitrofurantoin
SancusoQL
nitrofurantoin macrocrystals
SyndrosPA
nitrofurantoin monohydrate
VarubiQL
nitrofurantoin monohydrate/macrocrystals
phosphasal
DIGESTIVE AIDS
urelle
TIER 02 Creon
uretron d/s
Zenpep
uribel
TIER 03 SucraidPA
urin d/s
uro-mp
GASTROINTESTINAL - MISC.
uro-458
TIER 01 alosetron hydrochloride
uroav-b
ana-lex
uroav-81
balsalazide disodium
uryl
calcium acetate
ustell
colocort
uticap
cromolyn sodium
utira-c
enulose
utrona-c
generlac
vilamit mb
hydrocort ene 100MG
vilevev mb
hydrocortisone
Hyophen
hydrocortisone acetate/pramoxine
Methenamine Mandelate
lactulose
TIER 03 Monurol
lanthanum carbonate
Uta
lidocaine HCL/hydrocortisone acetate
mesalamine
URINARY ANTISPASMODICS
mesalamine DR
TIER 01 bethanechol chloride
metoclopramide HCL
darifenacin hydrobromide ERPA,ST
pramcort
flavoxate HCL
procto-MED HC
oxybutynin chloride
procto-PAK
oxybutynin chloride ER
proctosol HC
tolterodine tartrate
proctozone-HC
tolterodine tartrate ER
sevelamer carbonate
trospium chloride
sulfasalazine
trospium chloride ER
ursodiol
TIER 03 MyrbetriqPA
Lidocaine HCL-hydrocortisone Acetate With Aloe
ToviazPA
TIER 02 Apriso
VesicarePA
Canasa
Cortifoam
VAGINAL PRODUCTS
Linzess
TIER 01 clindamycin phosphate
Proctofoam HC
estradiol
Sfrowasa
metronidazole vaginal
TIER 03 Amitiza
terconazole
Analpram-HC
vandazole
Auryxia
vcf vaginal contraceptivegel
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 12
yuvafem
ferrous sulfate
Miconazole 3
folic acid
Terconazole
gnp folic acid
TIER 02 Clindesse
iron supplement childrens
Encare
kp folic acid
Options Gynol II Vaginal Contraceptive
px folic acid
Premarin
ra folic acid
Shur-seal
sm folic acid
Today Sponge
wee care
Vcf Vaginal Contraceptive Film
yl folic acid
Vcf Vaginal Contraceptive Foam
CVS folic acid
TIER 03 Avc
Hydroxocobalamin
Cleocin
HM folic acid
Crinone
TIER 02 Ferretts IPS
Endometrin
Ferrous Sulfate
Estring
Iron Chews Pediatric
Fem PH
Iron Up
Femring
Nascobal
First-progesterone VGS 100 Compounding Kit
Novaferrum Pediatric Drops
First-progesterone VGS 200 Compounding Kit
TIER 03 Droxia
Gynazole-1
Ferrous Sulfate Heptahydrate
IntrarosaPA
TIER 05 miglustat
Relagard
CerdelgaPA
ElelysoPA
GENITOURINARY - MISC.
GranixPA
LeukinePA
TIER 01 acetic acid 0.25%
Mircera
alfuzosin HCL ER
Mozobil
aminoacetic acid
Neulasta
argyle sterile saline 100ML
Neulasta Onpro Kit
curity sterile saline
Neupogen
cytra k crystals
Nplate
dutasteride
Procrit
dutasteride/tamsulosin hydrochloride
Promacta
dutasteride/tamsulosin HCL
Zarxio
finasteride
glycine
ANTICOAGULANTS
neomycin/polymyxin b sulfates
phenazo
TIER 01 jantoven
phenazopyridine hydrochloride
warfarin sodium
phenazopyridine hydrocholride
TIER 02 Eliquis
phenazopyridine HCL
Eliquis Starter Pack
potassium citrate ER
Xarelto
potassium citrate/citric acid
Xarelto Starter Pack
sodium chloride
TIER 03 Bevyxxa
sodium chloride 0.9%
Pradaxa
sodium citrate/citric acid
TIER 05 enoxaparin sodium
tamsulosin HCL
fondaparinux sodium
taron-crystals
Fragmin
Tricitrates
TIER 02 Elmiron
HEMOSTATICS
TIER 03 Cardura XL
TIER 01 tranexamic acidQL
Cystagon
TIER 03 Amicar
K-phos NO 2
Lithostat
HEMATOLOGICAL - MISC.
Oracit
TIER 01 anagrelide hydrochloride
Potassium Citrate Monohydrate
aspirin/dipyridamole
Rapaflo
cilostazol
Renacidin
clopidogrel
Sorbitol
dipyridamole
Sorbitol-mannitol
pentoxifylline ER
Thiola
prasugrel
TIER 03 Brilinta
HEMATOLOGICAL
TIER 05 AdvatePA
HEMATOPOIETIC AGENTS
AdynovatePA
AfstylaPA
TIER 01 bprotected pedia iron
Alphanate/Von Willebrand Factor Complex/HumanPA
cyanocobalamin
Alphanine SDPA
fa-8
AlprolixPA
ferosul
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 13
BebulinPA
Mucotrol
BenefixPA
Nafrinse Daily/Acidulated
CoagadexPA
Neutrasal
CorifactPA
Oramagicrx
EloctatePA
OravigST
FeibaPA
Salicept
Fibryga
Salivamax
HaegardaPA
Helixate FSPA
NEUROLOGY, CNS, PSYCH
Hemofil MPA
ANTIANXIETY AGENTS
Humate-pPA
TIER 01 alprazolam
IdelvionPA
alprazolam odt
IxinityPA
alprazolam ER
KoatePA
alprazolam XR
Koate-dviPA
buspirone HCL
Kogenate FSPA
chlordiazepoxide HCL
Kogenate FS Bio-setPA
clorazepate dipotassium
Monoclate-pPA
diazepam
MononinePA
diazepam intensol
NovosevenPA
droperidol
Novoseven RtPA
gene-xene TAB 15MG
ProfilninePA
gene-xene TAB 3.75MG
Profilnine SDPA
gene-xene TAB 7.5MG
RecombinatePA
hydroxyzine pamoate
Riastap
hydroxyzine HCL
RixubisPA
lorazepam
Thrombate Iii
lorazepam intensol
Thrombate Iii W/10 ML Sterile Water
meprobamate
Thrombate Iii W/20 ML Sterile Water
oxazepam
XynthaPA
Alprazolam Intensol
Xyntha SolofusePA
Diazepam
Hydroxyzine Pamoate
MOUTH/THROAT/DENTAL AGENT
Oxazepam
TIER 01 cavarest
ANTIDEPRESSANTS
cevimeline HCL
TIER 01 amitriptyline HCL
chlorhexidine gluconate
bupropion hydrochloride
clinpro 5000
bupropion HCL
clotrimazole
bupropion HCL ER
denta 5000 plus
bupropion HCL SR
dentagel
bupropion HCL XL
easygel
citalopram
fluoridex
citalopram hydrobromide
fluoridex daily renewal
clomipramine HCL
fluoridex enhanced whitening
desipramine HCL
fluoridex sensitivity relief
desvenlafaxine ERQL
fluoridex sensitivity relief/sls free
doxepin HCL
lidocaine viscous
escitalopram oxalate
lidocaine HCL viscous
fluoxetine HCL
neutral sodium fluoride
fluvoxamine maleate
nystatin
fluvoxamine maleate ER
oralone dental paste
imipramine pamoate
paroex
imipramine HCL
periogard
mirtazapine
phos-flur
mirtazapine odt
pilocarpine hydrochloride
nefazodone HCL
pilocarpine HCL
nortriptyline hydrochloride
prevident rinse
nortriptyline HCL
topex topical anesthetic
paroxetine HCL
triamcinolone acetonide dental paste
paroxetine HCL ER
Lidocaine HCL
phenelzine sulfate
SF
protriptyline HCL
SF 5000 plus
sertraline hydrochloride
TIER 03 Arestin
sertraline HCL
Bocasal
tranylcypromine sulfate
Debacterol
trazodone hydrochloride
Gelclair
trazodone hydrochorlide
Gelx
trazodone hydrocloride
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 14
trazodone HCL
HYPNOTICS
trimipramine maleate
TIER 01 estazolam
venlafaxine HCLQL
phenobarbital
venlafaxine HCL ER
temazepam
Amoxapine
triazolam
Fluoxetine DR
zaleplonQL
Maprotiline HCL
zolpidem tartrateQL
Nefazodone HCL
Flurazepam HCL
TIER 02 duloxetine hydroclorideQL
Phenobarbital
duloxetine HCLQL
Phenobarbital Sodium
TIER 03 Desvenlafaxine ER
Quazepam
EmsamQL
Triazolam
Khedezla
TIER 02 eszopicloneQL
Marplan
zolpidem tartrate ERQL
Viibryd
TIER 03 Amytal Sodium
Viibryd Starter Pack
Butisol Sodium
Chloral Hydrate
ANTIPSYCHOTICS
Doral
TIER 01 aripiprazoleQL
RozeremQL
aripiprazole odtQL
Seconal Sodium
chlorpromazine HCL
SilenorQL,ST
clozapineQL
clozapine odtQL
ADHD, NARCOLEPSY, ETC.
compro
TIER 01 armodafinilQL,PA,ST
fluphenazine decanoate
atomoxetineQL
fluphenazine HCL
caffeine citrate
haloperidol
dexmethylphenidate hydrochloride
haloperidol decanoate
dexmethylphenidate HCL
haloperidol lactate
dexmethylphenidate HCL ERQL
lithium carbonate
dextroamphetamine sulfateQL
lithium carbonate ER
guanfacine ERPA
loxapine
methamphetamine HCLQL
loxapine succinate
methylphenidate hydrochlorideQL
olanzapineQL
methylphenidate HCLQL
olanzapine odtQL
modafinilQL,PA
paliperidone ERQL
zenzediQL
perphenazine
TIER 02 amphetamine/dextroamphetamineQL
prochlorperazine
dextroamphetamine sulfate ERQL
prochlorperazine maleate
metadate ERQL
quetiapine fumarateQL
methylphenidate hydrochloride ERQL
quetiapine fumarate ERQL
methylphenidate hydrocloride ERQL
risperidoneQL
methylphenidate HCL CDQL
risperidone odtQL
methylphenidate HCL ERQL
risperidone M-TABQL
Methylphenidate HCL ERQL
thioridazine HCL
Methylphenidate HCL ER (LA)
thiothixene
TIER 03 DaytranaQL,PA
trifluoperazine HCL
Quillivant XRQL
ziprasidone HCLQL
VyvansePA
Clozapine Odt
Fluphenazine HCL
ANTICONVULSANTS
Lithium
TIER 01 carbamazepine
Lithium Carbonate
carbamazepine ER
Risperidone OdtQL
clonazepam
TIER 03 Abilify Maintena
clonazepam odt
Aristada
divalproex sodium
Chlorpromazine HCL
divalproex sodium DR
EquetroQL
divalproex sodium ER
FanaptQL
epitol
Fanapt Titration PackQL
ethosuximide
Invega Sustenna
felbamate
Invega Trinza
gabapentin
LatudaQL
lamotrigine
NuplazidPA
lamotrigine odt
RexultiPA
lamotrigine titration
SaphrisQL,PA
lamotrigine ER
VraylarPA
levetiracetam
Zyprexa Relprevv
levetiracetam ER
TIER 05 Risperdal Consta
oxcarbazepine
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 15
phenytoin
Fluoxetine
phenytoin infatabs
Galantamine Hydrobromide
phenytoin sodium extended
Perphenazine/Amitriptyline
primidone
TIER 02 donepezil HCLST
roweepra
TIER 03 ChantixPA
roweepra XR
Chantix Continuing Month PAKPA
tiagabine hydrochloride
Chantix Starting Month PAKPA
topiramate
NuedextaPA
valproic acid
Savella
vigabatrin
Savella Titration Pack
zonisamide
TIER 05 glatiramer acetate
Diazepam Rectal Gel
glatopa
Topiramate ER
tetrabenazinePA
TIER 03 Banzel
AmpyraPA
BriviactPA
AubagioPA
Celontin
Avonex
Dilantin
Avonex Pen
Dilantin Infatabs
Betaseron
Dilantin-125
Copaxone
FycompaPA
GilenyaPA
LyricaPA
Tecfidera
OnfiPA
Tecfidera Starter Pack
Oxtellar XR
XyremPA
Peganone
Sabril
NEUROMUSCULAR AGENTS
Trokendi XRPA
TIER 03 Xeomin
Vimpat
TIER 05 riluzole
BotoxPA
ANTIPARKINSON AGENTS
DysportPA
TIER 01 amantadine HCL
MyoblocPA
benztropine mesylate
bromocriptine mesylate
MUSCULOSKELETAL AGENTS
carbidopa
TIER 01 baclofen
carbidopa/levodopa
carisoprodol
carbidopa/levodopa odt
carisoprodol/aspirin
carbidopa/levodopa ER
carisoprodol/aspirin/codeine
entacapone
cyclobenzaprine hydrochloride
pramipexole dihydrochloride
cyclobenzaprine HCL
pramipexole dihydrochloride ER
dantrolene sodium
rasagiline mesylate
methocarbamol
ropinirole ER
orphenadrine citrate
ropinirole HCL
orphenadrine citrate ER
selegiline HCL
tizanidine hydrochloride
tolcapone
tizanidine HCL
trihexyphenidyl HCL
Chlorzoxazone
Carbidopa/Levodopa/Entacapone
TIER 02 metaxallST
TIER 03 NeuproPA
metaxaloneST
Zelapar
ANTIMYASTHENIC AGENTS
NEUROLOGY, PSYCH - MISC.
TIER 01 pyridostigmine bromide
TIER 01 acamprosate calcium DR
pyridostigmine bromide ER
bupropion HCL SR
Guanidine HCL
disulfiram
TIER 03 Mestinon
donepezil hydrochloride
donepezil hydrochloride odt
OPHTHALMOLOGY AND OTIC
fluoxetine HCL
ANTI-INFECTIVES
galantamine hydrobromide
TIER 01 bacitracin/polymyxin b
galantamine hydrobromide ER
ciprofloxacin HCL
memantine hydrochloride
erythromycin
memantine hydrochloride ER
gatifloxacin
memantine HCL
gentamicin sulfate
memantine HCL titration PAK
levofloxacin
olanzapine/fluoxetineQL
moxifloxacin
pimozide
moxifloxacin hydrochloride
rivastigmine tartrate
moxifloxacin HCL
rivastigmine transdermal system
neo-polycin
Chlordiazepoxide/Amitriptyline
neomycin/bacitracin/polymyxin
Ergoloid Mesylates
neomycin/polymyxin/bacitracin
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 16
neomycin/polymyxin/gramicidin
Lumigan
ofloxacin
Travatan Z
polycin
polymyxin b sulfate/trimethoprim sulfate
CYCLOPLEGIC MYDRIATICS
sodium sulfacetamide
TIER 01 cyclopentolate hydrochloride
sulfacetamide sodium
cyclopentolate HCL
tobramycin
homatropaire
tobramycin sulfate
homatropine HBR
trifluridine
tropicamide
trimethoprim sulfate/polymyxin b sulfate
Atropine Sulfate
Bacitracin
TIER 03 Cyclomydril
Gentak
TIER 03 Azasite
DECONGESTANTS
Besivance
TIER 01 altafrin
Betadine Ophthalmic Prep
phenylephrine HCL
Ciloxan
Moxeza
MIOTICS
Natacyn
TIER 01 pilocarpine HCL
Sulfacetamide Sodium
TIER 03 Phospholine Iodide
Tobrex
Zirgan
ADRENERGIC AGENTS
TIER 01 apraclonidine
ARTIFICIAL TEAR/LUBRICANT
brimonidine tartrate
TIER 03 Lacrisert
TIER 03 Alphagan P
Iopidine
BETA-BLOCKERS
Simbrinza
TIER 01 betaxolol HCL
dorzolamide HCL/timolol maleate
IMMUNOMODULATORS
levobunolol HCL
TIER 02 Restasis
timolol maleate
Restasis Multidose
Carteolol HCL
Metipranolol
LOCAL ANESTHETICS
Timolol Maleate Ophthalmic Gel Forming
TIER 01 altacaine
TIER 03 Betimol
proparacaine HCL
Betoptic-s
tetcaine
Combigan
tetracaine HCL
Timoptic Ocudose
tetravisc
tetravisc forte
OPHTHALMIC STEROIDS
TIER 03 Akten
TIER 01 fluorometholone
neo-polycin HC
OPHTHALMICS - MISC.
neomycin/polymyxin/bacitracin/hydrocortisone
TIER 01 azelastine HCL
neomycin/polymyxin/dexamethasone
cromolyn sodium
prednisolone acetate
diclofenac sodium
sulfacetamide sodium/prednisolone sodium phosphate
dorzolamide HCL
tobramycin/dexamethasone
epinastine HCL
Dexamethasone Sodium Phosphate
ketorolac tromethamine
Neomycin/Polymyxin/Hydrocortisone
olopatadine hydrochloride
Prednisolone Sodium Phosphate
olopatadine HCL
TIER 03 Alrex
Bromfenac
Blephamide
Flurbiprofen Sodium
Blephamide S.o.p.
TIER 03 Alocril
Durezol
Alomide
Flarex
Azopt
FML
Bepreve
FML Forte
Emadine
Lotemax
Ilevro
Maxidex
Lastacaft
Pred Mild
Nevanac
Pred-G
Pazeo
Pred-G S.o.p.
Xiidra
Tobradex
Tobradex ST
OTIC AGENTS
Zylet
TIER 01 acetasol HC
acetic acid
PROSTAGLANDINS
fluocinolone acetonide
TIER 01 latanoprost
fluocinolone acetonide ear drops
Bimatoprost
hydrocortisone/acetic acid
TIER 03
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 17
neomycin/polymyxin/hydrocortisone
kp aspirin
neomycin/polymyxin/HC
meijer aspirin EC
ofloxacin
miniprin low dose
Ciprofloxacin
norwich aspirin
TIER 02 Ciprodex
phrenilin forte
TIER 03 Cipro HC
px aspirin
Coly-mycin S
px enteric aspirin
qc aspirin
OXYTOCICS
qc aspirin low dose
qc chewable aspirin low dose
qc childrens aspirin
TIER 01 methergine
qc enteric aspirin
methylergonovine maleate
ra aspirin
ra aspirin adult low dose
PAIN MANAGEMENT
ra aspirin adult low strength
ANALGESICS - NONNARCOTIC
ra aspirin childrens
TIER 01 adult aspirin regimen
ra aspirin EC
adult aspirin EC low strength
ra aspirin EC adult low strength
aspir-low
ra childrens aspirin
aspir-81
salsalate
aspirin
sm aspirin
aspirin adult low dose
sm aspirin adult low strength
aspirin adult low strength
sm aspirin enteric coated
aspirin childrens
sm aspirin low dose
aspirin enteric coated adult low strength
sm aspirin EC low strength
aspirin low dose
sm childrens aspirin
aspirin low strength
st joseph aspirin
aspirin regimen low dose/adult
st joseph low dose aspirin
aspirin EC
tgt aspirin
aspirin EC low dose
tgt aspirin low dose
aspirin 81
tgt childrens aspirin
aspirin 81 low dose
tgt enteric-coated aspirin
aspirtab
zebutal
bayer advanced aspirin regular strength
Butalbital/Aspirin/Caffeine
bayer aspirin
CVS aspirin
bayer aspirin regimen
CVS aspirin adult low dose
bayer aspirin EC low dose
CVS aspirin adult low strength
bayer chewable low dose
CVS aspirin low dose
bayer low dose
CVS aspirin low strength
butalbital/acetaminophen
CVS aspirin EC
butalbital/acetaminophen/caffeine
CVS enteric aspirin
butalbital/aspirin/caffeine
EC-81 aspirin
childrens aspirin
HM aspirin
childrens aspirin low strength
HM aspirin EC
choline magnesium trisalicylate
HM aspirin EC low dose
diflunisal
MM aspirin
ecotrin
SB aspirin
ecotrin low strength
SB aspirin adult low strength
ecpirin
SB aspirin EC
enteric coated aspirin
SB childrens aspirin
eq adult aspirin low strength
SB low dose asa EC
eq aspirin
Tencon
eq aspirin adult low dose
Vanatol LQ
eq aspirin low dose
Vanatol S
eq aspirin EC
TIER 05 Prialt
eq childrens aspirin
eql aspirin
ANALGESICS - OPIOID
eql aspirin low dose
TIER 01 acetaminophen/codeineQL
eql aspirin EC
acetaminophen/codeine phosphateQL
esgic
ascomp/codeine
gnp adult aspirin low strength
buprenorphine HCL
gnp aspirin
buprenorphine HCL/naloxone HCLPA
gnp aspirin low dose
butalbital/acetaminophen/caffeine/codeine
goodsense aspirin
butalbital/aspirin/caffeine/codeine
goodsense aspirin adult low strength
butorphanol tartrateQL
goodsense aspirin low dose
codeine sulfate
h-e-b aspirin
endocetQL
kls aspirin low dose
fentanyl
kls aspirin EC
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 18
fentanyl citrate oral transmucosalQL,PA
naproxen
hydrocodone bitartrate/acetaminophenQL
naproxen sodium
hydrocodone/acetaminophenQL
naproxen DR
hydrocodone/ibuprofen
oxaprozin
hydromorphone hydrochloride
piroxicam
hydromorphone hydrochloride ER
profeno
hydromorphone HCL
sulindac
hydromorphone HCL ER
Fenoprofen Calcium
ibudone
Ketoprofen
lorcetQL
Ketorolac Tromethamine
lorcet plusQL
Meclofenamate Sodium
lorcet HDQL
Tolmetin Sodium
meperidine HCL
TIER 02 celecoxib
methadone HCL
TIER 03 Indocin
methadone HCL intensol
Ridaura
methadose
TIER 05 ActemraPA
morphine sulfate
EnbrelPA
morphine sulfate ER
Enbrel SureclickPA
oxycodone hydrochloride
HumiraPA
oxycodone HCL
Humira Pediatric Crohns Disease Starter PackPA
oxycodone/acetaminophenQL
Humira PenPA
oxycodone/aspirin
Humira Pen-crohns DiseasestarterPA
oxymorphone hydrochloride
Humira Pen-psoriasis StarterPA
pentazocine/naloxone HCL
KevzaraPA
tramadol hydrochloride/acetaminophenQL
KineretPA
tramadol HCL
OrenciaPA
tramadol HCL ER
Orencia ClickjectPA
verdrocet
OtezlaPA
vicodinQL
SimponiPA
vicodin ESQL
XeljanzPA
vicodin HPQL
Xeljanz XRPA
Codeine Sulfate
Hydromorphone HCL
MIGRAINE PRODUCTS
Levorphanol Tartrate
TIER 01 eletriptan hydrobromideQL,PA,ST
Meperidine HCL
ergotamine tartrate/caffeine
Methadone HCL
naratriptan HCLQL
Morphine Sulfate
rizatriptan benzoateQL
Morphine Sulfate ER
rizatriptan benzoate odtQL
Oxycodone/Ibuprofen
sumatriptanQL
Oxymorphone Hydrochloride ER
sumatriptan succinateQL
TIER 02 Oxycodone HCL ER
sumatriptan succinate refillQL
Oxycontin
zolmitriptanQL
TIER 03 BunavailPA
zolmitriptan odtQL
FentoraQL,PA
TIER 02 almotriptanQL,PA,ST
Kadian
almotriptan malateQL,PA,ST
Lortab
frovatriptan succinateQL,PA,ST
Nucynta
TIER 03 Dihydroergotamine MesylateQL
Oxycodone/AcetaminophenQL
Ergomar
PrimlevQL
Migergot
ZomigQL
ANTI-INFLAMMATORY
TIER 01 diclofenac potassium
GOUT AGENTS
diclofenac sodium DR
TIER 01 allopurinol
diclofenac sodium ER
probenecid
diclofenac sodium/misoprostol
probenecid/colchicine
etodolac
TIER 03 Colchicine
etodolac ER
Colcrys
fenoprofen calcium
DuzalloPA
flurbiprofen
Mitigare
ibu
Uloric
ibuprofen
ZurampicPA
indomethacin
indomethacin ER
LOCAL ANESTHETICS-INJ
ketorolac tromethamine
TIER 01 bupivacaine HCL
leflunomide
bupivacaine/epinephrine
mefenamic acid
chloroprocaine hydrochloride
meloxicam
lidocaine HCL
nabumetone
lidocaine/epinephrine
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 19
polocaine
Desloratadine Odt
polocaine-mpf
TIER 03 Brompheniramine Tannate
ropivacaine
ropivacaine HCL
NASAL AGENTS
sensorcaine
TIER 01 azelastine hydrochloride
sensorcaine-mpf
azelastine HCL
sensorcaine-mpf/epinephrine
fluticasone propionate
sensorcaine/epinephrine
ipratropium bromide
xylocaine dental
mometasone furoate
Ropivacaine Hydrochloride
olopatadine HCL
TIER 03 Mepivacaine HCL
triamcinolone acetonide
Sensorcaine-mpf/Epinephrine
Flunisolide
TIER 03 Adrenalin
RESPIRATORY, ALLERGY, ETC
Beconase AQ
ANTIHISTAMINES
COUGH/COLD/ALLERGY
TIER 01 allergy
TIER 01 acetylcysteine
allergy childrens
benzonatate
allergy relief
biotuss
allergy relief child
biotuss pediatric
allergy relief childrens
bromfed DM
carbinoxamine maleate
bromphen/pseudoephedrine HCL/dextromethorphan HBR
cetirizine HCL
giltuss pediatric
childrens loratadine
hydrocodone bitartrate/homatropine methylbromide
claritin allergy childrens
hydrocodone polistirex/chlorpheniramine polistirex
cyproheptadine hydrochloride
hydrocodone/homatropine
cyproheptadine HCL
hydromet
diphenhydramine HCL
nebusal
eq allergy relief
nortuss-DE
eq allergy relief childrens
promethazine VC plain
eq childrens loratadine
promethazine VC/codeine
eq loratadine
promethazine-DM
eql allergy relief
promethazine/codeine
gnp loratadine
promethazine/dextromethorphan
gnp loratadine childrens
promethazine/phenylephrine
kls allerclear
promethazine/phenylephrine/codeine
kp loratadine
pulmosal
loradamed
sodium chloride
loratadine
tussigon
loratadine childrens
TIER 03 Carbaphen 12
meijer allergy relief
Carbaphen 12 PED
meijer loratadine
Decon-a
pharbedryl
Hypersal
phenadoz
Nortuss-EX
promethazine HCL
Relhist
promethazine HCL plain
Sski
promethegan
px allergy relief
ANTIASTHMATIC/COPD AGENTS
qc allergy relief childrens
qc loratadine allergy relief
TIER 01 albuterol sulfate
ra allergy relief 24 HOUR
albuterol TAB 4MG
ra loratadine
budesonide
ra loratadine childrens
cromolyn sodium
sm allergy relief loratadine
difil-G forte
sm childrens loratadine
ipratropium bromide
sm loratadine
ipratropium bromide/albuterol sulfate
tgt allergy relief
levalbuterol
tgt allergy relief medication
levalbuterol hydrochloride
tgt loratadine childrens
levalbuterol HCL
wal-itin
montelukast sodium
wal-itin childrens
terbutaline sulfate
CVS allergy relief
theochron
CVS allergy relief childrens
theophylline CR
HM loratadine
theophylline ER
HM loratadine childrens
zafirlukast
SB loratadine
zileuton ERST
SB loratadine allergy relief
Albuterol Sulfate ER
TIER 02 desloratadine
Elixophyllin
levocetirizine dihydrochloride
Fluticasone Propionate/SalmeterolPA
TIER 02
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 20
Advair DiskusPA
Bexsero
Advair HFAPA
Engerix-b
Anoro Ellipta
Fluad 2017-2018
Armonair Respiclick 113
Fluarix Quadrivalent 2017-2018
Armonair Respiclick 232
Flublok 2015-2016
Armonair Respiclick 55
Flublok 2017-2018
Arnuity Ellipta
Flucelvax Quadrivalent 2017-2018
Breo ElliptaPA
Flulaval Quadrivalent 2017-2018
Flovent Diskus
Fluvirin 2015-2016QL
Flovent HFA
Fluvirin 2017-2018QL
Incruse Ellipta
Fluzone High-dose PF 2017-2018
Proair HFA
Fluzone Intradermal Quadrivalent 2017-2018
Proair Respiclick
Fluzone Quadrivalent 2017-2018
Pulmicort Flexhaler
Gardasil 9
Serevent Diskus
Havrix
Spiriva Handihaler
Heplisav-b
Spiriva Respimat
Hiberix
SymbicortPA
Ipol Inactivated IPV
Ventolin HFA
M-m-r II
TIER 03 AlvescoST
Menactra
Asmanex HFAST
Menveo
Asmanex Twisthaler 120 Metered DosesST
Pedvax HIB
Asmanex Twisthaler 14 Metered DosesST
Pneumovax 23
Asmanex Twisthaler 30 Metered DosesST
Pneumovax 23/1 Dose
Asmanex Twisthaler 60 Metered DosesST
Prevnar 13
Asmanex Twisthaler 7 Metered DosesST
Proquad
Atrovent HFA
Recombivax HB
Bevespi Aerosphere
Rotarix
Brovana
Rotateq
Combivent Respimat
Trumenba
DalirespPA
Twinrix
Metaproterenol Sulfate
Vaqta
Perforomist
Varivax
QvarST
Qvar RedihalerPA
VITAMINS
Stiolto Respimat
VITAMINS
Striverdi Respimat
TIER 01 aqueous vitamin d infants
Theo-24
bprotected pedia d-vite
Trelegy ElliptaPA
d 1000
Utibron Neohaler
d 10000
ZyfloST
d 2000
TIER 05 NucalaPA
d 400
XolairPA
d 5000
d-1000
RESPIRATORY AGENTS - MISC
d-1000 extra strength
TIER 03 Curosurf
d-2000 maximum strength
Survanta Intratracheal
d-3-5
TIER 05 EsbrietPA
d-400
KalydecoPA
d-5000
OfevPA
decara
OrkambiPA
delta d3
Pulmozyme
dialyvite vitamin d 5000
dialyvite vitamin d3 max
TOXOIDS
d2000 ultra strength
d3
TIER 03 Boostrix
d3 adult
Infanrix
d3 adult gummy
Kinrix
d3 high potency
Pediarix
d3 kids
Quadracel
d3 maximum strength
d3 super strength
VACCINES
d3 ultra strength
d3 vitamin
d3 2000
TIER 02 Flublok Quadrivalent 2017-2018
d3-1000
TIER 03 Acthib
d3-50
Afluria PF 2017-2018
eql vitamin d3
Afluria Quadrivalent 2017-2018
eql vitamin d3 gummies
Afluria 2017-2018QL
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 21
gnp d 1000
CO-natal Fa
gnp d 2000
Elite-OB
gnp vitamin d
Inatal GT
gnp vitamin d maximum strength
M-vit
gnp vitamin d super strength
Multi Prenatal
gnp vitamin d3 extra strength
Mynatal Advance
healthy kids vitamin d3
Mynatal Plus
just d
Mynatal Ultracaplet
kp vitamin d
Mynatal-z
kp vitamin d3
Mynate 90 Plus
maximum d3
Obstetrix EC
nat-rul vitamin d
Perry Prenatal
natural vitamin d-3
Pr Natal 400
optimal-d
Pre-natal Formula
optimal-d pack
Prenaissance Plus
opurity vitamin d
Prenatabs RX
pronutrients vitamin d3
Prenatal
ra vitamin d-3
Prenatal And Iron
sm vitamin d
Prenatal Forte
sm vitamin d3
Prenatal Low Iron
thera-d rapid repletion
Prenatal 19
thera-d 2000
Prenatal-u
vitajoy daily d gummies
PNV-select
vitamin d
PNV-DHA
vitamin d high potency
Se-natal 19
vitamin d 400
Taron-prex
vitamin d-1000
Tricare
vitamin d-1000 maximum strength
Trinatal RX 1
vitamin d-3
Trinate
vitamin d-400
Ultimatecare One
vitamin d3
Vinate II
vitamin d3 adult gummies
Vinate M
vitamin d3 gummies
Vinate One
vitamin d3 gummies adult
Vitafol-OB
vitamin d3 maximum strength
TIER 02 sm prenatal vitamins
vitamin d3 super strength
Atabex Prenatal
vitamin d3 ultra potency
Citranatal Assure
vitamin d3 400
Citranatal B-calm
CVS d3
Citranatal Bloom DHA
CVS vitamin d childrens gummies
Citranatal DHA
CVS vitamin d3
Citranatal 90 DHA
HM vitamin d
Classic Prenatal
HM vitamin d3
Clinical Nutrients Prenatal Formula
PA vitamin d-3
CVS Prenatal
PA vitamin d-3 gummy
Eql Prenatal Formula
TIER 02 Baby Super Daily D3
Ezfe Forte
Baby Vitamin D3 Drops
Gnp Daily Prenatal
Bio-d-mulsion
Gnp Prenatal
Bio-d-mulsion Forte
Goodsense Prenatal Vitamins
CVS Vitamin D3 Drops/Infants
Hemenatal OB + DHA
Ddrops
HM One Daily Prenatal Combo
Decara
HM Prenatal
D3 Dots
Kosher Prenatal Plus Iron
HM Vitamin D3
Kp Prenatal Multivitamins
Mommys Bliss Vitamin D Organic
Kpn Prenatal
Replesta
Nestabs DHA
Replesta Childrens
Niva-plus
Replesta Nx
O-CAL Fa
Sm Vitamin D3 Maximum Strength
Obstetrix DHA
Super Daily D3
One-a-day Womens Prenatal
Thera-d 4000
Preferaob +dha
Vitamelts Vitamin D
Prenatal Complete
Vitamin D3
Prenatal Formula A-free
Wellesse Vitamin D3
Prenatal Multi +dha
Prenatal Multivitamin
MULTIVITAMINS
Prenatal One Daily
Prenatal Plus
TIER 01 Complete Natal DHA
Prenatal Vitamin
Completenate
Prenatal Vitamin & Mineral
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 22
Prenatal Vitamin/Iron
Acti-lance Lite Safety Lancets 28G
Prenatal Vitamins
Acti-lance Special Safety Lancets 17G
Prenatal Vitamins Plus Low Iron
Acti-lance Special Safetylancets 17G
Preplus
Acti-lance Universal Safety Lancets 23G
Px Prenatal Multivitamins
Active 1ST Blood Lancets 30G/Easy Twist CAP
PA Prenatal Formula
Adjustable Lancing Device
PNV Folic Acid + Iron Multivitamin
Advanced Mobile Lancet 30G
PNV Ob+dha
Advocate Insulin Pen Needles
PNV Prenatal Plus Multivitamin
Advocate Insulin Pen Needles 29GX12.7MM
Qc Prenatal
Advocate Insulin Pen Needles 31GX5MM
Ra One Daily
Advocate Insulin Pen Needles 31GX8MM
Ra Prenatal
Advocate Insulin Syringe/U-100/0.3ML/29GX1/2"
Ra Prenatal Formula/Folicacid
Advocate Insulin Syringe/U-100/0.3ML/30GX5/16"
Right Step Prenatal
Advocate Insulin Syringe/U-100/0.3ML/31GX5/16"
Select-ob+dha
Advocate Insulin Syringe/U-100/0.5ML/29GX1/2"
Sm One Daily Prenatal
