drug tier notes - premera blue cross essentials formulary (e4).pdf2 = preferred brand drugs. 3 =...
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E4- Premera Essentials Formulary
Formulary ID 3114
CURRENT AS OF 8/1/2019
lowercase italics = Generic drugsUPPERCASE BOLD = Brand name drugs
Tier1 = Preferred Generic Drugs2 = Preferred Brand Drugs3 = Preferred Specialty Drugs4 = Non Preferred Drugs (all)EX = ExcludedMB = Covered under Medical benefit.PV = Preventive Drug
NotesCN = Coverage NoteOCH = Oral Chemo DrugPA = Prior Authorization RequiredQL = Quantity Limit AppliesSP = Specialty Pharmacy Drug
Drug Tier NotesAntihistamine Drugs
ANTIVERT ORAL TABLET 12.5 MG, 25 MG 4
carbinoxamine maleate EX
CENTERGY 1
CENTERGY DM 1
cetirizine oral solution 1 mg/ml 1
CLARINEX ORAL TABLET EX
CLARINEX-D 12 HOUR EX
clemastine oral tablet EX
cyproheptadine 1
desloratadine 1
diphenhydramine hcl injection solution 50 mg/ml 1
diphenhydramine hcl injection syringe MB
diphenhydramine hcl oral capsule 50 mg 1
diphenhydramine hcl oral elixir 1
fexofenadine oral tablet 180 mg, 60 mg EX
fexofenadine-pseudoephedrine EX
HISTEX-AC 1
hydrocodone-chlorpheniramine 1
hydroxyzine hcl intramuscular solution 50 mg/ml MB
hydroxyzine hcl oral 1
hydroxyzine pamoate 1
KARBINAL ER EX
levocetirizine 1
meclizine oral tablet 12.5 mg, 25 mg 1
PHENADOZ 1
PHENERGAN RECTAL 4
promethazine injection solution25 mg/ml 4
promethazine oral 1
promethazine rectal 1
PROMETHAZINE VC 1
Drug Tier Notespromethazine-dm 1
promethazine-phenyleph-codeine 1
promethazine-phenylephrine 1
PROMETHEGAN 1
RESPA-AR 4
RYCLORA EX
RYDEX 1
RYVENT EX
SEMPREX-D EX
TUSSICAPS 4
VISTARIL 4
XYZAL ORAL TABLET EX
Anti-Infective Agents
abacavir 1
abacavir-lamivudine 4
abacavir-lamivudine-zidovudine 1
ACTICLATE EX
acyclovir oral 1
adefovir 1
AEMCOLO 4 PA
albendazole 4
ALBENZA 4
ALFERON N 4
ALINIA 4
amantadine hcl 1
amikacin injection solution 500 mg/2 ml 4
amoxicil-clarithromy-lansopraz 1
amoxicillin oral capsule 1
amoxicillin oral suspension for reconstitution 1
amoxicillin oral tablet 1
amoxicillin oral tablet,chewable125 mg, 250 mg 1
amoxicillin-pot clavulanate 1
amphotericin b 4
ampicillin oral capsule 1
ampicillin-sulbactam injection recon soln 15 gram 4
ANCOBON 4
APTIVUS 2
ARAKODA 4
ARIKAYCE MB SP
atazanavir 1
atovaquone 1
atovaquone-proguanil 1
ATRIPLA EX
AUGMENTIN ES-600 4
AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML, 250-62.5 MG/5 ML
4
AUGMENTIN ORAL TABLET500-125 MG, 875-125 MG 4
1
Drug Tier NotesAUGMENTIN XR 4
AVIDOXY EX PA
AVIDOXY DK EX
azithromycin oral 1
AZULFIDINE 4
AZULFIDINE EN-TABS 4
BACIIM 4
BACTRIM 4
BACTRIM DS 4
BARACLUDE 4
BAXDELA ORAL 4
benznidazole 4
BENZODOX 30 EX
BENZODOX 60 EX
BETHKIS 3 PA; SP
BIKTARVY 2
BILTRICIDE 4
CAPASTAT 4
CAYSTON 4 SP
cefaclor oral capsule 1
cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml
1
cefaclor oral tablet extended release 12 hr 4
cefadroxil oral capsule 1
cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml
1
cefadroxil oral tablet 1
cefdinir 1
cefditoren pivoxil 1
cefixime 1
cefpodoxime 1
cefprozil 1
cefuroxime axetil oral suspension for reconstitution 125 mg/5 ml 1
cefuroxime axetil oral tablet 1
cephalexin 1
chloroquine phosphate 1
CIMDUO 4
CIPRO ORAL SUSPENSION,MICROCAPSULE RECON
4
CIPRO ORAL TABLET 250 MG, 500 MG 4
CIPRO XR 4
ciprofloxacin 1
ciprofloxacin (mixture) 1
ciprofloxacin hcl oral 1
clarithromycin 1
CLEOCIN HCL 4
CLEOCIN PEDIATRIC 4
clindamycin hcl 1
Drug Tier Notesclindamycin palmitate hcl 1
CLINDAMYCIN PEDIATRIC 1
COARTEM 4
colistin (colistimethate na) 4
COMBIVIR 4
COMPLERA 2
COREMINO 4
CRESEMBA ORAL 4
CRIXIVAN ORAL CAPSULE200 MG, 400 MG 2
cycloserine 2
CYTOVENE MB SP
dapsone oral 1
DARAPRIM 4 SP
DELSTRIGO EX
demeclocycline 1
DESCOVY 4
dicloxacillin 1
didanosine 1
DIFICID 4
DIFLUCAN 4
DORYX MPC EX
DORYX ORAL TABLET,DELAYED RELEASE (DR/EC) 200 MG, 50 MG
EX
DOVATO ORAL TABLET 50-300 MG 2 SP
DOVATO ORAL TABLET 50-300 MG 4 SP
doxycycline hyclate oral capsule 1
doxycycline hyclate oral tablet100 mg, 150 mg, 50 mg, 75 mg 1
doxycycline hyclate oral tablet,delayed release (dr/ec)100 mg, 150 mg, 200 mg, 50 mg, 75 mg
1
doxycycline hyclate oral tablet,delayed release (dr/ec) 80 mg
EX
doxycycline monohydrate oral capsule 1
doxycycline monohydrate oral capsule,ir - delay rel,biphase EX
doxycycline monohydrate oral suspension for reconstitution 1
doxycycline monohydrate oral tablet 1
E.E.S. 400 ORAL TABLET 1
E.E.S. GRANULES 4
EDURANT 2
efavirenz 1
EMTRIVA 2
EMVERM 4
entecavir 1
EPCLUSA 3 PA; SP
EPIVIR 4
2
Drug Tier NotesEPIVIR HBV ORAL SOLUTION 2
EPIVIR HBV ORAL TABLET 4
EPZICOM 4
ERYPED 200 EX
ERYPED 400 EX
ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 250 MG, 333 MG
1
ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG
4
ERYTHROCIN (AS STEARATE) ORAL TABLET 250 MG 1
erythromycin ethylsuccinate oral suspension for reconstitution 4
erythromycin ethylsuccinate oral tablet 1
erythromycin oral capsule,delayed release(dr/ec) 1
erythromycin oral tablet 1
erythromycin stearate oral tablet250 mg 4
ethambutol 1
EVOTAZ 4
FACTIVE 4
famciclovir 1
FIRVANQ 4
FLAGYL 4
fluconazole 1
flucytosine 1
FLUMADINE ORAL TABLET 4
fosamprenavir 1
FURADANTIN 4
FUZEON SUBCUTANEOUS RECON SOLN 3 SP
ganciclovir intravenous MB SP
ganciclovir sodium intravenous recon soln MB SP
GENVOYA 2
GOCOVRI EX SP
griseofulvin microsize 1
griseofulvin ultramicrosize 4
HARVONI 3 PA; SP
HEPSERA 4
HIPREX 4
hydroxychloroquine 1
HYOPHEN 1
IMPAVIDO 4
INTELENCE 2
INTRON A INJECTION 3 SP
INVIRASE ORAL TABLET 2
ISENTRESS HD 2
ISENTRESS ORAL POWDER IN PACKET 4
ISENTRESS ORAL TABLET 2
Drug Tier NotesISENTRESS ORAL TABLET,CHEWABLE 2
isoniazid oral 1
itraconazole oral capsule 1
itraconazole oral solution 4
ivermectin 1
JULUCA 2
KALETRA ORAL SOLUTION 4
KALETRA ORAL TABLET 2
KEFLEX ORAL CAPSULE 4
ketoconazole oral 1
KITABIS PAK 4 PA; SP
KRINTAFEL EX
lamivudine 1
lamivudine-zidovudine 1
ledipasvir-sofosbuvir 4 PA; SP
LEVAQUIN ORAL TABLET 500 MG, 750 MG 4
levofloxacin oral 1
LEXIVA ORAL SUSPENSION 2
LEXIVA ORAL TABLET 4
LINCOCIN 4
linezolid 1
lopinavir-ritonavir 1
LUGOLS ORAL 1
MACROBID 4
MACRODANTIN 4
MALARONE 4
MALARONE PEDIATRIC 4
MAVYRET 3 PA; SP
mefloquine 1
MEPRON 4
methenamine hippurate 1
methenamine mandelate 1
metronidazole oral 1
MINOCIN ORAL CAPSULE 50 MG EX PA
minocycline oral capsule 1
minocycline oral tablet 1
minocycline oral tablet extended release 24 hr 105 mg, 115 mg, 55 mg, 65 mg, 80 mg
EX
minocycline oral tablet extended release 24 hr 135 mg, 45 mg, 90 mg
EX PA
MINOLIRA ER EX
MODERIBA 3 SP
MONDOXYNE NL 4
MONODOX EX
MONUROL 4
MORGIDOX EX PA
MORGIDOX 1X 50 EX
MORGIDOX 1X100 EX
MORGIDOX 2X100 EX
3
Drug Tier NotesMOXATAG 4
moxifloxacin oral 1
MYAMBUTOL ORAL TABLET400 MG 4
MYCOBUTIN 4
NEBUPENT 4
neomycin 1
nevirapine 1
nitrofurantoin 1
nitrofurantoin macrocrystal 1
nitrofurantoin monohyd/m-cryst 1
NORVIR ORAL CAPSULE 2
NORVIR ORAL POWDER IN PACKET 2
NORVIR ORAL SOLUTION 2
NORVIR ORAL TABLET 4
NOXAFIL ORAL 4
NUZYRA (7 DAY WITH LOAD DOSE) 4
NUZYRA (7 DAY) 4
NUZYRA ORAL 4
nystatin oral suspension 1
nystatin oral tablet 1
ODEFSEY 2
ofloxacin oral tablet 300 mg, 400 mg 1
OKEBO ORAL CAPSULE 75 MG 4
OMECLAMOX-PAK 2
ONMEL 4
ORACEA EX
oseltamivir 1
OSMOLEX ER EX
paromomycin 1
PASER 4
PEGASYS 3 SP
PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 180 MCG/0.5 ML
3 SP
PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5 ML 3 SP
penicillin v potassium 1
PHOSPHASAL 1
PIFELTRO EX
PLAQUENIL EX
polymyxin b sulfate 4
praziquantel 4
PREVYMIS ORAL 4
PREZCOBIX 4
PREZISTA ORAL SUSPENSION 2
PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG 2
PRIFTIN 4
primaquine 4
Drug Tier NotesPRIMSOL 4
PYLERA 4
pyrazinamide 1
QUALAQUIN 4
quinidine gluconate oral 1
quinidine sulfate oral tablet 1
quinine sulfate 1
REBETOL ORAL SOLUTION 4 SP
RELENZA DISKHALER 4 QL (2 EA per 365 days)
RESCRIPTOR ORAL TABLET 4
RETROVIR ORAL CAPSULE 4
RETROVIR ORAL SYRUP 4
REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG 4
REYATAZ ORAL POWDER IN PACKET 4
RIBASPHERE ORAL CAPSULE 3 SP
RIBASPHERE ORAL TABLET600 MG 3 SP
RIBASPHERE RIBAPAK ORAL TABLETS,DOSE PACK 600 MG (7)- 400 MG (7), 600 MG (7)- 600 MG (7), 600-400 MG (28)-MG (28), 600-600 MG (28)-MG (28)
3 SP
ribavirin oral capsule 3 SP
ribavirin oral tablet 200 mg 3 SP
rifabutin 1
RIFADIN ORAL 4
RIFAMATE 4
rifampin oral 1
RIFATER 4
rimantadine 1
ritonavir 1
SELZENTRY 2
SEYSARA EX
SIRTURO 4
SITAVIG EX
SIVEXTRO ORAL 4
sofosbuvir-velpatasvir 4 PA; SP
SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR105 MG, 115 MG, 55 MG, 65 MG, 80 MG
EX
SOLOSEC 4
SOLOXIDE 1
SOVALDI 3 PA; SP
SPECTRACEF ORAL TABLET400 MG 4
SPORANOX 4
SPORANOX PULSEPAK 4
SSKI 2
stavudine oral capsule 1
streptomycin 2
STRIBILD 4
4
Drug Tier NotesSTROMECTOL 4
STRONG IODINE ORAL 1
sulfadiazine 1
sulfamethoxazole-trimethoprim oral 1
sulfasalazine 1
SULFATRIM 1
SUPRAX ORAL CAPSULE 4
SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 4
SUPRAX ORAL TABLET,CHEWABLE 4
SUSTIVA 4
SYLATRON 4 SP
SYMFI 2
SYMFI LO 2
SYMTUZA EX
SYNAGIS MB SP
TAMIFLU ORAL CAPSULE 30 MG 4 QL (40 EA per 365
days)
TAMIFLU ORAL CAPSULE 45 MG, 75 MG 4 QL (20 EA per 365
days)
TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION 4 QL (360 ML per 365
days)
TARGADOX EX
tenofovir disoproxil fumarate 1
terbinafine hcl oral 1
tetracycline 4
tinidazole 1
TIVICAY 2
TOBI EX SP
TOBI PODHALER EX SP
tobramycin in 0.225 % nacl 3 SP
tobramycin sulfate 4
tobramycin with nebulizer 3 PA; SP
TOLSURA EX
TRECATOR 4
triacetin 4
trimethoprim 1
TRIMPEX 4
TRIUMEQ 2
TRIZIVIR 4
TROGARZO MB SP
TRUVADA 2
UR N-C 1
URELLE 4
URETRON D-S ORAL TABLET81.6-10.8-40.8 MG 1
URIBEL 4
URIMAR-T 1
URIN DS 1
UROGESIC-BLUE 4
URO-MP 1
UROQID-ACID NO.2 4
Drug Tier NotesURYL 1
USTELL 1
UTIRA-C 1
valacyclovir 1
VALCYTE 4
valganciclovir oral recon soln 4
valganciclovir oral tablet 1
VALTREX EX
VANCOCIN 4
vancomycin oral capsule 4
VEMLIDY 4
VFEND 4
VIBRAMYCIN ORAL CAPSULE100 MG EX
VIBRAMYCIN ORAL SUSPENSION FOR RECONSTITUTION
EX
VIBRAMYCIN ORAL SYRUP EX
VIDEX 2 GRAM PEDIATRIC 2
VIDEX EC 4
VIEKIRA PAK 4 PA; SP
VIRACEPT ORAL TABLET 2
VIRAMUNE 4
VIRAMUNE XR 4
VIREAD ORAL POWDER 4
VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG 2
VIREAD ORAL TABLET 300 MG 4
voriconazole oral 1
VOSEVI 3 PA; SP
XIFAXAN 4 PA; QL (60 EA per 30 days)
XIMINO EX
XOFLUZA 4 PA
ZEPATIER 4 PA; SP
ZERIT ORAL CAPSULE 30 MG 4
ZIAGEN 4
zidovudine 1
ZITHROMAX ORAL PACKET 4
ZITHROMAX ORAL SUSPENSION FOR RECONSTITUTION
4
ZITHROMAX ORAL TABLET250 MG, 500 MG 4
ZITHROMAX TRI-PAK 4
ZITHROMAX Z-PAK 4
ZOVIRAX ORAL 4
ZYVOX ORAL 4
Antineoplastic Agents
abiraterone 3 PA; SP; OCH
ABRAXANE MB SP
ADCETRIS MB SP
AFINITOR 4 PA; SP; OCH
5
Drug Tier NotesAFINITOR DISPERZ 4 PA; SP; OCH
ALECENSA 4 PA; SP; OCH
ALFERON N 4
ALIQOPA MB SP
ALKERAN 4 OCH
ALUNBRIG 4 PA; SP; OCH
anastrozole 1 OCH
ARIMIDEX EX OCH
AROMASIN 4 OCH
ARRANON MB SP
ARZERRA MB SP
AVASTIN MB SP
azacitidine 4 SP
AZEDRA DOSIMETRIC MB SP
AZEDRA THERAPEUTIC MB SP
BALVERSA 4 PA; SP; OCH
BAVENCIO MB SP
BELEODAQ MB SP
bendamustine MB SP
BENDEKA MB SP
BESPONSA MB SP
bexarotene 1 PA; OCH
bicalutamide 1 OCH
BLINCYTO INTRAVENOUS KIT MB SP
bortezomib MB SP
BOSULIF 4 PA; SP; OCH
BRAFTOVI EX SP; OCH
CABOMETYX 4 PA; SP; OCH
CALQUENCE 4 PA; SP; OCH
capecitabine 3 SP; OCH
CAPRELSA 4 PA; SP; OCH
CARAC EX
CASODEX 4 OCH
COMETRIQ 4 PA; OCH
COPIKTRA EX SP; OCH
COTELLIC 4 PA; SP; OCH
cyclophosphamide oral capsule 4 OCH
CYRAMZA MB SP
DACOGEN MB SP
DARZALEX MB SP
DAURISMO 4 PA; SP; OCH
decitabine MB SP
diclofenac sodium topical gel 3 % 4
DROXIA 2
EFUDEX TOPICAL CREAM 4
ELIGARD 3 SP
ELIGARD (3 MONTH) 3 SP
ELIGARD (4 MONTH) 3 SP
ELIGARD (6 MONTH) 3 SP
ELZONRIS MB SP
EMCYT 2 OCH
Drug Tier NotesEMPLICITI MB SP
ERBITUX MB SP
ERIVEDGE 4 PA; SP; OCH
ERLEADA 4 PA; SP; OCH
erlotinib 3 PA; SP
ERWINAZE 4
etoposide oral 1 OCH
EVOMELA MB SP
exemestane 1 OCH
FARESTON 4 OCH
FARYDAK 4 SP; OCH
FASLODEX 4
FEMARA 4 OCH
FIRMAGON KIT W DILUENT SYRINGE 4 SP
FLUOROPLEX EX
fluorouracil topical cream 0.5 % EX
fluorouracil topical cream 5 % 4
fluorouracil topical solution 1
flutamide 1 OCH
FOLOTYN MB SP
fulvestrant 4
GAZYVA MB SP
GILOTRIF 4 PA; SP; OCH
GLEEVEC 4 SP; OCH
GLEOSTINE 2 OCH
HALAVEN MB SP
HERCEPTIN HYLECTA MB SP
HERCEPTIN INTRAVENOUS RECON SOLN 150 MG MB SP
HYCAMTIN ORAL 3 SP; OCH
HYDREA 4 OCH
hydroxyurea 1 OCH
IBRANCE 4 PA; SP; OCH
ICLUSIG 4 PA; SP; OCH
IDHIFA 4 PA; SP; OCH
imatinib 3 SP; OCH
IMBRUVICA 4 PA; SP; OCH
IMFINZI MB SP
IMLYGIC 4 SP
INFUGEM MB
INLYTA 4 PA; SP; OCH
INTRON A INJECTION 3 SP
IRESSA 4 PA; SP; OCH
ISTODAX MB SP
IXEMPRA MB SP
JAKAFI 4 SP; OCH
JEVTANA MB SP
KADCYLA MB SP
KEYTRUDA INTRAVENOUS SOLUTION MB SP
KISQALI 4 PA; SP; OCH
6
Drug Tier NotesKISQALI FEMARA CO-PACK 4 PA; SP; OCH
KYMRIAH MB SP
KYPROLIS MB SP
LARTRUVO MB SP
LENVIMA 4 PA; SP; OCH
letrozole 1 OCH
LEUKERAN 2 OCH
leuprolide subcutaneous kit 4 SP
LIBTAYO MB SP
LONSURF 4 PA; SP; OCH
LORBRENA 4 PA; SP; OCH
LUMOXITI MB SP
LUPANETA PACK (1 MONTH) 4 PA; SP
LUPANETA PACK (3 MONTH) 4 PA; SP
LUPRON DEPOT 4 SP
LUPRON DEPOT (3 MONTH) 4 SP
LUPRON DEPOT (4 MONTH) 4 SP
LUPRON DEPOT (6 MONTH) 4 SP
LUPRON DEPOT-PED 4 SP
LUPRON DEPOT-PED (3 MONTH) 4 SP
LUTATHERA MB SP
LYNPARZA ORAL TABLET 4 PA; SP; OCH
LYSODREN 2 OCH
MATULANE 4 OCH
megestrol oral suspension 1
megestrol oral tablet 1 OCH
MEKINIST 4 PA; SP; OCH
MEKTOVI EX SP; OCH
melphalan 1 OCH
mercaptopurine 1 OCH
methotrexate sodium (pf) 1
methotrexate sodium injection 1
methotrexate sodium oral 1 OCH
mitoxantrone MB SP
MYLERAN 2 OCH
MYLOTARG MB SP
NERLYNX 4 PA; SP; OCH
NEXAVAR 4 PA; SP; OCH
NILANDRON 4 OCH
nilutamide 4 OCH
NINLARO 4 PA; SP; OCH
ODOMZO 4 PA; SP; OCH
ONIVYDE MB SP
OPDIVO MB SP
OTREXUP (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.4 ML, 12.5 MG/0.4 ML, 15 MG/0.4 ML, 17.5 MG/0.4 ML, 20 MG/0.4 ML, 22.5 MG/0.4 ML, 25 MG/0.4 ML
2
PANRETIN 4
PERJETA MB SP
Drug Tier NotesPICATO EX
PIQRAY EX
POLIVY MB SP
POMALYST 4 PA; SP; OCH
PORTRAZZA MB SP
POTELIGEO MB SP
PROLEUKIN MB SP
PURIXAN 4 SP; OCH
RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML
2
REVLIMID 3 PA; SP; OCH
RITUXAN MB SP
RITUXAN HYCELA MB SP
romidepsin MB SP
RUBRACA 4 PA; SP; OCH
RYDAPT 4 PA; SP; OCH
SIKLOS 4
SOLARAZE EX
SOLTAMOX 4 OCH
SPRYCEL 3 PA; SP; OCH
STIVARGA 4 PA; SP; OCH
SUPPRELIN LA 4 SP
SUTENT 3 PA; SP; OCH
SYLATRON 4 SP
SYLVANT MB SP
SYNRIBO 4 PA; SP
TABLOID 2 OCH
TAFINLAR 4 PA; SP; OCH
TAGRISSO 4 PA; SP; OCH
TALZENNA EX SP; OCH
tamoxifen 1 OCH
TARCEVA 3 PA; SP; OCH
TARGRETIN ORAL 4 PA; OCH
TARGRETIN TOPICAL 2 PA
TASIGNA 4 PA; SP; OCH
TECENTRIQ MB SP
TEMODAR INTRAVENOUS MB SP
TEMODAR ORAL 4 SP; OCH
temozolomide 3 SP; OCH
temsirolimus MB SP
TEPADINA 4
TIBSOVO EX SP; OCH
TOLAK 4
toremifene 1 OCH
TORISEL MB SP
TREANDA INTRAVENOUS RECON SOLN MB SP
7
Drug Tier NotesTRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION
MB
tretinoin (chemotherapy) 1 OCH
TREXALL 4 OCH
TRIPTODUR MB SP
TYKERB 4 PA; SP; OCH
UNITUXIN MB SP
VALCHLOR 4 PA; SP
VANTAS 4 SP
VECTIBIX MB SP
VELCADE MB SP
VENCLEXTA 4 PA; SP; OCH
VENCLEXTA STARTING PACK 4 PA; SP; OCH
VERZENIO 4 PA; SP; OCH
VIDAZA 4 SP
VITRAKVI 4 PA; SP; OCH
VIZIMPRO EX SP; OCH
VOTRIENT 4 PA; SP; OCH
VYXEOS MB SP
XALKORI 4 PA; SP; OCH
XATMEP 4 OCH
XELODA 4 SP; OCH
XOSPATA 4 PA; SP; OCH
XTANDI 3 PA; SP; OCH
YERVOY MB SP
YESCARTA MB SP
YONDELIS MB SP
YONSA 3 PA; SP; OCH
ZALTRAP MB SP
ZEJULA 4 PA; SP; OCH
ZELBORAF 4 PA; SP; OCH
ZOLADEX MB SP
ZOLINZA 4 PA; SP; OCH
ZYDELIG 4 SP; OCH
ZYKADIA ORAL CAPSULE 4 PA; SP; OCH
ZYKADIA ORAL TABLET 4 PA; SP
ZYTIGA ORAL TABLET 250 MG 4 PA; SP; OCH
ZYTIGA ORAL TABLET 500 MG 3 PA; SP; OCH
Antitoxins,Immune Glob,Toxoids,Vaccines
ACTHIB (PF) 2
ADACEL(TDAP ADOLESN/ADULT)(PF) 2
bcg vaccine, live (pf) MB
BEXSERO 2
BIOTHRAX 2
BIVIGAM MB SP
BOOSTRIX TDAP 2
CUVITRU MB SP
CYTOGAM INTRAVENOUS SOLUTION 50 MG/ML MB SP
Drug Tier NotesDAPTACEL (DTAP PEDIATRIC) (PF) 2
ENGERIX-B (PF) 2
ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 2
FLEBOGAMMA DIF MB SP
GAMASTAN MB SP
GAMASTAN S/D MB SP
GAMMAGARD LIQUID MB SP
GAMMAGARD S-D (IGA < 1 MCG/ML) MB SP
GAMMAKED MB SP
GAMMAPLEX MB SP
GAMMAPLEX (WITH SORBITOL) MB SP
GAMUNEX-C MB SP
GARDASIL 9 (PF) 2
GRASTEK 4
HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML
2
HAVRIX (PF) INTRAMUSCULAR SYRINGE 2
HEPLISAV-B (PF) 2
HIBERIX (PF) 2
HIZENTRA MB SP
HYPERRHO S/D MB SP
HYQVIA MB SP
IMOVAX RABIES VACCINE (PF) 2
INFANRIX (DTAP) (PF) 2
IPOL 2
IXIARO (PF) 2
KINRIX (PF) 2
MENACTRA (PF) INTRAMUSCULAR SOLUTION 2
MENVEO A-C-Y-W-135-DIP (PF) 2
MICRHOGAM ULTRA-FILTERED PLUS MB SP
M-M-R II (PF) 2
OCTAGAM MB SP
ORALAIR SUBLINGUAL TABLET 100 INDX REACTIVITY, 100 IR (3) /300 IR (6)
MB
ORALAIR SUBLINGUAL TABLET 300 INDX REACTIVITY 4 SP
PANZYGA MB SP
PEDIARIX (PF) 2
PEDVAX HIB (PF) 2
PENTACEL (PF) 2
PENTACEL ACTHIB COMPONENT (PF) 2
PENTACEL DTAP-IPV COMPNT (PF) 4
8
Drug Tier NotesPNEUMOVAX 23 2
PREVNAR 13 (PF) 2
PRIVIGEN MB SP
PROQUAD (PF) 2
QUADRACEL (PF) 4
RABAVERT (PF) 2
RAGWITEK 4
RECOMBIVAX HB (PF) 2
RHOGAM ULTRA-FILTERED PLUS MB SP
RHOPHYLAC MB SP
ROTARIX 2
ROTATEQ VACCINE 2
SHINGRIX (PF) 2
SHINGRIX GE ANTIGEN COMPONENT 2
STAMARIL (PF) 4
TDVAX 2
TENIVAC (PF) 2
tetanus,diphtheria tox ped(pf) 2
TRUMENBA 2
TWINRIX (PF) INTRAMUSCULAR SYRINGE 2
TYPHIM VI 2
VAQTA (PF) 2
VARIVAX (PF) 2
VAXCHORA ACTIVE COMPONENT 2
VAXCHORA VACCINE 2
VIVOTIF 2
WINRHO SDF MB SP
YF-VAX (PF) 2
ZOSTAVAX (PF) 2
Autonomic Drugs
acebutolol 1
ADRENALIN INJECTION 1
ADVAIR DISKUS 4
ADVAIR HFA 2
AIRDUO RESPICLICK 4
albuterol sulfate inhalation hfa aerosol inhaler 4
albuterol sulfate inhalation solution for nebulization 1
albuterol sulfate oral 1
alfuzosin 1
AMRIX EX
ANASPAZ 1
ANORO ELLIPTA 2
ARCAPTA NEOHALER 4
ARICEPT 4
atenolol 1
atenolol-chlorthalidone 1
atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 4
Drug Tier NotesATROVENT HFA 4
AUVI-Q EX
baclofen oral tablet 10 mg, 20 mg 1
baclofen oral tablet 5 mg 4
BENTYL INTRAMUSCULAR 4
benztropine injection 4
benztropine oral 1
BETAPACE 4
BETAPACE AF 4
betaxolol oral 1
bethanechol chloride 1
BEVESPI AEROSPHERE 4
bisoprolol fumarate 1
bisoprolol-hydrochlorothiazide 1
BOTOX MB SP
BREO ELLIPTA 2
BROMFED DM 4
brompheniramine-pseudoeph-dm oral syrup 4
BROVANA EX
BYSTOLIC 4
CAFERGOT EX
CARDURA 4
CARDURA XL 4
carisoprodol 1
carisoprodol-asa-codeine 1 PA
carisoprodol-aspirin 1
carvedilol 1
carvedilol phosphate 1
CATAPRES 4
CATAPRES-TTS-1 4
CATAPRES-TTS-2 4
CATAPRES-TTS-3 4
CENTERGY 1
CENTERGY DM 1
cevimeline 1
CHANTIX CONTINUING MONTH BOX PV CN; QL (180 EA per
365 days)
CHANTIX ORAL TABLET 0.5 MG PV CN; QL (180 Days
per 365 days)
CHANTIX ORAL TABLET 1 MG PV CN; QL (180 EA per 365 days)
CHANTIX STARTING MONTH BOX PV CN; QL (180 EA per
365 days)
chlordiazepoxide-clidinium 4
chlorzoxazone oral tablet 250 mg, 375 mg, 750 mg 1 PA
chlorzoxazone oral tablet 500 mg 1
CLARINEX-D 12 HOUR EX
clonidine 4
clonidine hcl 1
CLORPRES ORAL TABLET0.1-15 MG, 0.2-15 MG 1
9
Drug Tier NotesCLORPRES ORAL TABLET0.3-15 MG 2
COMBIVENT RESPIMAT 2
COMFORT PAC-CYCLOBENZAPRINE EX
COMFORT PAC-TIZANIDINE EX
COREG EX
COREG CR 4
CORGARD 4
CUVPOSA 4
cyclobenzaprine oral capsule,extended release 24hr EX
cyclobenzaprine oral tablet 1
CYCLOTENS REFILL EX
CYCLOTENS STARTER EX
D.H.E.45 EX
DANTRIUM ORAL CAPSULE25 MG, 50 MG 4
dantrolene 1
DIBENZYLINE 4
dicyclomine intramuscular 1
dicyclomine oral capsule 1
dicyclomine oral solution 1
dicyclomine oral tablet 1
dihydroergotamine injection 1
dihydroergotamine nasal 4 QL (8 Vials per 30 days)
diphenoxylate-atropine 1
donepezil 1
DONNATAL ORAL ELIXIR 16.2 MG-0.1037 MG/5 ML (5 ML), 16.2-0.1037 -0.0194 MG/5 ML
4
DONNATAL ORAL TABLET 4
doxazosin 1
DULERA 2
dutasteride-tamsulosin 1
DUTOPROL 4
DYSPORT 4 SP
ED-SPAZ 1
epinephrine 0.3 mg auto-inject 2
epinephrine 0.3 mg auto-inject inner, suv 1
epinephrine 0.3 mg auto-inject latex-free, sdv 2
epinephrine 0.3 mg auto-inject latex-free, suv 2
epinephrine 0.3 mg auto-inject outer, suv 1
epinephrine 0.3 mg auto-inject outer, suv, 1
epinephrine 0.3 mg auto-inject suv, outer 2
epinephrine injection auto-injector 0.15 mg/0.15 ml, 0.15 mg/0.3 ml
2
epinephrine injection solution 1
Drug Tier Notesepinephrine injection syringe 0.1 mg/ml 1
EPIPEN 2 PA
EPIPEN 2-PAK 2 PA
EPIPEN JR 2 PA
EPIPEN JR 2-PAK 2 PA
EPISNAP 2 PA
ergoloid 1
ERGOMAR EX
ergotamine-caffeine 1
EVOXAC 4
EXELON TRANSDERMAL 4
FEXMID EX
fexofenadine-pseudoephedrine EX
FLOMAX 4
fluticasone propion-salmeterol inhalation aerosol powdr breath activated
4
fluticasone propion-salmeterol inhalation blister with device 1
galantamine 1
GLYCATE 4
glycopyrrolate oral 1
GUAIFENESIN DAC 1
guanidine 1
HEMANGEOL EX SP
HISTEX-AC 1
HYDROCODONE COMPOUND 1
hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 1
hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml (5 ml) 2
hydrocodone-homatropine oral tablet 1
HYDROMET 1
hyoscyamine sulfate 1
HYOSYNE 1
INCRUSE ELLIPTA 2
INDERAL LA EX
INDERAL XL 4
INNOPRAN XL EX
ipratropium bromide inhalation 1
ipratropium-albuterol 1
JALYN 4
KAPSPARGO SPRINKLE 2
KAPVAY 4
labetalol oral 1
levalbuterol hcl EX
levalbuterol tartrate EX
LEVBID 4
LEVSIN ORAL 4
LEVSIN/SL 4
LIBRAX (WITH CLIDINIUM) EX
LOMOTIL 4
10
Drug Tier NotesLONHALA MAGNAIR REFILL 4
LONHALA MAGNAIR STARTER 4
LOPRESSOR HCT 4
LOPRESSOR ORAL 4
LORTUSS EX ORAL SYRUP 1
LORZONE 4 PA
LUCEMYRA EX PA
MESTINON ORAL 4
MESTINON TIMESPAN 4
metaproterenol oral syrup 1
metaproterenol oral tablet 10 mg 1
METAXALL 4
metaxalone 4
methocarbamol oral 1
methscopolamine 1
methyldopa 1
methyldopa-hydrochlorothiazide 4
metoprolol succinate 1
metoprolol su-hydrochlorothiaz oral tablet extended release 24 hr 100-12.5 mg, 25-12.5 mg
4
metoprolol ta-hydrochlorothiaz 1
metoprolol tartrate oral 1
midodrine 1
MIGERGOT 1
MIGRANAL EX QL (8 Vials per 30 days)
MINIPRESS 4
MYOBLOC MB SP
nadolol 4
nadolol-bendroflumethiazide oral tablet 80-5 mg 4
NAMZARIC 4
NICORELIEF PV CN
NICORETTE BUCCAL GUM 4 MG PV
nicotine (polacrilex) buccal gum PV CN
nicotine (polacrilex) buccal lozenge 2 mg PV
nicotine (polacrilex) buccal lozenge 4 mg PV CN
nicotine (polacrilex) buccal mini lozenge 2 mg PV CN
nicotine (polacrilex) buccal mini lozenge 4 mg PV
nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr
PV CN
nicotine transdermal patch, td daily, sequential PV CN
NICOTROL PV CN
NICOTROL NS PV CN
NORGESIC FORTE EX
NORTHERA 4 SP
NULEV 4
Drug Tier Notesorphenadrine citrate injection 4
orphenadrine citrate oral 1
OSCIMIN 1
OSCIMIN SL 1
OSCIMIN SR 1
PERFOROMIST 2
phenobarb-hyoscy-atropine-scop oral elixir 4
phenobarb-hyoscy-atropine-scop oral tablet 1
PHENOHYTRO ORAL ELIXIR 4
PHENOHYTRO ORAL TABLET 1
phenoxybenzamine 4
pilocarpine hcl oral 1
pindolol 1
prazosin 1
PROAIR HFA 2
PROAIR RESPICLICK 2
PROMETHAZINE VC 1
promethazine-phenyleph-codeine 1
promethazine-phenylephrine 1
propantheline 1
propranolol oral 1
propranolol-hydrochlorothiazid 4
PROVENTIL HFA EX
pyridostigmine bromide oral syrup 1
pyridostigmine bromide oral tablet 30 mg 4
pyridostigmine bromide oral tablet 60 mg 1
pyridostigmine bromide oral tablet extended release 1
QBREXZA 4 PA
QUIT 2 BUCCAL GUM PV CN
QUIT 4 BUCCAL GUM PV CN
RAPAFLO EX
RAZADYNE ER 4
RAZADYNE ORAL TABLET 4
RESPA-AR 4
rivastigmine 1
rivastigmine tartrate 1
ROBAXIN 4
ROBAXIN-750 4
RYDEX 1
SALAGEN (PILOCARPINE) 4
SEEBRI NEOHALER 4
SEMPREX-D EX
SEREVENT DISKUS 2
silodosin 1
SKELAXIN 4
SOMA 4
SORINE 1
11
Drug Tier NotesSOTALOL AF 1
sotalol oral 1
SOTYLIZE 4
SPIRIVA RESPIMAT 2
SPIRIVA WITH HANDIHALER 2
STIOLTO RESPIMAT 4
STOP SMOKING AID PV CN
STRIVERDI RESPIMAT 4
SYMAX DUOTAB 4
SYMAX FASTABS 1
SYMAX-SL 4
SYMAX-SR 4
SYMBICORT 2
tamsulosin 1
TENORETIC 100 4
TENORETIC 50 4
TENORMIN 4
terazosin 1
terbutaline 1
timolol maleate oral 1
tizanidine 1
TOPROL XL 2
TRELEGY ELLIPTA 2
trihexyphenidyl 1
TUDORZA PRESSAIR 4
TUSNEL C 1
URECHOLINE 4
UROXATRAL EX
UTIBRON NEOHALER 4
VENTOLIN HFA 4
VIRTUSSIN DAC 1
WIXELA INHUB 1
XEOMIN 4 SP
XOPENEX EX
XOPENEX CONCENTRATE EX
XOPENEX HFA EX
YUPELRI 4
ZANAFLEX 4
ZIAC 4
Blood Formation, Coagulation, Thrombosis
ACD-A 4
ADULT ASPIRIN REGIMEN PV CN
ADULT LOW DOSE ASPIRIN PV CN
ADVATE MB SP
ADYNOVATE MB SP
AFSTYLA MB SP
AGGRENOX 4
AGRYLIN 4
ALPHANATE MB SP
ALPHANINE SD MB SP
ALPROLIX MB SP
Drug Tier NotesAMICAR 4
aminocaproic acid oral tablet 4
anagrelide 1
ARANESP (IN POLYSORBATE) 4 SP; OCH
ARIXTRA 4 SP
ASPIR-81 PV CN
ASPIRIN CHILDRENS PV CN
ASPIRIN LOW DOSE PV CN
aspirin oral tablet PV CN
aspirin oral tablet,chewable PV CN
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg PV CN
aspirin-dipyridamole 4
ASPIR-LOW PV CN
ASPIR-TRIN PV CN
AZESCO EX
BAL-CARE DHA 1
BAL-CARE DHA ESSENTIAL 4
BAYER ASPIRIN PV CN
BAYER CHEWABLE ASPIRIN PV CN
BENEFIX MB SP
BEVYXXA EX
BRILINTA 2
butalbital-aspirin-caffeine 1
CABLIVI 3 PA; SP
CADEAU DHA EX
CALCIUM PNV 4
CENTRATEX 1
CHILDREN'S ASPIRIN PV CN
CHILDREN'S IRON PV CN
cilostazol 1
CITRANATAL (DUAL-IRON) 4
CITRANATAL 90 DHA (ALGAL OIL) 4
CITRANATAL ASSURE ORAL COMBO PACK 35 MG IRON-1 MG -50 MG-300 MG
4
CITRANATAL B-CALM (FE GLUC) 4
CITRANATAL BLOOM 4
CITRANATAL DHA (ALGAL OIL) 4
CITRANATAL HARMONY (IRON FUM) 4
clopidogrel 1
C-NATE DHA 4
COAGADEX MB SP
COMPLETENATE 4
CONCEPT DHA 4
CONCEPT OB 4
CORIFACT MB SP
CORVITA 150 1
COUMADIN ORAL 2
DDAVP INJECTION 4
12
Drug Tier NotesDDAVP NASAL SOLUTION 4
DDAVP ORAL 4
desmopressin injection 4
desmopressin nasal spray,non-aerosol 1
desmopressin oral 1
dipyridamole oral 1
DOPTELET (10 TAB PACK) 4 PA; SP; OCH
DOPTELET (15 TAB PACK) 4 PA; SP; OCH
DUET DHA BALANCED ORAL COMBO PACK 25 MG IRON-1 MG -267 MG-233 MG
4
DUET DHA WITH OMEGA-3 ORAL COMBO PACK 25 MG IRON-1 MG -400 MG
4
DURLAZA 4
E.C. PRIN PV CN
ECOTRIN PV CN
ECOTRIN LOW STRENGTH PV CN
EFFIENT 4
ELIQUIS 2
ELITE-OB 4
ELITE-OB 400 1
ELOCTATE MB SP
ENBRACE HR 4
enoxaparin 3 SP
ENTERIC COATED ASPIRIN PV CN
EPOGEN INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML
4 SP; OCH
ESCAVITE PV
ESCAVITE D PV
ESCAVITE LQ PV
EXTRA-VIRT PLUS DHA 4
FE C PLUS 1
FEIBA NF MB SP
FER-IN-SOL PV CN
FEROCON 1
FERRAPLUS 90 1
FERREX 150 FORTE EX
FERROCITE PLUS 1
ferrous sulfate oral drops PV CN
FIBRYGA MB SP
FIORINAL EX
FOLET ONE 4
FOLIVANE-F 1
FOLIVANE-OB 1
FOLIVANE-PLUS 1
fondaparinux 4 SP
FRAGMIN SUBCUTANEOUS SOLUTION 4 SP
FRAGMIN SUBCUTANEOUS SYRINGE 4 SP
Drug Tier NotesFULPHILA MB SP; OCH
GRANIX 3 SP; OCH
HELIXATE FS MB SP
HEMATINIC PLUS VIT/MINERALS 1
HEMATINIC/FOLIC ACID 1
HEMATOGEN 1
HEMATOGEN FA 1
HEMATOGEN FORTE 1
HEMENATAL OB 1
HEMENATAL OB + DHA 1
HEMETAB 1
HEMLIBRA 4 PA; SP
HEMOFIL M HIGH MB SP
HEMOFIL M LOW MB SP
HEMOFIL M MID MB SP
HEMOFIL M SUPER HIGH MB SP
heparin (porcine) injection cartridge 1
heparin (porcine) injection solution 1
HEPARIN LOCK MB
heparin lock flush (porcine) intravenous syringe 100 unit/ml MB
heparin, porcine (pf) injection 1
HUMATE-P MB SP
IDELVION MB SP
IFEREX 150 FORTE EX
IRONUP PV CN
IXINITY MB SP
JANTOVEN 1
JIVI MB SP
KOATE MB SP
KOGENATE FS MB SP
KOSHER PRENATAL PLUS IRON 4
KOVALTRY MB SP
LEUKINE INJECTION RECON SOLN 4 SP; OCH
LITE COAT ASPIRIN PV CN
LOVENOX EX SP
LYSTEDA 4
MARNATAL-F 4
MIRCERA 4 SP; OCH
M-NATAL PLUS 1
MONONINE MB SP
MOZOBIL 4 SP; OCH
MULPLETA EX SP; OCH
MULTIGEN FOLIC 1
MULTIGEN PLUS 1
MULTI-VIT WITH FLUORIDE-IRON PV CN
MYFERON 150 FORTE EX
MYNATAL ADVANCE 1
13
Drug Tier NotesMYNATAL ORAL CAPSULE 1
MYNATAL PLUS 1
MYNATAL-Z 1
NATACHEW (FE BIS-GLYCINATE) 4
NEEVODHA (WITH ALGAL OIL) 4
NESTABS 4
NESTABS ABC 4
NESTABS DHA 4
NESTABS ONE 4
NEULASTA 4 PA; SP; OCH
NEUPOGEN 4 PA; SP; OCH
NEWGEN 4
NEXA PLUS 4
NIVESTYM 3 SP; OCH
NOCDURNA (MEN) 4
NOCDURNA (WOMEN) 4
NOCTIVA EX
NOVAFERRUM ORAL DROPS PV CN
NOVOEIGHT MB SP
NOVOSEVEN RT MB SP
NPLATE 4 SP; OCH
NUWIQ MB SP
OB COMPLETE ONE EX
OB COMPLETE ORAL TABLET EX
OB COMPLETE PETITE EX
OB COMPLETE PREMIER EX
OB COMPLETE WITH DHA EX
OBIZUR MB SP
OBSTETRIX DHA 1
OBSTETRIX EC 4
OBSTETRIX ONE 4
OBTREX DHA 4
O-CAL PRENATAL 4
PEDIA IRON PV CN
pentoxifylline 1
PLAVIX ORAL TABLET 75 MG EX
PNV 29-1 1
PNV OB+DHA ORAL COMBO PACK 27-1-50-250 MG 1
PNV-DHA 1
PNV-DHA + DOCUSATE 1
PNV-FERROUS FUMARATE-DOCU-FA 1
PNV-OMEGA 1
PNV-SELECT 1
POLY-IRON 150 FORTE EX
POLY-VI-FLOR WITH IRON PV
PR NATAL 400 1
PR NATAL 400 EC 1
PR NATAL 430 1
PR NATAL 430 EC 1
Drug Tier NotesPRADAXA EX
prasugrel 1
PREFERA-OB 4
PREFERA-OB ONE 4
PREFERA-OB PLUS DHA 4
PRENA1 PEARL 1
PRENA1 TRUE 1
PRENAISSANCE 1
PRENAISSANCE PLUS 1
PRENATA 4
PRENATABS FA 1
PRENATABS RX 1
PRENATAL LOW IRON 1
PRENATAL PLUS 1
PRENATAL PLUS (CALCIUM CARB) 1
PRENATAL PLUS DHA ORAL COMBO PACK 4
PRENATAL VITAMIN PLUS LOW IRON 1
PRENATE DHA 4
PRENATE DHA (FERR ASP GLYCIN) 4
PRENATE ELITE 4
PRENATE ELITE (IRON ASP GLYC) 4
PRENATE ENHANCE 4
PRENATE ESSENTIAL 4
PRENATE ESSENTIAL(IRON-ASP-GL) 4
PRENATE MINI (FERR ASP GLYCIN) 4
PRENATE PIXIE 4
PRENATE RESTORE 4
PRENATE STAR 4
PREPLUS 1
PRETAB 1
PRIMACARE 4
PROCRIT 4 SP; OCH
PROFILNINE MB SP
PROMACTA 4 PA; SP; OCH
PROVIDA DHA 4
PROVIDA OB 4
PUREFE OB PLUS 4
PUREVIT DUALFE PLUS 1
QUFLORA FE PV
QUFLORA FE (FERROUS SULFATE) PV
REBINYN MB SP
RECOMBINATE MB SP
RETACRIT 4 SP
RIASTAP MB SP
RIXUBIS MB SP
R-NATAL OB 4
14
Drug Tier NotesSAVAYSA EX
SELECT-OB 4
SELECT-OB (FOLIC ACID) 4
SELECT-OB + DHA 4
SE-NATAL 19 1
SE-NATAL 19 (WITH DOCUSATE) 1
SE-TAN PLUS 1
ST JOSEPH ASPIRIN PV
STIMATE 4 SP
TARON FORTE 1
TARON-C DHA 1
TARON-PREX PRENATAL-DHA 1
TAVALISSE 4 PA; SP
THRIVITE RX 4
THRIVITE-19 1
TL-SELECT 1
tranexamic acid oral 1
TRETTEN MB SP
TRIADVANCE 1
TRICARE 4
TRICON 1
TRIGELS-F FORTE 1
TRINATAL RX 1 1
TRINATE 1
TRISTART DHA 4
TRIVEEN-DUO DHA 1
TRIVEEN-ONE 1
TRIVEEN-PRX RNF 1
UDENYCA 4 PA; SP; OCH
VENA-BAL DHA 1
VINACAL 1
VINATE CARE 1
VINATE DHA RF EX
VINATE GT 1
