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A Iii\ Arkansas + • BlueAdvantage T. ~ BlueCross BlueShield • 9. Administrators of Arkansas

MhlependentlicenseeoiftheBlueCroaandBlueSl'.idAsaocialion Nl~~tt1.-.11. .. a..N-..»..~

July 2021

Arkansas Blue Cross and Blue Shield Standard with Step Drug List

The Arkansas Blue Cross and Blue Shield Standard with Step Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.

PLAN MEMBER

Your benefit plan provides you with a prescription benefit program administered by Arkansas Blue Cross and Blue Shield. Ask your doctor to consider prescribing, when medically appropriate, a preferred medicine from this list. Take this list along when you or a

covered family member sees a doctor.

Please note:

Your specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. Products recently approved by the U.S. Food and Drug Administration (FDA) may not be covered upon release to the market.

•

Your prescription benefit plan design may alter coverage of certain products or vary copay1 amounts based on the condition being treated.

•

You may be responsible for the full cost of non-formulary products that are removed from coverage.

•

For specific information regarding your prescription benefit coverage and copay information, please visit www.arkansasbluecross.com or contact an Arkansas Blue Cross and Blue Shield Customer Care representative at 1-800-863-5561.

•

Arkansas Blue Cross and Blue Shield may contact your doctor after receiving your prescription to request consideration of a drug list product or generic equivalent. This may result in your doctor prescribing, when medically appropriate, a different brand-name product or generic equivalent in place of your original prescription.

•

In most instances, a brand-name drug for which a generic product becomes available will be designated as a non-preferred option upon release of the generic product to the market.

•

HEALTH CARE PROVIDER

Your patient is covered under a prescription benefit plan administered by Arkansas Blue Cross and Blue Shield. As a way to help manage health care costs, authorize generic substitution whenever possible. If you believe a brand-name product is

necessary, consider prescribing a brand name on this list.

Please note:

• Generics should be considered the first line of prescribing.

• The member's prescription benefit plan design may alter coverage of certain products or vary copay amounts based on the condition being treated.

• This drug list represents a summary of prescription coverage. It is not all-inclusive and does not guarantee coverage. The member's specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. Products recently approved by the FDA may not be covered upon release to the market.

• The member's prescription benefit plan may have a different copay for specific products on the list.

• Unless specifically indicated, drug list products will include all dosage forms.

• Log in to www.arkansasbluecross.com to check coverage and copay information for a specific medicine.

ANALGESICS naproxen (except naproxen CR or § NSAIDs, TOPICAL § OPIOID ANALGESICS § GOUT

naproxen suspension) diclofenac sodium gel 1% PA buprenorphine transdermal § NSAIDs allopurinol diclofenac sodium solution QL

§ NSAIDs, COMBINATIONS diclofenac sodium colchicine tablet codeine-acetaminophen QL ibuprofen diclofenac sodium- § COX-2 INHIBITORS probenecid fentanyl transdermal QL meloxicam misoprostol celecoxib

Your specific prescription benefit plan design may not cover certain products or categories, regardless of their appearance in this document. For specific information, visit www.arkansasbluecross.com or contact an Arkansas Blue Cross and Blue Shield Customer Care representative at 1-800-863-5561.

www.arkansasbluecross.comwww.arkansasbluecross.comwww.arkansasbluecross.comwww.arkansasbluecross.comwww.arkansasbluecross.com

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fentanyl transmucosal efavirenz-emtricitabine- nitrofurantoin (except NDC^ PROSTATE CANCER § ANTIARRHYTHMICS lozenge PA tenofovir disoproxil 70408023932) § LUTEINIZING HORMONE- disopyramide

hydrocodone ext-rel QL fumarate QL pyrimethamine PA RELEASING HORMONE sotalol hydrocodone-acetaminophen efavirenz-lamivudine- sulfamethoxazole- (LHRH) AGONISTS MULTAQ

QL tenofovir disoproxil trimethoprim ELIGARD SGM hydromorphone QL fumarate QL vancomycin capsule QL ANTILIPEMICS

hydromorphone ext-rel QL BIKTARVY QL EMVERM LUTEINIZING HORMONE- ACL INHIBITORS / methadone QL CIMDUO QL XIFAXAN 550 MG PA RELEASING HORMONE COMBINATIONS morphine QL COMPLERA QL

ANTINEOPLASTIC AGENTS

(LHRH) ANTAGONISTS NEXLETOL PA morphine ext-rel QL DESCOVY QL FIRMAGON † NEXLIZET PA morphine suppository QL DOVATO QL oxycodone QL EVOTAZ QL § MISCELLANEOUS § BILE ACID RESINS ANTIMETABOLITES oxycodone-acetaminophen GENVOYA QL ERIVEDGE SGM cholestyramine

LONSURF SGMQL ODEFSEY QL LYNPARZA SGM colesevelam tramadol (except NDC^ PREZCOBIX QL BIOSIMILARS ODOMZO SGM

§ CHOLESTEROL STRIBILD QL RUBRACA SGM52817019610) QL KANJINTI † ABSORPTION INHIBITORS SYMTUZA QL ZEJULA SGMtramadol ext-rel tablet QL RUXIENCE † TEMIXYS QL

CARDIOVASCULAR ezetimibe BELBUCA QL TRAZIMERA †

TRIUMEQ QLNUCYNTA QL ZIRABEV † § FIBRATES TRUVADA QLNUCYNTA ER QL § ACE INHIBITORS fenofibrate (except fenofibrate capsule SUBSYS PA HORMONAL INTEGRASE INHIBITORS fosinopril 50 mg, 130 mg; fenofibrate tablet 40 mg, XTAMPZA ER QL ANTINEOPLASTIC AGENTS

ISENTRESS QL lisinopril 120 mg)

ANTI INFECTIVES § ANTIANDROGENS

TIVICAY QL quinapril fenofibric acid delayed-rel abiraterone SGM ramipril

ANTIBACTERIALS § NUCLEOSIDE REVERSE bicalutamide § HMG-CoA REDUCTASE

TRANSCRIPTASE ERLEADA SGM § ACE INHIBITOR / INHIBITORS / § CEPHALOSPORINS INHIBITORS NUBEQA SGM DIURETIC COMBINATIONS COMBINATIONS

cefdinir abacavir tablet QL XTANDI SGM fosinopril-hydrochlorothiazide atorvastatin cefprozil lamivudine QL YONSA SGM lisinopril-hydrochlorothiazide ezetimibe-simvastatin cefuroxime axetil

quinapril-hydrochlorothiazide fluvastatin cephalexin § KINASE INHIBITORS § PROTEASE INHIBITORS lovastatin SUPRAX imatinib mesylate SGM § ANGIOTENSIN II atazanavir QL pravastatin § ERYTHROMYCINS / AFINITOR SGM RECEPTOR ANTAGONISTS / NORVIR QL rosuvastatin MACROLIDES DIURETIC COMBINATIONS ALECENSA SGMPREZISTA QL simvastatin azithromycin ALUNBRIG SGM candesartan / candesartan-clarithromycin ANTIVIRALS BOSULIF SGM hydrochlorothiazide § NIACINS clarithromycin ext-rel § CYTOMEGALOVIRUS CABOMETYX SGM irbesartan / irbesartan- niacin ext-rel erythromycins AGENTS COPIKTRA SGM hydrochlorothiazide § OMEGA-3 FATTY ACIDS DIFICID ST, QL IBRANCE SGM losartan / losartan-valganciclovir omega-3 acid ethyl esters PA

IRESSA SGM hydrochlorothiazide § FLUOROQUINOLONES VASCEPA PA

§ HEPATITIS B AGENTS KISQALI SGM olmesartan / olmesartan-ciprofloxacin

entecavir KISQALI FEMARA CO- hydrochlorothiazide PCSK9 INHIBITORS levofloxacin PACK SGM telmisartan / telmisartan-lamivudine PRALUENT PAmoxifloxacin

VEMLIDY RYDAPT SGM hydrochlorothiazide SPRYCEL SGM valsartan / valsartan- § BETA-BLOCKERS § PENICILLINS

§ HEPATITIS C AGENTS STIVARGA SGM hydrochlorothiazide atenolol amoxicillin

ribavirin SGM XOSPATA SGM carvedilol amoxicillin-clavulanate § ANGIOTENSIN II EPCLUSA (genotypes 1, 2, 3, 4, 5, 6) carvedilol phosphate ext-rel dicloxacillin MONOCLONAL ANTIBODIES RECEPTOR ANTAGONIST / SGM metoprolol succinate ext-rel penicillin VK CALCIUM CHANNEL HARVONI (genotypes 1, 4, 5, 6) PERJETA † metoprolol tartrate

PHESGO SGM BLOCKER COMBINATIONS § TETRACYCLINES SGM nadolol VOSEVI 2 SGM amlodipine-olmesartan pindolol doxycycline hyclate 20 mg MULTIPLE MYELOMA amlodipine-telmisartan propranolol doxycycline hyclate capsule § HERPES AGENTS IMMUNOMODULATORS amlodipine-valsartan propranolol ext-rel minocycline acyclovir capsule, tablet POMALYST SGM BYSTOLIC tetracycline § ANGIOTENSIN II valacyclovir REVLIMID SGM

RECEPTOR ANTAGONIST / § CALCIUM CHANNEL § ANTIFUNGALS THALOMID SGM § INFLUENZA AGENTS CALCIUM CHANNEL BLOCKERS

fluconazole oseltamivir QL PROTEASOME INHIBITORS BLOCKER / DIURETIC amlodipine itraconazole PA COMBINATIONS RELENZA QL NINLARO SGM diltiazem ext-rel (except generics terbinafine tablet

VELCADE † amlodipine-valsartan- for CARDIZEM LA) § MISCELLANEOUS hydrochlorothiazide ANTIRETROVIRAL AGENTS nifedipine ext-rel clindamycin olmesartan-amlodipine-§ ANTIRETROVIRAL verapamil ext-rel ivermectin hydrochlorothiazide COMBINATIONS linezolid PA

abacavir-lamivudine QL metronidazole


www.arkansasbluecross.comwww.arkansasbluecross.com

§ CALCIUM CHANNEL BLOCKER / ANTILIPEMIC COMBINATIONS

amlodipine-atorvastatin

§ DIGITALIS GLYCOSIDES

digoxin

§ DIRECT RENIN INHIBITORS / DIURETIC COMBINATIONS

aliskiren TEKTURNA HCT ST

§ DIURETICS

amiloride furosemide hydrochlorothiazide metolazone spironolactone-

hydrochlorothiazide torsemide triamterene triamterene-

hydrochlorothiazide

HEART FAILURE

BIDIL CORLANOR ENTRESTO

§ NITRATES

isosorbide dinitrate (except isosorbide dinitrate 40 mg)

isosorbide mononitrate nitroglycerin lingual spray nitroglycerin sublingual

PULMONARY ARTERIAL HYPERTENSION

§ ENDOTHELIN RECEPTOR ANTAGONISTS

ambrisentan SGM bosentan SGM OPSUMIT SGM

§ PHOSPHODIESTERASE INHIBITORS

sildenafil SGM

PROSTACYCLIN RECEPTOR AGONISTS

UPTRAVI SGM

§ PROSTAGLANDIN VASODILATORS

treprostinil SGM ORENITRAM SGM

SOLUBLE GUANYLATE CYCLASE STIMULATORS

ADEMPAS SGM

§ MISCELLANEOUS

ranolazine ext-rel

CENTRAL NERVOUS SYSTEM

ANTIANXIETY

§ BENZODIAZEPINES

alprazolam clonazepam diazepam lorazepam oxazepam

§ ANTICONVULSANTS

carbamazepine carbamazepine ext-rel clobazam diazepam rectal gel divalproex sodium divalproex sodium ext-rel ethosuximide gabapentin lamotrigine lamotrigine ext-rel levetiracetam levetiracetam ext-rel oxcarbazepine phenobarbital phenytoin phenytoin sodium extended primidone rufinamide tiagabine topiramate valproic acid vigabatrin SGM zonisamide FYCOMPA NAYZILAM OXTELLAR XR VALTOCO VIMPAT XCOPRI

§ ANTIDEMENTIA

donepezil galantamine galantamine ext-rel memantine rivastigmine rivastigmine transdermal NAMZARIC