Advocate Insulin Syringe/U-100/0.5ML/30GX5/16"
Sm Prenatal Vitamins
Advocate Insulin Syringe/U-100/0.5ML/31GX5/16"
Theranatal Core Nutrition
Advocate Insulin Syringe/U-100/1ML/29GX1/2"
Tri-TABS DHA
Advocate Insulin Syringe/U-100/1ML/30GX5/16"
Tricare Prenatal
Advocate Insulin Syringe/U-100/1ML/31GX5/16"
Triveen-duo DHA
Advocate Lancets
Vitafol Ultra
Advocate Lancets 30G
Vitafol-ob+dha
Advocate Lancing Device
Vol-plus
Advocate Rapid-safe Lancing Device
Vp-heme OB + DHA
Advocate Safety Lancets
TIER 03 Nestabs One
Advocate Safety Lancets 26G
Prefera OB
Agamatrix Ultra-thin Lancets 33G
Provida DHA
Alternate Site Lancing Device
Tristart DHA
Aqua Lance Adjustable Lancing Device
Assure Comfort Lancets Ultra Thin 28G
MEDICAL DEVICES
Assure Comfort Lancets Ultra Thin 30G
Assure Haemolance Plus High Flow 18G
DIABETIC SUPPLIES
Assure Haemolance Plus Low Flow 25G
TIER 01 Insulin Syringe 1ML/31G X1/4"
Assure Haemolance Plus Micro Flow 28G
Insulin Syringes 0.3ML/31G X 1/4"
Assure Haemolance Plus Normal Flow 21G
Insulin Syringes 0.5ML/31G X 1/4"
Assure Haemolance Plus Pediatric Blade
Pen Needles 31G X 6MM
Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"
Pen Needles 31G X 8MM
Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2"
Pen Needles 32G X 4MM
Assure Lance Lancets
Pen Needles 32G X 5MM
Assure Lance Lancets 21G
Pen Needles 32G X 6MM
Assure Lance Plus Safety Lancets 25G
TIER 02 Accu-chek Aviva
Assure Lance Plus Safety Lancets 30G
Accu-chek Aviva Plus
Assure Lancets
Accu-chek Compact Plus
Aurora Lancet Super Thin 30G
Accu-chek Compact Test Drum
Aurora Lancet Thin 23G
Accu-chek Fastclix Lancetdevice Kit
Aurora Pen Needles 29GX12MM
Accu-chek Fastclix Lancets
Aurora Pen Needles 31G X 6MM
Accu-chek Guide
Aurora Pen Needles 31G X 8MM
Accu-chek Multiclix Lanc Et Device Kit
Aurora Unifine Pentips/Mini/31GX3/16"
Accu-chek Multiclix Lancets
Aurora Unifine Pentips/32GX5/32"
Accu-chek Safe-t-pro Lancets
Auto-lancet
Accu-chek Safe-t-pro Pluslancets
Auto-lancet Mini
Accu-chek Smartview Strips
Autolet Impression Lancing Device
Accu-chek Soft Touch Lancets
Autolet II Clinisafe
Accu-chek Softclix Lancetdevice Kit
Autolet Lancing Device
Accu-chek Softclix Lancets
Autolet Lite Clinisafe
Accutrend Glucose
Autolet Lite Starter Pack
Onetouch Club Lancets Fine Point
Autolet Mini
Onetouch Combo Pack
Autolet Platforms
Onetouch Delica Lancets Fine 30G
Autolet Plus
Onetouch Delica Lancing Device
AF Lancets Super Thin
Onetouch Finepoint Lancets
B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16"
Onetouch Suresoft Lancing Device/18G
B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16"
Onetouch Suresoft Lancing Device/21G
B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16"
Onetouch Suresoft Lancing Device/28G
B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2"
Onetouch Ultra Blue
B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2"
Onetouch Ultrasoft Lancets
Bayer Microlet Lancets
Onetouch Verio Test Strips
Bayer Microlet 2 Lancing Device
TIER 03 Acti-lance Lancets 28G
Bullseye Mini Safety Lancets
Bullseye Safety Lancets
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 23
BD Autoshield Duo 30G X 3/16"
Careone Insulin Syringes/0.3ML/31G X 5/16"
BD Autoshield 29G X 3/16"
Careone Insulin Syringes/0.5ML/30G X 1/2"
BD Autoshield 29G X 5/16"
Careone Insulin Syringes/0.5ML/31G X 5/16"
BD Insulin Syringe LUER-LOK/U-100/1ML
Careone Insulin Syringes/1ML/30G X 1/2"
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"
Careone Insulin Syringes/1ML/31GX5/16"
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"
Careone Lancet Thin
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"
Careone Lancet Ultra Thin
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"
Careone Unifine Pentips Pen Needles 32GX4MM
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"
Careone Unifine Pentips Plus Pen Needles 29GX12MM
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"
Careone Unifine Pentips Plus Pen Needles 31GX5MM
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"
Careone Unifine Pentips Plus Pen Needles 31GX6MM
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 15/64"
Careone Unifine Pentips Plus Pen Needles 31GX8MM
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16"
Careone Unifine Pentips Plus Pen Needles 32GX4MM
BD Insulin Syringe Safetyglide/U-100/0.5ML/31G X 15/64"
Careone Unifine Pentips 29GX12MM
BD Insulin Syringe Safetyglide/U-100/1ML/31G X 15/64"
Careone Unifine Pentips 31GX5MM
BD Insulin Syringe Safetyglide/1ML/29G X 1/2"
Careone Unifine Pentips 31GX6MM
BD Insulin Syringe Slip Tip/U-100/1ML
Careone Unifine Pentips 31GX8MM
BD Insulin Syringe U-100/0.3ML/29G X 1/2"
Caretouch Lancing Device With Ejector
BD Insulin Syringe Ultra Fine/1ML/30G X 1/2"
Caretouch Pen Needles 31 G X 6 MM
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"
Caretouch Pen Needles 31GX 5MM
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16"
Caretouch Pen Needles 31GX 8MM
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"
Caretouch Pen Needles 32GX 4MM
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"
Caretouch Pen Needles 32GX 5MM
BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64"
Caretouch Twist Lancets 28G
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"
Caretouch Twist Lancets 30G
BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64"
Caretouch Twist Lancets 33G
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"
Cleanlet Lancets 28G
BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64"
Clever Chek Lancets Ultrathin
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"
Clever Chek Lancets Ultrathin 30G
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"
Clever Choice Comfort EZ Insulin Pen Needles 31GX8MM
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"
Clever Choice Comfort EZ Insulin Pen Needles 33GX4MM
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"
Clever Choice Comfort EZ Insulin Syringe/U-100/1ML/31GX5/16"
BD Insulin Syringe Ultrafine/1ML/30G X 1/2"
Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2"
BD Insulin Syringe Ultrafine/1ML/31G X 5/16"
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1"
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 1/2"
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8"
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16"
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2"
Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16"
BD Insulin Syringe/U-100/0.5ML/30G X 1/2"
Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2"
BD Insulin Syringe/U-100/1ML/27G X 1/2"
BD Insulin Syringe/U-100/2ML/27.5G X 5/8"
Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 1/2"
BD Insulin Syringe/U-500/0.5ML/31G X 15/64"
BD Lancet Ultrafine 30G
Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 1/2"
BD Lancet Ultrafine 33G
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2"
Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16"
BD Microtainer Lancets
Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16"
BD Pen Needle/Mini/Ultrafine/31G X 3/16"
Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X 1/2"
BD Pen Needle/Nano/Ultra Fine/32G X 4MM
BD Pen Needle/SHORT/Ultrafine/31G X 5/16"
Clever Choice Comfort EZ Insulin Syringe/1ML/28G X 1/2"
BD Pen Needle/Ultrafine/29G X 12.7MM
Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2"
BD Pen Needle/Ultrafine/29GX1/2" 12.7MM
Clever Choice Comfort EZ Insulin Syringe/1ML/30G X 5/16"
BD Pen Needles SHORT/Ultrafine/31G X 5/16"
BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2"
Clever Choice Comfort EZ Lancets 21G
BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2"
Clever Choice Comfort EZ Lancets 23G
Clever Choice Comfort EZ Lancets 28G
BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16"
Clever Choice Comfort EZ Pen Needles 29GX12MM
BD Ultra-fine Micro Pen Needles 6MM X 32G
Clever Choice Comfort EZ Pen Needles 31GX5MM
BD-insul SYR Mis LO Dose
Clever Choice Comfort EZ Pen Needles 31GX6MM
Cardiocom Lancing Device
Clever Choice Comfort EZ Pen Needles 31GX8MM
Carefine Pen Needle 32GX4MM
Clever Choice Comfort EZ Pen Needles 32GX4MM
Carefine Pen Needles 29GX1/2"
Clever Choice Comfort EZ Pen Needles 32GX5MM
Carefine Pen Needles 30GX5/16"
Clever Choice Comfort EZ Pen Needles 32GX6MM
Carefine Pen Needles 31GX6MM
Clever Choice Comfort EZ Pen Needles 32GX8MM
Carefine Pen Needles 31GX8MM
Clever Choice Comfort EZ Pen Needles 33GX4MM
Carefine Pen Needles 32GX5MM
Clever Choice Comfort EZ Pen Needles 33GX5MM
Carefine Pen Needles 32GX6MM
Clever Choice Comfort EZ Pen Needles 33GX6MM
Careone Advanced Lancing Device
Clever Choice Comfort EZ Pen Needles 33GX8MM
Careone Insulin Syringes/0.3ML/30G X 1/2"
Clickfine Pen Needle Universal/31GX1/4"
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 24
Clickfine Pen Needle Universal/31GX5/16"
Easy Comfort Insulin Syringe/0.5ML/30G X 5/16"
Clickfine Pen Needle 32GX5/32"
Easy Comfort Insulin Syringe/0.5ML/31G X 5/16"
Clickfine Pen Needles/31GX1/4"
Easy Comfort Insulin Syringe/1ML/30G X 5/16"
Clickfine Pen Needles/31GX5/16"
Easy Comfort Insulin Syringe/1ML/31G X 5/16"
Clickfine Universal Pen Needles 31GX5/16"
Easy Comfort Lancets
Coaguchek Lancets
Easy Comfort Lancets 30G/Pull Top
Comfort Assist Insulin Syringe 0.3ML/29G X 1/2"
Easy Comfort Lancets 30G/Thin Top
Comfort Assist Insulin Syringe/0.3ML/30G X 5/16"
Easy Comfort Pen Needles 31GX1/4"
Comfort Assist Insulin Syringe/0.3ML/31G X 5/16"
Easy Comfort Pen Needles 31GX3/16"
Comfort Assist Insulin Syringe/0.5ML/29G X 1/2"
Easy Comfort Pen Needles 31GX5/16"
Comfort Assist Insulin Syringe/0.5ML/30G X 5/16"
Easy Comfort Pen Needles 32GX5/32"
Comfort Assist Insulin Syringe/0.5ML/31G X 5/16"
Easy Glide Pen Needles 33G X 5/32"
Comfort Assist Insulin Syringe/1ML/29G X 1/2"
Easy Mini Eject Lancing Device
Comfort Assist Insulin Syringe/1ML/30G X 5/16"
Easy Mini Lancing Device
Comfort Assist Insulin Syringe/1ML/31G X 5/16"
Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2"
Comfort Assured Lancets Micro Thin 33G
Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2"
Comfort Assured Lancets Super Thin 28G
Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX5/16"
Comfort Lancets
Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16"
CVS Lancets Micro Thin 33G
CVS Lancets Micro-thin 33G
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X 1/2"
CVS Lancets Original
CVS Lancets Thin 26G
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X 5/16"
CVS Lancets Ultra Thin 30G
CVS Lancets Ultra-thin 30G
Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X 1/2"
CVS Lancets 21G
Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X 1/2"
CVS Lancing Device
Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2"
CVS Ultra Thin Lancets
Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2"
Droplet Lancets Ultra Thin 30G
Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2"
Droplet Lancing Device
Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2"
Droplet Pen Needles 29GX10MM
Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16"
Droplet Pen Needles 29GX12MM
Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2"
Droplet Pen Needles 31GX5MM
Easy Touch Insulin Syringe/U-100/1ML/28G X 1/2"
Droplet Pen Needles 31GX6MM
Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2"
Droplet Pen Needles 31GX8MM
Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2"
Droplet Pen Needles 32G X 1/4"
Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16"
Droplet Pen Needles 32G X 3/16"
Easy Touch Insulin Syringe/0.3ML/30G X 5/16"
Droplet Pen Needles 32G X 5/16"
Easy Touch Insulin Syringe/0.3ML/31G X 5/16"
Droplet Pen Needles 32G X 5/32"
Easy Touch Insulin Syringe/0.5ML/29G X 1/2"
Droplet Pen Needles 32GX4MM
Easy Touch Insulin Syringe/0.5ML/30G X 5/16"
Droplet Pen Needles 32GX5MM
Easy Touch Insulin Syringe/1ML/30G X 5/16"
Droplet Pen Needles 32GX6MM
Easy Touch Lancets 21G/Pressure Activated
Droplet Pen Needles 32GX8MM
Easy Touch Lancets 23G/Pressure Activated
Drug Mart Adjustable Lancing Device
Easy Touch Lancets 26G/Pressure Activated
Drug Mart Lancets Thin
Easy Touch Lancets 26G/Pull-top
Drug Mart Lancets Ultra Thin
Easy Touch Lancets 26G/Twist
Drug Mart On-the-go Lancets Gentle 30G
Easy Touch Lancets 28G/Pressure Activated
Drug Mart Unifine Pentips 31GX5MM
Easy Touch Lancets 28G/Pull-top
Drug Mart Unifine Pentipsplus 32GX4MM
Easy Touch Lancets 28G/Twist
Drug Mart Unifine Pentips29G X 12MM
Easy Touch Lancets 30G/Button-activated
Drug Mart Unifine Pentips31GX6MM
Easy Touch Lancets 30G/Pressure Activated
Drug Mart Unifine Pentips31GX8MM
Easy Touch Lancets 30G/Pull-top
Drug Mart Unifine Pentips32GX4MM
Easy Touch Lancets 30G/Twist
Drug Mart Unilet Lancets Super Thin 30G
Easy Touch Lancets 32G/Pressure Activated
Drug Mart Unilet Lancets Ultra Thin 28G
Easy Touch Lancets 32G/Pull-top
Drug Mart Unilet Micro Thin Lancets 33G
Easy Touch Lancets 32G/Twist
Duane Reade Lancet Alternate Site 26G
Easy Touch Lancets 33G/Twist
Duane Reade Lancet Super Thin 30G
Easy Touch Lancing Device/Ejector
Duane Reade Lancet Ultra Thin 28G
Easy Touch Pen Needle 30 G X 5/16"
Duane Reade Unifine Pentips 29G X 12MM
Easy Touch Pen Needles 29GX1/2"
Duane Reade Unifine Pentips 31G X 6MM Ultra SHORT
Easy Touch Pen Needles 31GX1/4"
Duane Reade Unifine Pentips 31G X 8MM SHORT
Easy Touch Pen Needles 31GX5/16"
E-z Ject Lancets
Easy Touch Pen Needles 32GX1/4"
E-z Ject Lancets Color
Easy Touch Pen Needles 32GX3/16"
E-z Ject Lancets Super Thin
Easy Touch Pen Needles 32GX5/32"
E-z Ject Lancets Super Thin 30G
Easy Touch Pen Needles/31G X 3/16"
E-z Ject Lancets Thin 26G
Easy Touch Safety Lancets21G/Pressure Activated
E-z Ject Lancets 21G
Easy Touch Safety Lancets23G/Pressure Activated
E-ZJECT Lancets Micro-thin 33G
Easy Touch Safety Lancets26G/Button Activated
Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"
Easy Touch Safety Lancets26G/Pressure Activated
Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2"
Easy Touch Safety Lancets28G/Button Activated
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 25
Easy Touch Safety Lancets28G/Pressure Activated
Fifty50 Unilet Lancets 33G
Easy Touch Sheathlock Safety Insulin Syringe 1ML/29GX1/2"
Fine 30
Fingerstix Lancets
Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16"
Fora Lancets
Fora Lancing Device
Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16"
Fora Lancing Device/Clearcap
Freds Pharmacy Autolet Lancing Device
Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2"
Freds Pharmacy Unifine Pentips Pen Needles 32GX4MM
Easy Touch 32GX5MM
Freds Pharmacy Unifine Pentips Plus 31GX5MM
Easy Touch 32GX6MM
Freds Pharmacy Unifine Pentips Plus 31GX8MM
Easy Twist & CAP Lancets
Freds Pharmacy Unilet Lancets Super Thin 30G
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2"
Freds Pharmacy Unilet Lancets Ultra Thin 28G
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16"
Freestyle Lancets
Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16"
Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X 5/16"
Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16"
Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2"
Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X 5/16"
Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16"
Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2"
Freestyle Precision Insulin Syringe/U-100/1ML/31G X 5/16"
Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16"
Elite-thin Insulin Syringe/0.3ML/31G X 5/16"
Freestyle Precision Insulin Syringes/U-100/1ML/30G X 5/16"
Elite-thin Insulin Syringe/0.5ML/29G X 1/2"
Freestyle Unistick II Lancets
Elite-thin Insulin Syringe/0.5ML/30G X 5/16"
Genteel Butterfly Touch Lancets
Elite-thin Insulin Syringe/1ML/29G X 5/16"
Genteel Contact Tips/Blue
Elite-thin Insulin Syringe/1ML/30G X 5/16"
Genteel Contact Tips/Clear
Embrace Lancets Ultra Thin 30G
Genteel Contact Tips/Green
Eql Color Lancets Micro Thin 33G
Genteel Contact Tips/Orange
Eql Color Lancets 21G
Genteel Contact Tips/Rainbow
Eql Insulin Syringe/0.3ML/29G X 1/2"
Genteel Contact Tips/Violet
Eql Insulin Syringe/0.3ML/30G X 5/16"
Genteel Contact Tips/Yellow
Eql Insulin Syringe/0.3ML/31G X 5/16"
Genteel Lancing Device/Buff Black
Eql Insulin Syringe/0.5ML/29G X 1/2"
Genteel Lancing Device/Butterfly Blue
Eql Insulin Syringe/0.5ML/30G X 5/16"
Genteel Lancing Device/Glorious Gold
Eql Insulin Syringe/0.5ML/31G X 5/16"
Genteel Lancing Device/Playful Purple
Eql Insulin Syringe/1ML/29G X 1/2"
Genteel Lancing Device/Precious Platinum
Eql Insulin Syringe/1ML/30G X 5/16"
Genteel Lancing Device/Princess Pink
Eql Insulin Syringe/1ML/31G X 5/16"
Genteel Lancing Device/Stately Silver
Eql Super Thin Lancets 30G
Genteel Lancing Device/Willowy White
Eql SHORT Pen Needles 31G X 8MM
Genteel Nozzles
Eql Thin Lancets 26G
Gentle-let GP Lancets
Eql Ultra SHORT Pen Needles 31G X 6MM
Gentle-let Lancets General Purpose Style/Fine Point
Excel Comfort Point Insulin Pen Needles 31G X 4MM
Gentle-let Lancets General Purpose Style/Medium Point
Exel Comfort Point Insulin Pen Needles 29G X 12MM
Gentle-let Lancets Safety Style/Fine Point
Exel Comfort Point Insulin Pen Needles 31G X 6MM
Gentle-let Lancets Safety Style/Medium Point
Exel Comfort Point Insulin Pen Needles 31G X 8MM
Gentle-let Platforms 2.4MM
Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2"
Gentle-let Platforms 3.0MM
Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16"
Global Ease Inject Pen Needles 29GX12MM
Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2"
Global Ease Inject Pen Needles 31GX8MM
Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2"
Global Ease Inject Pen Needles 32GX4MM
Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16"
Global Ease Inject Pen Neeedles 31GX5MM
Exel Comfort Point Insulin Syringe/1ML/28G X 1/2"
Global Easy Glide Insulinsyringe/U-100/0.3ML/31G X 5/16"
Exel Comfort Point Insulin Syringe/1ML/29G X 1/2"
Exel Comfort Point Insulin Syringe/1ML/30G X 5/16"
Global Easy Glide Pen Needles 32GX4MM
EZ Smart Blood Glucose Lancets
Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X 1/2"
EZ-lets Lancets 21G
EZ-lets Lancets 23G
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 1/2"
EZ-lets Lancets 26G Super-soft
EZ-lets Lancets 28G Ultra-soft
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 5/16"
EZ-lets Lancets 30G
Fifty50 Pen Needles 31G X3/16" (5MM)
Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X 5/16"
Fifty50 Pen Needles 31G X5/16" (8MM)
Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X 1/2"
Fifty50 Pen Needles 31GX5MM
Fifty50 Pen Needles/31GX8MM
Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X 1/2"
Fifty50 Pen Needles/32GX4MM
Fifty50 Pen Needles/32GX6MM
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 1/2"
Fifty50 Safety Seal Lancets 30G
Fifty50 Safety Seal Lancets 32G
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 5/16"
Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X 5/16"
Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X 5/16"
Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X 5/16"
Global Inject Ease Insulin Syringe/U-100/1ML/28G X 1/2"
Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16"
Global Inject Ease Insulin Syringe/U-100/1ML/29G X 1/2"
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 26
Global Inject Ease Insulin Syringe/U-100/1ML/30G X 1/2"
H-e-b IN Control Pen Needles 31GX8MM
Global Inject Ease Insulin Syringe/U-100/1ML/30G X 5/16"
H-e-b IN Control Pen Needles/Nano/32GX4MM
Global Inject Ease Insulin Syringe/U-100/1ML/31G X 5/16"
H-e-b IN Control Unifine Pentips Plus 31GX5MM
Global Inject Ease Lancets 28G
H-e-b IN Control Unifine Pentips Plus 32GX4MM
Global Inject Ease Lancets 30G
Haemolance
Global Insulin Syringe/U-100/0.3ML/30G X 1/2"
Haemolance Low Flow Lancets
Global Insulin Syringes/U-100/0.3ML/30GX5/16"
Haemolance Plus
Global Lancing Device
Haemolance Plus High Flow
Glucocom Lancets 28G
Haemolance Plus Low Flow
Glucocom Lancets 30G
Haemolance Plus Max Flow
Glucocom Lancets 33G
Haemolance Plus Pediatric Flow
Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2"
Health Care Lancing Device
Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16"
Healthwise Mini Pen Needles 31GX6MM
Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16"
Healthwise Pen Needles 29GX12MM
Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2"
Healthwise SHORT Pen Needles 31GX8MM
Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16"
Healthwise Unifine Pentips Pen Needles 32GX4MM
Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16"
Healthy Accents Autolet Impression Lancing Device
Glucopro Insulin Syringe/U-100/1ML/30G X 1/2"
Healthy Accents Unifine Pentips Pen Needles 29GX12MM
Glucopro Insulin Syringe/U-100/1ML/30G X 5/16"
Healthy Accents Unifine Pentips Pen Needles 31GX5MM
Glucopro Insulin Syringe/U-100/1ML/31G X 5/16"
Healthy Accents Unifine Pentips Pen Needles 31GX6MM
Gnp Clickfine Pen Needle Universal/31GX5/16"
Healthy Accents Unifine Pentips Pen Needles 31GX8MM
Gnp Clickfine Universal Pen Needles 31GX1/4"
Healthy Accents Unifine Pentips Pen Needles 32GX4MM
Gnp Clickfine Universal Pen Needles 31GX5/16"
Healthy Accents Unilet Lancets Super Thin 30G
Gnp Insulin Syringe/0.3ML/29G X 1/2"
Hy-vee Lancets
Gnp Insulin Syringe/0.3ML/30G X 5/16"
Hy-vee Thin Lancets
Gnp Insulin Syringe/0.3ML/31G X 5/16"
Hypolance AST Lancing Kit
Gnp Insulin Syringe/0.5ML/28G X 1/2"
Insulin Syringe/Needle 0.3ML/30G X 5/16"
Gnp Insulin Syringe/0.5ML/29G X 1/2"
Insulin Syringe/Needle 0.3ML/31G X 5/16"
Gnp Insulin Syringe/0.5ML/30G X 5/16"
Insulin Syringe/Needle 0.5ML/29G X 1/2"
Gnp Insulin Syringe/0.5ML/31G X 5/16"
Insulin Syringe/Needle 0.5ML/30G X 5/16"
Gnp Insulin Syringe/1ML/28G X 1/2"
Insulin Syringe/Needle 0.5ML/31G X 5/16"
Gnp Insulin Syringe/1ML/29G X 1/2"
Insulin Syringe/Needle 1ML/29G X 1/2"
Gnp Insulin Syringe/1ML/30G X 5/16"
Insulin Syringe/Needle 1ML/30G X 5/16"
Gnp Insulin Syringe/1ML/31G X 5/16"
Insulin Syringe/Needle 1ML/31G X 5/16"
Gnp Lancets
Insulin Syringe/U-100/0.3ML/29G X 1/2"
Gnp Lancets Micro Thin 33G
Insulin Syringe/U-100/0.5ML/29G X 1/2"
Gnp Lancets Super Thin 30G
Insulin Syringe/U-100/1ML/29G X 1/2"
Gnp Lancets Thin
Insulin Syringe/U-100/1ML/30G X 5/16"
Gnp Lancets Thin 26G
Insulin Syringe/U-100/1ML/31G X 5/16"
Gnp Lancets 21G
Insulin Syringe/0.3ML/29G X 1/2"
Gnp Micro Thin Lancets 33G
Insulin Syringe/0.3ML/29G X 1"
Gnp Super Thin Lancets/30G
Insulin Syringe/0.3ML/30G X 5/16"
Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"
Insulin Syringe/0.3ML/31G X 5/16"
Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" SHORT
Insulin Syringe/0.5ML/27G X 1/2"
Insulin Syringe/0.5ML/28G X 1/2"
Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" SHORT
Insulin Syringe/0.5ML/30G X 1/2"
Insulin Syringe/0.5ML/30G X 5/16"
Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"
Insulin Syringe/0.5ML/31G X 5/16"
Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"
Insulin Syringe/1ML/28G X 1/2"
Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORT
Insulin Syringe/1ML/29G X 1/2"
Insulin Syringe/1ML/30G X 5/16"
Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT
Insulin Syringes/0.5ML/27GX1/2"
Insulin Syringes/0.5ML/28GX1/2"
Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2"
Insulin Syringes/0.5ML/29GX1/2"
Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2"
Insulin Syringes/0.5ML/30GX5/16"
Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORT
Insulin Syringes/0.5ML/31GX 5/16"
Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" SHORT
Insulin Syringes/0.5ML/31GX5/16"
Insulin Syringes/1ML/27GX/1/2"
Goodsense Lancets Micro-thin 33G
Insulin Syringes/1ML/27GX1/2"
Goodsense Lancets Ultra-thin 30G
Insulin Syringes/1ML/28GX1/2"
Goodsense Lancing Device
Insulin Syringes/1ML/29GX1/2"
Goodsense Universal 1 Micro Thin 33G
Insulin Syringes/1ML/30GX1/2"
Goodsense Universal 1 Micro-thin 33G
Insulin Syringes/1ML/31GX5/16"
Goodsense Universal 1 Thin 26G
Insupen Pen Needles 32G X4MM
H-e-b Incontrol Advanced Lancing Device
Insupen Sensitive 32GX6MM
H-e-b Incontrol Lancets Micro Thin 33G
Insupen Sensitive 32GX8MM
H-e-b Incontrol Lancets Super Thin 30G
Insupen Ultrafin 29GX12MM
H-e-b Incontrol Lancets Ultra Thin 28G
Insupen Ultrafin 30GX8MM
H-e-b Incontrol Pen Needles 29GX12MM
Insupen Ultrafin 31GX6MM
H-e-b IN Control Pen Needles 31GX5MM
Insupen Ultrafin 31GX8MM
H-e-b IN Control Pen Needles 31GX6MM
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 27
Insupen 29G X 12MM
Leader Insulin Syringe/0.5ML/30G X 5/16"
Insupen 31G X 5MM
Leader Insulin Syringe/0.5ML/31G X 5/16"
Insupen 31G X 8MM
Leader Insulin Syringe/1ML/28G X 1/2"
Insupen 32G X 4MM
Leader Insulin Syringe/1ML/29G X 1/2"
Insupen 33GX4MM
Leader Insulin Syringe/1ML/30G X 5/16"
IN Touch Lancing Device
Leader Insulin Syringe/1ML/31G X 5/16"
IN Touch Sterile Lancets 30G
Leader Lancets Colored
Kinney Lancets
Leader Super Thin Lancet
Kinney Thin Lancets
Leader Thin Lancets
Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16"
Leader Unifine Pentips Plus/Mini/31GX3/16"
Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16"
Leader Unifine Pentips Plus/SHORT/31GX5/16"
Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16"
Leader Unifine Pentips/Mini/31GX3/16"
Kinray Insulin Syringe/0.5ML/29G X 1/2"
Leader Unifine Pentips/Nano/32GX5/32"
Kmart Valu Plus Insulin Syringe/0.3ML/30G
Leader Unifine Pentips/Plus/32GX5/32"
Kmart Valu Plus Insulin Syringe/0.5ML/29G
Liberty Medical Lancets 30G
Kmart Valu Plus Insulin Syringe/0.5ML/30G
Liberty Mini Lancing Device
Kmart Valu Plus Insulin Syringe/1ML/29G
Lifescan Unistik II Lancets
Kmart Valu Plus Insulin Syringe/1ML/30G
Lifescan Unistik 2 Deep Penetration
Kroger Insulin Syringe/0.3ML/29G X 1/2"
Lite Touch Lancets
Kroger Insulin Syringe/0.3ML/30G X 5/16"
Lite Touch Lancing Pen
Kroger Insulin Syringe/0.3ML/31G X 5/16"