VINATE M 1
VINATE ONE 1
VINATE ULTRA 1
VIRT-ADVANCE 1
VIRT-C DHA 1
VIRT-NATE DHA 4
VIRT-PN DHA 1
VIRT-PN PLUS 1
VIRTPREX 4
VIRT-SELECT 1
VIRT-VITE GT 1
VITAFOL FE+ (WITH DOCUSATE) 4
VITAFOL GUMMIES 4
VITAFOL NANO 4
VITAFOL ULTRA 4
VITAFOL-OB 4
Drug Tier NotesVITAFOL-OB+DHA 4
VITAFOL-ONE 4
VITAMED MD ONE RX 4
VITAPEARL 4
VITATRUE 4
VONVENDI MB SP
VP-CH PLUS 4
VP-CH-PNV 1
VP-PNV-DHA 4
warfarin 1
WILATE MB SP
XARELTO 2
XYNTHA MB SP
XYNTHA SOLOFUSE MB SP
YOSPRALA EX
ZARXIO 4 PA; SP; OCH
ZATEAN-PN DHA 1
ZATEAN-PN PLUS 1
ZONTIVITY 4
Cardiovascular Drugs
ACCUPRIL 4
ACCURETIC 4
acebutolol 1
acetazolamide 1
ADALAT CC 4
ADCIRCA 4 PA; SP
ADEMPAS 4 SP
AFEDITAB CR 1
AGGRENOX 4
ALDACTAZIDE 4
ALDACTONE 4
aliskiren 4
ALTACE 4
ALTOPREV EX
ALYQ 3 SP
ambrisentan 3 SP
amiloride 1
amiloride-hydrochlorothiazide 1
amiodarone oral 1
amlodipine 1
amlodipine-atorvastatin 4
amlodipine-benazepril 1
amlodipine-olmesartan 4
amlodipine-valsartan 1
amlodipine-valsartan-hcthiazid 1
ANTARA ORAL CAPSULE 30 MG, 90 MG 4
aspirin-dipyridamole 4
ATACAND EX
ATACAND HCT EX
atenolol 1
atenolol-chlorthalidone 1
15
Drug Tier Notesatorvastatin oral tablet 10 mg, 20 mg PV CN
atorvastatin oral tablet 40 mg, 80 mg 1
AVALIDE EX
AVAPRO EX
AZOR EX
benazepril 1
benazepril-hydrochlorothiazide 1
BENICAR EX
BENICAR HCT EX
BETAPACE 4
BETAPACE AF 4
betaxolol oral 1
BIDIL 4
bisoprolol fumarate 1
bisoprolol-hydrochlorothiazide 1
bosentan 4 SP
bumetanide injection 4
bumetanide oral 1
BYSTOLIC 4
CADUET ORAL TABLET 10-10 MG, 10-20 MG, 10-40 MG, 10-80 MG, 5-10 MG, 5-20 MG, 5-40 MG, 5-80 MG
4
CALAN 4
CALAN SR 4
candesartan 1
candesartan-hydrochlorothiazid 1
captopril 1
captopril-hydrochlorothiazide 1
CARDIZEM CD 4
CARDIZEM LA 4
CARDIZEM ORAL TABLET 120 MG, 30 MG, 60 MG 4
CARDURA 4
CARDURA XL 4
CAROSPIR EX
CARTIA XT 1
carvedilol 1
carvedilol phosphate 1
CATAPRES 4
CATAPRES-TTS-1 4
CATAPRES-TTS-2 4
CATAPRES-TTS-3 4
chlorothiazide 1
chlorthalidone oral tablet 25 mg, 50 mg 1
cholestyramine (with sugar) 1
CHOLESTYRAMINE LIGHT 1
CIALIS EX
cilostazol 1
clonidine 4
clonidine hcl 1
Drug Tier NotesCLORPRES ORAL TABLET0.1-15 MG, 0.2-15 MG 1
CLORPRES ORAL TABLET0.3-15 MG 2
colesevelam 4
COLESTID 4
COLESTID FLAVORED 4
colestipol 1
COREG EX
COREG CR 4
CORGARD 4
CORLANOR 4 PA
COZAAR EX
CRESTOR EX
DEMADEX ORAL TABLET 20 MG 4
DIBENZYLINE 4
DIGITEK 1
DIGOX 1
digoxin injection 4
digoxin oral solution 50 mcg/ml 1
digoxin oral tablet 1
DILANTIN 2
DILANTIN EXTENDED 2
DILANTIN INFATABS 4
DILANTIN KAPSEAL ORAL CAPSULE 100 MG 2
DILANTIN-125 2
DILATRATE-SR 2
diltiazem hcl oral 1
DILT-XR 1
DIOVAN EX
DIOVAN HCT EX
dipyridamole oral 1
disopyramide phosphate oral capsule 1
DIURIL 4
dofetilide 4
doxazosin 1
DUTOPROL 4
DYAZIDE 4
DYRENIUM 4
EDARBI EX
EDARBYCLOR EX
EDECRIN 4
ELIXOPHYLLIN ORAL ELIXIR80 MG/15 ML 4
enalapril maleate 1
enalapril-hydrochlorothiazide 1
ENTRESTO 2 PA
EPANED ORAL SOLUTION 4
eplerenone 1
epoprostenol (glycine) MB SP
16
Drug Tier Noteseprosartan 1
ethacrynic acid 4
EXFORGE EX
EXFORGE HCT EX
EZALLOR SPRINKLE EX
ezetimibe 1
ezetimibe-simvastatin 1
felodipine 1
fenofibrate micronized 1
fenofibrate nanocrystallized oral tablet 145 mg, 48 mg 1
fenofibrate nanocrystallized oral tablet 160 mg 4
fenofibrate oral capsule 2
fenofibrate oral tablet 1
fenofibric acid 1
fenofibric acid (choline) 1
FENOGLIDE 4
FIBRICOR 4
flecainide 1
FLOLAN MB SP
FLOLIPID EX
fluvastatin PV CN
fosinopril 1
fosinopril-hydrochlorothiazide 1
furosemide injection solution 4
furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 1
furosemide oral solution 40 mg/4 ml 2
furosemide oral tablet 1
gemfibrozil 1
GONITRO 4
guanfacine 1
HEMANGEOL EX SP
hydralazine oral 1
hydrochlorothiazide 1
HYZAAR EX
indapamide 1
INDERAL LA EX
INDERAL XL 4
INNOPRAN XL EX
INSPRA 4
INTUNIV ER 4
irbesartan 1
irbesartan-hydrochlorothiazide 1
ISOCHRON 4
ISORDIL 4
ISORDIL TITRADOSE ORAL TABLET 5 MG 4
isosorbide dinitrate oral 1
isosorbide mononitrate 1
isoxsuprine 1
Drug Tier Notesisradipine 1
JUXTAPID 4 PA; SP
KAPSPARGO SPRINKLE 2
KAPVAY 4
labetalol oral 1
LANOXIN ORAL 4
LANOXIN PEDIATRIC 4
LASIX 4
LESCOL 4
LESCOL XL 4
LETAIRIS 3 SP
LEVATOL 4
LEVITRA ORAL TABLET 10 MG, 2.5 MG, 20 MG EX
LIPITOR EX
LIPOFEN 4
lisinopril 1
lisinopril-hydrochlorothiazide 1
LIVALO EX
LOPID 4
LOPRESSOR HCT 4
LOPRESSOR ORAL 4
losartan 1
losartan-hydrochlorothiazide 1
LOTENSIN HCT 4
LOTENSIN ORAL TABLET 10 MG, 20 MG, 40 MG 4
LOTREL ORAL CAPSULE 10-20 MG, 10-40 MG, 5-10 MG, 5-20 MG, 5-40 MG
EX
lovastatin PV CN
LOVAZA 4
MATZIM LA 1
MAXZIDE 4
MAXZIDE-25MG 4
methyclothiazide 4
methyldopa 1
methyldopa-hydrochlorothiazide 4
metolazone 1
metoprolol succinate 1
metoprolol su-hydrochlorothiaz oral tablet extended release 24 hr 100-12.5 mg, 25-12.5 mg
4
metoprolol ta-hydrochlorothiaz 1
metoprolol tartrate oral 1
mexiletine 1
MICARDIS EX
MICARDIS HCT EX
MICROZIDE 4
MINIPRESS 4
MINITRAN 2
minoxidil oral 1
moexipril 1
17
Drug Tier NotesMULTAQ 4
nadolol 4
nadolol-bendroflumethiazide oral tablet 80-5 mg 4
niacin oral tablet 500 mg 4
niacin oral tablet extended release 24 hr 1
NIACOR 4
NIASPAN EXTENDED-RELEASE 4
nicardipine oral 1
nifedipine 1
nimodipine 1
nisoldipine 4
NITRO-BID 1
NITRO-DUR 4
nitroglycerin oral 1
nitroglycerin sublingual 1
nitroglycerin transdermal patch 24 hour 1
nitroglycerin translingual spray,non-aerosol 1
NITROLINGUAL 4
NITROMIST 4
NITROSTAT 4
NITRO-TIME 1
NORPACE 4
NORPACE CR 4
NORVASC EX
NYMALIZE 4
olmesartan 1
olmesartan-amlodipin-hcthiazid 4
olmesartan-hydrochlorothiazide 1
omega-3 acid ethyl esters 4
OPSUMIT 4 SP
ORENITRAM 4 SP
PACERONE ORAL TABLET100 MG, 200 MG, 400 MG 1
perindopril erbumine 1
phenoxybenzamine 4
PHENYTEK 4
phenytoin oral suspension 1
phenytoin oral tablet,chewable 1
phenytoin sodium extended 1
pindolol 1
PRALUENT PEN 2 PA
PRAVACHOL ORAL TABLET20 MG, 40 MG, 80 MG 4
pravastatin PV CN
prazosin 1
PRESTALIA 4
PREVALITE ORAL POWDER 4
PREVALITE ORAL POWDER IN PACKET 1
Drug Tier NotesPRINIVIL ORAL TABLET 10 MG, 20 MG, 5 MG 4
procainamide injection 4
PROCARDIA 4
PROCARDIA XL 4
propafenone 1
propranolol oral 1
propranolol-hydrochlorothiazid 4
QBRELIS 4
QUESTRAN 4
QUESTRAN LIGHT ORAL POWDER 4
quinapril 1
quinapril-hydrochlorothiazide 1
quinidine gluconate oral 1
quinidine sulfate oral tablet 1
ramipril 1
RANEXA 4
ranolazine 4
REMODULIN 4 SP
REPATHA PUSHTRONEX 2 PA
REPATHA SURECLICK 2 PA
REPATHA SYRINGE 2 PA
REVATIO INTRAVENOUS MB SP
REVATIO ORAL SUSPENSION FOR RECONSTITUTION 3 SP
REVATIO ORAL TABLET 4 PA; SP
rosuvastatin oral tablet 10 mg, 5 mg PV CN
rosuvastatin oral tablet 20 mg, 40 mg 1
RYTHMOL SR 4
sildenafil EX
sildenafil (antihypertensive) intravenous MB SP
sildenafil (antihypertensive) oral suspension for reconstitution 3 SP
sildenafil (antihypertensive) oral tablet 4 PA; SP
simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg PV CN
simvastatin oral tablet 80 mg 1
SORINE 1
SOTALOL AF 1
sotalol oral 1
SOTYLIZE 4
spironolactone 1
spironolacton-hydrochlorothiaz 1
STAXYN EX
STENDRA EX
SULAR ORAL TABLET EXTENDED RELEASE 24 HR17 MG, 34 MG, 8.5 MG
4
tadalafil EX
tadalafil (antihypertensive) 3 PA; SP
18
Drug Tier NotesTARKA ORAL TABLET, IR - ER, BIPHASIC 24HR 2-180 MG, 2-240 MG, 4-240 MG
4
TAZTIA XT 1
TEKTURNA 4
TEKTURNA HCT 4
telmisartan 1
telmisartan-amlodipine 1
telmisartan-hydrochlorothiazid 1
TENORETIC 100 4
TENORETIC 50 4
TENORMIN 4
terazosin 1
THEO-24 4
THEOCHRON 1
theophylline oral elixir 1
theophylline oral solution 1
theophylline oral tablet extended release 12 hr 1
theophylline oral tablet extended release 24 hr 1
TIAZAC 4
TIKOSYN 4
timolol maleate oral 1
TOPROL XL 2
torsemide oral 1
TRACLEER 3 SP
trandolapril 1
trandolapril-verapamil 4
treprostinil sodium 4 SP
triamterene-hydrochlorothiazid 1
TRIBENZOR EX
TRICOR EX
TRIGLIDE ORAL TABLET 160 MG 4
TRIKLO 4
TRILIPIX 4
TWYNSTA 4
TYVASO 4 SP
TYVASO INSTITUTIONAL START KIT 4 SP
TYVASO REFILL KIT 4 SP
TYVASO STARTER KIT 4 SP
UPTRAVI 4 SP
valsartan 1
valsartan-hydrochlorothiazide 1
vardenafil EX
VARITHENA MB SP
VASCEPA EX
VASERETIC 4
VASOTEC 4
VECAMYL 4
VELETRI MB SP
Drug Tier NotesVENTAVIS 4 SP
verapamil oral 1
VERELAN 4
VERELAN PM 4
VIAGRA EX
VIT 3 1
VYNDAQEL EX
VYTORIN 10-10 EX
VYTORIN 10-20 EX
VYTORIN 10-40 EX
VYTORIN 10-80 EX
WELCHOL EX
ZESTORETIC 4
ZESTRIL 4
ZETIA EX
ZIAC 4
ZOCOR ORAL TABLET 10 MG, 20 MG, 40 MG, 80 MG EX
ZYPITAMAG EX PA
Cellular And Gene Therapy
KYMRIAH MB SP
LUXTURNA MB SP
YESCARTA MB SP
ZOLGENSMA MB SP
Central Nervous System Agents
ABILIFY MAINTENA 4
ABILIFY MYCITE 4
ABILIFY ORAL TABLET 4
ABSTRAL EX
acamprosate 1
acetaminophen-caff-dihydrocod oral capsule 1 PA
acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 240 mg-24 mg /10 ml (10 ml), 300 mg-30 mg /12.5 ml
1 PA
acetaminophen-codeine oral tablet 1 PA
ACTIQ EX
ACTIVE-PAC EX
ADASUVE 4
ADDERALL 4
ADDERALL XR 4
ADDYI 4
ADHANSIA XR 4 PA
ADULT ASPIRIN REGIMEN PV CN
ADULT LOW DOSE ASPIRIN PV CN
ADZENYS ER 4 PA
ADZENYS XR-ODT 4 PA
AGGRENOX 4
AIMOVIG AUTOINJECTOR 2 PA
AJOVY EX
19
Drug Tier NotesALLZITAL EX
almotriptan malate 1 QL (18 Tablets per 30 days)
alprazolam 1
ALPRAZOLAM INTENSOL 4
ALSUMA 4 QL (8 ML per 30 days)
amantadine hcl 1
AMBIEN 4
AMBIEN CR 4
AMERGE EX QL (18 EA per 30 days)
amitriptyline 1
amitriptyline-chlordiazepoxide 1
amoxapine 1
amphetamine sulfate 4
ANAFRANIL 4
ANAPROX DS 4
APADAZ 4 PA
APLENZIN 4 PA
APOKYN 4 SP
APTENSIO XR 4 PA
APTIOM 4
aripiprazole 1
ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML, 662 MG/2.4 ML, 882 MG/3.2 ML
4
armodafinil 4
ARTHROTEC 50 4
ARTHROTEC 75 4
ARYMO ER 4 PA; QL (90 EA per 30 days)
ASCOMP WITH CODEINE 1 PA
ASPIR-81 PV CN
ASPIRIN CHILDRENS PV CN
ASPIRIN LOW DOSE PV CN
aspirin oral tablet PV CN
aspirin oral tablet,chewable PV CN
aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg PV CN
aspirin-dipyridamole 4
ASPIR-LOW PV CN
ASPIR-TRIN PV CN
ATIVAN ORAL 4
atomoxetine 1
AUSTEDO 4 PA; SP
AZILECT 4
BANZEL 4
BAYER ASPIRIN PV CN
BAYER CHEWABLE ASPIRIN PV CN
BELBUCA 4 PA
belladonna alkaloids-opium 1 PA
BELSOMRA 4 PA
Drug Tier Notesbenzhydrocodone-acetaminophen 4 PA
benztropine injection 4
benztropine oral 1
BRISDELLE EX
BRIVIACT ORAL 4
bromocriptine 1
BUNAVAIL BUCCAL FILM 2.1-0.3 MG, 4.2-0.7 MG 4 QL (90 EA Max Qty
Per Fill Retail)
BUNAVAIL BUCCAL FILM 6.3-1 MG 4 QL (60 EA Max Qty
Per Fill Retail)
BUPAP ORAL TABLET 50-300 MG EX
BUPRENEX MB PA
buprenorphine 4 PA
buprenorphine hcl injection MB PA
buprenorphine hcl sublingual 1 PA
buprenorphine-naloxone sublingual film 12-3 mg 1 QL (60 EA Max Qty
Per Fill Retail)
buprenorphine-naloxone sublingual film 2-0.5 mg, 4-1 mg, 8-2 mg
1 QL (90 EA Max Qty Per Fill Retail)
buprenorphine-naloxone sublingual tablet 1 QL (90 EA per 30
days)
bupropion hcl (smoking deter) PV CN
bupropion hcl oral tablet 1
bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg
1
bupropion hcl oral tablet extended release 24 hr 450 mg 4 PA
bupropion hcl oral tablet sustained-release 12 hr 1
buspirone 1
BUTALBITAL COMPOUND W/CODEINE 1 PA
butalbital-acetaminop-caf-cod 4 PA
butalbital-acetaminophen EX
butalbital-acetaminophen-caff oral capsule 1
butalbital-acetaminophen-caff oral tablet 50-325-40 mg 1
butalbital-aspirin-caffeine 1
BUTISOL ORAL TABLET 30 MG 4
butorphanol tartrate injection 4 PA
butorphanol tartrate nasal 1 PA; QL (5 ML per 30 days)
BUTRANS EX PA
cabergoline 1
CAFERGOT EX
caffeine citrate oral 1
CAMBIA EX
CAPSFENAC PAK EX
CAPXIB EX
carbamazepine 1
CARBATROL 4
20
Drug Tier Notescarbidopa 1
carbidopa-levodopa 1
carbidopa-levodopa-entacapone 1
carisoprodol-asa-codeine 1 PA
carisoprodol-aspirin 1
CELEBREX EX
celecoxib 1
CELEXA ORAL TABLET EX
CELONTIN ORAL CAPSULE300 MG 4
CHERATUSSIN AC 1
CHILDREN'S ASPIRIN PV CN
chlordiazepoxide hcl 1
chlordiazepoxide-clidinium 4
chlorpromazine 4
choline,magnesium salicylate 1
citalopram 1
clobazam 4
clomipramine 1
clonazepam 1
clorazepate dipotassium 1
clozapine oral tablet 1
clozapine oral tablet,disintegrating 100 mg, 12.5 mg, 25 mg
1
clozapine oral tablet,disintegrating 150 mg, 200 mg
2
CLOZARIL 4
codeine sulfate oral tablet 1 PA
codeine-butalbital-asa-caff 1 PA
codeine-guaifenesin 1
CODITUSSIN AC 4
COMFORT PAC-IBUPROFEN EX
COMFORT PAC-MELOXICAM EX
COMFORT PAC-NAPROXEN EX
COMPAZINE 4
COMPRO 1
COMTAN 4
CONCERTA 4
CONZIP 4 PA
COTEMPLA XR-ODT 4 PA
CYCLOSET 4
CYMBALTA 4
D.H.E.45 EX
DAYPRO 4
DAYTRANA 4 PA
DEMEROL ORAL TABLET 100 MG 4 PA
DEPAKENE ORAL CAPSULE 4
DEPAKOTE 4
DEPAKOTE ER 4
DEPAKOTE SPRINKLES 4
Drug Tier NotesDERMACINRX LEXITRAL EX
desipramine 1
DESOXYN 4
desvenlafaxine 4 PA
desvenlafaxine succinate 4
DEXEDRINE SPANSULE 4
dexmethylphenidate 1
dextroamphetamine 1
dextroamphetamine-amphetamine 1
DIACOMIT EX SP
DIASTAT EX
DIASTAT ACUDIAL 4
diazepam injection solution 1
diazepam injection syringe MB
DIAZEPAM INTENSOL 1
diazepam oral 1
DICLO GEL EX
DICLO GEL-XRYLIX SHEET EX
diclofenac epolamine EX
diclofenac potassium 1
diclofenac sodium oral 1
diclofenac sodium topical drops 4
diclofenac sodium topical gel 1 % 4
diclofenac-misoprostol 4
DICLOFEX DC EX
DICLOFONO EX
DICLOPAK EX PA
DICLOPR EX PA
DICLOTRAL EX
DICLOVIX EX
DICLOZOR EX
diflunisal 1
dihydroergotamine injection 1
dihydroergotamine nasal 4 QL (8 Vials per 30 days)
DILANTIN 2
DILANTIN EXTENDED 2
DILANTIN INFATABS 4
DILANTIN KAPSEAL ORAL CAPSULE 100 MG 2
DILANTIN-125 2
DILAUDID 4 PA
DISALCID 4
DISKETS 1 PA
DITHOL EX
divalproex 1
DOLOPHINE ORAL 4 PA
DONNATAL ORAL ELIXIR 16.2 MG-0.1037 MG/5 ML (5 ML), 16.2-0.1037 -0.0194 MG/5 ML
4
DONNATAL ORAL TABLET 4
DORAL 4
21
Drug Tier Notesdoxepin oral 1
DUEXIS EX
duloxetine 1
DUOPA MB SP
DURAGESIC EX PA
DURLAZA 4
DVORAH 4 PA
DYANAVEL XR 4 PA
E.C. PRIN PV CN
EC-NAPROSYN 4
EC-NAPROXEN 1
ECOTRIN PV CN
ECOTRIN LOW STRENGTH PV CN
EDLUAR 4 PA
EFFEXOR XR 4
ELDEPRYL 4
eletriptan 1 QL (18 EA per 30 days)
EMBEDA ORAL CAPSULE,ORAL ONLY,EXT.REL PELL
EX PA; QL (90 Tablets per 30 days)
EMGALITY PEN 2 PA
EMGALITY SYRINGE 2 PA
EMSAM 4
ENDOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG
1 PA
entacapone 1
ENTERIC COATED ASPIRIN PV CN
EPIDIOLEX 4 PA; SP
EPITOL 1
EQUETRO 4
ERGOMAR EX
ergotamine-caffeine 1
escitalopram oxalate 1
ESGIC EX
estazolam 1
eszopiclone 4
ethosuximide 1
etodolac 1
EVEKEO 4 PA
EVEKEO ODT 4 PA
EVZIO INJECTION AUTO-INJECTOR 2 MG/0.4 ML EX
EXALGO ER ORAL TABLET EXTENDED RELEASE 24 HR16 MG
4 PA; QL (60 EA per 30 days)
FANAPT 4 PA
FAZACLO 4
felbamate 1
FELBATOL 4
FELDENE EX
fenoprofen oral capsule EX PA
fenoprofen oral tablet EX
Drug Tier NotesFENORTHO ORAL CAPSULE200 MG EX
fentanyl 1 PA
fentanyl citrate buccal lozenge on a handle 4 PA
fentanyl citrate buccal tablet, effervescent EX
FENTORA EX
FETZIMA 4 PA
FIORICET ORAL CAPSULE EX
FIORINAL EX
FIORINAL-CODEINE #3 EX PA
FLECTOR EX
FLEXIPAK EX PA
fluoxetine oral capsule 1
fluoxetine oral capsule,delayed release(dr/ec) 1
fluoxetine oral solution 1
fluoxetine oral tablet 10 mg, 20 mg 1
fluoxetine oral tablet 60 mg 1 PA
fluphenazine hcl injection 4
fluphenazine hcl oral 1
flurazepam 1
flurbiprofen 1
fluvoxamine 1
FOCALIN 4
FOCALIN XR 4
FORFIVO XL 4 PA
FROVA EX QL (18 EA per 30 days)
frovatriptan 1 QL (18 EA per 30 days)
FYCOMPA ORAL SUSPENSION 4
FYCOMPA ORAL TABLET 4
gabapentin oral capsule 1
gabapentin oral solution 1
gabapentin oral tablet 600 mg, 800 mg 1
GABITRIL 4
GEODON 4
GOCOVRI EX SP
GRALISE 4 PA
GRALISE 30-DAY STARTER PACK 4 PA
GUAIATUSSIN AC 1
GUAIFENESIN AC 1
GUAIFENESIN DAC 1
guanfacine 1
HALCION ORAL TABLET 0.25 MG 4
HALDOL 4
haloperidol 1
haloperidol lactate injection 4
22
Drug Tier Noteshaloperidol lactate oral 1
HEMANGEOL EX SP
HETLIOZ 4 PA; SP
HISTEX-AC 1
HORIZANT EX
HYCET 4 PA
HYDROCODONE COMPOUND 1
hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml), 7.5-325 mg/15 ml
1 PA
hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 2.5-325 mg, 5-300 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg
1 PA
hydrocodone-chlorpheniramine 1
hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 1
hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml (5 ml) 2
hydrocodone-homatropine oral tablet 1
hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg
1 PA
HYDROMET 1
hydromorphone (pf) injection solution 10 mg/ml MB
hydromorphone injection syringe0.5 mg/0.5 ml EX
hydromorphone oral liquid 1 PA
hydromorphone oral tablet 1 PA
hydromorphone oral tablet extended release 24 hr 1 PA; QL (60 EA per
30 days)
hydromorphone rectal 1 PA
hydroxyzine hcl intramuscular solution 50 mg/ml MB
hydroxyzine hcl oral 1
hydroxyzine pamoate 1
HYSINGLA ER 4 PA
IBU 1
IBUDONE 4 PA
ibuprofen oral suspension 1
ibuprofen oral tablet 400 mg, 600 mg, 800 mg 1
ibuprofen-oxycodone 1 PA
imipramine hcl 1
imipramine pamoate 4
IMITREX NASAL EX QL (18 EA per 30 days)
IMITREX ORAL EX QL (18 EA per 30 days)
IMITREX STATDOSE PEN EX QL (8 Injections per 30 days)
IMITREX STATDOSE REFILL EX QL (8 Injections per 30 days)
IMITREX SUBCUTANEOUS EX QL (8 Injections per 30 days)
INBRIJA 4 PA; SP
Drug Tier NotesINDERAL LA EX
INDERAL XL 4
INDOCIN ORAL EX PA
INDOCIN RECTAL EX
indomethacin oral 1
INFLAMMACIN EX
INFLAMMA-K EX
INGREZZA 4 PA; SP
INGREZZA INITIATION PACK 4 PA; SP
INNOPRAN XL EX
INTERMEZZO 4
INTUNIV ER 4
INVEGA 4
INVEGA SUSTENNA 4
INVEGA TRINZA 4
isometh-dichloral-acetaminophn 1
JORNAY PM 4 PA
KADIAN ORAL CAPSULE,EXTEND.RELEASE PELLETS 10 MG, 100 MG, 20 MG, 200 MG, 30 MG, 40 MG, 50 MG, 60 MG, 80 MG
4 PA; QL (90 EA per 30 days)
KEPPRA ORAL 4
KEPPRA XR 4
ketoprofen oral capsule 4
ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg 4
ketorolac injection cartridge 4
ketorolac injection solution 1
ketorolac intramuscular solution 1
ketorolac intramuscular syringe 4
ketorolac oral 1
KHEDEZLA 4 PA
KLONOPIN 4
LAMICTAL ODT 4
LAMICTAL ODT STARTER (BLUE) 4
LAMICTAL ODT STARTER (GREEN) 4
LAMICTAL ODT STARTER (ORANGE) 4
LAMICTAL ORAL TABLET 4
LAMICTAL ORAL TABLET, CHEWABLE DISPERSIBLE 25 MG, 5 MG
4
LAMICTAL STARTER (BLUE) KIT 4
LAMICTAL STARTER (GREEN) KIT 4
LAMICTAL STARTER (ORANGE) KIT 4
LAMICTAL XR 4
LAMICTAL XR STARTER (BLUE) 4
LAMICTAL XR STARTER (GREEN) 4
23
Drug Tier NotesLAMICTAL XR STARTER (ORANGE) 4
lamotrigine 1
LATUDA 4 PA
LAZANDA EX
levetiracetam oral 1
levorphanol tartrate EX
LEXAPRO ORAL TABLET EX
LEXIXRYL EX
LIBRAX (WITH CLIDINIUM) EX
LIDOXIB EX
LITE COAT ASPIRIN PV CN
lithium carbonate 1
lithium citrate 1
LITHOBID 4
LODINE ORAL TABLET 4
LODOSYN 4
LORAZEPAM INTENSOL 1
lorazepam oral 1
LORCET (HYDROCODONE) 1 PA
LORCET HD 1 PA
LORCET PLUS ORAL TABLET7.5-325 MG 4 PA
LORTAB ELIXIR ORAL SOLUTION 10-300 MG/15 ML 4 PA
LORTUSS EX ORAL SYRUP 1
loxapine succinate 1
LUNESTA 4
LYRICA 4 PA
LYRICA CR 4 PA
maprotiline 1
MARPLAN 4
MAXALT ORAL TABLET 10 MG EX QL (18 EA per 30 days)
MAXALT-MLT EX QL (18 EA per 30 days)
meclofenamate 4
mefenamic acid 4
meloxicam 1
memantine oral capsule,sprinkle,er 24hr 4
memantine oral solution 1
memantine oral tablet 1
memantine oral tablets,dose pack 2
meperidine injection cartridge 4 PA
meperidine oral 1 PA
meprobamate 4
METADATE ER 4
METHADONE INTENSOL 1 PA
methadone oral concentrate 1 PA
methadone oral solution 1 PA
methadone oral tablet 1 PA
methadone oral tablet,soluble 1 PA
Drug Tier NotesMETHADOSE ORAL CONCENTRATE 4 PA
METHADOSE ORAL TABLET,SOLUBLE 1 PA
methamphetamine 1
METHYLIN ORAL SOLUTION 4
methylphenidate hcl oral capsule, er biphasic 30-70 1
methylphenidate hcl oral capsule,er biphasic 50-50 1
methylphenidate hcl oral solution 1
methylphenidate hcl oral tablet 1
methylphenidate hcl oral tablet extended release 1
methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg, 36 mg, 54 mg
1
methylphenidate hcl oral tablet extended release 24hr 72 mg 4 PA
methylphenidate hcl oral tablet,chewable 1
midazolam oral syrup 10 mg/5 ml (2 mg/ml) 4
midazolam oral syrup 2 mg/ml 1
MIGERGOT 1
MIGRANAL EX QL (8 Vials per 30 days)
MIGRANOW EX
MIRAPEX 4
MIRAPEX ER 4
mirtazapine oral tablet 1
mirtazapine oral tablet,disintegrating 4
MOBIC ORAL TABLET 4
modafinil 4
molindone 1
MORPHABOND ER 4 PA; QL (60 EA per 30 days)
morphine concentrate oral solution 1 PA
morphine concentrate oral syringe 10 mg/0.5 ml 4 PA
morphine concentrate oral syringe 20 mg/ml EX
morphine intramuscular EX
morphine oral capsule, er multiphase 24 hr 1 PA; QL (60 EA per
30 days)
morphine oral capsule,extend.release pellets 1 PA; QL (90 EA per
30 days)
morphine oral solution 1 PA
morphine oral tablet 1 PA
morphine oral tablet extended release 100 mg, 200 mg 1 PA; QL (120 EA per
30 days)
morphine oral tablet extended release 15 mg, 30 mg, 60 mg 1 PA; QL (60 EA per
30 days)
morphine rectal 1 PA
MS CONTIN 4 PA; QL (120 EA per 30 days)
24
Drug Tier NotesMYDAYIS 4 PA
MYSOLINE 4
nabumetone 1
NALFON ORAL CAPSULE 400 MG EX
NALFON ORAL TABLET EX
NALOCET 4 PA
naloxone 1
naltrexone 1
NAMENDA ORAL TABLET 4
NAMENDA TITRATION PAK 4
NAMENDA XR EX
NAMZARIC 4
NAPRELAN CR EX
NAPROSYN ORAL SUSPENSION 4
NAPROSYN ORAL TABLET500 MG 4
naproxen 1
naproxen sodium oral tablet 275 mg, 550 mg 1
naproxen sodium oral tablet, er multiphase 24 hr EX
naratriptan 1 QL (18 EA per 30 days)
NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION 4
NARDIL 4
nefazodone 4
NEUPRO EX
NEURONTIN 4
NORCO ORAL TABLET 10-325 MG EX PA
NORCO ORAL TABLET 5-325 MG, 7.5-325 MG EX
NORGESIC FORTE EX
NORPRAMIN ORAL TABLET10 MG, 25 MG 4
nortriptyline 1
NUCYNTA 4 PA; QL (181 EA Max Qty Per Fill Retail)
NUCYNTA ER 4 PA; QL (60 EA per 30 days)
NUDICLO SOLUPAK EX
NUDICLO TABPAK EX
NUDROXIPAK EX
NUDROXIPAK DSDR-50 EX
NUDROXIPAK DSDR-75 EX
NUDROXIPAK E-400 EX
NUDROXIPAK I-800 EX
NUDROXIPAK N-500 EX
NUEDEXTA 4
NUPLAZID ORAL CAPSULE 4 PA; SP
NUPLAZID ORAL TABLET 10 MG 4 PA; SP
NUVIGIL EX
Drug Tier NotesOBREDON EX
olanzapine intramuscular 4
olanzapine oral 1
olanzapine-fluoxetine 1
ONFI ORAL SUSPENSION 4
ONFI ORAL TABLET 10 MG, 20 MG 4
ONZETRA XSAIL EX QL (16 units per 30 days)
OPANA ORAL EX PA
opium tincture 4
ORAP 4
OSMOLEX ER EX
oxaprozin 1
OXAYDO 4 PA
oxazepam 1
oxcarbazepine 1
OXTELLAR XR 4
oxycodone oral capsule 1 PA
oxycodone oral concentrate 1 PA
oxycodone oral solution 1 PA
oxycodone oral syringe 4 PA
oxycodone oral tablet 1 PA
oxycodone oral tablet,oral only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg
EX PA; QL (90 EA per 30 days)
oxycodone oral tablet,oral only,ext.rel.12 hr 60 mg, 80 mg EX PA; QL (120 EA per
30 days)
oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg
1 PA
oxycodone-aspirin 1 PA
OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG
2 PA; QL (90 EA per 30 days)
OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 60 MG, 80 MG
2 PA; QL (120 EA per 30 days)
oxymorphone oral tablet 1 PA
oxymorphone oral tablet extended release 12 hr 1 PA; QL (90 EA per
30 days)
paliperidone 1
PAMELOR 4
PARLODEL 4
PARNATE 4
paroxetine hcl oral tablet 1
paroxetine hcl oral tablet extended release 24 hr 1
paroxetine mesylate(menop.sym) 1
PAXIL 4
PAXIL CR 4
PEGANONE 4
PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP
EX
25
Drug Tier Notespentazocine-naloxone 1 PA
PERCOCET ORAL TABLET 10-325 MG, 2.5-325 MG, 5-325 MG, 7.5-325 MG
EX PA
perphenazine 1
perphenazine-amitriptyline 1
PERSERIS EX
PEXEVA 4 PA
PHENADOZ 1
phenelzine 1
PHENERGAN RECTAL 4
phenobarb-hyoscy-atropine-scop oral elixir 4
phenobarb-hyoscy-atropine-scop oral tablet 1
phenobarbital 1
PHENOHYTRO ORAL ELIXIR 4
PHENOHYTRO ORAL TABLET 1
PHENYTEK 4
phenytoin oral suspension 1
phenytoin oral tablet,chewable 1
phenytoin sodium extended 1
PHRENILIN FORTE(WITH CAFFEINE) EX
pimozide 1
piroxicam 1
pramipexole 1
PRIALT MB SP
primidone 1
PRIMLEV 4 PA
PRISTIQ 4
PROBUPHINE MB SP
PROCENTRA 1
prochlorperazine 1
prochlorperazine edisylate 4
prochlorperazine maleate 1
promethazine injection solution25 mg/ml 4
promethazine oral 1
promethazine rectal 1
promethazine-codeine 1
promethazine-phenyleph-codeine 1
PROMETHEGAN 1
propranolol oral 1
protriptyline 1
PROVIGIL 4
PROZAC ORAL CAPSULE EX
QMIIZ ODT EX
quazepam 4
QUDEXY XR 4
quetiapine oral tablet 1
quetiapine oral tablet extended release 24 hr 4
QUILLICHEW ER 4 PA
Drug Tier NotesQUILLIVANT XR 4 PA
RADICAVA MB SP
rasagiline 4
RELEXXII 4 PA
RELPAX EX QL (18 EA per 30 days)
REMERON ORAL TABLET 15 MG, 30 MG 4
REMERON SOLTAB 4
REPREXAIN ORAL TABLET2.5-200 MG 1
REQUIP ORAL TABLET 0.25 MG, 3 MG, 5 MG 4
REQUIP XL 4
RESTORIL 4
REVIA 4
REXULTI 4 PA
RILUTEK 4
riluzole 1
RISPERDAL 4
RISPERDAL CONSTA 4
risperidone oral solution 1
risperidone oral syringe 4
risperidone oral tablet 1
risperidone oral tablet,disintegrating 1
RITALIN 4
RITALIN LA ORAL CAPSULE,ER BIPHASIC 50-5010 MG, 20 MG, 30 MG, 40 MG
4
rizatriptan 1 QL (18 EA per 30 days)
ropinirole 1
ROWEEPRA 1
ROWEEPRA XR 1
ROXICODONE EX PA
ROXYBOND 4 PA
ROZEREM 4 PA
RYDEX 1
RYTARY EX
SABRIL 4 SP
salsalate 1
SAPHRIS 4 PA
SARAFEM ORAL TABLET 10 MG, 20 MG 4
SAVELLA 4 PA
SECONAL SODIUM 1
selegiline hcl 1
SEROQUEL 4
SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 4
sertraline 1
SILENOR 4
SINEMET 4
SINEMET CR 4
26
Drug Tier NotesSMARTRX GABAKIT EX
SMARTRX GABA-V KIT EX
SOLUPAK EX
SPRAVATO MB SP
SPRITAM 4
SPRIX EX SP
ST JOSEPH ASPIRIN PV
STALEVO 100 4
STALEVO 125 4
STALEVO 150 4
STALEVO 200 4
STALEVO 50 4
STALEVO 75 4
STRATTERA 4
SUBLOCADE MB SP
SUBOXONE SUBLINGUAL FILM 12-3 MG 4 QL (60 EA Max Qty
Per Fill Retail)
SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG, 8-2 MG 4 QL (90 EA Max Qty
Per Fill Retail)
SUBSYS EX
SUBVENITE 4
SUBVENITE STARTER (BLUE) KIT 4
SUBVENITE STARTER (GREEN) KIT 4
SUBVENITE STARTER (ORANGE) KIT 4
sulindac 1
sumatriptan 1 QL (18 UNITS per 30 days)
sumatriptan succinate oral 1 QL (18 EA per 30 days)
sumatriptan succinate subcutaneous cartridge 1 QL (8 Injections per
30 days)
sumatriptan succinate subcutaneous pen injector 1 QL (8 Injections per
30 days)
sumatriptan succinate subcutaneous solution 1 QL (8 Injections per
30 days)
sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml
1 QL (8 ML per 30 days)
sumatriptan-naproxen EX PA; QL (18 EA per 30 Days)
SUMAVEL DOSEPRO SUBCUTANEOUS NEEDLE-FREE INJECTOR 4 MG/0.5 ML
EX QL (8 ML per 30 days)
SUNOSI 4 PA; QL (30 EA per 30 days)
SURE RESULT DSS PREMIUM PACK EX
SYMBYAX ORAL CAPSULE 12-50 MG, 3-25 MG, 6-25 MG, 6-50 MG
4
SYMPAZAN 4 PA
TASMAR ORAL TABLET 100 MG 4
TEGRETOL ORAL SUSPENSION 4
Drug Tier NotesTEGRETOL ORAL TABLET 4
TEGRETOL XR 4
temazepam 1
TENCON ORAL TABLET 50-325 MG 1
tetrabenazine 4 SP
thioridazine 1
thiothixene 1
tiagabine 1
timolol maleate oral 1
TIVORBEX EX
TOFRANIL 4
tolcapone 1
tolmetin 1
TOPAMAX 4
topiramate oral capsule, sprinkle 1
topiramate oral capsule,sprinkle,er 24hr 4
topiramate oral tablet 1
tramadol oral capsule,er biphase 24 hr 17-83 4 PA
tramadol oral capsule,er biphase 24 hr 25-75 4 PA
tramadol oral tablet 1 PA
tramadol oral tablet extended release 24 hr 1 PA
tramadol oral tablet, er multiphase 24 hr 1 PA
tramadol-acetaminophen 1 PA
TRANXENE T-TAB ORAL TABLET 7.5 MG 4
tranylcypromine 1
trazodone 1
TREXIMET ORAL TABLET 85-500 MG EX PA; QL (18 EA per
30 days)
TREZIX ORAL CAPSULE 320.5-30-16 MG 4 PA
triazolam 1
trifluoperazine 1
trihexyphenidyl 1
TRILEPTAL 4
trimipramine 1
TRINTELLIX 4 PA
TRIXYLITRAL EX
TROKENDI XR 4
TUSNEL C 1
TUSSICAPS 4
TYLENOL-CODEINE #3 4 PA
TYLENOL-CODEINE #4 4 PA
ULTRACET 4 PA
ULTRAM 4 PA
ULTRAM ER ORAL TABLET EXTENDED RELEASE 24 HR300 MG
4 PA
VALIUM 4
27
Drug Tier Notesvalproic acid 1
valproic acid (as sodium salt) oral solution 1
VANATOL LQ EX
VANATOL S EX
venlafaxine 1
VERDROCET 1 PA
VERSACLOZ 4 PA
VICODIN 4 PA
VICODIN ES 4 PA
VICODIN HP 4 PA
vigabatrin 3 SP
VIGADRONE 3 SP
VIIBRYD ORAL TABLET 4 PA
VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)
4 PA
VIMOVO EX
VIMPAT ORAL SOLUTION 4
VIMPAT ORAL TABLET 4
VIRTUSSIN AC 1
VIRTUSSIN DAC 1
VISTARIL 4
VIVITROL MB SP
VIVLODEX EX
VOLTAREN TOPICAL 4
VOLTAREN-XR 4
VRAYLAR 4 PA
VYVANSE 4 PA
WELLBUTRIN SR 4
WELLBUTRIN XL 4
WPR PLUS EX
XADAGO EX
XANAX 4
XANAX XR 4
XELITRAL EX
XENAFLAMM EX
XENAZINE EX SP
XRYLIX (DICLOFENAC-KINES TAPE) EX
XTAMPZA ER 4 PA
XYLON 10 4 PA
XYREM 4 PA; QL (540 ML per 30 days)
YOSPRALA EX
zaleplon 1
ZARONTIN 4
ZEBUTAL ORAL CAPSULE 50-325-40 MG EX
ZELAPAR 4
ZEMBRACE SYMTOUCH EX PA; QL (8 Injections per 30 days)
ZENZEDI ORAL TABLET 10 MG, 5 MG 4
Drug Tier NotesZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG
4 PA
ziprasidone hcl 1
ZIPSOR EX
ZOHYDRO ER ORAL CAPSULE, ORAL ONLY, ER 12HR
4 PA; QL (60 EA per 30 days)
zolmitriptan 1 QL (18 EA per 30 days)
ZOLOFT EX
zolpidem 1
ZOLPIMIST 4 PA
ZOMIG NASAL EX PA; QL (18 UNITS per 30 days)
ZOMIG ORAL EX QL (18 EA per 30 days)
ZOMIG ZMT EX QL (18 EA per 30 days)
ZONEGRAN ORAL CAPSULE100 MG, 25 MG EX
zonisamide 1
ZORVOLEX 4 PA
ZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 1.4-0.36 MG, 2.9-0.71 MG, 5.7-1.4 MG
EX QL (90 EA per 30 days)
ZUBSOLV SUBLINGUAL TABLET 11.4-2.9 MG EX QL (30 EA per 30
days)
ZUBSOLV SUBLINGUAL TABLET 8.6-2.1 MG EX QL (60 EA per 30
days)
ZYBAN 4
ZYPREXA 4
ZYPREXA RELPREVV 4
ZYPREXA ZYDIS 4
Contraceptives (E.G. Foams, Devices)
CAYA CONTOURED PV CN
FC2 FEMALE CONDOM PV CN
FEMCAP PV CN
GYNOL II PV CN
TODAY CONTRACEPTIVE SPONGE PV CN
VAGINAL CONTRACEPTIVE FILM PV CN
VAGINAL CONTRACEPTIVE FOAM PV CN
VCF CONTRACEPTIVE FILM PV CN
VCF CONTRACEPTIVE GEL PV CN
WIDE-SEAL DIAPHRAGM 60 PV CN
WIDE-SEAL DIAPHRAGM 65 PV CN
WIDE-SEAL DIAPHRAGM 70 PV CN
WIDE-SEAL DIAPHRAGM 75 PV CN
WIDE-SEAL DIAPHRAGM 80 PV CN
WIDE-SEAL DIAPHRAGM 85 PV CN
WIDE-SEAL DIAPHRAGM 90 PV CN
WIDE-SEAL DIAPHRAGM 95 PV CN
28
Drug Tier NotesDevices
1ST TIER UNIFINE PENTIPS 2
1ST TIER UNIFINE PENTIPS PLUS 2
1ST TIER UNILET COMFORTOUCH 2
2TEK CONTROL (HIGH-NORMAL) 2
ACCUCAINE KIT EX
ACCU-CHEK AVIVA CONTROL SOLN 2
ACCU-CHEK COMP BLUE CONT, M-H 2
ACCU-CHEK COMPACT PLUS CONTROL 2
ACCU-CHEK FASTCLIX LANCET DRUM 2