ANTIDEPRESSANTS

§ SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

citalopram escitalopram fluoxetine (except fluoxetine tablet 60

mg, fluoxetine tablet [generics for

SARAFEM])

paroxetine HCl paroxetine HCl ext-rel sertraline TRINTELLIX ST

§ SEROTONIN NOREPINEPHRINE

REUPTAKE INHIBITORS (SNRIs)

desvenlafaxine ext-rel duloxetine venlafaxine venlafaxine ext-rel capsule

§ MISCELLANEOUS AGENTS

bupropion bupropion ext-rel (except

bupropion ext-rel tablet 450 mg)

mirtazapine trazodone

§ ANTIPARKINSONIAN AGENTS

amantadine carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopa-

entacapone entacapone pramipexole pramipexole ext-rel rasagiline ropinirole ropinirole ext-rel selegiline INBRIJA SGM KYNMOBI SGM NEUPRO

ANTIPSYCHOTICS

§ ATYPICALS

aripiprazole clozapine olanzapine quetiapine quetiapine ext-rel risperidone ziprasidone ABILIFY MAINTENA LATUDA PERSERIS VRAYLAR ST

§ ATTENTION DEFICIT HYPERACTIVITY DISORDER

amphetamine-dextroamphetamine mixed salts QL

amphetamine-dextroamphetamine mixed salts ext-rel QL

atomoxetine QL dexmethylphenidate ext-rel

QL guanfacine ext-rel QL methylphenidate QL methylphenidate ext-rel QL MYDAYIS QL VYVANSE QL

FIBROMYALGIA

pregabalin ST, QL

HYPNOTICS

§ NONBENZODIAZEPINES

eszopiclone ramelteon zolpidem zolpidem ext-rel BELSOMRA ST

§ TRICYCLICS

doxepin

MIGRAINE

ACUTE MIGRAINE AGENTS

§ Triptans

eletriptan QL naratriptan QL rizatriptan QL sumatriptan QL zolmitriptan QL ONZETRA XSAIL ST ZEMBRACE SYMTOUCH ST ZOMIG NASAL SPRAY QL

Miscellaneous

NURTEC ODT ST REYVOW ST UBRELVY ST

PREVENTIVE MIGRAINE AGENTS

Monoclonal Antibodies

AIMOVIG ST AJOVY ST EMGALITY ST

§ MOVEMENT DISORDERS

tetrabenazine SGM AUSTEDO SGM INGREZZA SGM

§ MULTIPLE SCLEROSIS AGENTS

dimethyl fumarate delayed-rel SGM

glatiramer SGM AUBAGIO SGM BETASERON SGM COPAXONE SGM GILENYA SGM KESIMPTA SGM MAYZENT SGM OCREVUS † REBIF SGM TYSABRI †

VUMERITY SGM ZEPOSIA SGM

§ MUSCULOSKELETAL THERAPY AGENTS

cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg)

§ NARCOLEPSY

armodafinil PA modafinil PA SUNOSI PA

POSTHERPETIC NEURALGIA (PHN)

GRALISE ST

PSYCHOTHERAPEUTIC -MISCELLANEOUS

§ OPIOID ANTAGONISTS

naloxone injection NARCAN NASAL SPRAY

§ PARTIAL OPIOID AGONIST / OPIOID ANTAGONIST COMBINATIONS

buprenorphine-naloxone sublingual QL

ZUBSOLV QL

PSEUDOBULBAR AFFECT AGENTS

NUEDEXTA PA

ENDOCRINE AND METABOLIC

ACROMEGALY

SOMATULINE DEPOT SGM

§ ANDROGENS

testosterone gel (except authorized generics for TESTIM and VOGELXO)

PA testosterone solution PA ANDRODERM PA NATESTO PA

ANTIDIABETICS

AMYLIN ANALOGS

SYMLINPEN

§ BIGUANIDES

metformin metformin ext-rel (except generics

for FORTAMET and GLUMETZA)

§ BIGUANIDE / SULFONYLUREA COMBINATIONS

glipizide-metformin

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS

JANUVIA

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR / BIGUANIDE COMBINATIONS

JANUMET JANUMET XR

INCRETIN MIMETIC AGENTS

OZEMPIC RYBELSUS TRULICITY VICTOZA



GASTROINTESTINAL

INCRETIN MIMETIC AGENT / INSULIN COMBINATIONS

SOLIQUA XULTOPHY

glipizide glipizide ext-rel

SUPPLIES

§ EXTENDED CYCLE

ethinyl estradiol-levonorgestrel

PREMPRO

§ TRANSDERMAL

estradiol

promethazine scopolamine transdermal trimethobenzamide SANCUSO PA, QL

ACCU-CHEK AVIVA PLUS CLIMARA PRO INSULINS STRIPS AND KITS 3 OTC PROGESTIN INTRAUTERINE COMBIPATCH § ANTISPASMODICS

BASAGLAR ACCU-CHEK COMPACT DEVICES DIVIGEL dicyclomine

FIASP HUMULIN R U-500 LEVEMIR

PLUS STRIPS AND KITS 3

OTC ACCU-CHEK GUIDE

KYLEENA †

MIRENA †

SKYLA †

EVAMIST

§ VAGINAL § H2 RECEPTOR ANTAGONISTS

NOVOLIN 70/30 OTC NOVOLIN N OTC NOVOLIN R OTC NOVOLOG NOVOLOG MIX 70/30 TOUJEO TRESIBA

§ INSULIN SENSITIZERS

pioglitazone

§ INSULIN SENSITIZER / BIGUANIDE COMBINATIONS

pioglitazone-metformin

STRIPS AND KITS 3 OTC ACCU-CHEK SMARTVIEW

STRIPS AND KITS 3 OTC BD ULTRAFINE INSULIN

SYRINGES AND NEEDLES OTC

DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM PA

OMNIPOD DASH QL ONETOUCH ULTRA

STRIPS AND KITS 3 OTC ONETOUCH VERIO STRIPS

AND KITS 3 OTC

§ TRANSDERMAL

ethinyl estradiol-norelgestromin

§ VAGINAL

ethinyl estradiol-etonogestrel ANNOVERA

ENDOMETRIOSIS

ORILISSA PA

FERTILITY REGULATORS

GNRH / LHRH ANTAGONISTS

estradiol vaginal cream IMVEXXY

§ PHENYLKETONURIA TREATMENT AGENTS

sapropterin SGM

§ PHOSPHATE BINDER AGENTS

calcium acetate sevelamer carbonate PHOSLYRA VELPHORO ST

POLYNEUROPATHY

famotidine

INFLAMMATORY BOWEL DISEASE

§ ORAL AGENTS

balsalazide budesonide capsule budesonide ext-rel mesalamine delayed-rel

(except mesalamine delayed-rel tablet

800 mg)

mesalamine ext-rel sulfasalazine sulfasalazine delayed-rel PENTASA

§ INSULIN SENSITIZER / § CALCIUM RECEPTOR CETROTIDE TEGSEDI SGM

SULFONYLUREA COMBINATIONS

ANTAGONISTS

cinacalcet SGM OVULATION STIMULANTS, GONADOTROPINS

POTASSIUM-REMOVING AGENTS

§ RECTAL AGENTS

hydrocortisone enema pioglitazone-glimepiride

§ MEGLITINIDES CALCIUM REGULATORS

§ BISPHOSPHONATES

GONAL-F PA OVIDREL

LOKELMA VELTASSA

mesalamine suppository mesalamine suspension CORTIFOAM

nateglinide repaglinide

SODIUM-GLUCOSE

alendronate ibandronate risedronate

GAUCHER DISEASE

CERDELGA SGM CEREZYME †

PROGESTINS

§ ORAL

medroxyprogesterone

§ IRRITABLE BOWEL SYNDROME

alosetron CO-TRANSPORTER 2 (SGLT2) INHIBITORS

FARXIGA

§ CALCITONINS

calcitonin-salmon § GLUCOCORTICOIDS

dexamethasone

megestrol acetate progesterone, micronized

LINZESS VIBERZI

JARDIANCE PARATHYROID HORMONES fludrocortisone VAGINAL § LAXATIVES

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITOR /

FORTEO SGM TYMLOS SGM

MISCELLANEOUS

hydrocortisone tablet methylprednisolone prednisolone solution prednisone

CRINONE PA ENDOMETRIN PA

§ SELECTIVE ESTROGEN

lactulose solution peg 3350-electrolytes CLENPIQ

BIGUANIDE COMBINATIONS

SYNJARDY SYNJARDY XR XIGDUO XR

PROLIA †

§ CARNITINE DEFICIENCY AGENTS

GLUCOSE ELEVATING AGENTS

BAQSIMI

RECEPTOR MODULATORS

raloxifene

§ THYROID SUPPLEMENTS

OPIOID-INDUCED CONSTIPATION

MOVANTIK SYMPROIC

levocarnitine GLUCAGEN HYPOKIT levothyroxine

SODIUM-GLUCOSE GLUCAGON EMERGENCY liothyronine PANCREATIC ENZYMES CO-TRANSPORTER 2 CENTRAL PRECOCIOUS KIT SYNTHROID CREON (SGLT2) INHIBITOR / DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR COMBINATIONS

PUBERTY

SUPPRELIN LA † TRIPTODUR †

GVOKE

HEREDITARY TYROSINEMIA TYPE 1 AGENTS

UTERINE FIBROIDS

ORIAHNN PA

VIOKACE ZENPEP

§ PROTON PUMP

GLYXAMBI CONTRACEPTIVES ORFADIN SGM INHIBITORS

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITOR / DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR/BIGUANIDE COMBINATIONS

TRIJARDY XR

§ MONOPHASIC

ethinyl estradiol-drospirenone

ethinyl estradiol-drospirenone-levomefolate

ethinyl estradiol-norethindrone acetate

ethinyl estradiol-norethindrone acetate-iron

HUMAN GROWTH HORMONES

GENOTROPIN SGM NORDITROPIN SGM

MENOPAUSAL SYMPTOM AGENTS

§ ORAL

estradiol

§ ANTIDIARRHEALS

diphenoxylate-atropine loperamide

§ ANTIEMETICS

aprepitant QL dronabinol PA, QL granisetron QL meclizine

esomeprazole delayed-rel lansoprazole delayed-rel omeprazole delayed-rel pantoprazole delayed-rel

tablet DEXILANT ST

§ STEROIDS, RECTAL

PROCTOFOAM-HC

§ SULFONYLUREAS

glimepiride § TRIPHASIC

ethinyl estradiol-norgestimate

estradiol-norethindrone DUAVEE PREMPHASE

metoclopramide ondansetron QL prochlorperazine

§ MISCELLANEOUS

sucralfate tablet



GENITOURINARY BRILINTA RESPIRATORY § LEUKOTRIENE ONEXTON MODULATORS

§ BENIGN PROSTATIC THROMBOCYTOPENIA ALPHA-1 ANTITRYPSIN § ACTINIC KERATOSIS montelukast

HYPERPLASIA AGENTS DEFICIENCY AGENTS fluorouracil cream 5% zafirlukast alfuzosin ext-rel DOPTELET SGM PROLASTIN-C † fluorouracil solution

doxazosin MULPLETA SGM § NASAL ANTIHISTAMINES imiquimod § ANAPHYLAXIS

IMMUNOLOGIC AGENTS

PICATO dutasteride azelastine spray QLTREATMENT AGENTS TOLAK dutasteride-tamsulosin olopatadine spray QL

epinephrine auto-injector ZYCLARA

silodosin finasteride

EPIPEN § NASAL STEROIDS / ALLERGENIC EXTRACTS § ANTIBIOTICS EPIPEN JR COMBINATIONS tamsulosin

GRASTEK PA SYMJEPI gentamicin QLterazosin flunisolide QLORALAIR PA mupirocin ointment fluticasone QL

