blue cross blue shield of wyoming standard drug list ... · blue cross blue shield of wyoming...

2278 WY © Prime Therapeutics LLC 01/16

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Contents

Introduction .................................................................... I Member prescription benefit ............................................ I Prior Authorization ........................................................... I How to use this list .......................................................... II Specialty Products ........................................................ III Generic substitution ...................................................... III Abbreviation Key ............................................................ III

Therapeutic Class Drug List

Anti-Infective Agents ....................................................... 1 Cancer Drugs .................................................................. 7 Hormones, Diabetes and Related Drugs ...................... 10 Heart and Circulatory Drugs ......................................... 17 Respiratory Agents ....................................................... 26 Gastrointestinal Drugs .................................................. 28 Genitourinary Drugs ...................................................... 31 Central Nervous System Drugs .................................... 32 Pain Relief Drugs .......................................................... 40 Neuromuscular Drugs ................................................... 45 Blood Modifying Drugs .................................................. 50 Topical Products ........................................................... 52 Miscellaneous Categories (includes Supplies

and Devices) ............................................................. 58 Index ............................................................................. 62

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 (Prime) is an independent company that manages pharmacy benefits for Blue Cross Blue Shield of Wyoming members

January 2016

Blue Cross Blue Shield of Wyoming Standard Drug List

Blue Cross Blue Shield of Wyoming Standard Drug List, January 2016 I

Introduction

This Blue Cross Blue Shield of Wyoming (BCBSWY) Standard Drug List, also called a patient medication guide, includes Brand drugs and Generic drugs. This guide, current at time of printing and subject to change, is updated quarterly. Members and physicians can review the most up-to-date version of the Standard Drug List at www.wyomingblue.com/pharmacy.

The Standard Drug List includes a list of prescription drugs, insulin, and diabetic supplies that reflect the current recommendations of BCBSWY. The Standard Drug List is developed in conjunction with Prime Therapeutics’ National Pharmacy & Therapeutics Committee, which includes practicing physicians and pharmacists dedicated to providing patients with high-quality, cost-effective drug therapy. The Committee includes physicians and pharmacists from throughout the country. Prime Therapeutics does not have voting privileges. Drugs are reviewed in terms of safety, efficacy, and clinical uniqueness.

Member prescription benefit

Medications and supplies on this list are Preferred products. Drugs or supplies not listed are Non-Preferred (NP). Coverage of Preferred and Non-Preferred drugs will vary depending on your individual prescription benefit.

Some drugs may be excluded from coverage. For example, drugs indicated for cosmetic purposes, e.g., Propecia, for hair growth, are not covered. Prescription drugs may be excluded from coverage if there are over-the-counter (OTC) versions marketed. OTC drugs are not covered with the exception of insulin and selected diabetic supplies.

Prior Authorization

Drugs are selected for prior authorization (PA) because of actual or potential misuse or overuse that may be of clinical and/or economic concern. Drugs selected for PA require that specific clinical criteria are met before the drugs will be covered under a member’s prescription benefit.

Not all drugs selected for PA are on the Standard Drug List. Coverage of Preferred and Non-Preferred drugs will vary depending on your individual prescription benefit. Drugs selected for PA are subject to change. For information about benefit coverage on specific drugs, please call 800.442.2376.

Blue Cross Blue Shield of Wyoming Standard Drug List, January 2016 II

How to use this list

This list is organized into broad therapeutic categories (e.g. Hormones, Diabetes and Related Drugs).Within most categories, drugs are sub-grouped based upon drug class (e.g Corticosteroids). All drugs listed, whether generic or brand, are Preferred drugs. The graphic below shows the information that is provided in each column of the medication list and is an example only. Please use the drug search function to find current information for drugs on the medication list.

The first column of the chart lists the drug name.

Generic drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand drug in (parentheses). Some generic products have no reference brand.

Brand prescription drugs are shown in capital letters followed by the generic name.

The second column indicates if the drug is a specialty drug. Note: Additional information about specialty drugs can be found in this document under the header for Specialty Products.

The columns indicate the Utilization Management (UM) program(s) that apply to the prescription drug (e.g., Prior Authorization and Quantity Limits). If an indicator is present in the column(s), then the UM program noted is possibly applied to your benefit. Some plans may have UM on additional medications beyond those noted in this document.

Blue Cross Blue Shield of Wyoming Standard Drug List, January 2016 III

Specialty Products

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. These high cost medications also have one or more of the following characteristics:

• Unique storage or shipment requirements

• Additional education and support required from a health care professional

• Usually not stocked at retail pharmacies

Generic substitution

BCBSWY 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-name counterparts, but are usually less expensive. Generic drugs are manufactured under the same strict standards of FDA’s Good Manufacturing Practice regulations that are required for brand products including batch requirements for identity, strength, purity, and quality.

An FDA-approved generic drug may be substituted for the brand counterpart because 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 the use of generic drugs, Preferred brand drugs usually become Non-Preferred after the generic equivalent version is added to the drug guide. If the brand drug you are looking for does not appear on this list, it may be present under the generic name. You can ask your pharmacist for assistance.

Abbreviation/acronym 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 tablets 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

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Blue Cross Blue Shield of Wyoming Standard Drug List, January 2016 1

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ANTI-INFECTIVE AGENTSPENICILLINSAMOXICILLIN – amoxicillin (trihydrate)

chew tab 125 mgAMOXICILLIN – amoxicillin (trihydrate)

chew tab 250 mgamoxicillin (trihydrate) cap 250 mgamoxicillin (trihydrate) cap 500 mgamoxicillin (trihydrate) for susp

125 mg/5mlamoxicillin (trihydrate) for susp



400 mg/5mlamoxicillin (trihydrate) tab 500 mgamoxicillin (trihydrate) tab 875 mgamoxicillin & k clavulanate for susp

200-28.5 mg/5mlamoxicillin & k clavulanate for susp

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

400-57 mg/5mlamoxicillin & k clavulanate for susp

600-42.9 mg/5ml (Augmentin es-600)amoxicillin & k clavulanate tab sr 12hr

1000-62.5 mg (Augmentin xr)amoxicillin & k clavulanate tab

250-125 mgamoxicillin & k clavulanate tab

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

875-125 mg (Augmentin)AMOXICILLIN/CLAVULANATE P –

amoxicillin & k clavulanate chew tab200-28.5 mg

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AMOXICILLIN/CLAVULANATE P –amoxicillin & k clavulanate chew tab400-57 mg

AMPICILLIN – ampicillin for susp 125mg/5ml

AMPICILLIN – ampicillin for susp 250mg/5ml

ampicillin cap 250 mgampicillin cap 500 mgAUGMENTIN – amoxicillin & k

clavulanate for susp 125-31.25 mg/5mldicloxacillin sodium cap 250 mgdicloxacillin sodium cap 500 mgpenicillin v potassium for soln

125 mg/5mlpenicillin v potassium for soln

250 mg/5mlpenicillin v potassium tab 250 mgpenicillin v potassium tab 500 mgCEPHALOSPORINScefaclor cap 250 mgcefaclor cap 500 mgcefadroxil cap 500 mgcefadroxil for susp 250 mg/5mlcefadroxil for susp 500 mg/5mlcefadroxil tab 1 gmcefdinir cap 300 mgcefdinir for susp 125 mg/5mlcefdinir for susp 250 mg/5mlcefixime for susp 100 mg/5ml (Suprax)cefixime for susp 200 mg/5ml (Suprax)cefpodoxime proxetil for susp

50 mg/5mlcefpodoxime proxetil for susp

100 mg/5mlcefpodoxime proxetil tab 100 mgcefpodoxime proxetil tab 200 mg

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2 Blue Cross Blue Shield of Wyoming Standard Drug List, January 2016

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cefprozil for susp 125 mg/5mlcefprozil for susp 250 mg/5mlcefprozil tab 250 mgcefprozil tab 500 mgCEFTIN – cefuroxime axetil for susp 125

mg/5mlceftriaxone sodium for inj 10 gmcefuroxime axetil tab 250 mg (Ceftin)cefuroxime axetil tab 500 mg (Ceftin)cephalexin cap 250 mg (Keflex)cephalexin cap 500 mg (Keflex)cephalexin cap 750 mg (Keflex)cephalexin for susp 125 mg/5mlcephalexin for susp 250 mg/5mlSUPRAX – cefixime cap 400 mgSUPRAX – cefixime chew tab 100 mgSUPRAX – cefixime chew tab 200 mgSUPRAX – cefixime for susp 100 mg/5mlSUPRAX – cefixime for susp 200 mg/5mlSUPRAX – cefixime for susp 500 mg/5mlMACROLIDESAZITHROMYCIN – azithromycin powd

pack for susp 1 gmazithromycin for susp 100 mg/5ml

(Zithromax)azithromycin for susp 200 mg/5ml

(Zithromax)azithromycin tab 250 mg (Zithromax)azithromycin tab 500 mg (Zithromax)azithromycin tab 600 mg (Zithromax)clarithromycin for susp 125 mg/5mlclarithromycin for susp 250 mg/5ml

(Biaxin)clarithromycin tab sr 24hr 500 mg

(Biaxin xl pac)clarithromycin tab 250 mg (Biaxin)

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clarithromycin tab 500 mg (Biaxin)E.E.S. 400 – erythromycin ethylsuccinate

tab 400 mgERY-TAB – erythromycin tab delayed

release 250 mgERY-TAB – erythromycin tab delayed

release 333 mgERY-TAB – erythromycin tab delayed

release 500 mgERYTHROCIN STEARATE –

erythromycin stearate tab 250 mgERYTHROMYCIN BASE – erythromycin

tab 250 mgERYTHROMYCIN BASE – erythromycin

tab 500 mgERYTHROMYCIN ETHYLSUCCINA –

erythromycin ethylsuccinate tab 400 mgerythromycin w/ delayed release

particles cap 250 mgTETRACYCLINESdemeclocycline hcl tab 150 mgdemeclocycline hcl tab 300 mgdoxycycline hyclate cap 50 mgdoxycycline hyclate cap 100 mg

(Vibramycin)doxycycline hyclate tab delayed

release 75 mgdoxycycline hyclate tab delayed

release 100 mgdoxycycline hyclate tab delayed

release 150 mg (Doryx)doxycycline hyclate tab 20 mgdoxycycline hyclate tab 100 mgdoxycycline monohydrate cap 50 mgdoxycycline monohydrate cap 75 mg

(Monodox)doxycycline monohydrate cap 100 mg

(Monodox)

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doxycycline monohydrate cap 150 mg(Adoxa)

doxycycline monohydrate for susp25 mg/5ml (Vibramycin)

doxycycline monohydrate tab 50 mg(Adoxa)

doxycycline monohydrate tab 75 mg(Adoxa)

doxycycline monohydrate tab 100 mg(Adoxa pak 1/100)

doxycycline monohydrate tab 150 mg(Adoxa pak 1/150)

minocycline hcl cap 50 mg (Minocin)minocycline hcl cap 75 mg (Minocin)minocycline hcl cap 100 mg (Minocin)minocycline hcl tab sr 24hr 45 mgminocycline hcl tab sr 24hr 90 mgminocycline hcl tab sr 24hr 135 mgminocycline hcl tab 50 mgminocycline hcl tab 75 mgminocycline hcl tab 100 mgTETRACYCLINE HCL – tetracycline hcl

cap 250 mgTETRACYCLINE HCL – tetracycline hcl

cap 500 mgFLUOROQUINOLONESciprofloxacin for oral susp 250 mg/5ml

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

(10%) (10 gm/100ml) (Cipro)CIPROFLOXACIN HCL – ciprofloxacin

hcl tab 100 mg (base equiv)ciprofloxacin hcl tab 250 mg (base

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

equiv) (Cipro)ciprofloxacin hcl tab 750 mg (base

equiv)

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ciprofloxacin-ciprofloxacin hcl tab sr24hr 500 mg (base eq) (Cipro xr)

ciprofloxacin-ciprofloxacin hcl tab sr24hr 1000 mg(base eq) (Cipro xr)

levofloxacin oral soln 25 mg/ml(Levaquin)

levofloxacin tab 250 mg (Levaquin)levofloxacin tab 500 mg (Levaquin)levofloxacin tab 750 mg (Levaquin)moxifloxacin hcl tab 400 mg (base

equiv) (Avelox)OFLOXACIN – ofloxacin tab 400 mgAMINOGLYCOSIDESneomycin sulfate tab 500 mgparomomycin sulfate cap 250 mgtobramycin nebu soln 300 mg/5ml

(Tobi)• •

TUBERCULOSISethambutol hcl tab 100 mg (Myambutol)ethambutol hcl tab 400 mg (Myambutol)ISONIAZID – isoniazid syrup 50 mg/5mlisoniazid tab 100 mgisoniazid tab 300 mgPRIFTIN – rifapentine tab 150 mgpyrazinamide tab 500 mgrifabutin cap 150 mg (Mycobutin)RIFAMATE – isoniazid & rifampin cap

150-300 mgrifampin cap 150 mg (Rifadin)rifampin cap 300 mg (Rifadin)FUNGAL INFECTIONSfluconazole for susp 10 mg/ml

(Diflucan)fluconazole for susp 40 mg/ml

(Diflucan)fluconazole tab 50 mg (Diflucan)fluconazole tab 100 mg (Diflucan)

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fluconazole tab 150 mg (Diflucan)fluconazole tab 200 mg (Diflucan)flucytosine cap 250 mg (Ancobon)flucytosine cap 500 mg (Ancobon)griseofulvin microsize susp

125 mg/5mlgriseofulvin microsize tab 500 mg

(Grifulvin v)griseofulvin ultramicrosize tab 125 mg

(Gris-peg)griseofulvin ultramicrosize tab 250 mg

(Gris-peg)itraconazole cap 100 mg (Sporanox)LAMISIL – terbinafine hcl oral granules

packet 125 mgLAMISIL – terbinafine hcl oral granules

packet 187.5 mgNOXAFIL – posaconazole tab delayed

release 100 mg•

NOXAFIL – posaconazole susp 40 mg/ml •nystatin oral powdernystatin tab 500000 unitSPORANOX – itraconazole oral soln 10

mg/mlterbinafine hcl tab 250 mg (Lamisil)voriconazole for susp 40 mg/ml (Vfend) •voriconazole tab 50 mg (Vfend) •voriconazole tab 200 mg (Vfend) •VIRAL INFECTIONSCytomegalovirusVALCYTE – valganciclovir hcl for soln 50

mg/ml (base equiv)valganciclovir hcl tab 450 mg (base

equivalent) (Valcyte)Hepatitisadefovir dipivoxil tab 10 mg (Hepsera) •BARACLUDE – entecavir oral soln 0.05

mg/ml•

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DAKLINZA – daclatasvir dihydrochloridetab 30 mg (base equivalent)

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DAKLINZA – daclatasvir dihydrochloridetab 60 mg (base equivalent)

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entecavir tab 0.5 mg (Baraclude) •entecavir tab 1 mg (Baraclude) •EPIVIR HBV – lamivudine oral soln 5 mg/

ml (hbv)HARVONI – ledipasvir-sofosbuvir tab

90-400 mg• •

lamivudine tab 100 mg (hbv) (Epivirhbv)

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

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

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

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

• •

ribavirin cap 200 mg (Rebetol) • •ribavirin tab 200 mg (Copegus) • •SOVALDI – sofosbuvir tab 400 mg • •Herpesacyclovir cap 200 mg (Zovirax)acyclovir susp 200 mg/5ml (Zovirax)acyclovir tab 400 mg (Zovirax)acyclovir tab 800 mg (Zovirax)famciclovir tab 125 mg (Famvir)famciclovir tab 250 mg (Famvir)famciclovir tab 500 mg (Famvir)valacyclovir hcl tab 500 mg (Valtrex)valacyclovir hcl tab 1 gm (Valtrex)HIV/AIDSabacavir sulfate tab 300 mg (base

equiv) (Ziagen)abacavir sulfate-lamivudine-zidovudine

tab 300-150-300 mg (Trizivir)

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APTIVUS – tipranavir cap 250 mgAPTIVUS – tipranavir oral soln 100 mg/mlATRIPLA – efavirenz-emtricitabine-

tenofovir df tab 600-200-300 mgCOMPLERA – emtricitabine-rilpivirine-

tenofovir df tab 200-25-300 mgCRIXIVAN – indinavir sulfate cap 200 mgCRIXIVAN – indinavir sulfate cap 400 mgdidanosine delayed release capsule

125 mg (Videx ec)didanosine delayed release capsule



400 mg (Videx ec)EDURANT – rilpivirine hcl tab 25 mg

(base equivalent)EMTRIVA – emtricitabine caps 200 mgEMTRIVA – emtricitabine soln 10 mg/mlEPZICOM – abacavir sulfate-lamivudine

tab 600-300 mgEVOTAZ – atazanavir sulfate-cobicistat

tab 300-150 mg (base equiv)FUZEON – enfuvirtide for inj 90 mgINTELENCE – etravirine tab 25 mgINTELENCE – etravirine tab 100 mgINTELENCE – etravirine tab 200 mgINVIRASE – saquinavir mesylate cap 200

mgINVIRASE – saquinavir mesylate tab 500

mgISENTRESS – raltegravir potassium tab

400 mg (base equiv)ISENTRESS – raltegravir potassium

packet for susp 100 mg (base equiv)ISENTRESS – raltegravir potassium

chew tab 25 mg (base equiv)

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ISENTRESS – raltegravir potassiumchew tab 100 mg (base equiv)

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

KALETRA – lopinavir-ritonavir tab 100-25mg

KALETRA – lopinavir-ritonavir tab 200-50mg

lamivudine oral soln 10 mg/ml (Epivir)lamivudine tab 150 mg (Epivir)lamivudine tab 300 mg (Epivir)lamivudine-zidovudine tab 150-300 mg

(Combivir)LEXIVA – fosamprenavir calcium tab 700

mg (base equiv)LEXIVA – fosamprenavir calcium susp 50

mg/ml (base equiv)nevirapine tab sr 24hr 400 mg

(Viramune xr)nevirapine tab 200 mg (Viramune)NORVIR – ritonavir cap 100 mgNORVIR – ritonavir tab 100 mgNORVIR – ritonavir oral soln 80 mg/mlPREZCOBIX – darunavir-cobicistat tab

800-150 mgPREZISTA – darunavir ethanolate susp

100 mg/ml (base equiv)PREZISTA – darunavir ethanolate tab 75

mg (base equiv)PREZISTA – darunavir ethanolate tab 150



mg (base equiv)RESCRIPTOR – delavirdine mesylate tab

100 mgRESCRIPTOR – delavirdine mesylate tab

200 mg

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REYATAZ – atazanavir sulfate oralpowder packet 50 mg (base equiv)

REYATAZ – atazanavir sulfate cap 150mg (base equiv)



SELZENTRY – maraviroc tab 150 mgSELZENTRY – maraviroc tab 300 mgstavudine cap 15 mg (Zerit)stavudine cap 20 mg (Zerit)stavudine cap 30 mg (Zerit)stavudine cap 40 mg (Zerit)stavudine for oral soln 1 mg/ml (Zerit)STRIBILD – elvitegrav-cobicis-emtricitab-

tenofov tab 150-150-200-300 mgSUSTIVA – efavirenz tab 600 mgSUSTIVA – efavirenz cap 50 mgSUSTIVA – efavirenz cap 200 mgTIVICAY – dolutegravir sodium tab 50 mg

(base equiv)TRIUMEQ – abacavir-dolutegravir-

lamivudine tab 600-50-300 mgTRUVADA – emtricitabine-tenofovir

disoproxil fumarate tab 200-300 mgTYBOST – cobicistat tab 150 mgVIDEX – didanosine for soln 2 gmVIDEX – didanosine for soln 4 gmVIRACEPT – nelfinavir mesylate tab 250

mgVIRACEPT – nelfinavir mesylate tab 625

mgVIRAMUNE – nevirapine susp 50 mg/5mlVIRAMUNE XR – nevirapine tab sr 24hr

100 mgVIREAD – tenofovir disoproxil fumarate

oral powder 40 mg/gm

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VIREAD – tenofovir disoproxil fumaratetab 150 mg




VITEKTA – elvitegravir tab 85 mgVITEKTA – elvitegravir tab 150 mgZIAGEN – abacavir sulfate soln 20 mg/ml

(base equiv)zidovudine cap 100 mg (Retrovir)zidovudine syrup 10 mg/ml (Retrovir)zidovudine tab 300 mgInfluenzaRELENZA DISKHALER – zanamivir aero

powder breath activated 5 mg/blisterrimantadine hydrochloride tab 100 mg

(Flumadine)TAMIFLU – oseltamivir phosphate for

susp 6 mg/ml (base equiv)TAMIFLU – oseltamivir phosphate cap 30

mg (base equiv)TAMIFLU – oseltamivir phosphate cap 45

mg (base equiv)TAMIFLU – oseltamivir phosphate cap 75

mg (base equiv)MALARIAatovaquone-proguanil hcl tab

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

250-100 mg (Malarone)chloroquine phosphate tab 250 mgchloroquine phosphate tab 500 mg

(Aralen)COARTEM – artemether-lumefantrine tab

20-120 mgDARAPRIM – pyrimethamine tab 25 mg

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hydroxychloroquine sulfate tab 200 mg(Plaquenil)

mefloquine hcl tab 250 mgPRIMAQUINE PHOSPHATE –

primaquine phosphate tab 26.3 mg (15mg base)

quinine sulfate cap 324 mg (Qualaquin)WORM INFECTIONSALBENZA – albendazole tab 200 mgBILTRICIDE – praziquantel tab 600 mgivermectin tab 3 mg (Stromectol)OTHER ANTI-INFECTIVESatovaquone susp 750 mg/5ml (Mepron)clindamycin hcl cap 75 mg (Cleocin)clindamycin hcl cap 150 mg (Cleocin)clindamycin hcl cap 300 mg (Cleocin)clindamycin palmitate hcl for soln

75 mg/5ml (base equiv) (Cleocinpediatric gr)

DAPSONE – dapsone tab 25 mgDAPSONE – dapsone tab 100 mglinezolid tab 600 mg (Zyvox)metronidazole cap 375 mg (Flagyl)metronidazole tab 250 mg (Flagyl)metronidazole tab 500 mg (Flagyl)NEBUPENT – pentamidine isethionate for

nebulization soln 300 mgSIVEXTRO – tedizolid phosphate tab 200

mgsulfamethoxazole-trimethoprim susp

200-40 mg/5mlsulfamethoxazole-trimethoprim tab

400-80 mg (Bactrim)sulfamethoxazole-trimethoprim tab

800-160 mg (Bactrim ds)tinidazole tab 250 mg (Tindamax)tinidazole tab 500 mg (Tindamax)

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trimethoprim tab 100 mgvancomycin hcl cap 125 mg (Vancocin

hcl)vancomycin hcl cap 250 mg (Vancocin

hcl)XIFAXAN – rifaximin tab 550 mgZYVOX – linezolid for susp 100 mg/5mlCANCER DRUGS

ACTIMMUNE – interferon gamma-1b inj100 mcg/0.5ml (2000000 unit/0.5ml)

• •

AFINITOR – everolimus tab 2.5 mg • •AFINITOR – everolimus tab 5 mg • •AFINITOR – everolimus tab 7.5 mg • •AFINITOR – everolimus tab 10 mg • •AFINITOR DISPERZ – everolimus tab for

oral susp 2 mg• •

AFINITOR DISPERZ – everolimus tab fororal susp 3 mg

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AFINITOR DISPERZ – everolimus tab fororal susp 5 mg

• •

ALKERAN – melphalan tab 2 mganastrozole tab 1 mg (Arimidex)bexarotene cap 75 mg (Targretin) • •bicalutamide tab 50 mg (Casodex)BOSULIF – bosutinib tab 100 mg • •BOSULIF – bosutinib tab 500 mg • •capecitabine tab 150 mg (Xeloda) • •capecitabine tab 500 mg (Xeloda) • •CAPRELSA – vandetanib tab 100 mg • •CAPRELSA – vandetanib tab 300 mg • •COMETRIQ – cabozantinib s-malate cap

3 x 20 mg (60 mg dose) kit• •

COMETRIQ – cabozantinib s-mal cap 1 x80 mg & 1 x 20 mg (100 dose) kit

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COMETRIQ – cabozantinib s-mal cap 1 x80 mg & 3 x 20 mg (140 dose) kit

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CYCLOPHOSPHAMIDE –cyclophosphamide cap 25 mg

CYCLOPHOSPHAMIDE –cyclophosphamide cap 50 mg

EMCYT – estramustine phosphatesodium cap 140 mg

ERIVEDGE – vismodegib cap 150 mg • •ETOPOSIDE – etoposide cap 50 mgexemestane tab 25 mg (Aromasin)FARESTON – toremifene citrate tab 60

mg (base equivalent)FARYDAK – panobinostat lactate cap 10

mg (base equivalent)• •

FARYDAK – panobinostat lactate cap 15mg (base equivalent)

• •

FARYDAK – panobinostat lactate cap 20mg (base equivalent)

• •

flutamide cap 125 mgGILOTRIF – afatinib dimaleate tab 20 mg

(base equivalent)• •

GILOTRIF – afatinib dimaleate tab 30 mg(base equivalent)

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GILOTRIF – afatinib dimaleate tab 40 mg(base equivalent)

• •

GLEEVEC – imatinib mesylate tab 100mg (base equivalent)

• •

GLEEVEC – imatinib mesylate tab 400mg (base equivalent)

• •

GLEOSTINE – lomustine cap 5 mgGLEOSTINE – lomustine cap 10 mgGLEOSTINE – lomustine cap 40 mgGLEOSTINE – lomustine cap 100 mgHEXALEN – altretamine cap 50 mg • •HYCAMTIN – topotecan hcl cap 0.25 mg

(base equiv)• •

HYCAMTIN – topotecan hcl cap 1 mg(base equiv)

• •

hydroxyurea cap 500 mg (Hydrea)

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IBRANCE – palbociclib cap 75 mg • •IBRANCE – palbociclib cap 100 mg • •IBRANCE – palbociclib cap 125 mg • •ICLUSIG – ponatinib hcl tab 15 mg (base

equiv)• •

ICLUSIG – ponatinib hcl tab 45 mg (baseequiv)

• •

IMBRUVICA – ibrutinib cap 140 mg • •INLYTA – axitinib tab 1 mg • •INLYTA – axitinib tab 5 mg • •IRESSA – gefitinib tab 250 mg • •JAKAFI – ruxolitinib phosphate tab 5 mg


JAKAFI – ruxolitinib phosphate tab 10 mg(base equivalent)

• •


• •


• •


• •

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

• •

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

• •

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

• •

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

• •

letrozole tab 2.5 mg (Femara)LEUCOVORIN CALCIUM – leucovorin

calcium tab 10 mgLEUCOVORIN CALCIUM – leucovorin

calcium tab 15 mgleucovorin calcium tab 5 mg

2016


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leucovorin calcium tab 25 mgLEUKERAN – chlorambucil tab 2 mgLOMUSTINE – lomustine cap 10 mgLOMUSTINE – lomustine cap 40 mgLOMUSTINE – lomustine cap 100 mgLONSURF – trifluridine-tipiracil tab

15-6.14 mg• •

LONSURF – trifluridine-tipiracil tab20-8.19 mg

• •

LYNPARZA – olaparib cap 50 mg • •LYSODREN – mitotane tab 500 mg • •MATULANE – procarbazine hcl cap 50

mg• •

megestrol acetate susp 40 mg/ml(Megace oral)

megestrol acetate tab 20 mgmegestrol acetate tab 40 mgMEKINIST – trametinib dimethyl sulfoxide

tab 0.5 mg (base equivalent)• •

MEKINIST – trametinib dimethyl sulfoxidetab 2 mg (base equivalent)

• •

mercaptopurine tab 50 mg (Purinethol)MESNEX – mesna tab 400 mgmethotrexate sodium tab 2.5 mg (base

equiv)MYLERAN – busulfan tab 2 mgNEXAVAR – sorafenib tosylate tab 200


NILANDRON – nilutamide tab 150 mgODOMZO – sonidegib phosphate cap

200 mg (base equivalent)• •

POMALYST – pomalidomide cap 1 mg • •POMALYST – pomalidomide cap 2 mg • •POMALYST – pomalidomide cap 3 mg • •POMALYST – pomalidomide cap 4 mg • •PURIXAN – mercaptopurine susp 2000

mg/100ml (20 mg/ml)• •

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SOLTAMOX – tamoxifen citrate oral soln10 mg/5ml (base equivalent)

SPRYCEL – dasatinib tab 20 mg • •SPRYCEL – dasatinib tab 50 mg • •SPRYCEL – dasatinib tab 70 mg • •SPRYCEL – dasatinib tab 80 mg • •SPRYCEL – dasatinib tab 100 mg • •SPRYCEL – dasatinib tab 140 mg • •STIVARGA – regorafenib tab 40 mg • •SUTENT – sunitinib malate cap 12.5 mg


SUTENT – sunitinib malate cap 25 mg(base equivalent)

• •

SUTENT – sunitinib malate cap 37.5 mg(base equivalent)

• •

SUTENT – sunitinib malate cap 50 mg(base equivalent)

• •

SYLATRON – peginterferon alfa-2b for injkit 200 mcg

• •


• •


• •

TABLOID – thioguanine tab 40 mgTAFINLAR – dabrafenib mesylate cap 50


TAFINLAR – dabrafenib mesylate cap 75mg (base equivalent)

• •

tamoxifen citrate tab 10 mg (baseequivalent)

tamoxifen citrate tab 20 mg (baseequivalent)

TARCEVA – erlotinib hcl tab 25 mg (baseequivalent)

• •

TARCEVA – erlotinib hcl tab 100 mg(base equivalent)

• •

TARCEVA – erlotinib hcl tab 150 mg(base equivalent)

• •

2016


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TASIGNA – nilotinib hcl cap 150 mg (baseequivalent)

• •

TASIGNA – nilotinib hcl cap 200 mg (baseequivalent)

• •

temozolomide cap 5 mg (Temodar) • •temozolomide cap 20 mg (Temodar) • •temozolomide cap 100 mg (Temodar) • •temozolomide cap 140 mg (Temodar) • •temozolomide cap 180 mg (Temodar) • •temozolomide cap 250 mg (Temodar) • •tretinoin cap 10 mg • •TYKERB – lapatinib ditosylate tab 250 mg

(base equiv)• •

VOTRIENT – pazopanib hcl tab 200 mg(base equiv)

• •

XALKORI – crizotinib cap 200 mg • •XALKORI – crizotinib cap 250 mg • •XTANDI – enzalutamide cap 40 mg • •ZELBORAF – vemurafenib tab 240 mg • •ZOLINZA – vorinostat cap 100 mg • •ZYDELIG – idelalisib tab 100 mg • •ZYDELIG – idelalisib tab 150 mg • •ZYKADIA – ceritinib cap 150 mg • •ZYTIGA – abiraterone acetate tab 250 mg • •HORMONES, DIABETES AND RELATED DRUGSCORTICOSTEROIDSbudesonide cap sr 24hr 3 mg (Entocort

ec)CORTISONE ACETATE – cortisone

acetate tab 25 mgDEXAMETHASONE – dexamethasone

soln 0.5 mg/5mlDEXAMETHASONE – dexamethasone

tab 1 mgDEXAMETHASONE – dexamethasone

tab 2 mgdexamethasone elixir 0.5 mg/5ml

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DEXAMETHASONE INTENSOL –dexamethasone conc 1 mg/ml

dexamethasone tab 0.5 mgdexamethasone tab 0.75 mgdexamethasone tab 1.5 mgdexamethasone tab 4 mgdexamethasone tab 6 mgfludrocortisone acetate tab 0.1 mghydrocortisone tab 5 mg (Cortef)hydrocortisone tab 10 mg (Cortef)hydrocortisone tab 20 mg (Cortef)methylprednisolone tab 4 mg dose

pack (Medrol dosepak)methylprednisolone tab 4 mg (Medrol)methylprednisolone tab 8 mg (Medrol)methylprednisolone tab 16 mg (Medrol)methylprednisolone tab 32 mg (Medrol)prednisolone sod phos orally disintegr

tab 10 mg (base eq) (Orapred odt)prednisolone sod phos orally disintegr

tab 15 mg (base eq) (Orapred odt)prednisolone sod phos orally disintegr

tab 30 mg (base eq) (Orapred odt)prednisolone sod phosph oral

soln 6.7 mg/5ml (5 mg/5ml base)(Pediapred)

prednisolone sod phosphate oral soln15 mg/5ml (base equiv)

prednisolone syrup 15 mg/5ml (uspsolution equivalent) (Prelone)

PREDNISONE – prednisone tab 50 mgPREDNISONE – prednisone oral soln 5

mg/5mlPREDNISONE – prednisone tab 5 mg

dose packPREDNISONE – prednisone tab 10 mg

dose packprednisone tab 1 mg

2016


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prednisone tab 2.5 mgprednisone tab 5 mgprednisone tab 10 mgprednisone tab 20 mgMALE HORMONESANDRODERM – testosterone td patch

24hr 2 mg/24hrANDRODERM – testosterone td patch

24hr 4 mg/24hrANDROGEL – testosterone td gel 20.25

mg/1.25gm (1.62%)ANDROGEL – testosterone td gel 40.5

mg/2.5gm (1.62%)ANDROGEL PUMP – testosterone td gel

20.25 mg/act (1.62%)ANDROXY – fluoxymesterone tab 10 mgdanazol cap 50 mgdanazol cap 100 mgdanazol cap 200 mgoxandrolone tab 2.5 mg (Oxandrin)oxandrolone tab 10 mg (Oxandrin)testosterone td gel 25 mg/2.5gm (1%)

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

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

(Androgel pump)ESTROGENSCLIMARA PRO – estradiol-levonorgestrel

td patch weekly 0.045-0.015 mg/dayDIVIGEL – estradiol td gel 0.25

mg/0.25gm (0.1%)DIVIGEL – estradiol td gel 0.5 mg/0.5gm

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

(0.1%)estradiol & norethindrone acetate tab

0.5-0.1 mg (Activella)

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estradiol & norethindrone acetate tab1-0.5 mg (Activella)

estradiol tab 0.5 mg (Estrace)estradiol tab 1 mg (Estrace)estradiol tab 2 mg (Estrace)estradiol td patch twice weekly

0.025 mg/24hr (Vivelle-dot)estradiol td patch twice weekly




0.1 mg/24hr (Vivelle-dot)estradiol td patch weekly

0.025 mg/24hr (Climara)estradiol td patch weekly

0.0375 mg/24hr (37.5 mcg/24hr)(Climara)

estradiol td patch weekly 0.05 mg/24hr(Climara)


estradiol td patch weekly0.075 mg/24hr (Climara)


ESTROPIPATE – estropipate tab 3 mgestropipate tab 0.75 mgestropipate tab 1.5 mgnorethindrone acetate-ethinyl estradiol

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

tab 1 mg-5 mcgPREMARIN – estrogens, conjugated tab

0.3 mgPREMARIN – estrogens, conjugated tab

0.45 mg

2016


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PREMARIN – estrogens, conjugated tab0.625 mg



PREMPHASE – conj est 0.625(14)/conjest-medroxypro ac tab 0.625-5mg(14)

PREMPRO – conjugated estrogen-medroxyprogest acetate tab 0.3-1.5 mg

PREMPRO – conjugated estrogen-medroxyprogest acetate tab 0.45-1.5mg

PREMPRO – conjugated estrogen-medroxyprogest acetate tab 0.625-2.5mg

PREMPRO – conjugated estrogen-medroxyprogest acetate tab 0.625-5 mg

PROGESTINSmedroxyprogesterone acetate tab

2.5 mg (Provera)medroxyprogesterone acetate tab

5 mg (Provera)medroxyprogesterone acetate tab

10 mg (Provera)megestrol acetate susp 625 mg/5ml

(Megace es)norethindrone acetate tab 5 mg

(Aygestin)progesterone micronized cap 100 mg

(Prometrium)progesterone micronized cap 200 mg

(Prometrium)BIRTH CONTROLdesogest-eth estrad & eth estrad tab

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

0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)

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desogestrel & ethinyl estradiol tab0.15 mg-30 mcg (Desogen)

drospirenone-ethinyl estradiol tab3-0.02 mg (Yaz)

drospirenone-ethinyl estradiol tab3-0.03 mg (Yasmin 28)

ELLA – ulipristal acetate tab 30 mgethynodiol diacetate & ethinyl estradiol

tab 1 mg-35 mcglevonorg-eth est tab 0.1-0.02mg(84) &

eth est tab 0.01mg(7) (Loseasonique)levonorg-eth est tab 0.15-0.03mg(84) &

eth est tab 0.01mg(7) (Seasonique)levonorgestrel & ethinyl estradiol (91-

day) tab 0.15-0.03 mglevonorgestrel & ethinyl estradiol tab

0.1 mg-20 mcglevonorgestrel & ethinyl estradiol tab

0.15 mg-30 mcglevonorgestrel tab 1.5 mg (Plan b one-

step)levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcglevonorgestrel-ethinyl estradiol

(continuous) tab 90-20 mcgmedroxyprogesterone acetate im susp

150 mg/ml (Depo-provera contrac)NECON 1/50-28 – norethindrone &

mestranol tab 1 mg-50 mcgNECON 10/11-28 – norethindrone-eth

estradiol tab 0.5-35/1-35 mg-mcg(10/11)

norethindrone & ethinyl estradiol tab0.4 mg-35 mcg (Ovcon-35)

norethindrone & ethinyl estradiol tab0.5 mg-35 mcg (Brevicon-28)

norethindrone & ethinyl estradiol tab1 mg-35 mcg (Norinyl 1+35)

norethindrone & ethinyl estradiol-fechew tab 0.4 mg-35 mcg (Femcon fe)

2016


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norethindrone & ethinyl estradiol-fechew tab 0.8 mg-25 mcg (Generessfe)

norethindrone ac-ethinyl estrad-fe tab1-20/1-30/1-35 mg-mcg (Estrostep fe)

norethindrone ace & ethinyl estradioltab 1 mg-20 mcg (Loestrin 1/20-21)

norethindrone ace & ethinyl estradioltab 1.5 mg-30 mcg (Loestrin 1.5/30-21)

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

norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30 mcg (Loestrin fe1.5/30)

norethindrone ace-ethinyl estradiol-fetab 1 mg-20 mcg (24)

norethindrone tab 0.35 mg (Nor-qd)norethindrone-eth estradiol tab

0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)

norethindrone-eth estradiol tab0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl28)

norgestimate & ethinyl estradiol tab0.25 mg-35 mcg (Ortho-cyclen)

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

norgestrel & ethinyl estradiol tab0.3 mg-30 mcg

NUVARING – etonogestrel-ethinylestradiol va ring 0.120-0.015 mg/24hr

OGESTREL – norgestrel & ethinylestradiol tab 0.5 mg-50 mcg

ORTHO TRI-CYCLEN LO –norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg

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

ZOVIA 1/50E – ethynodiol diacetate &ethinyl estradiol tab 1 mg-50 mcg

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INFERTILITYCETROTIDE – cetrorelix acetate for inj kit

0.25 mg• •

chorionic gonadotropin for inj 10000unit

• •

clomiphene citrate tab 50 mg (Clomid)FOLLISTIM AQ – follitropin beta inj 75

unit/0.5ml• •

FOLLISTIM AQ – follitropin beta inj 300unit/0.36ml

• •


• •


• •

GONAL-F – follitropin alfa for inj 450 unit • •GONAL-F – follitropin alfa for inj 1050 unit • •GONAL-F RFF – follitropin alfa for inj 75

unit• •

GONAL-F RFF PEN – follitropin alfa inj300 unit/0.5ml

• •


• •


• •

GONAL-F RFF REDIJECT – follitropinalfa inj 300 unit/0.5ml

• •


• •


• •

OVIDREL – choriogonadotropin alfa inj250 mcg/0.5ml

• •

REPRONEX – menotropins for inj 75 unit • •DIABETESacarbose tab 25 mg (Precose)acarbose tab 50 mg (Precose)acarbose tab 100 mg (Precose)BYDUREON – exenatide extended

release for susp pen-injector 2 mg

2016


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BYDUREON – exenatide extendedrelease for inj susp 2 mg

BYETTA – exenatide soln pen-injector 5mcg/0.02ml

BYETTA – exenatide soln pen-injector 10mcg/0.04ml

glimepiride tab 1 mg (Amaryl)glimepiride tab 2 mg (Amaryl)glimepiride tab 4 mg (Amaryl)glipizide tab sr 24hr 2.5 mg (Glucotrol

xl)glipizide tab sr 24hr 5 mg (Glucotrol xl)glipizide tab sr 24hr 10 mg (Glucotrol xl)glipizide tab 5 mg (Glucotrol)glipizide tab 10 mg (Glucotrol)glipizide-metformin hcl tab 2.5-250 mgglipizide-metformin hcl tab 2.5-500 mgglipizide-metformin hcl tab 5-500 mgGLUCAGON EMERGENCY KIT –

glucagon (rdna) for inj kit 1 mgGLYBURIDE – glyburide tab 1.25 mgGLYBURIDE – glyburide tab 2.5 mgGLYBURIDE – glyburide tab 5 mgglyburide micronized tab 1.5 mg

