blue cross and blue shield of alabama july 2017 generics ... · blue cross and blue shield of...

July 2017

Blue Cross and Blue Shield of Alabama Generics Plus Drug Guide

Please consider talking to your doctor about prescribing preferred generic and brand

medications, which may help reduce your out-of-pocket costs. This list may help guide you

and your doctor in selecting an appropriate medication for you.

For questions about the Blue Cross and Blue Shield of Alabama 2017 Prescription Drug

Guide, call the customer service number on the back of your Blue Cross ID card or visit

AlabamaBlue.com/pharmacy.

The Prescription Drug Guide is regularly updated. Please visit

AlabamaBlue.com/pharmacy for the most up-to-date information.

Contents

Introduction ...................................................................... I

Member Prescription Benefit ........................................... I

Pharmacy and Therapeutics (P&T) Committee ............... I

Brand Drugs and Generic Drugs .................................... II

Classification ................................................................... II

Generic Substitution ....................................................... II

Specialty Drugs ............................................................... II

Compound Drugs ............................................................ II

Contraceptives ............................................................... III

Utilization Management ................................................. III

Prior Authorization ......................................................... III

Dispensing Limits ........................................................... III

Step Therapy ................................................................. III

Notice ............................................................................. III

Key ................................................................................. IV

Generic and Brand Name Drugs not Covered ............... 1

Therapeutic Class Drug List

Anti-Infective Drugs .................................................... 2

Cancer Drugs ............................................................. 8

Hormones, Diabetes and Related Drugs ................. 11

Heart and Circulatory Drugs..................................... 18

Respiratory Agents ................................................... 27Gastrointestinal Drugs .............................................. 29Genitourinary Drugs ................................................. 32Central Nervous System Drugs................................ 33Pain Relief Drugs ..................................................... 41Neuromuscular Drugs .............................................. 45Supplements ............................................................ 47Blood Modifying Drugs ............................................. 48Topical Drugs ........................................................... 49Miscellaneous Categories ........................................ 53Index ......................................................................... 57

To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or

go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for

and click on Search.

Prime Therapeutics LLC®, an independent company, provides pharmacy benefit management services for Blue Cross and Blue Shield of

Alabama, an independent licensee of the Blue Cross and Blue Shield Association.

4157-D AL © Prime Therapeutics LLC 07/17

Blue Cross and Blue Shield of Alabama July 2017 Generics Plus Drug Guide I

Introduction

Blue Cross and Blue Shield of Alabama is pleased to present the January 2017 Generics Plus Drug Guide.

The Generics Plus Drug Guide includes all Preferred Brand and a partial listing of Generic drugs. Brand name

drugs not listed in this Generics Plus Drug Guide are Non-Preferred Brands. Blue Cross may choose to not add a

drug to the Preferred Brand tier for reasons including safety or effectiveness, or because a similar, more cost-

effective drug is already available as a Preferred Brand or Generic drug. New brand drugs are Non-Preferred until

reviewed and approved for inclusion by the Pharmacy and Therapeutics (P&T) Committee.

Physicians are encouraged to prescribe drugs listed in this Generics Plus Drug Guide. Members are encouraged

to show this Generics Plus Drug Guide to their physician and pharmacist.

Member Prescription Benefit

The Blue Cross prescription benefit is multi-tiered, placing prescription drugs into one of the following copayment

levels.

Tier 1 – Lowest copayment – Generic drugs and select Preferred Brand drugs– listed and unlisted generic drugs

Tier 2 – Middle copayment – Preferred Brand drugs – all shown in the Prescription Drug Guide

Tier 3 – Highest copayment – Non-Preferred Brand drugs – unlisted

Tier 4 – Specialty (if applicable)

Coverage is limited to prescription products approved by the Food and Drug Administration (FDA) as evidenced

by a New Drug Application (NDA), Abbreviated New Drug Application (ANDA), or Biologics License Application

(BLA) on file. Any legal requirements or group specific benefits for coverage will supersede this (e.g., preventive

drugs per the Affordable Care Act).

In addition, some benefits (e.g., closed plan designs) do not provide coverage of the Non-Preferred Brand drugs

(Tier 3). The drug benefit includes most prescription drug classes, although some restrictions and exclusions

apply. For example, investigational drugs and drugs indicated for cosmetic purposes (e.g., Propecia for hair

growth) are not covered. Coverage and copayment levels vary depending on the plan. Drugs that require Prior

Authorization, Step Therapy, or that have Dispensing Limits are noted in the Generics Plus Drug Guide.

Pharmacy and Therapeutics (P&T) Committee

The P&T Committee is comprised of independent practicing physicians and pharmacists. The Committee meets

at least quarterly. Decisions to add or remove drugs from the Generics Plus Drug Guide are based on the drug’s

safety, efficacy, uniqueness and cost.

Members and physicians can view the most up-to-date version of the Generics Plus Drug Guide at

AlabamaBlue.com/pharmacy.

Blue Cross and Blue Shield of Alabama July 2017 Generics Plus Drug Guide II

Brand Drugs and Generic Drugs

Classification

Prescription drugs are classified as either a Brand drug or a Generic drug. Blue Cross uses the Brand or Generic

status provided by a nationally recognized company providing drug product information. The Brand/Generic status

for a specific drug/specific marketer can sometimes change over the life of a product in the marketplace and

change from Brand to Generic (or Generic to Brand). Such changes might change your copayment share. Brand

drug or Generic drug status is never based upon a product having a trade name. Generic drugs often have trade

names.

Generic Substitution

Blue Cross encourages generic utilization as a way to provide high quality drugs at a reduced cost. Generic drugs

are as safe and effective as their brand counterparts, but are usually less expensive. Generic drugs are

manufactured under the same strict requirements of FDA’s current Good Manufacturing Practice regulations

required for Brand drugs and cover the manufacturing, identity, strength, purity and quality.

An FDA-approved Generic drug may be substituted for the Brand counterpart when it:

Contains the same active ingredient(s) as the brand drug

Is identical in strength, dosage form, and route of administration

Is therapeutically equivalent and can be expected to have the same clinical effect and safety profile

To encourage use of Generic drugs, Tier 2 Preferred Brand drugs typically move to Tier 3 after an equivalent

generic version becomes available.

Specialty Drugs

Specialty drugs are used in the treatment of medical conditions such as hepatitis, multiple sclerosis and

rheumatoid arthritis. Specialty drugs may be oral or injectable medications that can either be self-

administered or administered by a health care professional.

Some Blue Cross members must obtain their specialty drugs from Prime Therapeutics Specialty Pharmacy.

If the preferred provider is not utilized you may be responsible for up to 100 percent of the drug cost. Your

plan may have a different coverage level for self-administered specialty drugs. If you have questions about

your coverage for specialty drugs or your prescription drug benefit, call the number on the back of your ID

card. A complete listing of specialty drugs is also available at AlabamaBlue.com/pharmacy.

Compound Drugs

Compound drugs are defined as a drug product made or modified to have characteristics that are specifically

prescribed for an individual patient when commercial drug products are not available or appropriate. To be

eligible for coverage, compounded drugs must contain at least one FDA-approved prescription ingredient and

must not be a copy of a commercially available product. All compounded drugs are subject to review and may

require prior authorization. Drugs used in compounded drugs may be subject to additional coverage criteria and

utilization management edits. Compounds are covered only when medically necessary. Compound drugs are

always classified as the highest cost-sharing non-specialty drug Tier.

Blue Cross and Blue Shield of Alabama July 2017 Generics Plus Drug Guide III

Contraceptives

Some or all of the contraceptive methods or prescription drugs listed in this Prescription Drug Guide may not be

covered under your plan because of your employer’s religious beliefs. To find out if contraceptive methods and

prescription drugs are excluded, you may find this information in the exclusions section of your benefit booklet or

you may contact your group administrator.

Utilization Management

Blue Cross is committed to supporting proper selection and use of drugs for its members. To help assure these

goals are met, several programs have been developed to promote drug selection that encourages both

effectiveness and safety. Detailed coverage criteria can be found at AlabamaBlue.com/pharmacy. Preferred

generic or brand drugs requiring Prior Authorization or Step Therapy, or drugs with Dispensing Limits will be

noted in the Therapeutic Class Drug List portion of the Generics Plus Drug Guide.

Prior Authorization

Some drugs require Prior Authorization (PA) because of their high potential for misuse or overuse. Drugs selected

for Prior Authorization may require that specific clinical criteria are met before the drugs will be covered under a

member’s prescription benefit. Approval is required for claims to process at network pharmacies.

Dispensing Limits

Dispensing Limits (DL) identify gender or age restrictions, and/or the maximum quantity that can be dispensed

over a specific period of time. Limits are in place to encourage appropriate drug utilization, enhance member

outcomes, and reduce drug benefit costs. Limits are typically developed based upon FDA-approved drug labeling.

Step Therapy

Step Therapy (ST) programs help manage the cost of expensive drugs by redirecting members to safe, effective

and less expensive alternatives. Drugs included in the Step Therapy program require a more cost-effective

prerequisite drug be tried before the Step Therapy drug will be approved for coverage. If the member meets the

prerequisite requirement, the requested drug will be covered automatically without requiring review. If prerequisite

drugs are not found in the claims history, Prior Authorization may be required. Drugs and drug categories included

in the Step Therapy program are subject to change.

Notice

The purpose of the Blue Cross Generics Plus Drug Guide is to provide a guide to coverage. The Generics Plus

Drug Guide is not intended to dictate to physicians how to practice medicine. Physicians should exercise their

medical judgment in providing the care they feel is most appropriate for their patients.

Neither this Generics Plus Drug Guide, nor the successful adjudication of a pharmacy claim, is guarantee of

payment.

Blue Cross and Blue Shield of Alabama July 2017 Generics Plus Drug Guide IV

Key cap ................................................................. capsules

chew ............................................................. chewable

conc .......................................................... concentrate

cr...................................................... controlled release

dr ........................................................ delayed release

ec ........................................................... enteric coated

effe............................................................ effervescent

equiv ........................................................... equivalent

er....................................................... extended release

inhal.............................................................. inhalation

inj .................................................................... injection

liq ......................................................................... liquid

lotn ...................................................................... lotion

nebu .............................................................. nebulizer

odt. ....................................... orally disintegrating tabs

oint ................................................................ ointment

ophth .......................................................... ophthalmic

osm ..................................................... osmotic release

powd ................................................................ powder

sa ....................................................... sustained action

sl .................................................................. sublingual

soln .................................................................. solution

sr ...................................................... sustained release

suppos ................................................... suppositories

susp ........................................................... suspension

tab ...................................................................... tablets

td ............................................................... transdermal

Selected generic and brand name drugs are not covered because of safety or effectiveness concerns. This list issubject to change.

Blue Cross and Blue Shield of Alabama July 2017 Generics Plus Drug Guide 1

acetaminophen/salicylamide/phenyltoloxamineAla-QuinAlcortin AAmoxapineArmour ThyroidbenzphetamineButisolcarisoprodolcarisoprodol/aspirincarisoprodol/aspirin/codeinechlordiazepoxide/clidinium bromideCortane-B lotionCortane-B AqueousCortane-B-OticDemerol tabsDidrexdiethylpropionDiethylpropiondiethylpropion ext-releaseDonnatalEpifoamErgoloid mesylatesesterified estrogens/methyltestosteroneExodermExondys 51flavoxateHalcionhydrocortisone/iodoquinolhydrocortisone/pramoxine/chloroxylenolisoxsuprine 10 mgIsoxsuprine 20 mgketoconazole tabsLibraxMeperidine oral solnmeperidine tabsmeprobamateNature-ThroidNefazodone 100 mg, 150 mg, 200 mgnefazodone 50 mg, 250 mgNovacort

Opana ERopium tincture 1%Oticin HC NRParegoricpb/hyoscy/atrop/scopol tabpentazocine/naloxonephendimetrazinePhendimetrazine ext-releasePhospholine IodidePramosonePramosone EPramoticpramoxinepramoxine/hydrocortisone topicalRegimexSeconalSomathioridazinethyroid tabs, 15 mg, 30 mg, 60 mg, 90 mgThyrolarTriazolam tabs, 0.125 mgtriazolam tabs, 0.25 mgWesthroidWP Thyroidzileuton ext-releaseZyfloZyflo CR

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ANTI-INFECTIVE DRUGSPENICILLINSamoxicillin (trihydrate) cap

250 mg1

amoxicillin (trihydrate) cap500 mg

1

amoxicillin (trihydrate) for susp125 mg/5ml

1


1


1


1

amoxicillin (trihydrate) tab500 mg

1

amoxicillin (trihydrate) tab875 mg

1

amoxicillin & k clavulanate forsusp 200-28.5 mg/5ml

1

amoxicillin & k clavulanatefor susp 250-62.5 mg/5ml(Augmentin)

1

amoxicillin & k clavulanate forsusp 400-57 mg/5ml

1

amoxicillin & k clavulanatefor susp 600-42.9 mg/5ml(Augmentin es-600)

1

amoxicillin & k clavulanate tab sr12hr 1000-62.5 mg (Augmentinxr)

1

amoxicillin & k clavulanate tab250-125 mg

1

amoxicillin & k clavulanate tab500-125 mg (Augmentin)

1

amoxicillin & k clavulanate tab875-125 mg (Augmentin)

1

AMOXICILLIN/CLAVULANATE P– amoxicillin & k clavulanatechew tab 200-28.5 mg

2

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AMOXICILLIN/CLAVULANATE P– amoxicillin & k clavulanatechew tab 400-57 mg

2

ampicillin cap 250 mg 1

ampicillin cap 500 mg 1

dicloxacillin sodium cap 250 mg 1

dicloxacillin sodium cap 500 mg 1

penicillin v potassium for soln125 mg/5ml

1

penicillin v potassium for soln250 mg/5ml

1

penicillin v potassium tab250 mg

1

penicillin v potassium tab500 mg

1

CEPHALOSPORINScefaclor cap 250 mg 1

cefaclor cap 500 mg 1

cefadroxil cap 500 mg 1

cefadroxil for susp 250 mg/5ml 1

cefadroxil for susp 500 mg/5ml 1

cefadroxil tab 1 gm 1

cefdinir cap 300 mg 1

cefdinir for susp 125 mg/5ml 1

cefdinir for susp 250 mg/5ml 1

cefixime for susp 100 mg/5ml(Suprax)

1

cefixime for susp 200 mg/5ml(Suprax)

1

cefpodoxime proxetil for susp50 mg/5ml

1

cefpodoxime proxetil for susp100 mg/5ml

1

cefpodoxime proxetil tab 100 mg 1

cefpodoxime proxetil tab 200 mg 1

cefprozil for susp 125 mg/5ml 1

cefprozil for susp 250 mg/5ml 1

2017


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cefprozil tab 250 mg 1

cefprozil tab 500 mg 1

ceftriaxone sodium for inj250 mg

1

ceftriaxone sodium for inj500 mg (Rocephin)

1

ceftriaxone sodium for inj 1 gm(Rocephin)

1

ceftriaxone sodium for inj 2 gm 1

cefuroxime axetil tab 250 mg(Ceftin)

1

cefuroxime axetil tab 500 mg(Ceftin)

1

cephalexin cap 250 mg (Keflex) 1

cephalexin cap 500 mg (Keflex) 1

cephalexin for susp 125 mg/5ml 1

cephalexin for susp 250 mg/5ml 1

SUPRAX – cefixime cap 400 mg 2

SUPRAX – cefixime chew tab 100mg

2

SUPRAX – cefixime chew tab 200mg

2

SUPRAX – cefixime for susp 100mg/5ml

2


2


2

MACROLIDESazithromycin for susp

100 mg/5ml (Zithromax)1

azithromycin for susp200 mg/5ml (Zithromax)

1

azithromycin tab 250 mg(Zithromax)

1


1


1

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clarithromycin for susp125 mg/5ml

1

clarithromycin for susp250 mg/5ml (Biaxin)

1

clarithromycin tab sr 24hr500 mg (Biaxin xl pac)

1

clarithromycin tab 250 mg(Biaxin)

1

clarithromycin tab 500 mg(Biaxin)

1

erythromycin w/ delayed releaseparticles cap 250 mg

1

TETRACYCLINESdemeclocycline hcl tab 150 mg 1

demeclocycline hcl tab 300 mg 1

doxycycline hyclate cap 50 mg 1

doxycycline hyclate cap 100 mg(Vibramycin)

1

doxycycline hyclate tab 20 mg 1

doxycycline hyclate tab 100 mg 1

doxycycline monohydrate cap50 mg

1

doxycycline monohydrate cap75 mg (Monodox)

1

doxycycline monohydrate cap100 mg (Monodox)

1

doxycycline monohydrate cap150 mg (Adoxa)

1

doxycycline monohydrate tab50 mg (Adoxa)

1

doxycycline monohydrate tab75 mg (Adoxa)

1

doxycycline monohydrate tab100 mg (Adoxa pak 1/100)

1

doxycycline monohydrate tab150 mg (Adoxa pak 1/150)

1

minocycline hcl cap 50 mg(Minocin)

1

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1


1

MINOCYCLINE HCL ER –minocycline hcl tab sr 24hr 45mg

2 •

minocycline hcl tab 50 mg 1



tetracycline hcl cap 250 mg(Tetracycline hcl)

1

tetracycline hcl cap 500 mg(Tetracycline hcl)

1

FLUOROQUINOLONESciprofloxacin for oral susp

250 mg/5ml (5%) (5 gm/100ml)(Cipro)

1

ciprofloxacin for oralsusp 500 mg/5ml (10%)(10 gm/100ml) (Cipro)

1

CIPROFLOXACIN HCL –ciprofloxacin hcl tab 100 mg(base equiv)

2

ciprofloxacin hcl tab 250 mg(base equiv) (Cipro)

1

ciprofloxacin hcl tab 500 mg(base equiv) (Cipro)

1

ciprofloxacin hcl tab 750 mg(base equiv)

1

ciprofloxacin-ciprofloxacin hcltab sr 24hr 500 mg (base eq)(Cipro xr)

1

ciprofloxacin-ciprofloxacin hcltab sr 24hr 1000 mg(base eq)(Cipro xr)

1

LEVOFLOXACIN – levofloxacinoral soln 25 mg/ml

2

levofloxacin tab 250 mg(Levaquin)

1

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1


1

ofloxacin tab 400 mg 1

AMINOGLYCOSIDESneomycin sulfate tab 500 mg 1

paromomycin sulfate cap250 mg

1

tobramycin nebu soln300 mg/5ml (Tobi)

1 • •

TUBERCULOSISethambutol hcl tab 100 mg

(Myambutol)1

ethambutol hcl tab 400 mg(Myambutol)

1

isoniazid tab 100 mg 1

isoniazid tab 300 mg 1

PRIFTIN – rifapentine tab 150 mg 2

pyrazinamide tab 500 mg 1

rifabutin cap 150 mg (Mycobutin) 1

rifampin cap 150 mg (Rifadin) 1

rifampin cap 300 mg (Rifadin) 1

FUNGAL INFECTIONSfluconazole for susp 10 mg/ml

(Diflucan)1

fluconazole for susp 40 mg/ml(Diflucan)

1

fluconazole tab 50 mg (Diflucan) 1




flucytosine cap 250 mg(Ancobon)

1

flucytosine cap 500 mg(Ancobon)

1

griseofulvin microsize susp125 mg/5ml

1

2017


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griseofulvin microsize tab500 mg (Grifulvin v)

1

itraconazole cap 100 mg(Sporanox)

1

NOXAFIL – posaconazole susp40 mg/ml

2

nystatin tab 500000 unit 1

terbinafine hcl tab 250 mg(Lamisil)

1

voriconazole for susp 40 mg/ml(Vfend)

1

voriconazole tab 50 mg (Vfend) 1

voriconazole tab 200 mg (Vfend) 1

VIRAL INFECTIONSCytomegalovirusvalganciclovir hcl for soln

50 mg/ml (base equiv) (Valcyte)1

valganciclovir hcl tab 450 mg(base equivalent) (Valcyte)

1

Hepatitisadefovir dipivoxil tab 10 mg

(Hepsera)1

BARACLUDE – entecavir oralsoln 0.05 mg/ml

2

entecavir tab 0.5 mg (Baraclude) 1

entecavir tab 1 mg (Baraclude) 1

EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg

2 • •

HARVONI – ledipasvir-sofosbuvir tab 90-400 mg

2 • •

lamivudine tab 100 mg (hbv)(Epivir hbv)

1

PEGASYS – peginterferonalfa-2a inj 180 mcg/ml

2 • •

PEGASYS – peginterferonalfa-2a inj 180 mcg/0.5ml

2 • •

PEGASYS PROCLICK –peginterferon alfa-2a inj 135mcg/0.5ml

2 • •

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PEGASYS PROCLICK –peginterferon alfa-2a inj 180mcg/0.5ml

2 • •

ribavirin cap 200 mg (Rebetol) 1 •ribavirin tab 200 mg (Copegus) 1 •SOVALDI – sofosbuvir tab 400

mg2 • •

Herpesacyclovir cap 200 mg (Zovirax) 1

acyclovir susp 200 mg/5ml(Zovirax)

1

acyclovir tab 400 mg (Zovirax) 1

acyclovir tab 800 mg (Zovirax) 1

famciclovir tab 125 mg (Famvir) 1



valacyclovir hcl tab 500 mg(Valtrex)

1

valacyclovir hcl tab 1 gm(Valtrex)

1

HIV/AIDSabacavir sulfate tab 300 mg

(base equiv) (Ziagen)1 •

abacavir sulfate-lamivudine tab600-300 mg (Epzicom)

1 •

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg(Trizivir)

1 •

ATRIPLA – efavirenz-emtricitabine-tenofovir df tab600-200-300 mg

2 •

COMPLERA – emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg

2 •

DESCOVY – emtricitabine-tenofovir alafenamide fumaratetab 200-25 mg

2 •

didanosine delayed releasecapsule 125 mg (Videx ec)

1 •

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1 •


1 •

EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg(base equiv)

2 •

GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg

2 •

INTELENCE – etravirine tab 25mg

2 •


2 •


2 •

ISENTRESS – raltegravirpotassium packet for susp 100mg (base equiv)

2 •

ISENTRESS – raltegravirpotassium tab 400 mg (baseequiv)

2 •

ISENTRESS – raltegravirpotassium chew tab 25 mg(base equiv)

2 •

ISENTRESS – raltegravirpotassium chew tab 100 mg(base equiv)

2 •

KALETRA – lopinavir-ritonavirtab 100-25 mg

2 •

KALETRA – lopinavir-ritonavirtab 200-50 mg

2 •

lamivudine oral soln 10 mg/ml(Epivir)

1 •

lamivudine tab 150 mg (Epivir) 1 •lamivudine tab 300 mg (Epivir) 1 •lamivudine-zidovudine tab

150-300 mg (Combivir)1 •

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lopinavir-ritonavir soln400-100 mg/5ml (80-20 mg/ml)(Kaletra)

1 •

nevirapine tab sr 24hr 100 mg(Viramune xr)

1 •

nevirapine tab sr 24hr 400 mg(Viramune xr)

1 •

nevirapine tab 200 mg (Viramune) 1 •NORVIR – ritonavir tab 100 mg 2 •NORVIR – ritonavir oral soln 80

mg/ml2 •

ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg

2 •

PREZCOBIX – darunavir-cobicistat tab 800-150 mg

2 •

PREZISTA – darunavirethanolate susp 100 mg/ml(base equiv)

2 •

PREZISTA – darunavirethanolate tab 75 mg (baseequiv)

2 •


2 •


2 •


2 •

REYATAZ – atazanavir sulfatecap 150 mg (base equiv)

2 •


2 •


2 •

stavudine cap 15 mg (Zerit) 1 •stavudine cap 20 mg (Zerit) 1 •stavudine cap 30 mg (Zerit) 1 •

2017


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stavudine cap 40 mg (Zerit) 1 •STRIBILD – elvitegrav-cobic-

emtricitab-tenofovdf tab150-150-200-300 mg

2 •

SUSTIVA – efavirenz tab 600 mg 2 •SUSTIVA – efavirenz cap 50 mg 2 •SUSTIVA – efavirenz cap 200 mg 2 •TIVICAY – dolutegravir sodium

tab 10 mg (base equiv)2 •

TIVICAY – dolutegravir sodiumtab 25 mg (base equiv)

2 •

TIVICAY – dolutegravir sodiumtab 50 mg (base equiv)

2 •

TRIUMEQ – abacavir-dolutegravir-lamivudine tab600-50-300 mg

2 •

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 100-150 mg

2 •


2 •


2 •


2 •

VIRAMUNE – nevirapine susp 50mg/5ml

2 •

VIREAD – tenofovir disoproxilfumarate oral powder 40 mg/gm

2 •

VIREAD – tenofovir disoproxilfumarate tab 150 mg

2 •


2 •


2 •


2 •

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ZIAGEN – abacavir sulfate soln20 mg/ml (base equiv)

2 •

zidovudine cap 100 mg (Retrovir) 1 •zidovudine syrup 10 mg/ml

(Retrovir)1 •

zidovudine tab 300 mg 1 •Influenzaoseltamivir phosphate cap

30 mg (base equiv) (Tamiflu)1 •

oseltamivir phosphate cap45 mg (base equiv) (Tamiflu)

1 •

oseltamivir phosphate cap75 mg (base equiv) (Tamiflu)

1 •

TAMIFLU – oseltamivirphosphate for susp 6 mg/ml(base equiv)

2 •

MALARIAatovaquone-proguanil hcl tab

62.5-25 mg (Malarone)1

atovaquone-proguanil hcl tab250-100 mg (Malarone)

1

chloroquine phosphate tab500 mg (Aralen)

1

DARAPRIM – pyrimethamine tab25 mg

2

hydroxychloroquine sulfate tab200 mg (Plaquenil)

1

mefloquine hcl tab 250 mg 1

PRIMAQUINE PHOSPHATE –primaquine phosphate tab 26.3mg (15 mg base)

2

WORM INFECTIONSALBENZA – albendazole tab 200

mg2

BILTRICIDE – praziquantel tab600 mg

2

ivermectin tab 3 mg (Stromectol) 1

OTHER ANTI-INFECTIVES

2017


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clindamycin hcl cap 75 mg(Cleocin)

1


1


1

clindamycin palmitate hcl forsoln 75 mg/5ml (base equiv)(Cleocin pediatric gr)

1

dapsone tab 25 mg 1

dapsone tab 100 mg 1

IMPAVIDO – miltefosine cap 50mg

2

linezolid for susp 100 mg/5ml(Zyvox)

1

linezolid tab 600 mg (Zyvox) 1

metronidazole tab 250 mg(Flagyl)

1

metronidazole tab 500 mg(Flagyl)

1

sulfamethoxazole-trimethoprimsusp 200-40 mg/5ml

1

sulfamethoxazole-trimethoprimtab 400-80 mg (Bactrim)

1

sulfamethoxazole-trimethoprimtab 800-160 mg (Bactrim ds)

1

trimethoprim tab 100 mg 1

vancomycin hcl cap 125 mg(Vancocin hcl)

1

vancomycin hcl cap 250 mg(Vancocin hcl)

1

XIFAXAN – rifaximin tab 550 mg 2

CANCER DRUGSACTIMMUNE – interferon

gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)

2 •

AFINITOR – everolimus tab 2.5mg

2 • • •

AFINITOR – everolimus tab 5 mg 2 • • •

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AFINITOR – everolimus tab 7.5mg

2 • • •

AFINITOR – everolimus tab 10mg

2 • • •

AFINITOR DISPERZ – everolimustab for oral susp 2 mg

2 • • •


2 • • •


2 • • •

ALECENSA – alectinib hcl cap150 mg (base equivalent)

2 • • •

ALKERAN – melphalan tab 2 mg 2

anastrozole tab 1 mg (Arimidex) 1

bexarotene cap 75 mg (Targretin) 1 • •bicalutamide tab 50 mg

(Casodex)1

BOSULIF – bosutinib tab 100 mg 2 • • •BOSULIF – bosutinib tab 500 mg 2 • • •capecitabine tab 150 mg (Xeloda) 1 • •capecitabine tab 500 mg (Xeloda) 1 • •CAPRELSA – vandetanib tab 100

mg2 • • •

CAPRELSA – vandetanib tab 300mg

2 • • •

COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60 mgdose) kit

2 • • •

COMETRIQ – cabozantinib s-malcap 1 x 80 mg & 1 x 20 mg (100dose) kit

2 • • •

COMETRIQ – cabozantinib s-malcap 1 x 80 mg & 3 x 20 mg (140dose) kit

2 • • •

COTELLIC – cobimetinibfumarate tab 20 mg (baseequivalent)

2 • • •

CYCLOPHOSPHAMIDE –cyclophosphamide cap 25 mg

2

2017


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CYCLOPHOSPHAMIDE –cyclophosphamide cap 50 mg

2

EMCYT – estramustinephosphate sodium cap 140 mg

2

ERIVEDGE – vismodegib cap150 mg

2 • • •

ETOPOSIDE – etoposide cap 50mg

2

exemestane tab 25 mg(Aromasin)

1

FARESTON – toremifene citratetab 60 mg (base equivalent)

2

FARYDAK – panobinostat lactatecap 10 mg (base equivalent)

2 • • •


2 • • •


2 • • •

flutamide cap 125 mg 1

GILOTRIF – afatinib dimaleatetab 20 mg (base equivalent)

2 • • •


2 • • •


2 • • •

GLEOSTINE – lomustine cap 5mg

2


2


2


2

HEXALEN – altretamine cap 50mg

2 • •

HYCAMTIN – topotecan hcl cap0.25 mg (base equiv)

2 • •

HYCAMTIN – topotecan hcl cap 1mg (base equiv)

2 • •

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hydroxyurea cap 500 mg(Hydrea)

1

IBRANCE – palbociclib cap 75mg

2 • • •


2 • • •


2 • • •

ICLUSIG – ponatinib hcl tab 15mg (base equiv)

2 • • •

ICLUSIG – ponatinib hcl tab 45mg (base equiv)

2 • • •

imatinib mesylate tab 100 mg(base equivalent) (Gleevec)

1 • • •

imatinib mesylate tab 400 mg(base equivalent) (Gleevec)

1 • • •

IMBRUVICA – ibrutinib cap 140mg

2 • • •

INLYTA – axitinib tab 1 mg 2 • • •INLYTA – axitinib tab 5 mg 2 • • •IRESSA – gefitinib tab 250 mg 2 • • •JAKAFI – ruxolitinib phosphate

tab 5 mg (base equivalent)2 • • •

JAKAFI – ruxolitinib phosphatetab 10 mg (base equivalent)

2 • • •


2 • • •


2 • • •


2 • • •

KISQALI – ribociclib succinatetab 200 mg (base equiv)

2 • • •

LENVIMA 10 MG DAILY DOSE –lenvatinib cap therapy pack 10mg (10 mg daily dose)

2 • • •

LENVIMA 14 MG DAILY DOSE –lenvatinib cap therapy pack 10& 4 mg (14 mg daily dose)

2 • • •

2017


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LENVIMA 18 MG DAILY DOSE –lenvatinib cap therapy pack 10& 4 (2) mg (18 mg daily dose)

2 • • •

LENVIMA 20 MG DAILY DOSE –lenvatinib cap therapy pack 10(2) mg (20 mg daily dose)

2 • • •

LENVIMA 24 MG DAILY DOSE –lenvatinib cap therapy pack 10(2) & 4 mg (24 mg daily dose)

2 • • •

LENVIMA 8 MG DAILY DOSE –lenvatinib cap therapy pack 4(2) mg (8 mg daily dose)

2 • • •

letrozole tab 2.5 mg (Femara) 1

LEUCOVORIN CALCIUM –leucovorin calcium tab 10 mg

2

LEUCOVORIN CALCIUM –leucovorin calcium tab 15 mg

2

leucovorin calcium tab 5 mg 1

leucovorin calcium tab 25 mg 1

LEUKERAN – chlorambucil tab 2mg

2

LONSURF – trifluridine-tipiraciltab 15-6.14 mg

2 • • •

LONSURF – trifluridine-tipiraciltab 20-8.19 mg

2 • • •

LYNPARZA – olaparib cap 50 mg 2 • • •LYSODREN – mitotane tab 500

mg2 • •

MATULANE – procarbazine hclcap 50 mg

2 • •

megestrol acetate susp 40 mg/ml(Megace oral)

1

megestrol acetate tab 20 mg 1

megestrol acetate tab 40 mg 1

MEKINIST – trametinib dimethylsulfoxide tab 0.5 mg (baseequivalent)

2 • • •

MEKINIST – trametinib dimethylsulfoxide tab 2 mg (baseequivalent)

2 • • •

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mercaptopurine tab 50 mg(Purinethol)

1

methotrexate sodium tab 2.5 mg(base equiv)

1

MYLERAN – busulfan tab 2 mg 2

NEXAVAR – sorafenib tosylatetab 200 mg (base equivalent)

2 • • •

nilutamide tab 150 mg (Nilandron) 1

NINLARO – ixazomib citrate cap2.3 mg (base equivalent)

2 • • •

NINLARO – ixazomib citrate cap3 mg (base equivalent)

2 • • •

NINLARO – ixazomib citrate cap4 mg (base equivalent)

2 • • •

ODOMZO – sonidegib phosphatecap 200 mg (base equivalent)

2 • • •

POMALYST – pomalidomide cap1 mg

2 • • •


2 • • •


2 • • •


2 • • •

PURIXAN – mercaptopurine susp2000 mg/100ml (20 mg/ml)

2 •

SPRYCEL – dasatinib tab 20 mg 2 • • •SPRYCEL – dasatinib tab 50 mg 2 • • •SPRYCEL – dasatinib tab 70 mg 2 • • •SPRYCEL – dasatinib tab 80 mg 2 • • •SPRYCEL – dasatinib tab 100 mg 2 • • •SPRYCEL – dasatinib tab 140 mg 2 • • •STIVARGA – regorafenib tab 40

mg2 • • •

SUTENT – sunitinib malate cap12.5 mg (base equivalent)

2 • • •

SUTENT – sunitinib malate cap25 mg (base equivalent)

2 • • •

2017


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SUTENT – sunitinib malate cap37.5 mg (base equivalent)

2 • • •

SUTENT – sunitinib malate cap50 mg (base equivalent)

2 • • •

SYLATRON – peginterferonalfa-2b for inj kit 200 mcg

2 • •


2 • •


2 • •

TABLOID – thioguanine tab 40mg

2

TAFINLAR – dabrafenib mesylatecap 50 mg (base equivalent)

2 • • •

TAFINLAR – dabrafenib mesylatecap 75 mg (base equivalent)

2 • • •

TAGRISSO – osimertinibmesylate tab 40 mg (baseequivalent)

2 • • •

TAGRISSO – osimertinibmesylate tab 80 mg (baseequivalent)

2 • • •

tamoxifen citrate tab 10 mg(base equivalent)

1

tamoxifen citrate tab 20 mg(base equivalent)

1

TARCEVA – erlotinib hcl tab 25mg (base equivalent)

2 • • •


2 • • •


2 • • •

TASIGNA – nilotinib hcl cap 150mg (base equivalent)

2 • • •

TASIGNA – nilotinib hcl cap 200mg (base equivalent)

2 • • •

temozolomide cap 5 mg(Temodar)

1 • •


1 • •

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1 • •


1 • •


1 • •


1 • •

tretinoin cap 10 mg 1 • •TYKERB – lapatinib ditosylate

tab 250 mg (base equiv)2 • • •

VOTRIENT – pazopanib hcl tab200 mg (base equiv)