§ URINARY RAGWITEK PA § ANTICHOLINERGICS mometasone nasal spray QL § ANTIFUNGALS ANTISPASMODICS ipratropium inhalation DYMISTA ST, QL AUTOIMMUNE AGENTS

solution QL ciclopirox PAdarifenacin ext-rel (PHYSICIAN-SPIRIVA QL PHOSPHODIESTERASE-4 clotrimazole oxybutynin ADMINISTERED)

oxybutynin ext-rel YUPELRI QL INHIBITORS econazole QL REMICADE † ketoconazole cream 2% QL SIMPONI ARIA † ANTICHOLINERGIC / BETA

solifenacin DALIRESP nystatin QL

STELARA INTRAVENOUS † AGONIST COMBINATIONS PULMONARY FIBROSIS tolterodine

NAFTIN tolterodine ext-rel § SHORT ACTING AGENTS trospium AUTOIMMUNE AGENTS § ANTIPSORIATICS

trospium ext-rel ipratropium-albuterol ESBRIET SGM(SELF-ADMINISTERED) 4 acitretin PAMYRBETRIQ ST inhalation solution QL OFEV SGM COSENTYX SGM calcipotriene ointment, TOVIAZ ST ENBREL SGM LONG ACTING SEVERE ASTHMA AGENTS solution QL

HUMIRA SGMHEMATOLOGIC ANORO ELLIPTA QL DUPIXENT SGM methoxsalen

OTEZLA SGM STIOLTO RESPIMAT QL FASENRA AUTOINJECTOR § ANTICOAGULANTS RINVOQ SGM § ANTISEBORRHEICS SGM

warfarin SKYRIZI SGM ANTICHOLINERGIC / BETA NUCALA AUTOINJECTOR ketoconazole shampoo 2%

ELIQUIS STELARA AGONIST / STEROID SGM selenium sulfide lotion 2.5%

XARELTO SUBCUTANEOUS SGM INHALANT COMBINATIONS XOLAIR † ATOPIC DERMATITIS TREMFYA SGM BREZTRI AEROSPHERE

§ CHELATING AGENTS XELJANZ SGM STEROID / BETA AGONIST Injectable QL deferasirox SGM XELJANZ XR SGM COMBINATIONS TRELEGY ELLIPTA QL DUPIXENT SGM deferiprone SGM ADVAIR DISKUS QL

§ DISEASE-MODIFYING deferoxamine † § ANTIHISTAMINES, LOW § Topical ADVAIR HFA ‡, QLANTIRHEUMATIC DRUGS penicillamine capsule ST SEDATING BREO ELLIPTA ‡, QL pimecrolimus PA (DMARDs) trientine ST levocetirizine SYMBICORT QL tacrolimus PA

RASUVO SGM EUCRISA ST HEMATOPOIETIC GROWTH § ANTITUSSIVES § STEROID INHALANTS CORTICOSTEROIDS

§ HEREDITARY FACTORS benzonatate (except NDCs^ budesonide inhalation § Low Potency ANGIOEDEMA ARANESP SGM 69336012615, 69499032915) suspension QL desonide QLicatibant SGMNIVESTYM SGM ARNUITY ELLIPTA QL hydrocortisone QLBETA AGONISTS, RETACRIT SGM FLOVENT DISKUS QLIMMUNOMODULATORS

ZIEXTENZO SGM INHALANTS FLOVENT HFA QL § Medium Potency IMMUNE GLOBULINS

§ SHORT ACTING PULMICORT FLEXHALER hydrocortisone butyrate HEMOPHILIA A AGENTS CUTAQUIG SGM QLalbuterol inhalation solution cream, ointment, solution ADVATE † QVAR REDIHALER QLQLIMMUNOSUPPRESSANTS QLADYNOVATE †

albuterol sulfate CFC-free TOPICAL

mometasone QLAFSTYLA † § RAPAMYCIN DERIVATIVES

aerosol QL triamcinolone cream, lotion, ELOCTATE † everolimus SGM

levalbuterol tartrate CFC-free ointment (except triamcinolone DERMATOLOGY ESPEROCT †

NUTRITIONAL / SUPPLEMENTS

aerosol QL ointment 0.05%) QLACNEJIVI †

KOGENATE FS † LONG ACTING § Topical § High Potency KOVALTRY †

§ ELECTROLYTES Hand-held Active Inhalation adapalene PA desoximetasone QL NOVOEIGHT † benzoyl peroxide fluocinonide (except fluocinonide potassium chloride liquid SEREVENT QLNUWIQ † clindamycin gel (except NDC^ cream 0.1%) QLSTRIVERDI RESPIMAT QL

VITAMINS AND MINERALS 68682046275) BRYHALI PAHEMOPHILIA B AGENTS Nebulized Passive Inhalation clindamycin solution QL§ FOLIC ACID / REBINYN † § Very High Potency

COMBINATIONS PERFOROMIST QL clindamycin-benzoyl peroxide clobetasol cream, foam, gel, § PLATELET AGGREGATION folic acid § CYSTIC FIBROSIS erythromycin solution lotion, ointment, shampoo INHIBITORS

§ PRENATAL VITAMINS tobramycin inhalation erythromycin-benzoyl QLclopidogrel solution SGM peroxide

dipyridamole ext-rel-aspirin prenatal vitamins § LOCAL ANALGESICS BETHKIS SGM tretinoin PA, ** prasugrel CITRANATAL

EPIDUO lidocaine patch PA



§ LOCAL ANESTHETICS sulfacetamide tobramycin

loteprednol prednisolone acetate 1%

CARBONIC ANHYDRASE INHIBITOR /

RHO KINASE INHIBITOR / PROSTAGLANDIN

lidocaine-prilocaine BESIVANCE DUREZOL SYMPATHOMIMETIC COMBINATIONS

§ ROSACEA

azelaic acid gel PA

§ ANTI-INFECTIVE / ANTI-INFLAMMATORY

§ ANTIVIRALS

trifluridine

COMBINATIONS

SIMBRINZA ROCKLATAN ST

§ SYMPATHOMIMETICS metronidazole FINACEA FOAM PA

COMBINATIONS

neomycin-polymyxin B- BETA-BLOCKERS DRY EYE DISEASE

RESTASIS brimonidine ALPHAGAN P

ORACEA PA bacitracin-hydrocortisone § Nonselective XIIDRA SOOLANTRA PA neomycin-polymyxin B- timolol maleate solution SYMPATHOMIMETIC / BETA-

OPHTHALMIC

§ ANTIALLERGICS

azelastine

dexamethasone tobramycin-dexamethasone TOBRADEX OINTMENT

Selective

BETOPTIC S

§ PROSTAGLANDINS

latanoprost travoprost LUMIGAN ST

BLOCKER COMBINATIONS

COMBIGAN

OTIC

cromolyn sodium olopatadine

ANTI-INFLAMMATORIES

§ Nonsteroidal

§ CARBONIC ANHYDRASE INHIBITORS

ZIOPTAN ST § ANTI-INFECTIVES

acetic acid

§ ANTI-INFECTIVES bromfenac diclofenac

dorzolamide AZOPT

RETINAL DISORDERS

EYLEA † ofloxacin otic

ciprofloxacin erythromycin gentamicin QL levofloxacin moxifloxacin

ketorolac QL ILEVRO PROLENSA

§ Steroidal

§ CARBONIC ANHYDRASE INHIBITOR / BETA-BLOCKER COMBINATIONS

dorzolamide-timolol

LUCENTIS †

RHO KINASE INHIBITORS

RHOPRESSA

§ ANTI-INFECTIVE / ANTI-INFLAMMATORY COMBINATIONS

ciprofloxacin-dexamethasone neomycin-polymyxin B-

ofloxacin dexamethasone hydrocortisone

QUICK REFERENCE DRUG LIST

A

abacavir tablet QL abacavir-lamivudine QL ABILIFY MAINTENA abiraterone SGM ACCU-CHEK AVIVA PLUS

STRIPS AND KITS 3 OTC ACCU-CHEK COMPACT

PLUS STRIPS AND KITS 3

OTC ACCU-CHEK GUIDE

STRIPS AND KITS 3 OTC ACCU-CHEK SMARTVIEW

STRIPS AND KITS 3 OTC acetic acid acitretin PA acyclovir capsule, tablet adapalene PA ADEMPAS SGM ADVAIR DISKUS QL ADVAIR HFA ‡, QL ADVATE †

ADYNOVATE †

AFINITOR SGM AFSTYLA †

AIMOVIG ST AJOVY ST albuterol inhalation solution

QL albuterol sulfate CFC-free

aerosol QL ALECENSA SGM alendronate alfuzosin ext-rel aliskiren allopurinol alosetron ALPHAGAN P

alprazolam ALUNBRIG SGM amantadine ambrisentan SGM amiloride amlodipine amlodipine-atorvastatin amlodipine-olmesartan amlodipine-telmisartan amlodipine-valsartan amlodipine-valsartan-

hydrochlorothiazide amoxicillin amoxicillin-clavulanate amphetamine-

dextroamphetamine mixed salts QL

amphetamine-dextroamphetamine mixed salts ext-rel QL

ANDRODERM PA ANNOVERA ANORO ELLIPTA QL aprepitant QL ARANESP SGM aripiprazole armodafinil PA ARNUITY ELLIPTA QL atazanavir QL atenolol atomoxetine QL atorvastatin AUBAGIO SGM AUSTEDO SGM azelaic acid gel PA azelastine azelastine spray QL azithromycin

AZOPT

B

balsalazide BAQSIMI BASAGLAR BD ULTRAFINE INSULIN

SYRINGES AND NEEDLES OTC

BELBUCA QL BELSOMRA ST

benzonatate (except NDCs^

69336012615, 69499032915)

benzoyl peroxide BESIVANCE BETASERON SGM BETHKIS SGM BETOPTIC S bicalutamide BIDIL BIKTARVY QL bosentan SGM BOSULIF SGM BREO ELLIPTA ‡, QL BREZTRI AEROSPHERE

QL BRILINTA brimonidine bromfenac BRYHALI PA budesonide capsule budesonide ext-rel budesonide inhalation

suspension QL buprenorphine transdermal

QL buprenorphine-naloxone

sublingual QL

bupropion bupropion ext-rel (except

bupropion ext-rel tablet 450 mg)

BYSTOLIC

C

CABOMETYX SGM calcipotriene ointment,

solution QL calcitonin-salmon calcium acetate candesartan candesartan-

hydrochlorothiazide carbamazepine carbamazepine ext-rel carbidopa-levodopa carbidopa-levodopa ext-rel carbidopa-levodopa-

entacapone carvedilol carvedilol phosphate ext-rel cefdinir cefprozil cefuroxime axetil celecoxib cephalexin CERDELGA SGM CEREZYME †

CETROTIDE cholestyramine ciclopirox PA CIMDUO QL cinacalcet SGM ciprofloxacin ciprofloxacin-dexamethasone citalopram CITRANATAL

clarithromycin clarithromycin ext-rel CLENPIQ CLIMARA PRO clindamycin clindamycin gel (except NDC^

68682046275)

clindamycin gel, solution QL clindamycin-benzoyl

peroxide clobazam clobetasol cream, foam, gel,

lotion, ointment, shampoo QL

clonazepam clopidogrel clotrimazole clozapine codeine-acetaminophen QL colchicine tablet colesevelam COMBIGAN COMBIPATCH COMPLERA QL COPAXONE SGM COPIKTRA SGM CORLANOR CORTIFOAM COSENTYX SGM CREON CRINONE PA cromolyn sodium CUTAQUIG SGM cyclobenzaprine (except

cyclobenzaprine tablet 7.5 mg)

D

DALIRESP


www.arkansasbluecross.com

darifenacin ext-rel ELIQUIS finasteride IBRANCE SGM liothyronine deferasirox SGM ELOCTATE † FIRMAGON † ibuprofen lisinopril deferiprone SGM EMGALITY ST FLOVENT DISKUS QL icatibant SGM lisinopril-hydrochlorothiazide deferoxamine † EMVERM FLOVENT HFA QL ILEVRO LOKELMA DESCOVY QL ENBREL SGM fluconazole imatinib mesylate SGM LONSURF SGM desonide QL ENDOMETRIN PA fludrocortisone imiquimod loperamide desoximetasone QL entacapone flunisolide QL IMVEXXY lorazepam desvenlafaxine ext-rel entecavir fluocinonide (except fluocinonide INBRIJA SGM losartan dexamethasone ENTRESTO cream 0.1%) QL INGREZZA SGM losartan-hydrochlorothiazide DEXCOM CONTINUOUS EPCLUSA SGM fluorouracil cream 5% ipratropium inhalation loteprednol

GLUCOSE MONITORING EPIDUO fluorouracil solution solution QL lovastatin SYSTEM PA epinephrine auto-injector fluoxetine (except fluoxetine tablet 60 ipratropium-albuterol LUCENTIS †

