2018 covered drug list - blue cross and blue shield of ... covered drug list. ... an independent...

2018 Covered Drug List

201804HQ1509 R08/17 Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Ser vice & Indemnity Company. HMO Louisiana, Inc. is a subsidiary of Blue Cross and Blue Shield of Louisiana.

Both companies are independent licensees of the Blue Cross and Blue Shield Association.

Understanding Your Covered Drug List

Blue Cross and Blue Shield of Louisiana and our subsidiary, HMO Louisiana, Inc., along with Express Scripts, an independent company that serves as our pharmacy benefit manager, created this Covered Drug List to help you understand your drug benefits. Because drug benefits can be complex, understanding your benefits is key to getting the most from your health plan.

Throughout the year, our Blue Cross Pharmacy and Therapeutics Committee, a group of Louisiana doctors and pharmacists, reviews published literature about the safety, efficacy and cost of prescription drugs.

You and your doctor always make the final decision for your healthcare needs. The information in this List can help you and your doctor make informed decisions before you fill your next prescription. That way, together you may choose the best drug for you while keeping your costs down.

Please talk to your doctor or pharmacist about any questions or concerns you may have about your drug therapy.

Please Note: Inclusion of a drug in a drug formulary does not guarantee that a member's physician or other authorized prescriber will prescribe the drug for a particular medical condition or mental illness.

Before you fill a prescription for any drug, you should take the following steps, if needed: 1) Check to see if the drugs you take are on the drug List. 2) Talk to your doctor about switching to a drug that is on the List, if needed. Important Notes: This List is intended to include all drugs that your plan covers as of the time the document was created. But

the List may change as changes occur in the marketplace. This List may not apply to all benefit plans. Some benefit plans may have different coverage for specific drugs. The List applies only to prescription drugs that network pharmacies dispense on an outpatient basis. See your member contract or certificate for pharmacy coverage for any exclusions and limitations that apply. How can you find information about your drugs? Use the index at the end of this List to look up a drug you may take to quickly learn several important things: If you must first try one or more prescription drugs before your plan will cover a specific drug for your condition, If your doctor must get prior authorization before your plan will pay for a drug, If your plan limits the quantity that will be covered each time you fill a prescription

04HQ1509 R10/17 i

Drug Requirements/Limits

generic drug name QPD BRAND DRUG NAME PA; ST

Key: generic drugs are in lower case italics BRAND NAME drugs are in ALL CAPS

Key: PA = Prior authorization QPD = Quantity per dispensing limits ST = Step therapy restrictions SP = Specialty drug restrictions

Example of How Drugs Are Listed:

What do the abbreviations in the Requirements/Limits column mean? PA: Medications requiring prior authorization

We must authorize certain drugs before your plan will pay for them. After considering current medical literature, the Pharmacy and Therapeutics Committee sets up the criteria needed for the drugs to be authorized. Then, Express Scripts processes the prior authorization requests.

If you need prior authorization, have your doctor contact Express Scripts: Call: 18008422015 Fax: 18772515896 For the physician fax form, go to: www.bcbsla.com > Provider > Pharmacy.

ST: Medications requiring participation in the step therapy program For drugs in our step therapy program, you must first try certain prescription drugs (Step 1) before your plan will cover other drugs (Step 2) for your condition. If one of the Step 1 drugs is not right for you, your doctor may call us for a prior authorization for a Step 2 drug. You can find more information about drugs that you must try first at www.bcbsla.com/CoveredDrugs.

QPD: Medications that have quantity per dispensing limits Covered prescriptions have a daysupply limitation (typically up to a 30day supply at a retail pharmacy and up to a 90day supply for mailorder). Your plan also limits the amount of certain drugs that can be dispensed at one time. We call those restrictions quantity per dispensing (QPD) limits.

QPD limits are additional to the daysupply limitation and are based on the manufacturers recommended dosage and duration of therapy, common usage for episodic or intermittent treatment, FDAapproved recommendations or clinical studies and as determined by Blue Cross. QPD limits or allowances are subject to quantity limits per day supply, per dispensing event or any combination of the two. See your member contract or certificate for the limits for your plan. For a complete list of drugs and their QPD limitations, go to www.bcbsla.com/CoveredDrugs.

SP: Specialty drug restrictions Certain drugs are commonly called specialty drugs. Specialty drugs include biotechnology drugs or other drug products that may require special ordering, handling or customer service. Your policy may limit specialty drugs to the retail day supply listed in your plan (typically a 30day supply). Read your Schedule

04HQ1509 R10/17 ii

of Benefits for any restrictions that apply to you. For a complete list of specialty drugs, go to www.bcbsla.com/CoveredDrugs.

Questions? If your doctor prescribes a drug that is not in this List, or if you have any questions, call Express Scripts at 18667817533.

For more information and updates, go to: www.bcbsla.com/CoveredDrugs or www.expressscripts.com.

04HQ1509 R10/17 iii

http:www.express-scripts.comwww.bcbsla.com/CoveredDrugswww.bcbsla.com/CoveredDrugs

Table of Contents

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*.................................................................................................................5 *Aminoglycosides*....................................................................................................................................................................5 *Analgesics - Anti-Inflammatory*............................................................................................................................................. 6 *Analgesics - Nonnarcotic*....................................................................................................................................................... 8 *Analgesics - Opioid*.............................................................................................................................................................. 10 *Androgens-Anabolic*............................................................................................................................................................ 12 *Anorectal Agents*................................................................................................................................................................. 12 *Anthelmintics*.......................................................................................................................................................................13 *Antianginal Agents*...............................................................................................................................................................13 *Antianxiety Agents*...............................................................................................................................................................13 *Antiarrhythmics*................................................................................................................................................................... 14 *Antiasthmatic And Bronchodilator Agents*..........................................................................................................................14 *Anticoagulants*.....................................................................................................................................................................16 *Anticonvulsants*................................................................................................................................................................... 17 *Antidepressants*...................................................................................................................................................................19 *Antidiabetics*........................................................................................................................................................................20 *Antidiarrheals*...................................................................................................................................................................... 23 *Antidotes And Specific Antagonists*.....................................................................................................................................23 *Antidotes*............................................................................................................................................................................. 23 *Antiemetics*..........................................................................................................................................................................24 *Antifungals*...........................................................................................................................................................................24 *Antihistamines*.....................................................................................................................................................................25 *Antihyperlipidemics*.............................................................................................................................................................25 *Antihypertensives*................................................................................................................................................................26 *Anti-Infective Agents - Misc.*................................................................................................................................................28 *Antimalarials*........................................................................................................................................................................29 *Antimyasthenic Agents*........................................................................................................................................................29 *Antimyasthenic/Cholinergic Agents*.................................................................................................................................... 29 *Antimycobacterial Agents*................................................................................................................................................... 29 *Antineoplastic - Bcl-2 Inhibitors***...................................................................................................................................... 30 *Antineoplastics And Adjunctive Therapies*.......................................................................................................................... 30 *Antiparkinson Agents*.......................................................................................................................................................... 33 *Antipsychotics/Antimanic Agents*........................................................................................................................................34 *Antiretrovirals Adjuvants***.................................................................................................................................................35 *Antivirals*..............................................................................................................................................................................35 *Assorted Classes*.................................................................................................................................................................. 38 *Beta Blockers*....................................................................................................................................................................... 39 *Bile Acid Synthesis Disorder Agents***................................................................................................................................ 40 *Calcium Channel Blockers*....................................................................................................................................................40 *Cardiotonics*.........................................................................................................................................................................41 *Cardiovascular Agents - Misc.*..............................................................................................................................................41 *Cephalosporins*.................................................................................................................................................................... 41 *Contraceptives*.....................................................................................................................................................................42 *Corticosteroids*.................................................................................................................................................................... 47 *Cough/Cold/Allergy* ............................................................................................................................................................. 47 *Cyclin-Dependent Kinases (Cdk) Inhibitors***......................................................................................................................49 *Cystic Fibrosis Agent - Combinations***...............................................................................................................................49 *Dermatologicals*...................................................................................................................................................................49 *Diagnostic Products*.............................................................................................................................................................54 *Digestive Aids*...................................................................................................................................................................... 55