ACCU-CHEK GUIDE L1-L2 CTRL SOL 2
ACCU-CHEK MULTICLIX LANCET 2
ACCU-CHEK SAFE-T-PRO 2
ACCU-CHEK SAFE-T-PRO PLUS 2
ACCU-CHEK SMARTVIEW CONTRL SOL 2
ACCU-CHEK SOFTCLIX LANCETS 2
ACCUTREND GLUCOSE CONTROL 2
ACE AEROSOL CLOUD ENHANCER 2
ACTI-LANCE LANCETS 2
ACUICYN 1
ADVANCED TRAVEL LANCETS 2
ADVOCATE CONTROL SOLUTION HIGH 2
ADVOCATE LANCET 2
ADVOCATE LOW CONTROL 2
ADVOCATE PEN NEEDLE 2
ADVOCATE REDI-CODE+ CTRL HIGH 2
ADVOCATE REDI-CODE+ CTRL LOW 2
ADVOCATE SYRINGES 2
AEROCHAMBER PLUS FLOW-VU 2
AEROCHAMBER PLUS FLOW-VU,L MSK 2
AEROCHAMBER PLUS FLOW-VU,M MSK 2
AEROCHAMBER PLUS FLOW-VU,S MSK 2
AEROGEAR ACTION ASTHMA KIT 4
AEROTRACH PLUS 4
AGAMATRIX CONTROL HIGH 2
Drug Tier NotesAGAMATRIX CONTROL NORM-HI 2
AIRZONE PEAK FLOW METER 4
ALEVICYN PLUS EX
ALLERGIST TRAY 1/2 ML 27GX3/8" SYRINGE 2
ALLERGIST TRAY INTRADERMAL BEV SYRINGE 2
ALLERGIST TRAY REGULAR BEVEL SYRINGE 2
ALLERGY SYRINGE SYRINGE1 ML 27 GAUGE X 3/8", 1 ML 27 X 1/2"
2
ALTERNATE SITE LANCET 2
AQUORAL EX
ASSURE 4 CONTROL SOLUTION 2
ASSURE DOSE NORMAL CONTROL 2
ASSURE DOSE NORM-HI CONTROL 2
ASSURE HAEMOLANCE PLUS18 GAUGE, 21 GAUGE, 25 GAUGE, 28 GAUGE
2
ASSURE ID INSULIN SAFETY 2
ASSURE ID PEN NEEDLE 2
ASSURE LANCE 2
ASSURE LANCE PLUS 2
ASSURE PRISM CONTROL 1-2 SOLN 2
ASTERO EX
ASTHMA CHECK METER 4
ATOPICLAIR EX
ATRAPRO CP EX
ATRAPRO DERMAL SPRAY EX
ATRAPRO HYDROGEL EX
AUTOJECT 2 INJECTION DEVICE 4
AUTOPEN 1 TO 21 UNITS 4
AUTOPEN 2 TO 42 UNITS 4
AVENOVA EX
AVO CREAM EX
BD ALLERGIST TRAY REG BEVEL SYRINGE 2
BD ALLERGIST TRAY REG BEVEL TRAY 1/2 ML 27 X 1/2" 2
BD ALLERGY SYRINGE SYRINGE 1 ML 28 GAUGE X 1/2"
2
BD AUTOSHIELD DUO PEN NEEDLE 2
BD BULK LUER-LOK NON-STERILE SYRINGE 20 ML, 5 ML, 60 ML
2
BD BULK SLIP TIP NON-STERILE SYRINGE 10 ML, 20 ML, 60 ML
2
BD BULK SYRINGE SLIP TIP 2
BD ECCENTRIC TIP SYRINGE 2
29
Drug Tier NotesBD ECLIPSE 2
BD ECLIPSE LUER-LOK 2
BD FILTER NEEDLE 5-MICRON NOKO 2
BD FILTER NEEDLE-5 MICRON 2
BD INSULIN SYRINGE 2
BD INSULIN SYRINGE HALF UNIT SYRINGE 0.3 ML 31 GAUGE X 5/16"
2
BD INSULIN SYRINGE MICRO-FINE SYRINGE 1 ML 28 GAUGE X 1/2"
2
BD INSULIN SYRINGE SAFETY-LOK 2
BD INSULIN SYRINGE SLIP TIP 2
BD INSULIN SYRINGE U-500 2
BD INSULIN SYRINGE ULTRA-FINE SYRINGE 0.3 ML 30 GAUGE X 1/2", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 30 GAUGE X 1/2", 0.5 ML 31 GAUGE X 5/16", 1 ML 30 GAUGE X 1/2", 1 ML 31 GAUGE X 5/16
2
BD INTEGRA NEEDLE 2
BD INTEGRA SYRINGE SYRINGE 3 ML 21 GAUGE X 1 1/2", 3 ML 22 GAUGE X 1 1/2", 3 ML 23 GAUGE X 1", 3 ML 25 GAUGE X 1", 3 ML 25 GAUGE X 5/8"
2
BD INTRADERMAL BEVEL NEEDLES 2
BD LAB ECCENTRIC NON-STERILE 2
BD LO-DOSE MICRO-FINE IV SYRINGE 1/2 ML 28 GAUGE X 1/2"
2
BD LO-DOSE ULTRA-FINE SYRINGE 0.5 ML 29 GAUGE X 1/2"
2
BD LUER-LOK BULK SYRINGE 2
BD LUER-LOK SYRINGE SYRINGE 1 ML, 1 ML 20 GAUGE X 1", 10 ML, 10 ML 20 X 1 1/2", 10 ML 20 X 1", 10 ML 21 GAUGE X 1", 10 ML 21 X 1 1/2", 10 ML 22 X 1", 10 ML 23X 1 1/4 ", 20 ML, 3 ML, 3 ML 18 X 1 1/2", 3 ML 20 GAUGE X 1 1/2", 3 ML 20 GAUGE X 1", 3 ML 21 GAUGE X 1 1/2", 3 ML 21 GAUGE X 1", 3 ML 22 GAUGE X 1", 3 ML 22 X 1 1/2", 3 ML 23 GAUGE X 1 1/2", 3 ML 23 X 1", 3 ML 25 GAUGE X 1", 3 ML 25 X 1 1/2 ", 3 ML 25 X 5/8", 3 ML 26 X 5/8", 5 ML, 5 ML 20 X 1 1/2", 5 ML 20 X 1", 5 ML 21 GAUGE X 1 1/2", 5 ML 21 GAUGE X 1", 60 ML
2
BD LUER-LOK TIP CONTROL SYRING 2
BD MICROTAINER LANCET 2
BD NANO 2ND GEN PEN NEEDLE 2
Drug Tier NotesBD NOKOR ADMIX NEEDLE 2
BD PRECISIONGLIDE 2
BD PRECISIONGLIDE NON-STERILE 2
BD PRE-FILLED NORMAL SALINE 1
BD REGULAR BEVEL NEEDLES 2
BD SAFETYGLIDE ALLERGIST TRAY 2
BD SAFETYGLIDE INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 31 GAUGE X 15/64", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 15/64", 1 ML 29 GAUGE X 1/2", 1 ML 31 GAUGE X 15/64"
2
BD SAFETYGLIDE NEEDLE 2
BD SAFETYGLIDE SHIELDING REG 2
BD SAFETYGLIDE SYRINGE 2
BD SAFETYGLIDE TB REG BEVEL 2
BD SAFETYGLIDE TUBERCULIN 2
BD SAFETY-LOK DETACHABLE NEEDL 2
BD SAFETY-LOK TUBERCULIN 2
BD SAFETY-LOK WITH LUER-LOK 2
BD SHORT BEVEL NEEDLES 2
BD SHORT BEVEL THIN WALL 2
B-D SLIP TIP SYRINGE 2
BD SLIP TIP SYRINGE SYRINGE 1 ML 26 GAUGE X 5/8", 10 ML, 3 ML
2
BD SPECIALTY USE NEEDLES NEEDLE 16 GAUGE X 1 1/2", 16 GAUGE X 1", 21 GAUGE X 2", 23 GAUGE X 1 1/4", 25 GAUGE X 7/8", 27 GAUGE X 1 1/4", 30 GAUGE X 1/2"
2
BD SPECIALTY USE NEEDLES NEEDLE 30 GAUGE X 1" 1
BD SYRINGE BULK STERILE PAK 2
BD SYRINGE SYRINGE 1 ML, 60 ML 2
BD TUBERCULIN SLIP-TIP 2
BD TUBERCULIN SYRINGE SYRINGE 1 ML 21 GAUGE X 1", 1 ML 25 GAUGE X 5/8", 1 ML 26 GAUGE X 3/8", 1 ML 27 X 1/2", 1/2 ML 27 X 1/2 "
2
BD ULTRA FINE LANCETS 2
BD ULTRA-FINE II LANCETS 2
BD ULTRA-FINE MICRO PEN NEEDLE 2
BD ULTRA-FINE MINI PEN NEEDLE 2
30
Drug Tier NotesBD ULTRA-FINE NANO PEN NEEDLE 2
BD ULTRA-FINE ORIG PEN NEEDLE 2
BD ULTRA-FINE SHORT PEN NEEDLE 2
BD VEO INSULIN SYR HALF UNIT 2
BD VEO INSULIN SYRINGE UF 2
BEAU RX EX
BIAFINE EMULSION EX
BIONECT TOPICAL CREAM EX
BIONECT TOPICAL FOAM EX
BIONECT TOPICAL GEL EX
BREATHERITE MDI SPACER 4
BREATHERITE VALVED MDI CHAMBER 4
BREATHERITE VALVED MDI SPACER 4
BREEZE 2 CONTROL SOLUTION, NML 2
BULLSEYE MINI SAFETY LANCETS 2
CAPHOSOL EX
CAREFINE PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 3/16", 32 GAUGE X 5/32"
2
CAREONE THIN LANCET 2
CAREONE ULTRA THIN LANCET 2
CARESENS LANCETS 2
CARETOUCH INSULIN SYRINGE 2
CARETOUCH PEN NEEDLE 2
CARETOUCH TWIST LANCET 2
CELACYN POST PROCEDURE EX
CERAMAX TOPICAL CREAM EX
CLEVER CHEK LANCETS 2
CLEVER CHOICE LEVEL 1 CONTROL 2
CLEVER CHOICE LEVEL 2 CONTROL 2
CLEVER CHOICE LEVEL 3 CONTROL 2
CLICKFINE PEN NEEDLE 2
COAGUCHEK LANCETS 2
COLOR LANCETS 2
COMFORT EZ INSULIN SYRINGE 2
COMFORT EZ LANCETS 21 GAUGE, 28 GAUGE 2
COMFORT EZ PEN NEEDLES 2
COMFORT LANCETS 2
CONTOUR CONTROL SOLUTION, LOW 2
Drug Tier NotesCONTOUR NEXT LEV 1 CONTROL SOL 2
CONTOUR NEXT LEV 2 CONTROL SOL 2
COOL CONTROL A SOLUTION 2
COOL CONTROL B SOLUTION 2
CYCLOTENS REFILL EX
CYCLOTENS STARTER EX
DIATRUE CONTROL SOLN NORMAL 2
DIATRUE CONTROL SOLUTION HIGH 2
DIATRUE CONTROL SOLUTION LOW 2
DROPLET INSULIN SYRINGE SYRINGE 0.3 ML 30 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 15/64", 0.3 ML 31 GAUGE X 5/16", 1 ML 30 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 31 GAUGE X 15/64", 1 ML 31 GAUGE X 5/16
2
DROPLET LANCETS 2
DROPLET PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 3/16", 32 GAUGE X 5/32"
2
DUROLANE MB SP
EASIVENT HOLDING CHAMBER 4
EASIVENT MASK LARGE 4
EASIVENT MASK MEDIUM 4
EASIVENT MASK SMALL 4
EASY COMFORT INSULIN SYRINGE 2
EASY COMFORT LANCETS 2
EASY COMFORT PEN NEEDLES 2
EASY GLIDE CATHETER TIP SYRING 2
EASY GLIDE INSULIN SYRINGE 2
EASY GLIDE LUER LOCK SYRINGE SYRINGE 3 ML, 60 ML
2
EASY PLUS II HIGH CONTROL 2
EASY TOUCH FLIPLOCK SYRINGE SYRINGE 3 ML 22 GAUGE X 1"
2
EASY TOUCH FLURINGE FLIPLOCK SYRINGE 1 ML 25 GAUGE X 5/8"
2
EASY TOUCH FLURINGE SHEATHLOCK SYRINGE 1 ML 25 GAUGE X 5/8"
2
EASY TOUCH FLURINGE SYRINGE 1 ML 25 GAUGE X 1" 2
EASY TOUCH HIGH-LOW CONTROL 2
31
Drug Tier NotesEASY TOUCH INSULIN SYRINGE 2
EASY TOUCH LANCETS 2
EASY TOUCH LUER LOCK INSULIN 2
EASY TOUCH LUER LOCK SYRINGE SYRINGE 3 ML, 5 ML 2
EASY TOUCH NEEDLE 2
EASY TOUCH SAFETY LANCETS 2
EASY TOUCH SHEATHLOCK SYRG-NDL SYRINGE 3 ML 22 GAUGE X 1"
2
EASY TOUCH SHEATHLOCK SYRINGE SYRINGE 3 ML, 5 ML 2
EASY TOUCH SYRINGE 1 ML 25 GAUGE X 1", 3 ML 22 X 1 1/2"
2
EASY TOUCH TUBERCULIN SHEATHLK SYRINGE 1 ML 25 GAUGE X 5/8"
2
EASY TOUCH TWIST LANCETS 2
EASY TOUCH UNI-SLIP SYRINGE 1 ML, 3 ML, 5 ML 2
EASY TRAK HIGH CONTROL 2
EASY TRAK LOW CONTROL 2
EASY TWIST AND CAP LANCETS 2
EASYMAX LOW CONTROL 2
EASYMAX NORMAL CONTROL 2
ELEMENT COMPACT HIGH CONTROL 2
ELEMENT COMPACT NORMAL CONTROL 2
ELEMENT HIGH CONTROL 2
ELEMENT LOW CONTROL 2
ELEMENT NORMAL CONTROL 2
ELETONE EX
EMBRACE GLUCOSE CONTROL HIGH 2
EMBRACE LANCETS 2
EMULSION SB EX
EPICERAM EX
EPISIL EX
EUFLEXXA MB SP
EVENCARE G3 CONTROL 2
EVOLUTION NORMAL CONTROL 2
EXEL HYPODERMIC NEEDLES NEEDLE 21 GAUGE X 1" 2
EXEL INSULIN SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 1 ML 30 GAUGE X 5/16, 1/2 ML 28 GAUGE X 1/2"
2
EXEL SYRINGE SYRINGE 3 ML 23 GAUGE X 1 1/2" 2
E-Z JECT LANCETS 2
Drug Tier NotesE-Z JECT THIN LANCETS 2
EZ SMART LANCETS 2
FEMCAP PV CN
FIFTY50 SAFETY SEAL LANCETS 2
FINE 30 UNIVERSAL LANCETS 2
FINGERSTIX LANCETS 2
FORA GTEL KETONE TEST STRIP EX
FORA GTEL MULTI-FUNCTN MONITOR EX
FORA HIGH CONTROL 2
FORA LOW CONTROL 2
FORA NORMAL CONTROL 2
FORA V10-V12-D10-D20 STRP-LNCT 4 PA
FORACARE GDH HIGH CONTROL 2
FORACARE GDH LOW CONTROL 2
FORACARE GDH NORMAL CONTROL 2
FORACARE LANCETS 2
FREESTYLE CONTROL 2
FREESTYLE LANCETS 2
FREESTYLE LIBRE 10 DAY READER MB
FREESTYLE LIBRE 10 DAY SENSOR 4
FREESTYLE LIBRE 14 DAY READER MB
FREESTYLE LIBRE 14 DAY SENSOR 4
FREESTYLE PRECISION 2
FREESTYLE UNISTIK 2 2
GE100 CONTROL SOLUTION NORMAL 2
GELCLAIR EX
GEL-ONE MB SP
GELSYN-3 MB SP
GELX EX
GENADUR EX
GENADUR (WITH LEXINAL) EX
GENVISC 850 MB SP
GLUCOCARD 01 NORMAL CONTROL 2
GLUCOCARD SHINE 2
GLUCOCOM LANCETS 2
GLUCOSE CONTROL 2
HEALTHWISE INSULIN SYRINGE 2
HEALTHWISE PEN NEEDLE 2
HEALTHY ACCENTS UNIFINE PENTIP 2
HEALTHY ACCENTS UNILET LANCET 2
HEPARIN LOCK MB
32
Drug Tier Notesheparin lock flush (porcine) intravenous syringe 100 unit/ml MB
HPR EX
HPR PLUS EX
HPR PLUS HYDROGEL EX
HPR PLUS-MB HYDROGEL EX
huber safety needles (disp.) 2
HYALGAN MB SP
HYLATOPIC EX
HYLATOPICPLUS TOPICAL CREAM EX
HYLATOPICPLUS TOPICAL FOAM EX
HYMOVIS MB SP
HYPER-SAL 4
INCONTROL PEN NEEDLE 2
INCONTROL SUPER THIN LANCETS 2
INCONTROL ULTRA THIN LANCETS 2
INFINITY CONTROL SOLUTION HIGH 2
INFINITY CONTROL SOLUTION LOW 2
INFINITY CONTROL SOLUTION NORM 2
INJECT EASE LANCETS 2
insulin syr/ndl u100 half mark 2
INSULIN SYRINGE MICROFINE SYRINGE 1/2 ML 28 GAUGE X 1/2"
2
insulin syringe needleless 2
INSULIN SYRINGE SYRINGE0.5 ML 29 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2"
2
insulin syringe-needle u-100 syringe 0.3 ml 29 gauge, 0.3 ml 29 gauge x 1/2", 0.3 ml 30, 0.3 ml 30 gauge x 1/2", 0.3 ml 30 gauge x 5/16", 0.3 ml 31 gauge x 1/4", 0.3 ml 31 gauge x 15/64", 0.3 ml 31 gauge x 5/16", 0.5 ml 29 gauge x 1/2", 0.5 ml 30 gauge x 1/2", 0.5 ml 30 gauge x 5/16", 0.5 ml 31 gauge x 5/16", 1 ml 28 gauge, 1 ml 28 gauge x 1/2", 1 ml 29 gauge x 1/2", 1 ml 29 gauge x 7/16", 1 ml 30 gauge x 1/2", 1 ml 30 gauge x 3/8", 1 ml 30 gauge x 5/16, 1 ml 30 gauge x 7/16", 1 ml 31 gauge x 1/4", 1 ml 31 gauge x 15/64", 1 ml 31 gauge x 5/16, 1/2 ml 28 gauge, 1/2 ml 28 gauge x 1/2", 1/2 ml 29 , 1/2 ml 30 gauge, 1/2 ml 31 gauge x 1/4", 1/2 ml 31 gauge x 15/64"
2
INSUPEN NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/32", 33 GAUGE X 5/32"
2
INVACARE LANCETS 2
Drug Tier NotesKAMDOY EX
lancets 2
LANCETS, SUPER THIN 2
LANCETS,THIN 2
LANCETS,ULTRA THIN 2
LDO PLUS EX
LIDOTREX EX
LIDOTREX (WITH VITAMIN E) EX
LITE TOUCH INSULIN PEN NEEDLES 2
LITE TOUCH INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 5/16", 1 ML 28 GAUGE, 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 30 GAUGE X 7/16", 1 ML 31 GAUGE X 5/16, 1/2 ML 28 GAUGE, 1/2 ML 28 GAUGE X 1/2", 1/2 ML 29 , 1/2 ML 30 GAUGE
2
LITE TOUCH LANCETS 2
LITEAIRE MDI CHAMBER 4
LITETOUCH-LARGE MASK 4
LITETOUCH-SMALL MASK 4
LOUTREX EX
LUER LOCK SYRINGE 2
LYCELLE EX
MAXI-COMFORT INSULIN SYRINGE 2
MB HYDROGEL EX
MB HYDROGEL (CYCLOMETHICONE) EX
MEDISENSE MID CONTROL 2
MEDISENSE THIN LANCETS 2
MEDLANCE PLUS LANCETS 2
MEDPOINT NORMAL CONTROL 2
MICRO THIN LANCETS 2
MICROCHAMBER 4
MICROCYN EX
MICROCYN HYDROGEL EX
MICRODOT HIGH-LOW CONTROL 2
MICRODOT INSULIN PEN NEEDLE NEEDLE 31 GAUGE X 1/4", 32 GAUGE X 5/32"
2
MICRODOT NORMAL CONTROL 2
MICROLET LANCET 2
MICROSPACER 4
MINI ULTRA-THIN II 2
MONOJECT ALLERGY TRAY TRAY 1 ML 28 X 1/2" 2
33
Drug Tier NotesMONOJECT DISPOSABLE SYRINGE 2
MONOJECT HYPODERMIC NEEDLES NEEDLE 14 GAUGE X 1"
2
MONOJECT INSULIN SAFETY SYRING 2
MONOJECT INSULIN SYRINGE 2
MONOJECT LUER-LOCK TIP SYRINGE 3 ML 2
MONOJECT MAGELLAN SYRINGE SYRINGE 1 ML 25 GAUGE X 5/8"
2
MONOJECT PHARMACY TRAY LUER SYRINGE 20 ML, 3 ML, 60 ML
2
MONOJECT REG TIP NON-STERILE SYRINGE 20 ML, 3 ML
2
MONOJECT SAFETY LUER LOCK TIP 2
MONOJECT SAFETY SYRINGES SYRINGE 3 ML 21 GAUGE X 1 1/2", 3 ML 22 GAUGE X 1", 3 ML 23 GAUGE X 1"
2
MONOJECT SYRINGE ECCENTRI LUER 2
MONOJECT SYRINGE LUER LOK SYRINGE 60 ML 2
MONOJECT SYRINGE REGULAR LUER 2
MONOJECT SYRINGE SYRINGE 1/2 ML 28 GAUGE, 3 ML, 3 ML 20 GAUGE X 1 1/2", 3 ML 21 GAUGE X 1 1/2", 3 ML 22 X 1 1/2"
2
MONOJECT SYRINGE TOOMEY TYPE 2
MONOJECT TUBERCULIN SYRINGE SYRINGE 1 ML 26 GAUGE X 3/8"
2
MONOJECT ULTRA COMFORT INSULIN 2
MONOLET LANCETS 2
MONOLET THIN LANCETS 2
MONOVISC MB SP
MUGARD 4
MYGLUCOHEALTH CONTROL SOLUTION 2
MYGLUCOHEALTH LANCETS 2
NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 %
4
needle (disp) 16 g 2
needle (disp) 18 g 2
needle (disp) 19 g 1
needle (disp) 23 gauge 1
NEOSALUS EX
NEUTRASAL MUCOUS MEMBRANE POWDER IN PACKET
EX
Drug Tier NotesNIVATOPIC PLUS EX
NOKOR NEEDLE 2
NORMAL SALINE FLUSH 1
NORM-JECT SYRINGE 10 ML, 20 ML 2
NOVA MAX GLUCOSE CONTROL 2
NOVA SAFETY LANCETS 2
NOVA SUREFLEX LANCETS 2
NOVOFINE 32 2
NOVOFINE PLUS 2
NOVOPEN ECHO 4
NUVAIL EX
ON CALL LANCET 2
ON CALL PLUS CONTROL 2
ON CALL PLUS LANCET 2
ON CALL VIVID CONTROL 2
ONETOUCH DELICA LANCETS 2
ONETOUCH SURESOFT LANCING DEV 21 GAUGE, 28 GAUGE
2
ONETOUCH ULTRA CONTROL 2
ONETOUCH ULTRASOFT LANCETS 2
ONETOUCH VERIO HIGH CONTROL 2
ONETOUCH VERIO MID CONTROL 2
ON-THE-GO LANCETS 2
OPTICHAMBER ADULT MASK-LARGE 4
OPTICHAMBER DIAMOND LG MASK 4
OPTICHAMBER DIAMOND-MED MSK 4
OPTICHAMBER DIAMOND-SML MASK 4
ORAMAGICRX EX
ORTHOVISC MB SP
PANDA MASK 4
PEDIATRIC PANDA MASK 4
PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 5/32"
2
pen needle, diabetic needle 29 gauge x 1/2", 31 gauge x 1/4", 31 gauge x 3/16", 31 gauge x 5/16", 32 gauge x 1/4", 32 gauge x 3/16", 32 gauge x 5/32"
2
PENTIPS 2
PISTON SYRINGE WITH ENFIT 2
POCKET CHAMBER 4
POLY HUB NEEDLE NEEDLE18 GAUGE X 1 1/2", 18 GAUGE X 1", 23 GAUGE X 1"
2
PR CREAM EX
34
Drug Tier NotesPRECISION XTRA B-KETONE 4
PRESERA EX
PRESSURE ACTIVATED LANCETS 2
PRIMEAIRE 4
PRO COMFORT INSULIN SYRINGE 2
PRO COMFORT LANCET 30 GAUGE 2
PRO COMFORT PEN NEEDLE 2
PROCHAMBER 4
PRODIGY CONTROL SOLUTION, LOW 2
PRODIGY CONTROL SOLUTION,HIGH 2
PRODIGY INSULIN SYRINGE 2
PRODIGY LANCETS 2
PRODIGY TWIST TOP LANCET 2
PROMISEB EX
PROTHELIAL MB SP
PRUCLAIR EX
PRUMYX EX
PRUTECT EX
PULMOSAL 4
PUSH BUTTON SAFETY LANCETS 2
RADIAPLEXRX EX
READYLANCE SAFETY LANCETS 21 GAUGE, 26 GAUGE, 28 GAUGE, 30 GAUGE
2
RECEDO EX
REFUAH PLUS GLUCOSE CONTROL 2
REGENECARE EX
REGENECARE WITH ALOE EX
RELIAMED LANCET 28 GAUGE, 30 GAUGE 2
RELIAMED SAFETY SEAL LANCETS 2
RELIAMED TWIST AND CAP LANCET 2
RELION NEEDLES 2
RELION PEN NEEDLES 2
RELION THIN LANCETS 2
RELION ULTRA THIN PLUS LANCETS 2
RIGHTEST CONTROL SOLUTION HIGH 2
RIGHTEST CONTROL SOLUTION NORM 2
RIGHTEST GL300 LANCETS 2
SAFESNAP INSULIN SYRINGE SYRINGE 0.3 ML 30 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 1 ML 28 GAUGE X 1/2"
2
Drug Tier NotesSAFESNAP SYRINGE SYRINGE 1 ML 25 GAUGE X 5/8"
2
SAFETY LANCETS 2
safety needles 2
SAFETY SEAL LANCETS 2
SAFETY-LET LANCETS 2
SALIVAMAX EX
SIDESTREAM PEDIATRIC FACE MASK 4
SILVRSTAT 2
SINGLE-LET 2
SMART SENSE LANCETS 2
SMARTEST CONTROL 2
SMARTEST LANCET 2
sodium chloride 0.9 % (flush) injection syringe MB
sodium chloride inhalation 1
SOFT TOUCH LANCETS 2
SOLUS V2 CONTROL SOLUTION, LOW 2
SOLUS V2 CONTROL SOLUTION,HIGH 2
SOLUS V2 LANCETS 2
SONAFINE EX
SP ANTIPRURITIC EX
SPRAY AND STRETCH 4
STERILANCE TL 30 GAUGE 2
SUPARTZ FX MB SP
SUPER THIN LANCETS , 28 GAUGE, 30 GAUGE 2
SURE COMFORT INS. SYR. U-100 2
SURE COMFORT INSULIN SYRINGE 2
SURE COMFORT LANCETS 21 GAUGE, 28 GAUGE, 30 GAUGE
2
SURE COMFORT PEN NEEDLE 2
SURE-FINE PEN NEEDLES 2
SURE-JECT INSULIN SYRINGE 2
SURE-LANCE 2
SURE-LANCE ULTRA THIN 2
SURE-TOUCH LANCET 2
SURGUARD2 SAFETY NEEDLE 18 GAUGE X 1 1/2" 2
SURGUARD2 SAFETY SYRINGE 1 ML 25 GAUGE X 5/8", 3 ML 22 GAUGE X 1"
2
SUVICORT EX
SYNVISC MB SP
SYNVISC-ONE MB SP
syringe (disposable) 2
syringe (reusable) 2
SYRINGE 3CC/21GX1-1/2" 2
syringe with needle 2
35
Drug Tier Notessyringe with needle, safety 2
TECHLITE INSULIN SYRINGE 2
TECHLITE LANCETS 2
TECHLITE PEN NEEDLE NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/32"
2
TELCARE CONTROL 2
TELCARE LANCETS 2
TERUMO INSULIN SYRINGE SYRINGE 0.3 ML 30 X 3/8", 0.5 ML 29 GAUGE X 1/2", 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1/2 ML 28 GAUGE X 1/2", 1/2 ML 30 X 3/8"
2
TERUMO SYRINGE SYRINGE 3 ML 23 GAUGE X 1 1/2", 30 ML 2
THIN LANCETS 2
THINPRO INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 X 3/8", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 31 X 3/8", 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 3/8", 1/2 ML 28 GAUGE X 1/2", 1/2 ML 30 X 3/8"
2
TOPCARE CLICKFINE 2
TOPCARE ULTRA COMFORT 2
TOPCARE UNIVERSAL1 LANCET 2
TRIVISC MB SP
TRUE COMFORT INSULIN SYRINGE 2
TRUE COMFORT LANCET 2
TRUE COMFORT PEN NEEDLE 2
TRUEPLUS INSULIN 2
TRUEPLUS LANCETS 2
TRUEPLUS PEN NEEDLE 2
TUBERCULIN SYRINGE SYRINGE 1 ML 25 GAUGE X 1", 1 ML 27 X 1/2"
2
tuberculin-allergy syringes 2
TWIST LANCETS 30 GAUGE 2
ULTICARE INSULIN SYR HALF UNIT 2
ULTICARE INSULIN SYRINGE 2
ULTICARE PEN NEEDLE 2
ULTICARE SAFETY SYRINGE SYRINGE 3 ML 22 GAUGE X 1" 2
ULTICARE SYRINGE 0.3 ML 30 GAUGE X 1/2", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 30 GAUGE X 1/2", 0.5 ML 31 GAUGE X 5/16", 1 ML 30 GAUGE X 1/2", 1 ML 31 GAUGE X 5/16
2
ULTILET BASIC LANCETS 2
ULTILET CLASSIC LANCETS 2
Drug Tier NotesULTILET INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE, 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 5/16", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 31 GAUGE X 5/16, 1/2 ML 29
2
ULTILET LANCETS 2
ULTILET PEN NEEDLE 2
ULTRA COMFORT INSULIN SYRINGE SYRINGE 0.3 ML 29 GAUGE X 1/2", 0.3 ML 30, 0.3 ML 30 GAUGE X 5/16", 0.3 ML 31 GAUGE X 5/16", 0.5 ML 29 GAUGE X 1/2", 0.5 ML 30 GAUGE X 5/16", 0.5 ML 31 GAUGE X 5/16", 1 ML 28 GAUGE, 1 ML 28 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2", 1 ML 30 GAUGE X 5/16, 1 ML 30 GAUGE X 7/16", 1 ML 31 GAUGE X 5/16, 1/2 ML 28 GAUGE, 1/2 ML 28 GAUGE X 1/2", 1/2 ML 29 , 1/2 ML 30 GAUGE
2
ULTRA FINE LANCETS 2
ULTRA FLO PEN NEEDLE 2
ULTRA THIN II LANCETS 2
ULTRA THIN LANCETS , 28 GAUGE, 30 GAUGE, 33 GAUGE
2
ULTRA THIN PLUS LANCETS 2
ULTRA TLC LANCETS 2
ULTRACARE INSULIN SYRINGE 2
ULTRA-CARE LANCETS 2
ULTRACARE PEN NEEDLE NEEDLE 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 3/16", 32 GAUGE X 5/32"
2
ULTRALANCE LANCETS 2
ULTRA-THIN II (SHORT) INS SYR 2
ULTRA-THIN II (SHORT) PEN NDL 2
ULTRA-THIN II INS PEN NEEDLES 2
ULTRA-THIN II INSULIN SYRINGE SYRINGE 0.5 ML 29 GAUGE X 1/2", 1 ML 29 GAUGE X 1/2"
2
ULTRA-THIN II LANCETS 28 GAUGE 2
ULTRATRAK HIGH-LOW CONTROL 2
ULTRATRAK NORMAL CONTROL 2
36
Drug Tier NotesUNIFINE PENTIPS NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 1/4", 32 GAUGE X 5/32"
2
UNIFINE PENTIPS PLUS NEEDLE 29 GAUGE X 1/2", 31 GAUGE X 1/4", 31 GAUGE X 3/16", 31 GAUGE X 5/16", 32 GAUGE X 5/32"
2
UNILET COMFORTOUCH LANCET 2
UNILET EXCELITE II LANCET 2
UNILET EXCELITE LANCET 2
UNILET GP LANCET 2
UNILET LANCET 28 GAUGE, 33 GAUGE 2
UNILET LANCETS 2
UNILET SUPER THIN LANCETS 2
UNISTIK 3 COMFORT LANCET 2
UNISTIK 3 EXTRA LANCET 2
UNISTIK 3 GENTLE 2
UNISTIK 3 LANCETS 2
UNISTIK 3 NORMAL LANCET 2
UNISTIK CZT LANCET 2
UNISTIK PRO LANCET 2
UNISTIK SAFETY 2
UNISTIK TOUCH LANCETS 2
UNISTRIP HIGH CONTROL 2
UNISTRIP LOW CONTROL 2
UNIVERSAL 1 LANCETS 2
VANISHPOINT SYRINGE SYRINGE 0.5 ML 30 GAUGE X 1/2", 1 ML 25 GAUGE X 1", 1 ML 29 GAUGE X 1/2", 3 ML 21 GAUGE X 1 1/2", 3 ML 22 X 1 1/2", 3 ML 23 GAUGE X 1 1/2"
2
VARITHENA ADMINISTRATION PACK MB SP
VERASENS CONTROL SOLN-LEVEL 1 2
VERIFINE PEN NEEDLE 2
VEXASYN EX PA
VISCO-3 MB SP
VIVAGUARD LANCET 2
VORTEX VHC FROG MASK-CHILD 4
VORTEX VHC LADYBUG MASK-TODDLR 4
WAVESENSE CONTROL SOLUTION 2
XCLAIR EX
Diagnostic Agents
ACCU-CHEK AVIVA PLUS TEST STRP 4 PA
ACCU-CHEK COMPACT PLUS TEST 4 PA
ACCU-CHEK GUIDE 4 PA
Drug Tier NotesACCU-CHEK SMARTVIEW TEST STRIP 4 PA
ACCUTREND GLUCOSE 4 PA
ADVANCED GLUC METER TEST STRIP 4 PA
ADVOCATE REDI-CODE 4 PA
ADVOCATE REDI-CODE PLUS STRIP 4 PA
ADVOCATE TEST STRIPS 4 PA
AGAMATRIX AMP TEST STRIPS 4 PA
ASSURE 4 STRIPS 4 PA
ASSURE PLATINUM STRIP 4 PA
ASSURE PRISM MULTI STRIP 4 PA
AZEDRA DOSIMETRIC MB SP
AZEDRA THERAPEUTIC MB SP
BIONIME RIGHTEST TEST STRIPS 4 PA
BLOOD GLUCOSE TEST 4 PA
BREEZE 2 TEST STRIPS 4 PA
CARESENS N TEST STRIPS 4 PA
CARETOUCH TEST STRIP 4 PA
CHOICEDM CLARUS STRIP 4 PA
CLEVER CHOICE MICRO TEST STRIP 4 PA
CLEVER CHOICE PRO STRIP 4 PA
CLEVER CHOICE TALK TEST 4 PA
CLEVER CHOICE TEST STRIPS 4 PA
CLEVER CHOICE VOICE+ TEST 4 PA
CONTOUR NEXT TEST STRIPS 4 PA
CONTOUR TEST STRIPS 4 PA
COOL GLUCOSE TEST STRIP 4 PA
DARIO BLOOD GLUCOSE TEST STRIP 4 PA
DIATRUE PLUS TEST STRIP 4 PA
DM2 4 PA
EASY GLUCO G2 4 PA
EASY PLUS II TEST 4 PA
EASY STEP 4 PA
EASY TALK GLUCOSE TEST 4 PA
EASY TOUCH TEST STRIP 4 PA
EASY TRAK GLUCOSE TEST 4 PA
EASYGLUCO PLUS STRIP 4 PA
EASYGLUCO TEST 4 PA
EASYMAX 4 PA
EASYMAX 15 4 PA
ELEMENT COMPACT TEST STRIPS 4 PA
ELEMENT TEST STRIPS 4 PA
EMBRACE BLOOD GLUCOSE SYSTEM STRIP 4 PA
EMBRACE EVO TEST STRIPS 4 PA
EMBRACE PRO TEST STRIPS 4 PA
37
Drug Tier NotesEMBRACE TALK TEST STRIPS 4 PA
EVENCARE G2 STRIP 4 PA
EVENCARE G3 TEST 4 PA
EVENCARE MINI GLUCOSE TEST STR 4 PA
EVENCARE PROVIEW TEST STRIP 4 PA
EVENCARE TEST 4 PA
EVOLUTION TEST STRIPS 4 PA
EZ SMART PLUS TEST 4 PA
EZ SMART TEST 4 PA
FIFTY50 TEST STRIP 4 PA
FLUCAINE 1
fluorescein-proparacaine 1
FORA 6 CONNECT GLUCOSE STRIP 4 PA
FORA D15G STRIPS 4 PA
FORA D20 STRIP 4 PA
FORA D40-G31 TEST STRIPS 4 PA
FORA G20 STRIP 4 PA
FORA G30-PREMIUM V10 TEST STRP 4 PA
FORA GD50 TEST STRIPS 4 PA
FORA GTEL GLUCOSE TEST STRIP 4 PA
FORA TEST STRIP 4 PA
FORA TN'G VOICE TEST STRIPS 4 PA
FORA V10 STRIP 4 PA
FORA V10-V12-D10-D20 STRIPS 4 PA
FORA V12 GLUCOSE 4 PA
FORA V20 STRIP 4 PA
FORA V30A STRIP 4 PA
FORACARE GD20 4 PA
FORACARE GD40 4 PA
FORTISCARE GLUCOSE TEST STRIPS 4 PA
FREESTYLE INSULINX STRIP 4 PA
FREESTYLE INSULINX TEST STRIPS 4 PA
FREESTYLE LITE STRIPS 4 PA
FREESTYLE PRECISION NEO STRIPS 4 PA
FREESTYLE TEST 4 PA
GE100 BLOOD GLUCOSE TEST STRIP 4 PA
GENSTRIP TEST STRIP 4 PA
GENULTIMATE TEST STRIP 4 PA
GLUCAGEN DIAGNOSTIC KIT 4
GLUCO NAVII TEST STRIP 4 PA
GLUCOCARD 01 SENSOR PLUS 4 PA
GLUCOCARD EXPRESSION STRIP 4 PA
Drug Tier NotesGLUCOCARD SHINE TEST STRIPS 4 PA
GLUCOCARD VITAL SENSOR 4 PA
GLUCOCARD VITAL TEST STRIPS 4 PA
GLUCOCOM GLUCOSE 4 PA
GM100 STRIP 4 PA
GOODLIFE AC-302 TEST STRIP 4 PA
HARMONY GLUCOSE TEST STRIP 4 PA
HEALTHPRO TEST STRIPS 4 PA
IGLUCOSE TEST STRIP 4 PA
INFINITY TEST STRIPS 4 PA
INFINITY VOICE TEST STRIP 4 PA
isosulfan blue 1
MACRILEN EX SP
MD-GASTROVIEW 1
MICRO BLOOD GLUCOSE 4 PA
MICRODOT BLOOD GLUCOSE SYSTEM STRIP 4 PA
MICRODOT XTRA BLOOD GLUCOSE 4 PA
MYGLUCOHEALTH STRIP 4 PA
NEUTEK 2TEK TEST STRIPS 4 PA
NOVA MAX GLUCOSE TEST 4 PA
ON CALL EXPRESS TEST STRIP 4 PA
ON CALL PLUS TEST STRIP 4 PA
ON CALL VIVID TEST STRIP 4 PA
ONETOUCH ULTRA BLUE TEST STRIP 2
ONETOUCH VERIO 2
OPTIUM EZ 4 PA
OPTIUM TEST 4 PA
OPTUMRX STRIP 4 PA
PHARMACIST CHOICE 4 PA
PRECISION PCX PLUS TEST 4 PA
PRECISION PCX TEST 4 PA
PRECISION POINT OF CARE TEST 4 PA
PRECISION Q-I-D TEST 4 PA
PRECISION XTRA TEST 4 PA
PREMIER TEST STRIP 4 PA
PREMIUM V10 STRIP 4 PA
PRO VOICE V8-V9 TEST STRIP 4 PA
PRODIGY NO CODING 4 PA
QUINTET AC STRIP 4 PA
QUINTET GLUCOSE TEST STRIPS 4 PA
REFUAH PLUS 4 PA
RELION CONFIRM-MICRO 4 PA
RELION PRIME TEST STRIPS 4 PA
RELION ULTIMA 4 PA
REVEAL TEST STRIP 4 PA
38
Drug Tier NotesRIGHTEST GS250S TEST STRIPS 4 PA
RIGHTEST GS260 TEST STRIPS 4 PA
RIGHTEST GS550 TEST STRIPS 4 PA
SMART SENSE TEST STRIPS 4 PA
SMARTEST TEST 4 PA
SOLUS V2 TEST STRIPS 4 PA
SURE-TEST EASYPLUS MINI STRIP 4 PA
TD GOLD TEST STRIP 4 PA
TELCARE TEST STRIPS 4 PA
TEST N'GO TEST 4 PA
TRUE METRIX GLUCOSE TEST STRIP 4 PA
TRUE METRIX PRO TEST STRIP 4 PA
TRUETEST TEST STRIPS 4 PA
TRUETRACK TEST 4 PA
ULTIMA TEST STRIPS 4 PA
ULTRATRAK 4 PA
ULTRATRAK ULTIMATE STRIP 4 PA
UNISTRIP1 TEST STRIP 4 PA
VERASENS TEST STRIP 4 PA
VIVAGUARD INO TEST STRIP 4 PA
WAVESENSE JAZZ 4 PA
WAVESENSE PRESTO STRIP 4 PA
Electrolytic, Caloric, And Water Balance
ACCURETIC 4
acetazolamide 1
acetic acid irrigation 4
ALDACTAZIDE 4
ALDACTONE 4
amiloride 1
amiloride-hydrochlorothiazide 1
amlodipine-valsartan-hcthiazid 1
ammonium chloride MB
ATACAND HCT EX
atenolol-chlorthalidone 1
AURYXIA 4 PA
AVALIDE EX
AV-PHOS 250 NEUTRAL 1
BAL-CARE DHA 1
BD PRE-FILLED NORMAL SALINE 1
benazepril-hydrochlorothiazide 1
BENICAR HCT EX
bisoprolol-hydrochlorothiazide 1
bumetanide injection 4
bumetanide oral 1
BUPHENYL 4
Drug Tier NotesCALCIUM 600 WITH VITAMIN D3 ORAL TABLET PV CN
calcium acetate oral capsule 1
calcium acetate oral tablet 667 mg 1
CALCIUM PNV 4
CALCIUM-FOLIC ACID-VITAMIN D 1
candesartan-hydrochlorothiazid 1
captopril-hydrochlorothiazide 1
CARBAGLU 4 SP
CAROSPIR EX
chlorothiazide 1
chlorthalidone oral tablet 25 mg, 50 mg 1
CLORPRES ORAL TABLET0.1-15 MG, 0.2-15 MG 1
CLORPRES ORAL TABLET0.3-15 MG 2
CONSTULOSE 1
CRYSVITA MB PA; SP
CYTRA K CRYSTALS 1
CYTRA-2 1
CYTRA-3 1
CYTRA-K 1
DEMADEX ORAL TABLET 20 MG 4
DIOVAN HCT EX
DIURIL 4
DUTOPROL 4
DUZALLO EX
DYAZIDE 4
DYRENIUM 4
EDARBYCLOR EX
EDECRIN 4
EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 20 MEQ
2
EFFER-K ORAL TABLET, EFFERVESCENT 25 MEQ 1
ELIXOPHYLLIN ORAL ELIXIR80 MG/15 ML 4
enalapril-hydrochlorothiazide 1
ENULOSE 1
ethacrynic acid 4
EXFORGE HCT EX
FOLGARD OS EX
fosinopril-hydrochlorothiazide 1
FOSRENOL EX
furosemide injection solution 4
furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 1
furosemide oral solution 40 mg/4 ml 2
furosemide oral tablet 1
GENERLAC 1
39
Drug Tier NotesGLYCINE UROLOGIC 4
glycine urologic solution 4
hydrochlorothiazide 1
HYPER-SAL 4
HYZAAR EX
indapamide 1
irbesartan-hydrochlorothiazide 1
JYNARQUE 4 PA; SP
KLOR-CON 1
KLOR-CON 10 1
KLOR-CON 8 1
KLOR-CON M10 1
KLOR-CON M15 1
KLOR-CON M20 1
KLOR-CON SPRINKLE ORAL CAPSULE, EXTENDED RELEASE 8 MEQ
1
KLOR-CON/EF 4
K-PHOS NO 2 2
K-PHOS ORIGINAL 4
K-PHOS-NEUTRAL 1
KRISTALOSE EX
K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ, 20 MEQ
2
K-TAB ORAL TABLET EXTENDED RELEASE 8 MEQ 1
lactulose oral packet 4
lactulose oral solution 1
lanthanum 1
LASIX 4
lisinopril-hydrochlorothiazide 1
LITHOSTAT 4
LOKELMA EX
LOPRESSOR HCT 4
losartan-hydrochlorothiazide 1
LOTENSIN HCT 4
MARNATAL-F 4
MAXZIDE 4
MAXZIDE-25MG 4
methyclothiazide 4
methyldopa-hydrochlorothiazide 4
metolazone 1
metoprolol su-hydrochlorothiaz oral tablet extended release 24 hr 100-12.5 mg, 25-12.5 mg
4
metoprolol ta-hydrochlorothiaz 1
MICARDIS HCT EX
MICROZIDE 4
M-NATAL PLUS 1
MYNATAL ADVANCE 1
MYNATAL ORAL CAPSULE 1
MYNATAL PLUS 1
MYNATAL-Z 1
Drug Tier Notesnadolol-bendroflumethiazide oral tablet 80-5 mg 4
NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 %
4
NESTABS 4
NESTABS DHA 4
NEWGEN 4
NORMAL SALINE FLUSH 1
OB COMPLETE ONE EX
OB COMPLETE PREMIER EX
O-CAL PRENATAL 4
olmesartan-amlodipin-hcthiazid 4
olmesartan-hydrochlorothiazide oral tablet 20-12.5 mg, 40-12.5 mg
1
olmesartan-hydrochlorothiazide oral tablet 40-25 mg 4
ORACIT 4
PHOSLYRA 4 PA
PHOSPHA 250 NEUTRAL 1
PHYSIOLYTE 4
PHYSIOSOL IRRIGATION 4
PNV 29-1 1
PNV OB+DHA ORAL COMBO PACK 27-1-50-250 MG 1
PNV-DHA + DOCUSATE 1
PNV-OMEGA 1
potassium chloride oral 1
potassium citrate 1
potassium citrate-citric acid oral solution 1
PR NATAL 400 1
PR NATAL 400 EC 1
PR NATAL 430 1
PR NATAL 430 EC 1
PRENAISSANCE 1
PRENAISSANCE PLUS 1
PRENATABS FA 1
PRENATABS RX 1
PRENATAL LOW IRON 1
PRENATAL PLUS 1
PRENATAL PLUS (CALCIUM CARB) 1
PRENATAL VITAMIN PLUS LOW IRON 1
PRENATE CHEWABLE 4
PREPLUS 1
PRETAB 1
probenecid 1
probenecid-colchicine 1
propranolol-hydrochlorothiazid 4
PULMOSAL 4
quinapril-hydrochlorothiazide 1
RAVICTI 4 PA; SP
40
Drug Tier NotesRENAGEL ORAL TABLET 800 MG EX
RENVELA 4 PA
ringer's irrigation 4
SAMSCA 4 SP
sevelamer carbonate oral powder in packet 4
sevelamer carbonate oral tablet 1
sevelamer hcl 4
SHOHL'S MODIFIED 4
sodium chloride 0.9 % (flush) injection syringe MB
sodium chloride inhalation 1
sodium citrate-citric acid 1
sodium phenylbutyrate 4
sodium polystyrene sulfonate oral powder 4
sodium polystyrene sulfonate oral suspension 1
sodium polystyrene sulfonate rectal enema 30 gram/120 ml 4
spironolactone 1
spironolacton-hydrochlorothiaz 1
SPS (WITH SORBITOL) ORAL 1
SPS (WITH SORBITOL) RECTAL 4
TEKTURNA HCT 4
telmisartan-hydrochlorothiazid 1
TENORETIC 100 4
TENORETIC 50 4
THEO-24 4
THEOCHRON 1
theophylline oral elixir 1
theophylline oral solution 1
theophylline oral tablet extended release 12 hr 1
theophylline oral tablet extended release 24 hr 1
THRIVITE RX 4
TL-SELECT 1
torsemide oral 1
TRIADVANCE 1
triamterene-hydrochlorothiazid 1
TRIBENZOR EX
TRICITRATES 1
TRINATAL RX 1 1
TRINATE 1
TRIVEEN-DUO DHA 1
TRIVEEN-ONE 1
TRIVEEN-PRX RNF 1
UROCIT-K 10 4
UROCIT-K 15 4
UROCIT-K 5 4
valsartan-hydrochlorothiazide 1
Drug Tier NotesVASERETIC 4
VELPHORO 4 PA
VELTASSA 4 SP
VENA-BAL DHA 1
VINACAL 1
VINATE ONE 1
VINATE ULTRA 1
VIRT-ADVANCE 1
VIRT-PHOS 250 NEUTRAL 1
VIRT-PN PLUS 1
VIRTPREX 4
VIRTRATE-2 1
VIRTRATE-K 1
VIRT-SELECT 1
VITAFOL GUMMIES 4
VITAFOL-OB 4
VITAFOL-OB+DHA 4
ZATEAN-PN PLUS 1
ZESTORETIC 4
ZIAC 4
ZINGIBER 4
Enzymes
ALDURAZYME MB SP
BRINEURA MB SP
CEREZYME INTRAVENOUS RECON SOLN 400 UNIT MB SP
ELAPRASE MB SP
ELELYSO MB SP
FABRAZYME MB SP
HYQVIA HY COMPONENT MB
KANUMA MB SP
LUMIZYME MB SP
MEPSEVII MB SP
NAGLAZYME MB SP
PALYNZIQ 4 PA; SP
PULMOZYME 4 SP
REVCOVI 4 PA; SP
STRENSIQ 4 PA; SP
SUCRAID 4
VIMIZIM MB SP
VPRIV MB SP
XIAFLEX MB PA; SP
Eye, Ear, Nose And Throat (Eent) Preps.