DEXILANT ST EPIPEN mg, fluoxetine tablet [generics for inhalation solution QL LUMIGAN ST dexmethylphenidate ext-rel EPIPEN JR SARAFEM]) irbesartan LYNPARZA SGM

QL ERIVEDGE SGM fluticasone QL irbesartan-diazepam ERLEADA SGM fluvastatin hydrochlorothiazide M

diazepam rectal gel erythromycin folic acid IRESSA SGM MAYZENT SGM diclofenac erythromycin solution FORTEO SGM ISENTRESS QL meclizine diclofenac sodium erythromycin-benzoyl fosinopril isosorbide dinitrate (except medroxyprogesterone diclofenac sodium gel 1% peroxide fosinopril-hydrochlorothiazide isosorbide dinitrate 40 mg) megestrol acetate

PA erythromycins furosemide isosorbide mononitrate meloxicam diclofenac sodium solution ESBRIET SGM FYCOMPA itraconazole PA memantine diclofenac sodium- escitalopram ivermectin mesalamine delayed-rel

misoprostol esomeprazole delayed-rel G (except mesalamine delayed-rel tablet dicloxacillin ESPEROCT † gabapentin J 800 mg) dicyclomine estradiol galantamine JANUMET mesalamine ext-rel DIFICID ST, QL estradiol vaginal cream galantamine ext-rel JANUMET XR mesalamine suppository digoxin estradiol-norethindrone GENOTROPIN SGM JANUVIA mesalamine suspension diltiazem ext-rel (except generics eszopiclone gentamicin QL JARDIANCE metformin

for CARDIZEM LA) ethinyl estradiol- GENVOYA QL JIVI † metformin ext-rel (except generics dimethyl fumarate delayed- drospirenone GILENYA SGM for FORTAMET and GLUMETZA)

rel SGM ethinyl estradiol- glatiramer SGM K methadone QL diphenoxylate-atropine drospirenone-levomefolate glimepiride KANJINTI † methoxsalen dipyridamole ext-rel-aspirin ethinyl estradiol-etonogestrel glipizide KESIMPTA SGM methylphenidate QL disopyramide ethinyl estradiol- glipizide ext-rel ketoconazole cream 2% QL methylphenidate ext-rel QL divalproex sodium levonorgestrel glipizide-metformin ketoconazole shampoo 2% methylprednisolone divalproex sodium ext-rel ethinyl estradiol- GLUCAGEN HYPOKIT ketorolac QL metoclopramide DIVIGEL norelgestromin GLUCAGON EMERGENCY KISQALI SGM metolazone donepezil ethinyl estradiol- KIT KISQALI FEMARA CO- metoprolol succinate ext-rel DOPTELET SGM norethindrone acetate GLYXAMBI PACK SGM metoprolol tartrate dorzolamide ethinyl estradiol- GONAL-F PA KOGENATE FS † metronidazole dorzolamide-timolol norethindrone acetate-iron GRALISE ST KOVALTRY † minocycline DOVATO QL ethinyl estradiol-norgestimate granisetron QL KYLEENA † MIRENA †

doxazosin ethosuximide GRASTEK PA KYNMOBI SGM mirtazapine doxepin EUCRISA ST guanfacine ext-rel QL modafinil PA doxycycline hyclate 20 mg EVAMIST GVOKE L mometasone QL doxycycline hyclate capsule everolimus SGM lactulose solution mometasone nasal spray QL dronabinol PA, QL DUAVEE duloxetine DUPIXENT SGM DUREZOL dutasteride

EVOTAZ QL EYLEA †

ezetimibe ezetimibe-simvastatin

F

H

HARVONI SGM HUMIRA SGM HUMULIN R U-500 hydrochlorothiazide hydrocodone ext-rel QL

lamivudine QL lamotrigine lamotrigine ext-rel lansoprazole delayed-rel latanoprost LATUDA

montelukast morphine QL morphine ext-rel QL morphine suppository QL MOVANTIK moxifloxacin

dutasteride-tamsulosin famotidine hydrocodone-acetaminophen levalbuterol tartrate CFC-free MULPLETA SGM DYMISTA ST, QL FARXIGA QL aerosol QL MULTAQ

E FASENRA AUTOINJECTOR

SGM hydrocortisone QL hydrocortisone butyrate

LEVEMIR levetiracetam

mupirocin ointment MYDAYIS QL

econazole QL fenofibrate (except fenofibrate capsule cream, ointment, solution levetiracetam ext-rel MYRBETRIQ ST efavirenz-emtricitabine- 50 mg, 130 mg; fenofibrate tablet 40 mg, QL levocarnitine

tenofovir disoproxil 120 mg) hydrocortisone enema levocetirizine N

fumarate QL fenofibric acid delayed-rel hydrocortisone tablet levofloxacin nadolol efavirenz-lamivudine- fentanyl transdermal QL hydromorphone QL levothyroxine NAFTIN

tenofovir disoproxil fentanyl transmucosal hydromorphone ext-rel QL lidocaine patch PA naloxone injection fumarate QL lozenge PA lidocaine-prilocaine NAMZARIC

eletriptan QL FIASP I linezolid PA naproxen (except naproxen CR or ELIGARD SGM FINACEA FOAM PA ibandronate LINZESS naproxen suspension)



naratriptan QL OPSUMIT SGM PROLIA † solifenacin torsemide NARCAN NASAL SPRAY ORACEA PA promethazine SOLIQUA TOUJEO nateglinide ORALAIR PA propranolol SOMATULINE DEPOT SGM TOVIAZ ST NATESTO PA ORENITRAM SGM propranolol ext-rel SOOLANTRA PA tramadol (except NDC^ NAYZILAM ORFADIN SGM PULMICORT FLEXHALER sotalol 52817019610) QL neomycin-polymyxin B- ORIAHNN PA QL SPIRIVA QL tramadol ext-rel tablet QL

bacitracin-hydrocortisone ORILISSA PA pyrimethamine PA spironolactone- travoprost neomycin-polymyxin B- oseltamivir QL hydrochlorothiazide TRAZIMERA †

dexamethasone OTEZLA SGM Q SPRYCEL SGM trazodone neomycin-polymyxin B- OVIDREL quetiapine STELARA INTRAVENOUS † TRELEGY ELLIPTA QL

hydrocortisone oxazepam quetiapine ext-rel STELARA TREMFYA SGM NEUPRO oxcarbazepine quinapril SUBCUTANEOUS SGM treprostinil SGM NEXLETOL PA OXTELLAR XR quinapril-hydrochlorothiazide STIOLTO RESPIMAT QL TRESIBA NEXLIZET PA oxybutynin QVAR REDIHALER QL STIVARGA SGM tretinoin PA, ** niacin ext-rel oxybutynin ext-rel STRIBILD QL triamcinolone cream, lotion, nifedipine ext-rel oxycodone QL R STRIVERDI RESPIMAT QL ointment (except triamcinolone NINLARO SGM oxycodone-acetaminophen RAGWITEK PA SUBSYS PA ointment 0.05%) QL nitrofurantoin (except NDC^ QL raloxifene sucralfate tablet triamterene

70408023932) OZEMPIC ramelteon sulfacetamide triamterene-nitroglycerin lingual spray nitroglycerin sublingual P

ramipril ranolazine ext-rel

sulfamethoxazole-trimethoprim

hydrochlorothiazide trientine ST

NIVESTYM SGM pantoprazole delayed-rel rasagiline sulfasalazine trifluridine NORDITROPIN SGM tablet RASUVO SGM sulfasalazine delayed-rel TRIJARDY XR NORVIR QL paroxetine HCl REBIF SGM sumatriptan QL trimethobenzamide NOVOEIGHT † paroxetine HCl ext-rel REBINYN † SUNOSI PA TRINTELLIX ST NOVOLIN 70/30 OTC peg 3350-electrolytes RELENZA QL SUPPRELIN LA † TRIPTODUR † NOVOLIN N OTC penicillamine capsule ST REMICADE † SUPRAX TRIUMEQ QL NOVOLIN R OTC penicillin VK repaglinide SYMBICORT QL trospium NOVOLOG PENTASA RESTASIS SYMJEPI trospium ext-rel NOVOLOG MIX 70/30 PERFOROMIST QL RETACRIT SGM SYMLINPEN TRULICITY NUBEQA SGM PERJETA † REVLIMID SGM SYMPROIC TRUVADA QL NUCALA AUTOINJECTOR PERSERIS REYVOW ST SYMTUZA QL TYMLOS SGM

SGM phenobarbital RHOPRESSA SYNJARDY TYSABRI †

NUCYNTA QL phenytoin ribavirin SGM SYNJARDY XR NUCYNTA ER QL phenytoin sodium extended RINVOQ SGM SYNTHROID U NUEDEXTA PA NURTEC ODT ST

PHESGO SGM PHOSLYRA

risedronate risperidone T

UBRELVY ST UPTRAVI SGM

NUWIQ † PICATO rivastigmine tacrolimus PA nystatin QL pimecrolimus PA rivastigmine transdermal tamsulosin V

O

OCREVUS † ODEFSEY QL

pindolol pioglitazone pioglitazone-glimepiride pioglitazone-metformin

rizatriptan QL ROCKLATAN ST ropinirole ropinirole ext-rel

TEGSEDI SGM TEKTURNA HCT ST telmisartan telmisartan-

valacyclovir valganciclovir valproic acid valsartan

ODOMZO SGM OFEV SGM

POMALYST SGM potassium chloride liquid

rosuvastatin RUBRACA SGM

hydrochlorothiazide TEMIXYS QL

valsartan-hydrochlorothiazide VALTOCO

ofloxacin ofloxacin otic

PRALUENT PA pramipexole

rufinamide RUXIENCE †

terazosin terbinafine tablet

vancomycin capsule QL VASCEPA PA

olanzapine pramipexole ext-rel RYBELSUS testosterone gel (except authorized VELCADE † olmesartan prasugrel RYDAPT SGM generics for TESTIM and VOGELXO) VELPHORO ST olmesartan-amlodipine- pravastatin PA VELTASSA

hydrochlorothiazide prednisolone acetate 1% S testosterone solution PA VEMLIDY olmesartan- prednisolone solution SANCUSO PA, QL tetrabenazine SGM venlafaxine

hydrochlorothiazide olopatadine olopatadine spray QL

prednisone pregabalin ST, QL PREMPHASE

sapropterin SGM scopolamine transdermal selegiline

tetracycline THALOMID SGM tiagabine

venlafaxine ext-rel capsule verapamil ext-rel VIBERZI

omega-3 acid ethyl esters PREMPRO selenium sulfide lotion 2.5% timolol maleate solution VICTOZA PA

omeprazole delayed-rel prenatal vitamins PREZCOBIX QL

SEREVENT QL sertraline

TIVICAY QL TOBRADEX OINTMENT

vigabatrin SGM VIMPAT

OMNIPOD DASH QL PREZISTA QL sevelamer carbonate tobramycin VIOKACE ondansetron QL primidone sildenafil SGM tobramycin inhalation VOSEVI 2 SGM ONETOUCH ULTRA probenecid silodosin solution SGM VRAYLAR ST

STRIPS AND KITS 3 OTC prochlorperazine SIMBRINZA tobramycin-dexamethasone VUMERITY SGM ONETOUCH VERIO STRIPS

AND KITS 3 OTC PROCTOFOAM-HC progesterone, micronized

SIMPONI ARIA †

simvastatin

TOLAK tolterodine

VYVANSE QL

ONEXTON PROLASTIN-C † SKYLA † tolterodine ext-rel W ONZETRA XSAIL ST PROLENSA SKYRIZI SGM topiramate warfarin



- -

X XIGDUO XR Y ZEMBRACE SYMTOUCH ZIRABEV † XIIDRA

YONSA SGM ST zolmitriptan QL

XOLAIR † XOSPATA SGM

YUPELRI QL ZENPEP ZEPOSIA SGM

zolpidem zolpidem ext-rel

XTAMPZA ER QL Z ZIEXTENZO SGM XTANDI SGM ZIOPTAN ST XULTOPHY

zafirlukast ZEJULA SGM

ziprasidone

XARELTO XCOPRI XELJANZ SGM XELJANZ XR SGM XIFAXAN 550 MG PA

ZOMIG NASAL SPRAY QL zonisamide ZUBSOLV QL ZYCLARA

PREFERRED OPTIONS LIST NON FORMULARY DRUG NAME(S) PREFERRED OPTION(S)* NON FORMULARY DRUG NAME(S) PREFERRED OPTION(S)*

ABILIFY aripiprazole, clozapine, olanzapine, quetiapine, AMITIZA quetiapine ext-rel, risperidone, ziprasidone, LATUDA, VRAYLAR ST AMRIX

