2017 national formulary - guidantrx

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1 2017 National Formulary Effective 04/01/2017 The Formulary List is a guide providing common preferred brand medicines within select therapeutic categories. The Formulary List does not include all drugs covered by your prescription drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition to categories not listed, and should be considered as the first line of prescribing. For benefit coverage or restrictions please check your benefit plan document(s). This listing is revised periodically as new drugs and new prescribing information becomes available. It is recommended that you bring this list of medications when you or a covered family member sees a physician or other healthcare provider. Tier Definitions 1 Generics 2 Preferred Brands 3 Non-Preferred Brands 4 Excluded Drugs - 100% Patient Liability (ST) Step Therapy

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Page 1: 2017 National Formulary - GuidantRx

1

2017 National Formulary

Effective 04/01/2017 The Formulary List is a guide providing common preferred brand medicines within select therapeutic categories. The Formulary List does not include all drugs covered by your prescription drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition to categories not listed, and should be considered as the first line of prescribing. For benefit coverage or restrictions please check your benefit plan document(s). This listing is revised periodically as new drugs and new prescribing information becomes available. It is recommended that you bring this list of medications when you or a covered family member sees a physician or other healthcare provider. Tier Definitions 1 Generics 2 Preferred Brands 3 Non-Preferred Brands 4 Excluded Drugs - 100% Patient Liability (ST) Step Therapy

Page 2: 2017 National Formulary - GuidantRx

2

Non-Preferred and Excluded* Drugs with Preferred Alternatives The following is a list of non-preferred and excluded* brand-name medications with covered preferred alternatives that are on the formulary.

Column 1 lists the Drug Class.

Column 2 lists non-preferred and excluded* brand-name medications.

o Note: Drugs marked with * are excluded for 4 Tier benefit plans and are considered non-preferred for 3 Tier

benefit plans.

Column 3 lists covered preferred alternatives.

Additional covered alternatives may be available. Costs for covered alternatives may vary. Other prescription benefit

considerations may apply.

Drug Class Non-Preferred or Excluded* Preferred Alternatives

AUTONOMIC & CENTAL NERVOUS SYSTEM

Antidepressants

Pexeva*, Sarafem*, Viibryd*

Generic SSRIs, trazodone

Antipsychotics Fanapt, Invega Rexulti, Saphris aripiprazole, olanzapine,

quetiapine, Latuda, Seroquel XR

Narcotic Analgesics Abstral*, Fentora* Kadian ER,

oxycodone ER Zohydro ER

Fentanyl lozenge, fentanyl

transdermal patch, morphine

sulfate ER, Embeda, Hysingla ER,

Nucynta ER, Oxycontin

Narcotic Antagonists Suboxone, Vivitrol Buprenorphine-naloxone, Zubsolv

Sleep Agents Intermezzo, Zolpimist ezsopiclone, zaleplon,

zolpidem/ER, Belsomra, Rozerem

CARDIOVASCULAR

Angiotensin II Receptor Antagonists +

Diuretic Combinations

Benicar (HCT), Edarbi, Edarbyclor,

Teveten HCT

candesartanHCT, irbesartanHCT,

losartanHCT, valsartanHCT

Statins Livalo atorvastatin, rosuvastatin,

simvastatin, Vytorin

DERMATOLOGICAL

Oral Agents For Rosacea

Doxycycline 40 mg capsules

Oracea

Topical Agents for Acne/Rosacea Atralin, Avage, Azelex, BenzaClin

Gel Pump, Veltin*

Adapalene, clindamycin/benzoyl

peroxide, clindamycin PLUS

tretinoin, topical erythromycin,

topical metronidazole, tretinoin,

Acanya, Epiduo, Finacea, Tazorac

Topical Agents for Actinic Keratosis Aldara, flurouracil 0.5% cream*,

Zyclara*

Flurouracil, imiquimod 5% cream,

Picato

DIABETES

Blood Glucose Meters & Strips

Advocate*, Bayer* (Breeze,

Contour), Nipro* (TRUEtrack,

TRUEtest), Omnis Health*

Abbott (Freestyle),

LifeScan (OneTouch)

Page 3: 2017 National Formulary - GuidantRx

3

Drug Class Non-Preferred or Excluded* Preferred Alternatives

(Embrace, Victory), Prodigy*,

Roche* (Accu-Chek), UniStrip*

DPP-4 Inhibitors & Combos Alogliptin*, Kazano*,Kombiglyze*,

Nesina*, Onglyza*, Oseni*

Janumet (XR), Januvia, Tradjenta,

Jentadueto (XR)

Incretin Mimetics (GLP-1 Agonists) Byetta*, Bydureon*, Tanzeum* Trulicity, Victoza

Insulins Humulin*, Relion* Novolin

Apidra*, Afrezza*, Humalog* NovoLog

SGLT-2s Farxiga*, Xigduo XR* Ivokana, Invokamet, Jardiance,

S;ynjardy

Other Glumetza*, Riomet metformin

EAR/NOSE

Nasal Steroids

Nasonex, Beconase AQ*,

Omnaris*, Veramyst*, Zetonna*

flunisolide, fluticasone propionate,

triamcinolone acetonide, Dymista,

QNASL

Otic Fluoroquinolone Antibiotics Cetraxal* ciprofloxacin otic solution,

Ciprodex

ENDOCRINE (OTHER)

Growth Hormone

Genotropin*, Humatrope*,

Nutropin AQ*, Omnitrope*,

Saizen*, Zomacton*, Zorbtive*

Norditropin

Estrogen Products Divigel*, Enjuvia*, Estring* estradiol, Premarin

Topical Testosterone Products

Fortesta*, Natesto*, Striant*,

Testim*, Vogelxo*

AndroGel, Axiron

GASTROINTESTINAL

Anti-Inflammatory / Anti-Ulcer Agents

Duexis*, Vimovo* famotidine PLUS ibuprofen,

omeprazole PLUS naproxen

Inflammatory Bowel Agents Asacol HD*, Delzicol*, Dipentum,

Lialda*, Linzess*

Amitiza, Apriso, balsalazide

disodium, Pentasa

Pancreatic Enzymes Pancreaze, Pertzye, Ultresa Pancrelipase, Creon, Viokace,

Zenpep

Proton Pump Inhibitors Dexilant, Nexium DR, Zegerid Rx esomeprazole magnesium,

lansoprazole, omeparazole,

pantoprazole

HEMATOLOGICAL

Erythropoiesis-Stimulating Agents

Aranesp*, Epogen*, Mircera* Procrit

Anticoagulants Pradaxa* Clopidogrel, Eliquis, Xarelto

HEPATITIS

Antivirals

Rebetrol, RibaPak* ribavirin capsules, ribavirin tablets,

Moderiba

Page 4: 2017 National Formulary - GuidantRx

4

Drug Class Non-Preferred or Excluded* Preferred Alternatives

Hepatitis C (genotype 1, 4) Daklinza*, Epclusa*, Harvoni*,

Sovaldi*, Technivie*, Viekira*

Zepatier

INFLAMMATORY CONDITIONS

Tumor Necrosis Factor Antagonists and

Other Drugs for Inflammatory Conditions

Actemra, Cimzia, Cosentyx,

Orencia*, Otezla*, Remicade*,

SImponi*, Stelara, Talz*, Xeljanz*

Enbrel, Humira

OBSTETRICAL & GYNECOLOGICAL

Gonadotropin-Releasing Hormone

(GnRH) antagonists (for infertility)

Ganirelix*, Pregnyl Cetrotide, Novarel

Ovulatory Stimulants (for infertility) Bravelle*, Follistim AQ* Clomiphene, Gonal F, Menopur,

Repronex

Vaginal Progesterones Endometrin Crinone 8% Gel

OPHTHALMIC

Antiglaucoma Drugs

Azopt, Rescula, Simbrinza, Zioptan* Betaxolol, dorzolamide,

latanoprost, levobunol, timolol,

Alphagan P 0.1%, Combigan,

Cosopt PF, Travatan Z

Ophthalmic Non-Steroidal Anti-

Inflammatory Drugs (NSAIDS)

Acuvail* Bromfenac drops, diclofenac

drops, ketorolac drops, Ilevro,

Nevanac, Prolensa

OSTEOARTHRITIS

Hyaluronic Acid Derivatives

Euflexxa*, Gel-One*, Gel-Syn*,

Hyalgan*, Monovisc*, Orthovisc*,

Supartz*

Synvisc, Synvisc One

RESPIRATORY

Inhaled Beta Agonists

Arcapta Neohaler*, Foradil,

Perforomist*, Proventil HFA*,

Xopenex HFA*

Proair HFA/ RespiClick, Serevent

Diskus, Ventolin HFA

Inhaled Corticosteroids Alvesco*, Pulmicort Flexhaler*,

QVAR*, Symbicort*

Advair Diskus/HFA, Arnuity Ellipta,

Asmanex HFA Twisthaler, Breo

Ellipta, Dulera, Flovent Diskus/HFA

Other (COPD) Daliresp*, Tudorza Respimat* Anoro Ellipta, Incruse Ellipta,

Spiriva, Stiolto Respimat

UROLOGICAL

Erectile Dysfunction Oral Agents

Levitra*, Staxyn*, Stendra* Cialis, Viagra

Antispasmotics Enablex, Gelnique*, Toviaz* oxybutynin, tolterodine,

Myrbetriq, Vesicare

Page 5: 2017 National Formulary - GuidantRx

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2017 National Drug Formulary Effective 04/01/2017

Drug Name Tier Notes

1st choice lancets super thin 2

1st choice lancets thin 2

1st choice lancets ultra thin 2

1st tier unifine pentips 3

1st tier unilet comfortouch 2

abacavir sulfate oral tablet 1

abacavir-lamivudine-zidovudine oral tablet 1

ABILIFY ORAL TABLET 3

ABSORICA ORAL CAPSULE 2

ABSTRAL SUBLINGUAL TABLET SUBLINGUAL 3

ACANYA EXTERNAL GEL 2

acarbose oral tablet 1

ACCOLATE ORAL TABLET 3

ACCUCAINE COMBINATION KIT 3

ACCU-CHEK AVIVA CONNECT KIT 3

ACCU-CHEK AVIVA IN VITRO STRIP 3

ACCU-CHEK AVIVA PLUS IN VITRO STRIP 3

ACCU-CHEK AVIVA PLUS KIT 3

ACCU-CHEK COMPACT PLUS IN VITRO STRIP 3

ACCU-CHEK COMPACT TEST DRUM IN VITRO STRIP

3

ACCU-CHEK FASTCLIX LANCETS 3

ACCU-CHEK MULTICLIX LANCETS 3

ACCU-CHEK NANO SMARTVIEW KIT 3

ACCU-CHEK SAFE-T PRO LANCETS 3

ACCU-CHEK SMARTVIEW IN VITRO STRIP 3

ACCU-CHEK SOFT TOUCH LANCETS 2

ACCU-CHEK SOFTCLIX LANCETS 3

ACCU-CHEK VOICEMATE KIT 3

ACCURETIC ORAL TABLET 3

Page 6: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

ACCUTREND GLUCOSE IN VITRO STRIP 3

acebutolol hcl oral capsule 1

acetaminophen-codeine #3 oral tablet 1

acetaminophen-codeine oral solution 1

acetaminophen-codeine oral tablet 1

acetasol hc otic solution 1

acetazolamide oral tablet 1

acetic acid otic solution 1

ACIPHEX ORAL TABLET DELAYED RELEASE 3

acitretin oral capsule 1

ACTEMRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3

ST; Must try and fail: Humira OR Enbrel, AND Cimzia prior to coverage being considered.