1

*Direct-Acting P2y12 Inhibitors***.........................................................................................................................................55 *Diuretics*...............................................................................................................................................................................55 *Endocrine And Metabolic Agents - Misc.*.............................................................................................................................56 *Estrogens*............................................................................................................................................................................. 57 *Estrogen-Selective Estrogen Receptor Modulator Comb***................................................................................................58 *Fluoroquinolones*.................................................................................................................................................................58 *Gastrointestinal Agents - Misc.*............................................................................................................................................59 *Genitourinary Agents - Miscellaneous*................................................................................................................................ 60 *Gout Agents*.........................................................................................................................................................................61 *Hematological Agents - Misc.*.............................................................................................................................................. 61 *Hematopoietic Agents*.........................................................................................................................................................62 *Hemostatics*.........................................................................................................................................................................64 *Hepatitis C Agent - Combinations***....................................................................................................................................64 *Hereditary Orotic Aciduria Treatment - Agents**.................................................................................................................64 *Hypnotics*.............................................................................................................................................................................64 *Hypophosphatasia (Hpp) Agents***..................................................................................................................................... 64 *Ibs Agent - Mu-Opioid Receptor Agonists***....................................................................................................................... 65 *Insulin-Incretin Mimetic Combinations***........................................................................................................................... 65 *Isocitrate Dehydrogenase-2 (Idh2) Inhibitors***..................................................................................................................65 *Laxatives*.............................................................................................................................................................................. 65 *Leptin Analogues***............................................................................................................................................................. 67 *Lymphocyte Function-Associated Antigen-1 (Lfa-1) Antag***............................................................................................. 68 *Macrolides*........................................................................................................................................................................... 68 *Medical Devices*...................................................................................................................................................................68 *Migraine Products*............................................................................................................................................................... 69 *Minerals & Electrolytes*....................................................................................................................................................... 69 *Monobactams***..................................................................................................................................................................73 *Mouth/Throat/Dental Agents*............................................................................................................................................. 73 *Multivitamins*.......................................................................................................................................................................74 *Musculoskeletal Therapy Agents*.........................................................................................................................................80 *Nasal Agents - Systemic And Topical*................................................................................................................................... 80 *Neprilysin Inhib (Arni)-Angiotensin Ii Recept Antag Comb***..............................................................................................81 *Neurogenic Orthostatic Hypotension (Noh) - Agents***......................................................................................................81 *Neuromuscular Agents*........................................................................................................................................................ 81 *Ophthalmic Agents*.............................................................................................................................................................. 81 *Otic Agents*.......................................................................................................................................................................... 85 *Oxytocics*............................................................................................................................................................................. 85 *Passive Immunizing Agents*................................................................................................................................................. 85 *Pcsk9 Inhibitors***............................................................................................................................................................... 85 *Pediatric Multiple Vitamins & Minerals W/ Fluoride***...................................................................................................... 85 *Pediatric Multiple Vitamins W/Fluoride-Iron-Zinc***.......................................................................................................... 85 *Penicillins*.............................................................................................................................................................................86 *Pharmaceutical Adjuvants*...................................................................................................................................................86 *Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors***............................................................................................................... 86 *Phosphodiesterase 4 (Pde4) Inhibitors***............................................................................................................................86 *Poly (Adp-Ribose) Polymerase (Parp) Inhibitors**...............................................................................................................86 *Poly (Adp-Ribose) Polymerase (Parp) Inhibitors***..............................................................................................................86 *Potassium Removing Agents***........................................................................................................................................... 87 *Progestins*............................................................................................................................................................................ 87 *Protease-Activated Receptor-1 (Par-1) Antagonists***........................................................................................................87 *Psychotherapeutic And Neurological Agents - Misc.*...........................................................................................................87 *Pulmonary Fibrosis Agents - Kinase Inhibitors***................................................................................................................ 90 *Pulmonary Fibrosis Agents***.............................................................................................................................................. 90 *Pulmonary Hypertension - Prostacyclin Receptor Agonist***..............................................................................................90

2

*Respiratory Agents - Misc.*...................................................................................................................................................90 *Serotonin Modulators***..................................................................................................................................................... 91 *Sglt2 Inhibitor - Dpp-4 Inhibitor Combinations***............................................................................................................... 91 *Sinus Node Inhibitors**........................................................................................................................................................ 91 *Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb***........................................................................................ 91 *Sulfonamides*....................................................................................................................................................................... 91 *Tetracyclines*........................................................................................................................................................................91 *Thyroid Agents*.....................................................................................................................................................................92 *Toxoids*................................................................................................................................................................................ 92 *Ulcer Drugs*.......................................................................................................................................................................... 93 *Urinary Anti-Infectives*.........................................................................................................................................................94 *Urinary Antispasmodics*.......................................................................................................................................................95 *Vaccines*...............................................................................................................................................................................95 *Vaginal Products*..................................................................................................................................................................97 *Vasopressors*....................................................................................................................................................................... 97 *Vitamins*...............................................................................................................................................................................98

3

Drug Name Requirements/Limits

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*

*Adhd Agent - Selective Alpha Adrenergic Agonists***

clonidine hcl er QPD

guanfacine hcl er QPD

*Adhd Agent - Selective Norepinephrine Reuptake Inhibitor***

atomoxetine hcl QPD

*Amphetamine Mixtures***

amphetamine-dextroamphet er QPD

amphetamine-dextroamphetamine QPD

MYDAYIS QPD

*Amphetamines***

dextroamphetamine sulfate er QPD

dextroamphetamine sulfate oral solution

dextroamphetamine sulfate oral tablet QPD

methamphetamine hcl QPD

VYVANSE QPD

*Analeptics***

caffeine citrate oral

*Stimulants - Misc.***

armodafinil PA; QPD

DAYTRANA QPD

dexmethylphenidate hcl QPD

dexmethylphenidate hcl er QPD

metadate er oral tablet extended release 20 mg QPD

methylphenidate hcl er (cd) QPD

methylphenidate hcl er (la) QPD

methylphenidate hcl er oral tablet extended release 10 mg, 18 mg, 20 mg, 27 mg, 36 mg, 54 mg

QPD

methylphenidate hcl er oral tablet extended release 24 hour QPD

methylphenidate hcl oral solution QPD

methylphenidate hcl oral tablet QPD

methylphenidate hcl oral tablet chewable QPD

modafinil PA; QPD

QUILLIVANT XR QPD

*Aminoglycosides*

*Aminoglycosides***

BETHKIS PA; SP; QPD

neomycin sulfate oral

You can find information on what the symbols and abbreviations on this

table mean by going to the beginning of this List. 5


paromomycin sulfate oral

TOBI PODHALER PA; SP; QPD

tobramycin inhalation PA; SP; QPD

*Analgesics - Anti-Inflammatory*

*Antirheumatic - Janus Kinase (Jak) Inhibitors***

XELJANZ PA; SP; QPD

XELJANZ XR PA; SP; QPD

*Antirheumatic Antimetabolites***

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML, 12.5 MG/0.25ML, 15 MG/0.3ML, 17.5 MG/0.35ML, 20 MG/0.4ML, 22.5 MG/0.45ML, 25 MG/0.5ML, 30 MG/0.6ML, 7.5 MG/0.15ML

SP; QPD

*Anti-Tnf-Alpha - Monoclonal Antibodies***

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

PA; SP; QPD

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT PA; SP; QPD

HUMIRA PEN-CROHNS STARTER SUBCUTANEOUS PEN-INJECTOR KIT PA; SP; QPD

HUMIRA PEN-PSORIASIS STARTER SUBCUTANEOUS PEN-INJECTOR KIT PA; SP; QPD

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT PA; SP; QPD

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR PA; SP; QPD

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE PA; SP; QPD

*Anti-Tnf-Alpha - Monoclonoal Antibodies***

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML, 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