acetazolamide 1
acetic acid otic (ear) 1
ACULAR 4
ACULAR LS 4
ACUVAIL (PF) EX
ADRENALIN NASAL 4
ADVANCED DNA MEDICATED COLLECT EX
41
Drug Tier NotesAK-POLY-BAC 1
AKTEN (PF) 4
ALOCRIL EX
ALOMIDE EX
ALPHAGAN P 4
ALREX 4
ALTACAINE 1
apraclonidine 1
ASTEPRO NASAL SPRAY,NON-AEROSOL 4
atropine ophthalmic (eye) drops 1
atropine ophthalmic (eye) ointment 1
AZASITE 4
azelastine 1
AZOPT 4
bacitracin ophthalmic (eye) 1
bacitracin-polymyxin b ophthalmic (eye) 1
BECONASE AQ EX
BEPREVE 4
BESIVANCE 4
BETADINE OPHTHALMIC PREP 2
betaxolol ophthalmic (eye) 1
BETIMOL 4
BETOPTIC S 4
bevacizumab intravitreal syringe2.5 mg/0.1 ml MB SP
bimatoprost ophthalmic (eye) 1
BLEPH-10 4
BLEPHAMIDE 4
BLEPHAMIDE S.O.P. 4
brimonidine 1
brimonidine-dorzolamide (pf) 4
bromfenac 1
BROMSITE 4
budesonide nasal EX
carteolol 4
CEQUA 4 PA
CETRAXAL EX
chlorhexidine gluconate mucous membrane 1
CILOXAN 4
CIPRO HC 4
CIPRODEX 4
ciprofloxacin hcl ophthalmic (eye) 1
ciprofloxacin hcl otic (ear) 1
COLY-MYCIN S 4
COMBIGAN 4
CORTANE-B TOPICAL 4
COSOPT EX
COSOPT (PF) EX
Drug Tier Notescromolyn ophthalmic (eye) 1
CYCLOGYL 2
CYCLOMYDRIL 4
cyclopentolate 1
cyclopen-tropic-phenyleph-watr MB
CYCLOSPORINE IN KLARITY 4
CYSTARAN 4 SP
DERMOTIC OIL 4
dexamethasone sodium phosphate ophthalmic (eye) 1
diclofenac sodium ophthalmic (eye) 1
dorzolamide 1
dorzolamide (pf) 4
dorzolamide-timolol 1
dorzolamide-timolol (pf) ophthalmic (eye) dropperette 1
dorzolamide-timolol (pf) ophthalmic (eye) drops 4
doxycycline hyclate oral tablet 20 mg 1
DUREZOL 4
DYMISTA EX
epinastine 1
erythromycin ophthalmic (eye) 1
EYLEA MB SP
FLAC OTIC OIL 4
FLAREX EX
FLUCAINE 1
flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) EX
fluocinolone acetonide oil 1
fluorescein-proparacaine 1
fluorometholone 1
flurbiprofen sodium 1
fluticasone propionate nasal 1
FML FORTE EX
FML LIQUIFILM EX
FML S.O.P. EX
gatifloxacin 1
gatifloxacin-dexamethasone 4
GELFILM OPHTHALMIC (EYE) 4
GENTAK OPHTHALMIC (EYE) OINTMENT 1
gentamicin ophthalmic (eye) 1
GLYDO 1
GONIOVISC EX
HOMATROPAIRE 1
homatropine hbr 1
hydrocortisone-acetic acid 1
ILEVRO 4
ILUVIEN MB SP
INVELTYS 4
42
Drug Tier NotesIOPIDINE OPHTHALMIC (EYE) DROPPERETTE 4
ipratropium bromide nasal 1
ISOPTO CARPINE 4
ISTALOL EX
JETREA (PF) INTRAVITREAL SOLUTION 0.125 MG/0.1 ML (1.25 MG/ML)
MB SP
ketorolac ophthalmic (eye) 1
KLARITY (CHONDROITIN) 4
LACRISERT 4
LASTACAFT 4
latanoprost 1
latanoprost (pf) 4 PA
levobunolol ophthalmic (eye) drops 0.5 % 1
levofloxacin ophthalmic (eye) 1
lidocaine hcl mucous membrane jelly 1
lidocaine hcl mucous membrane jelly in applicator 1
lidocaine hcl mucous membrane solution 4 % (40 mg/ml) 1
LIDOCAINE VISCOUS 1
LOTEMAX 4
LOTEMAX SM 4
loteprednol etabonate 4
LUCENTIS MB SP
LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 % 4 PA
MACUGEN MB SP
MAXIDEX EX
MAXITROL 4
methazolamide 4
metipranolol 1
MITOSOL MB
mometasone nasal EX
MOXEZA 4
moxifloxacin ophthalmic (eye) 1
MYDRIACYL 4
NASONEX EX
NATACYN 4
neomycin-bacitracin-poly-hc 1
neomycin-bacitracin-polymyxin 1
neomycin-polymyxin b-dexameth 1
neomycin-polymyxin-gramicidin 1
neomycin-polymyxin-hc 1
NEO-POLYCIN 1
NEO-POLYCIN HC 1
NEVANAC EX
OCUFLOX 4
ofloxacin ophthalmic (eye) 1
ofloxacin otic (ear) 1
olopatadine nasal 4
Drug Tier Notesolopatadine ophthalmic (eye) 1
OMNARIS EX
OTIPRIO 4
OTOVEL 4
OXERVATE 4 SP
OZURDEX MB SP
PAREMYD 4
PAROEX ORAL RINSE 1
PATADAY 4
PATANASE 4
PATANOL 4
PAZEO 4
PERIDEX 4
PERIOGARD 1
phenylephrine hcl ophthalmic (eye) 1
PHOSPHOLINE IODIDE 2
pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 % 1
POLYCIN 1
polymyxin b sulf-trimethoprim 1
POLYTRIM 4
PRED FORTE 4
PRED MILD EX
PRED-G 4
PRED-G S.O.P. 4
prednisol ace-gatiflox-bromfen 4
prednisoln sp-gatiflox-bromfen 4
prednisolone acetate 1
prednisolone acetate (pf) 4
prednisolone acetate-bromfenac 4
prednisolone acetate-nepafenac 4
prednisolone acet-gatifloxacin 2
prednisolone sod ph-bromfenac 4
prednisolone sod ph-gatifloxac 4
prednisolone sodium phosphate ophthalmic (eye) 1
prednisolone-moxiflo-nepafenac 4
prednisolone-moxifloxacin hcl 4
PROLENSA 4
proparacaine 1
QNASL EX
RESTASIS 4
RESTASIS MULTIDOSE 4
RETISERT MB SP
RHOPRESSA 4 PA
ROCKLATAN 4 PA
SIMBRINZA 4
SINUVA MB SP
sulfacetamide sodium ophthalmic (eye) 1
sulfacetamide-prednisolone 1
TETCAINE 1
43
Drug Tier Notestetracaine hcl 1
tetracaine hcl (pf) ophthalmic (eye) 1
TETRAVISC 4
TETRAVISC FORTE 4
TICALAST EX
TICANASE EX
TICASPRAY EX
timol-brimon-dorzo-latanop(pf) 4
timolol maleate ophthalmic (eye) 1
timolol-brimonidi-dorzolam(pf) 4
timolol-dorzolamid-latanop(pf) 4
timolol-latanoprost(pf) 4
TIMOPTIC EX
TIMOPTIC OCUDOSE (PF) EX
TIMOPTIC-XE EX
TOBRADEX 4
TOBRADEX ST 4
tobramycin 1
tobramycin-dexamethasone 1
TOBREX 4
TRAVATAN Z 4 PA
triamcinolone acetonide nasal EX
trifluridine 1
tropicamide 1
TRUSOPT 4
TYZINE 4
VIGAMOX 4
VISUDYNE MB SP
VYZULTA EX
XALATAN EX
XELPROS 4 PA
XHANCE EX
XIIDRA 4
YUTIQ MB SP
ZETONNA EX
ZIOPTAN (PF) EX
ZIRGAN 4
ZYLET 4
ZYMAXID 4
Gastrointestinal Drugs
ACIPHEX EX
ACIPHEX SPRINKLE EX
ACTIGALL 4
AKYNZEO (NETUPITANT) 4
alosetron 4
AMITIZA 4 PA
amoxicil-clarithromy-lansopraz 1
ANTIVERT ORAL TABLET 12.5 MG, 25 MG 4
aprepitant 1
APRISO 2
Drug Tier NotesARTHROTEC 50 4
ARTHROTEC 75 4
ASACOL HD EX
AZULFIDINE 4
AZULFIDINE EN-TABS 4
balsalazide 1
BONJESTA EX
CANASA 4
CARAFATE 4
CESAMET 4
CHENODAL 4 SP
CHOLBAM 4 SP
cimetidine EX
cimetidine hcl oral EX
CIMZIA 4 PA; SP; QL (1 EA per 30 days)
CIMZIA POWDER FOR RECONST 4 PA; SP; QL (1 EA per
30 days)
CIMZIA STARTER KIT 4 PA; SP; QL (1 EA per 30 days)
CITRANATAL 90 DHA (ALGAL OIL) 4
CITRANATAL ASSURE ORAL COMBO PACK 35 MG IRON-1 MG -50 MG-300 MG
4
CITRANATAL HARMONY (IRON FUM) 4
CLENPIQ PV CN
COLAZAL EX
COLYTE WITH FLAVOR PACKS ORAL RECON SOLN240-22.72-6.72 -5.84 GRAM
4
COMPAZINE 4
COMPRO 1
CREON 2
CYTOTEC 4
DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) EX
DEXILANT EX
DICLEGIS 4
diclofenac-misoprostol 4
DIPENTUM EX
diphenoxylate-atropine 1
doxylamine-pyridoxine (vit b6) 4
dronabinol 4
DUEXIS EX
EMEND 4
ENDARI EX SP
ENTEREG 4
ENTYVIO MB SP
ESOMEP-EZS EX
esomeprazole magnesium EX
esomeprazole strontium oral capsule,delayed release(dr/ec)49.3 mg
EX
44
Drug Tier Notesfamotidine oral suspension 1
famotidine oral tablet 20 mg, 40 mg 1
GATTEX 30-VIAL 4 SP
GATTEX ONE-VIAL 4 SP
GAVILYTE-C PV CN; QL (2 Preps per 365 days)
GAVILYTE-G PV CN; QL (2 Preps per 365 days)
GAVILYTE-N PV CN; QL (2 Preps per 365 days)
GIALAX EX
GOLYTELY ORAL POWDER IN PACKET PV CN; QL (2 PREPS
per 365 days)
GOLYTELY ORAL RECON SOLN 4
granisetron hcl oral 1
HUMIRA PEDIATRIC CROHNS START 3 PA; SP; QL (3 EA per
30 days)
HUMIRA PEN 3 PA; SP; QL (6 EA per 30 days)
HUMIRA PEN CROHNS-UC-HS START 3 PA; SP; QL (6 EA per
30 days)
HUMIRA PEN PSOR-UVEITS-ADOL HS 3 PA; SP; QL (4 EA per
30 days)
HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML
3 PA; SP; QL (4 EA per 30 days)
HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) 3 PA; SP; QL (2 EA per 30 days)
HUMIRA(CF) PEDI CROHNS STARTER 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN CROHNS-UC-HS 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN PSOR-UV-ADOL HS 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML
3 PA; SP; QL (2 EA per 30 days)
INFLECTRA MB SP
lansoprazole EX
LIALDA 4
LINZESS 4 PA
LOMOTIL 4
loperamide oral capsule 1
LOTRONEX 4
MARINOL 4
meclizine oral tablet 12.5 mg, 25 mg 1
mesalamine 1
mesalamine with cleansing wipe 1 PA
metoclopramide hcl injection solution 1
metoclopramide hcl injection syringe 4
metoclopramide hcl oral 1
misoprostol 1
Drug Tier NotesMOTEGRITY 4 PA
MOTOFEN 4
MOVANTIK 4 PA
MOVIPREP PV CN; QL (2 PREPS per 365 days)
MYTESI 4
NEXIUM EX
NEXIUM PACKET EX
nizatidine EX
NULYTELY WITH FLAVOR PACKS 4
OBSTETRIX EC 4
OCALIVA 4 SP
OMECLAMOX-PAK 2
OMEPPI EX
omeprazole oral capsule,delayed release(dr/ec) 1
omeprazole-sodium bicarbonate EX
ondansetron 1
ondansetron hcl oral 1
opium tincture 4
OSMOPREP PV CN; QL (2 PREPS per 365 days)
PANCREAZE ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,500-35,500- 61,500 UNIT, 16,800-56,800- 98,400 UNIT, 2,600-6,200- 10,850 UNIT, 21,000-54,700- 83,900 UNIT, 4,200-14,200- 24,600 UNIT
EX
pantoprazole oral 1
paregoric 1
peg 3350-electrolytes PV CN; QL (2 Preps per 365 days)
PEG-3350 WITH FLAVOR PACKS PV QL (2 Preps per 365
days)
peg-electrolyte soln PV CN; QL (2 Preps per 365 days)
PEG-PREP PV CN; QL (2 PREPS per 365 days)
PENTASA 2
PEPCID ORAL TABLET EX
PERTZYE EX
PLENVU PV
PNV OB+DHA ORAL COMBO PACK 27-1-50-250 MG 1
PNV-DHA + DOCUSATE 1
polyethylene glycol 3350 oral powder PV CN; QL (2 Preps per
365 days)
polyethylene glycol 3350 oral powder in packet PV CN; QL (2 PREPS
per 365 days)
PRENAISSANCE 1
PRENAISSANCE PLUS 1
PREPOPIK PV CN; QL (2 PREPS per 365 days)
PREVACID EX
PREVACID SOLUTAB EX
45
Drug Tier NotesPRILOSEC ORAL SUSP,DELAYED RELEASE FOR RECON
EX
prochlorperazine 1
prochlorperazine edisylate 4
prochlorperazine maleate 1
PROTONIX ORAL EX
PYLERA 4
rabeprazole oral tablet,delayed release (dr/ec) EX
ranitidine hcl oral capsule 1
ranitidine hcl oral syrup 1
ranitidine hcl oral tablet 150 mg, 300 mg 1
REGLAN ORAL 4
RELISTOR ORAL 4
RELISTOR SUBCUTANEOUS SOLUTION 4
RELISTOR SUBCUTANEOUS SYRINGE 4
REMICADE MB SP
RENFLEXIS MB SP
ROWASA RECTAL ENEMA KIT 4 PA
SANCUSO EX
scopolamine base 1
SE-NATAL 19 (WITH DOCUSATE) 1
SFROWASA 4
SIMPONI 4 PA; SP
SIMPONI ARIA MB SP
sucralfate 1
sulfasalazine 1
SUPREP BOWEL PREP KIT PV CN; QL (2 PREPS per 365 days)
SUSTOL 4
SYMPROIC 4
SYNDROS 4
TARON-PREX PRENATAL-DHA 1
TIGAN ORAL CAPSULE 300 MG 1
TL-SELECT 1
TRANSDERM-SCOP 2
TRILYTE WITH FLAVOR PACKETS PV CN; QL (2 Preps per
365 days)
trimethobenzamide oral 1
TRIVEEN-PRX RNF 1
TRULANCE EX PA
URSO 250 4
URSO FORTE 4
ursodiol 1
VARUBI ORAL 4
VIBERZI 2
VIMOVO EX
VINACAL 1
VINATE ULTRA 1
Drug Tier NotesVIOKACE EX
VIRTPREX 4
VIRT-SELECT 1
VP-CH PLUS 4
XERMELO 4 PA; SP
YOSPRALA EX
ZANTAC ORAL TABLET EX
ZEGERID EX
ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT
2
ZOFRAN ORAL TABLET 4
ZUPLENZ EX
Gold Compounds
RIDAURA 4
Heavy Metal Antagonists
CHEMET 4
CUPRIMINE 2
deferasirox 4 SP
DEPEN TITRATABS 2
D-PENAMINE 4
EXJADE 4 PA; SP
FERRIPROX 4
JADENU 4 PA; SP
JADENU SPRINKLE 4 PA; SP
penicillamine 1
SYPRINE 4
trientine 4
Hormones And Synthetic Substitutes
acarbose 1
ACTIVELLA 4
ACTOPLUS MET 4
ACTOPLUS MET XR 4
ACTOS 4
ADLYXIN EX PA
ADMELOG SOLOSTAR U-100 INSULIN EX
ADMELOG U-100 INSULIN LISPRO EX
ADVAIR DISKUS 4
ADVAIR HFA 2
AEROSPAN 4
AFIRMELLE PV
AFREZZA INHALATION CARTRIDGE WITH INHALER12 UNIT, 4 UNIT, 4 UNIT (90)/ 8 UNIT (90), 4 UNIT/8 UNIT/ 12 UNIT (60), 8 UNIT, 8 UNIT (90)/ 12 UNIT (90)
EX
46
Drug Tier NotesAFTERA PV CN
A-HYDROCORT 4
AIRDUO RESPICLICK 4
alogliptin EX
alogliptin-metformin EX
alogliptin-pioglitazone EX
ALORA 4 QL (8 EA per 30 days)
ALTAVERA (28) PV CN
ALVESCO EX
ALYACEN 1/35 (28) PV CN
ALYACEN 7/7/7 (28) PV CN
AMABELZ 1
AMARYL 4
AMETHIA PV CN
AMETHIA LO PV CN
AMETHYST (28) PV CN
ANADROL-50 4
anastrozole 1 OCH
ANDRODERM 2
ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP20.25 MG/1.25 GRAM (1.62 %)
EX
ANDROGEL TRANSDERMAL GEL IN PACKET EX
ANDROID EX
ANGELIQ 4
APIDRA SOLOSTAR U-100 INSULIN EX
APIDRA U-100 INSULIN EX
APRI PV CN
ARANELLE (28) PV CN
ARIMIDEX EX OCH
ARMONAIR RESPICLICK 4
ARMOUR THYROID 2
ARNUITY ELLIPTA 2
AROMASIN 4 OCH
ASHLYNA PV CN
ASMANEX HFA 2
ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)
2
AUBRA PV CN
AUBRA EQ PV
AUROVELA 1.5/30 (21) PV
AUROVELA 1/20 (21) PV
AUROVELA 24 FE PV
AUROVELA FE 1.5/30 (28) PV
AUROVELA FE 1-20 (28) PV
AVANDAMET ORAL TABLET2-1,000 MG 4
Drug Tier NotesAVANDIA ORAL TABLET 2 MG, 4 MG 4
AVEED EX SP
AVIANE PV CN
AYGESTIN 4
AYUNA PV
AZURETTE (28) PV CN
BALCOLTRA PV
BALZIVA (28) PV CN
BASAGLAR KWIKPEN U-100 INSULIN 2
BEKYREE (28) PV CN
BETA-1 EX
BEYAZ PV CN
BIJUVA EX
BLISOVI 24 FE PV CN
BLISOVI FE 1.5/30 (28) PV CN
BLISOVI FE 1/20 (28) PV CN
BREO ELLIPTA 2
BREVICON (28) PV CN
BRIELLYN PV CN
budesonide inhalation 1
budesonide oral capsule,delayed,extend.release 1
budesonide oral tablet,delayed and ext.release 4
BYDUREON BCISE 2 PA
BYDUREON SUBCUTANEOUS PEN INJECTOR 2 PA
BYETTA 2 PA
calcitonin (salmon) 1
CAMILA PV CN
CAMRESE PV CN
CAMRESE LO PV CN
CAZIANT (28) PV CN
CHATEAL (28) PV CN
CHATEAL EQ (28) PV
chlorpropamide 4
cinacalcet 1
CLIMARA 4 QL (4 EA per 30 days)
CLIMARA PRO EX QL (4 EA per 30 days)
colesevelam 4
COMBIPATCH 2
CORTEF 4
cortisone 1
COVARYX 1
COVARYX H.S. 1
CRINONE VAGINAL GEL 4 % 4
CRYSELLE (28) PV CN
CYCLAFEM 1/35 (28) PV CN
CYCLAFEM 7/7/7 (28) PV CN
CYCLESSA (28) PV CN
47
Drug Tier NotesCYRED PV CN
CYRED EQ PV
CYTOMEL EX
danazol 4
DASETTA 1/35 (28) PV CN
DASETTA 7/7/7 (28) PV CN
DAYSEE PV CN
DDAVP 4
DEBLITANE PV CN
DECADRON 4
DELESTROGEN 4
DELTASONE ORAL TABLET20 MG 1
DELYLA (28) PV CN
DEPO-ESTRADIOL 2
DEPO-MEDROL 2
DEPO-SUBQ PROVERA 104 PV CN
DEPO-TESTOSTERONE INTRAMUSCULAR OIL 100 MG/ML
2
DEPO-TESTOSTERONE INTRAMUSCULAR OIL 200 MG/ML
4
desmopressin injection 4
desmopressin nasal spray with pump 1
desmopressin nasal spray,non-aerosol 1
desmopressin oral 1
desog-e.estradiol/e.estradiol PV CN
desogestrel-ethinyl estradiol PV CN
DEXAMETHASONE INTENSOL 1
dexamethasone oral elixir 1
dexamethasone oral solution 1
dexamethasone oral tablet 1
dexamethasone oral tablets,dose pack 4
dexamethasone sodium phos (pf) 1
dexamethasone sodium phosphate injection 1
DEXONTO MB
DEXPAK 10 DAY 4
DEXPAK 13 DAY 4
DEXPAK 6 DAY 4
DIVIGEL 2
DM2 EX
DOTTI 1
DOUBLEDEX (PF) EX
drospirenone-e.estradiol-lm.fa PV CN
drospirenone-ethinyl estradiol PV CN
DUAVEE 4
DUETACT 4
DULERA 2
DXEVO EX
Drug Tier NotesECONTRA EZ PV CN
ECONTRA ONE-STEP PV CN
EEMT 1
EEMT HS 1
EGRIFTA SUBCUTANEOUS RECON SOLN 1 MG MB SP
ELESTRIN 4
ELIGARD 3 SP
ELIGARD (3 MONTH) 3 SP
ELIGARD (4 MONTH) 3 SP
ELIGARD (6 MONTH) 3 SP
ELINEST PV CN
ELLA PV CN
EMFLAZA EX PA; SP
EMOQUETTE PV CN
ENPRESSE PV CN
ENSKYCE PV CN
ENTOCORT EC 4
ERRIN PV CN
ESTARYLLA PV CN
ESTRACE 4
estradiol oral 1
estradiol transdermal patch semiweekly 1 QL (8 EA per 30
days)
estradiol transdermal patch weekly 1 QL (4 EA per 30
days)
estradiol vaginal 1
estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml 1
estradiol-norethindrone acet 1
ESTRING 2
ESTROGEL EX
estrogens-methyltestosterone 1
ESTROSTEP FE-28 PV CN
ethynodiol diac-eth estradiol PV CN
EUTHYROX 4
EVAMIST 4
EVISTA 4
exemestane 1 OCH
FALMINA (28) PV CN
FARESTON 4 OCH
FARXIGA 2 PA
FAYOSIM PV CN
FEMARA 4 OCH
FEMHRT LOW DOSE 4
FEMRING EX
FEMYNOR PV CN
FIASP FLEXTOUCH U-100 INSULIN 2
FIASP U-100 INSULIN 2
FIRMAGON KIT W DILUENT SYRINGE 4 SP
FLOVENT DISKUS 4
48
Drug Tier NotesFLOVENT HFA 4
fludrocortisone 1
fluticasone propion-salmeterol inhalation aerosol powdr breath activated
4
fluticasone propion-salmeterol inhalation blister with device 1
FORTAMET EX
FORTEO 3 PA; SP
FORTESTA EX
FYAVOLV 1
GENERESS FE PV CN
GENOTROPIN 3 PA; SP
GENOTROPIN MINIQUICK 3 PA; SP
GIANVI (28) PV CN
glimepiride 1
glipizide 1
glipizide-metformin 1
GLUCAGEN DIAGNOSTIC KIT 4
GLUCAGEN HYPOKIT 4
GLUCAGON EMERGENCY KIT (HUMAN) 2
GLUCOPHAGE EX
GLUCOPHAGE XR EX
GLUCOTROL 4
GLUCOTROL XL 4
GLUMETZA EX
glyburide 1
glyburide micronized 1
glyburide-metformin 1
GLYNASE 4
GLYSET 4
GLYXAMBI EX PA
HAILEY 24 FE PV
HEATHER PV CN
HIDEX 4
HUMALOG JUNIOR KWIKPEN U-100 EX
HUMALOG KWIKPEN INSULIN EX
HUMALOG MIX 50-50 INSULN U-100 EX
HUMALOG MIX 50-50 KWIKPEN EX
HUMALOG MIX 75-25 KWIKPEN EX
HUMALOG MIX 75-25(U-100)INSULN EX
HUMALOG U-100 INSULIN EX
HUMATROPE EX SP
HUMULIN 70/30 U-100 INSULIN EX
HUMULIN 70/30 U-100 KWIKPEN EX
HUMULIN N NPH INSULIN KWIKPEN EX
Drug Tier NotesHUMULIN N NPH U-100 INSULIN EX
HUMULIN R REGULAR U-100 INSULN EX
HUMULIN R U-500 (CONC) INSULIN 2
HUMULIN R U-500 (CONC) KWIKPEN 2
hydrocortisone oral 1
hydroxyprogest(pf)(preg presv) MB SP
hydroxyprogesterone cap(ppres) MB SP
hydroxyprogesterone caproate 4
IMVEXXY MAINTENANCE PACK 4
IMVEXXY STARTER PACK 4
INCASSIA PV
INCRELEX 4 PA; SP
insulin lispro EX
INTRAROSA MB
INTROVALE PV CN
INVOKAMET 2
INVOKAMET XR 4
INVOKANA 2 PA
ISIBLOOM PV CN
JANUMET 2
JANUMET XR 2
JANUVIA 2 PA
JARDIANCE 2 PA
JASMIEL (28) PV
JENCYCLA PV CN
JENTADUETO EX
JENTADUETO XR EX
JINTELI 1
JOLESSA PV CN
JULEBER PV CN
JUNEL 1.5/30 (21) PV CN
JUNEL 1/20 (21) PV CN
JUNEL FE 1.5/30 (28) PV CN
JUNEL FE 1/20 (28) PV CN
JUNEL FE 24 PV CN
KAITLIB FE PV CN
KALLIGA PV
KARIVA (28) PV CN
KAZANO EX
KELNOR 1/35 (28) PV CN
KELNOR 1-50 PV CN
KISQALI FEMARA CO-PACK 4 PA; SP; OCH
KOMBIGLYZE XR 2
KORLYM 4 PA; SP
KURVELO (28) PV CN
KYLEENA PV SP; CN
l norgest/e.estradiol-e.estrad PV CN
49
Drug Tier NotesLANTUS SOLOSTAR U-100 INSULIN 2
LANTUS U-100 INSULIN 2
LARIN 1.5/30 (21) PV CN
LARIN 1/20 (21) PV CN
LARIN 24 FE PV CN
LARIN FE 1.5/30 (28) PV CN
LARIN FE 1/20 (28) PV CN
LARISSIA PV CN
LAYOLIS FE PV CN
LEENA 28 PV CN
LESSINA PV CN
letrozole 1 OCH
leuprolide subcutaneous kit 4 SP
LEVEMIR FLEXTOUCH U-100 INSULN 2
LEVEMIR U-100 INSULIN 2
LEVONEST (28) PV CN
levonorgestrel oral tablet 1.5 mg PV
levonorgestrel-ethinyl estrad PV CN
levonorg-eth estrad triphasic PV CN
LEVORA-28 PV CN
LEVO-T 4
levothyroxine oral 1
LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG
1
LILETTA PV SP; CN
LILLOW (28) PV CN
liothyronine oral 1
LO LOESTRIN FE PV CN
LOESTRIN 1.5/30 (21) PV CN
LOESTRIN 1/20 (21) PV CN
LOESTRIN FE 1.5/30 (28-DAY) PV CN
LOESTRIN FE 1/20 (28-DAY) PV CN
LOPREEZA 1
LORYNA (28) PV CN
LOSEASONIQUE PV CN
LOW-OGESTREL (28) PV CN
LO-ZUMANDIMINE (28) PV
LUGOLS ORAL 1
LUPANETA PACK (1 MONTH) 4 PA; SP
LUPANETA PACK (3 MONTH) 4 PA; SP
LUPRON DEPOT 4 SP
LUPRON DEPOT (3 MONTH) 4 SP
LUPRON DEPOT (4 MONTH) 4 SP
LUPRON DEPOT (6 MONTH) 4 SP
LUPRON DEPOT-PED 4 SP
LUPRON DEPOT-PED (3 MONTH) 4 SP
LUTERA (28) PV CN
LYZA PV CN
Drug Tier NotesMAKENA MB SP
MAKENA (PF) 4 SP
MARLISSA (28) PV CN
MAS CARE-PAK (PF) EX
MEDROL 4
MEDROL (PAK) 4
medroxyprogesterone intramuscular PV CN
medroxyprogesterone oral 1
megestrol oral suspension 1
megestrol oral tablet 1 OCH
MELODETTA 24 FE PV CN
MENEST 4
MENOSTAR 4 QL (4 EA per 30 days)
metformin oral solution 4 PA
metformin oral tablet 1
metformin oral tablet extended release 24 hr 1
metformin oral tablet extended release 24hr EX
metformin oral tablet,er gast.retention 24 hr EX
methimazole oral tablet 10 mg, 5 mg 1
METHITEST EX
methylprednisolone 1
methylprednisolone acetate 1
methyltestosterone oral capsule 1
MIACALCIN INJECTION 4
MIBELAS 24 FE PV CN
MICROGESTIN 1.5/30 (21) PV CN
MICROGESTIN 1/20 (21) PV CN
MICROGESTIN 24 FE PV CN
MICROGESTIN FE 1.5/30 (28) PV CN
MICROGESTIN FE 1/20 (28) PV CN
miglitol 1
MILI PV CN
MILLIPRED DP 1
MILLIPRED ORAL TABLET 1
MIMVEY 1
MIMVEY LO 1
MINASTRIN 24 FE PV CN
MINIVELLE 4 QL (8 EA per 30 days)
MIRCETTE (28) PV CN
MIRENA PV CN
MONO-LINYAH PV CN
MY CHOICE PV CN
MY WAY PV CN
MYALEPT 4 SP
NATAZIA PV CN
nateglinide 4
NATESTO EX
50
Drug Tier NotesNATPARA 4 PA; SP
NATURE-THROID 1
NECON 0.5/35 (28) PV CN
NESINA EX
NEW DAY PV
NEXPLANON PV CN
NEXT CHOICE ONE DOSE PV CN
NIKKI (28) PV CN
NOCDURNA (MEN) 4
NOCDURNA (WOMEN) 4
NOCTIVA EX
NORA-BE PV CN
NORDITROPIN FLEXPRO EX SP
noreth-ethinyl estradiol-iron PV CN
norethindrone (contraceptive) PV CN
norethindrone acetate 1
norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg
1
norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg PV CN
norethindrone-e.estradiol-iron PV CN
norgestimate-ethinyl estradiol PV CN
norgestrel-ethinyl estradiol PV CN
NORLYDA PV CN
NORLYROC PV CN
NORTREL 0.5/35 (28) PV CN
NORTREL 1/35 (21) PV CN
NORTREL 1/35 (28) PV CN
NORTREL 7/7/7 (28) PV CN
NOVOLIN 70/30 U-100 INSULIN 2
NOVOLIN 70-30 FLEXPEN U-100 2
NOVOLIN N NPH U-100 INSULIN 2
NOVOLIN R REGULAR U-100 INSULN 2
NOVOLOG FLEXPEN U-100 INSULIN 2
NOVOLOG MIX 70-30 U-100 INSULN 2
NOVOLOG MIX 70-30FLEXPEN U-100 2
NOVOLOG PENFILL U-100 INSULIN 2
NOVOLOG U-100 INSULIN ASPART 2
NP THYROID 1
NUTROPIN AQ NUSPIN EX SP
NUVARING PV CN
OCELLA PV CN
octreotide acetate 3 SP
OGESTREL (28) PV CN
OMNITROPE 3 PA; SP
ONGLYZA 2 PA
Drug Tier NotesOPCICON ONE-STEP PV CN
OPTION-2 PV CN
ORAPRED ODT 4
ORILISSA 4 PA
ORSYTHIA PV CN
ORTHO MICRONOR PV CN
ORTHO TRI-CYCLEN (28) PV CN
ORTHO-NOVUM 1/35 (28) PV CN
ORTHO-NOVUM 7/7/7 (28) PV CN
OSENI EX
OSPHENA 4
OXANDRIN 4
oxandrolone 1
OZEMPIC 2 PA
PARAGARD T 380A PV CN
PHILITH PV CN
PIMTREA (28) PV CN
pioglitazone 1
pioglitazone-glimepiride 1
pioglitazone-metformin 1
PIRMELLA PV CN
PLAN B ONE-STEP PV CN
PORTIA 28 PV CN
PRANDIN ORAL TABLET 1 MG, 2 MG 4
PRECOSE 4
prednisolone oral solution 15 mg/5 ml 1
prednisolone sodium phosphate oral 1
prednisone 1
PREDNISONE INTENSOL 1
PREFEST 4
PREMARIN ORAL 2
PREMARIN VAGINAL 2
PREMPHASE 4
PREMPRO 4
PREVIFEM PV CN
progesterone 1
progesterone micronized 1
PROGLYCEM 2
PROMETRIUM 4
propylthiouracil 1
PROVERA 4
PULMICORT EX
PULMICORT FLEXHALER 2
QTERN 2 PA
QUARTETTE PV CN
QVAR REDIHALER 2
RAJANI PV CN
raloxifene 1 OCH
RAYOS EX
51
Drug Tier NotesRECLIPSEN (28) PV CN
repaglinide oral tablet 0.5 mg, 1 mg 1
repaglinide oral tablet 2 mg 4
repaglinide-metformin 1
RIOMET 4 PA
RIVELSA PV CN
SAFYRAL PV CN
SAIZEN EX SP
SAIZEN SAIZENPREP EX PA; SP
SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML
4 SP
SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON
3 SP
SAXENDA EX
SEASONIQUE PV CN
SEGLUROMET 4
SENSIPAR 4 SP
SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG
4 PA; SP
SETLAKIN PV CN
SHAROBEL PV CN
SIGNIFOR 4 PA; SP
SIGNIFOR LAR 4 PA; SP
SIMLIYA (28) PV
SIMPESSE PV
SKYLA PV CN
SOLIQUA 100/33 4 PA
SOLTAMOX 4 OCH
SOMATULINE DEPOT 4 SP
SOMAVERT 4 SP
SPRINTEC (28) PV CN
SRONYX PV CN
SSKI 2
STARLIX 4
STEGLATRO 4 PA
STEGLUJAN 4 PA
STIMATE 4 SP
STRIANT 4
STRONG IODINE ORAL 1
SUPPRELIN LA 4 SP
SYEDA PV CN
SYMBICORT 2
SYMLINPEN 120 2 PA
SYMLINPEN 60 2 PA
SYNAREL 4
SYNJARDY 2
SYNJARDY XR 2
SYNTHROID 2
TAKE ACTION PV CN
Drug Tier Notestamoxifen 1 OCH
TAPAZOLE 4
TAPERDEX EX
TARINA 24 FE PV
TARINA FE 1/20 (28) PV CN
TARINA FE 1-20 EQ (28) PV
TAYTULLA PV CN
TESTIM EX
TESTOPEL MB
testosterone 12.5 mg/1.25 gram 1
testosterone 12.5 mg/1.25 gram inner 1
testosterone 12.5 mg/1.25 gram inner EX
testosterone 12.5 mg/1.25 gram outer 1
testosterone 12.5 mg/1.25 gram outer EX
testosterone 50 mg/5 gram pkt 1
testosterone 50 mg/5 gram pkt inner 1
testosterone 50 mg/5 gram pkt inner EX
testosterone 50 mg/5 gram pkt outer 1
testosterone 50 mg/5 gram pkt outer EX
testosterone cypionate 1
testosterone enanthate 4
testosterone transdermal gel 1
testosterone transdermal gel in metered-dose pump 10 mg/0.5 gram /actuation
EX
testosterone transdermal gel in metered-dose pump 20.25 mg/1.25 gram (1.62 %)
1
testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1.62 % (20.25 mg/1.25 gram), 1.62 % (40.5 mg/2.5 gram)
1
testosterone transdermal solution in metered pump w/app 1
TESTRED EX
thyroid (pork) 1
THYROLAR-1 2
THYROLAR-1/2 2
THYROLAR-1/4 2
THYROLAR-2 2
THYROLAR-3 2
TILIA FE PV CN
TIROSINT EX
TIROSINT-SOL EX
tolazamide 1
tolbutamide 1
toremifene 1 OCH
TOUJEO MAX U-300 SOLOSTAR 2
52
Drug Tier NotesTOUJEO SOLOSTAR U-300 INSULIN 2
TRADJENTA EX
TRELEGY ELLIPTA 2
TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION
MB
TRESIBA FLEXTOUCH U-100 2
TRESIBA FLEXTOUCH U-200 2
TRESIBA U-100 INSULIN 2
TRI FEMYNOR PV CN
TRI-ESTARYLLA PV CN
TRI-LEGEST FE PV CN
TRI-LINYAH PV CN
TRI-LO-ESTARYLLA PV CN
TRI-LO-MARZIA PV CN
TRI-LO-MILI PV
TRI-LO-SPRINTEC PV CN
TRI-MILI PV CN
TRI-PREVIFEM (28) PV CN
TRIPTODUR MB SP
TRI-SPRINTEC (28) PV CN
TRIVORA (28) PV CN
TRI-VYLIBRA PV CN
TRI-VYLIBRA LO PV
TRULICITY EX
TULANA PV CN
TYDEMY PV CN
TYMLOS 3 PA; SP
UCERIS 4
UNITHROID 1
VAGIFEM EX
VANTAS 4 SP
VELIVET TRIPHASIC REGIMEN (28) PV CN
VERIPRED 20 1
VICTOZA 2-PAK 2 PA
VICTOZA 3-PAK 2 PA
VIENVA PV CN
VIORELE (28) PV CN
VIVELLE-DOT EX QL (8 EA per 30 days)
VOGELXO EX
VYFEMLA (28) PV CN
VYLIBRA PV CN
WELCHOL EX
WERA (28) PV CN
WESTHROID ORAL TABLET130 MG, 195 MG, 32.5 MG, 65 MG, 97.5 MG
1
WIXELA INHUB 1
WP THYROID 2
WYMZYA FE PV CN
XIGDUO XR 2
Drug Tier NotesXULANE PV CN
XULTOPHY 100/3.6 2 PA
XYOSTED EX
YASMIN (28) PV CN
YAZ (28) PV CN
YUVAFEM 1
ZARAH PV CN
ZENCHENT (28) PV CN
ZILRETTA MB SP
ZOLADEX MB SP
ZOMACTON EX SP
ZORBTIVE 4 PA; SP
ZOVIA 1/35E (28) PV CN
ZUMANDIMINE (28) PV
Local Anesthetics (Parenteral)
ACCUCAINE KIT EX
lidocaine hcl injection solution 10 mg/ml (1 %) MB
XYLOCAINE INJECTION SOLUTION 10 MG/ML (1 %) 4
Miscellaneous Therapeutic Agents
acetylcysteine MB
ACTEMRA ACTPEN 3 PA; SP
ACTEMRA INTRAVENOUS MB SP
ACTEMRA SUBCUTANEOUS 3 PA; SP
ACTIMMUNE 4 SP
ACTONEL ORAL TABLET 150 MG, 35 MG, 5 MG 4
alendronate 1
allopurinol 1
AMPYRA 4 PA; SP; QL (60 EA per 30 days)
ANAPROX DS 4
ANTABUSE 4
ARAVA 4
ARCALYST 4 SP
ASTAGRAF XL 4
ATELVIA 4
AUBAGIO 4 PA; SP
AVODART EX
AVONEX (WITH ALBUMIN) 3 SP; QL (4 EA per 30 days)
AVONEX INTRAMUSCULAR PEN INJECTOR KIT 3 SP; QL (4 EA per 30
days)
AVONEX INTRAMUSCULAR SYRINGE KIT 3 SP; QL (4 EA per 30
days)
AZASAN 4
azathioprine 1
AZULFIDINE 4
AZULFIDINE EN-TABS 4
BENLYSTA INTRAVENOUS MB SP
BENLYSTA SUBCUTANEOUS 3 PA; SP
BERINERT INTRAVENOUS KIT MB SP
53
Drug Tier NotesBETASERON SUBCUTANEOUS KIT 3 SP; QL (30 EA per
30 days)
BETASERON SUBCUTANEOUS RECON SOLN
3
BINOSTO 4
BONIVA ORAL 4
BOTOX MB SP
calcitonin (salmon) 1
CARNITOR (SUGAR-FREE) 4
CARNITOR ORAL 4
CELLCEPT 4
CERDELGA 4 SP
CHEMET 4
CIMZIA 4 PA; SP; QL (1 EA per 30 days)
CIMZIA POWDER FOR RECONST 4 PA; SP; QL (1 EA per
30 days)
CIMZIA STARTER KIT 4 PA; SP; QL (1 EA per 30 days)
cinacalcet 1
CINRYZE MB SP
CLINPRO 5000 4
colchicine 2
COLCRYS 2
COMFORT PAC-NAPROXEN EX
COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML 4 SP; QL (30 ML per
30 days)
COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML 4 SP; QL (12 ML per
30 days)
CRYOSERV 1
CUPRIMINE 2
cyclophosphamide oral capsule 4 OCH
cyclosporine modified 1
cyclosporine oral capsule 1
CYSTADANE 4 SP
CYSTAGON 4 SP
dalfampridine 4 PA; SP; QL (60 EA per 30 days)
DEMSER 2
DENTA 5000 PLUS 1
DENTAGEL 1
DEPEN TITRATABS 2
disulfiram 1
dutasteride 1
dutasteride-tamsulosin 1
DUZALLO EX
DYSPORT 4 SP
EC-NAPROSYN 4
EC-NAPROXEN ORAL TABLET,DELAYED RELEASE (DR/EC) 375 MG
1
EC-NAPROXEN ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG
2
ELIDEL 4
Drug Tier NotesELMIRON 2
ENBREL 3 PA; SP; QL (4 EA per 30 days)
ENBREL MINI 3 PA; SP; QL (4 ML per 30 days)
ENBREL SURECLICK 3 PA; SP; QL (4 ML per 30 days)
ENDARI EX SP
ENTYVIO MB SP
ENVARSUS XR 4
ESCAVITE PV
ESCAVITE D PV
ESCAVITE LQ PV
etidronate disodium 1
EVENITY 4 PA; SP
EVISTA 4
EVOTAZ 4
EVZIO INJECTION AUTO-INJECTOR 2 MG/0.4 ML EX
EXONDYS 51 MB SP
EXTAVIA SUBCUTANEOUS KIT EX SP; QL (15 Kits per
30 days)
EXTAVIA SUBCUTANEOUS RECON SOLN EX SP; QL (15 EA per
30 days)
febuxostat 4
finasteride oral tablet 5 mg 1
FIRAZYR 3 PA; SP
FIRDAPSE 4 PA; SP
FIRMAGON KIT W DILUENT SYRINGE 4 SP
FLORIVA PV
FLORIVA (FLUORIDE-VITAMIN D3) PV
FLORIVA PLUS PV
FLUORABON PV
fluoride (sodium) dental gel 1
fluoride (sodium) oral drops PV CN
fluoride (sodium) oral tablet,chewable PV CN
FLUORIDEX DAILY DEFENSE DENTAL PASTE 4
FLUORIDEX SENSITIVITY RELIEF DENTAL PASTE 4
FLUORITAB ORAL TABLET,CHEWABLE PV CN
FLURA-DROPS PV
FORTEO 3 PA; SP
FOSAMAX ORAL TABLET 70 MG 4
FOSAMAX PLUS D 4
FOSRENOL EX
GALAFOLD 3 PA; SP
GAMIFANT MB SP
GENGRAF ORAL CAPSULE100 MG, 25 MG 1
GENGRAF ORAL SOLUTION 1
54
Drug Tier NotesGILENYA 3 PA; SP
glatiramer 4 SP
GLATOPA SUBCUTANEOUS SYRINGE 20 MG/ML 4 SP; QL (30 Syringes
per 30 days)
GLATOPA SUBCUTANEOUS SYRINGE 40 MG/ML 4 SP
GLUCAGEN HYPOKIT 4
GLUCAGON EMERGENCY KIT (HUMAN) 2
GRASTEK 4
HAEGARDA 4 SP
HUMIRA PEDIATRIC CROHNS START 3 PA; SP; QL (3 EA per
30 days)
HUMIRA PEN 3 PA; SP; QL (6 EA per 30 days)
HUMIRA PEN CROHNS-UC-HS START 3 PA; SP; QL (6 EA per
30 days)
HUMIRA PEN PSOR-UVEITS-ADOL HS 3 PA; SP; QL (4 EA per
30 days)
HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML
3 PA; SP; QL (4 EA per 30 days)
HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) 3 PA; SP; QL (2 EA per 30 days)
HUMIRA(CF) PEDI CROHNS STARTER 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN CROHNS-UC-HS 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN PSOR-UV-ADOL HS 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML
3 PA; SP; QL (2 EA per 30 days)
hydroxychloroquine 1
ibandronate oral 1
ILARIS (PF) SUBCUTANEOUS SOLUTION MB SP
IMURAN 4
INDOCIN ORAL EX PA
INDOCIN RECTAL EX
indomethacin oral 1
INFLECTRA MB SP
INTRON A INJECTION 3 SP
JALYN 4
KALBITOR 4 SP
KEVEYIS 4 SP
KEVZARA 4 PA; SP
KINERET EX PA; SP
KRYSTEXXA MB SP
KUVAN 4 SP
lanthanum 1
leflunomide 1
LEMTRADA MB SP
leucovorin calcium injection recon soln 100 mg, 200 mg, 50 mg, 500 mg
4
Drug Tier Notesleucovorin calcium oral 1
levocarnitine (with sugar) 1
levocarnitine oral tablet 1
LIPOCHOL PLUS 4
LUDENT FLUORIDE PV CN
LUGOLS ORAL 1
MAVENCLAD (10 TABLET PACK) EX SP
MAVENCLAD (4 TABLET PACK) EX SP
MAVENCLAD (5 TABLET PACK) EX SP
MAVENCLAD (6 TABLET PACK) EX SP
MAVENCLAD (7 TABLET PACK) EX SP
MAVENCLAD (8 TABLET PACK) EX SP
MAVENCLAD (9 TABLET PACK) EX SP
MAYZENT 4 PA; SP
MAYZENT STARTER PACK 4 PA; SP
MEPHYTON 4
mercaptopurine 1 OCH
MESNEX ORAL 4
methotrexate sodium (pf) 1
methotrexate sodium injection 1
methotrexate sodium oral 1 OCH
MIACALCIN INJECTION 4
miglustat 4 SP
MITIGARE 2
MULTI-VIT WITH FLUORIDE-IRON PV CN
MULTIVITAMIN WITH FLUORIDE PV CN
MULTI-VITAMIN WITH FLUORIDE ORAL DROPS PV CN
MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG
PV CN
MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG
PV
MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG
PV CN
MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG
PV
MVC-FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG
PV CN
MVC-FLUORIDE ORAL TABLET,CHEWABLE 1 MG PV
mycophenolate mofetil 1
mycophenolate sodium 1
MYFORTIC 4
55
Drug Tier NotesMYOBLOC MB SP
naloxone 1
naltrexone 1
NAPRELAN CR EX
NAPROSYN ORAL SUSPENSION 4
NAPROSYN ORAL TABLET500 MG 4
naproxen 1
naproxen sodium oral tablet 275 mg, 550 mg 1
naproxen sodium oral tablet, er multiphase 24 hr EX
NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION 4
NATPARA 4 PA; SP
NEORAL 4
NICAZEL EX
NITYR 4 SP
NULOJIX MB SP
OCREVUS MB SP
octreotide acetate 3 SP
OLUMIANT 4 PA; SP
ONPATTRO MB SP
ORALAIR SUBLINGUAL TABLET 100 INDX REACTIVITY, 100 IR (3) /300 IR (6)
MB
ORALAIR SUBLINGUAL TABLET 300 INDX REACTIVITY 4 SP
ORENCIA 4 PA; SP; QL (4 ML per 30 days)
ORENCIA (WITH MALTOSE) MB SP
ORENCIA CLICKJECT 4 PA; SP; QL (4 ML per 30 days)
ORFADIN 4 SP
OTEZLA 3 PA; SP
OTEZLA STARTER 3 PA; SP
OTREXUP (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.4 ML, 12.5 MG/0.4 ML, 15 MG/0.4 ML, 17.5 MG/0.4 ML, 20 MG/0.4 ML, 22.5 MG/0.4 ML, 25 MG/0.4 ML
2
penicillamine 1
phytonadione (vitamin k1) oral tablet 5 mg 1
pimecrolimus 1
PLAQUENIL EX
PLEGRIDY 3 SP; QL (1 ML per 30 days)
POLY-VI-FLOR PV
POLY-VI-FLOR WITH IRON PV
POMALYST 4 PA; SP; OCH
POTABA ORAL CAPSULE 4
PREVIDENT 4
PREVIDENT 5000 BOOSTER PLUS 4
Drug Tier NotesPREVIDENT 5000 DRY MOUTH 4
PREVIDENT 5000 ENAMEL PROTECT 4
PREVIDENT 5000 PLUS 4
PREVIDENT 5000 SENSITIVE 4
PREZCOBIX 4
probenecid 1
probenecid-colchicine 1
PROCYSBI 4 SP
PROGRAF ORAL 4
PROLEUKIN MB SP
PROLIA 4 SP
PROSCAR 4
PURIXAN 4 SP; OCH
QUFLORA PV
QUFLORA FE PV
QUFLORA FE (FERROUS SULFATE) PV
QUFLORA PEDIATRIC PV
QUFLORA PEDIATRIC DROPS PV
RAGWITEK 4
raloxifene 1 OCH
RAPAMUNE 4
RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML
2
REBIF (WITH ALBUMIN) 3 SP; QL (6 ML per 30 days)
REBIF REBIDOSE 3 SP; QL (6 ML per 30 days)
REBIF TITRATION PACK 3 SP; QL (5 ML per 30 days)
REMICADE MB SP
RENAGEL ORAL TABLET 800 MG EX
RENFLEXIS MB SP
RENVELA 4 PA
REVIA 4
REVLIMID 3 PA; SP; OCH
RIDAURA 4
risedronate 1
RUCONEST MB SP
RUZURGI EX
SANDIMMUNE ORAL 4
SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 50 MCG/ML, 500 MCG/ML
4 SP
SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON
3 SP
SENSIPAR 4 SP
56
Drug Tier Notessevelamer carbonate oral powder in packet 4
sevelamer carbonate oral tablet 1
sevelamer hcl 4
SF 1
SF 5000 PLUS 1
SIMPONI 4 PA; SP
SIMPONI ARIA MB SP
sirolimus 1
SODIUM FLUORIDE 5000 PLUS 1
sodium polystyrene sulfonate oral powder 4
sodium polystyrene sulfonate oral suspension 1
sodium polystyrene sulfonate rectal enema 30 gram/120 ml 4
SOLIRIS MB SP
SPINRAZA (PF) MB SP
SPS (WITH SORBITOL) ORAL 1
SPS (WITH SORBITOL) RECTAL 4
SSKI 2
STELARA INTRAVENOUS MB SP
STELARA SUBCUTANEOUS 3 PA; SP
STRONG IODINE ORAL 1
sulfasalazine 1
SYMTUZA EX
tacrolimus oral 1
TAKHZYRO MB SP
TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG
3 PA; SP; QL (14 EA per 30 days)
TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46), 240 MG
3 PA; SP; QL (60 EA per 30 days)
TEGSEDI EX SP
THALOMID 3 SP; OCH
THIOLA 4 SP
TIVORBEX EX
TREXALL 4 OCH
TRIPLE VITAMIN WITH FLUORIDE PV CN
TRI-VI-FLOR PV
TRI-VITAMIN WITH FLUORIDE PV CN
TRI-VITE WITH FLUORIDE PV
TYBOST 2
TYMLOS 3 PA; SP
TYSABRI MB SP
ULORIC 4
ULTOMIRIS MB SP
VISTOGARD 4 SP; OCH
VITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.25 MG FLUOR. (0.55 MG)/ML
PV CN
Drug Tier NotesVITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.5 MG FLUORIDE (1.1 MG)/ML
PV
VIVITROL MB SP
XATMEP 4 OCH
XELJANZ 3 PA; SP
XELJANZ XR 3 PA; SP
XEOMIN 4 SP
XGEVA 4 SP
XURIDEN 4 SP
ZAVESCA 4 SP
ZORTRESS 2
ZYLOPRIM 4
Oxytocics
METHERGINE 4
methylergonovine oral 1
PREPIDIL 4
PROSTIN E2 4
Pharmaceutical Aids
DILUENT FOR EPOPROSTENOL/FLOLA MB SP
FORMA-RAY 1
LUMOXITI IV SOLN STABILIZER MB SP
PH 12 DILUENT FOR FLOLAN MB SP
RADIAGEL MB
Radioactive Agents
AZEDRA DOSIMETRIC MB SP
AZEDRA THERAPEUTIC MB SP
LUTATHERA MB SP
XOFIGO MB SP
Respiratory Tract Agents
ACCOLATE 4
acetylcysteine MB
ADCIRCA 4 PA; SP
ADEMPAS 4 SP
ADRENALIN INJECTION 1
ADVAIR DISKUS 4
ADVAIR HFA 2
AEROSPAN 4
AIRDUO RESPICLICK 4
albuterol sulfate inhalation hfa aerosol inhaler 4
albuterol sulfate inhalation solution for nebulization 1
albuterol sulfate oral 1
ALOCRIL EX
ALVESCO EX
ALYQ 3 PA; SP
ambrisentan 3 SP
ANORO ELLIPTA 2
ARALAST NP MB SP
ARCAPTA NEOHALER 4
57
Drug Tier NotesARMONAIR RESPICLICK 4
ARNUITY ELLIPTA 2
ASMANEX HFA 2
ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (14 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)
2
atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 4
ATROVENT HFA 4
AUVI-Q EX
BECONASE AQ EX
benzonatate 1
BEVESPI AEROSPHERE 4
BONJESTA EX
bosentan 4 SP
BREO ELLIPTA 2
BROMFED DM 4
brompheniramine-pseudoeph-dm oral syrup 4
BROVANA EX
budesonide inhalation 1
budesonide nasal EX
carbinoxamine maleate EX
CENTERGY 1
CENTERGY DM 1
cetirizine oral solution 1 mg/ml 1
CHERATUSSIN AC 1
CINQAIR MB SP
CLARINEX ORAL TABLET EX
CLARINEX-D 12 HOUR EX
clemastine oral tablet EX
codeine sulfate oral tablet 1 PA
codeine-guaifenesin 1
CODITUSSIN AC 4
COMBIVENT RESPIMAT 2
cromolyn ophthalmic (eye) 1
cromolyn oral 1
cyproheptadine 1
DALIRESP 4
desloratadine 1
DICLEGIS 4
diphenhydramine hcl injection solution 50 mg/ml 1
diphenhydramine hcl injection syringe MB
diphenhydramine hcl oral capsule 50 mg 1
diphenhydramine hcl oral elixir 1
diphenoxylate-atropine 1
doxylamine-pyridoxine (vit b6) 4
DULERA 2
Drug Tier NotesDUPIXENT 4 PA; SP
DYMISTA EX
ELIXOPHYLLIN ORAL ELIXIR80 MG/15 ML 4
epinephrine injection auto-injector 0.15 mg/0.15 ml, 0.15 mg/0.3 ml
2
epinephrine injection solution 1
epinephrine injection syringe 0.1 mg/ml 1
EPIPEN 2 PA
EPIPEN 2-PAK 2 PA
EPIPEN JR 2 PA
EPIPEN JR 2-PAK 2 PA
EPISNAP 2 PA
epoprostenol (glycine) MB SP
ESBRIET 4 PA; SP
FASENRA MB SP
fexofenadine oral tablet 180 mg, 60 mg EX
fexofenadine-pseudoephedrine EX
FLOLAN MB SP
FLOVENT DISKUS 4
FLOVENT HFA 4
flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) EX
fluticasone propionate nasal 1
fluticasone propion-salmeterol inhalation aerosol powdr breath activated
4
fluticasone propion-salmeterol inhalation blister with device 1
GASTROCROM 4
GLASSIA MB SP
GUAIATUSSIN AC 1
GUAIFENESIN AC 1
GUAIFENESIN DAC 1
HISTEX-AC 1
HYDROCODONE COMPOUND 1
hydrocodone-chlorpheniramine 1
hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 1
hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml (5 ml) 2
hydrocodone-homatropine oral tablet 1
HYDROMET 1
INCRUSE ELLIPTA 2
ipratropium bromide inhalation 1
ipratropium-albuterol 1
KALYDECO 3 PA; SP
KARBINAL ER EX
LETAIRIS 3 SP
levalbuterol hcl EX
levalbuterol tartrate EX
58
Drug Tier Noteslevocetirizine 1
LOMOTIL 4
LORTUSS EX ORAL SYRUP 1
LUGOLS ORAL 1
metaproterenol oral syrup 1
metaproterenol oral tablet 10 mg 1
mometasone nasal EX
montelukast 1
NASONEX EX
NUCALA SUBCUTANEOUS AUTO-INJECTOR 4 PA; SP
NUCALA SUBCUTANEOUS RECON SOLN MB SP
NUCALA SUBCUTANEOUS SYRINGE 4 PA; SP
NUEDEXTA 4
OBREDON EX
OFEV 4 PA; SP
OMNARIS EX
OPSUMIT 4 SP
ORENITRAM 4 SP
ORKAMBI 3 PA; SP
PERFOROMIST 2
PROAIR HFA 2
PROAIR RESPICLICK 2
PROLASTIN-C MB SP
promethazine injection solution25 mg/ml 4
promethazine oral 1
PROMETHAZINE VC 1
promethazine-codeine 1
promethazine-dm 1
promethazine-phenyleph-codeine 1
promethazine-phenylephrine 1
PROVENTIL HFA EX
PULMICORT EX
PULMICORT FLEXHALER 2
PULMOZYME 4 SP
QNASL EX
QVAR REDIHALER 2
REMODULIN 4 SP
RESPA-AR 4
REVATIO INTRAVENOUS MB SP
REVATIO ORAL SUSPENSION FOR RECONSTITUTION 3 SP
REVATIO ORAL TABLET 4 PA; SP
RYCLORA EX
RYDEX 1
RYVENT EX
SEMPREX-D EX
SEREVENT DISKUS 2
sildenafil (antihypertensive) intravenous MB SP
Drug Tier Notessildenafil (antihypertensive) oral suspension for reconstitution 3 SP
sildenafil (antihypertensive) oral tablet 4 PA; SP
SINGULAIR EX
SINUVA MB SP
SPIRIVA RESPIMAT 2
SPIRIVA WITH HANDIHALER 2
SSKI 2
STRIVERDI RESPIMAT 4
STRONG IODINE ORAL 1
SURFAXIN 4
SYMBICORT 2
SYMDEKO 3 PA; SP
tadalafil (antihypertensive) 3 PA; SP
terbutaline 1
TESSALON PERLES 4
THEO-24 4
THEOCHRON 1
theophylline oral elixir 1
theophylline oral solution 1
theophylline oral tablet extended release 12 hr 1
theophylline oral tablet extended release 24 hr 1
TICALAST EX
TICANASE EX
TICASPRAY EX
TRACLEER 3 SP
TRELEGY ELLIPTA 2
treprostinil sodium 4 SP
triamcinolone acetonide nasal EX
TUDORZA PRESSAIR 4
TUSNEL C 1
TUSSICAPS 4
TYVASO 4 SP
TYVASO INSTITUTIONAL START KIT 4 SP
TYVASO REFILL KIT 4 SP
TYVASO STARTER KIT 4 SP
UPTRAVI 4 SP
UTIBRON NEOHALER 4
VELETRI MB SP
VENTAVIS 4 SP
VENTOLIN HFA 4
VIRTUSSIN AC 1
VIRTUSSIN DAC 1
WIXELA INHUB 1
XHANCE EX
XOLAIR MB SP
XOPENEX EX
XOPENEX CONCENTRATE EX
XOPENEX HFA EX
59
Drug Tier NotesXYZAL ORAL TABLET EX
zafirlukast 4
ZEMAIRA MB SP
ZETONNA EX
zileuton 4 PA
ZYFLO 4 PA
Skin And Mucous Membrane Agents
ABSORICA EX
ACANYA TOPICAL GEL WITH PUMP 4
ACCUCAINE KIT EX
acitretin 4
acyclovir topical 1
ACZONE 4 PA
adapalene EX
adapalene-benzoyl peroxide EX
ADAZIN EX
ADVANCED ALLERGY COLLECT KIT EX PA
AGONEAZE EX
AKTIPAK EX
ALA-CORT TOPICAL CREAM 1 % 1
ALA-QUIN EX
ALA-SCALP 4
alclometasone 1
ALCOHOL PADS 2
ALCOHOL PREP PADS 2
alcohol swabs 2
ALCOHOL WIPES 2
ALCORTIN A EX
ALDARA 4
ALTABAX 4
ALTRENO EX
amcinonide 4
ammonium lactate 1
AMNESTEEM 1
ANACAINE EX
ANA-LEX KIT EX PA
ANALPRAM-HC RECTAL CREAM 4
ANALPRAM-HC SINGLES RECTAL CREAM 2.5-1 % (4G) 4
ANALPRAM-HC TOPICAL 4
ANASTIA EX
ANODYNE LPT EX
ANUCORT-HC 4
ANUSOL-HC RECTAL SUPPOSITORY EX
ANUSOL-HC TOPICAL EX
APEXICON E 1
APRIZIO PAK EX
AQUA GLYCOLIC HC EX PA
Drug Tier NotesASTERO EX
ATOPICLAIR EX
ATRALIN 4
AVAGE EX
AVAR LS EX
AVAR TOPICAL CLEANSER EX
AVAR TOPICAL PADS, MEDICATED EX
AVAR-E EX
AVAR-E GREEN EX
AVAR-E LS EX
AVC VAGINAL 4
AVITA TOPICAL CREAM 1
AVITA TOPICAL GEL 4 PA
AVO CREAM EX
azelaic acid 4
AZELEX 4 PA
BENSAL HP TOPICAL OINTMENT 3 % EX
BENZACLIN EX
BENZACLIN PUMP EX
BENZAMYCIN 4
BENZEPRO TOPICAL TOWELETTE 1
BENZODOX 30 EX
BENZODOX 60 EX
benzoyl peroxide topical cleanser7 % 1
benzoyl peroxide topical foam EX
BESER 4
BESER KIT EX
betamethasone dipropionate 1
betamethasone valerate 1
betamethasone, augmented 1
BIAFINE EMULSION EX
BP 10-1 4
BPO TOPICAL GEL 1
BPO TOPICAL TOWELETTE 6 % 1
BRYHALI 4 PA
calcipotriene 1
calcipotriene-betamethasone 4
CALCITRENE 1
calcitriol topical 1
CALICYLIC EX
CAPEX 4 PA
CAPSFENAC PAK EX
CAPXIB EX
CARAC EX
CELACYN EX
CEM-UREA 1
CENTANY EX
CENTANY AT EX
60
Drug Tier NotesCERACADE EX
CETACAINE 4
CICLODAN KIT TOPICAL COMBO PACK EX PA
CICLODAN KIT TOPICAL SOLUTION EX
CICLODAN TOPICAL CREAM EX
CICLODAN TOPICAL SOLUTION 1
ciclopirox 1
ciclopirox-ure-camph-menth-euc 4
CLARAVIS 1
CLEANSING WASH TOPICAL CLEANSER 1
CLEOCIN T 4
CLEOCIN VAGINAL 4
CLINDACIN ETZ EX
CLINDACIN P EX
CLINDACIN PAC EX
CLINDAGEL EX
clindamycin phosphate topical foam 1
clindamycin phosphate topical gel 1
clindamycin phosphate topical gel, once daily EX
clindamycin phosphate topical lotion 1
clindamycin phosphate topical solution 1
clindamycin phosphate topical swab 1
clindamycin phosphate vaginal 1
clindamycin-benzoyl peroxide topical gel 4
clindamycin-benzoyl peroxide topical gel with pump 1.2-2.5 % 1
clindamycin-benzoyl peroxide topical gel with pump 1-5 % 4
clindamycin-tretinoin 4
CLINDESSE 4
clobetasol 4
clobetasol-emollient 4
CLOBEX 4
clocortolone pivalate 4 PA
CLODAN EX
CLODAN KIT EX
CLODERM 4 PA
clotrimazole mucous membrane 1
clotrimazole topical solution 1
clotrimazole-betamethasone 1
COMFORT PAC-NAPROXEN EX
CONDYLOX TOPICAL GEL EX
CORDRAN TAPE LARGE ROLL EX
CORDRAN TOPICAL CREAM EX
CORDRAN TOPICAL LOTION EX
Drug Tier NotesCORDRAN TOPICAL OINTMENT EX
COREMINO 4
CORMAX SCALP 1
CORTENEMA 4
CORTIFOAM EX
CORTISPORIN TOPICAL 4
COSENTYX 3 PA; SP
COSENTYX (2 SYRINGES) 3 PA; SP
COSENTYX PEN 3 PA; SP
COSENTYX PEN (2 PENS) 3 PA; SP
CROTAN 4
CURITY ALCOHOL SWABS 2
CUTIVATE TOPICAL CREAM 4
CUTIVATE TOPICAL LOTION 4
dapsone topical 4
DEBACTEROL 4
DENAVIR EX
DERMACINRX CLORHEXACIN EX
DERMACINRX EMPRICAINE EX
DERMACINRX LEXITRAL EX
DERMACINRX PHN PAK EX
DERMACINRX PRIZOPAK EX
DERMACINRX SILAPAK EX
DERMACINRX SURGICAL PHARMAPAK EX
DERMACINRX THERAZOLE PAK EX
DERMACINRX ZRM PAK EX
DERMA-SMOOTHE/FS BODY OIL 4
DERMA-SMOOTHE/FS SCALP OIL 4
DERMASORB HC COMPLETE KIT EX PA
DERMASORB TA COMPLETE KIT EX
DERMATOP TOPICAL OINTMENT 4
DERMAWERX SDS EX
DERMAWERX SURGICAL PLUS PAK EX
DERMAZENE TOPICAL CREAM 1
DERMAZYL KIT EX
DESONATE 4 PA
desonide 4
DESOWEN 4
desoximetasone topical cream 4
desoximetasone topical gel 4
desoximetasone topical ointment 4
desoximetasone topical spray,non-aerosol EX
DEXERYL EX
DICLO GEL EX
61
Drug Tier NotesDICLO GEL-XRYLIX SHEET EX
diclofenac epolamine EX
diclofenac sodium topical 4
DICLOFEX DC EX
DICLOFONO EX
DICLOPAK EX PA
DICLOPR EX PA
DICLOTRAL EX
DICLOVIX EX
DICLOZOR EX
DIFFERIN EX
diflorasone 4
DIPROLENE TOPICAL OINTMENT 4
DITHOL EX
DOLOTRANZ EX
DOVONEX TOPICAL 4
doxepin topical EX
doxycycline monohydrate oral capsule,ir - delay rel,biphase EX
DRITHOCREME HP 4
DRYSOL 4
DRYSOL DAB-O-MATIC 4
DUAC EX
DUOBRII EX
DUPIXENT 4 PA; SP
EASY TOUCH ALCOHOL PREP PADS 2
econazole 1
ECOZA 4
EFUDEX TOPICAL CREAM 4
ELETONE EX
ELIDEL 4
ELIMITE 4
ELLZIA PAK EX PA
ELOCON TOPICAL CREAM 4
ENBREL 3 PA; SP; QL (4 EA per 30 days)
ENBREL MINI 3 PA; SP; QL (4 ML per 30 days)
ENBREL SURECLICK 3 PA; SP; QL (4 ML per 30 days)
ENSTILAR EX
EPIDUO FORTE EX
EPIDUO TOPICAL GEL WITH PUMP EX
EPIFOAM 4
ERTACZO EX
ERY PADS 1
ERYGEL 4
erythromycin with ethanol 1
erythromycin-benzoyl peroxide 1
ESKATA EX
ethyl chloride 1
Drug Tier NotesEUCRISA 4
EURAX 4
EVOCLIN 4
EXELDERM 4
EXODERM 4
EXTINA 4
FABIOR EX
FEM PH 1
FINACEA 4 PA
FLECTOR EX
FLEXIPAK EX PA
fluocinolone 1
fluocinolone and shower cap 1
fluocinonide 4
FLUOCINONIDE-E 4
fluocinonide-emollient EX
FLUOROPLEX EX
fluorouracil topical cream 0.5 % EX
fluorouracil topical cream 5 % 4
fluorouracil topical solution 1
flurandrenolide topical cream 1
flurandrenolide topical lotion 4
flurandrenolide topical ointment 4
fluticasone propionate topical 1
FORMADON TOPICAL SOLUTION 1
FROTEK EX
gentamicin topical 1
GYNAZOLE-1 4
halobetasol propionate topical cream 1
halobetasol propionate topical foam EX PA
halobetasol propionate topical ointment 1
HALOG EX
HEMMOREX-HC 4
HPR PLUS-MB HYDROGEL EX
HUMIRA PEDIATRIC CROHNS START 3 PA; SP; QL (3 EA per
30 days)
HUMIRA PEN 3 PA; SP; QL (6 EA per 30 days)
HUMIRA PEN CROHNS-UC-HS START 3 PA; SP; QL (6 EA per
30 days)
HUMIRA PEN PSOR-UVEITS-ADOL HS 3 PA; SP; QL (4 EA per
30 days)
HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML
3 PA; SP; QL (4 EA per 30 days)
HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) 3 PA; SP; QL (2 EA per 30 days)
HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML
3 PA; SP; QL (2 EA per 30 days)
62
Drug Tier NotesHUMIRA(CF) PEN CROHNS-UC-HS 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN PSOR-UV-ADOL HS 3 PA; SP; QL (2 EA per
30 days)
HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML
3 PA; SP; QL (2 EA per 30 days)
HYDRO 35 EX
HYDRO 40 4
hydrocortisone acetate rectal 1
hydrocortisone butyrate 4
hydrocortisone butyr-emollient 4
hydrocortisone rectal 1
hydrocortisone topical cream 1 %, 2.5 % 1
hydrocortisone topical cream with perineal applicator 1
hydrocortisone topical lotion 2.5 % 1
hydrocortisone topical ointment 1 %, 2.5 % 1
hydrocortisone valerate 1
hydrocortisone-iodoquinl-aloe2 4 PA
hydrocortisone-iodoquinol 1
hydrocortisone-iodoquinol-aloe 1
hydrocortisone-pramoxine rectal 1
hydrocortisone-pramoxine topical 4
ILUMYA EX SP
imiquimod topical cream in metered-dose pump EX
imiquimod topical cream in packet 1
IMPOYZ EX
INFLAMMACIN EX
INFLAMMA-K EX
INFLECTRA MB SP
INOVA EX
INOVA 4-1 EX
INOVA 8-2 EX
isotretinoin 4
JUBLIA EX
KENALOG TOPICAL 4
KERAFOAM 4
KERALAC EX
KERALYT RX 4
KERALYT SCALP COMPLETE EX PA
KERYDIN EX
ketoconazole topical 1
KLARON 4
L.E.T. (LIDO-EPINEPH-TETRA) 4 PA
LDO PLUS EX
LEVA SET EX
LEVULAN 4
LEXETTE EX PA
LEXIXRYL EX
Drug Tier Noteslidocaine hcl laryngotracheal 1
lidocaine hcl topical cream 3 %, 3.88 % EX
lidocaine hcl topical lotion EX
lidocaine hcl-hydrocortison ac rectal cream 3-0.5 % 1
lidocaine hcl-hydrocortison ac rectal gel 4
lidocaine hcl-hydrocortison ac rectal kit 2 %-2 % (7 gram) EX
lidocaine hcl-hydrocortison ac rectal kit 3-0.5 %, 3-1 % (7 gram) EX PA
lidocaine hcl-hydrocortison ac topical 1
lidocaine topical adhesive patch,medicated 1
lidocaine topical ointment 1
lidocaine-hydrocortisone-aloe rectal gel 1
lidocaine-hydrocortisone-aloe rectal kit 3-2.5 % (7 gram) EX PA
lidocaine-prilocaine topical cream 1
lidocaine-prilocaine topical kit EX
lidocaine-racepinep-tetracaine 4 PA
lidocaine-tetracaine 4 PA
LIDODERM EX
LIDO-K EX
LIDOPAC EX
LIDOPATCH EX
LIDOPIN EX
LIDOPRIL EX
LIDOPRIL XR EX
LIDO-PRILO CAINE PACK EX
LIDOPRO PATCH EX
LIDOPURE PATCH EX
LIDORX EX
LIDOTRAL EX
LIDOTRANS 5 PAK EX
LIDOVEX EX
LIDOXIB EX
LIDOZION EX
LIDTOPIC MAX EX
LIMENCIN (LIDOCAINE-MENTHOL) EX
lindane topical shampoo 1
LIPROZONEPAK EX
LIVIXIL PAK EX
LOCOID LIPOCREAM 4 PA
LOCOID TOPICAL CREAM 4
LOCOID TOPICAL LOTION 4
LOCOID TOPICAL SOLUTION 4
LOPROX (AS OLAMINE) 4
LOPROX KIT EX PA
LOPROX TOPICAL SHAMPOO 4
LOTRISONE TOPICAL CREAM 4
63
Drug Tier NotesLUGOLS TOPICAL 1
luliconazole 4
LUXAMEND EX
LUXIQ 4
LUZU 4
mafenide acetate 1
malathion 4
MB HYDROGEL EX
MEDOLOR PAK EX
MENTAX 4
MENTHO-CAINE EX
methoxsalen 1
METROCREAM 4
METROGEL TOPICAL GEL 1 % 4
METROGEL TOPICAL GEL WITH PUMP 4
METROGEL VAGINAL 4
METROLOTION 4
metronidazole topical 1
metronidazole vaginal 1
miconazole nitrate-zinc ox-pet 4
MICONAZOLE-3 VAGINAL SUPPOSITORY 1
MICORT-HC 4
MIGRANOW EX
minocycline oral tablet extended release 24 hr 105 mg, 115 mg, 55 mg, 65 mg, 80 mg
EX
minocycline oral tablet extended release 24 hr 135 mg, 45 mg, 90 mg
EX PA
MINOLIRA ER EX
MIRVASO EX
mometasone topical 1
MORGIDOX 1X 50 EX
MORGIDOX 1X100 EX
MORGIDOX 2X100 EX
mupirocin 1
mupirocin calcium 1
MYORISAN 1
naftifine topical cream 1 % 4
naftifine topical cream 2 % 1
naftifine topical gel 4
NAFTIN TOPICAL CREAM 2 % 4
NAFTIN TOPICAL GEL 4
NATROBA 4
NEO-SYNALAR EX
NEO-SYNALAR KIT EX
NEUAC EX
NEUAC KIT EX
NEURAPTINE EX
NEURCAINE EX
NIZORAL TOPICAL SHAMPOO 4
Drug Tier NotesNOLIX EX
NORITATE EX
NOVACORT EX
NOXIPAK EX
NUCORT 4 PA
NUDICLO SOLUPAK EX
NUDICLO TABPAK EX
NUDROXIPAK EX
NUDROXIPAK DSDR-50 EX
NUDROXIPAK DSDR-75 EX
NUDROXIPAK E-400 EX
NUDROXIPAK I-800 EX
NUDROXIPAK N-500 EX
NUMBONEX EX
NUSURGEPAK SURGICAL PREP EX PA
NUTRIARX EX
NUVAKAAN EX
NUVESSA 4
NYAMYC 1
nystatin topical cream 1
nystatin topical ointment 1
nystatin topical powder 4
nystatin-triamcinolone 1
NYSTOP 1
OLUX 4
OLUX-E 4
ONEXTON EX
ORACEA EX
ORALONE 1
ORAVIG EX
OTEZLA 3 PA; SP
OTEZLA STARTER 3 PA; SP
OVACE 4
OVACE PLUS SHAMPOO EX
OVACE PLUS TOPICAL CLEANSER EX
OVACE PLUS TOPICAL CREAM EX
OVACE PLUS TOPICAL FOAM EX
OVACE PLUS TOPICAL LOTION EX
OVACE PLUS WASH EX
OVIDE 4
oxiconazole 1
OXISTAT 4
OXSORALEN ULTRA 4
PACNEX 4
PACNEX HP 4
PACNEX LP 4
PAINGO KFT EX
PANDEL EX
PANRETIN 4
64
Drug Tier NotesPENLAC 4
PENNSAID TOPICAL SOLUTION IN METERED-DOSE PUMP
EX
permethrin topical cream 1
phenazopyridine oral tablet 100 mg, 200 mg 1
PICATO EX
pimecrolimus 1
PLEXION EX
PLEXION CLEANSING CLOTHS EX
PLIAGLIS 4 PA
PODOCON 2
podofilox 1
PONTOCAINE 4
PRAMOSONE 4
prednicarbate 4
PRIKAAN EX
PRIKAAN LITE EX
PRILOLID EX
PRILOVIX EX
PRILOVIX LITE EX
PRILOVIX PLUS EX
PROCORT 4
PROCTOCORT 4
PROCTOFOAM HC 4
PROCTO-MED HC 1
PROCTO-PAK 1
PROCTOSOL HC TOPICAL 1
PROCTOZONE-HC 1
PROTOPIC 4
PRUCLAIR EX
PRUDOXIN 4
PRUTECT EX
PSORCON EX
PYRIDIUM 4
QBREXZA 4 PA
QUTENZA EX SP
RECTIV 4
REGRANEX 4
RELADOR PAK EX
RELADOR PAK PLUS EX
RELAGARD 4
REMICADE MB SP
RENFLEXIS MB SP
RESTIZAN EX
RETIN-A 4
RETIN-A MICRO EX
RETIN-A MICRO PUMP EX
RHOFADE 4
ROSADAN TOPICAL CREAM 4
ROSADAN TOPICAL GEL 4
Drug Tier NotesROSADAN TOPICAL KIT, CLEANSER AND GEL EX PA
ROSADAN TOPICAL KIT,CLEANSER AND CREAM EX PA
ROSANIL 4
ROSULA EX
ROSULA CLEANSING CLOTHS EX
RYNODERM EX
SALEX EX
salicylic acid er-ceramides topical kit,cleanser and cream er EX PA
salicylic acid topical cream 1
salicylic acid topical cream,extended release 1
salicylic acid topical film forming liquid w/appl 1
salicylic acid topical film-forming soln er w/ appl 1
salicylic acid topical foam 1
salicylic acid topical gel 1
salicylic acid topical liquid 26 % 1
salicylic acid topical lotion 1
salicylic acid topical lotion,extended release 1
salicylic acid topical shampoo 1
SALIMEZ 4
SALIMEZ FORTE EX
SALKERA 4
SALVAX EX
SALVAX DUO PLUS EX
SANADERMRX EX
SANTYL 2
SCALACORT 1
SCALACORT DK EX PA
selenium sulfide topical lotion 1
selenium sulfide topical shampoo2.25 %, 2.3 % 1
SELRX EX
SERNIVO 4 PA
SILALITE PAK EX
SILAZONE-II EX
SILIQ EX PA; SP
SILVADENE 2
silver nitrate 1
silver nitrate applicators 1
silver sulfadiazine 1
SKLICE 4
SKYRIZI 3 PA; SP
SOLARAZE EX
SOLODYN ORAL TABLET EXTENDED RELEASE 24 HR105 MG, 115 MG, 55 MG, 65 MG, 80 MG
EX
SOLUPAK EX
SONAFINE EX
65
Drug Tier NotesSOOLANTRA 4
SORIATANE ORAL CAPSULE10 MG, 17.5 MG, 25 MG 4
SORILUX EX
SP SCAR MANAGEMENT EX
spinosad 1
SPRAY AND STRETCH 4
SSD 1
SSS 10-5 1
STELARA INTRAVENOUS MB SP
STELARA SUBCUTANEOUS 3 PA; SP
sulfacetamide sodium (acne) 1
sulfacetamide sodium topical 1
sulfacetamide sodium-sulfur topical cleanser 4
sulfacetamide sodium-sulfur topical cream 4
sulfacetamide sodium-sulfur topical lotion 4
sulfacetamide sodium-sulfur topical pads, medicated 10-4 % EX
sulfacetamide sodium-sulfur topical suspension 10-5 % 4
sulfacetamide sodium-sulfur topical suspension 8-4 % 1
sulfacetamide sod-sulfur-urea topical cleanser 4
sulfacetamide-sulfur-cleansr23 EX PA
SULFACLEANSE 8-4 EX
sulfact na-sul-avobnz-otn-ocsa EX
SULFAMYLON 4
SUMADAN EX
SUMADAN XLT EX
SUMAXIN EX
SUMAXIN CP EX
SUMAXIN TS 4
SURE COMFORT ALCOHOL PREP PADS 2
SURE RESULT DSS PREMIUM PACK EX
SURE RESULT TAC PAK EX
SYNALAR EX
SYNALAR CREAM KIT EX PA
SYNALAR OINTMENT KIT EX PA
SYNALAR TS EX
SYNERA 4 PA
SYNVEXIA TC EX
TACLONEX EX
tacrolimus topical 1
TALTZ AUTOINJECTOR EX PA; SP
TALTZ AUTOINJECTOR (2 PACK) EX PA; SP
TALTZ AUTOINJECTOR (3 PACK) EX PA; SP
TALTZ SYRINGE EX PA; SP
Drug Tier NotesTARGRETIN TOPICAL 2 PA
tazarotene 4
TAZORAC EX
TEMOVATE TOPICAL CREAM 4
TEMOVATE TOPICAL OINTMENT 4
terconazole 1
TEROCIN (LIDOCAINE-MENTHOL) EX
TERSI FOAM 4
TETRIX EX
TEXACORT 4 PA
TOLAK 4
TOPICORT EX
TRANZAREL EX
TREMFYA 3 PA; SP
tretinoin 1
tretinoin (emollient) EX
tretinoin microspheres 1
TRETIN-X CREAM KIT EX
TRETIN-X TOPICAL CREAM0.075 % EX PA
triamcinolone acetonide dental 1
triamcinolone acetonide topical aerosol 1
triamcinolone acetonide topical cream 1
triamcinolone acetonide topical lotion 1
triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 % 1
TRIANEX EX
TRI-CHLOR 1
TRIDERM TOPICAL CREAM 0.1 % 1
TRIDERM TOPICAL CREAM 0.5 % 4
TRIDESILON 4
TRIPLE DYE 4
ULESFIA 4
ULTILET ALCOHOL SWAB 2
ULTRASAL-ER 4
ULTRAVATE TOPICAL CREAM EX
ULTRAVATE TOPICAL LOTION EX PA
ULTRAVATE TOPICAL OINTMENT EX
ULTRAVATE X EX
UMECTA TOPICAL FOAM 1
URAMAXIN EX
URAMAXIN GT EX
UREA NAIL STICK 1
urea topical cream 39 %, 40 %, 45 %, 47 %, 50 % 1
urea topical cream 41 % 4
urea topical foam 1
66
Drug Tier Notesurea topical gel 45 % 1
urea topical lotion 40 % 2
URE-K EX
UREVAZ EX
UTOPIC EX
UVADEX 4
VALCHLOR 4 PA; SP
VANDAZOLE 1
VANOS 4
VANOXIDE-HC 2
VASELINE WHITE PETROLEUM EX
VECTICAL EX
VELTIN EX
VERDESO EX
VEREGEN EX
VIRASAL 4
VOLTAREN TOPICAL 4
VUSION 4
VYTONE EX
WEBCOL 2
WHYTEDERM SURGIPAK EX
WHYTEDERM TDPAK EX
WHYTEDERM TRILASIL PAK EX
WPR PLUS EX
XCLAIR EX
XELITRAL EX
XENAFLAMM EX
XEPI EX
XERESE EX
XILAPAK EX
XIMINO EX
XOLEGEL EX
XRYLIDERM EX
XRYLIX (DICLOFENAC-KINES TAPE) EX
ZENATANE 1
ZEYOCAINE EX
ZIANA EX
ZITHRANOL 4
ZONALON EX
ZOVIRAX TOPICAL 4
ZTLIDO EX PA
ZYCLARA EX
ZYPRAM EX
Smooth Muscle Relaxants
darifenacin 1
DETROL EX
DETROL LA EX
DITROPAN XL ORAL TABLET EXTENDED RELEASE 24HR 10 MG, 5 MG
4
Drug Tier NotesELIXOPHYLLIN ORAL ELIXIR80 MG/15 ML 4
ENABLEX 4
flavoxate 1
GELNIQUE TRANSDERMAL GEL IN METERED-DOSE PUMP100 MG/GRAM (10 %)
EX
GELNIQUE TRANSDERMAL GEL IN PACKET EX
MYRBETRIQ EX
oxybutynin chloride 1
OXYTROL EX
solifenacin 1
THEO-24 4
THEOCHRON 1
theophylline oral elixir 1
theophylline oral solution 1
theophylline oral tablet extended release 12 hr 1
theophylline oral tablet extended release 24 hr 1
tolterodine 1
TOVIAZ EX
trospium 1
VESICARE EX
Vitamins
AZESCO EX
B COMPLEX 100 INJECTION 4
B-12 COMPLIANCE EX
BAL-CARE DHA 1
BAL-CARE DHA ESSENTIAL 4
BONJESTA EX
CADEAU DHA EX
calcitriol oral 1
CALCIUM 600 WITH VITAMIN D3 ORAL TABLET PV CN
CALCIUM PNV 4
CENTRATEX 1
CIFEREX EX
CITRANATAL (DUAL-IRON) 4
CITRANATAL 90 DHA (ALGAL OIL) 4
CITRANATAL ASSURE ORAL COMBO PACK 35 MG IRON-1 MG -50 MG-300 MG
4
CITRANATAL B-CALM (FE GLUC) 4
CITRANATAL BLOOM 4
CITRANATAL DHA (ALGAL OIL) 4
CITRANATAL HARMONY (IRON FUM) 4
C-NATE DHA 4
COMPLETE NATAL DHA 1
COMPLETENATE 4
CORVITA 1
67
Drug Tier NotesCORVITA 150 1
cyanocobalamin (vitamin b-12) injection 1
DERMACINRX PUREFOLIX EX
DICLEGIS 4
doxercalciferol oral 4
doxylamine-pyridoxine (vit b6) 4
DRISDOL ORAL CAPSULE 4
DUET DHA BALANCED ORAL COMBO PACK 25 MG IRON-1 MG -267 MG-233 MG
4
DUET DHA WITH OMEGA-3 ORAL COMBO PACK 25 MG IRON-1 MG -400 MG
4
DURACHOL EX
ELITE OB WITH DHA 1
ELITE-OB 4
ELITE-OB 400 1
ENBRACE HR 4
ergocalciferol (vitamin d2) oral capsule 50,000 unit 1
ESCAVITE PV
ESCAVITE D PV
ESCAVITE LQ PV
EXTRA-VIRT PLUS DHA 4
FA-8 PV CN
FABB EX
FE C PLUS 1
FERRAPLUS 90 1
FERREX 150 FORTE EX
FERROCITE PLUS 1
FLORIVA PV
FLORIVA (FLUORIDE-VITAMIN D3) PV
FLORIVA PLUS PV
FOLBEE EX
FOLBIC EX
FOLET ONE 4
FOLGARD RX EX
folic acid injection 1
folic acid oral capsule 0.8 mg PV CN
folic acid oral tablet 1 mg 1
folic acid oral tablet 400 mcg, 800 mcg PV CN
FOLIVANE-F 1
FOLIVANE-OB 1
FOLIVANE-PLUS 1
FOLIXAPURE EX
FOLPLEX 2.2 EX
FOLTRATE EX
FOSAMAX PLUS D 4
GENADUR (WITH LEXINAL) EX
HEMATINIC PLUS VIT/MINERALS 1
Drug Tier NotesHEMATINIC/FOLIC ACID 1
HEMATOGEN FA 1
HEMATOGEN FORTE 1
HEMENATAL OB 1
HEMENATAL OB + DHA 1
HEMETAB 1
hydroxocobalamin 1
IFEREX 150 FORTE EX
KOSHER PRENATAL PLUS IRON 4
MARNATAL-F 4
MEPHYTON 4
M-NATAL PLUS 1
MULTIGEN FOLIC 1
MULTIGEN PLUS 1
MULTI-VIT WITH FLUORIDE-IRON PV CN
MULTIVITAMIN WITH FLUORIDE PV CN
MULTI-VITAMIN WITH FLUORIDE ORAL DROPS PV CN
MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG
PV CN
MULTI-VITAMIN WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG
PV
MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG
PV CN
MULTIVITAMINS WITH FLUORIDE ORAL TABLET,CHEWABLE 1 MG
PV
MVC-FLUORIDE ORAL TABLET,CHEWABLE 0.25 MG, 0.5 MG
PV CN
MVC-FLUORIDE ORAL TABLET,CHEWABLE 1 MG PV
MYFERON 150 FORTE EX
MYNATAL 1
MYNATAL ADVANCE 1
MYNATAL PLUS 1
MYNATAL-Z 1
MYNATE 90 PLUS 1
MYNEPHRON EX
NASCOBAL EX
NATACHEW (FE BIS-GLYCINATE) 4
NEEVODHA (WITH ALGAL OIL) 4
NEPHPLEX RX 1
NEPHRO-VITE RX 1
NESTABS 4
NESTABS ABC 4
NESTABS DHA 4
NESTABS ONE 4
68
Drug Tier NotesNEURIN-SL EX
NEWGEN 4
NEXA PLUS 4
NICAZEL EX
NIVA-FOL EX
NOXIFOL-D3 EX
OB COMPLETE ONE EX
OB COMPLETE ORAL TABLET EX
OB COMPLETE PETITE EX
OB COMPLETE PREMIER EX
OB COMPLETE WITH DHA EX
OBSTETRIX DHA 1
OBSTETRIX EC 4
OBSTETRIX ONE 4
OBTREX DHA 4
O-CAL PRENATAL 4
ORTHO DF EX
paricalcitol hemodialysis port injection solution 5 mcg/ml 4
paricalcitol oral 1
PHYSICIANS EZ USE B-12 EX
phytonadione (vitamin k1) oral tablet 5 mg 1
PNV 29-1 1
PNV OB+DHA ORAL COMBO PACK 27-1-50-250 MG 1
PNV-DHA 1
PNV-DHA + DOCUSATE 1
PNV-FERROUS FUMARATE-DOCU-FA 1
PNV-OMEGA 1
PNV-SELECT 1
PNV-VP-U 1
POLY-IRON 150 FORTE EX
POLY-VI-FLOR PV
POLY-VI-FLOR WITH IRON PV
PR NATAL 400 1
PR NATAL 400 EC 1
PR NATAL 430 1
PR NATAL 430 EC 1
PREFERA-OB 4
PREFERA-OB ONE 4
PREFERA-OB PLUS DHA 4
PRENA1 CHEW 1
PRENA1 PEARL 1
PRENA1 TRUE 1
PRENAISSANCE 1
PRENAISSANCE PLUS 1
PRENATA 4
PRENATABS FA 1
PRENATABS RX 1
PRENATAL LOW IRON 1
PRENATAL PLUS 1
Drug Tier NotesPRENATAL PLUS (CALCIUM CARB) 1
PRENATAL PLUS DHA ORAL COMBO PACK 4
PRENATAL VITAMIN PLUS LOW IRON 1
PRENATAL-U 1
PRENATE AM 4
PRENATE CHEWABLE 4
PRENATE DHA 4
PRENATE DHA (FERR ASP GLYCIN) 4
PRENATE ELITE 4
PRENATE ELITE (IRON ASP GLYC) 4
PRENATE ENHANCE 4
PRENATE ESSENTIAL 4
PRENATE ESSENTIAL(IRON-ASP-GL) 4
PRENATE MINI (FERR ASP GLYCIN) 4
PRENATE PIXIE 4
PRENATE RESTORE 4
PRENATE STAR 4
PREPLUS 1
PRETAB 1
PRIMACARE 4
PROVIDA DHA 4
PROVIDA OB 4
PUREFE OB PLUS 4
QUFLORA PV
QUFLORA FE PV
QUFLORA FE (FERROUS SULFATE) PV
QUFLORA PEDIATRIC PV
QUFLORA PEDIATRIC DROPS PV
RAYALDEE 4
RENAL CAPS 1
RENA-VITE RX 1
RENO CAPS 1
REVESTA EX
R-NATAL OB 4
ROCALTROL 4
ROXIFOL-D EX
SELECT-OB 4
SELECT-OB + DHA 4
SE-NATAL 19 1
SE-NATAL 19 (WITH DOCUSATE) 1
TARON FORTE 1
TARON-C DHA 1
TARON-PREX PRENATAL-DHA 1
THRIVITE RX 4
THRIVITE-19 1
69
Drug Tier NotesTL-SELECT 1
TRIADVANCE 1
TRICARE 4
TRIGELS-F FORTE 1
TRINATAL RX 1 1
TRINATE 1
TRIPHROCAPS 1
TRIPLE VITAMIN WITH FLUORIDE PV CN
TRISTART DHA 4
TRIVEEN-DUO DHA 1
TRIVEEN-ONE 1
TRIVEEN-PRX RNF 1
TRI-VI-FLOR PV
TRI-VITAMIN WITH FLUORIDE PV CN
TRI-VITE WITH FLUORIDE PV
TRUST NATAL DHA 1
V-C FORTE 1
VENA-BAL DHA 1
VIC-FORTE 1
VINACAL 1
VINATE CARE 1
VINATE DHA RF EX
VINATE GT 1
VINATE II 1
VINATE M 1
VINATE ONE 1
VINATE PN CARE 1
VINATE ULTRA 1
VIRT-ADVANCE 1
VIRT-C DHA 1
VIRT-GARD EX
VIRT-NATE DHA 4
VIRT-PN DHA 1
VIRT-PN PLUS 1
VIRTPREX 4
VIRT-SELECT 1
VIRT-VITE EX
VIRT-VITE GT 1
VIT 3 1
VITAFOL FE+ (WITH DOCUSATE) 4
VITAFOL GUMMIES 4
VITAFOL NANO 4
VITAFOL ULTRA 4
VITAFOL-OB 4
VITAFOL-OB+DHA 4
VITAFOL-ONE 4
VITAMED MD ONE RX 4
VITAMEDMD REDICHEW RX 4
VITAMIN D2 1
Drug Tier NotesVITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.25 MG FLUOR. (0.55 MG)/ML
PV CN
VITAMINS A,C,D AND FLUORIDE ORAL DROPS 0.5 MG FLUORIDE (1.1 MG)/ML
PV
VITAPEARL 4
VITATRUE 4
VP-CH PLUS 4
VP-CH-PNV 1
VP-PNV-DHA 4
VP-VITE RX 1
ZATEAN-PN DHA 1
ZATEAN-PN PLUS 1
ZAVARA EX
ZEMPLAR ORAL CAPSULE 1 MCG, 2 MCG 4
ZINGIBER 4
70
Index1ST TIER UNIFINE PENTIPS ......................... 291ST TIER UNIFINE PENTIPS PLUS .............. 291ST TIER UNILET COMFORTOUCH ............. 292TEK CONTROL (HIGH-NORMAL) ............... 29abacavir ............................................................. 1abacavir-lamivudine ...........................................1abacavir-lamivudine-zidovudine ........................ 1ABILIFY ...........................................................19ABILIFY MAINTENA .......................................19ABILIFY MYCITE ............................................ 19abiraterone ........................................................ 5ABRAXANE ...................................................... 5ABSORICA ..................................................... 60ABSTRAL ....................................................... 19acamprosate ....................................................19ACANYA ......................................................... 60acarbose ..........................................................46ACCOLATE .....................................................57ACCUCAINE KIT ................................ 29, 53, 60ACCU-CHEK AVIVA CONTROL SOLN ......... 29ACCU-CHEK AVIVA PLUS TEST STRP ....... 37ACCU-CHEK COMP BLUE CONT, M-H ........ 29ACCU-CHEK COMPACT PLUS CONTROL .. 29ACCU-CHEK COMPACT PLUS TEST ...........37ACCU-CHEK FASTCLIX LANCET DRUM .....29ACCU-CHEK GUIDE ...................................... 37ACCU-CHEK GUIDE L1-L2 CTRL SOL .........29ACCU-CHEK MULTICLIX LANCET ............... 29ACCU-CHEK SAFE-T-PRO ............................29ACCU-CHEK SAFE-T-PRO PLUS ................. 29ACCU-CHEK SMARTVIEW CONTRL SOL ... 29ACCU-CHEK SMARTVIEW TEST STRIP ...... 37ACCU-CHEK SOFTCLIX LANCETS .............. 29ACCUPRIL ...................................................... 15ACCURETIC ............................................. 15, 39ACCUTREND GLUCOSE ............................... 37ACCUTREND GLUCOSE CONTROL ............ 29ACD-A ............................................................. 12ACE AEROSOL CLOUD ENHANCER ........... 29acebutolol .................................................... 9, 15acetaminophen-caff-dihydrocod ...................... 19acetaminophen-codeine .................................. 19acetazolamide ..................................... 15, 39, 41acetic acid ..................................................39, 41acetylcysteine ............................................ 53, 57ACIPHEX .........................................................44ACIPHEX SPRINKLE ..................................... 44acitretin ............................................................ 60ACTEMRA .......................................................53ACTEMRA ACTPEN .......................................53ACTHIB (PF) ..................................................... 8ACTICLATE ...................................................... 1ACTIGALL ...................................................... 44ACTI-LANCE LANCETS .................................29ACTIMMUNE ...................................................53ACTIQ ............................................................. 19ACTIVELLA .................................................... 46ACTIVE-PAC ...................................................19ACTONEL ....................................................... 53ACTOPLUS MET ............................................ 46ACTOPLUS MET XR ...................................... 46ACTOS ............................................................ 46ACUICYN ........................................................ 29ACULAR ......................................................... 41ACULAR LS ....................................................41ACUVAIL (PF) .................................................41acyclovir .......................................................1, 60ACZONE ......................................................... 60ADACEL(TDAP ADOLESN/ADULT)(PF) .........8ADALAT CC ....................................................15adapalene ........................................................60adapalene-benzoyl peroxide ........................... 60ADASUVE ....................................................... 19ADAZIN ........................................................... 60ADCETRIS ........................................................ 5ADCIRCA .................................................. 15, 57ADDERALL .....................................................19
ADDERALL XR ...............................................19ADDYI ............................................................. 19adefovir ..............................................................1ADEMPAS .................................................15, 57ADHANSIA XR ................................................19ADLYXIN .........................................................46ADMELOG SOLOSTAR U-100 INSULIN ....... 46ADMELOG U-100 INSULIN LISPRO ..............46ADRENALIN ......................................... 9, 41, 57ADULT ASPIRIN REGIMEN ..................... 12, 19ADULT LOW DOSE ASPIRIN .................. 12, 19ADVAIR DISKUS .................................. 9, 46, 57ADVAIR HFA ........................................ 9, 46, 57ADVANCED ALLERGY COLLECT KIT ......... 60ADVANCED DNA MEDICATED COLLECT ... 41ADVANCED GLUC METER TEST STRIP ......37ADVANCED TRAVEL LANCETS ...................29ADVATE ..........................................................12ADVOCATE CONTROL SOLUTION HIGH .... 29ADVOCATE LANCET .....................................29ADVOCATE LOW CONTROL ........................ 29ADVOCATE PEN NEEDLE ............................ 29ADVOCATE REDI-CODE ............................... 37ADVOCATE REDI-CODE PLUS .....................37ADVOCATE REDI-CODE+ CTRL HIGH .........29ADVOCATE REDI-CODE+ CTRL LOW ......... 29ADVOCATE SYRINGES .................................29ADVOCATE TEST STRIPS ............................ 37ADYNOVATE .................................................. 12ADZENYS ER ................................................. 19ADZENYS XR-ODT .........................................19AEMCOLO ........................................................ 1AEROCHAMBER PLUS FLOW-VU ............... 29AEROCHAMBER PLUS FLOW-VU,L MSK ... 29AEROCHAMBER PLUS FLOW-VU,M MSK .. 29AEROCHAMBER PLUS FLOW-VU,S MSK ... 29AEROGEAR ACTION ASTHMA KIT ..............29AEROSPAN .............................................. 46, 57AEROTRACH PLUS ....................................... 29AFEDITAB CR ................................................ 15AFINITOR ..........................................................5AFINITOR DISPERZ ......................................... 6AFIRMELLE .................................................... 46AFREZZA ........................................................46AFSTYLA ........................................................ 12AFTERA .......................................................... 47AGAMATRIX AMP TEST STRIPS ..................37AGAMATRIX CONTROL HIGH ...................... 29AGAMATRIX CONTROL NORM-HI ............... 29AGGRENOX ........................................12, 15, 19AGONEAZE .................................................... 60AGRYLIN ........................................................ 12A-HYDROCORT ..............................................47AIMOVIG AUTOINJECTOR ............................19AIRDUO RESPICLICK ..........................9, 47, 57AIRZONE PEAK FLOW METER .................... 29AJOVY ............................................................ 19AK-POLY-BAC ............................................... 42AKTEN (PF) .................................................... 42AKTIPAK .........................................................60AKYNZEO (NETUPITANT) .............................44ALA-CORT ......................................................60ALA-QUIN ....................................................... 60ALA-SCALP ....................................................60albendazole ....................................................... 1ALBENZA ......................................................... 1albuterol sulfate ........................................... 9, 57alclometasone ................................................. 60ALCOHOL PADS ............................................60ALCOHOL PREP PADS ................................. 60alcohol swabs .................................................. 60ALCOHOL WIPES .......................................... 60ALCORTIN A .................................................. 60ALDACTAZIDE ......................................... 15, 39ALDACTONE ............................................ 15, 39ALDARA ......................................................... 60ALDURAZYME ............................................... 41