2 • • •

XALKORI – crizotinib cap 200 mg 2 • • •XALKORI – crizotinib cap 250 mg 2 • • •XTANDI – enzalutamide cap 40

mg2 • • •

ZELBORAF – vemurafenib tab240 mg

2 • • •

ZOLINZA – vorinostat cap 100mg

2 • • •

ZYDELIG – idelalisib tab 100 mg 2 • • •ZYDELIG – idelalisib tab 150 mg 2 • • •ZYKADIA – ceritinib cap 150 mg 2 • • •ZYTIGA – abiraterone acetate tab

250 mg2 • • •

ZYTIGA – abiraterone acetate tab500 mg

2 • • •

HORMONES, DIABETES AND RELATED DRUGSCORTICOSTEROIDSbudesonide delayed release

particles cap 3 mg (Entocort ec)1

CORTISONE ACETATE –cortisone acetate tab 25 mg

2

DEXAMETHASONE –dexamethasone soln 0.5mg/5ml

2

dexamethasone elixir 0.5 mg/5ml 1

dexamethasone tab 0.5 mg 1

2017


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dexamethasone tab 4 mg 1

dexamethasone tab 6 mg 1

fludrocortisone acetate tab0.1 mg

1

hydrocortisone tab 5 mg (Cortef) 1

hydrocortisone tab 10 mg(Cortef)

1

hydrocortisone tab 20 mg(Cortef)

1

methylprednisolone tab therapypack 4 mg (21) (Medroldosepak)

1

methylprednisolone tab 4 mg(Medrol)

1


1


1


1

prednisolone sod phosph oralsoln 6.7 mg/5ml (5 mg/5mlbase) (Pediapred)

1

prednisolone sod phosphateoral soln 15 mg/5ml (baseequiv)

1

prednisolone syrup 15 mg/5ml(usp solution equivalent)(Prelone)

1

PREDNISONE – prednisone oralsoln 5 mg/5ml

2

prednisone tab 1 mg 1

prednisone tab 2.5 mg 1




MALE HORMONES

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ANDROGEL – testosterone td gel20.25 mg/1.25gm (1.62%)

2 • •

ANDROGEL – testosterone td gel40.5 mg/2.5gm (1.62%)

2 • •

ANDROGEL PUMP –testosterone td gel 20.25 mg/act (1.62%)

2 • •

danazol cap 50 mg 1 •danazol cap 100 mg 1 •danazol cap 200 mg 1 •testosterone cypionate im

inj in oil 100 mg/ml (Depo-testosterone)

1

testosterone cypionate iminj in oil 200 mg/ml (Depo-testosterone)

1

testosterone enanthate im inj inoil 200 mg/ml

1

testosterone td gel 25 mg/2.5gm(1%) (Androgel)

1 • •

testosterone td gel 50 mg/5gm(1%) (Androgel)

1 • •

testosterone td gel 12.5 mg/act(1%) (Androgel pump)

1 • •

ESTROGENSCLIMARA PRO – estradiol-

levonorgestrel td patch weekly0.045-0.015 mg/day

2

DIVIGEL – estradiol td gel 0.25mg/0.25gm (0.1%)

2

DIVIGEL – estradiol td gel 0.5mg/0.5gm (0.1%)

2

DIVIGEL – estradiol td gel 1 mg/gm (0.1%)

2

estradiol & norethindroneacetate tab 0.5-0.1 mg(Activella)

1

estradiol & norethindroneacetate tab 1-0.5 mg (Activella)

1

estradiol tab 0.5 mg (Estrace) 1

2017


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estradiol tab 1 mg (Estrace) 1

estradiol tab 2 mg (Estrace) 1

estradiol td patch twice weekly0.025 mg/24hr (Vivelle-dot)

1


1


1


1


1

estradiol td patch weekly0.025 mg/24hr (Climara)

1

estradiol td patch weekly0.0375 mg/24hr (37.5 mcg/24hr)(Climara)

1


1


1


1


1

norethindrone acetate-ethinylestradiol tab 0.5 mg-2.5 mcg(Femhrt low dose)

1

norethindrone acetate-ethinylestradiol tab 1 mg-5 mcg

1

PREMARIN – estrogens,conjugated tab 0.3 mg

2


2


2


2


2

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PREMPHASE – conj est0.625(14)/conj est-medroxyproac tab 0.625-5mg(14)

2

PREMPRO – conjugatedestrogen-medroxyprogestacetate tab 0.3-1.5 mg

2


2


2

PREMPRO – conjugatedestrogen-medroxyprogestacetate tab 0.625-5 mg

2

PROGESTINSmedroxyprogesterone acetate

tab 2.5 mg (Provera)1

medroxyprogesterone acetatetab 5 mg (Provera)

1

medroxyprogesterone acetatetab 10 mg (Provera)

1

norethindrone acetate tab 5 mg(Aygestin)

1

progesterone micronized cap100 mg (Prometrium)

1

progesterone micronized cap200 mg (Prometrium)

1

BIRTH CONTROLdesogest-eth estrad & eth estrad

tab 0.15-0.02/0.01 mg(21/5)(Mircette)

1

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)

1

desogestrel & ethinyl estradioltab 0.15 mg-30 mcg (Desogen)

1

drospirenone-ethinyl estradioltab 3-0.02 mg (Yaz)

1

drospirenone-ethinyl estradioltab 3-0.03 mg (Yasmin 28)

1

2017


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ELLA – ulipristal acetate tab 30mg

2

ethynodiol diacetate & ethinylestradiol tab 1 mg-35 mcg

1

ethynodiol diacetate & ethinylestradiol tab 1 mg-50 mcg(Zovia 1/50e)

1

levonorg-eth est tab0.1-0.02mg(84) & eth est tab0.01mg(7) (Loseasonique)

1

levonorg-eth est tab0.15-0.03mg(84) & eth est tab0.01mg(7) (Seasonique)

1

levonorgestrel & ethinylestradiol (91-day) tab0.15-0.03 mg

1

levonorgestrel & ethinylestradiol tab 0.1 mg-20 mcg

1

levonorgestrel & ethinylestradiol tab 0.15 mg-30 mcg

1

levonorgestrel-eth estra tab0.05-30/0.075-40/0.125-30mg-mcg

1

medroxyprogesterone acetate imsusp prefilled syr 150 mg/ml(Depo-provera contrac)

1

medroxyprogesterone acetate imsusp 150 mg/ml (Depo-proveracontrac)

1

norethindrone & ethinyl estradioltab 0.4 mg-35 mcg (Ovcon-35)

1

norethindrone & ethinylestradiol tab 0.5 mg-35 mcg(Brevicon-28)

1

norethindrone & ethinyl estradioltab 1 mg-35 mcg (Norinyl 1+35)

1

norethindrone & ethinylestradiol-fe chew tab0.4 mg-35 mcg (Femcon fe)

1

norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg(Estrostep fe)

1

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norethindrone ace & ethinylestradiol tab 1 mg-20 mcg(Loestrin 1/20-21)

1

norethindrone ace & ethinylestradiol tab 1.5 mg-30 mcg(Loestrin 1.5/30-21)

1

norethindrone ace & ethinylestradiol-fe tab 1 mg-20 mcg(Loestrin fe 1/20)

1

norethindrone ace & ethinylestradiol-fe tab 1.5 mg-30 mcg(Loestrin fe 1.5/30)

1

norethindrone tab 0.35 mg (Nor-qd)

1

norethindrone-eth estradiol tab0.5-35/0.75-35/1-35 mg-mcg(Ortho-novum 7/7/7)

1

norethindrone-eth estradiol tab0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl 28)

1

norgestimate & ethinyl estradioltab 0.25 mg-35 mcg (Ortho-cyclen)

1

norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg (Ortho tri-cyclen lo)

1

norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg (Ortho tri-cyclen)

1

norgestrel & ethinyl estradiol tab0.3 mg-30 mcg

1

NUVARING – etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr

2

XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr

2

INFERTILITYchorionic gonadotropin for inj

10000 unit1 •

FOLLISTIM AQ – follitropin betainj 75 unit/0.5ml

2 •

2017


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2 •


2 •


2 •

LUPRON DEPOT-PED (1-MONTH– leuprolide acetate for injpediatric kit 7.5 mg

2 •


2 •

LUPRON DEPOT-PED (1-MONTH– leuprolide acetate for injpediatric kit 15 mg

2 •

LUPRON DEPOT-PED (3-MONTH– leuprolide acetate (3 month)for inj pediatric kit 11.25 mg

2 •

LUPRON DEPOT-PED (3-MONTH– leuprolide acetate (3 month)for inj pediatric kit 30 mg

2 •

SYNAREL – nafarelin acetatenasal soln 2 mg/ml (200 mcg/act) (base eq)

2

DIABETESacarbose tab 25 mg (Precose) 1

acarbose tab 50 mg (Precose) 1

acarbose tab 100 mg (Precose) 1

glimepiride tab 1 mg (Amaryl) 1



glipizide tab sr 24hr 2.5 mg(Glucotrol xl)

1

glipizide tab sr 24hr 5 mg(Glucotrol xl)

1

glipizide tab sr 24hr 10 mg(Glucotrol xl)

1

glipizide tab 5 mg (Glucotrol) 1

glipizide tab 10 mg (Glucotrol) 1

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glipizide-metformin hcl tab2.5-250 mg

1

glipizide-metformin hcl tab2.5-500 mg

1

glipizide-metformin hcl tab5-500 mg

1

GLUCAGON EMERGENCY KIT –glucagon (rdna) for inj kit 1 mg

2

glyburide micronized tab 1.5 mg(Glynase)

1

glyburide micronized tab 3 mg(Glynase)

1

glyburide micronized tab 6 mg(Glynase)

1

glyburide tab 1.25 mg 1

glyburide tab 2.5 mg 1

glyburide tab 5 mg 1

glyburide-metformin tab1.25-250 mg (Glucovance)

1

glyburide-metformin tab2.5-500 mg (Glucovance)

1

glyburide-metformin tab5-500 mg (Glucovance)

1

JARDIANCE – empagliflozin tab10 mg

2 •

JARDIANCE – empagliflozin tab25 mg

2 •

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr2.5-1000 mg

2 •

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr 5-500mg

2 •

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr5-1000 mg

2 •

metformin hcl tab sr 24hr 500 mg(Glucophage xr)

1

metformin hcl tab sr 24hr 750 mg(Glucophage xr)

1

2017


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its

metformin hcl tab 500 mg(Glucophage)

1


1


1

nateglinide tab 60 mg (Starlix) 1

nateglinide tab 120 mg (Starlix) 1

ONGLYZA – saxagliptin hcl tab2.5 mg (base equiv)

2 •

ONGLYZA – saxagliptin hcl tab 5mg (base equiv)

2 •

pioglitazone hcl tab 15 mg (baseequiv) (Actos)

1 •


1 •


1 •

pioglitazone hcl-metformin hcltab 15-500 mg (Actoplus met)

1 •

pioglitazone hcl-metformin hcltab 15-850 mg (Actoplus met)

1 •

repaglinide tab 0.5 mg (Prandin) 1

repaglinide tab 1 mg (Prandin) 1

repaglinide tab 2 mg (Prandin) 1

SYNJARDY – empagliflozin-metformin hcl tab 5-500 mg

2 •

SYNJARDY – empagliflozin-metformin hcl tab 5-1000 mg

2 •

SYNJARDY – empagliflozin-metformin hcl tab 12.5-500 mg

2 •

SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000mg

2 •

VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)

2 • •

DIABETES - INSULINSRapid-Acting Insulins

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NOVOLOG – insulin aspart inj100 unit/ml

2

NOVOLOG FLEXPEN – insulinaspart soln pen-injector 100unit/ml

2

NOVOLOG PENFILL – insulinaspart soln cartridge 100 unit/ml

2

Short-Acting InsulinsNOVOLIN R – insulin regular

(human) inj 100 unit/ml2

Intermediate-Acting InsulinsNOVOLIN N – insulin nph

(human) (isophane) inj 100unit/ml

2

NOVOLIN 70/30 – insulin nphisophane & regular human inj100 unit/ml (70-30)

2

NOVOLOG MIX 70/30 – insulinaspart prot & aspart (human)inj 100 unit/ml (70-30)

2

NOVOLOG MIX 70/30 PREFILL– insulin aspart prot & aspartsus pen-inj 100 unit/ml (70-30)

2

Basal InsulinsLANTUS – insulin glargine inj

100 unit/ml2

LANTUS SOLOSTAR – insulinglargine soln pen-injector 100unit/ml

2

LEVEMIR – insulin detemir inj100 unit/ml

2

LEVEMIR FLEXTOUCH – insulindetemir soln pen-injector 100unit/ml

2

THYROID REGULATIONlevothyroxine sodium tab

25 mcg (Synthroid)1

levothyroxine sodium tab50 mcg (Synthroid)

1

2017


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1


1


1


1


1


1


1


1


1


1

liothyronine sodium tab 5 mcg(Cytomel)

1


1


1

methimazole tab 5 mg (Tapazole) 1

methimazole tab 10 mg(Tapazole)

1

propylthiouracil tab 50 mg 1

GROWTH HORMONEINCRELEX – mecasermin inj 40

mg/4ml (10 mg/ml)2 •

OMNITROPE – somatropin for inj5.8 mg

2 • •

OMNITROPE – somatropin inj 5mg/1.5ml

2 • •

OMNITROPE – somatropin inj 10mg/1.5ml

2 • •

OTHER HORMONES AND RELATED DRUGS

Drug Name Tier

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its

alendronate sodium tab 5 mg 1 •alendronate sodium tab 10 mg 1 •alendronate sodium tab 35 mg 1 •alendronate sodium tab 70 mg

(Fosamax)1 •

cabergoline tab 0.5 mg 1

calcitonin (salmon) nasal soln200 unit/act (Miacalcin)

1

calcitriol cap 0.25 mcg (Rocaltrol) 1

calcitriol cap 0.5 mcg (Rocaltrol) 1

calcitriol oral soln 1 mcg/ml(Rocaltrol)

1

desmopressin acetate inj 4 mcg/ml (Ddavp)

1

desmopressin acetate nasal soln0.01% (refrigerated) (Ddavp)

1

desmopressin acetate nasalspray soln 0.01% (Ddavp)

1

desmopressin acetate nasalspray soln 0.01% (refrigerated)

1

desmopressin acetate tab 0.1 mg(Ddavp)

1

desmopressin acetate tab 0.2 mg(Ddavp)

1

ibandronate sodium tab 150 mg(base equivalent) (Boniva)

1 •

levocarnitine oral soln1 gm/10ml (10%) (Carnitor)

1

levocarnitine tab 330 mg(Carnitor)

1


2 •


2 •

LUPRON DEPOT-PED (1-MONTH– leuprolide acetate for injpediatric kit 15 mg

2 •

2017


Drug Name Tier

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its

METHERGINE –methylergonovine maleate tab0.2 mg

2

octreotide acetate inj 50 mcg/ml(0.05 mg/ml) (Sandostatin)

1 •


1 •


1 •


1 •

octreotide acetate inj 1000 mcg/ml (1 mg/ml) (Sandostatin)

1 •

ORFADIN – nitisinone susp 4mg/ml

2 •

ORFADIN – nitisinone cap 2 mg 2 •ORFADIN – nitisinone cap 5 mg 2 •ORFADIN – nitisinone cap 10 mg 2 •ORFADIN – nitisinone cap 20 mg 2 •paricalcitol cap 1 mcg (Zemplar) 1

paricalcitol cap 2 mcg (Zemplar) 1

paricalcitol cap 4 mcg (Zemplar) 1

raloxifene hcl tab 60 mg (Evista) 1

risedronate sodium tab 5 mg(Actonel)

1 •


1 •


1 •


1 •

SANDOSTATIN LAR DEPOT –octreotide acetate for im inj kit10 mg

2 •


2 •


2 •

Drug Name Tier

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SENSIPAR – cinacalcet hcl tab30 mg (base equiv)

2


2


2

STIMATE – desmopressinacetate nasal soln 1.5 mg/ml

2

STRENSIQ – asfotase alfasubcutaneous inj 18 mg/0.45ml

2 • •


2 • •

STRENSIQ – asfotase alfasubcutaneous inj 40 mg/ml

2 • •


2 • •

HEART AND CIRCULATORY DRUGSANGIOTENSIN CONVERTING ENZYME (ACE)INHIBITORS AND COMBINATIONSbenazepril &

hydrochlorothiazide tab5-6.25 mg

1

benazepril &hydrochlorothiazide tab10-12.5 mg (Lotensin hct)

1

benazepril &hydrochlorothiazide tab20-12.5 mg (Lotensin hct)

1

benazepril &hydrochlorothiazide tab20-25 mg (Lotensin hct)

1

benazepril hcl tab 5 mg 1

benazepril hcl tab 10 mg(Lotensin)

1


1


1

captopril tab 12.5 mg 1

captopril tab 25 mg 1

2017


Drug Name Tier

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its



CAPTOPRIL/HYDROCHLOROTHIA– captopril &hydrochlorothiazide tab 25-15mg

2

CAPTOPRIL/HYDROCHLOROTHIA– captopril &hydrochlorothiazide tab 50-15mg

2

enalapril maleate &hydrochlorothiazide tab5-12.5 mg

1

enalapril maleate &hydrochlorothiazide tab10-25 mg (Vaseretic)

1

enalapril maleate tab 2.5 mg(Vasotec)

1

enalapril maleate tab 5 mg(Vasotec)

1


1


1

fosinopril sodium &hydrochlorothiazide tab10-12.5 mg

1

fosinopril sodium &hydrochlorothiazide tab20-12.5 mg

1

fosinopril sodium tab 10 mg 1



lisinopril & hydrochlorothiazidetab 10-12.5 mg (Zestoretic)

1

lisinopril & hydrochlorothiazidetab 20-12.5 mg (Zestoretic)

1

lisinopril & hydrochlorothiazidetab 20-25 mg (Zestoretic)

1

Drug Name Tier

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lisinopril tab 2.5 mg (Zestril) 1

lisinopril tab 5 mg (Prinivil) 1



lisinopril tab 30 mg (Zestril) 1

lisinopril tab 40 mg (Zestril) 1

moexipril hcl tab 7.5 mg(Univasc)

1

moexipril hcl tab 15 mg (Univasc) 1

moexipril-hydrochlorothiazidetab 7.5-12.5 mg

1

moexipril-hydrochlorothiazidetab 15-12.5 mg (Uniretic)

1

moexipril-hydrochlorothiazidetab 15-25 mg

1

perindopril erbumine tab 2 mg 1

perindopril erbumine tab 4 mg(Aceon)

1

perindopril erbumine tab 8 mg(Aceon)

1

quinapril hcl tab 5 mg (Accupril) 1




quinapril-hydrochlorothiazidetab 10-12.5 mg (Accuretic)

1

quinapril-hydrochlorothiazidetab 20-12.5 mg (Accuretic)

1

quinapril-hydrochlorothiazidetab 20-25 mg (Accuretic)

1

ramipril cap 1.25 mg (Altace) 1

ramipril cap 2.5 mg (Altace) 1

ramipril cap 5 mg (Altace) 1

ramipril cap 10 mg (Altace) 1

trandolapril tab 1 mg (Mavik) 1



2017


Drug Name Tier

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its

ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS)AND COMBINATIONSamlodipine besylate-valsartan

tab 5-160 mg (Exforge)1

amlodipine besylate-valsartantab 5-320 mg (Exforge)

1


1


1

amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)

1

amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg (Exforge hct)

1

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct)

1


1


1

candesartan cilexetil tab 4 mg(Atacand)

1


1


1


1

candesartan cilexetil-hydrochlorothiazide tab16-12.5 mg (Atacand hct)

1

candesartan cilexetil-hydrochlorothiazide tab32-12.5 mg (Atacand hct)

1

Drug Name Tier

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its

candesartan cilexetil-hydrochlorothiazide tab32-25 mg (Atacand hct)

1

irbesartan tab 75 mg (Avapro) 1



irbesartan-hydrochlorothiazidetab 150-12.5 mg (Avalide)

1

irbesartan-hydrochlorothiazidetab 300-12.5 mg (Avalide)

1

losartan potassium &hydrochlorothiazide tab50-12.5 mg (Hyzaar)

1

losartan potassium &hydrochlorothiazide tab100-12.5 mg (Hyzaar)

1

losartan potassium &hydrochlorothiazide tab100-25 mg (Hyzaar)

1

losartan potassium tab 25 mg(Cozaar)

1


1


1

olmesartan medoxomil tab 5 mg(Benicar)

1

olmesartan medoxomil tab20 mg (Benicar)

1

olmesartan medoxomil tab40 mg (Benicar)

1

olmesartan medoxomil-hydrochlorothiazide tab20-12.5 mg (Benicar hct)

1

olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg (Benicar hct)

1

olmesartan medoxomil-hydrochlorothiazide tab40-25 mg (Benicar hct)

1

telmisartan tab 20 mg (Micardis) 1

2017


Drug Name Tier

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its



telmisartan-hydrochlorothiazidetab 40-12.5 mg (Micardis hct)

1

telmisartan-hydrochlorothiazidetab 80-12.5 mg (Micardis hct)

1

telmisartan-hydrochlorothiazidetab 80-25 mg (Micardis hct)

1

valsartan tab 40 mg (Diovan) 1




valsartan-hydrochlorothiazidetab 80-12.5 mg (Diovan hct)

1


1

valsartan-hydrochlorothiazidetab 160-25 mg (Diovan hct)

1


1

valsartan-hydrochlorothiazidetab 320-25 mg (Diovan hct)

1

BETA BLOCKERS AND COMBINATIONSacebutolol hcl cap 200 mg

(Sectral)1

acebutolol hcl cap 400 mg(Sectral)

1

atenolol & chlorthalidone tab50-25 mg (Tenoretic 50)

1

atenolol & chlorthalidone tab100-25 mg (Tenoretic 100)

1

atenolol tab 25 mg (Tenormin) 1



bisoprolol & hydrochlorothiazidetab 2.5-6.25 mg (Ziac)

1

bisoprolol & hydrochlorothiazidetab 5-6.25 mg (Ziac)

1

Drug Name Tier

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its

bisoprolol & hydrochlorothiazidetab 10-6.25 mg (Ziac)

1

bisoprolol fumarate tab 5 mg(Zebeta)

1

bisoprolol fumarate tab 10 mg(Zebeta)

1

carvedilol tab 3.125 mg (Coreg) 1



carvedilol tab 25 mg (Coreg) 1

labetalol hcl tab 100 mg(Trandate)

1


1


1

metoprolol &hydrochlorothiazide tab50-25 mg (Lopressor hct)

1

metoprolol &hydrochlorothiazide tab100-25 mg (Lopressor hct)

1

metoprolol succinate tab sr 24hr25 mg (tartrate equiv) (Toprol xl)

1

metoprolol succinate tab sr 24hr50 mg (tartrate equiv) (Toprol xl)

1

metoprolol succinate tab sr 24hr100 mg (tartrate equiv) (Toprolxl)

1

metoprolol succinate tab sr 24hr200 mg (tartrate equiv) (Toprolxl)

1

metoprolol tartrate tab 25 mg 1

metoprolol tartrate tab 50 mg(Lopressor)

1

metoprolol tartrate tab 100 mg(Lopressor)

1

nadolol tab 20 mg (Corgard) 1



2017


Drug Name Tier

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its

pindolol tab 5 mg 1

pindolol tab 10 mg 1

propranolol hcl cap sr 24hr60 mg (Inderal la)

1


1


1


1

propranolol hcl tab 10 mg 1





CALCIUM CHANNEL BLOCKERS ANDCOMBINATIONSamlodipine besylate tab 2.5 mg

(Norvasc)1

amlodipine besylate tab 5 mg(Norvasc)

1

amlodipine besylate tab 10 mg(Norvasc)

1

amlodipine besylate-benazeprilhcl cap 2.5-10 mg (Lotrel)

1

amlodipine besylate-benazeprilhcl cap 5-10 mg (Lotrel)

1


1


1


1


1

diltiazem hcl cap sr 24hr 120 mg 1



Drug Name Tier

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its

diltiazem hcl coated beads capsr 24hr 120 mg (Cardizem cd)

1


1


1


1


1

diltiazem hcl extended releasebeads cap sr 24hr 120 mg(Tiazac)

1


1


1


1


1


1

diltiazem hcl tab 30 mg(Cardizem)

1


1

diltiazem hcl tab 90 mg 1


1

felodipine tab sr 24hr 2.5 mg 1

felodipine tab sr 24hr 5 mg 1

felodipine tab sr 24hr 10 mg 1

nifedipine tab sr 24hr 30 mg(Adalat cc)

1

2017


Drug Name Tier

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its


1


1

nifedipine tab sr 24hr osmoticrelease 30 mg (Procardia xl)

1


1


1

verapamil hcl cap sr 24hr 120 mg(Verelan)

1


1


1


1

verapamil hcl tab cr 120 mg(Calan sr)

1


1


1

verapamil hcl tab 40 mg 1

verapamil hcl tab 80 mg (Calan) 1

verapamil hcl tab 120 mg (Calan) 1

CHEST PAINisosorbide dinitrate tab 5 mg

(Isordil titradose)1

isosorbide dinitrate tab 10 mg 1



isosorbide mononitrate tab sr24hr 30 mg (Imdur)

1


1


1

Drug Name Tier

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Lim

its

isosorbide mononitrate tab10 mg

1

isosorbide mononitrate tab20 mg

1

nitroglycerin sl tab 0.3 mg(Nitrostat)

1


1


1

nitroglycerin td patch 24hr0.1 mg/hr (Nitro-dur)

1


1


1


1

CHOLESTEROL LOWERINGatorvastatin calcium tab 10 mg

(base equivalent) (Lipitor)1

atorvastatin calcium tab 20 mg(base equivalent) (Lipitor)

1


1


1

cholestyramine light powderpackets 4 gm

1

cholestyramine light powder4 gm/dose (Questran light)

1

cholestyramine powder packets4 gm (Questran)

1

cholestyramine powder 4 gm/dose (Questran)

1

choline fenofibrate cap dr 45 mg(fenofibric acid equiv) (Trilipix)

1

choline fenofibrate cap dr135 mg (fenofibric acid equiv)(Trilipix)

1

2017


Drug Name Tier

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its

colestipol hcl granule packets5 gm (Colestid flavored)

1

colestipol hcl granules 5 gm(Colestid flavored)

1

colestipol hcl tab 1 gm (Colestid) 1

fenofibrate micronized cap67 mg (Lofibra)

1


1


1

fenofibrate tab 48 mg (Tricor) 1

fenofibrate tab 54 mg (Lofibra) 1

fenofibrate tab 145 mg (Tricor) 1

fenofibrate tab 160 mg (Lofibra) 1

gemfibrozil tab 600 mg (Lopid) 1

lovastatin tab 10 mg 1

lovastatin tab 20 mg (Mevacor) 1

lovastatin tab 40 mg (Mevacor) 1

niacin tab cr 500 mg(antihyperlipidemic) (Niaspan)

1


1


1

pravastatin sodium tab 10 mg 1

pravastatin sodium tab 20 mg(Pravachol)

1


1


1

rosuvastatin calcium tab 5 mg(Crestor)

1


1


1

Drug Name Tier

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1

simvastatin tab 5 mg (Zocor) 1





ZETIA – ezetimibe tab 10 mg 1

FLUID RETENTIONacetazolamide cap sr 12hr

500 mg (Diamox)1

acetazolamide tab 125 mg 1

acetazolamide tab 250 mg 1

amiloride & hydrochlorothiazidetab 5-50 mg

1

amiloride hcl tab 5 mg 1

bumetanide tab 0.5 mg 1

bumetanide tab 1 mg 1

bumetanide tab 2 mg 1

chlorothiazide tab 500 mg 1

chlorthalidone tab 25 mg 1

chlorthalidone tab 50 mg 1

furosemide oral soln 10 mg/ml 1

furosemide tab 20 mg (Lasix) 1



hydrochlorothiazide cap 12.5 mg(Microzide)

1

hydrochlorothiazide tab 12.5 mg 1

hydrochlorothiazide tab 25 mg 1

hydrochlorothiazide tab 50 mg 1

indapamide tab 1.25 mg 1

indapamide tab 2.5 mg 1

methazolamide tab 25 mg(Neptazane)

1

2017


Drug Name Tier

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its

methazolamide tab 50 mg(Neptazane)

1

metolazone tab 2.5 mg(Zaroxolyn)

1

metolazone tab 5 mg (Zaroxolyn) 1

metolazone tab 10 mg 1

spironolactone &hydrochlorothiazide tab25-25 mg (Aldactazide)

1

spironolactone tab 25 mg(Aldactone)

1


1


1

torsemide tab 5 mg (Demadex) 1




triamterene &hydrochlorothiazide cap37.5-25 mg (Dyazide)

1

triamterene &hydrochlorothiazide tab37.5-25 mg (Maxzide-25)

1

triamterene &hydrochlorothiazide tab75-50 mg (Maxzide)

1

HEART RHYTHMamiodarone hcl tab 100 mg 1

amiodarone hcl tab 200 mg(Cordarone)

1

amiodarone hcl tab 400 mg 1

disopyramide phosphate cap100 mg (Norpace)

1

disopyramide phosphate cap150 mg (Norpace)

1

flecainide acetate tab 50 mg 1


Drug Name Tier

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its


mexiletine hcl cap 150 mg 1



propafenone hcl cap sr 12hr225 mg (Rythmol sr)

1


1


1

propafenone hcl tab 150 mg(Rythmol)

1

propafenone hcl tab 225 mg(Rythmol)

1

propafenone hcl tab 300 mg 1

quinidine gluconate tab cr324 mg

1

sotalol hcl (afib/afl) tab 80 mg(Betapace af)

1


1


1

sotalol hcl tab 80 mg (Betapace) 1



sotalol hcl tab 240 mg 1

OTHER HEART RELATED DRUGSamlodipine besylate-atorvastatin

calcium tab 2.5-10 mg (Caduet)1

amlodipine besylate-atorvastatincalcium tab 2.5-20 mg (Caduet)

1

amlodipine besylate-atorvastatincalcium tab 2.5-40 mg (Caduet)

1

amlodipine besylate-atorvastatincalcium tab 5-10 mg (Caduet)

1


1

2017


Drug Name Tier

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its


1


1


1


1


1


1

clonidine hcl tab 0.1 mg(Catapres)

1


1


1

clonidine hcl td patch weekly0.1 mg/24hr (Catapres-tts-1)

1


1


1

digoxin tab 125 mcg (0.125 mg)(Lanoxin)

1

digoxin tab 250 mcg (0.25 mg)(Lanoxin)

1

doxazosin mesylate tab 1 mg(Cardura)

1


1


1


1

ENTRESTO – sacubitril-valsartantab 24-26 mg

2 • •


2 • •

Drug Name Tier

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its


2 • •

eplerenone tab 25 mg (Inspra) 1

eplerenone tab 50 mg (Inspra) 1

guanfacine hcl tab 1 mg (Tenex) 1

guanfacine hcl tab 2 mg (Tenex) 1

hydralazine hcl tab 10 mg 1




LETAIRIS – ambrisentan tab 5mg

2 • • •

LETAIRIS – ambrisentan tab 10mg

2 • • •

methyldopa tab 250 mg 1

methyldopa tab 500 mg 1

midodrine hcl tab 2.5 mg 1

midodrine hcl tab 5 mg 1

midodrine hcl tab 10 mg 1

minoxidil tab 2.5 mg 1

minoxidil tab 10 mg 1

OPSUMIT – macitentan tab 10mg

2 • • •

phenoxybenzamine hcl cap10 mg (Dibenzyline)

1

prazosin hcl cap 1 mg (Minipress) 1



sildenafil citrate tab 20 mg(Revatio)

1 • • •

terazosin hcl cap 1 mg 1




TRACLEER – bosentan tab 62.5mg

2 • • •

2017


Drug Name Tier

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its

TRACLEER – bosentan tab 125mg

2 • • •

UPTRAVI – selexipag tab therapypack 200 mcg (140) & 800 mcg(60)

2 • • •

UPTRAVI – selexipag tab 200mcg

2 • • •


2 • • •


2 • • •


2 • • •


2 • • •


2 • • •


2 • • •


2 • • •

ERECTILE DYSFUNCTIONCIALIS – tadalafil tab 2.5 mg 2 •CIALIS – tadalafil tab 5 mg 2 •CIALIS – tadalafil tab 10 mg 2 •CIALIS – tadalafil tab 20 mg 2 •BEE STING KITSEPINEPHRINE (Mylan products)

– epinephrine solution auto-injector 0.15 mg/0.3ml (1:2000)

1

EPINEPHRINE (Mylan products)– epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000)

1

RESPIRATORY AGENTSANTIHISTAMINEScetirizine hcl oral soln 1 mg/ml

(5 mg/5ml)1

CLEMASTINE FUMARATE –clemastine fumarate tab 2.68mg

2

Drug Name Tier

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its

cyproheptadine hcl syrup2 mg/5ml

1

cyproheptadine hcl tab 4 mg 1

DESLORATADINE ODT –desloratadine tab orallydisintegrating 2.5 mg

2

DESLORATADINE ODT –desloratadine tab orallydisintegrating 5 mg

2

desloratadine tab 5 mg (Clarinex) 1

levocetirizine dihydrochloridesoln 2.5 mg/5ml (0.5 mg/ml)(Xyzal)

1

levocetirizine dihydrochloridetab 5 mg (Xyzal)

1

promethazine hcl suppos12.5 mg

1

promethazine hcl suppos 25 mg 1

promethazine hcl suppos 50 mg 1

promethazine hcl syrup6.25 mg/5ml

1

promethazine hcl tab 12.5 mg 1

promethazine hcl tab 25 mg 1

promethazine hcl tab 50 mg 1

NASAL PRODUCTSazelastine hcl nasal spray 0.1%

(137 mcg/spray)1 •

azelastine hcl nasal spray 0.15%(205.5 mcg/spray) (Astepro)

1 •

flunisolide nasal soln 25 mcg/act(0.025%)

1 •

fluticasone propionate nasalsusp 50 mcg/act (Flonase)

1 •

ipratropium bromide nasal soln0.03% (21 mcg/spray) (Atrovent)

1 •

ipratropium bromide nasal soln0.06% (42 mcg/spray) (Atrovent)

1 •

mometasone furoate nasal susp50 mcg/act (Nasonex)

1 •

2017


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triamcinolone acetonide nasalaerosol suspension 55 mcg/act(Nasacort aq)

1 •

COUGH/COLD/ALLERGYacetylcysteine inhal soln 10% 1

acetylcysteine inhal soln 20% 1

ASTHMA/COPDADVAIR DISKUS – fluticasone-

salmeterol aer powder ba100-50 mcg/dose

2 •

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba250-50 mcg/dose

2 •

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba500-50 mcg/dose

2 •

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21mcg/act

2 •


2 •


2 •

albuterol sulfate soln nebu0.083% (2.5 mg/3ml)

1

albuterol sulfate soln nebu 0.5%(5 mg/ml)

1

albuterol sulfate soln nebu0.63 mg/3ml (base equiv)

1

albuterol sulfate soln nebu1.25 mg/3ml (base equiv)

