employer large group: traditional 2022

2022 Formulary

Employer-sponsored large group (traditional) plans

List of covered drugs

Please read This document contains information about the drugs we cover in this plan

Important Priority Health requires the use of an A-rated generic drug when one is available Even if a drug is on the approved drug list it may not be included in your employerrsquos prescription drug program Check your Priority Health coverage documents and riders to find out if any approved drugs are not included This list changes frequently For the most current information please refer to the ldquoApproved Drug Listrdquo at priorityhealthcom

T1 - $

T2 - $$

T3 - $$$

T4 - $$$$

T5 - $$$$$

T6 - Vaccine Coverage

T9 - $$$$$$$$$

Coverage Levels

AL Age Limits

PA Prior Authorization

PV Preventative

QL Quantity Limits

QL Quantity Limits

SP Limited to a 1 month supply per fill

ST Step Therapy

Below is a list of drug name formatting patterns that may appear in the following pages

List of Patterns

lowercase italics Generic drugs

UPPERCASE BOLD Brand name drugs

2

3

CURRENT AS OF 712022

Medication Coverage Level Restrictions

Antihistamine Drugs

Antihistamine Drugs

promethazine hcl oral tablet 25 mg T1

Ethanolamine Derivatives

carbinoxamine maleate oral solution T1

carbinoxamine maleate oral tablet 4 mg T1


clemastine fumarate oral syrup T9

clemastine fumarate oral tablet 134 mg T9


DICOPANOL FUSEPAQ T9

diphenhydramine hcl oral capsule T9

diphenhydramine hcl oral elixir T9

diphenhydramine hcl oral liquid 125 mg5ml T9

FIRST-MOUTHWASH BLM T2

KARBINAL ER ORAL SUSPENSION EXTENDED RELEASE

T9

RYVENT T9

First Gen Antihist Derivatives Misc

cyproheptadine hcl oral T1

First Generation Antihistamines

ANTIVERT ORAL TABLET 50 MG T9




chlorpheniramine maleate er T9









hydroxyzine hcl oral syrup T1

hydroxyzine hcl oral tablet T1

hydroxyzine pamoate oral capsule 100 mg 50 mg

T1

4



T9

meclizine hcl oral tablet 125 mg 25 mg T9

promethazine hcl oral syrup T1

promethazine hcl oral tablet 125 mg 50 mg T1

promethazine hcl rectal suppository 125 mg 25 mg

T1

PROMETHEGAN RECTAL SUPPOSITORY 125 MG 25 MG

T3

PROMETHEGAN RECTAL SUPPOSITORY 50 MG

T9

RYCLORA ORAL SYRUP T9

RYVENT T9

VISTARIL T3

Other Antihistamines

ALAWAY T1

cimetidine hcl oral solution 300 mg5ml T3

cimetidine oral tablet 200 mg T9

cimetidine oral tablet 300 mg 400 mg 800 mg T1

famotidine oral suspension reconstituted T3

famotidine oral tablet 10 mg 20 mg T9

famotidine oral tablet 40 mg T3




T1

ketotifen fumarate ophthalmic T1

LASTACAFT T3 ST QL (1 bottle per 30 days) AL

nizatidine T3

olopatadine hcl nasal T2

olopatadine hcl ophthalmic solution 01 T1 QL (5 ML per 30 days)


PATADAY OPHTHALMIC SOLUTION 02 T3 ST QL (25 ML per 30 days)