ACTIGALL ORAL CAPSULE 3

acti-lance 28g 1

acti-lance lite lancets 28g 1

acti-lance special lancets 17g 1

acti-lance universal 23g 1

ACTIMMUNE SUBCUTANEOUS SOLUTION 2

ACTIQ BUCCAL LOZENGE ON A HANDLE 3

ACTIVE 1ST BLOOD LANCETS 30G 2

ACTIVELLA ORAL TABLET 3

ACTONEL ORAL TABLET 3

ACTOPLUS MET ORAL TABLET 3

ACTOS ORAL TABLET 3

ACULAR OPHTHALMIC SOLUTION 3

ACUVAIL OPHTHALMIC SOLUTION 3

acyclovir external ointment 1

acyclovir oral capsule 1

acyclovir oral suspension 1

acyclovir oral tablet 1

ACZONE EXTERNAL GEL 3

ADALAT CC ORAL TABLET EXTENDED RELEASE 24 HOUR

3

adapalene external gel 1

adapalene external lotion 3

ADCIRCA ORAL TABLET 2

Page 7: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

ADDERALL ORAL TABLET 3

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

ADDYI ORAL TABLET 3

ADEMPAS ORAL TABLET 2

ADLYXIN STARTER PACK SUBCUTANEOUS PEN- INJECTOR KIT

3

ADLYXIN SUBCUTANEOUS SOLUTION PEN- INJECTOR

3

ADOXA ORAL CAPSULE 3

ADRENACLICK INJECTION SOLUTION AUTO- INJECTOR

3

ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED

2

ADVAIR HFA INHALATION AEROSOL 2

ADVATE INTRAVENOUS SOLUTION RECONSTITUTED

2

ADVICOR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ADVOCATE BLOOD GLUCOSE SYSTEM KIT 3

ADVOCATE INSULIN PEN NEEDLES 2

ADVOCATE LANCETS 2

ADVOCATE LANCETS 30G 2

ADVOCATE REDI-CODE IN VITRO STRIP 3

ADVOCATE REDI-CODE KIT 3

ADVOCATE REDI-CODE+ TEST IN VITRO STRIP 3

ADVOCATE SAFETY LANCETS 2

ADVOCATE SAFETY LANCETS 26G 2

ADVOCATE TEST IN VITRO STRIP 3

adynovate intravenous solution reconstituted 3

ADZENYS XR-ODT ORAL TABLET EXTENDED RELEASE DISPERSIBLE

3

AEROCHAMBER MINI CHAMBER DEVICE 2

AEROCHAMBER MV 2

AEROCHAMBER PLUS FLO-VU 2

AEROCHAMBER PLUS FLO-VU LARGE 2

AEROCHAMBER PLUS FLO-VU MEDIUM 2

AEROCHAMBER PLUS FLO-VU SMALL 2

Page 8: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

AEROCHAMBER PLUS FLO-VU W/MASK 2

AEROCHAMBER PLUS FLOW VU 2

AEROCHAMBER W/FLOWSIGNAL 2

AEROCHAMBER Z-STAT PLUS 2

AEROCHAMBER Z-STAT PLUS CHAMBR 2

AEROCHAMBER Z-STAT PLUS/LARGE 2

AEROCHAMBER Z-STAT PLUS/MEDIUM 2

AEROCHAMBER Z-STAT PLUS/SMALL 2

AEROVENT PLUS DEVICE 2

afeditab cr oral tablet extended release 24 hour 1

AFINITOR DISPERZ ORAL TABLET SOLUBLE 2

AFINITOR ORAL TABLET 2

AGAMATRIX AMP TEST IN VITRO STRIP 3

AGAMATRIX JAZZ TEST IN VITRO STRIP 3

AGAMATRIX JAZZ WIRELESS 2 KIT 3

AGAMATRIX PRESTO KIT 3

AGAMATRIX PRESTO TEST IN VITRO STRIP 3

AGAMATRIX ULTRA-THIN LANCETS 2

AGGRENOX ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

ak-poly-bac ophthalmic ointment 1

ala-cort external cream 1

ALBENZA ORAL TABLET 2

albuterol sulfate inhalation nebulization solution 1

albuterol sulfate oral syrup 1

albuterol sulfate oral tablet 1

ALCAINE OPHTHALMIC SOLUTION 3

alclometasone dipropionate external cream 1

alclometasone dipropionate external ointment 1

ALCORTIN A EXTERNAL GEL 3

ALDACTAZIDE ORAL TABLET 3

ALDACTONE ORAL TABLET 3

ALDARA EXTERNAL CREAM 3

ALECENSA ORAL CAPSULE 3

alendronate sodium oral solution 1

alendronate sodium oral tablet 1

ALFERON N INJECTION SOLUTION 2

Page 9: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

alfuzosin hcl er oral tablet extended release 24 hour

1

ALINIA ORAL SUSPENSION RECONSTITUTED 2

ALINIA ORAL TABLET 2

allopurinol oral tablet 1

almotriptan malate oral tablet 1

ALOCRIL OPHTHALMIC SOLUTION 3

alogliptin benzoate oral tablet 3

alogliptin-metformin hcl oral tablet 3

alogliptin-pioglitazone oral tablet 3

ALORA TRANSDERMAL PATCH TWICE WEEKLY 3

alosetron hcl oral tablet 1

ALPHAGAN P OPHTHALMIC SOLUTION 2

ALPHANATE INTRAVENOUS SOLUTION RECONSTITUTED

2

ALPHANATE/VWF COMPLEX/HUMAN INTRAVENOUS SOLUTION RECONSTITUTED

2

ALPHANINE SD INTRAVENOUS SOLUTION RECONSTITUTED

2

alprazolam er oral tablet extended release 24 hour

1

alprazolam intensol oral concentrate 1

alprazolam oral tablet 1

alprazolam oral tablet dispersible 1

alprazolam xr oral tablet extended release 24 hour

1

ALPROLIX INTRAVENOUS SOLUTION RECONSTITUTED

2

ALREX OPHTHALMIC SUSPENSION 2

ALSUMA SUBCUTANEOUS SOLUTION AUTO- INJECTOR

3

ALTABAX EXTERNAL OINTMENT 3

altacaine ophthalmic solution 1

ALTACE ORAL CAPSULE 3

altafluor ophthalmic solution 1

altavera oral tablet 1

ALTOPREV ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ALVESCO INHALATION AEROSOL SOLUTION 3

Page 10: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

alyacen 1/35 oral tablet 1

alyacen 7/7/7 oral tablet 1

amantadine hcl oral capsule 1

amantadine hcl oral syrup 1

AMARYL ORAL TABLET 3

AMBIEN CR ORAL TABLET EXTENDED RELEASE 3

AMBIEN ORAL TABLET 3

amcinonide external cream 1

amcinonide external lotion 1

amcinonide external ointment 1

AMERGE ORAL TABLET 3

amethia oral tablet 1

amethyst oral tablet 1

AMICAR ORAL TABLET 2

amiloride hcl oral tablet 1

amiloride-hydrochlorothiazide oral tablet 1

amiodarone hcl oral tablet 1

AMITIZA ORAL CAPSULE 2

amitriptyline hcl oral tablet 1

amlodipine besy-benazepril hcl oral capsule 1

amlodipine besylate oral tablet 1

amlodipine besylate-valsartan oral tablet 1

amlodipine-atorvastatin oral tablet 1

amlodipine-valsartan-hctz oral tablet 1

amnesteem oral capsule 1

amoxapine oral tablet 1

amoxicill-clarithro-lansopraz oral 1

amoxicillin oral suspension reconstituted 1

amoxicillin oral tablet 1

amoxicillin-pot clavulanate er oral tablet extended release 12 hour

1

amoxicillin-pot clavulanate oral suspension reconstituted

1

amoxicillin-pot clavulanate oral tablet 1

amphetamine-dextroamphet er oral capsule extended release 24 hour

1

amphetamine-dextroamphetamine oral tablet 1

Page 11: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

ampicillin oral capsule 1

ampicillin oral suspension reconstituted 1

ampicillin sodium injection solution reconstituted 1

AMPYRA ORAL TABLET EXTENDED RELEASE 12 HOUR

2

AMRIX ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

ANAFRANIL ORAL CAPSULE 3

ANALPRAM E RECTAL KIT 3

ANAPROX ORAL TABLET 3

anaspaz oral tablet dispersible 1

anastrozole oral tablet 1

ANCOBON ORAL CAPSULE 3

ANDRODERM TRANSDERMAL PATCH 24 HOUR 3

ANDROGEL PUMP TRANSDERMAL GEL 2

ANDROGEL TRANSDERMAL GEL 2

ANDROID ORAL CAPSULE 3

androxy oral tablet 1

ANGELIQ ORAL TABLET 3

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED

2

ANTABUSE ORAL TABLET 3

ANTARA ORAL CAPSULE 3

anucort-hc rectal suppository 1

ANUSOL-HC RECTAL SUPPOSITORY 3

ANZEMET ORAL TABLET 3

apexicon e external cream 1

APIDRA INJECTION SOLUTION 3

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

3

APLENZIN ORAL TABLET EXTENDED RELEASE 24 HOUR

3

apraclonidine hcl ophthalmic solution 1

aprepitant oral capsule 1

apri oral tablet 1

APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2

APTIVUS ORAL CAPSULE 2

Page 12: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

APTIVUS ORAL SOLUTION 2

aranelle oral tablet 1

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 3

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE

3

ARAVA ORAL TABLET 3

arbinoxa oral solution 1

arbinoxa oral tablet 1

ARCAPTA NEOHALER INHALATION CAPSULE 3

ARIMIDEX ORAL TABLET 3

aripiprazole oral tablet 1

aripiprazole oral tablet dispersible 1

ARIXTRA SUBCUTANEOUS SOLUTION 3

armodafinil oral tablet 1

ARMOUR THYROID ORAL TABLET 2

ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED

2

AROMASIN ORAL TABLET 3

ARTHROTEC ORAL TABLET DELAYED RELEASE 3

ASACOL HD ORAL TABLET DELAYED RELEASE 3

ascomp-codeine oral capsule 1

ashlyna oral tablet 1

ASMANEX 120 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED

2

ASMANEX 14 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED

2

ASMANEX 30 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED

2

ASMANEX 60 METERED DOSES INHALATION AEROSOL POWDER BREATH ACTIVATED

2

aspirin-dipyridamole er oral capsule extended release 12 hour

1

ASSURE 4 TEST IN VITRO STRIP 3

assure comfort lancets 28g 2

assure comfort lancets 30g 2

ASSURE HAEMOLANCE PLUS HIGH 2

ASSURE HAEMOLANCE PLUS LOW 2

ASSURE HAEMOLANCE PLUS MICRO 2

Page 13: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

ASSURE HAEMOLANCE PLUS NORMAL 2

ASSURE HAEMOLANCE PLUS PED 2

ASSURE LANCE LANCETS 2

ASSURE LANCE LANCETS 21G 2

ASSURE LANCE PLUS SAFETY 25G 2

ASSURE LANCE PLUS SAFETY 30G 2

ASSURE PLATINUM IN VITRO STRIP 3

ASSURE PRISM MULTI TEST IN VITRO STRIP 3

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

ATACAND HCT ORAL TABLET 3

ATACAND ORAL TABLET 3

ATELVIA ORAL TABLET DELAYED RELEASE 3

atenolol oral tablet 1

atenolol-chlorthalidone oral tablet 1

ATIVAN ORAL TABLET 3

atorvastatin calcium oral tablet 1

atovaquone oral suspension 1

atovaquone-proguanil hcl oral tablet 1

ATRALIN EXTERNAL GEL 3

ATRIPLA ORAL TABLET 2

atropine sulfate ophthalmic solution 1

ATROVENT HFA INHALATION AEROSOL SOLUTION

2

ATROVENT NASAL SOLUTION 3

AUBAGIO ORAL TABLET 2

aubra oral tablet 1

AUGMENTIN ORAL TABLET 3

AUGMENTIN XR ORAL TABLET EXTENDED RELEASE 12 HOUR

3

AVAGE EXTERNAL CREAM 3

AVALIDE ORAL TABLET 3

AVAPRO ORAL TABLET 3

AVAR EXTERNAL PAD 3

AVC VAGINAL VAGINAL CREAM 3

aviane oral tablet 1

Page 14: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

AVINZA ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

avita external cream 1

AVITA EXTERNAL GEL 3

AVODART ORAL CAPSULE 3

AVONEX INTRAMUSCULAR KIT 3

AXERT ORAL TABLET 3

AXIRON TRANSDERMAL SOLUTION 2

azacitidine injection suspension reconstituted 1

AZASAN ORAL TABLET 2

AZASITE OPHTHALMIC SOLUTION 2

azathioprine oral tablet 1

azelastine hcl nasal solution 1

azelastine hcl ophthalmic solution 1

AZELEX EXTERNAL CREAM 3

AZILECT ORAL TABLET 2

azithromycin oral suspension reconstituted 1

azithromycin oral tablet 1

AZOPT OPHTHALMIC SUSPENSION 3

AZOR ORAL TABLET 2

AZULFIDINE EN-TABS ORAL TABLET DELAYED RELEASE

3

AZULFIDINE ORAL TABLET 3

azurette oral tablet 1

bacitracin ophthalmic ointment 1

bacitracin-polymyxin b ophthalmic ointment 1

bacitra-neomycin-polymyxin-hc ophthalmic ointment

1

baclofen oral tablet 1

BACTRIM ORAL TABLET 3

BACTROBAN EXTERNAL OINTMENT 3

balsalazide disodium oral capsule 1

balziva oral tablet 1

BANZEL ORAL TABLET 2

BARACLUDE ORAL TABLET 3

BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

3

Page 15: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

BAYER BREEZE 2 TEST IN VITRO DISK 3

BAYER CONTOUR LINK MONITOR KIT 3

BAYER CONTOUR MONITOR KIT 3

BAYER CONTOUR NEXT EZ KIT 3

BAYER CONTOUR NEXT LINK KIT 3

BAYER CONTOUR NEXT MONITOR KIT 3

BAYER CONTOUR NEXT TEST IN VITRO STRIP 3

BAYER CONTOUR NEXT USB MONITOR KIT 3

BAYER CONTOUR TEST IN VITRO STRIP 3

BAYER MICROLET LANCETS 2

BD DISP NEEDLES 2

BD INSULIN SYRINGE 2

BD INSULIN SYRINGE MICROFINE 2

BD LANCET ULTRAFINE 30G 2

BD LANCET ULTRAFINE 33G 2

BD MICROTAINER LANCETS 2

BD PEN NEEDLE MINI U/F 3

BEBULIN INTRAVENOUS SOLUTION RECONSTITUTED

2

BEBULIN VH INTRAVENOUS SOLUTION RECONSTITUTED

2

BECONASE AQ NASAL SUSPENSION 3

bekyree oral tablet 1

belladonna tincture 2

BELSOMRA ORAL TABLET 2

benazepril hcl oral tablet 1

benazepril-hydrochlorothiazide oral tablet 1

BENEFIX INTRAVENOUS KIT 2

BENEFIX INTRAVENOUS SOLUTION RECONSTITUTED

2

BENICAR HCT ORAL TABLET 3

BENICAR ORAL TABLET 3

BENTYL ORAL CAPSULE 3

BENZACLIN EXTERNAL GEL 3

BENZACLIN WITH PUMP EXTERNAL GEL 3

BENZAMYCIN EXTERNAL GEL 3

BENZEFOAM EXTERNAL FOAM 3

Page 16: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

BENZEPRO CREAMY WASH EXTERNAL LIQUID 3

benzonatate oral capsule 1

benzoyl peroxide external foam 1

benzoyl peroxide-erythromycin external gel 1

benztropine mesylate oral tablet 1

BEPREVE OPHTHALMIC SOLUTION 2

BERINERT INTRAVENOUS KIT 2

BESIVANCE OPHTHALMIC SUSPENSION 3

BETAGAN OPHTHALMIC SOLUTION 3

betamethasone dipropionate aug external cream 1

betamethasone dipropionate external lotion 1

betamethasone dipropionate external ointment 1

betamethasone valerate external cream 1

betamethasone valerate external lotion 1

betamethasone valerate external ointment 1

BETAPACE AF ORAL TABLET 3

BETAPACE ORAL TABLET 3

BETASERON SUBCUTANEOUS KIT 2

betaxolol hcl ophthalmic solution 1

betaxolol hcl oral tablet 1

bethanechol chloride oral tablet 1

BETIMOL OPHTHALMIC SOLUTION 3

BETOPTIC-S OPHTHALMIC SUSPENSION 3

BEYAZ ORAL TABLET 2

BG STAR TEST IN VITRO STRIP 3

BIAXIN ORAL TABLET 3

bicalutamide oral tablet 1

BIDIL ORAL TABLET 3

BILTRICIDE ORAL TABLET 2

bimatoprost external solution 1

bimatoprost ophthalmic solution 1

BINOSTO ORAL TABLET EFFERVESCENT 3

BIONECT EXTERNAL CREAM 3

BIONECT EXTERNAL GEL 3

bisoprolol fumarate oral tablet 1

bisoprolol-hydrochlorothiazide oral tablet 1

Page 17: 2017 National Formulary - GuidantRx

17

Drug Name Tier Notes

BIVIGAM INTRAVENOUS SOLUTION 3

BLEPH-10 OPHTHALMIC SOLUTION 3

BLEPHAMIDE OPHTHALMIC SUSPENSION 3

BLEPHAMIDE S.O.P. OPHTHALMIC OINTMENT 3

blisovi 24 fe oral tablet 1

blisovi fe 1.5/30 oral tablet 1

blood glucose monitor system kit 3

blood glucose test in vitro strip 3

BONIVA ORAL TABLET 3

BOOSTRIX INTRAMUSCULAR SUSPENSION 2

BOSULIF ORAL TABLET 2

bp cleansing wash external emulsion 1

BRAVELLE INJECTION SOLUTION RECONSTITUTED 3

BREATHERITE 2

BREATHERITE COLL SPACER ADULT 2

BREATHERITE COLL SPACER CHILD 2

BREATHERITE COLL SPACER INFANT 2

BREATHERITE RIGID SPACER/MASK 2

BREATHERITE SPACER NEONATE 2

BREATHERITE SPACER SMALL CHILD 2

BREATHERITE/LARGE MASK 2

BREATHERITE/MEDIUM MASK 2

BREATHERITE/SMALL MASK 2

BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED

2

BREVICON (28) ORAL TABLET 3

briellyn oral tablet 1

BRILINTA ORAL TABLET 2

brimonidine tartrate ophthalmic solution 1

BRINTELLIX ORAL TABLET 2

BRISDELLE ORAL CAPSULE 3

BROMFED DM ORAL SYRUP 3

bromfenac sodium ophthalmic solution 1

bromocriptine mesylate oral tablet 1

budesonide inhalation suspension 1

budesonide oral capsule delayed release particles 1

bullseye mini safety lancets 2

Page 18: 2017 National Formulary - GuidantRx

18

Drug Name Tier Notes

bumetanide oral tablet 1

BUPHENYL ORAL POWDER 3

BUPHENYL ORAL TABLET 3

buprenorphine hcl sublingual tablet sublingual 1

buprenorphine hcl-naloxone hcl sublingual tablet sublingual

1

buproban oral tablet extended release 12 hour 1

bupropion hcl er (smoking det) oral tablet extended release 12 hour

1

bupropion hcl er (xl) oral tablet extended release 24 hour

1

bupropion hcl oral tablet 1

buspirone hcl oral tablet 1

butalbital-apap-caff-cod oral capsule 1

butalbital-apap-caffeine oral tablet 1

butalbital-asa-caff-codeine oral capsule 1

butalbital-aspirin-caffeine oral capsule 1

BUTISOL SODIUM ORAL TABLET 3

BUTRANS TRANSDERMAL PATCH WEEKLY 2

BYDUREON SUBCUTANEOUS PEN-INJECTOR 3

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER

3

BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

3

BYSTOLIC ORAL TABLET 2

cabergoline oral tablet 1

CADUET ORAL TABLET 3

CAFERGOT ORAL TABLET 3

CALAN ORAL TABLET 3

calcipotriene external cream 1

calcipotriene external ointment 1

calcipotriene external solution 1

calcitonin (salmon) nasal solution 1

calcitrene external ointment 1

calcitriol oral capsule 1

calcium acetate (phos binder) oral capsule 1

calcium acetate oral capsule 1

camila oral tablet 1

Page 19: 2017 National Formulary - GuidantRx

19

Drug Name Tier Notes

camrese oral tablet 1

CANASA RECTAL SUPPOSITORY 2

candesartan cilexetil oral tablet 1

candesartan cilexetil-hctz oral tablet 1

CANTIL ORAL TABLET 3

CAPEX EXTERNAL SHAMPOO 3

CAPITAL/CODEINE ORAL SUSPENSION 3

CAPRELSA ORAL TABLET 2

captopril oral tablet 1

captopril-hydrochlorothiazide oral tablet 1

CARAC EXTERNAL CREAM 2

carafate oral suspension 1

CARAFATE ORAL TABLET 3

CARBAGLU ORAL TABLET 2

carbamazepine er oral tablet extended release 12 hour

1

carbamazepine oral suspension 1

carbamazepine oral tablet 1

carbidopa-levodopa er oral tablet extended release

1

carbidopa-levodopa oral tablet 1

carbidopa-levodopa oral tablet dispersible 1

carbidopa-levodopa-entacapone oral tablet 1

carbinoxamine maleate oral solution 1

carbinoxamine maleate oral tablet 1

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

CARDIZEM ORAL TABLET 3

CARDURA ORAL TABLET 3

CARDURA XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

CAREONE BLOOD GLUCOSE SYSTEM KIT 3

CAREONE BLOOD GLUCOSE TEST IN VITRO STRIP 3

careone lancet thin 23g 2

careone lancet ultra thin 28g 2

careone unifine pentips 3

careone unifine pentips plus 2

Page 20: 2017 National Formulary - GuidantRx

20

Drug Name Tier Notes

CARESENS N GLUCOSE TEST IN VITRO STRIP 3

CARIMUNE NF INTRAVENOUS SOLUTION RECONSTITUTED

3

carisoprodol oral tablet 1

carisoprodol-aspirin oral tablet 1

carisoprodol-aspirin-codeine oral tablet 1

carteolol hcl ophthalmic solution 1

cartia xt oral capsule extended release 24 hour 1

carvedilol oral tablet 1

CASODEX ORAL TABLET 3

CATAPRES ORAL TABLET 3

caziant oral tablet 1

CEDAX ORAL CAPSULE 3

CEDAX ORAL SUSPENSION RECONSTITUTED 3

cefaclor oral capsule 1

cefaclor oral suspension reconstituted 1

cefadroxil oral capsule 1

cefadroxil oral suspension reconstituted 1

cefazolin sodium injection solution reconstituted 1

cefdinir oral capsule 1

cefdinir oral suspension reconstituted 1

cefditoren pivoxil oral tablet 1

cefixime oral suspension reconstituted 1

cefprozil oral suspension reconstituted 1

cefprozil oral tablet 1

ceftibuten oral capsule 1

ceftibuten oral suspension reconstituted 1

CEFTIN ORAL SUSPENSION RECONSTITUTED 3

CEFTIN ORAL TABLET 3

cefuroxime axetil oral tablet 1

CELEBREX ORAL CAPSULE 3

celecoxib oral capsule 1

CELEXA ORAL TABLET 3

CELLCEPT ORAL CAPSULE 3

CELLCEPT ORAL SUSPENSION RECONSTITUTED 3

CENTANY EXTERNAL OINTMENT 3

cephalexin oral suspension reconstituted 1

Page 21: 2017 National Formulary - GuidantRx

21

Drug Name Tier Notes

cephalexin oral tablet 1

CEREBYX INJECTION SOLUTION 3

CERVARIX INTRAMUSCULAR SUSPENSION 2

cetirizine hcl oral solution 1

cetirizine hcl oral syrup 1

CETRAXAL OTIC SOLUTION 3

CETROTIDE SUBCUTANEOUS KIT 2

cevimeline hcl oral capsule 1

CHANTIX CONTINUING MONTH PAK ORAL TABLET

2

CHANTIX ORAL TABLET 2

chateal oral tablet 1

CHENODAL ORAL TABLET 2

cheratussin ac oral syrup 1

chlordiazepoxide hcl oral capsule 1

chlordiazepoxide-amitriptyline oral tablet 1

chlordiazepoxide-clidinium oral capsule 1

chloroquine phosphate oral tablet 1

chlorothiazide oral tablet 1

chlorpromazine hcl oral tablet 1

chlorzoxazone oral tablet 1

cholestyramine light oral packet 1

cholestyramine oral packet 1

chorionic gonadotropin intramuscular solution reconstituted

1

CIALIS ORAL TABLET 2

ciclopirox external gel 1

ciclopirox external shampoo 1

ciclopirox olamine external suspension 1

cilostazol oral tablet 1

CILOXAN OPHTHALMIC OINTMENT 3

CILOXAN OPHTHALMIC SOLUTION 3

cimetidine hcl oral solution 1

cimetidine oral tablet 1

CIMZIA STARTER KIT SUBCUTANEOUS KIT 3 ST; Must try and fail Humira OR Enbrel

Page 22: 2017 National Formulary - GuidantRx

22

Drug Name Tier Notes

CIMZIA SUBCUTANEOUS KIT 3 ST; Must try and fail Humira OR Enbrel

CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED

2

CIPRO HC OTIC SUSPENSION 3

CIPRO ORAL TABLET 3

CIPRO XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

CIPRODEX OTIC SUSPENSION 2

ciprofloxacin hcl ophthalmic solution 1

ciprofloxacin hcl oral tablet 1

ciprofloxacin hcl otic solution 1

ciprofloxacin-ciproflox hcl er oral tablet extended release 24 hour

1

citalopram hydrobromide oral solution 1

citalopram hydrobromide oral tablet 1

claravis oral capsule 1

CLARIFOAM EF EXTERNAL FOAM 3

CLARINEX ORAL TABLET 3

clarithromycin er oral tablet extended release 24 hour

1

clarithromycin oral suspension reconstituted 1

clarithromycin oral tablet 1

clemastine fumarate oral tablet 1

CLEOCIN ORAL CAPSULE 3

CLEOCIN ORAL SOLUTION RECONSTITUTED 3

CLEOCIN VAGINAL CREAM 3

CLEOCIN-T EXTERNAL GEL 3

CLEOCIN-T EXTERNAL LOTION 3

CLEOCIN-T EXTERNAL SOLUTION 3

CLEOCIN-T EXTERNAL SWAB 3

CLEVER CHEK AUTO-CODE TEST IN VITRO STRIP 3

CLEVER CHEK AUTO-CODE VOICE IN VITRO STRIP 3

CLEVER CHEK LANCETS 2

CLEVER CHEK SYSTEM KIT 3

CLEVER CHEK TEST IN VITRO STRIP 3

CLEVER CHOICE AUTO-CODE TEST IN VITRO STRIP 3

CLEVER CHOICE MICRO SYSTEM KIT 3

Page 23: 2017 National Formulary - GuidantRx

23

Drug Name Tier Notes

CLEVER CHOICE MICRO TEST IN VITRO STRIP 3

CLIMARA PRO TRANSDERMAL PATCH WEEKLY 3

CLIMARA TRANSDERMAL PATCH WEEKLY 3

clindacin etz external swab 1

clindacin-p external swab 1

CLINDAGEL EXTERNAL GEL 3

clindamycin hcl oral capsule 1

clindamycin palmitate hcl oral solution reconstituted

1

clindamycin phos-benzoyl perox external gel 1

clindamycin phosphate external foam 1

clindamycin phosphate external gel 1

clindamycin phosphate external lotion 1

clindamycin phosphate external solution 1

clindamycin phosphate external swab 1

clindamycin phosphate vaginal cream 1

clindamycin-tretinoin external gel 1

clobetasol propionate e external cream 1

clobetasol propionate external liquid 1

clobetasol propionate external ointment 1

clobetasol propionate external shampoo 1

clobetasol propionate external solution 1

CLOBEX EXTERNAL SHAMPOO 3

CLOBEX SPRAY EXTERNAL LIQUID 3

clocortolone pivalate external cream 3

clocortolone pivalate pump external cream 3

clodan external shampoo 1

CLODERM EXTERNAL CREAM 3

CLODERM PUMP EXTERNAL CREAM 3

clomiphene citrate oral tablet 1

clomipramine hcl oral capsule 1

clonazepam oral tablet 1

clonazepam oral tablet dispersible 1

clonidine hcl oral tablet 1

clopidogrel bisulfate oral tablet 1

clorazepate dipotassium oral tablet 1

clorpres oral tablet 1

Page 24: 2017 National Formulary - GuidantRx

24

Drug Name Tier Notes

clotrimazole external cream 1

clotrimazole external solution 1

clotrimazole mouth/throat lozenge 1

clotrimazole mouth/throat troche 1

clotrimazole-betamethasone external cream 1

clotrimazole-betamethasone external lotion 1

clozapine oral tablet 1

clozapine oral tablet dispersible 100 mg 1

clozapine oral tablet dispersible 150 mg 3

CLOZARIL ORAL TABLET 3

COAGADEX INTRAVENOUS SOLUTION RECONSTITUTED

2

COAGUCHEK LANCETS 2

COARTEM ORAL TABLET 2

codeine sulfate oral tablet 1

COLAZAL ORAL CAPSULE 3

colchicine oral capsule 1

colchicine oral tablet 1

colchicine-probenecid oral tablet 1

COLCRYS ORAL TABLET 2

COLESTID ORAL TABLET 3

colestipol hcl oral tablet 1

colocort rectal enema 1

COLY-MYCIN S OTIC SUSPENSION 3

COMBIGAN OPHTHALMIC SOLUTION 2

COMBIPATCH TRANSDERMAL PATCH TWICE WEEKLY

2

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION

2

COMBIVIR ORAL TABLET 3

COMETRIQ (140 MG DAILY DOSE) ORAL KIT 3

comfort assured lancets 28g 2

comfort assured lancets 33g 2

COMFORT EZ INSULIN SYRINGE 2

COMFORT EZ PEN NEEDLES 2

comfort lancets 2

COMPACT SPACE CHAMBER DEVICE 2

Page 25: 2017 National Formulary - GuidantRx

25

Drug Name Tier Notes

COMPACT SPACE CHAMBER/LG MASK DEVICE 2

COMPACT SPACE CHAMBER/MED MASK DEVICE 2

COMPACT SPACE CHAMBER/SM MASK DEVICE 2

COMPAZINE ORAL TABLET 3

COMPLERA ORAL TABLET 2

COMTAN ORAL TABLET 3

CONDYLOX EXTERNAL SOLUTION 3

constulose oral solution 1

CONTROL AST IN VITRO STRIP 3

CONTROL BLOOD GLUCOSE SYSTEM KIT 3

CONTROL TEST IN VITRO STRIP 3

CONZIP ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

COOL BLOOD GLUCOSE TEST STRIPS IN VITRO STRIP

3

COOL MONITOR KIT KIT 3

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2

COPEGUS ORAL TABLET 3

CORDARONE ORAL TABLET 3

CORDRAN EXTERNAL CREAM 3

COREG CR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2

COREG ORAL TABLET 3

CORGARD ORAL TABLET 3

CORIFACT INTRAVENOUS KIT 2

cormax scalp application external solution 1

CORTEF ORAL TABLET 3

CORTENEMA RECTAL ENEMA 3

CORTIFOAM RECTAL FOAM 2

CORTISPORIN-TC OTIC SUSPENSION 3

CORZIDE ORAL TABLET 3

COSENTYX 300 DOSE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3

ST; Must try and fail: Humira OR Enbrel, AND Cimzia prior to coverage being considered.

COSENTYX SENSOREADY 300 DOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3

ST; Must try and fail: Humira OR Enbrel, AND Cimzia prior to coverage being considered.