PA; SP; QPD

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT PA; SP; QPD

HUMIRA PEN-CROHNS STARTER SUBCUTANEOUS PEN-INJECTOR KIT PA; SP; QPD

HUMIRA PEN-PSORIASIS STARTER SUBCUTANEOUS PEN-INJECTOR KIT PA; SP; QPD

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT PA; SP; QPD

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR PA; SP; QPD

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE PA; SP; QPD

*Cyclooxygenase 2 (Cox-2) Inhibitors***

celecoxib oral QPD

*Gold Compounds***

RIDAURA

*Interleukin-1 Blockers***

ARCALYST SP; QPD

*Interleukin-1 Receptor Antagonist (Il-1Ra)***

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE PA; SP; QPD




*Interleukin-6 Receptor Inhibitors***

ACTEMRA SUBCUTANEOUS PA; SP; QPD

*Nonsteroidal Anti-Inflammatory Agent Combinations***

diclofenac-misoprostol oral tablet delayed release

*Nonsteroidal Anti-Inflammatory Agents (Nsaids)***

diclofenac potassium

diclofenac sodium er

diclofenac sodium oral

etodolac er

etodolac oral

fenoprofen calcium oral tablet PA

flurbiprofen oral

ibuprofen oral suspension

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

indomethacin er

indomethacin oral

ketoprofen er PA

ketoprofen oral capsule 75 mg

ketorolac tromethamine oral QPD

meclofenamate sodium oral

mefenamic acid oral PA

meloxicam oral tablet QPD

nabumetone oral

naproxen dr

naproxen oral

naproxen sodium oral tablet 275 mg, 550 mg

oxaprozin

piroxicam oral

sulindac oral

tolmetin sodium PA

*Pyrimidine Synthesis Inhibitors***

leflunomide oral QPD

*Selective Costimulation Modulators***

ORENCIA CLICKJECT PA; SP; QPD

ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE PA; SP; QPD

*Soluble Tumor Necrosis Factor Receptor Agents***

ENBREL MINI PA; SP; QPD

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE PA; SP; QPD




ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED PA; SP; QPD

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR PA; SP; QPD

*Analgesics - Nonnarcotic*

*Analgesics-Sedatives***

butalbital-acetaminophen oral tablet 50-325 mg QPD

butalbital-apap QPD

butalbital-apap-caffeine oral capsule QPD

butalbital-apap-caffeine oral tablet 50-325-40 mg QPD

butalbital-asa-caffeine

butalbital-aspirin-caffeine

tencon oral tablet 50-325 mg QPD

zebutal oral capsule 50-325-40 mg QPD

*Salicylates***

adult aspirin ec low strength

aspir-81

aspirin 81

aspirin adult low dose

aspirin adult low strength

aspirin childrens

aspirin ec low dose

aspirin ec low strength

aspirin ec oral tablet delayed release 81 mg

aspirin low dose adult

aspirin low dose oral tablet chewable

aspirin low dose oral tablet delayed release

aspirin low strength

aspirin oral tablet chewable

aspirin oral tablet delayed release 81 mg

aspir-low

bayer aspirin ec low dose

bayer low dose

childrens aspirin

childrens aspirin low strength

cvs aspirin adult low dose

cvs aspirin adult low strength

cvs aspirin ec oral tablet delayed release 81 mg

cvs aspirin low dose




diflunisal oral

ec-81 aspirin

ecotrin low strength

eq aspirin adult low dose

eq aspirin low dose oral tablet chewable

eq childrens aspirin

eql aspirin low dose

gnp adult aspirin low strength oral tablet chewable

gnp aspirin low dose

gnp aspirin oral tablet delayed release 81 mg

goodsense aspirin adult low st

goodsense aspirin low dose

goodsense aspirin oral tablet chewable

hm aspirin ec low dose

hm aspirin oral tablet chewable

kls aspirin low dose

kp aspirin

miniprin low dose

px aspirin oral tablet chewable

px enteric aspirin oral tablet delayed release 81 mg

qc aspirin low dose

qc childrens aspirin

ra aspirin adult low dose

ra aspirin adult low strength

ra aspirin childrens

ra aspirin ec adult low st

ra aspirin ec oral tablet delayed release 81 mg

ra childrens aspirin

salsalate oral

sb aspirin adult low strength

sb aspirin oral tablet delayed release

sb childrens aspirin

sb low dose asa ec

sm aspirin adult low strength

sm aspirin ec low strength

sm childrens aspirin

st joseph low dose

tgt aspirin low dose oral tablet delayed release




tgt aspirin oral tablet chewable

tgt aspirin oral tablet delayed release

tgt childrens aspirin

*Analgesics - Opioid*

*Codeine Combinations***

acetaminophen-codeine PA; QPD

acetaminophen-codeine #2 PA; QPD



ascomp-codeine PA; QPD

butalbital-apap-caff-cod PA; QPD

butalbital-asa-caff-codeine PA; QPD

*Hydrocodone Combinations***

hydrocodone-acetaminophen oral solution 7.5-325 mg/15ml PA; QPD

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 2.5-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

PA; QPD

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg PA; QPD

lorcet PA; QPD

lorcet hd PA; QPD

lorcet plus oral tablet 7.5-325 mg PA; QPD

verdrocet PA; QPD

vicodin es oral tablet 7.5-300 mg PA; QPD

vicodin hp oral tablet 10-300 mg PA; QPD

vicodin oral tablet 5-300 mg PA; QPD

*Opioid Agonists***

codeine sulfate oral tablet PA

EMBEDA PA; ST; QPD

fentanyl citrate buccal PA; QPD

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

PA; QPD

hydromorphone hcl er PA; QPD

hydromorphone hcl oral PA

hydromorphone hcl rectal PA

HYSINGLA ER PA; QPD

levorphanol tartrate oral PA

meperidine hcl oral PA

methadone hcl intensol PA

methadone hcl oral PA




methadose oral concentrate 10 mg/ml PA

methadose oral tablet soluble PA

methadose sugar-free PA

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml PA

morphine sulfate er beads PA; QPD

morphine sulfate er oral capsule extended release 24 hour PA; QPD

morphine sulfate er oral tablet extended release PA; QPD

morphine sulfate oral PA

morphine sulfate rectal PA

NUCYNTA PA

oxycodone hcl oral capsule PA

oxycodone hcl oral concentrate 100 mg/5ml PA

oxycodone hcl oral solution PA

oxycodone hcl oral tablet PA

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT PA; QPD

oxymorphone hcl PA

oxymorphone hcl er PA; QPD

tramadol hcl er (biphasic) oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg

QPD

tramadol hcl er oral tablet extended release 24 hour QPD

tramadol hcl oral

*Opioid Combinations***

endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg PA; QPD

oxycodone-acetaminophen oral solution PA; QPD

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

PA; QPD

oxycodone-aspirin oral tablet 4.8355-325 mg PA; QPD

oxycodone-ibuprofen PA; QPD

*Opioid Partial Agonists***

butorphanol tartrate nasal QPD

BUTRANS PA; QPD

pentazocine-naloxone hcl

SUBOXONE SUBLINGUAL FILM

ZUBSOLV

*Tramadol Combinations***

tramadol-acetaminophen QPD




*Androgens-Anabolic*

*Anabolic Steroids***

ANADROL-50

oxandrolone oral

*Androgens***

ANDROGEL PUMP TRANSDERMAL GEL 20.25 MG/ACT (1.62%) PA; QPD

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

PA; QPD

danazol oral

METHITEST

testosterone cypionate intramuscular solution 100 mg/ml, 200 mg/ml

testosterone enanthate intramuscular solution

testosterone gel 12.5 mg/act (1%) transdermal PA; QPD

testosterone gel 50 mg/5gm (1%) transdermal PA; QPD

testosterone transdermal gel 12.5 mg/act (1%), 25 mg/2.5gm (1%), 50 mg/5gm (1%)