PATANASE T3

PATANOL T3

PAZEO T3 ST

PEPCID ORAL TABLET 20 MG T9


ranitidine hcl oral capsule T3

ranitidine hcl oral syrup 75 mg5ml T3

ranitidine hcl oral tablet 150 mg 75 mg T9

5


ranitidine hcl oral tablet 300 mg T3

VISTARIL T3

ZADITOR T1

ZANTAC 150 MAXIMUM STRENGTH T9

ZANTAC ORAL TABLET 300 MG T3

Phenothiazine Derivatives


promethazine hcl oral tablet T1


T1

promethazine vccodeine T1

promethazine-codeine oral syrup T1

promethazine-dm oral syrup T1


T3


T9

Propylamine Derivatives

BROMFED DM T9


HISTEX-AC T9

hydrocod polst-cpm polst er oral suspension extended release

T1

maxi-tuss cd T9

pseudoeph-bromphen-dm oral syrup 30-2-10 mg5ml

T1


TUZISTRA XR ORAL SUSPENSION EXTENDED RELEASE

T9

Second Generation Antihistamines

ALAVERT ALLERGYSINUS T9

ALAVERT ORAL TABLET DISPERSIBLE T9

ALLEGRA ALLERGY T9

ALLEGRA ALLERGY CHILDRENS ORAL SUSPENSION

T9

ALLEGRA-D ALLERGY amp CONGESTION T9

ALOMIDE T2

cetirizine hcl childrens alrgy oral solution T9

cetirizine hcl oral tablet T9

cetirizine hcl oral tablet chewable T9

cetirizine-pseudoephedrine er T9

6


childrens loratadine oral syrup T9

CLARINEX ORAL TABLET T9

CLARINEX-D 12 HOUR T9

CLARITIN ORAL SYRUP T9

CLARITIN ORAL TABLET T9

CLARITIN REDITABS T9

CLARITIN-D 12 HOUR T9


desloratadine oral tablet T9

fexofenadine hcl oral tablet 180 mg 60 mg T9

fexofenadine-pseudoephed er oral tablet extended release 24 hour

T9

levocetirizine dihydrochloride oral T9

loratadine oral tablet T9

loratadine-d 24hr T9

QUZYTTIR T9

SEMPREX-D T9

ZYRTEC ALLERGY ORAL TABLET T9

ZYRTEC-D ALLERGY amp CONGESTION T9

Anti-Infective Agents

1St Generation Cephalosporin Antibiotics

cefadroxil T1

cephalexin oral capsule T1

cephalexin oral suspension reconstituted T1

cephalexin oral tablet T2

KEFLEX T3

2Nd Generation Cephalosporin Antibiotics

cefaclor er T1

cefaclor oral capsule 250 mg T1

cefprozil T1

cefuroxime axetil oral tablet T1

3Rd Generation Cephalosporin Antibiotics

cefdinir T1

cefditoren pivoxil oral tablet 400 mg T1

cefixime oral suspension reconstituted T1

cefpodoxime proxetil T1

SPECTRACEF ORAL TABLET 400 MG T3

SUPRAX ORAL CAPSULE T2

SUPRAX ORAL SUSPENSION RECONSTITUTED 100 MG5ML 200 MG5ML

T3

7


SUPRAX ORAL SUSPENSION RECONSTITUTED 500 MG5ML

T2

SUPRAX ORAL TABLET CHEWABLE T3

Adamantane Antivirals

amantadine hcl oral T1

GOCOVRI T9

OSMOLEX ER T9

rimantadine hcl T1

Allylamine Antifungals

LAMISIL ORAL TABLET T3

terbinafine hcl oral T1

Amebicides

FLAGYL T3

METROGEL-VAGINAL T3

metronidazole benzoate T9

metronidazole oral T1

metronidazole vaginal T1

NUVESSA T9

paromomycin sulfate oral T1

VANDAZOLE T1

Aminoglycoside Antibiotics

ARIKAYCE T5PA SP (Limited to a 1 month supply per fill ) QL (28 vials per 28 days)

BETHKIS T5PA SP (Limited to a 56 day supply per fill) QL (280 ML per 56 days)

KITABIS PAK T4PA SP (Limited to a 56 day supply per fill) QL (280 ml per 56 days)


TOBI T5PA SP (Limited to a 56 day supply per fill) QL (280 ML per 56 days)