ACANYA adapalene PA, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275) QL, clindamycin- ANDROGEL

benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin PA, **, EPIDUO, ONEXTON ANGELIQ

ACIPHEX, ACIPHEX SPRINKLE esomeprazole delayed-rel, lansoprazole delayed-rel, omeprazole delayed-rel, pantoprazole ANTARA delayed-rel tablet, DEXILANT ST

ACTEMRA ACTPEN, ACTEMRA ENBREL SGM, HUMIRA SGM, RINVOQ SGM, SUBCUTANEOUS XELJANZ SGM, XELJANZ XR SGM APEXICON E

ACTICLATE doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline

Activite folic acid APIDRA

ACTOS pioglitazone APOKYN

ACUVAIL bromfenac, diclofenac, ketorolac QL, ILEVRO, APTENSIO XR

PROLENSA

acyclovir cream acyclovir capsule, acyclovir tablet, valacyclovir

ADDERALL amphetamine-dextroamphetamine mixed salts APTIVUS QL, methylphenidate QL

ADZENYS ER, ADZENYS XR-ODT amphetamine-dextroamphetamine mixed salts ARALAST NP ext-rel QL, dexmethylphenidate ext-rel QL, methylphenidate ext-rel QL, MYDAYIS QL, ARMOUR THYROID

VYVANSE QL ARTHROTEC

ALCORTIN A desonide QL, hydrocortisone QL

ALEVICYN GEL, ALEVICYN SG, desonide QL, hydrocortisone QL ALEVICYN SOLUTION

ALIQOPA COPIKTRA SGM ASACOL HD

ALLISON MEDICAL INSULIN BD ULTRAFINE INSULIN SYRINGES OTC SYRINGES 5

ALORA estradiol, DIVIGEL, EVAMIST ASCENSIA STRIPS AND KITS 6

ALPROLIX Consult doctor

ALREX azelastine, cromolyn sodium, olopatadine

ALTOPREV atorvastatin, ezetimibe-simvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin

ALVESCO ARNUITY ELLIPTA QL, FLOVENT DISKUS QL, FLOVENT HFA QL,

ASMANEX, ASMANEX HFA

PULMICORT FLEXHALER QL, QVAR REDIHALER QL

LINZESS, MOVANTIK, SYMPROIC


testosterone gel (except authorized generics for TESTIM and VOGELXO) PA, testosterone solution PA, ANDRODERM PA, NATESTO PA

estradiol-norethindrone, PREMPHASE, PREMPRO

fenofibrate (except fenofibrate capsule 50 mg, 130 mg; fenofibrate tablet 40 mg, 120 mg), fenofibric acid delayed-rel

desoximetasone (except desoximetasone ointment 0.05%) QL, fluocinonide (except fluocinonide cream 0.1%) QL, BRYHALI PA

FIASP, NOVOLOG

INBRIJA SGM, KYNMOBI SGM

amphetamine-dextroamphetamine mixed salts ext-rel QL, dexmethylphenidate ext-rel QL, methylphenidate ext-rel QL, MYDAYIS QL, VYVANSE QL

Consult doctor

PROLASTIN-C †

levothyroxine, liothyronine, SYNTHROID

celecoxib; diclofenac sodium, ibuprofen, meloxicam or naproxen (except naproxen CR or naproxen suspension) WITH esomeprazole delayed-rel, lansoprazole delayed-rel, omeprazole delayed-rel, pantoprazole delayed-rel tablet or DEXILANT ST

balsalazide, mesalamine delayed-rel, mesalamine ext-rel, sulfasalazine, sulfasalazine delayed-rel, PENTASA

ACCU-CHEK AVIVA PLUS STRIPS AND KITS 3 OTC, ACCU-CHEK COMPACT PLUS STRIPS AND KITS 3 OTC, ACCU-CHEK GUIDE STRIPS AND KITS 3 OTC, ACCU-CHEK SMARTVIEW STRIPS AND KITS 3 OTC, ONETOUCH ULTRA STRIPS AND KITS 3 OTC, ONETOUCH VERIO STRIPS AND KITS 3 OTC

ARNUITY ELLIPTA QL, FLOVENT DISKUS QL, FLOVENT HFA QL, PULMICORT FLEXHALER QL, QVAR REDIHALER QL



- -NON FORMULARY DRUG NAME(S) PREFERRED OPTION(S)* NON FORMULARY DRUG NAME(S) PREFERRED OPTION(S)*

ATACAND, ATACAND HCT candesartan, candesartan-hydrochlorothiazide, BERINERT icatibant SGM irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, BETAPACE, BETAPACE AF sotalol

olmesartan, olmesartan-hydrochlorothiazide, BETIMOL timolol maleate solution, BETOPTIC S telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide

BEVESPI AEROSPHERE ANORO ELLIPTA QL, STIOLTO RESPIMAT QL ATIVAN alprazolam, clonazepam, diazepam, lorazepam,

oxazepam BEYAZ ethinyl estradiol-drospirenone, ethinyl estradiol-

ATOPADERM desonide QL, hydrocortisone QL drospirenone-levomefolate, ethinyl estradiol-norethindrone acetate, ethinyl estradiol-

ATROVENT HFA ipratropium inhalation solution QL, SPIRIVA QL, norethindrone acetate-iron

YUPELRI QL bimatoprost solution 0.03% latanoprost, travoprost, LUMIGAN, ZIOPTAN ST

AVASTIN ZIRABEV † BORTEZOMIB NINLARO SGM, VELCADE †

BREEZE 2 STRIPS AND KITS 6 ACCU-CHEK AVIVA PLUS STRIPS AND KITS 3 AVENOVA Consult doctor OTC, ACCU-CHEK COMPACT PLUS STRIPS

AVONEX dimethyl fumarate delayed-rel SGM, glatiramer SGM, AUBAGIO SGM, BETASERON SGM, COPAXONE SGM, GILENYA SGM, KESIMPTA SGM, MAYZENT SGM, OCREVUS † , REBIF SGM, TYSABRI † , ZEPOSIA SGM

AND KITS 3 OTC, ACCU-CHEK GUIDE STRIPS AND KITS 3 OTC, ACCU-CHEK SMARTVIEW STRIPS AND KITS 3 OTC, ONETOUCH ULTRA STRIPS AND KITS 3 OTC, ONETOUCH VERIO STRIPS AND KITS 3 OTC

AZASITE ciprofloxacin, erythromycin, gentamicin QL, levofloxacin, moxifloxacin, ofloxacin, sulfacetamide, tobramycin, BESIVANCE

BROMSITE bromfenac, diclofenac, ketorolac QL, ILEVRO, PROLENSA

AZELEX adapalene PA, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275) QL,

Bupap diclofenac sodium, ibuprofen, naproxen (except naproxen CR or naproxen suspension)

clindamycin solution QL, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide,

bupropion ext-rel tablet 450 mg bupropion, bupropion ext-rel (except bupropion ext-rel tablet 450 mg)

tretinoin PA, **, EPIDUO, ONEXTON butalbital-acetaminophen tablet 50- diclofenac sodium, ibuprofen, naproxen (except

AZESCO 7 prenatal vitamins, CITRANATAL 300 mg, BUTALBITAL-ACETAMINOPHEN (NDC^

naproxen CR or naproxen suspension)

AZOR amlodipine-olmesartan, amlodipine-telmisartan, 69499034230 only)

amlodipine-valsartan butalbital-acetaminophen-caffeine diclofenac sodium, ibuprofen, naproxen (except

BANZEL SUSPENSION clobazam, lamotrigine, rufinamide, topiramate capsule naproxen CR or naproxen suspension)

BARACLUDE TABLET entecavir, lamivudine, VEMLIDY BUTRANS buprenorphine transdermal QL, BELBUCA QL

BEAU RX Consult doctor BYDUREON OZEMPIC, RYBELSUS, TRULICITY, VICTOZA

BECONASE AQ flunisolide QL, fluticasone QL, BYETTA OZEMPIC, RYBELSUS, TRULICITY, VICTOZA

mometasone nasal spray QL, DYMISTA ST, QL CAFERGOT eletriptan QL, rizatriptan QL, sumatriptan QL,

BENICAR, BENICAR HCT candesartan, candesartan-hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide,

zolmitriptan QL, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST, UBRELVY ST, ZEMBRACE SYMTOUCH ST, ZOMIG NASAL SPRAY QL

telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide

calcipotriene cream calcipotriene ointment QL, calcipotriene solution QL

BENSAL HP desonide QL, hydrocortisone QL calcipotriene-betamethasone calcipotriene ointment QL or calcipotriene

BENZAC AC adapalene PA, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275) QL, clindamycin solution QL, clindamycin-benzoyl peroxide, erythromycin solution,

solution QL WITH desoximetasone (except desoximetasone ointment 0.05%) QL, fluocinonide (except fluocinonide cream 0.1%) QLor BRYHALI PA

erythromycin-benzoyl peroxide, tretinoin PA, **, EPIDUO, ONEXTON

calcitriol ointment calcipotriene ointment QL, calcipotriene solution QL

BENZACLIN adapalene PA, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275) QL, clindamycin solution QL, clindamycin-

CAMBIA diclofenac sodium, ibuprofen, naproxen (except naproxen CR or naproxen suspension)

benzoyl peroxide, erythromycin solution, CARAC fluorouracil cream 5%, fluorouracil solution,

erythromycin-benzoyl peroxide, tretinoin PA, **, imiquimod, PICATO, TOLAK, ZYCLARA

EPIDUO, ONEXTON CARAFATE sucralfate tablet

benzonatate (NDCs^ 69336012615, 69499032915 only)

benzonatate (except NDCs^ 69336012615, 69499032915) CARBINOXAMINE TABLET 6 MG levocetirizine

BEPREVE azelastine, cromolyn sodium, olopatadine CARDIZEM, CARDIZEM CD, CARDIZEM LA

diltiazem ext-rel (except generics for CARDIZEM LA)




CARNITOR, CARNITOR SF

carisoprodol 250 mg

CELEBREX

chlordiazepoxide-clidinium (NDCs^ 11534019701, 42494040901, 51293069601, 51293069610 only)

chlorzoxazone 375 mg, chlorzoxazone 500 mg (NDC^ 73007001303 only), chlorzoxazone 750 mg, CHLORZOXAZONE 250 MG

CICATRACE

CILOXAN

CIMZIA PREFILLED SYRINGE

CIPRO HC

CIPRODEX

CLINDAGEL

clindamycin gel (NDC^ 68682046275 only)

clobetasol spray

CLOBEX SPRAY

clocortolone cream

COLAZAL

colchicine capsule

COLCRYS

CONSENSI

CONTOUR NEXT STRIPS AND KITS 6

CONTOUR STRIPS AND KITS 6

levocarnitine


celecoxib, diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

dicyclomine


Consult doctor

ciprofloxacin, erythromycin, gentamicin QL, levofloxacin, moxifloxacin, ofloxacin, sulfacetamide, tobramycin, BESIVANCE

COSENTYX SGM, ENBREL SGM, HUMIRA SGM, OTEZLA SGM, RINVOQ SGM, STELARA SUBCUTANEOUS SGM, TREMFYA SGM, XELJANZ SGM, XELJANZ XR SGM

ciprofloxacin-dexamethasone, ofloxacin otic

ciprofloxacin-dexamethasone, ofloxacin otic

erythromycin solution

adapalene, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275), clindamycin solution, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin PA, **, EPIDUO, ONEXTON

clobetasol foam QL

clobetasol foam QL

hydrocortisone butyrate cream QL, hydrocortisone butyrate ointment QL, hydrocortisone butyrate solution QL, mometasone QL, triamcinolone cream QL, triamcinolone lotion QL, triamcinolone ointment (except triamcinolone ointment 0.05%) QL

balsalazide, mesalamine delayed-rel (except mesalamine delayed-rel tablet 800 mg), mesalamine ext-rel, sulfasalazine, sulfasalazine delayed-rel, PENTASA

colchicine tablet

colchicine tablet

amlodipine WITH celecoxib


ACCU-CHEK AVIVA PLUS STRIPS AND KITS 3

OTC, ACCU-CHEK COMPACT PLUS STRIPS AND KITS 3 OTC, ACCU-CHEK GUIDE STRIPS AND KITS 3 OTC, ACCU-CHEK SMARTVIEW STRIPS AND KITS 3 OTC, ONETOUCH ULTRA