PA; QPD

testosterone transdermal solution PA; QPD

*Anorectal Agents*

*Intrarectal Steroids***

colocort

CORTIFOAM

hydrocortisone rectal enema

UCERIS RECTAL

*Nitrate Vasodilating Agents***

RECTIV

*Rectal Anesthetic/Steroids***

hydrocortisone ace-pramoxine rectal cream 1-1 %

hydrocortisone ace-pramoxine rectal cream 2.5-1 % QPD

lidocaine-hydrocortisone ace rectal cream

pramcort rectal

*Rectal Steroids***

anucort-hc

hydrocortisone acetate rectal

hydrocortisone rectal cream

procto-med hc

procto-pak

proctosol hc

proctozone-hc rectal




*Anthelmintics*

*Anthelmintics***

ALBENZA

BILTRICIDE

EMVERM QPD

ivermectin oral

praziquantel oral

*Antianginal Agents*

*Antianginals-Other***

RANEXA

*Nitrates***

isosorbide dinitrate er

isosorbide dinitrate oral

isosorbide mononitrate

isosorbide mononitrate er

nitro-bid

nitroglycerin er

nitroglycerin sublingual

nitroglycerin transdermal patch 24 hour

nitro-time

*Antianxiety Agents*

*Antianxiety Agents - Misc.***

buspirone hcl oral

hydroxyzine hcl oral syrup

hydroxyzine hcl oral tablet

hydroxyzine pamoate oral

meprobamate

*Benzodiazepines***

alprazolam er

alprazolam intensol

alprazolam oral tablet

alprazolam oral tablet dispersible

alprazolam xr

chlordiazepoxide hcl

clorazepate dipotassium

diazepam intensol

diazepam oral solution 1 mg/ml




diazepam oral tablet

lorazepam intensol

lorazepam oral

oxazepam

*Antiarrhythmics*

*Antiarrhythmics Type I-A***

disopyramide phosphate oral

NORPACE CR

quinidine gluconate er

quinidine sulfate oral

*Antiarrhythmics Type I-B***

mexiletine hcl oral

*Antiarrhythmics Type I-C***

flecainide acetate

propafenone hcl

propafenone hcl er

*Antiarrhythmics Type Iii***

amiodarone hcl oral

dofetilide

MULTAQ

pacerone oral tablet 100 mg, 200 mg, 400 mg

*Antiasthmatic And Bronchodilator Agents*

*5-Lipoxygenase Inhibitors***

zileuton er PA; QPD

ZYFLO PA; QPD

*Adrenergic Combinations***

ADVAIR DISKUS QPD

ADVAIR HFA QPD

ANORO ELLIPTA QPD

BEVESPI AEROSPHERE PA; QPD

BREO ELLIPTA QPD

COMBIVENT RESPIMAT QPD

DULERA PA; QPD

FLUTICASONE-SALMETEROL QPD

ipratropium-albuterol QPD

STIOLTO RESPIMAT QPD

SYMBICORT QPD




TRELEGY ELLIPTA QPD

UTIBRON NEOHALER PA; QPD

*Anti-Inflammatory Agents***

cromolyn sodium inhalation

*Beta Adrenergics***

albuterol sulfate er

albuterol sulfate inhalation

albuterol sulfate oral

ARCAPTA NEOHALER PA; QPD

BROVANA PA; QPD

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml, 1.25 mg/0.5ml, 1.25 mg/3ml