ALECENSA .......................................................6alendronate ......................................................53ALEVICYN PLUS ............................................29ALFERON N ..................................................1, 6alfuzosin ............................................................ 9ALINIA ...............................................................1ALIQOPA .......................................................... 6aliskiren ........................................................... 15ALKERAN ......................................................... 6ALLERGIST TRAY 1/2 ML 27GX3/8" ............ 29ALLERGIST TRAY INTRADERMAL BEV ......29ALLERGIST TRAY REGULAR BEVEL ..........29ALLERGY SYRINGE ...................................... 29allopurinol ........................................................ 53ALLZITAL ....................................................... 20almotriptan malate ........................................... 20ALOCRIL ...................................................42, 57alogliptin .......................................................... 47alogliptin-metformin ......................................... 47alogliptin-pioglitazone ...................................... 47ALOMIDE ........................................................ 42ALORA ............................................................47alosetron ..........................................................44ALPHAGAN P .................................................42ALPHANATE .................................................. 12ALPHANINE SD ..............................................12alprazolam ....................................................... 20ALPRAZOLAM INTENSOL ............................ 20ALPROLIX ...................................................... 12ALREX ............................................................ 42ALSUMA ......................................................... 20ALTABAX ....................................................... 60ALTACAINE ....................................................42ALTACE .......................................................... 15ALTAVERA (28) ..............................................47ALTERNATE SITE LANCET .......................... 29ALTOPREV ..................................................... 15ALTRENO ....................................................... 60ALUNBRIG ........................................................6ALVESCO ................................................. 47, 57ALYACEN 1/35 (28) ........................................47ALYACEN 7/7/7 (28) .......................................47ALYQ .........................................................15, 57AMABELZ ....................................................... 47amantadine hcl ............................................ 1, 20AMARYL ......................................................... 47AMBIEN .......................................................... 20AMBIEN CR .................................................... 20ambrisentan ...............................................15, 57amcinonide ...................................................... 60AMERGE .........................................................20AMETHIA ........................................................ 47AMETHIA LO .................................................. 47AMETHYST (28) ............................................. 47AMICAR .......................................................... 12amikacin ............................................................ 1amiloride .................................................... 15, 39amiloride-hydrochlorothiazide ....................15, 39aminocaproic acid ............................................12amiodarone ......................................................15AMITIZA .......................................................... 44amitriptyline ..................................................... 20amitriptyline-chlordiazepoxide ......................... 20amlodipine ....................................................... 15amlodipine-atorvastatin ................................... 15amlodipine-benazepril ..................................... 15amlodipine-olmesartan .................................... 15amlodipine-valsartan ....................................... 15amlodipine-valsartan-hcthiazid .................. 15, 39ammonium chloride ......................................... 39ammonium lactate ........................................... 60AMNESTEEM ..................................................60amoxapine ....................................................... 20amoxicil-clarithromy-lansopraz .................... 1, 44amoxicillin .......................................................... 1amoxicillin-pot clavulanate .................................1amphetamine sulfate ....................................... 20
71
amphotericin b ................................................... 1ampicillin ............................................................1ampicillin-sulbactam .......................................... 1AMPYRA ......................................................... 53AMRIX ............................................................... 9ANACAINE ......................................................60ANADROL-50 ................................................. 47ANAFRANIL ....................................................20anagrelide ........................................................12ANA-LEX KIT ..................................................60ANALPRAM-HC ..............................................60ANALPRAM-HC SINGLES .............................60ANAPROX DS ...........................................20, 53ANASPAZ ......................................................... 9ANASTIA .........................................................60anastrozole .................................................. 6, 47ANCOBON ........................................................ 1ANDRODERM .................................................47ANDROGEL .................................................... 47ANDROID ........................................................47ANGELIQ ........................................................ 47ANODYNE LPT ...............................................60ANORO ELLIPTA ....................................... 9, 57ANTABUSE .....................................................53ANTARA ......................................................... 15ANTIVERT ...................................................1, 44ANUCORT-HC ................................................ 60ANUSOL-HC ................................................... 60APADAZ ..........................................................20APEXICON E .................................................. 60APIDRA SOLOSTAR U-100 INSULIN ............47APIDRA U-100 INSULIN .................................47APLENZIN .......................................................20APOKYN ......................................................... 20apraclonidine ................................................... 42aprepitant .........................................................44APRI ................................................................ 47APRISO ...........................................................44APRIZIO PAK ................................................. 60APTENSIO XR ................................................ 20APTIOM ...........................................................20APTIVUS ........................................................... 1AQUA GLYCOLIC HC .................................... 60AQUORAL ...................................................... 29ARAKODA ........................................................ 1ARALAST NP ................................................. 57ARANELLE (28) ..............................................47ARANESP (IN POLYSORBATE) ....................12ARAVA ............................................................53ARCALYST ..................................................... 53ARCAPTA NEOHALER ..............................9, 57ARICEPT ...........................................................9ARIKAYCE ........................................................1ARIMIDEX ................................................... 6, 47aripiprazole ...................................................... 20ARISTADA ...................................................... 20ARIXTRA .........................................................12armodafinil ....................................................... 20ARMONAIR RESPICLICK ........................ 47, 58ARMOUR THYROID ....................................... 47ARNUITY ELLIPTA ...................................47, 58AROMASIN ................................................. 6, 47ARRANON ........................................................ 6ARTHROTEC 50 ....................................... 20, 44ARTHROTEC 75 ....................................... 20, 44ARYMO ER ..................................................... 20ARZERRA ......................................................... 6ASACOL HD ................................................... 44ASCOMP WITH CODEINE ............................. 20ASHLYNA ....................................................... 47ASMANEX HFA ........................................ 47, 58ASMANEX TWISTHALER ........................ 47, 58ASPIR-81 .................................................. 12, 20aspirin ........................................................ 12, 20ASPIRIN CHILDRENS .............................. 12, 20ASPIRIN LOW DOSE ............................... 12, 20aspirin-dipyridamole ............................ 12, 15, 20ASPIR-LOW .............................................. 12, 20ASPIR-TRIN .............................................. 12, 20
ASSURE 4 CONTROL SOLUTION ................ 29ASSURE 4 STRIPS .........................................37ASSURE DOSE NORMAL CONTROL ...........29ASSURE DOSE NORM-HI CONTROL ...........29ASSURE HAEMOLANCE PLUS .................... 29ASSURE ID INSULIN SAFETY ...................... 29ASSURE ID PEN NEEDLE ............................. 29ASSURE LANCE ............................................ 29ASSURE LANCE PLUS ..................................29ASSURE PLATINUM ...................................... 37ASSURE PRISM CONTROL 1-2 SOLN ......... 29ASSURE PRISM MULTI STRIP ......................37ASTAGRAF XL ............................................... 53ASTEPRO ....................................................... 42ASTERO ....................................................29, 60ASTHMA CHECK METER ..............................29ATACAND .......................................................15ATACAND HCT ........................................ 15, 39atazanavir .......................................................... 1ATELVIA ......................................................... 53atenolol ........................................................ 9, 15atenolol-chlorthalidone .......................... 9, 15, 39ATIVAN ........................................................... 20atomoxetine ..................................................... 20ATOPICLAIR .............................................29, 60atorvastatin ...................................................... 16atovaquone ........................................................1atovaquone-proguanil ........................................1ATRALIN .........................................................60ATRAPRO CP .................................................29ATRAPRO DERMAL SPRAY ......................... 29ATRAPRO HYDROGEL ................................. 29ATRIPLA ........................................................... 1atropine ..................................................9, 42, 58ATROVENT HFA ........................................ 9, 58AUBAGIO ........................................................53AUBRA ............................................................47AUBRA EQ ..................................................... 47AUGMENTIN .....................................................1AUGMENTIN ES-600 ........................................1AUGMENTIN XR ...............................................2AUROVELA 1.5/30 (21) .................................. 47AUROVELA 1/20 (21) ..................................... 47AUROVELA 24 FE ..........................................47AUROVELA FE 1.5/30 (28) ............................ 47AUROVELA FE 1-20 (28) ............................... 47AURYXIA ........................................................ 39AUSTEDO ....................................................... 20AUTOJECT 2 INJECTION DEVICE ................29AUTOPEN 1 TO 21 UNITS ............................. 29AUTOPEN 2 TO 42 UNITS ............................. 29AUVI-Q ........................................................ 9, 58AVAGE ............................................................60AVALIDE ...................................................16, 39AVANDAMET ..................................................47AVANDIA ........................................................ 47AVAPRO ......................................................... 16AVAR .............................................................. 60AVAR LS .........................................................60AVAR-E ...........................................................60AVAR-E GREEN ............................................. 60AVAR-E LS ..................................................... 60AVASTIN ...........................................................6AVC VAGINAL ................................................60AVEED ............................................................ 47AVENOVA .......................................................29AVIANE ........................................................... 47AVIDOXY .......................................................... 2AVIDOXY DK .................................................... 2AVITA ..............................................................60AVO CREAM .............................................29, 60AVODART .......................................................53AVONEX ......................................................... 53AVONEX (WITH ALBUMIN) ........................... 53AV-PHOS 250 NEUTRAL ............................... 39AYGESTIN ...................................................... 47AYUNA ............................................................47azacitidine ..........................................................6AZASAN ..........................................................53
AZASITE ......................................................... 42azathioprine ..................................................... 53AZEDRA DOSIMETRIC ........................ 6, 37, 57AZEDRA THERAPEUTIC ..................... 6, 37, 57azelaic acid ......................................................60azelastine ........................................................ 42AZELEX .......................................................... 60AZESCO ....................................................12, 67AZILECT ......................................................... 20azithromycin ...................................................... 2AZOPT ............................................................ 42AZOR .............................................................. 16AZULFIDINE ......................................... 2, 44, 53AZULFIDINE EN-TABS ........................ 2, 44, 53AZURETTE (28) .............................................. 47B COMPLEX 100 ............................................ 67B-12 COMPLIANCE ........................................67BACIIM ..............................................................2bacitracin ......................................................... 42bacitracin-polymyxin b ..................................... 42baclofen ............................................................. 9BACTRIM .......................................................... 2BACTRIM DS .................................................... 2BAL-CARE DHA ................................. 12, 39, 67BAL-CARE DHA ESSENTIAL ..................12, 67BALCOLTRA .................................................. 47balsalazide .......................................................44BALVERSA .......................................................6BALZIVA (28) ..................................................47BANZEL .......................................................... 20BARACLUDE ....................................................2BASAGLAR KWIKPEN U-100 INSULIN ........ 47BAVENCIO ........................................................6BAXDELA ......................................................... 2BAYER ASPIRIN ...................................... 12, 20BAYER CHEWABLE ASPIRIN .................12, 20bcg vaccine, live (pf) ..........................................8BD ALLERGIST TRAY REG BEVEL ............. 29BD ALLERGY SYRINGE ................................ 29BD AUTOSHIELD DUO PEN NEEDLE .......... 29BD BULK LUER-LOK NON-STERILE ........... 29BD BULK SLIP TIP NON-STERILE ............... 29BD BULK SYRINGE SLIP TIP ........................29BD ECCENTRIC TIP SYRINGE ......................29BD ECLIPSE ................................................... 30BD ECLIPSE LUER-LOK ............................... 30BD FILTER NEEDLE 5-MICRON NOKO ........30BD FILTER NEEDLE-5 MICRON ................... 30BD INSULIN SYRINGE ...................................30BD INSULIN SYRINGE HALF UNIT ...............30BD INSULIN SYRINGE MICRO-FINE ............ 30BD INSULIN SYRINGE SAFETY-LOK ...........30BD INSULIN SYRINGE SLIP TIP ................... 30BD INSULIN SYRINGE U-500 ........................ 30BD INSULIN SYRINGE ULTRA-FINE ............ 30BD INTEGRA NEEDLE ...................................30BD INTEGRA SYRINGE ................................. 30BD INTRADERMAL BEVEL NEEDLES ......... 30BD LAB ECCENTRIC NON-STERILE ............30BD LO-DOSE MICRO-FINE IV ....................... 30BD LO-DOSE ULTRA-FINE ........................... 30BD LUER-LOK BULK SYRINGE ....................30BD LUER-LOK SYRINGE ...............................30BD LUER-LOK TIP CONTROL SYRING ........30BD MICROTAINER LANCET ......................... 30BD NANO 2ND GEN PEN NEEDLE ...............30BD NOKOR ADMIX NEEDLE .........................30BD PRECISIONGLIDE ....................................30BD PRECISIONGLIDE NON-STERILE .......... 30BD PRE-FILLED NORMAL SALINE ........ 30, 39BD REGULAR BEVEL NEEDLES ..................30BD SAFETYGLIDE ALLERGIST TRAY ......... 30BD SAFETYGLIDE INSULIN SYRINGE .........30BD SAFETYGLIDE NEEDLE ..........................30BD SAFETYGLIDE SHIELDING REG ............30BD SAFETYGLIDE SYRINGE ........................ 30BD SAFETYGLIDE TB REG BEVEL ..............30BD SAFETYGLIDE TUBERCULIN .................30BD SAFETY-LOK DETACHABLE NEEDL .... 30
72
BD SAFETY-LOK TUBERCULIN ................... 30BD SAFETY-LOK WITH LUER-LOK ..............30BD SHORT BEVEL NEEDLES .......................30BD SHORT BEVEL THIN WALL .................... 30BD SLIP TIP SYRINGE ...................................30B-D SLIP TIP SYRINGE ................................. 30BD SPECIALTY USE NEEDLES ....................30BD SYRINGE .................................................. 30BD SYRINGE BULK STERILE PAK .............. 30BD TUBERCULIN SLIP-TIP ........................... 30BD TUBERCULIN SYRINGE ..........................30BD ULTRA FINE LANCETS ........................... 30BD ULTRA-FINE II LANCETS ........................30BD ULTRA-FINE MICRO PEN NEEDLE ........30BD ULTRA-FINE MINI PEN NEEDLE ............ 30BD ULTRA-FINE NANO PEN NEEDLE ......... 31BD ULTRA-FINE ORIG PEN NEEDLE ...........31BD ULTRA-FINE SHORT PEN NEEDLE ....... 31BD VEO INSULIN SYR HALF UNIT ............... 31BD VEO INSULIN SYRINGE UF .................... 31BEAU RX ........................................................ 31BECONASE AQ ........................................42, 58BEKYREE (28) ................................................47BELBUCA ....................................................... 20BELEODAQ ...................................................... 6belladonna alkaloids-opium ............................. 20BELSOMRA .................................................... 20benazepril ........................................................ 16benazepril-hydrochlorothiazide ..................16, 39bendamustine .................................................... 6BENDEKA .........................................................6BENEFIX ......................................................... 12BENICAR ........................................................ 16BENICAR HCT ..........................................16, 39BENLYSTA ..................................................... 53BENSAL HP ....................................................60BENTYL ............................................................ 9BENZACLIN ....................................................60BENZACLIN PUMP ........................................ 60BENZAMYCIN .................................................60BENZEPRO .....................................................60benzhydrocodone-acetaminophen .................. 20benznidazole ..................................................... 2BENZODOX 30 ........................................... 2, 60BENZODOX 60 ........................................... 2, 60benzonatate .....................................................58benzoyl peroxide ............................................. 60benztropine ..................................................9, 20BEPREVE ....................................................... 42BERINERT ...................................................... 53BESER ............................................................ 60BESER KIT ..................................................... 60BESIVANCE ....................................................42BESPONSA ...................................................... 6BETA-1 ............................................................47BETADINE OPHTHALMIC PREP .................. 42betamethasone dipropionate ........................... 60betamethasone valerate .................................. 60betamethasone, augmented ............................60BETAPACE .................................................9, 16BETAPACE AF ........................................... 9, 16BETASERON .................................................. 54betaxolol ................................................ 9, 16, 42bethanechol chloride ......................................... 9BETHKIS ...........................................................2BETIMOL ........................................................ 42BETOPTIC S ................................................... 42bevacizumab ................................................... 42BEVESPI AEROSPHERE ...........................9, 58BEVYXXA ....................................................... 12bexarotene .........................................................6BEXSERO ......................................................... 8BEYAZ ............................................................ 47BIAFINE EMULSION ................................ 31, 60bicalutamide ...................................................... 6BIDIL ............................................................... 16BIJUVA ........................................................... 47BIKTARVY ........................................................ 2BILTRICIDE ...................................................... 2
bimatoprost ......................................................42BINOSTO ........................................................ 54BIONECT ........................................................ 31BIONIME RIGHTEST TEST STRIPS ..............37BIOTHRAX ........................................................8bisoprolol fumarate ...................................... 9, 16bisoprolol-hydrochlorothiazide ...............9, 16, 39BIVIGAM ........................................................... 8BLEPH-10 ....................................................... 42BLEPHAMIDE .................................................42BLEPHAMIDE S.O.P. ..................................... 42BLINCYTO ........................................................ 6BLISOVI 24 FE ................................................47BLISOVI FE 1.5/30 (28) .................................. 47BLISOVI FE 1/20 (28) ..................................... 47BLOOD GLUCOSE TEST ...............................37BONIVA ...........................................................54BONJESTA ......................................... 44, 58, 67BOOSTRIX TDAP ............................................. 8bortezomib .........................................................6bosentan ....................................................16, 58BOSULIF ...........................................................6BOTOX ........................................................9, 54BP 10-1 ........................................................... 60BPO .................................................................60BRAFTOVI ........................................................ 6BREATHERITE MDI SPACER ....................... 31BREATHERITE VALVED MDI CHAMBER .... 31BREATHERITE VALVED MDI SPACER ........31BREEZE 2 CONTROL SOLUTION, NML .......31BREEZE 2 TEST STRIPS ...............................37BREO ELLIPTA .................................... 9, 47, 58BREVICON (28) .............................................. 47BRIELLYN .......................................................47BRILINTA ........................................................12brimonidine ...................................................... 42brimonidine-dorzolamide (pf) ...........................42BRINEURA ......................................................41BRISDELLE .................................................... 20BRIVIACT ........................................................20BROMFED DM ............................................9, 58bromfenac ........................................................42bromocriptine ...................................................20brompheniramine-pseudoeph-dm ............... 9, 58BROMSITE ......................................................42BROVANA .................................................. 9, 58BRYHALI .........................................................60budesonide .......................................... 42, 47, 58BULLSEYE MINI SAFETY LANCETS ............31bumetanide ................................................16, 39BUNAVAIL ...................................................... 20BUPAP ............................................................ 20BUPHENYL .....................................................39BUPRENEX .....................................................20buprenorphine ................................................. 20buprenorphine hcl ............................................20buprenorphine-naloxone ..................................20bupropion hcl ................................................... 20bupropion hcl (smoking deter) ......................... 20buspirone .........................................................20BUTALBITAL COMPOUND W/CODEINE ......20butalbital-acetaminop-caf-cod ......................... 20butalbital-acetaminophen ................................ 20butalbital-acetaminophen-caff ......................... 20butalbital-aspirin-caffeine ...........................12, 20BUTISOL .........................................................20butorphanol tartrate ......................................... 20BUTRANS ....................................................... 20BYDUREON .................................................... 47BYDUREON BCISE ........................................ 47BYETTA .......................................................... 47BYSTOLIC .................................................. 9, 16cabergoline ...................................................... 20CABLIVI .......................................................... 12CABOMETYX ....................................................6CADEAU DHA .......................................... 12, 67CADUET ..........................................................16CAFERGOT ................................................ 9, 20caffeine citrate ................................................. 20
CALAN ............................................................ 16CALAN SR ...................................................... 16calcipotriene .................................................... 60calcipotriene-betamethasone .......................... 60calcitonin (salmon) .....................................47, 54CALCITRENE ................................................. 60calcitriol ......................................................60, 67CALCIUM 600 WITH VITAMIN D3 ........... 39, 67calcium acetate ................................................39CALCIUM PNV ....................................12, 39, 67CALCIUM-FOLIC ACID-VITAMIN D ...............39CALICYLIC ..................................................... 60CALQUENCE ....................................................6CAMBIA .......................................................... 20CAMILA ...........................................................47CAMRESE .......................................................47CAMRESE LO .................................................47CANASA ......................................................... 44candesartan .....................................................16candesartan-hydrochlorothiazid ................ 16, 39CAPASTAT ....................................................... 2capecitabine ...................................................... 6CAPEX ............................................................ 60CAPHOSOL .................................................... 31CAPRELSA .......................................................6CAPSFENAC PAK ....................................20, 60captopril ........................................................... 16captopril-hydrochlorothiazide .....................16, 39CAPXIB ..................................................... 20, 60CARAC ........................................................6, 60CARAFATE .....................................................44CARBAGLU .................................................... 39carbamazepine ................................................ 20CARBATROL ..................................................20carbidopa .........................................................21carbidopa-levodopa ......................................... 21carbidopa-levodopa-entacapone ..................... 21carbinoxamine maleate ............................... 1, 58CARDIZEM ......................................................16CARDIZEM CD ............................................... 16CARDIZEM LA ................................................16CARDURA .................................................. 9, 16CARDURA XL .............................................9, 16CAREFINE PEN NEEDLE .............................. 31CAREONE THIN LANCET ..............................31CAREONE ULTRA THIN LANCET ................ 31CARESENS LANCETS ...................................31CARESENS N TEST STRIPS .........................37CARETOUCH INSULIN SYRINGE ................. 31CARETOUCH PEN NEEDLE ..........................31CARETOUCH TEST STRIP ............................37CARETOUCH TWIST LANCET ......................31carisoprodol ....................................................... 9carisoprodol-asa-codeine ............................ 9, 21carisoprodol-aspirin ..................................... 9, 21CARNITOR ......................................................54CARNITOR (SUGAR-FREE) .......................... 54CAROSPIR ................................................16, 39carteolol ........................................................... 42CARTIA XT ..................................................... 16carvedilol ..................................................... 9, 16carvedilol phosphate ....................................9, 16CASODEX .........................................................6CATAPRES .................................................9, 16CATAPRES-TTS-1 ......................................9, 16CATAPRES-TTS-2 ......................................9, 16CATAPRES-TTS-3 ......................................9, 16CAYA CONTOURED ...................................... 28CAYSTON ......................................................... 2CAZIANT (28) ................................................. 47cefaclor .............................................................. 2cefadroxil ........................................................... 2cefdinir ............................................................... 2cefditoren pivoxil ................................................2cefixime ............................................................. 2cefpodoxime ...................................................... 2cefprozil ............................................................. 2cefuroxime axetil ................................................2CELACYN ....................................................... 60
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CELACYN POST PROCEDURE .................... 31CELEBREX ..................................................... 21celecoxib ..........................................................21CELEXA .......................................................... 21CELLCEPT ......................................................54CELONTIN ...................................................... 21CEM-UREA ..................................................... 60CENTANY ....................................................... 60CENTANY AT ................................................. 60CENTERGY .............................................1, 9, 58CENTERGY DM ...................................... 1, 9, 58CENTRATEX .............................................12, 67cephalexin ......................................................... 2CEQUA ............................................................42CERACADE .................................................... 61CERAMAX ...................................................... 31CERDELGA .................................................... 54CEREZYME .....................................................41CESAMET ....................................................... 44CETACAINE ....................................................61cetirizine ...................................................... 1, 58CETRAXAL ..................................................... 42cevimeline ..........................................................9CHANTIX ...........................................................9CHANTIX CONTINUING MONTH BOX ............9CHANTIX STARTING MONTH BOX ................ 9CHATEAL (28) ................................................ 47CHATEAL EQ (28) ..........................................47CHEMET ................................................... 46, 54CHENODAL .................................................... 44CHERATUSSIN AC .................................. 21, 58CHILDREN'S ASPIRIN ............................. 12, 21CHILDREN'S IRON .........................................12chlordiazepoxide hcl ........................................ 21chlordiazepoxide-clidinium .......................... 9, 21chlorhexidine gluconate ...................................42chloroquine phosphate ...................................... 2chlorothiazide ............................................ 16, 39chlorpromazine ................................................ 21chlorpropamide ................................................47chlorthalidone ............................................ 16, 39chlorzoxazone ................................................... 9CHOICEDM CLARUS ..................................... 37CHOLBAM ...................................................... 44cholestyramine (with sugar) .............................16CHOLESTYRAMINE LIGHT ........................... 16choline,magnesium salicylate ..........................21CIALIS .............................................................16CICLODAN ......................................................61CICLODAN KIT ...............................................61ciclopirox ..........................................................61ciclopirox-ure-camph-menth-euc ..................... 61CIFEREX ......................................................... 67cilostazol ....................................................12, 16CILOXAN ........................................................ 42CIMDUO ............................................................ 2cimetidine ........................................................ 44cimetidine hcl ...................................................44CIMZIA ...................................................... 44, 54CIMZIA POWDER FOR RECONST ..........44, 54CIMZIA STARTER KIT ............................. 44, 54cinacalcet ...................................................47, 54CINQAIR ......................................................... 58CINRYZE .........................................................54CIPRO ............................................................... 2CIPRO HC ....................................................... 42CIPRO XR ......................................................... 2CIPRODEX ......................................................42ciprofloxacin .......................................................2ciprofloxacin (mixture) ....................................... 2ciprofloxacin hcl ........................................... 2, 42citalopram ........................................................ 21CITRANATAL (DUAL-IRON) ....................12, 67CITRANATAL 90 DHA (ALGAL OIL) .12, 44, 67CITRANATAL ASSURE ..................... 12, 44, 67CITRANATAL B-CALM (FE GLUC) ......... 12, 67CITRANATAL BLOOM ............................. 12, 67CITRANATAL DHA (ALGAL OIL) ............12, 67
CITRANATAL HARMONY (IRON FUM)............................................................. 12, 44, 67CLARAVIS ...................................................... 61CLARINEX .................................................. 1, 58CLARINEX-D 12 HOUR ..........................1, 9, 58clarithromycin .................................................... 2CLEANSING WASH ....................................... 61clemastine ................................................... 1, 58CLENPIQ .........................................................44CLEOCIN ........................................................ 61CLEOCIN HCL .................................................. 2CLEOCIN PEDIATRIC ...................................... 2CLEOCIN T ..................................................... 61CLEVER CHEK LANCETS .............................31CLEVER CHOICE LEVEL 1 CONTROL .........31CLEVER CHOICE LEVEL 2 CONTROL .........31CLEVER CHOICE LEVEL 3 CONTROL .........31CLEVER CHOICE MICRO TEST STRIP ........ 37CLEVER CHOICE PRO .................................. 37CLEVER CHOICE TALK TEST ...................... 37CLEVER CHOICE TEST STRIPS ...................37CLEVER CHOICE VOICE+ TEST ...................37CLICKFINE PEN NEEDLE ............................. 31CLIMARA ........................................................ 47CLIMARA PRO ............................................... 47CLINDACIN ETZ ............................................. 61CLINDACIN P ................................................. 61CLINDACIN PAC ............................................ 61CLINDAGEL ....................................................61clindamycin hcl .................................................. 2clindamycin palmitate hcl ...................................2CLINDAMYCIN PEDIATRIC ............................. 2clindamycin phosphate .................................... 61clindamycin-benzoyl peroxide ......................... 61clindamycin-tretinoin ........................................61CLINDESSE .................................................... 61CLINPRO 5000 ............................................... 54clobazam ......................................................... 21clobetasol ........................................................ 61clobetasol-emollient .........................................61CLOBEX ..........................................................61clocortolone pivalate ........................................61CLODAN ......................................................... 61CLODAN KIT .................................................. 61CLODERM ...................................................... 61clomipramine ................................................... 21clonazepam ..................................................... 21clonidine ...................................................... 9, 16clonidine hcl .................................................9, 16clopidogrel ....................................................... 12clorazepate dipotassium ..................................21CLORPRES .....................................9, 10, 16, 39clotrimazole ..................................................... 61clotrimazole-betamethasone ........................... 61clozapine ......................................................... 21CLOZARIL ...................................................... 21C-NATE DHA ............................................ 12, 67COAGADEX ....................................................12COAGUCHEK LANCETS ............................... 31COARTEM ........................................................ 2codeine sulfate .......................................... 21, 58codeine-butalbital-asa-caff .............................. 21codeine-guaifenesin .................................. 21, 58CODITUSSIN AC ...................................... 21, 58COLAZAL ....................................................... 44colchicine .........................................................54COLCRYS ....................................................... 54colesevelam ...............................................16, 47COLESTID ...................................................... 16COLESTID FLAVORED ..................................16colestipol ..........................................................16colistin (colistimethate na) ................................. 2COLOR LANCETS ..........................................31COLY-MYCIN S .............................................. 42COLYTE WITH FLAVOR PACKS .................. 44COMBIGAN .....................................................42COMBIPATCH ................................................ 47COMBIVENT RESPIMAT ......................... 10, 58COMBIVIR .........................................................2
COMETRIQ ....................................................... 6COMFORT EZ INSULIN SYRINGE ................ 31COMFORT EZ LANCETS ...............................31COMFORT EZ PEN NEEDLES ...................... 31COMFORT LANCETS .................................... 31COMFORT PAC-CYCLOBENZAPRINE .........10COMFORT PAC-IBUPROFEN ....................... 21COMFORT PAC-MELOXICAM .......................21COMFORT PAC-NAPROXEN ............ 21, 54, 61COMFORT PAC-TIZANIDINE ........................ 10COMPAZINE ............................................. 21, 44COMPLERA ...................................................... 2COMPLETE NATAL DHA ...............................67COMPLETENATE .....................................12, 67COMPRO .................................................. 21, 44COMTAN .........................................................21CONCEPT DHA .............................................. 12CONCEPT OB .................................................12CONCERTA .................................................... 21CONDYLOX .................................................... 61CONSTULOSE ................................................39CONTOUR CONTROL SOLUTION, LOW ......31CONTOUR NEXT LEV 1 CONTROL SOL ......31CONTOUR NEXT LEV 2 CONTROL SOL ......31CONTOUR NEXT TEST STRIPS ....................37CONTOUR TEST STRIPS .............................. 37CONZIP ........................................................... 21COOL CONTROL A SOLUTION .................... 31COOL CONTROL B SOLUTION .................... 31COOL GLUCOSE TEST STRIP ......................37COPAXONE .................................................... 54COPIKTRA ........................................................6CORDRAN ...................................................... 61CORDRAN TAPE LARGE ROLL ................... 61COREG ..................................................... 10, 16COREG CR ............................................... 10, 16COREMINO .................................................2, 61CORGARD ................................................ 10, 16CORIFACT ...................................................... 12CORLANOR ....................................................16CORMAX .........................................................61CORTANE-B ................................................... 42CORTEF ..........................................................47CORTENEMA ................................................. 61CORTIFOAM ...................................................61cortisone .......................................................... 47CORTISPORIN ................................................61CORVITA ........................................................ 67CORVITA 150 ........................................... 12, 68COSENTYX .....................................................61COSENTYX (2 SYRINGES) ............................61COSENTYX PEN ............................................ 61COSENTYX PEN (2 PENS) ............................ 61COSOPT ......................................................... 42COSOPT (PF) ................................................. 42COTELLIC .........................................................6COTEMPLA XR-ODT ......................................21COUMADIN .....................................................12COVARYX .......................................................47COVARYX H.S. ...............................................47COZAAR ......................................................... 16CREON ............................................................44CRESEMBA ...................................................... 2CRESTOR ....................................................... 16CRINONE ........................................................ 47CRIXIVAN ......................................................... 2cromolyn .................................................... 42, 58CROTAN ......................................................... 61CRYOSERV .................................................... 54CRYSELLE (28) .............................................. 47CRYSVITA ...................................................... 39CUPRIMINE .............................................. 46, 54CURITY ALCOHOL SWABS .......................... 61CUTIVATE .......................................................61CUVITRU ...........................................................8CUVPOSA .......................................................10cyanocobalamin (vitamin b-12) ........................68CYCLAFEM 1/35 (28) ..................................... 47CYCLAFEM 7/7/7 (28) .................................... 47
74
CYCLESSA (28) ..............................................47cyclobenzaprine ...............................................10CYCLOGYL .....................................................42CYCLOMYDRIL .............................................. 42cyclopentolate ..................................................42cyclopen-tropic-phenyleph-watr .......................42cyclophosphamide .......................................6, 54cycloserine .........................................................2CYCLOSET ..................................................... 21cyclosporine .....................................................54CYCLOSPORINE IN KLARITY .......................42cyclosporine modified ...................................... 54CYCLOTENS REFILL ...............................10, 31CYCLOTENS STARTER .......................... 10, 31CYMBALTA .................................................... 21cyproheptadine ............................................ 1, 58CYRAMZA .........................................................6CYRED ............................................................ 48CYRED EQ ......................................................48CYSTADANE .................................................. 54CYSTAGON .................................................... 54CYSTARAN .....................................................42CYTOGAM ........................................................ 8CYTOMEL ....................................................... 48CYTOTEC ....................................................... 44CYTOVENE .......................................................2CYTRA K CRYSTALS .................................... 39CYTRA-2 ......................................................... 39CYTRA-3 ......................................................... 39CYTRA-K ........................................................ 39D.H.E.45 .................................................... 10, 21DACOGEN ........................................................ 6dalfampridine ................................................... 54DALIRESP ...................................................... 58danazol ............................................................ 48DANTRIUM ..................................................... 10dantrolene ........................................................10dapsone .......................................................2, 61DAPTACEL (DTAP PEDIATRIC) (PF) ............. 8DARAPRIM ....................................................... 2darifenacin ....................................................... 67DARIO BLOOD GLUCOSE TEST STRIP ...... 37DARZALEX ....................................................... 6DASETTA 1/35 (28) ........................................ 48DASETTA 7/7/7 (28) ....................................... 48DAURISMO ....................................................... 6DAYPRO ......................................................... 21DAYSEE ..........................................................48DAYTRANA .................................................... 21DDAVP ................................................ 12, 13, 48DEBACTEROL ................................................61DEBLITANE .................................................... 48DECADRON ....................................................48decitabine .......................................................... 6deferasirox .......................................................46DELESTROGEN ............................................. 48DELSTRIGO ......................................................2DELTASONE .................................................. 48DELYLA (28) ...................................................48DELZICOL .......................................................44DEMADEX .................................................16, 39demeclocycline .................................................. 2DEMEROL .......................................................21DEMSER ......................................................... 54DENAVIR ........................................................ 61DENTA 5000 PLUS .........................................54DENTAGEL .....................................................54DEPAKENE .....................................................21DEPAKOTE .....................................................21DEPAKOTE ER ...............................................21DEPAKOTE SPRINKLES ............................... 21DEPEN TITRATABS .................................46, 54DEPO-ESTRADIOL ........................................ 48DEPO-MEDROL ..............................................48DEPO-SUBQ PROVERA 104 ......................... 48DEPO-TESTOSTERONE ................................48DERMACINRX CLORHEXACIN .....................61DERMACINRX EMPRICAINE .........................61DERMACINRX LEXITRAL ........................21, 61
DERMACINRX PHN PAK ............................... 61DERMACINRX PRIZOPAK .............................61DERMACINRX PUREFOLIX ...........................68DERMACINRX SILAPAK ............................... 61DERMACINRX SURGICAL PHARMAPAK .... 61DERMACINRX THERAZOLE PAK .................61DERMACINRX ZRM PAK ...............................61DERMA-SMOOTHE/FS BODY OIL ................ 61DERMA-SMOOTHE/FS SCALP OIL .............. 61DERMASORB HC COMPLETE KIT ............... 61DERMASORB TA COMPLETE KIT ............... 61DERMATOP .................................................... 61DERMAWERX SDS ........................................ 61DERMAWERX SURGICAL PLUS PAK ..........61DERMAZENE ..................................................61DERMAZYL KIT ..............................................61DERMOTIC OIL .............................................. 42DESCOVY ......................................................... 2desipramine ..................................................... 21desloratadine ............................................... 1, 58desmopressin ............................................ 13, 48desog-e.estradiol/e.estradiol ........................... 48desogestrel-ethinyl estradiol ............................48DESONATE .....................................................61desonide .......................................................... 61DESOWEN ...................................................... 61desoximetasone .............................................. 61DESOXYN ....................................................... 21desvenlafaxine .................................................21desvenlafaxine succinate ................................ 21DETROL ..........................................................67DETROL LA .................................................... 67dexamethasone ............................................... 48DEXAMETHASONE INTENSOL .................... 48dexamethasone sodium phos (pf) ................... 48dexamethasone sodium phosphate ...........42, 48DEXEDRINE SPANSULE ............................... 21DEXERYL ........................................................61DEXILANT .......................................................44dexmethylphenidate ........................................ 21DEXONTO .......................................................48DEXPAK 10 DAY ............................................ 48DEXPAK 13 DAY ............................................ 48DEXPAK 6 DAY .............................................. 48dextroamphetamine .........................................21dextroamphetamine-amphetamine ..................21DIACOMIT .......................................................21DIASTAT ......................................................... 21DIASTAT ACUDIAL ........................................21DIATRUE CONTROL SOLN NORMAL .......... 31DIATRUE CONTROL SOLUTION HIGH ........ 31DIATRUE CONTROL SOLUTION LOW .........31DIATRUE PLUS TEST STRIP ........................ 37diazepam ......................................................... 21DIAZEPAM INTENSOL ...................................21DIBENZYLINE ...........................................10, 16DICLEGIS ............................................44, 58, 68DICLO GEL ............................................... 21, 61DICLO GEL-XRYLIX SHEET ....................21, 62diclofenac epolamine .................................21, 62diclofenac potassium ....................................... 21diclofenac sodium ............................6, 21, 42, 62diclofenac-misoprostol ...............................21, 44DICLOFEX DC .......................................... 21, 62DICLOFONO ............................................. 21, 62DICLOPAK ................................................21, 62DICLOPR .................................................. 21, 62DICLOTRAL ..............................................21, 62DICLOVIX ..................................................21, 62dicloxacillin ........................................................ 2DICLOZOR ................................................21, 62dicyclomine ......................................................10didanosine ......................................................... 2DIFFERIN ........................................................ 62DIFICID ..............................................................2diflorasone ....................................................... 62DIFLUCAN ........................................................ 2diflunisal ...........................................................21DIGITEK .......................................................... 16
DIGOX ............................................................. 16digoxin ............................................................. 16dihydroergotamine .....................................10, 21DILANTIN ..................................................16, 21DILANTIN EXTENDED ............................. 16, 21DILANTIN INFATABS ...............................16, 21DILANTIN KAPSEAL ................................16, 21DILANTIN-125 ...........................................16, 21DILATRATE-SR .............................................. 16DILAUDID ....................................................... 21diltiazem hcl .....................................................16DILT-XR .......................................................... 16DILUENT FOR EPOPROSTENOL/FLOLA .... 57DIOVAN ...........................................................16DIOVAN HCT ............................................ 16, 39DIPENTUM ......................................................44diphenhydramine hcl ................................... 1, 58diphenoxylate-atropine ........................ 10, 44, 58DIPROLENE ....................................................62dipyridamole .............................................. 13, 16DISALCID ........................................................21DISKETS ......................................................... 21disopyramide phosphate ................................. 16disulfiram ......................................................... 54DITHOL ..................................................... 21, 62DITROPAN XL ................................................ 67DIURIL .......................................................16, 39divalproex ........................................................ 21DIVIGEL .......................................................... 48DM2 ........................................................... 37, 48dofetilide .......................................................... 16DOLOPHINE ................................................... 21DOLOTRANZ .................................................. 62donepezil ......................................................... 10DONNATAL .............................................. 10, 21DOPTELET (10 TAB PACK) .......................... 13DOPTELET (15 TAB PACK) .......................... 13DORAL ............................................................21DORYX ..............................................................2DORYX MPC .....................................................2dorzolamide ..................................................... 42dorzolamide (pf) ...............................................42dorzolamide-timolol ......................................... 42dorzolamide-timolol (pf) ................................... 42DOTTI ..............................................................48DOUBLEDEX (PF) .......................................... 48DOVATO ........................................................... 2DOVONEX .......................................................62doxazosin .................................................. 10, 16doxepin ...................................................... 22, 62doxercalciferol ................................................. 68doxycycline hyclate ......................................2, 42doxycycline monohydrate ............................ 2, 62doxylamine-pyridoxine (vit b6) .............44, 58, 68D-PENAMINE ..................................................46DRISDOL ........................................................ 68DRITHOCREME HP ........................................62dronabinol ........................................................44DROPLET INSULIN SYRINGE .......................31DROPLET LANCETS ..................................... 31DROPLET PEN NEEDLE ............................... 31drospirenone-e.estradiol-lm.fa .........................48drospirenone-ethinyl estradiol ......................... 48DROXIA .............................................................6DRYSOL ..........................................................62DRYSOL DAB-O-MATIC ................................ 62DUAC .............................................................. 62DUAVEE ..........................................................48DUET DHA BALANCED ...........................13, 68DUET DHA WITH OMEGA-3 .................... 13, 68DUETACT ....................................................... 48DUEXIS ..................................................... 22, 44DULERA ..............................................10, 48, 58duloxetine ........................................................ 22DUOBRII ......................................................... 62DUOPA ............................................................22DUPIXENT ................................................ 58, 62DURACHOL .................................................... 68DURAGESIC ................................................... 22
75
DUREZOL ....................................................... 42DURLAZA ................................................. 13, 22DUROLANE .................................................... 31dutasteride .......................................................54dutasteride-tamsulosin .............................. 10, 54DUTOPROL ........................................ 10, 16, 39DUZALLO ................................................. 39, 54DVORAH ......................................................... 22DXEVO ............................................................ 48DYANAVEL XR ...............................................22DYAZIDE ...................................................16, 39DYMISTA .................................................. 42, 58DYRENIUM ............................................... 16, 39DYSPORT ................................................. 10, 54E.C. PRIN .................................................. 13, 22E.E.S. 400 ......................................................... 2E.E.S. GRANULES ........................................... 2EASIVENT HOLDING CHAMBER ..................31EASIVENT MASK LARGE ............................. 31EASIVENT MASK MEDIUM ........................... 31EASIVENT MASK SMALL ..............................31EASY COMFORT INSULIN SYRINGE ........... 31EASY COMFORT LANCETS ..........................31EASY COMFORT PEN NEEDLES ................. 31EASY GLIDE CATHETER TIP SYRING .........31EASY GLIDE INSULIN SYRINGE .................. 31EASY GLIDE LUER LOCK SYRINGE ............31EASY GLUCO G2 ........................................... 37EASY PLUS II HIGH CONTROL .................... 31EASY PLUS II TEST ....................................... 37EASY STEP .................................................... 37EASY TALK GLUCOSE TEST ....................... 37EASY TOUCH ................................................. 32EASY TOUCH ALCOHOL PREP PADS ........ 62EASY TOUCH FLIPLOCK SYRINGE .............31EASY TOUCH FLURINGE ..............................31EASY TOUCH FLURINGE FLIPLOCK ...........31EASY TOUCH FLURINGE SHEATHLOCK ....31EASY TOUCH HIGH-LOW CONTROL ...........31EASY TOUCH INSULIN SYRINGE ................ 32EASY TOUCH LANCETS ............................... 32EASY TOUCH LUER LOCK INSULIN ............32EASY TOUCH LUER LOCK SYRINGE ..........32EASY TOUCH SAFETY LANCETS ................32EASY TOUCH SHEATHLOCK SYRG-NDL ... 32EASY TOUCH SHEATHLOCK SYRINGE ......32EASY TOUCH TEST STRIP ........................... 37EASY TOUCH TUBERCULIN SHEATHLK .... 32EASY TOUCH TWIST LANCETS ...................32EASY TOUCH UNI-SLIP .................................32EASY TRAK GLUCOSE TEST .......................37EASY TRAK HIGH CONTROL ....................... 32EASY TRAK LOW CONTROL ........................32EASY TWIST AND CAP LANCETS ............... 32EASYGLUCO PLUS ....................................... 37EASYGLUCO TEST ........................................37EASYMAX .......................................................37EASYMAX 15 ..................................................37EASYMAX LOW CONTROL ...........................32EASYMAX NORMAL CONTROL ................... 32EC-NAPROSYN ........................................ 22, 54EC-NAPROXEN ........................................ 22, 54econazole ........................................................ 62ECONTRA EZ ................................................. 48ECONTRA ONE-STEP ................................... 48ECOTRIN .................................................. 13, 22ECOTRIN LOW STRENGTH .................... 13, 22ECOZA ............................................................ 62EDARBI ...........................................................16EDARBYCLOR ......................................... 16, 39EDECRIN .................................................. 16, 39EDLUAR ..........................................................22ED-SPAZ .........................................................10EDURANT ......................................................... 2EEMT ...............................................................48EEMT HS .........................................................48efavirenz ............................................................ 2EFFER-K ......................................................... 39EFFEXOR XR ..................................................22