Lite Touch Pen Needles/31G X 3/16"
Kroger Insulin Syringe/0.5ML/29G X 1/2"
Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2"
Kroger Insulin Syringe/0.5ML/30G X 5/16"
Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2"
Kroger Insulin Syringe/0.5ML/31G X 5/16"
Litetouch Insulin Syringe/U-100/1ML/28G X 1/2"
Kroger Insulin Syringe/1ML/29G X 1/2"
Litetouch Insulin Syringe/U-100/1ML/29G X 1/2"
Kroger Insulin Syringe/1ML/30G X 5/16"
Litetouch Insulin Syringe/U-100/1ML/31G X 5/16"
Kroger Insulin Syringe/1ML/31G X 5/16"
Litetouch Insulin Syringe/0.3ML/29G X 1/2"
Kroger Lancets
Litetouch Insulin Syringe/0.3ML/30G X 5/16"
Kroger Lancets Micro Thin33G
Litetouch Insulin Syringe/0.3ML/31G X 5/16"
Kroger Lancets Super Thin
Litetouch Insulin Syringe/0.5ML/30G X 5/16"
Kroger Lancets Thin
Litetouch Insulin Syringe/0.5ML/31G X 5/16"
Kroger Lancets Thin 26G
Litetouch Insulin Syringe/1ML/30G X 5/16"
Kroger Lancets Ultrathin 30G
Litetouch Lancets Micro Thin 33G
Kroger Lancets 21G
Litetouch Pen Needles 29GX12.7MM
Kroger Lancing Device
Litetouch Pen Needles 31G X 6MM
Kroger Pen Needles 29G X 12MM
Litetouch Pen Needles 31GX8MM SHORT
Kroger Pen Needles 31G X 8MM
Live Better Advanced Lancing Device
Kroger Pen Needles 31GX1/4"
Live Better Lancet Super Thin 30G
Lancet Device Adjustable
Live Better Lancet Ultra Thin 28G
Lancet Device With Ejector
Live Better Pen Needles 29G X 12MM
Lancet Transporter Case
Live Better Pen Needles 31G X 12MM
Lancets
Live Better Pen Needles 31G X 6MM
Lancets Bullseye Safety
Longs Insulin Syringe/0.5ML/31G X 5/16"
Lancets Micro Thin 33G
Longs Lancets Standard
Lancets Safety Seal 21G
Longs Lancets Thin
Lancets Safety Seal 26G
Longs Lancets Ultra Thin
Lancets Safety Seal 28G
Magellan Insulin Safety Syringe/U-100/0.3ML/29G X 1/2"
Lancets Safety Seal 30G
Magellan Insulin Safety Syringe/U-100/0.3ML/30G X 5/16"
Lancets Super Thin 28G
Magellan Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"
Lancets Thin
Magellan Insulin Safety Syringe/U-100/0.5ML/30G X 5/16"
Lancets Twist Top
Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2"
Lancets Ultra Fine
Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16"
Lancets Ultra Thin
Marathon Medical Pentips 29GX12MM
Lancets Ultra Thin 30G
Marathon Medical Pentips 31GX5MM
Lancets 26G Twist Top
Marathon Medical Pentips 31GX8MM
Lancets 28G
Marathon Medical Pentips 32GX4MM
Lancets 30G
Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2"
Lancets 30G Twist Top
Maxi-comfort Insulin Syringe/U-100/1ML/28GX1/2"
Lancets 30G/Twist Top
Medic Insulin Syringe/0.3ML/30G X 5/16"
Lancets 31G Twist Top
Medic Insulin Syringe/0.5ML/30G X 5/16"
Lancets 33G Universal Design
Medichoice Pre-set Safety Lancet Dual Use
Lancing Device
Medichoice Pre-set Safety Lancet Low Flow
Lancing Device Adjustable
Medichoice Pre-set Safety Lancet Medium Flow
Lanzo
Medichoice Pre-set Safety Lancet Moderate Flow
Leader Advanced Lancing Device
Medichoice Safety Lancet Extra
Leader Insulin Syringe/0.3ML/29G X 1/2"
Medichoice Safety Lancet Normal
Leader Insulin Syringe/0.3ML/30G X 5/16"
Medicine Shoppe Lancets
Leader Insulin Syringe/0.3ML/31G X 5/16"
Medicine Shoppe Lancets Thin
Leader Insulin Syringe/0.5ML/28G X 1/2"
Medicine Shoppe Pen Needles 29G X 12MM
Leader Insulin Syringe/0.5ML/29G X 1/2"
Medicine Shoppe Pen Needles 31G X 6MM
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 28
Medicine Shoppe Pen Needles 31G X 8MM
MM Insulin Syringe/U-100/1ML/30G X 5/16"
Medisense Thin Lancets
MM Insulin Syringe/U-100/1ML/31G X 5/16"
Medlance Plus Extra Lancets 21G
MM Lancing Device
Medlance Plus Lancets
MM Pen Needles 31G X 1/4"
Medlance Plus Lancets Lite 25G
MM Pen Needles 31G X 3/16"
Medlance Plus Lite Lancets 25G
MM Pen Needles 31G X 5/16"
Medlance Plus Special Lancets 0.8MM
MM Pen Needles 32G X 5/32"
Medlance Plus Superlite 30G
MM Twist Lancets
Medlance Plus Superlite 30G/Comfort Max
MS Insulin Syringe/0.3ML/29G X 1/2"
Medlance Plus Universal Lancets 21G
MS Insulin Syringe/0.3ML/30G X 5/16"
Medlance Plus/Lite 25G
MS Insulin Syringe/0.3ML/31G X 5/16"
Medlance/Extra
MS Insulin Syringe/0.5ML/29G X 1/2"
Medlance/Lite
MS Insulin Syringe/0.5ML/30G X 5/16"
Medlance/Universal
MS Insulin Syringe/0.5ML/31G X 5/16"
Meijer Color Lancets Universal 33G
MS Insulin Syringe/1ML/29G X 1/2"
Meijer Lancets
MS Insulin Syringe/1ML/30G X 5/16"
Meijer Lancets Thin
MS Insulin Syringe/1ML/31G X 5/16"
Meijer Lancets Universal 21G
Nova Safety Lancets 23G
Meijer Lancets Universal 30G
Nova Safety Lancets 28G
Meijer Lancets Universal 33G
Nova Sureflex Lancets
Meijer Pen Needles 29G X 12MM
Nova Sureflex Lancing Device
Meijer Pen Needles 31G X 6MM
Novofine Autocover 30GX8MM
Meijer Pen Needles 31G X 8MM
Novofine Plus 32GX4MM
Meijer Super Thin Lancets
Novofine 32GX6MM
Microlet Lancets
Novotwist 32GX5MM
Microlet Next
On Call Lancets
Microtainer Safety Flow Lancet/Sterile/Single-use
On Call Lancing Device
Mini Lancing Device
On Call Plus Lancets
Monoject Insulin Syringe Regular LUER Tip/Softpack/1ML
On Call Plus Lancing Device
Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8"
Onetouch Delica Lancets Extra Fine 33G
Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2"
Pen Needles 29G X 12MM
Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X 1/2"
Pen Needles 29GX1/2"
Pen Needles 30GX5/16"
Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2"
Pen Needles 30GX5MM
Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2"
Pen Needles 30GX8MM
Pen Needles 31G X 1/4" SHORT
Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2"
Pen Needles 31G X 3/16"
Pen Needles 31G X 5MM
Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X 1/2"
Pen Needles 31GX5/16"
Pen Needles 31GX6MM (1/4")
Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X 1/2"
Pen Needles 31GX8MM
Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X 1/2"
Pen Needles 31GX8MM (5/16")
Pen Needles 32GX4MM
Monoject Insulin Syringe/Softpack/1ML/27G X 1/2"
Penlet II Automatic Bloodsampler
Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16"
Penlet II Replacement CAPS
Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16"
Penlet II Replacement CAPS-deep
Monoject Insulin Syringe/U-100/1ML/28G X 1/2"
Penlet II Replacement CAPS-regular
Monoject Insulin Syringe/U-100/1ML/30G X 5/16"
Pentips 29G X 12MM
Monoject Insulin Syringe/1ML
Pentips 29GX12MM
Monoject Insulin Syringe/1ML/31G X 5/16"
Pentips 31G X 5MM
Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"
Pentips 31G X 8MM
Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"
Pentips 31GX5MM
Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"
Pentips 31GX6MM
Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"
Pentips 31GX8MM
Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"
Pentips 32G X 4MM
Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"
Pentips 32GX4MM
Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"
Perfect Lancets 30G
Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2"
Perfect Pressure Activated Safety Lancets 28G
Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2"
Pharmacist Choice Ultra Thin Lancets
Monojector End CAPS
Pharmacist Choice Ultra Thin Lancets 28G
Monojector Opd End CAPS
Pharmacist Choice Ultra Thin Lancets 30G
Monolet Lancets
Pharmacist Choice Ultra Thin Lancets 31G
Monolet Opd Lancets
Pharmacist Choice Ultra Thin Lancets 33G
Monolettor Safety Lancets
Pharmacy Counter Lancets
Multi-lancet Device
Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16"
Multi-lancet Device 2
Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2"
Myglucohealth Mgh Softlance Lancets 30G
Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2"
MM Insulin Syringe/U-100/0.3ML/30G X 5/16"
Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8"
MM Insulin Syringe/U-100/0.3ML/31G X 5/16"
Precision Sure-dose Insulin Syringe/1ML/28G X 1/2"
MM Insulin Syringe/U-100/1/2ML/30G X 5/16"
MM Insulin Syringe/U-100/1/2ML/31G X 5/16"
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 29
Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X 1/2"
Qc Pen Needles 31G X 6MM
Qc Pen Needles 31G X 8MM
Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2"
Qc Unifine Pentips 32GX4MM
Precision Thins GP Lancet
Qc Unilet Lancets 28G/Ultra Thin
Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2"
Qc Unilet Lancets 33G/Micro Thin
Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16"
Ra E-ZJECT Color Lancets Micro-thin 33G
Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2"
Ra E-ZJECT Lancets Thin 26G
Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2"
Ra E-ZJECT Lancets Thin 28G
Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16"
Ra E-ZJECT Lancets Ultra Thin 30G
Preferred Plus Insulin Syringe/U-100/1ML/28G X 1/2"
Ra E-ZJECT Lancets 28G
Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2"
Ra Insulin Syringe/U-100/0.5ML/30G X 5/16"
Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16"
Ra Insulin Syringe/U-100/1 ML/30G X 5/16"
Preferred Plus Lancets Colored 21G
Ra Insulin Syringe/0.5ML/29G X 1/2"
Preferred Plus Lancets Super Thin 30G
Ra Insulin Syringe/1ML/29G X 1/2"
Preferred Plus Lancets Thin 26G
Ra Lancing Device
Preferred Plus Unifine Pentips 29G X 12MM
Ra Pen Needles 31G X 5MM 3/16"
Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORT
Ra Pen Needles 31G X 8MM 5/16"
Preferred Plus Unifine Pentips 31G X 8MM SHORT
Readylance Safety Lancets/21G/2.2MM
Preferred Plus Unifine Pentips 32GX4MM
Readylance Safety Lancets/23G/1.8MM
Preferred Plus Unifine Pentips/Mini/31GX5MM
Readylance Safety Lancets/26G/1.8MM
Pressure Activated Safetylancet 21G
Readylance Safety Lancets/28G/1.8MM
Pro Comfort Insulin Syringes/0.5ML/30G X 1/2"
Readylance Safety Lancets/30G/1.6MM
Pro Comfort Insulin Syringes/0.5ML/30G X 5/16"
Reality Insulin Syringe/U-100/0.5ML/28G X 1/2"
Pro Comfort Insulin Syringes/0.5ML/31G X 5/16"
Reality Insulin Syringe/U-100/0.5ML/29G X 1/2"
Pro Comfort Insulin Syringes/1ML/30G X 1/2"
Reality Insulin Syringe/U-100/1ML/28G X 1/2"
Pro Comfort Insulin Syringes/1ML/30G X 5/16"
Reality Insulin Syringe/U-100/1ML/29G X 1/2"
Pro Comfort Insulin Syringes/1ML/31G X 5/16"
Reality Lancets
Pro Comfort Lancets 30G
Reality Trigger Lancets
Pro Comfort Lancets 31G
Relion Insulin Syringe 0.5ML/31G X 15/64"
Pro Comfort Pen Needles/ 31G X 8MM
Relion Insulin Syringe 1ML/31GX15/64"
Pro Comfort Pen Needles/ 32G X 4MM
Relion Insulin Syringe/U -100/0.5ML/29G
Pro Comfort Pen Needles/ 32G X 5MM
Relion Insulin Syringe/U-00/1ML/29G X 1/2"
Pro Comfort Pen Needles/ 32G X 6MM
Relion Insulin Syringe/U-100/0.3ML/29G
Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16"
Relion Insulin Syringe/U-100/0.3ML/29G X 1/2"
Prodigy Insulin Syringe/1/2ML/31G X 5/16"
Relion Insulin Syringe/U-100/0.3ML/30G
Prodigy Insulin Syringe/1ML/28G X 1/2"
Relion Insulin Syringe/U-100/0.3ML/30G X 5/16"
Prodigy Lancing Device
Relion Insulin Syringe/U-100/0.3ML/31G X 15/64"
Prodigy Pressure Activated Safety Lancets
Relion Insulin Syringe/U-100/0.3ML/31G X 5/16"
Prodigy Safety Lancets
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"
Prodigy Twist Top Lancets
Relion Insulin Syringe/U-100/0.5ML/30G
Pss Select GP Lancets
Relion Insulin Syringe/U-100/0.5ML/30G X 5/16"
Pss Select Platforms
Relion Insulin Syringe/U-100/0.5ML/31G X 5/16"
Pss Select Safety Lancets
Relion Insulin Syringe/U-100/1ML/30G
Push Button Safety Lancets 21G
Relion Insulin Syringe/U-100/1ML/30G X 5/16"
Push Button Safety Lancets 28G
Relion Insulin Syringe/U-100/1ML/31G X 15/64"
Px Advanced Lancing Device
Relion Insulin Syringe/U-100/1ML/31G X 5/16"
Px Extra SHORT Pen Needles 31GX6MM
Relion Lancets Micro-thin33G
Px Insulin Syringe/U-100/0.5ML/30G X 1/2"
Relion Lancets Standard 21G
Px Lancet Auto Injector
Relion Lancets Thin 26G
Px Lancets Ultra Thin
Relion Lancets Ultra-thin30G
Px Lancets Ultra Thin 28G
Relion Lancing Device
Px Mini Pen Needles 31GX5MM
Relion Mini Pen Needles 31GX6MM
Px Pen Needle 29GX12MM
Relion Pen Needles 29GX12MM
Px Pen Needle 31GX8MM
Relion Pen Needles 31GX6MM
Px Shortlength Pen Needles/31GX8MM
Relion Pen Needles 31GX8MM
PC Lancets Super Thin 30G
Relion Pen Needles 32GX4MM
PC Unifine Pentips 29G X 1/2"
Relion SHORT Pen Needles 31GX8MM
PC Unifine Pentips 31G X 5MM Mini
Relion Thin Lancets
PC Unifine Pentips 31G X 6MM Ultra SHORT
Relion Ultra Thin Lancets
PC Unifine Pentips 31G X 8MM SHORT
Relion Ultra Thin Lancets30G
Qc Advanced Lancing Device
Relion Ultra Thin Plus Lancets 32G
Qc Insulin Syringe/0.3ML/29G X 1/2"
Relion Ultra Thin Plus Lancets 33G
Qc Insulin Syringe/0.5ML/29G X 1/2"
Relion 2-IN-1 Lancing Device 25G
Qc Insulin Syringe/0.5ML/31G X 5/16"
Relion 2-IN-1 Lancing Device 30G
Qc Insulin Syringe/1ML/29G X 1/2"
Rexall Lancets Ultra Thin
Qc Insulin Syringe/1ML/31G X 5/16"
Rightest Gl300 Lancets
Qc Lancets
Rightest GD-L500 Alternate Site Adapter
Qc Lancets Super Thin
Rightest GD500 Lancing Device
Qc Lancets Thin
Safe-t-lance Low Flow 25G
Qc Lancets Ultra Thin
Safe-t-lance Normal Flow 21G
Qc Pen Needles 29G X 12MM
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 30
Safe-t-lance Plus Safety Lancet High Flow
Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"
Safe-t-lance Plus Safety Lancet Low Flow
Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"
Safe-t-lance Plus Safety Lancet Normal Flow
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"
Safesnap Insulin Syringe/0.3ML/30G X 5/16"
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"
Safesnap Insulin Syringe/0.5ML/29G X 1/2"
Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16
Safesnap Insulin Syringe/0.5ML/30G X 5/16"
Sure Comfort Insulin Syringe/U-100/1ML/28G X 1/2"
Safesnap Insulin Syringe/1ML/28G X 1/2"
Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2"
Safesnap Insulin Syringe/1ML/29G X 1/2"
Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2"
Safety Insulin Syringes 0.5ML/29GX1/2"
Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16"
Safety Insulin Syringes 0.5ML/30GX5/16"
Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16"
Safety Insulin Syringes 1ML/27GX1/2"
Sure Comfort Insulin Syringes/U-100/1ML/31GX6MM
Safety Insulin Syringes 1ML/29GX1/2"
Sure Comfort Insulin Syringes/0.5ML/31G X 6MM
Safety Insulin Syringes 1ML/30GX1/2"
Sure Comfort Lancets 18G
Safety Lancet 21G/Pressure Activated
Sure Comfort Lancets 21G
Safety Lancet 28G/Pressure Activated
Sure Comfort Lancets 23G
Safety Lancets
Sure Comfort Lancets 28G
Safety Lancets 21G
Sure Comfort Lancets 30G
Safety Lancets 28G
Sure Comfort Lancing Pen
Safety Let Lancets
Sure Comfort Pen Needles 29GX1/2" 12.7MM
Safety Seal Lancets 28G
Sure Comfort Pen Needles 30GX5/16" SHORT
Safety Seal Lancets 30G
Sure Comfort Pen Needles 31GX3/16" (5MM)
Safety-glide Insulin Syringe/0.3ML/29G X 1/2"
Sure Comfort Pen Needles 31GX5/16" (8MM)
Saps Health Twist Top Lancets 30G
Sure Comfort Pen Needles 32GX5/32"
Sapscare Twist Top Lancets 30G
Sure Comfort Pen Needles 32GX6MM
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X 1/2"
Sure-fine Pen Needles 29GX1/2" 12.7MM
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X 5/16"
Sure-fine Pen Needles 31GX3/16" 5MM
Sure-fine Pen Needles 31GX5/16" 8MM
Select-lite Device/Lancets
Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2"
Select-lite Lancing Device
Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16"
Shopko Autolet Lancing Device
Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16"
Shopko On-the-go Comfort Lancets 30G
Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2"
Shopko Unifine Pentips Pen Needles/Micro/32GX4MM
Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2"
Shopko Unifine Pentips Pen Needles/Mini/31GX5MM
Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16"
Shopko Unifine Pentips Pen Needles/Original/29GX12MM
Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16"
Shopko Unifine Pentips Pen Needles/SHORT/31GX8MM
Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2"
Shopko Unifine Pentips Plus Pen Needles/Micro/Removr/32GX4MM
Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2"
Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16"
Shopko Unifine Pentips Plus Pen Needles/Mini/Remover/31GX5MM
Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16"
Sure-lance Flat Lancets
Shopko Unifine Pentips Plus Pen Needles/Remover/29GX12MM
Sure-lance Lancets 26G
Sure-lance Thin Lancets 28G
Shopko Unifine Pentips Plus Pen Needles/SHORT/Removr/31GX8MM
Sure-lance Ultra Thin Lancets
Shopko Unilet Lancets Super Thin 30G
Sure-pen
Shopko Unilet Lancets Ultra Thin 28G
Sure-touch Lancets Universal
Side Button Safety Lancet21G
Surelite Lancets
Simple Diagnostics Lancing Device
SB Insulin Syringe/U-100/0.5ML/29G X 1/2"
Single-let
SB Insulin Syringe/U-100/0.5ML/30G X 5/16"
Sm Lancets 21G
SB Insulin Syringe/U-100/1ML/29G X 1/2"
Sm Micro Thin Lancets 33G
SB Insulin Syringe/U-100/1ML/30G X 5/16"
Sm Super Thin Lancets 30G
SB Insulin Syringe/U-100/1ML/31G X 5/16"
Sm Thin Lancets 26G
SB Lancets Thin
Sm Truedraw Lancing Device
SB Lancets Ultra Thin
Smart Diabetes Vantage Lancing Device
Techlite AST Lancets
Smart Sense Color Lancets Universal 33G
Techlite Insulin Syringe U-100/0.3ML/29G X 1/2"
Smart Sense Standard Lancets Universal 21G
Techlite Insulin Syringe U-100/0.3ML/30G X 1/2"
Smart Sense Super Thin Lancets Universal 30G
Techlite Insulin Syringe U-100/0.3ML/30G X 5/16"
Smart Sense Thin Lancets Universal 26G
Techlite Insulin Syringe U-100/0.3ML/31G X 15/64"
Smartest Lancets 28G
Techlite Insulin Syringe U-100/0.3ML/31G X 5/16"
Solus V2 Lancing Device
Techlite Insulin Syringe U-100/0.5ML/29G X 1/2"
Solus V2 Pressure Activated Safety Lancets 28G
Techlite Insulin Syringe U-100/0.5ML/30G X 1/2"
Solus V2 Twist Lancets 30G
Techlite Insulin Syringe U-100/0.5ML/30G X 5/16"
Sterilance PA
Techlite Insulin Syringe U-100/0.5ML/31G X 15/64"
Sterilance TL
Techlite Insulin Syringe U-100/0.5ML/31G X 5/16"
Super Thin Lancets
Techlite Insulin Syringe U-100/1ML/29G X 1/2"
Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"
Techlite Insulin Syringe U-100/1ML/30G X 1/2"
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2"
Techlite Insulin Syringe U-100/1ML/30G X 5/16"
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"
Techlite Insulin Syringe U-100/1ML/31G X 15/64"
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16
Techlite Insulin Syringe U-100/1ML/31G X 5/16"
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"
Techlite Lancets
Sure Comfort Insulin Syringe/U-100/0.3ML/31GX1/4"
Techlite Lancets 30G
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 31
Techlite Pen Needles 29G X 10MM
Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X 5/16"
Techlite Pen Needles 29G X 12 MM
Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16"
Techlite Pen Needles 31G X 5MM
Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16"
Techlite Pen Needles/31G X 5MM
Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16"
Techlite Pen Needles/31G X 6 MM
Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16"
Techlite Pen Needles/31G X 8MM
Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16"
Techlite Pen Needles/32G X 4MM
Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16"
Techlite Pen Needles/32G X 6MM
Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16"
Techlite Pen Needles/32G X 8MM
Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2"
Tgt Advanced Lancing Device
Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16"
Tgt Lancet Alternate Site
Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2"
Tgt Lancet Micro Thin 33G
Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16"
Tgt Lancet Super Thin 30G
Ulticare Insulin Syringe/U-100/1ML/30G X 1/2"
Tgt Lancet Thin 23G
Ulticare Insulin Syringe/U-100/1ML/31G X 5/16"
Tgt Lancet Thin 26G
Ulticare Insulin Syringe/0.3ML/29G X 1/2"
Tgt Lancet Ultra Thin 28G
Ulticare Insulin Syringe/0.3ML/30G X 1/2"
Tgt Lancet Ultra Thin 30G
Ulticare Insulin Syringe/0.3ML/30G X 5/16"
Tgt Lancing Device
Ulticare Insulin Syringe/0.5ML/28G X 1/2"
Thinlets GP Lancets
Ulticare Insulin Syringe/0.5ML/29G X 1/2"
Todays Health Advanced Lancing Device
Ulticare Insulin Syringe/0.5ML/30G X 1/2"
Todays Health Mini Pen Needles 31G X 1/4"
Ulticare Insulin Syringe/0.5ML/30G X 5/16"
Todays Health Original Pen Needles 29G X 1/2"
Ulticare Insulin Syringe/1ML/28G X 1/2"
Todays Health Super Thin Lancets 30G
Ulticare Insulin Syringe/1ML/29G X 1/2"
Todays Health SHORT Pen Needles 31G X 5/16"
Ulticare Insulin Syringe/1ML/30G X 1/2"
Todays Health Ultra Thin Lancets 28G
Ulticare Insulin Syringe/1ML/30G X 5/16"
Topcare Clickfine Universal Pen Eedles 31GX1/4"
Ulticare Micro Pen Needles 31G X 8MM
Topcare Clickfine Universal Pen Eedles 31GX5/16"
Ulticare Micro Pen Needles 32G X 4MM
Topcare Lancets Micro-thin 33G
Ulticare Micro Pen Needles/32G X 4MM
Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"
Ulticare Mini Pen Needles Ulti-fine IV
Ulticare Mini Pen Needles 31GX6MM
Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"
Ulticare Mini Pen Needles/31G X 6MM
Ulticare Mini Pen Needles31GX6MM
Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X 1/2"
Ulticare Original Pen Needles Ulti-fine
Ulticare Pen Needles 31G X 5MM/Mini
Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"
Ulticare Pen Needles/29G X 12.7MM
Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"
Ulticare SHORT Pen Needles Ulti-fine IV
Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"
Ulticare SHORT Pen Needles 31GX8MM
Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"
Ulticare SHORT Pen Needles/31G X 8MM
Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16"
Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4"
Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16"
Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4"
Travel Lancets Advanced 28G
Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4"
Travel Lancets 30G
Ulticare U-100 Insulin Syringes/1ML/31G X 1/4"
Truedraw Lancing Device
Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16"
Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2"
Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16"
Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16"
Ultilet Classic Lancets
Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16"
Ultilet Insulin Syringe 31X6MM
Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2"
Ultilet Insulin Syringe/SHORT/0.3ML/30G X 12.7MM
Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2"
Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16"
Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16"
Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16"
Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16"
Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16"
Trueplus Insulin Syringe/U-100/1ML/28G X 1/2"
Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16"
Trueplus Insulin Syringe/U-100/1ML/29G X 1/2"
Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16"
Trueplus Insulin Syringe/U-100/1ML/30G X 5/16"
Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16"
Trueplus Insulin Syringe/U-100/1ML/31G X 5/16"
Ultilet Insulin Syringe/U-100/0.5ML/30G X 1/2"
Trueplus Lancets 26G
Ultilet Insulin Syringe/U-100/0.5ML/31GX6MM
Trueplus Lancets 28G
Ultilet Insulin Syringe/U-100/1ML/30G X 1/2"
Trueplus Lancets 28G Super Thin
Ultilet Insulin Syringe/0.3ML/30G X 8MM
Trueplus Lancets 30G
Ultilet Insulin Syringe/0.3ML/31G X 8MM
Trueplus Lancets 30G Ultra Thin
Ultilet Insulin Syringe/0.5ML/30G X 8MM
Trueplus Lancets 33G
Ultilet Insulin Syringe/1ML/30G X 8MM
Trueplus Lancets 33G Micro Thin
Ultilet Insulin Syringe/1ML/31G X 8MM
Trueplus Pen Needles 29GX12MM
Ultilet Lancets
Trueplus Pen Needles 31GX5MM
Ultilet Lancets 33G
Trueplus Pen Needles 31GX6MM
Ultilet Pen Needle 29GX12.7MM
Trueplus Pen Needles 31GX8MM
Ultilet Pen Needle 31GX5MM
Trueplus Pen Needles 32GX4MM
Ultilet Pen Needle 31GX8MM
Trueplus Safety Lancets 28G
Ultilet Pen Needle 32GX4MM
Ulti-lance Automatic/ Clear Tip
Ultilet Pen Needle 32GX4MM/SHORT
Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2"
Ultilet Safety Lancets 21G X 2.2MM
Ulticare Insulin Safety Syringe/1ML/29G X 1/2"
Ultilet Safety Lancets 23G
Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X 5/16"
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 32
Ultilet SHORT Pen Needles 31GX5/16"
Unistik Touch Safety Lancets 30G
Ultilet SHORT Pen Needles31GX3/16"
Unistik 1
Ultilet U-100 Insulin Syringes/1ML/31G X 6MM
Unistik 2
Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"
Unistik 2 Comfort
Ultra Thin Lancets 28G
Unistik 2 Extra
Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"
Unistik 2 Neonatal
Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"
Unistik 2 Normal
Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"
Unistik 2 Super
Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"
Unistik 3
Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"
Unistik 3 Comfort
Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"
Unistik 3 Extra
Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16"
Unistik 3 Extra Single Use Safety Lancets/21G
Ultra-comfort Insulin Syringe/U-100/1ML/28G X 1/2"
Unistik 3 Gentle
Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2"
Unistik 3 Neonatal
Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16"
Unistik 3 Normal
Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16"
Universal 1 Lancets Thin 26G
Ultra-thin II Auto Lancet
Universal 1 Lancets Ultra Thin 30G
Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/30GX5/16"
Universal 1 Lancets/33G/Micro-thin
Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2"
Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/31GX5/16"
Value Health Insulin Syringe/U-100/1ML/29G X 1/2"
Value Plus Lancets Standard 21G
Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/30GX5/16"
Value Plus Lancets Super Thin 30G
Value Plus Lancets Thin 26G
Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/31GX5/16"