(Glynase)glyburide micronized tab 3 mg

(Glynase)glyburide micronized tab 6 mg

(Glynase)glyburide tab 1.25 mgglyburide tab 2.5 mgglyburide tab 5 mgglyburide-metformin tab 1.25-250 mg

(Glucovance)glyburide-metformin tab 2.5-500 mg

(Glucovance)glyburide-metformin tab 5-500 mg

(Glucovance)

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INVOKAMET – canagliflozin-metforminhcl tab 50-500 mg




INVOKANA – canagliflozin tab 100 mgINVOKANA – canagliflozin tab 300 mgJANUMET – sitagliptin-metformin hcl tab

50-500 mgJANUMET – sitagliptin-metformin hcl tab

50-1000 mgJANUMET XR – sitagliptin-metformin hcl

tab sr 24hr 50-500 mgJANUMET XR – sitagliptin-metformin hcl

tab sr 24hr 50-1000 mgJANUMET XR – sitagliptin-metformin hcl

tab sr 24hr 100-1000 mgJANUVIA – sitagliptin phosphate tab 25

mg (base equiv)JANUVIA – sitagliptin phosphate tab 50

mg (base equiv)JANUVIA – sitagliptin phosphate tab 100

mg (base equiv)JARDIANCE – empagliflozin tab 10 mgJARDIANCE – empagliflozin tab 25 mgKOMBIGLYZE XR – saxagliptin-

metformin hcl tab sr 24hr 2.5-1000 mgKOMBIGLYZE XR – saxagliptin-

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

metformin hcl tab sr 24hr 5-1000 mgmetformin hcl tab sr 24hr 500 mg

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

(Glucophage xr)metformin hcl tab sr 24hr osmotic

500 mg (Fortamet)

2016


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metformin hcl tab sr 24hr osmotic1000 mg (Fortamet)

metformin hcl tab 500 mg (Glucophage)metformin hcl tab 850 mg (Glucophage)metformin hcl tab 1000 mg

(Glucophage)nateglinide tab 60 mg (Starlix)nateglinide tab 120 mg (Starlix)ONGLYZA – saxagliptin hcl tab 2.5 mg

(base equiv)ONGLYZA – saxagliptin hcl tab 5 mg

(base equiv)pioglitazone hcl tab 15 mg (base equiv)

(Actos)pioglitazone hcl tab 30 mg (base equiv)

(Actos)pioglitazone hcl tab 45 mg (base equiv)

(Actos)pioglitazone hcl-glimepiride tab

30-2 mg (Duetact)pioglitazone hcl-glimepiride tab

30-4 mg (Duetact)pioglitazone hcl-metformin hcl tab

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

15-850 mg (Actoplus met)repaglinide tab 0.5 mg (Prandin)repaglinide tab 1 mg (Prandin)repaglinide tab 2 mg (Prandin)tolazamide tab 250 mgVICTOZA – liraglutide soln pen-injector

18 mg/3ml (6 mg/ml)DIABETES - INSULINSRapid-Acting InsulinsNOVOLOG – insulin aspart inj 100 unit/mlNOVOLOG FLEXPEN – insulin aspart

soln pen-injector 100 unit/ml

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NOVOLOG PENFILL – insulin aspart solncartridge 100 unit/ml

NOVOLOG PENFILL – insulin aspart inj100 unit/ml

Short-Acting InsulinsHUMULIN R U-500 (CONCENTR –

insulin regular (human) inj 500 unit/mlNOVOLIN R – insulin regular (human) inj

100 unit/mlIntermediate-Acting InsulinsNOVOLIN N – insulin nph (human)

(isophane) inj 100 unit/mlNOVOLIN 70/30 – insulin nph isophane &

regular human inj 100 unit/ml (70-30)NOVOLOG MIX 70/30 – insulin aspart

prot & aspart (human) inj 100 unit/ml(70-30)

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

Basal InsulinsLANTUS – insulin glargine inj 100 unit/mlLANTUS SOLOSTAR – insulin glargine

soln pen-injector 100 unit/mlLEVEMIR – insulin detemir inj 100 unit/mlLEVEMIR FLEXPEN – insulin detemir

soln pen-injector 100 unit/mlLEVEMIR FLEXTOUCH – insulin detemir

soln pen-injector 100 unit/mlTOUJEO SOLOSTAR – insulin glargine

soln pen-injector 300 unit/mlTHYROID REGULATIONlevothyroxine sodium tab 25 mcg

(Synthroid)levothyroxine sodium tab 50 mcg



(Synthroid)

2016


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levothyroxine sodium tab 100 mcg(Synthroid)








liothyronine sodium tab 5 mcg(Cytomel)



methimazole tab 5 mg (Tapazole)methimazole tab 10 mg (Tapazole)propylthiouracil tab 50 mgGROWTH HORMONEINCRELEX – mecasermin inj 40 mg/4ml

(10 mg/ml)• •

OMNITROPE – somatropin for inj 5.8 mg • •OMNITROPE – somatropin inj 5 mg/1.5ml • •OMNITROPE – somatropin inj 10

mg/1.5ml• •

OTHER HORMONES AND RELATED DRUGSACTONEL – risedronate sodium tab 5 mgACTONEL – risedronate sodium tab 30

mgACTONEL – risedronate sodium tab 35

mg

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ACTONEL – risedronate sodium tab 150mg

ALENDRONATE SODIUM – alendronatesodium tab 40 mg

alendronate sodium tab 5 mgalendronate sodium tab 10 mgalendronate sodium tab 35 mgalendronate sodium tab 70 mg

(Fosamax)cabergoline tab 0.5 mgcalcitonin (salmon) nasal soln 200 unit/

act (Miacalcin)calcitriol cap 0.25 mcg (Rocaltrol)calcitriol cap 0.5 mcg (Rocaltrol)calcitriol oral soln 1 mcg/ml (Rocaltrol)desmopressin acetate nasal soln

0.01% (refrigerated) (Ddavp)desmopressin acetate nasal spray soln

0.01% (Ddavp)desmopressin acetate nasal spray soln

0.01% (refrigerated)desmopressin acetate tab 0.1 mg

(Ddavp)desmopressin acetate tab 0.2 mg

(Ddavp)doxercalciferol cap 0.5 mcg (Hectorol)doxercalciferol cap 1 mcg (Hectorol)doxercalciferol cap 2.5 mcg (Hectorol)FORTEO – teriparatide (recombinant) inj

600 mcg/2.4ml• •

ibandronate sodium tab 150 mg (baseequivalent) (Boniva)

levocarnitine oral soln 1 gm/10ml(10%) (Carnitor)

levocarnitine tab 330 mg (Carnitor)methylergonovine maleate tab 0.2 mgORFADIN – nitisinone cap 2 mg • •ORFADIN – nitisinone cap 5 mg • •

2016


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ORFADIN – nitisinone cap 10 mg • •paricalcitol cap 1 mcg (Zemplar)paricalcitol cap 2 mcg (Zemplar)paricalcitol cap 4 mcg (Zemplar)PROLIA – denosumab inj 60 mg/ml •raloxifene hcl tab 60 mg (Evista)risedronate sodium tab 5 mg (Actonel)risedronate sodium tab 30 mg (Actonel)risedronate sodium tab 35 mg (Actonel)risedronate sodium tab 150 mg

(Actonel)SENSIPAR – cinacalcet hcl tab 30 mg

(base equiv)SENSIPAR – cinacalcet hcl tab 60 mg

(base equiv)SENSIPAR – cinacalcet hcl tab 90 mg

(base equiv)sodium phenylbutyrate oral powder

3 gm/teaspoonful (Buphenyl)• •

STIMATE – desmopressin acetate nasalsoln 1.5 mg/ml

HEART AND CIRCULATORY DRUGSANGIOTENSIN CONVERTING ENZYME (ACE)INHIBITORS AND COMBINATIbenazepril & hydrochlorothiazide tab

5-6.25 mgbenazepril & hydrochlorothiazide tab

10-12.5 mg (Lotensin hct)benazepril & hydrochlorothiazide tab

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

20-25 mg (Lotensin hct)benazepril hcl tab 5 mgbenazepril hcl tab 10 mg (Lotensin)benazepril hcl tab 20 mg (Lotensin)benazepril hcl tab 40 mg (Lotensin)captopril tab 12.5 mgcaptopril tab 25 mg

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captopril tab 50 mgcaptopril tab 100 mgCAPTOPRIL/HYDROCHLOROTHIA –

captopril & hydrochlorothiazide tab25-15 mg

CAPTOPRIL/HYDROCHLOROTHIA –captopril & hydrochlorothiazide tab25-25 mg



enalapril maleate &hydrochlorothiazide tab 5-12.5 mg

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

enalapril maleate tab 2.5 mg (Vasotec)enalapril maleate tab 5 mg (Vasotec)enalapril maleate tab 10 mg (Vasotec)enalapril maleate tab 20 mg (Vasotec)fosinopril sodium &

hydrochlorothiazide tab 10-12.5 mgfosinopril sodium &

hydrochlorothiazide tab 20-12.5 mgfosinopril sodium tab 10 mgfosinopril sodium tab 20 mgfosinopril sodium tab 40 mglisinopril & hydrochlorothiazide tab

10-12.5 mg (Zestoretic)lisinopril & hydrochlorothiazide tab

20-12.5 mg (Zestoretic)lisinopril & hydrochlorothiazide tab

20-25 mg (Zestoretic)lisinopril tab 2.5 mg (Zestril)lisinopril tab 5 mg (Prinivil)lisinopril tab 10 mg (Prinivil)

2016


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lisinopril tab 20 mg (Prinivil)lisinopril tab 30 mg (Zestril)lisinopril tab 40 mg (Zestril)moexipril hcl tab 7.5 mg (Univasc)moexipril hcl tab 15 mg (Univasc)moexipril-hydrochlorothiazide tab

7.5-12.5 mgmoexipril-hydrochlorothiazide tab

15-12.5 mg (Uniretic)moexipril-hydrochlorothiazide tab

15-25 mgperindopril erbumine tab 2 mgperindopril erbumine tab 4 mg (Aceon)perindopril erbumine tab 8 mg (Aceon)quinapril hcl tab 5 mg (Accupril)quinapril hcl tab 10 mg (Accupril)quinapril hcl tab 20 mg (Accupril)quinapril hcl tab 40 mg (Accupril)quinapril-hydrochlorothiazide tab

10-12.5 mg (Accuretic)quinapril-hydrochlorothiazide tab

20-12.5 mg (Accuretic)quinapril-hydrochlorothiazide tab

20-25 mg (Accuretic)ramipril cap 1.25 mg (Altace)ramipril cap 2.5 mg (Altace)ramipril cap 5 mg (Altace)ramipril cap 10 mg (Altace)trandolapril tab 1 mg (Mavik)trandolapril tab 2 mg (Mavik)trandolapril tab 4 mg (Mavik)ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS)AND COMBINATIONSamlodipine-valsartan-

hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)

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

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

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

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

candesartan cilexetil tab 4 mg(Atacand)




candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg(Atacand hct)

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

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

EPROSARTAN MESYLATE – eprosartanmesylate tab 600 mg

irbesartan tab 75 mg (Avapro)irbesartan tab 150 mg (Avapro)irbesartan tab 300 mg (Avapro)irbesartan-hydrochlorothiazide tab

150-12.5 mg (Avalide)irbesartan-hydrochlorothiazide tab

300-12.5 mg (Avalide)losartan potassium &

hydrochlorothiazide tab 50-12.5 mg(Hyzaar)

2016


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losartan potassium &hydrochlorothiazide tab 100-12.5 mg(Hyzaar)

losartan potassium &hydrochlorothiazide tab 100-25 mg(Hyzaar)

losartan potassium tab 25 mg (Cozaar)losartan potassium tab 50 mg (Cozaar)losartan potassium tab 100 mg

(Cozaar)telmisartan tab 20 mg (Micardis)telmisartan tab 40 mg (Micardis)telmisartan tab 80 mg (Micardis)telmisartan-hydrochlorothiazide tab

40-12.5 mg (Micardis hct)telmisartan-hydrochlorothiazide tab

80-12.5 mg (Micardis hct)telmisartan-hydrochlorothiazide tab

80-25 mg (Micardis hct)valsartan tab 40 mg (Diovan)valsartan tab 80 mg (Diovan)valsartan tab 160 mg (Diovan)valsartan tab 320 mg (Diovan)valsartan-hydrochlorothiazide tab

80-12.5 mg (Diovan hct)valsartan-hydrochlorothiazide tab


160-25 mg (Diovan hct)valsartan-hydrochlorothiazide tab


320-25 mg (Diovan hct)BETA BLOCKERS AND COMBINATIONSacebutolol hcl cap 200 mg (Sectral)acebutolol hcl cap 400 mg (Sectral)atenolol & chlorthalidone tab 50-25 mg

(Tenoretic 50)

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atenolol & chlorthalidone tab100-25 mg (Tenoretic 100)

atenolol tab 25 mg (Tenormin)atenolol tab 50 mg (Tenormin)atenolol tab 100 mg (Tenormin)betaxolol hcl tab 10 mg (Kerlone)betaxolol hcl tab 20 mg (Kerlone)bisoprolol & hydrochlorothiazide tab

2.5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide tab

5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide tab

10-6.25 mg (Ziac)bisoprolol fumarate tab 5 mg (Zebeta)bisoprolol fumarate tab 10 mg (Zebeta)carvedilol tab 3.125 mg (Coreg)carvedilol tab 6.25 mg (Coreg)carvedilol tab 12.5 mg (Coreg)carvedilol tab 25 mg (Coreg)DUTOPROL – metoprolol &

hydrochlorothiazide tab sr 24hr 25-12.5mg

DUTOPROL – metoprolol &hydrochlorothiazide tab sr 24hr 50-12.5mg

DUTOPROL – metoprolol &hydrochlorothiazide tab sr 24hr100-12.5 mg

labetalol hcl tab 100 mg (Trandate)labetalol hcl tab 200 mg (Trandate)labetalol hcl tab 300 mg (Trandate)metoprolol & hydrochlorothiazide tab

50-25 mg (Lopressor hct)metoprolol & hydrochlorothiazide tab

100-25 mg (Lopressor hct)metoprolol & hydrochlorothiazide tab

100-50 mg

2016


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metoprolol succinate tab sr 24hr 25 mg(Toprol xl)

metoprolol succinate tab sr 24hr 50 mg(Toprol xl)

metoprolol succinate tab sr 24hr100 mg (Toprol xl)

metoprolol succinate tab sr 24hr200 mg (Toprol xl)

metoprolol tartrate tab 25 mgmetoprolol tartrate tab 50 mg

(Lopressor)metoprolol tartrate tab 100 mg

(Lopressor)nadolol & bendroflumethiazide tab

40-5 mg (Corzide)nadolol & bendroflumethiazide tab

80-5 mg (Corzide)nadolol tab 20 mg (Corgard)nadolol tab 40 mg (Corgard)nadolol tab 80 mg (Corgard)pindolol tab 5 mgpindolol tab 10 mgPROPRANOLOL HCL – propranolol hcl

oral soln 20 mg/5mlPROPRANOLOL HCL – propranolol hcl

oral soln 40 mg/5mlpropranolol hcl cap sr 24hr 60 mg

(Inderal la)propranolol hcl cap sr 24hr 80 mg



(Inderal la)propranolol hcl tab 10 mgpropranolol hcl tab 20 mgpropranolol hcl tab 40 mgpropranolol hcl tab 60 mg

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propranolol hcl tab 80 mgPROPRANOLOL/HYDROCHLOROTH –

propranolol & hydrochlorothiazide tab40-25 mg

PROPRANOLOL/HYDROCHLOROTH –propranolol & hydrochlorothiazide tab80-25 mg

TIMOLOL MALEATE – timolol maleatetab 5 mg



CALCIUM CHANNEL BLOCKERS ANDCOMBINATIONSamlodipine besylate tab 2.5 mg

(Norvasc)amlodipine besylate tab 5 mg (Norvasc)amlodipine besylate tab 10 mg

(Norvasc)amlodipine besylate-atorvastatin

calcium tab 2.5-10 mg (Caduet)amlodipine besylate-atorvastatin



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






calcium tab 10-40 mg (Caduet)

2016


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amlodipine besylate-atorvastatincalcium tab 10-80 mg (Caduet)

amlodipine besylate-benazepril hcl cap2.5-10 mg (Lotrel)

amlodipine besylate-benazepril hcl cap5-10 mg (Lotrel)





amlodipine besylate-valsartan tab5-160 mg (Exforge)




diltiazem hcl cap sr 12hr 60 mgdiltiazem hcl cap sr 12hr 90 mgdiltiazem hcl cap sr 12hr 120 mgdiltiazem hcl cap sr 24hr 120 mgdiltiazem hcl cap sr 24hr 180 mgdiltiazem hcl cap sr 24hr 240 mgdiltiazem hcl coated beads cap sr 24hr

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




360 mg (Cardizem cd)

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diltiazem hcl coated beads tab sr 24hr180 mg (Cardizem la)





diltiazem hcl extended release beadscap sr 24hr 120 mg (Tiazac)






diltiazem hcl tab 30 mg (Cardizem)diltiazem hcl tab 60 mg (Cardizem)diltiazem hcl tab 90 mgdiltiazem hcl tab 120 mg (Cardizem)felodipine tab sr 24hr 2.5 mgfelodipine tab sr 24hr 5 mgfelodipine tab sr 24hr 10 mgnicardipine hcl cap 20 mgnicardipine hcl cap 30 mgnifedipine cap 10 mg (Procardia)nifedipine cap 20 mgnifedipine tab sr 24hr 30 mg (Adalat cc)nifedipine tab sr 24hr 60 mg (Adalat cc)nifedipine tab sr 24hr 90 mg (Adalat cc)nifedipine tab sr 24hr osmotic release

30 mg (Procardia xl)

2016


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nifedipine tab sr 24hr osmotic release60 mg (Procardia xl)

nifedipine tab sr 24hr osmotic release90 mg (Procardia xl)

nimodipine cap 30 mgnisoldipine tab sr 24hr 8.5 mg (Sular)nisoldipine tab sr 24hr 17 mg (Sular)nisoldipine tab sr 24hr 34 mg (Sular)telmisartan-amlodipine tab 40-5 mg

(Twynsta)telmisartan-amlodipine tab 40-10 mg



(Twynsta)VERAPAMIL HCL – verapamil hcl tab 40

mgverapamil hcl cap sr 24hr 100 mg

(Verelan pm)verapamil hcl cap sr 24hr 120 mg

(Verelan)verapamil hcl cap sr 24hr 180 mg





(Verelan)verapamil hcl tab cr 120 mg (Calan sr)verapamil hcl tab cr 180 mg (Calan sr)verapamil hcl tab cr 240 mg (Calan sr)verapamil hcl tab 80 mg (Calan)verapamil hcl tab 120 mg (Calan)CHEST PAIN

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ISOSORBIDE DINITRATE – isosorbidedinitrate tab 30 mg

ISOSORBIDE DINITRATE ER –isosorbide dinitrate tab cr 40 mg

isosorbide dinitrate tab 5 mg (Isordiltitradose)

isosorbide dinitrate tab 10 mgisosorbide dinitrate tab 20 mgisosorbide mononitrate tab sr 24hr

30 mg (Imdur)isosorbide mononitrate tab sr 24hr

60 mg (Imdur)isosorbide mononitrate tab sr 24hr

120 mg (Imdur)isosorbide mononitrate tab 10 mgisosorbide mononitrate tab 20 mgNITRO-BID – nitroglycerin oint 2%nitroglycerin cap cr 2.5 mgnitroglycerin cap cr 6.5 mgnitroglycerin cap cr 9 mgnitroglycerin td patch 24hr 0.1 mg/hr

(Nitro-dur)nitroglycerin td patch 24hr 0.2 mg/hr



(Nitro-dur)NITROSTAT – nitroglycerin sl tab 0.3 mgNITROSTAT – nitroglycerin sl tab 0.4 mgNITROSTAT – nitroglycerin sl tab 0.6 mgCHOLESTEROL LOWERINGatorvastatin calcium tab 10 mg (base

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

equivalent) (Lipitor)atorvastatin calcium tab 40 mg (base

equivalent) (Lipitor)

2016


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atorvastatin calcium tab 80 mg (baseequivalent) (Lipitor)

cholestyramine light powder packets4 gm

cholestyramine light powder 4 gm/dose (Questran light)

cholestyramine powder packets 4 gm(Questran)

cholestyramine powder 4 gm/dose(Questran)

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

choline fenofibrate cap dr 135 mg(fenofibric acid equiv) (Trilipix)

colestipol hcl granule packets 5 gm(Colestid flavored)

colestipol hcl granules 5 gm (Colestidflavored)

colestipol hcl tab 1 gm (Colestid)CRESTOR – rosuvastatin calcium tab 5

mgCRESTOR – rosuvastatin calcium tab 10



mgfenofibrate micronized cap 43 mg

(Antara)fenofibrate micronized cap 67 mg

(Lofibra)fenofibrate micronized cap 130 mg

(Antara)fenofibrate micronized cap 134 mg

(Lofibra)fenofibrate micronized cap 200 mg

(Lofibra)fenofibrate tab 48 mg (Tricor)fenofibrate tab 54 mg (Lofibra)fenofibrate tab 145 mg (Tricor)

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fenofibrate tab 160 mg (Lofibra)fluvastatin sodium cap 20 mg (Lescol)fluvastatin sodium cap 40 mg (Lescol)gemfibrozil tab 600 mg (Lopid)lovastatin tab 10 mglovastatin tab 20 mg (Mevacor)lovastatin tab 40 mg (Mevacor)niacin tab cr 500 mg

(antihyperlipidemic) (Niaspan)niacin tab cr 750 mg

(antihyperlipidemic) (Niaspan)niacin tab cr 1000 mg

(antihyperlipidemic) (Niaspan)pravastatin sodium tab 10 mgpravastatin sodium tab 20 mg

(Pravachol)pravastatin sodium tab 40 mg

(Pravachol)pravastatin sodium tab 80 mg

(Pravachol)simvastatin tab 5 mg (Zocor)simvastatin tab 10 mg (Zocor)simvastatin tab 20 mg (Zocor)simvastatin tab 40 mg (Zocor)simvastatin tab 80 mg (Zocor)WELCHOL – colesevelam hcl tab 625 mgWELCHOL – colesevelam hcl packet for

susp 3.75 gmFLUID RETENTIONACETAZOLAMIDE – acetazolamide tab

125 mgacetazolamide cap sr 12hr 500 mg

(Diamox)acetazolamide tab 250 mgamiloride & hydrochlorothiazide tab

5-50 mgamiloride hcl tab 5 mg

2016


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bumetanide tab 0.5 mgbumetanide tab 1 mgbumetanide tab 2 mgCHLOROTHIAZIDE – chlorothiazide tab

250 mgchlorothiazide tab 500 mgCHLORTHALIDONE – chlorthalidone tab

25 mgCHLORTHALIDONE – chlorthalidone tab

50 mgfurosemide oral soln 10 mg/mlfurosemide tab 20 mg (Lasix)furosemide tab 40 mg (Lasix)furosemide tab 80 mg (Lasix)hydrochlorothiazide cap 12.5 mg

(Microzide)hydrochlorothiazide tab 12.5 mghydrochlorothiazide tab 25 mghydrochlorothiazide tab 50 mgindapamide tab 1.25 mgindapamide tab 2.5 mgmethazolamide tab 25 mg (Neptazane)methazolamide tab 50 mg (Neptazane)metolazone tab 2.5 mg (Zaroxolyn)metolazone tab 5 mg (Zaroxolyn)metolazone tab 10 mgspironolactone & hydrochlorothiazide

tab 25-25 mg (Aldactazide)spironolactone tab 25 mg (Aldactone)spironolactone tab 50 mg (Aldactone)spironolactone tab 100 mg (Aldactone)torsemide tab 5 mg (Demadex)torsemide tab 10 mg (Demadex)torsemide tab 20 mg (Demadex)torsemide tab 100 mg (Demadex)

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

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

triamterene & hydrochlorothiazide tab75-50 mg (Maxzide)

TRIAMTERENE/HYDROCHLOROTH –triamterene & hydrochlorothiazide cap50-25 mg

HEART RHYTHMamiodarone hcl tab 100 mgamiodarone hcl tab 200 mg (Cordarone)amiodarone hcl tab 400 mgdisopyramide phosphate cap 100 mg

(Norpace)disopyramide phosphate cap 150 mg

(Norpace)flecainide acetate tab 50 mgflecainide acetate tab 100 mgflecainide acetate tab 150 mgmexiletine hcl cap 150 mgmexiletine hcl cap 200 mgmexiletine hcl cap 250 mgpropafenone hcl cap sr 12hr 225 mg

(Rythmol sr)propafenone hcl cap sr 12hr 325 mg

(Rythmol sr)propafenone hcl cap sr 12hr 425 mg

(Rythmol sr)propafenone hcl tab 150 mg (Rythmol)propafenone hcl tab 225 mg (Rythmol)propafenone hcl tab 300 mgquinidine gluconate tab cr 324 mgQUINIDINE SULFATE – quinidine sulfate

tab 200 mgQUINIDINE SULFATE ER – quinidine

sulfate tab cr 300 mgquinidine sulfate tab 300 mg

2016


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



sotalol hcl tab 80 mg (Betapace)sotalol hcl tab 120 mg (Betapace)sotalol hcl tab 160 mg (Betapace)sotalol hcl tab 240 mgOTHER HEART RELATED DRUGSADCIRCA – tadalafil tab 20 mg (pah) • •clonidine hcl tab 0.1 mg (Catapres)clonidine hcl tab 0.2 mg (Catapres)clonidine hcl tab 0.3 mg (Catapres)clonidine hcl td patch weekly

0.1 mg/24hr (Catapres-tts-1)clonidine hcl td patch weekly

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

0.3 mg/24hr (Catapres-tts-3)DIGOXIN – digoxin oral soln 0.05 mg/mldigoxin tab 125 mcg (0.125 mg)

(Lanoxin)digoxin tab 250 mcg (0.25 mg)

(Lanoxin)doxazosin mesylate tab 1 mg (Cardura)doxazosin mesylate tab 2 mg (Cardura)doxazosin mesylate tab 4 mg (Cardura)doxazosin mesylate tab 8 mg (Cardura)eplerenone tab 25 mg (Inspra)eplerenone tab 50 mg (Inspra)guanfacine hcl tab 1 mg (Tenex)guanfacine hcl tab 2 mg (Tenex)hydralazine hcl tab 10 mghydralazine hcl tab 25 mghydralazine hcl tab 50 mg

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hydralazine hcl tab 100 mgLANOXIN – digoxin tab 62.5 mcg (0.0625

mg)LANOXIN – digoxin tab 125 mcg (0.125

mg)LANOXIN – digoxin tab 187.5 mcg

(0.1875 mg)LANOXIN – digoxin tab 250 mcg (0.25

mg)LETAIRIS – ambrisentan tab 5 mg • •LETAIRIS – ambrisentan tab 10 mg • •methyldopa tab 250 mgmethyldopa tab 500 mgmidodrine hcl tab 2.5 mgmidodrine hcl tab 5 mgmidodrine hcl tab 10 mgminoxidil tab 2.5 mgminoxidil tab 10 mgOPSUMIT – macitentan tab 10 mg • •phenoxybenzamine hcl cap 10 mg

(Dibenzyline)prazosin hcl cap 1 mg (Minipress)prazosin hcl cap 2 mg (Minipress)prazosin hcl cap 5 mg (Minipress)sildenafil citrate tab 20 mg (Revatio) • •terazosin hcl cap 1 mgterazosin hcl cap 2 mgterazosin hcl cap 5 mgterazosin hcl cap 10 mgTRACLEER – bosentan tab 62.5 mg • •TRACLEER – bosentan tab 125 mg • •ERECTILE DYSFUNCTIONVIAGRA – sildenafil citrate tab 25 mg •VIAGRA – sildenafil citrate tab 50 mg •VIAGRA – sildenafil citrate tab 100 mg •BEE STING KITS

2016


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EPIPEN 2-PAK – epinephrine solutionauto-injector 0.3 mg/0.3ml (1:1000)

EPIPEN-JR 2-PAK – epinephrine solutionauto-injector 0.15 mg/0.3ml (1:2000)

RESPIRATORY AGENTSANTIHISTAMINEScyproheptadine hcl syrup 2 mg/5mlcyproheptadine hcl tab 4 mgdesloratadine tab orally disintegrating

2.5 mg (Clarinex reditabs)desloratadine tab orally disintegrating

5 mg (Clarinex reditabs)desloratadine tab 5 mg (Clarinex)levocetirizine dihydrochloride soln

2.5 mg/5ml (0.5 mg/ml) (Xyzal)levocetirizine dihydrochloride tab 5 mg

(Xyzal)promethazine hcl suppos 12.5 mgpromethazine hcl suppos 25 mgpromethazine hcl suppos 50 mgpromethazine hcl syrup 6.25 mg/5mlpromethazine hcl tab 12.5 mgpromethazine hcl tab 25 mgpromethazine hcl tab 50 mgNASAL PRODUCTSASTEPRO – azelastine hcl nasal spray

0.15% (205.5 mcg/spray)azelastine hcl nasal spray 0.1%

(137 mcg/spray)azelastine hcl nasal spray 0.15%

(205.5 mcg/spray) (Astepro)BACTROBAN NASAL – mupirocin

calcium nasal oint 2%budesonide nasal susp 32 mcg/act

(Rhinocort aqua)flunisolide nasal soln 25 mcg/act

(0.025%) (Flunisolide)

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fluticasone propionate nasal susp50 mcg/act (Flonase)

ipratropium bromide nasal soln 0.03%(21 mcg/spray) (Atrovent)

ipratropium bromide nasal soln 0.06%(42 mcg/spray) (Atrovent)

olopatadine hcl nasal soln 0.6%(Patanase)

triamcinolone acetonide nasal aerosolsuspension 55 mcg/act (Nasacort aq)

COUGH/COLD/ALLERGYacetylcysteine inhal soln 10%acetylcysteine inhal soln 20%SSKI – potassium iodide soln 1 gm/mlASTHMA/COPDADVAIR DISKUS – fluticasone-salmeterol

aer powder ba 100-50 mcg/doseADVAIR DISKUS – fluticasone-salmeterol

aer powder ba 250-50 mcg/doseADVAIR DISKUS – fluticasone-salmeterol

aer powder ba 500-50 mcg/doseADVAIR HFA – fluticasone-salmeterol

inhal aerosol 45-21 mcg/actADVAIR HFA – fluticasone-salmeterol

inhal aerosol 115-21 mcg/actADVAIR HFA – fluticasone-salmeterol

inhal aerosol 230-21 mcg/actalbuterol sulfate soln nebu 0.083%

(2.5 mg/3ml)albuterol sulfate soln nebu 0.5% (5 mg/

ml)albuterol sulfate soln nebu

0.63 mg/3ml (base equiv)albuterol sulfate soln nebu

1.25 mg/3ml (base equiv)albuterol sulfate syrup 2 mg/5mlalbuterol sulfate tab sr 12hr 4 mg

(Vospire er)

2016


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albuterol sulfate tab sr 12hr 8 mg(Vospire er)

albuterol sulfate tab 2 mgalbuterol sulfate tab 4 mgANORO ELLIPTA – umeclidinium-

vilanterol aero powd ba 62.5-25 mcg/inh

ARNUITY ELLIPTA – fluticasone furoateaerosol powder breath activ 100 mcg/act

ARNUITY ELLIPTA – fluticasone furoateaerosol powder breath activ 200 mcg/act

ASMANEX HFA – mometasone furoateinhal aerosol suspension 100 mcg/act

ASMANEX HFA – mometasone furoateinhal aerosol suspension 200 mcg/act

ASMANEX TWISTHALER 120 ME –mometasone furoate inhal powd 220mcg/inh (breath activated)

ASMANEX TWISTHALER 14 MET –mometasone furoate inhal powd 220mcg/inh (breath activated)




ATROVENT HFA – ipratropium bromidehfa inhal aerosol 17 mcg/act

BREO ELLIPTA – fluticasone furoate-vilanterol aero powd ba 100-25 mcg/inh

BREO ELLIPTA – fluticasone furoate-vilanterol aero powd ba 200-25 mcg/inh

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

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budesonide inhalation susp 0.5 mg/2ml(Pulmicort)

budesonide inhalation susp 1 mg/2ml(Pulmicort)

COMBIVENT RESPIMAT – ipratropium-albuterol inhal aerosol soln 20-100 mcg/act

CROMOLYN SODIUM – cromolyn sodiumsoln nebu 20 mg/2ml

DULERA – mometasone furoate-formoterol fumarate aerosol 100-5 mcg/act

DULERA – mometasone furoate-formoterol fumarate aerosol 200-5 mcg/act

dyphylline-guaifenesin liqd100-100 mg/5ml

FLOVENT DISKUS – fluticasonepropionate aer pow ba 50 mcg/blister



FLOVENT HFA – fluticasone propionatehfa inhal aero 44 mcg/act (50/valve)

FLOVENT HFA – fluticasone propionatehfa inhal aer 110 mcg/act (125/valve)

FLOVENT HFA – fluticasone propionatehfa inhal aer 220 mcg/act (250/valve)

FORADIL AEROLIZER – formoterolfumarate inhal cap 12 mcg

INCRUSE ELLIPTA – umeclidinium braero powd breath act 62.5 mcg/inh(base eq)

ipratropium bromide inhal soln 0.02%ipratropium-albuterol nebu soln

0.5-2.5(3) mg/3ml (Duoneb)levalbuterol hcl soln nebu conc

1.25 mg/0.5ml (base equiv)levalbuterol hcl soln nebu 0.31 mg/3ml

(base equiv) (Xopenex)

2016


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levalbuterol hcl soln nebu 0.63 mg/3ml(base equiv) (Xopenex)

levalbuterol hcl soln nebu 1.25 mg/3ml(base equiv) (Xopenex)

montelukast sodium chew tab 4 mg(base equiv) (Singulair)

montelukast sodium chew tab 5 mg(base equiv) (Singulair)

montelukast sodium oral granulespacket 4 mg (base equiv) (Singulair)

montelukast sodium tab 10 mg (baseequiv) (Singulair)

PROAIR HFA – albuterol sulfate inhalaero 108 mcg/act (90mcg base equiv)

PROAIR RESPICLICK – albuterol sulfateaer pow ba 108 mcg/act (90 mcg baseequiv)

QVAR – beclomethasone diprop inhalaero soln 40 mcg/act (50/valve)

QVAR – beclomethasone diprop inhalaero soln 80 mcg/act (100/valve)

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

SPIRIVA HANDIHALER – tiotropiumbromide monohydrate inhal cap 18 mcg(base equiv)

SPIRIVA RESPIMAT – tiotropium bromidemonohydrate inhal aerosol 1.25 mcg/act

SPIRIVA RESPIMAT – tiotropium bromidemonohydrate inhal aerosol 2.5 mcg/act

SYMBICORT – budesonide-formoterolfumarate dihyd aerosol 80-4.5 mcg/act

SYMBICORT – budesonide-formoterolfumarate dihyd aerosol 160-4.5 mcg/act

terbutaline sulfate tab 2.5 mgterbutaline sulfate tab 5 mgtheophylline soln 80 mg/15mltheophylline tab sr 12hr 100 mg

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theophylline tab sr 12hr 200 mgtheophylline tab sr 12hr 300 mgtheophylline tab sr 12hr 450 mgtheophylline tab sr 24hr 400 mgtheophylline tab sr 24hr 600 mgVENTOLIN HFA – albuterol sulfate inhal

aero 108 mcg/act (90mcg base equiv)zafirlukast tab 10 mg (Accolate)zafirlukast tab 20 mg (Accolate)OTHER RESPIRATORY DRUGSKALYDECO – ivacaftor tab 150 mg • •KALYDECO – ivacaftor packet 50 mg • •KALYDECO – ivacaftor packet 75 mg • •PULMOZYME – dornase alfa inhal soln 1

mg/ml• •

GASTROINTESTINAL DRUGSLAXATIVESbisacodyl tab & peg 3350-kcl-sod

bicarb-nacl for soln kitlactulose solution 10 gm/15mlpeg 3350-kcl-sod bicarb-nacl for soln

420 gm (Nulytely/flavor pack)peg 3350-kcl-na bicarb-nacl-na sulfate

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

for soln 240 gm (Colyte-flavor packs)polyethylene glycol 3350 oral packetpolyethylene glycol 3350 oral powderANTIDIARRHEALSdiphenoxylate w/ atropine tab

2.5-0.025 mg (Lomotil)DIPHENOXYLATE/ATROPINE –

diphenoxylate w/ atropine liq 2.5-0.025mg/5ml

loperamide hcl cap 2 mgULCER/GERD

2016


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amoxicillin cap-clarithro tab-lansoprazcap dr therapy pack (Prevpac)

CARAFATE – sucralfate susp 1 gm/10mlcimetidine hcl soln 300 mg/5mlcimetidine tab 200 mgcimetidine tab 300 mgcimetidine tab 400 mgcimetidine tab 800 mgdicyclomine hcl cap 10 mg (Bentyl)dicyclomine hcl oral soln 10 mg/5mldicyclomine hcl tab 20 mg (Bentyl)esomeprazole magnesium cap delayed

release 20 mg (base eq) (Nexium)esomeprazole magnesium cap delayed

release 40 mg (base eq) (Nexium)famotidine for susp 40 mg/5ml (Pepcid)famotidine tab 20 mg (Pepcid)famotidine tab 40 mg (Pepcid)glycopyrrolate tab 1 mg (Robinul)glycopyrrolate tab 2 mg (Robinul forte)hyoscyamine sulfate elixir

0.125 mg/5mlhyoscyamine sulfate soln 0.125 mg/mlhyoscyamine sulfate tab disp 0.125 mg

(Anaspaz)hyoscyamine sulfate tab sl 0.125 mg

(Levsin/sl)hyoscyamine sulfate tab sr 12hr

0.375 mg (Levbid)hyoscyamine sulfate tab 0.125 mg

(Levsin)lansoprazole cap delayed release

15 mg (Prevacid)lansoprazole cap delayed release

30 mg (Prevacid)methscopolamine bromide tab 2.5 mg

(Pamine)

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methscopolamine bromide tab 5 mg(Pamine forte)

misoprostol tab 100 mcg (Cytotec)misoprostol tab 200 mcg (Cytotec)NEXIUM – esomeprazole magnesium for

delayed release susp pack 2.5 mgNEXIUM – esomeprazole magnesium for

delayed release susp packet 5 mgNEXIUM – esomeprazole magnesium for



delayed release susp packet 40 mgnizatidine cap 150 mgnizatidine cap 300 mg (Axid)nizatidine oral soln 15 mg/ml (Axid)omeprazole cap delayed release 10 mg

(Prilosec)omeprazole cap delayed release 20 mg

(Prilosec)omeprazole cap delayed release 40 mg

(Prilosec)omeprazole-sodium bicarbonate cap

20-1100 mg (Zegerid)omeprazole-sodium bicarbonate cap

40-1100 mg (Zegerid)pantoprazole sodium ec tab 20 mg

(base equiv) (Protonix)pantoprazole sodium ec tab 40 mg

(base equiv) (Protonix)PROPANTHELINE BROMIDE –

propantheline bromide tab 15 mgrabeprazole sodium ec tab 20 mg

(Aciphex)ranitidine hcl cap 150 mgranitidine hcl cap 300 mgranitidine hcl syrup 15 mg/ml

(75 mg/5ml)

2016


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ranitidine hcl tab 150 mg (Zantac)ranitidine hcl tab 300 mg (Zantac)sucralfate tab 1 gm (Carafate)NAUSEA AND VOMITINGdronabinol cap 2.5 mg (Marinol)dronabinol cap 5 mg (Marinol)dronabinol cap 10 mg (Marinol)EMEND – aprepitant capsule therapy

pack 80 & 125 mgEMEND – aprepitant capsule 40 mgEMEND – aprepitant capsule 80 mgEMEND – aprepitant capsule 125 mggranisetron hcl inj 0.1 mg/mlgranisetron hcl inj 1 mg/mlgranisetron hcl inj 4 mg/4ml (1 mg/ml)granisetron hcl tab 1 mgmeclizine hcl tab 12.5 mgmeclizine hcl tab 25 mgondansetron hcl oral soln 4 mg/5ml

(Zofran)ondansetron hcl tab 4 mg (Zofran)ondansetron hcl tab 8 mg (Zofran)ondansetron hcl tab 24 mgondansetron orally disintegrating tab

4 mg (Zofran odt)ondansetron orally disintegrating tab

8 mg (Zofran odt)TRANSDERM-SCOP – scopolamine td

patch 72hr 1 mg/3daystrimethobenzamide hcl cap 300 mg

(Tigan)DIGESTIVE ENZYMESCREON – pancrelipase (lip-prot-amyl) dr

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

cap 6000-19000-30000 unit

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CREON – pancrelipase (lip-prot-amyl) drcap 12000-38000-60000 unit



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







OTHER GASTROINTESTINAL DRUGSalosetron hcl tab 0.5 mg (base equiv)

(Lotronex)alosetron hcl tab 1 mg (base equiv)