EFFIENT ..........................................................13EFUDEX ...................................................... 6, 62EGRIFTA .........................................................48ELAPRASE ..................................................... 41ELDEPRYL ..................................................... 22ELELYSO ........................................................41ELEMENT COMPACT HIGH CONTROL ....... 32ELEMENT COMPACT NORMAL CONTROL .32ELEMENT COMPACT TEST STRIPS ............ 37ELEMENT HIGH CONTROL ...........................32ELEMENT LOW CONTROL ........................... 32ELEMENT NORMAL CONTROL ....................32ELEMENT TEST STRIPS ............................... 37ELESTRIN .......................................................48ELETONE ..................................................32, 62eletriptan ..........................................................22ELIDEL ......................................................54, 62ELIGARD .................................................... 6, 48ELIGARD (3 MONTH) .................................6, 48ELIGARD (4 MONTH) .................................6, 48ELIGARD (6 MONTH) .................................6, 48ELIMITE .......................................................... 62ELINEST ......................................................... 48ELIQUIS .......................................................... 13ELITE OB WITH DHA ..................................... 68ELITE-OB ..................................................13, 68ELITE-OB 400 ...........................................13, 68ELIXOPHYLLIN ............................ 16, 39, 58, 67ELLA ............................................................... 48ELLZIA PAK ................................................... 62ELMIRON ........................................................ 54ELOCON ......................................................... 62ELOCTATE ..................................................... 13ELZONRIS ........................................................ 6EMBEDA ......................................................... 22EMBRACE BLOOD GLUCOSE SYSTEM ......37EMBRACE EVO TEST STRIPS ......................37EMBRACE GLUCOSE CONTROL HIGH .......32EMBRACE LANCETS .................................... 32EMBRACE PRO TEST STRIPS ..................... 37EMBRACE TALK TEST STRIPS ....................38EMCYT .............................................................. 6EMEND ............................................................44EMFLAZA ....................................................... 48EMGALITY PEN ..............................................22EMGALITY SYRINGE .....................................22EMOQUETTE ..................................................48EMPLICITI .........................................................6EMSAM ........................................................... 22EMTRIVA .......................................................... 2EMULSION SB ................................................32EMVERM ...........................................................2ENABLEX ....................................................... 67enalapril maleate ............................................. 16enalapril-hydrochlorothiazide .....................16, 39ENBRACE HR ...........................................13, 68ENBREL ....................................................54, 62ENBREL MINI ........................................... 54, 62ENBREL SURECLICK ..............................54, 62ENDARI .....................................................44, 54ENDOCET ....................................................... 22ENGERIX-B (PF) ...............................................8ENGERIX-B PEDIATRIC (PF) .......................... 8enoxaparin .......................................................13ENPRESSE ..................................................... 48ENSKYCE ....................................................... 48ENSTILAR .......................................................62entacapone ......................................................22entecavir ............................................................ 2ENTEREG ....................................................... 44ENTERIC COATED ASPIRIN ................... 13, 22ENTOCORT EC .............................................. 48ENTRESTO ..................................................... 16ENTYVIO ...................................................44, 54ENULOSE ....................................................... 39ENVARSUS XR ...............................................54EPANED ..........................................................16EPCLUSA ......................................................... 2EPICERAM ......................................................32
EPIDIOLEX ..................................................... 22EPIDUO ...........................................................62EPIDUO FORTE ..............................................62EPIFOAM ........................................................ 62epinastine ........................................................ 42epinephrine ................................................10, 58EPIPEN ..................................................... 10, 58EPIPEN 2-PAK ..........................................10, 58EPIPEN JR ................................................10, 58EPIPEN JR 2-PAK .................................... 10, 58EPISIL ............................................................. 32EPISNAP ...................................................10, 58EPITOL ............................................................22EPIVIR ...............................................................2EPIVIR HBV ...................................................... 3eplerenone .......................................................16EPOGEN ......................................................... 13epoprostenol (glycine) ............................... 16, 58eprosartan ....................................................... 17EPZICOM .......................................................... 3EQUETRO .......................................................22ERBITUX ...........................................................6ergocalciferol (vitamin d2) ............................... 68ergoloid ............................................................10ERGOMAR ................................................10, 22ergotamine-caffeine ...................................10, 22ERIVEDGE ........................................................ 6ERLEADA ......................................................... 6erlotinib .............................................................. 6ERRIN ............................................................. 48ERTACZO ....................................................... 62ERWINAZE ....................................................... 6ERY PADS ...................................................... 62ERYGEL ..........................................................62ERYPED 200 .....................................................3ERYPED 400 .....................................................3ERY-TAB ...........................................................3ERYTHROCIN (AS STEARATE) ...................... 3erythromycin ................................................ 3, 42erythromycin ethylsuccinate .............................. 3erythromycin stearate ........................................ 3erythromycin with ethanol ................................62erythromycin-benzoyl peroxide ........................62ESBRIET ......................................................... 58ESCAVITE ...........................................13, 54, 68ESCAVITE D ....................................... 13, 54, 68ESCAVITE LQ .....................................13, 54, 68escitalopram oxalate ........................................22ESGIC ............................................................. 22ESKATA ..........................................................62ESOMEP-EZS ................................................. 44esomeprazole magnesium .............................. 44esomeprazole strontium .................................. 44ESTARYLLA ................................................... 48estazolam ........................................................ 22ESTRACE ....................................................... 48estradiol ........................................................... 48estradiol valerate ............................................. 48estradiol-norethindrone acet ............................48ESTRING .........................................................48ESTROGEL .....................................................48estrogens-methyltestosterone ......................... 48ESTROSTEP FE-28 ........................................ 48eszopiclone ......................................................22ethacrynic acid ...........................................17, 39ethambutol .........................................................3ethosuximide ................................................... 22ethyl chloride ................................................... 62ethynodiol diac-eth estradiol ............................48etidronate disodium ......................................... 54etodolac ........................................................... 22etoposide ........................................................... 6EUCRISA ........................................................ 62EUFLEXXA ..................................................... 32EURAX ............................................................ 62EUTHYROX .....................................................48EVAMIST .........................................................48EVEKEO ..........................................................22EVEKEO ODT ................................................. 22
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EVENCARE G2 ...............................................38EVENCARE G3 CONTROL ............................ 32EVENCARE G3 TEST .....................................38EVENCARE MINI GLUCOSE TEST STR .......38EVENCARE PROVIEW TEST STRIP .............38EVENCARE TEST .......................................... 38EVENITY ......................................................... 54EVISTA ......................................................48, 54EVOCLIN .........................................................62EVOLUTION NORMAL CONTROL ................ 32EVOLUTION TEST STRIPS ........................... 38EVOMELA .........................................................6EVOTAZ ...................................................... 3, 54EVOXAC ......................................................... 10EVZIO ........................................................22, 54EXALGO ER ................................................... 22EXEL HYPODERMIC NEEDLES ....................32EXEL INSULIN ................................................32EXEL SYRINGE .............................................. 32EXELDERM .....................................................62EXELON ..........................................................10exemestane ................................................. 6, 48EXFORGE ....................................................... 17EXFORGE HCT .........................................17, 39EXJADE .......................................................... 46EXODERM ...................................................... 62EXONDYS 51 .................................................. 54EXTAVIA ......................................................... 54EXTINA ........................................................... 62EXTRA-VIRT PLUS DHA ..........................13, 68EYLEA .............................................................42E-Z JECT LANCETS .......................................32E-Z JECT THIN LANCETS ............................. 32EZ SMART LANCETS .................................... 32EZ SMART PLUS TEST ................................. 38EZ SMART TEST ............................................ 38EZALLOR SPRINKLE .................................... 17ezetimibe ......................................................... 17ezetimibe-simvastatin ...................................... 17FA-8 .................................................................68FABB ...............................................................68FABIOR ...........................................................62FABRAZYME .................................................. 41FACTIVE ........................................................... 3FALMINA (28) ................................................. 48famciclovir ..........................................................3famotidine ........................................................ 45FANAPT .......................................................... 22FARESTON .................................................6, 48FARXIGA ........................................................ 48FARYDAK ......................................................... 6FASENRA ....................................................... 58FASLODEX ....................................................... 6FAYOSIM ........................................................ 48FAZACLO ....................................................... 22FC2 FEMALE CONDOM .................................28FE C PLUS ................................................13, 68febuxostat ........................................................ 54FEIBA NF ........................................................ 13felbamate .........................................................22FELBATOL ..................................................... 22FELDENE ........................................................22felodipine ......................................................... 17FEM PH ........................................................... 62FEMARA ..................................................... 6, 48FEMCAP ................................................... 28, 32FEMHRT LOW DOSE ..................................... 48FEMRING ........................................................ 48FEMYNOR .......................................................48fenofibrate ........................................................17fenofibrate micronized ..................................... 17fenofibrate nanocrystallized .............................17fenofibric acid .................................................. 17fenofibric acid (choline) ....................................17FENOGLIDE ....................................................17fenoprofen ....................................................... 22FENORTHO .................................................... 22fentanyl ............................................................ 22fentanyl citrate ................................................. 22
FENTORA ....................................................... 22FER-IN-SOL .................................................... 13FEROCON .......................................................13FERRAPLUS 90 ........................................13, 68FERREX 150 FORTE ................................13, 68FERRIPROX ....................................................46FERROCITE PLUS ................................... 13, 68ferrous sulfate ..................................................13FETZIMA ......................................................... 22FEXMID ........................................................... 10fexofenadine ................................................ 1, 58fexofenadine-pseudoephedrine ............. 1, 10, 58FIASP FLEXTOUCH U-100 INSULIN .............48FIASP U-100 INSULIN ....................................48FIBRICOR ....................................................... 17FIBRYGA ........................................................ 13FIFTY50 SAFETY SEAL LANCETS ...............32FIFTY50 TEST STRIP .....................................38FINACEA .........................................................62finasteride ........................................................ 54FINE 30 UNIVERSAL LANCETS ....................32FINGERSTIX LANCETS ................................. 32FIORICET ........................................................22FIORINAL ..................................................13, 22FIORINAL-CODEINE #3 ................................. 22FIRAZYR ......................................................... 54FIRDAPSE ...................................................... 54FIRMAGON KIT W DILUENT SYRINGE............................................................... 6, 48, 54FIRVANQ .......................................................... 3FLAC OTIC OIL .............................................. 42FLAGYL ............................................................ 3FLAREX .......................................................... 42flavoxate .......................................................... 67FLEBOGAMMA DIF ..........................................8flecainide ......................................................... 17FLECTOR ..................................................22, 62FLEXIPAK .................................................22, 62FLOLAN .................................................... 17, 58FLOLIPID ........................................................ 17FLOMAX ......................................................... 10FLORIVA ...................................................54, 68FLORIVA (FLUORIDE-VITAMIN D3) ....... 54, 68FLORIVA PLUS ........................................ 54, 68FLOVENT DISKUS ................................... 48, 58FLOVENT HFA ......................................... 49, 58FLUCAINE ................................................ 38, 42fluconazole ........................................................ 3flucytosine ..........................................................3fludrocortisone ................................................. 49FLUMADINE ..................................................... 3flunisolide ...................................................42, 58fluocinolone ..................................................... 62fluocinolone acetonide oil ................................ 42fluocinolone and shower cap ........................... 62fluocinonide ..................................................... 62FLUOCINONIDE-E ..........................................62fluocinonide-emollient ......................................62FLUORABON ..................................................54fluorescein-proparacaine ........................... 38, 42fluoride (sodium) ..............................................54FLUORIDEX DAILY DEFENSE ...................... 54FLUORIDEX SENSITIVITY RELIEF ............... 54FLUORITAB ....................................................54fluorometholone ...............................................42FLUOROPLEX ............................................ 6, 62fluorouracil ................................................... 6, 62fluoxetine ......................................................... 22fluphenazine hcl ...............................................22FLURA-DROPS .............................................. 54flurandrenolide .................................................62flurazepam .......................................................22flurbiprofen .......................................................22flurbiprofen sodium .......................................... 42flutamide ............................................................ 6fluticasone propionate ......................... 42, 58, 62fluticasone propion-salmeterol .............10, 49, 58fluvastatin ........................................................ 17fluvoxamine ..................................................... 22
FML FORTE .................................................... 42FML LIQUIFILM .............................................. 42FML S.O.P. ......................................................42FOCALIN .........................................................22FOCALIN XR ...................................................22FOLBEE .......................................................... 68FOLBIC ........................................................... 68FOLET ONE .............................................. 13, 68FOLGARD OS .................................................39FOLGARD RX .................................................68folic acid ...........................................................68FOLIVANE-F ............................................. 13, 68FOLIVANE-OB ..........................................13, 68FOLIVANE-PLUS ......................................13, 68FOLIXAPURE ................................................. 68FOLOTYN ......................................................... 6FOLPLEX 2.2 .................................................. 68FOLTRATE ..................................................... 68fondaparinux ....................................................13FORA 6 CONNECT GLUCOSE STRIP .......... 38FORA D15G STRIPS ...................................... 38FORA D20 .......................................................38FORA D40-G31 TEST STRIPS .......................38FORA G20 .......................................................38FORA G30-PREMIUM V10 TEST STRP ........ 38FORA GD50 TEST STRIPS ............................38FORA GTEL GLUCOSE TEST STRIP ........... 38FORA GTEL KETONE TEST STRIP .............. 32FORA GTEL MULTI-FUNCTN MONITOR ......32FORA HIGH CONTROL ..................................32FORA LOW CONTROL .................................. 32FORA NORMAL CONTROL ...........................32FORA TEST STRIP .........................................38FORA TN'G VOICE TEST STRIPS .................38FORA V10 ....................................................... 38FORA V10-V12-D10-D20 STRIPS ..................38FORA V10-V12-D10-D20 STRP-LNCT .......... 32FORA V12 GLUCOSE .................................... 38FORA V20 ....................................................... 38FORA V30A .................................................... 38FORACARE GD20 ..........................................38FORACARE GD40 ..........................................38FORACARE GDH HIGH CONTROL .............. 32FORACARE GDH LOW CONTROL ............... 32FORACARE GDH NORMAL CONTROL ........32FORACARE LANCETS .................................. 32FORFIVO XL ................................................... 22FORMADON ................................................... 62FORMA-RAY ...................................................57FORTAMET .....................................................49FORTEO ....................................................49, 54FORTESTA ..................................................... 49FORTISCARE GLUCOSE TEST STRIPS ...... 38FOSAMAX .......................................................54FOSAMAX PLUS D .................................. 54, 68fosamprenavir ....................................................3fosinopril .......................................................... 17fosinopril-hydrochlorothiazide ....................17, 39FOSRENOL ...............................................39, 54FRAGMIN ........................................................13FREESTYLE CONTROL .................................32FREESTYLE INSULINX ..................................38FREESTYLE INSULINX TEST STRIPS ......... 38FREESTYLE LANCETS ................................. 32FREESTYLE LIBRE 10 DAY READER ..........32FREESTYLE LIBRE 10 DAY SENSOR ..........32FREESTYLE LIBRE 14 DAY READER ..........32FREESTYLE LIBRE 14 DAY SENSOR ..........32FREESTYLE LITE STRIPS .............................38FREESTYLE PRECISION ...............................32FREESTYLE PRECISION NEO STRIPS ........38FREESTYLE TEST ......................................... 38FREESTYLE UNISTIK 2 ................................. 32FROTEK ..........................................................62FROVA ............................................................ 22frovatriptan .......................................................22FULPHILA .......................................................13fulvestrant .......................................................... 6FURADANTIN ................................................... 3
77
furosemide .................................................17, 39FUZEON ............................................................3FYAVOLV ........................................................49FYCOMPA .......................................................22gabapentin .......................................................22GABITRIL ........................................................22GALAFOLD .....................................................54galantamine ..................................................... 10GAMASTAN ......................................................8GAMASTAN S/D ...............................................8GAMIFANT ......................................................54GAMMAGARD LIQUID .....................................8GAMMAGARD S-D (IGA < 1 MCG/ML)................................. 8GAMMAKED ..................................................... 8GAMMAPLEX ................................................... 8GAMMAPLEX (WITH SORBITOL) ................... 8GAMUNEX-C .................................................... 8ganciclovir ..........................................................3ganciclovir sodium ............................................. 3GARDASIL 9 (PF) .............................................8GASTROCROM .............................................. 58gatifloxacin .......................................................42gatifloxacin-dexamethasone ............................42GATTEX 30-VIAL ............................................45GATTEX ONE-VIAL ........................................45GAVILYTE-C ...................................................45GAVILYTE-G ...................................................45GAVILYTE-N ...................................................45GAZYVA ............................................................6GE100 BLOOD GLUCOSE TEST STRIP .......38GE100 CONTROL SOLUTION NORMAL ...... 32GELCLAIR ...................................................... 32GELFILM .........................................................42GELNIQUE ......................................................67GEL-ONE ........................................................ 32GELSYN-3 .......................................................32GELX ...............................................................32gemfibrozil ....................................................... 17GENADUR ...................................................... 32GENADUR (WITH LEXINAL) ................... 32, 68GENERESS FE ............................................... 49GENERLAC .................................................... 39GENGRAF .......................................................54GENOTROPIN ................................................ 49GENOTROPIN MINIQUICK ............................ 49GENSTRIP TEST STRIP ................................ 38GENTAK ......................................................... 42gentamicin ................................................. 42, 62GENULTIMATE TEST STRIP .........................38GENVISC 850 ................................................. 32GENVOYA .........................................................3GEODON .........................................................22GIALAX ........................................................... 45GIANVI (28) .....................................................49GILENYA .........................................................55GILOTRIF ..........................................................6GLASSIA .........................................................58glatiramer .........................................................55GLATOPA ....................................................... 55GLEEVEC ......................................................... 6GLEOSTINE ......................................................6glimepiride ....................................................... 49glipizide ............................................................49glipizide-metformin .......................................... 49GLUCAGEN DIAGNOSTIC KIT ................38, 49GLUCAGEN HYPOKIT ............................. 49, 55GLUCAGON EMERGENCY KIT (HUMAN)................................................................... 49, 55GLUCO NAVII TEST STRIP ........................... 38GLUCOCARD 01 NORMAL CONTROL .........32GLUCOCARD 01 SENSOR PLUS ................. 38GLUCOCARD EXPRESSION .........................38GLUCOCARD SHINE ..................................... 32GLUCOCARD SHINE TEST STRIPS ............. 38GLUCOCARD VITAL SENSOR ......................38GLUCOCARD VITAL TEST STRIPS ..............38GLUCOCOM GLUCOSE ................................ 38GLUCOCOM LANCETS ................................. 32GLUCOPHAGE ...............................................49
GLUCOPHAGE XR .........................................49GLUCOSE CONTROL .................................... 32GLUCOTROL ..................................................49GLUCOTROL XL ............................................ 49GLUMETZA .....................................................49glyburide .......................................................... 49glyburide micronized ........................................49glyburide-metformin .........................................49GLYCATE ....................................................... 10GLYCINE UROLOGIC .................................... 40glycine urologic solution .................................. 40glycopyrrolate .................................................. 10GLYDO ............................................................42GLYNASE ....................................................... 49GLYSET .......................................................... 49GLYXAMBI ......................................................49GM100 .............................................................38GOCOVRI ....................................................3, 22GOLYTELY ..................................................... 45GONIOVISC .................................................... 42GONITRO ........................................................17GOODLIFE AC-302 TEST STRIP ...................38GRALISE .........................................................22GRALISE 30-DAY STARTER PACK ..............22granisetron hcl ................................................. 45GRANIX ...........................................................13GRASTEK ................................................... 8, 55griseofulvin microsize ........................................ 3griseofulvin ultramicrosize ................................. 3GUAIATUSSIN AC ....................................22, 58GUAIFENESIN AC ....................................22, 58GUAIFENESIN DAC ........................... 10, 22, 58guanfacine ................................................. 17, 22guanidine ......................................................... 10GYNAZOLE-1 ................................................. 62GYNOL II .........................................................28HAEGARDA ....................................................55HAILEY 24 FE .................................................49HALAVEN ......................................................... 6HALCION ........................................................ 22HALDOL ..........................................................22halobetasol propionate .................................... 62HALOG ............................................................62haloperidol ....................................................... 22haloperidol lactate ..................................... 22, 23HARMONY GLUCOSE TEST STRIP ............. 38HARVONI .......................................................... 3HAVRIX (PF) ..................................................... 8HEALTHPRO TEST STRIPS .......................... 38HEALTHWISE INSULIN SYRINGE ................ 32HEALTHWISE PEN NEEDLE .........................32HEALTHY ACCENTS UNIFINE PENTIP ........32HEALTHY ACCENTS UNILET LANCET ........32HEATHER ....................................................... 49HELIXATE FS ................................................. 13HEMANGEOL ..................................... 10, 17, 23HEMATINIC PLUS VIT/MINERALS ..........13, 68HEMATINIC/FOLIC ACID ......................... 13, 68HEMATOGEN ................................................. 13HEMATOGEN FA ..................................... 13, 68HEMATOGEN FORTE .............................. 13, 68HEMENATAL OB ......................................13, 68HEMENATAL OB + DHA ..........................13, 68HEMETAB .................................................13, 68HEMLIBRA ......................................................13HEMMOREX-HC ............................................. 62HEMOFIL M HIGH .......................................... 13HEMOFIL M LOW ........................................... 13HEMOFIL M MID .............................................13HEMOFIL M SUPER HIGH ............................. 13heparin (porcine) ............................................. 13HEPARIN LOCK ....................................... 13, 32heparin lock flush (porcine) ....................... 13, 33heparin, porcine (pf) ........................................ 13HEPLISAV-B (PF) .............................................8HEPSERA ......................................................... 3HERCEPTIN ......................................................6HERCEPTIN HYLECTA ....................................6HETLIOZ ......................................................... 23
HIBERIX (PF) .................................................... 8HIDEX ..............................................................49HIPREX ............................................................. 3HISTEX-AC ..................................... 1, 10, 23, 58HIZENTRA ........................................................ 8HOMATROPAIRE ........................................... 42homatropine hbr .............................................. 42HORIZANT ...................................................... 23HPR ................................................................. 33HPR PLUS ...................................................... 33HPR PLUS HYDROGEL ................................. 33HPR PLUS-MB HYDROGEL .................... 33, 62huber safety needles (disp.) ............................ 33HUMALOG JUNIOR KWIKPEN U-100 ...........49HUMALOG KWIKPEN INSULIN .....................49HUMALOG MIX 50-50 INSULN U-100 ........... 49HUMALOG MIX 50-50 KWIKPEN .................. 49HUMALOG MIX 75-25 KWIKPEN .................. 49HUMALOG MIX 75-25(U-100)INSULN ...........49HUMALOG U-100 INSULIN ............................49HUMATE-P ......................................................13HUMATROPE ................................................. 49HUMIRA .............................................. 45, 55, 62HUMIRA PEDIATRIC CROHNS START............................................................. 45, 55, 62HUMIRA PEN ......................................45, 55, 62HUMIRA PEN CROHNS-UC-HS START............................................................. 45, 55, 62HUMIRA PEN PSOR-UVEITS-ADOL HS............................................................. 45, 55, 62HUMIRA(CF) ....................................... 45, 55, 62HUMIRA(CF) PEDI CROHNS STARTER............................................................. 45, 55, 62HUMIRA(CF) PEN ...............................45, 55, 63HUMIRA(CF) PEN CROHNS-UC-HS . 45, 55, 63HUMIRA(CF) PEN PSOR-UV-ADOL HS............................................................. 45, 55, 63HUMULIN 70/30 U-100 INSULIN ....................49HUMULIN 70/30 U-100 KWIKPEN ................. 49HUMULIN N NPH INSULIN KWIKPEN .......... 49HUMULIN N NPH U-100 INSULIN ..................49HUMULIN R REGULAR U-100 INSULN ........ 49HUMULIN R U-500 (CONC) INSULIN ............ 49HUMULIN R U-500 (CONC) KWIKPEN ..........49HYALGAN .......................................................33HYCAMTIN ........................................................6HYCET ............................................................ 23hydralazine ...................................................... 17HYDREA ........................................................... 6HYDRO 35 .......................................................63HYDRO 40 .......................................................63hydrochlorothiazide ................................... 17, 40HYDROCODONE COMPOUND ......... 10, 23, 58hydrocodone-acetaminophen .......................... 23hydrocodone-chlorpheniramine ............. 1, 23, 58hydrocodone-homatropine ...................10, 23, 58hydrocodone-ibuprofen ....................................23hydrocortisone ........................................... 49, 63hydrocortisone acetate .................................... 63hydrocortisone butyrate ................................... 63hydrocortisone butyr-emollient ........................ 63hydrocortisone valerate ................................... 63hydrocortisone-acetic acid ...............................42hydrocortisone-iodoquinl-aloe2 ....................... 63hydrocortisone-iodoquinol ............................... 63hydrocortisone-iodoquinol-aloe ....................... 63hydrocortisone-pramoxine ............................... 63HYDROMET ........................................ 10, 23, 58hydromorphone ............................................... 23hydromorphone (pf) ......................................... 23hydroxocobalamin ........................................... 68hydroxychloroquine ..................................... 3, 55hydroxyprogest(pf)(preg presv) ....................... 49hydroxyprogesterone cap(ppres) .....................49hydroxyprogesterone caproate ........................49hydroxyurea .......................................................6hydroxyzine hcl ............................................1, 23hydroxyzine pamoate .................................. 1, 23HYLATOPIC ....................................................33
78
HYLATOPICPLUS .......................................... 33HYMOVIS ........................................................ 33HYOPHEN .........................................................3hyoscyamine sulfate ........................................ 10HYOSYNE ....................................................... 10HYPERRHO S/D ............................................... 8HYPER-SAL ..............................................33, 40HYQVIA .............................................................8HYQVIA HY COMPONENT ............................ 41HYSINGLA ER ................................................ 23HYZAAR ....................................................17, 40ibandronate ......................................................55IBRANCE .......................................................... 6IBU .................................................................. 23IBUDONE ........................................................ 23ibuprofen ..........................................................23ibuprofen-oxycodone ....................................... 23ICLUSIG ............................................................ 6IDELVION ........................................................13IDHIFA ...............................................................6IFEREX 150 FORTE ................................. 13, 68IGLUCOSE TEST STRIP ................................ 38ILARIS (PF) .....................................................55ILEVRO ........................................................... 42ILUMYA ...........................................................63ILUVIEN .......................................................... 42imatinib .............................................................. 6IMBRUVICA ...................................................... 6IMFINZI ..............................................................6imipramine hcl ................................................. 23imipramine pamoate ........................................ 23imiquimod ........................................................ 63IMITREX .......................................................... 23IMITREX STATDOSE PEN ............................. 23IMITREX STATDOSE REFILL ........................23IMLYGIC ............................................................6IMOVAX RABIES VACCINE (PF) .....................8IMPAVIDO .........................................................3IMPOYZ ...........................................................63IMURAN .......................................................... 55IMVEXXY MAINTENANCE PACK ..................49IMVEXXY STARTER PACK ........................... 49INBRIJA .......................................................... 23INCASSIA ....................................................... 49INCONTROL PEN NEEDLE ........................... 33INCONTROL SUPER THIN LANCETS .......... 33INCONTROL ULTRA THIN LANCETS ...........33INCRELEX ...................................................... 49INCRUSE ELLIPTA .................................. 10, 58indapamide ................................................ 17, 40INDERAL LA .......................................10, 17, 23INDERAL XL ....................................... 10, 17, 23INDOCIN ................................................... 23, 55indomethacin ............................................. 23, 55INFANRIX (DTAP) (PF) .................................... 8INFINITY CONTROL SOLUTION HIGH ......... 33INFINITY CONTROL SOLUTION LOW ..........33INFINITY CONTROL SOLUTION NORM ....... 33INFINITY TEST STRIPS ................................. 38INFINITY VOICE TEST STRIP ........................38INFLAMMACIN ......................................... 23, 63INFLAMMA-K ............................................23, 63INFLECTRA ........................................ 45, 55, 63INFUGEM .......................................................... 6INGREZZA ...................................................... 23INGREZZA INITIATION PACK ....................... 23INJECT EASE LANCETS ............................... 33INLYTA ..............................................................6INNOPRAN XL ....................................10, 17, 23INOVA ............................................................. 63INOVA 4-1 ....................................................... 63INOVA 8-2 ....................................................... 63INSPRA ........................................................... 17insulin lispro .....................................................49insulin syr/ndl u100 half mark .......................... 33INSULIN SYRINGE ......................................... 33INSULIN SYRINGE MICROFINE ....................33insulin syringe needleless ................................33insulin syringe-needle u-100 ............................33
INSUPEN .........................................................33INTELENCE ...................................................... 3INTERMEZZO ................................................. 23INTRAROSA ................................................... 49INTRON A ............................................... 3, 6, 55INTROVALE ....................................................49INTUNIV ER .............................................. 17, 23INVACARE LANCETS ....................................33INVEGA ...........................................................23INVEGA SUSTENNA ...................................... 23INVEGA TRINZA .............................................23INVELTYS ....................................................... 42INVIRASE ..........................................................3INVOKAMET ................................................... 49INVOKAMET XR ............................................. 49INVOKANA ..................................................... 49IOPIDINE .........................................................43IPOL .................................................................. 8ipratropium bromide .............................10, 43, 58ipratropium-albuterol ..................................10, 58irbesartan .........................................................17irbesartan-hydrochlorothiazide .................. 17, 40IRESSA ............................................................. 6IRONUP ...........................................................13ISENTRESS ...................................................... 3ISENTRESS HD ................................................ 3ISIBLOOM .......................................................49ISOCHRON ..................................................... 17isometh-dichloral-acetaminophn ......................23isoniazid .............................................................3ISOPTO CARPINE ..........................................43ISORDIL .......................................................... 17ISORDIL TITRADOSE .................................... 17isosorbide dinitrate .......................................... 17isosorbide mononitrate .................................... 17isosulfan blue ...................................................38isotretinoin ....................................................... 63isoxsuprine ...................................................... 17isradipine ......................................................... 17ISTALOL ......................................................... 43ISTODAX ...........................................................6itraconazole ....................................................... 3ivermectin .......................................................... 3IXEMPRA .......................................................... 6IXIARO (PF) ...................................................... 8IXINITY ............................................................ 13JADENU ..........................................................46JADENU SPRINKLE .......................................46JAKAFI ..............................................................6JALYN .......................................................10, 55JANTOVEN ..................................................... 13JANUMET ....................................................... 49JANUMET XR ................................................. 49JANUVIA .........................................................49JARDIANCE ....................................................49JASMIEL (28) ..................................................49JENCYCLA ..................................................... 49JENTADUETO ................................................ 49JENTADUETO XR .......................................... 49JETREA (PF) .................................................. 43JEVTANA ..........................................................6JINTELI ........................................................... 49JIVI .................................................................. 13JOLESSA ........................................................49JORNAY PM ................................................... 23JUBLIA ............................................................63JULEBER ........................................................49JULUCA ............................................................ 3JUNEL 1.5/30 (21) .......................................... 49JUNEL 1/20 (21) ............................................. 49JUNEL FE 1.5/30 (28) .....................................49JUNEL FE 1/20 (28) ........................................49JUNEL FE 24 .................................................. 49JUXTAPID .......................................................17JYNARQUE .....................................................40KADCYLA ......................................................... 6KADIAN ...........................................................23KAITLIB FE .....................................................49KALBITOR ...................................................... 55
KALETRA ......................................................... 3KALLIGA .........................................................49KALYDECO .................................................... 58KAMDOY .........................................................33KANUMA .........................................................41KAPSPARGO SPRINKLE ........................ 10, 17KAPVAY ....................................................10, 17KARBINAL ER ............................................1, 58KARIVA (28) ................................................... 49KAZANO ......................................................... 49KEFLEX ............................................................ 3KELNOR 1/35 (28) .......................................... 49KELNOR 1-50 ................................................. 49KENALOG .......................................................63KEPPRA ..........................................................23KEPPRA XR ....................................................23KERAFOAM ....................................................63KERALAC ....................................................... 63KERALYT RX ..................................................63KERALYT SCALP COMPLETE ..................... 63KERYDIN ........................................................ 63ketoconazole ............................................... 3, 63ketoprofen ........................................................23ketorolac .................................................... 23, 43KEVEYIS ......................................................... 55KEVZARA ....................................................... 55KEYTRUDA .......................................................6KHEDEZLA ..................................................... 23KINERET .........................................................55KINRIX (PF) ...................................................... 8KISQALI ............................................................ 6KISQALI FEMARA CO-PACK ....................7, 49KITABIS PAK ....................................................3KLARITY (CHONDROITIN) ............................ 43KLARON ......................................................... 63KLONOPIN ......................................................23KLOR-CON ..................................................... 40KLOR-CON 10 ................................................ 40KLOR-CON 8 .................................................. 40KLOR-CON M10 ............................................. 40KLOR-CON M15 ............................................. 40KLOR-CON M20 ............................................. 40KLOR-CON SPRINKLE .................................. 40KLOR-CON/EF ................................................40KOATE ............................................................ 13KOGENATE FS ...............................................13KOMBIGLYZE XR ...........................................49KORLYM ......................................................... 49KOSHER PRENATAL PLUS IRON .......... 13, 68KOVALTRY .....................................................13K-PHOS NO 2 ................................................. 40K-PHOS ORIGINAL ........................................ 40K-PHOS-NEUTRAL ........................................ 40KRINTAFEL ...................................................... 3KRISTALOSE ................................................. 40KRYSTEXXA ...................................................55K-TAB ............................................................. 40KURVELO (28) ................................................49KUVAN ............................................................55KYLEENA ....................................................... 49KYMRIAH ....................................................7, 19KYPROLIS ........................................................ 7l norgest/e.estradiol-e.estrad ........................... 49L.E.T. (LIDO-EPINEPH-TETRA) .....................63labetalol ..................................................... 10, 17LACRISERT .................................................... 43lactulose .......................................................... 40LAMICTAL ...................................................... 23LAMICTAL ODT ..............................................23LAMICTAL ODT STARTER (BLUE) .............. 23LAMICTAL ODT STARTER (GREEN) ........... 23LAMICTAL ODT STARTER (ORANGE) ........ 23LAMICTAL STARTER (BLUE) KIT ................ 23LAMICTAL STARTER (GREEN) KIT ............. 23LAMICTAL STARTER (ORANGE) KIT .......... 23LAMICTAL XR ................................................ 23LAMICTAL XR STARTER (BLUE) ................. 23LAMICTAL XR STARTER (GREEN) .............. 23LAMICTAL XR STARTER (ORANGE) ........... 24
79
lamivudine ......................................................... 3lamivudine-zidovudine ....................................... 3lamotrigine ....................................................... 24lancets ............................................................. 33LANCETS, SUPER THIN ................................33LANCETS,THIN .............................................. 33LANCETS,ULTRA THIN ................................. 33LANOXIN ........................................................ 17LANOXIN PEDIATRIC .................................... 17lansoprazole .................................................... 45lanthanum ..................................................40, 55LANTUS SOLOSTAR U-100 INSULIN ...........50LANTUS U-100 INSULIN ................................50LARIN 1.5/30 (21) ........................................... 50LARIN 1/20 (21) .............................................. 50LARIN 24 FE ................................................... 50LARIN FE 1.5/30 (28) ......................................50LARIN FE 1/20 (28) .........................................50LARISSIA ........................................................50LARTRUVO .......................................................7LASIX ........................................................ 17, 40LASTACAFT ................................................... 43latanoprost .......................................................43latanoprost (pf) ................................................ 43LATUDA ..........................................................24LAYOLIS FE ................................................... 50LAZANDA ....................................................... 24LDO PLUS ................................................ 33, 63ledipasvir-sofosbuvir ..........................................3LEENA 28 ....................................................... 50leflunomide ...................................................... 55LEMTRADA .................................................... 55LENVIMA .......................................................... 7LESCOL .......................................................... 17LESCOL XL .................................................... 17LESSINA ......................................................... 50LETAIRIS .................................................. 17, 58letrozole ....................................................... 7, 50leucovorin calcium ........................................... 55LEUKERAN .......................................................7LEUKINE .........................................................13leuprolide ..................................................... 7, 50LEVA SET ....................................................... 63levalbuterol hcl ...........................................10, 58levalbuterol tartrate ....................................10, 58LEVAQUIN ........................................................ 3LEVATOL ........................................................17LEVBID ........................................................... 10LEVEMIR FLEXTOUCH U-100 INSULN ........ 50LEVEMIR U-100 INSULIN .............................. 50levetiracetam ................................................... 24LEVITRA ......................................................... 17levobunolol ...................................................... 43levocarnitine .................................................... 55levocarnitine (with sugar) .................................55levocetirizine ................................................1, 59levofloxacin ..................................................3, 43LEVONEST (28) ..............................................50levonorgestrel .................................................. 50levonorgestrel-ethinyl estrad ........................... 50levonorg-eth estrad triphasic ........................... 50LEVORA-28 .................................................... 50levorphanol tartrate ..........................................24LEVO-T ........................................................... 50levothyroxine ................................................... 50LEVOXYL ........................................................50LEVSIN ............................................................10LEVSIN/SL ...................................................... 10LEVULAN ........................................................63LEXAPRO ....................................................... 24LEXETTE ........................................................ 63LEXIVA ..............................................................3LEXIXRYL ................................................. 24, 63LIALDA ........................................................... 45LIBRAX (WITH CLIDINIUM) ..................... 10, 24LIBTAYO ...........................................................7lidocaine .......................................................... 63lidocaine hcl .........................................43, 53, 63lidocaine hcl-hydrocortison ac ......................... 63
LIDOCAINE VISCOUS ....................................43lidocaine-hydrocortisone-aloe ..........................63lidocaine-prilocaine ..........................................63lidocaine-racepinep-tetracaine ........................ 63lidocaine-tetracaine ......................................... 63LIDODERM ..................................................... 63LIDO-K ............................................................ 63LIDOPAC ........................................................ 63LIDOPATCH ....................................................63LIDOPIN .......................................................... 63LIDOPRIL ........................................................63LIDOPRIL XR ..................................................63LIDO-PRILO CAINE PACK ............................ 63LIDOPRO PATCH ...........................................63LIDOPURE PATCH .........................................63LIDORX ........................................................... 63LIDOTRAL ...................................................... 63LIDOTRANS 5 PAK ........................................ 63LIDOTREX ...................................................... 33LIDOTREX (WITH VITAMIN E) .......................33LIDOVEX .........................................................63LIDOXIB .................................................... 24, 63LIDOZION ....................................................... 63LIDTOPIC MAX ...............................................63LILETTA ..........................................................50LILLOW (28) ................................................... 50LIMENCIN (LIDOCAINE-MENTHOL) ............. 63LINCOCIN ......................................................... 3lindane ............................................................. 63linezolid ..............................................................3LINZESS ......................................................... 45liothyronine ...................................................... 50LIPITOR .......................................................... 17LIPOCHOL PLUS ........................................... 55LIPOFEN ......................................................... 17LIPROZONEPAK ............................................ 63lisinopril ............................................................17lisinopril-hydrochlorothiazide ..................... 17, 40LITE COAT ASPIRIN ................................ 13, 24LITE TOUCH INSULIN PEN NEEDLES ......... 33LITE TOUCH INSULIN SYRINGE .................. 33LITE TOUCH LANCETS ................................. 33LITEAIRE MDI CHAMBER ............................. 33LITETOUCH-LARGE MASK ...........................33LITETOUCH-SMALL MASK ...........................33lithium carbonate ............................................. 24lithium citrate ................................................... 24LITHOBID ........................................................24LITHOSTAT .................................................... 40LIVALO ........................................................... 17LIVIXIL PAK ....................................................63LO LOESTRIN FE ...........................................50LOCOID ...........................................................63LOCOID LIPOCREAM .................................... 63LODINE ........................................................... 24LODOSYN .......................................................24LOESTRIN 1.5/30 (21) .................................... 50LOESTRIN 1/20 (21) ....................................... 50LOESTRIN FE 1.5/30 (28-DAY) ......................50LOESTRIN FE 1/20 (28-DAY) .........................50LOKELMA .......................................................40LOMOTIL ............................................ 10, 45, 59LONHALA MAGNAIR REFILL ....................... 11LONHALA MAGNAIR STARTER ...................11LONSURF ......................................................... 7loperamide .......................................................45LOPID ..............................................................17lopinavir-ritonavir ............................................... 3LOPREEZA ..................................................... 50LOPRESSOR ............................................ 11, 17LOPRESSOR HCT ..............................11, 17, 40LOPROX ......................................................... 63LOPROX (AS OLAMINE) ............................... 63LOPROX KIT ...................................................63lorazepam ........................................................24LORAZEPAM INTENSOL ...............................24LORBRENA ...................................................... 7LORCET (HYDROCODONE) ..........................24LORCET HD ....................................................24
LORCET PLUS ............................................... 24LORTAB ELIXIR ............................................. 24LORTUSS EX ......................................11, 24, 59LORYNA (28) .................................................. 50LORZONE ....................................................... 11losartan ............................................................17losartan-hydrochlorothiazide ..................... 17, 40LOSEASONIQUE ............................................50LOTEMAX ....................................................... 43LOTEMAX SM .................................................43LOTENSIN ...................................................... 17LOTENSIN HCT ........................................ 17, 40loteprednol etabonate ......................................43LOTREL .......................................................... 17LOTRISONE ....................................................63LOTRONEX .....................................................45LOUTREX ....................................................... 33lovastatin ......................................................... 17LOVAZA ..........................................................17LOVENOX ....................................................... 13LOW-OGESTREL (28) ....................................50loxapine succinate ........................................... 24LO-ZUMANDIMINE (28) ................................. 50LUCEMYRA .................................................... 11LUCENTIS .......................................................43LUDENT FLUORIDE .......................................55LUER LOCK SYRINGE .................................. 33LUGOLS ....................................3, 50, 55, 59, 64luliconazole ......................................................64LUMIGAN ........................................................43LUMIZYME ......................................................41LUMOXITI ......................................................... 7LUMOXITI IV SOLN STABILIZER ..................57LUNESTA ........................................................24LUPANETA PACK (1 MONTH) .................. 7, 50LUPANETA PACK (3 MONTH) .................. 7, 50LUPRON DEPOT ........................................ 7, 50LUPRON DEPOT (3 MONTH) .................... 7, 50LUPRON DEPOT (4 MONTH) .................... 7, 50LUPRON DEPOT (6 MONTH) .................... 7, 50LUPRON DEPOT-PED ............................... 7, 50LUPRON DEPOT-PED (3 MONTH) ............7, 50LUTATHERA ...............................................7, 57LUTERA (28) ...................................................50LUXAMEND .................................................... 64LUXIQ ..............................................................64LUXTURNA .....................................................19LUZU ............................................................... 64LYCELLE ........................................................ 33LYNPARZA ....................................................... 7LYRICA ........................................................... 24LYRICA CR ..................................................... 24LYSODREN .......................................................7LYSTEDA ........................................................13LYZA ............................................................... 50MACRILEN ......................................................38MACROBID .......................................................3MACRODANTIN ............................................... 3MACUGEN ...................................................... 43mafenide acetate ............................................. 64MAKENA .........................................................50MAKENA (PF) .................................................50MALARONE ......................................................3MALARONE PEDIATRIC ................................. 3malathion ......................................................... 64maprotiline ....................................................... 24MARINOL ........................................................45MARLISSA (28) .............................................. 50MARNATAL-F .....................................13, 40, 68MARPLAN .......................................................24MAS CARE-PAK (PF) .....................................50MATULANE ...................................................... 7MATZIM LA .....................................................17MAVENCLAD (10 TABLET PACK) ................55MAVENCLAD (4 TABLET PACK) ..................55MAVENCLAD (5 TABLET PACK) ..................55MAVENCLAD (6 TABLET PACK) ..................55MAVENCLAD (7 TABLET PACK) ..................55MAVENCLAD (8 TABLET PACK) ..................55