Value Plus Lancing Device
Valumark Lancet Super Thin 30G
Ultra-thin II Insulin Syringe SHORT/U-100/1ML/30GX5/16"
Valumark Lancet Ultra Thin 28G
Ultra-thin II Insulin Syringe SHORT/U-100/1ML/31GX5/16"
Valumark Pen Needles 29GX12MM
Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2"
Valumark Pen Needles 31G X 6MM
Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2"
Valumark Pen Needles 31G X 8MM
Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2"
Vanishpoint Insulin Syringe/0.5ML/30G X 1/2"
Ultra-thin II Lancets 28G
Vanishpoint Insulin Syringe/0.5ML/30G X 5/16"
Ultra-thin II Lancets 30G
Vanishpoint Insulin Syringe/1ML/29G X 1/2"
Ultra-thin II Mini Pen Neeedles/31GX3/16"
Vanishpoint Insulin Syringe/1ML/29G X 5/16"
Ultra-thin II Pen Needles 29GX1/2"
Vanishpoint Insulin Syringe/1ML/30G X 5/16"
Ultra-thin II Pen Needles/SHORT/31GX5/16"
Vida Mia Autolet Lancing Device
Ultra-thin II Safety Autolancets 26G
Vida Mia Unifine Pentips Mini 31GX6MM
Ultralance
Vida Mia Unifine Pentips Original 29GX12MM
Unifine Pentips Plus 29GX12MM
Vida Mia Unifine Pentips 32GX4MM
Unifine Pentips Plus 31GX5MM
Vida Mia Unilet Lancets Super Thin 30G
Unifine Pentips Plus 31GX6MM
Vida Mia Unilet Lancets Ultra Thin 28G
Unifine Pentips Plus 31GX8MM
Vida Mia Unipfine Pentipsshort 31GX8MM
Unifine Pentips Plus 32GX4MM
Vitalet Pro Lancets
Unifine Pentips 29GX12MM
Vitalet Pro Plus Lancets
Unifine Pentips 31G X 3/16"
Vp Insulin Syringe/U-100/0.3ML/29G X 1/2"
Unifine Pentips 31G X 6MM
Walgreens Advanced Travellancets 28G
Unifine Pentips 31G X 8MM
Walgreens Comfort Assuredlancets Micro Thin/33G
Unifine Pentips 31GX5MM
Walgreens Comfort Assuredlancets Super Thin/28G
Unifine Pentips 31GX6MM
Walgreens Lancets
Unifine Pentips 31GX8MM
Walgreens Thin Lancets
Unifine Pentips 32GX4MM
Walgreens Ultra Thin Lancets
Unilet Comfortouch Lancet
Wegmans Unifine Pentips Plus 32GX4MM
Unilet Excelite
Wegmans Unifine Pentips Plus/Mini/31GX5MM
Unilet Excelite II
Wegmans Unifine Pentips Plus/SHORT/31GX8MM
Unilet G.p. Lancet
Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MM
Unilet G.p. Superlite Lancet
1ST Choice Lancets Super Thin
Unilet GP 28 Ultra Thin
1ST Choice Lancets Thin
Unilet Lancet
1ST Choice Lancets Ultra Thin
Unilet Lancets Micro-thin33G
1ST Tier Unifine Pentips /Mini/31GX5MM
Unilet Lancets Super-thin30G
1ST Tier Unifine Pentips Plus 31GX8MM
Unilet Lancets Ultra-thin 28G
1ST Tier Unifine Pentips Plus 32GX4MM
Unilet Superlite Lancet
1ST Tier Unifine Pentips Plus/Mini/31GX5MM
Unistik CZT Comfort
1ST Tier Unifine Pentips Plus/Original/29GX12MM
Unistik CZT Normal
1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM
Unistik Pro Safety Lancet 21G
1ST Tier Unifine Pentips 29GX12MM
Unistik Pro Safety Lancet 25G
1ST Tier Unifine Pentips 31GX6MM
Unistik Pro Safety Lancet 28G
1ST Tier Unifine Pentips 31GX8MM
Unistik Safety Lancets 28G
1ST Tier Unifine Pentips 32GX4MM
Unistik Safety Lancets 30G
1ST Tier Unilet Comfortouch Lancets 28G
Unistik Touch Safety Lancets 21G
1ST Tier Unilet Comfortouch Lancets 30G
Unistik Touch Safety Lancets 23G
Unistik Touch Safety Lancets 28G
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 33
MEDICAL DEVICES - MISC
TIER 01 naloxone HCL
TIER 03 Aerochamber Mini Aerosol Chamber
Naloxone HCL
Aerochamber MV
TIER 03 Chemet
Aerochamber Plus Flow VU
TIER 05 naltrexone HCL
Aerochamber Plus Flow-VU
ExjadePA
Aerochamber Plus Flow-VU/Large Mask
FerriproxPA
Aerochamber Plus Flow-VU/Mask
JadenuPA
Aerochamber Plus Flow-VU/Medium Mask
Jadenu SprinklePA
Aerochamber Plus Flow-VU/Small Mask
VivitrolPA
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU
Aerochamber Z-stat Plus/Flowsignal
Aerochamber Z-stat Plus/Large Mask
Aerochamber Z-stat Plus/Medium Mask
Aerochamber Z-stat Plus/Small Mask
Aerochamber/Flowsignal
Aerovent Plus Holding Chamber/Collapsible
Breatherite
Breatherite Collapsible Adult Spacer W/Mask
Breatherite Collapsible Child Spacer W/Mask
Breatherite Collapsible Infant Spacer W/Mask
Breatherite Collapsible Small Child Spacer W/Mask
Breatherite Collapsible Spacer W/ Neonate Mask
Breatherite Rigid Spacer W/Mask
Breatherite W/Large Mask
Breatherite W/Medium Mask
Breatherite W/Small Mask
Clever Choice Anti-staticvalved Holding Chamber/Adult Large
Clever Choice Anti-staticvalved Holding Chamber/Medium
Clever Choice Anti-staticvalved Holding Chamber/Small
Compact Space Chamber/Anti-static
Compact Space Chamber/Anti-static/Large Mask
Compact Space Chamber/Anti-static/Medium Mask
Compact Space Chamber/Anti-static/Small Mask
Easivent
Easivent/Mask-large
Easivent/Mask-medium
Easivent/Mask-small
Flexichamber
Flexichamber Adult Mask/Small
Flexichamber Child Mask/Large
Flexichamber Child Mask/Small
Inspirachamber/Anti-static Valved/Mouthpiece
Inspirachamber/Large
Inspirachamber/Soothermask/Inspiramask/Medium
Inspirachamber/Soothermask/Inspiramask/Small
Inspirease Drug Delivery System
Inspirease Reservoir Bags
Liteaire
Microchamber
Microspacer
Optichamber Advantage/Large Mask
Optichamber Advantage/Medium Face Mask
Optichamber Advantage/Small Face Mask
Optichamber Diamond
Optichamber Diamond/Largeface Mask
Optichamber Diamond/Medium Face Mask
Optichamber Diamond/Smallface Mask
Optihaler
Optihaler MDI Drug Delivery System
Pocket Chamber
Pocket Spacer
Riteflo
Valved Holding Chamber
Vortex Valved Holding Chamber
Watchhaler
MISCELLANEOUS
Effective June 1, 2018
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 34
Index
A
Advate, 13
Akten, 17
Advocate Insulin Pen Needles, 23
Akynzeo, 12
abacavir, 2
Advocate Insulin Pen Needles 29GX12.7MM, 23
ala-cort, 6
abacavir sulfate/lamivudine/zidovudine, 2
Albenza, 2
abacavir/lamivudine, 2
Advocate Insulin Pen Needles 31GX5MM, 23
albuterol sulfate, 20
Abilify Maintena, 15
Albuterol Sulfate ER, 20
acamprosate calcium DR, 16
Advocate Insulin Pen Needles 31GX8MM, 23
albuterol TAB 4MG, 20
acarbose, 10
alclometasone dipropionate, 6
Accu-chek Aviva, 23
Advocate Insulin Syringe/U-100/0.3ML/29GX1/2", 23
Aldactazide, 5
Accu-chek Aviva Plus, 23
Alecensa, 3
Accu-chek Compact Plus, 23
Advocate Insulin Syringe/U-100/0.3ML/30GX5/16", 23
alendronate sodium, 10
Accu-chek Compact Test Drum, 23
Alendronate Sodium, 10
Accu-chek Fastclix Lancetdevice Kit, 23
Advocate Insulin Syringe/U-100/0.3ML/31GX5/16", 23
Alferon N, 3
Accu-chek Fastclix Lancets, 23
alfuzosin HCL ER, 13
Accu-chek Guide, 23
Advocate Insulin Syringe/U-100/0.5ML/29GX1/2", 23
Alinia, 2
Accu-chek Multiclix Lanc Et Device Kit, 23
allergy, 20
Advocate Insulin Syringe/U-100/0.5ML/30GX5/16", 23
allergy childrens, 20
Accu-chek Multiclix Lancets, 23
allergy relief, 20
Accu-chek Safe-t-pro Lancets, 23
Advocate Insulin Syringe/U-100/0.5ML/31GX5/16", 23
allergy relief child, 20
Accu-chek Safe-t-pro Pluslancets, 23
allergy relief childrens, 20
Accu-chek Smartview Strips, 23
Advocate Insulin Syringe/U-100/1ML/29GX1/2", 23
allopurinol, 19
Accu-chek Soft Touch Lancets, 23
almotriptan, 19
Accu-chek Softclix Lancetdevice Kit, 23
Advocate Insulin Syringe/U-100/1ML/30GX5/16", 23
almotriptan malate, 19
Accu-chek Softclix Lancets, 23
Alocril, 17
Accutrend Glucose, 23
Advocate Insulin Syringe/U-100/1ML/31GX5/16", 23
Alomide, 17
acebutolol HCL, 4
alosetron hydrochloride, 12
acebutolol hydrochloride, 4
Advocate Lancets, 23
Alphagan P, 17
acetaminophen/codeine, 18
Advocate Lancets 30G, 23
Alphanate/Von Willebrand Factor Complex/Human, 13
acetaminophen/codeine phosphate, 18
Advocate Lancing Device, 23
acetasol HC, 17
Advocate Rapid-safe Lancing Device, 23
Alphanine SD, 13
acetazolamide, 5
Advocate Safety Lancets, 23
alprazolam, 14
acetazolamide ER, 5
Advocate Safety Lancets 26G, 23
alprazolam ER, 14
acetazolamide sodium, 5
Adynovate, 13
Alprazolam Intensol, 14
acetic acid, 17
Aerochamber Mini Aerosol Chamber, 34
alprazolam odt, 14
acetic acid 0.25%, 13
Aerochamber MV, 34
alprazolam XR, 14
acetylcysteine, 20
Aerochamber Plus Flow VU, 34
Alprolix, 13
acitretin, 6
Aerochamber Plus Flow-VU, 34
Alrex, 17
Actemra, 19
Aerochamber Plus Flow-VU/Large Mask, 34
Altabax, 6
Acthib, 21
altacaine, 17
Acti-lance Lancets 28G, 23
Aerochamber Plus Flow-VU/Mask, 34
altafrin, 17
Acti-lance Lite Safety Lancets 28G, 23
Aerochamber Plus Flow-VU/Medium Mask, 34
altavera, 8
Acti-lance Special Safety Lancets 17G, 23
Alternate Site Lancing Device, 23
Aerochamber Plus Flow-VU/Small Mask, 34
Aluminum Chloride Hexahydrate, 7
Acti-lance Special Safetylancets 17G, 23
Alunbrig, 3
Acti-lance Universal Safety Lancets 23G, 23
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU, 34
Alvesco, 21
alyacen 1/35, 8
Actimmune, 3
Aerochamber Z-stat Plus/Flowsignal, 34
alyacen 7/7/7, 8
Active 1ST Blood Lancets 30G/Easy Twist CAP, 23
Aerochamber Z-stat Plus/Large Mask, 34
amabelz, 8
Aerochamber Z-stat Plus/Medium Mask, 34
amantadine HCL, 16
Actoplus Met XR, 10
Amcinonide, 7
acyclovir, 2, 6
Aerochamber Z-stat Plus/Small Mask, 34
amethia, 8
Aczone, 6
Aerochamber/Flowsignal, 34
amethia LO, 8
adapalene, 5
Aerovent Plus Holding Chamber/Collapsible, 34
amethyst, 8
adapalene and benzoyl peroxide, 5
Amicar, 13
adapalene P.M., 5
AF Lancets Super Thin, 23
amikacin sulfate, 1
Adcirca, 5
afeditab CR, 4
amiloride HCL, 5
adefovir dipivoxil, 2
Afinitor, 3
Amiloride HCL, 5
Adempas, 5
Afinitor Disperz, 3
amiloride/hydrochlorothiazide, 5
Adjustable Lancing Device, 23
Afluria 2017-2018, 21
aminoacetic acid, 13
Admelog, 10
Afluria PF 2017-2018, 21
amiodarone HCL, 4
Adrenalin, 20
Afluria Quadrivalent 2017-2018, 21
amiodarone hydrochloride, 4
adult aspirin EC low strength, 18
Afstyla, 13
amiodarone hydrocloride, 4
adult aspirin regimen, 18
aftera, 8
Amitiza, 12
Advair Diskus, 21
Agamatrix Ultra-thin Lancets 33G, 23
amitriptyline HCL, 14
Advair HFA, 21
agoneaze, 7
amlodipine besylate, 4
Advanced Mobile Lancet 30G, 23
amlodipine besylate/atorvastatin calcium, 5
aspir-81, 18
Aurora Unifine Pentips/32GX5/32", 23
aspir-low, 18
Aurora Unifine Pentips/Mini/31GX3/16", 23
amlodipine besylate/benazepril HCL, 4
aspirin, 18
amlodipine besylate/benazepril hydrochloride, 4
aspirin 81, 18
Auryxia, 12
aspirin 81 low dose, 18
Auto-lancet, 23
amlodipine besylate/valsartan, 4
aspirin adult low dose, 18
Auto-lancet Mini, 23
amlodipine/olmesartan medoxomil, 5
aspirin adult low strength, 18
Autolet II Clinisafe, 23
amlodipine/valsartan/hctz, 5
aspirin childrens, 18
Autolet Impression Lancing Device, 23
ammonium lactate, 7
aspirin EC, 18
Autolet Lancing Device, 23
amnesteem, 5
aspirin EC low dose, 18
Autolet Lite Clinisafe, 23
Amoxapine, 15
aspirin enteric coated adult low strength, 18
Autolet Lite Starter Pack, 23
amoxicillin, 1
Autolet Mini, 23
Amoxicillin, 1
aspirin low dose, 18
Autolet Platforms, 23
amoxicillin/clavulanate potassium, 1
aspirin low strength, 18
Autolet Plus, 23
Amoxicillin/Clavulanate Potassium, 1
aspirin regimen low dose/adult, 18
Auvi-q, 5
amoxicillin/clavulanate potassium ER, 1
aspirin/dipyridamole, 13
Avage, 7
amphetamine/dextroamphetamine, 15
aspirtab, 18
Avandia, 10
Ampicillin, 1
Assure Comfort Lancets Ultra Thin 28G, 23
avar cleanser, 5
Ampyra, 16
avar-e emollient, 5
Amytal Sodium, 15
Assure Comfort Lancets Ultra Thin 30G, 23
avar-e green, 5
ana-lex, 12
Avc, 13
Anacaine, 7
Assure Haemolance Plus High Flow 18G, 23
aviane, 8
Anadrol-50, 8
avidoxy, 1
anagrelide hydrochloride, 13
Assure Haemolance Plus Low Flow 25G, 23
avita, 5
Analpram-HC, 12
Avonex, 16
anastrozole, 3
Assure Haemolance Plus Micro Flow 28G, 23
Avonex Pen, 16
Androgel, 8
Azasan, 3
Androgel P.M., 8
Assure Haemolance Plus Normal Flow 21G, 23
Azasite, 17
anodyne lpt, 7
azathioprine, 3
Anoro Ellipta, 21
Assure Haemolance Plus Pediatric Blade, 23
azelastine HCL, 17, 20
Anzemet, 12
azelastine hydrochloride, 20
Apexicon E, 7
Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X 1/2", 23
Azelex, 6
Apidra, 10
azithromycin, 1
Apidra Solostar, 10
Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2", 23
Azithromycin, 1
apraclonidine, 17
Azopt, 17
aprepitant, 12
Assure Lance Lancets, 23
azurette, 8
apri, 8
Assure Lance Lancets 21G, 23
B
Apriso, 12
Assure Lance Plus Safety Lancets 25G, 23
B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16", 23
Aptivus, 2
Aqua Lance Adjustable Lancing Device, 23
Assure Lance Plus Safety Lancets 30G, 23
B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16", 23
aqueous vitamin d infants, 21
Assure Lancets, 23
B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16", 23
aranelle, 8
Astagraf XL, 3
Arestin, 14
Atabex Prenatal, 22
B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 23
argyle sterile saline 100ML, 13
atazanavir, 2
aripiprazole, 15
atazanavir sulfate, 2
B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2", 23
aripiprazole odt, 15
atenolol, 4
Aristada, 15
atenolol/chlorthalidone, 5
Baby Super Daily D3, 22
armodafinil, 15
atomoxetine, 15
Baby Vitamin D3 Drops, 22
Armonair Respiclick 113, 21
atorvastatin calcium, 5
baciim, 2
Armonair Respiclick 232, 21
atovaquone, 2
bacitracin, 2
Armonair Respiclick 55, 21
atovaquone/proguanil HCL, 2
Bacitracin, 17
Armour Thyroid, 11
Atripla, 2
bacitracin/polymyxin b, 16
Arnica Flower, 7
atropine sulfate, 11
baclofen, 16
Arnuity Ellipta, 21
Atropine Sulfate, 11, 17
balsalazide disodium, 12
ascomp/codeine, 18
Atrovent HFA, 21
balziva, 8
ashlyna, 8
Aubagio, 16
Banzel, 16
Asmanex HFA, 21
aubra, 8
Baraclude, 2
Asmanex Twisthaler 120 Metered Doses, 21
augmented betamethasone dipropionate, 6
Baxdela, 1
bayer advanced aspirin regular strength, 18
Asmanex Twisthaler 14 Metered Doses, 21
Augmented Betamethasone Dipropionate, 7
bayer aspirin, 18
Asmanex Twisthaler 30 Metered Doses, 21
Augmentin, 1
bayer aspirin EC low dose, 18
Aurora Lancet Super Thin 30G, 23
bayer aspirin regimen, 18
Asmanex Twisthaler 60 Metered Doses, 21
Aurora Lancet Thin 23G, 23
bayer chewable low dose, 18
Aurora Pen Needles 29GX12MM, 23
bayer low dose, 18
Asmanex Twisthaler 7 Metered Doses, 21
Aurora Pen Needles 31G X 6MM, 23
Bayer Microlet 2 Lancing Device, 23
Aurora Pen Needles 31G X 8MM, 23
Bayer Microlet Lancets, 23
BD Autoshield 29G X 3/16", 24
100/1ML/25G X 5/8", 24
Betaseron, 16
BD Autoshield 29G X 5/16", 24
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2", 24
betaxolol HCL, 4, 17
BD Autoshield Duo 30G X 3/16", 24
bethanechol chloride, 12
BD Insulin Syringe LUER-LOK/U-100/1ML, 24
BD Insulin Syringe/U-100/0.5ML/30G X 1/2", 24
Betimol, 17
Betoptic-s, 17
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2", 24
BD Insulin Syringe/U-100/1ML/27G X 1/2", 24
Bevespi Aerosphere, 21
Bevyxxa, 13
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8", 24
BD Insulin Syringe/U-100/2ML/27.5G X 5/8", 24
bexarotene, 3
Bexsero, 21
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2", 24
BD Insulin Syringe/U-500/0.5ML/31G X 15/64", 24
bicalutamide, 3
Bidil, 5
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2", 24
BD Lancet Ultrafine 30G, 24
Biktarvy, 2
BD Lancet Ultrafine 33G, 24
Bimatoprost, 17
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2", 24
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2", 24
Bio-d-mulsion, 22
Bio-d-mulsion Forte, 22
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8", 24
BD Microtainer Lancets, 24
Bio-statin, 1
BD Pen Needle/Mini/Ultrafine/31G X 3/16", 24
biotuss, 20
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2", 24
biotuss pediatric, 20
BD Pen Needle/Nano/Ultra Fine/32G X 4MM, 24
bisoprolol fumarate, 4
BD Insulin Syringe Safetyglide/1ML/29G X 1/2", 24
bisoprolol fumarate/hydrochlorothiazide, 5
BD Pen Needle/SHORT/Ultrafine/31G X 5/16", 24
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 15/64", 24
Blephamide, 17
BD Pen Needle/Ultrafine/29G X 12.7MM, 24
Blephamide S.o.p., 17
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16", 24
blisovi 24 FE, 8
BD Pen Needle/Ultrafine/29GX1/2" 12.7MM, 24
blisovi FE 1.5/30, 8
BD Insulin Syringe Safetyglide/U-100/0.5ML/31G X 15/64", 24
blisovi FE 1/20, 8
BD Pen Needles SHORT/Ultrafine/31G X 5/16", 24
Bocasal, 14
BD Insulin Syringe Safetyglide/U-100/1ML/31G X 15/64", 24
Boostrix, 21
BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2", 24
Boric Acid, 7
BD Insulin Syringe Slip Tip/U-100/1ML, 24
Bosulif, 3
BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2", 24
Botox, 16
BD Insulin Syringe U-100/0.3ML/29G X 1/2", 24
bp 10-1, 6
BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16", 24
bp foam, 6
BD Insulin Syringe Ultra Fine/1ML/30G X 1/2", 24
bp wash, 6
BD Ultra-fine Micro Pen Needles 6MM X 32G, 24
bpo foaming cloths, 6
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16", 24
bprotected pedia d-vite, 21
BD-insul SYR Mis LO Dose, 24
bprotected pedia iron, 13
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16", 24
Bebulin, 14
Bravelle, 10
Beconase AQ, 20
Breatherite, 34
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16", 24
bekyree, 8
Breatherite Collapsible Adult Spacer W/Mask, 34
Belladonna & Opium, 11
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 24
Belladonna Alkaloids & Opium, 11
Breatherite Collapsible Child Spacer W/Mask, 34
belladonna alkaloids/phenobarbital, 11
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16", 24
benazepril HCL, 4
Breatherite Collapsible Infant Spacer W/Mask, 34
benazepril HCL/hydrochlorothiazide, 5
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2", 24
Benefix, 14
Breatherite Collapsible Small Child Spacer W/Mask, 34
Bensal HP, 7
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16", 24
benzepro, 5
Breatherite Collapsible Spacer W/ Neonate Mask, 34
benzepro creamy wash, 5
BD Insulin Syringe Ultrafine/1ML/30G X 1/2", 24
benzepro foaming cloths, 5
Breatherite Rigid Spacer W/Mask, 34
benzepro SHORT contact, 5
Breatherite W/Large Mask, 34
BD Insulin Syringe Ultrafine/1ML/31G X 5/16", 24
Benziq, 6
Breatherite W/Medium Mask, 34
Benziq LS, 6
Breatherite W/Small Mask, 34
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2", 24
Benznidazole, 2
Breo Ellipta, 21
benzoin compound tincture, 7
briellyn, 8
BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64", 24
Benzoin Tincture, 7
Brilinta, 13
benzonatate, 20
brimonidine tartrate, 17
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2", 24
benzoyl peroxide, 6
Briviact, 16
Benzoyl Peroxide 8%, 6
bromfed DM, 20
BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64", 24
benzoyl peroxide- HC, 6
Bromfenac, 17
benztropine mesylate, 16
bromocriptine mesylate, 16
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2", 24
Bepreve, 17
bromphen/pseudoephedrine HCL/dextromethorphan HBR, 20
Besivance, 17
BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64", 24
Betadine Ophthalmic Prep, 17
Brompheniramine Tannate, 20
betamethasone dipropionate, 6
Brovana, 21
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1", 24
betamethasone sodium phosphate/betamethasone acetate, 8
budesonide, 8, 20
Bullseye Mini Safety Lancets, 23
BD Insulin Syringe/Detachable Needle/U-
betamethasone valerate, 6
Bullseye Safety Lancets, 23
bumetanide, 5
Carefine Pen Needles 31GX6MM, 24
cefprozil, 1
Bunavail, 19
Carefine Pen Needles 31GX8MM, 24
ceftriaxone sodium, 1
bupivacaine HCL, 19
Carefine Pen Needles 32GX5MM, 24
cefuroxime axetil, 1
bupivacaine/epinephrine, 19
Carefine Pen Needles 32GX6MM, 24
celecoxib, 19
buprenorphine HCL, 18
Careone Advanced Lancing Device, 24
Celontin, 16
buprenorphine HCL/naloxone HCL, 18
Careone Insulin Syringes/0.3ML/30G X 1/2", 24
Cem-urea, 7
bupropion HCL, 14
cephalexin, 1
bupropion HCL ER, 14
Careone Insulin Syringes/0.3ML/31G X 5/16", 24
Cerdelga, 13
bupropion HCL SR, 14, 16
cerovel, 7
bupropion HCL XL, 14
Careone Insulin Syringes/0.5ML/30G X 1/2", 24
Cesamet, 12
bupropion hydrochloride, 14
cetirizine HCL, 20
buspirone HCL, 14
Careone Insulin Syringes/0.5ML/31G X 5/16", 24
Cetrotide, 10
butalbital/acetaminophen, 18
cevimeline HCL, 14
butalbital/acetaminophen/caffeine, 18
Careone Insulin Syringes/1ML/30G X 1/2", 24
Chantix, 16
butalbital/acetaminophen/caffeine/codeine, 18
Chantix Continuing Month PAK, 16
Careone Insulin Syringes/1ML/31GX5/16", 24
Chantix Starting Month PAK, 16
butalbital/aspirin/caffeine, 18
chateal, 8
Butalbital/Aspirin/Caffeine, 18
Careone Lancet Thin, 24
Chemet, 34
butalbital/aspirin/caffeine/codeine, 18
Careone Lancet Ultra Thin, 24
Chenodal, 12
Butisol Sodium, 15
Careone Unifine Pentips 29GX12MM, 24
childrens aspirin, 18
butorphanol tartrate, 18
Careone Unifine Pentips 31GX5MM, 24
childrens aspirin low strength, 18
Bydureon, 10
Careone Unifine Pentips 31GX6MM, 24
childrens loratadine, 20
Bydureon Pen, 10
Careone Unifine Pentips 31GX8MM, 24
Chloral Hydrate, 15
Byetta, 10
Careone Unifine Pentips Pen Needles 32GX4MM, 24
chlordiazepoxide HCL, 14
Bystolic, 4
Chlordiazepoxide/Amitriptyline, 16
C
Careone Unifine Pentips Plus Pen Needles 29GX12MM, 24
chlorhexidine gluconate, 14
chloroprocaine hydrochloride, 19
cabergoline, 11
Careone Unifine Pentips Plus Pen Needles 31GX5MM, 24
chloroquine phosphate, 2
caffeine citrate, 15
Chloroquine Phosphate, 2
calcipotriene, 6
Careone Unifine Pentips Plus Pen Needles 31GX6MM, 24
chlorothiazide, 5
calcipotriene/betamethasone dipropionate, 6
Chlorothiazide, 5
Careone Unifine Pentips Plus Pen Needles 31GX8MM, 24
chlorpromazine HCL, 15
calcitonin salmon, 10
Chlorpromazine HCL, 15
calcitonin-salmon, 10
Careone Unifine Pentips Plus Pen Needles 32GX4MM, 24
Chlorpropamide, 10
calcitrene, 6
chlorthalidone, 5
Calcitriol, 6
Caretouch Lancing Device With Ejector, 24
Chlorzoxazone, 16
calcitriol, 11
Cholbam, 12
calcium acetate, 12
Caretouch Pen Needles 31 G X 6 MM, 24
cholestyramine, 5
Calquence, 3
cholestyramine light, 5
camila, 8
Caretouch Pen Needles 31GX 5MM, 24
choline magnesium trisalicylate, 18
Camphor, 6
Caretouch Pen Needles 31GX 8MM, 24
Chorionic Gonadotropin, 10
camrese, 8
Caretouch Pen Needles 32GX 4MM, 24
Cialis, 5
camrese LO, 8
Caretouch Pen Needles 32GX 5MM, 24
ciclodan, 6
Canasa, 12
Caretouch Twist Lancets 28G, 24
ciclopirox, 6
candesartan cilexetil, 4
Caretouch Twist Lancets 30G, 24
ciclopirox nail lacquer, 6
candesartan cilexetil/hydrochlorothiazide, 5
Caretouch Twist Lancets 33G, 24
ciclopirox olamine, 6
carisoprodol, 16
ciclopirox treatment, 6
capecitabine, 3
carisoprodol/aspirin, 16
cilostazol, 13
Capex, 7
carisoprodol/aspirin/codeine, 16
Ciloxan, 17
Caprelsa, 3
Carteolol HCL, 17
cimetidine, 11
captopril, 4
cartia XT, 4
Cimetidine HCL, 11
Captopril/Hydrochlorothiazide, 5
carvedilol, 4
Cimzia, 12
Carafate, 12
carvedilol phosphate, 4
Cimzia Starter Kit, 12
Carbaglu, 11
Cascara Sagrada, 11
Cipro, 1
carbamazepine, 15
cavarest, 14
Cipro HC, 18
carbamazepine ER, 15
Caverject, 5
Ciprodex, 18
Carbaphen 12, 20
Caverject Impulse, 5
ciprofloxacin, 1
Carbaphen 12 PED, 20
Cayston, 2
Ciprofloxacin, 18
carbidopa, 16
caziant, 8
ciprofloxacin ER, 1
carbidopa/levodopa, 16
cefaclor, 1
ciprofloxacin HCL, 1, 16
carbidopa/levodopa ER, 16
Cefaclor, 1
Ciprofloxacin HCL, 1
carbidopa/levodopa odt, 16
Cefaclor ER, 1
citalopram, 14
Carbidopa/Levodopa/Entacapone, 16
cefadroxil, 1
citalopram hydrobromide, 14
carbinoxamine maleate, 20
Cefazolin Sodium, 1
Citranatal 90 DHA, 22
Cardiocom Lancing Device, 24
cefdinir, 1
Citranatal Assure, 22
Cardura XL, 13
Cefditoren Pivoxil, 1
Citranatal B-calm, 22
Carefine Pen Needle 32GX4MM, 24
cefixime, 1
Citranatal Bloom DHA, 22
Carefine Pen Needles 29GX1/2", 24
cefpodoxime proxetil, 1
Citranatal DHA, 22
Carefine Pen Needles 30GX5/16", 24
claravis, 6
Clever Choice Comfort EZ Pen Needles 32GX8MM, 24
Cometriq, 3
clarithromycin, 1
Comfort Assist Insulin Syringe 0.3ML/29G X 1/2", 25
Clarithromycin, 1
Clever Choice Comfort EZ Pen Needles 33GX4MM, 24
clarithromycin ER, 1
Comfort Assist Insulin Syringe/0.3ML/30G X 5/16", 25
claritin allergy childrens, 20
Clever Choice Comfort EZ Pen Needles 33GX5MM, 24
Classic Prenatal, 22
Comfort Assist Insulin Syringe/0.3ML/31G X 5/16", 25
Cleanlet Lancets 28G, 24
Clever Choice Comfort EZ Pen Needles 33GX6MM, 24
Cleocin, 13
Comfort Assist Insulin Syringe/0.5ML/29G X 1/2", 25
Clever Chek Lancets Ultrathin, 24
Clever Choice Comfort EZ Pen Needles 33GX8MM, 24
Clever Chek Lancets Ultrathin 30G, 24
Comfort Assist Insulin Syringe/0.5ML/30G X 5/16", 25
Clever Choice Anti-staticvalved Holding Chamber/Adult Large, 34
Clickfine Pen Needle 32GX5/32", 25
Clickfine Pen Needle Universal/31GX1/4", 24
Comfort Assist Insulin Syringe/0.5ML/31G X 5/16", 25
Clever Choice Anti-staticvalved Holding Chamber/Medium, 34
Clickfine Pen Needle Universal/31GX5/16", 25
Comfort Assist Insulin Syringe/1ML/29G X 1/2", 25
Clever Choice Anti-staticvalved Holding Chamber/Small, 34
Clickfine Pen Needles/31GX1/4", 25
Comfort Assist Insulin Syringe/1ML/30G X 5/16", 25
Clever Choice Comfort EZ Insulin Pen Needles 31GX8MM, 24
Clickfine Pen Needles/31GX5/16", 25
Clickfine Universal Pen Needles 31GX5/16", 25
Comfort Assist Insulin Syringe/1ML/31G X 5/16", 25
Clever Choice Comfort EZ Insulin Pen Needles 33GX4MM, 24
Climara Pro, 8
Comfort Assured Lancets Micro Thin 33G, 25
Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2", 24
clindacin etz pledgets, 6
clindacin-p, 6
Comfort Assured Lancets Super Thin 28G, 25
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 1/2", 24
Clindagel, 6
clindamycin HCL, 2
Comfort Lancets, 25
Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16", 24
clindamycin palmitate HCL, 2
Compact Space Chamber/Anti-static, 34
clindamycin phosphate, 6, 12
Compact Space Chamber/Anti-static/Large Mask, 34
Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16", 24
clindamycin phosphate/tretinoin, 6
clindamycin/benzoyl peroxide, 6
Compact Space Chamber/Anti-static/Medium Mask, 34
Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2", 24
Clindesse, 13
Clinical Nutrients Prenatal Formula, 22
Compact Space Chamber/Anti-static/Small Mask, 34
Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 1/2", 24
clinpro 5000, 14
clobetasol propionate, 6
Complera, 2
Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 1/2", 24
clobetasol propionate e, 6
Complete Natal DHA, 22
clobetasol propionate emollient, 7