TOBI PODHALER T5PA SP (Limited to a 1 month supply per fill ) QL (224 Capsules per 28 days)

tobramycin inhalation T4PA SP (Limited to a 56 day supply per fill) QL (280 ml per 56 days)

tobramycin sulfate injection solution 80 mg2ml T1

ZEMDRI T9

Aminomethylcyclines

NUZYRA INTRAVENOUS T9

NUZYRA ORAL TABLET 150 MG T9

SEYSARA T9

8


Aminopenicillin Antibiotics

amoxicill-clarithro-lansopraz T3

amoxicillin oral capsule T1

amoxicillin oral suspension reconstituted T1

amoxicillin oral tablet T1

amoxicillin oral tablet chewable 125 mg 250 mg T1

amoxicillin-pot clavulanate er T1

amoxicillin-pot clavulanate oral suspension reconstituted 200-285 mg5ml 400-57 mg5ml 600-429 mg5ml

T1

amoxicillin-pot clavulanate oral tablet 500-125 mg 875-125 mg

T1

amoxicillin-pot clavulanate oral tablet chewable T1

ampicillin oral capsule T1

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-3125 MG5ML 250-625 MG5ML

T3

AUGMENTIN ORAL TABLET 500-125 MG 875-125 MG

T3

AUGMENTIN XR T3

Anthelmintics

albendazole oral T4SP (Max day supply up to 31 days) QL (6 tablets per 30 Days)

ALBENZA T9

BILTRICIDE T5SP (Limited to a 1 month supply per fill)

EMVERM T9

ivermectin oral T1 QL (10 tablets per 1 claim)

STROMECTOL T3 QL (5 Tablets per 1 day)

Antifungals Miscellaneous

BREXAFEMME T9

griseofulvin microsize oral T1

griseofulvin ultramicrosize T2

Anti-Infectives (Systemic) Misc

PYLERA T9

Antimalarials

ACTICLATE T9

ARAKODA T3

atovaquone-proguanil hcl T1

chloroquine phosphate oral T1

COARTEM T2

DARAPRIM T9

9


DORYX MPC T9

DORYX ORAL TABLET DELAYED RELEASE200 MG 50 MG 80 MG

T9

doxycycline hyclate oral capsule T1

doxycycline hyclate oral tablet 100 mg T1

doxycycline hyclate oral tablet 50 mg 75 mg T9

doxycycline hyclate oral tablet delayed release100 mg 150 mg 200 mg 50 mg 75 mg

T9

doxycycline monohydrate oral capsule 100 mg T1

doxycycline monohydrate oral capsule 150 mg 75 mg

T9

doxycycline monohydrate oral suspension reconstituted

T1

doxycycline monohydrate oral tablet 100 mg 150 mg

T9


T1

hydroxychloroquine sulfate oral tablet 100 mg 300 mg 400 mg

T9

hydroxychloroquine sulfate oral tablet 200 mg T1

KRINTAFEL T1 QL (2 tablets per 365 Days)

LYMEPAK T9

MALARONE T3

mefloquine hcl T1

MINOCIN ORAL CAPSULE 100 MG 50 MG T3

minocycline hcl oral capsule T1

minocycline hcl oral tablet 100 mg T9

minocycline hcl oral tablet 50 mg 75 mg T1

MONDOXYNE NL T9

PLAQUENIL T3

primaquine phosphate oral T1

pyrimethamine oral T4SP (Limited to a 1 month supply per fill)

QUALAQUIN T3 PA

quinidine gluconate er T4SP (Max day supply up to 31 days)

quinidine sulfate oral T1

quinine sulfate oral T1

TARGADOX T9

tetracycline hcl oral T3

VIBRAMYCIN ORAL CAPSULE T3

10


VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED

T3

VIBRAMYCIN ORAL SYRUP T2

Antimycobacterials Miscellaneous

dapsone oral T1

Antiprotozoals Miscellaneous

ALINIA ORAL SUSPENSION RECONSTITUTED

T5SP (Limited to a 1 month supply per fill) QL (60 ML per 6 months)

ALINIA ORAL TABLET T5SP (Limited to a 1 month supply per fill) QL (6 tablets per 6 months)

atovaquone oral T4SP (Limited to a 1 month supply per fill)