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MAVENCLAD (9 TABLET PACK) ..................55MAVYRET ......................................................... 3MAXALT ..........................................................24MAXALT-MLT ................................................. 24MAXI-COMFORT INSULIN SYRINGE ............33MAXIDEX ........................................................ 43MAXITROL ......................................................43MAXZIDE .................................................. 17, 40MAXZIDE-25MG ....................................... 17, 40MAYZENT ....................................................... 55MAYZENT STARTER PACK .......................... 55MB HYDROGEL ........................................33, 64MB HYDROGEL (CYCLOMETHICONE) ........ 33MD-GASTROVIEW ......................................... 38meclizine ......................................................1, 45meclofenamate ................................................ 24MEDISENSE MID CONTROL ......................... 33MEDISENSE THIN LANCETS ........................ 33MEDLANCE PLUS LANCETS ........................33MEDOLOR PAK ..............................................64MEDPOINT NORMAL CONTROL .................. 33MEDROL ......................................................... 50MEDROL (PAK) .............................................. 50medroxyprogesterone ......................................50mefenamic acid ............................................... 24mefloquine ......................................................... 3megestrol .....................................................7, 50MEKINIST ......................................................... 7MEKTOVI .......................................................... 7MELODETTA 24 FE ........................................50meloxicam ....................................................... 24melphalan .......................................................... 7memantine .......................................................24MENACTRA (PF) .............................................. 8MENEST ..........................................................50MENOSTAR .................................................... 50MENTAX ......................................................... 64MENTHO-CAINE .............................................64MENVEO A-C-Y-W-135-DIP (PF) ..................... 8meperidine .......................................................24MEPHYTON .............................................. 55, 68meprobamate .................................................. 24MEPRON ...........................................................3MEPSEVII ........................................................41mercaptopurine ............................................7, 55mesalamine ..................................................... 45mesalamine with cleansing wipe ..................... 45MESNEX ......................................................... 55MESTINON ......................................................11MESTINON TIMESPAN .................................. 11METADATE ER ...............................................24metaproterenol .......................................... 11, 59METAXALL ..................................................... 11metaxalone ...................................................... 11metformin .........................................................50methadone .......................................................24METHADONE INTENSOL .............................. 24METHADOSE ..................................................24methamphetamine ...........................................24methazolamide ................................................ 43methenamine hippurate .....................................3methenamine mandelate ................................... 3METHERGINE .................................................57methimazole .................................................... 50METHITEST .................................................... 50methocarbamol ................................................11methotrexate sodium ................................... 7, 55methotrexate sodium (pf) .............................7, 55methoxsalen .................................................... 64methscopolamine ............................................ 11methyclothiazide ........................................17, 40methyldopa ................................................ 11, 17methyldopa-hydrochlorothiazide ..........11, 17, 40methylergonovine ............................................ 57METHYLIN ...................................................... 24methylphenidate hcl .........................................24methylprednisolone ......................................... 50methylprednisolone acetate .............................50methyltestosterone .......................................... 50
metipranolol ..................................................... 43metoclopramide hcl ......................................... 45metolazone ................................................ 17, 40metoprolol succinate ..................................11, 17metoprolol su-hydrochlorothiaz ........... 11, 17, 40metoprolol ta-hydrochlorothiaz ............ 11, 17, 40metoprolol tartrate ..................................... 11, 17METROCREAM .............................................. 64METROGEL .................................................... 64METROGEL VAGINAL ................................... 64METROLOTION .............................................. 64metronidazole .............................................. 3, 64mexiletine ........................................................ 17MIACALCIN .............................................. 50, 55MIBELAS 24 FE ..............................................50MICARDIS .......................................................17MICARDIS HCT ........................................ 17, 40miconazole nitrate-zinc ox-pet .........................64MICONAZOLE-3 ............................................. 64MICORT-HC .................................................... 64MICRHOGAM ULTRA-FILTERED PLUS ......... 8MICRO BLOOD GLUCOSE ............................38MICRO THIN LANCETS ................................. 33MICROCHAMBER .......................................... 33MICROCYN ..................................................... 33MICROCYN HYDROGEL ................................33MICRODOT BLOOD GLUCOSE SYSTEM .... 38MICRODOT HIGH-LOW CONTROL ...............33MICRODOT INSULIN PEN NEEDLE ..............33MICRODOT NORMAL CONTROL ................. 33MICRODOT XTRA BLOOD GLUCOSE ......... 38MICROGESTIN 1.5/30 (21) .............................50MICROGESTIN 1/20 (21) ................................50MICROGESTIN 24 FE .....................................50MICROGESTIN FE 1.5/30 (28) ....................... 50MICROGESTIN FE 1/20 (28) .......................... 50MICROLET LANCET ...................................... 33MICROSPACER ..............................................33MICROZIDE .............................................. 17, 40midazolam ....................................................... 24midodrine .........................................................11MIGERGOT ............................................... 11, 24miglitol ............................................................. 50miglustat .......................................................... 55MIGRANAL ............................................... 11, 24MIGRANOW ..............................................24, 64MILI ................................................................. 50MILLIPRED ..................................................... 50MILLIPRED DP ............................................... 50MIMVEY .......................................................... 50MIMVEY LO .................................................... 50MINASTRIN 24 FE .......................................... 50MINI ULTRA-THIN II ....................................... 33MINIPRESS ...............................................11, 17MINITRAN ....................................................... 17MINIVELLE ..................................................... 50MINOCIN ........................................................... 3minocycline ..................................................3, 64MINOLIRA ER .............................................3, 64minoxidil ...........................................................17MIRAPEX ........................................................ 24MIRAPEX ER .................................................. 24MIRCERA ........................................................13MIRCETTE (28) ...............................................50MIRENA .......................................................... 50mirtazapine ...................................................... 24MIRVASO ........................................................64misoprostol ...................................................... 45MITIGARE ....................................................... 55MITOSOL ........................................................ 43mitoxantrone ......................................................7M-M-R II (PF) .....................................................8M-NATAL PLUS ..................................13, 40, 68MOBIC .............................................................24modafinil .......................................................... 24MODERIBA ....................................................... 3moexipril .......................................................... 17molindone ........................................................ 24mometasone ........................................43, 59, 64
MONDOXYNE NL ............................................. 3MONODOX ........................................................3MONOJECT ALLERGY TRAY ....................... 33MONOJECT DISPOSABLE SYRINGE ...........34MONOJECT HYPODERMIC NEEDLES .........34MONOJECT INSULIN SAFETY SYRING .......34MONOJECT INSULIN SYRINGE ....................34MONOJECT LUER-LOCK TIP ....................... 34MONOJECT MAGELLAN SYRINGE ..............34MONOJECT PHARMACY TRAY LUER .........34MONOJECT REG TIP NON-STERILE ........... 34MONOJECT SAFETY LUER LOCK TIP ........ 34MONOJECT SAFETY SYRINGES ................. 34MONOJECT SYRINGE ................................... 34MONOJECT SYRINGE ECCENTRI LUER .....34MONOJECT SYRINGE LUER LOK ................34MONOJECT SYRINGE REGULAR LUER ..... 34MONOJECT SYRINGE TOOMEY TYPE ........ 34MONOJECT TUBERCULIN SYRINGE ...........34MONOJECT ULTRA COMFORT INSULIN .... 34MONOLET LANCETS .....................................34MONOLET THIN LANCETS ........................... 34MONO-LINYAH ...............................................50MONONINE .....................................................13MONOVISC ..................................................... 34montelukast ..................................................... 59MONUROL ........................................................ 3MORGIDOX .......................................................3MORGIDOX 1X 50 ...................................... 3, 64MORGIDOX 1X100 ..................................... 3, 64MORGIDOX 2X100 ..................................... 3, 64MORPHABOND ER ........................................ 24morphine ..........................................................24morphine concentrate ......................................24MOTEGRITY ................................................... 45MOTOFEN .......................................................45MOVANTIK ..................................................... 45MOVIPREP ......................................................45MOXATAG ........................................................ 4MOXEZA ......................................................... 43moxifloxacin .................................................4, 43MOZOBIL ........................................................ 13MS CONTIN .................................................... 24MUGARD ........................................................ 34MULPLETA ..................................................... 13MULTAQ ......................................................... 18MULTIGEN FOLIC .................................... 13, 68MULTIGEN PLUS ..................................... 13, 68MULTI-VIT WITH FLUORIDE-IRON ... 13, 55, 68MULTIVITAMIN WITH FLUORIDE ........... 55, 68MULTI-VITAMIN WITH FLUORIDE .......... 55, 68MULTIVITAMINS WITH FLUORIDE .........55, 68mupirocin ......................................................... 64mupirocin calcium ............................................64MVC-FLUORIDE ....................................... 55, 68MY CHOICE .................................................... 50MY WAY ..........................................................50MYALEPT ....................................................... 50MYAMBUTOL ................................................... 4MYCOBUTIN .....................................................4mycophenolate mofetil .....................................55mycophenolate sodium ....................................55MYDAYIS ........................................................ 25MYDRIACYL ................................................... 43MYFERON 150 FORTE ............................ 13, 68MYFORTIC ......................................................55MYGLUCOHEALTH ........................................38MYGLUCOHEALTH CONTROL SOLUTION . 34MYGLUCOHEALTH LANCETS ......................34MYLERAN .........................................................7MYLOTARG ...................................................... 7MYNATAL ........................................... 14, 40, 68MYNATAL ADVANCE ........................ 13, 40, 68MYNATAL PLUS ................................ 14, 40, 68MYNATAL-Z ........................................14, 40, 68MYNATE 90 PLUS ..........................................68MYNEPHRON ................................................. 68MYOBLOC ................................................ 11, 56MYORISAN ..................................................... 64
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MYRBETRIQ ................................................... 67MYSOLINE ......................................................25MYTESI ........................................................... 45nabumetone .....................................................25nadolol ....................................................... 11, 18nadolol-bendroflumethiazide ............... 11, 18, 40naftifine ............................................................ 64NAFTIN ........................................................... 64NAGLAZYME ..................................................41NALFON ..........................................................25NALOCET ....................................................... 25naloxone .................................................... 25, 56naltrexone ..................................................25, 56NAMENDA ...................................................... 25NAMENDA TITRATION PAK ......................... 25NAMENDA XR ................................................ 25NAMZARIC ............................................... 11, 25NAPRELAN CR ........................................ 25, 56NAPROSYN .............................................. 25, 56naproxen ....................................................25, 56naproxen sodium ....................................... 25, 56naratriptan ....................................................... 25NARCAN ................................................... 25, 56NARDIL ........................................................... 25NASCOBAL .................................................... 68NASONEX .................................................43, 59NATACHEW (FE BIS-GLYCINATE) .........14, 68NATACYN ....................................................... 43NATAZIA .........................................................50nateglinide ....................................................... 50NATESTO ....................................................... 50NATPARA ................................................. 51, 56NATROBA .......................................................64NATURE-THROID ...........................................51NEBUPENT .......................................................4NEBUSAL ................................................. 34, 40NECON 0.5/35 (28) ......................................... 51needle (disp) 16 g ............................................34needle (disp) 18 g ............................................34needle (disp) 19 g ............................................34needle (disp) 23 gauge ....................................34NEEVODHA (WITH ALGAL OIL) ............. 14, 68nefazodone ......................................................25neomycin ........................................................... 4neomycin-bacitracin-poly-hc ............................43neomycin-bacitracin-polymyxin ....................... 43neomycin-polymyxin b-dexameth .................... 43neomycin-polymyxin-gramicidin ...................... 43neomycin-polymyxin-hc ................................... 43NEO-POLYCIN ................................................43NEO-POLYCIN HC ......................................... 43NEORAL ......................................................... 56NEOSALUS .....................................................34NEO-SYNALAR .............................................. 64NEO-SYNALAR KIT ....................................... 64NEPHPLEX RX ............................................... 68NEPHRO-VITE RX .......................................... 68NERLYNX ......................................................... 7NESINA ........................................................... 51NESTABS ........................................... 14, 40, 68NESTABS ABC .........................................14, 68NESTABS DHA ...................................14, 40, 68NESTABS ONE .........................................14, 68NEUAC ............................................................64NEUAC KIT ..................................................... 64NEULASTA ..................................................... 14NEUPOGEN .................................................... 14NEUPRO ......................................................... 25NEURAPTINE ................................................. 64NEURCAINE ................................................... 64NEURIN-SL ..................................................... 69NEURONTIN ................................................... 25NEUTEK 2TEK TEST STRIPS ....................... 38NEUTRASAL .................................................. 34NEVANAC .......................................................43nevirapine .......................................................... 4NEW DAY ........................................................51NEWGEN ............................................ 14, 40, 69NEXA PLUS .............................................. 14, 69
NEXAVAR ......................................................... 7NEXIUM ...........................................................45NEXIUM PACKET ...........................................45NEXPLANON .................................................. 51NEXT CHOICE ONE DOSE ............................ 51niacin ............................................................... 18NIACOR .......................................................... 18NIASPAN EXTENDED-RELEASE ..................18nicardipine ....................................................... 18NICAZEL ................................................... 56, 69NICORELIEF ...................................................11NICORETTE ....................................................11nicotine ............................................................ 11nicotine (polacrilex) ..........................................11NICOTROL ......................................................11NICOTROL NS ................................................11nifedipine ......................................................... 18NIKKI (28) ....................................................... 51NILANDRON ..................................................... 7nilutamide .......................................................... 7nimodipine ....................................................... 18NINLARO .......................................................... 7nisoldipine ........................................................18NITRO-BID ...................................................... 18NITRO-DUR .................................................... 18nitrofurantoin ......................................................4nitrofurantoin macrocrystal ................................ 4nitrofurantoin monohyd/m-cryst ......................... 4nitroglycerin ..................................................... 18NITROLINGUAL ............................................. 18NITROMIST .....................................................18NITROSTAT .................................................... 18NITRO-TIME ....................................................18NITYR ..............................................................56NIVA-FOL ........................................................69NIVATOPIC PLUS .......................................... 34NIVESTYM ...................................................... 14nizatidine ......................................................... 45NIZORAL .........................................................64NOCDURNA (MEN) .................................. 14, 51NOCDURNA (WOMEN) ............................ 14, 51NOCTIVA .................................................. 14, 51NOKOR NEEDLE ............................................34NOLIX ..............................................................64NORA-BE ........................................................51NORCO ........................................................... 25NORDITROPIN FLEXPRO ............................. 51noreth-ethinyl estradiol-iron ............................. 51norethindrone (contraceptive) ..........................51norethindrone acetate ......................................51norethindrone ac-eth estradiol .........................51norethindrone-e.estradiol-iron ......................... 51NORGESIC FORTE .................................. 11, 25norgestimate-ethinyl estradiol ..........................51norgestrel-ethinyl estradiol .............................. 51NORITATE ...................................................... 64NORLYDA .......................................................51NORLYROC .................................................... 51NORMAL SALINE FLUSH ........................34, 40NORM-JECT ................................................... 34NORPACE .......................................................18NORPACE CR ................................................ 18NORPRAMIN .................................................. 25NORTHERA .................................................... 11NORTREL 0.5/35 (28) .....................................51NORTREL 1/35 (21) ........................................51NORTREL 1/35 (28) ........................................51NORTREL 7/7/7 (28) .......................................51nortriptyline ...................................................... 25NORVASC .......................................................18NORVIR .............................................................4NOVA MAX GLUCOSE CONTROL ................34NOVA MAX GLUCOSE TEST ........................ 38NOVA SAFETY LANCETS ............................. 34NOVA SUREFLEX LANCETS ........................ 34NOVACORT .................................................... 64NOVAFERRUM ...............................................14NOVOEIGHT ................................................... 14NOVOFINE 32 .................................................34
NOVOFINE PLUS ........................................... 34NOVOLIN 70/30 U-100 INSULIN .................... 51NOVOLIN 70-30 FLEXPEN U-100 ..................51NOVOLIN N NPH U-100 INSULIN ..................51NOVOLIN R REGULAR U-100 INSULN .........51NOVOLOG FLEXPEN U-100 INSULIN .......... 51NOVOLOG MIX 70-30 U-100 INSULN ........... 51NOVOLOG MIX 70-30FLEXPEN U-100 ......... 51NOVOLOG PENFILL U-100 INSULIN ............ 51NOVOLOG U-100 INSULIN ASPART ............ 51NOVOPEN ECHO ........................................... 34NOVOSEVEN RT ............................................ 14NOXAFIL ...........................................................4NOXIFOL-D3 ...................................................69NOXIPAK ........................................................ 64NP THYROID .................................................. 51NPLATE .......................................................... 14NUCALA ......................................................... 59NUCORT ......................................................... 64NUCYNTA ....................................................... 25NUCYNTA ER ................................................. 25NUDICLO SOLUPAK ................................25, 64NUDICLO TABPAK .................................. 25, 64NUDROXIPAK .......................................... 25, 64NUDROXIPAK DSDR-50 .......................... 25, 64NUDROXIPAK DSDR-75 .......................... 25, 64NUDROXIPAK E-400 ................................25, 64NUDROXIPAK I-800 ................................. 25, 64NUDROXIPAK N-500 ................................25, 64NUEDEXTA ...............................................25, 59NULEV ............................................................ 11NULOJIX ......................................................... 56NULYTELY WITH FLAVOR PACKS .............. 45NUMBONEX ....................................................64NUPLAZID ...................................................... 25NUSURGEPAK SURGICAL PREP ................ 64NUTRIARX ...................................................... 64NUTROPIN AQ NUSPIN .................................51NUVAIL ........................................................... 34NUVAKAAN .................................................... 64NUVARING ..................................................... 51NUVESSA ....................................................... 64NUVIGIL .......................................................... 25NUWIQ ............................................................ 14NUZYRA ............................................................4NUZYRA (7 DAY WITH LOAD DOSE) ............. 4NUZYRA (7 DAY) ..............................................4NYAMYC ......................................................... 64NYMALIZE ...................................................... 18nystatin ........................................................ 4, 64nystatin-triamcinolone ......................................64NYSTOP ..........................................................64OB COMPLETE ........................................ 14, 69OB COMPLETE ONE ......................... 14, 40, 69OB COMPLETE PETITE ...........................14, 69OB COMPLETE PREMIER .................14, 40, 69OB COMPLETE WITH DHA ..................... 14, 69OBIZUR ...........................................................14OBREDON ................................................ 25, 59OBSTETRIX DHA ..................................... 14, 69OBSTETRIX EC .................................. 14, 45, 69OBSTETRIX ONE ..................................... 14, 69OBTREX DHA ...........................................14, 69O-CAL PRENATAL .............................14, 40, 69OCALIVA ........................................................ 45OCELLA ..........................................................51OCREVUS .......................................................56OCTAGAM ........................................................ 8octreotide acetate ...................................... 51, 56OCUFLOX ....................................................... 43ODEFSEY ......................................................... 4ODOMZO .......................................................... 7OFEV ...............................................................59ofloxacin ...................................................... 4, 43OGESTREL (28) ............................................. 51OKEBO ............................................................. 4olanzapine ....................................................... 25olanzapine-fluoxetine .......................................25olmesartan .......................................................18
82
olmesartan-amlodipin-hcthiazid .................18, 40olmesartan-hydrochlorothiazide ................ 18, 40olopatadine ...................................................... 43OLUMIANT ......................................................56OLUX ...............................................................64OLUX-E ........................................................... 64OMECLAMOX-PAK .................................... 4, 45omega-3 acid ethyl esters ............................... 18OMEPPI ...........................................................45omeprazole ......................................................45omeprazole-sodium bicarbonate ..................... 45OMNARIS ..................................................43, 59OMNITROPE ...................................................51ON CALL EXPRESS TEST STRIP .................38ON CALL LANCET ......................................... 34ON CALL PLUS CONTROL ........................... 34ON CALL PLUS LANCET .............................. 34ON CALL PLUS TEST STRIP ........................ 38ON CALL VIVID CONTROL ........................... 34ON CALL VIVID TEST STRIP ........................ 38ondansetron .....................................................45ondansetron hcl ............................................... 45ONETOUCH DELICA LANCETS ....................34ONETOUCH SURESOFT LANCING DEV ......34ONETOUCH ULTRA BLUE TEST STRIP ...... 38ONETOUCH ULTRA CONTROL .................... 34ONETOUCH ULTRASOFT LANCETS ........... 34ONETOUCH VERIO ........................................38ONETOUCH VERIO HIGH CONTROL ........... 34ONETOUCH VERIO MID CONTROL ............. 34ONEXTON .......................................................64ONFI ................................................................ 25ONGLYZA ....................................................... 51ONIVYDE .......................................................... 7ONMEL ..............................................................4ONPATTRO .................................................... 56ON-THE-GO LANCETS .................................. 34ONZETRA XSAIL ............................................25OPANA ............................................................25OPCICON ONE-STEP .................................... 51OPDIVO .............................................................7opium tincture ............................................ 25, 45OPSUMIT .................................................. 18, 59OPTICHAMBER ADULT MASK-LARGE ....... 34OPTICHAMBER DIAMOND LG MASK .......... 34OPTICHAMBER DIAMOND-MED MSK ......... 34OPTICHAMBER DIAMOND-SML MASK ....... 34OPTION-2 ........................................................51OPTIUM EZ ..................................................... 38OPTIUM TEST ................................................ 38OPTUMRX .......................................................38ORACEA ..................................................... 4, 64ORACIT ...........................................................40ORALAIR .................................................... 8, 56ORALONE .......................................................64ORAMAGICRX ................................................34ORAP .............................................................. 25ORAPRED ODT .............................................. 51ORAVIG .......................................................... 64ORENCIA ........................................................ 56ORENCIA (WITH MALTOSE) .........................56ORENCIA CLICKJECT ...................................56ORENITRAM .............................................18, 59ORFADIN ........................................................ 56ORILISSA ........................................................51ORKAMBI ....................................................... 59orphenadrine citrate .........................................11ORSYTHIA ...................................................... 51ORTHO DF ......................................................69ORTHO MICRONOR .......................................51ORTHO TRI-CYCLEN (28) ............................. 51ORTHO-NOVUM 1/35 (28) ..............................51ORTHO-NOVUM 7/7/7 (28) .............................51ORTHOVISC ................................................... 34OSCIMIN ......................................................... 11OSCIMIN SL ....................................................11OSCIMIN SR ................................................... 11oseltamivir ......................................................... 4OSENI ............................................................. 51
OSMOLEX ER .............................................4, 25OSMOPREP ....................................................45OSPHENA .......................................................51OTEZLA .................................................... 56, 64OTEZLA STARTER .................................. 56, 64OTIPRIO ..........................................................43OTOVEL ..........................................................43OTREXUP (PF) ........................................... 7, 56OVACE ............................................................64OVACE PLUS ................................................. 64OVACE PLUS SHAMPOO ..............................64OVACE PLUS WASH ..................................... 64OVIDE ............................................................. 64OXANDRIN ..................................................... 51oxandrolone .....................................................51oxaprozin ......................................................... 25OXAYDO ......................................................... 25oxazepam ........................................................ 25oxcarbazepine ................................................. 25OXERVATE .....................................................43oxiconazole ......................................................64OXISTAT ......................................................... 64OXSORALEN ULTRA .....................................64OXTELLAR XR ............................................... 25oxybutynin chloride ..........................................67oxycodone ....................................................... 25oxycodone-acetaminophen ............................. 25oxycodone-aspirin ........................................... 25OXYCONTIN ................................................... 25oxymorphone ...................................................25OXYTROL ....................................................... 67OZEMPIC ........................................................ 51OZURDEX ....................................................... 43PACERONE .................................................... 18PACNEX ..........................................................64PACNEX HP ....................................................64PACNEX LP .................................................... 64PAINGO KFT .................................................. 64paliperidone ..................................................... 25PALYNZIQ ...................................................... 41PAMELOR .......................................................25PANCREAZE .................................................. 45PANDA MASK ................................................ 34PANDEL ..........................................................64PANRETIN .................................................. 7, 64pantoprazole ....................................................45PANZYGA ......................................................... 8PARAGARD T 380A ....................................... 51paregoric ..........................................................45PAREMYD .......................................................43paricalcitol ........................................................69PARLODEL .....................................................25PARNATE ....................................................... 25PAROEX ORAL RINSE .................................. 43paromomycin ..................................................... 4paroxetine hcl .................................................. 25paroxetine mesylate(menop.sym) ................... 25PASER .............................................................. 4PATADAY ....................................................... 43PATANASE .....................................................43PATANOL ....................................................... 43PAXIL .............................................................. 25PAXIL CR ........................................................25PAZEO ............................................................ 43PEDIA IRON ....................................................14PEDIARIX (PF) ..................................................8PEDIATRIC PANDA MASK ............................34PEDVAX HIB (PF) .............................................8peg 3350-electrolytes ...................................... 45PEG-3350 WITH FLAVOR PACKS ................ 45PEGANONE .................................................... 25PEGASYS ......................................................... 4PEGASYS PROCLICK ..................................... 4peg-electrolyte soln ......................................... 45PEGINTRON ..................................................... 4PEG-PREP ...................................................... 45PEN NEEDLE ..................................................34pen needle, diabetic ........................................ 34penicillamine ..............................................46, 56
penicillin v potassium .........................................4PENLAC ..........................................................65PENNSAID ................................................ 25, 65PENTACEL (PF) ............................................... 8PENTACEL ACTHIB COMPONENT (PF) ........ 8PENTACEL DTAP-IPV COMPNT (PF) .............8PENTASA ....................................................... 45pentazocine-naloxone ..................................... 26PENTIPS ......................................................... 34pentoxifylline ....................................................14PEPCID ........................................................... 45PERCOCET .....................................................26PERFOROMIST ........................................ 11, 59PERIDEX .........................................................43perindopril erbumine ........................................18PERIOGARD ...................................................43PERJETA .......................................................... 7permethrin ....................................................... 65perphenazine ...................................................26perphenazine-amitriptyline .............................. 26PERSERIS ...................................................... 26PERTZYE ........................................................ 45PEXEVA .......................................................... 26PH 12 DILUENT FOR FLOLAN ......................57PHARMACIST CHOICE ..................................38PHENADOZ ................................................ 1, 26phenazopyridine .............................................. 65phenelzine ....................................................... 26PHENERGAN ..............................................1, 26phenobarb-hyoscy-atropine-scop .............. 11, 26phenobarbital ...................................................26PHENOHYTRO ......................................... 11, 26phenoxybenzamine ................................... 11, 18phenylephrine hcl ............................................ 43PHENYTEK ............................................... 18, 26phenytoin ................................................... 18, 26phenytoin sodium extended .......................18, 26PHILITH ...........................................................51PHOSLYRA .....................................................40PHOSPHA 250 NEUTRAL ..............................40PHOSPHASAL ..................................................4PHOSPHOLINE IODIDE ................................. 43PHRENILIN FORTE(WITH CAFFEINE) ......... 26PHYSICIANS EZ USE B-12 ............................69PHYSIOLYTE ..................................................40PHYSIOSOL IRRIGATION ............................. 40phytonadione (vitamin k1) ......................... 56, 69PICATO ....................................................... 7, 65PIFELTRO .........................................................4pilocarpine hcl ............................................11, 43pimecrolimus ............................................. 56, 65pimozide .......................................................... 26PIMTREA (28) ................................................. 51pindolol ...................................................... 11, 18pioglitazone ..................................................... 51pioglitazone-glimepiride ...................................51pioglitazone-metformin .................................... 51PIQRAY .............................................................7PIRMELLA ...................................................... 51piroxicam ......................................................... 26PISTON SYRINGE WITH ENFIT .................... 34PLAN B ONE-STEP ........................................51PLAQUENIL ................................................4, 56PLAVIX ............................................................14PLEGRIDY ...................................................... 56PLENVU .......................................................... 45PLEXION .........................................................65PLEXION CLEANSING CLOTHS ...................65PLIAGLIS ........................................................ 65PNEUMOVAX 23 .............................................. 9PNV 29-1 ............................................. 14, 40, 69PNV OB+DHA ...............................14, 40, 45, 69PNV-DHA .................................................. 14, 69PNV-DHA + DOCUSATE ..............14, 40, 45, 69PNV-FERROUS FUMARATE-DOCU-FA . 14, 69PNV-OMEGA ...................................... 14, 40, 69PNV-SELECT ............................................14, 69PNV-VP-U ....................................................... 69POCKET CHAMBER ...................................... 34
83
PODOCON ...................................................... 65podofilox .......................................................... 65POLIVY ............................................................. 7POLY HUB NEEDLE ...................................... 34POLYCIN .........................................................43polyethylene glycol 3350 ................................. 45POLY-IRON 150 FORTE .......................... 14, 69polymyxin b sulfate ............................................ 4polymyxin b sulf-trimethoprim ..........................43POLYTRIM ...................................................... 43POLY-VI-FLOR ......................................... 56, 69POLY-VI-FLOR WITH IRON ............... 14, 56, 69POMALYST .................................................7, 56PONTOCAINE .................................................65PORTIA 28 ...................................................... 51PORTRAZZA .................................................... 7POTABA ......................................................... 56potassium chloride ...........................................40potassium citrate ............................................. 40potassium citrate-citric acid ............................. 40POTELIGEO ......................................................7PR CREAM ..................................................... 34PR NATAL 400 ................................... 14, 40, 69PR NATAL 400 EC ............................. 14, 40, 69PR NATAL 430 ................................... 14, 40, 69PR NATAL 430 EC ............................. 14, 40, 69PRADAXA .......................................................14PRALUENT PEN .............................................18pramipexole ..................................................... 26PRAMOSONE ................................................. 65PRANDIN ........................................................ 51prasugrel ..........................................................14PRAVACHOL ..................................................18pravastatin ....................................................... 18praziquantel ....................................................... 4prazosin ..................................................... 11, 18PRECISION PCX PLUS TEST ........................38PRECISION PCX TEST .................................. 38PRECISION POINT OF CARE TEST ............. 38PRECISION Q-I-D TEST .................................38PRECISION XTRA B-KETONE ...................... 35PRECISION XTRA TEST ................................38PRECOSE ....................................................... 51PRED FORTE ................................................. 43PRED MILD .....................................................43PRED-G ...........................................................43PRED-G S.O.P. ............................................... 43prednicarbate ...................................................65prednisol ace-gatiflox-bromfen ........................ 43prednisoln sp-gatiflox-bromfen ........................ 43prednisolone .................................................... 51prednisolone acetate ....................................... 43prednisolone acetate (pf) .................................43prednisolone acetate-bromfenac ..................... 43prednisolone acetate-nepafenac ..................... 43prednisolone acet-gatifloxacin ......................... 43prednisolone sod ph-bromfenac ...................... 43prednisolone sod ph-gatifloxac ........................43prednisolone sodium phosphate ................43, 51prednisolone-moxiflo-nepafenac ..................... 43prednisolone-moxifloxacin hcl ......................... 43prednisone .......................................................51PREDNISONE INTENSOL ..............................51PREFERA-OB ...........................................14, 69PREFERA-OB ONE .................................. 14, 69PREFERA-OB PLUS DHA ....................... 14, 69PREFEST ........................................................ 51PREMARIN ..................................................... 51PREMIER TEST STRIP .................................. 38PREMIUM V10 ................................................ 38PREMPHASE ..................................................51PREMPRO ...................................................... 51PRENA1 CHEW .............................................. 69PRENA1 PEARL .......................................14, 69PRENA1 TRUE ......................................... 14, 69PRENAISSANCE .......................... 14, 40, 45, 69PRENAISSANCE PLUS ............... 14, 40, 45, 69PRENATA ................................................. 14, 69PRENATABS FA ................................ 14, 40, 69
PRENATABS RX ................................ 14, 40, 69PRENATAL LOW IRON ......................14, 40, 69PRENATAL PLUS .............................. 14, 40, 69PRENATAL PLUS (CALCIUM CARB)............................................................. 14, 40, 69PRENATAL PLUS DHA ............................14, 69PRENATAL VITAMIN PLUS LOW IRON............................................................. 14, 40, 69PRENATAL-U ................................................. 69PRENATE AM .................................................69PRENATE CHEWABLE ............................40, 69PRENATE DHA .........................................14, 69PRENATE DHA (FERR ASP GLYCIN) .... 14, 69PRENATE ELITE ...................................... 14, 69PRENATE ELITE (IRON ASP GLYC) ...... 14, 69PRENATE ENHANCE ...............................14, 69PRENATE ESSENTIAL ............................ 14, 69PRENATE ESSENTIAL(IRON-ASP-GL) .. 14, 69PRENATE MINI (FERR ASP GLYCIN) .....14, 69PRENATE PIXIE ....................................... 14, 69PRENATE RESTORE ............................... 14, 69PRENATE STAR .......................................14, 69PREPIDIL ........................................................ 57PREPLUS ............................................14, 40, 69PREPOPIK ...................................................... 45PRESERA ....................................................... 35PRESSURE ACTIVATED LANCETS ............. 35PRESTALIA .................................................... 18PRETAB ..............................................14, 40, 69PREVACID ...................................................... 45PREVACID SOLUTAB ....................................45PREVALITE .................................................... 18PREVIDENT .................................................... 56PREVIDENT 5000 BOOSTER PLUS ..............56PREVIDENT 5000 DRY MOUTH .................... 56PREVIDENT 5000 ENAMEL PROTECT .........56PREVIDENT 5000 PLUS ................................ 56PREVIDENT 5000 SENSITIVE ....................... 56PREVIFEM ...................................................... 51PREVNAR 13 (PF) ............................................ 9PREVYMIS ........................................................ 4PREZCOBIX ................................................4, 56PREZISTA .........................................................4PRIALT ............................................................26PRIFTIN .............................................................4PRIKAAN ........................................................ 65PRIKAAN LITE ............................................... 65PRILOLID ........................................................65PRILOSEC ...................................................... 46PRILOVIX ........................................................65PRILOVIX LITE ............................................... 65PRILOVIX PLUS ............................................. 65PRIMACARE .............................................14, 69primaquine .........................................................4PRIMEAIRE .....................................................35primidone .........................................................26PRIMLEV .........................................................26PRIMSOL .......................................................... 4PRINIVIL ......................................................... 18PRISTIQ .......................................................... 26PRIVIGEN ......................................................... 9PRO COMFORT INSULIN SYRINGE ............. 35PRO COMFORT LANCET .............................. 35PRO COMFORT PEN NEEDLE ......................35PRO VOICE V8-V9 TEST STRIP ....................38PROAIR HFA ............................................ 11, 59PROAIR RESPICLICK ..............................11, 59probenecid .................................................40, 56probenecid-colchicine ................................40, 56PROBUPHINE .................................................26procainamide ................................................... 18PROCARDIA ...................................................18PROCARDIA XL ............................................. 18PROCENTRA ..................................................26PROCHAMBER .............................................. 35prochlorperazine ........................................26, 46prochlorperazine edisylate .........................26, 46prochlorperazine maleate .......................... 26, 46PROCORT .......................................................65
PROCRIT ........................................................ 14PROCTOCORT ............................................... 65PROCTOFOAM HC ........................................ 65PROCTO-MED HC ..........................................65PROCTO-PAK ................................................ 65PROCTOSOL HC ............................................65PROCTOZONE-HC .........................................65PROCYSBI ......................................................56PRODIGY CONTROL SOLUTION, LOW ....... 35PRODIGY CONTROL SOLUTION,HIGH ........35PRODIGY INSULIN SYRINGE ....................... 35PRODIGY LANCETS ...................................... 35PRODIGY NO CODING .................................. 38PRODIGY TWIST TOP LANCET ....................35PROFILNINE ...................................................14progesterone ................................................... 51progesterone micronized ................................. 51PROGLYCEM ................................................. 51PROGRAF .......................................................56PROLASTIN-C ................................................ 59PROLENSA .....................................................43PROLEUKIN ............................................... 7, 56PROLIA ........................................................... 56PROMACTA ....................................................14promethazine .........................................1, 26, 59PROMETHAZINE VC ............................1, 11, 59promethazine-codeine ............................... 26, 59promethazine-dm .........................................1, 59promethazine-phenyleph-codeine ... 1, 11, 26, 59promethazine-phenylephrine ................. 1, 11, 59PROMETHEGAN ........................................ 1, 26PROMETRIUM ................................................ 51PROMISEB ..................................................... 35propafenone .................................................... 18propantheline ...................................................11proparacaine ....................................................43propranolol ...........................................11, 18, 26propranolol-hydrochlorothiazid ............ 11, 18, 40propylthiouracil ................................................ 51PROQUAD (PF) ................................................ 9PROSCAR .......................................................56PROSTIN E2 ................................................... 57PROTHELIAL ..................................................35PROTONIX ......................................................46PROTOPIC ......................................................65protriptyline ...................................................... 26PROVENTIL HFA ......................................11, 59PROVERA .......................................................51PROVIDA DHA ......................................... 14, 69PROVIDA OB ............................................14, 69PROVIGIL ....................................................... 26PROZAC ......................................................... 26PRUCLAIR ................................................ 35, 65PRUDOXIN ......................................................65PRUMYX ......................................................... 35PRUTECT ..................................................35, 65PSORCON ...................................................... 65PULMICORT ............................................. 51, 59PULMICORT FLEXHALER .......................51, 59PULMOSAL .............................................. 35, 40PULMOZYME ............................................41, 59PUREFE OB PLUS ................................... 14, 69PUREVIT DUALFE PLUS ...............................14PURIXAN .................................................... 7, 56PUSH BUTTON SAFETY LANCETS ............. 35PYLERA ...................................................... 4, 46pyrazinamide ..................................................... 4PYRIDIUM ....................................................... 65pyridostigmine bromide ................................... 11QBRELIS .........................................................18QBREXZA ................................................. 11, 65QMIIZ ODT ...................................................... 26QNASL ...................................................... 43, 59QTERN ............................................................ 51QUADRACEL (PF) ............................................9QUALAQUIN .....................................................4QUARTETTE ...................................................51quazepam ........................................................26QUDEXY XR ................................................... 26
84
QUESTRAN .................................................... 18QUESTRAN LIGHT .........................................18quetiapine ........................................................ 26QUFLORA .................................................56, 69QUFLORA FE ..................................... 14, 56, 69QUFLORA FE (FERROUS SULFATE)............................................................. 14, 56, 69QUFLORA PEDIATRIC ............................ 56, 69QUFLORA PEDIATRIC DROPS ...............56, 69QUILLICHEW ER ............................................26QUILLIVANT XR ............................................. 26quinapril ........................................................... 18quinapril-hydrochlorothiazide .....................18, 40quinidine gluconate ......................................4, 18quinidine sulfate ...........................................4, 18quinine sulfate ................................................... 4QUINTET AC ...................................................38QUINTET GLUCOSE TEST STRIPS ..............38QUIT 2 ............................................................. 11QUIT 4 ............................................................. 11QUTENZA ....................................................... 65QVAR REDIHALER .................................. 51, 59RABAVERT (PF) ...............................................9rabeprazole ......................................................46RADIAGEL ......................................................57RADIAPLEXRX ...............................................35RADICAVA ......................................................26RAGWITEK ................................................. 9, 56RAJANI ........................................................... 51raloxifene ................................................... 51, 56ramipril .............................................................18RANEXA ......................................................... 18ranitidine hcl .................................................... 46ranolazine ........................................................ 18RAPAFLO ....................................................... 11RAPAMUNE ....................................................56rasagiline ......................................................... 26RASUVO (PF) ............................................. 7, 56RAVICTI .......................................................... 40RAYALDEE .....................................................69RAYOS ............................................................51RAZADYNE .....................................................11RAZADYNE ER ...............................................11READYLANCE SAFETY LANCETS .............. 35REBETOL ......................................................... 4REBIF (WITH ALBUMIN) ................................56REBIF REBIDOSE .......................................... 56REBIF TITRATION PACK .............................. 56REBINYN ........................................................ 14RECEDO ......................................................... 35RECLIPSEN (28) .............................................52RECOMBINATE ..............................................14RECOMBIVAX HB (PF) .................................... 9RECTIV ........................................................... 65REFUAH PLUS ............................................... 38REFUAH PLUS GLUCOSE CONTROL ......... 35REGENECARE ............................................... 35REGENECARE WITH ALOE .......................... 35REGLAN ......................................................... 46REGRANEX .................................................... 65RELADOR PAK .............................................. 65RELADOR PAK PLUS ....................................65RELAGARD .................................................... 65RELENZA DISKHALER ....................................4RELEXXII ........................................................ 26RELIAMED LANCET ...................................... 35RELIAMED SAFETY SEAL LANCETS .......... 35RELIAMED TWIST AND CAP LANCET .........35RELION CONFIRM-MICRO ............................ 38RELION NEEDLES ......................................... 35RELION PEN NEEDLES .................................35RELION PRIME TEST STRIPS ...................... 38RELION THIN LANCETS ................................35RELION ULTIMA ............................................ 38RELION ULTRA THIN PLUS LANCETS ........35RELISTOR ...................................................... 46RELPAX .......................................................... 26REMERON ...................................................... 26REMERON SOLTAB ...................................... 26
REMICADE ......................................... 46, 56, 65REMODULIN .............................................18, 59RENAGEL ................................................. 41, 56RENAL CAPS ................................................. 69RENA-VITE RX ............................................... 69RENFLEXIS ........................................ 46, 56, 65RENO CAPS ................................................... 69RENVELA ................................................. 41, 56repaglinide ....................................................... 52repaglinide-metformin ......................................52REPATHA PUSHTRONEX ............................. 18REPATHA SURECLICK ................................. 18REPATHA SYRINGE ...................................... 18REPREXAIN ....................................................26REQUIP ...........................................................26REQUIP XL ..................................................... 26RESCRIPTOR ................................................... 4RESPA-AR ............................................1, 11, 59RESTASIS .......................................................43RESTASIS MULTIDOSE ................................ 43RESTIZAN .......................................................65RESTORIL ...................................................... 26RETACRIT ...................................................... 14RETIN-A .......................................................... 65RETIN-A MICRO ............................................. 65RETIN-A MICRO PUMP ..................................65RETISERT .......................................................43RETROVIR ........................................................ 4REVATIO ...................................................18, 59REVCOVI ........................................................ 41REVEAL TEST STRIP .................................... 38REVESTA ........................................................69REVIA ........................................................26, 56REVLIMID ................................................... 7, 56REXULTI ......................................................... 26REYATAZ ..........................................................4RHOFADE .......................................................65RHOGAM ULTRA-FILTERED PLUS ................9RHOPHYLAC ....................................................9RHOPRESSA ..................................................43RIASTAP .........................................................14RIBASPHERE ................................................... 4RIBASPHERE RIBAPAK ..................................4ribavirin .............................................................. 4RIDAURA .................................................. 46, 56rifabutin ..............................................................4RIFADIN ............................................................ 4RIFAMATE ........................................................ 4rifampin ..............................................................4RIFATER ........................................................... 4RIGHTEST CONTROL SOLUTION HIGH ...... 35RIGHTEST CONTROL SOLUTION NORM .... 35RIGHTEST GL300 LANCETS ........................ 35RIGHTEST GS250S TEST STRIPS ................39RIGHTEST GS260 TEST STRIPS .................. 39RIGHTEST GS550 TEST STRIPS .................. 39RILUTEK ......................................................... 26riluzole ............................................................. 26rimantadine ........................................................4ringer's .............................................................41RIOMET ...........................................................52risedronate .......................................................56RISPERDAL ....................................................26RISPERDAL CONSTA ....................................26risperidone .......................................................26RITALIN .......................................................... 26RITALIN LA .....................................................26ritonavir ..............................................................4RITUXAN ...........................................................7RITUXAN HYCELA ...........................................7rivastigmine ..................................................... 11rivastigmine tartrate ......................................... 11RIVELSA ......................................................... 52RIXUBIS .......................................................... 14rizatriptan .........................................................26R-NATAL OB ............................................ 14, 69ROBAXIN ........................................................ 11ROBAXIN-750 .................................................11ROCALTROL .................................................. 69