1

albuterol sulfate syrup 2 mg/5ml 1

albuterol sulfate tab 2 mg 1

albuterol sulfate tab 4 mg 1

ANORO ELLIPTA –umeclidinium-vilanterol aeropowd ba 62.5-25 mcg/inh

2 •

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ASMANEX HFA – mometasonefuroate inhal aerosolsuspension 100 mcg/act

2 •

ASMANEX HFA – mometasonefuroate inhal aerosolsuspension 200 mcg/act

2 •

ASMANEX TWISTHALER 120 ME– mometasone furoate inhalpowd 220 mcg/inh (breathactivated)

2 •

ASMANEX TWISTHALER 14 MET– mometasone furoate inhalpowd 220 mcg/inh (breathactivated)

2 •


2 •


2 •


2 •

BREO ELLIPTA – fluticasonefuroate-vilanterol aero powdba 100-25 mcg/inh

2 •

BREO ELLIPTA – fluticasonefuroate-vilanterol aero powdba 200-25 mcg/inh

2 •

budesonide inhalation susp0.25 mg/2ml (Pulmicort)

1

budesonide inhalation susp0.5 mg/2ml (Pulmicort)

1

budesonide inhalation susp1 mg/2ml (Pulmicort)

1

CROMOLYN SODIUM – cromolynsodium soln nebu 20 mg/2ml

2

2017


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DULERA – mometasone furoate-formoterol fumarate aerosol100-5 mcg/act

2 •

DULERA – mometasone furoate-formoterol fumarate aerosol200-5 mcg/act

2 •

ipratropium bromide inhal soln0.02%

1

ipratropium-albuterol nebu soln0.5-2.5(3) mg/3ml (Duoneb)

1

levalbuterol hcl soln nebu conc1.25 mg/0.5ml (base equiv)

1

levalbuterol hcl soln nebu0.31 mg/3ml (base equiv)(Xopenex)

1


1


1

montelukast sodium chew tab4 mg (base equiv) (Singulair)

1 •

montelukast sodium chew tab5 mg (base equiv) (Singulair)

1 •

montelukast sodiumoral granules packet 4 mg(base equiv) (Singulair)

1 •

montelukast sodium tab 10 mg(base equiv) (Singulair)

1 •

PROAIR HFA – albuterol sulfateinhal aero 108 mcg/act (90mcgbase equiv)

2 •

PROAIR RESPICLICK – albuterolsulfate aer pow ba 108 mcg/act(90 mcg base equiv)

2 •

QVAR – beclomethasone dipropinhal aero soln 40 mcg/act (50/valve)

2 •

QVAR – beclomethasone dipropinhal aero soln 80 mcg/act(100/valve)

2 •

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SEREVENT DISKUS – salmeterolxinafoate aer pow ba 50 mcg/dose (base equiv)

2 •

SPIRIVA HANDIHALER– tiotropium bromidemonohydrate inhal cap 18 mcg(base equiv)

2 •

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhalaerosol 1.25 mcg/act

2 •

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhalaerosol 2.5 mcg/act

2 •

STIOLTO RESPIMAT – tiotropiumbr-olodaterol inhal aero soln2.5-2.5 mcg/act

2 •

STRIVERDI RESPIMAT –olodaterol hcl inhal aerosolsoln 2.5 mcg/act (base equiv)

2 •

terbutaline sulfate tab 2.5 mg 1

terbutaline sulfate tab 5 mg 1

theophylline tab sr 12hr 100 mg 1






zafirlukast tab 10 mg (Accolate) 1 •zafirlukast tab 20 mg (Accolate) 1 •OTHER RESPIRATORY DRUGSKALYDECO – ivacaftor tab 150

mg2 • • •

KALYDECO – ivacaftor packet 50mg

2 • • •

KALYDECO – ivacaftor packet 75mg

2 • • •

PULMOZYME – dornase alfainhal soln 1 mg/ml

2 •

GASTROINTESTINAL DRUGS

2017


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LAXATIVESlactulose solution 10 gm/15ml 1

peg 3350-kcl-sod bicarb-naclfor soln 420 gm (Nulytely/flavorpack)

1

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)

1

peg 3350-kcl-na bicarb-nacl-nasulfate for soln 240 gm (Colyte-flavor packs)

1

ANTIDIARRHEALSdiphenoxylate w/ atropine tab

2.5-0.025 mg (Lomotil)1

loperamide hcl cap 2 mg 1

ULCER/GERDcimetidine hcl soln 300 mg/5ml 1

cimetidine tab 300 mg 1



dicyclomine hcl cap 10 mg(Bentyl)

1

dicyclomine hcl oral soln10 mg/5ml

1

dicyclomine hcl tab 20 mg(Bentyl)

1

esomeprazole magnesium capdelayed release 20 mg (baseeq) (Nexium)

1 •

esomeprazole magnesium capdelayed release 40 mg (baseeq) (Nexium)

1 •

famotidine tab 20 mg (Pepcid) 1

famotidine tab 40 mg (Pepcid) 1

glycopyrrolate tab 1 mg (Robinul) 1

glycopyrrolate tab 2 mg (Robinulforte)

1

lansoprazole cap delayedrelease 15 mg (Prevacid)

1 •

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lansoprazole cap delayedrelease 30 mg (Prevacid)

1 •

methscopolamine bromide tab2.5 mg (Pamine)

1

methscopolamine bromide tab5 mg (Pamine forte)

1

misoprostol tab 100 mcg(Cytotec)

1

misoprostol tab 200 mcg(Cytotec)

1

NEXIUM – esomeprazolemagnesium for delayedrelease susp pack 2.5 mg

2 • •

NEXIUM – esomeprazolemagnesium for delayedrelease susp packet 5 mg

2 • •


2 • •


2 • •


2 • •

NIZATIDINE – nizatidine oral soln15 mg/ml

2

omeprazole cap delayed release10 mg (Prilosec)

1 •


1 •


1 •

pantoprazole sodium ec tab20 mg (base equiv) (Protonix)

1 •

pantoprazole sodium ec tab40 mg (base equiv) (Protonix)

1 •

ranitidine hcl cap 150 mg 1

ranitidine hcl cap 300 mg 1

ranitidine hcl syrup 15 mg/ml(75 mg/5ml)

1

2017


Drug Name Tier

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ranitidine hcl tab 150 mg (Zantac) 1

ranitidine hcl tab 300 mg (Zantac) 1

sucralfate tab 1 gm (Carafate) 1

NAUSEA AND VOMITINGaprepitant capsule therapy pack

80 & 125 mg (Emend)1 •

aprepitant capsule 80 mg(Emend)

1 •

EMEND – aprepitant for oralsusp 125 mg (125 mg/5ml)

2 •

EMEND – aprepitant capsule 40mg

2

EMEND – aprepitant capsule 125mg

2 •

granisetron hcl tab 1 mg 1 •meclizine hcl tab 12.5 mg 1

meclizine hcl tab 25 mg 1

ondansetron hcl inj 4 mg/2ml(2 mg/ml)

1

ondansetron hcl inj 40 mg/20ml(2 mg/ml) (Zofran)

1

ondansetron hcl oral soln4 mg/5ml (Zofran)

1 •

ondansetron hcl tab 4 mg(Zofran)

1 •

ondansetron hcl tab 8 mg(Zofran)

1 •

ondansetron hcl tab 24 mg 1 •ondansetron orally

disintegrating tab 4 mg (Zofranodt)

1 •

ondansetron orallydisintegrating tab 8 mg (Zofranodt)

1 •

trimethobenzamide hcl cap300 mg (Tigan)

1

DIGESTIVE ENZYMES

Drug Name Tier

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CREON – pancrelipase (lip-prot-amyl) dr cap 3000-9500-15000unit

2

CREON – pancrelipase (lip-prot-amyl) dr cap 6000-19000-30000unit

2

CREON – pancrelipase(lip-prot-amyl) dr cap12000-38000-60000 unit

2


2


2

ZENPEP – pancrelipase (lip-prot-amyl) dr cap 3000-10000-16000unit

2

ZENPEP – pancrelipase (lip-prot-amyl) dr cap 5000-17000-27000unit

2

ZENPEP – pancrelipase(lip-prot-amyl) dr cap10000-34000-55000 unit

2


2


2


2


2

OTHER GASTROINTESTINAL DRUGSASACOL HD – mesalamine tab

delayed release 800 mg2

balsalazide disodium cap750 mg (Colazal)

1

2017


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calcium acetate (phosphatebinder) cap 667 mg (169 mgca) (Phoslo)

1

calcium acetate (phosphatebinder) tab 667 mg (Eliphos)

1

CANASA – mesalamine suppos1000 mg

2

CHENODAL – chenodiol tab 250mg

2 •

DELZICOL – mesalamine cap dr400 mg

2

lactulose (encephalopathy)solution 10 gm/15ml

1

mesalamine enema 4 gm 1

metoclopramide hcl soln5 mg/5ml (10 mg/10ml)

1

metoclopramide hcl tab 5 mg(Reglan)

1

metoclopramide hcl tab 10 mg(Reglan)

1

sulfasalazine tab delayed release500 mg (Azulfidine en-tabs)

1

sulfasalazine tab 500 mg(Azulfidine)

1

ursodiol cap 300 mg (Actigall) 1

ursodiol tab 250 mg (Urso 250) 1

ursodiol tab 500 mg (Urso forte) 1

GENITOURINARY DRUGSURINARY TRACT INFECTIONSnitrofurantoin macrocrystalline

cap 25 mg (Macrodantin)1

nitrofurantoin macrocrystallinecap 50 mg (Macrodantin)

1

nitrofurantoin macrocrystallinecap 100 mg (Macrodantin)

1

nitrofurantoin monohydratemacrocrystalline cap 100 mg(Macrobid)

1

nitrofurantoin susp 25 mg/5ml(Furadantin)

1

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URINARY TRACT SPASMSoxybutynin chloride syrup

5 mg/5ml1

oxybutynin chloride tab sr 24hr5 mg (Ditropan xl)

1


1


1

oxybutynin chloride tab 5 mg 1

tolterodine tartrate cap sr 24hr2 mg (Detrol la)

1

tolterodine tartrate cap sr 24hr4 mg (Detrol la)

1

tolterodine tartrate tab 1 mg(Detrol)

1

tolterodine tartrate tab 2 mg(Detrol)

1

VESICARE – solifenacinsuccinate tab 5 mg

2

VESICARE – solifenacinsuccinate tab 10 mg

2

VAGINAL PRODUCTSclindamycin phosphate vaginal

cream 2% (Cleocin)1

ESTRACE – estradiol vaginalcream 0.1 mg/gm

2

metronidazole vaginal gel 0.75%(Metrogel-vaginal)

1

terconazole vaginal cream 0.4%(Terazol 7)

1

terconazole vaginal cream 0.8%(Terazol 3)

1

terconazole vaginal suppos80 mg

1

VAGIFEM – estradiol vaginal tab10 mcg

1

OTHER GENITOURINARY DRUGSalfuzosin hcl tab sr 24hr 10 mg

(Uroxatral)1

2017


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CYSTAGON – cysteaminebitartrate cap 50 mg

2 •

CYSTAGON – cysteaminebitartrate cap 150 mg

2 •

dutasteride cap 0.5 mg (Avodart) 1

finasteride tab 5 mg (Proscar) 1

potassium citrate tab cr 5 meq(540 mg) (Urocit-k 5)

1


1


1

tamsulosin hcl cap 0.4 mg(Flomax)

1

CENTRAL NERVOUS SYSTEM DRUGSANXIETYalprazolam tab sr 24hr 0.5 mg

(Xanax xr)1

alprazolam tab sr 24hr 1 mg(Xanax xr)

1


1


1

alprazolam tab 0.25 mg (Xanax) 1

alprazolam tab 0.5 mg (Xanax) 1

alprazolam tab 1 mg (Xanax) 1

alprazolam tab 2 mg (Xanax) 1

buspirone hcl tab 5 mg 1




diazepam tab 2 mg (Valium) 1



hydroxyzine hcl syrup 10 mg/5ml 1

hydroxyzine hcl tab 10 mg 1

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hydroxyzine pamoate cap 25 mg(Vistaril)

1

hydroxyzine pamoate cap 50 mg(Vistaril)

1

lorazepam conc 2 mg/ml(Lorazepam intensol)

1

lorazepam tab 0.5 mg (Ativan) 1

lorazepam tab 1 mg (Ativan) 1

lorazepam tab 2 mg (Ativan) 1

DEPRESSIONamitriptyline hcl tab 10 mg 1

amitriptyline hcl tab 25 mg 1





bupropion hcl tab sr 12hr100 mg (Wellbutrin sr)

1 •


1 •


1 •

bupropion hcl tab sr 24hr150 mg (Wellbutrin xl)

1 •

bupropion hcl tab sr 24hr300 mg (Wellbutrin xl)

1 •

bupropion hcl tab 75 mg(Wellbutrin)

1 •

bupropion hcl tab 100 mg(Wellbutrin)

1 •

citalopram hydrobromide oralsoln 10 mg/5ml

1 •

citalopram hydrobromide tab10 mg (base equiv) (Celexa)

1 •


1 •

2017


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1 •

clomipramine hcl cap 25 mg(Anafranil)

1


1


1

desipramine hcl tab 10 mg(Norpramin)

1


1


1


1


1


1

DOXEPIN HCL – doxepin hcl cap75 mg

2

doxepin hcl cap 10 mg 1




doxepin hcl conc 10 mg/ml 1

duloxetine hcl enteric coatedpellets cap 20 mg (Cymbalta)

1 •


1 •


1 •

escitalopram oxalate soln5 mg/5ml (base equiv)(Lexapro)

1 •

escitalopram oxalate tab 5 mg(base equiv) (Lexapro)

1 •


1 •

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1 •

FLUOXETINE DR – fluoxetine hclcap delayed release 90 mg

2 •

fluoxetine hcl cap 10 mg (Prozac) 1 •fluoxetine hcl cap 20 mg (Prozac) 1 •fluoxetine hcl cap 40 mg (Prozac) 1 •fluoxetine hcl solution

20 mg/5ml1 •

fluoxetine hcl tab 10 mg 1 •fluoxetine hcl tab 20 mg 1 •fluvoxamine maleate tab 25 mg 1 •fluvoxamine maleate tab 50 mg 1 •fluvoxamine maleate tab 100 mg 1 •imipramine hcl tab 10 mg

(Tofranil)1

imipramine hcl tab 25 mg(Tofranil)

1

imipramine hcl tab 50 mg(Tofranil)

1

mirtazapine tab 7.5 mg 1 •mirtazapine tab 15 mg (Remeron) 1 •mirtazapine tab 30 mg (Remeron) 1 •mirtazapine tab 45 mg (Remeron) 1 •nortriptyline hcl cap 10 mg

(Pamelor)1

nortriptyline hcl cap 25 mg(Pamelor)

1


1


1

paroxetine hcl tab sr 24hr12.5 mg (Paxil cr)

1 •

paroxetine hcl tab sr 24hr 25 mg(Paxil cr)

1 •

paroxetine hcl tab sr 24hr37.5 mg (Paxil cr)

1 •

2017


Drug Name Tier

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paroxetine hcl tab 10 mg (Paxil) 1 •paroxetine hcl tab 20 mg (Paxil) 1 •paroxetine hcl tab 30 mg (Paxil) 1 •paroxetine hcl tab 40 mg (Paxil) 1 •phenelzine sulfate tab 15 mg

(Nardil)1

sertraline hcl oral conc 20 mg/ml(Zoloft)

1 •

sertraline hcl tab 25 mg (Zoloft) 1 •sertraline hcl tab 50 mg (Zoloft) 1 •sertraline hcl tab 100 mg (Zoloft) 1 •tranylcypromine sulfate tab

10 mg (Parnate)1

trazodone hcl tab 50 mg 1




venlafaxine hcl cap sr 24hr37.5 mg (base equivalent)(Effexor xr)

1 •

venlafaxine hcl cap sr 24hr75 mg (base equivalent)(Effexor xr)

1 •

venlafaxine hcl cap sr 24hr150 mg (base equivalent)(Effexor xr)

1 •

venlafaxine hcl tab sr 24hr37.5 mg (base equivalent)(Venlafaxine hcl er)

1 •

venlafaxine hcl tab sr 24hr 75 mg(base equivalent) (Venlafaxinehcl er)

1 •

venlafaxine hcl tab sr 24hr150 mg (base equivalent)(Venlafaxine hcl er)

1 •

venlafaxine hcl tab 25 mg 1 •venlafaxine hcl tab 37.5 mg 1 •venlafaxine hcl tab 50 mg 1 •venlafaxine hcl tab 75 mg 1 •

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venlafaxine hcl tab 100 mg 1 •PSYCHOTIC AND BIPOLAR DISORDERSaripiprazole tab 2 mg (Abilify) 1 •aripiprazole tab 5 mg (Abilify) 1 •aripiprazole tab 10 mg (Abilify) 1 •aripiprazole tab 15 mg (Abilify) 1 •aripiprazole tab 20 mg (Abilify) 1 •aripiprazole tab 30 mg (Abilify) 1 •chlorpromazine hcl tab 10 mg 1

chlorpromazine hcl tab 25 mg 1




clozapine tab 25 mg (Clozaril) 1 •clozapine tab 50 mg 1 •clozapine tab 100 mg (Clozaril) 1 •clozapine tab 200 mg 1 •fluphenazine decanoate inj

25 mg/ml1

fluphenazine hcl tab 1 mg 1

fluphenazine hcl tab 2.5 mg 1



haloperidol decanoate im soln50 mg/ml (Haldol decanoate 50)

1

haloperidol decanoate im soln100 mg/ml (Haldol decanoate100)

1

haloperidol lactate oral conc2 mg/ml

1

haloperidol tab 0.5 mg 1

haloperidol tab 1 mg 1





2017


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lithium carbonate cap 150 mg(Lithium carbonate)

1

lithium carbonate cap 300 mg 1

lithium carbonate cap 600 mg(Lithium carbonate)

1

lithium carbonate tab cr 300 mg(Lithobid)

1

lithium carbonate tab cr 450 mg 1

lithium carbonate tab 300 mg 1

loxapine succinate cap 5 mg(Loxitane)

1

loxapine succinate cap 10 mg 1



olanzapine orally disintegratingtab 5 mg (Zyprexa zydis)

1 •


1 •


1 •


1 •

olanzapine tab 2.5 mg (Zyprexa) 1 •olanzapine tab 5 mg (Zyprexa) 1 •olanzapine tab 7.5 mg (Zyprexa) 1 •olanzapine tab 10 mg (Zyprexa) 1 •olanzapine tab 15 mg (Zyprexa) 1 •olanzapine tab 20 mg (Zyprexa) 1 •perphenazine tab 2 mg 1

perphenazine tab 4 mg 1



prochlorperazine maleatetab 5 mg (base equivalent)(Compazine)

1

prochlorperazine maleate tab10 mg (base equivalent)(Compazine)

1

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prochlorperazine suppos 25 mg 1

quetiapine fumarate tab sr 24hr50 mg (Seroquel xr)

1 •


1 •


1 •


1 •


1 •

quetiapine fumarate tab 25 mg(Seroquel)

1 •


1 •


1 •


1 •


1 •


1 •

risperidone orally disintegratingtab 0.25 mg

1 •

risperidone orally disintegratingtab 0.5 mg (Risperdal m-tab)

1 •

risperidone orally disintegratingtab 1 mg (Risperdal m-tab)

1 •


1 •


1 •


1 •

risperidone soln 1 mg/ml(Risperdal)

1 •

risperidone tab 0.25 mg(Risperdal)

1 •

2017


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risperidone tab 0.5 mg(Risperdal)

1 •

risperidone tab 1 mg (Risperdal) 1 •risperidone tab 2 mg (Risperdal) 1 •risperidone tab 3 mg (Risperdal) 1 •risperidone tab 4 mg (Risperdal) 1 •thiothixene cap 1 mg 1

thiothixene cap 2 mg 1



trifluoperazine hcl tab 1 mg 1




ziprasidone hcl cap 20 mg(Geodon)

1 •


1 •


1 •


1 •

SLEEP AIDSestazolam tab 1 mg 1

estazolam tab 2 mg 1

eszopiclone tab 1 mg (Lunesta) 1 •eszopiclone tab 2 mg (Lunesta) 1 •eszopiclone tab 3 mg (Lunesta) 1 •FLURAZEPAM HCL – flurazepam

hcl cap 15 mg2

FLURAZEPAM HCL – flurazepamhcl cap 30 mg

2

PHENOBARBITAL –phenobarbital tab 15 mg

2


2

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2


2

phenobarbital elixir 20 mg/5ml 1

phenobarbital tab 16.2 mg 1

phenobarbital tab 32.4 mg 1

temazepam cap 7.5 mg (Restoril) 1

temazepam cap 15 mg (Restoril) 1

temazepam cap 22.5 mg(Restoril)

1

temazepam cap 30 mg (Restoril) 1

zaleplon cap 5 mg (Sonata) 1 •zaleplon cap 10 mg (Sonata) 1 •zolpidem tartrate tab cr 6.25 mg

(Ambien cr)1 •

zolpidem tartrate tab cr 12.5 mg(Ambien cr)

1 •

zolpidem tartrate tab 5 mg(Ambien)

1 •

zolpidem tartrate tab 10 mg(Ambien)

1 •

HYPERACTIVITY/NARCOLEPSYADDERALL XR – amphetamine-

dextroamphetamine cap sr24hr 5 mg

1 •

ADDERALL XR – amphetamine-dextroamphetamine cap sr24hr 10 mg

1 •


1 •


1 •


1 •

2017


Drug Name Tier

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its


1 •

amphetamine-dextroamphetamine tab 5 mg(Adderall)

1 •

amphetamine-dextroamphetamine tab 7.5 mg(Adderall)

1 •


1 •

amphetamine-dextroamphetamine tab12.5 mg (Adderall)

1 •


1 •


1 •


1 •

caffeine citrate oral soln60 mg/3ml (10 mg/ml baseequiv) (Cafcit)

1

CONCERTA – methylphenidatehcl tab sa osm 18 mg

1 •


1 •


1 •


1 •

dexmethylphenidate hcl cap sr24 hr 5 mg (Focalin xr)

1 •


1 •


1 •

Drug Name Tier

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its


1 •


1 •


1 •

dextroamphetamine sulfate capsr 24hr 5 mg (Dexedrine)

1 •


1 •


1 •

dextroamphetamine sulfate tab5 mg

1 •

dextroamphetamine sulfate tab10 mg

1 •

guanfacine hcl tab sr 24hr 1 mg(base equiv) (Intuniv)

1 •


1 •


1 •


1 •

METHYLPHENIDATE HCL –methylphenidate hcl chew tab2.5 mg

2 •

METHYLPHENIDATE HCL –methylphenidate hcl chew tab5 mg

2 •

METHYLPHENIDATE HCL –methylphenidate hcl chew tab10 mg

2 •

methylphenidate hcl tab cr10 mg

1 •

methylphenidate hcl tab cr20 mg (Ritalin sr)

1 •

methylphenidate hcl tab 5 mg(Ritalin)

1 •


1 •

2017


Drug Name Tier

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its


1 •

modafinil tab 100 mg (Provigil) 1 • •modafinil tab 200 mg (Provigil) 1 • •VYVANSE – lisdexamfetamine

dimesylate cap 10 mg2 •

VYVANSE – lisdexamfetaminedimesylate cap 20 mg

2 •


2 •


2 •


2 •


2 •


2 •

VYVANSE – lisdexamfetaminedimesylate chew tab 10 mg

2 •


2 •


2 •


2 •


2 •


2 •

MULTIPLE SCLEROSISAUBAGIO – teriflunomide tab 7

mg2 • •

AUBAGIO – teriflunomide tab 14mg

2 • •

AVONEX – interferon beta-1aim prefilled syringe kit 30mcg/0.5ml

2 • •

Drug Name Tier

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its

AVONEX – interferon beta-1a forim inj kit 30mcg (33mcg(6.6mu)/vial)

2 • •

AVONEX PEN – interferonbeta-1a im auto-injector kit 30mcg/0.5ml

2 • •

BETASERON – interferon beta-1bfor inj kit 0.3 mg

2 • •

COPAXONE – glatiramer acetatesoln prefilled syringe 20 mg/ml

2 • •

COPAXONE – glatiramer acetatesoln prefilled syringe 40 mg/ml

2 • •

GILENYA – fingolimod hcl cap0.5 mg (base equiv)

2 • •

glatiramer acetate soln prefilledsyringe 20 mg/ml (Copaxone)

1 • •

PLEGRIDY – peginterferonbeta-1a soln pen-injector 125mcg/0.5ml

2 • •

PLEGRIDY – peginterferonbeta-1a soln prefilled syringe125 mcg/0.5ml

2 • •

PLEGRIDY STARTER PACK –peginterferon beta-1a solnpen-inj 63 & 94 mcg/0.5ml pack

2 • •

PLEGRIDY STARTER PACK –peginterferon beta-1a soln prefsyr 63 & 94 mcg/0.5ml pack

2 • •

REBIF – interferon beta-1a solnpref syr 22 mcg/0.5ml (12mu/ml)

2 • •

REBIF – interferon beta-1a solnpref syr 44 mcg/0.5ml (24mu/ml)

2 • •

REBIF REBIDOSE – interferonbeta-1a soln auto-inj 22mcg/0.5ml (12mu/ml)

2 • •

REBIF REBIDOSE – interferonbeta-1a soln auto-inj 44mcg/0.5ml (24mu/ml)

2 • •

REBIF REBIDOSE TITRATION– interferon beta-1a auto-

2 • •

2017


Drug Name Tier

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Lim

its

inj 6x8.8 mcg/0.2ml & 6x22mcg/0.5ml

REBIF TITRATION PACK –interferon beta-1a pref syr6x8.8 mcg/0.2ml & 6x22mcg/0.5ml

2 • •

TECFIDERA – dimethyl fumaratecapsule delayed release 120mg

2 • •

TECFIDERA – dimethyl fumaratecapsule delayed release 240mg

2 • •

TECFIDERA STARTER PACK –dimethyl fumarate capsule drstarter pack 120 mg & 240 mg

2 • •

OTHER CENTRAL NERVOUS SYSTEM DRUGSacamprosate calcium tab

delayed release 333 mg(Campral)

1

bupropion hcl (smokingdeterrent) tab sr 12hr 150 mg(Zyban)

1 •

CHANTIX – varenicline tartratetab 0.5 mg (base equiv)

2

CHANTIX – varenicline tartratetab 1 mg (base equiv)

2

CHANTIX CONTINUING MONTH– varenicline tartrate tab 1 mg(base equiv)

2

CHANTIX STARTING MONTH PA– varenicline tartrate tab 0.5mg x 11 & tab 1 mg x 42 pack

2

CHLORDIAZEPOXIDE/AMITRIPT – chlordiazepoxide-amitriptyline tab 5-12.5 mg

2

disulfiram tab 250 mg (Antabuse) 1

disulfiram tab 500 mg (Antabuse) 1

donepezil hydrochloride orallydisintegrating tab 5 mg (Ariceptodt)

1

Drug Name Tier

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its

donepezil hydrochloride orallydisintegrating tab 10 mg(Aricept odt)

1

donepezil hydrochloride tab5 mg (Aricept)

1

donepezil hydrochloride tab10 mg (Aricept)

1

GALANTAMINE HYDROBROMIDE– galantamine hydrobromideoral soln 4 mg/ml

2

galantamine hydrobromide capsr 24hr 8 mg (Razadyne er)

1


1


1

galantamine hydrobromide tab4 mg (Razadyne)

1


1


1

memantine hcl oral solution2 mg/ml (Namenda)

1

memantine hcl tab 5 mg(Namenda)

1

memantine hcl tab 10 mg(Namenda)

1

memantine hcl tab 5 mg (28)& 10 mg (21) titration pak(Namenda titration pa)

1

NICOTROL INHALER – nicotineinhaler system 10 mg (4 mgdelivered)

2

NICOTROL NS – nicotine nasalspray 10 mg/ml (0.5 mg/spray)

2

pimozide tab 1 mg (Orap) 1

pimozide tab 2 mg (Orap) 1

rivastigmine tartrate cap 1.5 mg(Exelon)

1

2017


Drug Name Tier

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its

rivastigmine tartrate cap 3 mg(Exelon)

1

rivastigmine tartrate cap 4.5 mg(Exelon)

1

rivastigmine tartrate cap 6 mg(Exelon)

1

tetrabenazine tab 12.5 mg(Xenazine)

1 •

tetrabenazine tab 25 mg(Xenazine)

1 •

PAIN RELIEF DRUGSNON-NARCOTIC DRUGSbutalbital-acetaminophen tab

50-325 mg1 •

butalbital-acetaminophen-caffeine cap 50-325-40 mg

1 •

butalbital-acetaminophen-caffeine tab 50-325-40 mg

1 •

butalbital-aspirin-caffeine cap50-325-40 mg (Fiorinal)

1 •

TENCON – butalbital-acetaminophen tab 50-325 mg

2 •

NARCOTIC DRUGSacetaminophen w/ codeine soln

120-12 mg/5ml1 •

acetaminophen w/ codeine tab300-15 mg (Tylenol/codeine)

1 •

acetaminophen w/ codeine tab300-30 mg (Tylenol/codeine #3)

1 •

acetaminophen w/ codeine tab300-60 mg (Tylenol/codeine #4)

1 •

buprenorphine hcl sl tab 2 mg(base equiv)

1 • •

buprenorphine hcl sl tab 8 mg(base equiv)

1 • •

butalbital-aspirin-caff w/ codeinecap 50-325-40-30 mg (Fiorinal/codeine #3)

1 •

codeine sulfate tab 15 mg(Codeine sulfate)

1 •

Drug Name Tier

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its

codeine sulfate tab 30 mg 1 •codeine sulfate tab 60 mg 1 •fentanyl citrate lozenge on a

handle 200 mcg (Actiq)1 • •

fentanyl citrate lozenge on ahandle 400 mcg (Actiq)

1 • •


1 • •


1 • •


1 • •


1 • •

fentanyl td patch 72hr 12 mcg/hr(Duragesic)

1 •


1 •


1 •


1 •

fentanyl td patch 72hr 100 mcg/hr (Duragesic)

1 •

hydrocodone-acetaminophensoln 7.5-325 mg/15ml (Hycet)

1 •

hydrocodone-acetaminophentab 10-325 mg (Norco)

1 •

hydrocodone-acetaminophentab 5-325 mg (Norco)

1 •

hydrocodone-acetaminophentab 7.5-325 mg (Norco)

1 •

hydrocodone-ibuprofen tab5-200 mg (Reprexain)

1 •

hydrocodone-ibuprofen tab7.5-200 mg (Vicoprofen)

1 •

hydrocodone-ibuprofen tab10-200 mg (Ibudone)

1 •

hydromorphone hcl liqd 1 mg/ml(Dilaudid)

1 •

2017


Drug Name Tier

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Lim

its

hydromorphone hcl tab 2 mg(Dilaudid)

1 •


1 •


1 •

methadone hcl conc 10 mg/ml(Methadose)

1 •

methadone hcl soln 5 mg/5ml(Methadone hcl)

1 •

methadone hcl soln 10 mg/5ml(Methadone hcl)

1 •

methadone hcl tab for oral susp40 mg

1 •

methadone hcl tab 5 mg(Dolophine hcl)

1 •

methadone hcl tab 10 mg(Dolophine)

1 •

MORPHINE SULFATE – morphinesulfate tab 15 mg

2 •

MORPHINE SULFATE – morphinesulfate tab 30 mg

2 •

morphine sulfate oral soln10 mg/5ml

1 •

morphine sulfate oral soln20 mg/5ml

1 •

morphine sulfate oral soln100 mg/5ml (20 mg/ml)

1 •

morphine sulfate tab cr 15 mg(Ms contin)

1 •


1 •


1 •


1 •


1 •

oxycodone hcl cap 5 mg 1 •

Drug Name Tier

Des

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Lim

its

oxycodone hcl conc 100 mg/5ml(20 mg/ml) (Oxycodone hcl)

1 •

oxycodone hcl soln 5 mg/5ml(Oxycodone hcl)

1 •

oxycodone hcl tab 5 mg(Roxicodone)

1 •

oxycodone hcl tab 10 mg 1 •oxycodone hcl tab 15 mg

(Roxicodone)1 •

oxycodone hcl tab 20 mg 1 •oxycodone hcl tab 30 mg

(Roxicodone)1 •

oxycodone w/ acetaminophentab 5-325 mg (Percocet)

1 •

oxycodone w/ acetaminophentab 7.5-325 mg (Percocet)

1 •

oxycodone w/ acetaminophentab 10-325 mg (Percocet)

1 •

oxycodone-aspirin tab4.8355-325 mg (Percodan)

1 •

OXYCONTIN – oxycodone hcltab er 12hr deter 10 mg

2 •


2 •


2 •


2 •


2 •


2 •


2 •

tramadol hcl tab sr 24hr 100 mg(Ultram er)

1 •


1 •


1 •

2017


Drug Name Tier

Des

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Lim

its

tramadol hcl tab 50 mg (Ultram) 1 •tramadol-acetaminophen tab

37.5-325 mg (Ultracet)1 •

RHEUMATOID AND OSTEOARTHRITIScelecoxib cap 50 mg (Celebrex) 1 •celecoxib cap 100 mg (Celebrex) 1 •celecoxib cap 200 mg (Celebrex) 1 •celecoxib cap 400 mg (Celebrex) 1 •diclofenac potassium tab 50 mg

(Cataflam)1

diclofenac sodium tab delayedrelease 25 mg

1


1


1

diclofenac sodium tab sr 24hr100 mg (Voltaren-xr)

1

ENBREL – etanercept forsubcutaneous inj 25 mg

2 • • •

ENBREL – etanerceptsubcutaneous soln prefilledsyringe 25 mg/0.5ml

2 • • •

ENBREL – etanerceptsubcutaneous soln prefilledsyringe 50 mg/ml

2 • • •

ENBREL SURECLICK –etanercept subcutaneoussolution auto-injector 50 mg/ml

2 • • •

etodolac cap 200 mg 1

etodolac cap 300 mg 1

etodolac tab sr 24hr 400 mg 1



etodolac tab 400 mg 1

etodolac tab 500 mg 1

flurbiprofen tab 50 mg 1

flurbiprofen tab 100 mg 1

Drug Name Tier

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its

HUMIRA – adalimumab prefilledsyringe kit 10 mg/0.2ml

2 • • •


2 • • •


2 • • •

HUMIRA PEDIATRIC CROHNS D– adalimumab prefilled syringekit 40 mg/0.8ml

2 • • •

HUMIRA PEN – adalimumab pen-injector kit 40 mg/0.8ml

2 • • •

HUMIRA PEN-CROHNS DISEASE– adalimumab pen-injector kit40 mg/0.8ml

2 • • •

HUMIRA PEN-PSORIASIS STAR –adalimumab pen-injector kit 40mg/0.8ml

2 • • •

ibuprofen susp 100 mg/5ml 1

ibuprofen tab 400 mg 1



ILARIS – canakinumabsubcutaneous inj 150 mg/ml

2 • • •

ILARIS – canakinumab for inj 180mg

2 • • •

indomethacin cap 25 mg 1

indomethacin cap 50 mg 1

ketoprofen cap 50 mg 1

ketoprofen cap 75 mg 1

leflunomide tab 10 mg (Arava) 1

leflunomide tab 20 mg (Arava) 1

meloxicam tab 7.5 mg (Mobic) 1

meloxicam tab 15 mg (Mobic) 1

nabumetone tab 500 mg 1

nabumetone tab 750 mg 1

naproxen sodium tab 275 mg(Anaprox)