LEVALBUTEROL TARTRATE PA; QPD

metaproterenol sulfate oral

PERFOROMIST PA; QPD

PROAIR HFA QPD

PROAIR RESPICLICK QPD

PROVENTIL HFA PA; QPD

SEREVENT DISKUS QPD

STRIVERDI RESPIMAT QPD

terbutaline sulfate oral

VENTOLIN HFA QPD

XOPENEX HFA PA; QPD

*Bronchodilators - Anticholinergics***

ATROVENT HFA QPD

INCRUSE ELLIPTA QPD

ipratropium bromide inhalation

SEEBRI NEOHALER PA; QPD

SPIRIVA HANDIHALER QPD

SPIRIVA RESPIMAT QPD

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED PA; QPD

*Leukotriene Receptor Antagonists***

montelukast sodium oral QPD

zafirlukast QPD

*Selective Phosphodiesterase 4 (Pde4) Inhibitors***

DALIRESP QPD

*Steroid Inhalants***

ALVESCO PA; QPD




ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/ACT, 200 MCG/ACT

QPD

ASMANEX 120 METERED DOSES PA; QPD





ASMANEX HFA PA; QPD

budesonide inhalation QPD

FLOVENT DISKUS QPD

FLOVENT HFA QPD

PULMICORT FLEXHALER PA; QPD

QVAR INHALATION AEROSOL SOLUTION QPD

QVAR REDIHALER QPD

*Xanthines***

THEO-24

theochron oral tablet extended release 12 hour 100 mg, 200 mg, 300 mg

theophylline

theophylline er

*Anticoagulants*

*Coumarin Anticoagulants***

COUMADIN ORAL

jantoven

warfarin sodium oral

*Direct Factor Xa Inhibitors***

ELIQUIS QPD

ELIQUIS STARTER PACK QPD

SAVAYSA PA; QPD

XARELTO QPD

XARELTO STARTER PACK QPD

*Heparins And Heparinoid-Like Agents***

heparin lock flush intravenous solution 1 unit/ml, 10 unit/ml, 100 unit/ml

heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 unit/ml

heparin sodium (porcine) pf

heparin sodium lock flush intravenous solution 100 unit/ml

*Low Molecular Weight Heparins***

enoxaparin sodium




FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML, 95000 UNIT/3.8ML

*Synthetic Heparinoid-Like Agents***

fondaparinux sodium

*Thrombin Inhibitors - Selective Direct & Reversible***

PRADAXA PA; QPD

*Anticonvulsants*

*Ampa Glutamate Receptor Antagonists***

FYCOMPA

*Anticonvulsants - Benzodiazepines***

clonazepam oral

DIASTAT ACUDIAL

DIASTAT PEDIATRIC

diazepam rectal

KLONOPIN

ONFI ORAL SUSPENSION

ONFI ORAL TABLET 10 MG, 20 MG

*Anticonvulsants - Misc.***

APTIOM QPD

BANZEL

carbamazepine er

carbamazepine oral

CARBATROL

epitol

gabapentin oral capsule

gabapentin oral solution 250 mg/5ml

gabapentin oral tablet

KEPPRA ORAL

KEPPRA XR

LAMICTAL ODT

LAMICTAL ORAL TABLET

LAMICTAL ORAL TABLET CHEWABLE 25 MG, 5 MG

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR

lamotrigine er

lamotrigine oral kit 25 & 50 & 100 mg, 25 (21)-50 (7) mg, 50 (42)-100(14) mg

lamotrigine oral tablet

lamotrigine oral tablet chewable




lamotrigine oral tablet dispersible

levetiracetam er

levetiracetam oral

LYRICA

MYSOLINE

oxcarbazepine

OXTELLAR XR

primidone oral

QUDEXY XR PA; QPD

roweepra

TEGRETOL ORAL SUSPENSION

TEGRETOL ORAL TABLET

TEGRETOL-XR

TOPAMAX

TOPAMAX SPRINKLE

topiramate oral capsule sprinkle

topiramate oral tablet

TRILEPTAL

TROKENDI XR PA; QPD

VIMPAT ORAL

ZONEGRAN

zonisamide oral

*Carbamates***

felbamate

FELBATOL

*Gaba Modulators***

GABITRIL

SABRIL PA; SP; QPD

tiagabine hcl

vigabatrin PA; SP; QPD

*Hydantoins***

DILANTIN INFATABS

DILANTIN ORAL CAPSULE 100 MG

DILANTIN ORAL CAPSULE 30 MG

DILANTIN ORAL SUSPENSION

PEGANONE

PHENYTEK

phenytoin infatabs




phenytoin oral suspension 125 mg/5ml

phenytoin oral tablet chewable

phenytoin sodium extended

*Succinimides***

CELONTIN

ethosuximide oral

ZARONTIN

*Valproic Acid***

DEPAKENE ORAL CAPSULE

DEPAKENE ORAL SOLUTION

DEPAKOTE

DEPAKOTE ER

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE

divalproex sodium er oral tablet extended release 24 hour

divalproex sodium oral capsule delayed release sprinkle

divalproex sodium oral tablet delayed release

valproate sodium oral solution

valproic acid oral capsule

valproic acid oral solution

*Antidepressants*

*Alpha-2 Receptor Antagonists (Tetracyclics)***

mirtazapine oral QPD

*Antidepressants - Misc.***

bupropion hcl er (sr) QPD

bupropion hcl er (xl) QPD

bupropion hcl oral

maprotiline hcl

*Modified Cyclics***

nefazodone hcl

trazodone hcl oral

TRINTELLIX ST

VIIBRYD ORAL TABLET ST; QPD

VIIBRYD STARTER PACK ST; QPD

*Monoamine Oxidase Inhibitors (Maois)***

EMSAM QPD

MARPLAN

phenelzine sulfate oral




tranylcypromine sulfate

*Selective Serotonin Reuptake Inhibitors (Ssris)***

citalopram hydrobromide QPD

escitalopram oxalate QPD

fluoxetine hcl oral capsule QPD

fluoxetine hcl oral capsule delayed release QPD

fluoxetine hcl oral solution QPD

fluoxetine hcl oral tablet 10 mg, 20 mg QPD

fluvoxamine maleate QPD

fluvoxamine maleate er QPD

paroxetine hcl er QPD

paroxetine hcl oral tablet QPD

sertraline hcl oral QPD

*Serotonin-Norepinephrine Reuptake Inhibitors (Snris)***

desvenlafaxine succinate er QPD

duloxetine hcl oral capsule delayed release particles 20 mg, 30 mg, 60 mg QPD

FETZIMA ST

FETZIMA TITRATION ST

venlafaxine hcl QPD

venlafaxine hcl er oral capsule extended release 24 hour QPD

*Tricyclic Agents***

amitriptyline hcl oral

amoxapine

clomipramine hcl oral

desipramine hcl oral

doxepin hcl oral

imipramine hcl oral

imipramine pamoate

nortriptyline hcl oral

protriptyline hcl

trimipramine maleate oral

*Antidiabetics*

*Alpha-Glucosidase Inhibitors***

acarbose

miglitol

*Antidiabetic - Amylin Analogs***

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR PA; QPD




SYMLINPEN 60 SUBCUTANEOUS SOLUTION PEN-INJECTOR PA; QPD

*Biguanides***

metformin hcl er QPD

metformin hcl oral QPD

*Diabetic Other***

GLUCAGEN HYPOKIT

GLUCAGON EMERGENCY

PROGLYCEM SP

*Dipeptidyl Peptidase-4 (Dpp-4) Inhibitors***

ALOGLIPTIN BENZOATE PA; ST; QPD

JANUVIA ST; QPD

TRADJENTA ST; QPD

*Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations***

JANUMET ST; QPD

JANUMET XR ST; QPD

JENTADUETO ST; QPD

JENTADUETO XR ST; QPD

*Dopamine Receptor Agonists - Ergot Derivatives***

CYCLOSET ST

*Human Insulin***

APIDRA PA

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR PA

FIASP

FIASP FLEXTOUCH

HUMALOG PA

HUMALOG JUNIOR KWIKPEN PA

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, 200 UNIT/ML

PA

HUMALOG MIX 50/50 PA

HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

PA

HUMALOG MIX 75/25 PA

HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

PA

HUMULIN R U-500 (CONCENTRATED)

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

LANTUS

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR




LEVEMIR

LEVEMIR FLEXTOUCH

NOVOLIN 70/30

NOVOLIN 70/30 RELION

NOVOLIN N

NOVOLIN N RELION

NOVOLIN R

NOVOLIN R RELION

NOVOLOG

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

NOVOLOG MIX 70/30

NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE

TOUJEO MAX SOLOSTAR

TOUJEO SOLOSTAR

TRESIBA FLEXTOUCH

*Incretin Mimetic Agents (Glp-1 Receptor Agonists)***

BYDUREON BCISE PA; QPD

BYDUREON SUBCUTANEOUS PEN-INJECTOR PA; QPD

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER PA; QPD

BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR PA; QPD

BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR PA; QPD

TRULICITY PA; QPD

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR PA; QPD

*Meglitinide Analogues***

nateglinide

repaglinide

*Meglitinide-Biguanide Combinations***

repaglinide-metformin hcl QPD

*Progesterone Receptor Antagonists***

KORLYM PA; SP; QPD

*Sodium-Glucose Co-Transporter 2 (Sglt2) Inhibitors***

FARXIGA ST; QPD

INVOKANA ST; QPD

JARDIANCE ST; QPD

STEGLATRO ST; QPD

*Sulfonylurea-Biguanide Combinations***

glipizide-metformin hcl QPD




glyburide-metformin QPD

*Sulfonylureas***

chlorpropamide QPD

glimepiride QPD

glipizide er QPD

glipizide oral QPD

glipizide xl QPD

glyburide micronized QPD

glyburide oral QPD

tolazamide QPD

tolbutamide QPD

*Sulfonylurea-Thiazolidinedione Combinations***

pioglitazone hcl-glimepiride QPD

*Thiazolidinedione-Biguanide Combinations***

ACTOPLUS MET XR ST; QPD

pioglitazone hcl-metformin hcl QPD

*Thiazolidinediones***

AVANDIA ORAL TABLET 2 MG, 4 MG ST; QPD

pioglitazone hcl QPD

*Antidiarrheals*

*Antidiarrheal - Chloride Channel Antagonists***

MYTESI SP; QPD

*Antiperistaltic Agents***

diphenoxylate-atropine

loperamide hcl oral capsule

opium

paregoric

*Antidotes And Specific Antagonists*

*Antidotes And Specific Antagonists***

VISTOGARD SP; QPD

*Antidotes*

*Antidotes - Chelating Agents***

CHEMET SP

EXJADE SP

FERRIPROX SP

JADENU SP

JADENU SPRINKLE SP




*Antidotes***

VISTOGARD SP; QPD

*Opioid Antagonists***

naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml QPD

naloxone hcl injection solution cartridge QPD

naloxone hcl injection solution prefilled syringe QPD

naltrexone hcl oral

NARCAN QPD

*Antiemetics*

*5-Ht3 Receptor Antagonists***

ANZEMET ORAL QPD

granisetron hcl oral QPD

ondansetron QPD

ondansetron hcl oral QPD

*Antiemetic Combinations***

AKYNZEO ORAL QPD

DICLEGIS QPD

*Antiemetics - Anticholinergic***

meclizine hcl oral tablet

scopolamine

trimethobenzamide hcl oral

*Antiemetics - Miscellaneous***

dronabinol

*Substance P/Neurokinin 1 (Nk1) Receptor Antagonists***

aprepitant QPD

EMEND ORAL SUSPENSION RECONSTITUTED QPD

*Antifungals*

*Antifungals***

flucytosine oral

griseofulvin microsize oral

griseofulvin ultramicrosize

nystatin oral tablet

terbinafine hcl oral QPD

*Imidazoles***

ketoconazole oral

*Triazoles***

CRESEMBA ORAL QPD




fluconazole oral suspension reconstituted

fluconazole oral tablet 100 mg, 200 mg, 50 mg

fluconazole oral tablet 150 mg QPD

itraconazole oral QPD

NOXAFIL ORAL QPD

SPORANOX ORAL SOLUTION QPD

voriconazole oral QPD

*Antihistamines*

*Antihistamines - Ethanolamines***

carbinoxamine maleate oral solution

carbinoxamine maleate oral tablet 4 mg

clemastine fumarate oral tablet 2.68 mg

diphenhydramine hcl oral capsule 50 mg

*Antihistamines - Non-Sedating***

desloratadine oral tablet QPD

*Antihistamines - Phenothiazines***

phenadoz

promethazine hcl oral

promethazine hcl rectal

promethegan

*Antihistamines - Piperidines***

cyproheptadine hcl oral

*Antihyperlipidemics*

*Antihyperlipidemics - Misc.***

omega-3-acid ethyl esters PA

*Bile Acid Sequestrants***

cholestyramine light

cholestyramine oral

colestipol hcl

prevalite

WELCHOL

*Fibric Acid Derivatives***

choline fenofibrate

fenofibrate micronized

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg

fenofibric acid

gemfibrozil oral




*Hmg Coa Reductase Inhibitors***

atorvastatin calcium oral tablet 10 mg, 20 mg QPD

atorvastatin calcium oral tablet 40 mg, 80 mg QPD

fluvastatin sodium QPD

fluvastatin sodium er QPD

LIVALO PA; ST; QPD

lovastatin QPD

pravastatin sodium QPD

rosuvastatin calcium oral tablet 10 mg, 5 mg QPD

rosuvastatin calcium oral tablet 20 mg, 40 mg QPD

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg QPD

simvastatin oral tablet 80 mg QPD

*Intest Cholest Absorp Inhib-Hmg Coa Reductase Inhib Comb***

ezetimibe-simvastatin QPD

*Intestinal Cholesterol Absorption Inhibitors***

ezetimibe QPD

*Nicotinic Acid Derivatives***

niacin er (antihyperlipidemic)