Page 26: 2017 National Formulary - GuidantRx

26

Drug Name Tier Notes

COSOPT OPHTHALMIC SOLUTION 3

COSOPT PF OPHTHALMIC SOLUTION 2

COUMADIN ORAL TABLET 2

covaryx hs oral tablet 1

COZAAR ORAL TABLET 3

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES

2

CRESTOR ORAL TABLET 3

CRIXIVAN ORAL CAPSULE 2

cromolyn sodium ophthalmic solution 1

cryselle-28 oral tablet 1

CUTIVATE EXTERNAL CREAM 3

CUTIVATE EXTERNAL LOTION 3

CUVITRU SUBCUTANEOUS SOLUTION 3

CUVPOSA ORAL SOLUTION 3

CVS ADVANCED GLUCOSE TEST IN VITRO STRIP 3

CVS BLOOD GLUCOSE METER KIT 3

cvs lancets 21g 2

cvs lancets micro thin 33g 2

cvs lancets thin 26g 2

cvs lancets ultra thin 30g 2

cvs ultra thin lancets 2

cyclafem 1/35 oral tablet 1

cyclafem 7/7/7 oral tablet 1

CYCLESSA ORAL TABLET 3

cyclobenzaprine hcl oral tablet 1

CYCLOGYL OPHTHALMIC SOLUTION 3

CYCLOMYDRIL OPHTHALMIC SOLUTION 3

cyclopentolate hcl ophthalmic solution 1

cycloserine oral capsule 3

CYCLOSET ORAL TABLET 3

cyclosporine modified oral capsule 1

cyclosporine modified oral solution 1

cyclosporine oral capsule 1

CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES

3

cyproheptadine hcl oral syrup 1

Page 27: 2017 National Formulary - GuidantRx

27

Drug Name Tier Notes

cyproheptadine hcl oral tablet 1

cyred oral tablet 1

CYSTADANE ORAL POWDER 2

CYSTARAN OPHTHALMIC SOLUTION 2

cytarabine (pf) injection solution 1

CYTOGAM INTRAVENOUS INJECTABLE 2

CYTOMEL ORAL TABLET 3

DAKLINZA ORAL TABLET 3

DALIRESP ORAL TABLET 3

danazol oral capsule 1

DANTRIUM ORAL CAPSULE 3

dantrolene sodium oral capsule 1

dapsone oral tablet 1

DARAPRIM ORAL TABLET 2

darifenacin hydrobromide er oral tablet extended release 24 hour

1

DARZALEX INTRAVENOUS SOLUTION 2

dasetta 1/35 oral tablet 1

dasetta 7/7/7 oral tablet 1

DAYPRO ORAL TABLET 3

daysee oral tablet 1

DAYTRANA TRANSDERMAL PATCH 2

DDAVP ORAL TABLET 3

deblitane oral tablet 1

delyla oral tablet 1

DELZICOL ORAL CAPSULE DELAYED RELEASE 3

DEMADEX ORAL TABLET 3

demeclocycline hcl oral tablet 1

DENAVIR EXTERNAL CREAM 3

DEPAKENE ORAL CAPSULE 3

DEPAKENE ORAL SYRUP 3

DEPAKOTE ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3

DEPAKOTE ORAL TABLET DELAYED RELEASE 3

DEPO-MEDROL INJECTION SUSPENSION 3

DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION

3

Page 28: 2017 National Formulary - GuidantRx

28

Drug Name Tier Notes

DERMATOP EXTERNAL OINTMENT 3

desipramine hcl oral tablet 1

desloratadine oral tablet 1

desmopressin ace spray refrig nasal solution 1

desmopressin acetate oral tablet 1

DESOGEN ORAL TABLET 3

desogestrel-ethinyl estradiol oral tablet 1

DESONATE EXTERNAL GEL 3

desonide external lotion 1

desonide external ointment 1

DESOWEN EXTERNAL LOTION 3

desoximetasone external cream 1

desoximetasone external gel 1

desoximetasone external ointment 1

desvenlafaxine er oral tablet extended release 24 hour

3

DETROL LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

DETROL ORAL TABLET 3

dexamethasone oral tablet 1

dexamethasone sodium phosphate ophthalmic solution

1

DEXCOM G4 PLAT PED RCV/SHARE KIT 2

DEXCOM G4 PLAT PED RECEIVER KIT 2

DEXCOM G4 PLATINUM RCV/SHARE KIT 2

DEXCOM G4 PLATINUM RECEIVER KIT 2

DEXCOM G4 PLATINUM TRANSMITTER KIT 2

DEXCOM G5 MOB/G4 PLAT SENSOR KIT 2

DEXCOM G5 MOBILE RECEIVER KIT 2

DEXCOM G5 MOBILE TRANSMITTER KIT 2

dexedrine oral tablet 1

DEXILANT ORAL CAPSULE DELAYED RELEASE 3

dexmethylphenidate hcl er oral capsule extended release 24 hour

1

dexmethylphenidate hcl oral tablet 1

dextroamphetamine sulfate oral solution 1

dextroamphetamine sulfate oral tablet 1

Page 29: 2017 National Formulary - GuidantRx

29

Drug Name Tier Notes

DIABETA ORAL TABLET 3

dialyvite oral tablet 1

DIASTAT PEDIATRIC RECTAL GEL 3

diatrue plus test in vitro strip 3

diazepam intensol oral concentrate 1

diazepam oral concentrate 1

diazepam oral tablet 1

diazepam rectal gel 1

diclofenac potassium oral tablet 1

diclofenac sodium er oral tablet extended release 24 hour

1

diclofenac sodium ophthalmic solution 1

diclofenac sodium transdermal gel 1

diclofenac-misoprostol oral tablet delayed release

1

dicloxacillin sodium oral capsule 1

dicyclomine hcl oral capsule 1

didanosine oral capsule delayed release 1

DIFFERIN EXTERNAL GEL 3

DIFFERIN EXTERNAL LOTION 3

DIFICID ORAL TABLET 2

diflorasone diacetate external cream 1

DIFLUCAN ORAL SUSPENSION RECONSTITUTED 3

DIFLUCAN ORAL TABLET 3

diflunisal oral tablet 1

digitek oral tablet 1

digox oral tablet 1

digoxin oral solution 1

digoxin oral tablet 1

dihydroergotamine mesylate nasal solution 1

DILANTIN ORAL CAPSULE 3

DILANTIN ORAL SUSPENSION 3

DILATRATE-SR ORAL CAPSULE EXTENDED RELEASE

2

DILAUDID ORAL TABLET 3

diltiazem cd oral capsule extended release 24 hour

1

Page 30: 2017 National Formulary - GuidantRx

30

Drug Name Tier Notes

diltiazem hcl er beads oral capsule extended release 24 hour

1

diltiazem hcl er coated beads oral capsule extended release 24 hour

1

diltiazem hcl oral tablet 1

DIOVAN HCT ORAL TABLET 3

DIOVAN ORAL TABLET 3

DIPENTUM ORAL CAPSULE 3

diphenhydramine hcl oral elixir 1

diphenoxylate-atropine oral liquid 1

diphenoxylate-atropine oral tablet 1

DIPROLENE AF EXTERNAL CREAM 3

dipyridamole oral tablet 1

DISALCID ORAL TABLET 3

disopyramide phosphate oral capsule 1

disulfiram oral tablet 1

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

divalproex sodium er oral tablet extended release 24 hour

1

divalproex sodium oral tablet delayed release 1

DIVIGEL TRANSDERMAL GEL 3

dofetilide oral capsule 1

DORAL ORAL TABLET 3

DORYX ORAL TABLET DELAYED RELEASE 3

dorzolamide hcl ophthalmic solution 1

dorzolamide hcl-timolol mal ophthalmic solution 1

DOVONEX EXTERNAL CREAM 3

doxazosin mesylate oral tablet 1

doxepin hcl oral capsule 1

doxepin hcl oral concentrate 1

doxycycline hyclate oral capsule 1

doxycycline hyclate oral tablet 1

doxycycline hyclate oral tablet delayed release 1

doxycycline monohydrate oral capsule 1

doxycycline oral capsule delayed release 3

dritho-creme hp external cream 1

Page 31: 2017 National Formulary - GuidantRx

31

Drug Name Tier Notes

dronabinol oral capsule 1

DROPLET LANCETS ULTRA THIN 30G 2

DROPLET PEN NEEDLES 2

drospirenone-ethinyl estradiol oral tablet 1

DROXIA ORAL CAPSULE 2

drug mart lancets thin 26g 2

drug mart lancets ultra thin 2

DRUG MART ON-THE-GO LANCET 30G 2

drug mart unifine pentips 3

DRUG MART UNILET LANCETS 28G 2

DRUG MART UNILET LANCETS 30G 2

duane reade lancet altern site 2

duane reade lancet super thin 2

duane reade lancet ultra thin 2

DUAVEE ORAL TABLET 2

DUETACT ORAL TABLET 3

DUEXIS ORAL TABLET 3

DULERA INHALATION AEROSOL 2

duloxetine hcl oral capsule delayed release particles

1

DUREZOL OPHTHALMIC EMULSION 3

dutasteride oral capsule 1

dutasteride-tamsulosin hcl oral capsule 1

DYMISTA NASAL SUSPENSION 2

DYRENIUM ORAL CAPSULE 3

e.e.s. 400 oral tablet 1

EASIVENT 2

EASIVENT MASK LARGE 2

EASIVENT MASK MEDIUM 2

EASIVENT MASK SMALL 2

easy comfort lancets 2

easy comfort pen needles 2

easy plus ii glucose test in vitro strip 3

EASY STEP GLUCOSE MONITOR KIT 3

EASY STEP TEST IN VITRO STRIP 3

easy talk blood glucose system kit 3

easy talk blood glucose test in vitro strip 3

Page 32: 2017 National Formulary - GuidantRx

32

Drug Name Tier Notes

EASY TOUCH FLIPLOCK NEEDLES 3

EASY TOUCH GLUCOSE SYSTEM KIT 2

EASY TOUCH HEALTHPRO SYSTEM KIT 3

EASY TOUCH HEALTHPRO TEST IN VITRO STRIP 3

EASY TOUCH HYPODERMIC NEEDLE 3

EASY TOUCH INSULIN SYRINGE 2

EASY TOUCH LANCETS 21G 2

EASY TOUCH LANCETS 23G 2

EASY TOUCH LANCETS 26G 2

EASY TOUCH LANCETS 26G/TWIST 2

EASY TOUCH LANCETS 28G 2

EASY TOUCH LANCETS 28G/TWIST 2

EASY TOUCH LANCETS 30G 2

EASY TOUCH LANCETS 30G/TWIST 2

EASY TOUCH LANCETS 32G 2

EASY TOUCH LANCETS 32G/TWIST 2

EASY TOUCH LANCETS 33G/TWIST 2

EASY TOUCH PEN NEEDLES 3

EASY TOUCH SAFETY LANCETS 21G 2

EASY TOUCH SAFETY LANCETS 23G 2

EASY TOUCH SAFETY LANCETS 26G 2

EASY TOUCH SAFETY LANCETS 28G 2

EASY TOUCH TEST IN VITRO STRIP 2

easy trak blood glucose system kit 3

easy trak blood glucose test in vitro strip 3

EASY TWIST & CAP LANCETS 2

EASYGLUCO IN VITRO STRIP 3

EASYGLUCO PLUS IN VITRO STRIP 3

EASYGLUCO PLUS KIT 3

EASYGLUCO PLUS STARTER KIT 3

EASYMAX 15 TEST IN VITRO STRIP 3

EASYMAX NG BLOOD GLUCOSE KIT 3

EASYMAX TEST IN VITRO STRIP 3

econazole nitrate external cream 1

ECOZA EXTERNAL FOAM 3

EDARBI ORAL TABLET 3

Page 33: 2017 National Formulary - GuidantRx

33

Drug Name Tier Notes

EDARBYCLOR ORAL TABLET 3

ed-spaz oral tablet dispersible 1

EDURANT ORAL TABLET 2

eemt hs oral tablet 1

EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

EFFIENT ORAL TABLET 2

EFUDEX EXTERNAL CREAM 3

EGRIFTA SUBCUTANEOUS SOLUTION RECONSTITUTED

2

element compact test in vitro strip 3

ELEMENT TEST IN VITRO STRIP 3

ELESTAT OPHTHALMIC SOLUTION 3

ELIDEL EXTERNAL CREAM 2

ELIGARD SUBCUTANEOUS KIT 2

ELIMITE EXTERNAL CREAM 3

elinest oral tablet 1

ELIQUIS ORAL TABLET 2

elite-ob oral tablet 1

ELOCON EXTERNAL LOTION 3

ELOCON EXTERNAL OINTMENT 3

ELOCTATE INTRAVENOUS SOLUTION RECONSTITUTED

2

EMADINE OPHTHALMIC SOLUTION 3

EMBEDA ORAL CAPSULE EXTENDED RELEASE 2

EMBRACE BLOOD GLUCOSE TEST IN VITRO STRIP 3

EMBRACE EVO BLOOD GLUCOSE TEST IN VITRO STRIP

3

EMBRACE EVO GLUCOSE MONITORING KIT 3

EMBRACE LANCETS ULTRA THIN 30G 2

EMBRACE PRO GLUCOSE TEST IN VITRO STRIP 3

EMCYT ORAL CAPSULE 2

EMEND ORAL CAPSULE 2

EMLA EXTERNAL CREAM 3

emoquette oral tablet 1

EMSAM TRANSDERMAL PATCH 24 HOUR 3

EMTRIVA ORAL CAPSULE 2

Page 34: 2017 National Formulary - GuidantRx

34

Drug Name Tier Notes

EMTRIVA ORAL SOLUTION 2

ENABLEX ORAL TABLET EXTENDED RELEASE 24 HOUR

3

enalapril maleate oral tablet 1

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

2

endocet oral tablet 1

ENGERIX-B INJECTION SUSPENSION 2

ENJUVIA ORAL TABLET 3

enoxaparin sodium subcutaneous solution 1

enpresse-28 oral tablet 1

enskyce oral tablet 1

entacapone oral tablet 1

entecavir oral tablet 1

ENTEREG ORAL CAPSULE 3

ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES

3

ENTRESTO ORAL TABLET 2

EPCLUSA ORAL TABLET 3

EPIDUO EXTERNAL GEL 2

EPIFOAM EXTERNAL FOAM 3

epinastine hcl ophthalmic solution 1

epinephrine hcl injection solution 1

epinephrine injection solution auto-injector 1

EPIPEN 2-PAK INJECTION SOLUTION AUTO- INJECTOR

2

EPIPEN JR 2-PAK INJECTION SOLUTION AUTO- INJECTOR

2

epitol oral tablet 1

EPIVIR HBV ORAL SOLUTION 2

EPIVIR HBV ORAL TABLET 3

EPIVIR ORAL SOLUTION 3

eplerenone oral tablet 1

EPOGEN INJECTION SOLUTION 3

eprosartan mesylate oral tablet 1

EPZICOM ORAL TABLET 2

eq blood glucose test in vitro strip 3

eql color lancets 21g 2

Page 35: 2017 National Formulary - GuidantRx

35

Drug Name Tier Notes

eql color lancets micro 33g 2

eql super thin lancets 30g 2

eql thin lancets 26g 2

EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

ERGOMAR SUBLINGUAL TABLET SUBLINGUAL 3

errin oral tablet 1

ERTACZO EXTERNAL CREAM 3

erygel external gel 1

ery-tab oral tablet delayed release 1

erythromycin base oral tablet 1

erythromycin ethylsuccinate oral tablet 1

erythromycin external gel 1

erythromycin external solution 1

erythromycin ophthalmic ointment 1

escitalopram oxalate oral solution 1

escitalopram oxalate oral tablet 1

ESGIC ORAL TABLET 3

esomeprazole magnesium oral capsule delayed release

1

est estrogens-methyltest hs oral tablet 1

estarylla oral tablet 1

estazolam oral tablet 1

estradiol transdermal patch twice weekly 1

estradiol transdermal patch weekly 1

estradiol-norethindrone acet oral tablet 1

ESTRING VAGINAL RING 3

ESTROGEL TRANSDERMAL GEL 3

ESTROSTEP FE ORAL TABLET 3

eszopiclone oral tablet 1

ethambutol hcl oral tablet 1

ethosuximide oral capsule 1

ethosuximide oral solution 1

etidronate disodium oral tablet 1

etodolac oral tablet 1

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

3

Page 36: 2017 National Formulary - GuidantRx

36

Drug Name Tier Notes

EURAX EXTERNAL CREAM 3

EVENCARE G2 TEST IN VITRO STRIP 3

EVENCARE G3 TEST IN VITRO STRIP 3

EVENCARE MINI GLUCOSE TEST IN VITRO STRIP 3

EVOCLIN EXTERNAL FOAM 3

EVOLUTION AUTOCODE IN VITRO STRIP 3

EVOXAC ORAL CAPSULE 3

EXEL COMFORT POINT INSULIN SYR 2

EXELDERM EXTERNAL SOLUTION 3

EXELON ORAL CAPSULE 3

EXELON TRANSDERMAL PATCH 24 HOUR 3

exemestane oral tablet 1

EXFORGE HCT ORAL TABLET 3

EXFORGE ORAL TABLET 3

EXJADE ORAL TABLET SOLUBLE 2

EXODERM EXTERNAL LOTION 3

EXTAVIA SUBCUTANEOUS KIT 3

e-z ject lancet micro-thin 33g 1

e-z ject lancet super thin 30g 1

e-z ject lancets 1

e-z ject lancets 21g 1

E-Z JECT LANCETS THIN 26G 2

EZ SMART BLOOD GLUCOSE LANCETS 2

EZ SMART BLOOD GLUCOSE TEST IN VITRO STRIP 3

EZ SMART PLUS GLUCOSE TEST IN VITRO STRIP 3

E-Z SPACER DEVICE 2

ezetimibe oral tablet 1

FABIOR EXTERNAL FOAM 3

FACTIVE ORAL TABLET 3

falmina oral tablet 1

famciclovir oral tablet 1

famotidine oral suspension reconstituted 1

famotidine oral tablet 1

FAMVIR ORAL TABLET 3

FANAPT ORAL TABLET 3

FARESTON ORAL TABLET 2

Page 37: 2017 National Formulary - GuidantRx

37

Drug Name Tier Notes

FARXIGA ORAL TABLET 3

FAZACLO ORAL TABLET DISPERSIBLE 3

felbamate oral suspension 1

felbamate oral tablet 1

FELBATOL ORAL SUSPENSION 3

FELBATOL ORAL TABLET 3

FELDENE ORAL CAPSULE 3

felodipine er oral tablet extended release 24 hour

1

FEMARA ORAL TABLET 3

FEMCON FE ORAL TABLET CHEWABLE 3

FEMHRT LOW DOSE ORAL TABLET 3

fenofibrate oral capsule 3

fenofibrate oral tablet 1

fenofibric acid oral capsule delayed release 1

FENOGLIDE ORAL TABLET 3

fenoprofen calcium oral capsule 3

fenoprofen calcium oral tablet 1

FENORTHO ORAL CAPSULE 3

fentanyl citrate buccal lozenge on a handle 1

FENTORA BUCCAL TABLET 3

FETZIMA TITRATION ORAL CAPSULE ER 24 HOUR THERAPY PACK

2

FIFTY50 GLUCOSE METER 2.0 KIT 3

FIFTY50 GLUCOSE TEST 2.0 IN VITRO STRIP 3

FIFTY50 PEN NEEDLES 2

FIFTY50 SAFETY SEAL LANCETS 2

FIFTY50 UNILET LANCETS 33G 2

FINACEA EXTERNAL GEL 2

finasteride oral tablet 1

FINE 30 2

FINGERSTIX LANCETS 2

FIORINAL ORAL CAPSULE 3

FIORINAL/CODEINE #3 ORAL CAPSULE 3

FLAGYL ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3

FLAGYL ORAL TABLET 3

Page 38: 2017 National Formulary - GuidantRx

38

Drug Name Tier Notes

FLAREX OPHTHALMIC SUSPENSION 3

flavoxate hcl oral tablet 1

FLEBOGAMMA DIF INTRAVENOUS SOLUTION 3

FLEBOGAMMA INTRAVENOUS SOLUTION 3

flecainide acetate oral tablet 1

FLECTOR TRANSDERMAL PATCH 2

FLEXICHAMBER DEVICE 2

FLOLAN INTRAVENOUS SOLUTION RECONSTITUTED

2

FLOMAX ORAL CAPSULE 3

FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED

2

FLOVENT HFA INHALATION AEROSOL 2

flucaine ophthalmic solution 1

fluconazole oral suspension reconstituted 1

fluconazole oral tablet 1

flucytosine oral capsule 1

fludrocortisone acetate oral tablet 1

FLUMADINE ORAL TABLET 3

flunisolide nasal solution 1

fluocinolone acetonide external cream 1

fluocinolone acetonide external solution 1

fluocinonide external cream 1

fluocinonide external gel 1

fluocinonide external ointment 1

fluocinonide-e external cream 1

fluorescein-benoxinate ophthalmic solution 1

fluoritab oral tablet chewable 1

fluorometholone ophthalmic suspension 1

fluorouracil external cream 0.5 % 3

fluorouracil external cream 5 % 1

fluorouracil external solution 1

fluoxetine hcl oral capsule 1

fluoxetine hcl oral solution 1

fluphenazine hcl oral concentrate 1

fluphenazine hcl oral tablet 1

flurandrenolide external cream 1

Page 39: 2017 National Formulary - GuidantRx

39

Drug Name Tier Notes

flurazepam hcl oral capsule 1

flurbiprofen oral tablet 1

flurbiprofen sodium ophthalmic solution 1

flurox ophthalmic solution 1

flutamide oral capsule 1

fluticasone propionate external cream 1

fluticasone propionate external lotion 1

fluticasone propionate nasal suspension 3

fluvastatin sodium er oral tablet extended release 24 hour

1

fluvastatin sodium oral capsule 1

fluvoxamine maleate oral tablet 1

FML FORTE OPHTHALMIC SUSPENSION 3

FML LIQUIFILM OPHTHALMIC SUSPENSION 3

FOCALIN ORAL TABLET 3

FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

folic acid oral tablet 1

FOLLISTIM AQ INJECTION SOLUTION 3

FOLLISTIM AQ SUBCUTANEOUS SOLUTION 3

fondaparinux sodium subcutaneous solution 1

FORA D10 BLOOD GLUCOSE TEST IN VITRO STRIP 3

FORA D15G BLOOD GLUCOSE TEST IN VITRO STRIP

3

FORA D20 BLOOD GLUCOSE TEST IN VITRO STRIP 3

FORA D40/G31 BLOOD GLUCOSE IN VITRO STRIP 3

FORA G20 BLOOD GLUCOSE SYSTEM KIT 3

FORA G20 BLOOD GLUCOSE TEST IN VITRO STRIP 3

FORA G30A BLOOD GLUCOSE TEST IN VITRO STRIP

3

FORA GD20 TEST IN VITRO STRIP 3

FORA GD50 BLOOD GLUCOSE TEST IN VITRO STRIP

3

FORA LANCETS 2

FORA TN'G VOICE KIT 3

FORA TN'G/TN'G VOICE IN VITRO STRIP 3

FORA V10 BLOOD GLUCOSE TEST IN VITRO STRIP 3

FORA V12 BLOOD GLUCOSE TEST IN VITRO STRIP 3

Page 40: 2017 National Formulary - GuidantRx

40

Drug Name Tier Notes

FORA V20 BLOOD GLUCOSE TEST IN VITRO STRIP 3

FORA V30A BLOOD GLUCOSE SYSTEM KIT 3

FORA V30A BLOOD GLUCOSE TEST IN VITRO STRIP

3

FORACARE GD40 TEST IN VITRO STRIP 3

FORACARE PREMIUM V10 TEST IN VITRO STRIP 3

FORACARE TEST N GO TEST IN VITRO STRIP 3

FORADIL AEROLIZER INHALATION CAPSULE 3

FORFIVO XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

FORTEO SUBCUTANEOUS SOLUTION 2

FORTESTA TRANSDERMAL GEL 3

fortical nasal solution 1

FORTISCARE GLUCOSE SYSTEM KIT 3

FORTISCARE TEST IN VITRO STRIP 3

FOSAMAX PLUS D ORAL TABLET 3

fosinopril sodium oral tablet 1

fosinopril sodium-hctz oral tablet 1

fosphenytoin sodium injection solution 1

FOSRENOL ORAL TABLET CHEWABLE 2

FRAGMIN SUBCUTANEOUS SOLUTION 2

freds pharmacy unifine pentip+ 2

freds pharmacy unilet lanc 28g 2

freds pharmacy unilet lanc 30g 2

FREESTYLE FREEDOM KIT 2

FREESTYLE FREEDOM LITE KIT 2

FREESTYLE INSULINX SYSTEM KIT 2

FREESTYLE INSULINX TEST IN VITRO STRIP 2

FREESTYLE LANCETS 2

FREESTYLE LITE TEST IN VITRO STRIP 2

FREESTYLE PRECISION NEO SYSTEM KIT 2

FREESTYLE PRECISION NEO TEST IN VITRO STRIP 2

FREESTYLE SIDEKICK II KIT 2

FREESTYLE TEST IN VITRO STRIP 2

FREESTYLE UNISTICK II LANCETS 2

FROVA ORAL TABLET 3

frovatriptan succinate oral tablet 1

Page 41: 2017 National Formulary - GuidantRx

41

Drug Name Tier Notes

FULYZAQ ORAL TABLET DELAYED RELEASE 3

furosemide oral solution 1

fyavolv oral tablet 1

FYCOMPA ORAL TABLET 2

gabapentin oral capsule 1

gabapentin oral tablet 1

GABITRIL ORAL TABLET 2

galantamine hydrobromide er oral capsule extended release 24 hour

1

GAMMAGARD INJECTION SOLUTION 2

GAMMAGARD S/D LESS IGA INTRAVENOUS SOLUTION RECONSTITUTED

2

ganirelix acetate subcutaneous solution 3

GARDASIL INTRAMUSCULAR SUSPENSION 2

gatifloxacin ophthalmic solution 1

gavilyte-g oral solution reconstituted 1

ge100 blood glucose system kit 3

ge100 blood glucose test in vitro strip 3

GELNIQUE TRANSDERMAL GEL 3

GEL-ONE INTRA-ARTICULAR PREFILLED SYRINGE 3

GELSYN-3 INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

2

gemfibrozil oral tablet 1

GENERESS FE ORAL TABLET CHEWABLE 3

gengraf oral capsule 1

gengraf oral solution 1

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED

3

GENSTRIP 50 IN VITRO STRIP 3

gentak ophthalmic ointment 1

gentamicin sulfate ophthalmic ointment 1

gentamicin sulfate ophthalmic solution 1

GENVISC 850 INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

3

GEODON ORAL CAPSULE 3

ght blood glucose monitor kit 3

ght test in vitro strip 3

gianvi oral tablet 1

Page 42: 2017 National Formulary - GuidantRx

42

Drug Name Tier Notes

GIAZO ORAL TABLET 3

gildagia oral tablet 1

gildess 1.5/30 oral tablet 1

gildess 1/20 oral tablet 1

gildess 24 fe oral tablet 1

gildess fe 1.5/30 oral tablet 1

GILENYA ORAL CAPSULE 2

GILOTRIF ORAL TABLET 2

glatopa subcutaneous solution prefilled syringe 1

GLEEVEC ORAL TABLET 3

GLEOSTINE ORAL CAPSULE 2

glimepiride oral tablet 1

glipizide er oral tablet extended release 24 hour 1

glipizide oral tablet 1

glipizide xl oral tablet extended release 24 hour 1

glipizide-metformin hcl oral tablet 1

global ease inject pen needles 2

global inject ease insulin syr 2

global inject ease lancets 28g 2

global inject ease lancets 30g 2

global insulin syringes 2

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED

2

GLUCAGON EMERGENCY INJECTION KIT 2

GLUCOCARD 01 BLOOD GLUCOSE KIT 3

GLUCOCARD 01 SENSOR PLUS IN VITRO STRIP 3

GLUCOCARD EXPRESSION MONITOR KIT 3

GLUCOCARD EXPRESSION TEST IN VITRO STRIP 3

GLUCOCARD SHINE KIT 3

GLUCOCARD SHINE TEST IN VITRO STRIP 3

GLUCOCARD VITAL MONITOR KIT 3

GLUCOCARD VITAL TEST IN VITRO STRIP 3

GLUCOCOM LANCETS 28G 2

GLUCOCOM LANCETS 30G 2

GLUCOCOM LANCETS 33G 2

GLUCOCOM MONITOR KIT 3

GLUCOCOM TEST IN VITRO STRIP 3

Page 43: 2017 National Formulary - GuidantRx

43

Drug Name Tier Notes

GLUCONAVII BLOOD GLUCOSE SYS KIT 3

GLUCONAVII BLOOD GLUCOSE TEST IN VITRO STRIP

3

GLUCOPHAGE ORAL TABLET 3

GLUCOPHAGE XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

glucose meter test in vitro strip 3

GLUCOTROL ORAL TABLET 3

GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR

3

glyburide micronized oral tablet 1

glyburide oral tablet 1

glyburide-metformin oral tablet 1

glycopyrrolate oral tablet 1

GLYNASE ORAL TABLET 3

GLYSET ORAL TABLET 3

GLYXAMBI ORAL TABLET 2

GMATE BLOOD GLUCOSE TEST IN VITRO STRIP 3

GMATE LANCETS 30G 2

GMATE SMART STARTER KIT 3

gnp easy touch glucose test in vitro strip 3

gnp insulin syringe 2

gnp lancets 2

gnp lancets 21g 2

gnp lancets micro thin 33g 2

gnp lancets super thin 30g 2

gnp lancets thin 2

gnp lancets thin 26g 2

gnp micro thin lancets 33g 2

gnp super thin lancets 30g 2

gnp ultra com insulin syringe 2

GOLYTELY ORAL SOLUTION RECONSTITUTED 3

GONAL-F INJECTION SOLUTION RECONSTITUTED 2

granisetron hcl oral tablet 1

GRIFULVIN V ORAL TABLET 3

Page 44: 2017 National Formulary - GuidantRx

44

Drug Name Tier Notes

griseofulvin microsize oral suspension 1

griseofulvin microsize oral tablet 1

griseofulvin ultramicrosize oral tablet 1

GRIS-PEG ORAL TABLET 3

guaiatussin ac oral syrup 1

guaifenesin ac oral syrup 1

guaifenesin-codeine oral solution 3

guanfacine hcl er oral tablet extended release 24 hour

1

guanfacine hcl oral tablet 1

guanidine hcl oral tablet 1

GUARDIAN REAL-TIME STARTER KIT 3

GUARDIAN REAL-TIME SYSTEM PED KIT 3

GYNAZOLE-1 VAGINAL CREAM 3

HALDOL DECANOATE INTRAMUSCULAR SOLUTION

3

halobetasol propionate external ointment 1

HALOG EXTERNAL CREAM 3

HALOG EXTERNAL OINTMENT 3

haloperidol decanoate intramuscular solution 1

haloperidol lactate oral concentrate 1

haloperidol oral tablet 1

HARVONI ORAL TABLET 3

HAVRIX INTRAMUSCULAR SUSPENSION 2

healthy accents unifine pentip 2

healthy accents unilet lancets 2

heather oral tablet 1

h-e-b incontrol lancets 28g 2

h-e-b incontrol lancets 30g 2

h-e-b incontrol lancets 33g 2

h-e-b incontrol pen needles 2

HELIXATE FS INTRAVENOUS KIT 2

hemmorex-hc rectal suppository 1

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED

2

heparin sodium (porcine) injection solution 1

HIPREX ORAL TABLET 3

Page 45: 2017 National Formulary - GuidantRx

45

Drug Name Tier Notes

homatropaire ophthalmic solution 1

homatropine hbr ophthalmic solution 1

HORIZANT ORAL TABLET EXTENDED RELEASE 3

HP ACTHAR INJECTION GEL 2

HUMALOG MIX 50/50 SUBCUTANEOUS SUSPENSION

3

HUMALOG MIX 75/25 SUBCUTANEOUS SUSPENSION

3

HUMALOG SUBCUTANEOUS SOLUTION 3

HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED

2

HUMATROPE INJECTION SOLUTION RECONSTITUTED

3

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 2

HUMIRA PEN-CROHNS STARTER SUBCUTANEOUS PEN-INJECTOR KIT

2

HUMIRA PEN-PSORIASIS STARTER SUBCUTANEOUS PEN-INJECTOR KIT

2

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION 3

HUMULIN N SUBCUTANEOUS SUSPENSION 3

HUMULIN R INJECTION SOLUTION 3

HYALGAN INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

3

HYCAMTIN ORAL CAPSULE 2

HYCET ORAL SOLUTION 3

hydralazine hcl oral tablet 1

HYDREA ORAL CAPSULE 3

hydrochlorothiazide oral tablet 1

hydrocod polst-cpm polst er oral suspension extended release

1

hydrocodone-acetaminophen oral solution 2.5- 108 mg/5ml

1

hydrocodone-acetaminophen oral solution 5-217 mg/10ml, 7.5-325 mg/15ml

3

hydrocodone-acetaminophen oral tablet 1

hydrocodone-homatropine oral tablet 1

hydrocodone-ibuprofen oral tablet 1

hydrocortisone ace-pramoxine rectal kit 1

hydrocortisone acetate rectal suppository 1

Page 46: 2017 National Formulary - GuidantRx

46

Drug Name Tier Notes

hydrocortisone butyrate external cream 1

hydrocortisone butyrate external solution 1

hydrocortisone external cream 1

hydrocortisone oral tablet 1

hydrocortisone rectal enema 1

hydrocortisone-acetic acid otic solution 1

hydromorphone hcl oral tablet 1

hydroxychloroquine sulfate oral tablet 1

hydroxyurea oral capsule 1

hydroxyzine hcl oral syrup 1

hydroxyzine hcl oral tablet 1

hydroxyzine pamoate oral capsule 1

HYMOVIS INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

3

hyoscyamine sulfate oral solution 1

hyoscyamine sulfate oral tablet dispersible 1

hyosyne oral solution 1

hypodermic needle 2

HYSINGLA ER ORAL TABLET ER 24 HOUR ABUSE- DETERRENT

2

HYZAAR ORAL TABLET 3

ibandronate sodium oral tablet 1

ICLUSIG ORAL TABLET 2

ILEVRO OPHTHALMIC SUSPENSION 2

ILOTYCIN OPHTHALMIC OINTMENT 3

imatinib mesylate oral tablet 1

IMBRUVICA ORAL CAPSULE 2

imipramine hcl oral tablet 1

imipramine pamoate oral capsule 1

imiquimod external cream 1

IMITREX NASAL SOLUTION 3

IMITREX ORAL TABLET 3

IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3

IMURAN ORAL TABLET 3

INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED

2

Page 47: 2017 National Formulary - GuidantRx

47

Drug Name Tier Notes

indapamide oral tablet 1

INDOCIN RECTAL SUPPOSITORY 3

indomethacin oral capsule 1

INFANRIX INTRAMUSCULAR SUSPENSION 2

INFINITY BLOOD GLUCOSE SYSTEM KIT 3

INFINITY BLOOD GLUCOSE TEST IN VITRO STRIP 3

INLYTA ORAL TABLET 2

INOVA EXTERNAL KIT 3

INSPIRACHAMBER/LARGE DEVICE 2

INSPIRACHAMBER/MEDIUM DEVICE 2

INSPIRACHAMBER/MOUTHPIECE DEVICE 2

INSPIRACHAMBER/SMALL DEVICE 2

INSPRA ORAL TABLET 3

insulin syringe 2

insulin syringe/needle 2

INTELENCE ORAL TABLET 2

INTERMEZZO SUBLINGUAL TABLET SUBLINGUAL 3

INTRON A INJECTION SOLUTION RECONSTITUTED 2

introvale oral tablet 1

INTUNIV ORAL TABLET EXTENDED RELEASE 24 HOUR

3

INVEGA ORAL TABLET EXTENDED RELEASE 24 HOUR

3

INVIRASE ORAL TABLET 2

INVOKAMET ORAL TABLET 2

INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2

INVOKANA ORAL TABLET 2

iophen c-nr oral liquid 1

IOPIDINE OPHTHALMIC SOLUTION 3

ipratropium bromide inhalation solution 1

ipratropium bromide nasal solution 1

ipratropium-albuterol inhalation solution 1

irbesartan oral tablet 1

irbesartan-hydrochlorothiazide oral tablet 1

ISENTRESS ORAL TABLET 2

isometheptene-dichloral-apap oral capsule 1

Page 48: 2017 National Formulary - GuidantRx

48

Drug Name Tier Notes

isoniazid oral tablet 1

ISOPTO ATROPINE OPHTHALMIC SOLUTION 3

ISOPTO CARPINE OPHTHALMIC SOLUTION 3

ISORDIL TITRADOSE ORAL TABLET 3

isosorbide dinitrate oral tablet 1

isosorbide mononitrate oral tablet 1

isradipine oral capsule 1

ISTALOL OPHTHALMIC SOLUTION 3

itraconazole oral capsule 1

ivermectin oral tablet 1

IXINITY INTRAVENOUS SOLUTION RECONSTITUTED

2

JAKAFI ORAL TABLET 2

JALYN ORAL CAPSULE 3

jantoven oral tablet 1

JANUMET ORAL TABLET 2

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2

JANUVIA ORAL TABLET 2

JARDIANCE ORAL TABLET 2

jencycla oral tablet 1

JENTADUETO ORAL TABLET 2

JENTADUETO XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2

jevantique lo oral tablet 1

jinteli oral tablet 1

jolessa oral tablet 1

jolivette oral tablet 1

juleber oral tablet 1

junel 1.5/30 oral tablet 1

junel 1/20 oral tablet 1

junel fe 1.5/30 oral tablet 1

junel fe 24 oral tablet 1

JUXTAPID ORAL CAPSULE 2

KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

kaitlib fe oral tablet chewable 1

Page 49: 2017 National Formulary - GuidantRx

49

Drug Name Tier Notes

KALETRA ORAL SOLUTION 2

KALETRA ORAL TABLET 2

KALYDECO ORAL TABLET 2

kariva oral tablet 1

KAZANO ORAL TABLET 3

kelnor 1/35 oral tablet 1

KENALOG EXTERNAL AEROSOL SOLUTION 3

KEPPRA ORAL SOLUTION 3

KEPPRA ORAL TABLET 3

ketoconazole external cream 1

ketoconazole external shampoo 1

ketoconazole oral tablet 1

ketoprofen oral capsule 1

ketorolac tromethamine ophthalmic solution 1

ketorolac tromethamine oral tablet 1

KHEDEZLA ORAL TABLET EXTENDED RELEASE 24 HOUR

3

kimidess oral tablet 1

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 ST

KINEVAC INJECTION SOLUTION RECONSTITUTED 2

kinney lancets 2

kinney thin lancets 2

KISQALI 200 DOSE ORAL TABLET 2

KLONOPIN ORAL TABLET 3

klor-con 10 oral tablet extended release 1

klor-con oral packet 1

KOATE-DVI INTRAVENOUS SOLUTION RECONSTITUTED

2

KOGENATE FS BIO-SET INTRAVENOUS KIT 2

KOGENATE FS INTRAVENOUS KIT 2

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

KOVALTRY INTRAVENOUS SOLUTION RECONSTITUTED

3

KRISTALOSE ORAL PACKET 3

kroger blood glucose test in vitro strip 3

kroger lancets 21g 2

Page 50: 2017 National Formulary - GuidantRx

50

Drug Name Tier Notes

kroger lancets micro thin 33g 2

kroger lancets thin 26g 2

kroger lancets ultrathin 30g 2

kroger premium blood glucose kit 3

kroger premium glucose test in vitro strip 3

kroger test in vitro strip 3

KRYSTEXXA INTRAVENOUS SOLUTION 2

k-sol oral solution 1

K-TAB ORAL TABLET EXTENDED RELEASE 3

kurvelo oral tablet 1

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE 3

labetalol hcl oral tablet 1

lactulose oral solution 1

LAMICTAL ODT ORAL TABLET DISPERSIBLE 3

LAMICTAL ORAL TABLET 3

LAMICTAL XR ORAL KIT 2

LAMISIL ORAL PACKET 2

LAMISIL ORAL TABLET 3

lamivudine oral solution 1

lamivudine oral tablet 1

lamivudine-zidovudine oral tablet 1

lamotrigine oral tablet 1

lamotrigine oral tablet dispersible 1

lancets 2

lancets 28g 2

lancets 30g 2

lancets micro thin 33g 2

lancets super thin 28g 2

lancets thin 2

LANCETS ULTRA FINE 2

LANCETS ULTRA THIN 2

lancets ultra thin 30g 2

LANOXIN ORAL TABLET 3

lansoprazole oral capsule delayed release 1

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

LANTUS SUBCUTANEOUS SOLUTION 2

Page 51: 2017 National Formulary - GuidantRx

51

Drug Name Tier Notes

larin 1.5/30 oral tablet 1

larin 1/20 oral tablet 1

larin 24 fe oral tablet 1

larin fe 1.5/30 oral tablet 1

larissia oral tablet 1

LASTACAFT OPHTHALMIC SOLUTION 3

latanoprost ophthalmic solution 1

LATUDA ORAL TABLET 2

layolis fe oral tablet chewable 1

leader insulin syringe 2

LEADER UNIFINE PENTIPS 2

LEADER UNIFINE PENTIPS PLUS 2

leena oral tablet 1

leflunomide oral tablet 1

LESCOL ORAL CAPSULE 3

LESCOL XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

lessina oral tablet 1

LETAIRIS ORAL TABLET 2

letrozole oral tablet 1

leucovorin calcium oral tablet 1

LEUKERAN ORAL TABLET 2

levalbuterol hcl inhalation nebulization solution 1

LEVAQUIN ORAL TABLET 3

LEVATOL ORAL TABLET 3

LEVEMIR SUBCUTANEOUS SOLUTION 2

levetiracetam oral solution 1

levetiracetam oral tablet 1

LEVITRA ORAL TABLET 3

levobunolol hcl ophthalmic solution 1

levocetirizine dihydrochloride oral tablet 1

levofloxacin ophthalmic solution 1

levofloxacin oral solution 3

levofloxacin oral tablet 1

levonest oral tablet 1

levonorgest-eth estrad 91-day oral tablet 1

levonorgestrel-ethinyl estrad oral tablet 1

Page 52: 2017 National Formulary - GuidantRx

52

Drug Name Tier Notes

levonorg-eth estrad triphasic oral tablet 1

levora 0.15/30 (28) oral tablet 1

LEVO-T ORAL TABLET 2

levothyroxine sodium oral tablet 1

levoxyl oral tablet 1

LEXAPRO ORAL SOLUTION 3

LEXAPRO ORAL TABLET 3

LEXIVA ORAL SUSPENSION 2

LEXIVA ORAL TABLET 2

LIALDA ORAL TABLET DELAYED RELEASE 3

liberty test in vitro strip 3

LIBRAX ORAL CAPSULE 3

lidocaine external ointment 1

lidocaine pak external ointment 1

lidocaine-hydrocortisone ace rectal cream 1

lidocaine-prilocaine external cream 1

lidocaine-tetracaine external cream 3

lindane external shampoo 1

linezolid oral tablet 1

LINZESS ORAL CAPSULE 3

liothyronine sodium oral tablet 1

LIPITOR ORAL TABLET 3

LIPOFEN ORAL CAPSULE 2

lisinopril oral tablet 1

lisinopril-hydrochlorothiazide oral tablet 1

lite touch lancets 2

LITE TOUCH PEN NEEDLES 2

LITEAIRE DEVICE 2

LITETOUCH INSULIN SYRINGE 2

LITETOUCH LANCETS 2