(Lotronex)ASACOL HD – mesalamine tab delayed

release 800 mgbalsalazide disodium cap 750 mg

(Colazal)calcium acetate (phosphate binder)

cap 667 mg (169 mg ca) (Phoslo)calcium acetate (phosphate binder) tab

667 mg (Eliphos)CANASA – mesalamine suppos 1000 mgCHENODAL – chenodiol tab 250 mg • •cromolyn sodium oral conc

100 mg/5ml (Gastrocrom)DELZICOL – mesalamine cap dr 400 mglactulose (encephalopathy) solution

10 gm/15ml

2016


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LIALDA – mesalamine tab delayedrelease 1.2 gm

mesalamine enema 4 gmmesalamine rectal enema 4 gm &

cleanser wipe kit (Rowasa)metoclopramide hcl inj 5 mg/mlmetoclopramide hcl orally

disintegrating tab 5 mg (Metozolv odt)metoclopramide hcl soln 5 mg/5ml

(10 mg/10ml)metoclopramide hcl tab 5 mg (Reglan)metoclopramide hcl tab 10 mg (Reglan)PENTASA – mesalamine cap cr 250 mgPENTASA – mesalamine cap cr 500 mgRENVELA – sevelamer carbonate tab

800 mgRENVELA – sevelamer carbonate packet

0.8 gmRENVELA – sevelamer carbonate packet

2.4 gmsulfasalazine tab delayed release

500 mg (Azulfidine en-tabs)sulfasalazine tab 500 mg (Azulfidine)ursodiol cap 300 mg (Actigall)ursodiol tab 250 mg (Urso 250)ursodiol tab 500 mg (Urso forte)GENITOURINARY DRUGSURINARY TRACT INFECTIONSMACRODANTIN – nitrofurantoin

macrocrystalline cap 25 mgmethenamine hippurate tab 1 gm

(Hiprex)methenamine mandelate tab 1 gmmethenamine-hyos-meth blue-sod

phos-phen sal tab 81.6 mgmethenamine-hyosc-meth blue-benz

acid-phenyl sal tab 81.6mg (Prosed/ds)

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methenamine-hyosc-meth blue-sodphos-phen sal cap 118 mg

methenamine-hyosc-meth blue-sodphos-phen sal cap 120 mg

methenamine-hyosc-meth blue-sodphos-phen sal tab 81 mg

methenamine-hyoscamine-meth blue-sod phos tab 81.6 mg (Urogesic-blue)

nitrofurantoin macrocrystalline cap25 mg (Macrodantin)



nitrofurantoin monohydratemacrocrystalline cap 100 mg(Macrobid)

nitrofurantoin susp 25 mg/5ml(Furadantin)

URINARY TRACT SPASMSbethanechol chloride tab 5 mg

(Urecholine)bethanechol chloride tab 10 mg



(Urecholine)MYRBETRIQ – mirabegron tab sr 24 hr

25 mgMYRBETRIQ – mirabegron tab sr 24 hr

50 mgoxybutynin chloride syrup 5 mg/5mloxybutynin chloride tab sr 24hr 5 mg

(Ditropan xl)oxybutynin chloride tab sr 24hr 10 mg

(Ditropan xl)oxybutynin chloride tab sr 24hr 15 mg

(Ditropan xl)oxybutynin chloride tab 5 mg

2016


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tolterodine tartrate cap sr 24hr 2 mg(Detrol la)

tolterodine tartrate cap sr 24hr 4 mg(Detrol la)

tolterodine tartrate tab 1 mg (Detrol)tolterodine tartrate tab 2 mg (Detrol)trospium chloride cap sr 24hr 60 mgtrospium chloride tab 20 mg (Sanctura)VESICARE – solifenacin succinate tab 5

mgVESICARE – solifenacin succinate tab 10

mgVAGINAL PRODUCTSCLEOCIN – clindamycin phosphate

vaginal suppos 100 mgclindamycin phosphate vaginal cream

2% (Cleocin)metronidazole vaginal gel 0.75%

(Metrogel-vaginal)PREMARIN – estrogens, conjugated

vaginal cream 0.625 mg/gmterconazole vaginal cream 0.4%

(Terazol 7)terconazole vaginal cream 0.8%

(Terazol 3)terconazole vaginal suppos 80 mgVAGIFEM – estradiol vaginal tab 10 mcgOTHER GENITOURINARY DRUGSalfuzosin hcl tab sr 24hr 10 mg

(Uroxatral)AVODART – dutasteride cap 0.5 mgCYSTAGON – cysteamine bitartrate cap

50 mg• •

CYSTAGON – cysteamine bitartrate cap150 mg

• •

CYTRA-3 – pot & sod citrates w/ cit acsyrup 550-500-334 mg/5ml

dutasteride cap 0.5 mg (Avodart)

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ELMIRON – pentosan polysulfate sodiumcaps 100 mg

finasteride tab 5 mg (Proscar)K-PHOS NO 2 – potassium & sodium

acid phosphates tab 305-700 mgphenazopyridine hcl tab 100 mg

(Pyridium)phenazopyridine hcl tab 200 mg

(Pyridium)pot & sod citrates w/ cit ac soln

550-500-334 mg/5mlpotassium citrate & citric acid powder

pack 3300-1002 mgpotassium citrate & citric acid soln

1100-334 mg/5mlpotassium citrate tab cr 5 meq

(540 mg) (Urocit-k 5)potassium citrate tab cr 10 meq

(1080 mg) (Urocit-k 10)potassium citrate tab cr 15 meq

(1620 mg) (Urocit-k 15)sodium citrate & citric acid soln

500-334 mg/5ml (Shohls solution modi)tamsulosin hcl cap 0.4 mg (Flomax)CENTRAL NERVOUS SYSTEM DRUGSANXIETYalprazolam orally disintegrating tab

0.25 mg (Niravam)alprazolam orally disintegrating tab

0.5 mgalprazolam orally disintegrating tab

1 mgalprazolam orally disintegrating tab

2 mgalprazolam tab sr 24hr 0.5 mg (Xanax

xr)alprazolam tab sr 24hr 1 mg (Xanax xr)alprazolam tab sr 24hr 2 mg (Xanax xr)alprazolam tab sr 24hr 3 mg (Xanax xr)

2016


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alprazolam tab 0.25 mg (Xanax)alprazolam tab 0.5 mg (Xanax)alprazolam tab 1 mg (Xanax)alprazolam tab 2 mg (Xanax)buspirone hcl tab 5 mgbuspirone hcl tab 7.5 mgbuspirone hcl tab 10 mgbuspirone hcl tab 15 mgbuspirone hcl tab 30 mgchlordiazepoxide hcl cap 5 mgchlordiazepoxide hcl cap 10 mgchlordiazepoxide hcl cap 25 mgclorazepate dipotassium tab 3.75 mg

(Tranxene t)clorazepate dipotassium tab 7.5 mg

(Tranxene t)clorazepate dipotassium tab 15 mg

(Tranxene t)DIAZEPAM – diazepam soln 1 mg/mldiazepam tab 2 mg (Valium)diazepam tab 5 mg (Valium)diazepam tab 10 mg (Valium)hydroxyzine hcl syrup 10 mg/5mlhydroxyzine hcl tab 10 mghydroxyzine hcl tab 25 mghydroxyzine hcl tab 50 mgHYDROXYZINE PAMOATE –

hydroxyzine pamoate cap 100 mghydroxyzine pamoate cap 25 mg

(Vistaril)hydroxyzine pamoate cap 50 mg

(Vistaril)lorazepam conc 2 mg/ml (Lorazepam

intensol)lorazepam tab 0.5 mg (Ativan)lorazepam tab 1 mg (Ativan)lorazepam tab 2 mg (Ativan)

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oxazepam cap 10 mgoxazepam cap 15 mgoxazepam cap 30 mgDEPRESSIONamitriptyline hcl tab 10 mgamitriptyline hcl tab 25 mgamitriptyline hcl tab 50 mgamitriptyline hcl tab 75 mgamitriptyline hcl tab 100 mgamitriptyline hcl tab 150 mgbupropion hcl tab sr 12hr 100 mg

(Wellbutrin sr)bupropion hcl tab sr 12hr 150 mg



(Wellbutrin xl)bupropion hcl tab sr 24hr 300 mg

(Wellbutrin xl)bupropion hcl tab 75 mg (Wellbutrin)bupropion hcl tab 100 mg (Wellbutrin)citalopram hydrobromide oral soln

10 mg/5mlcitalopram hydrobromide tab 10 mg

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

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

(base equiv) (Celexa)clomipramine hcl cap 25 mg (Anafranil)clomipramine hcl cap 50 mg (Anafranil)clomipramine hcl cap 75 mg (Anafranil)desipramine hcl tab 10 mg (Norpramin)desipramine hcl tab 25 mg (Norpramin)desipramine hcl tab 50 mg (Norpramin)desipramine hcl tab 75 mg (Norpramin)

2016


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desipramine hcl tab 100 mg(Norpramin)

desipramine hcl tab 150 mg(Norpramin)

DOXEPIN HCL – doxepin hcl cap 75 mgdoxepin hcl cap 10 mgdoxepin hcl cap 25 mgdoxepin hcl cap 50 mgdoxepin hcl cap 100 mgdoxepin hcl cap 150 mgdoxepin hcl conc 10 mg/mlduloxetine hcl enteric coated pellets

cap 20 mg (Cymbalta)duloxetine hcl enteric coated pellets

cap 30 mg (Cymbalta)duloxetine hcl enteric coated pellets

cap 60 mg (Cymbalta)escitalopram oxalate soln 5 mg/5ml

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

equiv) (Lexapro)escitalopram oxalate tab 10 mg (base

equiv) (Lexapro)escitalopram oxalate tab 20 mg (base

equiv) (Lexapro)fluoxetine hcl cap delayed release

90 mg (Prozac weekly)fluoxetine hcl cap 10 mg (Prozac)fluoxetine hcl cap 20 mg (Prozac)fluoxetine hcl cap 40 mg (Prozac)fluoxetine hcl solution 20 mg/5mlfluoxetine hcl tab 10 mgfluoxetine hcl tab 20 mgfluvoxamine maleate cap sr 24hr

100 mg (Luvox cr)fluvoxamine maleate cap sr 24hr

150 mg (Luvox cr)fluvoxamine maleate tab 25 mg

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fluvoxamine maleate tab 50 mgfluvoxamine maleate tab 100 mgimipramine hcl tab 10 mg (Tofranil)imipramine hcl tab 25 mg (Tofranil)imipramine hcl tab 50 mg (Tofranil)imipramine pamoate cap 75 mg

(Tofranil-pm)imipramine pamoate cap 100 mg



(Tofranil-pm)mirtazapine orally disintegrating tab

15 mg (Remeron soltab)mirtazapine orally disintegrating tab

30 mg (Remeron soltab)mirtazapine orally disintegrating tab

45 mg (Remeron soltab)mirtazapine tab 7.5 mgmirtazapine tab 15 mg (Remeron)mirtazapine tab 30 mg (Remeron)mirtazapine tab 45 mg (Remeron)NORTRIPTYLINE HCL – nortriptyline hcl

soln 10 mg/5mlnortriptyline hcl cap 10 mg (Pamelor)nortriptyline hcl cap 25 mg (Pamelor)nortriptyline hcl cap 50 mg (Pamelor)nortriptyline hcl cap 75 mg (Pamelor)paroxetine hcl tab sr 24hr 12.5 mg

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

cr)paroxetine hcl tab sr 24hr 37.5 mg

(Paxil cr)paroxetine hcl tab 10 mg (Paxil)paroxetine hcl tab 20 mg (Paxil)paroxetine hcl tab 30 mg (Paxil)

2016


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paroxetine hcl tab 40 mg (Paxil)phenelzine sulfate tab 15 mg (Nardil)protriptyline hcl tab 5 mg (Vivactil)protriptyline hcl tab 10 mg (Vivactil)sertraline hcl oral conc 20 mg/ml

(Zoloft)sertraline hcl tab 25 mg (Zoloft)sertraline hcl tab 50 mg (Zoloft)sertraline hcl tab 100 mg (Zoloft)tranylcypromine sulfate tab 10 mg

(Parnate)trazodone hcl tab 50 mgtrazodone hcl tab 100 mgtrazodone hcl tab 150 mgtrazodone hcl tab 300 mgvenlafaxine hcl cap sr 24hr 37.5 mg

(base equivalent) (Effexor xr)venlafaxine hcl cap sr 24hr 75 mg

(base equivalent) (Effexor xr)venlafaxine hcl cap sr 24hr 150 mg

(base equivalent) (Effexor xr)venlafaxine hcl tab sr 24hr 37.5 mg

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

equivalent) (Venlafaxine hcl er)venlafaxine hcl tab sr 24hr 150 mg

(base equivalent) (Venlafaxine hcl er)venlafaxine hcl tab 25 mgvenlafaxine hcl tab 37.5 mgvenlafaxine hcl tab 50 mgvenlafaxine hcl tab 75 mgvenlafaxine hcl tab 100 mgPSYCHOTIC AND BIPOLAR DISORDERSaripiprazole oral solution 1 mg/mlaripiprazole tab 2 mg (Abilify)aripiprazole tab 5 mg (Abilify)aripiprazole tab 10 mg (Abilify)

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aripiprazole tab 15 mg (Abilify)aripiprazole tab 20 mg (Abilify)aripiprazole tab 30 mg (Abilify)chlorpromazine hcl tab 10 mgchlorpromazine hcl tab 25 mgchlorpromazine hcl tab 50 mgchlorpromazine hcl tab 100 mgchlorpromazine hcl tab 200 mgclozapine tab 25 mg (Clozaril)clozapine tab 50 mgclozapine tab 100 mg (Clozaril)clozapine tab 200 mgFLUPHENAZINE HCL – fluphenazine hcl

elixir 2.5 mg/5mlFLUPHENAZINE HCL – fluphenazine hcl

oral conc 5 mg/mlfluphenazine hcl tab 1 mgfluphenazine hcl tab 2.5 mgfluphenazine hcl tab 5 mgfluphenazine hcl tab 10 mghaloperidol lactate oral conc 2 mg/mlhaloperidol tab 0.5 mghaloperidol tab 1 mghaloperidol tab 2 mghaloperidol tab 5 mghaloperidol tab 10 mghaloperidol tab 20 mgLITHIUM – lithium oral solution 8 meq/5mlLITHIUM CARBONATE – lithium

carbonate cap 150 mglithium carbonate cap 150 mg (Lithium

carbonate)lithium carbonate cap 300 mglithium carbonate cap 600 mg (Lithium

carbonate)

2016


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lithium carbonate tab cr 300 mg(Lithobid)

lithium carbonate tab cr 450 mglithium carbonate tab 300 mgloxapine succinate cap 5 mg (Loxitane)loxapine succinate cap 10 mgloxapine succinate cap 25 mgloxapine succinate cap 50 mgolanzapine orally disintegrating tab

5 mg (Zyprexa zydis)olanzapine orally disintegrating tab



20 mg (Zyprexa zydis)olanzapine tab 2.5 mg (Zyprexa)olanzapine tab 5 mg (Zyprexa)olanzapine tab 7.5 mg (Zyprexa)olanzapine tab 10 mg (Zyprexa)olanzapine tab 15 mg (Zyprexa)olanzapine tab 20 mg (Zyprexa)paliperidone tab sr 24hr 1.5 mg

(Invega)paliperidone tab sr 24hr 3 mg (Invega)paliperidone tab sr 24hr 6 mg (Invega)paliperidone tab sr 24hr 9 mg (Invega)perphenazine tab 2 mgperphenazine tab 4 mgperphenazine tab 8 mgperphenazine tab 16 mgprochlorperazine maleate tab 5 mg

(base equivalent) (Compazine)prochlorperazine maleate tab 10 mg

(base equivalent) (Compazine)prochlorperazine suppos 25 mg

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quetiapine fumarate tab 25 mg(Seroquel)






risperidone orally disintegrating tab0.25 mg

risperidone orally disintegrating tab0.5 mg (Risperdal m-tab)

risperidone orally disintegrating tab1 mg (Risperdal m-tab)




risperidone soln 1 mg/ml (Risperdal)risperidone tab 0.25 mg (Risperdal)risperidone tab 0.5 mg (Risperdal)risperidone tab 1 mg (Risperdal)risperidone tab 2 mg (Risperdal)risperidone tab 3 mg (Risperdal)risperidone tab 4 mg (Risperdal)SEROQUEL XR – quetiapine fumarate

tab sr 24hr 50 mgSEROQUEL XR – quetiapine fumarate



tab sr 24hr 300 mg

2016


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SEROQUEL XR – quetiapine fumaratetab sr 24hr 400 mg

thiothixene cap 1 mgthiothixene cap 2 mgthiothixene cap 5 mgthiothixene cap 10 mgtrifluoperazine hcl tab 1 mgtrifluoperazine hcl tab 2 mgtrifluoperazine hcl tab 5 mgtrifluoperazine hcl tab 10 mgziprasidone hcl cap 20 mg (Geodon)ziprasidone hcl cap 40 mg (Geodon)ziprasidone hcl cap 60 mg (Geodon)ziprasidone hcl cap 80 mg (Geodon)SLEEP AIDSestazolam tab 1 mgestazolam tab 2 mgeszopiclone tab 1 mg (Lunesta)eszopiclone tab 2 mg (Lunesta)eszopiclone tab 3 mg (Lunesta)FLURAZEPAM HCL – flurazepam hcl cap

15 mgFLURAZEPAM HCL – flurazepam hcl cap

30 mgmidazolam hcl syrup 2 mg/ml (base

equivalent)PHENOBARBITAL – phenobarbital tab 15

mgPHENOBARBITAL – phenobarbital tab 30

mgPHENOBARBITAL – phenobarbital tab 60

mgPHENOBARBITAL – phenobarbital tab

100 mgphenobarbital elixir 20 mg/5mlphenobarbital tab 16.2 mgphenobarbital tab 32.4 mg

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phenobarbital tab 64.8 mgphenobarbital tab 97.2 mgtemazepam cap 7.5 mg (Restoril)temazepam cap 15 mg (Restoril)temazepam cap 22.5 mg (Restoril)temazepam cap 30 mg (Restoril)zaleplon cap 5 mg (Sonata)zaleplon cap 10 mg (Sonata)zolpidem tartrate tab cr 6.25 mg

(Ambien cr)zolpidem tartrate tab cr 12.5 mg

(Ambien cr)zolpidem tartrate tab 5 mg (Ambien)zolpidem tartrate tab 10 mg (Ambien)HYPERACTIVITY/NARCOLEPSYamphetamine-dextroamphetamine cap

sr 24hr 5 mg (Adderall xr)amphetamine-dextroamphetamine cap





sr 24hr 30 mg (Adderall xr)amphetamine-dextroamphetamine tab

5 mg (Adderall)amphetamine-dextroamphetamine tab

7.5 mg (Adderall)amphetamine-dextroamphetamine tab

10 mg (Adderall)amphetamine-dextroamphetamine tab

12.5 mg (Adderall)amphetamine-dextroamphetamine tab

15 mg (Adderall)

2016


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its

amphetamine-dextroamphetamine tab20 mg (Adderall)

amphetamine-dextroamphetamine tab30 mg (Adderall)

caffeine citrate oral soln 60 mg/3ml(10 mg/ml base equiv) (Cafcit)

clonidine hcl tab sr 12hr 0.1 mg(Kapvay)

dexmethylphenidate hcl cap sr 24 hr5 mg (Focalin xr)




dexmethylphenidate hcl tab 2.5 mg(Focalin)

dexmethylphenidate hcl tab 5 mg(Focalin)

dexmethylphenidate hcl tab 10 mg(Focalin)

dextroamphetamine sulfate cap sr 24hr5 mg (Dexedrine)



dextroamphetamine sulfate oralsolution 5 mg/5ml (Procentra)

dextroamphetamine sulfate tab 5 mgdextroamphetamine sulfate tab 10 mgguanfacine hcl tab sr 24hr 1 mg (base

equiv) (Intuniv)guanfacine hcl tab sr 24hr 2 mg (base



equiv) (Intuniv)

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its

methylphenidate hcl cap cr 10 mg(Metadate cd)






methylphenidate hcl cap sr 24hr 20 mg(la) (Ritalin la)

•


•


•

methylphenidate hcl soln 5 mg/5ml(Methylin)

methylphenidate hcl soln 10 mg/5ml(Methylin)

methylphenidate hcl tab cr 10 mgmethylphenidate hcl tab cr 20 mg

(Ritalin sr)methylphenidate hcl tab 5 mg (Ritalin)methylphenidate hcl tab 10 mg (Ritalin)methylphenidate hcl tab 20 mg (Ritalin)modafinil tab 100 mg (Provigil)modafinil tab 200 mg (Provigil)STRATTERA – atomoxetine hcl cap 10

mg (base equiv)STRATTERA – atomoxetine hcl cap 18



mg (base equiv)

2016


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its

STRATTERA – atomoxetine hcl cap 60mg (base equiv)



VYVANSE – lisdexamfetamine dimesylatecap 10 mg







MULTIPLE SCLEROSISBETASERON – interferon beta-1b for inj

kit 0.3 mg• •

COPAXONE – glatiramer acetate solnprefilled syringe 20 mg/ml

• • •

COPAXONE – glatiramer acetate solnprefilled syringe 40 mg/ml

• •

glatiramer acetate soln prefilledsyringe 20 mg/ml (Copaxone)

• • •

PLEGRIDY – peginterferon beta-1a solnpen-injector 125 mcg/0.5ml

• •

PLEGRIDY – peginterferon beta-1a solnprefilled syringe 125 mcg/0.5ml

• •

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

• •

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

• •

Drug Name Spe

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REBIF – interferon beta-1a soln pref syr22 mcg/0.5ml (12mu/ml)

• •

REBIF – interferon beta-1a soln pref syr44 mcg/0.5ml (24mu/ml)

• •

REBIF REBIDOSE – interferon beta-1asoln auto-inj 22 mcg/0.5ml (12mu/ml)

• •

REBIF REBIDOSE – interferon beta-1asoln auto-inj 44 mcg/0.5ml (24mu/ml)

• •

REBIF REBIDOSE TITRATION –interferon beta-1a auto-inj 6x8.8mcg/0.2ml & 6x22 mcg/0.5ml

• •

REBIF TITRATION PACK – interferonbeta-1a pref syr 6x8.8 mcg/0.2ml &6x22 mcg/0.5ml

• •

TECFIDERA – dimethyl fumarate capsuledelayed release 120 mg

• •

TECFIDERA – dimethyl fumarate capsuledelayed release 240 mg

• •

TECFIDERA STARTER PACK – dimethylfumarate capsule dr starter pack 120mg & 240 mg

• •

OTHER CENTRAL NERVOUS SYSTEM DRUGSacamprosate calcium tab delayed

release 333 mg (Campral)bupropion hcl (smoking deterrent) tab

sr 12hr 150 mg (Zyban)CHANTIX – varenicline tartrate tab 0.5

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

(base equiv)CHANTIX CONTINUING MONTH –

varenicline tartrate tab 1 mg (baseequiv)

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

disulfiram tab 250 mg (Antabuse)disulfiram tab 500 mg (Antabuse)donepezil hydrochloride orally

disintegrating tab 5 mg (Aricept odt)

2016


Drug Name Spe

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its

donepezil hydrochloride orallydisintegrating tab 10 mg (Aricept odt)

donepezil hydrochloride tab 5 mg(Aricept)



fluoxetine hcl (pmdd) cap 10 mgfluoxetine hcl (pmdd) cap 20 mgGALANTAMINE HYDROBROMIDE –

galantamine hydrobromide oral soln 4mg/ml

galantamine hydrobromide cap sr 24hr8 mg (Razadyne er)



galantamine hydrobromide tab 4 mg(Razadyne)



memantine hcl oral solution 2 mg/ml(Namenda)

memantine hcl tab 5 mg (Namenda)memantine hcl tab 10 mg (Namenda)memantine hcl tab 5 mg (28) & 10 mg

(21) titration pak (Namenda titrationpa)

NAMENDA – memantine hcl oral solution2 mg/ml

NICOTROL INHALER – nicotine inhalersystem 10 mg (4 mg delivered)

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

olanzapine-fluoxetine hcl cap 3-25 mg(Symbyax)

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its





pimozide tab 1 mg (Orap)pimozide tab 2 mg (Orap)rivastigmine tartrate cap 1.5 mg

(Exelon)rivastigmine tartrate cap 3 mg (Exelon)rivastigmine tartrate cap 4.5 mg

(Exelon)rivastigmine tartrate cap 6 mg (Exelon)tetrabenazine tab 12.5 mg (Xenazine) • •tetrabenazine tab 25 mg (Xenazine) • •PAIN RELIEF DRUGSNON-NARCOTIC DRUGSbutalbital-acetaminophen tab

50-325 mgbutalbital-acetaminophen-caffeine cap

50-300-40 mg (Fioricet)butalbital-acetaminophen-caffeine cap

50-325-40 mgbutalbital-acetaminophen-caffeine tab

50-325-40 mgbutalbital-aspirin-caffeine cap

50-325-40 mg (Fiorinal)choline & magnesium salicylates liq

500 mg/5mldiflunisal tab 500 mgsalsalate tab 500 mgsalsalate tab 750 mgNARCOTIC DRUGSacetaminophen w/ codeine soln

120-12 mg/5ml

2016


Drug Name Spe

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its

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

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

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

buprenorphine hcl sl tab 2 mg (baseequiv)

buprenorphine hcl sl tab 8 mg (baseequiv)

butalbital-acetaminophen-caff w/ codcap 50-300-40-30 mg (Fioricet/codeine)

butalbital-acetaminophen-caff w/ codcap 50-325-40-30 mg

butalbital-aspirin-caff w/ codeine cap50-325-40-30 mg (Fiorinal/codeine #3)

butorphanol tartrate nasal soln 10 mg/ml

codeine sulfate tab 15 mg (Codeinesulfate)

codeine sulfate tab 30 mgcodeine sulfate tab 60 mgfentanyl citrate lozenge on a handle

200 mcg (Actiq)•

fentanyl citrate lozenge on a handle400 mcg (Actiq)

•


•


•


•


•

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

•


•


•

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•


•

hydrocodone-acetaminophen soln7.5-325 mg/15ml (Hycet)

hydrocodone-acetaminophen tab2.5-325 mg

hydrocodone-acetaminophen tab10-325 mg (Norco)

hydrocodone-acetaminophen tab5-300 mg (Xodol)

hydrocodone-acetaminophen tab7.5-300 mg (Xodol)

hydrocodone-acetaminophen tab5-325 mg (Norco)

hydrocodone-acetaminophen tab7.5-325 mg (Norco)

hydrocodone-acetaminophen tab10-300 mg (Xodol)

hydrocodone-ibuprofen tab 5-200 mg(Reprexain)

hydrocodone-ibuprofen tab 7.5-200 mg(Vicoprofen)

hydrocodone-ibuprofen tab 10-200 mg(Ibudone)

HYDROMORPHONE HCL –hydromorphone hcl suppos 3 mg

hydromorphone hcl liqd 1 mg/ml(Dilaudid)

hydromorphone hcl tab er 24hr deter8 mg (Exalgo)



hydromorphone hcl tab 2 mg (Dilaudid)hydromorphone hcl tab 4 mg (Dilaudid)hydromorphone hcl tab 8 mg (Dilaudid)

2016


Drug Name Spe

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its

methadone hcl conc 10 mg/ml(Methadose)

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

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

methadone hcl tab for oral susp 40 mgmethadone hcl tab 5 mg (Dolophine hcl)methadone hcl tab 10 mg (Dolophine)MORPHINE SULFATE – morphine sulfate

tab 15 mgMORPHINE SULFATE – morphine sulfate

tab 30 mgMORPHINE SULFATE – morphine sulfate

suppos 5 mgMORPHINE SULFATE – morphine sulfate



suppos 30 mgmorphine sulfate cap sr 24hr 10 mg

(Kadian)morphine sulfate cap sr 24hr 20 mg






(Kadian)MORPHINE SULFATE ER – morphine

sulfate beads cap sr 24hr 30 mgMORPHINE SULFATE ER – morphine

sulfate beads cap sr 24hr 45 mg

Drug Name Spe

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its

MORPHINE SULFATE ER – morphinesulfate beads cap sr 24hr 60 mg




morphine sulfate oral soln 10 mg/5mlmorphine sulfate oral soln 20 mg/5mlmorphine sulfate oral soln 100 mg/5ml

(20 mg/ml)morphine sulfate tab cr 15 mg (Ms

contin)morphine sulfate tab cr 30 mg (Ms




contin)NUCYNTA ER – tapentadol hcl tab sr

12hr 50 mgNUCYNTA ER – tapentadol hcl tab sr




12hr 250 mgOXYCODONE HCL – oxycodone hcl

conc 100 mg/5ml (20 mg/ml)oxycodone hcl cap 5 mgoxycodone hcl conc 100 mg/5ml

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

(Oxycodone hcl)oxycodone hcl tab 5 mg (Roxicodone)

2016


Drug Name Spe

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Lim

its

oxycodone hcl tab 10 mgoxycodone hcl tab 15 mg (Roxicodone)oxycodone hcl tab 20 mgoxycodone hcl tab 30 mg (Roxicodone)oxycodone w/ acetaminophen tab

2.5-325 mg (Percocet)oxycodone w/ acetaminophen tab

5-325 mg (Percocet)oxycodone w/ acetaminophen tab

7.5-325 mg (Percocet)oxycodone w/ acetaminophen tab

10-325 mg (Percocet)oxycodone-aspirin tab 4.8355-325 mg

(Percodan)oxycodone-ibuprofen tab 5-400 mgOXYCONTIN – oxycodone hcl tab er 12hr

deter 10 mg•

OXYCONTIN – oxycodone hcl tab er 12hrdeter 15 mg

•


•


•


•


•


•

oxymorphone hcl tab sr 12hr 5 mgoxymorphone hcl tab sr 12hr 7.5 mgoxymorphone hcl tab sr 12hr 10 mgoxymorphone hcl tab sr 12hr 15 mgoxymorphone hcl tab sr 12hr 20 mgoxymorphone hcl tab sr 12hr 30 mgoxymorphone hcl tab sr 12hr 40 mgoxymorphone hcl tab 5 mg (Opana)oxymorphone hcl tab 10 mg (Opana)

Drug Name Spe

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its

tramadol hcl tab sr 24hr 100 mg (Ultramer)



tramadol hcl tab sr 24hr biphasicrelease 100 mg



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

37.5-325 mg (Ultracet)RHEUMATOID AND OSTEOARTHRITIScelecoxib cap 50 mg (Celebrex)celecoxib cap 100 mg (Celebrex)celecoxib cap 200 mg (Celebrex)celecoxib cap 400 mg (Celebrex)diclofenac potassium tab 50 mg

(Cataflam)diclofenac sodium tab delayed release

25 mgdiclofenac sodium tab delayed release

50 mgdiclofenac sodium tab delayed release

75 mgdiclofenac sodium tab sr 24hr 100 mg

(Voltaren-xr)diclofenac w/ misoprostol tab delayed

release 50-0.2 mg (Arthrotec 50)diclofenac w/ misoprostol tab delayed

release 75-0.2 mg (Arthrotec 75)ENBREL – etanercept for subcutaneous

inj kit 25 mg• •

ENBREL – etanercept subcutaneous solnprefilled syringe 25 mg/0.5ml

• •

2016


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ENBREL – etanercept subcutaneous solnprefilled syringe 50 mg/ml

• •

ENBREL SURECLICK – etanerceptsubcutaneous solution auto-injector 50mg/ml

• •

etodolac cap 200 mgetodolac cap 300 mgetodolac tab sr 24hr 400 mgetodolac tab sr 24hr 500 mgetodolac tab sr 24hr 600 mgetodolac tab 400 mgetodolac tab 500 mgflurbiprofen tab 50 mgflurbiprofen tab 100 mgHUMIRA – adalimumab prefilled syringe

kit 10 mg/0.2ml• •

HUMIRA – adalimumab prefilled syringekit 20 mg/0.4ml

• •

HUMIRA – adalimumab prefilled syringekit 40 mg/0.8ml

• •

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

• •

HUMIRA PEN – adalimumab pen-injectorkit 40 mg/0.8ml

• •

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

• •

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

• •

ibuprofen susp 100 mg/5mlibuprofen tab 400 mgibuprofen tab 600 mgibuprofen tab 800 mgILARIS – canakinumab for inj 180 mg • •indomethacin cap cr 75 mgindomethacin cap 25 mg

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indomethacin cap 50 mgketoprofen cap 50 mgketoprofen cap 75 mgketorolac tromethamine tab 10 mgleflunomide tab 10 mg (Arava)leflunomide tab 20 mg (Arava)mefenamic acid cap 250 mg (Ponstel)meloxicam tab 7.5 mg (Mobic)meloxicam tab 15 mg (Mobic)nabumetone tab 500 mgnabumetone tab 750 mgNAPROXEN – naproxen susp 125

mg/5mlnaproxen sodium tab 275 mg (Anaprox)naproxen sodium tab 550 mg (Anaprox

ds)naproxen tab ec 375 mg (Ec-naprosyn)naproxen tab ec 500 mg (Ec-naprosyn)naproxen tab 250 mg (Naprosyn)naproxen tab 375 mg (Naprosyn)naproxen tab 500 mg (Naprosyn)oxaprozin tab 600 mg (Daypro)piroxicam cap 10 mg (Feldene)piroxicam cap 20 mg (Feldene)SIMPONI – golimumab subcutaneous

soln auto-injector 50 mg/0.5ml• •

SIMPONI – golimumab subcutaneoussoln auto-injector 100 mg/ml

• •

SIMPONI – golimumab subcutaneoussoln prefilled syringe 50 mg/0.5ml

• •

SIMPONI – golimumab subcutaneoussoln prefilled syringe 100 mg/ml

• •

sulindac tab 150 mgsulindac tab 200 mgtolmetin sodium cap 400 mgMIGRAINE HEADACHES

2016


Drug Name Spe

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its

acetaminophen-isometheptene-dichloral cap 325-65-100 mg

IMITREX – sumatriptan nasal spray 5 mg/act

IMITREX – sumatriptan nasal spray 20mg/act

isometheptene-caffeine-acetaminophen tab 65-20-325 mg(Prodrin)

MIGRANAL – dihydroergotaminemesylate nasal spray 4 mg/ml

naratriptan hcl tab 1 mg (base equiv)(Amerge)

naratriptan hcl tab 2.5 mg (base equiv)(Amerge)

rizatriptan benzoate orallydisintegrating tab 5 mg (Maxalt-mlt)

rizatriptan benzoate orallydisintegrating tab 10 mg (Maxalt-mlt)

rizatriptan benzoate tab 5 mg (Maxalt)rizatriptan benzoate tab 10 mg (Maxalt)SUMATRIPTAN SUCCINATE –

sumatriptan succinate solution prefilledsyringe 6 mg/0.5ml

SUMATRIPTAN SUCCINATE –sumatriptan succinate inj 4 mg/0.5ml

sumatriptan succinate inj 6 mg/0.5ml(Imitrex)

sumatriptan succinate solution auto-injector 4 mg/0.5ml (Imitrex statdosesys)

sumatriptan succinate solution auto-injector 6 mg/0.5ml (Imitrex statdosesys)

sumatriptan succinate solutioncartridge 4 mg/0.5ml (Imitrex statdoseref)

sumatriptan succinate solutioncartridge 6 mg/0.5ml (Imitrex statdoseref)

Drug Name Spe

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its

sumatriptan succinate tab 25 mg(Imitrex)



zolmitriptan orally disintegrating tab2.5 mg (Zomig zmt)

zolmitriptan orally disintegrating tab5 mg (Zomig zmt)

zolmitriptan tab 2.5 mg (Zomig)zolmitriptan tab 5 mg (Zomig)GOUTallopurinol tab 100 mg (Zyloprim)allopurinol tab 300 mg (Zyloprim)colchicine w/ probenecid tab

0.5-500 mgprobenecid tab 500 mgNEUROMUSCULAR DRUGSSEIZUREScarbamazepine cap sr 12hr 100 mg

(Carbatrol)carbamazepine cap sr 12hr 200 mg

(Carbatrol)carbamazepine cap sr 12hr 300 mg

(Carbatrol)carbamazepine chew tab 100 mgcarbamazepine susp 100 mg/5ml

(Tegretol)carbamazepine tab sr 12hr 200 mg

(Tegretol-xr)carbamazepine tab sr 12hr 400 mg

(Tegretol-xr)carbamazepine tab 200 mg (Tegretol)CELONTIN – methsuximide cap 300 mgclonazepam orally disintegrating tab

0.125 mg

2016


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its

clonazepam orally disintegrating tab0.25 mg

clonazepam orally disintegrating tab0.5 mg

clonazepam orally disintegrating tab1 mg

clonazepam orally disintegrating tab2 mg

clonazepam tab 0.5 mg (Klonopin)clonazepam tab 1 mg (Klonopin)clonazepam tab 2 mg (Klonopin)DIASTAT ACUDIAL – diazepam rectal gel

delivery system 10 mgDIASTAT ACUDIAL – diazepam rectal gel

delivery system 20 mgDIASTAT PEDIATRIC – diazepam rectal

gel delivery system 2.5 mgDILANTIN – phenytoin sodium extended

cap 30 mgDILANTIN – phenytoin sodium extended

cap 100 mgDILANTIN-125 – phenytoin susp 125

mg/5mldivalproex sodium cap sprinkle 125 mg

(Depakote sprinkles)divalproex sodium tab delayed release

125 mg (Depakote)divalproex sodium tab delayed release

250 mg (Depakote)divalproex sodium tab delayed release

500 mg (Depakote)divalproex sodium tab sr 24 hr 250 mg

(Depakote er)divalproex sodium tab sr 24 hr 500 mg

(Depakote er)ethosuximide cap 250 mg (Zarontin)ethosuximide soln 250 mg/5ml

(Zarontin)felbamate susp 600 mg/5ml (Felbatol)

Drug Name Spe

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its

felbamate tab 400 mg (Felbatol)felbamate tab 600 mg (Felbatol)gabapentin cap 100 mg (Neurontin)gabapentin cap 300 mg (Neurontin)gabapentin cap 400 mg (Neurontin)gabapentin oral soln 250 mg/5ml

(Neurontin)gabapentin tab 600 mg (Neurontin)gabapentin tab 800 mg (Neurontin)lamotrigine tab chewable dispersible

5 mg (Lamictal chewable di)lamotrigine tab chewable dispersible

25 mg (Lamictal chewable di)lamotrigine tab sr 24hr 25 mg (Lamictal

xr)lamotrigine tab sr 24hr 50 mg (Lamictal

xr)lamotrigine tab sr 24hr 100 mg

(Lamictal xr)lamotrigine tab sr 24hr 200 mg



(Lamictal xr)lamotrigine tab 25 mg (Lamictal)lamotrigine tab 100 mg (Lamictal)lamotrigine tab 150 mg (Lamictal)lamotrigine tab 200 mg (Lamictal)levetiracetam oral soln 100 mg/ml

(Keppra)levetiracetam tab sr 24hr 500 mg

(Keppra xr)levetiracetam tab sr 24hr 750 mg

(Keppra xr)levetiracetam tab 250 mg (Keppra)levetiracetam tab 500 mg (Keppra)levetiracetam tab 750 mg (Keppra)

2016


Drug Name Spe

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its

levetiracetam tab 1000 mg (Keppra)oxcarbazepine susp 300 mg/5ml

(60 mg/ml) (Trileptal)oxcarbazepine tab 150 mg (Trileptal)oxcarbazepine tab 300 mg (Trileptal)oxcarbazepine tab 600 mg (Trileptal)PHENYTEK – phenytoin sodium

extended cap 200 mgPHENYTEK – phenytoin sodium

extended cap 300 mgphenytoin chew tab 50 mg (Dilantin

infatabs)phenytoin sodium extended cap

100 mg (Dilantin)phenytoin sodium extended cap

200 mg (Phenytek)phenytoin sodium extended cap

300 mg (Phenytek)phenytoin susp 125 mg/5ml (Dilantin)primidone tab 50 mg (Mysoline)primidone tab 250 mg (Mysoline)SABRIL – vigabatrin tab 500 mgSABRIL – vigabatrin powd pack 500 mgTEGRETOL-XR – carbamazepine tab sr

12hr 100 mgtiagabine hcl tab 2 mg (Gabitril)tiagabine hcl tab 4 mg (Gabitril)topiramate sprinkle cap 15 mg

(Topamax sprinkle)topiramate sprinkle cap 25 mg

(Topamax sprinkle)topiramate tab 25 mg (Topamax)topiramate tab 50 mg (Topamax)topiramate tab 100 mg (Topamax)topiramate tab 200 mg (Topamax)valproate sodium syrup 250 mg/5ml

(base equiv) (Depakene)valproic acid cap 250 mg (Depakene)

Drug Name Spe

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its

zonisamide cap 25 mg (Zonegran)zonisamide cap 50 mgzonisamide cap 100 mg (Zonegran)PARKINSON'S DISEASEamantadine hcl cap 100 mgamantadine hcl syrup 50 mg/5mlAZILECT – rasagiline mesylate tab 0.5

mg (base equiv)AZILECT – rasagiline mesylate tab 1 mg

(base equiv)benztropine mesylate tab 0.5 mgbenztropine mesylate tab 1 mgbenztropine mesylate tab 2 mgbromocriptine mesylate cap 5 mg