CORDRAN OINTMENT

COREG CR

CoreMino

COZAAR

CRESEMBA

CRESTOR

CUPRIMINE

cyclobenzaprine ext-rel capsule, cyclobenzaprine tablet 7.5 mg

CYMBALTA

CYTOMEL

DARAPRIM

DAYTRANA

DELZICOL

DESFERAL

desoximetasone ointment 0.05%

DETROL LA

dexchlorpheniramine

Dexifol

Diclofex DC (NDC^ 51021037201 only)

Diclosaicin

STRIPS AND KITS 3 OTC, ONETOUCH VERIO STRIPS AND KITS 3 OTC

hydrocortisone butyrate cream QL, hydrocortisone butyrate ointment QL,hydrocortisone butyrate solution QL, mometasone QL, triamcinolone cream QL, triamcinolone lotion QL, triamcinolone ointment (except triamcinolone ointment 0.05%) QL

atenolol, carvedilol, carvedilol phosphate ext-rel, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, pindolol, propranolol, propranolol ext-rel, BYSTOLIC

doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline

candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan

itraconazole PA

atorvastatin, ezetimibe-simvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin

penicillamine capsule ST


desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule

levothyroxine, liothyronine, SYNTHROID

pyrimethamine PA

amphetamine-dextroamphetamine mixed salts ext-rel QL, dexmethylphenidate ext-rel QL, methylphenidate ext-rel QL, MYDAYIS QL, VYVANSE QL

balsalazide, mesalamine delayed-rel (except mesalamine delayed-rel tablet 800 mg), mesalamine ext-rel, sulfasalazine, sulfasalazine delayed-rel, PENTASA

deferasirox SGM, deferiprone SGM, deferoxamine †

hydrocortisone butyrate cream QL, hydrocortisone butyrate ointment QL, hydrocortisone butyrate solution QL, mometasone QL, triamcinolone cream QL, triamcinolone lotion QL, triamcinolone ointment (except triamcinolone ointment 0.05%) QL

darifenacin ext-rel, oxybutynin ext-rel, solifenacin, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, MYRBETRIQ ST, TOVIAZ ST

levocetirizine

folic acid

diclofenac sodium, diclofenac sodium gel 1% PA, diclofenac sodium solution, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

diclofenac sodium, diclofenac sodium gel 1% PA, diclofenac sodium solution, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)




DIFFERIN LOTION adapalene PA, benzoyl peroxide, clindamycin gel EFFEXOR XR desvenlafaxine ext-rel, duloxetine, venlafaxine, (except NDC^ 68682046275) QL, venlafaxine ext-rel capsule clindamycin solution QL, clindamycin-benzoyl peroxide, erythromycin solution, ELELYSO CERDELGA SGM, CEREZYME

†

erythromycin-benzoyl peroxide, tretinoin PA, **, EPIDUO, ONEXTON

ELIDEL pimecrolimus PA, tacrolimus PA, EUCRISA ST

diflorasone cream, diflorasone desoximetasone (except desoximetasone ELMIRON Consult doctor

ointment

dihydroergotamine spray

ointment 0.05%) QL, fluocinonide (except fluocinonide cream 0.1%) QL, BRYHALI PA

eletriptan QL, naratriptan QL, rizatriptan QL, sumatriptan QL, zolmitriptan QL, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST,

ENABLEX

ENLITE CONTINUOUS GLUCOSE

darifenacin ext-rel, oxybutynin ext-rel, solifenacin, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, MYRBETRIQ ST, TOVIAZ ST

DEXCOM CONTINUOUS GLUCOSE

UBRELVY ST, ZEMBRACE SYMTOUCH ST, MONITORING MONITORING SYSTEM PA

ZOMIG NASAL SPRAY QL ENTERAGAM alosetron, VIBERZI, XIFAXAN 550 MG PA

diltiazem ext-rel (generics for CARDIZEM LA only)

diltiazem ext-rel (except generics for CARDIZEM LA) ENTYVIO HUMIRA SGM,

STELARA SUBCUTANEOUS SGM,

DIOVAN, DIOVAN HCT candesartan, candesartan-hydrochlorothiazide, XELJANZ SGM

irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan- EPICERAM desonide QL, hydrocortisone QL

Diphen Elixir

hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide

levocetirizine

EPOGEN

ergotamine-caffeine

ARANESP SGM, RETACRIT SGM

eletriptan QL, naratriptan QL, rizatriptan QL, sumatriptan QL, zolmitriptan QL, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST, UBRELVY ST, ZEMBRACE SYMTOUCH ST, ZOMIG NASAL SPRAY QL

DORAL

DORYX, DORYX MPC

doxepin, eszopiclone, ramelteon, zolpidem, zolpidem ext-rel, BELSOMRA ST


ERYPED

estradiol vaginal tablet

ESTRING

erythromycins

estradiol vaginal cream, IMVEXXY


doxepin cream

doxycycline hyclate delayed-rel tablet 50 mg, 200 mg

doxycycline hyclate tablet 50 mg (NDC^ 72143021160 only), doxycycline hyclate tablet 75

desonide QL, pimecrolimus PA, hydrocortisone QL, tacrolimus PA, EUCRISA ST



EVEKEO

EVERSENSE CONTINUOUS GLUCOSE MONITORING SYSTEM

EXFORGE

amphetamine-dextroamphetamine mixed salts QL, methylphenidate QL


amlodipine-olmesartan, amlodipine-telmisartan, amlodipine-valsartan

mg, doxycycline hyclate tablet 150 mg

EXFORGE HCT amlodipine-valsartan-hydrochlorothiazide, olmesartan-amlodipine-hydrochlorothiazide

doxycycline monohydrate capsule 75 mg, doxycycline monohydrate capsul e 150 mg


EXJADE deferasirox SGM, deferiprone SGM, deferoxamine †

doxycycline monohydrate delayed-rel capsule

ORACEA PA EXTAVIA dimethyl fumarate delayed-rel SGM,

glatiramer SGM, AUBAGIO SGM, BETASERON SGM, COPAXONE SGM,

DULERA

DUTOPROL

DYRENIUM

ADVAIR DISKUS QL, ADVAIR HFA ‡ QL, BREO ELLIPTA ‡ QL, SYMBICORT QL

metoprolol succinate ext-rel WITH hydrochlorothiazide

amiloride, triamterene

FABIOR

GILENYA SGM, KESIMPTA SGM, MAYZENT SGM, OCREVUS † , REBIF SGM, TYSABRI † , ZEPOSIA SGM

adapalene PA, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275) QL, clindamycin solution QL, clindamycin-

EDARBI, EDARBYCLOR candesartan, candesartan-hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-

benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin PA, **, EPIDUO, ONEXTON

EDLUAR

E.E.S. GRANULES

hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide

doxepin, eszopiclone, ramelteon, zolpidem, zolpidem ext-rel, BELSOMRA ST

erythromycins

FANAPT

FEMRING

fenofibrate capsule 50 mg, 130 mg; fenofibrate tablet 40 mg, 120 mg

aripiprazole, clozapine, olanzapine, quetiapine, quetiapine ext-rel, risperidone, ziprasidone, LATUDA, VRAYLAR ST


fenofibrate (except fenofibrate capsule 50 mg, 130 mg; fenofibrate tablet 40 mg, 120 mg), fenofibric acid delayed-rel




FENOGLIDE TABLET 120 MG fenofibrate (except fenofibrate capsule 50 mg, FOSRENOL calcium acetate, sevelamer 130 mg; fenofibrate tablet 40 mg, 120 mg), carbonate, PHOSLYRA, VELPHORO ST fenofibric acid delayed-rel

FOSTEUM, FOSTEUM PLUS alendronate, ibandronate, risedronate fenoprofen, FENOPROFEN CAPSULE

diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

FREESTYLE LIBRE CONTINUOUS GLUCOSE


FERIVA 21/7 folic acid FREESTYLE STRIPS AND KITS 6 ACCU-CHEK AVIVA PLUS STRIPS AND

KITS 3 OTC, ACCU-CHEK COMPACT PLUS FERRIPROX deferasirox SGM, deferiprone SGM, STRIPS AND KITS 3 OTC, ACCU-CHEK GUIDE

deferoxamine † STRIPS AND KITS 3 OTC, ACCU-CHEK

FETZIMA desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule

SMARTVIEW STRIPS AND KITS 3 OTC, ONETOUCH ULTRA STRIPS AND KITS 3 OTC, ONETOUCH VERIO STRIPS AND KITS 3 OTC

Fexmid cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg)

FROVA eletriptan QL, ergotamine-caffeine, naratriptan QL, rizatriptan QL, sumatriptan QL,

FINACEA GEL azelaic acid gel PA, metronidazole, FINACEA FOAM PA, SOOLANTRA PA

zolmitriptan QL, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST, UBRELVY ST, ZEMBRACE SYMTOUCH ST,

FIORICET CAPSULE diclofenac sodium, ibuprofen, naproxen (except ZOMIG NASAL SPRAY QL naproxen CR or naproxen suspension)

FULPHILA ZIEXTENZO SGM FLAREX dexamethasone, loteprednol,

prednisolone acetate 1%, DUREZOL Genicin Vita-S folic acid

flucytosine capsule 500 mg fluconazole GLASSIA PROLASTIN-C †

GLEEVEC imatinib mesylate SGM, BOSULIF SGM,

fluocinonide cream 0.1% clobetasol cream QL SPRYCEL SGM

fluorouracil cream 0.5% fluorouracil cream 5%, fluorouracil solution, GLUMETZA metformin, metformin ext-rel (except generics

imiquimod, PICATO, TOLAK, ZYCLARA for FORTAMET and GLUMETZA)

fluoxetine tablet (generics for SARAFEM only)

fluoxetine (except fluoxetine tablet 60 mg, fluoxetine tablet [generics for SARAFEM]),

GLYCOPYRROLATE TABLET 1.5 MG

dicyclomine

paroxetine HCl ext-rel, sertraline GOLYTELY peg 3350-electrolytes, CLENPIQ

fluoxetine tablet 60 mg citalopram, escitalopram, fluoxetine (except GRANIX NIVESTYM SGM fluoxetine tablet 60 mg, fluoxetine tablet [generics for SARAFEM]), paroxetine HCl, GUARDIAN CONNECT DEXCOM CONTINUOUS GLUCOSE paroxetine HCl ext-rel, sertraline, TRINTELLIX CONTINUOUS GLUCOSE MONITORING SYSTEM PA ST MONITORING SYSTEM

flurandrenolide cream, desonide QL, hydrocortisone QL GUARDIAN REAL-TIME DEXCOM CONTINUOUS GLUCOSE flurandrenolide lotion CONTINUOUS GLUCOSE MONITORING SYSTEM PA

MONITORING SYSTEM flurandrenolide ointment hydrocortisone butyrate cream QL,

hydrocortisone butyrate ointment QL, halcinonide cream desoximetasone (except desoximetasone hydrocortisone butyrate solution QL, ointment 0.05%) QL, fluocinonide (except mometasone QL, triamcinolone cream QL, fluocinonide cream 0.1%) QL, BRYHALI PA triamcinolone lotion QL, triamcinolone ointment (except triamcinolone ointment 0.05%) QL HORIZANT gabapentin, GRALISE ST

FML FORTE, FML LIQUIFILM, dexamethasone, loteprednol, prednisolone acetat HUMALOG FIASP, NOVOLOG

FML S.O.P. e 1%, DUREZOL HUMALOG MIX 50/50 NOVOLOG MIX 70/30

FOCALIN XR amphetamine-dextroamphetamine mixed salts ext-rel QL, dexmethylphenidate ext-rel QL,

HUMALOG MIX 75/25 NOVOLOG MIX 70/30

methylphenidate ext-rel QL, MYDAYIS QL, HUMATROPE GENOTROPIN SGM, NORDITROPIN SGM