1

2017


Drug Name Tier

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its

naproxen sodium tab 550 mg(Anaprox ds)

1

naproxen susp 125 mg/5ml(Naprosyn)

1

naproxen tab ec 375 mg (Ec-naprosyn)

1

naproxen tab ec 500 mg (Ec-naprosyn)

1

naproxen tab 250 mg (Naprosyn) 1



oxaprozin tab 600 mg (Daypro) 1

piroxicam cap 10 mg (Feldene) 1

piroxicam cap 20 mg (Feldene) 1

SIMPONI – golimumabsubcutaneous soln auto-injector 50 mg/0.5ml

2 • • •

SIMPONI – golimumabsubcutaneous soln auto-injector 100 mg/ml

2 • • •

SIMPONI – golimumabsubcutaneous soln prefilledsyringe 50 mg/0.5ml

2 • • •

SIMPONI – golimumabsubcutaneous soln prefilledsyringe 100 mg/ml

2 • • •

sulindac tab 150 mg 1

sulindac tab 200 mg 1

MIGRAINE HEADACHESnaratriptan hcl tab 1 mg (base

equiv) (Amerge)1 •

naratriptan hcl tab 2.5 mg (baseequiv) (Amerge)

1 •

RELPAX – eletriptanhydrobromide tab 20 mg (baseequivalent)

2 •

RELPAX – eletriptanhydrobromide tab 40 mg (baseequivalent)

2 •

Drug Name Tier

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its

rizatriptan benzoate oraldisintegrating tab 5 mg (baseeq) (Maxalt-mlt)

1 •

rizatriptan benzoate oraldisintegrating tab 10 mg (baseeq) (Maxalt-mlt)

1 •

rizatriptan benzoate tab 5 mg(base equivalent) (Maxalt)

1 •

rizatriptan benzoate tab 10 mg(base equivalent) (Maxalt)

1 •

sumatriptan nasal spray 5 mg/act (Imitrex)

1 •

sumatriptan nasal spray 20 mg/act (Imitrex)

1 •

sumatriptan succinate inj6 mg/0.5ml (Imitrex)

1 •

sumatriptan succinate solutionauto-injector 4 mg/0.5ml(Imitrex statdose sys)

1 •

sumatriptan succinate solutionauto-injector 6 mg/0.5ml(Imitrex statdose sys)

1 •

sumatriptan succinate solutioncartridge 4 mg/0.5ml (Imitrexstatdose ref)

1 •

sumatriptan succinate solutioncartridge 6 mg/0.5ml (Imitrexstatdose ref)

1 •

sumatriptan succinate tab 25 mg(Imitrex)

1 •

sumatriptan succinate tab 50 mg(Imitrex)

1 •

sumatriptan succinate tab100 mg (Imitrex)

1 •

GOUTallopurinol tab 100 mg (Zyloprim) 1

allopurinol tab 300 mg (Zyloprim) 1

colchicine w/ probenecid tab0.5-500 mg

1

COLCRYS – colchicine tab 0.6mg

2

2017


Drug Name Tier

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Lim

its

probenecid tab 500 mg 1

LOCAL ANESTHETICS INJECTABLElidocaine hcl local inj 1%

(Xylocaine)1

lidocaine hcl local preservativefree (pf) inj 1% (Xylocaine-mpf)

1

NEUROMUSCULAR DRUGSSEIZUREScarbamazepine cap sr 12hr

100 mg (Carbatrol)1

carbamazepine cap sr 12hr200 mg (Carbatrol)

1

carbamazepine cap sr 12hr300 mg (Carbatrol)

1

carbamazepine chew tab 100 mg 1

carbamazepine susp 100 mg/5ml(Tegretol)

1

carbamazepine tab sr 12hr100 mg (Tegretol-xr)

1


1


1

carbamazepine tab 200 mg(Tegretol)

1

clonazepam tab 0.5 mg(Klonopin)

1

clonazepam tab 1 mg (Klonopin) 1

clonazepam tab 2 mg (Klonopin) 1

DIASTAT ACUDIAL – diazepamrectal gel delivery system 10mg

2

DIASTAT ACUDIAL – diazepamrectal gel delivery system 20mg

2

DIASTAT PEDIATRIC – diazepamrectal gel delivery system 2.5mg

2

DILANTIN – phenytoin sodiumextended cap 30 mg

2

Drug Name Tier

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ty

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its

divalproex sodium cap delayedrelease sprinkle 125 mg(Depakote sprinkles)

1

divalproex sodium tab delayedrelease 125 mg (Depakote)

1


1


1

divalproex sodium tab sr 24 hr250 mg (Depakote er)

1

divalproex sodium tab sr 24 hr500 mg (Depakote er)

1

ethosuximide cap 250 mg(Zarontin)

1

ethosuximide soln 250 mg/5ml(Zarontin)

1

gabapentin cap 100 mg(Neurontin)

1


1


1

gabapentin oral soln 250 mg/5ml(Neurontin)

1

gabapentin tab 600 mg(Neurontin)

1

gabapentin tab 800 mg(Neurontin)

1

lamotrigine tab chewabledispersible 5 mg (Lamictalchewable di)

1

lamotrigine tab chewabledispersible 25 mg (Lamictalchewable di)

1

lamotrigine tab 25 mg (Lamictal) 1




2017


Drug Name Tier

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Lim

its

levetiracetam oral soln 100 mg/ml (Keppra)

1

levetiracetam tab sr 24hr 500 mg(Keppra xr)

1

levetiracetam tab sr 24hr 750 mg(Keppra xr)

1

levetiracetam tab 250 mg(Keppra)

1


1


1


1

oxcarbazepine susp 300 mg/5ml(60 mg/ml) (Trileptal)

1

oxcarbazepine tab 150 mg(Trileptal)

1


1


1

phenytoin chew tab 50 mg(Dilantin infatabs)

1

phenytoin sodium extended cap100 mg (Dilantin)

1

phenytoin sodium extended cap200 mg (Phenytek)

1

phenytoin sodium extended cap300 mg (Phenytek)

1

phenytoin susp 125 mg/5ml(Dilantin)

1

primidone tab 50 mg (Mysoline) 1

primidone tab 250 mg (Mysoline) 1

topiramate sprinkle cap 15 mg(Topamax sprinkle)

1

topiramate sprinkle cap 25 mg(Topamax sprinkle)

1

topiramate tab 25 mg (Topamax) 1


Drug Name Tier

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its



valproate sodium oral soln250 mg/5ml (base equiv)(Depakene)

1

valproic acid cap 250 mg(Depakene)

1

zonisamide cap 25 mg(Zonegran)

1

zonisamide cap 50 mg 1

zonisamide cap 100 mg(Zonegran)

1

PARKINSON'S DISEASEamantadine hcl cap 100 mg 1

amantadine hcl syrup 50 mg/5ml 1

benztropine mesylate tab 0.5 mg 1

benztropine mesylate tab 1 mg 1

benztropine mesylate tab 2 mg 1

bromocriptine mesylate cap5 mg (base equivalent)(Parlodel)

1

bromocriptine mesylate tab2.5 mg (base equivalent)(Parlodel)

1

carbidopa & levodopa orallydisintegrating tab 10-100 mg

1


1


1

carbidopa & levodopa tab cr25-100 mg (Sinemet cr)

1

carbidopa & levodopa tab cr50-200 mg (Sinemet cr)

1

carbidopa & levodopa tab10-100 mg (Sinemet)

1


1

2017


Drug Name Tier

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its


1

entacapone tab 200 mg (Comtan) 1

pramipexole dihydrochloride tab0.125 mg (Mirapex)

1


1


1


1

pramipexole dihydrochloride tab1 mg (Mirapex)

1


1

rasagiline mesylate tab 0.5 mg(base equiv) (Azilect)

1

rasagiline mesylate tab 1 mg(base equiv) (Azilect)

1

ropinirole hydrochloride tab0.25 mg (Requip)

1

ropinirole hydrochloride tab0.5 mg (Requip)

1

ropinirole hydrochloride tab1 mg (Requip)

1


1


1


1


1

selegiline hcl cap 5 mg (Eldepryl) 1

selegiline hcl tab 5 mg 1

trihexyphenidyl hcl elixir 0.4 mg/ml

1

trihexyphenidyl hcl tab 2 mg 1

trihexyphenidyl hcl tab 5 mg 1

Drug Name Tier

Des

igna

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MUSCLE RELAXANTSbaclofen tab 10 mg 1

baclofen tab 20 mg 1

chlorzoxazone tab 500 mg(Parafon forte dsc)

1

cyclobenzaprine hcl tab 5 mg 1

cyclobenzaprine hcl tab 10 mg 1

dantrolene sodium cap 25 mg(Dantrium)

1

dantrolene sodium cap 50 mg(Dantrium)

1

dantrolene sodium cap 100 mg(Dantrolene sodium)

1

metaxalone tab 800 mg (Skelaxin) 1

methocarbamol tab 500 mg(Robaxin)

1

methocarbamol tab 750 mg(Robaxin-750)

1

orphenadrine citrate tab sr 12hr100 mg

1

tizanidine hcl tab 2 mg (baseequivalent)

1

tizanidine hcl tab 4 mg (baseequivalent) (Zanaflex)

1

OTHER NEUROMUSCULAR DRUGSpyridostigmine bromide tab

60 mg (Mestinon)1

RILUTEK – riluzole tab 50 mg 2

riluzole tab 50 mg (Rilutek) 1

SUPPLEMENTSVITAMINSergocalciferol cap 50000 unit

(Drisdol)1

MEPHYTON – phytonadione tab5 mg

2

MINERALS AND ELECTROLYTESpotassium chloride cap cr 8 meq

(Micro-k)1

2017


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potassium chloride cap cr 10meq (Micro-k)

1

potassium chloridemicroencapsulated crys cr tab10 meq

1

potassium chloridemicroencapsulated crys cr tab20 meq

1

potassium chloride oral soln10% (20 meq/15ml)

1

potassium chloride powderpacket 20 meq

1

potassium chloride tab cr 8 meq(600 mg)

1

potassium chloride tab cr 10meq (K-tab)

1

sodium fluoride chew tab0.25 mg f (from 0.55 mg naf)(Luride)

1

sodium fluoride chew tab 0.5 mgf (from 1.1 mg naf) (Luride)

1

sodium fluoride chew tab 1 mg f(from 2.2 mg naf) (Luride)

1

sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop naf)

1

sodium fluoride soln 0.5 mg/ml f(from 1.1 mg/ml naf) (Luride)

1

BLOOD MODIFYING DRUGSanagrelide hcl cap 0.5 mg

(Agrylin)1

anagrelide hcl cap 1 mg 1

BRILINTA – ticagrelor tab 60 mg 2

BRILINTA – ticagrelor tab 90 mg 2

cilostazol tab 50 mg (Pletal) 1

cilostazol tab 100 mg (Pletal) 1

clopidogrel bisulfate tab 75 mg(base equiv) (Plavix)

1

cyanocobalamin inj 1000 mcg/ml 1

dipyridamole tab 25 mg(Persantine)

1

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1


1

ELIQUIS – apixaban tab 2.5 mg 2 •ELIQUIS – apixaban tab 5 mg 2 •enoxaparin sodium inj

30 mg/0.3ml (Lovenox)1 •

enoxaparin sodium inj40 mg/0.4ml (Lovenox)

1 •


1 •


1 •

enoxaparin sodium inj 100 mg/ml (Lovenox)

1 •


1 •

enoxaparin sodium inj 150 mg/ml (Lovenox)

1 •

enoxaparin sodium inj300 mg/3ml (Lovenox)

1 •

FIRAZYR – icatibant acetate inj30 mg/3ml (base equivalent)

2 • • •

folic acid tab 1 mg 1

pentoxifylline tab cr 400 mg 1

warfarin sodium tab 1 mg(Coumadin)

1


1

warfarin sodium tab 2.5 mg(Coumadin)

1


1


1


1


1

2017


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warfarin sodium tab 7.5 mg(Coumadin)

1


1

XARELTO – rivaroxaban tab 10mg

2 •


2 •


2 •

XARELTO STARTER PACK –rivaroxaban tab starter therapypack 15 mg & 20 mg

2 •

TOPICAL DRUGSEYEAnti-infectivesBACITRACIN – bacitracin ophth

oint 500 unit/gm2

bacitracin-polymyxin b ophthoint

1

ciprofloxacin hcl ophth soln0.3% (Ciloxan)

1

erythromycin ophth oint 5 mg/gm

1

gentamicin sulfate ophth oint0.3%

1

gentamicin sulfate ophth soln0.3% (Garamycin)

1

NATACYN – natamycin ophthsusp 5%

2

neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt opoin

1

neomycin-polymy-gramicid opsol 1.75-10000-0.025mg-unt-mg/ml (Neosporin)

1

ofloxacin ophth soln 0.3%(Ocuflox)

1

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polymyxin b-trimethoprimophth soln 10000 unit/ml-0.1%(Polytrim)

1

sulfacetamide sodium ophthsoln 10% (Bleph-10)

1

tobramycin ophth soln 0.3%(Tobrex)

1

trifluridine ophth soln 1%(Viroptic)

1

Steroids and Combination Productsbacitracin-polymyxin-neomycin-

hc ophth oint 1%1

fluorometholone ophth susp0.1% (Fml liquifilm)

1

neomycin-polymyxin-dexamethasone ophth oint0.1% (Maxitrol)

1

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)

1

prednisolone acetate ophth susp1% (Pred forte)

1

sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%

1

tobramycin-dexamethasoneophth susp 0.3-0.1% (Tobradex)

1

Glaucomabrimonidine tartrate ophth soln

0.15% (Alphagan p)1

brimonidine tartrate ophth soln0.2%

1

carteolol hcl ophth soln 1% 1

dorzolamide hcl ophth soln 2%(Trusopt)

1

dorzolamide hcl-timolol maleateophth soln 22.3-6.8 mg/ml(Cosopt)

1

latanoprost ophth soln 0.005%(Xalatan)

1 •

2017


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levobunolol hcl ophth soln 0.5%(Betagan)

1

pilocarpine hcl ophth soln 1%(Isopto carpine)

1


1


1

timolol maleate ophth gelforming soln 0.25% (Timoptic-xe)

1

timolol maleate ophth gelforming soln 0.5% (Timoptic-xe)

1

timolol maleate ophth soln0.25% (Timoptic)

1

timolol maleate ophth soln 0.5%(Timoptic)

1

Other Eye Productsazelastine hcl ophth soln 0.05%

(Optivar)1

cromolyn sodium ophth soln 4% 1

cyclopentolate hcl ophth soln1% (Cyclogyl)

1

diclofenac sodium ophth soln0.1%

1

flurbiprofen sodium ophth soln0.03% (Ocufen)

1

ketorolac tromethamine ophthsoln 0.4% (Acular ls)

1

ketorolac tromethamine ophthsoln 0.5% (Acular)

1

olopatadine hcl ophth soln 0.1%(base equivalent) (Patanol)

1

tropicamide ophth soln 0.5% 1

tropicamide ophth soln 1%(Mydriacyl)

1

EARacetic acid otic soln 2% 1

hydrocortisone w/ acetic acidotic soln 1-2% (Vosol hc)

1

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neomycin-polymyxin-hc oticsoln 1% (Cortisporin)

1

neomycin-polymyxin-hc oticsusp 3.5 mg/ml-10000 unit/ml-1%

1

ofloxacin otic soln 0.3% 1

MOUTH AND THROAT (local)cevimeline hcl cap 30 mg

(Evoxac)1

chlorhexidine gluconate soln0.12% (Peridex)

1

clotrimazole troche 10 mg 1

lidocaine hcl viscous soln 2% 1

nystatin susp 100000 unit/ml 1

pilocarpine hcl tab 5 mg(Salagen)

1

pilocarpine hcl tab 7.5 mg(Salagen)

1

sodium fluoride cream 1.1%(Prevident 5000 plus)

1

sodium fluoride gel 1.1% (0.5% f)(Prevident fluoride)

1

triamcinolone acetonide dentalpaste 0.1%

1

ANORECTAL AGENTSCORTIFOAM – hydrocortisone

acetate rectal foam 10% (90mg/dose)

2

hydrocortisone enema100 mg/60ml (Cortenema)

1

hydrocortisone rectal cream2.5% (Anusol-hc)

1

SKIN CONDITIONS/PRODUCTSAcneadapalene cream 0.1% (Differin) 1

adapalene gel 0.1% (Differin) 1

adapalene gel 0.3% (Differin) 1

2017


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benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)

1

clindamycin phosph-benzoylperoxide (refrig) gel 1.2 (1)-5%(Duac)

1

clindamycin phosphate gel 1%(Cleocin-t)

1

clindamycin phosphate lotion1% (Cleocin-t)

1

clindamycin phosphate soln 1%(Cleocin-t)

1

clindamycin phosphate swab 1%(Cleocin-t)

1

clindamycin phosphate-benzoylperoxide gel 1-5% (Benzaclin)

1

erythromycin gel 2% (Erygel) 1

erythromycin pads 2% 1

erythromycin soln 2% 1

FINACEA – azelaic acid foam15%

2

FINACEA – azelaic acid gel 15% 2

isotretinoin cap 10 mg 1


isotretinoin cap 30 mg (Claravis) 1


metronidazole cream 0.75%(Metrocream)

1

metronidazole gel 0.75% 1

metronidazole gel 1% (Metrogel) 1

metronidazole lotion 0.75%(Metrolotion)

1

SOOLANTRA – ivermectin cream1%

2

sulfacetamide sodium lotion10% (acne) (Klaron)

1

tazarotene cream 0.1% (Tazorac) 1

TAZORAC – tazarotene cream0.05%

2

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TAZORAC – tazarotene cream0.1%

2

TAZORAC – tazarotene gel 0.05% 2

TAZORAC – tazarotene gel 0.1% 2

tretinoin cream 0.025% (Retin-a) 1



tretinoin gel 0.01% (Retin-a) 1

tretinoin gel 0.025% (Retin-a) 1

tretinoin microsphere gel 0.04%(Retin-a micro)

1

tretinoin microsphere gel 0.1%(Retin-a micro)

1

Anti-infectivesciclopirox gel 0.77% (Loprox) 1

ciclopirox olamine cream 0.77%(base equiv)

1

ciclopirox olamine susp 0.77%(base equiv)

1

ciclopirox shampoo 1% (Loproxshampoo)

1

ciclopirox solution 8% (Penlacnail lacquer)

1 • •

diclofenac sodium gel 1%(Voltaren)

1

econazole nitrate cream 1% 1

gentamicin sulfate cream 0.1% 1

ketoconazole cream 2% 1

ketoconazole shampoo 2%(Nizoral)

1

mupirocin calcium cream 2%(Bactroban)

1

mupirocin oint 2% (Bactroban) 1

nystatin cream 100000 unit/gm 1

nystatin oint 100000 unit/gm 1

nystatin topical powder 100000unit/gm

1

2017


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silver sulfadiazine cream 1%(Silvadene)

1

Corticosteroidsalclometasone dipropionate

cream 0.05% (Aclovate)1

alclometasone dipropionate oint0.05%

1

betamethasone dipropionateaugmented cream 0.05%(Diprolene af)

1

betamethasone dipropionateaugmented lotion 0.05%(Diprolene)

1

betamethasone dipropionateaugmented oint 0.05%(Diprolene)

1

betamethasone dipropionatecream 0.05%

1

betamethasone dipropionatelotion 0.05%

1

betamethasone dipropionateoint 0.05%

1

betamethasone valerate cream0.1%

1

betamethasone valerate lotion0.1%

1

betamethasone valerate oint0.1%

1

clobetasol propionate cream0.05% (Temovate)

1

clobetasol propionate emollientbase cream 0.05% (Temovate e)

1

clobetasol propionate foam0.05% (Olux)

1

clobetasol propionate gel 0.05%(Temovate)

1

clobetasol propionate oint 0.05%(Temovate)

1

clobetasol propionate soln0.05% (Temovate)

1

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desonide cream 0.05%(Desowen)

1

desonide lotion 0.05% (Desowen) 1

desonide oint 0.05% (Desowen) 1

desoximetasone cream 0.05%(Topicort)

1

desoximetasone cream 0.25%(Topicort)

1

desoximetasone gel 0.05%(Topicort)

1

desoximetasone oint 0.25%(Topicort)

1

fluocinolone acetonide cream0.01%

1

fluocinolone acetonide cream0.025% (Synalar)

1

fluocinolone acetonide oil 0.01%(body oil) (Derma-smoothe/fsbod)

1

fluocinolone acetonide oil 0.01%(scalp oil) (Derma-smoothe/fssca)

1

fluocinolone acetonide oint0.025% (Synalar)

1

fluocinolone acetonide soln0.01% (Synalar)

1

fluocinonide cream 0.05% 1

fluocinonide emulsified basecream 0.05%

1

fluocinonide gel 0.05% 1

fluocinonide oint 0.05% 1

fluocinonide soln 0.05% 1

fluticasone propionate cream0.05% (Cutivate)

1

fluticasone propionate oint0.005% (Cutivate)

1

halobetasol propionate cream0.05% (Ultravate)

1

halobetasol propionate oint0.05% (Ultravate)

1

2017


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hydrocortisone cream 2.5% 1

hydrocortisone lotion 2.5% 1

hydrocortisone oint 2.5% 1

hydrocortisone valerate cream0.2%

1

hydrocortisone valerate oint0.2% (Westcort)

1

mometasone furoate cream 0.1%(Elocon)

1

mometasone furoate oint 0.1%(Elocon)

1

mometasone furoate solution0.1% (lotion) (Elocon)

1

nystatin-triamcinolone cream100000-0.1 unit/gm-%

1

nystatin-triamcinolone oint100000-0.1 unit/gm-%

1

triamcinolone acetonide cream0.025%

1


1


1

triamcinolone acetonide lotion0.025%

1

triamcinolone acetonide lotion0.1%

1

triamcinolone acetonide oint0.025%

1


1


1

Other Skin Productsacitretin cap 10 mg (Soriatane) 1

acitretin cap 17.5 mg (Soriatane) 1

acitretin cap 25 mg (Soriatane) 1

calcipotriene cream 0.005%(Dovonex)

1

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calcipotriene oint 0.005% 1

calcipotriene soln 0.005%(50 mcg/ml)

1

diclofenac sodium (actinickeratoses) gel 3% (Solaraze)

1 • •

fluorouracil cream 5% (Efudex) 1 •fluorouracil soln 2% 1

fluorouracil soln 5% 1

imiquimod cream 5% (Aldara) 1 •lidocaine hcl gel 2% 1

lidocaine hcl soln 4% (Xylocaine) 1

lidocaine patch 5% (Lidoderm) 1

lidocaine-prilocaine cream2.5-2.5% (Emla)

1

malathion lotion 0.5% (Ovide) 1

permethrin cream 5% (Elimite) 1

podofilox soln 0.5% (Condylox) 1

selenium sulfide lotion 2.5% 1

STELARA – ustekinumab inj 45mg/0.5ml

2 • • •

STELARA – ustekinumab solnprefilled syringe 45 mg/0.5ml

2 • • •

STELARA – ustekinumab solnprefilled syringe 90 mg/ml

2 • • •

tacrolimus oint 0.03% (Protopic) 1

tacrolimus oint 0.1% (Protopic) 1

VALCHLOR – mechlorethaminehcl gel 0.016% (baseequivalent)

2 •

MISCELLANEOUS CATEGORIES (includes suppliesand devices)DIABETIC SUPPLIESBAYER BREEZE 2 BLOOD GLUC

– blood glucose monitoring kitw/ device

2

BAYER BREEZE 2 HIGH CONTR– blood glucose calibration -liquid - high

2

2017


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BAYER BREEZE 2 LOW CONTRO– blood glucose calibration -liquid - low

2

BAYER BREEZE 2 NORMAL CON– blood glucose calibration -liquid - normal

2

BAYER BREEZE 2 TEST DISC –glucose blood test disk

2 •

BAYER CONTOUR BLOODGLUCO – glucose blood teststrip

2 •

BAYER CONTOUR BLOODGLUCO – blood glucosemonitoring devices

2

BAYER CONTOUR BLOODGLUCO – blood glucosemonitoring kit w/ device

2

BAYER CONTOUR HIGHCONTRO – blood glucosecalibration - liquid - high

2

BAYER CONTOUR LINK BLOOD– blood glucose monitoring kitw/ device

2

BAYER CONTOUR LOWCONTROL – blood glucosecalibration - liquid - low

2

BAYER CONTOUR NEXT BLOOD– glucose blood test strip

2 •

BAYER CONTOUR NEXT BLOOD– blood glucose monitoring kitw/ device

2

BAYER CONTOUR NEXTCONTRO – blood glucosecalibration - liquid - normal

2

BAYER CONTOUR NEXTCONTRO – blood glucosecalibration - liquid - low

2

BAYER CONTOUR NEXT EZ BLO– blood glucose monitoring kitw/ device

2

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BAYER CONTOUR NEXT LINK B– blood glucose monitoring kitw/ device

2

BAYER CONTOUR NEXT LINK W– blood glucose monitoring kitw/ device

2

BAYER CONTOUR NORMALCONT – blood glucosecalibration - liquid - normal

2

CONTOUR NEXT ONE BLOODGL – blood glucose monitoringkit

2

B-D INSULIN SYRINGE MICRO –insulin syringe/needle u-100 1ml 28 x 1/2"

2

B-D INSULIN SYRINGE ULTRA –insulin syringe/needle u-1000.3 ml 30 x 1/2"

2

B-D INSULIN SYRINGE ULTRA –insulin syringe/needle u-100 1ml 31 x 5/16"

2

B-D INSULIN SYRINGE ULTRA –insulin syringe/needle u-1000.3 ml 31 x 5/16"

2

BAYER MICROLET LANCETS –lancets

2

BAYER MICROLET 2 LANCING –lancet devices

2

BD AUTOSHIELD 29G X 3/16" –insulin pen needle 29 g x 5 mm(3/16")

2

BD AUTOSHIELD 29G X 5/16" –insulin pen needle 29 g x 8 mm(5/16")

2

BD INSULIN SYRINGE LUER-L –insulin syringe (disp) u-100 1ml

2

BD INSULIN SYRINGE MICROF– insulin syringe/needle u-1000.3 ml 28 x 1/2"

2

2017


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BD INSULIN SYRINGE MICROF– insulin syringe/needle u-1001/2 ml 28 x 1/2"

2

BD INSULIN SYRINGE MICROF –insulin syringe/needle u-100 1ml 27 x 5/8"

2

BD INSULIN SYRINGE MICROF –insulin syringe/needle u-100 1ml 28 x 1/2"

2

BD INSULIN SYRINGE SAFETY– insulin syringe/needle u-1000.3 ml 31 x 15/64"

2

BD INSULIN SYRINGE ULTRAF– insulin syringe/needle u-1000.3 ml 30 x 1/2"

2

BD INSULIN SYRINGE ULTRAF– insulin syringe/needle u-1001/2 ml 31 x 5/16"

2


2


2

BD INSULIN SYRINGE ULTRAF –insulin syringe/needle u-100 1ml 30 x 1/2"

2


2


2


2


2

BD INSULIN SYRINGE/U-100/ –insulin syringe/needle u-1001/2 ml 30 x 1/2"

2

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BD INSULIN SYRINGE/U-500/ –insulin syringe/needle u-5000.5 ml 31g x 6mm (15/64")

2

BD LANCET ULTRAFINE 30G –lancets

2

BD LANCET ULTRAFINE 33G –lancets

2

BD MICROTAINER LANCETS –lancets

2

BD PEN NEEDLE/MINI/ULTRAF –insulin pen needle 31 g x 5 mm(3/16")

2

BD PEN NEEDLE/NANO/ULTRA –insulin pen needle 32 g x 4 mm(5/32")

2

BD PEN NEEDLE/SHORT/ULTRA– insulin pen needle 31 g x 8mm (1/3" or 5/16")

2

BD PEN NEEDLE/ULTRAFINE/2 –insulin pen needle 29 g x 12.7mm

2

BD PEN NEEDLES SHORT/ULTR– insulin pen needle 31 g x 8mm (1/3" or 5/16")

2

BD SYRINGE LUER-LOK/1ML –syringe (disposable) 1 ml

2

BD 1ML TUBERCULIN SYRINGE– syringe (disposable) 1 ml

2

FINGERSTIX LANCETS – lancets 2

MICROLET LANCETS – lancets 2

MICROLET NEXT – lancetdevices

2

SINGLE-LET – lancets 2

MISCELLANEOUS DRUGSazathioprine tab 50 mg (Imuran) 1

buprenorphine hcl-naloxone hclsl tab 2-0.5 mg (base equiv)

1 • •

buprenorphine hcl-naloxone hclsl tab 8-2 mg (base equiv)

1 • •

CHEMET – succimer cap 100 mg 2

2017


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cyclosporine cap 25 mg(Sandimmune)

1

cyclosporine cap 100 mg(Sandimmune)

1

cyclosporine modified cap25 mg (Neoral)

1

cyclosporine modified cap50 mg (Cyclosporine modifie)

1

cyclosporine modified cap100 mg (Neoral)

1

cyclosporine modified oral soln100 mg/ml (Neoral)

1

DEPEN TITRATABS –penicillamine tab 250 mg

2 •

mycophenolate mofetil cap250 mg (Cellcept)

1

mycophenolate mofetil for oralsusp 200 mg/ml (Cellcept)

1

mycophenolate mofetil tab500 mg (Cellcept)

1

mycophenolate sodium tab dr180 mg (mycophenolic acidequiv) (Myfortic)

1

mycophenolate sodium tab dr360 mg (mycophenolic acidequiv) (Myfortic)

1

naloxone hcl inj 0.4 mg/ml 1

naloxone hcl inj 4 mg/10ml 1

naltrexone hcl tab 50 mg (Revia) 1

NARCAN – naloxone hcl nasalspray 4 mg/0.1ml

2 •

RAPAMUNE – sirolimus oral soln1 mg/ml

2

REVLIMID – lenalidomide caps2.5 mg

2 • • •

REVLIMID – lenalidomide cap 5mg

2 • • •


2 • • •

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2 • • •


2 • • •


2 • • •

sirolimus tab 0.5 mg (Rapamune) 1

sirolimus tab 1 mg (Rapamune) 1

sirolimus tab 2 mg (Rapamune) 1

sodium polystyrene sulfonateoral susp 15 gm/60ml (Sps)

1

sodium polystyrene sulfonatepowder (Kayexalate)

1

SUBOXONE – buprenorphinehcl-naloxone hcl sl film 2-0.5mg (base equiv)

2 • •

SUBOXONE – buprenorphinehcl-naloxone hcl sl film 4-1 mg(base equiv)

2 • •

SUBOXONE – buprenorphinehcl-naloxone hcl sl film 8-2 mg(base equiv)

2 • •

SUBOXONE – buprenorphinehcl-naloxone hcl sl film 12-3mg (base equiv)

2 • •

tacrolimus cap 0.5 mg (Prograf) 1

tacrolimus cap 1 mg (Prograf) 1

tacrolimus cap 5 mg (Prograf) 1

THALOMID – thalidomide cap 50mg

2 • • •

THALOMID – thalidomide cap100 mg

2 • • •


2 • • •


2 • • •

2017


INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg(Epzicom)............................................................................5

abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg (Trizivir).................................................. 5

abacavir sulfate tab 300 mg (base equiv) (Ziagen).........5acamprosate calcium tab delayed release 333 mg(Campral).......................................................................... 40

acarbose tab 25 mg (Precose)........................................ 15acarbose tab 50 mg (Precose)........................................ 15acarbose tab 100 mg (Precose)...................................... 15acebutolol hcl cap 200 mg (Sectral)...............................21acebutolol hcl cap 400 mg (Sectral)...............................21acetaminophen w/ codeine soln 120-12 mg/5ml........... 41acetaminophen w/ codeine tab 300-15 mg (Tylenol/codeine)............................................................................ 41

acetaminophen w/ codeine tab 300-30 mg (Tylenol/codeine #3).......................................................................41

acetaminophen w/ codeine tab 300-60 mg (Tylenol/codeine #4).......................................................................41

acetazolamide cap sr 12hr 500 mg (Diamox)................ 24acetazolamide tab 125 mg............................................... 24acetazolamide tab 250 mg............................................... 24acetic acid otic soln 2%...................................................50acetylcysteine inhal soln 10%.........................................28acetylcysteine inhal soln 20%.........................................28acitretin cap 10 mg (Soriatane).......................................53acitretin cap 17.5 mg (Soriatane)....................................53acitretin cap 25 mg (Soriatane).......................................53ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)........................................................... 8

acyclovir cap 200 mg (Zovirax).........................................5acyclovir susp 200 mg/5ml (Zovirax)............................... 5acyclovir tab 400 mg (Zovirax)..........................................5acyclovir tab 800 mg (Zovirax)..........................................5adapalene cream 0.1% (Differin).....................................50adapalene gel 0.1% (Differin).......................................... 50adapalene gel 0.3% (Differin).......................................... 50ADDERALL XR – amphetamine-dextroamphetamine capsr 24hr 5 mg......................................................................37

ADDERALL XR – amphetamine-dextroamphetamine capsr 24hr 10 mg....................................................................37





adefovir dipivoxil tab 10 mg (Hepsera)............................5

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba100-50 mcg/dose...............................................................28



ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21mcg/act...............................................................................28

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 115-21mcg/act...............................................................................28

ADVAIR HFA – fluticasone-salmeterol inhal aerosol230-21 mcg/act..................................................................28

AFINITOR DISPERZ – everolimus tab for oral susp 2mg........................................................................................ 8



AFINITOR – everolimus tab 2.5 mg.....................................8AFINITOR – everolimus tab 5 mg........................................8AFINITOR – everolimus tab 7.5 mg.....................................8AFINITOR – everolimus tab 10 mg......................................8ALBENZA – albendazole tab 200 mg.................................. 7albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)..........28albuterol sulfate soln nebu 0.5% (5 mg/ml)...................28albuterol sulfate soln nebu 0.63 mg/3ml (baseequiv).................................................................................28

albuterol sulfate soln nebu 1.25 mg/3ml (baseequiv).................................................................................28

albuterol sulfate syrup 2 mg/5ml....................................28albuterol sulfate tab 2 mg................................................28albuterol sulfate tab 4 mg................................................28alclometasone dipropionate cream 0.05%(Aclovate)..........................................................................52

alclometasone dipropionate oint 0.05%.........................52ALECENSA – alectinib hcl cap 150 mg (baseequivalent)............................................................................8

alendronate sodium tab 5 mg......................................... 17alendronate sodium tab 10 mg....................................... 17alendronate sodium tab 35 mg....................................... 17alendronate sodium tab 70 mg (Fosamax).................... 17alfuzosin hcl tab sr 24hr 10 mg (Uroxatral)................... 32ALKERAN – melphalan tab 2 mg.........................................8allopurinol tab 100 mg (Zyloprim).................................. 44allopurinol tab 300 mg (Zyloprim).................................. 44alprazolam tab 0.25 mg (Xanax)......................................33alprazolam tab 0.5 mg (Xanax)........................................33alprazolam tab 1 mg (Xanax)...........................................33alprazolam tab 2 mg (Xanax)...........................................33alprazolam tab sr 24hr 0.5 mg (Xanax xr)......................33alprazolam tab sr 24hr 1 mg (Xanax xr).........................33alprazolam tab sr 24hr 2 mg (Xanax xr).........................33alprazolam tab sr 24hr 3 mg (Xanax xr).........................33amantadine hcl cap 100 mg............................................ 46amantadine hcl syrup 50 mg/5ml....................................46amiloride & hydrochlorothiazide tab 5-50 mg............... 24