(Parlodel)bromocriptine mesylate tab 2.5 mg

(Parlodel)carbidopa & levodopa orally

disintegrating tab 10-100 mgcarbidopa & levodopa orally

disintegrating tab 25-100 mgcarbidopa & levodopa orally

disintegrating tab 25-250 mgcarbidopa & levodopa tab cr 25-100 mg

(Sinemet cr)carbidopa & levodopa tab cr 50-200 mg

(Sinemet cr)carbidopa & levodopa tab 10-100 mg

(Sinemet)carbidopa & levodopa tab 25-100 mg

(Sinemet)carbidopa & levodopa tab 25-250 mg

(Sinemet)carbidopa tab 25 mg (Lodosyn)CARBIDOPA/LEVODOPA/ENTACA –

carbidopa-levodopa-entacapone tabs12.5-50-200 mg

2016


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its

CARBIDOPA/LEVODOPA/ENTACA –carbidopa-levodopa-entacapone tabs18.75-75-200 mg

CARBIDOPA/LEVODOPA/ENTACA –carbidopa-levodopa-entacapone tabs25-100-200 mg



CARBIDOPA/LEVODOPA/ENTACA –carbidopa-levodopa-entacapone tabs50-200-200 mg

entacapone tab 200 mg (Comtan)pramipexole dihydrochloride tab

0.125 mg (Mirapex)pramipexole dihydrochloride tab



0.75 mg (Mirapex)pramipexole dihydrochloride tab 1 mg

(Mirapex)pramipexole dihydrochloride tab

1.5 mg (Mirapex)ropinirole hydrochloride tab sr 24hr

2 mg (base equivalent) (Requip xl)ropinirole hydrochloride tab sr 24hr




12 mg (base equivalent) (Requip xl)ropinirole hydrochloride tab 0.25 mg

(Requip)

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its

ropinirole hydrochloride tab 0.5 mg(Requip)

ropinirole hydrochloride tab 1 mg(Requip)





selegiline hcl cap 5 mg (Eldepryl)selegiline hcl tab 5 mgtrihexyphenidyl hcl elixir 0.4 mg/mltrihexyphenidyl hcl tab 2 mgtrihexyphenidyl hcl tab 5 mgMUSCLE RELAXANTSbaclofen tab 10 mgbaclofen tab 20 mgchlorzoxazone tab 500 mg (Parafon

forte dsc)cyclobenzaprine hcl tab 5 mgcyclobenzaprine hcl tab 7.5 mg

(Fexmid)cyclobenzaprine hcl tab 10 mgDANTROLENE SODIUM – dantrolene

sodium cap 100 mgdantrolene sodium cap 25 mg

(Dantrium)dantrolene sodium cap 50 mg

(Dantrium)metaxalone tab 800 mg (Skelaxin)methocarbamol tab 500 mg (Robaxin)methocarbamol tab 750 mg

(Robaxin-750)orphenadrine citrate tab sr 12hr

100 mg

2016


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orphenadrine w/ aspirin & caffeine tab25-385-30 mg

tizanidine hcl cap 2 mg (baseequivalent) (Zanaflex)



tizanidine hcl tab 2 mg (baseequivalent)

tizanidine hcl tab 4 mg (baseequivalent) (Zanaflex)

OTHER NEUROMUSCULAR DRUGSpyridostigmine bromide tab 60 mg

(Mestinon)riluzole tab 50 mg (Rilutek)VITAMINSergocalciferol cap 50000 unit (Drisdol)MEPHYTON – phytonadione tab 5 mgMULTIVITAMINSESCAVITE LQ – pediatric multiple

vitamins w/ fl-fe drops 0.25-6 mg/mlpediatric multiple vitamins w/ fl-fe

drops 0.25-10 mg/mlpediatric multiple vitamins w/ fluoride

chew tab 0.25 mgpediatric multiple vitamins w/ fluoride

chew tab 0.5 mgpediatric multiple vitamins w/ fluoride

chew tab 1 mgpediatric multiple vitamins w/ fluoride

soln 0.25 mg/mlpediatric multiple vitamins w/ fluoride

soln 0.5 mg/mlpediatric vitamins acd w/ fluoride soln

0.25 mg/mlpediatric vitamins acd w/ fluoride soln

0.5 mg/ml

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PRENAPLUS – prenatal vit w/ fefumarate-fa tab 27-1 mg

PRENATABS FA – prenatal vit w/ fefumarate-fa tab 29-1 mg

PRENATABS RX – prenatal vit w/ ironcarbonyl-fa tab 29-1 mg

PRENATAL PLUS – prenatal vit w/ fefumarate-fa tab 27-1 mg

PRENATAL 19 – prenatal vit w/ fefumarate-fa chew tab 29-1 mg

PRENATAL 19 – prenatal vit w/ dss-fefumarate-fa tab 29-1 mg

PRENATAL-U – prenatal w/o a vit w/ fefumarate-fa cap 106.5-1 mg

TRI-VIT/FLUORIDE/IRON – pediatricvitamins acd fluoride & fe drops 0.25-10mg/ml

TRINATE – prenatal vit w/ fe fumarate-fatab 28-1 mg

VINACAL B – prenat w/o a w/fecbn-feglu-fa tab 20-1 mg & vit b6 tab pak

VINATE AZ EXTRA – prenatal vit w/ febisglycinate chelate-fa tab 29-1 mg

VINATE C – prenatal w/o a vit w/ fefumarate-fa tab 30-1 mg

VINATE CALCIUM – prenatal vit w/ ironcarbonyl-fe gluc-fa tab 27-1 mg

VINATE CARE – prenatal w/o a vit w/ fefum-fa tab chew 40-1 mg

VINATE DHA RF – prenat w/o a w/fefum-methylfol-omegas cap 27-1.13 mg

VINATE IC – prenatal w/o a w/fe fum-fepoly-fa cap 162.115.2-1 mg

VINATE II – prenatal vit w/ fe bisglycinatechelate-fa tab 29-1 mg

VINATE M – prenatal vit w/ sel-fefumarate-fa tab 27-1 mg

VINATE ONE – prenatal vit w/ fefumarate-fa tab 60-1 mg

MINERALS AND ELECTROLYTES

2016


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FLUOR-A-DAY – sodium fluoride-xylitolchew tab 0.55 (0.25 mg f)-236.79 mg

FLUOR-A-DAY – sodium fluoride-xylitolchew tab 1.1 (0.5 mg f)-236.79 mg

FLUOR-A-DAY – sodium fluoride-xylitolchew tab 2.2 (1 mg f)-236.79 mg

FLURA-DROPS – sodium fluoride soln0.25 mg/drop f (from 0.55 mg/drop naf)

K-PHOS – potassium phosphatemonobasic tab 500 mg

pot bicarbonate & chloride effer tab 25meq

pot phos monobasic w/sod phos di &monobas tab 155-852-130mg (K-phosneutral)

potassium bicarbonate effer tab 25meq

potassium chloride cap cr 8 meq(Micro-k)

potassium chloride cap cr 10 meq(Micro-k)

POTASSIUM CHLORIDE ER – potassiumchloride tab cr 8 meq (600 mg)

potassium chloride microencapsulatedcrys cr tab 10 meq

potassium chloride microencapsulatedcrys cr tab 20 meq

potassium chloride oral soln 10% (20meq/15ml)

potassium chloride oral soln 20% (40meq/15ml)

potassium chloride powder packet 20meq

potassium chloride tab cr 8 meq(600 mg)

potassium chloride tab cr 10 meq (K-tab)

SODIUM FLUORIDE – sodium fluoridetab 0.5 mg f (from 1.1 mg naf)

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SODIUM FLUORIDE – sodium fluoridetab 1 mg f (from 2.2 mg naf)

sodium fluoride chew tab 0.25 mg f(from 0.55 mg naf) (Luride)

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

sodium fluoride chew tab 1 mg f (from2.2 mg naf) (Luride)

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

sodium fluoride soln 0.5 mg/ml f (from1.1 mg/ml naf) (Luride)

SSKI – potassium iodide soln 1 gm/mlBLOOD MODIFYING DRUGSAMICAR – aminocaproic acid tab 500 mgAMICAR – aminocaproic acid syrup 25%anagrelide hcl cap 0.5 mg (Agrylin)anagrelide hcl cap 1 mgARANESP ALBUMIN FREE –

darbepoetin alfa soln prefilled syringe10 mcg/0.4ml

• •

ARANESP ALBUMIN FREE –darbepoetin alfa soln prefilled syringe25 mcg/0.42ml

• •


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• •

2016


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• •

ARANESP ALBUMIN FREE –darbepoetin alfa soln prefilled syringe500 mcg/ml

• •

ARANESP ALBUMIN FREE –darbepoetin alfa soln inj 25 mcg/ml

• •


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• •


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• •


• •

cilostazol tab 50 mg (Pletal)cilostazol tab 100 mg (Pletal)clopidogrel bisulfate tab 75 mg (base

equiv) (Plavix)clopidogrel bisulfate tab 300 mg (base

equiv) (Plavix)dipyridamole tab 25 mg (Persantine)dipyridamole tab 50 mg (Persantine)dipyridamole tab 75 mg (Persantine)EFFIENT – prasugrel hcl tab 5 mg (base

equiv)EFFIENT – prasugrel hcl tab 10 mg (base

equiv)enoxaparin sodium inj 30 mg/0.3ml

(Lovenox)enoxaparin sodium inj 40 mg/0.4ml



(Lovenox)

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enoxaparin sodium inj 100 mg/ml(Lovenox)

enoxaparin sodium inj 120 mg/0.8ml(Lovenox)

enoxaparin sodium inj 150 mg/ml(Lovenox)

enoxaparin sodium inj 300 mg/3ml(Lovenox)

FIRAZYR – icatibant acetate inj 30mg/3ml (base equivalent)

• •

folic acid tab 1 mgfondaparinux sodium subcutaneous inj

2.5 mg/0.5ml (Arixtra)fondaparinux sodium subcutaneous inj

5 mg/0.4ml (Arixtra)fondaparinux sodium subcutaneous inj

7.5 mg/0.6ml (Arixtra)fondaparinux sodium subcutaneous inj

10 mg/0.8ml (Arixtra)GRANIX – tbo-filgrastim soln prefilled

syringe 300 mcg/0.5ml• •

GRANIX – tbo-filgrastim soln prefilledsyringe 480 mcg/0.8ml

• •

NEULASTA – pegfilgrastim soln prefilledsyringe 6 mg/0.6ml

• •

NEULASTA DELIVERY KIT –pegfilgrastim soln prefilled syringe kit 6mg/0.6ml

• •

NEUPOGEN – filgrastim soln prefilledsyringe 300 mcg/0.5ml

• •

NEUPOGEN – filgrastim soln prefilledsyringe 480 mcg/0.8ml (600 mcg/ml)

• •

NEUPOGEN – filgrastim inj 300 mcg/ml • •NEUPOGEN – filgrastim inj 480

mcg/1.6ml (300 mcg/ml)• •

pentoxifylline tab cr 400 mgPROCRIT – epoetin alfa inj 2000 unit/ml • •PROCRIT – epoetin alfa inj 3000 unit/ml • •PROCRIT – epoetin alfa inj 4000 unit/ml • •

2016


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PROCRIT – epoetin alfa inj 10000 unit/ml • •PROCRIT – epoetin alfa inj 20000 unit/ml • •PROCRIT – epoetin alfa inj 40000 unit/ml • •tranexamic acid tab 650 mg (Lysteda)warfarin sodium tab 1 mg (Coumadin)warfarin sodium tab 2 mg (Coumadin)warfarin sodium tab 2.5 mg (Coumadin)warfarin sodium tab 3 mg (Coumadin)warfarin sodium tab 4 mg (Coumadin)warfarin sodium tab 5 mg (Coumadin)warfarin sodium tab 6 mg (Coumadin)warfarin sodium tab 7.5 mg (Coumadin)warfarin sodium tab 10 mg (Coumadin)XARELTO – rivaroxaban tab 10 mgXARELTO – rivaroxaban tab 15 mgXARELTO – rivaroxaban tab 20 mgXARELTO STARTER PACK –

rivaroxaban tab starter therapy pack 15mg & 20 mg

TOPICAL PRODUCTSEYEAnti-infectivesBACITRACIN – bacitracin ophth oint 500

unit/gmbacitracin-polymyxin b ophth ointCILOXAN – ciprofloxacin hcl ophth oint

0.3%ciprofloxacin hcl ophth soln 0.3%

(Ciloxan)erythromycin ophth oint 5 mg/gmgatifloxacin ophth soln 0.5% (Zymaxid)gentamicin sulfate ophth oint 0.3%gentamicin sulfate ophth soln 0.3%

(Garamycin)levofloxacin ophth soln 0.5%NATACYN – natamycin ophth susp 5%

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

neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml(Neosporin)

ofloxacin ophth soln 0.3% (Ocuflox)polymyxin b-trimethoprim ophth soln

10000 unit/ml-0.1% (Polytrim)sulfacetamide sodium ophth soln 10%

(Bleph-10)tobramycin ophth soln 0.3% (Tobrex)TOBREX – tobramycin ophth oint 0.3%trifluridine ophth soln 1% (Viroptic)VIGAMOX – moxifloxacin hcl ophth soln

0.5% (base equiv)Steroids and Combination ProductsALREX – loteprednol etabonate ophth

susp 0.2%bacitracin-polymyxin-neomycin-hc

ophth oint 1%DEXAMETHASONE SODIUM PHOS –

dexamethasone sodium phosphateophth soln 0.1%

fluorometholone ophth susp 0.1% (Fmlliquifilm)

LOTEMAX – loteprednol etabonate ophthgel 0.5%

LOTEMAX – loteprednol etabonate ophthoint 0.5%

LOTEMAX – loteprednol etabonate ophthsusp 0.5%

neomycin-polymyxin-dexamethasoneophth oint 0.1% (Maxitrol)

neomycin-polymyxin-dexamethasoneophth susp 0.1% (Maxitrol)

prednisolone acetate ophth susp 1%(Pred forte)

sulfacetamide sodium-prednisoloneophth soln 10-0.23(0.25)%

2016


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tobramycin-dexamethasone ophthsusp 0.3-0.1% (Tobradex)

ZYLET – loteprednol etabonate-tobramycin ophth susp 0.5-0.3%

GlaucomaALPHAGAN P – brimonidine tartrate

ophth soln 0.1%apraclonidine hcl ophth soln 0.5%

(base equivalent) (Iopidine)AZOPT – brinzolamide ophth susp 1%betaxolol hcl ophth soln 0.5%brimonidine tartrate ophth soln 0.15%

(Alphagan p)brimonidine tartrate ophth soln 0.2%carteolol hcl ophth soln 1%dorzolamide hcl ophth soln 2%

(Trusopt)dorzolamide hcl-timolol maleate ophth

soln 22.3-6.8 mg/ml (Cosopt)latanoprost ophth soln 0.005%

(Xalatan)LEVOBUNOLOL HCL – levobunolol hcl

ophth soln 0.25%levobunolol hcl ophth soln 0.5%

(Betagan)LUMIGAN – bimatoprost ophth soln

0.01%METIPRANOLOL – metipranolol ophth

soln 0.3%pilocarpine hcl ophth soln 1% (Isopto

carpine)pilocarpine hcl ophth soln 2% (Isopto

carpine)pilocarpine hcl ophth soln 4% (Isopto

carpine)SIMBRINZA – brinzolamide-brimonidine

tartrate ophth susp 1-0.2%timolol maleate ophth gel forming soln

0.25% (Timoptic-xe)

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timolol maleate ophth gel forming soln0.5% (Timoptic-xe)

timolol maleate ophth soln 0.25%(Timoptic)

timolol maleate ophth soln 0.5%(Timoptic)

TRAVATAN Z – travoprost ophth soln0.004% (benzalkonium free) (bak free)

Other Eye ProductsATROPINE SULFATE – atropine sulfate

ophth oint 1%atropine sulfate ophth soln 1% (Isopto

atropine)azelastine hcl ophth soln 0.05%

(Optivar)bromfenac sodium ophth soln 0.09%

(base equivalent)bromfenac sodium ophth soln 0.09%

(base equiv) (once-daily)cromolyn sodium ophth soln 4%cyclopentolate hcl ophth soln 1%

(Cyclogyl)cyclopentolate hcl ophth soln 2%

(Cyclogyl)diclofenac sodium ophth soln 0.1%epinastine hcl ophth soln 0.05%

(Elestat)flurbiprofen sodium ophth soln 0.03%

(Ocufen)homatropine hbr ophth soln 5% (Isopto

homatropine)ketorolac tromethamine ophth soln

0.4% (Acular ls)ketorolac tromethamine ophth soln

0.5% (Acular)PATADAY – olopatadine hcl ophth soln

0.2% (base equivalent)PAZEO – olopatadine hcl ophth soln 0.7%

(base equivalent)phenylephrine hcl ophth soln 2.5%

2016


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phenylephrine hcl ophth soln 10%tropicamide ophth soln 0.5%tropicamide ophth soln 1% (Mydriacyl)EARacetic acid otic soln 2%antipyrine-benzocaine otic soln

54-14 mg/ml (5.4-1.4%)antipyrine-benzocaine-polycosanol

otic sol 5.4-1.4-0.0097% (Treagan otic)CIPRO HC – ciprofloxacin-hydrocortisone

otic susp 0.2-1%CIPRODEX – ciprofloxacin-

dexamethasone otic susp 0.3-0.1%CORTANE-B AQUEOUS – pramoxine-hc-

chloroxylenol aqueous otic soln 10-10-1mg/ml

fluocinolone acetonide (otic) oil 0.01%(Dermotic)

hydrocortisone w/ acetic acid otic soln1-2% (Vosol hc)

neomycin-polymyxin-hc otic soln 1%(Cortisporin)

neomycin-polymyxin-hc otic susp3.5 mg/ml-10000 unit/ml-1%

ofloxacin otic soln 0.3%pramoxine-chloroxylenol otic liquid

1-0.1% (Pramotic)pramoxine-hc-chloroxylenol otic soln

10-10-1 mg/ml (Cortane-b-otic)MOUTH AND THROAT (LOCAL)cevimeline hcl cap 30 mg (Evoxac)chlorhexidine gluconate soln 0.12%

(Peridex)clotrimazole troche 10 mglidocaine hcl laryngotracheal soln 4%

(Lta 360 kit)lidocaine hcl viscous soln 2%nystatin susp 100000 unit/ml

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pilocarpine hcl tab 5 mg (Salagen)pilocarpine hcl tab 7.5 mg (Salagen)sodium fluoride cream 1.1% (Prevident

5000 plus)sodium fluoride gel 1.1% (0.5% f)

(Prevident fluoride)triamcinolone acetonide dental paste

0.1%ANORECTAL AGENTSCORTIFOAM – hydrocortisone acetate

rectal foam 10% (90 mg/dose)hydrocortisone acetate suppos 25 mg

(Anusol-hc)hydrocortisone acetate suppos 30 mg

(Proctocort)hydrocortisone enema 100 mg/60ml

(Cortenema)hydrocortisone rectal cream 1%

(Proctocort)hydrocortisone rectal cream 2.5%

(Anusol-hc)SKIN CONDITIONS/PRODUCTSAcneadapalene cream 0.1% (Differin)adapalene gel 0.1% (Differin)adapalene gel 0.3% (Differin)benzoyl peroxide-erythromycin gel

5-3% (Benzamycin)BP CLEANSING WASH – sulfacetamide

sodium-sulfur in urea emulsion 10-4%clindamycin phosph-benzoyl peroxide

(refrig) gel 1.2 (1)-5% (Duac)clindamycin phosphate foam 1%

(Evoclin)clindamycin phosphate gel 1%

(Cleocin-t)clindamycin phosphate lotion 1%

(Cleocin-t)

2016


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clindamycin phosphate soln 1%(Cleocin-t)

clindamycin phosphate swab 1%(Cleocin-t)

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

erythromycin gel 2% (Erygel)erythromycin pads 2%erythromycin soln 2%FINACEA – azelaic acid foam 15%FINACEA – azelaic acid gel 15%isotretinoin cap 10 mgisotretinoin cap 20 mgisotretinoin cap 30 mg (Claravis)isotretinoin cap 40 mgmetronidazole cream 0.75%

(Metrocream)metronidazole gel 0.75%metronidazole gel 1% (Metrogel)metronidazole lotion 0.75%

(Metrolotion)ORACEA – doxycycline (rosacea) cap

delayed release 40 mgPRASCION RA WITH SUNSCREE –

sulfacetamide sodium-sulfur-sunscreencream 10-5%

sulfacetamide sod-sulfur wash 9-4.5%& skin cleanser kit (Sumadan kit)

sulfacetamide sodium lotion 10%(acne) (Klaron)

sulfacetamide sodium w/ sulfurcleanser 10-2% (Avar ls cleanser)

sulfacetamide sodium w/ sulfurcleansing cloth 10-5%

sulfacetamide sodium w/ sulfurcleansing pad 10-4% (Sumaxin)

sulfacetamide sodium w/ sulfur cream10-2% (Avar-e ls)

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sulfacetamide sodium w/ sulfur cream10-5%

sulfacetamide sodium w/ sulfuremulsion 10-1%

sulfacetamide sodium w/ sulfuremulsion 10-5%

sulfacetamide sodium w/ sulfur foam10-5% (Clarifoam ef)

sulfacetamide sodium w/ sulfur lotion10-5%

sulfacetamide sodium w/ sulfur susp8-4% (Sumaxin ts)

sulfacetamide sodium w/ sulfur wash9-4% (Sumaxin wash)

sulfacetamide sodium w/ sulfur wash9-4.5% (Sumadan wash)

TAZORAC – tazarotene cream 0.05%TAZORAC – tazarotene cream 0.1%TAZORAC – tazarotene gel 0.05%TAZORAC – tazarotene gel 0.1%tretinoin cream 0.025% (Retin-a)tretinoin cream 0.05% (Retin-a)tretinoin cream 0.1% (Retin-a)tretinoin gel 0.01% (Retin-a)tretinoin gel 0.025%, (Retin-a)tretinoin gel 0.05% (Atralin)tretinoin microsphere gel 0.04% (Retin-

a micro)tretinoin microsphere gel 0.1% (Retin-a

micro)Anti-infectivesacyclovir oint 5% (Zovirax)ciclopirox gel 0.77% (Loprox)ciclopirox olamine cream 0.77% (base

equiv)ciclopirox olamine susp 0.77% (base

equiv)

2016


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ciclopirox shampoo 1% (Loproxshampoo)

ciclopirox solution kit 8% (Ciclodansolution ki)

ciclopirox solution 8% (Penlac naillacquer)

clotrimazole w/ betamethasone cream1-0.05% (Lotrisone)

clotrimazole w/ betamethasone lotion1-0.05%

diclofenac sodium soln 1.5%(Pennsaid)

econazole nitrate cream 1%GENTAMICIN SULFATE – gentamicin

sulfate cream 0.1%GENTAMICIN SULFATE – gentamicin

sulfate oint 0.1%iodoquinol-hydrocortisone in aloe

vehicle cream 1-1.9% (Vytone)ketoconazole cream 2%ketoconazole foam 2% (Extina)ketoconazole shampoo 2% (Nizoral)mupirocin calcium cream 2%

(Bactroban)mupirocin oint 2% (Bactroban)nystatin cream 100000 unit/gmnystatin oint 100000 unit/gmnystatin topical powdersilver sulfadiazine cream 1%

(Silvadene)Corticosteroidsalclometasone dipropionate cream

0.05% (Aclovate)alclometasone dipropionate oint 0.05%AMCINONIDE – amcinonide cream 0.1%betamethasone dipropionate

augmented cream 0.05% (Diproleneaf)

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betamethasone dipropionateaugmented gel 0.05%

betamethasone dipropionateaugmented lotion 0.05% (Diprolene)

betamethasone dipropionateaugmented oint 0.05% (Diprolene)

betamethasone dipropionate cream0.05%

betamethasone dipropionate lotion0.05%

betamethasone dipropionate oint0.05%

betamethasone valerate aerosol foam0.12% (Luxiq)

betamethasone valerate cream 0.1%betamethasone valerate lotion 0.1%betamethasone valerate oint 0.1%clobetasol propionate cream 0.05%

(Temovate)clobetasol propionate emollient base

cream 0.05% (Temovate e)clobetasol propionate emulsion foam

0.05% (Olux-e)clobetasol propionate foam 0.05%

(Olux)clobetasol propionate gel 0.05%

(Temovate)clobetasol propionate lotion 0.05%

(Clobex)clobetasol propionate oint 0.05%

(Temovate)clobetasol propionate shampoo 0.05%

(Clobex)clobetasol propionate soln 0.05%

(Temovate)desonide cream 0.05% (Desowen)desonide lotion 0.05% (Desowen)desonide oint 0.05% (Desowen)

2016


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DESOXIMETASONE – desoximetasonecream 0.05%

desoximetasone cream 0.25% (Topicort)desoximetasone gel 0.05% (Topicort)desoximetasone oint 0.25% (Topicort)DIFLORASONE DIACETATE –

diflorasone diacetate cream 0.05%DIFLORASONE DIACETATE –

diflorasone diacetate oint 0.05%fluocinolone acetonide cream 0.01%fluocinolone acetonide cream 0.025%

(Synalar)fluocinolone acetonide oil 0.01% (body

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

oil) (Derma-smoothe/fs sca)fluocinolone acetonide oint 0.025%

(Synalar)fluocinolone acetonide soln 0.01%

(Synalar)fluocinonide cream 0.05%fluocinonide cream 0.1% (Vanos)fluocinonide emulsified base cream

0.05%fluocinonide gel 0.05%fluocinonide oint 0.05%fluocinonide soln 0.05%fluticasone propionate cream 0.05%

(Cutivate)fluticasone propionate lotion 0.05%

(Cutivate)fluticasone propionate oint 0.005%

(Cutivate)halobetasol propionate cream 0.05%

(Ultravate)halobetasol propionate oint 0.05%

(Ultravate)hydrocortisone butyrate cream 0.1%

(Locoid)

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hydrocortisone butyrate hydrophiliclipo base cream 0.1% (Locoidlipocream)

hydrocortisone butyrate oint 0.1%(Locoid)

hydrocortisone butyrate soln 0.1%(Locoid)

hydrocortisone cream 1%hydrocortisone cream 2.5%hydrocortisone lotion 2% (Ala scalp)hydrocortisone lotion 2.5%hydrocortisone oint 2.5%hydrocortisone valerate cream 0.2%hydrocortisone valerate oint 0.2%

(Westcort)mometasone furoate cream 0.1%

(Elocon)mometasone furoate oint 0.1% (Elocon)mometasone furoate solution 0.1%

(lotion) (Elocon)nystatin-triamcinolone cream

100000-0.1 unit/gm-%nystatin-triamcinolone oint 100000-0.1

unit/gm-%prednicarbate cream 0.1% (Dermatop)prednicarbate oint 0.1% (Dermatop)TRIAMCINOLONE ACETONIDE –

triamcinolone acetonide oint 0.5%triamcinolone acetonide cream 0.025%triamcinolone acetonide cream 0.1%triamcinolone acetonide cream 0.5%triamcinolone acetonide lotion 0.025%triamcinolone acetonide lotion 0.1%triamcinolone acetonide oint 0.025%triamcinolone acetonide oint 0.1%Other Skin Productsacitretin cap 10 mg (Soriatane)

2016


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acitretin cap 17.5 mg (Soriatane)acitretin cap 25 mg (Soriatane)calcipotriene cream 0.005% (Dovonex)calcipotriene oint 0.005%calcipotriene soln 0.005% (50 mcg/ml)CARAC – fluorouracil cream 0.5%diclofenac sodium (actinic

keratoses) gel 3% (Solaraze)DRYSOL – aluminum chloride soln 20%ELIDEL – pimecrolimus cream 1%FLUOROPLEX – fluorouracil cream 1%fluorouracil cream 5% (Efudex)fluorouracil soln 2%fluorouracil soln 5%imiquimod cream 5% (Aldara)lactic acid (ammonium lactate) lotion

10%lidocaine hcl cream 3%lidocaine hcl gel 2%lidocaine hcl soln 4% (Xylocaine)lidocaine oint 5%lidocaine patch 5% (Lidoderm)lidocaine-prilocaine cream 2.5-2.5%

(Emla)lidocaine-prilocaine kit 2.5-2.5%lindane lotion 1%lindane shampoo 1%malathion lotion 0.5% (Ovide)methoxsalen rapid cap 10 mg

(Oxsoralen ultra)permethrin cream 5% (Elimite)PICATO – ingenol mebutate gel 0.015%PICATO – ingenol mebutate gel 0.05%podofilox soln 0.5% (Condylox)selenium sulfide lotion 2.5%

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STELARA – ustekinumab soln prefilledsyringe 45 mg/0.5ml

• •

STELARA – ustekinumab soln prefilledsyringe 90 mg/ml

• •

tacrolimus oint 0.03% (Protopic)tacrolimus oint 0.1% (Protopic)VALCHLOR – mechlorethamine hcl gel

0.016% (base equivalent)• •

VOLTAREN – diclofenac sodium gel 1%ZYCLARA – imiquimod cream 3.75%ZYCLARA PUMP – imiquimod cream

2.5%ZYCLARA PUMP – imiquimod cream

3.75%MISCELLANEOUS CATEGORIESDIABETIC SUPPLIESMany other diabetic supplies including Insulin Syringes,Lancets and Lancet Devices are Preferred for plansthat cover them, however, only commonly prescribedproducts are shown on the Preferred Drug List.Blood Glucose Monitors, Test Strips, and MonitorCalibration LiquidsACCU-CHEK ACTIVE GLUCOSE – blood

glucose calibration - liquidACCU-CHEK ACTIVE STRIPS – glucose

blood test stripACCU-CHEK AVIVA – glucose blood test

stripACCU-CHEK AVIVA – blood glucose

calibration - liquidACCU-CHEK AVIVA CONNECT – blood

glucose monitoring kit w/ deviceACCU-CHEK AVIVA PLUS – glucose

blood test stripACCU-CHEK AVIVA PLUS – blood

glucose monitoring kit w/ deviceACCU-CHEK COMFORT CURVE C –

blood glucose calibration - liquidACCU-CHEK COMFORT CURVE L –

blood glucose calibration - liquid

2016


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ACCU-CHEK COMPACT BLUE CO –blood glucose calibration - liquid

ACCU-CHEK COMPACT PLUS – glucoseblood test strip

ACCU-CHEK COMPACT PLUS CA –blood glucose monitoring kit

ACCU-CHEK COMPACT PLUS CL –blood glucose calibration - liquid

ACCU-CHEK COMPACT TEST DR –glucose blood test strip

ACCU-CHEK INSTANT GLUCOSE –blood glucose calibration - liquid

ACCU-CHEK NANO SMARTVIEW –blood glucose monitoring kit w/ device

ACCU-CHEK SMARTVIEW CONTR –blood glucose calibration - liquid

ACCU-CHEK SMARTVIEW STRIP –glucose blood test strip

ACCU-CHEK VOICEMATE – bloodglucose monitoring kit w/ device

ACCUTREND GLUCOSE – glucoseblood test strip

ACCUTREND GLUCOSE CONTROL –blood glucose calibration - liquid

ACETEST – acetone (urine) test tabASCENSIA AUTODISC LOW AND –

blood glucose calibration - liquidASCENSIA AUTODISC NORMAL – blood

glucose calibration - liquid - normalASCENSIA AUTODISC TEST ST –

glucose blood test diskBAYER BREEZE 2 BLOOD GLUC –

blood glucose monitoring kit w/ deviceBAYER BREEZE 2 HIGH CONTR – blood

glucose calibration - liquid - highBAYER BREEZE 2 LOW CONTRO –

blood glucose calibration - liquid - lowBAYER BREEZE 2 NORMAL CON –

blood glucose calibration - liquid -normal

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BAYER BREEZE 2 TEST DISC – glucoseblood test disk

BAYER CONTOUR BLOOD GLUCO –glucose blood test strip

BAYER CONTOUR BLOOD GLUCO –blood glucose monitoring devices

BAYER CONTOUR BLOOD GLUCO –blood glucose monitoring kit w/ device

BAYER CONTOUR HIGH CONTRO –blood glucose calibration - liquid - high

BAYER CONTOUR LINK BLOOD – bloodglucose monitoring kit w/ device

BAYER CONTOUR LOW CONTROL –blood glucose calibration - liquid - low

BAYER CONTOUR NEXT BLOOD –glucose blood test strip

BAYER CONTOUR NEXT BLOOD –blood glucose monitoring kit w/ device

BAYER CONTOUR NEXT CONTRO– blood glucose calibration - liquid -normal

BAYER CONTOUR NEXT CONTRO –blood glucose calibration - liquid - low

BAYER CONTOUR NEXT EZ BLO –blood glucose monitoring kit w/ device

BAYER CONTOUR NEXT LINK B – bloodglucose monitoring kit w/ device

BAYER CONTOUR NEXT LINK W –blood glucose monitoring kit w/ device

BAYER CONTOUR NEXT USB BL –blood glucose monitoring kit w/ device

BAYER CONTOUR NORMAL CONT– blood glucose calibration - liquid -normal

BAYER CONTOUR USB BLOOD G –blood glucose monitoring kit w/ device

BREEZE 2 BLOOD GLUCOSE MO –blood glucose monitoring devices

CHEMSTRIP UGK – urine glucose-ketones test strips

2016


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CHEMSTRIP-K – acetone (urine) teststrip

DIDGET – blood glucose monitoring kit w/device

KETO-DIASTIX – urine glucose-ketonestest strips

KETOSTIX – acetone (urine) test stripPRECISION XTRA – ketone blood test

stripOther Diabetic SuppliesALCOHOL SWABS - VARIOUSINJECTION DEVICE FOR INSULIN -

VARIOUSINSULIN PEN NEEDLES - NOVOFINEINSULIN PEN NEEDLES - NOVOTWISTINSULIN PEN NEEDLES - VARIOUSINSULIN SYRINGES - VARIOUSLANCET DEVICES - VARIOUSLANCETS - VARIOUSRESPIRATORY INHALER-ASSIST DEVICESThe Preferred Drug List includes most spacerdevices. The most commonly prescribed productsare AEROCHAMBER, EASIVENT, E-Z SPACER,INSPIREASE, and MICROCHAMBER.INHALER-ASSIST DEVICES - VARIOUSMISCELLANEOUS DRUGSazathioprine tab 50 mg (Imuran)buprenorphine hcl-naloxone hcl sl tab

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

8-2 mg (base equiv)CHEMET – succimer cap 100 mgCUPRIMINE – penicillamine cap 250 mg • •cyclosporine cap 25 mg (Sandimmune)cyclosporine cap 100 mg

(Sandimmune)cyclosporine modified cap 25 mg

(Neoral)

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cyclosporine modified cap 100 mg(Neoral)

cyclosporine modified oral soln100 mg/ml (Neoral)

mycophenolate mofetil cap 250 mg(Cellcept)

mycophenolate mofetil for oral susp200 mg/ml (Cellcept)

mycophenolate mofetil tab 500 mg(Cellcept)

mycophenolate sodium tab dr 180 mg(mycophenolic acid equiv) (Myfortic)

mycophenolate sodium tab dr 360 mg(mycophenolic acid equiv) (Myfortic)

naloxone hcl inj 0.4 mg/mlnaltrexone hcl tab 50 mg (Revia)RAPAMUNE – sirolimus oral soln 1 mg/mlREVLIMID – lenalidomide caps 2.5 mg • •REVLIMID – lenalidomide cap 5 mg • •REVLIMID – lenalidomide cap 10 mg • •REVLIMID – lenalidomide cap 15 mg • •REVLIMID – lenalidomide cap 20 mg • •REVLIMID – lenalidomide cap 25 mg • •SANDIMMUNE – cyclosporine oral soln

100 mg/mlSANDIMMUNE – cyclosporine cap 25 mgSANDIMMUNE – cyclosporine cap 100

mgsirolimus tab 0.5 mg (Rapamune)sirolimus tab 1 mg (Rapamune)sirolimus tab 2 mg (Rapamune)sodium polystyrene sulfonate oral

susp 15 gm/60ml (Sps)sodium polystyrene sulfonate powder

(Kayexalate)sodium polystyrene sulfonate rectal

susp 30 gm/120ml

2016


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SUBOXONE – buprenorphine hcl-naloxone hcl sl film 2-0.5 mg (baseequiv)

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

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

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 12-3 mg (baseequiv)

tacrolimus cap 0.5 mg (Prograf)tacrolimus cap 1 mg (Prograf)tacrolimus cap 5 mg (Prograf)THALOMID – thalidomide cap 50 mg • •THALOMID – thalidomide cap 100 mg • •THALOMID – thalidomide cap 150 mg • •THALOMID – thalidomide cap 200 mg • •ZORTRESS – everolimus tab 0.25 mgZORTRESS – everolimus tab 0.5 mgZORTRESS – everolimus tab 0.75 mg

2016


INDEX

Aabacavir sulfate-lamivudine-zidovudine tab300-150-300 mg (Trizivir).................................................. 4

abacavir sulfate tab 300 mg (base equiv) (Ziagen).........4acamprosate calcium tab delayed release 333 mg(Campral).......................................................................... 39

acarbose tab 25 mg (Precose)........................................ 13acarbose tab 50 mg (Precose)........................................ 13acarbose tab 100 mg (Precose)...................................... 13ACCU-CHEK ACTIVE GLUCOSE – blood glucosecalibration - liquid.............................................................. 58

ACCU-CHEK ACTIVE STRIPS – glucose blood teststrip.....................................................................................58

ACCU-CHEK AVIVA – blood glucose calibration -liquid...................................................................................58

ACCU-CHEK AVIVA CONNECT – blood glucosemonitoring kit w/ device.................................................... 58

ACCU-CHEK AVIVA – glucose blood test strip..................58ACCU-CHEK AVIVA PLUS – blood glucose monitoring kitw/ device............................................................................58

ACCU-CHEK AVIVA PLUS – glucose blood test strip....... 58ACCU-CHEK COMFORT CURVE C – blood glucosecalibration - liquid.............................................................. 58

ACCU-CHEK COMFORT CURVE L – blood glucosecalibration - liquid.............................................................. 58

ACCU-CHEK COMPACT BLUE CO – blood glucosecalibration - liquid.............................................................. 59

ACCU-CHEK COMPACT PLUS CA – blood glucosemonitoring kit..................................................................... 59

ACCU-CHEK COMPACT PLUS CL – blood glucosecalibration - liquid.............................................................. 59

ACCU-CHEK COMPACT PLUS – glucose blood teststrip.....................................................................................59

ACCU-CHEK COMPACT TEST DR – glucose blood teststrip.....................................................................................59

ACCU-CHEK INSTANT GLUCOSE – blood glucosecalibration - liquid.............................................................. 59

ACCU-CHEK NANO SMARTVIEW – blood glucosemonitoring kit w/ device.................................................... 59

ACCU-CHEK SMARTVIEW CONTR – blood glucosecalibration - liquid.............................................................. 59

ACCU-CHEK SMARTVIEW STRIP – glucose blood teststrip.....................................................................................59

ACCU-CHEK VOICEMATE – blood glucose monitoring kitw/ device............................................................................59

ACCUTREND GLUCOSE CONTROL – blood glucosecalibration - liquid.............................................................. 59

ACCUTREND GLUCOSE – glucose blood test strip.........59acebutolol hcl cap 200 mg (Sectral)...............................19acebutolol hcl cap 400 mg (Sectral)...............................19acetaminophen-isometheptene-dichloral cap325-65-100 mg..................................................................45

acetaminophen w/ codeine soln 120-12 mg/5ml........... 40acetaminophen 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 – acetazolamide tab 125 mg...............23acetazolamide cap sr 12hr 500 mg (Diamox)................ 23acetazolamide tab 250 mg............................................... 23ACETEST – acetone (urine) test tab................................. 59acetic acid otic soln 2%...................................................54acetylcysteine inhal soln 10%.........................................26acetylcysteine inhal soln 20%.........................................26acitretin cap 10 mg (Soriatane).......................................57acitretin cap 17.5 mg (Soriatane)....................................58acitretin cap 25 mg (Soriatane).......................................58ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)........................................................... 7

ACTONEL – risedronate sodium tab 5 mg........................ 16ACTONEL – risedronate sodium tab 30 mg...................... 16ACTONEL – risedronate sodium tab 35 mg...................... 16ACTONEL – risedronate sodium tab 150 mg.................... 16acyclovir cap 200 mg (Zovirax).........................................4acyclovir oint 5% (Zovirax)..............................................55acyclovir susp 200 mg/5ml (Zovirax)............................... 4acyclovir tab 400 mg (Zovirax)..........................................4acyclovir tab 800 mg (Zovirax)..........................................4adapalene cream 0.1% (Differin).....................................54adapalene gel 0.1% (Differin).......................................... 54adapalene gel 0.3% (Differin).......................................... 54ADCIRCA – tadalafil tab 20 mg (pah)................................25adefovir dipivoxil tab 10 mg (Hepsera)............................4ADVAIR DISKUS – fluticasone-salmeterol aer powder ba100-50 mcg/dose...............................................................26

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba250-50 mcg/dose...............................................................26

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba500-50 mcg/dose...............................................................26

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21mcg/act...............................................................................26