NIACOR

*Antihypertensives*

*Ace Inhibitor & Calcium Channel Blocker Combinations***

amlodipine besy-benazepril hcl

trandolapril-verapamil hcl er

*Ace Inhibitors & Thiazide/Thiazide-Like***

benazepril-hydrochlorothiazide

captopril-hydrochlorothiazide

enalapril-hydrochlorothiazide

fosinopril sodium-hctz

lisinopril-hydrochlorothiazide QPD

moexipril-hydrochlorothiazide

quinapril-hydrochlorothiazide

*Ace Inhibitors***

benazepril hcl oral QPD

captopril oral QPD

enalapril maleate oral QPD

EPANED ORAL SOLUTION ST; QPD

fosinopril sodium QPD




lisinopril oral QPD

moexipril hcl QPD

perindopril erbumine QPD

QBRELIS ST; QPD

quinapril hcl QPD

ramipril QPD

trandolapril QPD

*Adrenolytics-Central & Thiazide/Thiazide-Like Comb***

methyldopa-hydrochlorothiazide

*Agents For Pheochromocytoma***

DEMSER SP

phenoxybenzamine hcl oral

*Angiotensin Ii Receptor Antag & Ca Channel Blocker Comb***

amlodipine besylate-valsartan QPD

amlodipine-olmesartan QPD

telmisartan-amlodipine QPD

*Angiotensin Ii Receptor Antag & Thiazide/Thiazide-Like***

candesartan cilexetil-hctz

irbesartan-hydrochlorothiazide

losartan potassium-hctz

olmesartan medoxomil-hctz QPD

telmisartan-hctz

valsartan-hydrochlorothiazide

*Angiotensin Ii Receptor Antagonists***

candesartan cilexetil QPD

eprosartan mesylate QPD

irbesartan QPD

losartan potassium QPD

olmesartan medoxomil oral QPD

telmisartan QPD

valsartan QPD

*Angiotensin Ii Receptor Ant-Ca Channel Blocker-Thiazides***

amlodipine-valsartan-hctz QPD

olmesartan-amlodipine-hctz QPD

*Antiadrenergics - Centrally Acting***

clonidine hcl oral

clonidine hcl transdermal QPD

guanfacine hcl oral




methyldopa oral

*Antiadrenergics - Peripherally Acting***

doxazosin mesylate oral QPD

prazosin hcl oral QPD

terazosin hcl oral QPD

*Beta Blocker & Diuretic Combinations***

atenolol-chlorthalidone

bisoprolol-hydrochlorothiazide

metoprolol-hydrochlorothiazide

nadolol-bendroflumethiazide

propranolol-hctz

*Direct Renin Inhibitors & Thiazide/Thiazide-Like Comb***

TEKTURNA HCT ST

*Direct Renin Inhibitors***

TEKTURNA ST; QPD

*Selective Aldosterone Receptor Antagonists (Saras)***

eplerenone

*Vasodilators***

hydralazine hcl oral

minoxidil oral

*Anti-Infective Agents - Misc.*

*Anti-Infective Agents - Misc.***

metronidazole oral

NEBUPENT

PRIMSOL

tinidazole oral

trimethoprim oral

vancomycin hcl oral

XIFAXAN

*Anti-Infective Misc. - Combinations***

sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5ml

sulfamethoxazole-trimethoprim oral tablet

sulfatrim pediatric

*Antiprotozoal Agents***

ALINIA

atovaquone oral




*Leprostatics***

dapsone oral

*Lincosamides***

clindamycin hcl oral

clindamycin palmitate hcl

*Oxazolidinones***

linezolid oral QPD

*Antimalarials*

*Antimalarial Combinations***

atovaquone-proguanil hcl

COARTEM

*Antimalarials***

chloroquine phosphate oral

DARAPRIM PA; SP

hydroxychloroquine sulfate oral

mefloquine hcl

PRIMAQUINE PHOSPHATE ORAL

quinine sulfate oral

*Antimyasthenic Agents*

*Antimyasthenic Agents***

guanidine hcl oral

MESTINON ORAL SYRUP SP

pyridostigmine bromide er

pyridostigmine bromide oral

*Antimyasthenic/Cholinergic Agents***

guanidine hcl oral




*Antimyasthenic/Cholinergic Agents*

guanidine hcl oral




*Antimycobacterial Agents*

*Anti Tb Combinations***

RIFAMATE




RIFATER

*Antimycobacterial Agents***

CYCLOSERINE ORAL

ethambutol hcl oral

isoniazid oral

PASER

PRIFTIN

pyrazinamide oral

rifabutin

rifampin oral

SIRTURO SP

TRECATOR

*Antineoplastic - Bcl-2 Inhibitors***

*Antineoplastic - Bcl-2 Inhibitors***

VENCLEXTA SP; QPD

VENCLEXTA STARTING PACK SP; QPD

*Antineoplastics And Adjunctive Therapies*

*Alkylating Agents***

HEXALEN SP

MYLERAN SP

*Androgen Biosynthesis Inhibitors***

ZYTIGA SP; QPD

*Antiadrenals***

LYSODREN SP

*Antiandrogens***

bicalutamide QPD

ERLEADA SP; QPD

flutamide QPD

nilutamide SP

XTANDI SP; QPD

*Antiestrogens***

FARESTON

SOLTAMOX

tamoxifen citrate oral

*Antimetabolites***

capecitabine SP

mercaptopurine oral




methotrexate oral

methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml

SP

methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml SP

TABLOID

*Antineoplastic - Braf Kinase Inhibitors***

TAFINLAR SP; QPD

ZELBORAF SP; QPD

*Antineoplastic - Hedgehog Pathway Inhibitors***

ERIVEDGE SP; QPD

ODOMZO SP; QPD

*Antineoplastic - Histone Deacetylase Inhibitors***

FARYDAK SP

ZOLINZA SP; QPD

*Antineoplastic - Immunomodulators***

POMALYST SP; QPD

*Antineoplastic - Mek Inhibitors***

COTELLIC SP

MEKINIST SP; QPD

*Antineoplastic - Mtor Kinase Inhibitors***

AFINITOR SP; QPD

AFINITOR DISPERZ SP; QPD

*Antineoplastic - Multikinase Inhibitors***

NEXAVAR SP; QPD

RYDAPT SP; QPD

STIVARGA SP; QPD

SUTENT SP; QPD

*Antineoplastic - Proteasome Inhibitors***

NINLARO SP; QPD

*Antineoplastic - Tyrosine Kinase Inhibitors***

ALECENSA SP; QPD

ALUNBRIG SP; QPD

BOSULIF SP; QPD

CABOMETYX SP; QPD

CALQUENCE SP; QPD

CAPRELSA SP; QPD

COMETRIQ (100 MG DAILY DOSE) SP; QPD






GILOTRIF SP; QPD

ICLUSIG SP; QPD

imatinib mesylate SP

IMBRUVICA SP; QPD

INLYTA SP; QPD

IRESSA SP; QPD

LENVIMA 10 MG DAILY DOSE SP; QPD






NERLYNX SP; QPD

SPRYCEL SP; QPD

TAGRISSO SP; QPD

TARCEVA SP; QPD

TASIGNA SP; QPD

TYKERB SP; QPD

VOTRIENT SP; QPD

XALKORI SP; QPD

ZYKADIA SP; QPD

*Antineoplastic Combinations***

KISQALI FEMARA 200 DOSE SP; QPD



LONSURF SP

*Antineoplastics Misc.***

ACTIMMUNE PA; SP

hydroxyurea oral

MATULANE SP

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG SP; QPD

SYNRIBO SP

*Aromatase Inhibitors***

anastrozole oral QPD

exemestane QPD

letrozole oral QPD




*Estrogens-Antineoplastic***

EMCYT

*Folic Acid Antagonists Rescue Agents***

leucovorin calcium oral

*Imidazotetrazines***

temozolomide SP

*Janus Associated Kinase (Jak) Inhibitors***

JAKAFI SP; QPD

*Mitotic Inhibitors***

etoposide oral SP

*Nitrogen Mustards***

CYCLOPHOSPHAMIDE ORAL CAPSULE

LEUKERAN

melphalan SP

*Nitrosoureas***

GLEOSTINE SP

*Progestins-Antineoplastic***

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

megestrol acetate oral suspension 40 mg/ml

megestrol acetate oral tablet

*Retinoids***

tretinoin oral

*Selective Retinoid X Receptor Agonists***

bexarotene SP

*Topoisomerase I Inhibitors***