ROCKLATAN ..................................................43romidepsin ......................................................... 7ropinirole ..........................................................26ROSADAN ...................................................... 65ROSANIL ........................................................ 65ROSULA ......................................................... 65ROSULA CLEANSING CLOTHS ................... 65rosuvastatin ..................................................... 18ROTARIX .......................................................... 9ROTATEQ VACCINE ........................................9ROWASA ........................................................ 46ROWEEPRA ................................................... 26ROWEEPRA XR ............................................. 26ROXICODONE ................................................ 26ROXIFOL-D .....................................................69ROXYBOND ....................................................26ROZEREM .......................................................26RUBRACA ........................................................ 7RUCONEST .................................................... 56RUZURGI ........................................................ 56RYCLORA ...................................................1, 59RYDAPT ............................................................7RYDEX ............................................ 1, 11, 26, 59RYNODERM ....................................................65RYTARY ..........................................................26RYTHMOL SR .................................................18RYVENT ...................................................... 1, 59SABRIL ........................................................... 26SAFESNAP INSULIN SYRINGE .................... 35SAFESNAP SYRINGE ....................................35SAFETY LANCETS ........................................ 35safety needles ................................................. 35SAFETY SEAL LANCETS ..............................35SAFETY-LET LANCETS ................................ 35SAFYRAL ........................................................52SAIZEN ........................................................... 52SAIZEN SAIZENPREP ................................... 52SALAGEN (PILOCARPINE) ........................... 11SALEX .............................................................65salicylic acid .....................................................65salicylic acid er-ceramides ...............................65SALIMEZ .........................................................65SALIMEZ FORTE ............................................65SALIVAMAX ................................................... 35SALKERA ....................................................... 65salsalate .......................................................... 26SALVAX .......................................................... 65SALVAX DUO PLUS ...................................... 65SAMSCA ......................................................... 41SANADERMRX ...............................................65SANCUSO .......................................................46SANDIMMUNE ................................................56SANDOSTATIN .........................................52, 56SANDOSTATIN LAR DEPOT ...................52, 56SANTYL .......................................................... 65SAPHRIS .........................................................26SARAFEM .......................................................26SAVAYSA ....................................................... 15SAVELLA ........................................................26SAXENDA ....................................................... 52SCALACORT .................................................. 65SCALACORT DK ............................................65scopolamine base ............................................46SEASONIQUE .................................................52SECONAL SODIUM ........................................26SEEBRI NEOHALER ...................................... 11SEGLUROMET ............................................... 52SELECT-OB ..............................................15, 69SELECT-OB (FOLIC ACID) ............................15SELECT-OB + DHA ..................................15, 69selegiline hcl .................................................... 26selenium sulfide ...............................................65SELRX .............................................................65SELZENTRY ..................................................... 4SEMPREX-D ......................................... 1, 11, 59SE-NATAL 19 ........................................... 15, 69SE-NATAL 19 (WITH DOCUSATE) ....15, 46, 69SENSIPAR ................................................ 52, 56SEREVENT DISKUS .................................11, 59
85
SERNIVO ........................................................ 65SEROQUEL .................................................... 26SEROQUEL XR .............................................. 26SEROSTIM ......................................................52sertraline ..........................................................26SE-TAN PLUS .................................................15SETLAKIN .......................................................52sevelamer carbonate ................................. 41, 57sevelamer hcl ............................................ 41, 57SEYSARA ......................................................... 4SF .................................................................... 57SF 5000 PLUS ................................................ 57SFROWASA ....................................................46SHAROBEL .................................................... 52SHINGRIX (PF) ................................................. 9SHINGRIX GE ANTIGEN COMPONENT ......... 9SHOHL'S MODIFIED ...................................... 41SIDESTREAM PEDIATRIC FACE MASK ...... 35SIGNIFOR ....................................................... 52SIGNIFOR LAR ...............................................52SIKLOS ............................................................. 7SILALITE PAK ................................................ 65SILAZONE-II ................................................... 65sildenafil ...........................................................18sildenafil (antihypertensive) ....................... 18, 59SILENOR .........................................................26SILIQ ............................................................... 65silodosin ...........................................................11SILVADENE .................................................... 65silver nitrate ..................................................... 65silver nitrate applicators ...................................65silver sulfadiazine ............................................ 65SILVRSTAT .....................................................35SIMBRINZA .....................................................43SIMLIYA (28) ...................................................52SIMPESSE ...................................................... 52SIMPONI ................................................... 46, 57SIMPONI ARIA ..........................................46, 57simvastatin .......................................................18SINEMET .........................................................26SINEMET CR .................................................. 26SINGLE-LET ................................................... 35SINGULAIR .....................................................59SINUVA ..................................................... 43, 59sirolimus .......................................................... 57SIRTURO .......................................................... 4SITAVIG ............................................................ 4SIVEXTRO ........................................................ 4SKELAXIN ...................................................... 11SKLICE ........................................................... 65SKYLA ............................................................ 52SKYRIZI .......................................................... 65SMART SENSE LANCETS .............................35SMART SENSE TEST STRIPS ...................... 39SMARTEST CONTROL .................................. 35SMARTEST LANCET ..................................... 35SMARTEST TEST ...........................................39SMARTRX GABAKIT ..................................... 27SMARTRX GABA-V KIT .................................27sodium chloride ......................................... 35, 41sodium chloride 0.9 % (flush) .................... 35, 41sodium citrate-citric acid .................................. 41SODIUM FLUORIDE 5000 PLUS ................... 57sodium phenylbutyrate .................................... 41sodium polystyrene sulfonate .................... 41, 57sofosbuvir-velpatasvir ........................................4SOFT TOUCH LANCETS ............................... 35SOLARAZE .................................................7, 65solifenacin ........................................................67SOLIQUA 100/33 ............................................ 52SOLIRIS .......................................................... 57SOLODYN ...................................................4, 65SOLOSEC ......................................................... 4SOLOXIDE ........................................................ 4SOLTAMOX ................................................ 7, 52SOLUPAK ................................................. 27, 65SOLUS V2 CONTROL SOLUTION, LOW ...... 35SOLUS V2 CONTROL SOLUTION,HIGH ...... 35SOLUS V2 LANCETS .....................................35
SOLUS V2 TEST STRIPS ...............................39SOMA ..............................................................11SOMATULINE DEPOT ................................... 52SOMAVERT .................................................... 52SONAFINE ................................................ 35, 65SOOLANTRA ..................................................66SORIATANE ................................................... 66SORILUX .........................................................66SORINE .....................................................11, 18sotalol ........................................................ 12, 18SOTALOL AF ............................................12, 18SOTYLIZE ................................................. 12, 18SOVALDI ...........................................................4SP ANTIPRURITIC ......................................... 35SP SCAR MANAGEMENT ............................. 66SPECTRACEF .................................................. 4spinosad .......................................................... 66SPINRAZA (PF) .............................................. 57SPIRIVA RESPIMAT .................................12, 59SPIRIVA WITH HANDIHALER ................. 12, 59spironolactone ........................................... 18, 41spironolacton-hydrochlorothiaz ..................18, 41SPORANOX ...................................................... 4SPORANOX PULSEPAK ................................. 4SPRAVATO .....................................................27SPRAY AND STRETCH ........................... 35, 66SPRINTEC (28) ............................................... 52SPRITAM ........................................................ 27SPRIX ..............................................................27SPRYCEL ..........................................................7SPS (WITH SORBITOL) ........................... 41, 57SRONYX ......................................................... 52SSD ................................................................. 66SSKI ................................................ 4, 52, 57, 59SSS 10-5 ......................................................... 66ST JOSEPH ASPIRIN ...............................15, 27STALEVO 100 .................................................27STALEVO 125 .................................................27STALEVO 150 .................................................27STALEVO 200 .................................................27STALEVO 50 ...................................................27STALEVO 75 ...................................................27STAMARIL (PF) ................................................ 9STARLIX ......................................................... 52stavudine ........................................................... 4STAXYN .......................................................... 18STEGLATRO .................................................. 52STEGLUJAN ...................................................52STELARA ..................................................57, 66STENDRA ....................................................... 18STERILANCE TL ............................................ 35STIMATE ...................................................15, 52STIOLTO RESPIMAT ..................................... 12STIVARGA ........................................................ 7STOP SMOKING AID ..................................... 12STRATTERA ...................................................27STRENSIQ ...................................................... 41streptomycin ...................................................... 4STRIANT ......................................................... 52STRIBILD .......................................................... 4STRIVERDI RESPIMAT ............................12, 59STROMECTOL ................................................. 5STRONG IODINE ............................5, 52, 57, 59SUBLOCADE ..................................................27SUBOXONE .................................................... 27SUBSYS ..........................................................27SUBVENITE .................................................... 27SUBVENITE STARTER (BLUE) KIT .............. 27SUBVENITE STARTER (GREEN) KIT ........... 27SUBVENITE STARTER (ORANGE) KIT ........ 27SUCRAID ........................................................ 41sucralfate ......................................................... 46SULAR ............................................................ 18sulfacetamide sodium ................................43, 66sulfacetamide sodium (acne) ...........................66sulfacetamide sodium-sulfur ............................66sulfacetamide sod-sulfur-urea ......................... 66sulfacetamide-prednisolone .............................43sulfacetamide-sulfur-cleansr23 ........................66
SULFACLEANSE 8-4 ..................................... 66sulfact na-sul-avobnz-otn-ocsa ........................66sulfadiazine ........................................................5sulfamethoxazole-trimethoprim ......................... 5SULFAMYLON ................................................66sulfasalazine ..........................................5, 46, 57SULFATRIM ......................................................5sulindac ........................................................... 27SUMADAN ...................................................... 66SUMADAN XLT .............................................. 66sumatriptan ......................................................27sumatriptan succinate ......................................27sumatriptan-naproxen ......................................27SUMAVEL DOSEPRO .................................... 27SUMAXIN ........................................................ 66SUMAXIN CP .................................................. 66SUMAXIN TS .................................................. 66SUNOSI ...........................................................27SUPARTZ FX .................................................. 35SUPER THIN LANCETS .................................35SUPPRELIN LA .......................................... 7, 52SUPRAX ............................................................5SUPREP BOWEL PREP KIT ..........................46SURE COMFORT ALCOHOL PREP PADS ...66SURE COMFORT INS. SYR. U-100 ............... 35SURE COMFORT INSULIN SYRINGE ...........35SURE COMFORT LANCETS ......................... 35SURE COMFORT PEN NEEDLE ................... 35SURE RESULT DSS PREMIUM PACK ....27, 66SURE RESULT TAC PAK .............................. 66SURE-FINE PEN NEEDLES ...........................35SURE-JECT INSULIN SYRINGE ....................35SURE-LANCE ................................................. 35SURE-LANCE ULTRA THIN .......................... 35SURE-TEST EASYPLUS MINI ....................... 39SURE-TOUCH LANCET ................................. 35SURFAXIN ...................................................... 59SURGUARD2 SAFETY ...................................35SUSTIVA ........................................................... 5SUSTOL .......................................................... 46SUTENT ............................................................ 7SUVICORT ...................................................... 35SYEDA ............................................................ 52SYLATRON ...................................................5, 7SYLVANT ..........................................................7SYMAX DUOTAB ........................................... 12SYMAX FASTABS ..........................................12SYMAX-SL ...................................................... 12SYMAX-SR ......................................................12SYMBICORT ....................................... 12, 52, 59SYMBYAX .......................................................27SYMDEKO ...................................................... 59SYMFI ................................................................5SYMFI LO ..........................................................5SYMLINPEN 120 .............................................52SYMLINPEN 60 ...............................................52SYMPAZAN .................................................... 27SYMPROIC ..................................................... 46SYMTUZA ................................................... 5, 57SYNAGIS .......................................................... 5SYNALAR ....................................................... 66SYNALAR CREAM KIT .................................. 66SYNALAR OINTMENT KIT .............................66SYNALAR TS ..................................................66SYNAREL ....................................................... 52SYNDROS .......................................................46SYNERA ..........................................................66SYNJARDY ..................................................... 52SYNJARDY XR ............................................... 52SYNRIBO .......................................................... 7SYNTHROID ................................................... 52SYNVEXIA TC .................................................66SYNVISC .........................................................35SYNVISC-ONE ................................................35SYPRINE .........................................................46syringe (disposable) ........................................ 35syringe (reusable) ............................................35SYRINGE 3CC/21GX1-1/2" ............................ 35syringe with needle ..........................................35
86
syringe with needle, safety .............................. 36TABLOID ...........................................................7TACLONEX .....................................................66tacrolimus .................................................. 57, 66tadalafil ............................................................ 18tadalafil (antihypertensive) .........................18, 59TAFINLAR .........................................................7TAGRISSO ........................................................7TAKE ACTION ................................................ 52TAKHZYRO .....................................................57TALTZ AUTOINJECTOR ................................66TALTZ AUTOINJECTOR (2 PACK) ............... 66TALTZ AUTOINJECTOR (3 PACK) ............... 66TALTZ SYRINGE ............................................ 66TALZENNA ....................................................... 7TAMIFLU ...........................................................5tamoxifen ..................................................... 7, 52tamsulosin ....................................................... 12TAPAZOLE ..................................................... 52TAPERDEX ..................................................... 52TARCEVA ......................................................... 7TARGADOX ...................................................... 5TARGRETIN ................................................7, 66TARINA 24 FE ................................................ 52TARINA FE 1/20 (28) ...................................... 52TARINA FE 1-20 EQ (28) ................................52TARKA ............................................................ 19TARON FORTE .........................................15, 69TARON-C DHA ......................................... 15, 69TARON-PREX PRENATAL-DHA ....... 15, 46, 69TASIGNA .......................................................... 7TASMAR ......................................................... 27TAVALISSE .................................................... 15TAYTULLA ......................................................52tazarotene ........................................................66TAZORAC ....................................................... 66TAZTIA XT ...................................................... 19TD GOLD TEST STRIP ...................................39TDVAX .............................................................. 9TECENTRIQ ......................................................7TECFIDERA .................................................... 57TECHLITE INSULIN SYRINGE ...................... 36TECHLITE LANCETS ..................................... 36TECHLITE PEN NEEDLE ............................... 36TEGRETOL ..................................................... 27TEGRETOL XR ............................................... 27TEGSEDI .........................................................57TEKTURNA .....................................................19TEKTURNA HCT ...................................... 19, 41TELCARE CONTROL .....................................36TELCARE LANCETS ......................................36TELCARE TEST STRIPS ............................... 39telmisartan ....................................................... 19telmisartan-amlodipine .................................... 19telmisartan-hydrochlorothiazid ...................19, 41temazepam ......................................................27TEMODAR ........................................................ 7TEMOVATE .....................................................66temozolomide .................................................... 7temsirolimus ...................................................... 7TENCON ......................................................... 27TENIVAC (PF) ...................................................9tenofovir disoproxil fumarate ............................. 5TENORETIC 100 .................................12, 19, 41TENORETIC 50 ...................................12, 19, 41TENORMIN ............................................... 12, 19TEPADINA ........................................................ 7terazosin .................................................... 12, 19terbinafine hcl .................................................... 5terbutaline ..................................................12, 59terconazole ...................................................... 66TEROCIN (LIDOCAINE-MENTHOL) .............. 66TERSI FOAM .................................................. 66TERUMO INSULIN SYRINGE ........................ 36TERUMO SYRINGE ........................................36TESSALON PERLES ......................................59TEST N'GO TEST ........................................... 39TESTIM ........................................................... 52TESTOPEL ......................................................52
testosterone .....................................................52testosterone cypionate .................................... 52testosterone enanthate ....................................52TESTRED ........................................................52tetanus,diphtheria tox ped(pf) ............................9TETCAINE .......................................................43tetrabenazine ...................................................27tetracaine hcl ................................................... 44tetracaine hcl (pf) .............................................44tetracycline ........................................................ 5TETRAVISC .................................................... 44TETRAVISC FORTE ....................................... 44TETRIX ............................................................66TEXACORT .....................................................66THALOMID ......................................................57THEO-24 ....................................... 19, 41, 59, 67THEOCHRON ............................... 19, 41, 59, 67theophylline ................................... 19, 41, 59, 67THIN LANCETS .............................................. 36THINPRO INSULIN SYRINGE ........................36THIOLA ........................................................... 57thioridazine ...................................................... 27thiothixene ....................................................... 27THRIVITE RX ...................................... 15, 41, 69THRIVITE-19 ............................................. 15, 69thyroid (pork) ................................................... 52THYROLAR-1 ................................................. 52THYROLAR-1/2 .............................................. 52THYROLAR-1/4 .............................................. 52THYROLAR-2 ................................................. 52THYROLAR-3 ................................................. 52tiagabine .......................................................... 27TIAZAC ........................................................... 19TIBSOVO .......................................................... 7TICALAST .................................................44, 59TICANASE ................................................ 44, 59TICASPRAY ..............................................44, 59TIGAN ............................................................. 46TIKOSYN .........................................................19TILIA FE .......................................................... 52timol-brimon-dorzo-latanop(pf) ........................ 44timolol maleate .............................. 12, 19, 27, 44timolol-brimonidi-dorzolam(pf) ......................... 44timolol-dorzolamid-latanop(pf) ......................... 44timolol-latanoprost(pf) ......................................44TIMOPTIC ....................................................... 44TIMOPTIC OCUDOSE (PF) ............................ 44TIMOPTIC-XE ................................................. 44tinidazole ........................................................... 5TIROSINT ........................................................52TIROSINT-SOL ............................................... 52TIVICAY ............................................................ 5TIVORBEX ................................................ 27, 57tizanidine ......................................................... 12TL-SELECT ...................................15, 41, 46, 70TOBI .................................................................. 5TOBI PODHALER .............................................5TOBRADEX .................................................... 44TOBRADEX ST ...............................................44tobramycin ....................................................... 44tobramycin in 0.225 % nacl ............................... 5tobramycin sulfate ............................................. 5tobramycin with nebulizer .................................. 5tobramycin-dexamethasone ............................ 44TOBREX ..........................................................44TODAY CONTRACEPTIVE SPONGE ............28TOFRANIL ...................................................... 27TOLAK ........................................................ 7, 66tolazamide ....................................................... 52tolbutamide ...................................................... 52tolcapone ......................................................... 27tolmetin ............................................................ 27TOLSURA ......................................................... 5tolterodine ........................................................67TOPAMAX .......................................................27TOPCARE CLICKFINE ...................................36TOPCARE ULTRA COMFORT .......................36TOPCARE UNIVERSAL1 LANCET ................36TOPICORT ...................................................... 66
topiramate ........................................................27TOPROL XL .............................................. 12, 19toremifene ....................................................7, 52TORISEL ........................................................... 7torsemide ...................................................19, 41TOUJEO MAX U-300 SOLOSTAR ................. 52TOUJEO SOLOSTAR U-300 INSULIN ...........53TOVIAZ ........................................................... 67TRACLEER ............................................... 19, 59TRADJENTA ...................................................53tramadol ...........................................................27tramadol-acetaminophen .................................27trandolapril .......................................................19trandolapril-verapamil ...................................... 19tranexamic acid ............................................... 15TRANSDERM-SCOP ...................................... 46TRANXENE T-TAB ......................................... 27tranylcypromine ............................................... 27TRANZAREL ...................................................66TRAVATAN Z ..................................................44trazodone .........................................................27TREANDA ......................................................... 7TRECATOR .......................................................5TRELEGY ELLIPTA ............................12, 53, 59TRELSTAR ................................................. 8, 53TREMFYA ....................................................... 66treprostinil sodium ..................................... 19, 59TRESIBA FLEXTOUCH U-100 ....................... 53TRESIBA FLEXTOUCH U-200 ....................... 53TRESIBA U-100 INSULIN ...............................53tretinoin ............................................................66tretinoin (chemotherapy) ....................................8tretinoin (emollient) .......................................... 66tretinoin microspheres ..................................... 66TRETIN-X ........................................................ 66TRETIN-X CREAM KIT ................................... 66TRETTEN ........................................................ 15TREXALL .................................................... 8, 57TREXIMET ...................................................... 27TREZIX ............................................................27TRI FEMYNOR ................................................53triacetin .............................................................. 5TRIADVANCE ..................................... 15, 41, 70triamcinolone acetonide .......................44, 59, 66triamterene-hydrochlorothiazid .................. 19, 41TRIANEX .........................................................66triazolam .......................................................... 27TRIBENZOR ..............................................19, 41TRICARE ...................................................15, 70TRI-CHLOR .....................................................66TRICITRATES .................................................41TRICON ...........................................................15TRICOR ...........................................................19TRIDERM ........................................................ 66TRIDESILON ...................................................66trientine ............................................................46TRI-ESTARYLLA ............................................ 53trifluoperazine .................................................. 27trifluridine ......................................................... 44TRIGELS-F FORTE .................................. 15, 70TRIGLIDE ........................................................19trihexyphenidyl ...........................................12, 27TRIKLO ........................................................... 19TRI-LEGEST FE ..............................................53TRILEPTAL .....................................................27TRI-LINYAH .................................................... 53TRILIPIX ..........................................................19TRI-LO-ESTARYLLA ......................................53TRI-LO-MARZIA ............................................. 53TRI-LO-MILI .................................................... 53TRI-LO-SPRINTEC ......................................... 53TRILYTE WITH FLAVOR PACKETS ............. 46trimethobenzamide .......................................... 46trimethoprim .......................................................5TRI-MILI .......................................................... 53trimipramine .....................................................27TRIMPEX ...........................................................5TRINATAL RX 1 ..................................15, 41, 70TRINATE ............................................. 15, 41, 70
87
TRINTELLIX ....................................................27TRIPHROCAPS .............................................. 70TRIPLE DYE ................................................... 66TRIPLE VITAMIN WITH FLUORIDE ........ 57, 70TRI-PREVIFEM (28) ........................................53TRIPTODUR ................................................8, 53TRI-SPRINTEC (28) ........................................ 53TRISTART DHA ........................................ 15, 70TRIUMEQ .......................................................... 5TRIVEEN-DUO DHA ........................... 15, 41, 70TRIVEEN-ONE .................................... 15, 41, 70TRIVEEN-PRX RNF ...................... 15, 41, 46, 70TRI-VI-FLOR ............................................. 57, 70TRIVISC .......................................................... 36TRI-VITAMIN WITH FLUORIDE ............... 57, 70TRI-VITE WITH FLUORIDE ...................... 57, 70TRIVORA (28) ................................................. 53TRI-VYLIBRA ..................................................53TRI-VYLIBRA LO ............................................53TRIXYLITRAL ................................................. 27TRIZIVIR ............................................................5TROGARZO ...................................................... 5TROKENDI XR ................................................27tropicamide ...................................................... 44trospium ...........................................................67TRUE COMFORT INSULIN SYRINGE ........... 36TRUE COMFORT LANCET ............................ 36TRUE COMFORT PEN NEEDLE ....................36TRUE METRIX GLUCOSE TEST STRIP ........39TRUE METRIX PRO TEST STRIP ..................39TRUEPLUS INSULIN ......................................36TRUEPLUS LANCETS ................................... 36TRUEPLUS PEN NEEDLE ............................. 36TRUETEST TEST STRIPS ............................. 39TRUETRACK TEST ........................................ 39TRULANCE .....................................................46TRULICITY ......................................................53TRUMENBA ...................................................... 9TRUSOPT ....................................................... 44TRUST NATAL DHA .......................................70TRUVADA ......................................................... 5TUBERCULIN SYRINGE ................................ 36tuberculin-allergy syringes ...............................36TUDORZA PRESSAIR ..............................12, 59TULANA ..........................................................53TUSNEL C ...........................................12, 27, 59TUSSICAPS .......................................... 1, 27, 59TWINRIX (PF) ................................................... 9TWIST LANCETS ........................................... 36TWYNSTA .......................................................19TYBOST .......................................................... 57TYDEMY ..........................................................53TYKERB ............................................................8TYLENOL-CODEINE #3 ................................. 27TYLENOL-CODEINE #4 ................................. 27TYMLOS ....................................................53, 57TYPHIM VI .........................................................9TYSABRI .........................................................57TYVASO ....................................................19, 59TYVASO INSTITUTIONAL START KIT ....19, 59TYVASO REFILL KIT ............................... 19, 59TYVASO STARTER KIT ........................... 19, 59TYZINE ............................................................44UCERIS ........................................................... 53UDENYCA .......................................................15ULESFIA ......................................................... 66ULORIC ...........................................................57ULTICARE ...................................................... 36ULTICARE INSULIN SYR HALF UNIT ...........36ULTICARE INSULIN SYRINGE ......................36ULTICARE PEN NEEDLE .............................. 36ULTICARE SAFETY SYRINGE ...................... 36ULTILET ALCOHOL SWAB ........................... 66ULTILET BASIC LANCETS ............................36ULTILET CLASSIC LANCETS ....................... 36ULTILET INSULIN SYRINGE ......................... 36ULTILET LANCETS ........................................36ULTILET PEN NEEDLE ..................................36ULTIMA TEST STRIPS ...................................39
ULTOMIRIS .....................................................57ULTRA COMFORT INSULIN SYRINGE .........36ULTRA FINE LANCETS ................................. 36ULTRA FLO PEN NEEDLE ............................ 36ULTRA THIN II LANCETS .............................. 36ULTRA THIN LANCETS ................................. 36ULTRA THIN PLUS LANCETS ...................... 36ULTRA TLC LANCETS .................................. 36ULTRACARE INSULIN SYRINGE ..................36ULTRA-CARE LANCETS ............................... 36ULTRACARE PEN NEEDLE .......................... 36ULTRACET ..................................................... 27ULTRALANCE LANCETS .............................. 36ULTRAM ......................................................... 27ULTRAM ER ................................................... 27ULTRASAL-ER ............................................... 66ULTRA-THIN II (SHORT) INS SYR ................ 36ULTRA-THIN II (SHORT) PEN NDL ............... 36ULTRA-THIN II INS PEN NEEDLES .............. 36ULTRA-THIN II INSULIN SYRINGE ............... 36ULTRA-THIN II LANCETS ..............................36ULTRATRAK .................................................. 39ULTRATRAK HIGH-LOW CONTROL ............ 36ULTRATRAK NORMAL CONTROL ...............36ULTRATRAK ULTIMATE ............................... 39ULTRAVATE ...................................................66ULTRAVATE X ............................................... 66UMECTA ......................................................... 66UNIFINE PENTIPS ..........................................37UNIFINE PENTIPS PLUS ............................... 37UNILET COMFORTOUCH LANCET .............. 37UNILET EXCELITE II LANCET ...................... 37UNILET EXCELITE LANCET ......................... 37UNILET GP LANCET ......................................37UNILET LANCET ............................................ 37UNILET LANCETS ..........................................37UNILET SUPER THIN LANCETS ...................37UNISTIK 3 COMFORT LANCET .................... 37UNISTIK 3 EXTRA LANCET .......................... 37UNISTIK 3 GENTLE ........................................37UNISTIK 3 LANCETS ..................................... 37UNISTIK 3 NORMAL LANCET .......................37UNISTIK CZT LANCET ...................................37UNISTIK PRO LANCET ..................................37UNISTIK SAFETY ........................................... 37UNISTIK TOUCH LANCETS .......................... 37UNISTRIP HIGH CONTROL ........................... 37UNISTRIP LOW CONTROL ............................37UNISTRIP1 TEST STRIP ................................ 39UNITHROID .....................................................53UNITUXIN ..........................................................8UNIVERSAL 1 LANCETS ...............................37UPTRAVI ...................................................19, 59UR N-C .............................................................. 5URAMAXIN ..................................................... 66URAMAXIN GT ............................................... 66urea ........................................................... 66, 67UREA NAIL STICK ......................................... 66URECHOLINE .................................................12URE-K ............................................................. 67URELLE ............................................................ 5URETRON D-S ..................................................5UREVAZ ..........................................................67URIBEL ............................................................. 5URIMAR-T .........................................................5URIN DS ............................................................5UROCIT-K 10 .................................................. 41UROCIT-K 15 .................................................. 41UROCIT-K 5 .................................................... 41UROGESIC-BLUE ............................................ 5URO-MP ............................................................ 5UROQID-ACID NO.2 .........................................5UROXATRAL .................................................. 12URSO 250 ....................................................... 46URSO FORTE ................................................. 46ursodiol ............................................................ 46URYL .................................................................5USTELL .............................................................5UTIBRON NEOHALER ............................. 12, 59
UTIRA-C ............................................................5UTOPIC ........................................................... 67UVADEX ..........................................................67VAGIFEM ........................................................ 53VAGINAL CONTRACEPTIVE FILM ............... 28VAGINAL CONTRACEPTIVE FOAM ............. 28valacyclovir ........................................................ 5VALCHLOR .................................................8, 67VALCYTE ..........................................................5valganciclovir ..................................................... 5VALIUM ...........................................................27valproic acid .....................................................28valproic acid (as sodium salt) .......................... 28valsartan .......................................................... 19valsartan-hydrochlorothiazide ....................19, 41VALTREX ..........................................................5VANATOL LQ ................................................. 28VANATOL S ....................................................28VANCOCIN ....................................................... 5vancomycin ........................................................5VANDAZOLE .................................................. 67VANISHPOINT SYRINGE ...............................37VANOS ............................................................67VANOXIDE-HC ............................................... 67VANTAS ......................................................8, 53VAQTA (PF) ...................................................... 9vardenafil ......................................................... 19VARITHENA ....................................................19VARITHENA ADMINISTRATION PACK ........ 37VARIVAX (PF) ...................................................9VARUBI ...........................................................46VASCEPA ....................................................... 19VASELINE WHITE PETROLEUM .................. 67VASERETIC .............................................. 19, 41VASOTEC ....................................................... 19VAXCHORA ACTIVE COMPONENT ............... 9VAXCHORA VACCINE .....................................9V-C FORTE ..................................................... 70VCF CONTRACEPTIVE FILM ........................ 28VCF CONTRACEPTIVE GEL ......................... 28VECAMYL ....................................................... 19VECTIBIX .......................................................... 8VECTICAL .......................................................67VELCADE ......................................................... 8VELETRI ................................................... 19, 59VELIVET TRIPHASIC REGIMEN (28) ............ 53VELPHORO .................................................... 41VELTASSA ..................................................... 41VELTIN ............................................................67VEMLIDY ...........................................................5VENA-BAL DHA ................................. 15, 41, 70VENCLEXTA .....................................................8VENCLEXTA STARTING PACK ...................... 8venlafaxine ...................................................... 28VENTAVIS .................................................19, 59VENTOLIN HFA ........................................ 12, 59verapamil ......................................................... 19VERASENS CONTROL SOLN-LEVEL 1 ....... 37VERASENS TEST STRIP ............................... 39VERDESO ....................................................... 67VERDROCET .................................................. 28VEREGEN ....................................................... 67VERELAN ....................................................... 19VERELAN PM ................................................. 19VERIFINE PEN NEEDLE ................................ 37VERIPRED 20 ................................................. 53VERSACLOZ .................................................. 28VERZENIO ........................................................ 8VESICARE ...................................................... 67VEXASYN ....................................................... 37VFEND .............................................................. 5VIAGRA ...........................................................19VIBERZI .......................................................... 46VIBRAMYCIN ....................................................5VIC-FORTE ..................................................... 70VICODIN ..........................................................28VICODIN ES ....................................................28VICODIN HP ....................................................28VICTOZA 2-PAK ............................................. 53
88
VICTOZA 3-PAK ............................................. 53VIDAZA ............................................................. 8VIDEX 2 GRAM PEDIATRIC ............................ 5VIDEX EC ..........................................................5VIEKIRA PAK ................................................... 5VIENVA ........................................................... 53vigabatrin ......................................................... 28VIGADRONE ...................................................28VIGAMOX ........................................................44VIIBRYD .......................................................... 28VIMIZIM ........................................................... 41VIMOVO .................................................... 28, 46VIMPAT ........................................................... 28VINACAL .......................................15, 41, 46, 70VINATE CARE .......................................... 15, 70VINATE DHA RF .......................................15, 70VINATE GT ............................................... 15, 70VINATE II ........................................................ 70VINATE M ................................................. 15, 70VINATE ONE .......................................15, 41, 70VINATE PN CARE .......................................... 70VINATE ULTRA ............................ 15, 41, 46, 70VIOKACE ........................................................ 46VIORELE (28) ................................................. 53VIRACEPT ........................................................ 5VIRAMUNE ....................................................... 5VIRAMUNE XR ................................................. 5VIRASAL .........................................................67VIREAD ............................................................. 5VIRT-ADVANCE ................................. 15, 41, 70VIRT-C DHA ..............................................15, 70VIRT-GARD .....................................................70VIRT-NATE DHA .......................................15, 70VIRT-PHOS 250 NEUTRAL ............................41VIRT-PN DHA ........................................... 15, 70VIRT-PN PLUS ....................................15, 41, 70VIRTPREX .....................................15, 41, 46, 70VIRTRATE-2 ................................................... 41VIRTRATE-K ...................................................41VIRT-SELECT ............................... 15, 41, 46, 70VIRTUSSIN AC ......................................... 28, 59VIRTUSSIN DAC .................................12, 28, 59VIRT-VITE ....................................................... 70VIRT-VITE GT ........................................... 15, 70VISCO-3 .......................................................... 37VISTARIL .................................................... 1, 28VISTOGARD ................................................... 57VISUDYNE ...................................................... 44VIT 3 .......................................................... 19, 70VITAFOL FE+ (WITH DOCUSATE) ..........15, 70VITAFOL GUMMIES ........................... 15, 41, 70VITAFOL NANO ........................................15, 70VITAFOL ULTRA ...................................... 15, 70VITAFOL-OB .......................................15, 41, 70VITAFOL-OB+DHA .............................15, 41, 70VITAFOL-ONE .......................................... 15, 70VITAMED MD ONE RX ............................. 15, 70VITAMEDMD REDICHEW RX ........................ 70VITAMIN D2 .................................................... 70VITAMINS A,C,D AND FLUORIDE .......... 57, 70VITAPEARL .............................................. 15, 70VITATRUE .................................................15, 70VITRAKVI ..........................................................8VIVAGUARD INO TEST STRIP ......................39VIVAGUARD LANCET ................................... 37VIVELLE-DOT .................................................53VIVITROL .................................................. 28, 57VIVLODEX ...................................................... 28VIVOTIF .............................................................9VIZIMPRO ......................................................... 8VOGELXO .......................................................53VOLTAREN ...............................................28, 67VOLTAREN-XR ...............................................28VONVENDI ......................................................15voriconazole ...................................................... 5VORTEX VHC FROG MASK-CHILD .............. 37VORTEX VHC LADYBUG MASK-TODDLR ...37VOSEVI ............................................................. 5VOTRIENT ........................................................ 8
VP-CH PLUS .......................................15, 46, 70VP-CH-PNV ...............................................15, 70VP-PNV-DHA ............................................ 15, 70VPRIV ..............................................................41VP-VITE RX .....................................................70VRAYLAR ....................................................... 28VUSION ...........................................................67VYFEMLA (28) ................................................ 53VYLIBRA .........................................................53VYNDAQEL .....................................................19VYTONE ..........................................................67VYTORIN 10-10 .............................................. 19VYTORIN 10-20 .............................................. 19VYTORIN 10-40 .............................................. 19VYTORIN 10-80 .............................................. 19VYVANSE ....................................................... 28VYXEOS ............................................................8VYZULTA ........................................................ 44warfarin ............................................................15WAVESENSE CONTROL SOLUTION ........... 37WAVESENSE JAZZ ........................................39WAVESENSE PRESTO ..................................39WEBCOL .........................................................67WELCHOL ................................................ 19, 53WELLBUTRIN SR ...........................................28WELLBUTRIN XL ........................................... 28WERA (28) ...................................................... 53WESTHROID ...................................................53WHYTEDERM SURGIPAK ............................. 67WHYTEDERM TDPAK ....................................67WHYTEDERM TRILASIL PAK ....................... 67WIDE-SEAL DIAPHRAGM 60 ........................ 28WIDE-SEAL DIAPHRAGM 65 ........................ 28WIDE-SEAL DIAPHRAGM 70 ........................ 28WIDE-SEAL DIAPHRAGM 75 ........................ 28WIDE-SEAL DIAPHRAGM 80 ........................ 28WIDE-SEAL DIAPHRAGM 85 ........................ 28WIDE-SEAL DIAPHRAGM 90 ........................ 28WIDE-SEAL DIAPHRAGM 95 ........................ 28WILATE ...........................................................15WINRHO SDF ................................................... 9WIXELA INHUB .................................. 12, 53, 59WP THYROID ..................................................53WPR PLUS ................................................28, 67WYMZYA FE ................................................... 53XADAGO .........................................................28XALATAN ....................................................... 44XALKORI .......................................................... 8XANAX ............................................................ 28XANAX XR ...................................................... 28XARELTO ....................................................... 15XATMEP ......................................................8, 57XCLAIR ..................................................... 37, 67XELITRAL ................................................. 28, 67XELJANZ ........................................................ 57XELJANZ XR .................................................. 57XELODA ............................................................8XELPROS ....................................................... 44XENAFLAMM ............................................28, 67XENAZINE ...................................................... 28XEOMIN .................................................... 12, 57XEPI ................................................................ 67XERESE .......................................................... 67XERMELO .......................................................46XGEVA ............................................................ 57XHANCE ................................................... 44, 59XIAFLEX ......................................................... 41XIFAXAN ...........................................................5XIGDUO XR .................................................... 53XIIDRA ............................................................ 44XILAPAK .........................................................67XIMINO ........................................................5, 67XOFIGO ...........................................................57XOFLUZA ..........................................................5XOLAIR ........................................................... 59XOLEGEL ....................................................... 67XOPENEX ................................................. 12, 59XOPENEX CONCENTRATE .....................12, 59XOPENEX HFA .........................................12, 59
XOSPATA ......................................................... 8XRYLIDERM ................................................... 67XRYLIX (DICLOFENAC-KINES TAPE) ....28, 67XTAMPZA ER ................................................. 28XTANDI ............................................................. 8XULANE ..........................................................53XULTOPHY 100/3.6 ........................................ 53XURIDEN ........................................................ 57XYLOCAINE ....................................................53XYLON 10 ....................................................... 28XYNTHA ..........................................................15XYNTHA SOLOFUSE ..................................... 15XYOSTED ....................................................... 53XYREM ............................................................28XYZAL .........................................................1, 60YASMIN (28) ................................................... 53YAZ (28) .......................................................... 53YERVOY ............................................................8YESCARTA .................................................8, 19YF-VAX (PF) ..................................................... 9YONDELIS ........................................................ 8YONSA ..............................................................8YOSPRALA .........................................15, 28, 46YUPELRI ......................................................... 12YUTIQ ..............................................................44YUVAFEM ....................................................... 53zafirlukast ........................................................ 60zaleplon ........................................................... 28ZALTRAP ..........................................................8ZANAFLEX ..................................................... 12ZANTAC ..........................................................46ZARAH ............................................................ 53ZARONTIN ...................................................... 28ZARXIO ........................................................... 15ZATEAN-PN DHA ..................................... 15, 70ZATEAN-PN PLUS ............................. 15, 41, 70ZAVARA ..........................................................70ZAVESCA ....................................................... 57ZEBUTAL ........................................................28ZEGERID .........................................................46ZEJULA .............................................................8ZELAPAR ........................................................28ZELBORAF ....................................................... 8ZEMAIRA ........................................................ 60ZEMBRACE SYMTOUCH ...............................28ZEMPLAR ....................................................... 70ZENATANE ..................................................... 67ZENCHENT (28) ..............................................53ZENPEP .......................................................... 46ZENZEDI ......................................................... 28ZEPATIER .........................................................5ZERIT ................................................................ 5ZESTORETIC ............................................19, 41ZESTRIL ..........................................................19ZETIA .............................................................. 19ZETONNA ................................................. 44, 60ZEYOCAINE ....................................................67ZIAC .................................................... 12, 19, 41ZIAGEN ............................................................. 5ZIANA ..............................................................67zidovudine ......................................................... 5zileuton ............................................................ 60ZILRETTA ....................................................... 53ZINGIBER ................................................. 41, 70ZIOPTAN (PF) .................................................44ziprasidone hcl .................................................28ZIPSOR ........................................................... 28ZIRGAN ...........................................................44ZITHRANOL ....................................................67ZITHROMAX ..................................................... 5ZITHROMAX TRI-PAK ......................................5ZITHROMAX Z-PAK ......................................... 5ZOCOR ............................................................19ZOFRAN ..........................................................46ZOHYDRO ER .................................................28ZOLADEX ................................................... 8, 53ZOLGENSMA ..................................................19ZOLINZA ........................................................... 8zolmitriptan ...................................................... 28
89
ZOLOFT .......................................................... 28zolpidem .......................................................... 28ZOLPIMIST ..................................................... 28ZOMACTON ....................................................53ZOMIG .............................................................28ZOMIG ZMT .................................................... 28ZONALON .......................................................67ZONEGRAN .................................................... 28zonisamide ...................................................... 28ZONTIVITY ......................................................15ZORBTIVE ...................................................... 53ZORTRESS ..................................................... 57ZORVOLEX .....................................................28ZOSTAVAX (PF) ............................................... 9ZOVIA 1/35E (28) ............................................53ZOVIRAX .....................................................5, 67ZTLIDO ............................................................67ZUBSOLV ....................................................... 28ZUMANDIMINE (28) ........................................53ZUPLENZ ........................................................ 46ZYBAN ............................................................ 28ZYCLARA ....................................................... 67ZYDELIG ........................................................... 8ZYFLO .............................................................60ZYKADIA ...........................................................8ZYLET ............................................................. 44ZYLOPRIM ...................................................... 57ZYMAXID ........................................................ 44ZYPITAMAG ................................................... 19ZYPRAM ......................................................... 67ZYPREXA ........................................................28ZYPREXA RELPREVV ................................... 28ZYPREXA ZYDIS ............................................ 28ZYTIGA ............................................................. 8ZYVOX .............................................................. 5
90