Completenate, 22
Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16", 24
Clocortolone Pivalate, 7
compro, 15
Clocortolone Pivalate P.M., 7
Condylox, 7
Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16", 24
clodan, 7
constulose, 11
clomipramine HCL, 14
Copaxone, 16
Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X 1/2", 24
clonazepam, 15
Cordran, 7
clonazepam odt, 15
Corifact, 14
Clever Choice Comfort EZ Insulin Syringe/1ML/28G X 1/2", 24
clonidine HCL, 4
Cortifoam, 12
clopidogrel, 13
Cortisone Acetate, 8
Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2", 24
clorazepate dipotassium, 14
Cortisporin, 6
clotrimazole, 6, 14
Cosentyx, 6
Clever Choice Comfort EZ Insulin Syringe/1ML/30G X 5/16", 24
clotrimazole/betamethasone dipropionate, 6
Cosentyx Sensoready Pen, 6
Cotellic, 3
Clever Choice Comfort EZ Insulin Syringe/U-100/1ML/31GX5/16", 24
clozapine, 15
covaryx, 8
clozapine odt, 15
covaryx HS, 8
Clever Choice Comfort EZ Lancets 21G, 24
Clozapine Odt, 15
Creon, 12
CO-natal Fa, 22
Cresemba, 1
Clever Choice Comfort EZ Lancets 23G, 24
Coagadex, 14
Crinone, 13
Coaguchek Lancets, 25
Crixivan, 2
Clever Choice Comfort EZ Lancets 28G, 24
Coal TAR, 7
cromolyn sodium, 12, 17, 20
Coartem, 2
cryselle-28, 8
Clever Choice Comfort EZ Pen Needles 29GX12MM, 24
Cocaine HCL, 7
curity sterile saline, 13
codeine sulfate, 18
Curosurf, 21
Clever Choice Comfort EZ Pen Needles 31GX5MM, 24
Codeine Sulfate, 19
Cuvposa, 12
Colchicine, 19
CVS allergy relief, 20
Clever Choice Comfort EZ Pen Needles 31GX6MM, 24
Colcrys, 19
CVS allergy relief childrens, 20
colesevelam hydrochlori DE, 5
CVS aspirin, 18
Clever Choice Comfort EZ Pen Needles 31GX8MM, 24
colestipol HCL, 5
CVS aspirin adult low dose, 18
colistimethate sodium, 2
CVS aspirin adult low strength, 18
Clever Choice Comfort EZ Pen Needles 32GX4MM, 24
colocort, 12
CVS aspirin EC, 18
Coly-mycin S, 18
CVS aspirin low dose, 18
Clever Choice Comfort EZ Pen Needles 32GX5MM, 24
Colyte-flavor Packs, 11
CVS aspirin low strength, 18
Combigan, 17
CVS d3, 22
Clever Choice Comfort EZ Pen Needles 32GX6MM, 24
Combipatch, 8
CVS enteric aspirin, 18
Combivent Respimat, 21
CVS folic acid, 13
CVS Lancets 21G, 25
daysee, 8
Dilantin Infatabs, 16
CVS Lancets Micro Thin 33G, 25
Daytrana, 15
Dilantin-125, 16
CVS Lancets Micro-thin 33G, 25
Ddrops, 22
Dilatrate SR, 4
CVS Lancets Original, 25
Debacterol, 14
dilt-XR, 4
CVS Lancets Thin 26G, 25
deblitane, 8
diltiazem CD, 4
CVS Lancets Ultra Thin 30G, 25
decara, 21
diltiazem HCL, 4
CVS Lancets Ultra-thin 30G, 25
Decara, 22
diltiazem HCL CD, 4
CVS Lancing Device, 25
Decon-a, 20
diltiazem HCL ER, 4
CVS Prenatal, 22
delta d3, 21
Dipentum, 12
CVS Ultra Thin Lancets, 25
deltasone, 8
diphenhydramine HCL, 20
CVS vitamin d childrens gummies, 22
delyla, 8
diphenoxylate/atropine, 11
CVS vitamin d3, 22
demeclocycline HCL, 1
Diphenoxylate/Atropine, 11
CVS Vitamin D3 Drops/Infants, 22
demeclocycline hydrochloride, 1
dipyridamole, 13
cyanocobalamin, 13
Demser, 4
disopyramide phosphate, 4
cyclafem 1/35, 8
Denavir, 6
disulfiram, 16
cyclafem 7/7/7, 8
denta 5000 plus, 14
Diuril, 5
cyclobenzaprine HCL, 16
dentagel, 14
divalproex sodium, 15
cyclobenzaprine hydrochloride, 16
Depo-estradiol, 8
divalproex sodium DR, 15
Cyclomydril, 17
Depo-subq Provera 104, 9
divalproex sodium ER, 15
cyclopentolate HCL, 17
dermacinrx empricaine, 7
Divigel, 8
cyclopentolate hydrochloride, 17
dermacinrx prizopak, 7
dofetilide, 4
cyclophosphamide, 2
Descovy, 2
donepezil HCL, 16
Cyclophosphamide, 2
desipramine HCL, 14
donepezil hydrochloride, 16
Cycloserine, 1
desloratadine, 20
donepezil hydrochloride odt, 16
Cycloset, 10
Desloratadine Odt, 20
Doral, 15
cyclosporine, 3
desmopressin acetate, 11
dorzolamide HCL, 17
cyclosporine modified, 3
desogestrel/ethinyl estradiol, 8
dorzolamide HCL/timolol maleate, 17
Cyclosporine Modified, 3
Desonate, 7
doxazosin, 4
cyproheptadine HCL, 20
desonide, 7
doxazosin mesylate, 4
cyproheptadine hydrochloride, 20
desoximetasone, 7
doxepin HCL, 14
cyred, 8
desvenlafaxine ER, 14
Doxepin Hydrochloride, 6
Cystadane, 11
Desvenlafaxine ER, 15
doxercalciferol, 11
Cystagon, 13
dexamethasone, 8
doxycycline, 1
cytra k crystals, 13
Dexamethasone, 8
doxycycline hyclate, 1
D
Dexamethasone Intensol, 8
Doxycycline Hyclate, 1
dexamethasone sodium phosphate, 8
doxycycline monohydrate, 1
d 1000, 21
Dexamethasone Sodium Phosphate, 8, 17
Dritho-creme HP, 6
d 10000, 21
dronabinol, 12
d 2000, 21
Dexilant, 12
droperidol, 14
d 400, 21
dexmethylphenidate HCL, 15
Droplet Lancets Ultra Thin 30G, 25
d 5000, 21
dexmethylphenidate HCL ER, 15
Droplet Lancing Device, 25
d-1000, 21
dexmethylphenidate hydrochloride, 15
Droplet Pen Needles 29GX10MM, 25
d-1000 extra strength, 21
dextroamphetamine sulfate, 15
Droplet Pen Needles 29GX12MM, 25
d-2000 maximum strength, 21
dextroamphetamine sulfate ER, 15
Droplet Pen Needles 31GX5MM, 25
d-3-5, 21
dialyvite vitamin d 5000, 21
Droplet Pen Needles 31GX6MM, 25
d-400, 21
dialyvite vitamin d3 max, 21
Droplet Pen Needles 31GX8MM, 25
d-5000, 21
diazepam, 14
Droplet Pen Needles 32G X 1/4", 25
d2000 ultra strength, 21
Diazepam, 14
Droplet Pen Needles 32G X 3/16", 25
d3, 21
diazepam intensol, 14
Droplet Pen Needles 32G X 5/16", 25
d3 2000, 21
Diazepam Rectal Gel, 16
Droplet Pen Needles 32G X 5/32", 25
d3 adult, 21
diclofenac potassium, 19
Droplet Pen Needles 32GX4MM, 25
d3 adult gummy, 21
diclofenac sodium, 6, 17
Droplet Pen Needles 32GX5MM, 25
D3 Dots, 22
diclofenac sodium DR, 19
Droplet Pen Needles 32GX6MM, 25
d3 high potency, 21
diclofenac sodium ER, 19
Droplet Pen Needles 32GX8MM, 25
d3 kids, 21
diclofenac sodium/misoprostol, 19
drospirenone/ethinyl estradiol, 8
d3 maximum strength, 21
dicloxacillin sodium, 1
drospirenone/ethinyl estradiol/levomefolate calcium, 8
d3 super strength, 21
dicyclomine HCL, 11
d3 ultra strength, 21
didanosine, 2
Droxia, 13
d3 vitamin, 21
Dificid, 1
Drug Mart Adjustable Lancing Device, 25
d3-1000, 21
difil-G forte, 20
Drug Mart Lancets Thin, 25
d3-50, 21
Diflorasone Diacetate, 7
Drug Mart Lancets Ultra Thin, 25
Daliresp, 21
diflunisal, 18
Drug Mart On-the-go Lancets Gentle 30G, 25
danazol, 8
digitek, 3
dantrolene sodium, 16
digox, 3
Drug Mart Unifine Pentips 31GX5MM, 25
dapsone, 2, 6
digoxin, 4
Drug Mart Unifine Pentips29G X 12MM, 25
Daraprim, 2
Digoxin, 4
darifenacin hydrobromide ER, 12
Dihydroergotamine Mesylate, 19
Drug Mart Unifine Pentips31GX6MM, 25
dasetta 1/35, 8
Dilantin, 16
Drug Mart Unifine Pentips31GX8MM, 25
dasetta 7/7/7, 8
Drug Mart Unifine Pentips32GX4MM, 25
Easy Mini Lancing Device, 25
Activated, 25
Drug Mart Unifine Pentipsplus 32GX4MM, 25
Easy Touch 32GX5MM, 26
Easy Touch Lancets 32G/Pull-top, 25
Easy Touch 32GX6MM, 26
Easy Touch Lancets 32G/Twist, 25
Drug Mart Unilet Lancets Super Thin 30G, 25
Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2", 25
Easy Touch Lancets 33G/Twist, 25
Easy Touch Lancing Device/Ejector, 25
Drug Mart Unilet Lancets Ultra Thin 28G, 25
Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2", 25
Easy Touch Pen Needle 30 G X 5/16", 25
Drug Mart Unilet Micro Thin Lancets 33G, 25
Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX5/16", 25
Easy Touch Pen Needles 29GX1/2", 25
Easy Touch Pen Needles 31GX1/4", 25
Duane Reade Lancet Alternate Site 26G, 25
Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16", 25
Easy Touch Pen Needles 31GX5/16", 25
Easy Touch Pen Needles 32GX1/4", 25
Duane Reade Lancet Super Thin 30G, 25
Easy Touch Insulin Syringe/0.3ML/30G X 5/16", 25
Easy Touch Pen Needles 32GX3/16", 25
Easy Touch Pen Needles 32GX5/32", 25
Duane Reade Lancet Ultra Thin 28G, 25
Easy Touch Insulin Syringe/0.3ML/31G X 5/16", 25
Easy Touch Pen Needles/31G X 3/16", 25
Duane Reade Unifine Pentips 29G X 12MM, 25
Easy Touch Insulin Syringe/0.5ML/29G X 1/2", 25
Easy Touch Safety Lancets21G/Pressure Activated, 25
Duane Reade Unifine Pentips 31G X 6MM Ultra SHORT, 25
Easy Touch Insulin Syringe/0.5ML/30G X 5/16", 25
Easy Touch Safety Lancets23G/Pressure Activated, 25
Duane Reade Unifine Pentips 31G X 8MM SHORT, 25
Easy Touch Insulin Syringe/1ML/30G X 5/16", 25
Easy Touch Safety Lancets26G/Button Activated, 25
Duavee, 8
duloxetine HCL, 15
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X 1/2", 25
Easy Touch Safety Lancets26G/Pressure Activated, 25
duloxetine hydrocloride, 15
Durezol, 17
Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X 5/16", 25
Easy Touch Safety Lancets28G/Button Activated, 25
dutasteride, 13
dutasteride/tamsulosin HCL, 13
Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X 1/2", 25
Easy Touch Safety Lancets28G/Pressure Activated, 26
dutasteride/tamsulosin hydrochloride, 13
Dutoprol, 5
Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X 1/2", 25
Easy Touch Sheathlock Safety Insulin Syringe 1ML/29GX1/2", 26
Duzallo, 19
Dyrenium, 5
Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2", 25
Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16", 26
Dysport, 16
E
Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2", 25
Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16", 26
E-z Ject Lancets, 25
Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2", 25
Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2", 26
E-z Ject Lancets 21G, 25
E-z Ject Lancets Color, 25
Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2", 25
Easy Twist & CAP Lancets, 26
E-z Ject Lancets Super Thin, 25
easygel, 14
E-z Ject Lancets Super Thin 30G, 25
Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16", 25
EC-81 aspirin, 18
E-z Ject Lancets Thin 26G, 25
econazole nitrate, 6
E-ZJECT Lancets Micro-thin 33G, 25
Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2", 25
econtra EZ, 8
E.e.s. 400, 1
econtra one-step, 8
Easivent, 34
Easy Touch Insulin Syringe/U-100/1ML/28G X 1/2", 25
ecotrin, 18
Easivent/Mask-large, 34
ecotrin low strength, 18
Easivent/Mask-medium, 34
Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2", 25
ecpirin, 18
Easivent/Mask-small, 34
ed-spaz, 11
Easy Comfort Insulin Syringe/0.5ML/30G X 5/16", 25
Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2", 25
Edarbi, 4
Edarbyclor, 5
Easy Comfort Insulin Syringe/0.5ML/31G X 5/16", 25
Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16", 25
Edex, 5
Edurant, 2
Easy Comfort Insulin Syringe/1ML/30G X 5/16", 25
Easy Touch Lancets 21G/Pressure Activated, 25
eemt, 8
eemt HS, 8
Easy Comfort Insulin Syringe/1ML/31G X 5/16", 25
Easy Touch Lancets 23G/Pressure Activated, 25
efavirenz, 2
Egrifta, 11
Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2", 25
Easy Touch Lancets 26G/Pressure Activated, 25
Elelyso, 13
Elestrin, 8
Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2", 25
Easy Touch Lancets 26G/Pull-top, 25
eletriptan hydrobromide, 19
Easy Touch Lancets 26G/Twist, 25
Elidel, 7
Easy Comfort Lancets, 25
Easy Touch Lancets 28G/Pressure Activated, 25
Eligard, 3
Easy Comfort Lancets 30G/Pull Top, 25
elinest, 8
Easy Comfort Lancets 30G/Thin Top, 25
Easy Touch Lancets 28G/Pull-top, 25
Eliquis, 13
Easy Comfort Pen Needles 31GX1/4", 25
Easy Touch Lancets 28G/Twist, 25
Eliquis Starter Pack, 13
Easy Comfort Pen Needles 31GX3/16", 25
Easy Touch Lancets 30G/Button-activated, 25
Elite-OB, 22
Elite-thin Insulin Syringe/0.3ML/31G X 5/16", 26
Easy Comfort Pen Needles 31GX5/16", 25
Easy Touch Lancets 30G/Pressure Activated, 25
Elite-thin Insulin Syringe/0.5ML/29G X 1/2", 26
Easy Comfort Pen Needles 32GX5/32", 25
Easy Touch Lancets 30G/Pull-top, 25
Easy Touch Lancets 30G/Twist, 25
Elite-thin Insulin Syringe/0.5ML/30G X 5/16", 26
Easy Glide Pen Needles 33G X 5/32", 25
Easy Touch Lancets 32G/Pressure
Easy Mini Eject Lancing Device, 25
Elite-thin Insulin Syringe/1ML/29G X 5/16", 26
eq aspirin adult low dose, 18
ethacrynic acid, 5
eq aspirin EC, 18
ethambutol HCL, 1
Elite-thin Insulin Syringe/1ML/30G X 5/16", 26
eq aspirin low dose, 18
ethosuximide, 15
eq childrens aspirin, 18
Ethyl Chloride, 7
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2", 26
eq childrens loratadine, 20
Ethyl Chloride/Fine Pinpoint, 7
eq loratadine, 20
Ethyl Chloride/Fine Stream, 7
Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16", 26
eql allergy relief, 20
Ethyl Chloride/Medium Jet Stream, 7
eql aspirin, 18
Ethyl Chloride/Medium Stream, 7
Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16", 26
eql aspirin EC, 18
Ethyl Chloride/Mist, 7
eql aspirin low dose, 18
ethynodiol diacetate/ethinyl estradiol, 8
Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16", 26
Eql Color Lancets 21G, 26
Etidronate Disodium, 10
Eql Color Lancets Micro Thin 33G, 26
etodolac, 19
Elite-thin Insulin Syringe/U-100/1ML/28G X 1/2", 26
Eql Insulin Syringe/0.3ML/29G X 1/2", 26
etodolac ER, 19
Eql Insulin Syringe/0.3ML/30G X 5/16", 26
Etoposide, 3
Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16", 26
Eurax, 7
Eql Insulin Syringe/0.3ML/31G X 5/16", 26
Evamist, 8
Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2", 26
Evotaz, 2
Eql Insulin Syringe/0.5ML/29G X 1/2", 26
Excel Comfort Point Insulin Pen Needles 31G X 4MM, 26
Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16", 26
Eql Insulin Syringe/0.5ML/30G X 5/16", 26
Exel Comfort Point Insulin Pen Needles 29G X 12MM, 26
Elixophyllin, 20
Eql Insulin Syringe/0.5ML/31G X 5/16", 26
Ella, 9
Exel Comfort Point Insulin Pen Needles 31G X 6MM, 26
Elmiron, 13
Eql Insulin Syringe/1ML/29G X 1/2", 26
Eloctate, 14
Eql Insulin Syringe/1ML/30G X 5/16", 26
Exel Comfort Point Insulin Pen Needles 31G X 8MM, 26
Emadine, 17
Eql Insulin Syringe/1ML/31G X 5/16", 26
Embrace Lancets Ultra Thin 30G, 26
Eql Prenatal Formula, 22
Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2", 26
Emcyt, 3
Eql SHORT Pen Needles 31G X 8MM, 26
Emend, 12
Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16", 26
emoquette, 8
Eql Super Thin Lancets 30G, 26
Emsam, 15
Eql Thin Lancets 26G, 26
Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2", 26
Emtriva, 2
Eql Ultra SHORT Pen Needles 31G X 6MM, 26
Emverm, 2
Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2", 26
enalapril maleate, 4
eql vitamin d3, 21
enalapril maleate/hydrochlorothiazide, 5
eql vitamin d3 gummies, 21
Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16", 26
Enbrel, 19
Equetro, 15
Enbrel Sureclick, 19
Ergoloid Mesylates, 16
Exel Comfort Point Insulin Syringe/1ML/28G X 1/2", 26
Encare, 13
Ergomar, 19
endocet, 18
ergotamine tartrate/caffeine, 19
Exel Comfort Point Insulin Syringe/1ML/29G X 1/2", 26
Endometrin, 13
errin, 8
Engerix-b, 21
Ertaczo, 6
Exel Comfort Point Insulin Syringe/1ML/30G X 5/16", 26
enoxaparin sodium, 13
ery, 6
enpresse-28, 8
Ery-TAB, 1
Exelderm, 6
enskyce, 8
Eryped 400, 1
exemestane, 3
Enstilar, 7
Erythrocin Stearate, 1
Exjade, 34
entacapone, 16
erythromycin, 1, 6, 16
EZ Smart Blood Glucose Lancets, 26
entecavir, 2
erythromycin base, 1
EZ-lets Lancets 21G, 26
Entereg, 12
erythromycin ethylsuccinate, 1
EZ-lets Lancets 23G, 26
enteric coated aspirin, 18
Erythromycin Ethylsuccinate, 1
EZ-lets Lancets 26G Super-soft, 26
Entresto, 5
erythromycin/benzoyl peroxide, 6
EZ-lets Lancets 28G Ultra-soft, 26
enulose, 12
Esbriet, 21
EZ-lets Lancets 30G, 26
Envarsus XR, 3
escitalopram oxalate, 14
ezetimibe, 5
Epclusa, 2
esgic, 18
ezetimibe/simvastatin, 5
ephedrine sulfate, 5
esomeprazole magnesium, 11
Ezfe Forte, 22
Epifoam, 7
estarylla, 8
F
epinastine HCL, 17
estazolam, 15
fa-8, 13
Epinephrine, 5
esterified estrogens/methyltestosterone, 8
Fabior, 6
epinephrine HCL, 5
falmina, 8
Epipen 2-PAK, 5
esterified estrogens/methyltestosterone DS, 8
famciclovir, 2
Epipen-JR 2-PAK, 5
famotidine, 11
episone CRE, 7
esterified estrogens/methyltestosterone HS, 8
Fanapt, 15
epitol, 15
Fanapt Titration Pack, 15
Epivir HBV, 2
estradiol, 8, 12
Fareston, 3
eplerenone, 4
estradiol valerate, 8
Farydak, 3
Eprosartan Mesylate, 4
estradiol/norethindrone acetate, 8
Faslodex, 3
eq adult aspirin low strength, 18
Estring, 13
fayosim, 8
eq allergy relief, 20
Estrogel, 8
Feiba, 14
eq allergy relief childrens, 20
Estropipate, 8
felbamate, 15
eq aspirin, 18
eszopiclone, 15
felodipine ER, 4
Fem PH, 13
fluocinolone acetonide, 7, 17
100/1ML/30G X 5/16", 26
Femring, 13
fluocinolone acetonide body, 7
Freestyle Unistick II Lancets, 26
femynor, 8
fluocinolone acetonide ear drops, 17
frovatriptan succinate, 19
fenofibrate, 5
fluocinolone acetonide scalp, 7
furosemide, 5
Fenofibrate, 5
fluocinonide, 7
Furosemide, 5
fenofibrate micronized, 5
fluocinonide emulsified base, 7
Fuzeon, 2
Fenofibric Acid, 5
fluoridex, 14
fyavolv, 8
fenofibric acid DR, 5
fluoridex daily renewal, 14
Fycompa, 16
fenoprofen calcium, 19
fluoridex enhanced whitening, 14
G
Fenoprofen Calcium, 19
fluoridex sensitivity relief, 14
gabapentin, 15
fentanyl, 18
fluoridex sensitivity relief/sls free, 14
galantamine hydrobromide, 16
fentanyl citrate oral transmucosal, 19
fluorometholone, 17
Galantamine Hydrobromide, 16
Fentora, 19
Fluoxetine, 16
galantamine hydrobromide ER, 16
ferosul, 13
Fluoxetine DR, 15
Ganirelix Acetate, 10
Ferretts IPS, 13
fluoxetine HCL, 14, 16
Gardasil 9, 21
Ferriprox, 34
fluphenazine decanoate, 15
gatifloxacin, 16
ferrous sulfate, 13
fluphenazine HCL, 15
gavilyte-c, 11
Ferrous Sulfate, 13
Fluphenazine HCL, 15
gavilyte-G, 11
Ferrous Sulfate Heptahydrate, 13
flurandrenolide, 7
gavilyte-h, 11
Fiasp, 9
Flurazepam HCL, 15
gavilyte-n/flavor pack, 11
Fiasp Flextouch, 9
flurbiprofen, 19
Gebauers Pain Ease, 7
Fibryga, 14
Flurbiprofen Sodium, 17
Gebauers Spray And Stretch, 7
Fifty50 Pen Needles 31G X3/16" (5MM), 26
flutamide, 3
Gelclair, 14
fluticasone propionate, 7, 20
Gelx, 14
Fifty50 Pen Needles 31G X5/16" (8MM), 26
Fluticasone Propionate/Salmeterol, 20
gemfibrozil, 5
fluvastatin, 5
Genadur, 7
Fifty50 Pen Needles 31GX5MM, 26
fluvastatin sodium ER, 5
gene-xene TAB 15MG, 14
Fifty50 Pen Needles/31GX8MM, 26
Fluvirin 2015-2016, 21
gene-xene TAB 3.75MG, 14
Fifty50 Pen Needles/32GX4MM, 26
Fluvirin 2017-2018, 21
gene-xene TAB 7.5MG, 14
Fifty50 Pen Needles/32GX6MM, 26
fluvoxamine maleate, 14
generlac, 12
Fifty50 Safety Seal Lancets 30G, 26
fluvoxamine maleate ER, 14
gengraf, 3
Fifty50 Safety Seal Lancets 32G, 26
Fluzone High-dose PF 2017-2018, 21
Gentak, 17
Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X 5/16", 26
Fluzone Intradermal Quadrivalent 2017-2018, 21
gentamicin sulfate, 1, 6, 16
gentamicin sulfate pediatric, 1
Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X 5/16", 26
Fluzone Quadrivalent 2017-2018, 21
Genteel Butterfly Touch Lancets, 26
FML, 17
Genteel Contact Tips/Blue, 26
Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16", 26
FML Forte, 17
Genteel Contact Tips/Clear, 26
folic acid, 13
Genteel Contact Tips/Green, 26
Fifty50 Unilet Lancets 33G, 26
Follistim AQ, 10
Genteel Contact Tips/Orange, 26
Finacea, 6
fondaparinux sodium, 13
Genteel Contact Tips/Rainbow, 26
finasteride, 13
Fora Lancets, 26
Genteel Contact Tips/Violet, 26
Fine 30, 26
Fora Lancing Device, 26
Genteel Contact Tips/Yellow, 26
Fingerstix Lancets, 26
Fora Lancing Device/Clearcap, 26
Genteel Lancing Device/Buff Black, 26
First-progesterone VGS 100 Compounding Kit, 13
Forteo, 10
Genteel Lancing Device/Butterfly Blue, 26
fosamprenavir calcium, 2
First-progesterone VGS 200 Compounding Kit, 13
fosinopril sodium, 4
Genteel Lancing Device/Glorious Gold, 26
fosinopril sodium/hydrochlorothiazide, 5
Flarex, 17
Fragmin, 13
Genteel Lancing Device/Playful Purple, 26
flavoxate HCL, 12
Freds Pharmacy Autolet Lancing Device, 26
flecainide acetate, 4
Genteel Lancing Device/Precious Platinum, 26
Flector, 6
Freds Pharmacy Unifine Pentips Pen Needles 32GX4MM, 26
Flexichamber, 34
Genteel Lancing Device/Princess Pink, 26
Flexichamber Adult Mask/Small, 34
Freds Pharmacy Unifine Pentips Plus 31GX5MM, 26
Flexichamber Child Mask/Large, 34
Genteel Lancing Device/Stately Silver, 26
Flexichamber Child Mask/Small, 34
Freds Pharmacy Unifine Pentips Plus 31GX8MM, 26
Flovent Diskus, 21
Genteel Lancing Device/Willowy White, 26
Flovent HFA, 21
Freds Pharmacy Unilet Lancets Super Thin 30G, 26
Fluad 2017-2018, 21
Genteel Nozzles, 26
Fluarix Quadrivalent 2017-2018, 21
Freds Pharmacy Unilet Lancets Ultra Thin 28G, 26
Gentle-let GP Lancets, 26
Flublok 2015-2016, 21
Gentle-let Lancets General Purpose Style/Fine Point, 26
Flublok 2017-2018, 21
Freestyle Lancets, 26
Flublok Quadrivalent 2017-2018, 21
Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X 5/16", 26
Gentle-let Lancets General Purpose Style/Medium Point, 26
Flucelvax Quadrivalent 2017-2018, 21
fluconazole, 1
Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X 5/16", 26
Gentle-let Lancets Safety Style/Fine Point, 26
flucytosine, 1
fludrocortisone acetate, 8
Freestyle Precision Insulin Syringe/U-100/1ML/31G X 5/16", 26
Gentle-let Lancets Safety Style/Medium Point, 26
Flulaval Quadrivalent 2017-2018, 21
Flunisolide, 20
Freestyle Precision Insulin Syringes/U-
Gentle-let Platforms 2.4MM, 26
Gentle-let Platforms 3.0MM, 26
3ML/30G X 1/2", 27
Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 27
Genvoya, 2
Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16", 27
Gialax, 11
Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" SHORT, 27
gianvi, 8
Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16", 27
Gilenya, 16
Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" SHORT, 27
Gilotrif, 3
Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2", 27
giltuss pediatric, 20
Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2", 27
glatiramer acetate, 16
Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16", 27
glatopa, 16
Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2", 27
Gleostine, 2
Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16", 27
glimepiride, 10
Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORT, 27
glipizide, 10
Glucopro Insulin Syringe/U-100/1ML/30G X 1/2", 27
glipizide ER, 10
Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT, 27
glipizide XL, 10
Glucopro Insulin Syringe/U-100/1ML/30G X 5/16", 27
glipizide/metformin HCL, 10
Gnp Ultra Comfort Insulin Syringe/1ML/28G X 1/2", 27
Global Ease Inject Pen Needles 29GX12MM, 26
Glucopro Insulin Syringe/U-100/1ML/31G X 5/16", 27
Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 27
Global Ease Inject Pen Needles 31GX8MM, 26
glyburide, 10
Glyburide, 10
Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORT, 27
Global Ease Inject Pen Needles 32GX4MM, 26
glyburide micronized, 10
glyburide/metformin HCL, 10
Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" SHORT, 27
Global Ease Inject Pen Neeedles 31GX5MM, 26
glycine, 13
Glycolic Acid, 6
gnp vitamin d, 22
Global Easy Glide Insulinsyringe/U-100/0.3ML/31G X 5/16", 26
Glycolic Acid 70% High Purity, 6
gnp vitamin d maximum strength, 22
glycopyrrolate, 11
gnp vitamin d super strength, 22
Global Easy Glide Pen Needles 32GX4MM, 26
glydo, 7
gnp vitamin d3 extra strength, 22
gnp adult aspirin low strength, 18
Golytely, 11
Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X 1/2", 26
gnp aspirin, 18
Gonal-f, 10
gnp aspirin low dose, 18
Gonal-f RFF, 10
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 1/2", 26
Gnp Clickfine Pen Needle Universal/31GX5/16", 27
Gonal-f RFF Rediject, 10
goodsense aspirin, 18
Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 5/16", 26
Gnp Clickfine Universal Pen Needles 31GX1/4", 27
goodsense aspirin adult low strength, 18
goodsense aspirin low dose, 18
Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X 5/16", 26
Gnp Clickfine Universal Pen Needles 31GX5/16", 27
Goodsense Lancets Micro-thin 33G, 27
Goodsense Lancets Ultra-thin 30G, 27
Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X 1/2", 26
gnp d 1000, 22
Goodsense Lancing Device, 27
gnp d 2000, 22
Goodsense Prenatal Vitamins, 22
Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X 1/2", 26
Gnp Daily Prenatal, 22
Goodsense Universal 1 Micro Thin 33G, 27
gnp folic acid, 13
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 1/2", 26
Gnp Insulin Syringe/0.3ML/29G X 1/2", 27
Goodsense Universal 1 Micro-thin 33G, 27
Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 5/16", 26
Gnp Insulin Syringe/0.3ML/30G X 5/16", 27
Goodsense Universal 1 Thin 26G, 27
Gordofilm, 7
Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X 5/16", 26
Gnp Insulin Syringe/0.3ML/31G X 5/16", 27
Gordons Urea, 7
granisetron HCL, 12
Global Inject Ease Insulin Syringe/U-100/1ML/28G X 1/2", 26
Gnp Insulin Syringe/0.5ML/28G X 1/2", 27
Granix, 13
griseofulvin microsize, 1
Global Inject Ease Insulin Syringe/U-100/1ML/29G X 1/2", 26
Gnp Insulin Syringe/0.5ML/29G X 1/2", 27
griseofulvin ultramicrosize, 1
guanfacine ER, 15
Global Inject Ease Insulin Syringe/U-100/1ML/30G X 1/2", 27
Gnp Insulin Syringe/0.5ML/30G X 5/16", 27
guanfacine HCL, 4
Guanidine HCL, 16
Global Inject Ease Insulin Syringe/U-100/1ML/30G X 5/16", 27
Gnp Insulin Syringe/0.5ML/31G X 5/16", 27
Gynazole-1, 13
H
Global Inject Ease Insulin Syringe/U-100/1ML/31G X 5/16", 27
Gnp Insulin Syringe/1ML/28G X 1/2", 27
h-e-b aspirin, 18
Gnp Insulin Syringe/1ML/29G X 1/2", 27
H-e-b IN Control Pen Needles 31GX5MM, 27
Global Inject Ease Lancets 28G, 27
Gnp Insulin Syringe/1ML/30G X 5/16", 27
Global Inject Ease Lancets 30G, 27
Gnp Insulin Syringe/1ML/31G X 5/16", 27
H-e-b IN Control Pen Needles 31GX6MM, 27
Global Insulin Syringe/U-100/0.3ML/30G X 1/2", 27
Gnp Lancets, 27
Gnp Lancets 21G, 27
H-e-b IN Control Pen Needles 31GX8MM, 27
Global Insulin Syringes/U-100/0.3ML/30GX5/16", 27
Gnp Lancets Micro Thin 33G, 27
Gnp Lancets Super Thin 30G, 27
H-e-b IN Control Pen Needles/Nano/32GX4MM, 27
Global Lancing Device, 27
Gnp Lancets Thin, 27
Glucagen Hypokit, 10
Gnp Lancets Thin 26G, 27
H-e-b IN Control Unifine Pentips Plus 31GX5MM, 27
Glucagon Emergency Kit, 10
gnp loratadine, 20
Glucocom Lancets 28G, 27
gnp loratadine childrens, 20
H-e-b IN Control Unifine Pentips Plus 32GX4MM, 27
Glucocom Lancets 30G, 27
Gnp Micro Thin Lancets 33G, 27
Glucocom Lancets 33G, 27
Gnp Prenatal, 22
H-e-b Incontrol Advanced Lancing Device, 27
Glucopro Insulin Syringe/U-100/0.