HYCAMTIN ORAL SP

*Urinary Tract Protective Agents***

MESNEX ORAL SP

*Antiparkinson Agents*

*Antiparkinson Anticholinergics***

benztropine mesylate oral

trihexyphenidyl hcl

*Antiparkinson Dopaminergics***

amantadine hcl oral

bromocriptine mesylate oral

*Antiparkinson Monoamine Oxidase Inhibitors***

rasagiline mesylate oral




selegiline hcl oral

*Central/Peripheral Comt Inhibitors***

tolcapone

*Decarboxylase Inhibitors***

carbidopa oral

*Levodopa Combinations***

carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg

carbidopa-levodopa oral tablet

carbidopa-levodopa oral tablet dispersible

carbidopa-levodopa-entacapone

RYTARY

*Nonergoline Dopamine Receptor Agonists***

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE SP

NEUPRO QPD

pramipexole dihydrochloride

pramipexole dihydrochloride er

ropinirole hcl

ropinirole hcl er QPD

*Peripheral Comt Inhibitors***

entacapone

*Antipsychotics/Antimanic Agents*

*Antimanic Agents***

lithium

lithium carbonate er

lithium carbonate oral

*Antipsychotics - Misc.***

EQUETRO

LATUDA QPD

NUPLAZID SP; QPD

VRAYLAR QPD

ziprasidone hcl QPD

*Benzisoxazoles***

FANAPT QPD

FANAPT TITRATION PACK QPD

paliperidone er QPD

risperidone

risperidone m-tab oral tablet dispersible 0.5 mg, 1 mg, 2 mg




*Butyrophenones***

haloperidol lactate oral

haloperidol oral

*Dibenzodiazepines***

clozapine oral tablet

clozapine oral tablet dispersible 100 mg, 12.5 mg, 25 mg

CLOZAPINE ORAL TABLET DISPERSIBLE 150 MG, 200 MG

*Dibenzo-Oxepino Pyrroles***

SAPHRIS QPD

*Dibenzothiazepines***

quetiapine fumarate QPD

quetiapine fumarate er QPD

*Dibenzoxazepines***

loxapine succinate oral

*Phenothiazines***

chlorpromazine hcl oral

compro

fluphenazine hcl oral

perphenazine oral

prochlorperazine

prochlorperazine maleate oral

thioridazine hcl oral

trifluoperazine hcl oral

*Quinolinone Derivatives***

aripiprazole QPD

REXULTI QPD

*Thienbenzodiazepines***

olanzapine oral QPD

*Thioxanthenes***

thiothixene oral

*Antiretrovirals Adjuvants***

*Antiretrovirals Adjuvants***

TYBOST SP

*Antivirals*

*Antiretroviral Combinations***

abacavir sulfate-lamivudine SP

abacavir-lamivudine-zidovudine SP




ATRIPLA SP

BIKTARVY SP; QPD

CIMDUO SP; QPD

COMPLERA SP

DESCOVY SP

EVOTAZ SP; QPD

GENVOYA SP

JULUCA SP; QPD

KALETRA ORAL TABLET SP

lamivudine-zidovudine

lopinavir-ritonavir SP

ODEFSEY SP

PREZCOBIX SP; QPD

STRIBILD SP

SYMFI SP; QPD

SYMFI LO SP; QPD

TRIUMEQ SP

TRUVADA SP

*Antiretrovirals - Ccr5 Antagonists (Entry Inhibitor)***

SELZENTRY SP

*Antiretrovirals - Fusion Inhibitors***

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED SP

*Antiretrovirals - Integrase Inhibitors***

ISENTRESS SP

ISENTRESS HD SP

TIVICAY SP

*Antiretrovirals - Protease Inhibitors***

APTIVUS SP

atazanavir sulfate SP

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG SP

fosamprenavir calcium SP

INVIRASE SP

LEXIVA ORAL SUSPENSION SP

NORVIR SP

PREZISTA ORAL SUSPENSION SP

PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG SP

REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG SP

REYATAZ ORAL PACKET SP




ritonavir SP

VIRACEPT ORAL TABLET SP

*Antiretrovirals - Rti-Non-Nucleoside Analogues***

EDURANT SP

efavirenz SP

INTELENCE SP

nevirapine er

nevirapine oral tablet

RESCRIPTOR SP

SUSTIVA SP

*Antiretrovirals - Rti-Nucleoside Analogues-Purines***

abacavir sulfate oral solution SP

abacavir sulfate oral tablet

didanosine oral capsule delayed release 200 mg, 250 mg, 400 mg

VIDEX SP

*Antiretrovirals - Rti-Nucleoside Analogues-Pyrimidines***

EMTRIVA SP

lamivudine oral solution

lamivudine oral tablet 150 mg, 300 mg

*Antiretrovirals - Rti-Nucleoside Analogues-Thymidines***

stavudine oral capsule

zidovudine

*Antiretrovirals - Rti-Nucleotide Analogues***

tenofovir disoproxil fumarate SP

VIREAD SP

*Cmv Agents***

PREVYMIS ORAL QPD

valganciclovir hcl

*Hepatitis B Agents***

adefovir dipivoxil SP

BARACLUDE ORAL SOLUTION SP

entecavir SP

EPIVIR HBV ORAL SOLUTION SP

lamivudine oral tablet 100 mg

VEMLIDY SP

*Hepatitis C Agents***

moderiba 1200 dose pack QPD

moderiba 800 dose pack QPD




moderiba oral tablet 200 mg QPD

moderiba oral tablet therapy pack QPD

PEGASYS PROCLICK PA; SP; QPD

PEGASYS SUBCUTANEOUS SOLUTION PA; SP; QPD

PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5ML PA; SP; QPD

REBETOL ORAL SOLUTION SP; QPD

ribasphere QPD

ribasphere ribapak oral tablet 400 mg, 600 mg QPD

ribasphere ribapak oral tablet therapy pack QPD

ribavirin oral capsule QPD

ribavirin oral tablet 200 mg QPD

SOVALDI PA; SP

*Herpes Agents - Purine Analogues***

acyclovir oral

valacyclovir hcl oral QPD

*Herpes Agents - Thymidine Analogues***

famciclovir oral QPD

*Influenza Agents***

rimantadine hcl

*Neuraminidase Inhibitors***

oseltamivir phosphate QPD

RELENZA DISKHALER QPD

TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MG/ML QPD

*Assorted Classes*

*Antileprotics***

THALOMID SP

*Chelating Agents***

DEPEN TITRATABS SP

*Cyclosporine Analogs***

cyclosporine modified

cyclosporine oral capsule

gengraf oral capsule 100 mg, 25 mg

gengraf oral solution

SANDIMMUNE ORAL SOLUTION

*Immunomodulators For Myelodysplastic Syndromes***

REVLIMID SP; QPD




*Inosine Monophosphate Dehydrogenase Inhibitors***

mycophenolate mofetil

mycophenolate sodium

*Irrigation Solutions***

lactated ringers irrigation

ringers irrigation

sterile water for irrigation

tis-u-sol

*Macrolide Immunosuppressants***

RAPAMUNE ORAL SOLUTION

sirolimus oral

tacrolimus oral

ZORTRESS

*Potassium Removing Resins***

kionex

sodium polystyrene sulfonate oral

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

SODIUM POLYSTYRENE SULFONATE RECTAL SUSPENSION 50 GM/200ML

sps

VELTASSA SP; QPD

*Purine Analogs***

azathioprine oral

*Beta Blockers*

*Alpha-Beta Blockers***

carvedilol

carvedilol phosphate er

COREG CR ST

labetalol hcl oral

*Beta Blockers Cardio-Selective***

acebutolol hcl oral

atenolol oral QPD

betaxolol hcl oral

bisoprolol fumarate

BYSTOLIC ST

metoprolol succinate er

metoprolol tartrate oral QPD




*Beta Blockers Non-Selective***

HEMANGEOL SP

nadolol oral tablet 20 mg, 40 mg, 80 mg

pindolol

propranolol hcl er

propranolol hcl oral

sotalol hcl (af)