VYVANSE QL HUMULIN 70/30 NOVOLIN 70/30 OTC

FOLIC-K folic acid HUMULIN N NOVOLIN N OTC

FOLLISTIM AQ GONAL-F PA HUMULIN R NOVOLIN R OTC

Folvite-D folic acid hydrocortisone butyrate lipophilic hydrocortisone butyrate cream QL,

FORTAMET metformin, metformin ext-rel (except generics cream 0.1% hydrocortisone butyrate ointment QL,

for FORTAMET and GLUMETZA) hydrocortisone butyrate solution QL, mometasone QL, triamcinolone

FORTESTA testosterone gel (except authorized generics for cream QL, triamcinolone lotion QL, triamcinolone TESTIM and VOGELXO) PA, testosterone solution PA, ANDRODERM PA, NATESTO PA

ointment (except triamcinolone ointment 0.05%) QL

FOSAMAX PLUS D alendronate, ibandronate, risedronate hydrocortisone butyrate lotion hydrocortisone butyrate cream QL, hydrocortisone butyrate ointment QL,




hydrocortisone butyrate solution QL, KAMDOY desonide QL, hydrocortisone QL mometasone QL, triamcinolone cream QL, triamcinolone lotion QL, triamcinolone KAZANO JANUMET, JANUMET XR

ointment (except triamcinolone ointment 0.05%) QL

ketoconazole foam 2% ketoconazole shampoo 2%, selenium sulfide lotion 2.5%

HylaVite folic acid Ketodan ketoconazole shampoo 2%, selenium sulfide

hyoscyamine sulfate ext-rel dicyclomine lotion 2.5%

HYSINGLA ER fentanyl transdermal QL, hydrocodone ext-rel QL, hydromorphone ext-rel QL, methadone QL, morphine ext-rel QL,

ketoprofen capsule 25 mg diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

NUCYNTA ER QL, XTAMPZA ER QL ketoprofen ext-rel capsule diclofenac sodium, ibuprofen, meloxicam,

HYZAAR candesartan-hydrochlorothiazide, irbesartan-hydrochlorothiazide, losartan-

naproxen (except naproxen CR or naproxen suspension)

hydrochlorothiazide, olmesartan- KINERET ENBREL SGM, HUMIRA SGM, RINVOQ SGM, hydrochlorothiazide, telmisartan- XELJANZ SGM, XELJANZ XR SGM hydrochlorothiazide, valsartan-hydrochlorothiazide KOMBIGLYZE XR JANUMET, JANUMET XR

INCRUSE ELLIPTA SPIRIVA QL, YUPELRI QL KUVAN sapropterin SGM

INDERAL LA, INDERAL XL atenolol, carvedilol, carvedilol phosphate ext-rel, metoprolol succinate ext-rel, metoprolol tartrate, KYPROLIS NINLARO SGM, VELCADE †

nadolol, pindolol, propranolol, propranolol ext-rel, BYSTOLIC LACRISERT RESTASIS, XIIDRA

INDOCIN diclofenac sodium, ibuprofen, meloxicam, Lactojen Consult doctor

naproxen (except naproxen CR or naproxen suspension) LACTULOSE PAK lactulose solution

indomethacin capsule 20 mg diclofenac sodium, ibuprofen, meloxicam, LANOXIN TABLET (125 MCG and digoxin naproxen (except naproxen CR or naproxen 250 MCG only) suspension)

lanthanum carbonate calcium acetate, sevelamer carbonate, Inflammacin diclofenac sodium, diclofenac sodium gel 1% PA, PHOSLYRA, VELPHORO ST

diclofenac sodium solution, ibuprofen, meloxicam, naproxen (except naproxen CR or LANTUS 8 BASAGLAR, LEVEMIR

naproxen suspension) LASTACAFT azelastine, cromolyn sodium, olopatadine

INNOPRAN XL atenolol, carvedilol, carvedilol phosphate ext-rel, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, pindolol, propranolol, propranolol ext-rel,

LAZANDA fentanyl transmucosal lozenge PA, SUBSYS PA

BYSTOLIC LESCOL XL atorvastatin, ezetimibe-simvastatin, fluvastatin,

INTRAROSA estradiol vaginal cream, IMVEXXY lovastatin, pravastatin, rosuvastatin, simvastatin

INTUNIV amphetamine-dextroamphetamine mixed salts ext-rel QL, atomoxetine QL, dexmethylphenidate

LETAIRIS ambrisentan SGM, bosentan SGM, OPSUMIT SGM

ext-rel QL, guanfacine ext-rel QL, levorphanol fentanyl transdermal QL, hydrocodone ext-rel methylphenidate ext-rel QL, MYDAYIS QL, QL, hydromorphone ext-rel QL, methadone QL, VYVANSE QL morphine ext-rel QL,

INVELTYS dexamethasone, loteprednol, NUCYNTA ER QL, XTAMPZA ER QL

prednisolone acetate 1%, DUREZOL LEXAPRO citalopram, escitalopram, fluoxetine (except

INVIRASE atazanavir QL, EVOTAZ QL, PREZCOBIX QL, PREZISTA QL

fluoxetine tablet 60 mg, fluoxetine tablet [generics for SARAFEM]), paroxetine HCl, paroxetine HCl ext-rel, sertraline,

INVOKAMET, INVOKAMET XR SYNJARDY, SYNJARDY XR, XIGDUO XR TRINTELLIX ST

INVOKANA FARXIGA, JARDIANCE LEXIVA atazanavir QL, EVOTAZ QL, PREZCOBIX QL, PREZISTA QL

isosorbide dinitrate 40 mg isosorbide dinitrate (except isosorbide dinitrate 40 mg), isosorbide mononitrate LIALDA balsalazide, mesalamine delayed-rel (except

mesalamine delayed-rel tablet 800 ISTALOL timolol maleate solution, BETOPTIC S mg), mesalamine ext-rel, sulfasalazine,

JADENU deferasirox SGM, deferiprone SGM, sulfasalazine delayed-rel, PENTASA

deferoxamine † LIBRAX dicyclomine

JALYN dutasteride-tamsulosin; dutasteride or finasteride WITH alfuzosin ext-rel, doxazosin, silodosin, LIDOCAINE-TETRACAINE CREAM lidocaine-prilocaine tamsulosin or terazosin (NDC^ 71800063115 only)

JENTADUETO, JENTADUETO XR JANUMET, JANUMET XR LIDOTREX lidocaine-prilocaine




LIPITOR atorvastatin, ezetimibe-simvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin

LITHOSTAT Consult doctor

LIVALO atorvastatin, ezetimibe-simvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin

LOTEMAX, LOTEMAX SM dexamethasone, loteprednol, prednisolone acetate 1%, DUREZOL

Lorid folic acid

Lorzone cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg)

luliconazole ciclopirox PA, clotrimazole, econazole QL, ketoconazole cream 2% QL, NAFTIN

LUNESTA doxepin, eszopiclone, ramelteon, zolpidem, zolpidem ext-rel, BELSOMRA ST

LUPRON DEPOT ELIGARD SGM, FIRMAGON † , ORIAHNN PA, ORILISSA PA

LUPRON DEPOT-PED SUPPRELIN LA † , TRIPTODUR †

LYRICA duloxetine, pregabalin ST, QL

MACRODANTIN nitrofurantoin (except NDC^ 70408023932)

Matzim LA diltiazem ext-rel (except generics for CARDIZEM LA)

MAXIDEX dexamethasone, loteprednol, prednisolone acetate 1%, DUREZOL

MAVYRET EPCLUSA (genotypes 1, 2, 3, 4, 5, 6) SGM, HARVONI (genotypes 1, 4, 5, 6) SGM, VOSEVI 2 SGM

MAXALT, MAXALT-MLT eletriptan QL, naratriptan QL, rizatriptan QL, sumatriptan QL, zolmitriptan QL, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST, UBRELVY ST, ZEMBRACE SYMTOUCH ST, ZOMIG NASAL SPRAY QL

mefenamic acid (NDC^ 69336012830 diclofenac sodium, ibuprofen, meloxicam, only) naproxen (except naproxen CR or naproxen

suspension)

MENEST estradiol

MENOSTAR estradiol

mesalamine delayed-rel tablet 800 balsalazide, mesalamine delayed-rel (except mg mesalamine delayed-rel tablet 800 mg),

mesalamine ext-rel, sulfasalazine, sulfasalazine delayed-rel, PENTASA

metaxalone 400 mg cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg)

metformin ext-rel metformin, metformin ext-rel (except generics (generics for FORTAMET and for FORTAMET and GLUMETZA) GLUMETZA only)

methocarbamol 500 mg (NDC^ cyclobenzaprine (except cyclobenzaprine tablet 69036091010 only), 7.5 mg) methocarbamol 750 mg (NDCs^ 69036093090, 70868090190 only)

MIACALCIN INJECTION alendronate, calcitonin-salmon, ibandronate, risedronate, FORTEO SGM, PROLIA † , TYMLOS SGM

MIACALCIN NASAL SPRAY calcitonin-salmon

MICARDIS, MICARDIS HCT candesartan, candesartan-hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan-hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide, telmisartan, telmisartan-hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide

Migergot eletriptan QL, naratriptan QL, rizatriptan QL, sumatriptan QL, zolmitriptan QL, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST, UBRELVY ST, ZEMBRACE SYMTOUCH ST, ZOMIG NASAL SPRAY QL

MINIVELLE estradiol, DIVIGEL, EVAMIST

MILLIPRED dexamethasone, hydrocortisone tablet, methylprednisolone, prednisolone solution, prednisone

MINASTRIN 24 FE ethinyl estradiol-drospirenone, ethinyl estradiol-drospirenone-levomefolate, ethinyl estradiol-norethindrone acetate, ethinyl estradiol-norethindrone acetate-iron

MINOCIN doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline

minocycline ext-rel doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline

MIRVASO azelaic acid gel PA, metronidazole, FINACEA FOAM PA, SOOLANTRA PA

Mondoxyne NL capsule 75 mg doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline

MOVIPREP peg 3350-electrolytes, CLENPIQ

MultiPro Consult doctor

mupirocin cream gentamicin QL, mupirocin ointment

MYTESI diphenoxylate-atropine, loperamide

NAPRELAN diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

naproxen-esomeprazole diclofenac sodium, ibuprofen, meloxicam or naproxen (except naproxen CR or naproxen suspension) WITH esomeprazole delayed-rel, lansoprazole delayed-rel, omeprazole delayed-rel, pantoprazole delayed-rel tablet or DEXILANT ST

naproxen CR diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

naproxen suspension diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

NATAZIA ethinyl estradiol-drospirenone, ethinyl estradiol-drospirenone-levomefolate, ethinyl estradiol-levonorgestrel, ethinyl estradiol-norethindrone acetate, ethinyl estradiol-norethindrone acetate-iron, ethinyl estradiol-norgestimate

NATURE-THROID levothyroxine, liothyronine, SYNTHROID

NEO-SYNALAR desonide QL or hydrocortisone WITH gentamicin QL

NESINA JANUVIA




NEULASTA, NEULASTA ONPRO ZIEXTENZO SGM ONFI clobazam, lamotrigine, rufinamide, topiramate

NEUPOGEN NIVESTYM SGM ONGLYZA JANUVIA

NEVANAC bromfenac, diclofenac, ketorolac QL, ILEVRO, ORENCIA CLICKJECT, COSENTYX SGM, ENBREL SGM, PROLENSA ORENCIA SUBCUTANEOUS HUMIRA SGM, OTEZLA SGM, RINVOQ SGM,

NEXIUM esomeprazole delayed-rel, lansoprazole delayed-rel, omeprazole delayed-rel, pantoprazole

STELARA SUBCUTANEOUS SGM, XELJANZ SGM, XELJANZ XR SGM

delayed-rel tablet, DEXILANT ST orphenadrine-aspirin-caffeine cyclobenzaprine (except cyclobenzaprine tablet

niacin tablet 500 mg niacin ext-rel 7.5 mg)

Niacor niacin ext-rel Orphengesic Forte cyclobenzaprine (except cyclobenzaprine tablet

7.5 mg)

NICADAN folic acid ORTHO D folic acid

NICAPRIN folic acid ORTHO DF folic acid

NICAZEL, NICAZEL FORTE folic acid Oscimin SR dicyclomine

NICOMIDE folic acid OSENI JANUMET, JANUMET XR; JANUVIA WITH

NILANDRON abiraterone SGM, pioglitazone

bicalutamide, XTANDI SGM, YONSA SGM, OSMOPREP peg 3350-electrolytes, CLENPIQ

nitrofurantoin (NDC^ 70408023932 nitrofurantoin (except NDC^ 70408023932) OSPHENA estradiol only)