lithium carbonate er oral tablet extended release 1

lithium carbonate oral capsule 1

lithium oral solution 1

LIVALO ORAL TABLET 3

live better lancet super thin 2

live better lancet ultra thin 2

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Drug Name Tier Notes

LO LOESTRIN FE ORAL TABLET 2

LOCOID EXTERNAL CREAM 3

LOCOID EXTERNAL LOTION 3

LOCOID EXTERNAL SOLUTION 3

LOESTRIN 1.5/30 (21) ORAL TABLET 3

LOESTRIN 1/20 (21) ORAL TABLET 3

LOESTRIN FE 1.5/30 ORAL TABLET 3

LOFIBRA ORAL TABLET 3

lomedia 24 fe oral tablet 1

LOMOTIL ORAL TABLET 3

longs lancets standard 2

longs lancets thin 2

longs lancets ultra thin 2

loperamide hcl oral capsule 1

LOPID ORAL TABLET 3

lopreeza oral tablet 1

LOPRESSOR ORAL TABLET 3

LOPROX EXTERNAL SHAMPOO 3

lorazepam intensol oral concentrate 1

lorazepam oral concentrate 1

lorazepam oral tablet 1

lorcet oral tablet 1

lortab oral tablet 1

loryna oral tablet 1

LORZONE ORAL TABLET 3

losartan potassium oral tablet 1

losartan potassium-hctz oral tablet 1

LOTEMAX OPHTHALMIC SUSPENSION 2

LOTENSIN ORAL TABLET 3

LOTREL ORAL CAPSULE 3

LOTRISONE EXTERNAL CREAM 3

LOTRONEX ORAL TABLET 3

lovastatin oral tablet 1

LOVAZA ORAL CAPSULE 3

LOVENOX SUBCUTANEOUS SOLUTION 3

low-ogestrel oral tablet 1

Page 54: 2017 National Formulary - GuidantRx

54

Drug Name Tier Notes

loxapine succinate oral capsule 1

ludent oral tablet chewable 1

LUMIGAN OPHTHALMIC SOLUTION 2

LUNESTA ORAL TABLET 3

lutera oral tablet 1

LYRICA ORAL CAPSULE 2

LYSODREN ORAL TABLET 2

lyza oral tablet 1

MACROBID ORAL CAPSULE 3

MACRODANTIN ORAL CAPSULE 3

MALARONE ORAL TABLET 3

malathion external lotion 1

maprotiline hcl oral tablet 1

MARINOL ORAL CAPSULE 3

marlissa oral tablet 1

MARPLAN ORAL TABLET 3

MATULANE ORAL CAPSULE 2

MAVIK ORAL TABLET 3

MAXALT ORAL TABLET 3

MAXI-COMFORT INSULIN SYRINGE 2

MAXIDEX OPHTHALMIC SUSPENSION 3

MAXITROL OPHTHALMIC OINTMENT 3

MAXITROL OPHTHALMIC SUSPENSION 3

MAXZIDE-25 ORAL TABLET 3

meclizine hcl oral tablet 1

meclofenamate sodium oral capsule 1

medicine shoppe lancets 2

medicine shoppe lancets thin 2

MEDISENSE THIN LANCETS 2

medlance lite 25g 1

MEDLANCE PLUS EXTRA 21G 2

medlance plus lancets 1

MEDLANCE PLUS LITE 25G 2

MEDLANCE PLUS SPECIAL 0.8MM 2

MEDLANCE PLUS SUPERLITE 30G 2

MEDLANCE PLUS UNIVERSAL 21G 2

Page 55: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

medlance universal 21g 1

MEDROL ORAL TABLET THERAPY PACK 3

mefenamic acid oral capsule 1

mefloquine hcl oral tablet 1

MEGACE ES ORAL SUSPENSION 3

MEGACE ORAL ORAL SUSPENSION 3

megestrol acetate oral suspension 1

megestrol acetate oral tablet 1

meijer blood glucose kit 3

meijer blood glucose test in vitro strip 3

MEIJER LANCETS 2

MEIJER LANCETS THIN 2

MEIJER LANCETS UNIVERSAL 33G 2

meijer premium blood glucose kit 3

meijer premium glucose test in vitro strip 3

MEIJER SUPER THIN LANCETS 2

MEKINIST ORAL TABLET 2

meloxicam oral suspension 1

meloxicam oral tablet 1

memantine hcl oral solution 1

MENOPUR SUBCUTANEOUS SOLUTION RECONSTITUTED

2

MENTAX EXTERNAL CREAM 3

meperidine hcl oral solution 1

MEPHYTON ORAL TABLET 2

meprobamate oral tablet 1

MEPRON ORAL SUSPENSION 3

mercaptopurine oral tablet 1

mesalamine oral tablet delayed release 3

mesalamine rectal enema 1

MESNEX ORAL TABLET 2

METADATE CD ORAL CAPSULE EXTENDED RELEASE

3

metaproterenol sulfate oral syrup 1

metaproterenol sulfate oral tablet 1

metaxall oral tablet 1

metaxalone oral tablet 1

Page 56: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

metformin hcl er (mod) oral tablet extended release 24 hour

1

metformin hcl er oral tablet extended release 24 hour

1

metformin hcl oral tablet 1

methadone hcl oral solution 1

methadone hcl oral tablet soluble 1

methadose oral tablet soluble 1

methazolamide oral tablet 1

methenamine hippurate oral tablet 1

methenamine mandelate oral tablet 1

methimazole oral tablet 1

methocarbamol oral tablet 1

methotrexate oral tablet 1

methscopolamine bromide oral tablet 1

methyclothiazide oral tablet 1

methyldopa oral tablet 1

methyldopa-hydrochlorothiazide oral tablet 1

METHYLIN ORAL SOLUTION 3

methylphenidate hcl er (cd) oral capsule extended release

1

methylphenidate hcl er (la) oral capsule extended release 24 hour

1

methylphenidate hcl oral solution 1

methylphenidate hcl oral tablet 1

methylprednisolone acetate injection suspension 1

methylprednisolone oral tablet therapy pack 1

methyltestosterone oral capsule 1

metipranolol ophthalmic solution 1

metoclopramide hcl oral solution 1

metoclopramide hcl oral tablet 1

metoclopramide hcl oral tablet dispersible 1

metolazone oral tablet 1

metoprolol tartrate oral tablet 1

METOZOLV ODT ORAL TABLET DISPERSIBLE 3

METROCREAM EXTERNAL CREAM 3

METROGEL-VAGINAL VAGINAL GEL 3

Page 57: 2017 National Formulary - GuidantRx

57

Drug Name Tier Notes

METROLOTION EXTERNAL LOTION 3

metronidazole external cream 1

metronidazole external gel 1

metronidazole external lotion 1

metronidazole oral tablet 1

metronidazole vaginal gel 1

mexiletine hcl oral capsule 1

MIACALCIN NASAL SOLUTION 3

MICARDIS HCT ORAL TABLET 3

MICARDIS ORAL TABLET 3

miconazole 3 vaginal suppository 1

MICROCHAMBER 2

MICRODOT BLOOD GLUCOSE SYSTEM KIT 3

MICRODOT TEST IN VITRO STRIP 3

microgestin 1.5/30 oral tablet 1

microgestin 1/20 oral tablet 1

MICROGESTIN 24 FE ORAL TABLET 3

microgestin fe 1.5/30 oral tablet 1

MICROLET LANCETS 2

MICROSPACER 2

midazolam hcl oral syrup 1

midodrine hcl oral tablet 1

miglitol oral tablet 1

MIGRANAL NASAL SOLUTION 3

mimvey oral tablet 1

MINIPRESS ORAL CAPSULE 3

MINITRAN TRANSDERMAL PATCH 24 HOUR 3

MINIVELLE TRANSDERMAL PATCH TWICE WEEKLY

3

MINOCIN ORAL CAPSULE 3

minocycline hcl oral capsule 1

minoxidil oral tablet 1

MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE

3

MIRCETTE ORAL TABLET 3

Page 58: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

mirtazapine oral tablet 1

MIRVASO EXTERNAL GEL 2

MITIGARE ORAL CAPSULE 3

MITOSOL OPHTHALMIC KIT 3

MOBIC ORAL SUSPENSION 3

MOBIC ORAL TABLET 3

modafinil oral tablet 1

moderiba 800 dose pack oral tablet 1

moderiba oral tablet 1

MODICON (28) ORAL TABLET 3

moexipril hcl oral tablet 1

moexipril-hydrochlorothiazide oral tablet 1

mometasone furoate external ointment 1

mometasone furoate external solution 1

mometasone furoate nasal suspension 1

MONOCLATE-P INTRAVENOUS KIT 2

MONOJECT HYPODERMIC NEEDLE 2

MONOJECT INSULIN SYRINGE 2

MONOJECT ULTRA COMFORT SYRINGE 2

MONOLET LANCETS 2

mono-linyah oral tablet 1

mononessa oral tablet 1

MONONINE INTRAVENOUS SOLUTION RECONSTITUTED

2

MONOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

3

montelukast sodium oral packet 1

montelukast sodium oral tablet 1

MONUROL ORAL PACKET 3

morgidox oral capsule 1

morphine sulfate er oral capsule extended release 24 hour

1

morphine sulfate er oral tablet extended release 1

morphine sulfate rectal suppository 1

MOVANTIK ORAL TABLET 3

MOVIPREP ORAL SOLUTION RECONSTITUTED 3

MOXEZA OPHTHALMIC SOLUTION 2

Page 59: 2017 National Formulary - GuidantRx

59

Drug Name Tier Notes

MS CONTIN ORAL TABLET EXTENDED RELEASE 3

MULTAQ ORAL TABLET 3

mupirocin external ointment 1

MUSE URETHRAL PELLET 2

M-VIT ORAL TABLET 3

MYAMBUTOL ORAL TABLET 3

mycophenolate mofetil oral capsule 1

mycophenolate mofetil oral suspension reconstituted

1

MYDRIACYL OPHTHALMIC SOLUTION 3

MYGLUCOHEALTH BLOOD GLUCOSE KIT 3

MYGLUCOHEALTH LANCETS 30G 2

MYGLUCOHEALTH TEST IN VITRO STRIP 3

myorisan oral capsule 1

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR

2

MYSOLINE ORAL TABLET 3

myzilra oral tablet 1

nabumetone oral tablet 1

nadolol oral tablet 1

nadolol-bendroflumethiazide oral tablet 1

naftifine hcl external cream 1

NAFTIN EXTERNAL CREAM 3

NAFTIN EXTERNAL GEL 3

NALFON ORAL CAPSULE 3

naltrexone hcl oral tablet 1

NAMENDA ORAL SOLUTION 3

NAMENDA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2

naproxen oral tablet 1

naproxen sodium oral tablet 1

naratriptan hcl oral tablet 1

NARCAN NASAL LIQUID 2

NARDIL ORAL TABLET 3

NASCOBAL NASAL SOLUTION 2

NASONEX NASAL SUSPENSION 3

NATACYN OPHTHALMIC SUSPENSION 2

Page 60: 2017 National Formulary - GuidantRx

60

Drug Name Tier Notes

NATAZIA ORAL TABLET 2

nateglinide oral tablet 1

NATESTO NASAL GEL 3

nature-throid oral tablet 1

necon 0.5/35 (28) oral tablet 1

necon 1/35 (28) oral tablet 1

necon 1/50 (28) oral tablet 1

necon 7/7/7 oral tablet 1

nefazodone hcl oral tablet 1

neomycin-bacitracin zn-polymyx ophthalmic ointment

1

neomycin-polymyxin-dexameth ophthalmic ointment

1

neomycin-polymyxin-dexameth ophthalmic suspension

1

neomycin-polymyxin-gramicidin ophthalmic solution

1

neomycin-polymyxin-hc ophthalmic suspension 1

neomycin-polymyxin-hc otic solution 1

neo-polycin hc ophthalmic ointment 1

neo-polycin ophthalmic ointment 1

NEORAL ORAL CAPSULE 2

NEORAL ORAL SOLUTION 2

NEOSPORIN OPHTHALMIC SOLUTION 3

nephro-vite rx oral tablet 1

NEPTAZANE ORAL TABLET 3

NESINA ORAL TABLET 3

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE

2

NEUPRO TRANSDERMAL PATCH 24 HOUR 3

NEURONTIN ORAL CAPSULE 3

NEURONTIN ORAL TABLET 3

NEUTEK 2TEK TEST IN VITRO STRIP 3

NEVANAC OPHTHALMIC SUSPENSION 2

nevirapine oral suspension 1

nevirapine oral tablet 1

Page 61: 2017 National Formulary - GuidantRx

61

Drug Name Tier Notes

NEXAVAR ORAL TABLET 2

NEXIUM ORAL CAPSULE DELAYED RELEASE 3

NEXIUM ORAL PACKET 2

niacin er (antihyperlipidemic) oral tablet extended release

1

NIACOR ORAL TABLET 3

NIASPAN ORAL TABLET EXTENDED RELEASE 3

nifedipine er oral tablet extended release 24 hour

1

nifedipine oral capsule 1

nikki oral tablet 1

nimodipine oral capsule 1

nisoldipine er oral tablet extended release 24 hour

1

nitro-bid transdermal ointment 1

NITRO-DUR TRANSDERMAL PATCH 24 HOUR 3

nitrofurantoin macrocrystal oral capsule 1

nitrofurantoin monohyd macro oral capsule 1

nitroglycerin transdermal patch 24 hour 1

nitroglycerin translingual aerosol solution 1

NITROMIST TRANSLINGUAL AEROSOL SOLUTION 3

NITROSTAT SUBLINGUAL TABLET SUBLINGUAL 2

NIVA-PLUS ORAL TABLET 3

nizatidine oral capsule 1

nizatidine oral solution 1

NIZORAL EXTERNAL SHAMPOO 3

nodolor oral capsule 1

nora-be oral tablet 1

NORCO ORAL TABLET 3

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION

2

norethin ace-eth estrad-fe oral tablet 1

norethindrone acet-ethinyl est oral tablet 1

norethindrone oral tablet 1

norethindrone-eth estradiol oral tablet 1

norethin-eth estradiol-fe oral tablet chewable 1

norgestimate-eth estradiol oral tablet 1

Page 62: 2017 National Formulary - GuidantRx

62

Drug Name Tier Notes

norgestim-eth estrad triphasic oral tablet 1

NORINYL 1+35 (28) ORAL TABLET 3

NORINYL 1+50 (28) ORAL TABLET 3

NORITATE EXTERNAL CREAM 3

norlyroc oral tablet 1

NORPACE CR ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

NORPACE ORAL CAPSULE 3

NORPRAMIN ORAL TABLET 3

NOR-QD ORAL TABLET 3

nortrel 0.5/35 (28) oral tablet 1

nortrel 1/35 (21) oral tablet 1

nortrel 1/35 (28) oral tablet 1

nortrel 7/7/7 oral tablet 1

nortriptyline hcl oral capsule 1

nortriptyline hcl oral solution 1

NORVASC ORAL TABLET 3

NORVIR ORAL SOLUTION 2

NORVIR ORAL TABLET 2

NOVA MAX BLOOD GLUCOSE SYSTEM KIT 3

NOVA MAX GLUCOSE TEST IN VITRO STRIP 3

NOVA SAFETY LANCETS 23G 2

NOVA SAFETY LANCETS 28G 2

NOVA SUREFLEX LANCETS 2

NOVACORT EXTERNAL GEL 3

novarel intramuscular solution reconstituted 1

NOVOEIGHT INTRAVENOUS SOLUTION RECONSTITUTED

3

NOVOFINE 2

NOVOFINE PLUS 2

NOVOLIN 70/30 RELION SUBCUTANEOUS SUSPENSION

2

NOVOLIN 70/30 SUBCUTANEOUS SUSPENSION 2

NOVOLIN N RELION SUBCUTANEOUS SUSPENSION

2

NOVOLIN N SUBCUTANEOUS SUSPENSION 2

NOVOLIN R INJECTION SOLUTION 2

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63

Drug Name Tier Notes

NOVOLIN R RELION INJECTION SOLUTION 2

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

NOVOLOG MIX 70/30 SUBCUTANEOUS SUSPENSION

2

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE

2

NOVOSEVEN RT INTRAVENOUS SOLUTION RECONSTITUTED

2

NOXAFIL ORAL SUSPENSION 2

NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HOUR

2

NUCYNTA ORAL TABLET 2

NUEDEXTA ORAL CAPSULE 2

NULEV ORAL TABLET DISPERSIBLE 3

NUOX EXTERNAL GEL 3

NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION

3

NUTROPIN AQ PEN SUBCUTANEOUS SOLUTION 3

NUVARING VAGINAL RING 2

NUVIGIL ORAL TABLET 3

NUWIQ INTRAVENOUS KIT 3

NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED

3

nystatin external ointment 1

nystatin mouth/throat suspension 1

nystatin oral tablet 1

nystatin-triamcinolone external cream 1

OB COMPLETE ORAL TABLET 3

obizur intravenous solution reconstituted 2

O-CAL FA ORAL TABLET 3

ocella oral tablet 1

OCTAGAM INTRAVENOUS SOLUTION 3

OCUFEN OPHTHALMIC SOLUTION 3

OCUFLOX OPHTHALMIC SOLUTION 3

ofloxacin ophthalmic solution 1

ogestrel oral tablet 1

olanzapine oral tablet 1

Page 64: 2017 National Formulary - GuidantRx

64

Drug Name Tier Notes

olanzapine oral tablet dispersible 1

olanzapine-fluoxetine hcl oral capsule 1

OLEPTRO ORAL TABLET EXTENDED RELEASE 24 HOUR

3

olopatadine hcl nasal solution 1

olopatadine hcl ophthalmic solution 1

OLYSIO ORAL CAPSULE 3

omega-3-acid ethyl esters oral capsule 1

omeprazole oral capsule delayed release 1

omeprazole-sodium bicarbonate oral capsule 1

OMNARIS NASAL SUSPENSION 3

OMNIPRED OPHTHALMIC SUSPENSION 3

OMNITROPE SUBCUTANEOUS SOLUTION 3

ON CALL EXPRESS BLOOD GLUCOSE IN VITRO STRIP

3

ON CALL EXPRESS MONITORING SYS KIT 3

ON CALL LANCETS 2

ON CALL PLUS BLOOD GLUCOSE IN VITRO STRIP 3

ON CALL PLUS LANCETS 2

ON CALL PLUS METER KIT 3

ON CALL PLUS MONITORING SYSTEM KIT 3

ON CALL VIVID BLOOD GLUCOSE IN VITRO STRIP 3

ON CALL VIVID METER KIT 3

ON CALL VIVID MONITORING KIT 3

ON CALL VIVID PAL METER KIT 3

ondansetron hcl oral solution 1

ondansetron hcl oral tablet 1

ondansetron oral tablet dispersible 1

ONETOUCH DELICA LANCETS 33G 2

ONETOUCH DELICA LANCETS FINE 2

ONETOUCH ULTRA 2 KIT 2

ONETOUCH ULTRA BLUE IN VITRO STRIP 2

ONETOUCH ULTRA MINI KIT 2

ONETOUCH ULTRASOFT LANCETS 2

ONETOUCH VERIO FLEX SYSTEM KIT 2

ONETOUCH VERIO IN VITRO STRIP 2

ONETOUCH VERIO IQ SYSTEM KIT 2

Page 65: 2017 National Formulary - GuidantRx

65

Drug Name Tier Notes

ONETOUCH VERIO KIT 2

ONETOUCH VERIO SYNC SYSTEM KIT 2

ONFI ORAL SUSPENSION 2

ONGLYZA ORAL TABLET 3

ONMEL ORAL TABLET 3

OPANA ER ORAL TABLET ER 12 HOUR ABUSE- DETERRENT

2

OPANA ORAL TABLET 3

OPTICHAMBER DIAMOND 2

OPTICHAMBER DIAMOND-LG MASK DEVICE 2

OPTICHAMBER DIAMOND-MD MASK 2

OPTICHAMBER DIAMOND-SM MASK 2

OPTIUM TEST IN VITRO STRIP 3

OPTIUMEZ TEST IN VITRO STRIP 3

OPTUMRX BLOOD GLUCOSE METER KIT 3

OPTUMRX BLOOD GLUCOSE SYSTEM KIT 3

OPTUMRX BLOOD GLUCOSE TEST IN VITRO STRIP 3

ORACEA ORAL CAPSULE DELAYED RELEASE 2

ORAP ORAL TABLET 3

ORAPRED ODT ORAL TABLET DISPERSIBLE 3

ORENCIA CLICKJECT SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3

ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3

orphenadrine citrate er oral tablet extended release 12 hour

1

orsythia oral tablet 1

ORTHO MICRONOR ORAL TABLET 3

ORTHO TRI-CYCLEN (28) ORAL TABLET 3

ORTHO TRI-CYCLEN LO ORAL TABLET 3

ORTHO-CYCLEN (28) ORAL TABLET 3

ORTHO-NOVUM 1/35 (28) ORAL TABLET 3

ORTHO-NOVUM 7/7/7 (28) ORAL TABLET 3

ORTHOVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

3

oscimin oral tablet dispersible 1

oseltamivir phosphate oral capsule 1

OSENI ORAL TABLET 3

Page 66: 2017 National Formulary - GuidantRx

66

Drug Name Tier Notes

OSMOPREP ORAL TABLET 3

OTEZLA ORAL TABLET 3

OTREXUP SUBCUTANEOUS SOLUTION AUTO- INJECTOR

2

OVACE PLUS EXTERNAL SHAMPOO 3

OVACE PLUS WASH EXTERNAL LIQUID 3

OVACE WASH EXTERNAL LIQUID 3

OVCON-35 (28) ORAL TABLET 3

OVIDE EXTERNAL LOTION 3

OXANDRIN ORAL TABLET 3

oxandrolone oral tablet 1

oxaprozin oral tablet 1

OXAYDO ORAL TABLET ABUSE-DETERRENT 3

oxcarbazepine oral suspension 1

oxcarbazepine oral tablet 1

oxiconazole nitrate external cream 1

OXISTAT EXTERNAL CREAM 3

OXISTAT EXTERNAL LOTION 3

OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

oxybutynin chloride er oral tablet extended release 24 hour

1

oxybutynin chloride oral syrup 1

oxybutynin chloride oral tablet 1

oxycodone hcl er oral tablet er 12 hour abuse- deterrent

3

oxycodone hcl oral solution 1

oxycodone-acetaminophen oral tablet 1

oxycodone-aspirin oral tablet 1

oxycodone-ibuprofen oral tablet 1

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE- DETERRENT

2

oxymorphone hcl er oral tablet extended release 12 hour

1

oxymorphone hcl oral tablet 1

OXYTROL TRANSDERMAL PATCH TWICE WEEKLY 3

pacerone oral tablet 1

PACNEX WASH EXTERNAL LIQUID† 3

Page 67: 2017 National Formulary - GuidantRx

67

Drug Name Tier Notes

paliperidone er oral tablet extended release 24 hour

1

PAMELOR ORAL CAPSULE 3

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES

3

PANDEL EXTERNAL CREAM 3

pantoprazole sodium oral tablet delayed release 1

PARAFON FORTE DSC ORAL TABLET 3

PAREMYD OPHTHALMIC SOLUTION 3

PARLODEL ORAL TABLET 3

PARNATE ORAL TABLET 3

paromomycin sulfate oral capsule 1

paroxetine hcl oral tablet 1

PASER ORAL PACKET 3

PATADAY OPHTHALMIC SOLUTION 2

PATANASE NASAL SOLUTION 3

PATANOL OPHTHALMIC SOLUTION 3

PAXIL ORAL TABLET 3

pc lancets super thin 30g 2

pc unifine pentips 2

PCE ORAL TABLET DELAYED RELEASE 3

PEDIADERM HC EXTERNAL KIT 3

peg-3350/electrolytes oral solution reconstituted 1

PEGANONE ORAL TABLET 2

PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 3

PEG-INTRON REDIPEN SUBCUTANEOUS KIT 3

PEGINTRON SUBCUTANEOUS KIT 3

pen needles 3/16" 2

penicillin v potassium oral solution reconstituted 1

penicillin v potassium oral tablet 1

PENTASA ORAL CAPSULE EXTENDED RELEASE 2

PENTIPS 2

pentoxifylline er oral tablet extended release 1

PEPCID ORAL SUSPENSION RECONSTITUTED 3

PEPCID ORAL TABLET 3

PERCOCET ORAL TABLET 3

Page 68: 2017 National Formulary - GuidantRx

68

Drug Name Tier Notes

PERFOROMIST INHALATION NEBULIZATION SOLUTION

3

perindopril erbumine oral tablet 1

permethrin external cream 1

perphenazine oral tablet 1

perphenazine-amitriptyline oral tablet 1

PERSANTINE ORAL TABLET 3

PERTZYE ORAL CAPSULE DELAYED RELEASE PARTICLES

3

PEXEVA ORAL TABLET 3

PHARMACIST CHOICE AUTOCODE IN VITRO STRIP 3

PHARMACIST CHOICE AUTOCODE SYS KIT 3

PHARMACIST CHOICE LANCETS 2

pharmacist choice no coding in vitro strip 3

phenelzine sulfate oral tablet 1

phenobarbital oral elixir 1

phenobarbital oral solution 1

phenobarbital oral tablet 1

phenyleph-promethazine-cod oral syrup 1

phenytoin oral suspension 1

phenytoin sodium extended oral capsule 1

philith oral tablet 1

PICATO EXTERNAL GEL 2

pilocarpine hcl ophthalmic solution 1

pimozide oral tablet 1

pimtrea oral tablet 1

pindolol oral tablet 1

pioglitazone hcl oral tablet 1

pioglitazone hcl-glimepiride oral tablet 1

pioglitazone hcl-metformin hcl oral tablet 1

pirmella 1/35 oral tablet 1

pirmella 7/7/7 oral tablet 1

piroxicam oral capsule 1

PLAN B ONE-STEP ORAL TABLET 3

PLAQUENIL ORAL TABLET 3

PLAVIX ORAL TABLET 3

PLETAL ORAL TABLET 3

Page 69: 2017 National Formulary - GuidantRx

69

Drug Name Tier Notes

PLIAGLIS EXTERNAL CREAM 3

PNEUMOVAX 23 INJECTION INJECTABLE 2

pnv prenatal plus multivitamin oral tablet 1

pnv tabs 29-1 oral tablet 1

POCKET CHAMBER DEVICE 2

podofilox external solution 1

poly hub needle 2

polycin ophthalmic ointment 1

polymyxin b-trimethoprim ophthalmic solution 1

POLYTRIM OPHTHALMIC SOLUTION 3

POMALYST ORAL CAPSULE 2

PONSTEL ORAL CAPSULE 3

portia-28 oral tablet 1

potassium chloride er oral tablet extended release

1

potassium chloride oral packet 1

potassium chloride oral solution 1

POTIGA ORAL TABLET 2

PR BENZOYL PEROXIDE WASH EXTERNAL LIQUID 3

PRADAXA ORAL CAPSULE 3

PRALUENT SUBCUTANEOUS SOLUTION PEN- INJECTOR

2

PRALUENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2

pramipexole dihydrochloride er oral tablet extended release 24 hour

1

PRAMOSONE E EXTERNAL CREAM 3

PRAMOSONE EXTERNAL CREAM 3

PRAMOSONE EXTERNAL LOTION 3

PRAMOSONE EXTERNAL OINTMENT 3

PRANDIN ORAL TABLET 3

pravastatin sodium oral tablet 1

prazosin hcl oral capsule 1

PRECISION PCX IN VITRO STRIP 3

PRECISION PCX PLUS TEST IN VITRO STRIP 3

PRECISION POINT OF CARE TEST IN VITRO STRIP 3

PRECISION QID TEST IN VITRO STRIP 3

Page 70: 2017 National Formulary - GuidantRx

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Drug Name Tier Notes

PRECISION XTRA BLOOD GLUCOSE IN VITRO STRIP

2

PRECOSE ORAL TABLET 3

PRED FORTE OPHTHALMIC SUSPENSION 3

PRED MILD OPHTHALMIC SUSPENSION 2

PRED-G S.O.P. OPHTHALMIC OINTMENT 3

prednicarbate external ointment 1

prednisolone acetate ophthalmic suspension 1

prednisolone oral solution 1

prednisolone oral syrup 1

prednisolone sodium phosphate oral tablet dispersible

1

prednisone oral tablet 1

preferred plus insulin syringe 2

preferred plus lancets colored 2

preferred plus lancets thin 2

preferred plus unifine pentips 2

PREFEST ORAL TABLET 3

PREGNYL INTRAMUSCULAR SOLUTION RECONSTITUTED

3

PREMARIN ORAL TABLET 2

PREMARIN VAGINAL CREAM 2

premium blood glucose test in vitro strip 3

PREMPHASE ORAL TABLET 2

PREMPRO ORAL TABLET 2

prenatabs rx oral tablet 1

prenatal low iron oral tablet 1

prenatal oral tablet 1

prenatal plus iron oral tablet 1

prenatal plus oral tablet 1

prenatal vitamin plus low iron oral tablet 1

preplus oral tablet 1

PREVACID ORAL CAPSULE DELAYED RELEASE 3

prevalite oral packet 1

previfem oral tablet 1

PREVNAR 13 INTRAMUSCULAR SUSPENSION 2

PREVPAC ORAL 3

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Drug Name Tier Notes

PREZISTA ORAL SUSPENSION 2

PREZISTA ORAL TABLET 2

primaquine phosphate oral tablet 2

primidone oral tablet 1

PRIMLEV ORAL TABLET 3

PRIMSOL ORAL SOLUTION 3

PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HOUR

2

PRIVIGEN INTRAVENOUS SOLUTION 2

PROAIR HFA INHALATION AEROSOL SOLUTION 2

probenecid oral tablet 1

procainamide hcl injection solution 1

PROCARDIA ORAL CAPSULE 3

procentra oral solution 1

prochlorperazine maleate oral tablet 1

PROCRIT INJECTION SOLUTION 2

PRODIGY AUTOCODE BLOOD GLUCOSE KIT 3

PRODIGY INSULIN SYRINGE 2

PRODIGY LANCETS 28G 2

PRODIGY NO CODING BLOOD GLUC IN VITRO STRIP

3

PRODIGY POCKET BLOOD GLUCOSE KIT 3

PRODIGY SAFETY LANCETS 26G 2

PRODIGY TWIST TOP LANCETS 28G 2

PRODIGY VOICE BLOOD GLUCOSE KIT 3

PROFILNINE INTRAVENOUS SOLUTION RECONSTITUTED

2

PROFILNINE SD INTRAVENOUS SOLUTION RECONSTITUTED

2

progesterone micronized oral capsule 1

PROGRAF ORAL CAPSULE 3

PROLENSA OPHTHALMIC SOLUTION 2

PROLIA SUBCUTANEOUS SOLUTION 3

promethazine hcl oral tablet 1

promethazine hcl rectal suppository 1

promethazine vc plain oral syrup 1

promethazine vc/codeine oral syrup 1

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Drug Name Tier Notes

promethazine-dm oral syrup 1

promethazine-phenylephrine oral syrup 1

PROMETRIUM ORAL CAPSULE 3

propafenone hcl oral tablet 1

proparacaine hcl ophthalmic solution 1

propranolol hcl oral solution 1

propranolol hcl oral tablet 1

propranolol-hctz oral tablet 1

PROSCAR ORAL TABLET 3

PROTONIX ORAL TABLET DELAYED RELEASE 3

PROTOPIC EXTERNAL OINTMENT 3

protriptyline hcl oral tablet 1

PROVENTIL HFA INHALATION AEROSOL SOLUTION

3

PROVIGIL ORAL TABLET 3

PROZAC ORAL CAPSULE 3

pseudoeph-bromphen-dm oral syrup 1

psorcon external cream 3

PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED

3

PULMICORT INHALATION SUSPENSION 3

PULMOZYME INHALATION SOLUTION 2

px lancets ultra thin 2

px mini pen needles 2

PYLERA ORAL CAPSULE 2

pyrazinamide oral tablet 1

qc lancets super thin 30g 2

qc unilet lancets 28g 2

qc unilet lancets micro thin 2

QNASL NASAL AEROSOL SOLUTION 2

QSYMIA ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

QUALAQUIN ORAL CAPSULE 3

QUARTETTE ORAL TABLET 3

quasense oral tablet 1

quazepam oral tablet 1

QUESTRAN ORAL PACKET 3

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Drug Name Tier Notes

quetiapine fumarate oral tablet 1

QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE

2

QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED

2

quinapril-hydrochlorothiazide oral tablet 1

quinidine gluconate injection solution 1

quinidine sulfate er oral tablet extended release 1

quinine sulfate oral capsule 1

QUINTET AC BLOOD GLUCOSE TEST IN VITRO STRIP

3

QVAR INHALATION AEROSOL SOLUTION 3

ra e-zject lancets 28g 1

ra e-zject lancets thin 26g 1

ra e-zject lancets thin 28g 1

ra e-zject lancets ultra thin 1

ra lancets alternate site 1

ra lancets thin 2

ra lancets ultra thin 1

ra pen needles 2

RA TRUETEST TEST IN VITRO STRIP 3

rabeprazole sodium oral tablet delayed release 1

ramipril oral capsule 1

RANEXA ORAL TABLET EXTENDED RELEASE 12 HOUR

2

ranitidine hcl oral syrup 1

ranitidine hcl oral tablet 1

RAPAFLO ORAL CAPSULE 2

RAPAMUNE ORAL SOLUTION 2

RAPAMUNE ORAL TABLET 3

RAYOS ORAL TABLET DELAYED RELEASE 3

RAZADYNE ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

REBETOL ORAL CAPSULE 3

REBETOL ORAL SOLUTION 3

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3

reclipsen oral tablet 1

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Drug Name Tier Notes

RECOMBINATE INTRAVENOUS SOLUTION RECONSTITUTED

2

RECOMBIVAX HB INJECTION SUSPENSION 2

REFUAH PLUS BLOOD GLUCOSE TEST IN VITRO STRIP

3

REFUAH PLUS MONITORING SYSTEM KIT 3

REGLAN ORAL TABLET 3

REGRANEX EXTERNAL GEL 2

RELION CONFIRM GLUCOSE MONITOR KIT 3

RELION CONFIRM/MICRO TEST IN VITRO STRIP 3

RELION LANCETS THIN 26G 2

RELION LANCETS ULTRA-THIN 30G 2

RELION MICRO KIT 3

RELION PRIME TEST IN VITRO STRIP 3

RELION ULTIMA GLUCOSE SYSTEM KIT 3

RELION ULTIMA TEST IN VITRO STRIP 3

RELION ULTRA THIN LANCETS 30G 2

RELION ULTRA THIN PLUS LANCETS 2

RELISTOR SUBCUTANEOUS SOLUTION 2

RELPAX ORAL TABLET 2

REMERON ORAL TABLET 3

RENAGEL ORAL TABLET 3

rena-vite rx oral tablet 1

RENVELA ORAL PACKET 2

repaglinide oral tablet 1

REPATHA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

2

REPATHA SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

2

REQUIP ORAL TABLET 3

RESCRIPTOR ORAL TABLET 2

RESCULA OPHTHALMIC SOLUTION 3

reserpine oral tablet 1

RESTASIS OPHTHALMIC EMULSION 2

RESTORIL ORAL CAPSULE 3

RETIN-A EXTERNAL CREAM 3

RETIN-A EXTERNAL GEL 3

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Drug Name Tier Notes

RETIN-A MICRO EXTERNAL GEL 3

RETIN-A MICRO PUMP EXTERNAL GEL 3

RETROVIR ORAL CAPSULE 3

RETROVIR ORAL SYRUP 3

REVATIO ORAL TABLET 3

REVEAL BLOOD GLUCOSE MONITOR KIT 3

REVEAL BLOOD GLUCOSE TEST IN VITRO STRIP 3

REVIA ORAL TABLET 3

REVLIMID ORAL CAPSULE 2

REXALL BLOOD GLUCOSE SYSTEM KIT 3

REXALL BLOOD GLUCOSE TEST IN VITRO STRIP 3

REXALL LANCETS ULTRA THIN 30G 2

REYATAZ ORAL CAPSULE 2

RHEUMATREX ORAL TABLET 3

RHOFADE EXTERNAL CREAM 3

ribasphere oral capsule 1

ribasphere oral tablet 1

RIBASPHERE RIBAPAK ORAL TABLET 3

RIBATAB ORAL TABLET 3

ribavirin oral capsule 1

ribavirin oral tablet 1

RIFADIN ORAL CAPSULE 3

rifampin oral capsule 1

RIFATER ORAL TABLET 3

RIGHTEST GL300 LANCETS 2

RIGHTEST GM100 BLOOD GLUCOSE KIT 3

RIGHTEST GM300 BLOOD GLUCOSE KIT 3

RIGHTEST GM550 BLOOD GLUCOSE KIT 3

RIGHTEST GS100 BLOOD GLUCOSE IN VITRO STRIP

3

RIGHTEST GS300 BLOOD GLUCOSE IN VITRO STRIP

3

RIGHTEST GS550 BLOOD GLUCOSE IN VITRO STRIP

3

RILUTEK ORAL TABLET 3

riluzole oral tablet 1

rimantadine hcl oral tablet 1

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Drug Name Tier Notes

RIOMET ORAL SOLUTION 3

risedronate sodium oral tablet 1

risedronate sodium oral tablet delayed release 1

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED

2

RISPERDAL ORAL TABLET 3

risperidone oral tablet 1

risperidone oral tablet dispersible 1

RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

RITALIN ORAL TABLET 3

RITEFLO DEVICE 2

rivastigmine tartrate oral capsule 1

rivastigmine transdermal patch 24 hour 1

rixubis intravenous solution reconstituted 3

rizatriptan benzoate oral tablet 1

ROBAXIN ORAL TABLET 3

ROBINUL ORAL TABLET 3

ROCALTROL ORAL CAPSULE 3

ropinirole hcl oral tablet 1

rosadan external cream 1

rosadan external gel 1

rosuvastatin calcium oral tablet 1

ROTATEQ ORAL SOLUTION 2

ROZEREM ORAL TABLET 2

RYTHMOL ORAL TABLET 3

SABRIL ORAL TABLET 2

SAFESNAP INSULIN SYRINGE 2

safety lancet 21g/pressure act 2

safety lancet 28g/pressure act 2

SAFETY LANCETS 2

SAFETY LANCETS 21G 2

safety lancets 28g 2

SAFETY LET LANCETS 2

SAFETY SEAL LANCETS 2

SAFYRAL ORAL TABLET 2

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Drug Name Tier Notes

SAIZEN CLICK.EASY INJECTION SOLUTION RECONSTITUTED

3

SAIZEN INJECTION SOLUTION RECONSTITUTED 3

salsalate oral tablet 1

SANCUSO TRANSDERMAL PATCH 2

SANDIMMUNE ORAL CAPSULE 2

SANDIMMUNE ORAL SOLUTION 2

SANTYL EXTERNAL OINTMENT 2

sapscare twist top lancets 2

SARAFEM ORAL TABLET 3

SAVELLA ORAL TABLET 3

SEASONIQUE ORAL TABLET 3

seb-prev wash external liquid 1

SECTRAL ORAL CAPSULE 3

selegiline hcl oral tablet 1

selenium sulfide external lotion 1

selenium sulfide external shampoo 1

selenium sulf-pyrithione-urea external shampoo 1

SELZENTRY ORAL TABLET 2

SEMPREX-D ORAL CAPSULE 3

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED

2

serophene oral tablet 1

SEROQUEL ORAL TABLET 3

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED

3

sertraline hcl oral concentrate 1

sertraline hcl oral tablet 1

setlakin oral tablet 1

sharobel oral tablet 1

SHOPKO ON-THE-GO LANCETS 30G 2

SHOPKO UNIFINE PENTIPS 2

SHOPKO UNIFINE PENTIPS PLUS 2

SHOPKO UNILET LANCETS 28G 2

SHOPKO UNILET LANCETS 30G 2

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Drug Name Tier Notes

sildenafil citrate oral tablet 1

SILVADENE EXTERNAL CREAM 3

silver sulfadiazine external cream 1

SIMBRINZA OPHTHALMIC SUSPENSION 3

SIMCOR ORAL TABLET EXTENDED RELEASE 24 HOUR

2

SIMPONI SUBCUTANEOUS SOLUTION AUTO- INJECTOR

3

simvastatin oral tablet 1

SINEMET CR ORAL TABLET EXTENDED RELEASE 3

SINEMET ORAL TABLET 3

SINGLE-LET 2

SINGULAIR ORAL PACKET 3

SINGULAIR ORAL TABLET 3

sirolimus oral tablet 1

SIRTURO ORAL TABLET 2

SIVEXTRO ORAL TABLET 2

SKELAXIN ORAL TABLET 3

SKYLA INTRAUTERINE INTRAUTERINE DEVICE 3

sm glucose test in vitro strip 3

sm insulin syringe 2

sm lancets 21g 2

sm lancets 33g 2

sm super thin lancets 30g 2

sm thin lancets 26g 2

SMART SENSE COLOR LANCETS 33G 2

SMART SENSE PREMIUM SYSTEM KIT 3

SMART SENSE PREMIUM TEST IN VITRO STRIP 3

SMART SENSE STANDARD LANCETS 2

SMART SENSE SUPER THIN LANCETS 2

SMART SENSE THIN LANCETS 26G 2

SMART SENSE VALUE GLUCOSE SYS KIT 3

SMART SENSE VALUE TEST IN VITRO STRIP 3

SMARTEST BLOOD GLUCOSE TEST IN VITRO STRIP 3

SMARTEST EJECT STARTER KIT 3

SMARTEST LANCETS 28G 2

SMARTEST PERSONA STARTER KIT 3

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Drug Name Tier Notes

SMARTEST PRONTO STARTER KIT 3

SMARTEST PROTEGE STARTER KIT 3

sodium fluoride oral tablet chewable 1

sodium sulfacetamide external shampoo 1

SOLIQUA SUBCUTANEOUS SOLUTION PEN- INJECTOR

2

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR

2

SOLTAMOX ORAL SOLUTION 3

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED

2

SOLUS V2 BLOOD GLUCOSE SYSTEM KIT 3

SOLUS V2 LANCETS 28G 2

SOLUS V2 TEST IN VITRO STRIP 3

SOLUS V2 TWIST LANCETS 30G 2

SOMA ORAL TABLET 3

SORIATANE ORAL CAPSULE 3

SORILUX EXTERNAL FOAM 3

sorine oral tablet 1

sotalol hcl (af) oral tablet 1

sotalol hcl oral tablet 1

SOVALDI ORAL TABLET 3

SPIRIVA HANDIHALER INHALATION CAPSULE 2

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION

2

spironolactone oral tablet 1

spironolactone-hctz oral tablet 1

SPORANOX ORAL CAPSULE 3

SPORANOX ORAL SOLUTION 2

SPORANOX PULSEPAK ORAL CAPSULE 3

sprintec 28 oral tablet 1

SPRIX NASAL SOLUTION 3

SPRYCEL ORAL TABLET 2

sronyx oral tablet 1

ssd external cream 1

SSKI ORAL SOLUTION 3

sss 10-5 external foam 1

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80

Drug Name Tier Notes

STALEVO 75 ORAL TABLET 3

STARLIX ORAL TABLET 3

stavudine oral capsule 1

stavudine oral solution reconstituted 1

STAXYN ORAL TABLET DISPERSIBLE 3

STELARA INTRAVENOUS SOLUTION

3

ST; Must try and fail: Humira OR Enbrel, AND Cimzia prior to coverage being considered.

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3

ST; Must try and fail: Humira OR Enbrel, AND Cimzia prior to coverage being considered.