2017


amiloride hcl tab 5 mg..................................................... 24amiodarone hcl tab 100 mg.............................................25amiodarone hcl tab 400 mg.............................................25amiodarone hcl tab 200 mg (Cordarone)....................... 25amitriptyline hcl tab 10 mg..............................................33amitriptyline hcl tab 25 mg..............................................33amitriptyline hcl tab 50 mg..............................................33amitriptyline hcl tab 75 mg..............................................33amitriptyline hcl tab 100 mg............................................33amitriptyline hcl tab 150 mg............................................33amlodipine besylate-atorvastatin calcium tab 2.5-10mg (Caduet)......................................................................25

amlodipine besylate-atorvastatin calcium tab 2.5-20mg (Caduet)......................................................................25

amlodipine besylate-atorvastatin calcium tab 2.5-40mg (Caduet)......................................................................25

amlodipine besylate-atorvastatin calcium tab 5-10 mg(Caduet).............................................................................25








amlodipine besylate-benazepril hcl cap 2.5-10 mg(Lotrel)...............................................................................22

amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)...............................................................................22





amlodipine besylate tab 2.5 mg (Norvasc).................... 22amlodipine besylate tab 5 mg (Norvasc)....................... 22amlodipine besylate tab 10 mg (Norvasc)..................... 22amlodipine besylate-valsartan tab 5-160 mg(Exforge)........................................................................... 20

amlodipine besylate-valsartan tab 5-320 mg(Exforge)........................................................................... 20



amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)...........................................20

amlodipine-valsartan-hydrochlorothiazide tab 5-160-25mg (Exforge hct)..............................................................20

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct).........................................20

amlodipine-valsartan-hydrochlorothiazide tab10-160-25 mg (Exforge hct)............................................20

amlodipine-valsartan-hydrochlorothiazide tab10-320-25 mg (Exforge hct)............................................20

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 200-28.5 mg.....................................2

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 400-57 mg........................................2

amoxicillin & k clavulanate for susp 200-28.5mg/5ml.................................................................................2

amoxicillin & k clavulanate for susp 400-57 mg/5ml...... 2amoxicillin & k clavulanate for susp 250-62.5 mg/5ml(Augmentin)........................................................................2

amoxicillin & k clavulanate for susp 600-42.9 mg/5ml(Augmentin es-600)...........................................................2

amoxicillin & k clavulanate tab 250-125 mg.................... 2amoxicillin & k clavulanate tab 500-125 mg(Augmentin)........................................................................2

amoxicillin & k clavulanate tab 875-125 mg(Augmentin)........................................................................2

amoxicillin & k clavulanate tab sr 12hr 1000-62.5 mg(Augmentin xr)...................................................................2

amoxicillin (trihydrate) cap 250 mg..................................2amoxicillin (trihydrate) cap 500 mg..................................2amoxicillin (trihydrate) for susp 125 mg/5ml...................2amoxicillin (trihydrate) for susp 200 mg/5ml...................2amoxicillin (trihydrate) for susp 250 mg/5ml...................2amoxicillin (trihydrate) for susp 400 mg/5ml...................2amoxicillin (trihydrate) tab 500 mg...................................2amoxicillin (trihydrate) tab 875 mg...................................2amphetamine-dextroamphetamine tab 5 mg(Adderall).......................................................................... 38

amphetamine-dextroamphetamine tab 7.5 mg(Adderall).......................................................................... 38

amphetamine-dextroamphetamine tab 10 mg(Adderall).......................................................................... 38

amphetamine-dextroamphetamine tab 12.5 mg(Adderall).......................................................................... 38




ampicillin cap 250 mg........................................................ 2ampicillin cap 500 mg........................................................ 2anagrelide hcl cap 1 mg.................................................. 48anagrelide hcl cap 0.5 mg (Agrylin)............................... 48anastrozole tab 1 mg (Arimidex).......................................8

2017


ANDROGEL PUMP – testosterone td gel 20.25 mg/act(1.62%)...............................................................................12

ANDROGEL – testosterone td gel 20.25 mg/1.25gm(1.62%)...............................................................................12

ANDROGEL – testosterone td gel 40.5 mg/2.5gm(1.62%)...............................................................................12

ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba62.5-25 mcg/inh.................................................................28

aprepitant capsule 80 mg (Emend).................................31aprepitant capsule therapy pack 80 & 125 mg(Emend).............................................................................31

aripiprazole tab 2 mg (Abilify).........................................35aripiprazole tab 5 mg (Abilify).........................................35aripiprazole tab 10 mg (Abilify).......................................35aripiprazole tab 15 mg (Abilify).......................................35aripiprazole tab 20 mg (Abilify).......................................35aripiprazole tab 30 mg (Abilify).......................................35ASACOL HD – mesalamine tab delayed release 800mg...................................................................................... 31

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 100 mcg/act................................................... 28

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 200 mcg/act................................................... 28

ASMANEX TWISTHALER 120 ME – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 28

ASMANEX TWISTHALER 14 MET – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 28

ASMANEX TWISTHALER 30 MET – mometasone furoateinhal powd 110 mcg/inh (breath activated).......................28



atenolol & chlorthalidone tab 50-25 mg (Tenoretic50)...................................................................................... 21

atenolol & chlorthalidone tab 100-25 mg (Tenoretic100).................................................................................... 21

atenolol tab 25 mg (Tenormin)........................................ 21atenolol tab 50 mg (Tenormin)........................................ 21atenolol tab 100 mg (Tenormin)...................................... 21atorvastatin calcium tab 10 mg (base equivalent)(Lipitor)..............................................................................23

atorvastatin calcium tab 20 mg (base equivalent)(Lipitor)..............................................................................23



atovaquone-proguanil hcl tab 62.5-25 mg(Malarone)...........................................................................7

atovaquone-proguanil hcl tab 250-100 mg(Malarone)...........................................................................7

ATRIPLA – efavirenz-emtricitabine-tenofovir df tab600-200-300 mg.................................................................. 5

AUBAGIO – teriflunomide tab 7 mg...................................39AUBAGIO – teriflunomide tab 14 mg.................................39

AVONEX – interferon beta-1a for im inj kit 30mcg(33mcg(6.6 mu)/vial)......................................................... 39

AVONEX – interferon beta-1a im prefilled syringe kit 30mcg/0.5ml...........................................................................39

AVONEX PEN – interferon beta-1a im auto-injector kit 30mcg/0.5ml...........................................................................39

azathioprine tab 50 mg (Imuran).....................................55azelastine hcl nasal spray 0.1% (137 mcg/spray)......... 27azelastine hcl nasal spray 0.15% (205.5 mcg/spray)(Astepro)........................................................................... 27

azelastine hcl ophth soln 0.05% (Optivar)..................... 50azithromycin for susp 100 mg/5ml (Zithromax).............. 3azithromycin for susp 200 mg/5ml (Zithromax).............. 3azithromycin tab 250 mg (Zithromax).............................. 3azithromycin tab 500 mg (Zithromax).............................. 3azithromycin tab 600 mg (Zithromax).............................. 3B

BACITRACIN – bacitracin ophth oint 500 unit/gm............. 49bacitracin-polymyxin b ophth oint..................................49bacitracin-polymyxin-neomycin-hc ophth oint 1%.......49baclofen tab 10 mg...........................................................47baclofen tab 20 mg...........................................................47balsalazide disodium cap 750 mg (Colazal).................. 31BARACLUDE – entecavir oral soln 0.05 mg/ml...................5BAYER BREEZE 2 BLOOD GLUC – blood glucosemonitoring kit w/ device.................................................... 53

BAYER BREEZE 2 HIGH CONTR – blood glucosecalibration - liquid - high................................................... 53

BAYER BREEZE 2 LOW CONTRO – blood glucosecalibration - liquid - low.....................................................54

BAYER BREEZE 2 NORMAL CON – blood glucosecalibration - liquid - normal............................................... 54

BAYER BREEZE 2 TEST DISC – glucose blood testdisk.....................................................................................54

BAYER CONTOUR BLOOD GLUCO – blood glucosemonitoring devices............................................................ 54

BAYER CONTOUR BLOOD GLUCO – blood glucosemonitoring kit w/ device.................................................... 54

BAYER CONTOUR BLOOD GLUCO – glucose blood teststrip.....................................................................................54

BAYER CONTOUR HIGH CONTRO – blood glucosecalibration - liquid - high................................................... 54

BAYER CONTOUR LINK BLOOD – blood glucosemonitoring kit w/ device.................................................... 54

BAYER CONTOUR LOW CONTROL – blood glucosecalibration - liquid - low.....................................................54

BAYER CONTOUR NEXT BLOOD – blood glucosemonitoring kit w/ device.................................................... 54

BAYER CONTOUR NEXT BLOOD – glucose blood teststrip.....................................................................................54

BAYER CONTOUR NEXT CONTRO – blood glucosecalibration - liquid - low.....................................................54

BAYER CONTOUR NEXT CONTRO – blood glucosecalibration - liquid - normal............................................... 54

2017


BAYER CONTOUR NEXT EZ BLO – blood glucosemonitoring kit w/ device.................................................... 54

BAYER CONTOUR NEXT LINK B – blood glucosemonitoring kit w/ device.................................................... 54

BAYER CONTOUR NEXT LINK W – blood glucosemonitoring kit w/ device.................................................... 54

BAYER CONTOUR NORMAL CONT – blood glucosecalibration - liquid - normal............................................... 54

BAYER MICROLET LANCETS – lancets...........................54BAYER MICROLET 2 LANCING – lancet devices.............54BD AUTOSHIELD 29G X 3/16" – insulin pen needle 29 g x5 mm (3/16")......................................................................54

BD AUTOSHIELD 29G X 5/16" – insulin pen needle 29 g x8 mm (5/16")......................................................................54

BD INSULIN SYRINGE/U-100/ – insulin syringe/needleu-100 1/2 ml 30 x 1/2"...................................................... 55

BD INSULIN SYRINGE/U-500/ – insulin syringe/needleu-500 0.5 ml 31g x 6mm (15/64").....................................55

BD INSULIN SYRINGE LUER-L – insulin syringe (disp)u-100 1 ml......................................................................... 54

BD INSULIN SYRINGE MICROF – insulin syringe/needleu-100 1/2 ml 28 x 1/2"...................................................... 55

BD INSULIN SYRINGE MICROF – insulin syringe/needleu-100 0.3 ml 28 x 1/2"...................................................... 54

BD INSULIN SYRINGE MICROF – insulin syringe/needleu-100 1 ml 27 x 5/8"......................................................... 55

BD INSULIN SYRINGE MICROF – insulin syringe/needleu-100 1 ml 28 x 1/2"......................................................... 55

B-D INSULIN SYRINGE MICRO – insulin syringe/needleu-100 1 ml 28 x 1/2"......................................................... 54

BD INSULIN SYRINGE SAFETY – insulin syringe/needleu-100 0.3 ml 31 x 15/64".................................................. 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 1/2 ml 31 x 5/16".................................................... 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 1/2 ml 30 x 1/2"...................................................... 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 1/2 ml 31 x 15/64".................................................. 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 0.3 ml 30 x 1/2"...................................................... 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 0.3 ml 31 x 15/64".................................................. 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 1 ml 30 x 1/2"......................................................... 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 1 ml 31 x 5/16"....................................................... 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 0.3 ml 31 x 5/16".................................................... 55

BD INSULIN SYRINGE ULTRAF – insulin syringe/needleu-100 1 ml 31 x 15/64"..................................................... 55

B-D INSULIN SYRINGE ULTRA – insulin syringe/needleu-100 0.3 ml 30 x 1/2"...................................................... 54

B-D INSULIN SYRINGE ULTRA – insulin syringe/needleu-100 1 ml 31 x 5/16"....................................................... 54

B-D INSULIN SYRINGE ULTRA – insulin syringe/needleu-100 0.3 ml 31 x 5/16".................................................... 54

BD LANCET ULTRAFINE 30G – lancets...........................55BD LANCET ULTRAFINE 33G – lancets...........................55BD MICROTAINER LANCETS – lancets........................... 55BD 1ML TUBERCULIN SYRINGE – syringe (disposable) 1ml........................................................................................55

BD PEN NEEDLE/MINI/ULTRAF – insulin pen needle 31 gx 5 mm (3/16").................................................................. 55

BD PEN NEEDLE/NANO/ULTRA – insulin pen needle 32g x 4 mm (5/32")............................................................... 55

BD PEN NEEDLE/SHORT/ULTRA – insulin pen needle 31g x 8 mm (1/3" or 5/16")...................................................55

BD PEN NEEDLE/ULTRAFINE/2 – insulin pen needle 29 gx 12.7 mm..........................................................................55

BD PEN NEEDLES SHORT/ULTR – insulin pen needle 31g x 8 mm (1/3" or 5/16")...................................................55

BD SYRINGE LUER-LOK/1ML – syringe (disposable) 1ml........................................................................................55

benazepril & hydrochlorothiazide tab 5-6.25 mg.......... 18benazepril & hydrochlorothiazide tab 10-12.5 mg(Lotensin hct)...................................................................18

benazepril & hydrochlorothiazide tab 20-12.5 mg(Lotensin hct)...................................................................18

benazepril & hydrochlorothiazide tab 20-25 mg(Lotensin hct)...................................................................18

benazepril hcl tab 5 mg................................................... 18benazepril hcl tab 10 mg (Lotensin)...............................18benazepril hcl tab 20 mg (Lotensin)...............................18benazepril hcl tab 40 mg (Lotensin)...............................18benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)....................................................................51

benztropine mesylate tab 0.5 mg....................................46benztropine mesylate tab 1 mg.......................................46benztropine mesylate tab 2 mg.......................................46betamethasone dipropionate augmented cream 0.05%(Diprolene af)................................................................... 52

betamethasone dipropionate augmented lotion 0.05%(Diprolene)........................................................................ 52

betamethasone dipropionate augmented oint 0.05%(Diprolene)........................................................................ 52

betamethasone dipropionate cream 0.05%................... 52betamethasone dipropionate lotion 0.05%....................52betamethasone dipropionate oint 0.05%....................... 52betamethasone valerate cream 0.1%............................. 52betamethasone valerate lotion 0.1%.............................. 52betamethasone valerate oint 0.1%................................. 52BETASERON – interferon beta-1b for inj kit 0.3 mg.......... 39bexarotene cap 75 mg (Targretin).....................................8bicalutamide tab 50 mg (Casodex)...................................8BILTRICIDE – praziquantel tab 600 mg...............................7bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg(Ziac)..................................................................................21

bisoprolol & hydrochlorothiazide tab 5-6.25 mg(Ziac)..................................................................................21

bisoprolol & hydrochlorothiazide tab 10-6.25 mg(Ziac)..................................................................................21

bisoprolol fumarate tab 5 mg (Zebeta)...........................21

2017


bisoprolol fumarate tab 10 mg (Zebeta).........................21BOSULIF – bosutinib tab 100 mg........................................ 8BOSULIF – bosutinib tab 500 mg........................................ 8BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 100-25 mcg/inh............................................................ 28

BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 200-25 mcg/inh............................................................ 28

BRILINTA – ticagrelor tab 60 mg....................................... 48BRILINTA – ticagrelor tab 90 mg....................................... 48brimonidine tartrate ophth soln 0.2%.............................49brimonidine tartrate ophth soln 0.15% (Alphaganp)........................................................................................ 49

bromocriptine mesylate cap 5 mg (base equivalent)(Parlodel)...........................................................................46

bromocriptine mesylate tab 2.5 mg (base equivalent)(Parlodel)...........................................................................46

budesonide delayed release particles cap 3 mg(Entocort ec).................................................................... 11

budesonide inhalation susp 0.25 mg/2ml(Pulmicort)........................................................................ 28

budesonide inhalation susp 0.5 mg/2ml(Pulmicort)........................................................................ 28

budesonide inhalation susp 1 mg/2ml (Pulmicort).......28bumetanide tab 0.5 mg.................................................... 24bumetanide tab 1 mg........................................................24bumetanide tab 2 mg........................................................24buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (baseequiv).................................................................................55

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv).................................................................................55

buprenorphine hcl sl tab 2 mg (base equiv)................. 41buprenorphine hcl sl tab 8 mg (base equiv)................. 41bupropion hcl (smoking deterrent) tab sr 12hr 150 mg(Zyban).............................................................................. 40

bupropion hcl tab 75 mg (Wellbutrin)............................ 33bupropion hcl tab 100 mg (Wellbutrin).......................... 33bupropion hcl tab sr 12hr 100 mg (Wellbutrin sr).........33bupropion hcl tab sr 12hr 150 mg (Wellbutrin sr).........33bupropion hcl tab sr 12hr 200 mg (Wellbutrin sr).........33bupropion hcl tab sr 24hr 150 mg (Wellbutrin xl)......... 33bupropion hcl tab sr 24hr 300 mg (Wellbutrin xl)......... 33buspirone hcl tab 5 mg....................................................33buspirone hcl tab 10 mg..................................................33buspirone hcl tab 15 mg..................................................33buspirone hcl tab 30 mg..................................................33butalbital-acetaminophen-caffeine cap 50-325-40mg...................................................................................... 41

butalbital-acetaminophen-caffeine tab 50-325-40mg...................................................................................... 41

butalbital-acetaminophen tab 50-325 mg.......................41butalbital-aspirin-caffeine cap 50-325-40 mg(Fiorinal)............................................................................41

butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg(Fiorinal/codeine #3)....................................................... 41

Ccabergoline tab 0.5 mg.................................................... 17caffeine citrate oral soln 60 mg/3ml (10 mg/ml baseequiv) (Cafcit)...................................................................38

calcipotriene cream 0.005% (Dovonex)..........................53calcipotriene oint 0.005%.................................................53calcipotriene soln 0.005% (50 mcg/ml).......................... 53calcitonin (salmon) nasal soln 200 unit/act(Miacalcin)........................................................................ 17

calcitriol cap 0.25 mcg (Rocaltrol)..................................17calcitriol cap 0.5 mcg (Rocaltrol)....................................17calcitriol oral soln 1 mcg/ml (Rocaltrol).........................17calcium acetate (phosphate binder) cap 667 mg (169mg ca) (Phoslo)............................................................... 32

calcium acetate (phosphate binder) tab 667 mg(Eliphos)............................................................................32

CANASA – mesalamine suppos 1000 mg......................... 32candesartan cilexetil-hydrochlorothiazide tab 16-12.5mg (Atacand hct).............................................................20

candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg (Atacand hct).............................................................20

candesartan cilexetil-hydrochlorothiazide tab 32-25mg (Atacand hct).............................................................20

candesartan cilexetil tab 4 mg (Atacand)...................... 20candesartan cilexetil tab 8 mg (Atacand)...................... 20candesartan cilexetil tab 16 mg (Atacand).................... 20candesartan cilexetil tab 32 mg (Atacand).................... 20capecitabine tab 150 mg (Xeloda).................................... 8capecitabine tab 500 mg (Xeloda).................................... 8CAPRELSA – vandetanib tab 100 mg................................. 8CAPRELSA – vandetanib tab 300 mg................................. 8CAPTOPRIL/HYDROCHLOROTHIA – captopril &hydrochlorothiazide tab 25-15 mg.................................... 19

CAPTOPRIL/HYDROCHLOROTHIA – captopril &hydrochlorothiazide tab 50-15 mg.................................... 19

captopril tab 12.5 mg........................................................18captopril tab 25 mg...........................................................18captopril tab 50 mg...........................................................19captopril tab 100 mg.........................................................19carbamazepine cap sr 12hr 100 mg (Carbatrol)............45carbamazepine cap sr 12hr 200 mg (Carbatrol)............45carbamazepine cap sr 12hr 300 mg (Carbatrol)............45carbamazepine chew tab 100 mg................................... 45carbamazepine susp 100 mg/5ml (Tegretol)..................45carbamazepine tab 200 mg (Tegretol)............................45carbamazepine tab sr 12hr 100 mg (Tegretol-xr).......... 45carbamazepine tab sr 12hr 200 mg (Tegretol-xr).......... 45carbamazepine tab sr 12hr 400 mg (Tegretol-xr).......... 45carbidopa & levodopa orally disintegrating tab 10-100mg...................................................................................... 46

carbidopa & levodopa orally disintegrating tab 25-100mg...................................................................................... 46

carbidopa & levodopa orally disintegrating tab 25-250mg...................................................................................... 46

2017


carbidopa & levodopa tab cr 25-100 mg (Sinemetcr).......................................................................................46

carbidopa & levodopa tab cr 50-200 mg (Sinemetcr).......................................................................................46

carbidopa & levodopa tab 10-100 mg (Sinemet)...........46carbidopa & levodopa tab 25-100 mg (Sinemet)...........46carbidopa & levodopa tab 25-250 mg (Sinemet)...........47carteolol hcl ophth soln 1%............................................ 49carvedilol tab 3.125 mg (Coreg)......................................21carvedilol tab 6.25 mg (Coreg)........................................21carvedilol tab 12.5 mg (Coreg)........................................21carvedilol tab 25 mg (Coreg)...........................................21cefaclor cap 250 mg........................................................... 2cefaclor cap 500 mg........................................................... 2cefadroxil cap 500 mg........................................................2cefadroxil for susp 250 mg/5ml........................................ 2cefadroxil for susp 500 mg/5ml........................................ 2cefadroxil tab 1 gm.............................................................2cefdinir cap 300 mg............................................................2cefdinir for susp 125 mg/5ml............................................ 2cefdinir for susp 250 mg/5ml............................................ 2cefixime for susp 100 mg/5ml (Suprax)........................... 2cefixime for susp 200 mg/5ml (Suprax)........................... 2cefpodoxime proxetil for susp 50 mg/5ml....................... 2cefpodoxime proxetil for susp 100 mg/5ml..................... 2cefpodoxime proxetil tab 100 mg..................................... 2cefpodoxime proxetil tab 200 mg..................................... 2cefprozil for susp 125 mg/5ml...........................................2cefprozil for susp 250 mg/5ml...........................................2cefprozil tab 250 mg...........................................................3cefprozil tab 500 mg...........................................................3ceftriaxone sodium for inj 2 gm........................................3ceftriaxone sodium for inj 1 gm (Rocephin)....................3ceftriaxone sodium for inj 250 mg....................................3ceftriaxone sodium for inj 500 mg (Rocephin)................3cefuroxime axetil tab 250 mg (Ceftin).............................. 3cefuroxime axetil tab 500 mg (Ceftin).............................. 3celecoxib cap 50 mg (Celebrex)......................................43celecoxib cap 100 mg (Celebrex)....................................43celecoxib cap 200 mg (Celebrex)....................................43celecoxib cap 400 mg (Celebrex)....................................43cephalexin cap 250 mg (Keflex)........................................3cephalexin cap 500 mg (Keflex)........................................3cephalexin for susp 125 mg/5ml.......................................3cephalexin for susp 250 mg/5ml.......................................3cetirizine hcl oral soln 1 mg/ml (5 mg/5ml)................... 27cevimeline hcl cap 30 mg (Evoxac)................................50CHANTIX CONTINUING MONTH – varenicline tartrate tab1 mg (base equiv).............................................................40

CHANTIX STARTING MONTH PA – varenicline tartratetab 0.5 mg x 11 & tab 1 mg x 42 pack............................. 40

CHANTIX – varenicline tartrate tab 0.5 mg (baseequiv)................................................................................. 40

CHANTIX – varenicline tartrate tab 1 mg (base equiv)......40CHEMET – succimer cap 100 mg......................................55CHENODAL – chenodiol tab 250 mg.................................32

CHLORDIAZEPOXIDE/AMITRIPT – chlordiazepoxide-amitriptyline tab 5-12.5 mg............................................... 40

chlorhexidine gluconate soln 0.12% (Peridex)..............50chloroquine phosphate tab 500 mg (Aralen)...................7chlorothiazide tab 500 mg............................................... 24chlorpromazine hcl tab 10 mg........................................ 35chlorpromazine hcl tab 25 mg........................................ 35chlorpromazine hcl tab 50 mg........................................ 35chlorpromazine hcl tab 100 mg...................................... 35chlorpromazine hcl tab 200 mg...................................... 35chlorthalidone tab 25 mg.................................................24chlorthalidone tab 50 mg.................................................24chlorzoxazone tab 500 mg (Parafon forte dsc)............. 47cholestyramine light powder 4 gm/dose (Questranlight)...................................................................................23

cholestyramine light powder packets 4 gm.................. 23cholestyramine powder 4 gm/dose (Questran).............23cholestyramine powder packets 4 gm (Questran)........23choline fenofibrate cap dr 45 mg (fenofibric acidequiv) (Trilipix).................................................................23

choline fenofibrate cap dr 135 mg (fenofibric acidequiv) (Trilipix).................................................................23

chorionic gonadotropin for inj 10000 unit..................... 14CIALIS – tadalafil tab 2.5 mg............................................. 27CIALIS – tadalafil tab 5 mg................................................ 27CIALIS – tadalafil tab 10 mg.............................................. 27CIALIS – tadalafil tab 20 mg.............................................. 27ciclopirox gel 0.77% (Loprox)......................................... 51ciclopirox olamine cream 0.77% (base equiv)...............51ciclopirox olamine susp 0.77% (base equiv).................51ciclopirox shampoo 1% (Loprox shampoo).................. 51ciclopirox solution 8% (Penlac nail lacquer).................51cilostazol tab 50 mg (Pletal)............................................48cilostazol tab 100 mg (Pletal)..........................................48cimetidine hcl soln 300 mg/5ml...................................... 30cimetidine tab 300 mg......................................................30cimetidine tab 400 mg......................................................30cimetidine tab 800 mg......................................................30ciprofloxacin-ciprofloxacin hcl tab sr 24hr 1000mg(base eq) (Cipro xr)..................................................... 4

ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 mg(base eq) (Cipro xr)...........................................................4

ciprofloxacin for oral susp 250 mg/5ml (5%) (5gm/100ml) (Cipro)..............................................................4

ciprofloxacin for oral susp 500 mg/5ml (10%) (10gm/100ml) (Cipro)..............................................................4

CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg(base equiv).........................................................................4

ciprofloxacin hcl ophth soln 0.3% (Ciloxan)................. 49ciprofloxacin hcl tab 750 mg (base equiv).......................4ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)..........4ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)..........4citalopram hydrobromide oral soln 10 mg/5ml............. 33citalopram hydrobromide tab 10 mg (base equiv)(Celexa)............................................................................. 33

2017


citalopram hydrobromide tab 20 mg (base equiv)(Celexa)............................................................................. 33

citalopram hydrobromide tab 40 mg (base equiv)(Celexa)............................................................................. 34

clarithromycin for susp 125 mg/5ml.................................3clarithromycin for susp 250 mg/5ml (Biaxin).................. 3clarithromycin tab 250 mg (Biaxin).................................. 3clarithromycin tab 500 mg (Biaxin).................................. 3clarithromycin tab sr 24hr 500 mg (Biaxin xl pac)..........3CLEMASTINE FUMARATE – clemastine fumarate tab2.68 mg..............................................................................27

CLIMARA PRO – estradiol-levonorgestrel td patch weekly0.045-0.015 mg/day.......................................................... 12

clindamycin hcl cap 75 mg (Cleocin)...............................8clindamycin hcl cap 150 mg (Cleocin).............................8clindamycin hcl cap 300 mg (Cleocin).............................8clindamycin palmitate hcl for soln 75 mg/5ml (baseequiv) (Cleocin pediatric gr)............................................ 8

clindamycin phosphate-benzoyl peroxide gel 1-5%(Benzaclin)........................................................................51

clindamycin phosphate gel 1% (Cleocin-t)....................51clindamycin phosphate lotion 1% (Cleocin-t)............... 51clindamycin phosphate soln 1% (Cleocin-t)..................51clindamycin phosphate swab 1% (Cleocin-t)................ 51clindamycin phosphate vaginal cream 2%(Cleocin)............................................................................32

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2(1)-5% (Duac)....................................................................51

clobetasol propionate cream 0.05% (Temovate)...........52clobetasol propionate emollient base cream 0.05%(Temovate e).....................................................................52

clobetasol propionate foam 0.05% (Olux)......................52clobetasol propionate gel 0.05% (Temovate)................ 52clobetasol propionate oint 0.05% (Temovate)...............52clobetasol propionate soln 0.05% (Temovate).............. 52clomipramine hcl cap 25 mg (Anafranil)........................34clomipramine hcl cap 50 mg (Anafranil)........................34clomipramine hcl cap 75 mg (Anafranil)........................34clonazepam tab 0.5 mg (Klonopin).................................45clonazepam tab 1 mg (Klonopin)....................................45clonazepam tab 2 mg (Klonopin)....................................45clonidine hcl tab 0.1 mg (Catapres)............................... 26clonidine hcl tab 0.2 mg (Catapres)............................... 26clonidine hcl tab 0.3 mg (Catapres)............................... 26clonidine hcl td patch weekly 0.1 mg/24hr (Catapres-tts-1)...................................................................................26

clonidine hcl td patch weekly 0.2 mg/24hr (Catapres-tts-2)...................................................................................26

clonidine hcl td patch weekly 0.3 mg/24hr (Catapres-tts-3)...................................................................................26

clopidogrel bisulfate tab 75 mg (base equiv)(Plavix).............................................................................. 48

clotrimazole troche 10 mg............................................... 50clozapine tab 50 mg......................................................... 35clozapine tab 200 mg....................................................... 35clozapine tab 25 mg (Clozaril).........................................35

clozapine tab 100 mg (Clozaril).......................................35codeine sulfate tab 30 mg............................................... 41codeine sulfate tab 60 mg............................................... 41codeine sulfate tab 15 mg (Codeine sulfate).................41colchicine w/ probenecid tab 0.5-500 mg...................... 44COLCRYS – colchicine tab 0.6 mg....................................44colestipol hcl granule packets 5 gm (Colestidflavored)............................................................................24

colestipol hcl granules 5 gm (Colestid flavored).......... 24colestipol hcl tab 1 gm (Colestid)...................................24COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60mg dose) kit.........................................................................8

COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20mg (100 dose) kit................................................................ 8

COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20mg (140 dose) kit................................................................ 8

COMPLERA – emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg.................................................................... 5

CONCERTA – methylphenidate hcl tab sa osm 18 mg......38CONCERTA – methylphenidate hcl tab sa osm 27 mg......38CONCERTA – methylphenidate hcl tab sa osm 36 mg......38CONCERTA – methylphenidate hcl tab sa osm 54 mg......38CONTOUR NEXT ONE BLOOD GL – blood glucosemonitoring kit..................................................................... 54

COPAXONE – glatiramer acetate soln prefilled syringe 20mg/ml..................................................................................39

COPAXONE – glatiramer acetate soln prefilled syringe 40mg/ml..................................................................................39

CORTIFOAM – hydrocortisone acetate rectal foam 10%(90 mg/dose)..................................................................... 50

CORTISONE ACETATE – cortisone acetate tab 25mg...................................................................................... 11

COTELLIC – cobimetinib fumarate tab 20 mg (baseequivalent)............................................................................8

CREON – pancrelipase (lip-prot-amyl) dr cap3000-9500-15000 unit....................................................... 31

CREON – pancrelipase (lip-prot-amyl) dr cap6000-19000-30000 unit..................................................... 31

CREON – pancrelipase (lip-prot-amyl) dr cap12000-38000-60000 unit...................................................31

CREON – pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit.................................................31

CREON – pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit............................................... 31

CROMOLYN SODIUM – cromolyn sodium soln nebu 20mg/2ml............................................................................... 28

cromolyn sodium ophth soln 4%....................................50cyanocobalamin inj 1000 mcg/ml................................... 48cyclobenzaprine hcl tab 5 mg.........................................47cyclobenzaprine hcl tab 10 mg.......................................47cyclopentolate hcl ophth soln 1% (Cyclogyl)................50CYCLOPHOSPHAMIDE – cyclophosphamide cap 25mg........................................................................................ 8

CYCLOPHOSPHAMIDE – cyclophosphamide cap 50mg........................................................................................ 9

cyclosporine cap 25 mg (Sandimmune)........................ 56

2017


cyclosporine cap 100 mg (Sandimmune)...................... 56cyclosporine modified cap 50 mg (Cyclosporinemodifie)............................................................................. 56

cyclosporine modified cap 25 mg (Neoral)....................56cyclosporine modified cap 100 mg (Neoral)..................56cyclosporine modified oral soln 100 mg/ml(Neoral)..............................................................................56

cyproheptadine hcl syrup 2 mg/5ml...............................27cyproheptadine hcl tab 4 mg.......................................... 27CYSTAGON – cysteamine bitartrate cap 50 mg................33CYSTAGON – cysteamine bitartrate cap 150 mg..............33

Ddanazol cap 50 mg............................................................12danazol cap 100 mg..........................................................12danazol cap 200 mg..........................................................12dantrolene sodium cap 25 mg (Dantrium)..................... 47dantrolene sodium cap 50 mg (Dantrium)..................... 47dantrolene sodium cap 100 mg (Dantrolenesodium)............................................................................. 47

dapsone tab 25 mg.............................................................8dapsone tab 100 mg...........................................................8DARAPRIM – pyrimethamine tab 25 mg............................. 7DELZICOL – mesalamine cap dr 400 mg..........................32demeclocycline hcl tab 150 mg........................................ 3demeclocycline hcl tab 300 mg........................................ 3DEPEN TITRATABS – penicillamine tab 250 mg.............. 56DESCOVY – emtricitabine-tenofovir alafenamide fumaratetab 200-25 mg..................................................................... 5

desipramine hcl tab 10 mg (Norpramin)........................ 34desipramine hcl tab 25 mg (Norpramin)........................ 34desipramine hcl tab 50 mg (Norpramin)........................ 34desipramine hcl tab 75 mg (Norpramin)........................ 34desipramine hcl tab 100 mg (Norpramin)...................... 34desipramine hcl tab 150 mg (Norpramin)...................... 34DESLORATADINE ODT – desloratadine tab orallydisintegrating 2.5 mg.........................................................27

DESLORATADINE ODT – desloratadine tab orallydisintegrating 5 mg............................................................27

desloratadine tab 5 mg (Clarinex).................................. 27desmopressin acetate inj 4 mcg/ml (Ddavp).................17desmopressin acetate nasal soln 0.01% (refrigerated)(Ddavp)..............................................................................17

desmopressin acetate nasal spray soln 0.01%(Ddavp)..............................................................................17

desmopressin acetate nasal spray soln 0.01%(refrigerated).....................................................................17

desmopressin acetate tab 0.1 mg (Ddavp)....................17desmopressin acetate tab 0.2 mg (Ddavp)....................17desogest-eth estrad & eth estrad tab 0.15-0.02/0.01mg(21/5) (Mircette).......................................................... 13