OWEN MUMFORD NEEDLES 5 BD ULTRAFINE NEEDLES OTC NITROMIST nitroglycerin lingual spray,

nitroglycerin sublingual oxiconazole (NDCs^ 00168035830, ciclopirox PA, clotrimazole, econazole QL,

Nolix desonide QL, hydrocortisone QL 51672135902 only) ketoconazole cream 2% QL, NAFTIN

OXYCONTIN fentanyl transdermal QL, hydrocodone ext-rel

NORGESIC FORTE cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg)

QL, hydromorphone ext-rel QL, methadone QL, morphine ext-rel QL, NUCYNTA ER QL, XTAMPZA ER QL

NORITATE azelaic acid gel PA, metronidazole, FINACEA FOAM PA, SOOLANTRA PA

oxymorphone ext-rel fentanyl transdermal QL, hydrocodone ext-rel QL, hydromorphone ext-rel QL, methadone QL,

NORPACE disopyramide morphine ext-rel QL, NUCYNTA ER QL, XTAMPZA ER QL

NORVASC amlodipine OXYTROL darifenacin ext-rel, oxybutynin ext-rel, solifenacin, tolterodine, tolterodine ext-rel, trospium,

NOURIANZ amantadine, entacapone, pramipexole, trospium ext-rel, MYRBETRIQ ST, TOVIAZ ST pramipexole ext-rel, rasagiline, ropinirole, ropinirole ext-rel, selegiline, NEUPRO PANCREAZE CREON, VIOKACE, ZENPEP

NOVACORT desonide QL, hydrocortisone QL pantoprazole delayed-rel suspension esomeprazole delayed-rel, lansoprazole delayed-rel, omeprazole delayed-rel,

NOVO NORDISK NEEDLES 5 BD ULTRAFINE NEEDLES OTC pantoprazole delayed-rel tablet, DEXILANT ST

NOXAFIL fluconazole, itraconazole PA paroxetine mesylate capsule 7.5 mg paroxetine HCl

PAXIL, PAXIL CR citalopram, escitalopram, fluoxetine (except NuDiclo SoluPak, NuDiclo TabPak diclofenac sodium, diclofenac sodium gel 1% PA, fluoxetine tablet 60 mg, fluoxetine tablet

diclofenac sodium solution, ibuprofen, [generics for SARAFEM]), paroxetine HCl, meloxicam, naproxen (except naproxen CR or paroxetine HCl ext-rel, sertraline, TRINTELLIX naproxen suspension) ST

NUTROPIN AQ GENOTROPIN SGM, NORDITROPIN SGM PENNSAID diclofenac sodium, diclofenac sodium gel 1% PA,

NUVARING ethinyl estradiol-etonogestrel, ANNOVERA diclofenac sodium solution, ibuprofen, meloxicam , naproxen (except naproxen CR or naproxen

NUVIGIL armodafinil PA, modafinil PA, SUNOSI PA suspension)

OLEPTRO trazodone PERCOCET hydrocodone-acetaminophen QL, hydromorphone QL, morphine QL, oxycodone-

OLUX-E clobetasol foam QL acetaminophen QL, NUCYNTA QL

omeprazole-sodium bicarbonate esomeprazole delayed-rel, lansoprazole delayed- PERRIGO NEEDLES 5 BD ULTRAFINE NEEDLES OTC rel, omeprazole delayed-rel, pantoprazole delayed-rel tablet, DEXILANT ST PERTZYE CREON, VIOKACE, ZENPEP

OMNARIS flunisolide QL, fluticasone QL, PEXEVA citalopram, escitalopram, fluoxetine (except

mometasone nasal spray QL, DYMISTA ST, QL fluoxetine tablet 60 mg, fluoxetine tablet [generics for SARAFEM]), paroxetine HCl,

OMNITROPE GENOTROPIN SGM, NORDITROPIN SGM paroxetine HCl ext-rel, sertraline, TRINTELLIX ST

OMNIVEX folic acid




PLAVIX clopidogrel, prasugrel, BRILINTA QNASL flunisolide QL, fluticasone QL,

PLEGRIDY dimethyl fumarate delayed-rel SGM, mometasone nasal spray QL, DYMISTA ST, QL

glatiramer SGM, AUBAGIO SGM, BETASERON QTERN GLYXAMBI SGM, COPAXONE SGM, GILENYA SGM, KESIMPTA SGM, MAYZENT SGM, OCREVUS † , REBIF SGM, TYSABRI † , ZEPOSIA SGM

quazepam doxepin, eszopiclone, ramelteon, zolpidem, zolpidem ext-rel, BELSOMRA ST

POLYTOZA Consult doctor RAPAFLO alfuzosin ext-rel, doxazosin, silodosin, tamsulosin, terazosin

posaconazole delayed-rel tablet fluconazole, itraconazole PA RAYOS dexamethasone,

PRADAXA warfarin, ELIQUIS, XARELTO hydrocortisone tablet, methylprednisolone, predni

PRECISION XTRA STRIPS AND ACCU-CHEK AVIVA PLUS STRIPS AND solone solution, prednisone

KITS 6 KITS 3 OTC, ACCU-CHEK COMPACT PLUS RECEDO Consult doctor STRIPS AND KITS 3 OTC, ACCU-CHEK GUIDE STRIPS AND KITS 3 OTC, ACCU-CHEK RELION INSULIN NOVOLIN INSULIN OTC

SMARTVIEW STRIPS AND KITS 3 OTC, ONETOUCH ULTRA STRIPS AND KITS 3 OTC,

REMODULIN treprostinil SGM

ONETOUCH VERIO STRIPS AND KITS 3 OTC REPATHA PRALUENT PA

PRED FORTE, PRED MILD dexamethasone, loteprednol, prednisolone acetat RHEUMATE folic acid

e 1%, DUREZOL RIABNI RUXIENCE †

PREFEST estradiol-norethindrone, PREMPHASE, PREMPRO

RIBOZEL folic acid

PREMARIN estradiol RIMSO-50 Consult doctor

PREMARIN CREAM estradiol vaginal cream, IMVEXXY RIOMET metformin, metformin ext-rel (except generics

PRENATAL PLUS 7 prenatal vitamins, CITRANATAL for FORTAMET and GLUMETZA)

PREVACID esomeprazole delayed-rel, lansoprazole RITUXAN RUXIENCE †

delayed-rel, omeprazole delayed-rel, pantoprazole delayed-rel tablet, DEXILANT ST

ROZEREM doxepin, eszopiclone, ramelteon, zolpidem,

PREVIDENT Consult doctor zolpidem ext-rel, BELSOMRA ST

PRILOSEC esomeprazole delayed-rel, lansoprazole RyClora levocetirizine

delayed-rel, omeprazole delayed-rel, pantoprazole delayed-rel tablet, DEXILANT ST RYTARI carbidopa-levodopa, carbidopa-levodopa ext-rel

PRISTIQ desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule SABRIL vigabatrin SGM

PROAIR HFA, PROAIR RESPICLICK albuterol sulfate CFC-free aerosol QL, SAIZEN GENOTROPIN SGM, NORDITROPIN SGM

levalbuterol tartrate CFC-free aerosol QL SANDOSTATIN LAR SOMATULINE DEPOT SGM

PROCRIT ARANESP SGM, RETACRIT SGM SCARSILK PAD Consult doctor

PRODIGEN Consult doctor SEASONIQUE ethinyl estradiol-drospirenone, ethinyl estradiol-

PROMETRIUM medroxyprogesterone; progesterone, micronized drospirenone-levomefolate, ethinyl estradiol-levonorgestrel, ethinyl estradiol-norethindrone acetate, ethinyl estradiol-

PROTONIX esomeprazole delayed-rel, lansoprazole norethindrone acetate-iron

delayed-rel, omeprazole delayed-rel, pantoprazole delayed-rel tablet, DEXILANT ST SEROQUEL XR aripiprazole, clozapine, olanzapine,

quetiapine, quetiapine ext-rel, risperidone,

PROTOPIC pimecrolimus PA, tacrolimus PA, EUCRISA ST ziprasidone, LATUDA, VRAYLAR ST

PROVAD Consult doctor SIGNIFOR LAR SOMATULINE DEPOT SGM

PROVENTIL HFA albuterol sulfate CFC-free aerosol QL, SILENOR doxepin, eszopiclone, ramelteon, zolpidem,

levalbuterol tartrate CFC-free aerosol QL zolpidem ext-rel, BELSOMRA ST

PROVIGIL armodafinil PA, modafinil PA, SUNOSI PA SIL-K PAD Consult doctor

SILIVEX Consult doctor

PROZAC citalopram, escitalopram, fluoxetine (except fluoxetine tablet 60 mg, fluoxetine tablet SILTREX Consult doctor

[generics for SARAFEM]), paroxetine HCl, SIMPONI COSENTYX SGM, ENBREL SGM, paroxetine HCl ext-rel, sertraline, HUMIRA SGM, OTEZLA SGM, RINVOQ SGM, TRINTELLIX ST STELARA SUBCUTANEOUS SGM,

PSORCON desoximetasone (except desoximetasone XELJANZ SGM, XELJANZ XR SGM

ointment 0.05%) QL, fluocinonide (except SINGULAIR montelukast, zafirlukast fluocinonide cream 0.1%) QL, BRYHALI PA

SOMAVERT SOMATULINE DEPOT SGM




SORILUX

SPRIX

SUBOXONE

sucralfate suspension

sumatriptan-naproxen

SUPREP

SURE-TEST STRIPS AND KITS 6

Symax-SR

SYNERDERM

SYPRINE

TALIVA

TALTZ

TARGADOX

TASIGNA

TAYTULLA

TAZORAC

TECFIDERA

TESTIM

testosterone gel 1% (authorized generics for TESTIM and VOGELXO only)

calcipotriene ointment QL, calcipotriene solution QL

diclofenac sodium, ibuprofen, meloxicam, naproxen (except naproxen CR or naproxen suspension)

buprenorphine-naloxone sublingual QL, ZUBSOLV QL

sucralfate tablet

diclofenac sodium, ibuprofen or naproxen (except naproxen CR or naproxen suspension) WITH eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, NURTEC ODT ST, ONZETRA XSAIL ST, REYVOW ST, UBRELVY ST, ZEMBRACE SYMTOUCH ST, ZOMIG NASAL SPRAY QL

peg 3350-electrolytes, CLENPIQ


dicyclomine

desonide QL, hydrocortisone QL

trientine ST

folic acid

COSENTYX SGM, ENBREL SGM, HUMIRA SGM, OTEZLA SGM, SKYRIZI SGM, STELARA SUBCUTANEOUS SGM, TREMFYA SGM, XELJANZ SGM, XELJANZ XR SGM


imatinib mesylate SGM, BOSULIF SGM, SPRYCEL SGM

ethinyl estradiol-drospirenone, ethinyl estradiol-drospirenone-levomefolate, ethinyl estradiol-norethindrone acetate, ethinyl estradiol-norethindrone acetate-iron

adapalene PA, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275) QL, clindamycin solution QL, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin PA, **, EPIDUO, ONEXTON; calcipotriene ointment QL, calcipotriene solution QL

dimethyl fumarate delayed-rel SGM, glatiramer SGM, AUBAGIO SGM, BETASERON SGM, COPAXONE SGM, GILENYA SGM, KESIMPTA SGM, MAYZENT SGM, OCREVUS † , REBIF SGM, TYSABRI † , ZEPOSIA SGM



THEO-24

THIOLA, THIOLA EC

TIMOPTIC OCUDOSE

TIROSINT

TOBI, TOBI PODHALER

TOBRADEX ST

topiramate ext-rel capsule (generics for QUDEXY XR only)

TOPROL-XL

TRACLEER

TRADJENTA

tramadol (NDC^ 52817019610 only), tramadol ext-rel capsule

TRANSDERM SCOP

TRAVATAN Z

TRELSTAR MIXJECT

triamcinolone aerosol

mlndependentt.ma.aflhebluectmsandblueshialdaaxillicwl ......verapamil ext-rel suprax amlodipine...

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