Gnp Super Thin Lancets/30G, 27
H-e-b Incontrol Lancets Micro Thin 33G, 27
Humalog Kwikpen, 10
ibu, 19
Humalog Mix 50/50, 10
ibudone, 19
H-e-b Incontrol Lancets Super Thin 30G, 27
Humalog Mix 50/50 Kwikpen, 10
ibuprofen, 19
Humalog Mix 75/25, 10
Iclusig, 3
H-e-b Incontrol Lancets Ultra Thin 28G, 27
Humalog Mix 75/25 Kwikpen, 10
Idelvion, 14
Humate-p, 14
Idhifa, 3
H-e-b Incontrol Pen Needles 29GX12MM, 27
Humira, 19
Ilevro, 17
Humira Pediatric Crohns Disease Starter Pack, 19
imatinib mesylate, 3
Haegarda, 14
Imbruvica, 3
Haemolance, 27
Humira Pen, 19
imipramine HCL, 14
Haemolance Low Flow Lancets, 27
Humira Pen-crohns Diseasestarter, 19
imipramine pamoate, 14
Haemolance Plus, 27
Humira Pen-psoriasis Starter, 19
imiquimod, 7
Haemolance Plus High Flow, 27
Humulin 70/30, 10
IN Touch Lancing Device, 28
Haemolance Plus Low Flow, 27
Humulin 70/30 Kwikpen, 10
IN Touch Sterile Lancets 30G, 28
Haemolance Plus Max Flow, 27
Humulin N, 10
Inatal GT, 22
Haemolance Plus Pediatric Flow, 27
Humulin N Kwikpen, 10
Increlex, 11
halobetasol propionate, 7
Humulin R, 10
Incruse Ellipta, 21
Halog, 7
Humulin R U-500 (concentrated), 10
indapamide, 5
haloperidol, 15
Humulin R U-500 Kwikpen, 10
Indocin, 19
haloperidol decanoate, 15
Hy-vee Lancets, 27
indomethacin, 19
haloperidol lactate, 15
Hy-vee Thin Lancets, 27
indomethacin ER, 19
Halotin, 6
Hycamtin, 3
Infanrix, 21
Havrix, 21
hydralazine HCL, 4
Inlyta, 3
Health Care Lancing Device, 27
hydralazine hydrochloride, 4
Inspirachamber/Anti-static Valved/Mouthpiece, 34
Healthwise Mini Pen Needles 31GX6MM, 27
hydrochlorothiazide, 5
hydrocodone bitartrate/acetaminophen, 19
Inspirachamber/Large, 34
Healthwise Pen Needles 29GX12MM, 27
Inspirachamber/Soothermask/Inspiramask/Medium, 34
Healthwise SHORT Pen Needles 31GX8MM, 27
hydrocodone bitartrate/homatropine methylbromide, 20
Inspirachamber/Soothermask/Inspiramask/Small, 34
Healthwise Unifine Pentips Pen Needles 32GX4MM, 27
hydrocodone polistirex/chlorpheniramine polistirex, 20
Inspirease Drug Delivery System, 34
Healthy Accents Autolet Impression Lancing Device, 27
hydrocodone/acetaminophen, 19
Inspirease Reservoir Bags, 34
hydrocodone/homatropine, 20
Insulin Syringe 1ML/31G X1/4", 23
Healthy Accents Unifine Pentips Pen Needles 29GX12MM, 27
hydrocodone/ibuprofen, 19
Insulin Syringe/0.3ML/29G X 1", 27
hydrocort ene 100MG, 12
Insulin Syringe/0.3ML/29G X 1/2", 27
Healthy Accents Unifine Pentips Pen Needles 31GX5MM, 27
hydrocortisone, 7, 8, 12
Insulin Syringe/0.3ML/30G X 5/16", 27
hydrocortisone 1% IN absorbase, 7
Insulin Syringe/0.3ML/31G X 5/16", 27
Healthy Accents Unifine Pentips Pen Needles 31GX6MM, 27
hydrocortisone acetate/pramoxine, 12
Insulin Syringe/0.5ML/27G X 1/2", 27
hydrocortisone butyrate, 7
Insulin Syringe/0.5ML/28G X 1/2", 27
Healthy Accents Unifine Pentips Pen Needles 31GX8MM, 27
hydrocortisone butyrate (lipid), 7
Insulin Syringe/0.5ML/30G X 1/2", 27
hydrocortisone butyrate (lipophilic), 7
Insulin Syringe/0.5ML/30G X 5/16", 27
Healthy Accents Unifine Pentips Pen Needles 32GX4MM, 27
hydrocortisone valerate, 7
Insulin Syringe/0.5ML/31G X 5/16", 27
hydrocortisone/acetic acid, 17
Insulin Syringe/1ML/28G X 1/2", 27
Healthy Accents Unilet Lancets Super Thin 30G, 27
hydromet, 20
Insulin Syringe/1ML/29G X 1/2", 27
hydromorphone HCL, 19
Insulin Syringe/1ML/30G X 5/16", 27
healthy kids vitamin d3, 22
Hydromorphone HCL, 19
Insulin Syringe/Needle 0.3ML/30G X 5/16", 27
heather, 8
hydromorphone HCL ER, 19
Helixate FS, 14
hydromorphone hydrochloride, 19
Insulin Syringe/Needle 0.3ML/31G X 5/16", 27
Hemenatal OB + DHA, 22
hydromorphone hydrochloride ER, 19
Hemofil M, 14
Hydroxocobalamin, 13
Insulin Syringe/Needle 0.5ML/29G X 1/2", 27
Heplisav-b, 21
hydroxychloroquine sulfate, 2
Hexalen, 2
Hydroxyprogesterone Caproate, 3
Insulin Syringe/Needle 0.5ML/30G X 5/16", 27
Hiberix, 21
hydroxyurea, 3
HM aspirin, 18
hydroxyzine HCL, 14
Insulin Syringe/Needle 0.5ML/31G X 5/16", 27
HM aspirin EC, 18
hydroxyzine pamoate, 14
HM aspirin EC low dose, 18
Hydroxyzine Pamoate, 14
Insulin Syringe/Needle 1ML/29G X 1/2", 27
HM folic acid, 13
Hylira, 8
HM loratadine, 20
Hyophen, 12
Insulin Syringe/Needle 1ML/30G X 5/16", 27
HM loratadine childrens, 20
hyoscyamine sulfate, 11
HM One Daily Prenatal Combo, 22
hyoscyamine sulfate ER, 11
Insulin Syringe/Needle 1ML/31G X 5/16", 27
HM Prenatal, 22
hyoscyamine sulfate odt, 11
HM vitamin d, 22
hyoscyamine sulfate SR, 11
Insulin Syringe/U-100/0.3ML/29G X 1/2", 27
HM vitamin d3, 22
hyosyne, 11
HM Vitamin D3, 22
Hypersal, 20
Insulin Syringe/U-100/0.5ML/29G X 1/2", 27
homatropaire, 17
Hypolance AST Lancing Kit, 27
homatropine HBR, 17
I
Insulin Syringe/U-100/1ML/29G X 1/2", 27
Humalog, 10
ibandronate sodium, 10
Humalog Junior Kwikpen, 10
Insulin Syringe/U-100/1ML/30G X 5/16",
Ibrance, 3
27
Jakafi, 3
Koate, 14
Insulin Syringe/U-100/1ML/31G X 5/16", 27
jantoven, 13
Koate-dvi, 14
Janumet, 10
Kogenate FS, 14
Insulin Syringes 0.3ML/31G X 1/4", 23
Janumet XR, 10
Kogenate FS Bio-set, 14
Insulin Syringes 0.5ML/31G X 1/4", 23
Januvia, 10
Korlym, 10
Insulin Syringes/0.5ML/27GX1/2", 27
Jardiance, 10
Kosher Prenatal Plus Iron, 22
Insulin Syringes/0.5ML/28GX1/2", 27
jencycla, 9
kp aspirin, 18
Insulin Syringes/0.5ML/29GX1/2", 27
Jentadueto, 10
kp folic acid, 13
Insulin Syringes/0.5ML/30GX5/16", 27
Jentadueto XR, 10
kp loratadine, 20
Insulin Syringes/0.5ML/31GX 5/16", 27
jevantique LO, 8
Kp Prenatal Multivitamins, 22
Insulin Syringes/0.5ML/31GX5/16", 27
jinteli, 8
kp vitamin d, 22
Insulin Syringes/1ML/27GX/1/2", 27
jolessa, 9
kp vitamin d3, 22
Insulin Syringes/1ML/27GX1/2", 27
jolivette, 9
Kpn Prenatal, 22
Insulin Syringes/1ML/28GX1/2", 27
juleber, 9
Kristalose, 11
Insulin Syringes/1ML/29GX1/2", 27
junel 1.5/30, 9
Kroger Insulin Syringe/0.3ML/29G X 1/2", 28
Insulin Syringes/1ML/30GX1/2", 27
junel 1/20, 9
Insulin Syringes/1ML/31GX5/16", 27
junel FE 1.5/30, 9
Kroger Insulin Syringe/0.3ML/30G X 5/16", 28
Insupen 29G X 12MM, 28
junel FE 1/20, 9
Insupen 31G X 5MM, 28
junel FE 24, 9
Kroger Insulin Syringe/0.3ML/31G X 5/16", 28
Insupen 31G X 8MM, 28
just d, 22
Insupen 32G X 4MM, 28
K
Kroger Insulin Syringe/0.5ML/29G X 1/2", 28
Insupen 33GX4MM, 28
K-phos NO 2, 13
Insupen Pen Needles 32G X4MM, 27
Kroger Insulin Syringe/0.5ML/30G X 5/16", 28
Kadian, 19
Insupen Sensitive 32GX6MM, 27
kaitlib FE, 9
Insupen Sensitive 32GX8MM, 27
Kroger Insulin Syringe/0.5ML/31G X 5/16", 28
Kaletra, 2
Insupen Ultrafin 29GX12MM, 27
Kalydeco, 21
Insupen Ultrafin 30GX8MM, 27
Kroger Insulin Syringe/1ML/29G X 1/2", 28
kariva, 9
Insupen Ultrafin 31GX6MM, 27
kelnor 1/35, 9
Insupen Ultrafin 31GX8MM, 27
Kroger Insulin Syringe/1ML/30G X 5/16", 28
kelnor 1/50, 9
Intelence, 2
Keralyt Scalp, 8
Intrarosa, 13
Kroger Insulin Syringe/1ML/31G X 5/16", 28
ketoconazole, 1, 6
Intron A, 3
Ketoprofen, 19
introvale, 9
Kroger Lancets, 28
ketorolac tromethamine, 17, 19
Invega Sustenna, 15
Kroger Lancets 21G, 28
Ketorolac Tromethamine, 19
Invega Trinza, 15
Kroger Lancets Micro Thin33G, 28
Kevzara, 19
Invirase, 2
Kroger Lancets Super Thin, 28
Khedezla, 15
Invokamet, 10
Kroger Lancets Thin, 28
kimidess, 9
Invokamet XR, 10
Kroger Lancets Thin 26G, 28
Kineret, 19
Invokana, 10
Kroger Lancets Ultrathin 30G, 28
Kinney Lancets, 28
Iopidine, 17
Kroger Lancing Device, 28
Kinney Thin Lancets, 28
Ipol Inactivated IPV, 21
Kroger Pen Needles 29G X 12MM, 28
Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16", 28
ipratropium bromide, 20(2)
Kroger Pen Needles 31G X 8MM, 28
ipratropium bromide/albuterol sulfate, 20
Kroger Pen Needles 31GX1/4", 28
Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16", 28
irbesartan, 4
kurvelo, 9
irbesartan/hydrochlorothiazide, 5
Kuvan, 11
Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16", 28
Iressa, 3
L
Iron Chews Pediatric, 13
Kinray Insulin Syringe/0.5ML/29G X 1/2", 28
labetalol HCL, 4
iron supplement childrens, 13
labetalol hydrochloride, 4
Iron Up, 13
Kinrix, 21
Lacrisert, 17
Isentress, 2
Kisqali, 3
lactic acid, 7
Isentress HD, 2
Kisqali Femara 200 Dose, 3
lactic acid e, 7
isibloom, 9
Kisqali Femara 400 Dose, 3
lactic acid w/vitamin e, 7
isoniazid, 1
Kisqali Femara 600 Dose, 3
lactulose, 11, 12
Isoniazid, 1
Kitabis PAK, 1
lamivudine, 2
Isordil Titradose, 4
klofensaid II, 6
lamivudine/zidovudine, 2
isosorbide dinitrate, 4
kls allerclear, 20
lamotrigine, 15
Isosorbide Dinitrate ER, 4
kls aspirin EC, 18
lamotrigine ER, 15
isosorbide mononitrate, 4
kls aspirin low dose, 18
lamotrigine odt, 15
isosorbide mononitrate ER, 4
Kmart Valu Plus Insulin Syringe/0.3ML/30G, 28
lamotrigine titration, 15
isotretinoin, 6
Lancet Device Adjustable, 28
isoxsuprine HCL, 5
Kmart Valu Plus Insulin Syringe/0.5ML/29G, 28
Lancet Device With Ejector, 28
isradipine, 4
Lancet Transporter Case, 28
itraconazole, 1
Kmart Valu Plus Insulin Syringe/0.5ML/30G, 28
Lancets, 28
ivermectin, 2
Lancets 26G Twist Top, 28
Ixinity, 14
Kmart Valu Plus Insulin Syringe/1ML/29G, 28
Lancets 28G, 28
J
Lancets 30G, 28
Jadenu, 34
Kmart Valu Plus Insulin Syringe/1ML/30G, 28
Lancets 30G Twist Top, 28
Jadenu Sprinkle, 34
Lancets 30G/Twist Top, 28
Lancets 31G Twist Top, 28
Leader Unifine Pentips/Plus/32GX5/32", 28
Lindane, 7
Lancets 33G Universal Design, 28
linezolid, 2
Lancets Bullseye Safety, 28
leena, 9
Linzess, 12
Lancets Micro Thin 33G, 28
leflunomide, 19
liothyronine sodium, 11
Lancets Safety Seal 21G, 28
Lenvima 10 MG Daily Dose, 3
liprozonepak, 7
Lancets Safety Seal 26G, 28
Lenvima 14 MG Daily Dose, 3
lisinopril, 4
Lancets Safety Seal 28G, 28
Lenvima 18 MG Daily Dose, 3
lisinopril/hydrochlorothiazide, 5
Lancets Safety Seal 30G, 28
Lenvima 20 MG Daily Dose, 3
Lite Touch Lancets, 28
Lancets Super Thin 28G, 28
Lenvima 24 MG Daily Dose, 3
Lite Touch Lancing Pen, 28
Lancets Thin, 28
Lenvima 8 MG Daily Dose, 3
Lite Touch Pen Needles/31G X 3/16", 28
Lancets Twist Top, 28
lessina, 9
Liteaire, 34
Lancets Ultra Fine, 28
Letairis, 5
Litetouch Insulin Syringe/0.3ML/29G X 1/2", 28
Lancets Ultra Thin, 28
letrozole, 3
Lancets Ultra Thin 30G, 28
leucovorin calcium, 3
Litetouch Insulin Syringe/0.3ML/30G X 5/16", 28
Lancing Device, 28
Leucovorin Calcium, 3
Lancing Device Adjustable, 28
Leukeran, 2
Litetouch Insulin Syringe/0.3ML/31G X 5/16", 28
lansoprazole, 11
Leukine, 13
lansoprazole/amoxicillin/clarithromycin, 11
leuprolide acetate, 3
Litetouch Insulin Syringe/0.5ML/30G X 5/16", 28
levalbuterol, 20
lanthanum carbonate, 12
levalbuterol HCL, 20
Litetouch Insulin Syringe/0.5ML/31G X 5/16", 28
Lantus, 9
levalbuterol hydrochloride, 20
Lantus Solostar, 9
Levemir, 9
Litetouch Insulin Syringe/1ML/30G X 5/16", 28
Lanzo, 28
Levemir Flextouch, 9
larin 1.5/30, 9
levetiracetam, 15
Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2", 28
larin 1/20, 9
levetiracetam ER, 15
larin 24 FE, 9
levo-t, 11
Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2", 28
larin FE 1.5/30, 9
levobunolol HCL, 17
larin FE 1/20, 9
levocarnitine, 11
Litetouch Insulin Syringe/U-100/1ML/28G X 1/2", 28
larissia, 9
levocetirizine dihydrochloride, 20
Lastacaft, 17
levofloxacin, 1, 16
Litetouch Insulin Syringe/U-100/1ML/29G X 1/2", 28
latanoprost, 17
Levofloxacin, 1
Latrix XM, 8
levonest, 9
Litetouch Insulin Syringe/U-100/1ML/31G X 5/16", 28
Latuda, 15
levonorgestrel, 9
layolis FE, 9
levonorgestrel and ethinyl estradiol, 9
Litetouch Lancets Micro Thin 33G, 28
Leader Advanced Lancing Device, 28
levonorgestrel/ethinyl estradiol, 9
Litetouch Pen Needles 29GX12.7MM, 28
Leader Insulin Syringe/0.3ML/29G X 1/2", 28
levora 0.15/30-28, 9
Litetouch Pen Needles 31G X 6MM, 28
Levorphanol Tartrate, 19
Litetouch Pen Needles 31GX8MM SHORT, 28
Leader Insulin Syringe/0.3ML/30G X 5/16", 28
levothyroxine sodium, 11
levothyroxine/liothyronine, 11
Lithium, 15
Leader Insulin Syringe/0.3ML/31G X 5/16", 28
levoxyl, 11
lithium carbonate, 15
Levsin, 12
Lithium Carbonate, 15
Leader Insulin Syringe/0.5ML/28G X 1/2", 28
Lexiva, 2
lithium carbonate ER, 15
Liberty Medical Lancets 30G, 28
Lithostat, 13
Leader Insulin Syringe/0.5ML/29G X 1/2", 28
Liberty Mini Lancing Device, 28
Livalo, 5
lido bdk, 7
Live Better Advanced Lancing Device, 28
Leader Insulin Syringe/0.5ML/30G X 5/16", 28
lido-k, 7
Live Better Lancet Super Thin 30G, 28
lido-prilo caine pack, 7
Live Better Lancet Ultra Thin 28G, 28
Leader Insulin Syringe/0.5ML/31G X 5/16", 28
lidocaine, 7
Live Better Pen Needles 29G X 12MM, 28
lidocaine HCL, 7, 19
Leader Insulin Syringe/1ML/28G X 1/2", 28
Lidocaine HCL, 14
Live Better Pen Needles 31G X 12MM, 28
lidocaine HCL jelly, 7
Leader Insulin Syringe/1ML/29G X 1/2", 28
lidocaine HCL viscous, 14
Live Better Pen Needles 31G X 6MM, 28
Lidocaine HCL-hydrocortisone Acetate With Aloe, 12
livixil PAK, 7
Leader Insulin Syringe/1ML/30G X 5/16", 28
LO Loestrin FE, 9
lidocaine HCL/hydrocortisone acetate, 12
Longs Insulin Syringe/0.5ML/31G X 5/16", 28
Leader Insulin Syringe/1ML/31G X 5/16", 28
lidocaine hydrochloride, 7
lidocaine PAK, 7
Longs Lancets Standard, 28
Leader Lancets Colored, 28
lidocaine viscous, 14
Longs Lancets Thin, 28
Leader Super Thin Lancet, 28
lidocaine-prilocaine-cream base, 7
Longs Lancets Ultra Thin, 28
Leader Thin Lancets, 28
lidocaine/epinephrine, 19
Lonsurf, 3
Leader Unifine Pentips Plus/Mini/31GX3/16", 28
lidocaine/prilocaine, 7
loperamide HCL, 11
lidopin, 7
lopinavir/ritonavir, 2
Leader Unifine Pentips Plus/SHORT/31GX5/16", 28
lidopril, 7
lopreeza, 8
lidopril XR, 7
loradamed, 20
Leader Unifine Pentips/Mini/31GX3/16", 28
lidozion, 7
loratadine, 20
Lifescan Unistik 2 Deep Penetration, 28
loratadine childrens, 20
Leader Unifine Pentips/Nano/32GX5/32", 28
Lifescan Unistik II Lancets, 28
lorazepam, 14
lillow, 9
lorazepam intensol, 14
lorcet, 19
Medichoice Pre-set Safety Lancet Dual Use, 28
Meperidine HCL, 19
lorcet HD, 19
Mepivacaine HCL, 20
lorcet plus, 19
Medichoice Pre-set Safety Lancet Low Flow, 28
meprobamate, 14
Lortab, 19
mercaptopurine, 3
loryna, 9
Medichoice Pre-set Safety Lancet Medium Flow, 28
mesalamine, 12
losartan potassium, 4
mesalamine DR, 12
losartan potassium/hydrochlorothiazide, 5
Medichoice Pre-set Safety Lancet Moderate Flow, 28
Mesnex, 3
Mestinon, 16
Lotemax, 17
Medichoice Safety Lancet Extra, 28
metadate ER, 15
Loutrex, 6
Medichoice Safety Lancet Normal, 28
Metaproterenol Sulfate, 21
lovastatin, 5
Medicine Shoppe Lancets, 28
metaxall, 16
low-ogestrel, 9
Medicine Shoppe Lancets Thin, 28
metaxalone, 16
loxapine, 15
Medicine Shoppe Pen Needles 29G X 12MM, 28
metformin HCL, 10
loxapine succinate, 15
metformin HCL ER, 10
Lumigan, 17
Medicine Shoppe Pen Needles 31G X 6MM, 28
metformin hydrochloride, 10
Lupaneta Pack, 10
metformin hydrochloride ER, 10
Lupron Depot (1-month), 3
Medicine Shoppe Pen Needles 31G X 8MM, 29
methadone HCL, 19
Lupron Depot (3-month), 3
Methadone HCL, 19
Lupron Depot (4-month), 3
Medisense Thin Lancets, 29
methadone HCL intensol, 19
Lupron Depot (6-month), 3
Medlance Plus Extra Lancets 21G, 29
methadose, 19
Lupron Depot-PED (1-month), 10
Medlance Plus Lancets, 29
methamphetamine HCL, 15
Lupron Depot-PED (3-month), 10
Medlance Plus Lancets Lite 25G, 29
methazolamide, 5
lutera, 9
Medlance Plus Lite Lancets 25G, 29
methenamine hippurate, 12
Lynparza, 3
Medlance Plus Special Lancets 0.8MM, 29
methenamine mandelate, 12
Lyrica, 16
Methenamine Mandelate, 12
Lysodren, 3
Medlance Plus Superlite 30G, 29
methergine, 18
lyza, 9
Medlance Plus Superlite 30G/Comfort Max, 29
methimazole, 11
M
methocarbamol, 16
Medlance Plus Universal Lancets 21G, 29
methotrexate, 3
M-m-r II, 21
methotrexate sodium, 3
M-vit, 22
Medlance Plus/Lite 25G, 29
Methotrexate Sodium, 3
Magellan Insulin Safety Syringe/U-100/0.3ML/29G X 1/2", 28
Medlance/Extra, 29
methoxsalen, 6
Medlance/Lite, 29
methscopolamine bromide, 11
Magellan Insulin Safety Syringe/U-100/0.3ML/30G X 5/16", 28
Medlance/Universal, 29
Methyclothiazide, 5
medolor PAK, 7
methyldopa, 4
Magellan Insulin Safety Syringe/U-100/0.5ML/29G X 1/2", 28
Medrol, 8
Methyldopa/Hydrochlorothiazide, 5
medroxyprogesterone acetate, 9(2)
methylergonovine maleate, 18
Magellan Insulin Safety Syringe/U-100/0.5ML/30G X 5/16", 28
mefenamic acid, 19
methylphenidate HCL, 15
Mefloquine HCL, 2
methylphenidate HCL CD, 15
Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2", 28
megestrol acetate, 3, 9
methylphenidate HCL ER, 15
meijer allergy relief, 20
Methylphenidate HCL ER, 15
Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16", 28
meijer aspirin EC, 18
Methylphenidate HCL ER (LA), 15
Meijer Color Lancets Universal 33G, 29
methylphenidate hydrochloride, 15
Makena, 9
Meijer Lancets, 29
methylphenidate hydrochloride ER, 15
malathion, 7
Meijer Lancets Thin, 29
methylphenidate hydrocloride ER, 15
Maprotiline HCL, 15
Meijer Lancets Universal 21G, 29
methylprednisolone, 8
Marathon Medical Pentips 29GX12MM, 28
Meijer Lancets Universal 30G, 29
methylprednisolone acetate, 8
Meijer Lancets Universal 33G, 29
methylprednisolone dose pack, 8
Marathon Medical Pentips 31GX5MM, 28
meijer loratadine, 20
Methyltestosterone, 8
Marathon Medical Pentips 31GX8MM, 28
Meijer Pen Needles 29G X 12MM, 29
Metipranolol, 17
Marathon Medical Pentips 32GX4MM, 28
Meijer Pen Needles 31G X 6MM, 29
metoclopramide HCL, 12
marlissa, 9
Meijer Pen Needles 31G X 8MM, 29
metolazone, 5
Marplan, 15
Meijer Super Thin Lancets, 29
metoprolol succinate ER, 4
Matulane, 3
Mekinist, 3
Metoprolol Succinate ER/Hydrochlorothiazide, 5
matzim LA, 4
melodetta 24 FE, 9
Mavyret, 2
meloxicam, 19
metoprolol tartrate, 4
Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2", 28
melphalan, 2
metoprolol/hydrochlorothiazide, 5
memantine HCL, 16
Metoprolol/Hydrochlorothiazide, 5
Maxi-comfort Insulin Syringe/U-100/1ML/28GX1/2", 28
memantine HCL titration PAK, 16
metronidazole, 2, 6
memantine hydrochloride, 16
metronidazole vaginal, 12
Maxidex, 17
memantine hydrochloride ER, 16
mexiletine HCL, 4
maximum d3, 22
Menactra, 21
mibelas 24 FE, 9
me/naphos/mb/hyo 1, 12
Menest, 8
Miconazole 3, 13
meclizine HCL, 12
Menopur, 10
Microchamber, 34
Meclofenamate Sodium, 19
Menostar, 8
microgestin 1.5/30, 9
Medic Insulin Syringe/0.3ML/30G X 5/16", 28
Mentax, 6
microgestin 1/20, 9
Menveo, 21
microgestin FE, 9
Medic Insulin Syringe/0.5ML/30G X 5/16", 28
meperidine HCL, 19
microgestin FE 1.5/30, 9
Microlet Lancets, 29
Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2", 29
MS Insulin Syringe/0.5ML/29G X 1/2", 29
Microlet Next, 29
MS Insulin Syringe/0.5ML/30G X 5/16", 29
Microspacer, 34
Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2", 29
Microtainer Safety Flow Lancet/Sterile/Single-use, 29
MS Insulin Syringe/0.5ML/31G X 5/16", 29
Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X 1/2", 29
midodrine HCL, 5
MS Insulin Syringe/1ML/29G X 1/2", 29
Mifeprex, 11
Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X 1/2", 29
MS Insulin Syringe/1ML/30G X 5/16", 29
Migergot, 19
MS Insulin Syringe/1ML/31G X 5/16", 29
miglitol, 10
Monoject Insulin Syringe/Softpack/1ML/27G X 1/2", 29
Mucotrol, 14
miglustat, 13
Multaq, 4
mili, 9
Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X 1/2", 29
Multi Prenatal, 22
mimvey, 8
Multi-lancet Device, 29
mimvey LO, 8
Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16", 29
Multi-lancet Device 2, 29
Mini Lancing Device, 29
mupirocin, 6
miniprin low dose, 18
Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16", 29
Muse, 5
minitran, 4
my choice, 9
minocycline HCL, 1
Monoject Insulin Syringe/U-100/1ML/28G X 1/2", 29
my way, 9
minocycline hydrochloride, 1
mycophenolate mofetil, 3
minoxidil, 4
Monoject Insulin Syringe/U-100/1ML/30G X 5/16", 29
mycophenolic acid DR, 3
Mircera, 13
Myglucohealth Mgh Softlance Lancets 30G, 29
mirtazapine, 14
Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 29
mirtazapine odt, 14
Myleran, 2
misoprostol, 11
Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16", 29
Mynatal Advance, 22
Mitigare, 19
Mynatal Plus, 22
MM aspirin, 18
Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 29
Mynatal Ultracaplet, 22
MM Insulin Syringe/U-100/0.3ML/30G X 5/16", 29
Mynatal-z, 22
Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2", 29
Mynate 90 Plus, 22
MM Insulin Syringe/U-100/0.3ML/31G X 5/16", 29
Myobloc, 16
Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2", 29
myorisan, 6
MM Insulin Syringe/U-100/1/2ML/30G X 5/16", 29
Myrbetriq, 12
Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 29
myzilra, 9
MM Insulin Syringe/U-100/1/2ML/31G X 5/16", 29
N
Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 29
nabumetone, 19
MM Insulin Syringe/U-100/1ML/30G X 5/16", 29
nadolol, 4
Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2", 29
nadolol/bendroflumethiazide, 5
MM Insulin Syringe/U-100/1ML/31G X 5/16", 29
Nafrinse Daily/Acidulated, 14
Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 29
Naftin, 6
MM Lancing Device, 29
naloxone HCL, 34
MM Pen Needles 31G X 1/4", 29
Monojector End CAPS, 29
Naloxone HCL, 34
MM Pen Needles 31G X 3/16", 29
Monojector Opd End CAPS, 29
naltrexone HCL, 34
MM Pen Needles 31G X 5/16", 29
Monolet Lancets, 29
naproxen, 19
MM Pen Needles 32G X 5/32", 29
Monolet Opd Lancets, 29
naproxen DR, 19
MM Twist Lancets, 29
Monolettor Safety Lancets, 29
naproxen sodium, 19
modafinil, 15
mononessa, 9
naratriptan HCL, 19
moderiba, 2
Mononine, 14
Nascobal, 13
Moderiba, 2
montelukast sodium, 20
nat-rul vitamin d, 22
Moderiba 1200 Dose Pack, 2
Monurol, 12
Natacyn, 17
Moderiba 800 Dose Pack, 2
morgidox 1X100MG, 1
nateglinide, 10
moexipril HCL, 4
morgidox 1X50MG, 1
Natpara, 10
moexipril/hydrochlorothiazide, 5
morgidox 2X100MG, 1
natural vitamin d-3, 22
mometasone furoate, 7, 20
morphine sulfate, 19
Nature-throid, 11
Mommys Bliss Vitamin D Organic, 22
Morphine Sulfate, 19
Nature-throid Nt-2.5, 11
mondoxyne nl, 1
morphine sulfate ER, 19
Nebupent, 2
mono-linyah, 9
Morphine Sulfate ER, 19
nebusal, 20
Monoclate-p, 14
Motofen, 11
necon 0.5/35-28, 9
Monoject Insulin Syringe Regular LUER Tip/Softpack/1ML, 29
Movantik, 12
necon 7/7/7, 9
Moviprep, 11
nefazodone HCL, 14
Monoject Insulin Syringe/1ML, 29
Moxatag, 1
Nefazodone HCL, 15
Monoject Insulin Syringe/1ML/31G X 5/16", 29
Moxeza, 17
neo-polycin, 16
moxifloxacin, 16
neo-polycin HC, 17
Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8", 29
moxifloxacin HCL, 1, 16
Neo-synalar, 6
moxifloxacin hydrochloride, 16
neomycin sulfate, 1
Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2", 29
Mozobil, 13
neomycin/bacitracin/polymyxin, 16
MS Insulin Syringe/0.3ML/29G X 1/2", 29
neomycin/polymyxin b sulfates, 13
Monoject Insulin Syringe/Perm Needle/1ML/28G X 1/2", 29
MS Insulin Syringe/0.3ML/30G X 5/16", 29
neomycin/polymyxin/bacitracin, 16
neomycin/polymyxin/bacitracin/hydrocortisone, 17
Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X 1/2", 29
MS Insulin Syringe/0.3ML/31G X 5/16", 29
neomycin/polymyxin/dexamethasone, 17
neomycin/polymyxin/gramicidin, 17
nortriptyline HCL, 14
olopatadine hydrochloride, 17
neomycin/polymyxin/HC, 18
nortriptyline hydrochloride, 14
omega-3-acid ethyl esters, 5
Neomycin/Polymyxin/Hydrocortisone, 17
nortuss-DE, 20
omeprazole, 11
neomycin/polymyxin/hydrocortisone, 18
Nortuss-EX, 20
omeprazole DR, 11
Neosalus, 8
Norvir, 2
On Call Lancets, 29
Nerlynx, 3
norwich aspirin, 18
On Call Lancing Device, 29
Nestabs DHA, 22
Nova Safety Lancets 23G, 29
On Call Plus Lancets, 29
Nestabs One, 23
Nova Safety Lancets 28G, 29
On Call Plus Lancing Device, 29
neuac, 6
Nova Sureflex Lancets, 29
ondansetron HCL, 12
Neulasta, 13
Nova Sureflex Lancing Device, 29
ondansetron odt, 12
Neulasta Onpro Kit, 13
Novaferrum Pediatric Drops, 13
One-a-day Womens Prenatal, 22
Neupogen, 13
Novarel, 10
Onetouch Club Lancets Fine Point, 23
Neupro, 16
Novofine 32GX6MM, 29
Onetouch Combo Pack, 23
neutral sodium fluoride, 14
Novofine Autocover 30GX8MM, 29
Onetouch Delica Lancets Extra Fine 33G, 29
Neutrasal, 14
Novofine Plus 32GX4MM, 29
Nevanac, 17
Novolin 70/30, 10
Onetouch Delica Lancets Fine 30G, 23
nevirapine, 2
Novolin 70/30 Relion, 10
Onetouch Delica Lancing Device, 23
nevirapine ER, 2
Novolin N, 9
Onetouch Finepoint Lancets, 23
Nexavar, 3
Novolin N Relion, 9
Onetouch Suresoft Lancing Device/18G, 23
niacin ER, 5
Novolin R, 9
nicardipine HCL, 4
Novolin R Relion, 9
Onetouch Suresoft Lancing Device/21G, 23
nifedipine, 4
Novolog, 10
nifedipine ER, 4
Novolog Flexpen, 10
Onetouch Suresoft Lancing Device/28G, 23