sotalol hcl oral

SOTYLIZE

timolol maleate oral

*Bile Acid Synthesis Disorder Agents***

*Bile Acid Synthesis Disorder Agents***

CHOLBAM PA; SP

*Calcium Channel Blockers*

*Calcium Channel Blockers***

afeditab cr

amlodipine besylate oral

cartia xt

diltiazem cd

diltiazem hcl er beads

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg

diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

diltiazem hcl oral

dilt-xr

felodipine er

isradipine

nicardipine hcl oral

nifedical xl oral tablet extended release 24 hour 60 mg

nifedipine er

nifedipine er osmotic release

nifedipine oral

nimodipine oral QPD

nisoldipine er

NYMALIZE ORAL SOLUTION 60 MG/20ML

taztia xt

verapamil hcl er oral capsule extended release 24 hour




verapamil hcl er oral tablet extended release 120 mg, 180 mg, 240 mg

verapamil hcl oral

*Cardiotonics*

*Cardiac Glycosides***

digitek

digox

digoxin oral

LANOXIN ORAL TABLET 187.5 MCG, 62.5 MCG

*Cardiovascular Agents - Misc.*

*Calcium Channel Blocker & Hmg Coa Reductase Inhibit Comb***

amlodipine-atorvastatin QPD

*Nitrate & Vasodilator Combinations***

BIDIL

*Prostaglandin Vasodilators***

ORENITRAM PA; SP

TYVASO PA; SP

TYVASO REFILL PA; SP

TYVASO STARTER PA; SP

VENTAVIS PA; SP

*Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (Sgc)***

ADEMPAS PA; SP; QPD

*Pulmonary Hypertension - Endothelin Receptor Antagonists***

LETAIRIS PA; SP; QPD

OPSUMIT PA; SP

TRACLEER PA; SP

*Pulmonary Hypertension - Phosphodiesterase Inhibitors***

ADCIRCA PA; SP; QPD

REVATIO ORAL SUSPENSION RECONSTITUTED PA; SP; QPD

sildenafil citrate intravenous PA; SP; QPD

sildenafil citrate oral tablet 20 mg PA; QPD

*Selective Cgmp Phosphodiesterase Type 5 Inhibitors***

CIALIS ORAL TABLET 5 MG PA; QPD

*Cephalosporins*

*Cephalosporins - 1St Generation***

cefadroxil

cephalexin




*Cephalosporins - 2Nd Generation***

cefaclor

cefaclor er

cefprozil

cefuroxime axetil oral tablet

*Cephalosporins - 3Rd Generation***

cefdinir

cefditoren pivoxil

cefixime

cefpodoxime proxetil

SUPRAX ORAL CAPSULE

SUPRAX ORAL SUSPENSION RECONSTITUTED 500 MG/5ML

SUPRAX ORAL TABLET CHEWABLE

*Contraceptives*

*Biphasic Contraceptives - Oral***

azurette

bekyree

desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5)

kariva

kimidess

pimtrea

viorele

*Combination Contraceptives - Oral***

altavera

alyacen 1/35

apri

aubra

aviane

balziva

blisovi 24 fe

blisovi fe 1.5/30

blisovi fe 1/20

briellyn

chateal

cryselle-28

cyclafem 1/35

cyred




dasetta 1/35

delyla

desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

drospiren-eth estrad-levomefol

drospirenone-ethinyl estradiol

elinest

emoquette

enskyce

estarylla

ethynodiol diac-eth estradiol

falmina

femynor

gianvi

gildess fe 1.5/30

gildess fe 1/20

isibloom

juleber

junel 1.5/30

junel 1/20

junel fe 1.5/30

junel fe 1/20

junel fe 24

kaitlib fe

kelnor 1/35

kurvelo

larin 1.5/30

larin 1/20

larin 24 fe

larin fe 1.5/30

larin fe 1/20

larissia

layolis fe

lessina

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-30 mg-mcg

levora 0.15/30 (28)

lillow

loryna

low-ogestrel




lutera

marlissa

melodetta 24 fe

mibelas 24 fe

microgestin 1.5/30

microgestin 1/20

microgestin fe 1.5/30

microgestin fe 1/20

mono-linyah

mononessa

necon 0.5/35 (28)

necon 1/35 (28)

nikki

norethin ace-eth estrad-fe

norethindrone acet-ethinyl est

norethin-eth estradiol-fe

norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg

nortrel 0.5/35 (28)

nortrel 1/35 (21)

nortrel 1/35 (28)

ocella

ogestrel

orsythia

philith

pirmella 1/35

portia-28

previfem

rajani

reclipsen

sprintec 28

sronyx

syeda

tarina fe 1/20

tydemy

vestura

vienva

vyfemla

wera




wymzya fe

zarah

zenchent

zovia 1/35e (28)

*Combination Contraceptives - Transdermal***

xulane

*Combination Contraceptives - Vaginal***

NUVARING

*Continuous Contraceptives - Oral***

amethyst

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg

*Emergency Contraceptives***

econtra ez QPD

ELLA QPD

levonorgestrel oral tablet 1.5 mg QPD

my way QPD

next choice one dose QPD

opcicon one-step QPD

option 2 QPD

react QPD

*Extended-Cycle Contraceptives - Oral***

amethia QPD

amethia lo QPD

ashlyna QPD

camrese QPD

camrese lo QPD

daysee QPD

fayosim QPD

introvale QPD

jolessa QPD

levonorgest-eth est & eth est QPD

levonorgest-eth estrad 91-day QPD

quasense QPD

rivelsa QPD

setlakin QPD

*Progestin Contraceptives - Injectable***

medroxyprogesterone acetate intramuscular QPD




*Progestin Contraceptives - Oral***

camila

deblitane

errin

heather

jencycla

jolivette

lyza

nora-be

norethindrone oral

norlyda

norlyroc

sharobel

*Triphasic Contraceptives - Oral***

alyacen 7/7/7

aranelle

caziant

cyclafem 7/7/7

dasetta 7/7/7

enpresse-28

leena

levonest

levonorg-eth estrad triphasic

myzilra

necon 7/7/7

norgestim-eth estrad triphasic

nortrel 7/7/7

pirmella 7/7/7

tilia fe

tri femynor

tri-estarylla

tri-legest fe

tri-linyah

tri-lo-estarylla

tri-lo-marzia

tri-lo-sprintec

trinessa (28)

trinessa lo




tri-previfem

tri-sprintec

trivora (28)

velivet

*Corticosteroids*

*Glucocorticosteroids***

budesonide oral

cortisone acetate oral

deltasone

dexamethasone intensol

dexamethasone oral

hydrocortisone oral

methylprednisolone oral

millipred dp oral tablet therapy pack

millipred oral tablet

prednisolone oral solution

prednisolone oral syrup 15 mg/5ml

prednisolone sodium phosphate oral solution 15 mg/5ml, 25 mg/5ml, 6.7 (5 base) mg/5ml

prednisolone sodium phosphate oral tablet dispersible

prednisone intensol

prednisone oral

UCERIS ORAL

*Mineralocorticoids***

fludrocortisone acetate oral

*Cough/Cold/Allergy*

*Antitussive - Nonnarcotic***

benzonatate oral capsule 100 mg, 200 mg

*Antitussive - Opioid***

hydrocodone-homatropine

hydromet

tussigon

*Antitussive-Expectorant***

cheratussin ac oral syrup

g tussin ac

guaiatussin ac

guaifenesin ac

guaifenesin-codeine oral solution




MAR-COF CG EXPECTORANT

m-clear wc

relcof c

robafen ac oral solution

virtussin a/c

*Antitussive-Expectorants-Decongestant***

guaifenesin dac

lortuss ex oral liquid 30-10-100 mg/5ml

tusnel c

virtussin dac

*Decongestant & Antihistamine***

promethazine vc plain oral solution

promethazine-phenylephrine

*Iodine Expectorants***

SSKI

*Misc. Respiratory Inhalants***

HYPERSAL

nebusal inhalation nebulization solution 3 %

NEBUSAL INHALATION NEBULIZATION SOLUTION 6 %

pulmosal

sodium chloride inhalation nebulization solution 0.9 %, 10 %, 3 %, 7 %

*Mucolytics***

acetylcysteine inhalation

*Non-Narc Antitussive-Antihistamine***

promethazine-dm

*Non-Narc Antitussive-Decongestant-Antihistamine***

pseudoeph-bromphen-dm oral syrup 30-2-10 mg/5ml

*Opioid Antitussive-Antihistamine***

hydrocod polst-cpm polst er oral suspension extended release

promethazine-codeine oral syrup QPD

*Opioid Antitussive-Decongestant-Antihistamine***

MAR-COF BP

promethazine vc/codeine

promethazine-phenyleph-codeine

pseudoeph-chlorphen-hydrocod

rydex




*Cyclin-Dependent Kinases (Cdk) Inhibitors***

*Cyclin-Dependent Kinases (Cdk) Inhibitors***

IBRANCE SP; QPD

KISQALI 200 DOSE SP; QPD



VERZENIO SP; QPD

*Cystic Fibrosis Agent - Combinations***

*Cystic Fibrosis Agent - Combinations***

ORKAMBI PA; SP; QPD

*Dermatologicals*

*Acne Antibiotics***

ACZONE EXTERNAL GEL 7.5 % ST

clindacin-p

clindamycin phosphate external foam

clindamycin phosphate external gel

clindamycin phosphate external lotion

clindamycin phosphate external solution

clindamycin phosphate external swab

dapsone external

ery

erygel

erythromycin external

sulfacetamide sodium (acne)

*Acne Combinations***

avar cleanser

benzoyl peroxide-erythromycin

bp 10-1

bp cleansing wash

clindamycin phos-benzoyl perox

clindamycin-tretinoin PA

neuac external gel

sss 10-5

sulfacetamide sodium-sulf

2018 covered drug list - blue cross and blue shield of ... covered drug list. ... an independent...

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