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 115-21mcg/act...............................................................................26

ADVAIR HFA – fluticasone-salmeterol inhal aerosol230-21 mcg/act..................................................................26

AFINITOR DISPERZ – everolimus tab for oral susp 2mg........................................................................................ 7



AFINITOR – everolimus tab 2.5 mg.....................................7AFINITOR – everolimus tab 5 mg........................................7AFINITOR – everolimus tab 7.5 mg.....................................7AFINITOR – everolimus tab 10 mg......................................7ALBENZA – albendazole tab 200 mg.................................. 7

2016


albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)..........26albuterol sulfate soln nebu 0.5% (5 mg/ml)...................26albuterol sulfate soln nebu 0.63 mg/3ml (baseequiv).................................................................................26

albuterol sulfate soln nebu 1.25 mg/3ml (baseequiv).................................................................................26

albuterol sulfate syrup 2 mg/5ml....................................26albuterol sulfate tab 2 mg................................................27albuterol sulfate tab 4 mg................................................27albuterol sulfate tab sr 12hr 4 mg (Vospire er)..............26albuterol sulfate tab sr 12hr 8 mg (Vospire er)..............27alclometasone dipropionate cream 0.05%(Aclovate)..........................................................................56

alclometasone dipropionate oint 0.05%.........................56ALCOHOL SWABS - VARIOUS......................................... 60ALENDRONATE SODIUM – alendronate sodium tab 40mg...................................................................................... 16

alendronate sodium tab 5 mg......................................... 16alendronate sodium tab 10 mg....................................... 16alendronate sodium tab 35 mg....................................... 16alendronate sodium tab 70 mg (Fosamax).................... 16alfuzosin hcl tab sr 24hr 10 mg (Uroxatral)................... 32ALKERAN – melphalan tab 2 mg.........................................7allopurinol tab 100 mg (Zyloprim).................................. 45allopurinol tab 300 mg (Zyloprim).................................. 45alosetron hcl tab 0.5 mg (base equiv) (Lotronex).........30alosetron hcl tab 1 mg (base equiv) (Lotronex)............30ALPHAGAN P – brimonidine tartrate ophth soln 0.1%...... 53alprazolam orally disintegrating tab 0.5 mg.................. 32alprazolam orally disintegrating tab 1 mg..................... 32alprazolam orally disintegrating tab 2 mg..................... 32alprazolam orally disintegrating tab 0.25 mg(Niravam)...........................................................................32

alprazolam 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)......................32alprazolam tab sr 24hr 1 mg (Xanax xr).........................32alprazolam tab sr 24hr 2 mg (Xanax xr).........................32alprazolam tab sr 24hr 3 mg (Xanax xr).........................32ALREX – loteprednol etabonate ophth susp 0.2%.............52amantadine hcl cap 100 mg............................................ 47amantadine hcl syrup 50 mg/5ml....................................47AMCINONIDE – amcinonide cream 0.1%......................... 56AMICAR – aminocaproic acid syrup 25%..........................50AMICAR – aminocaproic acid tab 500 mg.........................50amiloride & hydrochlorothiazide tab 5-50 mg............... 23amiloride hcl tab 5 mg..................................................... 23amiodarone hcl tab 100 mg.............................................24amiodarone hcl tab 400 mg.............................................24amiodarone hcl tab 200 mg (Cordarone)....................... 24amitriptyline hcl tab 10 mg..............................................33amitriptyline hcl tab 25 mg..............................................33amitriptyline hcl tab 50 mg..............................................33amitriptyline hcl tab 75 mg..............................................33

amitriptyline hcl tab 100 mg............................................33amitriptyline hcl tab 150 mg............................................33amlodipine besylate-atorvastatin calcium tab 2.5-10mg (Caduet)......................................................................20

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

amlodipine besylate-atorvastatin calcium tab 2.5-40mg (Caduet)......................................................................20

amlodipine besylate-atorvastatin calcium tab 5-10 mg(Caduet).............................................................................20








amlodipine besylate-benazepril hcl cap 2.5-10 mg(Lotrel)...............................................................................21

amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)...............................................................................21





amlodipine besylate tab 2.5 mg (Norvasc).................... 20amlodipine besylate tab 5 mg (Norvasc)....................... 20amlodipine besylate tab 10 mg (Norvasc)..................... 20amlodipine besylate-valsartan tab 5-160 mg(Exforge)........................................................................... 21

amlodipine besylate-valsartan tab 5-320 mg(Exforge)........................................................................... 21



amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)...........................................18

amlodipine-valsartan-hydrochlorothiazide tab 5-160-25mg (Exforge hct)..............................................................18

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct).........................................18

amlodipine-valsartan-hydrochlorothiazide tab10-160-25 mg (Exforge hct)............................................18

2016


amlodipine-valsartan-hydrochlorothiazide tab10-320-25 mg (Exforge hct)............................................18

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 200-28.5 mg.....................................1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 400-57 mg........................................1

amoxicillin & k clavulanate for susp 200-28.5mg/5ml.................................................................................1

amoxicillin & k clavulanate for susp 400-57 mg/5ml...... 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml(Augmentin)........................................................................1

amoxicillin & k clavulanate for susp 600-42.9 mg/5ml(Augmentin es-600)...........................................................1

amoxicillin & k clavulanate tab 250-125 mg.................... 1amoxicillin & k clavulanate tab 500-125 mg(Augmentin)........................................................................1

amoxicillin & k clavulanate tab 875-125 mg(Augmentin)........................................................................1

amoxicillin & k clavulanate tab sr 12hr 1000-62.5 mg(Augmentin xr)...................................................................1

AMOXICILLIN – amoxicillin (trihydrate) chew tab 125mg........................................................................................ 1

AMOXICILLIN – amoxicillin (trihydrate) chew tab 250mg........................................................................................ 1

amoxicillin cap-clarithro tab-lansopraz cap dr therapypack (Prevpac).................................................................29

amoxicillin (trihydrate) cap 250 mg..................................1amoxicillin (trihydrate) cap 500 mg..................................1amoxicillin (trihydrate) for susp 125 mg/5ml...................1amoxicillin (trihydrate) for susp 200 mg/5ml...................1amoxicillin (trihydrate) for susp 250 mg/5ml...................1amoxicillin (trihydrate) for susp 400 mg/5ml...................1amoxicillin (trihydrate) tab 500 mg...................................1amoxicillin (trihydrate) tab 875 mg...................................1amphetamine-dextroamphetamine cap sr 24hr 5 mg(Adderall xr)..................................................................... 37

amphetamine-dextroamphetamine cap sr 24hr 10 mg(Adderall xr)..................................................................... 37





amphetamine-dextroamphetamine tab 5 mg(Adderall).......................................................................... 37

amphetamine-dextroamphetamine tab 7.5 mg(Adderall).......................................................................... 37


amphetamine-dextroamphetamine tab 12.5 mg(Adderall).......................................................................... 37




AMPICILLIN – ampicillin for susp 125 mg/5ml.................... 1AMPICILLIN – ampicillin for susp 250 mg/5ml.................... 1ampicillin cap 250 mg........................................................ 1ampicillin cap 500 mg........................................................ 1anagrelide hcl cap 1 mg.................................................. 50anagrelide hcl cap 0.5 mg (Agrylin)............................... 50anastrozole tab 1 mg (Arimidex).......................................7ANDRODERM – testosterone td patch 24hr 2mg/24hr..............................................................................11

ANDRODERM – testosterone td patch 24hr 4mg/24hr..............................................................................11

ANDROGEL PUMP – testosterone td gel 20.25 mg/act(1.62%)...............................................................................11

ANDROGEL – testosterone td gel 20.25 mg/1.25gm(1.62%)...............................................................................11

ANDROGEL – testosterone td gel 40.5 mg/2.5gm(1.62%)...............................................................................11

ANDROXY – fluoxymesterone tab 10 mg..........................11ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba62.5-25 mcg/inh.................................................................27

antipyrine-benzocaine otic soln 54-14 mg/ml(5.4-1.4%).......................................................................... 54

antipyrine-benzocaine-polycosanol otic sol5.4-1.4-0.0097% (Treagan otic).......................................54

apraclonidine hcl ophth soln 0.5% (base equivalent)(Iopidine)...........................................................................53

APTIVUS – tipranavir cap 250 mg.......................................5APTIVUS – tipranavir oral soln 100 mg/ml.......................... 5ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25mcg/ml................................................................................51

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40mcg/ml................................................................................51

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60mcg/ml................................................................................51

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj100 mcg/ml........................................................................ 51



ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 10 mcg/0.4ml..........................................50

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 25 mcg/0.42ml........................................50





2016




ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 500 mcg/ml.............................................51

aripiprazole oral solution 1 mg/ml..................................35aripiprazole 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).......................................35ARNUITY ELLIPTA – fluticasone furoate aerosol powderbreath activ 100 mcg/act.................................................. 27

ARNUITY ELLIPTA – fluticasone furoate aerosol powderbreath activ 200 mcg/act.................................................. 27

ASACOL HD – mesalamine tab delayed release 800mg...................................................................................... 30

ASCENSIA AUTODISC LOW AND – blood glucosecalibration - liquid.............................................................. 59

ASCENSIA AUTODISC NORMAL – blood glucosecalibration - liquid - normal............................................... 59

ASCENSIA AUTODISC TEST ST – glucose blood testdisk.....................................................................................59

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 100 mcg/act................................................... 27

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 200 mcg/act................................................... 27

ASMANEX TWISTHALER 120 ME – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 27

ASMANEX TWISTHALER 14 MET – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 27

ASMANEX TWISTHALER 30 MET – mometasone furoateinhal powd 110 mcg/inh (breath activated).......................27



ASTEPRO – azelastine hcl nasal spray 0.15% (205.5 mcg/spray)................................................................................. 26

atenolol & chlorthalidone tab 50-25 mg (Tenoretic50)...................................................................................... 19

atenolol & chlorthalidone tab 100-25 mg (Tenoretic100).................................................................................... 19

atenolol tab 25 mg (Tenormin)........................................ 19atenolol tab 50 mg (Tenormin)........................................ 19atenolol tab 100 mg (Tenormin)...................................... 19atorvastatin calcium tab 10 mg (base equivalent)(Lipitor)..............................................................................22

atorvastatin calcium tab 20 mg (base equivalent)(Lipitor)..............................................................................22



atovaquone-proguanil hcl tab 62.5-25 mg(Malarone)...........................................................................6

atovaquone-proguanil hcl tab 250-100 mg(Malarone)...........................................................................6

atovaquone susp 750 mg/5ml (Mepron)...........................7ATRIPLA – efavirenz-emtricitabine-tenofovir df tab600-200-300 mg.................................................................. 5

ATROPINE SULFATE – atropine sulfate ophth oint1%...................................................................................... 53

atropine sulfate ophth soln 1% (Isopto atropine)......... 53ATROVENT HFA – ipratropium bromide hfa inhal aerosol17 mcg/act......................................................................... 27

AUGMENTIN – amoxicillin & k clavulanate for susp125-31.25 mg/5ml............................................................... 1

AVODART – dutasteride cap 0.5 mg................................. 32azathioprine tab 50 mg (Imuran).....................................60azelastine hcl nasal spray 0.1% (137 mcg/spray)......... 26azelastine hcl nasal spray 0.15% (205.5 mcg/spray)(Astepro)........................................................................... 26

azelastine hcl ophth soln 0.05% (Optivar)..................... 53AZILECT – rasagiline mesylate tab 0.5 mg (baseequiv)................................................................................. 47

AZILECT – rasagiline mesylate tab 1 mg (base equiv)......47AZITHROMYCIN – azithromycin powd pack for susp 1gm........................................................................................ 2

azithromycin for susp 100 mg/5ml (Zithromax).............. 2azithromycin for susp 200 mg/5ml (Zithromax).............. 2azithromycin tab 250 mg (Zithromax).............................. 2azithromycin tab 500 mg (Zithromax).............................. 2azithromycin tab 600 mg (Zithromax).............................. 2AZOPT – brinzolamide ophth susp 1%..............................53

BBACITRACIN – bacitracin ophth oint 500 unit/gm............. 52bacitracin-polymyxin b ophth oint..................................52bacitracin-polymyxin-neomycin-hc ophth oint 1%.......52baclofen tab 10 mg...........................................................48baclofen tab 20 mg...........................................................48BACTROBAN NASAL – mupirocin calcium nasal oint2%...................................................................................... 26

balsalazide disodium cap 750 mg (Colazal).................. 30BARACLUDE – entecavir oral soln 0.05 mg/ml...................4BAYER BREEZE 2 BLOOD GLUC – blood glucosemonitoring kit w/ device.................................................... 59

BAYER BREEZE 2 HIGH CONTR – blood glucosecalibration - liquid - high................................................... 59

BAYER BREEZE 2 LOW CONTRO – blood glucosecalibration - liquid - low.....................................................59

BAYER BREEZE 2 NORMAL CON – blood glucosecalibration - liquid - normal............................................... 59

BAYER BREEZE 2 TEST DISC – glucose blood testdisk.....................................................................................59

BAYER CONTOUR BLOOD GLUCO – blood glucosemonitoring devices............................................................ 59

BAYER CONTOUR BLOOD GLUCO – blood glucosemonitoring kit w/ device.................................................... 59

2016


BAYER CONTOUR BLOOD GLUCO – glucose blood teststrip.....................................................................................59

BAYER CONTOUR HIGH CONTRO – blood glucosecalibration - liquid - high................................................... 59

BAYER CONTOUR LINK BLOOD – blood glucosemonitoring kit w/ device.................................................... 59

BAYER CONTOUR LOW CONTROL – blood glucosecalibration - liquid - low.....................................................59

BAYER CONTOUR NEXT BLOOD – blood glucosemonitoring kit w/ device.................................................... 59

BAYER CONTOUR NEXT BLOOD – glucose blood teststrip.....................................................................................59

BAYER CONTOUR NEXT CONTRO – blood glucosecalibration - liquid - low.....................................................59

BAYER CONTOUR NEXT CONTRO – blood glucosecalibration - liquid - normal............................................... 59

BAYER CONTOUR NEXT EZ BLO – blood glucosemonitoring kit w/ device.................................................... 59

BAYER CONTOUR NEXT LINK B – blood glucosemonitoring kit w/ device.................................................... 59

BAYER CONTOUR NEXT LINK W – blood glucosemonitoring kit w/ device.................................................... 59

BAYER CONTOUR NEXT USB BL – blood glucosemonitoring kit w/ device.................................................... 59

BAYER CONTOUR NORMAL CONT – blood glucosecalibration - liquid - normal............................................... 59

BAYER CONTOUR USB BLOOD G – blood glucosemonitoring kit w/ device.................................................... 59

benazepril & hydrochlorothiazide tab 5-6.25 mg.......... 17benazepril & hydrochlorothiazide tab 10-12.5 mg(Lotensin hct)...................................................................17

benazepril & hydrochlorothiazide tab 20-12.5 mg(Lotensin hct)...................................................................17

benazepril & hydrochlorothiazide tab 20-25 mg(Lotensin hct)...................................................................17

benazepril hcl tab 5 mg................................................... 17benazepril hcl tab 10 mg (Lotensin)...............................17benazepril hcl tab 20 mg (Lotensin)...............................17benazepril hcl tab 40 mg (Lotensin)...............................17benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)....................................................................54

benztropine mesylate tab 0.5 mg....................................47benztropine mesylate tab 1 mg.......................................47benztropine mesylate tab 2 mg.......................................47betamethasone dipropionate augmented cream 0.05%(Diprolene af)................................................................... 56

betamethasone dipropionate augmented gel0.05%................................................................................. 56

betamethasone dipropionate augmented lotion 0.05%(Diprolene)........................................................................ 56

betamethasone dipropionate augmented oint 0.05%(Diprolene)........................................................................ 56

betamethasone dipropionate cream 0.05%................... 56betamethasone dipropionate lotion 0.05%....................56betamethasone dipropionate oint 0.05%....................... 56

betamethasone valerate aerosol foam 0.12%(Luxiq)............................................................................... 56

betamethasone valerate cream 0.1%............................. 56betamethasone valerate lotion 0.1%.............................. 56betamethasone valerate oint 0.1%................................. 56BETASERON – interferon beta-1b for inj kit 0.3 mg.......... 39betaxolol hcl ophth soln 0.5%.........................................53betaxolol hcl tab 10 mg (Kerlone).................................. 19betaxolol hcl tab 20 mg (Kerlone).................................. 19bethanechol chloride tab 5 mg (Urecholine)................. 31bethanechol chloride tab 10 mg (Urecholine)............... 31bethanechol chloride tab 25 mg (Urecholine)............... 31bethanechol chloride tab 50 mg (Urecholine)............... 31bexarotene cap 75 mg (Targretin).....................................7bicalutamide tab 50 mg (Casodex)...................................7BILTRICIDE – praziquantel tab 600 mg...............................7bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for solnkit....................................................................................... 28

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg(Ziac)..................................................................................19

bisoprolol & hydrochlorothiazide tab 5-6.25 mg(Ziac)..................................................................................19

bisoprolol & hydrochlorothiazide tab 10-6.25 mg(Ziac)..................................................................................19

bisoprolol fumarate tab 5 mg (Zebeta)...........................19bisoprolol fumarate tab 10 mg (Zebeta).........................19BOSULIF – bosutinib tab 100 mg........................................ 7BOSULIF – bosutinib tab 500 mg........................................ 7BP CLEANSING WASH – sulfacetamide sodium-sulfur inurea emulsion 10-4%........................................................ 54

BREEZE 2 BLOOD GLUCOSE MO – blood glucosemonitoring devices............................................................ 59

BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 100-25 mcg/inh............................................................ 27

BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 200-25 mcg/inh............................................................ 27

brimonidine tartrate ophth soln 0.2%.............................53brimonidine tartrate ophth soln 0.15% (Alphaganp)........................................................................................ 53

bromfenac sodium ophth soln 0.09% (baseequivalent)........................................................................ 53

bromfenac sodium ophth soln 0.09% (base equiv)(once-daily).......................................................................53

bromocriptine mesylate cap 5 mg (Parlodel)................ 47bromocriptine mesylate tab 2.5 mg (Parlodel).............. 47budesonide cap sr 24hr 3 mg (Entocort ec)..................10budesonide inhalation susp 0.25 mg/2ml(Pulmicort)........................................................................ 27

budesonide inhalation susp 0.5 mg/2ml(Pulmicort)........................................................................ 27

budesonide inhalation susp 1 mg/2ml (Pulmicort).......27budesonide nasal susp 32 mcg/act (Rhinocortaqua)..................................................................................26

bumetanide tab 0.5 mg.................................................... 24bumetanide tab 1 mg........................................................24bumetanide tab 2 mg........................................................24

2016


buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (baseequiv).................................................................................60

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv).................................................................................60

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).............................................................................. 39

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 7.5 mg.................................................33buspirone hcl tab 10 mg..................................................33buspirone hcl tab 15 mg..................................................33buspirone hcl tab 30 mg..................................................33butalbital-acetaminophen-caffeine cap 50-325-40mg...................................................................................... 40

butalbital-acetaminophen-caffeine cap 50-300-40 mg(Fioricet)............................................................................40

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

butalbital-acetaminophen-caff w/ cod cap 50-325-40-30mg...................................................................................... 41

butalbital-acetaminophen-caff w/ cod cap 50-300-40-30mg (Fioricet/codeine)......................................................41

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

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

butorphanol tartrate nasal soln 10 mg/ml..................... 41BYDUREON – exenatide extended release for inj susp 2mg...................................................................................... 14

BYDUREON – exenatide extended release for susp pen-injector 2 mg......................................................................13

BYETTA – exenatide soln pen-injector 5 mcg/0.02ml........14BYETTA – exenatide soln pen-injector 10 mcg/0.04ml......14

Ccabergoline tab 0.5 mg.................................................... 16caffeine citrate oral soln 60 mg/3ml (10 mg/ml baseequiv) (Cafcit)...................................................................38

calcipotriene cream 0.005% (Dovonex)..........................58calcipotriene oint 0.005%.................................................58calcipotriene soln 0.005% (50 mcg/ml).......................... 58calcitonin (salmon) nasal soln 200 unit/act(Miacalcin)........................................................................ 16

calcitriol cap 0.25 mcg (Rocaltrol)..................................16calcitriol cap 0.5 mcg (Rocaltrol)....................................16calcitriol oral soln 1 mcg/ml (Rocaltrol).........................16

calcium acetate (phosphate binder) cap 667 mg (169mg ca) (Phoslo)............................................................... 30

calcium acetate (phosphate binder) tab 667 mg(Eliphos)............................................................................30

CANASA – mesalamine suppos 1000 mg......................... 30candesartan cilexetil-hydrochlorothiazide tab 16-12.5mg (Atacand hct).............................................................18

candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg (Atacand hct).............................................................18

candesartan cilexetil-hydrochlorothiazide tab 32-25mg (Atacand hct).............................................................18

candesartan cilexetil tab 4 mg (Atacand)...................... 18candesartan cilexetil tab 8 mg (Atacand)...................... 18candesartan cilexetil tab 16 mg (Atacand).................... 18candesartan cilexetil tab 32 mg (Atacand).................... 18capecitabine tab 150 mg (Xeloda).................................... 7capecitabine tab 500 mg (Xeloda).................................... 7CAPRELSA – vandetanib tab 100 mg................................. 7CAPRELSA – vandetanib tab 300 mg................................. 7CAPTOPRIL/HYDROCHLOROTHIA – captopril &hydrochlorothiazide tab 25-15 mg.................................... 17

CAPTOPRIL/HYDROCHLOROTHIA – captopril &hydrochlorothiazide tab 25-25 mg.................................... 17



captopril tab 12.5 mg........................................................17captopril tab 25 mg...........................................................17captopril tab 50 mg...........................................................17captopril tab 100 mg.........................................................17CARAC – fluorouracil cream 0.5%.....................................58CARAFATE – sucralfate susp 1 gm/10ml.......................... 29carbamazepine 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 200 mg (Tegretol-xr).......... 45carbamazepine tab sr 12hr 400 mg (Tegretol-xr).......... 45CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 12.5-50-200 mg.....................................47

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 18.75-75-200 mg...................................48

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 25-100-200 mg......................................48

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 31.25-125-200 mg................................ 48

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 37.5-150-200 mg...................................48

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 50-200-200 mg......................................48

carbidopa & levodopa orally disintegrating tab 10-100mg...................................................................................... 47

2016




carbidopa & levodopa tab cr 25-100 mg (Sinemetcr).......................................................................................47

carbidopa & levodopa tab cr 50-200 mg (Sinemetcr).......................................................................................47

carbidopa & levodopa tab 10-100 mg (Sinemet)...........47carbidopa & levodopa tab 25-100 mg (Sinemet)...........47carbidopa & levodopa tab 25-250 mg (Sinemet)...........47carbidopa tab 25 mg (Lodosyn)......................................47carteolol hcl ophth soln 1%............................................ 53carvedilol tab 3.125 mg (Coreg)......................................19carvedilol tab 6.25 mg (Coreg)........................................19carvedilol tab 12.5 mg (Coreg)........................................19carvedilol tab 25 mg (Coreg)...........................................19cefaclor cap 250 mg........................................................... 1cefaclor cap 500 mg........................................................... 1cefadroxil cap 500 mg........................................................1cefadroxil for susp 250 mg/5ml........................................ 1cefadroxil for susp 500 mg/5ml........................................ 1cefadroxil tab 1 gm.............................................................1cefdinir cap 300 mg............................................................1cefdinir for susp 125 mg/5ml............................................ 1cefdinir for susp 250 mg/5ml............................................ 1cefixime for susp 100 mg/5ml (Suprax)........................... 1cefixime for susp 200 mg/5ml (Suprax)........................... 1cefpodoxime proxetil for susp 50 mg/5ml....................... 1cefpodoxime proxetil for susp 100 mg/5ml..................... 1cefpodoxime proxetil tab 100 mg..................................... 1cefpodoxime proxetil tab 200 mg..................................... 1cefprozil for susp 125 mg/5ml...........................................2cefprozil for susp 250 mg/5ml...........................................2cefprozil tab 250 mg...........................................................2cefprozil tab 500 mg...........................................................2CEFTIN – cefuroxime axetil for susp 125 mg/5ml............... 2ceftriaxone sodium for inj 10 gm......................................2cefuroxime axetil tab 250 mg (Ceftin).............................. 2cefuroxime axetil tab 500 mg (Ceftin).............................. 2celecoxib cap 50 mg (Celebrex)......................................43celecoxib cap 100 mg (Celebrex)....................................43celecoxib cap 200 mg (Celebrex)....................................43celecoxib cap 400 mg (Celebrex)....................................43CELONTIN – methsuximide cap 300 mg...........................45cephalexin cap 250 mg (Keflex)........................................2cephalexin cap 500 mg (Keflex)........................................2cephalexin cap 750 mg (Keflex)........................................2cephalexin for susp 125 mg/5ml.......................................2cephalexin for susp 250 mg/5ml.......................................2CETROTIDE – cetrorelix acetate for inj kit 0.25 mg.......... 13cevimeline hcl cap 30 mg (Evoxac)................................54CHANTIX CONTINUING MONTH – varenicline tartrate tab1 mg (base equiv).............................................................39

CHANTIX STARTING MONTH PA – varenicline tartratetab 0.5 mg x 11 & tab 1 mg x 42 pack............................. 39

CHANTIX – varenicline tartrate tab 0.5 mg (baseequiv)................................................................................. 39

CHANTIX – varenicline tartrate tab 1 mg (base equiv)......39CHEMET – succimer cap 100 mg......................................60CHEMSTRIP-K – acetone (urine) test strip....................... 60CHEMSTRIP UGK – urine glucose-ketones test strips..... 59CHENODAL – chenodiol tab 250 mg.................................30chlordiazepoxide hcl cap 5 mg.......................................33chlordiazepoxide hcl cap 10 mg.....................................33chlordiazepoxide hcl cap 25 mg.....................................33chlorhexidine gluconate soln 0.12% (Peridex)..............54chloroquine phosphate tab 250 mg..................................6chloroquine phosphate tab 500 mg (Aralen)...................6CHLOROTHIAZIDE – chlorothiazide tab 250 mg..............24chlorothiazide 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 – chlorthalidone tab 25 mg.............. 24CHLORTHALIDONE – chlorthalidone tab 50 mg.............. 24chlorzoxazone tab 500 mg (Parafon forte dsc)............. 48cholestyramine 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 & magnesium salicylates liq 500 mg/5ml.........40choline 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..................... 13ciclopirox gel 0.77% (Loprox)......................................... 55ciclopirox olamine cream 0.77% (base equiv)...............55ciclopirox olamine susp 0.77% (base equiv).................55ciclopirox shampoo 1% (Loprox shampoo).................. 56ciclopirox solution kit 8% (Ciclodan solution ki).......... 56ciclopirox solution 8% (Penlac nail lacquer).................56cilostazol tab 50 mg (Pletal)............................................51cilostazol tab 100 mg (Pletal)..........................................51CILOXAN – ciprofloxacin hcl ophth oint 0.3%................... 52cimetidine hcl soln 300 mg/5ml...................................... 29cimetidine tab 200 mg......................................................29cimetidine tab 300 mg......................................................29cimetidine tab 400 mg......................................................29cimetidine tab 800 mg......................................................29CIPRODEX – ciprofloxacin-dexamethasone otic susp0.3-0.1%.............................................................................54

ciprofloxacin-ciprofloxacin hcl tab sr 24hr 1000mg(base eq) (Cipro xr)..................................................... 3

ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 mg(base eq) (Cipro xr)...........................................................3

ciprofloxacin for oral susp 250 mg/5ml (5%) (5gm/100ml) (Cipro)..............................................................3

2016


ciprofloxacin for oral susp 500 mg/5ml (10%) (10gm/100ml) (Cipro)..............................................................3

CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg(base equiv).........................................................................3

ciprofloxacin hcl ophth soln 0.3% (Ciloxan)................. 52ciprofloxacin hcl tab 750 mg (base equiv).......................3ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)..........3ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)..........3CIPRO HC – ciprofloxacin-hydrocortisone otic susp0.2-1%................................................................................54

citalopram hydrobromide oral soln 10 mg/5ml............. 33citalopram hydrobromide tab 10 mg (base equiv)(Celexa)............................................................................. 33

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

citalopram hydrobromide tab 40 mg (base equiv)(Celexa)............................................................................. 33

clarithromycin for susp 125 mg/5ml.................................2clarithromycin for susp 250 mg/5ml (Biaxin).................. 2clarithromycin tab 250 mg (Biaxin).................................. 2clarithromycin tab 500 mg (Biaxin).................................. 2clarithromycin tab sr 24hr 500 mg (Biaxin xl pac)..........2CLEOCIN – clindamycin phosphate vaginal suppos 100mg...................................................................................... 32

CLIMARA PRO – estradiol-levonorgestrel td patch weekly0.045-0.015 mg/day.......................................................... 11

clindamycin hcl cap 75 mg (Cleocin)...............................7clindamycin hcl cap 150 mg (Cleocin).............................7clindamycin hcl cap 300 mg (Cleocin).............................7clindamycin palmitate hcl for soln 75 mg/5ml (baseequiv) (Cleocin pediatric gr)............................................ 7

clindamycin phosphate-benzoyl peroxide gel 1-5%(Benzaclin)........................................................................55

clindamycin phosphate foam 1% (Evoclin)................... 54clindamycin phosphate gel 1% (Cleocin-t)....................54clindamycin phosphate lotion 1% (Cleocin-t)............... 54clindamycin phosphate soln 1% (Cleocin-t)..................55clindamycin phosphate swab 1% (Cleocin-t)................ 55clindamycin phosphate vaginal cream 2%(Cleocin)............................................................................32

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2(1)-5% (Duac)....................................................................54

clobetasol propionate cream 0.05% (Temovate)...........56clobetasol propionate emollient base cream 0.05%(Temovate e).....................................................................56

clobetasol propionate emulsion foam 0.05% (Olux-e)........................................................................................ 56

clobetasol propionate foam 0.05% (Olux)......................56clobetasol propionate gel 0.05% (Temovate)................ 56clobetasol propionate lotion 0.05% (Clobex)................ 56clobetasol propionate oint 0.05% (Temovate)...............56clobetasol propionate shampoo 0.05% (Clobex).......... 56clobetasol propionate soln 0.05% (Temovate).............. 56clomiphene citrate tab 50 mg (Clomid)..........................13clomipramine hcl cap 25 mg (Anafranil)........................33clomipramine hcl cap 50 mg (Anafranil)........................33

clomipramine hcl cap 75 mg (Anafranil)........................33clonazepam orally disintegrating tab 0.125 mg............ 45clonazepam orally disintegrating tab 0.25 mg.............. 46clonazepam orally disintegrating tab 0.5 mg................ 46clonazepam orally disintegrating tab 1 mg................... 46clonazepam orally disintegrating tab 2 mg................... 46clonazepam tab 0.5 mg (Klonopin).................................46clonazepam tab 1 mg (Klonopin)....................................46clonazepam tab 2 mg (Klonopin)....................................46clonidine hcl tab 0.1 mg (Catapres)............................... 25clonidine hcl tab 0.2 mg (Catapres)............................... 25clonidine hcl tab 0.3 mg (Catapres)............................... 25clonidine hcl tab sr 12hr 0.1 mg (Kapvay).....................38clonidine hcl td patch weekly 0.1 mg/24hr (Catapres-tts-1)...................................................................................25

clonidine hcl td patch weekly 0.2 mg/24hr (Catapres-tts-2)...................................................................................25

clonidine hcl td patch weekly 0.3 mg/24hr (Catapres-tts-3)...................................................................................25

clopidogrel bisulfate tab 75 mg (base equiv)(Plavix).............................................................................. 51

clopidogrel bisulfate tab 300 mg (base equiv)(Plavix).............................................................................. 51

clorazepate dipotassium tab 3.75 mg (Tranxene t).......33clorazepate dipotassium tab 7.5 mg (Tranxene t).........33clorazepate dipotassium tab 15 mg (Tranxene t)..........33clotrimazole troche 10 mg............................................... 54clotrimazole w/ betamethasone cream 1-0.05%(Lotrisone)........................................................................ 56

clotrimazole w/ betamethasone lotion 1-0.05%.............56clozapine tab 50 mg......................................................... 35clozapine tab 200 mg....................................................... 35clozapine tab 25 mg (Clozaril).........................................35clozapine tab 100 mg (Clozaril).......................................35COARTEM – artemether-lumefantrine tab 20-120 mg........ 6codeine sulfate tab 30 mg............................................... 41codeine sulfate tab 60 mg............................................... 41codeine sulfate tab 15 mg (Codeine sulfate).................41colchicine w/ probenecid tab 0.5-500 mg...................... 45colestipol hcl granule packets 5 gm (Colestidflavored)............................................................................23

colestipol hcl granules 5 gm (Colestid flavored).......... 23colestipol hcl tab 1 gm (Colestid)...................................23COMBIVENT RESPIMAT – ipratropium-albuterol inhalaerosol soln 20-100 mcg/act............................................ 27

COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60mg dose) kit.........................................................................7

COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20mg (100 dose) kit................................................................ 7

COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20mg (140 dose) kit................................................................ 7

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

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

2016


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

CORTANE-B AQUEOUS – pramoxine-hc-chloroxylenolaqueous otic soln 10-10-1 mg/ml..................................... 54

CORTIFOAM – hydrocortisone acetate rectal foam 10%(90 mg/dose)..................................................................... 54

CORTISONE ACETATE – cortisone acetate tab 25mg...................................................................................... 10

CREON – pancrelipase (lip-prot-amyl) dr cap3000-9500-15000 unit....................................................... 30

CREON – pancrelipase (lip-prot-amyl) dr cap6000-19000-30000 unit..................................................... 30

CREON – pancrelipase (lip-prot-amyl) dr cap12000-38000-60000 unit...................................................30

CREON – pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit.................................................30

CREON – pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit............................................... 30

CRESTOR – rosuvastatin calcium tab 5 mg......................23CRESTOR – rosuvastatin calcium tab 10 mg....................23CRESTOR – rosuvastatin calcium tab 20 mg....................23CRESTOR – rosuvastatin calcium tab 40 mg....................23CRIXIVAN – indinavir sulfate cap 200 mg........................... 5CRIXIVAN – indinavir sulfate cap 400 mg........................... 5CROMOLYN SODIUM – cromolyn sodium soln nebu 20mg/2ml............................................................................... 27

cromolyn sodium ophth soln 4%....................................53cromolyn sodium oral conc 100 mg/5ml(Gastrocrom).................................................................... 30

CUPRIMINE – penicillamine cap 250 mg.......................... 60cyclobenzaprine hcl tab 5 mg.........................................48cyclobenzaprine hcl tab 10 mg.......................................48cyclobenzaprine hcl tab 7.5 mg (Fexmid)......................48cyclopentolate hcl ophth soln 1% (Cyclogyl)................53cyclopentolate hcl ophth soln 2% (Cyclogyl)................53CYCLOPHOSPHAMIDE – cyclophosphamide cap 25mg........................................................................................ 8

CYCLOPHOSPHAMIDE – cyclophosphamide cap 50mg........................................................................................ 8

cyclosporine cap 25 mg (Sandimmune)........................ 60cyclosporine cap 100 mg (Sandimmune)...................... 60cyclosporine modified cap 25 mg (Neoral)....................60cyclosporine modified cap 100 mg (Neoral)..................60cyclosporine modified oral soln 100 mg/ml(Neoral)..............................................................................60

cyproheptadine hcl syrup 2 mg/5ml...............................26cyproheptadine hcl tab 4 mg.......................................... 26CYSTAGON – cysteamine bitartrate cap 50 mg................32CYSTAGON – cysteamine bitartrate cap 150 mg..............32CYTRA-3 – pot & sod citrates w/ cit ac syrup 550-500-334mg/5ml............................................................................... 32

DDAKLINZA – daclatasvir dihydrochloride tab 30 mg (baseequivalent)............................................................................4

DAKLINZA – daclatasvir dihydrochloride tab 60 mg (baseequivalent)............................................................................4

danazol cap 50 mg............................................................11danazol cap 100 mg..........................................................11danazol cap 200 mg..........................................................11dantrolene sodium cap 25 mg (Dantrium)..................... 48dantrolene sodium cap 50 mg (Dantrium)..................... 48DANTROLENE SODIUM – dantrolene sodium cap 100mg...................................................................................... 48

DAPSONE – dapsone tab 25 mg.........................................7DAPSONE – dapsone tab 100 mg.......................................7DARAPRIM – pyrimethamine tab 25 mg............................. 6DELZICOL – mesalamine cap dr 400 mg..........................30demeclocycline hcl tab 150 mg........................................ 2demeclocycline hcl tab 300 mg........................................ 2desipramine hcl tab 10 mg (Norpramin)........................ 33desipramine hcl tab 25 mg (Norpramin)........................ 33desipramine hcl tab 50 mg (Norpramin)........................ 33desipramine hcl tab 75 mg (Norpramin)........................ 33desipramine hcl tab 100 mg (Norpramin)...................... 34desipramine hcl tab 150 mg (Norpramin)...................... 34desloratadine tab 5 mg (Clarinex).................................. 26desloratadine tab orally disintegrating 2.5 mg(Clarinex reditabs)...........................................................26

desloratadine tab orally disintegrating 5 mg (Clarinexreditabs)............................................................................26

desmopressin acetate nasal soln 0.01% (refrigerated)(Ddavp)..............................................................................16

desmopressin acetate nasal spray soln 0.01%(Ddavp)..............................................................................16

desmopressin acetate nasal spray soln 0.01%(refrigerated).....................................................................16

desmopressin acetate tab 0.1 mg (Ddavp)....................16desmopressin acetate tab 0.2 mg (Ddavp)....................16desogest-eth estrad & eth estrad tab 0.15-0.02/0.01mg(21/5) (Mircette).......................................................... 12

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa).....12

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg(Desogen)......................................................................... 12

desonide cream 0.05% (Desowen)................................. 56desonide lotion 0.05% (Desowen).................................. 56desonide oint 0.05% (Desowen)......................................56desoximetasone cream 0.25% (Topicort).......................57DESOXIMETASONE – desoximetasone cream 0.05%..... 57desoximetasone gel 0.05% (Topicort)............................ 57desoximetasone oint 0.25% (Topicort)...........................57DEXAMETHASONE – dexamethasone soln 0.5mg/5ml............................................................................... 10

DEXAMETHASONE – dexamethasone tab 1 mg..............10DEXAMETHASONE – dexamethasone tab 2 mg..............10dexamethasone elixir 0.5 mg/5ml................................... 10DEXAMETHASONE INTENSOL – dexamethasone conc 1mg/ml..................................................................................10

DEXAMETHASONE SODIUM PHOS – dexamethasonesodium phosphate ophth soln 0.1%................................. 52

2016


dexamethasone tab 0.5 mg............................................. 10dexamethasone tab 0.75 mg........................................... 10dexamethasone tab 1.5 mg............................................. 10dexamethasone tab 4 mg................................................ 10dexamethasone tab 6 mg................................................ 10dexmethylphenidate hcl cap sr 24 hr 5 mg (Focalinxr).......................................................................................38

dexmethylphenidate hcl cap sr 24 hr 15 mg (Focalinxr).......................................................................................38



dexmethylphenidate hcl tab 2.5 mg (Focalin)............... 38dexmethylphenidate hcl tab 5 mg (Focalin).................. 38dexmethylphenidate hcl tab 10 mg (Focalin)................ 38dextroamphetamine sulfate cap sr 24hr 5 mg(Dexedrine)....................................................................... 38

dextroamphetamine sulfate cap sr 24hr 10 mg(Dexedrine)....................................................................... 38

dextroamphetamine sulfate cap sr 24hr 15 mg(Dexedrine)....................................................................... 38

dextroamphetamine sulfate oral solution 5 mg/5ml(Procentra)........................................................................38

dextroamphetamine sulfate tab 5 mg.............................38dextroamphetamine sulfate tab 10 mg...........................38DIASTAT ACUDIAL – diazepam rectal gel delivery system10 mg.................................................................................46

DIASTAT ACUDIAL – diazepam rectal gel delivery system20 mg.................................................................................46

DIASTAT PEDIATRIC – diazepam rectal gel deliverysystem 2.5 mg...................................................................46

DIAZEPAM – diazepam soln 1 mg/ml................................33diazepam 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)..........................................................................58

diclofenac sodium ophth soln 0.1%...............................53diclofenac sodium soln 1.5% (Pennsaid).......................56diclofenac 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

diclofenac w/ misoprostol tab delayed release 50-0.2mg (Arthrotec 50)............................................................ 43

diclofenac w/ misoprostol tab delayed release 75-0.2mg (Arthrotec 75)............................................................ 43

dicloxacillin sodium cap 250 mg...................................... 1dicloxacillin sodium cap 500 mg...................................... 1dicyclomine hcl cap 10 mg (Bentyl)...............................29dicyclomine hcl oral soln 10 mg/5ml............................. 29dicyclomine hcl tab 20 mg (Bentyl)................................29

didanosine delayed release capsule 125 mg (Videxec)........................................................................................ 5




DIDGET – blood glucose monitoring kit w/ device.............60DIFLORASONE DIACETATE – diflorasone diacetatecream 0.05%..................................................................... 57