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa).....13

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg(Desogen)......................................................................... 13

desonide cream 0.05% (Desowen)................................. 52

desonide lotion 0.05% (Desowen).................................. 52desonide oint 0.05% (Desowen)......................................52desoximetasone cream 0.05% (Topicort).......................52desoximetasone cream 0.25% (Topicort).......................52desoximetasone gel 0.05% (Topicort)............................ 52desoximetasone oint 0.25% (Topicort)...........................52DEXAMETHASONE – dexamethasone soln 0.5mg/5ml............................................................................... 11

dexamethasone elixir 0.5 mg/5ml................................... 11dexamethasone tab 0.5 mg............................................. 11dexamethasone tab 0.75 mg........................................... 12dexamethasone tab 1.5 mg............................................. 12dexamethasone tab 4 mg................................................ 12dexamethasone tab 6 mg................................................ 12dexmethylphenidate hcl cap sr 24 hr 5 mg (Focalinxr).......................................................................................38

dexmethylphenidate hcl cap sr 24 hr 10 mg (Focalinxr).......................................................................................38





dextroamphetamine sulfate cap sr 24hr 5 mg(Dexedrine)....................................................................... 38



dextroamphetamine sulfate tab 5 mg.............................38dextroamphetamine sulfate tab 10 mg...........................38DIASTAT ACUDIAL – diazepam rectal gel delivery system10 mg.................................................................................45

DIASTAT ACUDIAL – diazepam rectal gel delivery system20 mg.................................................................................45

DIASTAT PEDIATRIC – diazepam rectal gel deliverysystem 2.5 mg...................................................................45

diazepam tab 2 mg (Valium)............................................33diazepam tab 5 mg (Valium)............................................33diazepam tab 10 mg (Valium)..........................................33diclofenac potassium tab 50 mg (Cataflam)..................43diclofenac sodium (actinic keratoses) gel 3%(Solaraze)..........................................................................53

diclofenac sodium gel 1% (Voltaren)..............................51diclofenac sodium ophth soln 0.1%...............................50diclofenac sodium tab delayed release 25 mg..............43diclofenac sodium tab delayed release 50 mg..............43diclofenac sodium tab delayed release 75 mg..............43diclofenac sodium tab sr 24hr 100 mg (Voltaren-xr).......................................................................................43

dicloxacillin sodium cap 250 mg...................................... 2dicloxacillin sodium cap 500 mg...................................... 2dicyclomine hcl cap 10 mg (Bentyl)...............................30

2017


dicyclomine hcl oral soln 10 mg/5ml............................. 30dicyclomine hcl tab 20 mg (Bentyl)................................30didanosine delayed release capsule 125 mg (Videxec)........................................................................................ 5

didanosine delayed release capsule 200 mg (Videxec)........................................................................................ 6



digoxin tab 125 mcg (0.125 mg) (Lanoxin).................... 26digoxin tab 250 mcg (0.25 mg) (Lanoxin)...................... 26DILANTIN – phenytoin sodium extended cap 30 mg.........45diltiazem hcl cap sr 24hr 120 mg....................................22diltiazem hcl cap sr 24hr 180 mg....................................22diltiazem hcl cap sr 24hr 240 mg....................................22diltiazem hcl coated beads cap sr 24hr 120 mg(Cardizem cd)...................................................................22

diltiazem hcl coated beads cap sr 24hr 180 mg(Cardizem cd)...................................................................22




diltiazem hcl extended release beads cap sr 24hr 120mg (Tiazac).......................................................................22






diltiazem hcl tab 90 mg....................................................22diltiazem hcl tab 30 mg (Cardizem)................................22diltiazem hcl tab 60 mg (Cardizem)................................22diltiazem hcl tab 120 mg (Cardizem)..............................22diphenoxylate w/ atropine tab 2.5-0.025 mg(Lomotil)............................................................................30

dipyridamole tab 25 mg (Persantine)............................. 48dipyridamole tab 50 mg (Persantine)............................. 48dipyridamole tab 75 mg (Persantine)............................. 48disopyramide phosphate cap 100 mg (Norpace).......... 25disopyramide phosphate cap 150 mg (Norpace).......... 25disulfiram tab 250 mg (Antabuse).................................. 40disulfiram tab 500 mg (Antabuse).................................. 40divalproex sodium cap delayed release sprinkle 125mg (Depakote sprinkles)................................................ 45

divalproex sodium tab delayed release 125 mg(Depakote)........................................................................ 45



divalproex sodium tab sr 24 hr 250 mg (Depakoteer).......................................................................................45

divalproex sodium tab sr 24 hr 500 mg (Depakoteer).......................................................................................45

DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%)...........12DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%)...............12DIVIGEL – estradiol td gel 1 mg/gm (0.1%).......................12donepezil hydrochloride orally disintegrating tab 5 mg(Aricept odt)..................................................................... 40

donepezil hydrochloride orally disintegrating tab 10mg (Aricept odt).............................................................. 40

donepezil hydrochloride tab 5 mg (Aricept)..................40donepezil hydrochloride tab 10 mg (Aricept)................40dorzolamide hcl ophth soln 2% (Trusopt)..................... 49dorzolamide hcl-timolol maleate ophth soln 22.3-6.8mg/ml (Cosopt)................................................................ 49

doxazosin mesylate tab 1 mg (Cardura)........................26doxazosin mesylate tab 2 mg (Cardura)........................26doxazosin mesylate tab 4 mg (Cardura)........................26doxazosin mesylate tab 8 mg (Cardura)........................26doxepin hcl cap 10 mg.....................................................34doxepin hcl cap 25 mg.....................................................34doxepin hcl cap 50 mg.....................................................34doxepin hcl cap 100 mg...................................................34doxepin hcl conc 10 mg/ml............................................. 34DOXEPIN HCL – doxepin hcl cap 75 mg.......................... 34doxycycline hyclate cap 50 mg.........................................3doxycycline hyclate cap 100 mg (Vibramycin)................3doxycycline hyclate tab 20 mg......................................... 3doxycycline hyclate tab 100 mg....................................... 3doxycycline monohydrate cap 50 mg.............................. 3doxycycline monohydrate cap 150 mg (Adoxa)..............3doxycycline monohydrate cap 75 mg (Monodox)...........3doxycycline monohydrate cap 100 mg (Monodox).........3doxycycline monohydrate tab 50 mg (Adoxa)................ 3doxycycline monohydrate tab 75 mg (Adoxa)................ 3doxycycline monohydrate tab 100 mg (Adoxa pak1/100)................................................................................... 3

doxycycline monohydrate tab 150 mg (Adoxa pak1/150)................................................................................... 3

drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin28)...................................................................................... 13

drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz)......13DULERA – mometasone furoate-formoterol fumarateaerosol 100-5 mcg/act...................................................... 29

DULERA – mometasone furoate-formoterol fumarateaerosol 200-5 mcg/act...................................................... 29

duloxetine hcl enteric coated pellets cap 20 mg(Cymbalta)........................................................................ 34


2017



dutasteride cap 0.5 mg (Avodart)................................... 33E

econazole nitrate cream 1%............................................ 51ELIQUIS – apixaban tab 2.5 mg........................................ 48ELIQUIS – apixaban tab 5 mg........................................... 48ELLA – ulipristal acetate tab 30 mg...................................14EMCYT – estramustine phosphate sodium cap 140 mg......9EMEND – aprepitant capsule 40 mg..................................31EMEND – aprepitant capsule 125 mg................................31EMEND – aprepitant for oral susp 125 mg (125mg/5ml).............................................................................. 31

enalapril maleate & hydrochlorothiazide tab 5-12.5mg...................................................................................... 19

enalapril maleate & hydrochlorothiazide tab 10-25 mg(Vaseretic).........................................................................19

enalapril maleate tab 2.5 mg (Vasotec)..........................19enalapril maleate tab 5 mg (Vasotec).............................19enalapril maleate tab 10 mg (Vasotec)...........................19enalapril maleate tab 20 mg (Vasotec)...........................19ENBREL – etanercept for subcutaneous inj 25 mg........... 43ENBREL – etanercept subcutaneous soln prefilled syringe25 mg/0.5ml.......................................................................43

ENBREL – etanercept subcutaneous soln prefilled syringe50 mg/ml............................................................................43

ENBREL SURECLICK – etanercept subcutaneoussolution auto-injector 50 mg/ml.........................................43

enoxaparin sodium inj 30 mg/0.3ml (Lovenox)............. 48enoxaparin sodium inj 40 mg/0.4ml (Lovenox)............. 48enoxaparin sodium inj 60 mg/0.6ml (Lovenox)............. 48enoxaparin sodium inj 80 mg/0.8ml (Lovenox)............. 48enoxaparin sodium inj 100 mg/ml (Lovenox)................ 48enoxaparin sodium inj 120 mg/0.8ml (Lovenox)........... 48enoxaparin sodium inj 150 mg/ml (Lovenox)................ 48enoxaparin sodium inj 300 mg/3ml (Lovenox).............. 48entacapone tab 200 mg (Comtan)...................................47entecavir tab 0.5 mg (Baraclude)......................................5entecavir tab 1 mg (Baraclude).........................................5ENTRESTO – sacubitril-valsartan tab 24-26 mg............... 26ENTRESTO – sacubitril-valsartan tab 49-51 mg............... 26ENTRESTO – sacubitril-valsartan tab 97-103 mg............. 26EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg........... 5EPINEPHRINE (Mylan products) – epinephrine solutionauto-injector 0.15 mg/0.3ml (1:2000)................................27

EPINEPHRINE (Mylan products) – epinephrine solutionauto-injector 0.3 mg/0.3ml (1:1000)..................................27

eplerenone tab 25 mg (Inspra)........................................26eplerenone tab 50 mg (Inspra)........................................26ergocalciferol cap 50000 unit (Drisdol)..........................47ERIVEDGE – vismodegib cap 150 mg................................ 9erythromycin gel 2% (Erygel)..........................................51erythromycin ophth oint 5 mg/gm..................................49erythromycin pads 2%..................................................... 51erythromycin soln 2%...................................................... 51

erythromycin w/ delayed release particles cap 250mg........................................................................................ 3

escitalopram oxalate soln 5 mg/5ml (base equiv)(Lexapro)...........................................................................34

escitalopram oxalate tab 5 mg (base equiv)(Lexapro)...........................................................................34



esomeprazole magnesium cap delayed release 20 mg(base eq) (Nexium)..........................................................30

esomeprazole magnesium cap delayed release 40 mg(base eq) (Nexium)..........................................................30

estazolam tab 1 mg.......................................................... 37estazolam tab 2 mg.......................................................... 37ESTRACE – estradiol vaginal cream 0.1 mg/gm...............32estradiol & norethindrone acetate tab 0.5-0.1 mg(Activella)..........................................................................12

estradiol & norethindrone acetate tab 1-0.5 mg(Activella)..........................................................................12

estradiol tab 0.5 mg (Estrace).........................................12estradiol tab 1 mg (Estrace)............................................13estradiol tab 2 mg (Estrace)............................................13estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-dot).....................................................................................13

estradiol td patch twice weekly 0.0375 mg/24hr(Vivelle-dot)...................................................................... 13

estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-dot).....................................................................................13



estradiol td patch weekly 0.025 mg/24hr (Climara).......13estradiol td patch weekly 0.05 mg/24hr (Climara).........13estradiol td patch weekly 0.06 mg/24hr (Climara).........13estradiol td patch weekly 0.075 mg/24hr (Climara).......13estradiol td patch weekly 0.1 mg/24hr (Climara)...........13estradiol td patch weekly 0.0375 mg/24hr (37.5mcg/24hr) (Climara).........................................................13

eszopiclone tab 1 mg (Lunesta)......................................37eszopiclone tab 2 mg (Lunesta)......................................37eszopiclone tab 3 mg (Lunesta)......................................37ethambutol hcl tab 100 mg (Myambutol)......................... 4ethambutol hcl tab 400 mg (Myambutol)......................... 4ethosuximide cap 250 mg (Zarontin)..............................45ethosuximide soln 250 mg/5ml (Zarontin)..................... 45ethynodiol diacetate & ethinyl estradiol tab 1 mg-35mcg....................................................................................14

ethynodiol diacetate & ethinyl estradiol tab 1 mg-50mcg (Zovia 1/50e)............................................................14

etodolac cap 200 mg........................................................ 43etodolac cap 300 mg........................................................ 43etodolac tab 400 mg.........................................................43etodolac tab 500 mg.........................................................43

2017


etodolac tab sr 24hr 400 mg........................................... 43etodolac tab sr 24hr 500 mg........................................... 43etodolac tab sr 24hr 600 mg........................................... 43ETOPOSIDE – etoposide cap 50 mg...................................9EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg(base equiv).........................................................................6

exemestane tab 25 mg (Aromasin)...................................9F

famciclovir tab 125 mg (Famvir)....................................... 5famciclovir tab 250 mg (Famvir)....................................... 5famciclovir tab 500 mg (Famvir)....................................... 5famotidine tab 20 mg (Pepcid)........................................30famotidine tab 40 mg (Pepcid)........................................30FARESTON – toremifene citrate tab 60 mg (baseequivalent)............................................................................9

FARYDAK – panobinostat lactate cap 10 mg (baseequivalent)............................................................................9



felodipine tab sr 24hr 2.5 mg.......................................... 22felodipine tab sr 24hr 5 mg............................................. 22felodipine tab sr 24hr 10 mg........................................... 22fenofibrate micronized cap 67 mg (Lofibra).................. 24fenofibrate micronized cap 134 mg (Lofibra)................ 24fenofibrate micronized cap 200 mg (Lofibra)................ 24fenofibrate tab 54 mg (Lofibra)....................................... 24fenofibrate tab 160 mg (Lofibra)..................................... 24fenofibrate tab 48 mg (Tricor)......................................... 24fenofibrate tab 145 mg (Tricor)....................................... 24fentanyl citrate lozenge on a handle 200 mcg(Actiq)................................................................................41

fentanyl citrate lozenge on a handle 400 mcg(Actiq)................................................................................41





fentanyl td patch 72hr 12 mcg/hr (Duragesic)...............41fentanyl td patch 72hr 25 mcg/hr (Duragesic)...............41fentanyl td patch 72hr 50 mcg/hr (Duragesic)...............41fentanyl td patch 72hr 75 mcg/hr (Duragesic)...............41fentanyl td patch 72hr 100 mcg/hr (Duragesic).............41FINACEA – azelaic acid foam 15%................................... 51FINACEA – azelaic acid gel 15%.......................................51finasteride tab 5 mg (Proscar)........................................ 33FINGERSTIX LANCETS – lancets.....................................55FIRAZYR – icatibant acetate inj 30 mg/3ml (baseequivalent)......................................................................... 48

flecainide acetate tab 50 mg........................................... 25

flecainide acetate tab 100 mg......................................... 25flecainide acetate tab 150 mg......................................... 25fluconazole for susp 10 mg/ml (Diflucan)........................4fluconazole for susp 40 mg/ml (Diflucan)........................4fluconazole tab 50 mg (Diflucan)......................................4fluconazole tab 100 mg (Diflucan)....................................4fluconazole tab 150 mg (Diflucan)....................................4fluconazole tab 200 mg (Diflucan)....................................4flucytosine cap 250 mg (Ancobon)...................................4flucytosine cap 500 mg (Ancobon)...................................4fludrocortisone acetate tab 0.1 mg.................................12flunisolide nasal soln 25 mcg/act (0.025%)................... 27fluocinolone acetonide cream 0.01%............................. 52fluocinolone acetonide cream 0.025% (Synalar)...........52fluocinolone acetonide oil 0.01% (body oil) (Derma-smoothe/fs bod).............................................................. 52

fluocinolone acetonide oil 0.01% (scalp oil) (Derma-smoothe/fs sca)............................................................... 52

fluocinolone acetonide oint 0.025% (Synalar)...............52fluocinolone acetonide soln 0.01% (Synalar)................52fluocinonide cream 0.05%............................................... 52fluocinonide emulsified base cream 0.05%...................52fluocinonide gel 0.05%.....................................................52fluocinonide oint 0.05%....................................................52fluocinonide soln 0.05%...................................................52fluorometholone ophth susp 0.1% (Fml liquifilm)........ 49fluorouracil cream 5% (Efudex)...................................... 53fluorouracil soln 2%......................................................... 53fluorouracil soln 5%......................................................... 53FLUOXETINE DR – fluoxetine hcl cap delayed release 90mg...................................................................................... 34

fluoxetine hcl cap 10 mg (Prozac)..................................34fluoxetine hcl cap 20 mg (Prozac)..................................34fluoxetine hcl cap 40 mg (Prozac)..................................34fluoxetine hcl solution 20 mg/5ml.................................. 34fluoxetine hcl tab 10 mg.................................................. 34fluoxetine hcl tab 20 mg.................................................. 34fluphenazine decanoate inj 25 mg/ml.............................35fluphenazine hcl tab 1 mg............................................... 35fluphenazine hcl tab 2.5 mg............................................ 35fluphenazine hcl tab 5 mg............................................... 35fluphenazine hcl tab 10 mg............................................. 35FLURAZEPAM HCL – flurazepam hcl cap 15 mg..............37FLURAZEPAM HCL – flurazepam hcl cap 30 mg..............37flurbiprofen sodium ophth soln 0.03% (Ocufen)...........50flurbiprofen tab 50 mg......................................................43flurbiprofen tab 100 mg................................................... 43flutamide cap 125 mg.........................................................9fluticasone propionate cream 0.05% (Cutivate)............ 52fluticasone propionate nasal susp 50 mcg/act(Flonase)........................................................................... 27

fluticasone propionate oint 0.005% (Cutivate).............. 52fluvoxamine maleate tab 25 mg......................................34fluvoxamine maleate tab 50 mg......................................34fluvoxamine maleate tab 100 mg....................................34folic acid tab 1 mg............................................................48

2017


FOLLISTIM AQ – follitropin beta inj 75 unit/0.5ml..............14FOLLISTIM AQ – follitropin beta inj 300 unit/0.36ml..........15FOLLISTIM AQ – follitropin beta inj 600 unit/0.72ml..........15FOLLISTIM AQ – follitropin beta inj 900 unit/1.08ml..........15fosinopril sodium & hydrochlorothiazide tab 10-12.5mg...................................................................................... 19

fosinopril sodium & hydrochlorothiazide tab 20-12.5mg...................................................................................... 19

fosinopril sodium tab 10 mg........................................... 19fosinopril sodium tab 20 mg........................................... 19fosinopril sodium tab 40 mg........................................... 19furosemide oral soln 10 mg/ml....................................... 24furosemide tab 20 mg (Lasix)......................................... 24furosemide tab 40 mg (Lasix)......................................... 24furosemide tab 80 mg (Lasix)......................................... 24G

gabapentin cap 100 mg (Neurontin)...............................45gabapentin cap 300 mg (Neurontin)...............................45gabapentin cap 400 mg (Neurontin)...............................45gabapentin oral soln 250 mg/5ml (Neurontin)...............45gabapentin tab 600 mg (Neurontin)................................45gabapentin tab 800 mg (Neurontin)................................45galantamine hydrobromide cap sr 24hr 8 mg(Razadyne er)...................................................................40

galantamine hydrobromide cap sr 24hr 16 mg(Razadyne er)...................................................................40

galantamine hydrobromide cap sr 24hr 24 mg(Razadyne er)...................................................................40

GALANTAMINE HYDROBROMIDE – galantaminehydrobromide oral soln 4 mg/ml.......................................40

galantamine hydrobromide tab 4 mg (Razadyne).........40galantamine hydrobromide tab 8 mg (Razadyne).........40galantamine hydrobromide tab 12 mg (Razadyne).......40gemfibrozil tab 600 mg (Lopid).......................................24gentamicin sulfate cream 0.1%.......................................51gentamicin sulfate ophth oint 0.3%................................49gentamicin sulfate ophth soln 0.3% (Garamycin).........49GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg.............................................................6

GILENYA – fingolimod hcl cap 0.5 mg (base equiv)..........39GILOTRIF – afatinib dimaleate tab 20 mg (baseequivalent)............................................................................9

GILOTRIF – afatinib dimaleate tab 30 mg (baseequivalent)............................................................................9

GILOTRIF – afatinib dimaleate tab 40 mg (baseequivalent)............................................................................9

glatiramer acetate soln prefilled syringe 20 mg/ml(Copaxone)....................................................................... 39

GLEOSTINE – lomustine cap 5 mg..................................... 9GLEOSTINE – lomustine cap 10 mg................................... 9GLEOSTINE – lomustine cap 40 mg................................... 9GLEOSTINE – lomustine cap 100 mg................................. 9glimepiride tab 1 mg (Amaryl).........................................15glimepiride tab 2 mg (Amaryl).........................................15glimepiride tab 4 mg (Amaryl).........................................15

glipizide-metformin hcl tab 2.5-250 mg..........................15glipizide-metformin hcl tab 2.5-500 mg..........................15glipizide-metformin hcl tab 5-500 mg.............................15glipizide tab 5 mg (Glucotrol)..........................................15glipizide tab 10 mg (Glucotrol)........................................15glipizide tab sr 24hr 2.5 mg (Glucotrol xl)..................... 15glipizide tab sr 24hr 5 mg (Glucotrol xl)........................ 15glipizide tab sr 24hr 10 mg (Glucotrol xl)...................... 15GLUCAGON EMERGENCY KIT – glucagon (rdna) for injkit 1 mg..............................................................................15

glyburide-metformin tab 1.25-250 mg(Glucovance).................................................................... 15

glyburide-metformin tab 2.5-500 mg (Glucovance)...... 15glyburide-metformin tab 5-500 mg (Glucovance)......... 15glyburide micronized tab 1.5 mg (Glynase)...................15glyburide micronized tab 3 mg (Glynase)......................15glyburide micronized tab 6 mg (Glynase)......................15glyburide tab 1.25 mg.......................................................15glyburide tab 2.5 mg.........................................................15glyburide tab 5 mg............................................................15glycopyrrolate tab 1 mg (Robinul)..................................30glycopyrrolate tab 2 mg (Robinul forte).........................30granisetron hcl tab 1 mg................................................. 31griseofulvin microsize susp 125 mg/5ml......................... 4griseofulvin microsize tab 500 mg (Grifulvin v)..............5guanfacine hcl tab 1 mg (Tenex).................................... 26guanfacine hcl tab 2 mg (Tenex).................................... 26guanfacine hcl tab sr 24hr 1 mg (base equiv)(Intuniv).............................................................................38

guanfacine hcl tab sr 24hr 2 mg (base equiv)(Intuniv).............................................................................38

guanfacine hcl tab sr 24hr 3 mg (base equiv)(Intuniv).............................................................................38

guanfacine hcl tab sr 24hr 4 mg (base equiv)(Intuniv).............................................................................38H

halobetasol propionate cream 0.05% (Ultravate)..........52halobetasol propionate oint 0.05% (Ultravate)..............52haloperidol decanoate im soln 50 mg/ml (Haldoldecanoate 50)...................................................................35

haloperidol decanoate im soln 100 mg/ml (Haldoldecanoate 100).................................................................35

haloperidol lactate oral conc 2 mg/ml............................35haloperidol tab 0.5 mg..................................................... 35haloperidol tab 1 mg........................................................ 35haloperidol tab 2 mg........................................................ 35haloperidol tab 5 mg........................................................ 35haloperidol tab 10 mg...................................................... 35haloperidol tab 20 mg...................................................... 35HARVONI – ledipasvir-sofosbuvir tab 90-400 mg................5HEXALEN – altretamine cap 50 mg.....................................9HUMIRA – adalimumab prefilled syringe kit 10mg/0.2ml............................................................................ 43

HUMIRA – adalimumab prefilled syringe kit 20mg/0.4ml............................................................................ 43

2017


HUMIRA – adalimumab prefilled syringe kit 40mg/0.8ml............................................................................ 43

HUMIRA PEDIATRIC CROHNS D – adalimumab prefilledsyringe kit 40 mg/0.8ml.....................................................43

HUMIRA PEN – adalimumab pen-injector kit 40mg/0.8ml............................................................................ 43

HUMIRA PEN-CROHNS DISEASE – adalimumab pen-injector kit 40 mg/0.8ml.....................................................43

HUMIRA PEN-PSORIASIS STAR – adalimumab pen-injector kit 40 mg/0.8ml.....................................................43

HYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)....... 9HYCAMTIN – topotecan hcl cap 1 mg (base equiv)............ 9hydralazine hcl tab 10 mg............................................... 26hydralazine hcl tab 25 mg............................................... 26hydralazine hcl tab 50 mg............................................... 26hydralazine hcl tab 100 mg............................................. 26hydrochlorothiazide cap 12.5 mg (Microzide)............... 24hydrochlorothiazide tab 12.5 mg.................................... 24hydrochlorothiazide tab 25 mg....................................... 24hydrochlorothiazide tab 50 mg....................................... 24hydrocodone-acetaminophen soln 7.5-325 mg/15ml(Hycet)............................................................................... 41

hydrocodone-acetaminophen tab 7.5-325 mg(Norco).............................................................................. 41

hydrocodone-acetaminophen tab 5-325 mg(Norco).............................................................................. 41

hydrocodone-acetaminophen tab 10-325 mg(Norco).............................................................................. 41

hydrocodone-ibuprofen tab 10-200 mg (Ibudone)........ 41hydrocodone-ibuprofen tab 5-200 mg (Reprexain).......41hydrocodone-ibuprofen tab 7.5-200 mg(Vicoprofen)......................................................................41

hydrocortisone cream 2.5%.............................................53hydrocortisone enema 100 mg/60ml (Cortenema)........50hydrocortisone lotion 2.5%............................................. 53hydrocortisone oint 2.5%.................................................53hydrocortisone rectal cream 2.5% (Anusol-hc)............ 50hydrocortisone tab 5 mg (Cortef)................................... 12hydrocortisone tab 10 mg (Cortef)................................. 12hydrocortisone tab 20 mg (Cortef)................................. 12hydrocortisone valerate cream 0.2%..............................53hydrocortisone valerate oint 0.2% (Westcort)...............53hydrocortisone w/ acetic acid otic soln 1-2% (Vosolhc)...................................................................................... 50

hydromorphone hcl liqd 1 mg/ml (Dilaudid)..................41hydromorphone hcl tab 2 mg (Dilaudid)........................42hydromorphone hcl tab 4 mg (Dilaudid)........................42hydromorphone hcl tab 8 mg (Dilaudid)........................42hydroxychloroquine sulfate tab 200 mg (Plaquenil).......7hydroxyurea cap 500 mg (Hydrea)................................... 9hydroxyzine hcl syrup 10 mg/5ml...................................33hydroxyzine hcl tab 10 mg.............................................. 33hydroxyzine hcl tab 25 mg.............................................. 33hydroxyzine hcl tab 50 mg.............................................. 33hydroxyzine pamoate cap 25 mg (Vistaril).................... 33hydroxyzine pamoate cap 50 mg (Vistaril).................... 33

Iibandronate sodium tab 150 mg (base equivalent)(Boniva).............................................................................17

IBRANCE – palbociclib cap 75 mg...................................... 9IBRANCE – palbociclib cap 100 mg.................................... 9IBRANCE – palbociclib cap 125 mg.................................... 9ibuprofen susp 100 mg/5ml.............................................43ibuprofen tab 400 mg....................................................... 43ibuprofen tab 600 mg....................................................... 43ibuprofen tab 800 mg....................................................... 43ICLUSIG – ponatinib hcl tab 15 mg (base equiv)................ 9ICLUSIG – ponatinib hcl tab 45 mg (base equiv)................ 9ILARIS – canakinumab for inj 180 mg............................... 43ILARIS – canakinumab subcutaneous inj 150 mg/ml........ 43imatinib mesylate tab 100 mg (base equivalent)(Gleevec).............................................................................9

imatinib mesylate tab 400 mg (base equivalent)(Gleevec).............................................................................9

IMBRUVICA – ibrutinib cap 140 mg.....................................9imipramine hcl tab 10 mg (Tofranil)............................... 34imipramine hcl tab 25 mg (Tofranil)............................... 34imipramine hcl tab 50 mg (Tofranil)............................... 34imiquimod cream 5% (Aldara).........................................53IMPAVIDO – miltefosine cap 50 mg.....................................8INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml).........17indapamide tab 1.25 mg...................................................24indapamide tab 2.5 mg.....................................................24indomethacin cap 25 mg................................................. 43indomethacin cap 50 mg................................................. 43INLYTA – axitinib tab 1 mg...................................................9INLYTA – axitinib tab 5 mg...................................................9INTELENCE – etravirine tab 25 mg.....................................6INTELENCE – etravirine tab 100 mg...................................6INTELENCE – etravirine tab 200 mg...................................6ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml(Duoneb)........................................................................... 29

ipratropium bromide inhal soln 0.02%...........................29ipratropium bromide nasal soln 0.03% (21 mcg/spray)(Atrovent)..........................................................................27

ipratropium bromide nasal soln 0.06% (42 mcg/spray)(Atrovent)..........................................................................27

irbesartan-hydrochlorothiazide tab 150-12.5 mg(Avalide)............................................................................ 20

irbesartan-hydrochlorothiazide tab 300-12.5 mg(Avalide)............................................................................ 20

irbesartan tab 75 mg (Avapro)........................................ 20irbesartan tab 150 mg (Avapro)...................................... 20irbesartan tab 300 mg (Avapro)...................................... 20IRESSA – gefitinib tab 250 mg............................................ 9ISENTRESS – raltegravir potassium chew tab 25 mg(base equiv).........................................................................6

ISENTRESS – raltegravir potassium chew tab 100 mg(base equiv).........................................................................6

ISENTRESS – raltegravir potassium packet for susp 100mg (base equiv).................................................................. 6

2017


ISENTRESS – raltegravir potassium tab 400 mg (baseequiv)....................................................................................6

isoniazid tab 100 mg.......................................................... 4isoniazid tab 300 mg.......................................................... 4isosorbide dinitrate tab 10 mg........................................23isosorbide dinitrate tab 20 mg........................................23isosorbide dinitrate tab 30 mg........................................23isosorbide dinitrate tab 5 mg (Isordil titradose)........... 23isosorbide mononitrate tab 10 mg................................. 23isosorbide mononitrate tab 20 mg................................. 23isosorbide mononitrate tab sr 24hr 30 mg (Imdur).......23isosorbide mononitrate tab sr 24hr 60 mg (Imdur).......23isosorbide mononitrate tab sr 24hr 120 mg (Imdur).....23isotretinoin cap 10 mg..................................................... 51isotretinoin cap 20 mg..................................................... 51isotretinoin cap 40 mg..................................................... 51isotretinoin cap 30 mg (Claravis)....................................51itraconazole cap 100 mg (Sporanox)................................5ivermectin tab 3 mg (Stromectol)..................................... 7J

JAKAFI – ruxolitinib phosphate tab 5 mg (baseequivalent)............................................................................9





JARDIANCE – empagliflozin tab 10 mg.............................15JARDIANCE – empagliflozin tab 25 mg.............................15

KKALETRA – lopinavir-ritonavir tab 100-25 mg.....................6KALETRA – lopinavir-ritonavir tab 200-50 mg.....................6KALYDECO – ivacaftor packet 50 mg............................... 29KALYDECO – ivacaftor packet 75 mg............................... 29KALYDECO – ivacaftor tab 150 mg................................... 29ketoconazole cream 2%................................................... 51ketoconazole shampoo 2% (Nizoral)..............................51ketoprofen cap 50 mg...................................................... 43ketoprofen cap 75 mg...................................................... 43ketorolac tromethamine ophth soln 0.5% (Acular)....... 50ketorolac tromethamine ophth soln 0.4% (Acularls)....................................................................................... 50

KISQALI – ribociclib succinate tab 200 mg (base equiv).....9KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr2.5-1000 mg...................................................................... 15

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr5-500 mg............................................................................15

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr5-1000 mg......................................................................... 15

Llabetalol hcl tab 100 mg (Trandate)................................21labetalol hcl tab 200 mg (Trandate)................................21labetalol hcl tab 300 mg (Trandate)................................21lactulose (encephalopathy) solution 10 gm/15ml......... 32lactulose solution 10 gm/15ml........................................ 30lamivudine oral soln 10 mg/ml (Epivir)............................ 6lamivudine tab 150 mg (Epivir)......................................... 6lamivudine tab 300 mg (Epivir)......................................... 6lamivudine tab 100 mg (hbv) (Epivir hbv)........................5lamivudine-zidovudine tab 150-300 mg (Combivir)........ 6lamotrigine tab chewable dispersible 5 mg (Lamictalchewable di)..................................................................... 45

lamotrigine tab chewable dispersible 25 mg (Lamictalchewable di)..................................................................... 45

lamotrigine tab 25 mg (Lamictal)....................................45lamotrigine tab 100 mg (Lamictal)..................................45lamotrigine tab 150 mg (Lamictal)..................................45lamotrigine tab 200 mg (Lamictal)..................................45lansoprazole cap delayed release 15 mg(Prevacid)..........................................................................30

lansoprazole cap delayed release 30 mg(Prevacid)..........................................................................30

LANTUS – insulin glargine inj 100 unit/ml......................... 16LANTUS SOLOSTAR – insulin glargine soln pen-injector100 unit/ml......................................................................... 16

latanoprost ophth soln 0.005% (Xalatan).......................49leflunomide tab 10 mg (Arava)........................................43leflunomide tab 20 mg (Arava)........................................43LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 mg (14 mg daily dose)................................... 9

LENVIMA 18 MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 (2) mg (18 mg daily dose)............................10

LENVIMA 24 MG DAILY DOSE – lenvatinib cap therapypack 10 (2) & 4 mg (24 mg daily dose)............................10

LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapypack 10 mg (10 mg daily dose)..........................................9

LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapypack 10 (2) mg (20 mg daily dose).................................. 10

LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapypack 4 (2) mg (8 mg daily dose)...................................... 10

LETAIRIS – ambrisentan tab 5 mg.................................... 26LETAIRIS – ambrisentan tab 10 mg.................................. 26letrozole tab 2.5 mg (Femara)......................................... 10LEUCOVORIN CALCIUM – leucovorin calcium tab 10mg...................................................................................... 10

LEUCOVORIN CALCIUM – leucovorin calcium tab 15mg...................................................................................... 10

leucovorin calcium tab 5 mg...........................................10leucovorin calcium tab 25 mg.........................................10LEUKERAN – chlorambucil tab 2 mg................................ 10levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (baseequiv).................................................................................29

levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)(Xopenex)..........................................................................29

2017




LEVEMIR FLEXTOUCH – insulin detemir soln pen-injector100 unit/ml......................................................................... 16

LEVEMIR – insulin detemir inj 100 unit/ml.........................16levetiracetam oral soln 100 mg/ml (Keppra)..................46levetiracetam tab 250 mg (Keppra).................................46levetiracetam tab 500 mg (Keppra).................................46levetiracetam tab 750 mg (Keppra).................................46levetiracetam tab 1000 mg (Keppra)...............................46levetiracetam tab sr 24hr 500 mg (Keppra xr)...............46levetiracetam tab sr 24hr 750 mg (Keppra xr)...............46levobunolol hcl ophth soln 0.5% (Betagan).................. 50levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)...... 17levocarnitine tab 330 mg (Carnitor)................................17levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) (Xyzal).........................................................................27

levocetirizine dihydrochloride tab 5 mg (Xyzal)............27LEVOFLOXACIN – levofloxacin oral soln 25 mg/ml............ 4levofloxacin tab 250 mg (Levaquin)................................. 4levofloxacin tab 500 mg (Levaquin)................................. 4levofloxacin tab 750 mg (Levaquin)................................. 4levonorgestrel & ethinyl estradiol (91-day) tab0.15-0.03 mg.....................................................................14

levonorgestrel & ethinyl estradiol tab 0.1 mg-20mcg....................................................................................14

levonorgestrel & ethinyl estradiol tab 0.15 mg-30mcg....................................................................................14

levonorgestrel-eth estra tab0.05-30/0.075-40/0.125-30mg-mcg................................. 14

levonorg-eth est tab 0.1-0.02mg(84) & eth est tab0.01mg(7) (Loseasonique)..............................................14