STENDRA ORAL TABLET 3

STERILANCE TL 2

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION

2

STIVARGA ORAL TABLET 2

STRATTERA ORAL CAPSULE 2

STRIANT BUCCAL 3

STRIBILD ORAL TABLET 2

STROMECTOL ORAL TABLET 3

SUBOXONE SUBLINGUAL FILM 3

SUBSYS SUBLINGUAL LIQUID 3

SUCRAID ORAL SOLUTION 2

sucralfate oral tablet 1

SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

sulfacetamide sodium external liquid 1

sulfacetamide sodium ophthalmic solution 1

sulfacetamide sodium-sulfur external foam 1

sulfacetamide sodium-sulfur external lotion 1

sulfacetamide-prednisolone ophthalmic solution 1

sulfacetamide-sulfur in urea external emulsion 1

sulfadiazine oral tablet 1

sulfamethoxazole-trimethoprim oral suspension 1

sulfamethoxazole-trimethoprim oral tablet 1

SULFAMYLON EXTERNAL CREAM 2

sulfasalazine oral tablet 1

sulfasalazine oral tablet delayed release 1

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81

Drug Name Tier Notes

sulfatrim pediatric oral suspension 1

sulindac oral tablet 1

sumatriptan nasal solution 1

sumatriptan succinate oral tablet 1

sumatriptan succinate subcutaneous solution auto-injector

1

SUPARTZ FX INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

2

SUPARTZ INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

2

SUPRAX ORAL SUSPENSION RECONSTITUTED 3

SUPREP BOWEL PREP ORAL SOLUTION 2

sure comfort insulin syringe 2

sure comfort lancets 28g 2

sure comfort lancets 30g 2

sure comfort pen needles 2

SURE-FINE PEN NEEDLES 2

SURE-JECT INSULIN SYRINGE 2

SURE-LANCE FLAT LANCETS 2

SURE-LANCE THIN LANCETS 28G 2

SURE-LANCE ULTRA THIN LANCETS 2

SURE-TEST EASYPLUS MINI TEST IN VITRO STRIP 3

SURE-TOUCH LANCETS UNIVERSAL 2

SUSTIVA ORAL CAPSULE 2

SUTENT ORAL CAPSULE 2

syeda oral tablet 1

SYLATRON SUBCUTANEOUS KIT 2

symax fastabs oral tablet dispersible 1

SYMBICORT INHALATION AEROSOL 3

SYMBYAX ORAL CAPSULE 3

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN- INJECTOR

2

SYNALAR (CREAM) EXTERNAL KIT 3

SYNALAR EXTERNAL SOLUTION 3

SYNJARDY ORAL TABLET 2

SYNTHROID ORAL TABLET 2

SYNVISC INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

2

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82

Drug Name Tier Notes

SYNVISC ONE INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

2

TABLOID ORAL TABLET 2

TACLONEX EXTERNAL SUSPENSION 2

tacrolimus external ointment 1

tacrolimus oral capsule 1

TAFINLAR ORAL CAPSULE 2

TAMIFLU ORAL CAPSULE 2

TAMIFLU ORAL SUSPENSION RECONSTITUTED 2

tamoxifen citrate oral tablet 1

tamsulosin hcl oral capsule 1

TANZEUM SUBCUTANEOUS PEN-INJECTOR 3

TAPAZOLE ORAL TABLET 3

TARCEVA ORAL TABLET 2

TARKA ORAL TABLET EXTENDED RELEASE 3

TASIGNA ORAL CAPSULE 2

TASMAR ORAL TABLET 3

TAZORAC EXTERNAL CREAM 2

TAZORAC EXTERNAL GEL 2

taztia xt oral capsule extended release 24 hour 1

TECFIDERA ORAL CAPSULE DELAYED RELEASE 3

TECHLITE LANCETS 2

TECHLITE LANCETS 30G 2

TECHLITE PEN NEEDLES 2

TECHNIVIE ORAL TABLET 3

TEGRETOL ORAL SUSPENSION 3

TEGRETOL ORAL TABLET 3

TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 12 HOUR

3

TEKAMLO ORAL TABLET 2

TEKTURNA HCT ORAL TABLET 2

TEKTURNA ORAL TABLET 2

TELCARE BLOOD GLUCOSE SYSTEM KIT 3

TELCARE BLOOD GLUCOSE TEST IN VITRO STRIP 3

telmisartan oral tablet 1

telmisartan-amlodipine oral tablet 1

telmisartan-hctz oral tablet 1

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Drug Name Tier Notes

temazepam oral capsule 1

TEMODAR ORAL CAPSULE 3

TEMOVATE EXTERNAL OINTMENT 3

temozolomide oral capsule 1

TENEX ORAL TABLET 3

TENORETIC 50 ORAL TABLET 3

TENORMIN ORAL TABLET 3

TERAZOL 7 VAGINAL CREAM 3

terbinafine hcl oral tablet 1

terbutaline sulfate oral tablet 1

terconazole vaginal cream 1

terconazole vaginal suppository 1

TERSI EXTERNAL FOAM 3

TERUMO INSULIN SYRINGE 2

TERUMO SURGUARD2 SAFETY NEEDLE 2

TESSALON PERLES ORAL CAPSULE 3

TESTIM TRANSDERMAL GEL 3

TESTOPEL IMPLANT PELLET 3

testosterone cypionate intramuscular solution 1

testosterone transdermal gel 3

TESTRED ORAL CAPSULE 3

tetcaine ophthalmic solution 1

tetrabenazine oral tablet 1

tetracaine hcl ophthalmic solution 1

TETRAVISC FORTE OPHTHALMIC SOLUTION 3

TETRAVISC OPHTHALMIC SOLUTION 3

TEXACORT EXTERNAL SOLUTION 3

tgt blood glucose monitoring kit 3

tgt blood glucose test in vitro strip 3

tgt lancet alternate site 2

tgt lancet micro thin 33g 2

tgt lancet super thin 30g 2

tgt lancet thin 23g 2

tgt lancet thin 26g 2

tgt lancet ultra thin 28g 2

tgt lancet ultra thin 30g 2

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84

Drug Name Tier Notes

THALOMID ORAL CAPSULE 2

theochron oral tablet extended release 12 hour 1

theophylline er oral tablet extended release 12 hour

1

theophylline oral solution 1

thermazene external cream 1

thin lancets 2

THINPRO INSULIN SYRINGE 2

thioridazine hcl oral tablet 1

thiothixene oral capsule 1

thrivite rx oral tablet 3

THYROLAR-1/4 ORAL TABLET 3

tiagabine hcl oral tablet 1

TIAZAC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

ticlopidine hcl oral tablet 1

TIGAN ORAL CAPSULE 3

TIKOSYN ORAL CAPSULE 3

tilia fe oral tablet 1

timolol maleate ophthalmic solution 1

timolol maleate oral tablet 1

TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION 3

TIMOPTIC OPHTHALMIC SOLUTION 3

TINDAMAX ORAL TABLET 3

tinidazole oral tablet 1

TIROSINT ORAL CAPSULE 3

TIVICAY ORAL TABLET 2

tizanidine hcl oral tablet 1

TOBI PODHALER INHALATION CAPSULE 2

TOBRADEX OPHTHALMIC OINTMENT 2

TOBRADEX OPHTHALMIC SUSPENSION 3

TOBRADEX ST OPHTHALMIC SUSPENSION 2

tobramycin ophthalmic solution 1

tobramycin-dexamethasone ophthalmic suspension

1

TOBREX OPHTHALMIC OINTMENT 3

TOBREX OPHTHALMIC SOLUTION 3

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85

Drug Name Tier Notes

todays health thin lancets 28g 2

todays health thin lancets 30g 2

TOFRANIL ORAL TABLET 3

tolcapone oral tablet 1

tolmetin sodium oral capsule 1

tolterodine tartrate er oral capsule extended release 24 hour

1

tolterodine tartrate oral tablet 1

TOPAMAX ORAL TABLET 3

TOPICORT EXTERNAL CREAM 3

TOPICORT EXTERNAL GEL 3

TOPICORT EXTERNAL OINTMENT 3

TOPICORT SPRAY EXTERNAL LIQUID 3

topiramate oral tablet 1

torsemide oral tablet 1

TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR

2

TRACLEER ORAL TABLET 2

TRADJENTA ORAL TABLET 2

tramadol hcl er oral capsule extended release 24 hour

3

tramadol hcl er oral tablet extended release 24 hour

1

tramadol hcl oral tablet 1

tramadol-acetaminophen oral tablet 1

trandolapril oral tablet 1

trandolapril-verapamil hcl er oral tablet extended release

1

TRANSDERM-SCOP (1.5 MG) TRANSDERMAL PATCH 72 HOUR

2

TRANXENE-T ORAL TABLET 3

tranylcypromine sulfate oral tablet 1

TRAVATAN Z OPHTHALMIC SOLUTION 2

travel lancets 2

trazodone hcl oral tablet 1

TRECATOR ORAL TABLET 3

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86

Drug Name Tier Notes

TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

tretinoin external cream 1

tretinoin external gel 1

tretinoin microsphere external gel 1

tretinoin microsphere pump external gel 1

TRETTEN INTRAVENOUS SOLUTION RECONSTITUTED

2

TREXALL ORAL TABLET 2

TREXIMET ORAL TABLET 3

triamcinolone acetonide external aerosol solution

1

triamcinolone acetonide external cream 1

triamcinolone acetonide external lotion 1

triamcinolone acetonide nasal aerosol 3

triamterene-hctz oral tablet 1

trianex external ointment 1

TRIBENZOR ORAL TABLET 2

TRICARE ORAL TABLET 3

TRICOR ORAL TABLET 3

triderm external cream 1

tri-estarylla oral tablet 1

trifluoperazine hcl oral tablet 1

trifluridine ophthalmic solution 1

TRIGLIDE ORAL TABLET 3

trihexyphenidyl hcl oral elixir 1

trihexyphenidyl hcl oral tablet 1

tri-legest fe oral tablet 1

TRILEPTAL ORAL SUSPENSION 3

TRILEPTAL ORAL TABLET 3

tri-linyah oral tablet 1

TRILIPIX ORAL CAPSULE DELAYED RELEASE 3

tri-lo-estarylla oral tablet 1

tri-lo-marzia oral tablet 1

tri-lo-sprintec oral tablet 1

trimethobenzamide hcl oral capsule 1

trimethoprim oral tablet 1

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87

Drug Name Tier Notes

trinessa (28) oral tablet 1

trinessa lo oral tablet 1

TRI-NORINYL (28) ORAL TABLET 3

TRINTELLIX ORAL TABLET 2

tri-previfem oral tablet 1

tri-sprintec oral tablet 1

trivora (28) oral tablet 1

TRIZIVIR ORAL TABLET 3

TROKENDI XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

tropicamide ophthalmic solution 1

trospium chloride oral tablet 1

TRUE METRIX AIR GLUCOSE METER KIT 3

TRUE METRIX BLOOD GLUCOSE TEST IN VITRO STRIP

3

TRUE METRIX METER KIT 3

TRUE2GO BLOOD GLUCOSE MONITOR KIT 3

TRUEPLUS INSULIN SYRINGE 2

TRUEPLUS LANCETS 26G 2

TRUEPLUS LANCETS 28G 2

TRUEPLUS LANCETS 30G 2

TRUEPLUS LANCETS 33G 2

TRUEPLUS SAFETY LANCETS 28G 2

TRUERESULT BLOOD GLUCOSE KIT 3

TRUETEST TEST IN VITRO STRIP 3

TRUETRACK BLOOD GLUCOSE KIT 3

TRUETRACK SMART SYSTEM KIT 3

TRUETRACK TEST IN VITRO STRIP 3

TRULICITY SUBCUTANEOUS SOLUTION PEN- INJECTOR

2

TRUSOPT OPHTHALMIC SOLUTION 3

TRUVADA ORAL TABLET 2

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED

3

TUSSICAPS ORAL CAPSULE EXTENDED RELEASE 12 HOUR

2

tussigon oral tablet 1

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88

Drug Name Tier Notes

TUSSIONEX PENNKINETIC ER ORAL SUSPENSION EXTENDED RELEASE

3

TWINRIX INTRAMUSCULAR SUSPENSION 2

TWYNSTA ORAL TABLET 3

TYKERB ORAL TABLET 2

TYLENOL WITH CODEINE #3 ORAL TABLET 3

TYSABRI INTRAVENOUS CONCENTRATE 2

TYZEKA ORAL TABLET 2

ULORIC ORAL TABLET 2

ULTICARE INSULIN SYRINGE 2

ULTILET BASIC LANCETS 30G 2

ULTILET CLASSIC LANCETS 2

ULTILET LANCETS 2

ULTILET SAFETY LANCETS 23G 2

ULTIMA TEST IN VITRO STRIP 3

ultra thin lancets 28g 2

ultra thin lancets 30g 2

ULTRA TRAK PRO BLOOD GLUCOSE KIT 3

ULTRACET ORAL TABLET 3

ultra-comfort insulin syringe 2

ULTRAM ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ULTRAM ORAL TABLET 3

ULTRA-THIN II AUTO LANCET 2

ULTRA-THIN II LANCETS 2

ULTRA-THIN II MINI PEN NEEDLE 2

ULTRATRAK PRO TEST IN VITRO STRIP 3

ULTRATRAK ULTIMATE TEST IN VITRO STRIP 3

ULTRAVATE EXTERNAL OINTMENT 3

ULTRESA ORAL CAPSULE DELAYED RELEASE PARTICLES

3

UNIFINE PENTIPS 2

unifine pentips plus 2

UNILET COMFORTOUCH LANCET 2

UNILET EXCELITE 2

UNILET EXCELITE II 2

UNILET G.P. SUPERLITE LANCET 2

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Drug Name Tier Notes

UNILET GP 28 ULTRA THIN 2

UNILET MICRO-THIN 33G 2

UNILET SUPER-THIN 30G 2

UNILET ULTRA-THIN 28G 2

UNISTIK 3 GENTLE 2

UNISTIK SAFETY LANCETS 28G 2

UNISTIK SAFETY LANCETS 30G 2

UNISTIK TOUCH SAFETY LANC 21G 2

UNISTIK TOUCH SAFETY LANC 23G 2

UNISTIK TOUCH SAFETY LANC 28G 2

UNISTIK TOUCH SAFETY LANC 30G 2

UNISTRIP1 GENERIC IN VITRO STRIP 3

unithroid oral tablet 1

UNIVERSAL 1 LANCETS THIN 26G 2

UNIVERSAL 1 LANCETS ULTRA THIN 2

URECHOLINE ORAL TABLET 3

UROXATRAL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ursodiol oral capsule 1

VAGIFEM VAGINAL TABLET 3

valacyclovir hcl oral tablet 1

VALCYTE ORAL SOLUTION RECONSTITUTED 2

VALCYTE ORAL TABLET 3

valganciclovir hcl oral tablet 1

VALIUM ORAL TABLET 3

valproate sodium oral syrup 1

valproic acid oral capsule 1

valproic acid oral solution 1

valsartan oral tablet 1

valsartan-hydrochlorothiazide oral tablet 1

VALTREX ORAL TABLET 3

value plus lancet standard 21g 2

valumark lancet super thin 30g 2

valumark lancet ultra thin 28g 2

valved holding chamber device 2

VANCOCIN HCL ORAL CAPSULE 3

vancomycin hcl oral capsule 1

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Drug Name Tier Notes

vandazole vaginal gel 1

VASCEPA ORAL CAPSULE 2

VASOTEC ORAL TABLET 3

VECAMYL ORAL TABLET 3

velivet oral tablet 1

VELTIN EXTERNAL GEL 3

VEMLIDY ORAL TABLET 2

venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl oral tablet 1

VENTOLIN HFA INHALATION AEROSOL SOLUTION 2

VERAMYST NASAL SUSPENSION 3

verapamil hcl er oral capsule extended release 24 hour

1

verapamil hcl oral tablet 1

VERDESO EXTERNAL FOAM 3

VERELAN PM ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

VERSACLOZ ORAL SUSPENSION 3

VESICARE ORAL TABLET 2

vestura oral tablet 1

VEXOL OPHTHALMIC SUSPENSION 3

VFEND ORAL SUSPENSION RECONSTITUTED 3

VFEND ORAL TABLET 3

VIAGRA ORAL TABLET 2

VIBRAMYCIN ORAL CAPSULE 3

VIBRAMYCIN ORAL SYRUP 3

VICTOZA SUBCUTANEOUS SOLUTION PEN- INJECTOR

2

VIDA MIA UNILET LANCETS 28G 2

VIDA MIA UNILET LANCETS 30G 2

VIDAZA INJECTION SUSPENSION RECONSTITUTED 3

VIDEX EC ORAL CAPSULE DELAYED RELEASE 3

VIDEX ORAL SOLUTION RECONSTITUTED 2

VIEKIRA PAK ORAL TABLET THERAPY PACK 3

vienva oral tablet 1

VIIBRYD ORAL TABLET 3

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Drug Name Tier Notes

VIMOVO ORAL TABLET DELAYED RELEASE 3

VIMPAT ORAL SOLUTION 2

VIMPAT ORAL TABLET 2

VIOKACE ORAL TABLET 2

viorele oral tablet 1

VIRACEPT ORAL TABLET 2

VIRAMUNE ORAL SUSPENSION 3

VIRAMUNE ORAL TABLET 3

VIREAD ORAL TABLET 2

VIROPTIC OPHTHALMIC SOLUTION 3

virtussin a/c oral solution 1

VISTARIL ORAL CAPSULE 3

VITAMEDMD ONE RX/QUATREFOLIC ORAL CAPSULE

3

VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY

3

VIVITROL INTRAMUSCULAR SUSPENSION RECONSTITUTED

3

VOGELXO PUMP TRANSDERMAL GEL 3

VOGELXO TRANSDERMAL GEL 3

vol-care rx oral tablet 1

vol-plus oral tablet 1

vol-tab rx oral tablet 1

VOLTAREN TRANSDERMAL GEL 3

VOLTAREN-XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

voriconazole oral suspension reconstituted 1

voriconazole oral tablet 1

VORTEX VALVED HOLDING CHAMBER DEVICE 2

VOTRIENT ORAL TABLET 2

vp-vite rx oral tablet 1

vyfemla oral tablet 1

VYTORIN ORAL TABLET 2

VYVANSE ORAL CAPSULE 2

VYVANSE ORAL TABLET CHEWABLE 2

walgreens adv travel lancets 2

WALGREENS LANCETS 2

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Drug Name Tier Notes

walgreens lancets micro thin 2

walgreens lancets super thin 2

WALGREENS THIN LANCETS 2

WALGREENS ULTRA THIN LANCETS 2

warfarin sodium oral tablet 1

WAVESENSE AMP KIT 3

WAVESENSE PRESTO IN VITRO STRIP 3

wegmans unifine pentips plus 2

WELCHOL ORAL PACKET 2

WELCHOL ORAL TABLET 2

WELLBUTRIN ORAL TABLET 3

WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

wera oral tablet 1

WILATE INTRAVENOUS KIT 2

WP THYROID ORAL TABLET 3

wymzya fe oral tablet chewable 1

XALATAN OPHTHALMIC SOLUTION 3

XALKORI ORAL CAPSULE 2

XANAX ORAL TABLET 3

XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

XARELTO ORAL TABLET 2

XELJANZ ORAL TABLET 2 ST

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2

XENAZINE ORAL TABLET 3

XERESE EXTERNAL CREAM 3

XIFAXAN ORAL TABLET 2

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

XIIDRA OPHTHALMIC SOLUTION 3

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED

2

XOPENEX HFA INHALATION AEROSOL 3

XOPENEX INHALATION NEBULIZATION SOLUTION 3

XTANDI ORAL CAPSULE 3

xulane transdermal patch weekly 1

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Drug Name Tier Notes

XULTOPHY SUBCUTANEOUS SOLUTION PEN- INJECTOR

3

XYNTHA INTRAVENOUS KIT 2

XYNTHA SOLOFUSE INTRAVENOUS KIT 2

XYZAL ORAL TABLET 3

YASMIN 28 ORAL TABLET 3

YAZ ORAL TABLET 3

zafirlukast oral tablet 1

zaleplon oral capsule 1

ZANTAC ORAL TABLET 3

zarah oral tablet 1

ZARONTIN ORAL CAPSULE 3

ZARONTIN ORAL SOLUTION 3

ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 2

ZEGERID ORAL CAPSULE 3

ZELAPAR ORAL TABLET DISPERSIBLE 3

ZELBORAF ORAL TABLET 2

zenatane oral capsule 1

zenchent fe oral tablet chewable 1

zenchent oral tablet 1

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES

2

zenzedi oral tablet 1

zeosa oral tablet chewable 1

ZEPATIER ORAL TABLET 2

ZERIT ORAL CAPSULE 3

ZERIT ORAL SOLUTION RECONSTITUTED 3

ZESTORETIC ORAL TABLET 3

ZESTRIL ORAL TABLET 3

ZETIA ORAL TABLET 3

ZETONNA NASAL AEROSOL SOLUTION 3

ZIAC ORAL TABLET 3

ZIAGEN ORAL SOLUTION 2

ZIAGEN ORAL TABLET 3

ZIANA EXTERNAL GEL 2

zidovudine oral capsule 1

zidovudine oral syrup 1

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Drug Name Tier Notes

zidovudine oral tablet 1

ZIOPTAN OPHTHALMIC SOLUTION 3

ziprasidone hcl oral capsule 1

ZIPSOR ORAL CAPSULE 3

ZIRGAN OPHTHALMIC GEL 3

ZITHRANOL-RR EXTERNAL CREAM 3

ZITHROMAX ORAL SUSPENSION RECONSTITUTED 3

ZITHROMAX ORAL TABLET 3

ZITHROMAX Z-PAK ORAL TABLET 3

ZOCOR ORAL TABLET 3

ZODRYL AC 35 ORAL SUSPENSION 3

ZOFRAN ODT ORAL TABLET DISPERSIBLE 3

ZOFRAN ORAL SOLUTION 3

ZOFRAN ORAL TABLET 3

ZOLINZA ORAL CAPSULE 2

zolmitriptan oral tablet 1

zolmitriptan oral tablet dispersible 1

ZOLOFT ORAL CONCENTRATE 3

ZOLOFT ORAL TABLET 3

zolpidem tartrate er oral tablet extended release 1

zolpidem tartrate oral tablet 1

zolpidem tartrate sublingual tablet sublingual 1

ZOLPIMIST ORAL SOLUTION 3

ZOMACTON SUBCUTANEOUS SOLUTION RECONSTITUTED

3

ZOMIG NASAL SOLUTION 2

ZOMIG ORAL TABLET 3

ZOMIG ZMT ORAL TABLET DISPERSIBLE 3

ZONEGRAN ORAL CAPSULE 3

zonisamide oral capsule 1

ZORBTIVE SUBCUTANEOUS SOLUTION RECONSTITUTED

3

ZORTRESS ORAL TABLET 2

ZORVOLEX ORAL CAPSULE 2

ZOSTAVAX SUBCUTANEOUS SOLUTION RECONSTITUTED

2

zovia 1/35e (28) oral tablet 1

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Drug Name Tier Notes

ZOVIRAX EXTERNAL OINTMENT 3

ZOVIRAX ORAL CAPSULE 3

ZOVIRAX ORAL SUSPENSION 3

ZOVIRAX ORAL TABLET 3

ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 2

ZUPLENZ ORAL FILM 3

ZYBAN ORAL TABLET EXTENDED RELEASE 12 HOUR

3

ZYCLARA EXTERNAL CREAM 3

ZYCLARA PUMP EXTERNAL CREAM 3

ZYFLO ORAL TABLET 3

ZYLET OPHTHALMIC SUSPENSION 2

ZYLOPRIM ORAL TABLET 3

ZYMAXID OPHTHALMIC SOLUTION 3

ZYPREXA ORAL TABLET 3

ZYPREXA ZYDIS ORAL TABLET DISPERSIBLE 3

ZYTIGA ORAL TABLET 2

ZYVOX ORAL TABLET 3

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Index

1st choice lancets super thin ........ 1 1st choice lancets thin .................. 1 1st choice lancets ultra thin ......... 1 1st tier unifine pentips ................. 1 1st tier unilet comfortouch .......... 1 abacavir sulfate ............................ 1 abacavir-lamivudine-zidovudine.. 1 ABILIFY .......................................... 1 ABSORICA ..................................... 1 ABSTRAL ....................................... 1 ACANYA ........................................ 1 acarbose ....................................... 1 ACCOLATE ..................................... 1 ACCUCAINE ................................... 1 ACCU-CHEK AVIVA ........................ 1 ACCU-CHEK AVIVA CONNECT ....... 1 ACCU-CHEK AVIVA PLUS ............... 1 ACCU-CHEK COMPACT PLUS ........ 1 ACCU-CHEK COMPACT TEST DRUM ........................................... 1 ACCU-CHEK FASTCLIX LANCETS .... 1 ACCU-CHEK MULTICLIX LANCETS. 1 ACCU-CHEK NANO SMARTVIEW...1 ACCU-CHEK SAFE-T PRO LANCETS

1 ACCU-CHEK SMARTVIEW ............. 1 ACCU-CHEK SOFT TOUCH LANCETS ....................................... 1 ACCU-CHEK SOFTCLIX LANCETS ... 1 ACCU-CHEK VOICEMATE .............. 1 ACCURETIC ................................... 1 ACCUTREND GLUCOSE ................. 2 acebutolol hcl ............................... 2 acetaminophen-codeine .............. 2 acetaminophen-codeine #3 ......... 2 acetasol hc .................................... 2 acetazolamide .............................. 2 acetic acid ..................................... 2 ACIPHEX ........................................ 2 acitretin ........................................ 2 ACTEMRA ...................................... 2 ACTIGALL ...................................... 2 acti-lance 28g ............................... 2 acti-lance lite lancets 28g ............. 2 acti-lance special lancets 17g ....... 2 acti-lance universal 23g ................ 2 ACTIMMUNE ................................ 2 ACTIQ ............................................ 2

ACTIVE 1ST BLOOD LANCETS 30G ................................................ 2 ACTIVELLA ..................................... 2 ACTONEL ....................................... 2 ACTOPLUS MET ............................. 2 ACTOS ........................................... 2 ACULAR ......................................... 2 ACUVAIL ........................................ 2 acyclovir ........................................ 2 ACZONE ......................................... 2 ADALAT CC .................................... 2 adapalene ..................................... 2 ADCIRCA ........................................ 2 ADDERALL ..................................... 3 ADDERALL XR ................................ 3 ADDYI ............................................ 3 ADEMPAS ...................................... 3 ADLYXIN ........................................ 3 ADLYXIN STARTER PACK ............... 3 ADOXA .......................................... 3 ADRENACLICK ............................... 3 ADVAIR DISKUS ............................. 3 ADVAIR HFA .................................. 3 ADVATE ......................................... 3 ADVICOR ....................................... 3 ADVOCATE BLOOD GLUCOSE SYSTEM ......................................... 3 ADVOCATE INSULIN PEN NEEDLES ........................................ 3 ADVOCATE LANCETS ..................... 3 ADVOCATE LANCETS 30G ............. 3 ADVOCATE REDI-CODE ................. 3 ADVOCATE REDI-CODE+ TEST ....... 3 ADVOCATE SAFETY LANCETS ........ 3 ADVOCATE SAFETY LANCETS 26G ................................................ 3 ADVOCATE TEST ............................ 3 adynovate ..................................... 3 ADZENYS XR-ODT .......................... 3 AEROCHAMBER MINI CHAMBER..3 AEROCHAMBER MV ...................... 3 AEROCHAMBER PLUS FLO-VU ...... 3 AEROCHAMBER PLUS FLO-VU LARGE ............................................ 3 AEROCHAMBER PLUS FLO-VU MEDIUM ....................................... 3 AEROCHAMBER PLUS FLO-VU SMALL ........................................... 3

AEROCHAMBER PLUS FLO-VU W/MASK ....................................... 4

AEROCHAMBER PLUS FLOW VU...4 AEROCHAMBER W/FLOWSIGNAL ........................... 4

AEROCHAMBER Z-STAT PLUS ....... 4 AEROCHAMBER Z-STAT PLUS CHAMBR ....................................... 4

AEROCHAMBER Z-STAT PLUS/LARGE ................................. 4

AEROCHAMBER Z-STAT PLUS/MEDIUM ............................. 4

AEROCHAMBER Z-STAT PLUS/SMALL ................................. 4

AEROVENT PLUS ........................... 4 afeditab cr .................................... 4 AFINITOR ...................................... 4 AFINITOR DISPERZ ........................ 4 AGAMATRIX AMP TEST ................ 4 AGAMATRIX JAZZ TEST ................. 4 AGAMATRIX JAZZ WIRELESS 2 ...... 4 AGAMATRIX PRESTO .................... 4 AGAMATRIX PRESTO TEST............ 4 AGAMATRIX ULTRA-THIN LANCETS ....................................... 4

AGGRENOX ................................... 4 ak-poly-bac ................................... 4 ala-cort ......................................... 4 ALBENZA ....................................... 4 albuterol sulfate ........................... 4 ALCAINE ........................................ 4 alclometasone dipropionate ........ 4 ALCORTIN A .................................. 4 ALDACTAZIDE ............................... 4 ALDACTONE .................................. 4 ALDARA......................................... 4 ALECENSA ..................................... 4 alendronate sodium ..................... 4 ALFERON N ................................... 4 alfuzosin hcl er ............................. 5 ALINIA ........................................... 5 allopurinol .................................... 5 almotriptan malate ...................... 5 ALOCRIL ........................................ 5 alogliptin benzoate ....................... 5 alogliptin-metformin hcl .............. 5 alogliptin-pioglitazone.................. 5 ALORA ........................................... 5

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alosetron hcl ................................. 5 ALPHAGAN P ................................. 5 ALPHANATE .................................. 5 ALPHANATE/VWF COMPLEX/HUMAN ....................... 5 ALPHANINE SD .............................. 5 alprazolam .................................... 5 alprazolam er ................................ 5 alprazolam intensol ...................... 5 alprazolam xr ................................ 5 ALPROLIX ...................................... 5 ALREX ............................................ 5 ALSUMA ........................................ 5 ALTABAX ....................................... 5 altacaine ....................................... 5 ALTACE ......................................... 5 altafluor ........................................ 5 altavera ......................................... 5 ALTOPREV ..................................... 5 ALVESCO ....................................... 5 alyacen 1/35 ................................. 6 alyacen 7/7/7 ............................... 6 amantadine hcl ............................. 6 AMARYL ........................................ 6 AMBIEN ........................................ 6 AMBIEN CR ................................... 6 amcinonide ................................... 6 AMERGE........................................ 6 amethia ........................................ 6 amethyst ....................................... 6 AMICAR ........................................ 6 amiloride hcl ................................. 6 amiloride-hydrochlorothiazide .... 6 amiodarone hcl ............................ 6 AMITIZA ........................................ 6 amitriptyline hcl ........................... 6 amlodipine besy-benazepril hcl ... 6 amlodipine besylate ..................... 6 amlodipine besylate-valsartan ..... 6 amlodipine-atorvastatin ............... 6 amlodipine-valsartan-hctz............ 6 amnesteem ................................... 6 amoxapine .................................... 6 amoxicill-clarithro-lansopraz ........ 6 amoxicillin..................................... 6 amoxicillin-pot clavulanate .......... 6 amoxicillin-pot clavulanate er ...... 6 amphetamine-dextroamphet er.. 6

amphetamine- dextroamphetamine ..................... 6 ampicillin ....................................... 7 ampicillin sodium .......................... 7 AMPYRA ........................................ 7 AMRIX ........................................... 7 ANAFRANIL ................................... 7 ANALPRAM E ................................. 7 ANAPROX ...................................... 7 anaspaz ......................................... 7 anastrozole ................................... 7 ANCOBON ..................................... 7 ANDRODERM ................................ 7 ANDROGEL .................................... 7 ANDROGEL PUMP ......................... 7 ANDROID ....................................... 7 androxy ......................................... 7 ANGELIQ........................................ 7 ANORO ELLIPTA ............................ 7 ANTABUSE ..................................... 7 ANTARA ......................................... 7 anucort-hc ..................................... 7 ANUSOL-HC ................................... 7 ANZEMET ...................................... 7 apexicon e ..................................... 7 APIDRA .......................................... 7 APIDRA SOLOSTAR ........................ 7 APLENZIN ...................................... 7 apraclonidine hcl........................... 7 aprepitant ..................................... 7 apri ................................................ 7 APRISO .......................................... 7 APTIVUS....................................7, 8 aranelle ......................................... 8 ARANESP (ALBUMIN FREE) ........... 8 ARAVA ........................................... 8 arbinoxa ........................................ 8 ARCAPTA NEOHALER .................... 8 ARIMIDEX ...................................... 8 aripiprazole ................................... 8 ARIXTRA ........................................ 8 armodafinil .................................... 8 ARMOUR THYROID ....................... 8 ARNUITY ELLIPTA .......................... 8 AROMASIN .................................... 8 ARTHROTEC .................................. 8 ASACOL HD ................................... 8 ascomp-codeine ............................ 8 ashlyna .......................................... 8

ASMANEX 120 METERED DOSES.. 8 ASMANEX 14 METERED DOSES .... 8 ASMANEX 30 METERED DOSES .... 8 ASMANEX 60 METERED DOSES .... 8 aspirin-dipyridamole er ................ 8 ASSURE 4 TEST .............................. 8 assure comfort lancets 28g .......... 8 assure comfort lancets 30g .......... 8 ASSURE HAEMOLANCE PLUS HIGH ............................................. 8