DIFLORASONE DIACETATE – diflorasone diacetate oint0.05%................................................................................. 57

diflunisal tab 500 mg........................................................40DIGOXIN – digoxin oral soln 0.05 mg/ml...........................25digoxin tab 125 mcg (0.125 mg) (Lanoxin).................... 25digoxin tab 250 mcg (0.25 mg) (Lanoxin)...................... 25DILANTIN – phenytoin sodium extended cap 30 mg.........46DILANTIN – phenytoin sodium extended cap 100 mg.......46DILANTIN-125 – phenytoin susp 125 mg/5ml................... 46diltiazem hcl cap sr 12hr 60 mg......................................21diltiazem hcl cap sr 12hr 90 mg......................................21diltiazem hcl cap sr 12hr 120 mg....................................21diltiazem hcl cap sr 24hr 120 mg....................................21diltiazem hcl cap sr 24hr 180 mg....................................21diltiazem hcl cap sr 24hr 240 mg....................................21diltiazem hcl coated beads cap sr 24hr 120 mg(Cardizem cd)...................................................................21

diltiazem hcl coated beads cap sr 24hr 180 mg(Cardizem cd)...................................................................21




diltiazem hcl coated beads tab sr 24hr 180 mg(Cardizem la)....................................................................21





diltiazem hcl extended release beads cap sr 24hr 120mg (Tiazac).......................................................................21





2016



diltiazem hcl tab 90 mg....................................................21diltiazem hcl tab 30 mg (Cardizem)................................21diltiazem hcl tab 60 mg (Cardizem)................................21diltiazem hcl tab 120 mg (Cardizem)..............................21DIPHENOXYLATE/ATROPINE – diphenoxylate w/atropine liq 2.5-0.025 mg/5ml........................................... 28

diphenoxylate w/ atropine tab 2.5-0.025 mg(Lomotil)............................................................................28

dipyridamole tab 25 mg (Persantine)............................. 51dipyridamole tab 50 mg (Persantine)............................. 51dipyridamole tab 75 mg (Persantine)............................. 51disopyramide phosphate cap 100 mg (Norpace).......... 24disopyramide phosphate cap 150 mg (Norpace).......... 24disulfiram tab 250 mg (Antabuse).................................. 39disulfiram tab 500 mg (Antabuse).................................. 39divalproex sodium cap sprinkle 125 mg (Depakotesprinkles).......................................................................... 46

divalproex sodium tab delayed release 125 mg(Depakote)........................................................................ 46



divalproex sodium tab sr 24 hr 250 mg (Depakoteer).......................................................................................46

divalproex sodium tab sr 24 hr 500 mg (Depakoteer).......................................................................................46

DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%)...........11DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%)...............11DIVIGEL – estradiol td gel 1 mg/gm (0.1%).......................11donepezil hydrochloride orally disintegrating tab 5 mg(Aricept odt)..................................................................... 39

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

donepezil hydrochloride tab 5 mg (Aricept)..................40donepezil hydrochloride tab 10 mg (Aricept)................40donepezil hydrochloride tab 23 mg (Aricept)................40dorzolamide hcl ophth soln 2% (Trusopt)..................... 53dorzolamide hcl-timolol maleate ophth soln 22.3-6.8mg/ml (Cosopt)................................................................ 53

doxazosin mesylate tab 1 mg (Cardura)........................25doxazosin mesylate tab 2 mg (Cardura)........................25doxazosin mesylate tab 4 mg (Cardura)........................25doxazosin mesylate tab 8 mg (Cardura)........................25doxepin hcl cap 10 mg.....................................................34doxepin hcl cap 25 mg.....................................................34doxepin hcl cap 50 mg.....................................................34doxepin hcl cap 100 mg...................................................34doxepin hcl cap 150 mg...................................................34doxepin hcl conc 10 mg/ml............................................. 34DOXEPIN HCL – doxepin hcl cap 75 mg.......................... 34doxercalciferol cap 0.5 mcg (Hectorol)..........................16doxercalciferol cap 1 mcg (Hectorol).............................16doxercalciferol cap 2.5 mcg (Hectorol)..........................16

doxycycline hyclate cap 50 mg.........................................2doxycycline hyclate cap 100 mg (Vibramycin)................2doxycycline hyclate tab delayed release 75 mg............. 2doxycycline hyclate tab delayed release 100 mg........... 2doxycycline hyclate tab delayed release 150 mg(Doryx).................................................................................2

doxycycline hyclate tab 20 mg......................................... 2doxycycline hyclate tab 100 mg....................................... 2doxycycline monohydrate cap 50 mg.............................. 2doxycycline monohydrate cap 150 mg (Adoxa)..............3doxycycline monohydrate cap 75 mg (Monodox)...........2doxycycline monohydrate cap 100 mg (Monodox).........2doxycycline monohydrate for susp 25 mg/5ml(Vibramycin)....................................................................... 3

doxycycline 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

dronabinol cap 2.5 mg (Marinol).....................................30dronabinol cap 5 mg (Marinol)........................................30dronabinol cap 10 mg (Marinol)......................................30drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin28)...................................................................................... 12

drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz)......12DRYSOL – aluminum chloride soln 20%........................... 58DULERA – mometasone furoate-formoterol fumarateaerosol 100-5 mcg/act...................................................... 27

DULERA – mometasone furoate-formoterol fumarateaerosol 200-5 mcg/act...................................................... 27

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



dutasteride cap 0.5 mg (Avodart)................................... 32DUTOPROL – metoprolol & hydrochlorothiazide tab sr24hr 25-12.5 mg................................................................19

DUTOPROL – metoprolol & hydrochlorothiazide tab sr24hr 50-12.5 mg................................................................19

DUTOPROL – metoprolol & hydrochlorothiazide tab sr24hr 100-12.5 mg..............................................................19

dyphylline-guaifenesin liqd 100-100 mg/5ml.................27E

econazole nitrate cream 1%............................................ 56EDURANT – rilpivirine hcl tab 25 mg (base equivalent)...... 5E.E.S. 400 – erythromycin ethylsuccinate tab 400 mg........ 2EFFIENT – prasugrel hcl tab 5 mg (base equiv)............... 51EFFIENT – prasugrel hcl tab 10 mg (base equiv)............. 51ELIDEL – pimecrolimus cream 1%.................................... 58ELLA – ulipristal acetate tab 30 mg...................................12ELMIRON – pentosan polysulfate sodium caps 100mg...................................................................................... 32

2016


EMCYT – estramustine phosphate sodium cap 140 mg......8EMEND – aprepitant capsule 40 mg..................................30EMEND – aprepitant capsule 80 mg..................................30EMEND – aprepitant capsule 125 mg................................30EMEND – aprepitant capsule therapy pack 80 & 125mg...................................................................................... 30

EMTRIVA – emtricitabine caps 200 mg............................... 5EMTRIVA – emtricitabine soln 10 mg/ml............................. 5enalapril maleate & hydrochlorothiazide tab 5-12.5mg...................................................................................... 17

enalapril maleate & hydrochlorothiazide tab 10-25 mg(Vaseretic).........................................................................17

enalapril maleate tab 2.5 mg (Vasotec)..........................17enalapril maleate tab 5 mg (Vasotec).............................17enalapril maleate tab 10 mg (Vasotec)...........................17enalapril maleate tab 20 mg (Vasotec)...........................17ENBREL – etanercept for subcutaneous inj kit 25 mg.......43ENBREL – etanercept subcutaneous soln prefilled syringe25 mg/0.5ml.......................................................................43

ENBREL – etanercept subcutaneous soln prefilled syringe50 mg/ml............................................................................44

ENBREL SURECLICK – etanercept subcutaneoussolution auto-injector 50 mg/ml.........................................44

enoxaparin sodium inj 30 mg/0.3ml (Lovenox)............. 51enoxaparin sodium inj 40 mg/0.4ml (Lovenox)............. 51enoxaparin sodium inj 60 mg/0.6ml (Lovenox)............. 51enoxaparin sodium inj 80 mg/0.8ml (Lovenox)............. 51enoxaparin sodium inj 100 mg/ml (Lovenox)................ 51enoxaparin sodium inj 120 mg/0.8ml (Lovenox)........... 51enoxaparin sodium inj 150 mg/ml (Lovenox)................ 51enoxaparin sodium inj 300 mg/3ml (Lovenox).............. 51entacapone tab 200 mg (Comtan)...................................48entecavir tab 0.5 mg (Baraclude)......................................4entecavir tab 1 mg (Baraclude).........................................4epinastine hcl ophth soln 0.05% (Elestat)..................... 53EPIPEN-JR 2-PAK – epinephrine solution auto-injector0.15 mg/0.3ml (1:2000).....................................................26

EPIPEN 2-PAK – epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)............................................................. 26

EPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv)..............4eplerenone tab 25 mg (Inspra)........................................25eplerenone tab 50 mg (Inspra)........................................25EPROSARTAN MESYLATE – eprosartan mesylate tab600 mg...............................................................................18

EPZICOM – abacavir sulfate-lamivudine tab 600-300mg........................................................................................ 5

ergocalciferol cap 50000 unit (Drisdol)..........................49ERIVEDGE – vismodegib cap 150 mg................................ 8ERY-TAB – erythromycin tab delayed release 250 mg........2ERY-TAB – erythromycin tab delayed release 333 mg........2ERY-TAB – erythromycin tab delayed release 500 mg........2ERYTHROCIN STEARATE – erythromycin stearate tab250 mg.................................................................................2

ERYTHROMYCIN BASE – erythromycin tab 250 mg..........2ERYTHROMYCIN BASE – erythromycin tab 500 mg..........2

ERYTHROMYCIN ETHYLSUCCINA – erythromycinethylsuccinate tab 400 mg..................................................2

erythromycin gel 2% (Erygel)..........................................55erythromycin ophth oint 5 mg/gm..................................52erythromycin pads 2%..................................................... 55erythromycin soln 2%...................................................... 55erythromycin w/ delayed release particles cap 250mg........................................................................................ 2

ESCAVITE LQ – pediatric multiple vitamins w/ fl-fe drops0.25-6 mg/ml......................................................................49

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)..........................................................29

esomeprazole magnesium cap delayed release 40 mg(base eq) (Nexium)..........................................................29

estazolam tab 1 mg.......................................................... 37estazolam tab 2 mg.......................................................... 37estradiol & norethindrone acetate tab 0.5-0.1 mg(Activella)..........................................................................11

estradiol & norethindrone acetate tab 1-0.5 mg(Activella)..........................................................................11

estradiol tab 0.5 mg (Estrace).........................................11estradiol tab 1 mg (Estrace)............................................11estradiol tab 2 mg (Estrace)............................................11estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-dot).....................................................................................11

estradiol td patch twice weekly 0.0375 mg/24hr(Vivelle-dot)...................................................................... 11

estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-dot).....................................................................................11



estradiol td patch weekly 0.025 mg/24hr (Climara).......11estradiol td patch weekly 0.05 mg/24hr (Climara).........11estradiol td patch weekly 0.06 mg/24hr (Climara).........11estradiol td patch weekly 0.075 mg/24hr (Climara).......11estradiol td patch weekly 0.1 mg/24hr (Climara)...........11estradiol td patch weekly 0.0375 mg/24hr (37.5mcg/24hr) (Climara).........................................................11

ESTROPIPATE – estropipate tab 3 mg..............................11estropipate tab 0.75 mg................................................... 11estropipate tab 1.5 mg..................................................... 11eszopiclone tab 1 mg (Lunesta)......................................37eszopiclone tab 2 mg (Lunesta)......................................37eszopiclone tab 3 mg (Lunesta)......................................37ethambutol hcl tab 100 mg (Myambutol)......................... 3ethambutol hcl tab 400 mg (Myambutol)......................... 3

2016


ethosuximide cap 250 mg (Zarontin)..............................46ethosuximide soln 250 mg/5ml (Zarontin)..................... 46ethynodiol diacetate & ethinyl estradiol tab 1 mg-35mcg....................................................................................12

etodolac cap 200 mg........................................................ 44etodolac cap 300 mg........................................................ 44etodolac tab 400 mg.........................................................44etodolac tab 500 mg.........................................................44etodolac tab sr 24hr 400 mg........................................... 44etodolac tab sr 24hr 500 mg........................................... 44etodolac tab sr 24hr 600 mg........................................... 44ETOPOSIDE – etoposide cap 50 mg...................................8EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg(base equiv).........................................................................5

exemestane tab 25 mg (Aromasin)...................................8F

famciclovir tab 125 mg (Famvir)....................................... 4famciclovir tab 250 mg (Famvir)....................................... 4famciclovir tab 500 mg (Famvir)....................................... 4famotidine for susp 40 mg/5ml (Pepcid)........................29famotidine tab 20 mg (Pepcid)........................................29famotidine tab 40 mg (Pepcid)........................................29FARESTON – toremifene citrate tab 60 mg (baseequivalent)............................................................................8

FARYDAK – panobinostat lactate cap 10 mg (baseequivalent)............................................................................8



felbamate susp 600 mg/5ml (Felbatol)........................... 46felbamate tab 400 mg (Felbatol)..................................... 46felbamate tab 600 mg (Felbatol)..................................... 46felodipine tab sr 24hr 2.5 mg.......................................... 21felodipine tab sr 24hr 5 mg............................................. 21felodipine tab sr 24hr 10 mg........................................... 21fenofibrate micronized cap 43 mg (Antara)................... 23fenofibrate micronized cap 130 mg (Antara)................. 23fenofibrate micronized cap 67 mg (Lofibra).................. 23fenofibrate micronized cap 134 mg (Lofibra)................ 23fenofibrate micronized cap 200 mg (Lofibra)................ 23fenofibrate tab 54 mg (Lofibra)....................................... 23fenofibrate tab 160 mg (Lofibra)..................................... 23fenofibrate tab 48 mg (Tricor)......................................... 23fenofibrate tab 145 mg (Tricor)....................................... 23fentanyl 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%................................... 55FINACEA – azelaic acid gel 15%.......................................55finasteride tab 5 mg (Proscar)........................................ 32FIRAZYR – icatibant acetate inj 30 mg/3ml (baseequivalent)......................................................................... 51

flecainide acetate tab 50 mg........................................... 24flecainide acetate tab 100 mg......................................... 24flecainide acetate tab 150 mg......................................... 24FLOVENT DISKUS – fluticasone propionate aer pow ba50 mcg/blister.................................................................... 27

FLOVENT DISKUS – fluticasone propionate aer pow ba100 mcg/blister.................................................................. 27

FLOVENT DISKUS – fluticasone propionate aer pow ba250 mcg/blister.................................................................. 27

FLOVENT HFA – fluticasone propionate hfa inhal aer 110mcg/act (125/valve)...........................................................27

FLOVENT HFA – fluticasone propionate hfa inhal aer 220mcg/act (250/valve)...........................................................27

FLOVENT HFA – fluticasone propionate hfa inhal aero 44mcg/act (50/valve)............................................................. 27

fluconazole for susp 10 mg/ml (Diflucan)........................3fluconazole for susp 40 mg/ml (Diflucan)........................3fluconazole tab 50 mg (Diflucan)......................................3fluconazole tab 100 mg (Diflucan)....................................3fluconazole 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.................................10flunisolide nasal soln 25 mcg/act (0.025%)(Flunisolide)......................................................................26

fluocinolone acetonide cream 0.01%............................. 57fluocinolone acetonide cream 0.025% (Synalar)...........57fluocinolone acetonide oil 0.01% (body oil) (Derma-smoothe/fs bod).............................................................. 57

fluocinolone acetonide oil 0.01% (scalp oil) (Derma-smoothe/fs sca)............................................................... 57

fluocinolone acetonide oint 0.025% (Synalar)...............57fluocinolone acetonide (otic) oil 0.01% (Dermotic).......54fluocinolone acetonide soln 0.01% (Synalar)................57fluocinonide cream 0.05%............................................... 57fluocinonide cream 0.1% (Vanos)................................... 57fluocinonide emulsified base cream 0.05%...................57fluocinonide gel 0.05%.....................................................57fluocinonide oint 0.05%....................................................57fluocinonide soln 0.05%...................................................57FLUOR-A-DAY – sodium fluoride-xylitol chew tab 0.55(0.25 mg f)-236.79 mg...................................................... 50

2016


FLUOR-A-DAY – sodium fluoride-xylitol chew tab 1.1 (0.5mg f)-236.79 mg................................................................50

FLUOR-A-DAY – sodium fluoride-xylitol chew tab 2.2 (1mg f)-236.79 mg................................................................50

fluorometholone ophth susp 0.1% (Fml liquifilm)........ 52FLUOROPLEX – fluorouracil cream 1%............................ 58fluorouracil cream 5% (Efudex)...................................... 58fluorouracil soln 2%......................................................... 58fluorouracil soln 5%......................................................... 58fluoxetine hcl cap delayed release 90 mg (Prozacweekly).............................................................................. 34

fluoxetine hcl cap 10 mg (Prozac)..................................34fluoxetine hcl cap 20 mg (Prozac)..................................34fluoxetine hcl cap 40 mg (Prozac)..................................34fluoxetine hcl (pmdd) cap 10 mg....................................40fluoxetine hcl (pmdd) cap 20 mg....................................40fluoxetine hcl solution 20 mg/5ml.................................. 34fluoxetine hcl tab 10 mg.................................................. 34fluoxetine hcl tab 20 mg.................................................. 34FLUPHENAZINE HCL – fluphenazine hcl elixir 2.5mg/5ml............................................................................... 35

FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/ml........................................................................................35

fluphenazine hcl tab 1 mg............................................... 35fluphenazine hcl tab 2.5 mg............................................ 35fluphenazine hcl tab 5 mg............................................... 35fluphenazine hcl tab 10 mg............................................. 35FLURA-DROPS – sodium fluoride soln 0.25 mg/drop f(from 0.55 mg/drop naf)....................................................50

FLURAZEPAM HCL – flurazepam hcl cap 15 mg..............37FLURAZEPAM HCL – flurazepam hcl cap 30 mg..............37flurbiprofen sodium ophth soln 0.03% (Ocufen)...........53flurbiprofen tab 50 mg......................................................44flurbiprofen tab 100 mg................................................... 44flutamide cap 125 mg.........................................................8fluticasone propionate cream 0.05% (Cutivate)............ 57fluticasone propionate lotion 0.05% (Cutivate).............57fluticasone propionate nasal susp 50 mcg/act(Flonase)........................................................................... 26

fluticasone propionate oint 0.005% (Cutivate).............. 57fluvastatin sodium cap 20 mg (Lescol)..........................23fluvastatin sodium cap 40 mg (Lescol)..........................23fluvoxamine maleate cap sr 24hr 100 mg (Luvoxcr).......................................................................................34

fluvoxamine maleate cap sr 24hr 150 mg (Luvoxcr).......................................................................................34

fluvoxamine maleate tab 25 mg......................................34fluvoxamine maleate tab 50 mg......................................34fluvoxamine maleate tab 100 mg....................................34folic acid tab 1 mg............................................................51FOLLISTIM AQ – follitropin beta inj 75 unit/0.5ml..............13FOLLISTIM AQ – follitropin beta inj 300 unit/0.36ml..........13FOLLISTIM AQ – follitropin beta inj 600 unit/0.72ml..........13FOLLISTIM AQ – follitropin beta inj 900 unit/1.08ml..........13fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml(Arixtra)............................................................................. 51

fondaparinux sodium subcutaneous inj 5 mg/0.4ml(Arixtra)............................................................................. 51

fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml(Arixtra)............................................................................. 51

fondaparinux sodium subcutaneous inj 10 mg/0.8ml(Arixtra)............................................................................. 51

FORADIL AEROLIZER – formoterol fumarate inhal cap 12mcg.....................................................................................27

FORTEO – teriparatide (recombinant) inj 600mcg/2.4ml...........................................................................16

fosinopril sodium & hydrochlorothiazide tab 10-12.5mg...................................................................................... 17

fosinopril sodium & hydrochlorothiazide tab 20-12.5mg...................................................................................... 17

fosinopril sodium tab 10 mg........................................... 17fosinopril sodium tab 20 mg........................................... 17fosinopril sodium tab 40 mg........................................... 17furosemide oral soln 10 mg/ml....................................... 24furosemide tab 20 mg (Lasix)......................................... 24furosemide tab 40 mg (Lasix)......................................... 24furosemide tab 80 mg (Lasix)......................................... 24FUZEON – enfuvirtide for inj 90 mg.....................................5

Ggabapentin cap 100 mg (Neurontin)...............................46gabapentin cap 300 mg (Neurontin)...............................46gabapentin cap 400 mg (Neurontin)...............................46gabapentin oral soln 250 mg/5ml (Neurontin)...............46gabapentin tab 600 mg (Neurontin)................................46gabapentin tab 800 mg (Neurontin)................................46galantamine 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).......40gatifloxacin ophth soln 0.5% (Zymaxid).........................52gemfibrozil tab 600 mg (Lopid).......................................23GENTAMICIN SULFATE – gentamicin sulfate cream0.1%................................................................................... 56

GENTAMICIN SULFATE – gentamicin sulfate oint0.1%................................................................................... 56

gentamicin sulfate ophth oint 0.3%................................52gentamicin sulfate ophth soln 0.3% (Garamycin).........52GILOTRIF – afatinib dimaleate tab 20 mg (baseequivalent)............................................................................8

GILOTRIF – afatinib dimaleate tab 30 mg (baseequivalent)............................................................................8

GILOTRIF – afatinib dimaleate tab 40 mg (baseequivalent)............................................................................8

2016


glatiramer acetate soln prefilled syringe 20 mg/ml(Copaxone)....................................................................... 39

GLEEVEC – imatinib mesylate tab 100 mg (baseequivalent)............................................................................8

GLEEVEC – imatinib mesylate tab 400 mg (baseequivalent)............................................................................8

GLEOSTINE – lomustine cap 5 mg..................................... 8GLEOSTINE – lomustine cap 10 mg................................... 8GLEOSTINE – lomustine cap 40 mg................................... 8GLEOSTINE – lomustine cap 100 mg................................. 8glimepiride tab 1 mg (Amaryl).........................................14glimepiride tab 2 mg (Amaryl).........................................14glimepiride tab 4 mg (Amaryl).........................................14glipizide-metformin hcl tab 2.5-250 mg..........................14glipizide-metformin hcl tab 2.5-500 mg..........................14glipizide-metformin hcl tab 5-500 mg.............................14glipizide tab 5 mg (Glucotrol)..........................................14glipizide tab 10 mg (Glucotrol)........................................14glipizide tab sr 24hr 2.5 mg (Glucotrol xl)..................... 14glipizide tab sr 24hr 5 mg (Glucotrol xl)........................ 14glipizide tab sr 24hr 10 mg (Glucotrol xl)...................... 14GLUCAGON EMERGENCY KIT – glucagon (rdna) for injkit 1 mg..............................................................................14

GLYBURIDE – glyburide tab 1.25 mg................................14GLYBURIDE – glyburide tab 2.5 mg..................................14GLYBURIDE – glyburide tab 5 mg.....................................14glyburide-metformin tab 1.25-250 mg(Glucovance).................................................................... 14

glyburide-metformin tab 2.5-500 mg (Glucovance)...... 14glyburide-metformin tab 5-500 mg (Glucovance)......... 14glyburide micronized tab 1.5 mg (Glynase)...................14glyburide micronized tab 3 mg (Glynase)......................14glyburide micronized tab 6 mg (Glynase)......................14glyburide tab 1.25 mg.......................................................14glyburide tab 2.5 mg.........................................................14glyburide tab 5 mg............................................................14glycopyrrolate tab 1 mg (Robinul)..................................29glycopyrrolate tab 2 mg (Robinul forte).........................29GONAL-F – follitropin alfa for inj 450 unit..........................13GONAL-F – follitropin alfa for inj 1050 unit........................13GONAL-F RFF – follitropin alfa for inj 75 unit....................13GONAL-F RFF PEN – follitropin alfa inj 300 unit/0.5ml..... 13GONAL-F RFF PEN – follitropin alfa inj 450unit/0.75ml......................................................................... 13

GONAL-F RFF PEN – follitropin alfa inj 900 unit/1.5ml..... 13GONAL-F RFF REDIJECT – follitropin alfa inj 300unit/0.5ml............................................................................13

GONAL-F RFF REDIJECT – follitropin alfa inj 450unit/0.75ml......................................................................... 13

GONAL-F RFF REDIJECT – follitropin alfa inj 900unit/1.5ml............................................................................13

granisetron hcl inj 0.1 mg/ml.......................................... 30granisetron hcl inj 1 mg/ml............................................. 30granisetron hcl inj 4 mg/4ml (1 mg/ml).......................... 30granisetron hcl tab 1 mg................................................. 30

GRANIX – tbo-filgrastim soln prefilled syringe 300mcg/0.5ml...........................................................................51

GRANIX – tbo-filgrastim soln prefilled syringe 480mcg/0.8ml...........................................................................51

griseofulvin microsize susp 125 mg/5ml......................... 4griseofulvin microsize tab 500 mg (Grifulvin v)..............4griseofulvin ultramicrosize tab 125 mg (Gris-peg)......... 4griseofulvin ultramicrosize tab 250 mg (Gris-peg)......... 4guanfacine hcl tab 1 mg (Tenex).................................... 25guanfacine hcl tab 2 mg (Tenex).................................... 25guanfacine 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)..........57halobetasol propionate oint 0.05% (Ultravate)..............57haloperidol 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................4HEXALEN – altretamine cap 50 mg.....................................8homatropine hbr ophth soln 5% (Isoptohomatropine)....................................................................53

HUMIRA – adalimumab prefilled syringe kit 10mg/0.2ml............................................................................ 44



HUMIRA PEDIATRIC CROHNS D – adalimumab prefilledsyringe kit 40 mg/0.8ml.....................................................44

HUMIRA PEN – adalimumab pen-injector kit 40mg/0.8ml............................................................................ 44

HUMIRA PEN-CROHNS DISEASE – adalimumab pen-injector kit 40 mg/0.8ml.....................................................44

HUMIRA PEN-PSORIASIS STAR – adalimumab pen-injector kit 40 mg/0.8ml.....................................................44

HUMULIN R U-500 (CONCENTR – insulin regular(human) inj 500 unit/ml..................................................... 15

HYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)....... 8HYCAMTIN – topotecan hcl cap 1 mg (base equiv)............ 8hydralazine hcl tab 10 mg............................................... 25hydralazine hcl tab 25 mg............................................... 25hydralazine hcl tab 50 mg............................................... 25hydralazine hcl tab 100 mg............................................. 25hydrochlorothiazide cap 12.5 mg (Microzide)............... 24

2016


hydrochlorothiazide 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 2.5-325 mg...............41hydrocodone-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-acetaminophen tab 7.5-300 mg(Xodol)...............................................................................41

hydrocodone-acetaminophen tab 5-300 mg(Xodol)...............................................................................41

hydrocodone-acetaminophen tab 10-300 mg(Xodol)...............................................................................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 acetate suppos 25 mg (Anusol-hc)..... 54hydrocortisone acetate suppos 30 mg (Proctocort).....54hydrocortisone butyrate cream 0.1% (Locoid)..............57hydrocortisone butyrate hydrophilic lipo base cream0.1% (Locoid lipocream).................................................57

hydrocortisone butyrate oint 0.1% (Locoid)..................57hydrocortisone butyrate soln 0.1% (Locoid).................57hydrocortisone cream 1%................................................57hydrocortisone cream 2.5%.............................................57hydrocortisone enema 100 mg/60ml (Cortenema)........54hydrocortisone lotion 2.5%............................................. 57hydrocortisone lotion 2% (Ala scalp).............................57hydrocortisone oint 2.5%.................................................57hydrocortisone rectal cream 2.5% (Anusol-hc)............ 54hydrocortisone rectal cream 1% (Proctocort)...............54hydrocortisone tab 5 mg (Cortef)................................... 10hydrocortisone tab 10 mg (Cortef)................................. 10hydrocortisone tab 20 mg (Cortef)................................. 10hydrocortisone valerate cream 0.2%..............................57hydrocortisone valerate oint 0.2% (Westcort)...............57hydrocortisone w/ acetic acid otic soln 1-2% (Vosolhc)...................................................................................... 54

HYDROMORPHONE HCL – hydromorphone hcl suppos 3mg...................................................................................... 41

hydromorphone hcl liqd 1 mg/ml (Dilaudid)..................41hydromorphone hcl tab er 24hr deter 8 mg(Exalgo).............................................................................41

hydromorphone hcl tab er 24hr deter 12 mg(Exalgo).............................................................................41

hydromorphone hcl tab er 24hr deter 16 mg(Exalgo).............................................................................41

hydromorphone hcl tab 2 mg (Dilaudid)........................41hydromorphone hcl tab 4 mg (Dilaudid)........................41hydromorphone hcl tab 8 mg (Dilaudid)........................41

hydroxychloroquine sulfate tab 200 mg (Plaquenil).......7hydroxyurea cap 500 mg (Hydrea)................................... 8hydroxyzine 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).................... 33HYDROXYZINE PAMOATE – hydroxyzine pamoate cap100 mg...............................................................................33

hyoscyamine sulfate elixir 0.125 mg/5ml.......................29hyoscyamine sulfate soln 0.125 mg/ml..........................29hyoscyamine sulfate tab disp 0.125 mg (Anaspaz)...... 29hyoscyamine sulfate tab 0.125 mg (Levsin)..................29hyoscyamine sulfate tab sl 0.125 mg (Levsin/sl)..........29hyoscyamine sulfate tab sr 12hr 0.375 mg (Levbid).....29I

ibandronate sodium tab 150 mg (base equivalent)(Boniva).............................................................................16

IBRANCE – palbociclib cap 75 mg...................................... 8IBRANCE – palbociclib cap 100 mg.................................... 8IBRANCE – palbociclib cap 125 mg.................................... 8ibuprofen susp 100 mg/5ml.............................................44ibuprofen tab 400 mg....................................................... 44ibuprofen tab 600 mg....................................................... 44ibuprofen tab 800 mg....................................................... 44ICLUSIG – ponatinib hcl tab 15 mg (base equiv)................ 8ICLUSIG – ponatinib hcl tab 45 mg (base equiv)................ 8ILARIS – canakinumab for inj 180 mg............................... 44IMBRUVICA – ibrutinib cap 140 mg.....................................8imipramine hcl tab 10 mg (Tofranil)............................... 34imipramine hcl tab 25 mg (Tofranil)............................... 34imipramine hcl tab 50 mg (Tofranil)............................... 34imipramine pamoate cap 75 mg (Tofranil-pm).............. 34imipramine pamoate cap 100 mg (Tofranil-pm)............ 34imipramine pamoate cap 125 mg (Tofranil-pm)............ 34imipramine pamoate cap 150 mg (Tofranil-pm)............ 34imiquimod cream 5% (Aldara).........................................58IMITREX – sumatriptan nasal spray 5 mg/act................... 45IMITREX – sumatriptan nasal spray 20 mg/act................. 45INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml).........16INCRUSE ELLIPTA – umeclidinium br aero powd breathact 62.5 mcg/inh (base eq)...............................................27

indapamide tab 1.25 mg...................................................24indapamide tab 2.5 mg.....................................................24indomethacin cap cr 75 mg.............................................44indomethacin cap 25 mg................................................. 44indomethacin cap 50 mg................................................. 44INHALER-ASSIST DEVICES - VARIOUS..........................60INJECTION DEVICE FOR INSULIN -VARIOUS................60INLYTA – axitinib tab 1 mg...................................................8INLYTA – axitinib tab 5 mg...................................................8INSULIN PEN NEEDLES - NOVOFINE.............................60INSULIN PEN NEEDLES - NOVOTWIST..........................60INSULIN PEN NEEDLES - VARIOUS................................60

2016


INSULIN SYRINGES - VARIOUS...................................... 60INTELENCE – etravirine tab 25 mg.....................................5INTELENCE – etravirine tab 100 mg...................................5INTELENCE – etravirine tab 200 mg...................................5INVIRASE – saquinavir mesylate cap 200 mg.................... 5INVIRASE – saquinavir mesylate tab 500 mg..................... 5INVOKAMET – canagliflozin-metformin hcl tab 50-500mg...................................................................................... 14

INVOKAMET – canagliflozin-metformin hcl tab 50-1000mg...................................................................................... 14



INVOKANA – canagliflozin tab 100 mg..............................14INVOKANA – canagliflozin tab 300 mg..............................14iodoquinol-hydrocortisone in aloe vehicle cream1-1.9% (Vytone)................................................................56

ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml(Duoneb)........................................................................... 27

ipratropium bromide inhal soln 0.02%...........................27ipratropium bromide nasal soln 0.03% (21 mcg/spray)(Atrovent)..........................................................................26

ipratropium bromide nasal soln 0.06% (42 mcg/spray)(Atrovent)..........................................................................26

irbesartan-hydrochlorothiazide tab 150-12.5 mg(Avalide)............................................................................ 18

irbesartan-hydrochlorothiazide tab 300-12.5 mg(Avalide)............................................................................ 18

irbesartan tab 75 mg (Avapro)........................................ 18irbesartan tab 150 mg (Avapro)...................................... 18irbesartan tab 300 mg (Avapro)...................................... 18IRESSA – gefitinib tab 250 mg............................................ 8ISENTRESS – raltegravir potassium chew tab 25 mg(base equiv).........................................................................5

ISENTRESS – raltegravir potassium chew tab 100 mg(base equiv).........................................................................5

ISENTRESS – raltegravir potassium packet for susp 100mg (base equiv).................................................................. 5

ISENTRESS – raltegravir potassium tab 400 mg (baseequiv)....................................................................................5

isometheptene-caffeine-acetaminophen tab 65-20-325mg (Prodrin)..................................................................... 45

ISONIAZID – isoniazid syrup 50 mg/5ml............................. 3isoniazid tab 100 mg.......................................................... 3isoniazid tab 300 mg.......................................................... 3ISOSORBIDE DINITRATE ER – isosorbide dinitrate tab cr40 mg.................................................................................22

ISOSORBIDE DINITRATE – isosorbide dinitrate tab 30mg...................................................................................... 22

isosorbide dinitrate tab 10 mg........................................22isosorbide dinitrate tab 20 mg........................................22isosorbide dinitrate tab 5 mg (Isordil titradose)........... 22isosorbide mononitrate tab 10 mg................................. 22isosorbide mononitrate tab 20 mg................................. 22isosorbide mononitrate tab sr 24hr 30 mg (Imdur).......22

isosorbide mononitrate tab sr 24hr 60 mg (Imdur).......22isosorbide mononitrate tab sr 24hr 120 mg (Imdur).....22isotretinoin cap 10 mg..................................................... 55isotretinoin cap 20 mg..................................................... 55isotretinoin cap 40 mg..................................................... 55isotretinoin cap 30 mg (Claravis)....................................55itraconazole cap 100 mg (Sporanox)................................4ivermectin tab 3 mg (Stromectol)..................................... 7J

JAKAFI – ruxolitinib phosphate tab 5 mg (baseequivalent)............................................................................8





JANUMET – sitagliptin-metformin hcl tab 50-500 mg........14JANUMET – sitagliptin-metformin hcl tab 50-1000 mg......14JANUMET XR – sitagliptin-metformin hcl tab sr 24hr50-500 mg......................................................................... 14

JANUMET XR – sitagliptin-metformin hcl tab sr 24hr50-1000 mg....................................................................... 14

JANUMET XR – sitagliptin-metformin hcl tab sr 24hr100-1000 mg..................................................................... 14

JANUVIA – sitagliptin phosphate tab 25 mg (baseequiv)................................................................................. 14



JARDIANCE – empagliflozin tab 10 mg.............................14JARDIANCE – empagliflozin tab 25 mg.............................14

KKALETRA – lopinavir-ritonavir soln 400-100 mg/5ml(80-20 mg/ml)...................................................................... 5

KALETRA – lopinavir-ritonavir tab 100-25 mg.....................5KALETRA – lopinavir-ritonavir tab 200-50 mg.....................5KALYDECO – ivacaftor packet 50 mg............................... 28KALYDECO – ivacaftor packet 75 mg............................... 28KALYDECO – ivacaftor tab 150 mg................................... 28ketoconazole cream 2%................................................... 56ketoconazole foam 2% (Extina).......................................56ketoconazole shampoo 2% (Nizoral)..............................56KETO-DIASTIX – urine glucose-ketones test strips.......... 60ketoprofen cap 50 mg...................................................... 44ketoprofen cap 75 mg...................................................... 44ketorolac tromethamine ophth soln 0.5% (Acular)....... 53ketorolac tromethamine ophth soln 0.4% (Acularls)....................................................................................... 53

ketorolac tromethamine tab 10 mg.................................44KETOSTIX – acetone (urine) test strip.............................. 60

2016


KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr2.5-1000 mg...................................................................... 14

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr5-500 mg............................................................................14

KOMBIGLYZE XR – saxagliptin-metformin hcl tab sr 24hr5-1000 mg......................................................................... 14

K-PHOS NO 2 – potassium & sodium acid phosphates tab305-700 mg....................................................................... 32

K-PHOS – potassium phosphate monobasic tab 500mg...................................................................................... 50

Llabetalol hcl tab 100 mg (Trandate)................................19labetalol hcl tab 200 mg (Trandate)................................19labetalol hcl tab 300 mg (Trandate)................................19lactic acid (ammonium lactate) lotion 10%....................58lactulose (encephalopathy) solution 10 gm/15ml......... 30lactulose solution 10 gm/15ml........................................ 28LAMISIL – terbinafine hcl oral granules packet 125 mg...... 4LAMISIL – terbinafine hcl oral granules packet 187.5mg........................................................................................ 4

lamivudine oral soln 10 mg/ml (Epivir)............................ 5lamivudine tab 150 mg (Epivir)......................................... 5lamivudine tab 300 mg (Epivir)......................................... 5lamivudine tab 100 mg (hbv) (Epivir hbv)........................4lamivudine-zidovudine tab 150-300 mg (Combivir)........ 5lamotrigine tab chewable dispersible 5 mg (Lamictalchewable di)..................................................................... 46

lamotrigine tab chewable dispersible 25 mg (Lamictalchewable di)..................................................................... 46

lamotrigine tab 25 mg (Lamictal)....................................46lamotrigine tab 100 mg (Lamictal)..................................46lamotrigine tab 150 mg (Lamictal)..................................46lamotrigine tab 200 mg (Lamictal)..................................46lamotrigine tab sr 24hr 25 mg (Lamictal xr).................. 46lamotrigine tab sr 24hr 50 mg (Lamictal xr).................. 46lamotrigine tab sr 24hr 100 mg (Lamictal xr)................ 46lamotrigine tab sr 24hr 200 mg (Lamictal xr)................ 46lamotrigine tab sr 24hr 250 mg (Lamictal xr)................ 46lamotrigine tab sr 24hr 300 mg (Lamictal xr)................ 46LANCET DEVICES - VARIOUS......................................... 60LANCETS - VARIOUS........................................................ 60LANOXIN – digoxin tab 62.5 mcg (0.0625 mg)................. 25LANOXIN – digoxin tab 125 mcg (0.125 mg).................... 25LANOXIN – digoxin tab 187.5 mcg (0.1875 mg)............... 25LANOXIN – digoxin tab 250 mcg (0.25 mg)...................... 25lansoprazole cap delayed release 15 mg(Prevacid)..........................................................................29

lansoprazole cap delayed release 30 mg(Prevacid)..........................................................................29

LANTUS – insulin glargine inj 100 unit/ml......................... 15LANTUS SOLOSTAR – insulin glargine soln pen-injector100 unit/ml......................................................................... 15

latanoprost ophth soln 0.005% (Xalatan).......................53leflunomide tab 10 mg (Arava)........................................44leflunomide tab 20 mg (Arava)........................................44

LENVIMA 14MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 mg (14 mg daily dose)................................... 8

LENVIMA 24MG DAILY DOSE – lenvatinib cap therapypack 10 (2) & 4 mg (24 mg daily dose)..............................8

LENVIMA 10MG DAILY DOSE – lenvatinib cap therapypack 10 mg (10 mg daily dose)..........................................8

LENVIMA 20MG DAILY DOSE – lenvatinib cap therapypack 10 (2) mg (20 mg daily dose).................................... 8

LETAIRIS – ambrisentan tab 5 mg.................................... 25LETAIRIS – ambrisentan tab 10 mg.................................. 25letrozole tab 2.5 mg (Femara)........................................... 8LEUCOVORIN CALCIUM – leucovorin calcium tab 10mg........................................................................................ 8

LEUCOVORIN CALCIUM – leucovorin calcium tab 15mg........................................................................................ 8

leucovorin calcium tab 5 mg.............................................8leucovorin calcium tab 25 mg...........................................9LEUKERAN – chlorambucil tab 2 mg.................................. 9levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (baseequiv).................................................................................27

levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)(Xopenex)..........................................................................27



LEVEMIR FLEXPEN – insulin detemir soln pen-injector100 unit/ml......................................................................... 15

LEVEMIR FLEXTOUCH – insulin detemir soln pen-injector100 unit/ml......................................................................... 15