nikki, 9
Novolog Mix 70/30, 10
nilutamide, 3
Novolog Mix 70/30 Prefilled Flexpen, 10
Onetouch Ultra Blue, 23
nimodipine, 4
Novolog Penfill, 10
Onetouch Ultrasoft Lancets, 23
Ninlaro, 3
Novoseven, 14
Onetouch Verio Test Strips, 23
nisoldipine ER, 4
Novoseven Rt, 14
Onfi, 16
Nisoldipine ER, 4
Novotwist 32GX5MM, 29
opcicon one-step, 9
Nitro-bid, 4
Noxafil, 1
Opsumit, 5
Nitro-dur, 4
NP thyroid 120, 11
Optichamber Advantage/Large Mask, 34
nitro-time, 4
NP thyroid 15, 11
Optichamber Advantage/Medium Face Mask, 34
nitrofurantoin, 12
NP thyroid 30, 11
nitrofurantoin macrocrystals, 12
NP thyroid 60, 11
Optichamber Advantage/Small Face Mask, 34
nitrofurantoin monohydrate, 12
NP thyroid 90, 11
nitrofurantoin monohydrate/macrocrystals, 12
Nplate, 13
Optichamber Diamond, 34
Nucala, 21
Optichamber Diamond/Largeface Mask, 34
nitroglycerin, 4
Nucort, 7
nitroglycerin ER, 4
Nucynta, 19
Optichamber Diamond/Medium Face Mask, 34
nitroglycerin lingual, 4
Nuedexta, 16
nitroglycerin transdermal, 4
nulev, 11
Optichamber Diamond/Smallface Mask, 34
Nitromist, 4
Nuplazid, 15
Nityr, 11
Nuvaring, 9
Optihaler, 34
Niva-plus, 22
Nymalize, 4
Optihaler MDI Drug Delivery System, 34
nizatidine, 12
nystatin, 1, 6, 14
optimal-d, 22
Nizatidine, 12
nystatin/triamcinolone, 6
optimal-d pack, 22
nolix, 7
nystatin/triamcinolone acetonide, 6
option 2, 9
nora-be, 9
O
Options Gynol II Vaginal Contraceptive, 13
Norditropin Cartridge, 11
O-CAL Fa, 22
Norditropin Flexpro, 11
opurity vitamin d, 22
Obstetrix DHA, 22
norethindrone, 9
Oracit, 13
Obstetrix EC, 22
norethindrone & ethinyl estradiol ferrous fumarate, 9
oralone dental paste, 14
ocella, 9
Oramagicrx, 14
octreotide acetate, 11
norethindrone acetate, 9
Oravig, 14
Odefsey, 2
norethindrone acetate/ethinyl estradiol, 8, 9
Orencia, 19
Ofev, 21
Orencia Clickject, 19
ofloxacin, 1, 17, 18
norethindrone acetate/ethinyl estradiol/ferrous fumarate, 9
Orkambi, 21
Ogestrel, 9
orphenadrine citrate, 16
okebo, 1
norethindrone/ethinyl estradiol/ferrous fumarate, 9
orphenadrine citrate ER, 16
olanzapine, 15
orsythia, 9
olanzapine odt, 15
norgestimate/ethinyl estradiol, 9
oscimin, 11
olanzapine/fluoxetine, 16
Noritate, 6
oscimin SR, 11
olmesartan medoxomil, 4
norlyda, 9
oseltamivir phosphate, 2
olmesartan medoxomil/amlodipine/hydrochlorothiazide, 5
norlyroc, 9
Osmoprep, 11
Norpace CR, 4
Osphena, 10
nortrel 0.5/35 (28), 9
Otezla, 19
olmesartan medoxomil/hydrochlorothiazide, 5
nortrel 1/35, 9
Ovace Plus, 6
nortrel 7/7/7, 9
Ovidrel, 10
olopatadine HCL, 17, 20
oxandrolone, 8
Pen Needles 32G X 5MM, 23
pimtrea, 9
oxaprozin, 19
Pen Needles 32G X 6MM, 23
pindolol, 4
oxazepam, 14
Pen Needles 32GX4MM, 29
pioglitazone HCL, 10
Oxazepam, 14
penicillin v potassium, 1
pioglitazone HCL-glimepiride, 10
oxcarbazepine, 15
Penicillin V Potassium, 1
pioglitazone HCL/metformin HCL, 10
oxiconazole nitrate, 6
Penlet II Automatic Bloodsampler, 29
pirmella 1/35, 9
Oxistat, 6
Penlet II Replacement CAPS, 29
pirmella 7/7/7, 9
Oxtellar XR, 16
Penlet II Replacement CAPS-deep, 29
piroxicam, 19
oxybutynin chloride, 12
Penlet II Replacement CAPS-regular, 29
Pneumovax 23, 21
oxybutynin chloride ER, 12
Pentasa, 12
Pneumovax 23/1 Dose, 21
oxycodone HCL, 19
pentazocine/naloxone HCL, 19
PNV Folic Acid + Iron Multivitamin, 23
Oxycodone HCL ER, 19
Pentips 29G X 12MM, 29
PNV Ob+dha, 23
oxycodone hydrochloride, 19
Pentips 29GX12MM, 29
PNV Prenatal Plus Multivitamin, 23
oxycodone/acetaminophen, 19
Pentips 31G X 5MM, 29
PNV-DHA, 22
Oxycodone/Acetaminophen, 19
Pentips 31G X 8MM, 29
PNV-select, 22
oxycodone/aspirin, 19
Pentips 31GX5MM, 29
Pocket Chamber, 34
Oxycodone/Ibuprofen, 19
Pentips 31GX6MM, 29
Pocket Spacer, 34
Oxycontin, 19
Pentips 31GX8MM, 29
Podocon 25 IN Benzoin Tincture, 7
oxymorphone hydrochloride, 19
Pentips 32G X 4MM, 29
podofilox, 7
Oxymorphone Hydrochloride ER, 19
Pentips 32GX4MM, 29
polocaine, 20
P
pentoxifylline ER, 13
polocaine-mpf, 20
Perfect Lancets 30G, 29
polycin, 17
PA Prenatal Formula, 23
Perfect Pressure Activated Safety Lancets 28G, 29
polyethylene glycol 3350, 11
PA vitamin d-3, 22
polymyxin b sulfate, 2
PA vitamin d-3 gummy, 22
Perforomist, 21
polymyxin b sulfate/trimethoprim sulfate, 17
pacerone, 4
perindopril erbumine, 4
paliperidone ER, 15
periogard, 14
Pomalyst, 3
pantoprazole sodium, 11
permethrin, 7
port-prep, 7
pantoprazole sodium DR, 11
perphenazine, 15
portia-28, 9
paricalcitol, 11
Perphenazine/Amitriptyline, 16
potassium citrate ER, 13
paroex, 14
Perry Prenatal, 22
Potassium Citrate Monohydrate, 13
paromomycin sulfate, 1
pharbedryl, 20
potassium citrate/citric acid, 13
paroxetine HCL, 14
Pharmacist Choice Ultra Thin Lancets, 29
pr benzoyl peroxide wash, 6
paroxetine HCL ER, 14
Pr Natal 400, 22
Paser, 1
Pharmacist Choice Ultra Thin Lancets 28G, 29
Pradaxa, 13
Pazeo, 17
pramcort, 12
PC Lancets Super Thin 30G, 30
Pharmacist Choice Ultra Thin Lancets 30G, 29
pramipexole dihydrochloride, 16
PC Unifine Pentips 29G X 1/2", 30
pramipexole dihydrochloride ER, 16
PC Unifine Pentips 31G X 5MM Mini, 30
Pharmacist Choice Ultra Thin Lancets 31G, 29
Pramosone, 7
PC Unifine Pentips 31G X 6MM Ultra SHORT, 30
Pramosone E, 7
Pharmacist Choice Ultra Thin Lancets 33G, 29
pramox gel, 7
PC Unifine Pentips 31G X 8MM SHORT, 30
prasugrel, 13
Pharmacy Counter Lancets, 29
pravastatin sodium, 5
Pediarix, 21
phenadoz, 20
praziquantel, 2
Pedvax HIB, 21
phenazo, 13
prazosin HCL, 4
peg 3350/electrolytes, 11
phenazopyridine HCL, 13
Pre-natal Formula, 22
peg-3350/electrolytes, 11
phenazopyridine hydrochloride, 13
Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16", 29
peg-3350/NACL/NA bicarbonate/KCL, 11
phenazopyridine hydrocholride, 13
peg-prep, 11
phenelzine sulfate, 14
Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2", 29
Peganone, 16
phenobarbital, 15
Pegasys, 2
Phenobarbital, 15
Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2", 29
Pegasys Proclick, 2
Phenobarbital Sodium, 15
Pegintron, 2
phenohytro, 11
Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8", 29
pegylax, 11
phenoxybenzamine hydrochloride, 4
Pen Needles 29G X 12MM, 29
Phenylephrine HCL, 5
Precision Sure-dose Insulin Syringe/1ML/28G X 1/2", 29
Pen Needles 29GX1/2", 29
phenylephrine HCL, 17
Pen Needles 30GX5/16", 29
phenytoin, 16
Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X 1/2", 29
Pen Needles 30GX5MM, 29
phenytoin infatabs, 16
Pen Needles 30GX8MM, 29
phenytoin sodium extended, 16
Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2", 30
Pen Needles 31G X 1/4" SHORT, 29
philith, 9
Pen Needles 31G X 3/16", 29
phos-flur, 14
Precision Thins GP Lancet, 30
Pen Needles 31G X 5MM, 29
Phoslyra, 12
Pred Mild, 17
Pen Needles 31G X 6MM, 23
phosphasal, 12
Pred-G, 17
Pen Needles 31G X 8MM, 23
Phospholine Iodide, 17
Pred-G S.o.p., 17
Pen Needles 31GX5/16", 29
phrenilin forte, 18
Prednicarbate, 7
Pen Needles 31GX6MM (1/4"), 29
pilocarpine HCL, 14, 17
Prednisolone, 8
Pen Needles 31GX8MM, 29
pilocarpine hydrochloride, 14
prednisolone acetate, 17
Pen Needles 31GX8MM (5/16"), 29
pimozide, 16
prednisolone sodium phosphate, 8
Pen Needles 32G X 4MM, 23
Prednisolone Sodium Phosphate, 8, 17
previfem, 9
promethazine HCL, 20
prednisolone sodium phosphate odt, 8
Prevnar 13, 21
promethazine HCL plain, 20
prednisone, 8
Prevymis, 2
promethazine VC plain, 20
Prednisone, 8
Prezcobix, 2
promethazine VC/codeine, 20
Prednisone Intensol, 8
Prezista, 2
promethazine-DM, 20
Prefera OB, 23
Prialt, 18
promethazine/codeine, 20
Preferaob +dha, 22
Priftin, 1
promethazine/dextromethorphan, 20
Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2", 30
prikaan, 7
promethazine/phenylephrine, 20
prikaan lite, 7
promethazine/phenylephrine/codeine, 20
Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16", 30
prilolid, 7
promethegan, 20
priloxx LP, 7
Promiseb, 6
Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2", 30
Primaquine Phosphate, 2
pronutrients vitamin d3, 22
primidone, 16
propafenone HCL, 4
Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2", 30
Primlev, 19
propafenone HCL ER, 4
Primsol, 2
propafenone hydrochloride ER, 4
Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16", 30
Pro Comfort Insulin Syringes/0.5ML/30G X 1/2", 30
propafenone hydrochlorideer, 4
Propantheline Bromide, 11
Preferred Plus Insulin Syringe/U-100/1ML/28G X 1/2", 30
Pro Comfort Insulin Syringes/0.5ML/30G X 5/16", 30
proparacaine HCL, 17
propranolol HCL, 4
Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2", 30
Pro Comfort Insulin Syringes/0.5ML/31G X 5/16", 30
Propranolol HCL, 4
propranolol HCL ER, 4
Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16", 30
Pro Comfort Insulin Syringes/1ML/30G X 1/2", 30
propranolol hydrochloride, 4
Propranolol/Hydrochlorothiazide, 5
Preferred Plus Lancets Colored 21G, 30
Pro Comfort Insulin Syringes/1ML/30G X 5/16", 30
propylthiouracil, 11
Preferred Plus Lancets Super Thin 30G, 30
Proquad, 21
Pro Comfort Insulin Syringes/1ML/31G X 5/16", 30
protriptyline HCL, 14
Preferred Plus Lancets Thin 26G, 30
Provida DHA, 23
Preferred Plus Unifine Pentips 29G X 12MM, 30
Pro Comfort Lancets 30G, 30
Psorcon, 7
Pro Comfort Lancets 31G, 30
Pss Select GP Lancets, 30
Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORT, 30
Pro Comfort Pen Needles/ 31G X 8MM, 30
Pss Select Platforms, 30
Pss Select Safety Lancets, 30
Preferred Plus Unifine Pentips 31G X 8MM SHORT, 30
Pro Comfort Pen Needles/ 32G X 4MM, 30
Pulmicort Flexhaler, 21
pulmosal, 20
Preferred Plus Unifine Pentips 32GX4MM, 30
Pro Comfort Pen Needles/ 32G X 5MM, 30
Pulmozyme, 21
Push Button Safety Lancets 21G, 30
Preferred Plus Unifine Pentips/Mini/31GX5MM, 30
Pro Comfort Pen Needles/ 32G X 6MM, 30
Push Button Safety Lancets 28G, 30
Px Advanced Lancing Device, 30
Prefest, 8
Proair HFA, 21
px allergy relief, 20
Pregnyl W/Diluent Benzyl Alcohol/NACL, 10
Proair Respiclick, 21
px aspirin, 18
probenecid, 19
px enteric aspirin, 18
Premarin, 8, 13
probenecid/colchicine, 19
Px Extra SHORT Pen Needles 31GX6MM, 30
premium lidocaine, 7
prochlorperazine, 15
Premphase, 8
prochlorperazine maleate, 15
px folic acid, 13
Prempro, 8
Procort, 12
Px Insulin Syringe/U-100/0.5ML/30G X 1/2", 30
Prenaissance Plus, 22
Procrit, 13
Prenatabs RX, 22
procto-MED HC, 12
Px Lancet Auto Injector, 30
Prenatal, 22
procto-PAK, 12
Px Lancets Ultra Thin, 30
Prenatal 19, 22
Proctofoam HC, 12
Px Lancets Ultra Thin 28G, 30
Prenatal And Iron, 22
proctosol HC, 12
Px Mini Pen Needles 31GX5MM, 30
Prenatal Complete, 22
proctozone-HC, 12
Px Pen Needle 29GX12MM, 30
Prenatal Formula A-free, 22
Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16", 30
Px Pen Needle 31GX8MM, 30
Prenatal Forte, 22
Px Prenatal Multivitamins, 23
Prenatal Low Iron, 22
Prodigy Insulin Syringe/1/2ML/31G X 5/16", 30
Px Shortlength Pen Needles/31GX8MM, 30
Prenatal Multi +dha, 22
Prenatal Multivitamin, 22
Prodigy Insulin Syringe/1ML/28G X 1/2", 30
Pylera, 12
Prenatal One Daily, 22
pyrazinamide, 1
Prenatal Plus, 22
Prodigy Lancing Device, 30
pyridostigmine bromide, 16
Prenatal Vitamin, 22
Prodigy Pressure Activated Safety Lancets, 30
pyridostigmine bromide ER, 16
Prenatal Vitamin & Mineral, 22
Pyrogallic Acid, 8
Prenatal Vitamin/Iron, 23
Prodigy Safety Lancets, 30
Q
Prenatal Vitamins, 23
Prodigy Twist Top Lancets, 30
Qc Advanced Lancing Device, 30
Prenatal Vitamins Plus Low Iron, 23
profeno, 19
qc allergy relief childrens, 20
Prenatal-u, 22
Profilnine, 14
qc aspirin, 18
Preplus, 23
Profilnine SD, 14
qc aspirin low dose, 18
Prepopik, 11
progesterone, 9
qc chewable aspirin low dose, 18
Pressure Activated Safetylancet 21G, 30
Proglycem, 10
qc childrens aspirin, 18
prevalite, 5
Prolia, 10
qc enteric aspirin, 18
prevident rinse, 14
Promacta, 13
Qc Insulin Syringe/0.3ML/29G X 1/2", 30
Qc Insulin Syringe/0.5ML/29G X 1/2", 30
ranitidine HCL, 11
Relion Insulin Syringe/U-100/1ML/30G X 5/16", 30
Qc Insulin Syringe/0.5ML/31G X 5/16", 30
Rapaflo, 13
Rapamune, 3
Relion Insulin Syringe/U-100/1ML/31G X 15/64", 30
Qc Insulin Syringe/1ML/29G X 1/2", 30
rasagiline mesylate, 16
Qc Insulin Syringe/1ML/31G X 5/16", 30
rea LO 40, 7
Relion Insulin Syringe/U-100/1ML/31G X 5/16", 30
Qc Lancets, 30
react, 9
Qc Lancets Super Thin, 30
Readylance Safety Lancets/21G/2.2MM, 30
Relion Lancets Micro-thin33G, 30
Qc Lancets Thin, 30
Relion Lancets Standard 21G, 30
Qc Lancets Ultra Thin, 30
Readylance Safety Lancets/23G/1.8MM, 30
Relion Lancets Thin 26G, 30
qc loratadine allergy relief, 20
Relion Lancets Ultra-thin30G, 30
Qc Pen Needles 29G X 12MM, 30
Readylance Safety Lancets/26G/1.8MM, 30
Relion Lancing Device, 30
Qc Pen Needles 31G X 6MM, 30
Relion Mini Pen Needles 31GX6MM, 30
Qc Pen Needles 31G X 8MM, 30
Readylance Safety Lancets/28G/1.8MM, 30
Relion Pen Needles 29GX12MM, 30
Qc Prenatal, 23
Relion Pen Needles 31GX6MM, 30
Qc Unifine Pentips 32GX4MM, 30
Readylance Safety Lancets/30G/1.6MM, 30
Relion Pen Needles 31GX8MM, 30
Qc Unilet Lancets 28G/Ultra Thin, 30
Relion Pen Needles 32GX4MM, 30
Qc Unilet Lancets 33G/Micro Thin, 30
Reality Insulin Syringe/U-100/0.5ML/28G X 1/2", 30
Relion R, 10
Quadracel, 21
Relion SHORT Pen Needles 31GX8MM, 30
quasense, 9
Reality Insulin Syringe/U-100/0.5ML/29G X 1/2", 30
Quazepam, 15
Relion Thin Lancets, 30
quetiapine fumarate, 15
Reality Insulin Syringe/U-100/1ML/28G X 1/2", 30
Relion Ultra Thin Lancets, 30
quetiapine fumarate ER, 15
Relion Ultra Thin Lancets30G, 30
Quillivant XR, 15
Reality Insulin Syringe/U-100/1ML/29G X 1/2", 30
Relion Ultra Thin Plus Lancets 32G, 30
quinapril HCL, 4
Relion Ultra Thin Plus Lancets 33G, 30
quinapril hydrochloride, 4
Reality Lancets, 30
Relistor, 12
quinapril/hydrochlorothiazide, 5
Reality Trigger Lancets, 30
Renacidin, 13
quinidine gluconate CR, 4
Rebetol, 2
Renagel, 12
quinidine gluconate ER, 4
reclipsen, 9
repaglinide, 10
Quinidine Sulfate, 4
Recombinate, 14
Repaglinide/Metformin Hydrochloride, 10
quinine sulfate, 2
Recombivax HB, 21
Repatha, 5
Qvar, 21
Rectiv, 12
Repatha Pushtronex System, 5
Qvar Redihaler, 21
relador PAK, 7
Repatha Sureclick, 5
R
relador PAK plus, 7
Replesta, 22
Relagard, 13
Replesta Childrens, 22
ra allergy relief 24 HOUR, 20
Relenza Diskhaler, 2
Replesta Nx, 22
ra aspirin, 18
Relhist, 20
Rescriptor, 2
ra aspirin adult low dose, 18
Relion 2-IN-1 Lancing Device 25G, 30
Restasis, 17
ra aspirin adult low strength, 18
Relion 2-IN-1 Lancing Device 30G, 30
Restasis Multidose, 17
ra aspirin childrens, 18
Relion Insulin Syringe 0.5ML/31G X 15/64", 30
Revatio, 5
ra aspirin EC, 18
Revlimid, 3
ra aspirin EC adult low strength, 18
Relion Insulin Syringe 1ML/31GX15/64", 30
Rexall Lancets Ultra Thin, 30
ra childrens aspirin, 18
Rexulti, 15
Ra E-ZJECT Color Lancets Micro-thin 33G, 30
Relion Insulin Syringe/U -100/0.5ML/29G, 30
Reyataz, 2
Riastap, 14
Ra E-ZJECT Lancets 28G, 30
Relion Insulin Syringe/U-00/1ML/29G X 1/2", 30
ribasphere, 2
Ra E-ZJECT Lancets Thin 26G, 30
Ribasphere, 2
Ra E-ZJECT Lancets Thin 28G, 30
Relion Insulin Syringe/U-100/0.3ML/29G, 30
Ribasphere Ribapak, 2
Ra E-ZJECT Lancets Ultra Thin 30G, 30
ribavirin, 2
ra folic acid, 13
Relion Insulin Syringe/U-100/0.3ML/29G X 1/2", 30
Ridaura, 19
Ra Insulin Syringe/0.5ML/29G X 1/2", 30
rifabutin, 1
Ra Insulin Syringe/1ML/29G X 1/2", 30
Relion Insulin Syringe/U-100/0.3ML/30G, 30
Rifamate, 1
Ra Insulin Syringe/U-100/0.5ML/30G X 5/16", 30
rifampin, 1
Relion Insulin Syringe/U-100/0.3ML/30G X 5/16", 30
Rifater, 1
Ra Insulin Syringe/U-100/1 ML/30G X 5/16", 30
Right Step Prenatal, 23
Relion Insulin Syringe/U-100/0.3ML/31G X 15/64", 30
Rightest GD-L500 Alternate Site Adapter, 30
Ra Lancing Device, 30
ra loratadine, 20
Relion Insulin Syringe/U-100/0.3ML/31G X 5/16", 30
Rightest GD500 Lancing Device, 30
ra loratadine childrens, 20
Rightest Gl300 Lancets, 30
Ra One Daily, 23
Relion Insulin Syringe/U-100/0.5ML/29G X 1/2", 30
riluzole, 16
Ra Pen Needles 31G X 5MM 3/16", 30
rimantadine HCL, 2
Ra Pen Needles 31G X 8MM 5/16", 30
Relion Insulin Syringe/U-100/0.5ML/30G, 30
Riomet, 10
Ra Prenatal, 23
risedronate sodium, 10
Ra Prenatal Formula/Folicacid, 23
Relion Insulin Syringe/U-100/0.5ML/30G X 5/16", 30
risedronate sodium DR, 10
ra vitamin d-3, 22
Risperdal Consta, 15
rabeprazole sodium, 12
Relion Insulin Syringe/U-100/0.5ML/31G X 5/16", 30
risperidone, 15
rajani, 9
risperidone M-TAB, 15
raloxifene hydrochloride, 10
Relion Insulin Syringe/U-100/1ML/30G, 30
risperidone odt, 15
ramipril, 4
Risperidone Odt, 15
Ranexa, 4
Riteflo, 34
salicylic acid cream, 7
31
ritonavir, 2
salicylic acid lotion, 7
Shopko Unifine Pentips Pen Needles/Micro/32GX4MM, 31
rivastigmine tartrate, 16
salimez, 7
rivastigmine transdermal system, 16
salisol forte, 7
Shopko Unifine Pentips Pen Needles/Mini/31GX5MM, 31
rivelsa, 9
salitech forte, 7
Rixubis, 14
Salivamax, 14
Shopko Unifine Pentips Pen Needles/Original/29GX12MM, 31
rizatriptan benzoate, 19
salsalate, 18
rizatriptan benzoate odt, 19
Samsca, 11
Shopko Unifine Pentips Pen Needles/SHORT/31GX8MM, 31
ropinirole ER, 16
Sancuso, 12
ropinirole HCL, 16
Sandimmune, 3
Shopko Unifine Pentips Plus Pen Needles/Micro/Removr/32GX4MM, 31
ropivacaine, 20
Sandostatin Lar Depot, 11
ropivacaine HCL, 20
Saphris, 15
Shopko Unifine Pentips Plus Pen Needles/Mini/Remover/31GX5MM, 31
Ropivacaine Hydrochloride, 20
Saps Health Twist Top Lancets 30G, 31
rosadan, 6
Sapscare Twist Top Lancets 30G, 31
Shopko Unifine Pentips Plus Pen Needles/Remover/29GX12MM, 31
Rosadan Kit, 6
Savella, 16
rosanil cleanser, 6
Savella Titration Pack, 16
Shopko Unifine Pentips Plus Pen Needles/SHORT/Removr/31GX8MM, 31
rosuvastatin calcium, 5
SB aspirin, 18
Rotarix, 21
SB aspirin adult low strength, 18
Shopko Unilet Lancets Super Thin 30G, 31
Rotateq, 21
SB aspirin EC, 18
roweepra, 16
SB childrens aspirin, 18
Shopko Unilet Lancets Ultra Thin 28G, 31
roweepra XR, 16
SB Insulin Syringe/U-100/0.5ML/29G X 1/2", 31
Rozerem, 15
Shur-seal, 13
Rubraca, 3
SB Insulin Syringe/U-100/0.5ML/30G X 5/16", 31
Side Button Safety Lancet21G, 31
Rydapt, 3
Signifor, 11
S
SB Insulin Syringe/U-100/1ML/29G X 1/2", 31
sildenafil, 5
sildenafil citrate, 5
Sabril, 16
SB Insulin Syringe/U-100/1ML/30G X 5/16", 31
Silenor, 15
Safe-t-lance Low Flow 25G, 30
Simbrinza, 17
Safe-t-lance Normal Flow 21G, 30
SB Insulin Syringe/U-100/1ML/31G X 5/16", 31
Simple Diagnostics Lancing Device, 31
Safe-t-lance Plus Safety Lancet High Flow, 31
Simponi, 19
SB Lancets Thin, 31
simvastatin, 5
Safe-t-lance Plus Safety Lancet Low Flow, 31
SB Lancets Ultra Thin, 31
Single-let, 31
SB loratadine, 20
sirolimus, 3
Safe-t-lance Plus Safety Lancet Normal Flow, 31
SB loratadine allergy relief, 20
Sivextro, 2
SB low dose asa EC, 18
sm allergy relief loratadine, 20
Safesnap Insulin Syringe/0.3ML/30G X 5/16", 31
scalacort, 7
sm aspirin, 18
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X 1/2", 31
sm aspirin adult low strength, 18
Safesnap Insulin Syringe/0.5ML/29G X 1/2", 31
sm aspirin EC low strength, 18
Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X 5/16", 31
sm aspirin enteric coated, 18
Safesnap Insulin Syringe/0.5ML/30G X 5/16", 31
sm aspirin low dose, 18
scopolamine, 12
sm childrens aspirin, 18
Safesnap Insulin Syringe/1ML/28G X 1/2", 31
Se-natal 19, 22
sm childrens loratadine, 20
seb-prev wash, 6
sm folic acid, 13
Safesnap Insulin Syringe/1ML/29G X 1/2", 31
Seconal Sodium, 15
Sm Lancets 21G, 31
Select-lite Device/Lancets, 31
sm loratadine, 20
Safety Insulin Syringes 0.5ML/29GX1/2", 31
Select-lite Lancing Device, 31
Sm Micro Thin Lancets 33G, 31
Select-ob+dha, 23
Sm One Daily Prenatal, 23
Safety Insulin Syringes 0.5ML/30GX5/16", 31
selegiline HCL, 16
sm prenatal vitamins, 22
selenium sulfide, 6
Sm Prenatal Vitamins, 23
Safety Insulin Syringes 1ML/27GX1/2", 31
selenium sulfide shampoo, 6
Sm Super Thin Lancets 30G, 31
Selzentry, 2
Sm Thin Lancets 26G, 31
Safety Insulin Syringes 1ML/29GX1/2", 31
Sensipar, 11
Sm Truedraw Lancing Device, 31
sensorcaine, 20
sm vitamin d, 22
Safety Insulin Syringes 1ML/30GX1/2", 31
sensorcaine-mpf, 20
sm vitamin d3, 22
sensorcaine-mpf/epinephrine, 20
Sm Vitamin D3 Maximum Strength, 22
Safety Lancet 21G/Pressure Activated, 31
Sensorcaine-mpf/Epinephrine, 20
Smart Diabetes Vantage Lancing Device, 31
sensorcaine/epinephrine, 20
Safety Lancet 28G/Pressure Activated, 31
Serevent Diskus, 21
Smart Sense Color Lancets Universal 33G, 31
sertraline HCL, 14
Safety Lancets, 31
sertraline hydrochloride, 14
Smart Sense Standard Lancets Universal 21G, 31
Safety Lancets 21G, 31
setlakin, 9
Safety Lancets 28G, 31
sevelamer carbonate, 12
Smart Sense Super Thin Lancets Universal 30G, 31
Safety Let Lancets, 31
SF, 14
Safety Seal Lancets 28G, 31
SF 5000 plus, 14
Smart Sense Thin Lancets Universal 26G, 31
Safety Seal Lancets 30G, 31
Sfrowasa, 12
Safety-glide Insulin Syringe/0.3ML/29G X 1/2", 31
sharobel, 9
Smartest Lancets 28G, 31
Shopko Autolet Lancing Device, 31
sodium chloride, 13, 20
Salicept, 14
Shopko On-the-go Comfort Lancets 30G,
sodium chloride 0.9%, 13
salicylic acid, 7
sodium citrate/citric acid, 13
sumatriptan, 19
31
sodium hyaluronate, 7
sumatriptan succinate, 19
Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2", 31
sodium phenylbutyrate, 11
sumatriptan succinate refill, 19
sodium sulfacetamide, 6(2), 17
Sumaxin CP Kit, 6
Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16", 31
sodium sulfacetamide wash, 6
Super Daily D3, 22
sodium sulfacetamide/sulfur, 6
Super Thin Lancets, 31
Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16", 31
Sodium Sulfacetamide/Sulfur, 6
Supprelin LA, 10
sodium sulfacetamide/sulfur cleanser, 6
Suprax, 1
Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2", 31
Sodium Sulfacetamide/Sulfur Cleanser IN Urea, 6
Suprep Bowel Prep Kit, 11
Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2", 31
Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2", 31
sodium sulfacetamide/sulfur green, 6
sodium sulfacetamide/sulfur wash, 6
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2", 31
Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16", 31
Soltamox, 3
soluline, 7
Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16", 31
Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16", 31
solupicc, 7
Solus V2 Lancing Device, 31
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16, 31
Sure-ject Insulin Syringe/U-100/1ML/28G X 1/2", 31
Solus V2 Pressure Activated Safety Lancets 28G, 31
Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16", 31
Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2", 31
Solus V2 Twist Lancets 30G, 31
Somatuline Depot, 11
Sure Comfort Insulin Syringe/U-100/0.3ML/31GX1/4", 31
Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16", 31
Somavert, 11
Soolantra, 6
Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2", 31
Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16", 31
Sorbitol, 13
Sorbitol-mannitol, 13
Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2", 31
Sure-lance Flat Lancets, 31
sorine, 4
Sure-lance Lancets 26G, 31
sotalol HCL, 4
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2", 31
Sure-lance Thin Lancets 28G, 31
sotalol HCL (AF), 4
Sure-lance Ultra Thin Lancets, 31
sotalol hydrochloride, 4
Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16", 31
Sure-pen, 31
sotalol hydrochloride (AF), 4
Sure-touch Lancets Universal, 31
sotalol hydrocholride, 4
Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16, 31
Surelite Lancets, 31
Spiriva Handihaler, 21
Survanta Intratracheal, 21
Spiriva Respimat, 21
Sure Comfort Insulin Syringe/U-100/1ML/28G X 1/2", 31
Sutent, 3
spironolactone, 5
syeda, 9
spironolactone/hydrochlorothiazide, 5
Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2", 31
Sylatron, 3
Sporanox, 1
Symax Duotab, 12
sprintec 28, 9
Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2", 31
symax-SL, 11
Sprycel, 3
symax-SR, 11
sronyx, 9
Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16", 31
Symbicort, 21
Sski, 20
Symfi, 2
sss 10%-5%, 6
Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16", 31
Symfi LO, 2
st joseph aspirin, 18
Symlinpen 120, 10
st joseph low dose aspirin, 18
Sure Comfort Insulin Syringes/0.5ML/31G X 6MM, 31
Symlinpen 60, 10
stavudine, 2
Symproic, 12
Stelara, 6
Sure Comfort Insulin Syringes/U-100/1ML/31GX6MM, 31
Synarel, 10
Sterilance PA, 31
Syndros, 12
Sterilance TL, 31
Sure Comfort Lancets 18G, 31
Synera, 8
Stimate, 11
Sure Comfort Lancets 21G, 31