ASSURE HAEMOLANCE PLUS LOW .............................................. 8

ASSURE HAEMOLANCE PLUS MICRO .......................................... 8

ASSURE HAEMOLANCE PLUS NORMAL ....................................... 9

ASSURE HAEMOLANCE PLUS PED ............................................... 9

ASSURE LANCE LANCETS .............. 9 ASSURE LANCE LANCETS 21G ....... 9 ASSURE LANCE PLUS SAFETY 25G ............................................... 9

ASSURE LANCE PLUS SAFETY 30G ............................................... 9

ASSURE PLATINUM ....................... 9 ASSURE PRISM MULTI TEST .......... 9 ASTAGRAF XL ................................ 9 ATACAND ...................................... 9 ATACAND HCT .............................. 9 ATELVIA ........................................ 9 atenolol ........................................ 9 atenolol-chlorthalidone ............... 9 ATIVAN ......................................... 9 atorvastatin calcium ..................... 9 atovaquone .................................. 9 atovaquone-proguanil hcl ............ 9 ATRALIN ........................................ 9 ATRIPLA ........................................ 9 atropine sulfate ............................ 9 ATROVENT .................................... 9 ATROVENT HFA ............................ 9 AUBAGIO ...................................... 9 aubra ............................................ 9 AUGMENTIN ................................. 9 AUGMENTIN XR ............................ 9 AVAGE .......................................... 9 AVALIDE ........................................ 9 AVAPRO ........................................ 9 AVAR ............................................. 9

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AVC VAGINAL................................ 9 aviane ........................................... 9 AVINZA ....................................... 10 avita ............................................ 10 AVITA .......................................... 10 AVODART .................................... 10 AVONEX ...................................... 10 AXERT ......................................... 10 AXIRON ....................................... 10 azacitidine .................................. 10 AZASAN ....................................... 10 AZASITE ....................................... 10 azathioprine ............................... 10 azelastine hcl .............................. 10 AZELEX ........................................ 10 AZILECT ....................................... 10 azithromycin ............................... 10 AZOPT ......................................... 10 AZOR ........................................... 10 AZULFIDINE ................................. 10 AZULFIDINE EN-TABS .................. 10 azurette ...................................... 10 bacitracin .................................... 10 bacitracin-polymyxin b ............... 10 bacitra-neomycin-polymyxin-hc.10 baclofen ...................................... 10 BACTRIM ..................................... 10 BACTROBAN ............................... 10 balsalazide disodium .................. 10 balziva ......................................... 10 BANZEL ....................................... 10 BARACLUDE ................................ 10 BASAGLAR KWIKPEN .................. 10 BAYER BREEZE 2 TEST ................. 11 BAYER CONTOUR LINK MONITOR ................................... 11 BAYER CONTOUR MONITOR ...... 11 BAYER CONTOUR NEXT EZ ......... 11 BAYER CONTOUR NEXT LINK ...... 11 BAYER CONTOUR NEXT MONITOR ................................... 11 BAYER CONTOUR NEXT TEST ...... 11 BAYER CONTOUR NEXT USB MONITOR ................................... 11 BAYER CONTOUR TEST ............... 11 BAYER MICROLET LANCETS ........ 11 BD DISP NEEDLES ........................ 11 BD INSULIN SYRINGE .................. 11

BD INSULIN SYRINGE MICROFINE.................................. 11 BD LANCET ULTRAFINE 30G ........ 11 BD LANCET ULTRAFINE 33G ........ 11 BD MICROTAINER LANCETS ........ 11 BD PEN NEEDLE MINI U/F ........... 11 BEBULIN ...................................... 11 BEBULIN VH ................................ 11 BECONASE AQ ............................. 11 bekyree ....................................... 11 belladonna .................................. 11 BELSOMRA .................................. 11 benazepril hcl .............................. 11 benazepril-hydrochlorothiazide. 11 BENEFIX ....................................... 11 BENICAR ...................................... 11 BENICAR HCT .............................. 11 BENTYL ........................................ 11 BENZACLIN .................................. 11 BENZACLIN WITH PUMP ............. 11 BENZAMYCIN .............................. 11 BENZEFOAM................................ 11 BENZEPRO CREAMY WASH ......... 12 benzonatate ................................ 12 benzoyl peroxide ........................ 12 benzoyl peroxide-erythromycin. 12 benztropine mesylate ................. 12 BEPREVE ...................................... 12 BERINERT .................................... 12 BESIVANCE .................................. 12 BETAGAN .................................... 12 betamethasone dipropionate ..... 12 betamethasone dipropionate aug .............................................. 12 betamethasone valerate ............ 12 BETAPACE ................................... 12 BETAPACE AF .............................. 12 BETASERON ................................. 12 betaxolol hcl................................ 12 bethanechol chloride .................. 12 BETIMOL ..................................... 12 BETOPTIC-S ................................. 12 BEYAZ .......................................... 12 BG STAR TEST .............................. 12 BIAXIN ......................................... 12 bicalutamide ............................... 12 BIDIL ............................................ 12 BILTRICIDE ................................... 12 bimatoprost ................................ 12

BINOSTO ..................................... 12 BIONECT ..................................... 12 bisoprolol fumarate .................... 12 bisoprolol-hydrochlorothiazide..12 BIVIGAM ..................................... 13 BLEPH-10 .................................... 13 BLEPHAMIDE .............................. 13 BLEPHAMIDE S.O.P. .................... 13 blisovi 24 fe ................................ 13 blisovi fe 1.5/30 .......................... 13 blood glucose monitor system... 13 blood glucose test ...................... 13 BONIVA ....................................... 13 BOOSTRIX ................................... 13 BOSULIF ...................................... 13 bp cleansing wash ...................... 13 BRAVELLE .................................... 13 BREATHERITE .............................. 13 BREATHERITE COLL SPACER ADULT ......................................... 13

BREATHERITE COLL SPACER CHILD .......................................... 13

BREATHERITE COLL SPACER INFANT ....................................... 13

BREATHERITE RIGID SPACER/MASK ............................ 13

BREATHERITE SPACER NEONATE 13 BREATHERITE SPACER SMALL CHILD .......................................... 13

BREATHERITE/LARGE MASK ....... 13 BREATHERITE/MEDIUM MASK... 13 BREATHERITE/SMALL MASK ....... 13 BREO ELLIPTA ............................. 13 BREVICON (28) ........................... 13 briellyn ........................................ 13 BRILINTA ..................................... 13 brimonidine tartrate .................. 13 BRINTELLIX ................................. 13 BRISDELLE ................................... 13 BROMFED DM ............................ 13 bromfenac sodium ..................... 13 bromocriptine mesylate ............. 13 budesonide ................................. 13 bullseye mini safety lancets ....... 13 bumetanide ................................ 14 BUPHENYL .................................. 14 buprenorphine hcl ...................... 14 buprenorphine hcl-naloxone hcl 14 buproban .................................... 14

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bupropion hcl ............................. 14 bupropion hcl er (smoking det)..14 bupropion hcl er (xl) ................... 14 buspirone hcl .............................. 14 butalbital-apap-caff-cod ............. 14 butalbital-apap-caffeine ............. 14 butalbital-asa-caff-codeine ........ 14 butalbital-aspirin-caffeine .......... 14 BUTISOL SODIUM ....................... 14 BUTRANS .................................... 14 BYDUREON ................................. 14 BYETTA 5 MCG PEN .................... 14 BYSTOLIC .................................... 14 cabergoline ................................. 14 CADUET ...................................... 14 CAFERGOT .................................. 14 CALAN ......................................... 14 calcipotriene ............................... 14 calcitonin (salmon) ..................... 14 calcitrene .................................... 14 calcitriol ...................................... 14 calcium acetate .......................... 14 calcium acetate (phos binder) .... 14 camila ......................................... 14 camrese ...................................... 15 CANASA ...................................... 15 candesartan cilexetil .................. 15 candesartan cilexetil-hctz ........... 15 CANTIL ........................................ 15 CAPEX ......................................... 15 CAPITAL/CODEINE ...................... 15 CAPRELSA ................................... 15 captopril ..................................... 15 captopril-hydrochlorothiazide ... 15 CARAC ......................................... 15 carafate ...................................... 15 CARAFATE ................................... 15 CARBAGLU .................................. 15 carbamazepine ........................... 15 carbamazepine er ....................... 15 carbidopa-levodopa ................... 15 carbidopa-levodopa er ............... 15 carbidopa-levodopa- entacapone ................................. 15 carbinoxamine maleate .............. 15 CARDIZEM................................... 15 CARDIZEM CD ............................. 15 CARDURA .................................... 15 CARDURA XL ............................... 15

CAREONE BLOOD GLUCOSE SYSTEM ....................................... 15 CAREONE BLOOD GLUCOSE TEST ............................................. 15 careone lancet thin 23g .............. 15 careone lancet ultra thin 28g ..... 15 careone unifine pentips .............. 15 careone unifine pentips plus ...... 15 CARESENS N GLUCOSE TEST ....... 16 CARIMUNE NF ............................. 16 carisoprodol ................................ 16 carisoprodol-aspirin .................... 16 carisoprodol-aspirin-codeine ...... 16 carteolol hcl ................................ 16 cartia xt ....................................... 16 carvedilol..................................... 16 CASODEX ..................................... 16 CATAPRES.................................... 16 caziant ......................................... 16 CEDAX ......................................... 16 cefaclor ....................................... 16 cefadroxil .................................... 16 cefazolin sodium ......................... 16 cefdinir ........................................ 16 cefditoren pivoxil ........................ 16 cefixime ....................................... 16 cefprozil ...................................... 16 ceftibuten ................................... 16 CEFTIN ......................................... 16 cefuroxime axetil ........................ 16 CELEBREX .................................... 16 celecoxib ..................................... 16 CELEXA ........................................ 16 CELLCEPT ..................................... 16 CENTANY ..................................... 16 cephalexin............................ 16, 17 CEREBYX ...................................... 17 CERVARIX .................................... 17 cetirizine hcl ................................ 17 CETRAXAL .................................... 17 CETROTIDE .................................. 17 cevimeline hcl ............................. 17 CHANTIX ...................................... 17 CHANTIX CONTINUING MONTH PAK .............................................. 17 chateal ........................................ 17 CHENODAL .................................. 17 cheratussin ac ............................. 17 chlordiazepoxide hcl ................... 17

chlordiazepoxide-amitriptyline.. 17 chlordiazepoxide-clidinium ........ 17 chloroquine phosphate .............. 17 chlorothiazide ............................. 17 chlorpromazine hcl ..................... 17 chlorzoxazone ............................ 17 cholestyramine ........................... 17 cholestyramine light ................... 17 chorionic gonadotropin .............. 17 CIALIS .......................................... 17 ciclopirox .................................... 17 ciclopirox olamine ...................... 17 cilostazol ..................................... 17 CILOXAN ..................................... 17 cimetidine ................................... 17 cimetidine hcl ............................. 17 CIMZIA ........................................ 18 CIMZIA STARTER KIT ................... 17 CINRYZE ...................................... 18 CIPRO .......................................... 18 CIPRO HC .................................... 18 CIPRO XR ..................................... 18 CIPRODEX ................................... 18 ciprofloxacin hcl ......................... 18 ciprofloxacin-ciproflox hcl er ...... 18 citalopram hydrobromide .......... 18 claravis ........................................ 18 CLARIFOAM EF............................ 18 CLARINEX .................................... 18 clarithromycin ............................ 18 clarithromycin er ........................ 18 clemastine fumarate .................. 18 CLEOCIN ...................................... 18 CLEOCIN-T .................................. 18 CLEVER CHEK AUTO-CODE TEST. 18 CLEVER CHEK AUTO-CODE VOICE .......................................... 18

CLEVER CHEK LANCETS ............... 18 CLEVER CHEK SYSTEM ................ 18 CLEVER CHEK TEST ..................... 18 CLEVER CHOICE AUTO-CODE TEST ............................................ 18

CLEVER CHOICE MICRO SYSTEM 18 CLEVER CHOICE MICRO TEST ..... 19 CLIMARA ..................................... 19 CLIMARA PRO ............................. 19 clindacin etz ................................ 19 clindacin-p .................................. 19 CLINDAGEL ................................. 19

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clindamycin hcl ........................... 19 clindamycin palmitate hcl .......... 19 clindamycin phos-benzoyl perox 19 clindamycin phosphate .............. 19 clindamycin-tretinoin ................. 19 clobetasol propionate ................ 19 clobetasol propionate e ............. 19 CLOBEX ....................................... 19 CLOBEX SPRAY ............................ 19 clocortolone pivalate .................. 19 clocortolone pivalate pump ....... 19 clodan ......................................... 19 CLODERM ................................... 19 CLODERM PUMP ........................ 19 clomiphene citrate ..................... 19 clomipramine hcl ........................ 19 clonazepam ................................ 19 clonidine hcl ............................... 19 clopidogrel bisulfate ................... 19 clorazepate dipotassium ............ 19 clorpres ....................................... 19 clotrimazole ................................ 20 clotrimazole-betamethasone ..... 20 clozapine..................................... 20 CLOZARIL .................................... 20 COAGADEX ................................. 20 COAGUCHEK LANCETS ................ 20 COARTEM ................................... 20 codeine sulfate ........................... 20 COLAZAL ..................................... 20 colchicine .................................... 20 colchicine-probenecid ................ 20 COLCRYS ..................................... 20 COLESTID .................................... 20 colestipol hcl ............................... 20 colocort ...................................... 20 COLY-MYCIN S ............................ 20 COMBIGAN ................................. 20 COMBIPATCH ............................. 20 COMBIVENT RESPIMAT .............. 20 COMBIVIR ................................... 20 COMETRIQ (140 MG DAILY DOSE) .......................................... 20 comfort assured lancets 28g ...... 20 comfort assured lancets 33g ...... 20 COMFORT EZ INSULIN SYRINGE. 20 COMFORT EZ PEN NEEDLES ....... 20 comfort lancets .......................... 20 COMPACT SPACE CHAMBER ...... 20

COMPACT SPACE CHAMBER/LG MASK ........................................... 21 COMPACT SPACE CHAMBER/MED MASK ................ 21 COMPACT SPACE CHAMBER/SM MASK ........................................... 21 COMPAZINE ................................ 21 COMPLERA .................................. 21 COMTAN ..................................... 21 CONDYLOX .................................. 21 constulose ................................... 21 CONTROL AST ............................. 21 CONTROL BLOOD GLUCOSE SYSTEM ....................................... 21 CONTROL TEST ............................ 21 CONZIP ........................................ 21 COOL BLOOD GLUCOSE TEST STRIPS ......................................... 21 COOL MONITOR KIT .................... 21 COPAXONE .................................. 21 COPEGUS ..................................... 21 CORDARONE ............................... 21 CORDRAN .................................... 21 COREG ......................................... 21 COREG CR .................................... 21 CORGARD .................................... 21 CORIFACT .................................... 21 cormax scalp application ............ 21 CORTEF ........................................ 21 CORTENEMA ............................... 21 CORTIFOAM ................................ 21 CORTISPORIN-TC ......................... 21 CORZIDE ...................................... 21 COSENTYX 300 DOSE .................. 21 COSENTYX SENSOREADY 300 DOSE ........................................... 21 COSOPT ....................................... 22 COSOPT PF .................................. 22 COUMADIN ................................. 22 covaryx hs ................................... 22 COZAAR ....................................... 22 CREON ......................................... 22 CRESTOR ..................................... 22 CRIXIVAN ..................................... 22 cromolyn sodium ........................ 22 cryselle-28 ................................... 22 CUTIVATE .................................... 22 CUVITRU ...................................... 22 CUVPOSA .................................... 22

CVS ADVANCED GLUCOSE TEST..22 CVS BLOOD GLUCOSE METER .... 22 cvs lancets 21g ........................... 22 cvs lancets micro thin 33g .......... 22 cvs lancets thin 26g .................... 22 cvs lancets ultra thin 30g............ 22 cvs ultra thin lancets .................. 22 cyclafem 1/35 ............................. 22 cyclafem 7/7/7 ........................... 22 CYCLESSA .................................... 22 cyclobenzaprine hcl .................... 22 CYCLOGYL ................................... 22 CYCLOMYDRIL............................. 22 cyclopentolate hcl ...................... 22 cycloserine .................................. 22 CYCLOSET ................................... 22 cyclosporine ............................... 22 cyclosporine modified ................ 22 CYMBALTA .................................. 22 cyproheptadine hcl...............22, 23 cyred ........................................... 23 CYSTADANE ................................ 23 CYSTARAN................................... 23 cytarabine (pf) ............................ 23 CYTOGAM ................................... 23 CYTOMEL .................................... 23 DAKLINZA ................................... 23 DALIRESP .................................... 23 danazol ....................................... 23 DANTRIUM ................................. 23 dantrolene sodium ..................... 23 dapsone ...................................... 23 DARAPRIM .................................. 23 darifenacin hydrobromide er ..... 23 DARZALEX ................................... 23 dasetta 1/35 ............................... 23 dasetta 7/7/7.............................. 23 DAYPRO ...................................... 23 daysee ........................................ 23 DAYTRANA .................................. 23 DDAVP ........................................ 23 deblitane .................................... 23 delyla .......................................... 23 DELZICOL .................................... 23 DEMADEX ................................... 23 demeclocycline hcl ..................... 23 DENAVIR ..................................... 23 DEPAKENE .................................. 23 DEPAKOTE .................................. 23

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DEPAKOTE ER ............................. 23 DEPO-MEDROL ........................... 23 DEPO-TESTOSTERONE ................ 23 DERMATOP ................................. 24 desipramine hcl .......................... 24 desloratadine ............................. 24 desmopressin ace spray refrig... 24 desmopressin acetate ................ 24 DESOGEN .................................... 24 desogestrel-ethinyl estradiol ..... 24 DESONATE .................................. 24 desonide ..................................... 24 DESOWEN ................................... 24 desoximetasone ......................... 24 desvenlafaxine er ....................... 24 DETROL ....................................... 24 DETROL LA .................................. 24 dexamethasone .......................... 24 dexamethasone sodium phosphate................................... 24 DEXCOM G4 PLAT PED RCV/SHARE ................................. 24 DEXCOM G4 PLAT PED RECEIVER .................................... 24 DEXCOM G4 PLATINUM RCV/SHARE ................................. 24 DEXCOM G4 PLATINUM RECEIVER .................................... 24 DEXCOM G4 PLATINUM TRANSMITTER............................. 24 DEXCOM G5 MOB/G4 PLAT SENSOR ....................................... 24 DEXCOM G5 MOBILE RECEIVER..24 DEXCOM G5 MOBILE TRANSMITTER............................. 24 dexedrine.................................... 24 DEXILANT .................................... 24 dexmethylphenidate hcl ............ 24 dexmethylphenidate hcl er ........ 24 dextroamphetamine sulfate ...... 24 DIABETA ...................................... 25 dialyvite ...................................... 25 DIASTAT PEDIATRIC .................... 25 diatrue plus test ......................... 25 diazepam .................................... 25 diazepam intensol ...................... 25 diclofenac potassium ................. 25 diclofenac sodium ...................... 25 diclofenac sodium er .................. 25

diclofenac-misoprostol ............... 25 dicloxacillin sodium ..................... 25 dicyclomine hcl ........................... 25 didanosine .................................. 25 DIFFERIN ..................................... 25 DIFICID ........................................ 25 diflorasone diacetate .................. 25 DIFLUCAN .................................... 25 diflunisal ...................................... 25 digitek ......................................... 25 digox............................................ 25 digoxin......................................... 25 dihydroergotamine mesylate ..... 25 DILANTIN ..................................... 25 DILATRATE-SR ............................. 25 DILAUDID .................................... 25 diltiazem cd ................................. 25 diltiazem hcl ................................ 26 diltiazem hcl er beads ................. 26 diltiazem hcl er coated beads ..... 26 DIOVAN ....................................... 26 DIOVAN HCT................................ 26 DIPENTUM .................................. 26 diphenhydramine hcl .................. 26 diphenoxylate-atropine .............. 26 DIPROLENE AF ............................. 26 dipyridamole ............................... 26 DISALCID ..................................... 26 disopyramide phosphate ............ 26 disulfiram .................................... 26 DITROPAN XL .............................. 26 divalproex sodium ...................... 26 divalproex sodium er .................. 26 DIVIGEL ....................................... 26 dofetilide ..................................... 26 DORAL ......................................... 26 DORYX ......................................... 26 dorzolamide hcl .......................... 26 dorzolamide hcl-timolol mal ....... 26 DOVONEX .................................... 26 doxazosin mesylate..................... 26 doxepin hcl .................................. 26 doxycycline ................................. 26 doxycycline hyclate ..................... 26 doxycycline monohydrate .......... 26 dritho-creme hp .......................... 26 dronabinol................................... 27 DROPLET LANCETS ULTRA THIN 30G .............................................. 27

DROPLET PEN NEEDLES .............. 27 drospirenone-ethinyl estradiol...27 DROXIA ....................................... 27 drug mart lancets thin 26g ......... 27 drug mart lancets ultra thin ....... 27 DRUG MART ON-THE-GO LANCET 30G ................................ 27

drug mart unifine pentips .......... 27 DRUG MART UNILET LANCETS 28G ............................................. 27

DRUG MART UNILET LANCETS 30G ............................................. 27

duane reade lancet altern site... 27 duane reade lancet super thin... 27 duane reade lancet ultra thin .... 27 DUAVEE ...................................... 27 DUETACT .................................... 27 DUEXIS ........................................ 27 DULERA ....................................... 27 duloxetine hcl ............................. 27 DUREZOL .................................... 27 dutasteride ................................. 27 dutasteride-tamsulosin hcl ........ 27 DYMISTA ..................................... 27 DYRENIUM .................................. 27 e.e.s. 400 .................................... 27 EASIVENT .................................... 27 EASIVENT MASK LARGE .............. 27 EASIVENT MASK MEDIUM .......... 27 EASIVENT MASK SMALL ............. 27 easy comfort lancets .................. 27 easy comfort pen needles .......... 27 easy plus ii glucose test .............. 27 EASY STEP GLUCOSE MONITOR..27 EASY STEP TEST .......................... 27 easy talk blood glucose system.. 27 easy talk blood glucose test ....... 27 EASY TOUCH FLIPLOCK NEEDLES 28 EASY TOUCH GLUCOSE SYSTEM. 28 EASY TOUCH HEALTHPRO SYSTEM ....................................... 28

EASY TOUCH HEALTHPRO TEST.. 28 EASY TOUCH HYPODERMIC NEEDLE ....................................... 28

EASY TOUCH INSULIN SYRINGE.. 28 EASY TOUCH LANCETS 21G ........ 28 EASY TOUCH LANCETS 23G ........ 28 EASY TOUCH LANCETS 26G ........ 28

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EASY TOUCH LANCETS 26G/TWIST ................................. 28 EASY TOUCH LANCETS 28G ........ 28 EASY TOUCH LANCETS 28G/TWIST ................................. 28 EASY TOUCH LANCETS 30G ........ 28 EASY TOUCH LANCETS 30G/TWIST ................................. 28 EASY TOUCH LANCETS 32G ........ 28 EASY TOUCH LANCETS 32G/TWIST ................................. 28 EASY TOUCH LANCETS 33G/TWIST ................................. 28 EASY TOUCH PEN NEEDLES ........ 28 EASY TOUCH SAFETY LANCETS 21G ............................................. 28 EASY TOUCH SAFETY LANCETS 23G ............................................. 28 EASY TOUCH SAFETY LANCETS 26G ............................................. 28 EASY TOUCH SAFETY LANCETS 28G ............................................. 28 EASY TOUCH TEST ...................... 28 easy trak blood glucose system..28 easy trak blood glucose test ....... 28 EASY TWIST & CAP LANCETS ...... 28 EASYGLUCO ................................ 28 EASYGLUCO PLUS ....................... 28 EASYGLUCO PLUS STARTER ........ 28 EASYMAX 15 TEST ...................... 28 EASYMAX NG BLOOD GLUCOSE. 28 EASYMAX TEST ........................... 28 econazole nitrate........................ 28 ECOZA ......................................... 28 EDARBI ........................................ 28 EDARBYCLOR .............................. 29 ed-spaz ....................................... 29 EDURANT .................................... 29 eemt hs ....................................... 29 EFFEXOR XR ................................ 29 EFFIENT ....................................... 29 EFUDEX ....................................... 29 EGRIFTA ...................................... 29 element compact test ................ 29 ELEMENT TEST ............................ 29 ELESTAT ...................................... 29 ELIDEL ......................................... 29 ELIGARD ...................................... 29 ELIMITE ....................................... 29

elinest ......................................... 29 ELIQUIS........................................ 29 elite-ob ........................................ 29 ELOCON ....................................... 29 ELOCTATE .................................... 29 EMADINE ..................................... 29 EMBEDA ...................................... 29 EMBRACE BLOOD GLUCOSE TEST ............................................. 29 EMBRACE EVO BLOOD GLUCOSE TEST ............................................. 29 EMBRACE EVO GLUCOSE MONITORING .............................. 29 EMBRACE LANCETS ULTRA THIN 30G .............................................. 29 EMBRACE PRO GLUCOSE TEST... 29 EMCYT ......................................... 29 EMEND ........................................ 29 EMLA ........................................... 29 emoquette .................................. 29 EMSAM ....................................... 29 EMTRIVA...............................29, 30 ENABLEX ...................................... 30 enalapril maleate ........................ 30 ENBREL SURECLICK ..................... 30 endocet ....................................... 30 ENGERIX-B ................................... 30 ENJUVIA ...................................... 30 enoxaparin sodium ..................... 30 enpresse-28 ................................ 30 enskyce ....................................... 30 entacapone ................................. 30 entecavir ..................................... 30 ENTEREG ..................................... 30 ENTOCORT EC ............................. 30 ENTRESTO ................................... 30 EPCLUSA ...................................... 30 EPIDUO ........................................ 30 EPIFOAM ..................................... 30 epinastine hcl .............................. 30 epinephrine ................................. 30 epinephrine hcl ........................... 30 EPIPEN 2-PAK .............................. 30 EPIPEN JR 2-PAK .......................... 30 epitol ........................................... 30 EPIVIR .......................................... 30 EPIVIR HBV .................................. 30 eplerenone .................................. 30 EPOGEN ....................................... 30

eprosartan mesylate .................. 30 EPZICOM ..................................... 30 eq blood glucose test ................. 30 eql color lancets 21g .................. 30 eql color lancets micro 33g ........ 31 eql super thin lancets 30g .......... 31 eql thin lancets 26g .................... 31 EQUETRO .................................... 31 ERGOMAR ................................... 31 errin ............................................ 31 ERTACZO ..................................... 31 erygel .......................................... 31 ery-tab ........................................ 31 erythromycin .............................. 31 erythromycin base ..................... 31 erythromycin ethylsuccinate...... 31 escitalopram oxalate .................. 31 ESGIC .......................................... 31 esomeprazole magnesium ......... 31 est estrogens-methyltest hs ....... 31 estarylla ...................................... 31 estazolam ................................... 31 estradiol...................................... 31 estradiol-norethindrone acet ..... 31 ESTRING ...................................... 31 ESTROGEL ................................... 31 ESTROSTEP FE ............................. 31 eszopiclone ................................. 31 ethambutol hcl ........................... 31 ethosuximide .............................. 31 etidronate disodium ................... 31 etodolac ...................................... 31 EUFLEXXA ................................... 31 EURAX ......................................... 32 EVENCARE G2 TEST .................... 32 EVENCARE G3 TEST .................... 32 EVENCARE MINI GLUCOSE TEST. 32 EVOCLIN ..................................... 32 EVOLUTION AUTOCODE ............. 32 EVOXAC ...................................... 32 EXEL COMFORT POINT INSULIN SYR .............................................. 32

EXELDERM .................................. 32 EXELON ....................................... 32 exemestane ................................ 32 EXFORGE ..................................... 32 EXFORGE HCT ............................. 32 EXJADE ........................................ 32 EXODERM ................................... 32

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EXTAVIA ...................................... 32 e-z ject lancet micro-thin 33g ..... 32 e-z ject lancet super thin 30g ..... 32 e-z ject lancets ............................ 32 e-z ject lancets 21g ..................... 32 E-Z JECT LANCETS THIN 26G ....... 32 EZ SMART BLOOD GLUCOSE LANCETS ..................................... 32 EZ SMART BLOOD GLUCOSE TEST ............................................ 32 EZ SMART PLUS GLUCOSE TEST..32 E-Z SPACER ................................. 32 ezetimibe .................................... 32 FABIOR ........................................ 32 FACTIVE ...................................... 32 falmina ........................................ 32 famciclovir .................................. 32 famotidine .................................. 32 FAMVIR ....................................... 32 FANAPT ....................................... 32 FARESTON ................................... 32 FARXIGA ...................................... 33 FAZACLO ..................................... 33 felbamate ................................... 33 FELBATOL .................................... 33 FELDENE ..................................... 33 felodipine er ............................... 33 FEMARA ...................................... 33 FEMCON FE ................................. 33 FEMHRT LOW DOSE ................... 33 fenofibrate.................................. 33 fenofibric acid ............................. 33 FENOGLIDE ................................. 33 fenoprofen calcium .................... 33 FENORTHO .................................. 33 fentanyl citrate ........................... 33 FENTORA .................................... 33 FETZIMA TITRATION ................... 33 FIFTY50 GLUCOSE METER 2.0 ..... 33 FIFTY50 GLUCOSE TEST 2.0 ........ 33 FIFTY50 PEN NEEDLES ................ 33 FIFTY50 SAFETY SEAL LANCETS...33 FIFTY50 UNILET LANCETS 33G .... 33 FINACEA ...................................... 33 finasteride .................................. 33 FINE 30 ....................................... 33 FINGERSTIX LANCETS.................. 33 FIORINAL ..................................... 33 FIORINAL/CODEINE #3 ............... 33

FLAGYL ........................................ 33 FLAGYL ER ................................... 33 FLAREX ........................................ 34 flavoxate hcl ................................ 34 FLEBOGAMMA ............................ 34 FLEBOGAMMA DIF ...................... 34 flecainide acetate ....................... 34 FLECTOR ...................................... 34 FLEXICHAMBER ........................... 34 FLOLAN........................................ 34 FLOMAX ...................................... 34 FLOVENT DISKUS ......................... 34 FLOVENT HFA .............................. 34 flucaine ....................................... 34 fluconazole .................................. 34 flucytosine................................... 34 fludrocortisone acetate .............. 34 FLUMADINE ................................ 34 flunisolide ................................... 34 fluocinolone acetonide ............... 34 fluocinonide ................................ 34 fluocinonide-e ............................. 34 fluorescein-benoxinate ............... 34 fluoritab ...................................... 34 fluorometholone ......................... 34 fluorouracil ................................. 34 fluoxetine hcl .............................. 34 fluphenazine hcl .......................... 34 flurandrenolide ........................... 34 flurazepam hcl ............................ 35 flurbiprofen ................................. 35 flurbiprofen sodium .................... 35 flurox ........................................... 35 flutamide ..................................... 35 fluticasone propionate ............... 35 fluvastatin sodium ...................... 35 fluvastatin sodium er .................. 35 fluvoxamine maleate .................. 35 FML FORTE .................................. 35 FML LIQUIFILM............................ 35 FOCALIN ...................................... 35 FOCALIN XR ................................. 35 folic acid ...................................... 35 FOLLISTIM AQ ............................. 35 fondaparinux sodium .................. 35 FORA D10 BLOOD GLUCOSE TEST ............................................. 35 FORA D15G BLOOD GLUCOSE TEST ............................................. 35

FORA D20 BLOOD GLUCOSE TEST ............................................ 35

FORA D40/G31 BLOOD GLUCOSE .................................... 35

FORA G20 BLOOD GLUCOSE SYSTEM ....................................... 35

FORA G20 BLOOD GLUCOSE TEST ............................................ 35

FORA G30A BLOOD GLUCOSE TEST ............................................ 35

FORA GD20 TEST ........................ 35 FORA GD50 BLOOD GLUCOSE TEST ............................................ 35

FORA LANCETS ........................... 35 FORA TN'G VOICE ....................... 35 FORA TN'G/TN'G VOICE .............. 35 FORA V10 BLOOD GLUCOSE TEST ............................................ 35

FORA V12 BLOOD GLUCOSE TEST ............................................ 35

FORA V20 BLOOD GLUCOSE TEST ............................................ 36

FORA V30A BLOOD GLUCOSE SYSTEM ....................................... 36

FORA V30A BLOOD GLUCOSE TEST ............................................ 36

FORACARE GD40 TEST ................ 36 FORACARE PREMIUM V10 TEST. 36 FORACARE TEST N GO TEST ....... 36 FORADIL AEROLIZER ................... 36 FORFIVO XL ................................. 36 FORTEO ....................................... 36 FORTESTA ................................... 36 fortical ........................................ 36 FORTISCARE GLUCOSE SYSTEM.. 36 FORTISCARE TEST ....................... 36 FOSAMAX PLUS D ....................... 36 fosinopril sodium........................ 36 fosinopril sodium-hctz ................ 36 fosphenytoin sodium ................. 36 FOSRENOL .................................. 36 FRAGMIN .................................... 36 freds pharmacy unifine pentip+. 36 freds pharmacy unilet lanc 28g.. 36 freds pharmacy unilet lanc 30g.. 36 FREESTYLE FREEDOM ................. 36 FREESTYLE FREEDOM LITE .......... 36 FREESTYLE INSULINX SYSTEM .... 36 FREESTYLE INSULINX TEST .......... 36