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab0.01mg(7) (Seasonique)..................................................14

levothyroxine sodium tab 25 mcg (Synthroid)..............16levothyroxine sodium tab 50 mcg (Synthroid)..............16levothyroxine sodium tab 75 mcg (Synthroid)..............17levothyroxine sodium tab 88 mcg (Synthroid)..............17levothyroxine sodium tab 100 mcg (Synthroid)............17levothyroxine sodium tab 112 mcg (Synthroid)............ 17levothyroxine sodium tab 125 mcg (Synthroid)............17levothyroxine sodium tab 137 mcg (Synthroid)............17levothyroxine sodium tab 150 mcg (Synthroid)............17levothyroxine sodium tab 175 mcg (Synthroid)............17levothyroxine sodium tab 200 mcg (Synthroid)............17levothyroxine sodium tab 300 mcg (Synthroid)............17lidocaine hcl gel 2%......................................................... 53lidocaine hcl local inj 1% (Xylocaine)............................ 45lidocaine hcl local preservative free (pf) inj 1%(Xylocaine-mpf)................................................................45

lidocaine hcl soln 4% (Xylocaine)...................................53lidocaine hcl viscous soln 2%........................................ 50lidocaine patch 5% (Lidoderm)....................................... 53lidocaine-prilocaine cream 2.5-2.5% (Emla).................. 53

linezolid for susp 100 mg/5ml (Zyvox)............................. 8linezolid tab 600 mg (Zyvox)............................................. 8liothyronine sodium tab 5 mcg (Cytomel)..................... 17liothyronine sodium tab 25 mcg (Cytomel)................... 17liothyronine sodium tab 50 mcg (Cytomel)................... 17lisinopril & hydrochlorothiazide tab 10-12.5 mg(Zestoretic)....................................................................... 19

lisinopril & hydrochlorothiazide tab 20-12.5 mg(Zestoretic)....................................................................... 19

lisinopril & hydrochlorothiazide tab 20-25 mg(Zestoretic)....................................................................... 19

lisinopril tab 5 mg (Prinivil)............................................. 19lisinopril tab 10 mg (Prinivil)........................................... 19lisinopril tab 20 mg (Prinivil)........................................... 19lisinopril tab 2.5 mg (Zestril)........................................... 19lisinopril tab 30 mg (Zestril)............................................ 19lisinopril tab 40 mg (Zestril)............................................ 19lithium carbonate cap 300 mg.........................................36lithium carbonate cap 150 mg (Lithium carbonate)......36lithium carbonate cap 600 mg (Lithium carbonate)......36lithium carbonate tab cr 450 mg.....................................36lithium carbonate tab cr 300 mg (Lithobid)................... 36lithium carbonate tab 300 mg......................................... 36LONSURF – trifluridine-tipiracil tab 15-6.14 mg.................10LONSURF – trifluridine-tipiracil tab 20-8.19 mg.................10loperamide hcl cap 2 mg................................................. 30lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)(Kaletra)...............................................................................6

lorazepam conc 2 mg/ml (Lorazepam intensol)............ 33lorazepam tab 0.5 mg (Ativan)........................................ 33lorazepam tab 1 mg (Ativan)........................................... 33lorazepam tab 2 mg (Ativan)........................................... 33losartan potassium & hydrochlorothiazide tab 50-12.5mg (Hyzaar)...................................................................... 20

losartan potassium & hydrochlorothiazide tab 100-12.5mg (Hyzaar)...................................................................... 20

losartan potassium & hydrochlorothiazide tab 100-25mg (Hyzaar)...................................................................... 20

losartan potassium tab 25 mg (Cozaar).........................20losartan potassium tab 50 mg (Cozaar).........................20losartan potassium tab 100 mg (Cozaar).......................20lovastatin tab 10 mg.........................................................24lovastatin tab 20 mg (Mevacor).......................................24lovastatin tab 40 mg (Mevacor).......................................24loxapine succinate cap 10 mg........................................ 36loxapine succinate cap 25 mg........................................ 36loxapine succinate cap 50 mg........................................ 36loxapine succinate cap 5 mg (Loxitane)........................36LUPRON DEPOT-PED (1-MONTH – leuprolide acetate forinj pediatric kit 7.5 mg..................................................15,17

LUPRON DEPOT-PED (1-MONTH – leuprolide acetate forinj pediatric kit 11.25 mg..............................................15,17

LUPRON DEPOT-PED (1-MONTH – leuprolide acetate forinj pediatric kit 15 mg...................................................15,17

LUPRON DEPOT-PED (3-MONTH – leuprolide acetate (3month) for inj pediatric kit 11.25 mg................................. 15

2017


LUPRON DEPOT-PED (3-MONTH – leuprolide acetate (3month) for inj pediatric kit 30 mg......................................15

LYNPARZA – olaparib cap 50 mg......................................10LYSODREN – mitotane tab 500 mg...................................10

Mmalathion lotion 0.5% (Ovide).........................................53MATULANE – procarbazine hcl cap 50 mg....................... 10meclizine hcl tab 12.5 mg................................................ 31meclizine hcl tab 25 mg................................................... 31medroxyprogesterone acetate im susp 150 mg/ml(Depo-provera contrac).................................................. 14

medroxyprogesterone acetate im susp prefilled syr150 mg/ml (Depo-provera contrac)............................... 14

medroxyprogesterone acetate tab 2.5 mg(Provera)........................................................................... 13

medroxyprogesterone acetate tab 5 mg (Provera).......13medroxyprogesterone acetate tab 10 mg (Provera).....13mefloquine hcl tab 250 mg................................................ 7megestrol acetate susp 40 mg/ml (Megace oral).......... 10megestrol acetate tab 20 mg...........................................10megestrol acetate tab 40 mg...........................................10MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg(base equivalent)...............................................................10

MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (baseequivalent)......................................................................... 10

meloxicam tab 7.5 mg (Mobic)........................................43meloxicam tab 15 mg (Mobic).........................................43memantine hcl oral solution 2 mg/ml (Namenda)......... 40memantine hcl tab 5 mg (28) & 10 mg (21) titration pak(Namenda titration pa)....................................................40

memantine hcl tab 5 mg (Namenda).............................. 40memantine hcl tab 10 mg (Namenda)............................ 40MEPHYTON – phytonadione tab 5 mg.............................. 47mercaptopurine tab 50 mg (Purinethol).........................10mesalamine enema 4 gm................................................. 32metaxalone tab 800 mg (Skelaxin)..................................47metformin hcl tab 500 mg (Glucophage)....................... 16metformin hcl tab 850 mg (Glucophage)....................... 16metformin hcl tab 1000 mg (Glucophage)..................... 16metformin hcl tab sr 24hr 500 mg (Glucophage xr)......15metformin hcl tab sr 24hr 750 mg (Glucophage xr)......15methadone hcl conc 10 mg/ml (Methadose)................. 42methadone hcl soln 5 mg/5ml (Methadone hcl)............42methadone hcl soln 10 mg/5ml (Methadone hcl).......... 42methadone hcl tab for oral susp 40 mg.........................42methadone hcl tab 10 mg (Dolophine)...........................42methadone hcl tab 5 mg (Dolophine hcl).......................42methazolamide tab 25 mg (Neptazane)..........................24methazolamide tab 50 mg (Neptazane)..........................25METHERGINE – methylergonovine maleate tab 0.2mg...................................................................................... 18

methimazole tab 5 mg (Tapazole)................................... 17methimazole tab 10 mg (Tapazole)................................. 17methocarbamol tab 750 mg (Robaxin-750)....................47methocarbamol tab 500 mg (Robaxin)...........................47

methotrexate sodium tab 2.5 mg (base equiv)..............10methscopolamine bromide tab 2.5 mg (Pamine).......... 30methscopolamine bromide tab 5 mg (Pamineforte).................................................................................. 30

methyldopa tab 250 mg................................................... 26methyldopa tab 500 mg................................................... 26METHYLPHENIDATE HCL – methylphenidate hcl chewtab 2.5 mg......................................................................... 38

METHYLPHENIDATE HCL – methylphenidate hcl chewtab 5 mg............................................................................ 38

METHYLPHENIDATE HCL – methylphenidate hcl chewtab 10 mg.......................................................................... 38

methylphenidate hcl tab cr 10 mg..................................38methylphenidate hcl tab cr 20 mg (Ritalin sr)............... 38methylphenidate hcl tab 5 mg (Ritalin).......................... 38methylphenidate hcl tab 10 mg (Ritalin)........................ 38methylphenidate hcl tab 20 mg (Ritalin)........................ 39methylprednisolone tab 4 mg (Medrol)..........................12methylprednisolone tab 8 mg (Medrol)..........................12methylprednisolone tab 16 mg (Medrol)........................12methylprednisolone tab 32 mg (Medrol)........................12methylprednisolone tab therapy pack 4 mg (21)(Medrol dosepak).............................................................12

metoclopramide hcl soln 5 mg/5ml (10 mg/10ml).........32metoclopramide hcl tab 5 mg (Reglan)..........................32metoclopramide hcl tab 10 mg (Reglan)........................32metolazone tab 10 mg......................................................25metolazone tab 2.5 mg (Zaroxolyn)................................25metolazone tab 5 mg (Zaroxolyn)...................................25metoprolol & hydrochlorothiazide tab 50-25 mg(Lopressor hct)................................................................ 21

metoprolol & hydrochlorothiazide tab 100-25 mg(Lopressor hct)................................................................ 21

metoprolol succinate tab sr 24hr 25 mg (tartrate equiv)(Toprol xl)......................................................................... 21

metoprolol succinate tab sr 24hr 50 mg (tartrate equiv)(Toprol xl)......................................................................... 21

metoprolol succinate tab sr 24hr 100 mg (tartrateequiv) (Toprol xl)............................................................. 21

metoprolol succinate tab sr 24hr 200 mg (tartrateequiv) (Toprol xl)............................................................. 21

metoprolol tartrate tab 25 mg......................................... 21metoprolol tartrate tab 50 mg (Lopressor).................... 21metoprolol tartrate tab 100 mg (Lopressor).................. 21metronidazole cream 0.75% (Metrocream).................... 51metronidazole gel 0.75%..................................................51metronidazole gel 1% (Metrogel).................................... 51metronidazole lotion 0.75% (Metrolotion)......................51metronidazole tab 250 mg (Flagyl)................................... 8metronidazole tab 500 mg (Flagyl)................................... 8metronidazole vaginal gel 0.75% (Metrogel-vaginal)..............................................................................32

mexiletine hcl cap 150 mg...............................................25mexiletine hcl cap 200 mg...............................................25mexiletine hcl cap 250 mg...............................................25MICROLET LANCETS – lancets........................................55

2017


MICROLET NEXT – lancet devices................................... 55midodrine hcl tab 2.5 mg.................................................26midodrine hcl tab 5 mg....................................................26midodrine hcl tab 10 mg..................................................26minocycline hcl cap 50 mg (Minocin).............................. 3minocycline hcl cap 75 mg (Minocin).............................. 4minocycline hcl cap 100 mg (Minocin)............................ 4MINOCYCLINE HCL ER – minocycline hcl tab sr 24hr 45mg........................................................................................ 4

minocycline hcl tab 50 mg................................................ 4minocycline hcl tab 75 mg................................................ 4minocycline hcl tab 100 mg.............................................. 4minoxidil tab 2.5 mg.........................................................26minoxidil tab 10 mg..........................................................26mirtazapine tab 7.5 mg.....................................................34mirtazapine tab 15 mg (Remeron).................................. 34mirtazapine tab 30 mg (Remeron).................................. 34mirtazapine tab 45 mg (Remeron).................................. 34misoprostol tab 100 mcg (Cytotec)................................ 30misoprostol tab 200 mcg (Cytotec)................................ 30modafinil tab 100 mg (Provigil).......................................39modafinil tab 200 mg (Provigil).......................................39moexipril hcl tab 7.5 mg (Univasc).................................19moexipril hcl tab 15 mg (Univasc)..................................19moexipril-hydrochlorothiazide tab 7.5-12.5 mg.............19moexipril-hydrochlorothiazide tab 15-25 mg.................19moexipril-hydrochlorothiazide tab 15-12.5 mg(Uniretic)........................................................................... 19

mometasone furoate cream 0.1% (Elocon)................... 53mometasone furoate nasal susp 50 mcg/act(Nasonex)..........................................................................27

mometasone furoate oint 0.1% (Elocon)........................53mometasone furoate solution 0.1% (lotion)(Elocon).............................................................................53

montelukast sodium chew tab 4 mg (base equiv)(Singulair)......................................................................... 29

montelukast sodium chew tab 5 mg (base equiv)(Singulair)......................................................................... 29

montelukast sodium oral granules packet 4 mg (baseequiv) (Singulair)............................................................. 29

montelukast sodium tab 10 mg (base equiv)(Singulair)......................................................................... 29

MORPHINE SULFATE – morphine sulfate tab 15 mg....... 42MORPHINE SULFATE – morphine sulfate tab 30 mg....... 42morphine sulfate oral soln 10 mg/5ml........................... 42morphine sulfate oral soln 20 mg/5ml........................... 42morphine sulfate oral soln 100 mg/5ml (20 mg/ml)...... 42morphine sulfate tab cr 15 mg (Ms contin)................... 42morphine sulfate tab cr 30 mg (Ms contin)................... 42morphine sulfate tab cr 60 mg (Ms contin)................... 42morphine sulfate tab cr 100 mg (Ms contin)................. 42morphine sulfate tab cr 200 mg (Ms contin)................. 42mupirocin calcium cream 2% (Bactroban).................... 51mupirocin oint 2% (Bactroban).......................................51mycophenolate mofetil cap 250 mg (Cellcept)..............56

mycophenolate mofetil for oral susp 200 mg/ml(Cellcept)...........................................................................56

mycophenolate mofetil tab 500 mg (Cellcept)...............56mycophenolate sodium tab dr 180 mg (mycophenolicacid equiv) (Myfortic)......................................................56

mycophenolate sodium tab dr 360 mg (mycophenolicacid equiv) (Myfortic)......................................................56

MYLERAN – busulfan tab 2 mg.........................................10

Nnabumetone tab 500 mg.................................................. 43nabumetone tab 750 mg.................................................. 43nadolol tab 20 mg (Corgard)........................................... 21nadolol tab 40 mg (Corgard)........................................... 21nadolol tab 80 mg (Corgard)........................................... 21naloxone hcl inj 0.4 mg/ml.............................................. 56naloxone hcl inj 4 mg/10ml............................................. 56naltrexone hcl tab 50 mg (Revia)....................................56naproxen sodium tab 275 mg (Anaprox)....................... 43naproxen sodium tab 550 mg (Anaprox ds)..................44naproxen susp 125 mg/5ml (Naprosyn).........................44naproxen tab ec 375 mg (Ec-naprosyn).........................44naproxen tab ec 500 mg (Ec-naprosyn).........................44naproxen tab 250 mg (Naprosyn)................................... 44naproxen tab 375 mg (Naprosyn)................................... 44naproxen tab 500 mg (Naprosyn)................................... 44naratriptan hcl tab 1 mg (base equiv) (Amerge)........... 44naratriptan hcl tab 2.5 mg (base equiv) (Amerge)........ 44NARCAN – naloxone hcl nasal spray 4 mg/0.1ml............. 56NATACYN – natamycin ophth susp 5%............................. 49nateglinide tab 60 mg (Starlix)........................................16nateglinide tab 120 mg (Starlix)......................................16neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt op oin..................................49

neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml (Neosporin)................49

neomycin-polymyxin-dexamethasone ophth oint 0.1%(Maxitrol)...........................................................................49

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)................................................................. 49

neomycin-polymyxin-hc otic soln 1% (Cortisporin)..... 50neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000unit/ml-1%.........................................................................50

neomycin sulfate tab 500 mg............................................4nevirapine tab 200 mg (Viramune)....................................6nevirapine tab sr 24hr 100 mg (Viramune xr)..................6nevirapine tab sr 24hr 400 mg (Viramune xr)..................6NEXAVAR – sorafenib tosylate tab 200 mg (baseequivalent)......................................................................... 10

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 5 mg..............................................................30

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 10 mg............................................................30


2017



NEXIUM – esomeprazole magnesium for delayed releasesusp pack 2.5 mg..............................................................30

niacin tab cr 500 mg (antihyperlipidemic)(Niaspan)...........................................................................24



NICOTROL INHALER – nicotine inhaler system 10 mg (4mg delivered).....................................................................40

NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/spray)................................................................................. 40

nifedipine tab sr 24hr 30 mg (Adalat cc)........................22nifedipine tab sr 24hr 60 mg (Adalat cc)........................23nifedipine tab sr 24hr 90 mg (Adalat cc)........................23nifedipine tab sr 24hr osmotic release 30 mg(Procardia xl)....................................................................23

nifedipine tab sr 24hr osmotic release 60 mg(Procardia xl)....................................................................23

nifedipine tab sr 24hr osmotic release 90 mg(Procardia xl)....................................................................23

nilutamide tab 150 mg (Nilandron)................................. 10NINLARO – ixazomib citrate cap 2.3 mg (baseequivalent)......................................................................... 10

NINLARO – ixazomib citrate cap 3 mg (baseequivalent)......................................................................... 10

NINLARO – ixazomib citrate cap 4 mg (baseequivalent)......................................................................... 10

nitrofurantoin macrocrystalline cap 25 mg(Macrodantin)................................................................... 32



nitrofurantoin monohydrate macrocrystalline cap 100mg (Macrobid)..................................................................32

nitrofurantoin susp 25 mg/5ml (Furadantin)..................32nitroglycerin sl tab 0.3 mg (Nitrostat)............................ 23nitroglycerin sl tab 0.4 mg (Nitrostat)............................ 23nitroglycerin sl tab 0.6 mg (Nitrostat)............................ 23nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)..........23nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)..........23nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)..........23nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)..........23NIZATIDINE – nizatidine oral soln 15 mg/ml......................30norethindrone & ethinyl estradiol-fe chew tab 0.4mg-35 mcg (Femcon fe)................................................. 14

norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg(Brevicon-28)....................................................................14

norethindrone & ethinyl estradiol tab 1 mg-35 mcg(Norinyl 1+35)...................................................................14

norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg(Ovcon-35)........................................................................ 14

norethindrone ace & ethinyl estradiol-fe tab 1 mg-20mcg (Loestrin fe 1/20).....................................................14

norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30mcg (Loestrin fe 1.5/30)..................................................14

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg(Loestrin 1/20-21).............................................................14

norethindrone ace & ethinyl estradiol tab 1.5 mg-30mcg (Loestrin 1.5/30-21).................................................14

norethindrone acetate-ethinyl estradiol tab 1 mg-5mcg....................................................................................13

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5mcg (Femhrt low dose).................................................. 13

norethindrone acetate tab 5 mg (Aygestin)...................13norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35mg-mcg (Estrostep fe)....................................................14

norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)............................................... 14

norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl 28).........................................................14

norethindrone tab 0.35 mg (Nor-qd)...............................14norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg(Ortho-cyclen).................................................................. 14

norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35mg-mcg (Ortho tri-cyclen)..............................................14

norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25mg-mcg (Ortho tri-cyclen lo)......................................... 14

norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg.........14nortriptyline hcl cap 10 mg (Pamelor)............................34nortriptyline hcl cap 25 mg (Pamelor)............................34nortriptyline hcl cap 50 mg (Pamelor)............................34nortriptyline hcl cap 75 mg (Pamelor)............................34NORVIR – ritonavir oral soln 80 mg/ml................................6NORVIR – ritonavir tab 100 mg........................................... 6NOVOLIN 70/30 – insulin nph isophane & regular humaninj 100 unit/ml (70-30).......................................................16

NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/ml........................................................................................16

NOVOLIN R – insulin regular (human) inj 100 unit/ml....... 16NOVOLOG FLEXPEN – insulin aspart soln pen-injector100 unit/ml......................................................................... 16

NOVOLOG – insulin aspart inj 100 unit/ml........................ 16NOVOLOG MIX 70/30 – insulin aspart prot & aspart(human) inj 100 unit/ml (70-30)........................................ 16

NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &aspart sus pen-inj 100 unit/ml (70-30)..............................16

NOVOLOG PENFILL – insulin aspart soln cartridge 100unit/ml.................................................................................16

NOXAFIL – posaconazole susp 40 mg/ml...........................5NUVARING – etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr.........................................................14

nystatin cream 100000 unit/gm.......................................51nystatin oint 100000 unit/gm........................................... 51nystatin susp 100000 unit/ml.......................................... 50nystatin tab 500000 unit.....................................................5nystatin topical powder 100000 unit/gm........................51

2017


nystatin-triamcinolone cream 100000-0.1 unit/gm-%........................................................................................ 53

nystatin-triamcinolone oint 100000-0.1 unit/gm-%....... 53O

octreotide acetate inj 50 mcg/ml (0.05 mg/ml)(Sandostatin)....................................................................18




octreotide acetate inj 1000 mcg/ml (1 mg/ml)(Sandostatin)....................................................................18

ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg...................................................................... 6

ODOMZO – sonidegib phosphate cap 200 mg (baseequivalent)......................................................................... 10

ofloxacin ophth soln 0.3% (Ocuflox)..............................49ofloxacin otic soln 0.3%...................................................50ofloxacin tab 400 mg..........................................................4olanzapine orally disintegrating tab 5 mg (Zyprexazydis)................................................................................. 36

olanzapine orally disintegrating tab 10 mg (Zyprexazydis)................................................................................. 36



olanzapine tab 2.5 mg (Zyprexa).....................................36olanzapine tab 5 mg (Zyprexa)........................................36olanzapine tab 7.5 mg (Zyprexa).....................................36olanzapine tab 10 mg (Zyprexa)......................................36olanzapine tab 15 mg (Zyprexa)......................................36olanzapine tab 20 mg (Zyprexa)......................................36olmesartan medoxomil-hydrochlorothiazide tab20-12.5 mg (Benicar hct)................................................ 20

olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg (Benicar hct)................................................ 20

olmesartan medoxomil-hydrochlorothiazide tab 40-25mg (Benicar hct)..............................................................20

olmesartan medoxomil tab 5 mg (Benicar)................... 20olmesartan medoxomil tab 20 mg (Benicar)................. 20olmesartan medoxomil tab 40 mg (Benicar)................. 20olopatadine hcl ophth soln 0.1% (base equivalent)(Patanol)............................................................................50

omeprazole cap delayed release 10 mg (Prilosec)....... 30omeprazole cap delayed release 20 mg (Prilosec)....... 30omeprazole cap delayed release 40 mg (Prilosec)....... 30OMNITROPE – somatropin for inj 5.8 mg......................... 17OMNITROPE – somatropin inj 5 mg/1.5ml........................17OMNITROPE – somatropin inj 10 mg/1.5ml......................17ondansetron hcl inj 4 mg/2ml (2 mg/ml)........................ 31ondansetron hcl inj 40 mg/20ml (2 mg/ml) (Zofran)......31ondansetron hcl oral soln 4 mg/5ml (Zofran)................31

ondansetron hcl tab 24 mg............................................. 31ondansetron hcl tab 4 mg (Zofran).................................31ondansetron hcl tab 8 mg (Zofran).................................31ondansetron orally disintegrating tab 4 mg (Zofranodt).....................................................................................31

ondansetron orally disintegrating tab 8 mg (Zofranodt).....................................................................................31

ONGLYZA – saxagliptin hcl tab 2.5 mg (base equiv).........16ONGLYZA – saxagliptin hcl tab 5 mg (base equiv)............16OPSUMIT – macitentan tab 10 mg....................................26ORFADIN – nitisinone cap 2 mg........................................18ORFADIN – nitisinone cap 5 mg........................................18ORFADIN – nitisinone cap 10 mg......................................18ORFADIN – nitisinone cap 20 mg......................................18ORFADIN – nitisinone susp 4 mg/ml................................. 18orphenadrine citrate tab sr 12hr 100 mg....................... 47oseltamivir phosphate cap 30 mg (base equiv)(Tamiflu).............................................................................. 7

oseltamivir phosphate cap 45 mg (base equiv)(Tamiflu).............................................................................. 7

oseltamivir phosphate cap 75 mg (base equiv)(Tamiflu).............................................................................. 7

oxaprozin tab 600 mg (Daypro).......................................44oxcarbazepine susp 300 mg/5ml (60 mg/ml)(Trileptal)...........................................................................46

oxcarbazepine tab 150 mg (Trileptal)............................. 46oxcarbazepine tab 300 mg (Trileptal)............................. 46oxcarbazepine tab 600 mg (Trileptal)............................. 46oxybutynin chloride syrup 5 mg/5ml..............................32oxybutynin chloride tab 5 mg......................................... 32oxybutynin chloride tab sr 24hr 5 mg (Ditropan xl)......32oxybutynin chloride tab sr 24hr 10 mg (Ditropanxl)....................................................................................... 32

oxybutynin chloride tab sr 24hr 15 mg (Ditropanxl)....................................................................................... 32

oxycodone-aspirin tab 4.8355-325 mg (Percodan)....... 42oxycodone hcl cap 5 mg................................................. 42oxycodone hcl conc 100 mg/5ml (20 mg/ml)(Oxycodone hcl).............................................................. 42

oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)............42oxycodone hcl tab 10 mg................................................ 42oxycodone hcl tab 20 mg................................................ 42oxycodone hcl tab 5 mg (Roxicodone).......................... 42oxycodone hcl tab 15 mg (Roxicodone)........................ 42oxycodone hcl tab 30 mg (Roxicodone)........................ 42oxycodone w/ acetaminophen tab 5-325 mg(Percocet)......................................................................... 42

oxycodone w/ acetaminophen tab 7.5-325 mg(Percocet)......................................................................... 42

oxycodone w/ acetaminophen tab 10-325 mg(Percocet)......................................................................... 42

OXYCONTIN – oxycodone hcl tab er 12hr deter 10mg...................................................................................... 42


2017







Ppantoprazole sodium ec tab 20 mg (base equiv)(Protonix).......................................................................... 30

pantoprazole sodium ec tab 40 mg (base equiv)(Protonix).......................................................................... 30

paricalcitol cap 1 mcg (Zemplar).................................... 18paricalcitol cap 2 mcg (Zemplar).................................... 18paricalcitol cap 4 mcg (Zemplar).................................... 18paromomycin sulfate cap 250 mg.................................... 4paroxetine hcl tab 10 mg (Paxil).....................................35paroxetine hcl tab 20 mg (Paxil).....................................35paroxetine hcl tab 30 mg (Paxil).....................................35paroxetine hcl tab 40 mg (Paxil).....................................35paroxetine hcl tab sr 24hr 12.5 mg (Paxil cr)................ 34paroxetine hcl tab sr 24hr 25 mg (Paxil cr)................... 34paroxetine hcl tab sr 24hr 37.5 mg (Paxil cr)................ 34PEGASYS – peginterferon alfa-2a inj 180 mcg/ml.............. 5PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml......... 5PEGASYS PROCLICK – peginterferon alfa-2a inj 135mcg/0.5ml.............................................................................5

PEGASYS PROCLICK – peginterferon alfa-2a inj 180mcg/0.5ml.............................................................................5

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm(Colyte-flavor packs).......................................................30

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)...........................................................................30

peg 3350-kcl-sod bicarb-nacl for soln 420 gm(Nulytely/flavor pack)......................................................30

penicillin v potassium for soln 125 mg/5ml.....................2penicillin v potassium for soln 250 mg/5ml.....................2penicillin v potassium tab 250 mg....................................2penicillin v potassium tab 500 mg....................................2pentoxifylline tab cr 400 mg............................................48perindopril erbumine tab 2 mg....................................... 19perindopril erbumine tab 4 mg (Aceon).........................19perindopril erbumine tab 8 mg (Aceon).........................19permethrin cream 5% (Elimite)........................................53perphenazine tab 2 mg.................................................... 36perphenazine tab 4 mg.................................................... 36perphenazine tab 8 mg.................................................... 36perphenazine tab 16 mg.................................................. 36phenelzine sulfate tab 15 mg (Nardil)............................ 35phenobarbital elixir 20 mg/5ml........................................37PHENOBARBITAL – phenobarbital tab 15 mg.................. 37PHENOBARBITAL – phenobarbital tab 30 mg.................. 37

PHENOBARBITAL – phenobarbital tab 60 mg.................. 37PHENOBARBITAL – phenobarbital tab 100 mg................ 37phenobarbital tab 16.2 mg...............................................37phenobarbital tab 32.4 mg...............................................37phenoxybenzamine hcl cap 10 mg (Dibenzyline)......... 26phenytoin chew tab 50 mg (Dilantin infatabs)...............46phenytoin sodium extended cap 100 mg (Dilantin)...... 46phenytoin sodium extended cap 200 mg(Phenytek).........................................................................46

phenytoin sodium extended cap 300 mg(Phenytek).........................................................................46

phenytoin susp 125 mg/5ml (Dilantin)........................... 46pilocarpine hcl ophth soln 1% (Isopto carpine)............ 50pilocarpine hcl ophth soln 2% (Isopto carpine)............ 50pilocarpine hcl ophth soln 4% (Isopto carpine)............ 50pilocarpine hcl tab 5 mg (Salagen).................................50pilocarpine hcl tab 7.5 mg (Salagen)..............................50pimozide tab 1 mg (Orap)................................................ 40pimozide tab 2 mg (Orap)................................................ 40pindolol tab 5 mg..............................................................22pindolol tab 10 mg............................................................22pioglitazone hcl-metformin hcl tab 15-500 mg(Actoplus met)................................................................. 16

pioglitazone hcl-metformin hcl tab 15-850 mg(Actoplus met)................................................................. 16

pioglitazone hcl tab 15 mg (base equiv) (Actos)...........16pioglitazone hcl tab 30 mg (base equiv) (Actos)...........16pioglitazone hcl tab 45 mg (base equiv) (Actos)...........16piroxicam cap 10 mg (Feldene).......................................44piroxicam cap 20 mg (Feldene).......................................44PLEGRIDY – peginterferon beta-1a soln pen-injector 125mcg/0.5ml...........................................................................39

PLEGRIDY – peginterferon beta-1a soln prefilled syringe125 mcg/0.5ml...................................................................39

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpen-inj 63 & 94 mcg/0.5ml pack.......................................39

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpref syr 63 & 94 mcg/0.5ml pack..................................... 39

podofilox soln 0.5% (Condylox)......................................53polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% (Polytrim)...........................................................49

POMALYST – pomalidomide cap 1 mg............................. 10POMALYST – pomalidomide cap 2 mg............................. 10POMALYST – pomalidomide cap 3 mg............................. 10POMALYST – pomalidomide cap 4 mg............................. 10potassium chloride cap cr 8 meq (Micro-k)...................47potassium chloride cap cr 10 meq (Micro-k).................48potassium chloride microencapsulated crys cr tab 10meq....................................................................................48

potassium chloride microencapsulated crys cr tab 20meq....................................................................................48

potassium chloride oral soln 10% (20 meq/15ml).........48potassium chloride powder packet 20 meq.................. 48potassium chloride tab cr 10 meq (K-tab)..................... 48potassium chloride tab cr 8 meq (600 mg)....................48

2017


potassium citrate tab cr 5 meq (540 mg) (Urocit-k5)........................................................................................ 33

potassium citrate tab cr 10 meq (1080 mg) (Urocit-k10)...................................................................................... 33

potassium citrate tab cr 15 meq (1620 mg) (Urocit-k15)...................................................................................... 33

pramipexole dihydrochloride tab 0.125 mg(Mirapex)........................................................................... 47

pramipexole dihydrochloride tab 0.25 mg(Mirapex)........................................................................... 47

pramipexole dihydrochloride tab 0.5 mg (Mirapex)......47pramipexole dihydrochloride tab 0.75 mg(Mirapex)........................................................................... 47

pramipexole dihydrochloride tab 1 mg (Mirapex).........47pramipexole dihydrochloride tab 1.5 mg (Mirapex)......47pravastatin sodium tab 10 mg........................................ 24pravastatin sodium tab 20 mg (Pravachol)....................24pravastatin sodium tab 40 mg (Pravachol)....................24pravastatin sodium tab 80 mg (Pravachol)....................24prazosin hcl cap 1 mg (Minipress)................................. 26prazosin hcl cap 2 mg (Minipress)................................. 26prazosin hcl cap 5 mg (Minipress)................................. 26prednisolone acetate ophth susp 1% (Pred forte)........ 49prednisolone sod phosphate oral soln 15 mg/5ml(base equiv)......................................................................12

prednisolone sod phosph oral soln 6.7 mg/5ml (5mg/5ml base) (Pediapred).............................................. 12

prednisolone syrup 15 mg/5ml (usp solutionequivalent) (Prelone).......................................................12

PREDNISONE – prednisone oral soln 5 mg/5ml...............12prednisone tab 1 mg........................................................ 12prednisone tab 2.5 mg..................................................... 12prednisone tab 5 mg........................................................ 12prednisone tab 10 mg...................................................... 12prednisone tab 20 mg...................................................... 12PREMARIN – estrogens, conjugated tab 0.3 mg...............13PREMARIN – estrogens, conjugated tab 0.45 mg.............13PREMARIN – estrogens, conjugated tab 0.625 mg...........13PREMARIN – estrogens, conjugated tab 0.9 mg...............13PREMARIN – estrogens, conjugated tab 1.25 mg.............13PREMPHASE – conj est 0.625(14)/conj est-medroxyproac tab 0.625-5mg(14)........................................................13

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.3-1.5 mg......................................................13

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.45-1.5 mg....................................................13

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-2.5 mg..................................................13

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-5 mg.....................................................13

PREZCOBIX – darunavir-cobicistat tab 800-150 mg...........6PREZISTA – darunavir ethanolate susp 100 mg/ml (baseequiv)....................................................................................6

PREZISTA – darunavir ethanolate tab 75 mg (baseequiv)....................................................................................6




PRIFTIN – rifapentine tab 150 mg....................................... 4PRIMAQUINE PHOSPHATE – primaquine phosphate tab26.3 mg (15 mg base)........................................................ 7

primidone tab 50 mg (Mysoline)..................................... 46primidone tab 250 mg (Mysoline)................................... 46PROAIR HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 29