Synjardy, 10
Stiolto Respimat, 21
Sure Comfort Lancets 23G, 31
Synjardy XR, 10
Stivarga, 3
Sure Comfort Lancets 28G, 31
T
Streptomycin Sulfate, 1
Sure Comfort Lancets 30G, 31
Tabloid, 3
Stribild, 2
Sure Comfort Lancing Pen, 31
Taclonex, 7
Striverdi Respimat, 21
Sure Comfort Pen Needles 29GX1/2" 12.7MM, 31
tacrolimus, 3, 7
Sucraid, 12
Tafinlar, 3
sucralfate, 11
Sure Comfort Pen Needles 30GX5/16" SHORT, 31
Tagrisso, 3
sulfacetamide sodium, 6, 17
take action, 9
Sulfacetamide Sodium, 17
Sure Comfort Pen Needles 31GX3/16" (5MM), 31
Taltz, 6
sulfacetamide sodium/prednisolone sodium phosphate, 17
tamoxifen citrate, 3
Sure Comfort Pen Needles 31GX5/16" (8MM), 31
tamsulosin HCL, 13
sulfacetamide sodium/sulfur, 6
Tarceva, 3
sulfacetamide sodium/sulfur cleanser, 6
Sure Comfort Pen Needles 32GX5/32", 31
tarina FE 1/20, 9
Sulfadiazine, 1
taron-crystals, 13
sulfamethoxazole/trimethoprim, 2
Sure Comfort Pen Needles 32GX6MM, 31
Taron-prex, 22
sulfamethoxazole/trimethoprim DS, 2
Tasigna, 3
sulfamez wash, 6
Sure-fine Pen Needles 29GX1/2" 12.7MM, 31
tazarotene, 6
sulfasalazine, 12
Tazorac, 6
sulfatrim pediatric, 2
Sure-fine Pen Needles 31GX3/16" 5MM, 31
taztia XT, 4
Sulfurated Lime, 8
Tecfidera, 16
sulindac, 19
Sure-fine Pen Needles 31GX5/16" 8MM,
Tecfidera Starter Pack, 16
Techlite AST Lancets, 31
Texacort, 7
Todays Health Ultra Thin Lancets 28G, 32
Techlite Insulin Syringe U-100/0.3ML/29G X 1/2", 31
Tgt Advanced Lancing Device, 32
tgt allergy relief, 20
Tolazamide, 10
Techlite Insulin Syringe U-100/0.3ML/30G X 1/2", 31
tgt allergy relief medication, 20
Tolbutamide, 10
tgt aspirin, 18
tolcapone, 16
Techlite Insulin Syringe U-100/0.3ML/30G X 5/16", 31
tgt aspirin low dose, 18
Tolmetin Sodium, 19
tgt childrens aspirin, 18
tolterodine tartrate, 12
Techlite Insulin Syringe U-100/0.3ML/31G X 15/64", 31
tgt enteric-coated aspirin, 18
tolterodine tartrate ER, 12
Tgt Lancet Alternate Site, 32
Topcare Clickfine Universal Pen Eedles 31GX1/4", 32
Techlite Insulin Syringe U-100/0.3ML/31G X 5/16", 31
Tgt Lancet Micro Thin 33G, 32
Tgt Lancet Super Thin 30G, 32
Topcare Clickfine Universal Pen Eedles 31GX5/16", 32
Techlite Insulin Syringe U-100/0.5ML/29G X 1/2", 31
Tgt Lancet Thin 23G, 32
Tgt Lancet Thin 26G, 32
Topcare Lancets Micro-thin 33G, 32
Techlite Insulin Syringe U-100/0.5ML/30G X 1/2", 31
Tgt Lancet Ultra Thin 28G, 32
Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16", 32
Tgt Lancet Ultra Thin 30G, 32
Techlite Insulin Syringe U-100/0.5ML/30G X 5/16", 31
Tgt Lancing Device, 32
Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 32
tgt loratadine childrens, 20
Techlite Insulin Syringe U-100/0.5ML/31G X 15/64", 31
Thalomid, 3
Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 32
Theo-24, 21
Techlite Insulin Syringe U-100/0.5ML/31G X 5/16", 31
theochron, 20
Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 32
theophylline CR, 20
Techlite Insulin Syringe U-100/1ML/29G X 1/2", 31
theophylline ER, 20
Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 32
thera-d 2000, 22
Techlite Insulin Syringe U-100/1ML/30G X 1/2", 31
Thera-d 4000, 22
Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16", 32
thera-d rapid repletion, 22
Techlite Insulin Syringe U-100/1ML/30G X 5/16", 31
Theranatal Core Nutrition, 23
Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2", 32
Thinlets GP Lancets, 32
Techlite Insulin Syringe U-100/1ML/31G X 15/64", 31
Thiola, 13
Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2", 32
thioridazine HCL, 15
Techlite Insulin Syringe U-100/1ML/31G X 5/16", 31
thiothixene, 15
Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X 1/2", 32
Thrombate Iii, 14
Techlite Lancets, 31
Thrombate Iii W/10 ML Sterile Water, 14
topex topical anesthetic, 14
Techlite Lancets 30G, 31
Thrombate Iii W/20 ML Sterile Water, 14
topiramate, 16
Techlite Pen Needles 29G X 10MM, 32
Thyrolar-1, 11
Topiramate ER, 16
Techlite Pen Needles 29G X 12 MM, 32
Thyrolar-1/2, 11
Torisel, 3
Techlite Pen Needles 31G X 5MM, 32
Thyrolar-1/4, 11
torsemide, 5
Techlite Pen Needles/31G X 5MM, 32
Thyrolar-2, 11
Toujeo Max Solostar, 10
Techlite Pen Needles/31G X 6 MM, 32
Thyrolar-3, 11
Toujeo Solostar, 10
Techlite Pen Needles/31G X 8MM, 32
tiagabine hydrochloride, 16
Toviaz, 12
Techlite Pen Needles/32G X 4MM, 32
tilia FE, 9
Tracleer, 5
Techlite Pen Needles/32G X 6MM, 32
Timolol Maleate, 4
Tradjenta, 10
Techlite Pen Needles/32G X 8MM, 32
timolol maleate, 17
tramadol HCL, 19
Tekturna, 4
Timolol Maleate Ophthalmic Gel Forming, 17
tramadol HCL ER, 19
Tekturna HCT, 5
tramadol hydrochloride/acetaminophen, 19
telmisartan, 4
Timoptic Ocudose, 17
telmisartan/amlodipine, 5
tinidazole, 2
trandolapril, 4
telmisartan/hydrochlorothiazide, 5
Tivicay, 2
trandolapril/verapamil HCL ER, 5
temazepam, 15
tizanidine HCL, 16
Trandolapril/Verapamil HCL ER, 5
temozolomide, 2
tizanidine hydrochloride, 16
tranexamic acid, 13
Tencon, 18
Tobradex, 17
tranylcypromine sulfate, 14
tenofovir disoproxil fumarate, 2
Tobradex ST, 17
Travatan Z, 17
terazosin HCL, 4
tobramycin, 1, 17
Travel Lancets 30G, 32
terbinafine HCL, 1
Tobramycin, 1
Travel Lancets Advanced 28G, 32
terbutaline sulfate, 20
tobramycin sulfate, 1, 17
trazodone HCL, 15
terconazole, 12
Tobramycin Sulfate, 1
trazodone hydrochloride, 14
Terconazole, 13
tobramycin/dexamethasone, 17
trazodone hydrochorlide, 14
testosterone, 8
Tobrex, 17
trazodone hydrocloride, 14
testosterone cypionate, 8
Today Sponge, 13
Trecator, 1
testosterone enanthate, 8
Todays Health Advanced Lancing Device, 32
Trelegy Ellipta, 21
testosterone topical solution, 8
Trelstar Mixject, 3
tetcaine, 17
Todays Health Mini Pen Needles 31G X 1/4", 32
Tremfya, 6
tetrabenazine, 16
tretinoin, 3, 6
tetracaine HCL, 17
Todays Health Original Pen Needles 29G X 1/2", 32
Tretinoin Emollient, 7
tetracycline HCL, 1
tretinoin microsphere, 6
Tetracycline HCL, 1
Todays Health SHORT Pen Needles 31G X 5/16", 32
tretinoin microsphere P.M., 6
tetracycline hydrochloride, 1
Trexall, 3
tetravisc, 17
Todays Health Super Thin Lancets 30G, 32
tri femynor, 9
tetravisc forte, 17
tri-estarylla, 9
tri-legest FE, 9
Trueplus Lancets 30G, 32
X 5/16", 32
tri-linyah, 9
Trueplus Lancets 30G Ultra Thin, 32
Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16", 32
tri-LO-estarylla, 9
Trueplus Lancets 33G, 32
tri-LO-marzia, 9
Trueplus Lancets 33G Micro Thin, 32
Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2", 32
tri-LO-sprintec, 9
Trueplus Pen Needles 29GX12MM, 32
tri-mili, 9
Trueplus Pen Needles 31GX5MM, 32
Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16", 32
tri-sprintec, 9
Trueplus Pen Needles 31GX6MM, 32
Tri-TABS DHA, 23
Trueplus Pen Needles 31GX8MM, 32
Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2", 32
tri-vylibra, 9
Trueplus Pen Needles 32GX4MM, 32
triamcinolone acetonide, 7, 8, 20
Trueplus Safety Lancets 28G, 32
Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16", 32
triamcinolone acetonide dental paste, 14
Trumenba, 21
triamterene/hydrochlorothiazide, 5
Truvada, 2
Ulticare Insulin Syringe/U-100/1ML/30G X 1/2", 32
Trianex, 7
tulana, 9
triazolam, 15
tussigon, 20
Ulticare Insulin Syringe/U-100/1ML/31G X 5/16", 32
Triazolam, 15
Twinrix, 21
Tricare, 22
Tybost, 2
Ulticare Micro Pen Needles 31G X 8MM, 32
Tricare Prenatal, 23
tydemy, 9
Tricitrates, 13
Tykerb, 3
Ulticare Micro Pen Needles 32G X 4MM, 32
triderm, 7
Tymlos, 10
trifluoperazine HCL, 15
Tyvaso, 5
Ulticare Micro Pen Needles/32G X 4MM, 32
trifluridine, 17
Tyvaso Refill, 5
trihexyphenidyl HCL, 16
Tyvaso Starter, 5
Ulticare Mini Pen Needles 31GX6MM, 32
triklo, 5
U
Ulticare Mini Pen Needles Ulti-fine IV, 32
trilyte, 11
Ulticare Mini Pen Needles/31G X 6MM, 32
Uceris, 12
trimethobenzamide HCL, 12
Ulesfia, 8
trimethoprim, 2
Ulticare Mini Pen Needles31GX6MM, 32
Uloric, 19
trimethoprim sulfate/polymyxin b sulfate, 17
Ulticare Original Pen Needles Ulti-fine, 32
Ulti-lance Automatic/ Clear Tip, 32
Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2", 32
trimipramine maleate, 15
Ulticare Pen Needles 31G X 5MM/Mini, 32
Trimpex, 2
Ulticare Insulin Safety Syringe/1ML/29G X 1/2", 32
Trinatal RX 1, 22
Ulticare Pen Needles/29G X 12.7MM, 32
Trinate, 22
Ulticare SHORT Pen Needles 31GX8MM, 32
Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X 5/16", 32
trinessa, 9
trinessa LO, 9
Ulticare SHORT Pen Needles Ulti-fine IV, 32
Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X 5/16", 32
Tristart DHA, 23
Triumeq, 2
Ulticare SHORT Pen Needles/31G X 8MM, 32
Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16", 32
Triveen-duo DHA, 23
trivora-28, 9
Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4", 32
Ulticare Insulin Syringe/0.3ML/29G X 1/2", 32
Trokendi XR, 16
tropicamide, 17
Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4", 32
Ulticare Insulin Syringe/0.3ML/30G X 1/2", 32
trospium chloride, 12
trospium chloride ER, 12
Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4", 32
Ulticare Insulin Syringe/0.3ML/30G X 5/16", 32
Truedraw Lancing Device, 32
Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2", 32
Ulticare U-100 Insulin Syringes/1ML/31G X 1/4", 32
Ulticare Insulin Syringe/0.5ML/28G X 1/2", 32
Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16", 32
Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16", 32
Ulticare Insulin Syringe/0.5ML/29G X 1/2", 32
Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16", 32
Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16", 32
Ulticare Insulin Syringe/0.5ML/30G X 1/2", 32
Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2", 32
Ultilet Classic Lancets, 32
Ulticare Insulin Syringe/0.5ML/30G X 5/16", 32
Ultilet Insulin Syringe 31X6MM, 32
Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2", 32
Ultilet Insulin Syringe/0.3ML/30G X 8MM, 32
Ulticare Insulin Syringe/1ML/28G X 1/2", 32
Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16", 32
Ultilet Insulin Syringe/0.3ML/31G X 8MM, 32
Ulticare Insulin Syringe/1ML/29G X 1/2", 32
Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16", 32
Ultilet Insulin Syringe/0.5ML/30G X 8MM, 32
Ulticare Insulin Syringe/1ML/30G X 1/2", 32
Trueplus Insulin Syringe/U-100/1ML/28G X 1/2", 32
Ultilet Insulin Syringe/1ML/30G X 8MM, 32
Ulticare Insulin Syringe/1ML/30G X 5/16", 32
Trueplus Insulin Syringe/U-100/1ML/29G X 1/2", 32
Ultilet Insulin Syringe/1ML/31G X 8MM, 32
Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16", 32
Trueplus Insulin Syringe/U-100/1ML/30G X 5/16", 32
Ultilet Insulin Syringe/SHORT/0.3ML/30G X 12.7MM, 32
Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16", 32
Trueplus Insulin Syringe/U-100/1ML/31G X 5/16", 32
Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16", 32
Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16", 32
Trueplus Lancets 26G, 32
Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16", 32
Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16", 32
Trueplus Lancets 28G, 32
Trueplus Lancets 28G Super Thin, 32
Ultilet Insulin Syringe/SHORT/0.5ML/30G
Ulticare Insulin Syringe/SHORT/1ML/30G
X 5/16", 32
Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2", 33
Universal 1 Lancets Thin 26G, 33
Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16", 32
Universal 1 Lancets Ultra Thin 30G, 33
Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2", 33
Universal 1 Lancets/33G/Micro-thin, 33
Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16", 32
Uptravi, 5
Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2", 33
ure-k, 7
Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16", 32
urea, 7
Ultra-thin II Lancets 28G, 33
Urea, 7
Ultilet Insulin Syringe/U-100/0.5ML/30G X 1/2", 32
Ultra-thin II Lancets 30G, 33
urea hydrating, 7
Ultra-thin II Mini Pen Neeedles/31GX3/16", 33
Urea IN Zinc Undecylenate/Lactic Acid Vehicle, 7
Ultilet Insulin Syringe/U-100/0.5ML/31GX6MM, 32
Ultra-thin II Pen Needles 29GX1/2", 33
urea nail, 7
Ultilet Insulin Syringe/U-100/1ML/30G X 1/2", 32
Ultra-thin II Pen Needles/SHORT/31GX5/16", 33
Urea Nail, 8
Urea Topical, 7
Ultilet Lancets, 32
Ultra-thin II Safety Autolancets 26G, 33
urea-c40, 7
Ultilet Lancets 33G, 32
Ultralance, 33
urelle, 12
Ultilet Pen Needle 29GX12.7MM, 32
umecta mousse, 7
uremez-40, 7
Ultilet Pen Needle 31GX5MM, 32
Unifine Pentips 29GX12MM, 33
uretron d/s, 12
Ultilet Pen Needle 31GX8MM, 32
Unifine Pentips 31G X 3/16", 33
uribel, 12
Ultilet Pen Needle 32GX4MM, 32
Unifine Pentips 31G X 6MM, 33
urin d/s, 12
Ultilet Pen Needle 32GX4MM/SHORT, 32
Unifine Pentips 31G X 8MM, 33
uro-458, 12
Unifine Pentips 31GX5MM, 33
uro-mp, 12
Ultilet Safety Lancets 21G X 2.2MM, 32
Unifine Pentips 31GX6MM, 33
uroav-81, 12
Ultilet Safety Lancets 23G, 32
Unifine Pentips 31GX8MM, 33
uroav-b, 12
Ultilet SHORT Pen Needles 31GX5/16", 33
Unifine Pentips 32GX4MM, 33
ursodiol, 12
Unifine Pentips Plus 29GX12MM, 33
uryl, 12
Ultilet SHORT Pen Needles31GX3/16", 33
Unifine Pentips Plus 31GX5MM, 33
ustell, 12
Unifine Pentips Plus 31GX6MM, 33
Uta, 12
Ultilet U-100 Insulin Syringes/1ML/31G X 6MM, 33
Unifine Pentips Plus 31GX8MM, 33
Utibron Neohaler, 21
Unifine Pentips Plus 32GX4MM, 33
uticap, 12
Ultimatecare One, 22
Unilet Comfortouch Lancet, 33
utira-c, 12
Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16", 33
Unilet Excelite, 33
utrona-c, 12
Unilet Excelite II, 33
V
Ultra Thin Lancets 28G, 33
Unilet G.p. Lancet, 33
valacyclovir HCL, 2
Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2", 33
Unilet G.p. Superlite Lancet, 33
valganciclovir, 2
Unilet GP 28 Ultra Thin, 33
valganciclovir hydrochlorde, 2
Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16", 33
Unilet Lancet, 33
valproic acid, 16
Unilet Lancets Micro-thin33G, 33
valsartan, 4
Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16", 33
Unilet Lancets Super-thin30G, 33
valsartan/hydrochlorothiazide, 5
Unilet Lancets Ultra-thin 28G, 33
Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2", 33
Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2", 33
Unilet Superlite Lancet, 33
Unistik 1, 33
Value Health Insulin Syringe/U-100/1ML/29G X 1/2", 33
Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2", 33
Unistik 2, 33
Unistik 2 Comfort, 33
Value Plus Lancets Standard 21G, 33
Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16", 33
Unistik 2 Extra, 33
Value Plus Lancets Super Thin 30G, 33
Unistik 2 Neonatal, 33
Value Plus Lancets Thin 26G, 33
Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16", 33
Unistik 2 Normal, 33
Value Plus Lancing Device, 33
Unistik 2 Super, 33
Valumark Lancet Super Thin 30G, 33
Ultra-comfort Insulin Syringe/U-100/1ML/28G X 1/2", 33
Unistik 3, 33
Valumark Lancet Ultra Thin 28G, 33
Unistik 3 Comfort, 33
Valumark Pen Needles 29GX12MM, 33
Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2", 33
Unistik 3 Extra, 33
Valumark Pen Needles 31G X 6MM, 33
Unistik 3 Extra Single Use Safety Lancets/21G, 33
Valumark Pen Needles 31G X 8MM, 33
Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16", 33
Valved Holding Chamber, 34
Unistik 3 Gentle, 33
Vanatol LQ, 18
Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16", 33
Unistik 3 Neonatal, 33
Vanatol S, 18
Unistik 3 Normal, 33
vancomycin HCL, 2
Ultra-thin II Auto Lancet, 33
Unistik CZT Comfort, 33
vandazole, 12
Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/30GX5/16", 33
Unistik CZT Normal, 33
Vanishpoint Insulin Syringe/0.5ML/30G X 1/2", 33
Unistik Pro Safety Lancet 21G, 33
Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/31GX5/16", 33
Unistik Pro Safety Lancet 25G, 33
Vanishpoint Insulin Syringe/0.5ML/30G X 5/16", 33
Unistik Pro Safety Lancet 28G, 33
Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/30GX5/16", 33
Unistik Safety Lancets 28G, 33
Vanishpoint Insulin Syringe/1ML/29G X 1/2", 33
Unistik Safety Lancets 30G, 33
Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/31GX5/16", 33
Unistik Touch Safety Lancets 21G, 33
Vanishpoint Insulin Syringe/1ML/29G X 5/16", 33
Unistik Touch Safety Lancets 23G, 33
Ultra-thin II Insulin Syringe SHORT/U-100/1ML/30GX5/16", 33
Unistik Touch Safety Lancets 28G, 33
Vanishpoint Insulin Syringe/1ML/30G X 5/16", 33
Unistik Touch Safety Lancets 30G, 33
Ultra-thin II Insulin Syringe SHORT/U-100/1ML/31GX5/16", 33
unithroid, 11
vanoxide-HC, 6
unithroid direct, 11
Vaqta, 21
Varivax, 21
vitamin d3 gummies, 22
Y
Varubi, 12
vitamin d3 gummies adult, 22
yl folic acid, 13
Vcf Vaginal Contraceptive Film, 13
vitamin d3 maximum strength, 22
yuvafem, 13
Vcf Vaginal Contraceptive Foam, 13
vitamin d3 super strength, 22
Z
vcf vaginal contraceptivegel, 12
vitamin d3 ultra potency, 22
velivet, 9
Vivitrol, 34
Zaclir Cleansing, 6
Vemlidy, 2
Vol-plus, 23
zafirlukast, 20
venlafaxine HCL, 15
voriconazole, 1
zaleplon, 15
venlafaxine HCL ER, 15
Vortex Valved Holding Chamber, 34
zarah, 9
Ventavis, 5
Vosevi, 2
Zarxio, 13
Ventolin HFA, 21
Votrient, 3
zebutal, 18
verapamil HCL, 4
Vp Insulin Syringe/U-100/0.3ML/29G X 1/2", 33
Zejula, 3
verapamil HCL ER, 4
Zelapar, 16
verapamil HCL SR, 4
Vp-heme OB + DHA, 23
Zelboraf, 3
verdrocet, 19
Vraylar, 15
zenatane, 6
Veregen, 8
vyfemla, 9
zenchent, 9
Verzenio, 3
vylibra, 9
Zenpep, 12
Vesicare, 12
Vyvanse, 15
zenzedi, 15
Vibramycin, 1
W
zidovudine, 2
vicodin, 19
zileuton ER, 20
wal-itin, 20
vicodin ES, 19
ziprasidone HCL, 15
wal-itin childrens, 20
vicodin HP, 19
Zirgan, 17
Walgreens Advanced Travellancets 28G, 33
Victoza, 10
Zmax, 1
Vida Mia Autolet Lancing Device, 33
Zolinza, 3
Walgreens Comfort Assuredlancets Micro Thin/33G, 33
Vida Mia Unifine Pentips 32GX4MM, 33
zolmitriptan, 19
Vida Mia Unifine Pentips Mini 31GX6MM, 33
zolmitriptan odt, 19
Walgreens Comfort Assuredlancets Super Thin/28G, 33
zolpidem tartrate, 15
Vida Mia Unifine Pentips Original 29GX12MM, 33
zolpidem tartrate ER, 15
Walgreens Lancets, 33
Zomig, 19
Walgreens Thin Lancets, 33
Vida Mia Unilet Lancets Super Thin 30G, 33
zonisamide, 16
Walgreens Ultra Thin Lancets, 33
Zortress, 3
warfarin sodium, 13
Vida Mia Unilet Lancets Ultra Thin 28G, 33
zovia 1/35e, 9
Watchhaler, 34
Zovirax, 6
wee care, 13
Vida Mia Unipfine Pentipsshort 31GX8MM, 33
Zurampic, 19
Wegmans Unifine Pentips Plus 32GX4MM, 33
Zydelig, 3
Videx Pediatric, 2
Zyflo, 21
Wegmans Unifine Pentips Plus/Mini/31GX5MM, 33
vienva, 9
Zykadia, 3
vigabatrin, 16
Zylet, 17
Wegmans Unifine Pentips Plus/SHORT/31GX8MM, 33
Viibryd, 15
Zyprexa Relprevv, 15
Viibryd Starter Pack, 15
Zytiga, 3
Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MM, 33
vilamit mb, 12
1
vilevev mb, 12
Welchol, 5
1ST Choice Lancets Super Thin, 33
Vimpat, 16
Wellesse Vitamin D3, 22
1ST Choice Lancets Thin, 33
Vinate II, 22
wera, 9
1ST Choice Lancets Ultra Thin, 33
Vinate M, 22
Westhroid, 11
1ST Tier Unifine Pentips /Mini/31GX5MM, 33
Vinate One, 22
Wp Thyroid, 11
viorele, 9
wymzya FE, 9
1ST Tier Unifine Pentips 29GX12MM, 33
Viracept, 2
X
1ST Tier Unifine Pentips 31GX6MM, 33
Viramune, 2
1ST Tier Unifine Pentips 31GX8MM, 33
Viread, 2
Xalkori, 3
1ST Tier Unifine Pentips 32GX4MM, 33
Vitafol Ultra, 23
Xarelto, 13
1ST Tier Unifine Pentips Plus 31GX8MM, 33
Vitafol-OB, 22
Xarelto Starter Pack, 13
Vitafol-ob+dha, 23
Xeljanz, 19
1ST Tier Unifine Pentips Plus 32GX4MM, 33
vitajoy daily d gummies, 22
Xeljanz XR, 19
Vitalet Pro Lancets, 33
Xeomin, 16
1ST Tier Unifine Pentips Plus/Mini/31GX5MM, 33
Vitalet Pro Plus Lancets, 33
Xerese, 6
Vitamelts Vitamin D, 22
Xermelo, 12
1ST Tier Unifine Pentips Plus/Original/29GX12MM, 33
vitamin d, 22
Xifaxan, 2
vitamin d 400, 22
Xiidra, 17
1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM, 33
vitamin d high potency, 22
Xolair, 21
vitamin d-1000, 22
Xolegel, 6
1ST Tier Unilet Comfortouch Lancets 28G, 33
vitamin d-1000 maximum strength, 22
Xtandi, 3
vitamin d-3, 22
Xulane, 9
1ST Tier Unilet Comfortouch Lancets 30G, 33
vitamin d-400, 22
xylocaine dental, 20
vitamin d3, 22
Xyntha, 14
Vitamin D3, 22
Xyntha Solofuse, 14
vitamin d3 400, 22
Xyrem, 16
vitamin d3 adult gummies, 22
53379208.1
Non-Discrimination and Accessibility Notice
QualChoice complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. QualChoice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
QualChoice:
Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages
If you need these services, contact Customer Service at (501) 228-7111. If you believe that QualChoice has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
QualChoice Civil Rights Coordinator QualChoice P.O. Box 25610 Little Rock, AR 72221-5610 (501) 228-7111 Fax #: 501-707-6729 [email protected]
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the QualChoice Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Notice of Discrimination Grievance Procedures
It is the policy of QualChoice not to discriminate on the basis of race, color, national origin, sex, age or disability. QualChoice has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. 18116) and its implementing regulations at 45 CFR part 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the QualChoice Civil Rights Coordinator, who has been designated to coordinate the efforts of QualChoice to comply with Section 1557 (the “Section 1557 Coordinator”):
QualChoice Civil Rights Coordinator QualChoice P.O. Box 25610 Little Rock, AR 72221-5610 (501) 228-7111 Fax #: 501-707-6729 [email protected]
Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for QualChoice to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
Procedure:
Grievances must be submitted to the Section 1557 Coordinator within sixty (60) days of the date the person filing the grievance becomes aware of the alleged discriminatory action.
A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of QualChoice relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.
The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than thirty (30) days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.
The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the Vice President Corporate Responsibility within fifteen (15) days of receiving the Section 1557 Coordinator’s decision. The Vice President Corporate Responsibility shall issue a written decision in response to the appeal no later than thirty (30) days after its filing.
1607 CO 027 1 of 2
The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201.
Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. QualChoice will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements. QualChoice offers help for members with limited English proficiency (LEP). The following statement is printed in the top languages used in
Arkansas, as required by the Federal government. ATTENTION: If you speak [insert language], language assistance services, free of charge, are
available to you. Call 1-800-235-7111 (TTY: 711).
Spanish ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-235-7111 (TTY: 711). Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-235-7111 (TTY: 711). Marshallese LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1-800-235-7111 (TTY: 711). Chinese 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-235-7111 (TTY: 711).
Lao
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາ ລາວ, ການບໍ ລິ ການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-235-7111 (TTY: 711). Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-235-7111 (TTY: 711). Arabic
.(117)رقمهاتف الصم والبكم: 7111-235-800-1 ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقمGerman ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-235-7111 (TTY: 711). French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-235-7111 (ATS: 711). Hmong LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-800-235-7111 (TTY: 711). Korean
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-235-7111 (TTY: 711) 번으로 전화해 주십시오. Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-235-7111 (TTY: 711). Japanese 注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-800-235-7111 (TTY: 711)s まで、お電話にてご連絡ください。
Hindi
ध्यान दें: यदद आप द िंदी बोलते ैं तो आपके ललए मुफ्त में भाषा स ायता सेवाएिं उपलब्ध ैं। 1-800-235-7111 (TTY: 711) पर कॉल करें। Gujarati
સચુના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સવેાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-800-235-7111 (TTY: 711).
1607 CO 027 2 of 2
800.235.7111 | 501 228.7111 | FAX 501.228.0135 | QualChoice.com
1711 CR 011_01 6/2018