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FREESTYLE LANCETS ................... 36 FREESTYLE LITE TEST .................. 36 FREESTYLE PRECISION NEO SYSTEM ....................................... 36 FREESTYLE PRECISION NEO TEST 36 FREESTYLE SIDEKICK II ................ 36 FREESTYLE TEST .......................... 36 FREESTYLE UNISTICK II LANCETS 36 FROVA ......................................... 36 frovatriptan succinate ................ 36 FULYZAQ ..................................... 37 furosemide ................................. 37 fyavolv ........................................ 37 FYCOMPA ................................... 37 gabapentin ................................. 37 GABITRIL ..................................... 37 galantamine hydrobromide er... 37 GAMMAGARD ............................ 37 GAMMAGARD S/D LESS IGA ....... 37 ganirelix acetate ......................... 37 GARDASIL.................................... 37 gatifloxacin ................................. 37 gavilyte-g .................................... 37 ge100 blood glucose system ...... 37 ge100 blood glucose test ........... 37 GELNIQUE ................................... 37 GEL-ONE ..................................... 37 GELSYN-3 .................................... 37 gemfibrozil .................................. 37 GENERESS FE .............................. 37 gengraf ....................................... 37 GENOTROPIN .............................. 37 GENSTRIP 50 ............................... 37 gentak ......................................... 37 gentamicin sulfate ...................... 37 GENVISC 850 ............................... 37 GEODON ..................................... 37 ght blood glucose monitor ......... 37 ght test ....................................... 37 gianvi .......................................... 37 GIAZO ......................................... 38 gildagia ....................................... 38 gildess 1.5/30 ............................. 38 gildess 1/20 ................................ 38 gildess 24 fe ................................ 38 gildess fe 1.5/30 ......................... 38 GILENYA ...................................... 38 GILOTRIF ..................................... 38 glatopa ........................................ 38

GLEEVEC ...................................... 38 GLEOSTINE .................................. 38 glimepiride .................................. 38 glipizide ....................................... 38 glipizide er ................................... 38 glipizide xl ................................... 38 glipizide-metformin hcl ............... 38 global ease inject pen needles... 38 global inject ease insulin syr ....... 38 global inject ease lancets 28g ..... 38 global inject ease lancets 30g ..... 38 global insulin syringes ................. 38 GLUCAGEN HYPOKIT ................... 38 GLUCAGON EMERGENCY ............ 38 GLUCOCARD 01 BLOOD GLUCOSE ..................................... 38 GLUCOCARD 01 SENSOR PLUS... 38 GLUCOCARD EXPRESSION MONITOR .................................... 38 GLUCOCARD EXPRESSION TEST..38 GLUCOCARD SHINE ..................... 38 GLUCOCARD SHINE TEST ............ 38 GLUCOCARD VITAL MONITOR .... 38 GLUCOCARD VITAL TEST ............. 38 GLUCOCOM LANCETS 28G .......... 38 GLUCOCOM LANCETS 30G .......... 38 GLUCOCOM LANCETS 33G .......... 38 GLUCOCOM MONITOR ............... 38 GLUCOCOM TEST ........................ 38 GLUCONAVII BLOOD GLUCOSE SYS ............................................... 39 GLUCONAVII BLOOD GLUCOSE TEST ............................................. 39 GLUCOPHAGE ............................. 39 GLUCOPHAGE XR ........................ 39 glucose meter test ...................... 39 GLUCOTROL ................................ 39 GLUCOTROL XL ............................ 39 GLUMETZA .................................. 39 glyburide ..................................... 39 glyburide micronized .................. 39 glyburide-metformin .................. 39 glycopyrrolate ............................. 39 GLYNASE ..................................... 39 GLYSET ........................................ 39 GLYXAMBI ................................... 39 GMATE BLOOD GLUCOSE TEST.. 39 GMATE LANCETS 30G ................. 39 GMATE SMART STARTER ............ 39

gnp easy touch glucose test ....... 39 gnp insulin syringe ...................... 39 gnp lancets ................................. 39 gnp lancets 21g .......................... 39 gnp lancets micro thin 33g ......... 39 gnp lancets super thin 30g ......... 39 gnp lancets thin .......................... 39 gnp lancets thin 26g ................... 39 gnp micro thin lancets 33g ......... 39 gnp super thin lancets 30g ......... 39 gnp ultra com insulin syringe ..... 39 GOLYTELY ................................... 39 GONAL-F ..................................... 39 granisetron hcl ........................... 39 GRIFULVIN V ............................... 39 griseofulvin microsize ................. 40 griseofulvin ultramicrosize ......... 40 GRIS-PEG .................................... 40 guaiatussin ac ............................. 40 guaifenesin ac ............................. 40 guaifenesin-codeine ................... 40 guanfacine hcl ............................ 40 guanfacine hcl er ........................ 40 guanidine hcl .............................. 40 GUARDIAN REAL-TIME STARTER 40 GUARDIAN REAL-TIME SYSTEM PED ............................................. 40

GYNAZOLE-1 ............................... 40 HALDOL DECANOATE ................. 40 halobetasol propionate .............. 40 HALOG ........................................ 40 haloperidol ................................. 40 haloperidol decanoate ............... 40 haloperidol lactate ..................... 40 HARVONI .................................... 40 HAVRIX ....................................... 40 healthy accents unifine pentip... 40 healthy accents unilet lancets .... 40 heather ....................................... 40 h-e-b incontrol lancets 28g ........ 40 h-e-b incontrol lancets 30g ........ 40 h-e-b incontrol lancets 33g ........ 40 h-e-b incontrol pen needles ....... 40 HELIXATE FS ................................ 40 hemmorex-hc ............................. 40 HEMOFIL M ................................ 40 heparin sodium (porcine) ........... 40 HIPREX ........................................ 40 homatropaire ............................. 41

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homatropine hbr ........................ 41 HORIZANT ................................... 41 HP ACTHAR ................................. 41 HUMALOG .................................. 41 HUMALOG MIX 50/50 ................ 41 HUMALOG MIX 75/25 ................ 41 HUMATE-P .................................. 41 HUMATROPE .............................. 41 HUMIRA PEN .............................. 41 HUMIRA PEN-CROHNS STARTER 41 HUMIRA PEN-PSORIASIS STARTER ..................................... 41 HUMULIN 70/30 ......................... 41 HUMULIN N ................................ 41 HUMULIN R ................................ 41 HYALGAN .................................... 41 HYCAMTIN .................................. 41 HYCET ......................................... 41 hydralazine hcl ........................... 41 HYDREA ...................................... 41 hydrochlorothiazide ................... 41 hydrocod polst-cpm polst er ...... 41 hydrocodone-acetaminophen.... 41 hydrocodone-homatropine ........ 41 hydrocodone-ibuprofen ............. 41 hydrocortisone ........................... 42 hydrocortisone ace-pramoxine.. 41 hydrocortisone acetate .............. 41 hydrocortisone butyrate ............ 42 hydrocortisone-acetic acid ......... 42 hydromorphone hcl .................... 42 hydroxychloroquine sulfate ....... 42 hydroxyurea ............................... 42 hydroxyzine hcl ........................... 42 hydroxyzine pamoate ................. 42 HYMOVIS .................................... 42 hyoscyamine sulfate ................... 42 hyosyne ...................................... 42 hypodermic needle .................... 42 HYSINGLA ER .............................. 42 HYZAAR ....................................... 42 ibandronate sodium ................... 42 ICLUSIG ....................................... 42 ILEVRO ........................................ 42 ILOTYCIN ..................................... 42 imatinib mesylate ....................... 42 IMBRUVICA ................................. 42 imipramine hcl ............................ 42 imipramine pamoate .................. 42

imiquimod ................................... 42 IMITREX ....................................... 42 IMITREX STATDOSE SYSTEM ....... 42 IMURAN ...................................... 42 INCRUSE ELLIPTA ........................ 42 indapamide ................................. 43 INDOCIN ...................................... 43 indomethacin .............................. 43 INFANRIX ..................................... 43 INFINITY BLOOD GLUCOSE SYSTEM ....................................... 43 INFINITY BLOOD GLUCOSE TEST.43 INLYTA ......................................... 43 INOVA ......................................... 43 INSPIRACHAMBER/LARGE .......... 43 INSPIRACHAMBER/MEDIUM ...... 43 INSPIRACHAMBER/MOUTHPIEC E .................................................. 43 INSPIRACHAMBER/SMALL .......... 43 INSPRA ........................................ 43 insulin syringe ............................. 43 insulin syringe/needle ................ 43 INTELENCE .................................. 43 INTERMEZZO ............................... 43 INTRON A .................................... 43 introvale ...................................... 43 INTUNIV ...................................... 43 INVEGA ........................................ 43 INVIRASE ..................................... 43 INVOKAMET ................................ 43 INVOKAMET XR ........................... 43 INVOKANA .................................. 43 iophen c-nr .................................. 43 IOPIDINE ...................................... 43 ipratropium bromide .................. 43 ipratropium-albuterol ................. 43 irbesartan .................................... 43 irbesartan-hydrochlorothiazide. 43 ISENTRESS ................................... 43 isometheptene-dichloral-apap...43 isoniazid ...................................... 44 ISOPTO ATROPINE....................... 44 ISOPTO CARPINE ......................... 44 ISORDIL TITRADOSE .................... 44 isosorbide dinitrate ..................... 44 isosorbide mononitrate .............. 44 isradipine .................................... 44 ISTALOL ....................................... 44 itraconazole ................................ 44

ivermectin .................................. 44 IXINITY ........................................ 44 JAKAFI ......................................... 44 JALYN .......................................... 44 jantoven ..................................... 44 JANUMET .................................... 44 JANUMET XR ............................... 44 JANUVIA ..................................... 44 JARDIANCE .................................. 44 jencycla ....................................... 44 JENTADUETO .............................. 44 JENTADUETO XR ......................... 44 jevantique lo ............................... 44 jinteli ........................................... 44 jolessa ......................................... 44 jolivette ...................................... 44 juleber ........................................ 44 junel 1.5/30 ................................ 44 junel 1/20 ................................... 44 junel fe 1.5/30 ............................ 44 junel fe 24 ................................... 44 JUXTAPID .................................... 44 KADIAN ....................................... 44 kaitlib fe ...................................... 44 KALETRA ..................................... 45 KALYDECO................................... 45 kariva .......................................... 45 KAZANO ...................................... 45 kelnor 1/35 ................................. 45 KENALOG .................................... 45 KEPPRA ....................................... 45 ketoconazole .............................. 45 ketoprofen .................................. 45 ketorolac tromethamine ............ 45 KHEDEZLA ................................... 45 kimidess ...................................... 45 KINERET ...................................... 45 KINEVAC ..................................... 45 kinney lancets ............................. 45 kinney thin lancets ..................... 45 KISQALI 200 DOSE ...................... 45 KLONOPIN .................................. 45 klor-con ...................................... 45 klor-con 10 ................................. 45 KOATE-DVI .................................. 45 KOGENATE FS ............................. 45 KOGENATE FS BIO-SET ............... 45 KOMBIGLYZE XR ......................... 45 KOVALTRY ................................... 45

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KRISTALOSE ................................ 45 kroger blood glucose test ........... 45 kroger lancets 21g ...................... 45 kroger lancets micro thin 33g .... 46 kroger lancets thin 26g ............... 46 kroger lancets ultrathin 30g ....... 46 kroger premium blood glucose.. 46 kroger premium glucose test ..... 46 kroger test .................................. 46 KRYSTEXXA ................................. 46 k-sol ............................................ 46 K-TAB .......................................... 46 kurvelo ........................................ 46 KYLEENA ..................................... 46 labetalol hcl ................................ 46 lactulose ..................................... 46 LAMICTAL ................................... 46 LAMICTAL ODT ........................... 46 LAMICTAL XR .............................. 46 LAMISIL ....................................... 46 lamivudine .................................. 46 lamivudine-zidovudine ............... 46 lamotrigine ................................. 46 lancets ........................................ 46 lancets 28g ................................. 46 lancets 30g ................................. 46 lancets micro thin 33g ................ 46 lancets super thin 28g ................ 46 lancets thin ................................. 46 LANCETS ULTRA FINE.................. 46 LANCETS ULTRA THIN ................. 46 lancets ultra thin 30g .................. 46 LANOXIN ..................................... 46 lansoprazole ............................... 46 LANTUS ....................................... 46 LANTUS SOLOSTAR ..................... 46 larin 1.5/30 ................................. 47 larin 1/20 .................................... 47 larin 24 fe.................................... 47 larin fe 1.5/30 ............................. 47 larissia ......................................... 47 LASTACAFT.................................. 47 latanoprost ................................. 47 LATUDA ....................................... 47 layolis fe ...................................... 47 leader insulin syringe ................. 47 LEADER UNIFINE PENTIPS .......... 47 LEADER UNIFINE PENTIPS PLUS..47 leena ........................................... 47

leflunomide ................................. 47 LESCOL ........................................ 47 LESCOL XL .................................... 47 lessina ......................................... 47 LETAIRIS ...................................... 47 letrozole ...................................... 47 leucovorin calcium ...................... 47 LEUKERAN ................................... 47 levalbuterol hcl ........................... 47 LEVAQUIN ................................... 47 LEVATOL ...................................... 47 LEVEMIR ...................................... 47 levetiracetam .............................. 47 LEVITRA ....................................... 47 levobunolol hcl ........................... 47 levocetirizine dihydrochloride .... 47 levofloxacin ................................. 47 levonest ...................................... 47 levonorgest-eth estrad 91-day... 47 levonorgestrel-ethinyl estrad ..... 47 levonorg-eth estrad triphasic ..... 48 levora 0.15/30 (28) ..................... 48 LEVO-T ......................................... 48 levothyroxine sodium ................. 48 levoxyl ......................................... 48 LEXAPRO ..................................... 48 LEXIVA ......................................... 48 LIALDA ......................................... 48 liberty test ................................... 48 LIBRAX ......................................... 48 lidocaine ...................................... 48 lidocaine pak ............................... 48 lidocaine-hydrocortisone ace ..... 48 lidocaine-prilocaine .................... 48 lidocaine-tetracaine .................... 48 lindane ........................................ 48 linezolid ....................................... 48 LINZESS........................................ 48 liothyronine sodium .................... 48 LIPITOR ........................................ 48 LIPOFEN....................................... 48 lisinopril ...................................... 48 lisinopril-hydrochlorothiazide .... 48 lite touch lancets ........................ 48 LITE TOUCH PEN NEEDLES .......... 48 LITEAIRE ...................................... 48 LITETOUCH INSULIN SYRINGE ..... 48 LITETOUCH LANCETS ................... 48 lithium ......................................... 48

lithium carbonate ....................... 48 lithium carbonate er................... 48 LIVALO ........................................ 48 live better lancet super thin ....... 48 live better lancet ultra thin ........ 48 LO LOESTRIN FE .......................... 49 LOCOID ....................................... 49 LOESTRIN 1.5/30 (21) ................. 49 LOESTRIN 1/20 (21) .................... 49 LOESTRIN FE 1.5/30 .................... 49 LOFIBRA ...................................... 49 lomedia 24 fe.............................. 49 LOMOTIL ..................................... 49 longs lancets standard ............... 49 longs lancets thin ....................... 49 longs lancets ultra thin ............... 49 loperamide hcl............................ 49 LOPID .......................................... 49 lopreeza ...................................... 49 LOPRESSOR ................................. 49 LOPROX ...................................... 49 lorazepam ................................... 49 lorazepam intensol ..................... 49 lorcet .......................................... 49 lortab .......................................... 49 loryna.......................................... 49 LORZONE .................................... 49 losartan potassium ..................... 49 losartan potassium-hctz ............. 49 LOTEMAX .................................... 49 LOTENSIN.................................... 49 LOTREL ........................................ 49 LOTRISONE ................................. 49 LOTRONEX .................................. 49 lovastatin .................................... 49 LOVAZA ....................................... 49 LOVENOX .................................... 49 low-ogestrel ............................... 49 loxapine succinate ...................... 50 ludent ......................................... 50 LUMIGAN .................................... 50 LUNESTA ..................................... 50 lutera .......................................... 50 LYRICA......................................... 50 LYSODREN .................................. 50 lyza.............................................. 50 MACROBID ................................. 50 MACRODANTIN .......................... 50 MALARONE ................................. 50

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malathion ................................... 50 maprotiline hcl ........................... 50 MARINOL .................................... 50 marlissa ...................................... 50 MARPLAN ................................... 50 MATULANE ................................. 50 MAVIK ......................................... 50 MAXALT ...................................... 50 MAXI-COMFORT INSULIN SYRINGE ...................................... 50 MAXIDEX..................................... 50 MAXITROL ................................... 50 MAXZIDE-25 ............................... 50 meclizine hcl ............................... 50 meclofenamate sodium ............. 50 medicine shoppe lancets ............ 50 medicine shoppe lancets thin .... 50 MEDISENSE THIN LANCETS ......... 50 medlance lite 25g ....................... 50 MEDLANCE PLUS EXTRA 21G ..... 50 medlance plus lancets ................ 50 MEDLANCE PLUS LITE 25G ......... 50 MEDLANCE PLUS SPECIAL 0.8MM ........................................ 50 MEDLANCE PLUS SUPERLITE 30G ............................................. 50 MEDLANCE PLUS UNIVERSAL 21G ............................................. 50 medlance universal 21g ............. 51 MEDROL...................................... 51 mefenamic acid .......................... 51 mefloquine hcl ............................ 51 MEGACE ES ................................. 51 MEGACE ORAL ............................ 51 megestrol acetate ...................... 51 meijer blood glucose .................. 51 meijer blood glucose test ........... 51 MEIJER LANCETS ......................... 51 MEIJER LANCETS THIN ................ 51 MEIJER LANCETS UNIVERSAL 33G ............................................. 51 meijer premium blood glucose.. 51 meijer premium glucose test ..... 51 MEIJER SUPER THIN LANCETS .... 51 MEKINIST .................................... 51 meloxicam .................................. 51 memantine hcl ........................... 51 MENOPUR .................................. 51 MENTAX ...................................... 51

meperidine hcl ............................ 51 MEPHYTON ................................. 51 meprobamate ............................. 51 MEPRON ..................................... 51 mercaptopurine .......................... 51 mesalamine ................................. 51 MESNEX ...................................... 51 METADATE CD ............................ 51 metaproterenol sulfate .............. 51 metaxall ...................................... 51 metaxalone ................................. 51 metformin hcl ............................. 52 metformin hcl er ......................... 52 metformin hcl er (mod) .............. 52 methadone hcl ............................ 52 methadose .................................. 52 methazolamide ........................... 52 methenamine hippurate ............. 52 methenamine mandelate ........... 52 methimazole ............................... 52 methocarbamol .......................... 52 methotrexate .............................. 52 methscopolamine bromide ........ 52 methyclothiazide ........................ 52 methyldopa ................................. 52 methyldopa- hydrochlorothiazide .................... 52 METHYLIN ................................... 52 methylphenidate hcl ................... 52 methylphenidate hcl er (cd) ....... 52 methylphenidate hcl er (la) ........ 52 methylprednisolone.................... 52 methylprednisolone acetate ...... 52 methyltestosterone .................... 52 metipranolol ............................... 52 metoclopramide hcl .................... 52 metolazone ................................. 52 metoprolol tartrate ..................... 52 METOZOLV ODT .......................... 52 METROCREAM ............................ 52 METROGEL-VAGINAL .................. 52 METROLOTION ............................ 53 metronidazole ............................. 53 mexiletine hcl .............................. 53 MIACALCIN .................................. 53 MICARDIS .................................... 53 MICARDIS HCT ............................ 53 miconazole 3 ............................... 53 MICROCHAMBER ........................ 53

MICRODOT BLOOD GLUCOSE SYSTEM ....................................... 53

MICRODOT TEST ......................... 53 microgestin 1.5/30 ..................... 53 microgestin 1/20 ........................ 53 MICROGESTIN 24 FE ................... 53 microgestin fe 1.5/30 ................. 53 MICROLET LANCETS ................... 53 MICROSPACER ............................ 53 midazolam hcl ............................ 53 midodrine hcl ............................. 53 miglitol ........................................ 53 MIGRANAL .................................. 53 mimvey ....................................... 53 MINIPRESS .................................. 53 MINITRAN ................................... 53 MINIVELLE .................................. 53 MINOCIN .................................... 53 minocycline hcl ........................... 53 minoxidil ..................................... 53 MIRAPEX ER ................................ 53 MIRCERA ..................................... 53 MIRCETTE ................................... 53 mirtazapine ................................ 54 MIRVASO .................................... 54 MITIGARE ................................... 54 MITOSOL ..................................... 54 MOBIC ........................................ 54 modafinil .................................... 54 moderiba .................................... 54 moderiba 800 dose pack ............ 54 MODICON (28) ........................... 54 moexipril hcl ............................... 54 moexipril-hydrochlorothiazide...54 mometasone furoate ................. 54 MONOCLATE-P ........................... 54 MONOJECT HYPODERMIC NEEDLE ....................................... 54

MONOJECT INSULIN SYRINGE .... 54 MONOJECT ULTRA COMFORT SYRINGE ...................................... 54

MONOLET LANCETS.................... 54 mono-linyah ............................... 54 mononessa ................................. 54 MONONINE ................................ 54 MONOVISC ................................. 54 montelukast sodium .................. 54 MONUROL .................................. 54 morgidox .................................... 54

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morphine sulfate ........................ 54 morphine sulfate er .................... 54 MOVANTIK .................................. 54 MOVIPREP .................................. 54 MOXEZA ...................................... 54 MS CONTIN ................................. 55 MULTAQ ..................................... 55 mupirocin ................................... 55 MUSE .......................................... 55 M-VIT .......................................... 55 MYAMBUTOL .............................. 55 mycophenolate mofetil .............. 55 MYDRIACYL ................................. 55 MYGLUCOHEALTH BLOOD GLUCOSE .................................... 55 MYGLUCOHEALTH LANCETS 30G55 MYGLUCOHEALTH TEST ............. 55 myorisan ..................................... 55 MYRBETRIQ ................................ 55 MYSOLINE ................................... 55 myzilra ........................................ 55 nabumetone ............................... 55 nadolol ........................................ 55 nadolol-bendroflumethiazide .... 55 naftifine hcl ................................ 55 NAFTIN ........................................ 55 NALFON ...................................... 55 naltrexone hcl ............................. 55 NAMENDA .................................. 55 NAMENDA XR ............................. 55 naproxen .................................... 55 naproxen sodium ....................... 55 naratriptan hcl ............................ 55 NARCAN ...................................... 55 NARDIL ........................................ 55 NASCOBAL .................................. 55 NASONEX .................................... 55 NATACYN .................................... 55 NATAZIA ..................................... 56 nateglinide .................................. 56 NATESTO ..................................... 56 nature-throid .............................. 56 necon 0.5/35 (28) ....................... 56 necon 1/35 (28) .......................... 56 necon 1/50 (28) .......................... 56 necon 7/7/7 ................................ 56 nefazodone hcl ........................... 56 neomycin-bacitracin zn-polymyx56 neomycin-polymyxin-dexameth.56

neomycin-polymyxin-gramicidin 56 neomycin-polymyxin-hc ............. 56 neo-polycin ................................. 56 neo-polycin hc............................. 56 NEORAL ....................................... 56 NEOSPORIN ................................. 56 nephro-vite rx ............................. 56 NEPTAZANE ................................. 56 NESINA ........................................ 56 NEULASTA ................................... 56 NEUPOGEN ................................. 56 NEUPRO ...................................... 56 NEURONTIN ................................ 56 NEUTEK 2TEK TEST ...................... 56 NEVANAC .................................... 56 nevirapine ................................... 56 NEXAVAR ..................................... 57 NEXIUM ....................................... 57 niacin er (antihyperlipidemic) ..... 57 NIACOR ....................................... 57 NIASPAN ...................................... 57 nifedipine .................................... 57 nifedipine er ................................ 57 nikki ............................................. 57 nimodipine .................................. 57 nisoldipine er .............................. 57 nitro-bid ...................................... 57 NITRO-DUR ................................. 57 nitrofurantoin macrocrystal ....... 57 nitrofurantoin monohyd macro. 57 nitroglycerin ................................ 57 NITROMIST .................................. 57 NITROSTAT .................................. 57 NIVA-PLUS ................................... 57 nizatidine .................................... 57 NIZORAL ...................................... 57 nodolor ....................................... 57 nora-be ....................................... 57 NORCO ........................................ 57 NORDITROPIN FLEXPRO .............. 57 norethin ace-eth estrad-fe ......... 57 norethindrone............................. 57 norethindrone acet-ethinyl est.. 57 norethindrone-eth estradiol ....... 57 norethin-eth estradiol-fe ............ 57 norgestimate-eth estradiol ......... 57 norgestim-eth estrad triphasic...58 NORINYL 1+35 (28) ..................... 58 NORINYL 1+50 (28) ..................... 58

NORITATE ................................... 58 norlyroc ...................................... 58 NORPACE .................................... 58 NORPACE CR ............................... 58 NORPRAMIN ............................... 58 NOR-QD ...................................... 58 nortrel 0.5/35 (28) ...................... 58 nortrel 1/35 (21) ......................... 58 nortrel 1/35 (28) ......................... 58 nortrel 7/7/7 .............................. 58 nortriptyline hcl .......................... 58 NORVASC .................................... 58 NORVIR ....................................... 58 NOVA MAX BLOOD GLUCOSE SYSTEM ....................................... 58

NOVA MAX GLUCOSE TEST ........ 58 NOVA SAFETY LANCETS 23G ...... 58 NOVA SAFETY LANCETS 28G ...... 58 NOVA SUREFLEX LANCETS .......... 58 NOVACORT ................................. 58 novarel........................................ 58 NOVOEIGHT ................................ 58 NOVOFINE .................................. 58 NOVOFINE PLUS ......................... 58 NOVOLIN 70/30 .......................... 58 NOVOLIN 70/30 RELION ............. 58 NOVOLIN N ................................. 58 NOVOLIN N RELION .................... 58 NOVOLIN R ................................. 58 NOVOLIN R RELION .................... 59 NOVOLOG FLEXPEN .................... 59 NOVOLOG MIX 70/30 ................. 59 NOVOLOG PENFILL ..................... 59 NOVOSEVEN RT .......................... 59 NOXAFIL ...................................... 59 NUCYNTA .................................... 59 NUCYNTA ER ............................... 59 NUEDEXTA .................................. 59 NULEV ......................................... 59 NUOX .......................................... 59 NUTROPIN AQ NUSPIN 10 .......... 59 NUTROPIN AQ PEN ..................... 59 NUVARING .................................. 59 NUVIGIL ...................................... 59 NUWIQ ....................................... 59 nystatin ....................................... 59 nystatin-triamcinolone ............... 59 OB COMPLETE ............................ 59 obizur .......................................... 59

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O-CAL FA ..................................... 59 ocella .......................................... 59 OCTAGAM................................... 59 OCUFEN ...................................... 59 OCUFLOX .................................... 59 ofloxacin ..................................... 59 ogestrel ....................................... 59 olanzapine............................ 59, 60 olanzapine-fluoxetine hcl ........... 60 OLEPTRO ..................................... 60 olopatadine hcl ........................... 60 OLYSIO ........................................ 60 omega-3-acid ethyl esters .......... 60 omeprazole................................. 60 omeprazole-sodium bicarbonate ................................ 60 OMNARIS .................................... 60 OMNIPRED.................................. 60 OMNITROPE ............................... 60 ON CALL EXPRESS BLOOD GLUCOSE .................................... 60 ON CALL EXPRESS MONITORING SYS .............................................. 60 ON CALL LANCETS....................... 60 ON CALL PLUS BLOOD GLUCOSE 60 ON CALL PLUS LANCETS ............. 60 ON CALL PLUS METER ................ 60 ON CALL PLUS MONITORING SYSTEM ....................................... 60 ON CALL VIVID BLOOD GLUCOSE60 ON CALL VIVID METER ................ 60 ON CALL VIVID MONITORING..... 60 ON CALL VIVID PAL METER ......... 60 ondansetron ............................... 60 ondansetron hcl ......................... 60 ONETOUCH DELICA LANCETS 33G ............................................. 60 ONETOUCH DELICA LANCETS FINE ............................................ 60 ONETOUCH ULTRA 2 .................. 60 ONETOUCH ULTRA BLUE ............ 60 ONETOUCH ULTRA MINI ............ 60 ONETOUCH ULTRASOFT LANCETS

60 ONETOUCH VERIO................ 60, 61 ONETOUCH VERIO FLEX SYSTEM 60 ONETOUCH VERIO IQ SYSTEM 60 ONETOUCH VERIO SYNC SYSTEM ....................................... 61

ONFI ............................................ 61 ONGLYZA ..................................... 61 ONMEL ........................................ 61 OPANA ........................................ 61 OPANA ER ................................... 61 OPTICHAMBER DIAMOND .......... 61 OPTICHAMBER DIAMOND-LG MASK ........................................... 61 OPTICHAMBER DIAMOND-MD MASK ........................................... 61 OPTICHAMBER DIAMOND-SM MASK ........................................... 61 OPTIUM TEST .............................. 61 OPTIUMEZ TEST .......................... 61 OPTUMRX BLOOD GLUCOSE METER ......................................... 61 OPTUMRX BLOOD GLUCOSE SYSTEM ....................................... 61 OPTUMRX BLOOD GLUCOSE TEST ............................................. 61 ORACEA ....................................... 61 ORAP ........................................... 61 ORAPRED ODT............................. 61 ORENCIA ..................................... 61 ORENCIA CLICKJECT .................... 61 orphenadrine citrate er .............. 61 orsythia ....................................... 61 ORTHO MICRONOR ..................... 61 ORTHO TRI-CYCLEN (28) ............. 61 ORTHO TRI-CYCLEN LO ............... 61 ORTHO-CYCLEN (28) ................... 61 ORTHO-NOVUM 1/35 (28) .......... 61 ORTHO-NOVUM 7/7/7 (28) ........ 61 ORTHOVISC ................................. 61 oscimin ........................................ 61 oseltamivir phosphate ................ 61 OSENI .......................................... 61 OSMOPREP ................................. 62 OTEZLA ........................................ 62 OTREXUP ..................................... 62 OVACE PLUS ................................ 62 OVACE PLUS WASH ..................... 62 OVACE WASH .............................. 62 OVCON-35 (28) ........................... 62 OVIDE .......................................... 62 OXANDRIN .................................. 62 oxandrolone ................................ 62 oxaprozin .................................... 62 OXAYDO ...................................... 62

oxcarbazepine ............................ 62 oxiconazole nitrate ..................... 62 OXISTAT ...................................... 62 OXTELLAR XR .............................. 62 oxybutynin chloride.................... 62 oxybutynin chloride er ............... 62 oxycodone hcl ............................ 62 oxycodone hcl er ........................ 62 oxycodone-acetaminophen ....... 62 oxycodone-aspirin ...................... 62 oxycodone-ibuprofen ................. 62 OXYCONTIN ................................ 62 oxymorphone hcl ....................... 62 oxymorphone hcl er ................... 62 OXYTROL ..................................... 62 pacerone .................................... 62 PACNEX WASH............................ 62 paliperidone er ........................... 63 PAMELOR.................................... 63 PANCREAZE ................................ 63 PANDEL ....................................... 63 pantoprazole sodium ................. 63 PARAFON FORTE DSC ................. 63 PAREMYD ................................... 63 PARLODEL ................................... 63 PARNATE .................................... 63 paromomycin sulfate ................. 63 paroxetine hcl ............................. 63 PASER ......................................... 63 PATADAY .................................... 63 PATANASE .................................. 63 PATANOL .................................... 63 PAXIL ........................................... 63 pc lancets super thin 30g ........... 63 pc unifine pentips ....................... 63 PCE .............................................. 63 PEDIADERM HC .......................... 63 peg-3350/electrolytes ................ 63 PEGANONE ................................. 63 PEGINTRON ................................ 63 PEG-INTRON REDIPEN ................ 63 PEG-INTRON REDIPEN PAK 4 ...... 63 pen needles 3/16" ...................... 63 penicillin v potassium ................. 63 PENTASA ..................................... 63 PENTIPS ...................................... 63 pentoxifylline er ......................... 63 PEPCID ........................................ 63 PERCOCET ................................... 63