LEVEMIR – insulin detemir inj 100 unit/ml.........................15levetiracetam 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)...............................47levetiracetam tab sr 24hr 500 mg (Keppra xr)...............46levetiracetam tab sr 24hr 750 mg (Keppra xr)...............46LEVOBUNOLOL HCL – levobunolol hcl ophth soln0.25%................................................................................. 53

levobunolol hcl ophth soln 0.5% (Betagan).................. 53levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)...... 16levocarnitine tab 330 mg (Carnitor)................................16levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5 mg/ml) (Xyzal).........................................................................26

levocetirizine dihydrochloride tab 5 mg (Xyzal)............26levofloxacin ophth soln 0.5%.......................................... 52levofloxacin oral soln 25 mg/ml (Levaquin).................... 3levofloxacin tab 250 mg (Levaquin)................................. 3levofloxacin tab 500 mg (Levaquin)................................. 3levofloxacin tab 750 mg (Levaquin)................................. 3levonorgestrel & ethinyl estradiol (91-day) tab0.15-0.03 mg.....................................................................12

levonorgestrel & ethinyl estradiol tab 0.1 mg-20mcg....................................................................................12

2016


levonorgestrel & ethinyl estradiol tab 0.15 mg-30mcg....................................................................................12

levonorgestrel-eth estra tab0.05-30/0.075-40/0.125-30mg-mcg................................. 12

levonorgestrel-ethinyl estradiol (continuous) tab 90-20mcg....................................................................................12

levonorgestrel tab 1.5 mg (Plan b one-step)................. 12levonorg-eth est tab 0.1-0.02mg(84) & eth est tab0.01mg(7) (Loseasonique)..............................................12

levonorg-eth est tab 0.15-0.03mg(84) & eth est tab0.01mg(7) (Seasonique)..................................................12

levothyroxine sodium tab 25 mcg (Synthroid)..............15levothyroxine sodium tab 50 mcg (Synthroid)..............15levothyroxine sodium tab 75 mcg (Synthroid)..............15levothyroxine sodium tab 88 mcg (Synthroid)..............15levothyroxine sodium tab 100 mcg (Synthroid)............16levothyroxine sodium tab 112 mcg (Synthroid)............ 16levothyroxine sodium tab 125 mcg (Synthroid)............16levothyroxine sodium tab 137 mcg (Synthroid)............16levothyroxine sodium tab 150 mcg (Synthroid)............16levothyroxine sodium tab 175 mcg (Synthroid)............16levothyroxine sodium tab 200 mcg (Synthroid)............16levothyroxine sodium tab 300 mcg (Synthroid)............16LEXIVA – fosamprenavir calcium susp 50 mg/ml (baseequiv)....................................................................................5

LEXIVA – fosamprenavir calcium tab 700 mg (baseequiv)....................................................................................5

LIALDA – mesalamine tab delayed release 1.2 gm...........31lidocaine hcl cream 3%....................................................58lidocaine hcl gel 2%......................................................... 58lidocaine hcl laryngotracheal soln 4% (Lta 360 kit)......54lidocaine hcl soln 4% (Xylocaine)...................................58lidocaine hcl viscous soln 2%........................................ 54lidocaine oint 5%...............................................................58lidocaine patch 5% (Lidoderm)....................................... 58lidocaine-prilocaine cream 2.5-2.5% (Emla).................. 58lidocaine-prilocaine kit 2.5-2.5%..................................... 58lindane lotion 1%.............................................................. 58lindane shampoo 1%........................................................ 58linezolid tab 600 mg (Zyvox)............................................. 7liothyronine sodium tab 5 mcg (Cytomel)..................... 16liothyronine sodium tab 25 mcg (Cytomel)................... 16liothyronine sodium tab 50 mcg (Cytomel)................... 16lisinopril & hydrochlorothiazide tab 10-12.5 mg(Zestoretic)....................................................................... 17

lisinopril & hydrochlorothiazide tab 20-12.5 mg(Zestoretic)....................................................................... 17

lisinopril & hydrochlorothiazide tab 20-25 mg(Zestoretic)....................................................................... 17

lisinopril tab 5 mg (Prinivil)............................................. 17lisinopril tab 10 mg (Prinivil)........................................... 17lisinopril tab 20 mg (Prinivil)........................................... 18lisinopril tab 2.5 mg (Zestril)........................................... 17lisinopril tab 30 mg (Zestril)............................................ 18lisinopril tab 40 mg (Zestril)............................................ 18lithium carbonate cap 300 mg.........................................35

lithium carbonate cap 150 mg (Lithium carbonate)......35lithium carbonate cap 600 mg (Lithium carbonate)......35LITHIUM CARBONATE – lithium carbonate cap 150mg...................................................................................... 35

lithium carbonate tab cr 450 mg.....................................36lithium carbonate tab cr 300 mg (Lithobid)................... 36lithium carbonate tab 300 mg......................................... 36LITHIUM – lithium oral solution 8 meq/5ml........................35LOMUSTINE – lomustine cap 10 mg...................................9LOMUSTINE – lomustine cap 40 mg...................................9LOMUSTINE – lomustine cap 100 mg.................................9LONSURF – trifluridine-tipiracil tab 15-6.14 mg...................9LONSURF – trifluridine-tipiracil tab 20-8.19 mg...................9loperamide hcl cap 2 mg................................................. 28lorazepam 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)...................................................................... 18

losartan potassium & hydrochlorothiazide tab 100-12.5mg (Hyzaar)...................................................................... 19

losartan potassium & hydrochlorothiazide tab 100-25mg (Hyzaar)...................................................................... 19

losartan potassium tab 25 mg (Cozaar).........................19losartan potassium tab 50 mg (Cozaar).........................19losartan potassium tab 100 mg (Cozaar).......................19LOTEMAX – loteprednol etabonate ophth gel 0.5%..........52LOTEMAX – loteprednol etabonate ophth oint 0.5%.........52LOTEMAX – loteprednol etabonate ophth susp 0.5%....... 52lovastatin tab 10 mg.........................................................23lovastatin tab 20 mg (Mevacor).......................................23lovastatin tab 40 mg (Mevacor).......................................23loxapine succinate cap 10 mg........................................ 36loxapine succinate cap 25 mg........................................ 36loxapine succinate cap 50 mg........................................ 36loxapine succinate cap 5 mg (Loxitane)........................36LUMIGAN – bimatoprost ophth soln 0.01%.......................53LYNPARZA – olaparib cap 50 mg........................................9LYSODREN – mitotane tab 500 mg.....................................9

MMACRODANTIN – nitrofurantoin macrocrystalline cap 25mg...................................................................................... 31

malathion lotion 0.5% (Ovide).........................................58MATULANE – procarbazine hcl cap 50 mg......................... 9meclizine hcl tab 12.5 mg................................................ 30meclizine hcl tab 25 mg................................................... 30medroxyprogesterone acetate im susp 150 mg/ml(Depo-provera contrac).................................................. 12

medroxyprogesterone acetate tab 2.5 mg(Provera)........................................................................... 12

medroxyprogesterone acetate tab 5 mg (Provera).......12medroxyprogesterone acetate tab 10 mg (Provera).....12mefenamic acid cap 250 mg (Ponstel)...........................44mefloquine hcl tab 250 mg................................................ 7

2016


megestrol acetate susp 625 mg/5ml (Megace es).........12megestrol acetate susp 40 mg/ml (Megace oral)............ 9megestrol acetate tab 20 mg.............................................9megestrol acetate tab 40 mg.............................................9MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg(base equivalent).................................................................9

MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (baseequivalent)............................................................................9

meloxicam tab 7.5 mg (Mobic)........................................44meloxicam tab 15 mg (Mobic).........................................44memantine 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.............................. 49mercaptopurine tab 50 mg (Purinethol)...........................9mesalamine enema 4 gm................................................. 31mesalamine rectal enema 4 gm & cleanser wipe kit(Rowasa)........................................................................... 31

MESNEX – mesna tab 400 mg............................................9metaxalone tab 800 mg (Skelaxin)..................................48metformin hcl tab 500 mg (Glucophage)....................... 15metformin hcl tab 850 mg (Glucophage)....................... 15metformin hcl tab 1000 mg (Glucophage)..................... 15metformin hcl tab sr 24hr 500 mg (Glucophage xr)......14metformin hcl tab sr 24hr 750 mg (Glucophage xr)......14metformin hcl tab sr 24hr osmotic 500 mg(Fortamet)......................................................................... 14

metformin hcl tab sr 24hr osmotic 1000 mg(Fortamet)......................................................................... 15

methadone 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)..........................24methenamine hippurate tab 1 gm (Hiprex).................... 31methenamine-hyoscamine-meth blue-sod phos tab81.6 mg (Urogesic-blue)................................................. 31

methenamine-hyosc-meth blue-benz acid-phenyl saltab 81.6mg (Prosed/ds).................................................. 31

methenamine-hyosc-meth blue-sod phos-phen sal cap118 mg...............................................................................31

methenamine-hyosc-meth blue-sod phos-phen sal cap120 mg.............................................................................. 31

methenamine-hyosc-meth blue-sod phos-phen sal tab81 mg................................................................................ 31

methenamine-hyos-meth blue-sod phos-phen sal tab81.6 mg............................................................................. 31

methenamine mandelate tab 1 gm................................. 31methimazole tab 5 mg (Tapazole)................................... 16methimazole tab 10 mg (Tapazole)................................. 16methocarbamol tab 750 mg (Robaxin-750)....................48

methocarbamol tab 500 mg (Robaxin)...........................48methotrexate sodium tab 2.5 mg (base equiv)................9methoxsalen rapid cap 10 mg (Oxsoralen ultra)...........58methscopolamine bromide tab 2.5 mg (Pamine).......... 29methscopolamine bromide tab 5 mg (Pamineforte).................................................................................. 29

methyldopa tab 250 mg................................................... 25methyldopa tab 500 mg................................................... 25methylergonovine maleate tab 0.2 mg...........................16methylphenidate hcl cap cr 10 mg (Metadate cd).........38methylphenidate hcl cap cr 20 mg (Metadate cd).........38methylphenidate hcl cap cr 30 mg (Metadate cd).........38methylphenidate hcl cap cr 40 mg (Metadate cd).........38methylphenidate hcl cap cr 50 mg (Metadate cd).........38methylphenidate hcl cap cr 60 mg (Metadate cd).........38methylphenidate hcl cap sr 24hr 20 mg (la) (Ritalinla)....................................................................................... 38

methylphenidate hcl cap sr 24hr 30 mg (la) (Ritalinla)....................................................................................... 38

methylphenidate hcl cap sr 24hr 40 mg (la) (Ritalinla)....................................................................................... 38

methylphenidate hcl soln 5 mg/5ml (Methylin)............. 38methylphenidate hcl soln 10 mg/5ml (Methylin)........... 38methylphenidate 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)........................ 38methylprednisolone tab 4 mg dose pack (Medroldosepak)........................................................................... 10

methylprednisolone tab 4 mg (Medrol)..........................10methylprednisolone tab 8 mg (Medrol)..........................10methylprednisolone tab 16 mg (Medrol)........................10methylprednisolone tab 32 mg (Medrol)........................10METIPRANOLOL – metipranolol ophth soln 0.3%............ 53metoclopramide hcl inj 5 mg/ml..................................... 31metoclopramide hcl orally disintegrating tab 5 mg(Metozolv odt).................................................................. 31

metoclopramide hcl soln 5 mg/5ml (10 mg/10ml).........31metoclopramide hcl tab 5 mg (Reglan)..........................31metoclopramide hcl tab 10 mg (Reglan)........................31metolazone tab 10 mg......................................................24metolazone tab 2.5 mg (Zaroxolyn)................................24metolazone tab 5 mg (Zaroxolyn)...................................24metoprolol & hydrochlorothiazide tab 100-50 mg........ 19metoprolol & hydrochlorothiazide tab 50-25 mg(Lopressor hct)................................................................ 19

metoprolol & hydrochlorothiazide tab 100-25 mg(Lopressor hct)................................................................ 19

metoprolol succinate tab sr 24hr 25 mg (Toprol xl)......20metoprolol succinate tab sr 24hr 50 mg (Toprol xl)......20metoprolol succinate tab sr 24hr 100 mg (Toprolxl)....................................................................................... 20

metoprolol succinate tab sr 24hr 200 mg (Toprolxl)....................................................................................... 20

metoprolol tartrate tab 25 mg......................................... 20

2016


metoprolol tartrate tab 50 mg (Lopressor).................... 20metoprolol tartrate tab 100 mg (Lopressor).................. 20metronidazole cap 375 mg (Flagyl).................................. 7metronidazole cream 0.75% (Metrocream).................... 55metronidazole gel 0.75%..................................................55metronidazole gel 1% (Metrogel).................................... 55metronidazole lotion 0.75% (Metrolotion)......................55metronidazole tab 250 mg (Flagyl)................................... 7metronidazole tab 500 mg (Flagyl)................................... 7metronidazole vaginal gel 0.75% (Metrogel-vaginal)..............................................................................32

mexiletine hcl cap 150 mg...............................................24mexiletine hcl cap 200 mg...............................................24mexiletine hcl cap 250 mg...............................................24midazolam hcl syrup 2 mg/ml (base equivalent).......... 37midodrine hcl tab 2.5 mg.................................................25midodrine hcl tab 5 mg....................................................25midodrine hcl tab 10 mg..................................................25MIGRANAL – dihydroergotamine mesylate nasal spray 4mg/ml..................................................................................45

minocycline hcl cap 50 mg (Minocin).............................. 3minocycline hcl cap 75 mg (Minocin).............................. 3minocycline hcl cap 100 mg (Minocin)............................ 3minocycline hcl tab 50 mg................................................ 3minocycline hcl tab 75 mg................................................ 3minocycline hcl tab 100 mg.............................................. 3minocycline hcl tab sr 24hr 45 mg................................... 3minocycline hcl tab sr 24hr 90 mg................................... 3minocycline hcl tab sr 24hr 135 mg................................. 3minoxidil tab 2.5 mg.........................................................25minoxidil tab 10 mg..........................................................25mirtazapine orally disintegrating tab 15 mg (Remeronsoltab)............................................................................... 34

mirtazapine orally disintegrating tab 30 mg (Remeronsoltab)............................................................................... 34

mirtazapine orally disintegrating tab 45 mg (Remeronsoltab)............................................................................... 34

mirtazapine tab 7.5 mg.....................................................34mirtazapine tab 15 mg (Remeron).................................. 34mirtazapine tab 30 mg (Remeron).................................. 34mirtazapine tab 45 mg (Remeron).................................. 34misoprostol tab 100 mcg (Cytotec)................................ 29misoprostol tab 200 mcg (Cytotec)................................ 29modafinil tab 100 mg (Provigil).......................................38modafinil tab 200 mg (Provigil).......................................38moexipril hcl tab 7.5 mg (Univasc).................................18moexipril hcl tab 15 mg (Univasc)..................................18moexipril-hydrochlorothiazide tab 7.5-12.5 mg.............18moexipril-hydrochlorothiazide tab 15-25 mg.................18moexipril-hydrochlorothiazide tab 15-12.5 mg(Uniretic)........................................................................... 18

mometasone furoate cream 0.1% (Elocon)................... 57mometasone furoate oint 0.1% (Elocon)........................57mometasone furoate solution 0.1% (lotion)(Elocon).............................................................................57

montelukast sodium chew tab 4 mg (base equiv)(Singulair)......................................................................... 28

montelukast sodium chew tab 5 mg (base equiv)(Singulair)......................................................................... 28

montelukast sodium oral granules packet 4 mg (baseequiv) (Singulair)............................................................. 28

montelukast sodium tab 10 mg (base equiv)(Singulair)......................................................................... 28

morphine sulfate cap sr 24hr 10 mg (Kadian)...............42morphine sulfate cap sr 24hr 20 mg (Kadian)...............42morphine sulfate cap sr 24hr 30 mg (Kadian)...............42morphine sulfate cap sr 24hr 50 mg (Kadian)...............42morphine sulfate cap sr 24hr 60 mg (Kadian)...............42morphine sulfate cap sr 24hr 80 mg (Kadian)...............42morphine sulfate cap sr 24hr 100 mg (Kadian).............42MORPHINE SULFATE ER – morphine sulfate beads capsr 24hr 30 mg....................................................................42

MORPHINE SULFATE ER – morphine sulfate beads capsr 24hr 45 mg....................................................................42




MORPHINE SULFATE ER – morphine sulfate beads capsr 24hr 120 mg..................................................................42

MORPHINE SULFATE – morphine sulfate suppos 5mg...................................................................................... 42




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)................. 42moxifloxacin hcl tab 400 mg (base equiv) (Avelox)........3mupirocin calcium cream 2% (Bactroban).................... 56mupirocin oint 2% (Bactroban).......................................56mycophenolate mofetil cap 250 mg (Cellcept)..............60mycophenolate mofetil for oral susp 200 mg/ml(Cellcept)...........................................................................60

mycophenolate mofetil tab 500 mg (Cellcept)...............60mycophenolate sodium tab dr 180 mg (mycophenolicacid equiv) (Myfortic)......................................................60

mycophenolate sodium tab dr 360 mg (mycophenolicacid equiv) (Myfortic)......................................................60

2016


MYLERAN – busulfan tab 2 mg...........................................9MYRBETRIQ – mirabegron tab sr 24 hr 25 mg.................31MYRBETRIQ – mirabegron tab sr 24 hr 50 mg.................31

Nnabumetone tab 500 mg.................................................. 44nabumetone tab 750 mg.................................................. 44nadolol & bendroflumethiazide tab 40-5 mg(Corzide)............................................................................20

nadolol & bendroflumethiazide tab 80-5 mg(Corzide)............................................................................20

nadolol tab 20 mg (Corgard)........................................... 20nadolol tab 40 mg (Corgard)........................................... 20nadolol tab 80 mg (Corgard)........................................... 20naloxone hcl inj 0.4 mg/ml.............................................. 60naltrexone hcl tab 50 mg (Revia)....................................60NAMENDA – memantine hcl oral solution 2 mg/ml........... 40NAPROXEN – naproxen susp 125 mg/5ml....................... 44naproxen sodium tab 275 mg (Anaprox)....................... 44naproxen sodium tab 550 mg (Anaprox ds)..................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)........... 45naratriptan hcl tab 2.5 mg (base equiv) (Amerge)........ 45NATACYN – natamycin ophth susp 5%............................. 52nateglinide tab 60 mg (Starlix)........................................15nateglinide tab 120 mg (Starlix)......................................15NEBUPENT – pentamidine isethionate for nebulizationsoln 300 mg.........................................................................7

NECON 1/50-28 – norethindrone & mestranol tab 1 mg-50mcg.....................................................................................12

NECON 10/11-28 – norethindrone-eth estradiol tab0.5-35/1-35 mg-mcg (10/11)............................................. 12

neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt op oin..................................52

neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml (Neosporin)................52

neomycin-polymyxin-dexamethasone ophth oint 0.1%(Maxitrol)...........................................................................52

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)................................................................. 52

neomycin-polymyxin-hc otic soln 1% (Cortisporin)..... 54neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000unit/ml-1%.........................................................................54

neomycin sulfate tab 500 mg............................................3NEULASTA DELIVERY KIT – pegfilgrastim soln prefilledsyringe kit 6 mg/0.6ml.......................................................51

NEULASTA – pegfilgrastim soln prefilled syringe 6mg/0.6ml............................................................................ 51

NEUPOGEN – filgrastim inj 300 mcg/ml............................51NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/ml)...................................................................................... 51

NEUPOGEN – filgrastim soln prefilled syringe 300mcg/0.5ml...........................................................................51

NEUPOGEN – filgrastim soln prefilled syringe 480mcg/0.8ml (600 mcg/ml)................................................... 51

nevirapine tab 200 mg (Viramune)....................................5nevirapine tab sr 24hr 400 mg (Viramune xr)..................5NEXAVAR – sorafenib tosylate tab 200 mg (baseequivalent)............................................................................9

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 5 mg..............................................................29

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 10 mg............................................................29



NEXIUM – esomeprazole magnesium for delayed releasesusp pack 2.5 mg..............................................................29

niacin tab cr 500 mg (antihyperlipidemic)(Niaspan)...........................................................................23



nicardipine hcl cap 20 mg............................................... 21nicardipine hcl cap 30 mg............................................... 21NICOTROL INHALER – nicotine inhaler system 10 mg (4mg delivered).....................................................................40

NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/spray)................................................................................. 40

nifedipine cap 20 mg........................................................21nifedipine cap 10 mg (Procardia)....................................21nifedipine tab sr 24hr 30 mg (Adalat cc)........................21nifedipine tab sr 24hr 60 mg (Adalat cc)........................21nifedipine tab sr 24hr 90 mg (Adalat cc)........................21nifedipine tab sr 24hr osmotic release 30 mg(Procardia xl)....................................................................21

nifedipine tab sr 24hr osmotic release 60 mg(Procardia xl)....................................................................22

nifedipine tab sr 24hr osmotic release 90 mg(Procardia xl)....................................................................22

NILANDRON – nilutamide tab 150 mg................................ 9nimodipine cap 30 mg......................................................22nisoldipine tab sr 24hr 8.5 mg (Sular)............................22nisoldipine tab sr 24hr 17 mg (Sular).............................22nisoldipine tab sr 24hr 34 mg (Sular).............................22NITRO-BID – nitroglycerin oint 2%.................................... 22nitrofurantoin macrocrystalline cap 25 mg(Macrodantin)................................................................... 31

nitrofurantoin macrocrystalline cap 50 mg(Macrodantin)................................................................... 31

nitrofurantoin macrocrystalline cap 100 mg(Macrodantin)................................................................... 31

nitrofurantoin monohydrate macrocrystalline cap 100mg (Macrobid)..................................................................31

nitrofurantoin susp 25 mg/5ml (Furadantin)..................31

2016


nitroglycerin cap cr 2.5 mg............................................. 22nitroglycerin cap cr 6.5 mg............................................. 22nitroglycerin cap cr 9 mg................................................ 22nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)..........22nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)..........22nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)..........22nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)..........22NITROSTAT – nitroglycerin sl tab 0.3 mg.......................... 22NITROSTAT – nitroglycerin sl tab 0.4 mg.......................... 22NITROSTAT – nitroglycerin sl tab 0.6 mg.......................... 22nizatidine cap 150 mg...................................................... 29nizatidine cap 300 mg (Axid)...........................................29nizatidine oral soln 15 mg/ml (Axid)...............................29norethindrone & ethinyl estradiol-fe chew tab 0.4mg-35 mcg (Femcon fe)................................................. 12

norethindrone & ethinyl estradiol-fe chew tab 0.8mg-25 mcg (Generess fe)...............................................13

norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg(Brevicon-28)....................................................................12

norethindrone & ethinyl estradiol tab 1 mg-35 mcg(Norinyl 1+35)...................................................................12

norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg(Ovcon-35)........................................................................ 12

norethindrone ace & ethinyl estradiol-fe tab 1 mg-20mcg (Loestrin fe 1/20).....................................................13

norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30mcg (Loestrin fe 1.5/30)..................................................13

norethindrone ace & ethinyl estradiol tab 1 mg-20 mcg(Loestrin 1/20-21).............................................................13

norethindrone ace & ethinyl estradiol tab 1.5 mg-30mcg (Loestrin 1.5/30-21).................................................13

norethindrone ace-ethinyl estradiol-fe tab 1 mg-20mcg (24)............................................................................13

norethindrone acetate-ethinyl estradiol tab 1 mg-5mcg....................................................................................11

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5mcg (Femhrt low dose).................................................. 11

norethindrone acetate tab 5 mg (Aygestin)...................12norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35mg-mcg (Estrostep fe)....................................................13

norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg (Ortho-novum 7/7/7)............................................... 13

norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl 28).........................................................13

norethindrone tab 0.35 mg (Nor-qd)...............................13norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg(Ortho-cyclen).................................................................. 13

norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35mg-mcg (Ortho tri-cyclen)..............................................13

norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg.........13nortriptyline hcl cap 10 mg (Pamelor)............................34nortriptyline hcl cap 25 mg (Pamelor)............................34nortriptyline hcl cap 50 mg (Pamelor)............................34nortriptyline hcl cap 75 mg (Pamelor)............................34NORTRIPTYLINE HCL – nortriptyline hcl soln 10mg/5ml............................................................................... 34

NORVIR – ritonavir cap 100 mg.......................................... 5NORVIR – ritonavir oral soln 80 mg/ml................................5NORVIR – ritonavir tab 100 mg........................................... 5NOVOLIN 70/30 – insulin nph isophane & regular humaninj 100 unit/ml (70-30).......................................................15

NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/ml........................................................................................15

NOVOLIN R – insulin regular (human) inj 100 unit/ml....... 15NOVOLOG FLEXPEN – insulin aspart soln pen-injector100 unit/ml......................................................................... 15

NOVOLOG – insulin aspart inj 100 unit/ml........................ 15NOVOLOG MIX 70/30 – insulin aspart prot & aspart(human) inj 100 unit/ml (70-30)........................................ 15

NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &aspart sus pen-inj 100 unit/ml (70-30)..............................15

NOVOLOG PENFILL – insulin aspart inj 100 unit/ml.........15NOVOLOG PENFILL – insulin aspart soln cartridge 100unit/ml.................................................................................15

NOXAFIL – posaconazole susp 40 mg/ml...........................4NOXAFIL – posaconazole tab delayed release 100 mg......4NUCYNTA ER – tapentadol hcl tab sr 12hr 50 mg............ 42NUCYNTA ER – tapentadol hcl tab sr 12hr 100 mg.......... 42NUCYNTA ER – tapentadol hcl tab sr 12hr 150 mg.......... 42NUCYNTA ER – tapentadol hcl tab sr 12hr 200 mg.......... 42NUCYNTA ER – tapentadol hcl tab sr 12hr 250 mg.......... 42NUVARING – etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr.........................................................13

nystatin cream 100000 unit/gm.......................................56nystatin oint 100000 unit/gm........................................... 56nystatin oral powder...........................................................4nystatin susp 100000 unit/ml.......................................... 54nystatin tab 500000 unit.....................................................4nystatin topical powder....................................................56nystatin-triamcinolone cream 100000-0.1 unit/gm-%........................................................................................ 57

nystatin-triamcinolone oint 100000-0.1 unit/gm-%....... 57O

ODOMZO – sonidegib phosphate cap 200 mg (baseequivalent)............................................................................9

OFLOXACIN – ofloxacin tab 400 mg...................................3ofloxacin ophth soln 0.3% (Ocuflox)..............................52ofloxacin otic soln 0.3%...................................................54OGESTREL – norgestrel & ethinyl estradiol tab 0.5 mg-50mcg.....................................................................................13

olanzapine-fluoxetine hcl cap 3-25 mg (Symbyax)....... 40olanzapine-fluoxetine hcl cap 6-25 mg (Symbyax)....... 40olanzapine-fluoxetine hcl cap 6-50 mg (Symbyax)....... 40olanzapine-fluoxetine hcl cap 12-25 mg (Symbyax)..... 40olanzapine-fluoxetine hcl cap 12-50 mg (Symbyax)..... 40olanzapine orally disintegrating tab 5 mg (Zyprexazydis)................................................................................. 36

olanzapine orally disintegrating tab 10 mg (Zyprexazydis)................................................................................. 36


2016



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)......................................36olopatadine hcl nasal soln 0.6% (Patanase)..................26omeprazole cap delayed release 10 mg (Prilosec)....... 29omeprazole cap delayed release 20 mg (Prilosec)....... 29omeprazole cap delayed release 40 mg (Prilosec)....... 29omeprazole-sodium bicarbonate cap 20-1100 mg(Zegerid)............................................................................29

omeprazole-sodium bicarbonate cap 40-1100 mg(Zegerid)............................................................................29

OMNITROPE – somatropin for inj 5.8 mg......................... 16OMNITROPE – somatropin inj 5 mg/1.5ml........................16OMNITROPE – somatropin inj 10 mg/1.5ml......................16ondansetron hcl oral soln 4 mg/5ml (Zofran)................30ondansetron hcl tab 24 mg............................................. 30ondansetron hcl tab 4 mg (Zofran).................................30ondansetron hcl tab 8 mg (Zofran).................................30ondansetron orally disintegrating tab 4 mg (Zofranodt).....................................................................................30

ondansetron orally disintegrating tab 8 mg (Zofranodt).....................................................................................30

ONGLYZA – saxagliptin hcl tab 2.5 mg (base equiv).........15ONGLYZA – saxagliptin hcl tab 5 mg (base equiv)............15OPSUMIT – macitentan tab 10 mg....................................25ORACEA – doxycycline (rosacea) cap delayed release 40mg...................................................................................... 55

ORFADIN – nitisinone cap 2 mg........................................16ORFADIN – nitisinone cap 5 mg........................................16ORFADIN – nitisinone cap 10 mg......................................17orphenadrine citrate tab sr 12hr 100 mg....................... 48orphenadrine w/ aspirin & caffeine tab 25-385-30mg...................................................................................... 49

ORTHO TRI-CYCLEN LO – norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg................................... 13

OVIDREL – choriogonadotropin alfa inj 250mcg/0.5ml...........................................................................13

oxandrolone tab 2.5 mg (Oxandrin)................................11oxandrolone tab 10 mg (Oxandrin).................................11oxaprozin tab 600 mg (Daypro).......................................44oxazepam cap 10 mg........................................................33oxazepam cap 15 mg........................................................33oxazepam cap 30 mg........................................................33oxcarbazepine susp 300 mg/5ml (60 mg/ml)(Trileptal)...........................................................................47

oxcarbazepine tab 150 mg (Trileptal)............................. 47oxcarbazepine tab 300 mg (Trileptal)............................. 47oxcarbazepine tab 600 mg (Trileptal)............................. 47oxybutynin chloride syrup 5 mg/5ml..............................31oxybutynin chloride tab 5 mg......................................... 31oxybutynin chloride tab sr 24hr 5 mg (Ditropan xl)......31

oxybutynin chloride tab sr 24hr 10 mg (Ditropanxl)....................................................................................... 31

oxybutynin chloride tab sr 24hr 15 mg (Ditropanxl)....................................................................................... 31

oxycodone-aspirin tab 4.8355-325 mg (Percodan)....... 43oxycodone hcl cap 5 mg................................................. 42oxycodone hcl conc 100 mg/5ml (20 mg/ml)(Oxycodone hcl).............................................................. 42

OXYCODONE HCL – oxycodone hcl conc 100 mg/5ml (20mg/ml)................................................................................ 42

oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)............42oxycodone hcl tab 10 mg................................................ 43oxycodone hcl tab 20 mg................................................ 43oxycodone hcl tab 5 mg (Roxicodone).......................... 42oxycodone hcl tab 15 mg (Roxicodone)........................ 43oxycodone hcl tab 30 mg (Roxicodone)........................ 43oxycodone-ibuprofen tab 5-400 mg............................... 43oxycodone w/ acetaminophen tab 2.5-325 mg(Percocet)......................................................................... 43

oxycodone w/ acetaminophen tab 5-325 mg(Percocet)......................................................................... 43

oxycodone w/ acetaminophen tab 7.5-325 mg(Percocet)......................................................................... 43

oxycodone w/ acetaminophen tab 10-325 mg(Percocet)......................................................................... 43

OXYCONTIN – oxycodone hcl tab er 12hr deter 10mg...................................................................................... 43







oxymorphone hcl tab 5 mg (Opana)...............................43oxymorphone hcl tab 10 mg (Opana).............................43oxymorphone hcl tab sr 12hr 5 mg................................ 43oxymorphone hcl tab sr 12hr 7.5 mg............................. 43oxymorphone hcl tab sr 12hr 10 mg.............................. 43oxymorphone hcl tab sr 12hr 15 mg.............................. 43oxymorphone hcl tab sr 12hr 20 mg.............................. 43oxymorphone hcl tab sr 12hr 30 mg.............................. 43oxymorphone hcl tab sr 12hr 40 mg.............................. 43P

paliperidone tab sr 24hr 1.5 mg (Invega).......................36paliperidone tab sr 24hr 3 mg (Invega)..........................36paliperidone tab sr 24hr 6 mg (Invega)..........................36paliperidone tab sr 24hr 9 mg (Invega)..........................36pantoprazole sodium ec tab 20 mg (base equiv)(Protonix).......................................................................... 29

2016


pantoprazole sodium ec tab 40 mg (base equiv)(Protonix).......................................................................... 29

paricalcitol cap 1 mcg (Zemplar).................................... 17paricalcitol cap 2 mcg (Zemplar).................................... 17paricalcitol cap 4 mcg (Zemplar).................................... 17paromomycin sulfate cap 250 mg.................................... 3paroxetine hcl tab 10 mg (Paxil).....................................34paroxetine hcl tab 20 mg (Paxil).....................................34paroxetine hcl tab 30 mg (Paxil).....................................34paroxetine 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)................ 34PATADAY – olopatadine hcl ophth soln 0.2% (baseequivalent)......................................................................... 53

PAZEO – olopatadine hcl ophth soln 0.7% (baseequivalent)......................................................................... 53

pediatric multiple vitamins w/ fl-fe drops 0.25-10 mg/ml....................................................................................... 49

pediatric multiple vitamins w/ fluoride chew tab 0.25mg...................................................................................... 49

pediatric multiple vitamins w/ fluoride chew tab 0.5mg...................................................................................... 49

pediatric multiple vitamins w/ fluoride chew tab 1mg...................................................................................... 49

pediatric multiple vitamins w/ fluoride soln 0.25 mg/ml....................................................................................... 49

pediatric multiple vitamins w/ fluoride soln 0.5 mg/ml....................................................................................... 49

pediatric vitamins acd w/ fluoride soln 0.25 mg/ml...... 49pediatric vitamins acd w/ fluoride soln 0.5 mg/ml........ 49PEGASYS – peginterferon alfa-2a inj 180 mcg/ml.............. 4PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml......... 4PEGASYS PROCLICK – peginterferon alfa-2a inj 135mcg/0.5ml.............................................................................4

PEGASYS PROCLICK – peginterferon alfa-2a inj 180mcg/0.5ml.............................................................................4

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm(Colyte-flavor packs).......................................................28

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)...........................................................................28

peg 3350-kcl-sod bicarb-nacl for soln 420 gm(Nulytely/flavor pack)......................................................28

penicillin v potassium for soln 125 mg/5ml.....................1penicillin v potassium for soln 250 mg/5ml.....................1penicillin v potassium tab 250 mg....................................1penicillin v potassium tab 500 mg....................................1PENTASA – mesalamine cap cr 250 mg........................... 31PENTASA – mesalamine cap cr 500 mg........................... 31pentoxifylline tab cr 400 mg............................................51perindopril erbumine tab 2 mg....................................... 18perindopril erbumine tab 4 mg (Aceon).........................18perindopril erbumine tab 8 mg (Aceon).........................18permethrin cream 5% (Elimite)........................................58perphenazine tab 2 mg.................................................... 36perphenazine tab 4 mg.................................................... 36

perphenazine tab 8 mg.................................................... 36perphenazine tab 16 mg.................................................. 36phenazopyridine hcl tab 100 mg (Pyridium)..................32phenazopyridine hcl tab 200 mg (Pyridium)..................32phenelzine sulfate tab 15 mg (Nardil)............................ 35phenobarbital elixir 20 mg/5ml........................................37PHENOBARBITAL – phenobarbital tab 15 mg.................. 37PHENOBARBITAL – phenobarbital tab 30 mg.................. 37PHENOBARBITAL – phenobarbital tab 60 mg.................. 37PHENOBARBITAL – phenobarbital tab 100 mg................ 37phenobarbital tab 16.2 mg...............................................37phenobarbital tab 32.4 mg...............................................37phenobarbital tab 64.8 mg...............................................37phenobarbital tab 97.2 mg...............................................37phenoxybenzamine hcl cap 10 mg (Dibenzyline)......... 25phenylephrine hcl ophth soln 2.5%................................53phenylephrine hcl ophth soln 10%.................................54PHENYTEK – phenytoin sodium extended cap 200mg...................................................................................... 47

PHENYTEK – phenytoin sodium extended cap 300mg...................................................................................... 47

phenytoin chew tab 50 mg (Dilantin infatabs)...............47phenytoin sodium extended cap 100 mg (Dilantin)...... 47phenytoin sodium extended cap 200 mg(Phenytek).........................................................................47

phenytoin sodium extended cap 300 mg(Phenytek).........................................................................47

phenytoin susp 125 mg/5ml (Dilantin)........................... 47PICATO – ingenol mebutate gel 0.015%........................... 58PICATO – ingenol mebutate gel 0.05%............................. 58pilocarpine hcl ophth soln 1% (Isopto carpine)............ 53pilocarpine hcl ophth soln 2% (Isopto carpine)............ 53pilocarpine hcl ophth soln 4% (Isopto carpine)............ 53pilocarpine hcl tab 5 mg (Salagen).................................54pilocarpine hcl tab 7.5 mg (Salagen)..............................54pimozide tab 1 mg (Orap)................................................ 40pimozide tab 2 mg (Orap)................................................ 40pindolol tab 5 mg..............................................................20pindolol tab 10 mg............................................................20pioglitazone hcl-glimepiride tab 30-2 mg (Duetact)......15pioglitazone hcl-glimepiride tab 30-4 mg (Duetact)......15pioglitazone hcl-metformin hcl tab 15-500 mg(Actoplus met)................................................................. 15

pioglitazone hcl-metformin hcl tab 15-850 mg(Actoplus met)................................................................. 15

pioglitazone hcl tab 15 mg (base equiv) (Actos)...........15pioglitazone hcl tab 30 mg (base equiv) (Actos)...........15pioglitazone hcl tab 45 mg (base equiv) (Actos)...........15piroxicam 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

2016


PLEGRIDY STARTER PACK – peginterferon beta-1a solnpref syr 63 & 94 mcg/0.5ml pack..................................... 39

podofilox soln 0.5% (Condylox)......................................58polyethylene glycol 3350 oral packet.............................28polyethylene glycol 3350 oral powder........................... 28polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% (Polytrim)...........................................................52

POMALYST – pomalidomide cap 1 mg............................... 9POMALYST – pomalidomide cap 2 mg............................... 9POMALYST – pomalidomide cap 3 mg............................... 9POMALYST – pomalidomide cap 4 mg............................... 9pot & sod citrates w/ cit ac soln 550-500-334mg/5ml...............................................................................32

potassium bicarbonate effer tab 25 meq.......................50potassium chloride cap cr 8 meq (Micro-k)...................50potassium chloride cap cr 10 meq (Micro-k).................50POTASSIUM CHLORIDE ER – potassium chloride tab cr 8meq (600 mg)....................................................................50

potassium chloride microencapsulated crys cr tab 10meq....................................................................................50

potassium chloride microencapsulated crys cr tab 20meq....................................................................................50

potassium chloride oral soln 10% (20 meq/15ml).........50potassium chloride oral soln 20% (40 meq/15ml).........50potassium chloride powder packet 20 meq.................. 50potassium chloride tab cr 10 meq (K-tab)..................... 50potassium chloride tab cr 8 meq (600 mg)....................50potassium citrate & citric acid powder pack 3300-1002mg...................................................................................... 32

potassium citrate & citric acid soln 1100-334mg/5ml...............................................................................32

potassium citrate tab cr 5 meq (540 mg) (Urocit-k5)........................................................................................ 32

potassium citrate tab cr 10 meq (1080 mg) (Urocit-k10)...................................................................................... 32

potassium citrate tab cr 15 meq (1620 mg) (Urocit-k15)...................................................................................... 32

pot bicarbonate & chloride effer tab 25 meq.................50pot phos monobasic w/sod phos di & monobas tab155-852-130mg (K-phos neutral)................................... 50

pramipexole dihydrochloride tab 0.125 mg(Mirapex)........................................................................... 48

pramipexole dihydrochloride tab 0.25 mg(Mirapex)........................................................................... 48

pramipexole dihydrochloride tab 0.5 mg (Mirapex)......48pramipexole dihydrochloride tab 0.75 mg(Mirapex)........................................................................... 48

pramipexole dihydrochloride tab 1 mg (Mirapex).........48pramipexole dihydrochloride tab 1.5 mg (Mirapex)......48pramoxine-chloroxylenol otic liquid 1-0.1%(Pramotic)......................................................................... 54

pramoxine-hc-chloroxylenol otic soln 10-10-1 mg/ml(Cortane-b-otic)................................................................54

PRASCION RA WITH SUNSCREE – sulfacetamidesodium-sulfur-sunscreen cream 10-5%............................55

pravastatin sodium tab 10 mg........................................ 23

pravastatin sodium tab 20 mg (Pravachol)....................23pravastatin sodium tab 40 mg (Pravachol)....................23pravastatin sodium tab 80 mg (Pravachol)....................23prazosin hcl cap 1 mg (Minipress)................................. 25prazosin hcl cap 2 mg (Minipress)................................. 25prazosin hcl cap 5 mg (Minipress)................................. 25PRECISION XTRA – ketone blood test strip..................... 60prednicarbate cream 0.1% (Dermatop).......................... 57prednicarbate oint 0.1% (Dermatop).............................. 57prednisolone acetate ophth susp 1% (Pred forte)........ 52prednisolone sod phos orally disintegr tab 10 mg(base eq) (Orapred odt)..................................................10

prednisolone sod phos orally disintegr tab 15 mg(base eq) (Orapred odt)..................................................10

prednisolone sod phos orally disintegr tab 30 mg(base eq) (Orapred odt)..................................................10

prednisolone sod phosphate oral soln 15 mg/5ml(base equiv)......................................................................10

prednisolone sod phosph oral soln 6.7 mg/5ml (5mg/5ml base) (Pediapred).............................................. 10

prednisolone syrup 15 mg/5ml (usp solutionequivalent) (Prelone).......................................................10