PROAIR RESPICLICK – albuterol sulfate aer pow ba 108mcg/act (90 mcg base equiv)........................................... 29

probenecid tab 500 mg.................................................... 45prochlorperazine maleate tab 5 mg (base equivalent)(Compazine)..................................................................... 36

prochlorperazine maleate tab 10 mg (base equivalent)(Compazine)..................................................................... 36

prochlorperazine suppos 25 mg.....................................36progesterone micronized cap 100 mg(Prometrium).................................................................... 13

progesterone micronized cap 200 mg(Prometrium).................................................................... 13

promethazine hcl suppos 12.5 mg................................. 27promethazine hcl suppos 25 mg.................................... 27promethazine hcl suppos 50 mg.................................... 27promethazine hcl syrup 6.25 mg/5ml............................. 27promethazine hcl tab 12.5 mg.........................................27promethazine hcl tab 25 mg............................................27promethazine hcl tab 50 mg............................................27propafenone hcl cap sr 12hr 225 mg (Rythmol sr)....... 25propafenone hcl cap sr 12hr 325 mg (Rythmol sr)....... 25propafenone hcl cap sr 12hr 425 mg (Rythmol sr)....... 25propafenone hcl tab 300 mg........................................... 25propafenone hcl tab 150 mg (Rythmol)......................... 25propafenone hcl tab 225 mg (Rythmol)......................... 25propranolol hcl cap sr 24hr 60 mg (Inderal la)..............22propranolol hcl cap sr 24hr 80 mg (Inderal la)..............22propranolol hcl cap sr 24hr 120 mg (Inderal la)............22propranolol hcl cap sr 24hr 160 mg (Inderal la)............22propranolol hcl tab 10 mg............................................... 22propranolol hcl tab 20 mg............................................... 22propranolol hcl tab 40 mg............................................... 22propranolol hcl tab 60 mg............................................... 22propranolol hcl tab 80 mg............................................... 22propylthiouracil tab 50 mg.............................................. 17PULMOZYME – dornase alfa inhal soln 1 mg/ml.............. 29PURIXAN – mercaptopurine susp 2000 mg/100ml (20 mg/ml)...................................................................................... 10

pyrazinamide tab 500 mg...................................................4pyridostigmine bromide tab 60 mg (Mestinon)............. 47Q

quetiapine fumarate tab 25 mg (Seroquel).................... 36

2017


quetiapine fumarate tab 50 mg (Seroquel).................... 36quetiapine fumarate tab 100 mg (Seroquel).................. 36quetiapine fumarate tab 200 mg (Seroquel).................. 36quetiapine fumarate tab 300 mg (Seroquel).................. 36quetiapine fumarate tab 400 mg (Seroquel).................. 36quetiapine fumarate tab sr 24hr 50 mg (Seroquelxr).......................................................................................36

quetiapine fumarate tab sr 24hr 150 mg (Seroquelxr).......................................................................................36




quinapril hcl tab 5 mg (Accupril).................................... 19quinapril hcl tab 10 mg (Accupril).................................. 19quinapril hcl tab 20 mg (Accupril).................................. 19quinapril hcl tab 40 mg (Accupril).................................. 19quinapril-hydrochlorothiazide tab 10-12.5 mg(Accuretic)........................................................................ 19

quinapril-hydrochlorothiazide tab 20-12.5 mg(Accuretic)........................................................................ 19

quinapril-hydrochlorothiazide tab 20-25 mg(Accuretic)........................................................................ 19

quinidine gluconate tab cr 324 mg.................................25QVAR – beclomethasone diprop inhal aero soln 40 mcg/act (50/valve).....................................................................29

QVAR – beclomethasone diprop inhal aero soln 80 mcg/act (100/valve)...................................................................29

Rraloxifene hcl tab 60 mg (Evista)....................................18ramipril cap 1.25 mg (Altace).......................................... 19ramipril cap 2.5 mg (Altace)............................................ 19ramipril cap 5 mg (Altace)............................................... 19ramipril cap 10 mg (Altace)............................................. 19ranitidine hcl cap 150 mg................................................ 30ranitidine hcl cap 300 mg................................................ 30ranitidine hcl syrup 15 mg/ml (75 mg/5ml).................... 30ranitidine hcl tab 150 mg (Zantac)..................................31ranitidine hcl tab 300 mg (Zantac)..................................31RAPAMUNE – sirolimus oral soln 1 mg/ml........................ 56rasagiline mesylate tab 0.5 mg (base equiv)(Azilect)............................................................................. 47

rasagiline mesylate tab 1 mg (base equiv) (Azilect)..... 47REBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml(12mu/ml)...........................................................................39

REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml(24mu/ml)...........................................................................39

REBIF REBIDOSE – interferon beta-1a soln auto-inj 22mcg/0.5ml (12mu/ml).........................................................39

REBIF REBIDOSE – interferon beta-1a soln auto-inj 44mcg/0.5ml (24mu/ml).........................................................39

REBIF REBIDOSE TITRATION – interferon beta-1a auto-inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml............................ 39

REBIF TITRATION PACK – interferon beta-1a pref syr6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml................................. 40

RELPAX – eletriptan hydrobromide tab 20 mg (baseequivalent)......................................................................... 44

RELPAX – eletriptan hydrobromide tab 40 mg (baseequivalent)......................................................................... 44

repaglinide tab 0.5 mg (Prandin).................................... 16repaglinide tab 1 mg (Prandin)....................................... 16repaglinide tab 2 mg (Prandin)....................................... 16REVLIMID – lenalidomide cap 5 mg..................................56REVLIMID – lenalidomide cap 10 mg................................56REVLIMID – lenalidomide cap 15 mg................................56REVLIMID – lenalidomide cap 20 mg................................56REVLIMID – lenalidomide cap 25 mg................................56REVLIMID – lenalidomide caps 2.5 mg............................. 56REYATAZ – atazanavir sulfate cap 150 mg (baseequiv)....................................................................................6

REYATAZ – atazanavir sulfate cap 200 mg (baseequiv)....................................................................................6

REYATAZ – atazanavir sulfate cap 300 mg (baseequiv)....................................................................................6

ribavirin cap 200 mg (Rebetol)..........................................5ribavirin tab 200 mg (Copegus)........................................ 5rifabutin cap 150 mg (Mycobutin).....................................4rifampin cap 150 mg (Rifadin)...........................................4rifampin cap 300 mg (Rifadin)...........................................4RILUTEK – riluzole tab 50 mg........................................... 47riluzole tab 50 mg (Rilutek)............................................. 47risedronate sodium tab 5 mg (Actonel)......................... 18risedronate sodium tab 30 mg (Actonel)....................... 18risedronate sodium tab 35 mg (Actonel)....................... 18risedronate sodium tab 150 mg (Actonel)..................... 18risperidone orally disintegrating tab 0.25 mg............... 36risperidone orally disintegrating tab 0.5 mg (Risperdalm-tab)................................................................................ 36

risperidone orally disintegrating tab 1 mg (Risperdalm-tab)................................................................................ 36




risperidone soln 1 mg/ml (Risperdal).............................36risperidone tab 0.25 mg (Risperdal)...............................36risperidone tab 0.5 mg (Risperdal).................................37risperidone tab 1 mg (Risperdal)....................................37risperidone tab 2 mg (Risperdal)....................................37risperidone tab 3 mg (Risperdal)....................................37risperidone tab 4 mg (Risperdal)....................................37rivastigmine tartrate cap 1.5 mg (Exelon)......................40rivastigmine tartrate cap 3 mg (Exelon).........................41rivastigmine tartrate cap 4.5 mg (Exelon)......................41rivastigmine tartrate cap 6 mg (Exelon).........................41rizatriptan benzoate oral disintegrating tab 5 mg (baseeq) (Maxalt-mlt)................................................................44

2017


rizatriptan benzoate oral disintegrating tab 10 mg(base eq) (Maxalt-mlt).....................................................44

rizatriptan benzoate tab 5 mg (base equivalent)(Maxalt)..............................................................................44

rizatriptan benzoate tab 10 mg (base equivalent)(Maxalt)..............................................................................44

ropinirole hydrochloride tab 0.25 mg (Requip)............. 47ropinirole hydrochloride tab 0.5 mg (Requip)............... 47ropinirole hydrochloride tab 1 mg (Requip).................. 47ropinirole hydrochloride tab 2 mg (Requip).................. 47ropinirole hydrochloride tab 3 mg (Requip).................. 47ropinirole hydrochloride tab 4 mg (Requip).................. 47ropinirole hydrochloride tab 5 mg (Requip).................. 47rosuvastatin calcium tab 5 mg (Crestor)....................... 24rosuvastatin calcium tab 10 mg (Crestor)..................... 24rosuvastatin calcium tab 20 mg (Crestor)..................... 24rosuvastatin calcium tab 40 mg (Crestor)..................... 24S

SANDOSTATIN LAR DEPOT – octreotide acetate for iminj kit 10 mg.......................................................................18



selegiline hcl cap 5 mg (Eldepryl).................................. 47selegiline hcl tab 5 mg.....................................................47selenium sulfide lotion 2.5%........................................... 53SENSIPAR – cinacalcet hcl tab 30 mg (base equiv)..........18SENSIPAR – cinacalcet hcl tab 60 mg (base equiv)..........18SENSIPAR – cinacalcet hcl tab 90 mg (base equiv)..........18SEREVENT DISKUS – salmeterol xinafoate aer pow ba50 mcg/dose (base equiv)................................................ 29

sertraline hcl oral conc 20 mg/ml (Zoloft)......................35sertraline hcl tab 25 mg (Zoloft)..................................... 35sertraline hcl tab 50 mg (Zoloft)..................................... 35sertraline hcl tab 100 mg (Zoloft)................................... 35sildenafil citrate tab 20 mg (Revatio)............................. 26silver sulfadiazine cream 1% (Silvadene)...................... 52SIMPONI – golimumab subcutaneous soln auto-injector50 mg/0.5ml.......................................................................44

SIMPONI – golimumab subcutaneous soln auto-injector100 mg/ml..........................................................................44

SIMPONI – golimumab subcutaneous soln prefilledsyringe 50 mg/0.5ml..........................................................44

SIMPONI – golimumab subcutaneous soln prefilledsyringe 100 mg/ml.............................................................44

simvastatin tab 5 mg (Zocor).......................................... 24simvastatin tab 10 mg (Zocor)........................................ 24simvastatin tab 20 mg (Zocor)........................................ 24simvastatin tab 40 mg (Zocor)........................................ 24simvastatin tab 80 mg (Zocor)........................................ 24SINGLE-LET – lancets....................................................... 55sirolimus tab 0.5 mg (Rapamune)...................................56sirolimus tab 1 mg (Rapamune)......................................56sirolimus tab 2 mg (Rapamune)......................................56

sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)(Luride)..............................................................................48

sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)(Luride)..............................................................................48

sodium fluoride chew tab 1 mg f (from 2.2 mg naf)(Luride)..............................................................................48

sodium fluoride cream 1.1% (Prevident 5000 plus)...... 50sodium fluoride gel 1.1% (0.5% f) (Previdentfluoride).............................................................................50

sodium fluoride soln 0.125 mg/drop f (0.275 mg/dropnaf).....................................................................................48

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)(Luride)..............................................................................48

sodium polystyrene sulfonate oral susp 15 gm/60ml(Sps).................................................................................. 56

sodium polystyrene sulfonate powder(Kayexalate)......................................................................56

SOOLANTRA – ivermectin cream 1%............................... 51sotalol hcl (afib/afl) tab 80 mg (Betapace af).................25sotalol hcl (afib/afl) tab 120 mg (Betapace af)...............25sotalol hcl (afib/afl) tab 160 mg (Betapace af)...............25sotalol hcl tab 240 mg......................................................25sotalol hcl tab 80 mg (Betapace)....................................25sotalol hcl tab 120 mg (Betapace)..................................25sotalol hcl tab 160 mg (Betapace)..................................25SOVALDI – sofosbuvir tab 400 mg...................................... 5SPIRIVA HANDIHALER – tiotropium bromidemonohydrate inhal cap 18 mcg (base equiv)................... 29

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act................................................29

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act..................................................29

spironolactone & hydrochlorothiazide tab 25-25 mg(Aldactazide).....................................................................25

spironolactone tab 25 mg (Aldactone)...........................25spironolactone tab 50 mg (Aldactone)...........................25spironolactone tab 100 mg (Aldactone).........................25SPRYCEL – dasatinib tab 20 mg.......................................10SPRYCEL – dasatinib tab 50 mg.......................................10SPRYCEL – dasatinib tab 70 mg.......................................10SPRYCEL – dasatinib tab 80 mg.......................................10SPRYCEL – dasatinib tab 100 mg.....................................10SPRYCEL – dasatinib tab 140 mg.....................................10stavudine cap 15 mg (Zerit)...............................................6stavudine cap 20 mg (Zerit)...............................................6stavudine cap 30 mg (Zerit)...............................................6stavudine cap 40 mg (Zerit)...............................................7STELARA – ustekinumab inj 45 mg/0.5ml.........................53STELARA – ustekinumab soln prefilled syringe 45mg/0.5ml............................................................................ 53

STELARA – ustekinumab soln prefilled syringe 90 mg/ml........................................................................................53

STIMATE – desmopressin acetate nasal soln 1.5 mg/ml........................................................................................18

STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aerosoln 2.5-2.5 mcg/act..........................................................29

2017


STIVARGA – regorafenib tab 40 mg..................................10STRENSIQ – asfotase alfa subcutaneous inj 18mg/0.45ml.......................................................................... 18

STRENSIQ – asfotase alfa subcutaneous inj 28mg/0.7ml............................................................................ 18

STRENSIQ – asfotase alfa subcutaneous inj 40 mg/ml........................................................................................18

STRENSIQ – asfotase alfa subcutaneous inj 80mg/0.8ml............................................................................ 18

STRIBILD – elvitegrav-cobic-emtricitab-tenofovdf tab150-150-200-300 mg...........................................................7

STRIVERDI RESPIMAT – olodaterol hcl inhal aerosol soln2.5 mcg/act (base equiv).................................................. 29

SUBOXONE – buprenorphine hcl-naloxone hcl sl film2-0.5 mg (base equiv).......................................................56

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 4-1mg (base equiv)................................................................ 56



sucralfate tab 1 gm (Carafate).........................................31sulfacetamide sodium lotion 10% (acne) (Klaron)........51sulfacetamide sodium ophth soln 10% (Bleph-10)....... 49sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%.................................................................. 49

sulfamethoxazole-trimethoprim susp 200-40mg/5ml.................................................................................8

sulfamethoxazole-trimethoprim tab 400-80 mg(Bactrim)............................................................................. 8

sulfamethoxazole-trimethoprim tab 800-160 mg(Bactrim ds)........................................................................8

sulfasalazine tab delayed release 500 mg (Azulfidineen-tabs)............................................................................. 32

sulfasalazine tab 500 mg (Azulfidine)............................ 32sulindac tab 150 mg......................................................... 44sulindac tab 200 mg......................................................... 44sumatriptan nasal spray 5 mg/act (Imitrex)...................44sumatriptan nasal spray 20 mg/act (Imitrex).................44sumatriptan succinate inj 6 mg/0.5ml (Imitrex).............44sumatriptan succinate solution auto-injector 4mg/0.5ml (Imitrex statdose sys)....................................44

sumatriptan succinate solution auto-injector 6mg/0.5ml (Imitrex statdose sys)....................................44

sumatriptan succinate solution cartridge 4 mg/0.5ml(Imitrex statdose ref)...................................................... 44

sumatriptan succinate solution cartridge 6 mg/0.5ml(Imitrex statdose ref)...................................................... 44

sumatriptan succinate tab 25 mg (Imitrex)....................44sumatriptan succinate tab 50 mg (Imitrex)....................44sumatriptan succinate tab 100 mg (Imitrex)..................44SUPRAX – cefixime cap 400 mg......................................... 3SUPRAX – cefixime chew tab 100 mg................................ 3SUPRAX – cefixime chew tab 200 mg................................ 3SUPRAX – cefixime for susp 100 mg/5ml........................... 3SUPRAX – cefixime for susp 200 mg/5ml........................... 3

SUPRAX – cefixime for susp 500 mg/5ml........................... 3SUSTIVA – efavirenz cap 50 mg......................................... 7SUSTIVA – efavirenz cap 200 mg....................................... 7SUSTIVA – efavirenz tab 600 mg........................................ 7SUTENT – sunitinib malate cap 12.5 mg (baseequivalent)......................................................................... 10

SUTENT – sunitinib malate cap 25 mg (baseequivalent)......................................................................... 10

SUTENT – sunitinib malate cap 37.5 mg (baseequivalent)......................................................................... 11

SUTENT – sunitinib malate cap 50 mg (baseequivalent)......................................................................... 11

SYLATRON – peginterferon alfa-2b for inj kit 200 mcg..... 11SYLATRON – peginterferon alfa-2b for inj kit 300 mcg..... 11SYLATRON – peginterferon alfa-2b for inj kit 600 mcg..... 11SYNAREL – nafarelin acetate nasal soln 2 mg/ml (200mcg/act) (base eq)............................................................ 15

SYNJARDY – empagliflozin-metformin hcl tab 5-500mg...................................................................................... 16

SYNJARDY – empagliflozin-metformin hcl tab 5-1000mg...................................................................................... 16

SYNJARDY – empagliflozin-metformin hcl tab 12.5-500mg...................................................................................... 16

SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000mg...................................................................................... 16

TTABLOID – thioguanine tab 40 mg.................................... 11tacrolimus cap 0.5 mg (Prograf)..................................... 56tacrolimus cap 1 mg (Prograf)........................................ 56tacrolimus cap 5 mg (Prograf)........................................ 56tacrolimus oint 0.03% (Protopic).................................... 53tacrolimus oint 0.1% (Protopic)...................................... 53TAFINLAR – dabrafenib mesylate cap 50 mg (baseequivalent)......................................................................... 11

TAFINLAR – dabrafenib mesylate cap 75 mg (baseequivalent)......................................................................... 11

TAGRISSO – osimertinib mesylate tab 40 mg (baseequivalent)......................................................................... 11

TAGRISSO – osimertinib mesylate tab 80 mg (baseequivalent)......................................................................... 11

TAMIFLU – oseltamivir phosphate for susp 6 mg/ml (baseequiv)....................................................................................7

tamoxifen citrate tab 10 mg (base equivalent)..............11tamoxifen citrate tab 20 mg (base equivalent)..............11tamsulosin hcl cap 0.4 mg (Flomax).............................. 33TARCEVA – erlotinib hcl tab 25 mg (base equivalent).......11TARCEVA – erlotinib hcl tab 100 mg (base equivalent).....11TARCEVA – erlotinib hcl tab 150 mg (base equivalent).....11TASIGNA – nilotinib hcl cap 150 mg (base equivalent)..... 11TASIGNA – nilotinib hcl cap 200 mg (base equivalent)..... 11tazarotene cream 0.1% (Tazorac)....................................51TAZORAC – tazarotene cream 0.05%...............................51TAZORAC – tazarotene cream 0.1%.................................51TAZORAC – tazarotene gel 0.05%.................................... 51TAZORAC – tazarotene gel 0.1%...................................... 51

2017


TECFIDERA – dimethyl fumarate capsule delayed release120 mg...............................................................................40

TECFIDERA – dimethyl fumarate capsule delayed release240 mg...............................................................................40

TECFIDERA STARTER PACK – dimethyl fumaratecapsule dr starter pack 120 mg & 240 mg....................... 40

telmisartan-hydrochlorothiazide tab 40-12.5 mg(Micardis hct)................................................................... 21

telmisartan-hydrochlorothiazide tab 80-12.5 mg(Micardis hct)................................................................... 21

telmisartan-hydrochlorothiazide tab 80-25 mg(Micardis hct)................................................................... 21

telmisartan tab 20 mg (Micardis).................................... 20telmisartan tab 40 mg (Micardis).................................... 21telmisartan tab 80 mg (Micardis).................................... 21temazepam cap 7.5 mg (Restoril)................................... 37temazepam cap 15 mg (Restoril).................................... 37temazepam cap 22.5 mg (Restoril)................................. 37temazepam cap 30 mg (Restoril).................................... 37temozolomide cap 5 mg (Temodar)................................ 11temozolomide cap 20 mg (Temodar)..............................11temozolomide cap 100 mg (Temodar)............................11temozolomide cap 140 mg (Temodar)............................11temozolomide cap 180 mg (Temodar)............................11temozolomide cap 250 mg (Temodar)............................11TENCON – butalbital-acetaminophen tab 50-325 mg....... 41terazosin hcl cap 1 mg.....................................................26terazosin hcl cap 2 mg.....................................................26terazosin hcl cap 5 mg.....................................................26terazosin hcl cap 10 mg...................................................26terbinafine hcl tab 250 mg (Lamisil).................................5terbutaline sulfate tab 2.5 mg......................................... 29terbutaline sulfate tab 5 mg............................................ 29terconazole vaginal cream 0.4% (Terazol 7).................. 32terconazole vaginal cream 0.8% (Terazol 3).................. 32terconazole vaginal suppos 80 mg.................................32testosterone cypionate im inj in oil 100 mg/ml (Depo-testosterone).................................................................... 12

testosterone cypionate im inj in oil 200 mg/ml (Depo-testosterone).................................................................... 12

testosterone enanthate im inj in oil 200 mg/ml.............12testosterone td gel 12.5 mg/act (1%) (Androgelpump)................................................................................ 12

testosterone td gel 25 mg/2.5gm (1%) (Androgel)........ 12testosterone td gel 50 mg/5gm (1%) (Androgel)........... 12tetrabenazine tab 12.5 mg (Xenazine)............................ 41tetrabenazine tab 25 mg (Xenazine)............................... 41tetracycline hcl cap 250 mg (Tetracycline hcl)................4tetracycline hcl cap 500 mg (Tetracycline hcl)................4THALOMID – thalidomide cap 50 mg................................ 56THALOMID – thalidomide cap 100 mg.............................. 56THALOMID – thalidomide cap 150 mg.............................. 56THALOMID – thalidomide cap 200 mg.............................. 56theophylline tab sr 12hr 100 mg.....................................29theophylline tab sr 12hr 200 mg.....................................29theophylline tab sr 12hr 300 mg.....................................29

theophylline tab sr 12hr 450 mg.....................................29theophylline tab sr 24hr 400 mg.....................................29theophylline tab sr 24hr 600 mg.....................................29thiothixene cap 1 mg........................................................37thiothixene cap 2 mg........................................................37thiothixene cap 5 mg........................................................37thiothixene cap 10 mg......................................................37timolol maleate ophth gel forming soln 0.25%(Timoptic-xe).................................................................... 50

timolol maleate ophth gel forming soln 0.5%(Timoptic-xe).................................................................... 50

timolol maleate ophth soln 0.25% (Timoptic)................50timolol maleate ophth soln 0.5% (Timoptic)..................50TIVICAY – dolutegravir sodium tab 10 mg (base equiv)...... 7TIVICAY – dolutegravir sodium tab 25 mg (base equiv)...... 7TIVICAY – dolutegravir sodium tab 50 mg (base equiv)...... 7tizanidine hcl tab 2 mg (base equivalent)......................47tizanidine hcl tab 4 mg (base equivalent)(Zanaflex).......................................................................... 47

tobramycin-dexamethasone ophth susp 0.3-0.1%(Tobradex).........................................................................49

tobramycin nebu soln 300 mg/5ml (Tobi)........................ 4tobramycin ophth soln 0.3% (Tobrex)............................ 49tolterodine tartrate cap sr 24hr 2 mg (Detrol la)............32tolterodine tartrate cap sr 24hr 4 mg (Detrol la)............32tolterodine tartrate tab 1 mg (Detrol)............................. 32tolterodine tartrate tab 2 mg (Detrol)............................. 32topiramate sprinkle cap 15 mg (Topamax sprinkle)..... 46topiramate sprinkle cap 25 mg (Topamax sprinkle)..... 46topiramate tab 25 mg (Topamax).................................... 46topiramate tab 50 mg (Topamax).................................... 46topiramate tab 100 mg (Topamax).................................. 46topiramate tab 200 mg (Topamax).................................. 46torsemide tab 5 mg (Demadex).......................................25torsemide tab 10 mg (Demadex).....................................25torsemide tab 20 mg (Demadex).....................................25torsemide tab 100 mg (Demadex)...................................25TRACLEER – bosentan tab 62.5 mg.................................26TRACLEER – bosentan tab 125 mg..................................27tramadol-acetaminophen tab 37.5-325 mg(Ultracet)........................................................................... 43

tramadol hcl tab 50 mg (Ultram).....................................43tramadol hcl tab sr 24hr 100 mg (Ultram er)................. 42tramadol hcl tab sr 24hr 200 mg (Ultram er)................. 42tramadol hcl tab sr 24hr 300 mg (Ultram er)................. 42trandolapril tab 1 mg (Mavik).......................................... 19trandolapril tab 2 mg (Mavik).......................................... 19trandolapril tab 4 mg (Mavik).......................................... 19tranylcypromine sulfate tab 10 mg (Parnate)................35trazodone hcl tab 50 mg.................................................. 35trazodone hcl tab 100 mg................................................ 35trazodone hcl tab 150 mg................................................ 35trazodone hcl tab 300 mg................................................ 35tretinoin cap 10 mg...........................................................11tretinoin cream 0.025% (Retin-a).....................................51tretinoin cream 0.05% (Retin-a).......................................51

2017


tretinoin cream 0.1% (Retin-a).........................................51tretinoin gel 0.01% (Retin-a)............................................ 51tretinoin gel 0.025% (Retin-a)..........................................51tretinoin microsphere gel 0.04% (Retin-a micro).......... 51tretinoin microsphere gel 0.1% (Retin-a micro)............ 51triamcinolone acetonide cream 0.025%......................... 53triamcinolone acetonide cream 0.1%............................. 53triamcinolone acetonide cream 0.5%............................. 53triamcinolone acetonide dental paste 0.1%.................. 50triamcinolone acetonide lotion 0.025%..........................53triamcinolone acetonide lotion 0.1%..............................53triamcinolone acetonide nasal aerosol suspension 55mcg/act (Nasacort aq).................................................... 28

triamcinolone acetonide oint 0.025%............................. 53triamcinolone acetonide oint 0.1%................................. 53triamcinolone acetonide oint 0.5%................................. 53triamterene & hydrochlorothiazide cap 37.5-25 mg(Dyazide)........................................................................... 25

triamterene & hydrochlorothiazide tab 37.5-25 mg(Maxzide-25)..................................................................... 25

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)...........................................................................25

trifluoperazine hcl tab 1 mg............................................ 37trifluoperazine hcl tab 2 mg............................................ 37trifluoperazine hcl tab 5 mg............................................ 37trifluoperazine hcl tab 10 mg.......................................... 37trifluridine ophth soln 1% (Viroptic)............................... 49trihexyphenidyl hcl elixir 0.4 mg/ml............................... 47trihexyphenidyl hcl tab 2 mg...........................................47trihexyphenidyl hcl tab 5 mg...........................................47trimethobenzamide hcl cap 300 mg (Tigan).................. 31trimethoprim tab 100 mg................................................... 8TRIUMEQ – abacavir-dolutegravir-lamivudine tab600-50-300 mg.................................................................... 7

tropicamide ophth soln 0.5%.......................................... 50tropicamide ophth soln 1% (Mydriacyl)......................... 50TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 100-150 mg................................................................... 7

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 133-200 mg................................................................... 7



TYKERB – lapatinib ditosylate tab 250 mg (baseequiv)................................................................................. 11

UUPTRAVI – selexipag tab 200 mcg....................................27UPTRAVI – selexipag tab 400 mcg....................................27UPTRAVI – selexipag tab 600 mcg....................................27UPTRAVI – selexipag tab 800 mcg....................................27UPTRAVI – selexipag tab 1000 mcg..................................27UPTRAVI – selexipag tab 1200 mcg..................................27UPTRAVI – selexipag tab 1400 mcg..................................27UPTRAVI – selexipag tab 1600 mcg..................................27

UPTRAVI – selexipag tab therapy pack 200 mcg (140) &800 mcg (60)..................................................................... 27

ursodiol cap 300 mg (Actigall)........................................32ursodiol tab 250 mg (Urso 250)...................................... 32ursodiol tab 500 mg (Urso forte).................................... 32V

VAGIFEM – estradiol vaginal tab 10 mcg.......................... 32valacyclovir hcl tab 1 gm (Valtrex)................................... 5valacyclovir hcl tab 500 mg (Valtrex)............................... 5VALCHLOR – mechlorethamine hcl gel 0.016% (baseequivalent)......................................................................... 53

valganciclovir hcl for soln 50 mg/ml (base equiv)(Valcyte).............................................................................. 5

valganciclovir hcl tab 450 mg (base equivalent)(Valcyte).............................................................................. 5

valproate sodium oral soln 250 mg/5ml (base equiv)(Depakene)........................................................................46

valproic acid cap 250 mg (Depakene)............................46valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovanhct).....................................................................................21

valsartan-hydrochlorothiazide tab 160-12.5 mg (Diovanhct).....................................................................................21

valsartan-hydrochlorothiazide tab 160-25 mg (Diovanhct).....................................................................................21

valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovanhct).....................................................................................21

valsartan-hydrochlorothiazide tab 320-25 mg (Diovanhct).....................................................................................21

valsartan tab 40 mg (Diovan).......................................... 21valsartan tab 80 mg (Diovan).......................................... 21valsartan tab 160 mg (Diovan)........................................ 21valsartan tab 320 mg (Diovan)........................................ 21vancomycin hcl cap 125 mg (Vancocin hcl)....................8vancomycin hcl cap 250 mg (Vancocin hcl)....................8venlafaxine hcl cap sr 24hr 37.5 mg (base equivalent)(Effexor xr)....................................................................... 35

venlafaxine hcl cap sr 24hr 75 mg (base equivalent)(Effexor xr)....................................................................... 35

venlafaxine hcl cap sr 24hr 150 mg (base equivalent)(Effexor xr)....................................................................... 35

venlafaxine hcl tab 25 mg................................................35venlafaxine hcl tab 37.5 mg.............................................35venlafaxine hcl tab 50 mg................................................35venlafaxine hcl tab 75 mg................................................35venlafaxine hcl tab 100 mg..............................................35venlafaxine hcl tab sr 24hr 37.5 mg (base equivalent)(Venlafaxine hcl er)......................................................... 35

venlafaxine hcl tab sr 24hr 75 mg (base equivalent)(Venlafaxine hcl er)......................................................... 35

venlafaxine hcl tab sr 24hr 150 mg (base equivalent)(Venlafaxine hcl er)......................................................... 35

verapamil hcl cap sr 24hr 120 mg (Verelan).................. 23verapamil hcl cap sr 24hr 180 mg (Verelan).................. 23verapamil hcl cap sr 24hr 240 mg (Verelan).................. 23verapamil hcl cap sr 24hr 360 mg (Verelan).................. 23

2017


verapamil hcl tab cr 120 mg (Calan sr)..........................23verapamil hcl tab cr 180 mg (Calan sr)..........................23verapamil hcl tab cr 240 mg (Calan sr)..........................23verapamil hcl tab 40 mg.................................................. 23verapamil hcl tab 80 mg (Calan).....................................23verapamil hcl tab 120 mg (Calan)...................................23VESICARE – solifenacin succinate tab 5 mg.................... 32VESICARE – solifenacin succinate tab 10 mg...................32VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)...................................................................................... 16

VIRAMUNE – nevirapine susp 50 mg/5ml...........................7VIREAD – tenofovir disoproxil fumarate oral powder 40mg/gm.................................................................................. 7

VIREAD – tenofovir disoproxil fumarate tab 150 mg........... 7VIREAD – tenofovir disoproxil fumarate tab 200 mg........... 7VIREAD – tenofovir disoproxil fumarate tab 250 mg........... 7VIREAD – tenofovir disoproxil fumarate tab 300 mg........... 7voriconazole for susp 40 mg/ml (Vfend)..........................5voriconazole tab 50 mg (Vfend)........................................5voriconazole tab 200 mg (Vfend)......................................5VOTRIENT – pazopanib hcl tab 200 mg (base equiv).......11VYVANSE – lisdexamfetamine dimesylate cap 10 mg...... 39VYVANSE – lisdexamfetamine dimesylate cap 20 mg...... 39VYVANSE – lisdexamfetamine dimesylate cap 30 mg...... 39VYVANSE – lisdexamfetamine dimesylate cap 40 mg...... 39VYVANSE – lisdexamfetamine dimesylate cap 50 mg...... 39VYVANSE – lisdexamfetamine dimesylate cap 60 mg...... 39VYVANSE – lisdexamfetamine dimesylate cap 70 mg...... 39VYVANSE – lisdexamfetamine dimesylate chew tab 10mg...................................................................................... 39

VYVANSE – lisdexamfetamine dimesylate chew tab 20mg...................................................................................... 39





Wwarfarin sodium tab 1 mg (Coumadin).......................... 48warfarin sodium tab 2 mg (Coumadin).......................... 48warfarin sodium tab 2.5 mg (Coumadin)....................... 48warfarin sodium tab 3 mg (Coumadin).......................... 48warfarin sodium tab 4 mg (Coumadin).......................... 48warfarin sodium tab 5 mg (Coumadin).......................... 48warfarin sodium tab 6 mg (Coumadin).......................... 48warfarin sodium tab 7.5 mg (Coumadin)....................... 49warfarin sodium tab 10 mg (Coumadin)........................ 49X

XALKORI – crizotinib cap 200 mg..................................... 11XALKORI – crizotinib cap 250 mg..................................... 11XARELTO – rivaroxaban tab 10 mg...................................49

XARELTO – rivaroxaban tab 15 mg...................................49XARELTO – rivaroxaban tab 20 mg...................................49XARELTO STARTER PACK – rivaroxaban tab startertherapy pack 15 mg & 20 mg...........................................49

XIFAXAN – rifaximin tab 550 mg......................................... 8XTANDI – enzalutamide cap 40 mg...................................11XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr............................................................................ 14

Y

Zzafirlukast tab 10 mg (Accolate)..................................... 29zafirlukast tab 20 mg (Accolate)..................................... 29zaleplon cap 5 mg (Sonata).............................................37zaleplon cap 10 mg (Sonata)...........................................37ZELBORAF – vemurafenib tab 240 mg............................. 11ZENPEP – pancrelipase (lip-prot-amyl) dr cap3000-10000-16000 unit..................................................... 31

ZENPEP – pancrelipase (lip-prot-amyl) dr cap5000-17000-27000 unit..................................................... 31

ZENPEP – pancrelipase (lip-prot-amyl) dr cap10000-34000-55000 unit...................................................31

ZENPEP – pancrelipase (lip-prot-amyl) dr cap15000-51000-82000 unit...................................................31

ZENPEP – pancrelipase (lip-prot-amyl) dr cap20000-68000-109000 unit.................................................31

ZENPEP – pancrelipase (lip-prot-amyl) dr cap25000-85000-136000 unit.................................................31

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-136000-218000 unit...............................................31

ZETIA – ezetimibe tab 10 mg............................................ 24ZIAGEN – abacavir sulfate soln 20 mg/ml (base equiv)...... 7zidovudine cap 100 mg (Retrovir).....................................7zidovudine syrup 10 mg/ml (Retrovir)..............................7zidovudine tab 300 mg.......................................................7ziprasidone hcl cap 20 mg (Geodon)............................. 37ziprasidone hcl cap 40 mg (Geodon)............................. 37ziprasidone hcl cap 60 mg (Geodon)............................. 37ziprasidone hcl cap 80 mg (Geodon)............................. 37ZOLINZA – vorinostat cap 100 mg.................................... 11zolpidem tartrate tab cr 6.25 mg (Ambien cr)................37zolpidem tartrate tab cr 12.5 mg (Ambien cr)................37zolpidem tartrate tab 5 mg (Ambien)..............................37zolpidem tartrate tab 10 mg (Ambien)............................37zonisamide cap 50 mg..................................................... 46zonisamide cap 25 mg (Zonegran)................................. 46zonisamide cap 100 mg (Zonegran)............................... 46ZYDELIG – idelalisib tab 100 mg.......................................11ZYDELIG – idelalisib tab 150 mg.......................................11ZYKADIA – ceritinib cap 150 mg....................................... 11ZYTIGA – abiraterone acetate tab 250 mg........................11ZYTIGA – abiraterone acetate tab 500 mg........................11

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