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PERFOROMIST ............................ 64 perindopril erbumine ................. 64 permethrin ................................. 64 perphenazine .............................. 64 perphenazine-amitriptyline ....... 64 PERSANTINE ............................... 64 PERTZYE ...................................... 64 PEXEVA ....................................... 64 PHARMACIST CHOICE AUTOCODE ................................. 64 PHARMACIST CHOICE AUTOCODE SYS ........................... 64 PHARMACIST CHOICE LANCETS..64 pharmacist choice no coding...... 64 phenelzine sulfate ...................... 64 phenobarbital ............................. 64 phenyleph-promethazine-cod.... 64 phenytoin ................................... 64 phenytoin sodium extended ...... 64 philith ......................................... 64 PICATO ........................................ 64 pilocarpine hcl ............................ 64 pimozide ..................................... 64 pimtrea ....................................... 64 pindolol ....................................... 64 pioglitazone hcl .......................... 64 pioglitazone hcl-glimepiride ....... 64 pioglitazone hcl-metformin hcl.. 64 pirmella 1/35 .............................. 64 pirmella 7/7/7 ............................ 64 piroxicam .................................... 64 PLAN B ONE-STEP ....................... 64 PLAQUENIL ................................. 64 PLAVIX ........................................ 64 PLETAL ........................................ 64 PLIAGLIS ...................................... 65 PNEUMOVAX 23 ......................... 65 pnv prenatal plus multivitamin.. 65 pnv tabs 29-1 .............................. 65 POCKET CHAMBER ..................... 65 podofilox..................................... 65 poly hub needle .......................... 65 polycin ........................................ 65 polymyxin b-trimethoprim ......... 65 POLYTRIM ................................... 65 POMALYST .................................. 65 PONSTEL ..................................... 65 portia-28 ..................................... 65 potassium chloride ..................... 65

potassium chloride er ................. 65 POTIGA ........................................ 65 PR BENZOYL PEROXIDE WASH .... 65 PRADAXA ..................................... 65 PRALUENT ................................... 65 pramipexole dihydrochloride er.65 PRAMOSONE ............................... 65 PRAMOSONE E ............................ 65 PRANDIN ..................................... 65 pravastatin sodium ..................... 65 prazosin hcl ................................. 65 PRECISION PCX ............................ 65 PRECISION PCX PLUS TEST .......... 65 PRECISION POINT OF CARE TEST 65 PRECISION QID TEST ................... 65 PRECISION XTRA BLOOD GLUCOSE ..................................... 66 PRECOSE...................................... 66 PRED FORTE ................................ 66 PRED MILD .................................. 66 PRED-G S.O.P. ............................. 66 prednicarbate ............................. 66 prednisolone ............................... 66 prednisolone acetate .................. 66 prednisolone sodium phosphate66 prednisone .................................. 66 preferred plus insulin syringe ..... 66 preferred plus lancets colored... 66 preferred plus lancets thin ......... 66 preferred plus unifine pentips .... 66 PREFEST....................................... 66 PREGNYL ..................................... 66 PREMARIN ................................... 66 premium blood glucose test ....... 66 PREMPHASE ................................ 66 PREMPRO .................................... 66 prenatabs rx ................................ 66 prenatal ....................................... 66 prenatal low iron ........................ 66 prenatal plus ............................... 66 prenatal plus iron ........................ 66 prenatal vitamin plus low iron... 66 preplus ........................................ 66 PREVACID .................................... 66 prevalite ...................................... 66 previfem ...................................... 66 PREVNAR 13 ................................ 66 PREVPAC ..................................... 66 PREZISTA ..................................... 67

primaquine phosphate ............... 67 primidone ................................... 67 PRIMLEV ..................................... 67 PRIMSOL ..................................... 67 PRISTIQ ....................................... 67 PRIVIGEN .................................... 67 PROAIR HFA ................................ 67 probenecid ................................. 67 procainamide hcl ........................ 67 PROCARDIA ................................ 67 procentra .................................... 67 prochlorperazine maleate .......... 67 PROCRIT ...................................... 67 PRODIGY AUTOCODE BLOOD GLUCOSE .................................... 67

PRODIGY INSULIN SYRINGE ........ 67 PRODIGY LANCETS 28G .............. 67 PRODIGY NO CODING BLOOD GLUC ........................................... 67

PRODIGY POCKET BLOOD GLUCOSE .................................... 67

PRODIGY SAFETY LANCETS 26G..67 PRODIGY TWIST TOP LANCETS 28G ............................................. 67

PRODIGY VOICE BLOOD GLUCOSE .................................... 67

PROFILNINE ................................ 67 PROFILNINE SD ........................... 67 progesterone micronized ........... 67 PROGRAF .................................... 67 PROLENSA................................... 67 PROLIA ........................................ 67 promethazine hcl ....................... 67 promethazine vc plain ................ 67 promethazine vc/codeine .......... 67 promethazine-dm ...................... 68 promethazine-phenylephrine .... 68 PROMETRIUM ............................ 68 propafenone hcl ......................... 68 proparacaine hcl ......................... 68 propranolol hcl ........................... 68 propranolol-hctz ......................... 68 PROSCAR .................................... 68 PROTONIX ................................... 68 PROTOPIC ................................... 68 protriptyline hcl .......................... 68 PROVENTIL HFA .......................... 68 PROVIGIL .................................... 68 PROZAC ....................................... 68

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pseudoeph-bromphen-dm ......... 68 psorcon ....................................... 68 PULMICORT ................................ 68 PULMICORT FLEXHALER ............. 68 PULMOZYME .............................. 68 px lancets ultra thin .................... 68 px mini pen needles ................... 68 PYLERA ........................................ 68 pyrazinamide .............................. 68 qc lancets super thin 30g ........... 68 qc unilet lancets 28g................... 68 qc unilet lancets micro thin ........ 68 QNASL ......................................... 68 QSYMIA ....................................... 68 QUALAQUIN ............................... 68 QUARTETTE ................................ 68 quasense..................................... 68 quazepam ................................... 68 QUESTRAN .................................. 68 quetiapine fumarate .................. 69 QUILLICHEW ER .......................... 69 QUILLIVANT XR ........................... 69 quinapril-hydrochlorothiazide ... 69 quinidine gluconate .................... 69 quinidine sulfate er .................... 69 quinine sulfate ............................ 69 QUINTET AC BLOOD GLUCOSE TEST ............................................ 69 QVAR .......................................... 69 ra e-zject lancets 28g .................. 69 ra e-zject lancets thin 26g .......... 69 ra e-zject lancets thin 28g .......... 69 ra e-zject lancets ultra thin......... 69 ra lancets alternate site .............. 69 ra lancets thin ............................. 69 ra lancets ultra thin .................... 69 ra pen needles ............................ 69 RA TRUETEST TEST...................... 69 rabeprazole sodium.................... 69 ramipril ....................................... 69 RANEXA ...................................... 69 ranitidine hcl............................... 69 RAPAFLO ..................................... 69 RAPAMUNE ................................ 69 RAYOS ......................................... 69 RAZADYNE ER ............................. 69 REBETOL ..................................... 69 REBIF ........................................... 69 reclipsen ..................................... 69

RECOMBINATE ............................ 70 RECOMBIVAX HB......................... 70 REFUAH PLUS BLOOD GLUCOSE TEST ............................................. 70 REFUAH PLUS MONITORING SYSTEM ....................................... 70 REGLAN ....................................... 70 REGRANEX................................... 70 RELION CONFIRM GLUCOSE MONITOR .................................... 70 RELION CONFIRM/MICRO TEST..70 RELION LANCETS THIN 26G ........ 70 RELION LANCETS ULTRA-THIN 30G .............................................. 70 RELION MICRO ............................ 70 RELION PRIME TEST .................... 70 RELION ULTIMA GLUCOSE SYSTEM ....................................... 70 RELION ULTIMA TEST .................. 70 RELION ULTRA THIN LANCETS 30G .............................................. 70 RELION ULTRA THIN PLUS LANCETS ...................................... 70 RELISTOR ..................................... 70 RELPAX ........................................ 70 REMERON ................................... 70 RENAGEL ..................................... 70 rena-vite rx .................................. 70 RENVELA ..................................... 70 repaglinide .................................. 70 REPATHA ..................................... 70 REPATHA SURECLICK ................... 70 REQUIP ........................................ 70 RESCRIPTOR ................................ 70 RESCULA ...................................... 70 reserpine ..................................... 70 RESTASIS ..................................... 70 RESTORIL ..................................... 70 RETIN-A ....................................... 70 RETIN-A MICRO ........................... 71 RETIN-A MICRO PUMP ................ 71 RETROVIR .................................... 71 REVATIO ...................................... 71 REVEAL BLOOD GLUCOSE MONITOR .................................... 71 REVEAL BLOOD GLUCOSE TEST.. 71 REVIA ........................................... 71 REVLIMID .................................... 71

REXALL BLOOD GLUCOSE SYSTEM ....................................... 71

REXALL BLOOD GLUCOSE TEST...71 REXALL LANCETS ULTRA THIN 30G ............................................. 71

REYATAZ ..................................... 71 RHEUMATREX ............................. 71 RHOFADE .................................... 71 ribasphere .................................. 71 RIBASPHERE RIBAPAK ................. 71 RIBATAB ...................................... 71 ribavirin ...................................... 71 RIFADIN ...................................... 71 rifampin ...................................... 71 RIFATER ...................................... 71 RIGHTEST GL300 LANCETS ......... 71 RIGHTEST GM100 BLOOD GLUCOSE .................................... 71

RIGHTEST GM300 BLOOD GLUCOSE .................................... 71

RIGHTEST GM550 BLOOD GLUCOSE .................................... 71

RIGHTEST GS100 BLOOD GLUCOSE .................................... 71

RIGHTEST GS300 BLOOD GLUCOSE .................................... 71

RIGHTEST GS550 BLOOD GLUCOSE .................................... 71

RILUTEK ...................................... 71 riluzole ........................................ 71 rimantadine hcl .......................... 71 RIOMET ....................................... 72 risedronate sodium .................... 72 RISPERDAL .................................. 72 RISPERDAL CONSTA .................... 72 risperidone ................................. 72 RITALIN ....................................... 72 RITALIN LA .................................. 72 RITEFLO....................................... 72 rivastigmine ................................ 72 rivastigmine tartrate .................. 72 rixubis ......................................... 72 rizatriptan benzoate ................... 72 ROBAXIN ..................................... 72 ROBINUL ..................................... 72 ROCALTROL ................................ 72 ropinirole hcl .............................. 72 rosadan ....................................... 72 rosuvastatin calcium .................. 72

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ROTATEQ .................................... 72 ROZEREM .................................... 72 RYTHMOL.................................... 72 SABRIL ......................................... 72 SAFESNAP INSULIN SYRINGE 72 safety lancet 21g/pressure act... 72 safety lancet 28g/pressure act... 72 SAFETY LANCETS ......................... 72 SAFETY LANCETS 21G ................. 72 safety lancets 28g ....................... 72 SAFETY LET LANCETS .................. 72 SAFETY SEAL LANCETS ................ 72 SAFYRAL ...................................... 72 SAIZEN ........................................ 73 SAIZEN CLICK.EASY ..................... 73 salsalate ...................................... 73 SANCUSO .................................... 73 SANDIMMUNE ............................ 73 SANTYL........................................ 73 sapscare twist top lancets 73 SARAFEM .................................... 73 SAVELLA ...................................... 73 SEASONIQUE .............................. 73 seb-prev wash ............................ 73 SECTRAL ...................................... 73 selegiline hcl ............................... 73 selenium sulfide ......................... 73 selenium sulf-pyrithione-urea 73 SELZENTRY .................................. 73 SEMPREX-D ................................. 73 SEREVENT DISKUS ...................... 73 serophene .................................. 73 SEROQUEL .................................. 73 SEROQUEL XR ............................. 73 SEROSTIM ................................... 73 sertraline hcl ............................... 73 setlakin ....................................... 73 sharobel ...................................... 73 SHOPKO ON-THE-GO LANCETS 30G ............................................. 73 SHOPKO UNIFINE PENTIPS 73 SHOPKO UNIFINE PENTIPS PLUS 73 SHOPKO UNILET LANCETS 28G...73 SHOPKO UNILET LANCETS 30G...73 sildenafil citrate .......................... 74 SILVADENE .................................. 74 silver sulfadiazine ....................... 74 SIMBRINZA ................................. 74 SIMCOR ....................................... 74

SIMPONI ...................................... 74 simvastatin .................................. 74 SINEMET ...................................... 74 SINEMET CR ................................ 74 SINGLE-LET .................................. 74 SINGULAIR ................................... 74 sirolimus ...................................... 74 SIRTURO ...................................... 74 SIVEXTRO .................................... 74 SKELAXIN ..................................... 74 SKYLA .......................................... 74 sm glucose test ........................... 74 sm insulin syringe ....................... 74 sm lancets 21g ............................ 74 sm lancets 33g ............................ 74 sm super thin lancets 30g ........... 74 sm thin lancets 26g ..................... 74 SMART SENSE COLOR LANCETS 33G .............................................. 74 SMART SENSE PREMIUM SYSTEM ....................................... 74 SMART SENSE PREMIUM TEST... 74 SMART SENSE STANDARD LANCETS ...................................... 74 SMART SENSE SUPER THIN LANCETS ...................................... 74 SMART SENSE THIN LANCETS 26G .............................................. 74 SMART SENSE VALUE GLUCOSE SYS ............................................... 74 SMART SENSE VALUE TEST ......... 74 SMARTEST BLOOD GLUCOSE TEST ............................................. 74 SMARTEST EJECT STARTER ......... 74 SMARTEST LANCETS 28G ............ 74 SMARTEST PERSONA STARTER...74 SMARTEST PRONTO STARTER ..... 75 SMARTEST PROTEGE STARTER... 75 sodium fluoride ........................... 75 sodium sulfacetamide................. 75 SOLIQUA...................................... 75 SOLODYN .................................... 75 SOLTAMOX .................................. 75 SOLU-CORTEF .............................. 75 SOLUS V2 BLOOD GLUCOSE SYSTEM ....................................... 75 SOLUS V2 LANCETS 28G .............. 75 SOLUS V2 TEST ............................ 75 SOLUS V2 TWIST LANCETS 30G.. 75

SOMA.......................................... 75 SORIATANE ................................. 75 SORILUX ...................................... 75 sorine .......................................... 75 sotalol hcl ................................... 75 sotalol hcl (af) ............................. 75 SOVALDI...................................... 75 SPIRIVA HANDIHALER ................. 75 SPIRIVA RESPIMAT ..................... 75 spironolactone ........................... 75 spironolactone-hctz ................... 75 SPORANOX ................................. 75 SPORANOX PULSEPAK ................ 75 sprintec 28 .................................. 75 SPRIX ........................................... 75 SPRYCEL ...................................... 75 sronyx ......................................... 75 ssd............................................... 75 SSKI ............................................. 75 sss 10-5 ....................................... 75 STALEVO 75 ................................ 76 STARLIX ....................................... 76 stavudine .................................... 76 STAXYN ....................................... 76 STELARA...................................... 76 STENDRA .................................... 76 STERILANCE TL ............................ 76 STIOLTO RESPIMAT .................... 76 STIVARGA ................................... 76 STRATTERA ................................. 76 STRIANT ...................................... 76 STRIBILD ..................................... 76 STROMECTOL ............................. 76 SUBOXONE ................................. 76 SUBSYS ........................................ 76 SUCRAID ..................................... 76 sucralfate .................................... 76 SULAR ......................................... 76 sulfacetamide sodium ................ 76 sulfacetamide sodium-sulfur ..... 76 sulfacetamide-prednisolone ...... 76 sulfacetamide-sulfur in urea ...... 76 sulfadiazine................................. 76 sulfamethoxazole-trimethoprim 76 SULFAMYLON ............................. 76 sulfasalazine ............................... 76 sulfatrim pediatric ...................... 77 sulindac ...................................... 77 sumatriptan ................................ 77

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sumatriptan succinate ................ 77 SUPARTZ ..................................... 77 SUPARTZ FX ................................ 77 SUPRAX ....................................... 77 SUPREP BOWEL PREP ................. 77 sure comfort insulin syringe ....... 77 sure comfort lancets 28g ............ 77 sure comfort lancets 30g ............ 77 sure comfort pen needles .......... 77 SURE-FINE PEN NEEDLES ............ 77 SURE-JECT INSULIN SYRINGE ...... 77 SURE-LANCE FLAT LANCETS ....... 77 SURE-LANCE THIN LANCETS 28G 77 SURE-LANCE ULTRA THIN LANCETS ..................................... 77 SURE-TEST EASYPLUS MINI TEST 77 SURE-TOUCH LANCETS UNIVERSAL ................................. 77 SUSTIVA ...................................... 77 SUTENT ....................................... 77 syeda .......................................... 77 SYLATRON ................................... 77 symax fastabs ............................. 77 SYMBICORT ................................. 77 SYMBYAX .................................... 77 SYMLINPEN 120 .......................... 77 SYNALAR ..................................... 77 SYNALAR (CREAM) ...................... 77 SYNJARDY ................................... 77 SYNTHROID ................................. 77 SYNVISC ...................................... 77 SYNVISC ONE .............................. 78 TABLOID ...................................... 78 TACLONEX................................... 78 tacrolimus ................................... 78 TAFINLAR .................................... 78 TAMIFLU ..................................... 78 tamoxifen citrate ........................ 78 tamsulosin hcl ............................ 78 TANZEUM ................................... 78 TAPAZOLE ................................... 78 TARCEVA ..................................... 78 TARKA ......................................... 78 TASIGNA ..................................... 78 TASMAR ...................................... 78 TAZORAC .................................... 78 taztia xt ....................................... 78 TECFIDERA .................................. 78 TECHLITE LANCETS ..................... 78

TECHLITE LANCETS 30G .............. 78 TECHLITE PEN NEEDLES .............. 78 TECHNIVIE ................................... 78 TEGRETOL ................................... 78 TEGRETOL-XR .............................. 78 TEKAMLO .................................... 78 TEKTURNA ................................... 78 TEKTURNA HCT ........................... 78 TELCARE BLOOD GLUCOSE SYSTEM ....................................... 78 TELCARE BLOOD GLUCOSE TEST 78 telmisartan .................................. 78 telmisartan-amlodipine .............. 78 telmisartan-hctz .......................... 78 temazepam ................................. 79 TEMODAR ................................... 79 TEMOVATE .................................. 79 temozolomide ............................. 79 TENEX .......................................... 79 TENORETIC 50 ............................. 79 TENORMIN .................................. 79 TERAZOL 7 ................................... 79 terbinafine hcl ............................. 79 terbutaline sulfate ...................... 79 terconazole ................................. 79 TERSI ........................................... 79 TERUMO INSULIN SYRINGE ........ 79 TERUMO SURGUARD2 SAFETY NEEDLE ........................................ 79 TESSALON PERLES ....................... 79 TESTIM ........................................ 79 TESTOPEL .................................... 79 testosterone ............................... 79 testosterone cypionate ............... 79 TESTRED ...................................... 79 tetcaine ....................................... 79 tetrabenazine .............................. 79 tetracaine hcl .............................. 79 TETRAVISC ................................... 79 TETRAVISC FORTE ....................... 79 TEXACORT ................................... 79 tgt blood glucose monitoring ..... 79 tgt blood glucose test ................. 79 tgt lancet alternate site .............. 79 tgt lancet micro thin 33g ............ 79 tgt lancet super thin 30g ............. 79 tgt lancet thin 23g ....................... 79 tgt lancet thin 26g ....................... 79 tgt lancet ultra thin 28g .............. 79

tgt lancet ultra thin 30g .............. 79 THALOMID .................................. 80 theochron ................................... 80 theophylline ............................... 80 theophylline er ........................... 80 thermazene ................................ 80 thin lancets ................................. 80 THINPRO INSULIN SYRINGE ........ 80 thioridazine hcl ........................... 80 thiothixene ................................. 80 thrivite rx .................................... 80 THYROLAR-1/4 ............................ 80 tiagabine hcl ............................... 80 TIAZAC ........................................ 80 ticlopidine hcl ............................. 80 TIGAN ......................................... 80 TIKOSYN ...................................... 80 tilia fe .......................................... 80 timolol maleate .......................... 80 TIMOPTIC .................................... 80 TIMOPTIC OCUDOSE .................. 80 TINDAMAX .................................. 80 tinidazole .................................... 80 TIROSINT ..................................... 80 TIVICAY ....................................... 80 tizanidine hcl .............................. 80 TOBI PODHALER ......................... 80 TOBRADEX .................................. 80 TOBRADEX ST ............................. 80 tobramycin ................................. 80 tobramycin-dexamethasone ...... 80 TOBREX ....................................... 80 todays health thin lancets 28g... 81 todays health thin lancets 30g... 81 TOFRANIL .................................... 81 tolcapone ................................... 81 tolmetin sodium ......................... 81 tolterodine tartrate .................... 81 tolterodine tartrate er ................ 81 TOPAMAX ................................... 81 TOPICORT ................................... 81 TOPICORT SPRAY ........................ 81 topiramate.................................. 81 torsemide ................................... 81 TOUJEO SOLOSTAR ..................... 81 TOVIAZ ........................................ 81 TRACLEER ................................... 81 TRADJENTA ................................. 81 tramadol hcl ............................... 81

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tramadol hcl er ........................... 81 tramadol-acetaminophen .......... 81 trandolapril ................................. 81 trandolapril-verapamil hcl er ..... 81 TRANSDERM-SCOP (1.5 MG) ...... 81 TRANXENE-T ............................... 81 tranylcypromine sulfate ............. 81 TRAVATAN Z ............................... 81 travel lancets .............................. 81 trazodone hcl .............................. 81 TRECATOR ................................... 81 TRESIBA FLEXTOUCH .................. 82 tretinoin ...................................... 82 tretinoin microsphere ................ 82 tretinoin microsphere pump ...... 82 TRETTEN ..................................... 82 TREXALL ...................................... 82 TREXIMET ................................... 82 triamcinolone acetonide ............ 82 triamterene-hctz ........................ 82 trianex ........................................ 82 TRIBENZOR ................................. 82 TRICARE ...................................... 82 TRICOR ........................................ 82 triderm........................................ 82 tri-estarylla ................................. 82 trifluoperazine hcl ...................... 82 trifluridine................................... 82 TRIGLIDE ..................................... 82 trihexyphenidyl hcl ..................... 82 tri-legest fe ................................. 82 TRILEPTAL ................................... 82 tri-linyah ..................................... 82 TRILIPIX ....................................... 82 tri-lo-estarylla ............................. 82 tri-lo-marzia ................................ 82 tri-lo-sprintec .............................. 82 trimethobenzamide hcl .............. 82 trimethoprim .............................. 82 trinessa (28) ................................ 83 trinessa lo ................................... 83 TRI-NORINYL (28) ....................... 83 TRINTELLIX .................................. 83 tri-previfem ................................ 83 tri-sprintec .................................. 83 trivora (28) .................................. 83 TRIZIVIR ...................................... 83 TROKENDI XR .............................. 83 tropicamide ................................ 83

trospium chloride ....................... 83 TRUE METRIX AIR GLUCOSE METER ......................................... 83 TRUE METRIX BLOOD GLUCOSE TEST ............................................. 83 TRUE METRIX METER .................. 83 TRUE2GO BLOOD GLUCOSE MONITOR .................................... 83 TRUEPLUS INSULIN SYRINGE ...... 83 TRUEPLUS LANCETS 26G ............. 83 TRUEPLUS LANCETS 28G ............. 83 TRUEPLUS LANCETS 30G ............. 83 TRUEPLUS LANCETS 33G ............. 83 TRUEPLUS SAFETY LANCETS 28G 83 TRUERESULT BLOOD GLUCOSE.. 83 TRUETEST TEST ........................... 83 TRUETRACK BLOOD GLUCOSE .... 83 TRUETRACK SMART SYSTEM ....... 83 TRUETRACK TEST ........................ 83 TRULICITY .................................... 83 TRUSOPT ..................................... 83 TRUVADA .................................... 83 TUDORZA PRESSAIR .................... 83 TUSSICAPS ................................... 83 tussigon ....................................... 83 TUSSIONEX PENNKINETIC ER ...... 84 TWINRIX ...................................... 84 TWYNSTA .................................... 84 TYKERB ........................................ 84 TYLENOL WITH CODEINE #3 ....... 84 TYSABRI ....................................... 84 TYZEKA ........................................ 84 ULORIC ........................................ 84 ULTICARE INSULIN SYRINGE ....... 84 ULTILET BASIC LANCETS 30G ...... 84 ULTILET CLASSIC LANCETS .......... 84 ULTILET LANCETS ........................ 84 ULTILET SAFETY LANCETS 23G .... 84 ULTIMA TEST ............................... 84 ultra thin lancets 28g .................. 84 ultra thin lancets 30g .................. 84 ULTRA TRAK PRO BLOOD GLUCOSE ..................................... 84 ULTRACET .................................... 84 ultra-comfort insulin syringe ...... 84 ULTRAM ...................................... 84 ULTRAM ER ................................. 84 ULTRA-THIN II AUTO LANCET...... 84 ULTRA-THIN II LANCETS .............. 84

ULTRA-THIN II MINI PEN NEEDLE84 ULTRATRAK PRO TEST ................ 84 ULTRATRAK ULTIMATE TEST ...... 84 ULTRAVATE ................................. 84 ULTRESA ..................................... 84 UNIFINE PENTIPS ........................ 84 unifine pentips plus .................... 84 UNILET COMFORTOUCH LANCET84 UNILET EXCELITE ........................ 84 UNILET EXCELITE II ..................... 84 UNILET G.P. SUPERLITE LANCET. 84 UNILET GP 28 ULTRA THIN ......... 85 UNILET MICRO-THIN 33G ........... 85 UNILET SUPER-THIN 30G ............ 85 UNILET ULTRA-THIN 28G ............ 85 UNISTIK 3 GENTLE ...................... 85 UNISTIK SAFETY LANCETS 28G... 85 UNISTIK SAFETY LANCETS 30G... 85 UNISTIK TOUCH SAFETY LANC 21G ............................................. 85

UNISTIK TOUCH SAFETY LANC 23G ............................................. 85

UNISTIK TOUCH SAFETY LANC 28G ............................................. 85

UNISTIK TOUCH SAFETY LANC 30G ............................................. 85

UNISTRIP1 GENERIC ................... 85 unithroid ..................................... 85 UNIVERSAL 1 LANCETS THIN 26G ............................................. 85

UNIVERSAL 1 LANCETS ULTRA THIN ............................................ 85

URECHOLINE ............................... 85 UROXATRAL ................................ 85 ursodiol ....................................... 85 VAGIFEM .................................... 85 valacyclovir hcl ........................... 85 VALCYTE...................................... 85 valganciclovir hcl ........................ 85 VALIUM ...................................... 85 valproate sodium ....................... 85 valproic acid ............................... 85 valsartan ..................................... 85 valsartan-hydrochlorothiazide... 85 VALTREX ..................................... 85 value plus lancet standard 21g...85 valumark lancet super thin 30g..85 valumark lancet ultra thin 28g... 85 valved holding chamber ............. 85

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VANCOCIN HCL ........................... 85 vancomycin hcl ........................... 85 vandazole ................................... 86 VASCEPA ..................................... 86 VASOTEC ..................................... 86 VECAMYL .................................... 86 velivet ......................................... 86 VELTIN ........................................ 86 VEMLIDY ..................................... 86 venlafaxine hcl ............................ 86 venlafaxine hcl er ....................... 86 VENTOLIN HFA ............................ 86 VERAMYST .................................. 86 verapamil hcl .............................. 86 verapamil hcl er .......................... 86 VERDESO ..................................... 86 VERELAN PM............................... 86 VERSACLOZ ................................. 86 VESICARE .................................... 86 vestura ........................................ 86 VEXOL ......................................... 86 VFEND ......................................... 86 VIAGRA ....................................... 86 VIBRAMYCIN ............................... 86 VICTOZA ...................................... 86 VIDA MIA UNILET LANCETS 28G.86 VIDA MIA UNILET LANCETS 30G.86 VIDAZA ........................................ 86 VIDEX .......................................... 86 VIDEX EC ..................................... 86 VIEKIRA PAK ................................ 86 vienva ......................................... 86 VIIBRYD ....................................... 86 VIMOVO ...................................... 87 VIMPAT ....................................... 87 VIOKACE ..................................... 87 viorele ......................................... 87 VIRACEPT .................................... 87 VIRAMUNE .................................. 87 VIREAD ........................................ 87 VIROPTIC ..................................... 87 virtussin a/c ................................ 87 VISTARIL ...................................... 87 VITAMEDMD ONE RX/QUATREFOLIC ....................... 87 VIVELLE-DOT ............................... 87 VIVITROL ..................................... 87 VOGELXO .................................... 87 VOGELXO PUMP ......................... 87

vol-care rx ................................... 87 vol-plus........................................ 87 vol-tab rx ..................................... 87 VOLTAREN ................................... 87 VOLTAREN-XR ............................. 87 voriconazole ................................ 87 VORTEX VALVED HOLDING CHAMBER .................................... 87 VOTRIENT .................................... 87 vp-vite rx ..................................... 87 vyfemla ....................................... 87 VYTORIN ...................................... 87 VYVANSE ..................................... 87 walgreens adv travel lancets ...... 87 WALGREENS LANCETS ................ 87 walgreens lancets micro thin ...... 88 walgreens lancets super thin ...... 88 WALGREENS THIN LANCETS ....... 88 WALGREENS ULTRA THIN LANCETS ...................................... 88 warfarin sodium .......................... 88 WAVESENSE AMP ....................... 88 WAVESENSE PRESTO .................. 88 wegmans unifine pentips plus .... 88 WELCHOL .................................... 88 WELLBUTRIN ............................... 88 WELLBUTRIN XL .......................... 88 wera ............................................ 88 WILATE ........................................ 88 WP THYROID ............................... 88 wymzya fe ................................... 88 XALATAN ..................................... 88 XALKORI ...................................... 88 XANAX ......................................... 88 XANAX XR .................................... 88 XARELTO ..................................... 88 XELJANZ....................................... 88 XELJANZ XR ................................. 88 XENAZINE .................................... 88 XERESE ........................................ 88 XIFAXAN ...................................... 88 XIGDUO XR .................................. 88 XIIDRA ......................................... 88 XOLAIR ........................................ 88 XOPENEX ..................................... 88 XOPENEX HFA ............................. 88 XTANDI ........................................ 88 xulane.......................................... 88 XULTOPHY ................................... 89

XYNTHA ...................................... 89 XYNTHA SOLOFUSE .................... 89 XYZAL .......................................... 89 YASMIN 28 .................................. 89 YAZ .............................................. 89 zafirlukast ................................... 89 zaleplon ...................................... 89 ZANTAC ....................................... 89 zarah ........................................... 89 ZARONTIN ................................... 89 ZARXIO ........................................ 89 ZEGERID ...................................... 89 ZELAPAR ..................................... 89 ZELBORAF ................................... 89 zenatane ..................................... 89 zenchent ..................................... 89 zenchent fe ................................. 89 ZENPEP ....................................... 89 zenzedi ....................................... 89 zeosa ........................................... 89 ZEPATIER .................................... 89 ZERIT ........................................... 89 ZESTORETIC ................................ 89 ZESTRIL ....................................... 89 ZETIA ........................................... 89 ZETONNA .................................... 89 ZIAC ............................................ 89 ZIAGEN........................................ 89 ZIANA .......................................... 89 zidovudine............................ 89, 90 ZIOPTAN ..................................... 90 ziprasidone hcl ........................... 90 ZIPSOR ........................................ 90 ZIRGAN ....................................... 90 ZITHRANOL-RR ........................... 90 ZITHROMAX ................................ 90 ZITHROMAX Z-PAK ..................... 90 ZOCOR ........................................ 90 ZODRYL AC 35 ............................. 90 ZOFRAN ...................................... 90 ZOFRAN ODT .............................. 90 ZOLINZA ...................................... 90 zolmitriptan ................................ 90 ZOLOFT ....................................... 90 zolpidem tartrate ....................... 90 zolpidem tartrate er ................... 90 ZOLPIMIST .................................. 90 ZOMACTON ................................ 90 ZOMIG ........................................ 90

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ZOMIG ZMT ................................ 90 ZONEGRAN ................................. 90 zonisamide ................................. 90 ZORBTIVE .................................... 90 ZORTRESS ................................... 90 ZORVOLEX ................................... 90 ZOSTAVAX ................................... 90 zovia 1/35e (28) .......................... 90 ZOVIRAX...................................... 91 ZUBSOLV ..................................... 91 ZUPLENZ ..................................... 91 ZYBAN ......................................... 91 ZYCLARA ..................................... 91 ZYCLARA PUMP .......................... 91 ZYFLO .......................................... 91 ZYLET .......................................... 91 ZYLOPRIM ................................... 91 ZYMAXID ..................................... 91 ZYPREXA ..................................... 91 ZYPREXA ZYDIS ........................... 91 ZYTIGA ........................................ 91 ZYVOX ......................................... 91