PREDNISONE – prednisone oral soln 5 mg/5ml...............10PREDNISONE – prednisone tab 50 mg............................ 10PREDNISONE – prednisone tab 5 mg dose pack.............10PREDNISONE – prednisone tab 10 mg dose pack...........10prednisone tab 1 mg........................................................ 10prednisone tab 2.5 mg..................................................... 11prednisone tab 5 mg........................................................ 11prednisone tab 10 mg...................................................... 11prednisone tab 20 mg...................................................... 11PREMARIN – estrogens, conjugated tab 0.3 mg...............11PREMARIN – estrogens, conjugated tab 0.45 mg.............11PREMARIN – estrogens, conjugated tab 0.625 mg...........12PREMARIN – estrogens, conjugated tab 0.9 mg...............12PREMARIN – estrogens, conjugated tab 1.25 mg.............12PREMARIN – estrogens, conjugated vaginal cream 0.625mg/gm................................................................................ 32

PREMPHASE – conj est 0.625(14)/conj est-medroxyproac tab 0.625-5mg(14)........................................................12

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.3-1.5 mg......................................................12

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.45-1.5 mg....................................................12

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-2.5 mg..................................................12

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-5 mg.....................................................12

PRENAPLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg...................................................................................... 49

PRENATABS FA – prenatal vit w/ fe fumarate-fa tab 29-1mg...................................................................................... 49

PRENATABS RX – prenatal vit w/ iron carbonyl-fa tab 29-1mg...................................................................................... 49

PRENATAL PLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg...................................................................................... 49

2016


PRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab29-1 mg..............................................................................49

PRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg..............................................................................49

PRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap106.5-1 mg........................................................................ 49

PREZCOBIX – darunavir-cobicistat tab 800-150 mg...........5PREZISTA – darunavir ethanolate susp 100 mg/ml (baseequiv)....................................................................................5

PREZISTA – darunavir ethanolate tab 75 mg (baseequiv)....................................................................................5




PRIFTIN – rifapentine tab 150 mg....................................... 3PRIMAQUINE PHOSPHATE – primaquine phosphate tab26.3 mg (15 mg base)........................................................ 7

primidone tab 50 mg (Mysoline)..................................... 47primidone tab 250 mg (Mysoline)................................... 47PROAIR HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 28

PROAIR RESPICLICK – albuterol sulfate aer pow ba 108mcg/act (90 mcg base equiv)........................................... 28

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.....................................36PROCRIT – epoetin alfa inj 2000 unit/ml...........................51PROCRIT – epoetin alfa inj 3000 unit/ml...........................51PROCRIT – epoetin alfa inj 4000 unit/ml...........................51PROCRIT – epoetin alfa inj 10000 unit/ml.........................52PROCRIT – epoetin alfa inj 20000 unit/ml.........................52PROCRIT – epoetin alfa inj 40000 unit/ml.........................52progesterone micronized cap 100 mg(Prometrium).................................................................... 12

progesterone micronized cap 200 mg(Prometrium).................................................................... 12

PROLIA – denosumab inj 60 mg/ml...................................17promethazine hcl suppos 12.5 mg................................. 26promethazine hcl suppos 25 mg.................................... 26promethazine hcl suppos 50 mg.................................... 26promethazine hcl syrup 6.25 mg/5ml............................. 26promethazine hcl tab 12.5 mg.........................................26promethazine hcl tab 25 mg............................................26promethazine hcl tab 50 mg............................................26propafenone hcl cap sr 12hr 225 mg (Rythmol sr)....... 24propafenone hcl cap sr 12hr 325 mg (Rythmol sr)....... 24propafenone hcl cap sr 12hr 425 mg (Rythmol sr)....... 24propafenone hcl tab 300 mg........................................... 24propafenone hcl tab 150 mg (Rythmol)......................... 24propafenone hcl tab 225 mg (Rythmol)......................... 24

PROPANTHELINE BROMIDE – propantheline bromidetab 15 mg.......................................................................... 29

PROPRANOLOL/HYDROCHLOROTH – propranolol &hydrochlorothiazide tab 40-25 mg.................................... 20

PROPRANOLOL/HYDROCHLOROTH – propranolol &hydrochlorothiazide tab 80-25 mg.................................... 20

propranolol hcl cap sr 24hr 60 mg (Inderal la)..............20propranolol hcl cap sr 24hr 80 mg (Inderal la)..............20propranolol hcl cap sr 24hr 120 mg (Inderal la)............20propranolol hcl cap sr 24hr 160 mg (Inderal la)............20PROPRANOLOL HCL – propranolol hcl oral soln 20mg/5ml............................................................................... 20

PROPRANOLOL HCL – propranolol hcl oral soln 40mg/5ml............................................................................... 20

propranolol hcl tab 10 mg............................................... 20propranolol hcl tab 20 mg............................................... 20propranolol hcl tab 40 mg............................................... 20propranolol hcl tab 60 mg............................................... 20propranolol hcl tab 80 mg............................................... 20propylthiouracil tab 50 mg.............................................. 16protriptyline hcl tab 5 mg (Vivactil)................................ 35protriptyline hcl tab 10 mg (Vivactil).............................. 35PULMOZYME – dornase alfa inhal soln 1 mg/ml.............. 28PURIXAN – mercaptopurine susp 2000 mg/100ml (20 mg/ml)........................................................................................ 9

pyrazinamide tab 500 mg...................................................3pyridostigmine bromide tab 60 mg (Mestinon)............. 49Q

quetiapine fumarate tab 25 mg (Seroquel).................... 36quetiapine 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).................. 36quinapril hcl tab 5 mg (Accupril).................................... 18quinapril hcl tab 10 mg (Accupril).................................. 18quinapril hcl tab 20 mg (Accupril).................................. 18quinapril hcl tab 40 mg (Accupril).................................. 18quinapril-hydrochlorothiazide tab 10-12.5 mg(Accuretic)........................................................................ 18

quinapril-hydrochlorothiazide tab 20-12.5 mg(Accuretic)........................................................................ 18

quinapril-hydrochlorothiazide tab 20-25 mg(Accuretic)........................................................................ 18

quinidine gluconate tab cr 324 mg.................................24QUINIDINE SULFATE ER – quinidine sulfate tab cr 300mg...................................................................................... 24

QUINIDINE SULFATE – quinidine sulfate tab 200 mg.......24quinidine sulfate tab 300 mg...........................................24quinine sulfate cap 324 mg (Qualaquin).......................... 7QVAR – beclomethasone diprop inhal aero soln 40 mcg/act (50/valve).....................................................................28

QVAR – beclomethasone diprop inhal aero soln 80 mcg/act (100/valve)...................................................................28

2016


Rrabeprazole sodium ec tab 20 mg (Aciphex).................29raloxifene hcl tab 60 mg (Evista)....................................17ramipril cap 1.25 mg (Altace).......................................... 18ramipril cap 2.5 mg (Altace)............................................ 18ramipril cap 5 mg (Altace)............................................... 18ramipril cap 10 mg (Altace)............................................. 18ranitidine hcl cap 150 mg................................................ 29ranitidine hcl cap 300 mg................................................ 29ranitidine hcl syrup 15 mg/ml (75 mg/5ml).................... 29ranitidine hcl tab 150 mg (Zantac)..................................30ranitidine hcl tab 300 mg (Zantac)..................................30RAPAMUNE – sirolimus oral soln 1 mg/ml........................ 60REBIF – 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................................. 39

RELENZA DISKHALER – zanamivir aero powder breathactivated 5 mg/blister.......................................................... 6

RENVELA – sevelamer carbonate packet 0.8 gm.............31RENVELA – sevelamer carbonate packet 2.4 gm.............31RENVELA – sevelamer carbonate tab 800 mg..................31repaglinide tab 0.5 mg (Prandin).................................... 15repaglinide tab 1 mg (Prandin)....................................... 15repaglinide tab 2 mg (Prandin)....................................... 15REPRONEX – menotropins for inj 75 unit......................... 13RESCRIPTOR – delavirdine mesylate tab 100 mg..............5RESCRIPTOR – delavirdine mesylate tab 200 mg..............5REVLIMID – lenalidomide cap 5 mg..................................60REVLIMID – lenalidomide cap 10 mg................................60REVLIMID – lenalidomide cap 15 mg................................60REVLIMID – lenalidomide cap 20 mg................................60REVLIMID – lenalidomide cap 25 mg................................60REVLIMID – lenalidomide caps 2.5 mg............................. 60REYATAZ – atazanavir sulfate cap 150 mg (baseequiv)....................................................................................6

REYATAZ – atazanavir sulfate cap 200 mg (baseequiv)....................................................................................6

REYATAZ – atazanavir sulfate cap 300 mg (baseequiv)....................................................................................6

REYATAZ – atazanavir sulfate oral powder packet 50 mg(base equiv).........................................................................6

ribavirin cap 200 mg (Rebetol)..........................................4ribavirin tab 200 mg (Copegus)........................................ 4rifabutin cap 150 mg (Mycobutin).....................................3RIFAMATE – isoniazid & rifampin cap 150-300 mg.............3rifampin cap 150 mg (Rifadin)...........................................3

rifampin cap 300 mg (Rifadin)...........................................3riluzole tab 50 mg (Rilutek)............................................. 49rimantadine hydrochloride tab 100 mg (Flumadine)...... 6risedronate sodium tab 5 mg (Actonel)......................... 17risedronate sodium tab 30 mg (Actonel)....................... 17risedronate sodium tab 35 mg (Actonel)....................... 17risedronate sodium tab 150 mg (Actonel)..................... 17risperidone 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).................................36risperidone tab 1 mg (Risperdal)....................................36risperidone tab 2 mg (Risperdal)....................................36risperidone tab 3 mg (Risperdal)....................................36risperidone tab 4 mg (Risperdal)....................................36rivastigmine tartrate cap 1.5 mg (Exelon)......................40rivastigmine tartrate cap 3 mg (Exelon).........................40rivastigmine tartrate cap 4.5 mg (Exelon)......................40rivastigmine tartrate cap 6 mg (Exelon).........................40rizatriptan benzoate orally disintegrating tab 5 mg(Maxalt-mlt).......................................................................45

rizatriptan benzoate orally disintegrating tab 10 mg(Maxalt-mlt).......................................................................45

rizatriptan benzoate tab 5 mg (Maxalt)...........................45rizatriptan benzoate tab 10 mg (Maxalt).........................45ropinirole hydrochloride tab 0.25 mg (Requip)............. 48ropinirole hydrochloride tab 0.5 mg (Requip)............... 48ropinirole hydrochloride tab 1 mg (Requip).................. 48ropinirole hydrochloride tab 2 mg (Requip).................. 48ropinirole hydrochloride tab 3 mg (Requip).................. 48ropinirole hydrochloride tab 4 mg (Requip).................. 48ropinirole hydrochloride tab 5 mg (Requip).................. 48ropinirole hydrochloride tab sr 24hr 2 mg (baseequivalent) (Requip xl)................................................... 48

ropinirole hydrochloride tab sr 24hr 4 mg (baseequivalent) (Requip xl)................................................... 48



ropinirole hydrochloride tab sr 24hr 12 mg (baseequivalent) (Requip xl)................................................... 48S

SABRIL – vigabatrin powd pack 500 mg........................... 47SABRIL – vigabatrin tab 500 mg........................................47

2016


salsalate tab 500 mg.........................................................40salsalate tab 750 mg.........................................................40SANDIMMUNE – cyclosporine cap 25 mg.........................60SANDIMMUNE – cyclosporine cap 100 mg.......................60SANDIMMUNE – cyclosporine oral soln 100 mg/ml..........60selegiline hcl cap 5 mg (Eldepryl).................................. 48selegiline hcl tab 5 mg.....................................................48selenium sulfide lotion 2.5%........................................... 58SELZENTRY – maraviroc tab 150 mg................................. 6SELZENTRY – maraviroc tab 300 mg................................. 6SENSIPAR – cinacalcet hcl tab 30 mg (base equiv)..........17SENSIPAR – cinacalcet hcl tab 60 mg (base equiv)..........17SENSIPAR – cinacalcet hcl tab 90 mg (base equiv)..........17SEREVENT DISKUS – salmeterol xinafoate aer pow ba50 mcg/dose (base equiv)................................................ 28

SEROQUEL XR – quetiapine fumarate tab sr 24hr 50mg...................................................................................... 36





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)............................. 25silver sulfadiazine cream 1% (Silvadene)...................... 56SIMBRINZA – brinzolamide-brimonidine tartrate ophthsusp 1-0.2%.......................................................................53

SIMPONI – 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).......................................... 23simvastatin tab 10 mg (Zocor)........................................ 23simvastatin tab 20 mg (Zocor)........................................ 23simvastatin tab 40 mg (Zocor)........................................ 23simvastatin tab 80 mg (Zocor)........................................ 23sirolimus tab 0.5 mg (Rapamune)...................................60sirolimus tab 1 mg (Rapamune)......................................60sirolimus tab 2 mg (Rapamune)......................................60SIVEXTRO – tedizolid phosphate tab 200 mg.....................7sodium citrate & citric acid soln 500-334 mg/5ml(Shohls solution modi)................................................... 32

sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)(Luride)..............................................................................50

sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)(Luride)..............................................................................50

sodium fluoride chew tab 1 mg f (from 2.2 mg naf)(Luride)..............................................................................50

sodium fluoride cream 1.1% (Prevident 5000 plus)...... 54sodium fluoride gel 1.1% (0.5% f) (Previdentfluoride).............................................................................54

SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from1.1 mg naf)........................................................................ 50

SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from2.2 mg naf)........................................................................ 50

sodium fluoride soln 0.125 mg/drop f (0.275 mg/dropnaf).....................................................................................50

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)(Luride)..............................................................................50

sodium phenylbutyrate oral powder 3 gm/teaspoonful(Buphenyl)........................................................................ 17

sodium polystyrene sulfonate oral susp 15 gm/60ml(Sps).................................................................................. 60

sodium polystyrene sulfonate powder(Kayexalate)......................................................................60

sodium polystyrene sulfonate rectal susp 30gm/120ml...........................................................................60

SOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml (baseequivalent)............................................................................9

sotalol 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...................................... 4SPIRIVA HANDIHALER – tiotropium bromidemonohydrate inhal cap 18 mcg (base equiv)................... 28

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act................................................28

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act..................................................28

spironolactone & hydrochlorothiazide tab 25-25 mg(Aldactazide).....................................................................24

spironolactone tab 25 mg (Aldactone)...........................24spironolactone tab 50 mg (Aldactone)...........................24spironolactone tab 100 mg (Aldactone).........................24SPORANOX – itraconazole oral soln 10 mg/ml...................4SPRYCEL – dasatinib tab 20 mg.........................................9SPRYCEL – dasatinib tab 50 mg.........................................9SPRYCEL – dasatinib tab 70 mg.........................................9SPRYCEL – dasatinib tab 80 mg.........................................9SPRYCEL – dasatinib tab 100 mg.......................................9SPRYCEL – dasatinib tab 140 mg.......................................9SSKI – potassium iodide soln 1 gm/ml......................... 26,50stavudine cap 15 mg (Zerit)...............................................6stavudine cap 20 mg (Zerit)...............................................6stavudine cap 30 mg (Zerit)...............................................6stavudine cap 40 mg (Zerit)...............................................6stavudine for oral soln 1 mg/ml (Zerit)............................ 6

2016


STELARA – ustekinumab soln prefilled syringe 45mg/0.5ml............................................................................ 58

STELARA – ustekinumab soln prefilled syringe 90 mg/ml........................................................................................58

STIMATE – desmopressin acetate nasal soln 1.5 mg/ml........................................................................................17

STIVARGA – regorafenib tab 40 mg....................................9STRATTERA – atomoxetine hcl cap 10 mg (baseequiv)................................................................................. 38

STRATTERA – atomoxetine hcl cap 18 mg (baseequiv)................................................................................. 38






STRIBILD – elvitegrav-cobicis-emtricitab-tenofov tab150-150-200-300 mg...........................................................6

SUBOXONE – buprenorphine hcl-naloxone hcl sl film2-0.5 mg (base equiv).......................................................61

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 4-1mg (base equiv)................................................................ 61



sucralfate tab 1 gm (Carafate).........................................30sulfacetamide sodium lotion 10% (acne) (Klaron)........55sulfacetamide sodium ophth soln 10% (Bleph-10)....... 52sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%.................................................................. 52

sulfacetamide sodium w/ sulfur cleanser 10-2% (Avarls cleanser).......................................................................55

sulfacetamide sodium w/ sulfur cleansing cloth10-5%.................................................................................55

sulfacetamide sodium w/ sulfur cleansing pad 10-4%(Sumaxin)..........................................................................55

sulfacetamide sodium w/ sulfur cream 10-5%.............. 55sulfacetamide sodium w/ sulfur cream 10-2% (Avar-els)....................................................................................... 55

sulfacetamide sodium w/ sulfur emulsion 10-1%......... 55sulfacetamide sodium w/ sulfur emulsion 10-5%......... 55sulfacetamide sodium w/ sulfur foam 10-5% (Clarifoamef)....................................................................................... 55

sulfacetamide sodium w/ sulfur lotion 10-5%............... 55sulfacetamide sodium w/ sulfur susp 8-4% (Sumaxints)....................................................................................... 55

sulfacetamide sodium w/ sulfur wash 9-4.5%(Sumadan wash)..............................................................55

sulfacetamide sodium w/ sulfur wash 9-4% (Sumaxinwash)................................................................................. 55

sulfacetamide sod-sulfur wash 9-4.5% & skin cleanserkit (Sumadan kit)............................................................. 55

sulfamethoxazole-trimethoprim susp 200-40mg/5ml.................................................................................7

sulfamethoxazole-trimethoprim tab 400-80 mg(Bactrim)............................................................................. 7

sulfamethoxazole-trimethoprim tab 800-160 mg(Bactrim ds)........................................................................7

sulfasalazine tab delayed release 500 mg (Azulfidineen-tabs)............................................................................. 31

sulfasalazine tab 500 mg (Azulfidine)............................ 31sulindac tab 150 mg......................................................... 44sulindac tab 200 mg......................................................... 44sumatriptan succinate inj 6 mg/0.5ml (Imitrex).............45sumatriptan succinate solution auto-injector 4mg/0.5ml (Imitrex statdose sys)....................................45

sumatriptan succinate solution auto-injector 6mg/0.5ml (Imitrex statdose sys)....................................45

sumatriptan succinate solution cartridge 4 mg/0.5ml(Imitrex statdose ref)...................................................... 45

sumatriptan succinate solution cartridge 6 mg/0.5ml(Imitrex statdose ref)...................................................... 45

SUMATRIPTAN SUCCINATE – sumatriptan succinate inj 4mg/0.5ml............................................................................ 45

SUMATRIPTAN SUCCINATE – sumatriptan succinatesolution prefilled syringe 6 mg/0.5ml................................45

sumatriptan succinate tab 25 mg (Imitrex)....................45sumatriptan succinate tab 50 mg (Imitrex)....................45sumatriptan succinate tab 100 mg (Imitrex)..................45SUPRAX – cefixime cap 400 mg......................................... 2SUPRAX – cefixime chew tab 100 mg................................ 2SUPRAX – cefixime chew tab 200 mg................................ 2SUPRAX – cefixime for susp 100 mg/5ml........................... 2SUPRAX – cefixime for susp 200 mg/5ml........................... 2SUPRAX – cefixime for susp 500 mg/5ml........................... 2SUSTIVA – efavirenz cap 50 mg......................................... 6SUSTIVA – efavirenz cap 200 mg....................................... 6SUSTIVA – efavirenz tab 600 mg........................................ 6SUTENT – sunitinib malate cap 12.5 mg (baseequivalent)............................................................................9

SUTENT – sunitinib malate cap 25 mg (baseequivalent)............................................................................9

SUTENT – sunitinib malate cap 37.5 mg (baseequivalent)............................................................................9

SUTENT – sunitinib malate cap 50 mg (baseequivalent)............................................................................9

SYLATRON – peginterferon alfa-2b for inj kit 200 mcg....... 9SYLATRON – peginterferon alfa-2b for inj kit 300 mcg....... 9SYLATRON – peginterferon alfa-2b for inj kit 600 mcg....... 9SYMBICORT – budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act..................................................... 28

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act................................................... 28

TTABLOID – thioguanine tab 40 mg...................................... 9

2016


tacrolimus cap 0.5 mg (Prograf)..................................... 61tacrolimus cap 1 mg (Prograf)........................................ 61tacrolimus cap 5 mg (Prograf)........................................ 61tacrolimus oint 0.03% (Protopic).................................... 58tacrolimus oint 0.1% (Protopic)...................................... 58TAFINLAR – dabrafenib mesylate cap 50 mg (baseequivalent)............................................................................9

TAFINLAR – dabrafenib mesylate cap 75 mg (baseequivalent)............................................................................9

TAMIFLU – oseltamivir phosphate cap 30 mg (baseequiv)....................................................................................6



TAMIFLU – oseltamivir phosphate for susp 6 mg/ml (baseequiv)....................................................................................6

tamoxifen citrate tab 10 mg (base equivalent)................9tamoxifen citrate tab 20 mg (base equivalent)................9tamsulosin hcl cap 0.4 mg (Flomax).............................. 32TARCEVA – erlotinib hcl tab 25 mg (base equivalent).........9TARCEVA – erlotinib hcl tab 100 mg (base equivalent).......9TARCEVA – erlotinib hcl tab 150 mg (base equivalent).......9TASIGNA – nilotinib hcl cap 150 mg (base equivalent)..... 10TASIGNA – nilotinib hcl cap 200 mg (base equivalent)..... 10TAZORAC – tazarotene cream 0.05%...............................55TAZORAC – tazarotene cream 0.1%.................................55TAZORAC – tazarotene gel 0.05%.................................... 55TAZORAC – tazarotene gel 0.1%...................................... 55TECFIDERA – dimethyl fumarate capsule delayed release120 mg...............................................................................39

TECFIDERA – dimethyl fumarate capsule delayed release240 mg...............................................................................39

TECFIDERA STARTER PACK – dimethyl fumaratecapsule dr starter pack 120 mg & 240 mg....................... 39

TEGRETOL-XR – carbamazepine tab sr 12hr 100 mg......47telmisartan-amlodipine tab 40-5 mg (Twynsta)............. 22telmisartan-amlodipine tab 80-5 mg (Twynsta)............. 22telmisartan-amlodipine tab 40-10 mg (Twynsta)........... 22telmisartan-amlodipine tab 80-10 mg (Twynsta)........... 22telmisartan-hydrochlorothiazide tab 40-12.5 mg(Micardis hct)................................................................... 19

telmisartan-hydrochlorothiazide tab 80-12.5 mg(Micardis hct)................................................................... 19

telmisartan-hydrochlorothiazide tab 80-25 mg(Micardis hct)................................................................... 19

telmisartan tab 20 mg (Micardis).................................... 19telmisartan tab 40 mg (Micardis).................................... 19telmisartan tab 80 mg (Micardis).................................... 19temazepam 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)................................ 10temozolomide cap 20 mg (Temodar)..............................10temozolomide cap 100 mg (Temodar)............................10

temozolomide cap 140 mg (Temodar)............................10temozolomide cap 180 mg (Temodar)............................10temozolomide cap 250 mg (Temodar)............................10terazosin hcl cap 1 mg.....................................................25terazosin hcl cap 2 mg.....................................................25terazosin hcl cap 5 mg.....................................................25terazosin hcl cap 10 mg...................................................25terbinafine hcl tab 250 mg (Lamisil).................................4terbutaline sulfate tab 2.5 mg......................................... 28terbutaline sulfate tab 5 mg............................................ 28terconazole vaginal cream 0.4% (Terazol 7).................. 32terconazole vaginal cream 0.8% (Terazol 3).................. 32terconazole vaginal suppos 80 mg.................................32testosterone td gel 12.5 mg/act (1%) (Androgelpump)................................................................................ 11

testosterone td gel 25 mg/2.5gm (1%) (Androgel)........ 11testosterone td gel 50 mg/5gm (1%) (Androgel)........... 11tetrabenazine tab 12.5 mg (Xenazine)............................ 40tetrabenazine tab 25 mg (Xenazine)............................... 40TETRACYCLINE HCL – tetracycline hcl cap 250 mg..........3TETRACYCLINE HCL – tetracycline hcl cap 500 mg..........3THALOMID – thalidomide cap 50 mg................................ 61THALOMID – thalidomide cap 100 mg.............................. 61THALOMID – thalidomide cap 150 mg.............................. 61THALOMID – thalidomide cap 200 mg.............................. 61theophylline soln 80 mg/15ml......................................... 28theophylline tab sr 12hr 100 mg.....................................28theophylline tab sr 12hr 200 mg.....................................28theophylline tab sr 12hr 300 mg.....................................28theophylline tab sr 12hr 450 mg.....................................28theophylline tab sr 24hr 400 mg.....................................28theophylline tab sr 24hr 600 mg.....................................28thiothixene cap 1 mg........................................................37thiothixene cap 2 mg........................................................37thiothixene cap 5 mg........................................................37thiothixene cap 10 mg......................................................37tiagabine hcl tab 2 mg (Gabitril)..................................... 47tiagabine hcl tab 4 mg (Gabitril)..................................... 47timolol maleate ophth gel forming soln 0.25%(Timoptic-xe).................................................................... 53

timolol maleate ophth gel forming soln 0.5%(Timoptic-xe).................................................................... 53

timolol maleate ophth soln 0.25% (Timoptic)................53timolol maleate ophth soln 0.5% (Timoptic)..................53TIMOLOL MALEATE – timolol maleate tab 5 mg.............. 20TIMOLOL MALEATE – timolol maleate tab 10 mg............ 20TIMOLOL MALEATE – timolol maleate tab 20 mg............ 20tinidazole tab 250 mg (Tindamax).....................................7tinidazole tab 500 mg (Tindamax).....................................7TIVICAY – dolutegravir sodium tab 50 mg (base equiv)...... 6tizanidine hcl cap 2 mg (base equivalent)(Zanaflex).......................................................................... 49

tizanidine hcl cap 4 mg (base equivalent)(Zanaflex).......................................................................... 49

tizanidine hcl cap 6 mg (base equivalent)(Zanaflex).......................................................................... 49

2016


tizanidine hcl tab 2 mg (base equivalent)......................49tizanidine hcl tab 4 mg (base equivalent)(Zanaflex).......................................................................... 49

tobramycin-dexamethasone ophth susp 0.3-0.1%(Tobradex).........................................................................53

tobramycin nebu soln 300 mg/5ml (Tobi)........................ 3tobramycin ophth soln 0.3% (Tobrex)............................ 52TOBREX – tobramycin ophth oint 0.3%.............................52tolazamide tab 250 mg..................................................... 15tolmetin sodium cap 400 mg...........................................44tolterodine 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)..... 47topiramate sprinkle cap 25 mg (Topamax sprinkle)..... 47topiramate tab 25 mg (Topamax).................................... 47topiramate tab 50 mg (Topamax).................................... 47topiramate tab 100 mg (Topamax).................................. 47topiramate tab 200 mg (Topamax).................................. 47torsemide tab 5 mg (Demadex).......................................24torsemide tab 10 mg (Demadex).....................................24torsemide tab 20 mg (Demadex).....................................24torsemide tab 100 mg (Demadex)...................................24TOUJEO SOLOSTAR – insulin glargine soln pen-injector300 unit/ml......................................................................... 15

TRACLEER – bosentan tab 62.5 mg.................................25TRACLEER – bosentan tab 125 mg..................................25tramadol-acetaminophen tab 37.5-325 mg(Ultracet)........................................................................... 43

tramadol hcl tab 50 mg (Ultram).....................................43tramadol hcl tab sr 24hr biphasic release 100 mg........43tramadol hcl tab sr 24hr biphasic release 200 mg........43tramadol hcl tab sr 24hr biphasic release 300 mg........43tramadol hcl tab sr 24hr 100 mg (Ultram er)................. 43tramadol hcl tab sr 24hr 200 mg (Ultram er)................. 43tramadol hcl tab sr 24hr 300 mg (Ultram er)................. 43trandolapril tab 1 mg (Mavik).......................................... 18trandolapril tab 2 mg (Mavik).......................................... 18trandolapril tab 4 mg (Mavik).......................................... 18tranexamic acid tab 650 mg (Lysteda)........................... 52TRANSDERM-SCOP – scopolamine td patch 72hr 1mg/3days............................................................................30

tranylcypromine sulfate tab 10 mg (Parnate)................35TRAVATAN Z – travoprost ophth soln 0.004%(benzalkonium free) (bak free)......................................... 53

trazodone hcl tab 50 mg.................................................. 35trazodone hcl tab 100 mg................................................ 35trazodone hcl tab 150 mg................................................ 35trazodone hcl tab 300 mg................................................ 35tretinoin cap 10 mg...........................................................10tretinoin cream 0.025% (Retin-a).....................................55tretinoin cream 0.05% (Retin-a).......................................55tretinoin cream 0.1% (Retin-a).........................................55tretinoin gel 0.025%, (Retin-a).........................................55tretinoin gel 0.05% (Atralin).............................................55

tretinoin gel 0.01% (Retin-a)............................................ 55tretinoin microsphere gel 0.04% (Retin-a micro).......... 55tretinoin microsphere gel 0.1% (Retin-a micro)............ 55triamcinolone acetonide cream 0.025%......................... 57triamcinolone acetonide cream 0.1%............................. 57triamcinolone acetonide cream 0.5%............................. 57triamcinolone acetonide dental paste 0.1%.................. 54triamcinolone acetonide lotion 0.025%..........................57triamcinolone acetonide lotion 0.1%..............................57triamcinolone acetonide nasal aerosol suspension 55mcg/act (Nasacort aq).................................................... 26

triamcinolone acetonide oint 0.025%............................. 57triamcinolone acetonide oint 0.1%................................. 57TRIAMCINOLONE ACETONIDE – triamcinoloneacetonide oint 0.5%.......................................................... 57

TRIAMTERENE/HYDROCHLOROTH – triamterene &hydrochlorothiazide cap 50-25 mg................................... 24

triamterene & hydrochlorothiazide cap 37.5-25 mg(Dyazide)........................................................................... 24

triamterene & hydrochlorothiazide tab 37.5-25 mg(Maxzide-25)..................................................................... 24

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)...........................................................................24

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)............................... 52trihexyphenidyl hcl elixir 0.4 mg/ml............................... 48trihexyphenidyl hcl tab 2 mg...........................................48trihexyphenidyl hcl tab 5 mg...........................................48trimethobenzamide hcl cap 300 mg (Tigan).................. 30trimethoprim tab 100 mg................................................... 7TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1 mg...... 49TRIUMEQ – abacavir-dolutegravir-lamivudine tab600-50-300 mg.................................................................... 6

TRI-VIT/FLUORIDE/IRON – pediatric vitamins acd fluoride& fe drops 0.25-10 mg/ml................................................. 49

tropicamide ophth soln 0.5%.......................................... 54tropicamide ophth soln 1% (Mydriacyl)......................... 54trospium chloride cap sr 24hr 60 mg.............................32trospium chloride tab 20 mg (Sanctura)........................ 32TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 200-300 mg................................................................... 6

TYBOST – cobicistat tab 150 mg.........................................6TYKERB – lapatinib ditosylate tab 250 mg (baseequiv)................................................................................. 10

Uursodiol cap 300 mg (Actigall)........................................31ursodiol tab 250 mg (Urso 250)...................................... 31ursodiol tab 500 mg (Urso forte).................................... 31V

VAGIFEM – estradiol vaginal tab 10 mcg.......................... 32valacyclovir hcl tab 1 gm (Valtrex)................................... 4

2016


valacyclovir hcl tab 500 mg (Valtrex)............................... 4VALCHLOR – mechlorethamine hcl gel 0.016% (baseequivalent)......................................................................... 58

VALCYTE – valganciclovir hcl for soln 50 mg/ml (baseequiv)....................................................................................4

valganciclovir hcl tab 450 mg (base equivalent)(Valcyte).............................................................................. 4

valproate sodium syrup 250 mg/5ml (base equiv)(Depakene)........................................................................47

valproic acid cap 250 mg (Depakene)............................47valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovanhct).....................................................................................19

valsartan-hydrochlorothiazide tab 160-12.5 mg (Diovanhct).....................................................................................19

valsartan-hydrochlorothiazide tab 160-25 mg (Diovanhct).....................................................................................19

valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovanhct).....................................................................................19

valsartan-hydrochlorothiazide tab 320-25 mg (Diovanhct).....................................................................................19

valsartan tab 40 mg (Diovan).......................................... 19valsartan tab 80 mg (Diovan).......................................... 19valsartan tab 160 mg (Diovan)........................................ 19valsartan tab 320 mg (Diovan)........................................ 19vancomycin hcl cap 125 mg (Vancocin hcl)....................7vancomycin hcl cap 250 mg (Vancocin hcl)....................7venlafaxine 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

VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 28

verapamil hcl cap sr 24hr 120 mg (Verelan).................. 22verapamil hcl cap sr 24hr 180 mg (Verelan).................. 22verapamil hcl cap sr 24hr 240 mg (Verelan).................. 22verapamil hcl cap sr 24hr 360 mg (Verelan).................. 22verapamil hcl cap sr 24hr 100 mg (Verelan pm)............22verapamil hcl cap sr 24hr 200 mg (Verelan pm)............22verapamil hcl cap sr 24hr 300 mg (Verelan pm)............22verapamil hcl tab cr 120 mg (Calan sr)..........................22verapamil hcl tab cr 180 mg (Calan sr)..........................22verapamil hcl tab cr 240 mg (Calan sr)..........................22verapamil hcl tab 80 mg (Calan).....................................22

verapamil hcl tab 120 mg (Calan)...................................22VERAPAMIL HCL – verapamil hcl tab 40 mg.................... 22VESICARE – solifenacin succinate tab 5 mg.................... 32VESICARE – solifenacin succinate tab 10 mg...................32VIAGRA – sildenafil citrate tab 25 mg............................... 25VIAGRA – sildenafil citrate tab 50 mg............................... 25VIAGRA – sildenafil citrate tab 100 mg............................. 25VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)...................................................................................... 15

VIDEX – didanosine for soln 2 gm.......................................6VIDEX – didanosine for soln 4 gm.......................................6VIGAMOX – moxifloxacin hcl ophth soln 0.5% (baseequiv)................................................................................. 52

VINACAL B – prenat w/o a w/fecbn-feglu-fa tab 20-1 mg &vit b6 tab pak.................................................................... 49

VINATE AZ EXTRA – prenatal vit w/ fe bisglycinatechelate-fa tab 29-1 mg......................................................49

VINATE CALCIUM – prenatal vit w/ iron carbonyl-fe gluc-fa tab 27-1 mg...................................................................49

VINATE CARE – prenatal w/o a vit w/ fe fum-fa tab chew40-1 mg..............................................................................49

VINATE C – prenatal w/o a vit w/ fe fumarate-fa tab 30-1mg...................................................................................... 49

VINATE DHA RF – prenat w/o a w/fefum-methylfol-omegas cap 27-1.13 mg...................................................49

VINATE IC – prenatal w/o a w/fe fum-fe poly-fa cap162.115.2-1 mg..................................................................49

VINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab29-1 mg..............................................................................49

VINATE M – prenatal vit w/ sel-fe fumarate-fa tab 27-1mg...................................................................................... 49

VINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1mg...................................................................................... 49

VIRACEPT – nelfinavir mesylate tab 250 mg...................... 6VIRACEPT – nelfinavir mesylate tab 625 mg...................... 6VIRAMUNE – nevirapine susp 50 mg/5ml...........................6VIRAMUNE XR – nevirapine tab sr 24hr 100 mg................6VIREAD – tenofovir disoproxil fumarate oral powder 40mg/gm.................................................................................. 6

VIREAD – tenofovir disoproxil fumarate tab 150 mg........... 6VIREAD – tenofovir disoproxil fumarate tab 200 mg........... 6VIREAD – tenofovir disoproxil fumarate tab 250 mg........... 6VIREAD – tenofovir disoproxil fumarate tab 300 mg........... 6VITEKTA – elvitegravir tab 85 mg........................................6VITEKTA – elvitegravir tab 150 mg......................................6VOLTAREN – diclofenac sodium gel 1%........................... 58voriconazole for susp 40 mg/ml (Vfend)..........................4voriconazole tab 50 mg (Vfend)........................................4voriconazole tab 200 mg (Vfend)......................................4VOTRIENT – pazopanib hcl tab 200 mg (base equiv).......10VYVANSE – 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...... 39

2016


VYVANSE – lisdexamfetamine dimesylate cap 70 mg...... 39

Wwarfarin sodium tab 1 mg (Coumadin).......................... 52warfarin sodium tab 2 mg (Coumadin).......................... 52warfarin sodium tab 2.5 mg (Coumadin)....................... 52warfarin sodium tab 3 mg (Coumadin).......................... 52warfarin sodium tab 4 mg (Coumadin).......................... 52warfarin sodium tab 5 mg (Coumadin).......................... 52warfarin sodium tab 6 mg (Coumadin).......................... 52warfarin sodium tab 7.5 mg (Coumadin)....................... 52warfarin sodium tab 10 mg (Coumadin)........................ 52WELCHOL – colesevelam hcl packet for susp 3.75gm...................................................................................... 23

WELCHOL – colesevelam hcl tab 625 mg........................ 23

XXALKORI – crizotinib cap 200 mg..................................... 10XALKORI – crizotinib cap 250 mg..................................... 10XARELTO – rivaroxaban tab 10 mg...................................52XARELTO – rivaroxaban tab 15 mg...................................52XARELTO – rivaroxaban tab 20 mg...................................52XARELTO STARTER PACK – rivaroxaban tab startertherapy pack 15 mg & 20 mg...........................................52

XIFAXAN – rifaximin tab 550 mg......................................... 7XTANDI – enzalutamide cap 40 mg...................................10XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr............................................................................ 13

Y

Zzafirlukast tab 10 mg (Accolate)..................................... 28zafirlukast tab 20 mg (Accolate)..................................... 28zaleplon cap 5 mg (Sonata).............................................37zaleplon cap 10 mg (Sonata)...........................................37ZELBORAF – vemurafenib tab 240 mg............................. 10ZENPEP – pancrelipase (lip-prot-amyl) dr cap3000-10000-16000 unit..................................................... 30

ZENPEP – pancrelipase (lip-prot-amyl) dr cap5000-17000-27000 unit..................................................... 30

ZENPEP – pancrelipase (lip-prot-amyl) dr cap10000-34000-55000 unit...................................................30

ZENPEP – pancrelipase (lip-prot-amyl) dr cap15000-51000-82000 unit...................................................30

ZENPEP – pancrelipase (lip-prot-amyl) dr cap20000-68000-109000 unit.................................................30

ZENPEP – pancrelipase (lip-prot-amyl) dr cap25000-85000-136000 unit.................................................30

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-136000-218000 unit...............................................30

ZIAGEN – abacavir sulfate soln 20 mg/ml (base equiv)...... 6zidovudine cap 100 mg (Retrovir).....................................6zidovudine syrup 10 mg/ml (Retrovir)..............................6zidovudine tab 300 mg.......................................................6ziprasidone hcl cap 20 mg (Geodon)............................. 37

ziprasidone hcl cap 40 mg (Geodon)............................. 37ziprasidone hcl cap 60 mg (Geodon)............................. 37ziprasidone hcl cap 80 mg (Geodon)............................. 37ZOLINZA – vorinostat cap 100 mg.................................... 10zolmitriptan orally disintegrating tab 2.5 mg (Zomigzmt)....................................................................................45

zolmitriptan orally disintegrating tab 5 mg (Zomigzmt)....................................................................................45

zolmitriptan tab 2.5 mg (Zomig)......................................45zolmitriptan tab 5 mg (Zomig).........................................45zolpidem 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..................................................... 47zonisamide cap 25 mg (Zonegran)................................. 47zonisamide cap 100 mg (Zonegran)............................... 47ZORTRESS – everolimus tab 0.25 mg.............................. 61ZORTRESS – everolimus tab 0.5 mg................................ 61ZORTRESS – everolimus tab 0.75 mg.............................. 61ZOVIA 1/50E – ethynodiol diacetate & ethinyl estradiol tab1 mg-50 mcg..................................................................... 13

ZYCLARA – imiquimod cream 3.75%................................58ZYCLARA PUMP – imiquimod cream 2.5%...................... 58ZYCLARA PUMP – imiquimod cream 3.75%.................... 58ZYDELIG – idelalisib tab 100 mg.......................................10ZYDELIG – idelalisib tab 150 mg.......................................10ZYKADIA – ceritinib cap 150 mg....................................... 10ZYLET – loteprednol etabonate-tobramycin ophth susp0.5-0.3%.............................................................................53

ZYTIGA – abiraterone acetate tab 250 mg........................10ZYVOX – linezolid for susp 100 mg/5ml.............................. 7

blue cross blue shield of wyoming standard drug list ... · blue cross blue shield of wyoming...

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