BACTRIM T3

BACTRIM DS T3

benznidazole oral tablet 100 mg T3 QL (60 tablets per 1 lifetime) AL

benznidazole oral tablet 125 mg T9

dapsone oral T1

FLAGYL T3

IMPAVIDO T4PA SP (Limited to a 1 month supply per fill )

LAMPIT T3 QL (90 tablets per 30 years) AL

MEPRON T3



NEBUPENT T3

nitazoxanide oral T5SP (Limited to a 1 month supply per fill) QL (6 TABLETS per 6 Months)

pentamidine isethionate inhalation T1

PYLERA T9

SOLOSEC T9

sulfamethoxazole-trimethoprim oral suspension200-40 mg5ml

T1

sulfamethoxazole-trimethoprim oral tablet T1

tinidazole oral T1

Antituberculosis Agents

AVELOX ORAL T3

CIPRO ORAL SUSPENSION RECONSTITUTED T3

CIPRO ORAL TABLET 250 MG 500 MG T3

ciprofloxacin hcl oral T1

11


ciprofloxacin oral suspension reconstituted 500 mg5ml (10)

T1

ciprofloxacin-ciproflox hcl er T1

clarithromycin er T1

clarithromycin oral T1

cycloserine oral T1

ethambutol hcl oral T1

isoniazid oral T1

LEVAQUIN ORAL TABLET T3

levofloxacin oral T1

moxifloxacin hcl oral T1

MYCOBUTIN T2

pretomanid T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

PRIFTIN T2

pyrazinamide oral T1

rifabutin T4SP (Max of 31 days per dispensing)

RIFADIN ORAL T3

rifampin oral T1

SIRTURO T4SP (Limited to a 1 month supply per fill)

Antivirals Miscellaneous

LIVTENCITY T5PA SP (Limited to a 1 month supply per fill) QL (112 tablets per 28 days)

PAXLOVID ORAL TABLET THERAPY PACK20 X 150 MG amp 10 X 100MG

T2

PREVYMIS ORAL T4PA SP (Limited to a 1 month supply per fill)

XOFLUZA (40 MG DOSE) ORAL TABLET THERAPY PACK 1 X 40 MG

T2 QL (1 tablet per 1 fill) AL


T2 QL (2 tablets per 1 fill) AL





Azole Antifungals

CRESEMBA ORAL T4PA SP (Limited to a 1 month supply per fill ) QL (60 Capsules per 30 days)

12


DIFLUCAN T3

fluconazole oral T1

itraconazole oral capsule T2 QL (120 capsules per 30 days)

itraconazole oral solution T4PA SP (Limited to a 1 month supply per fill) QL (600 ML per 30 days)

ketoconazole oral T1

NOXAFIL ORAL TABLET DELAYED RELEASE T4PA SP (Limited to a 1 month supply per fill) QL (180 Tablets per 30 days)

posaconazole T4PA SP (Limited to a 1 month supply per fill) QL (180 tablets per 30 days)

SPORANOX ORAL CAPSULE T9

SPORANOX ORAL SOLUTION T5PA SP (Limited to a 1 month supply per fill) QL (600 ML per 30 days)

SPORANOX PULSEPAK T9

tolsura T9

VFEND ORAL SUSPENSION RECONSTITUTED

T5SP (Limited to a 1 month supply per fill) QL (300 ML per 30 days)

VFEND ORAL TABLET 200 MG T5SP (Limited to a 1 month supply per fill) QL (120 Tablets per 30 days)

VFEND ORAL TABLET 50 MG T5SP (Limited to a 1 month supply per fill) QL (480 tablets per 30 days)

voriconazole oral suspension reconstituted T4SP (Limited to a 1 month supply per fill ) QL (300 ML per 30 days)

voriconazole oral tablet 200 mg T4SP (Limited to a 1 month supply per fill ) QL (120 tablets per 30 days)

voriconazole oral tablet 50 mg T4SP (Limited to a 1 month supply per fill ) QL (480 Tablets per 30 days)

Erythromycin Antibiotics

EES 400 ORAL TABLET T4SP (Limited to a 1 month supply per fill)

EES GRANULES T4SP (Limited to a 1 month supply per fill )

ERYPED 200 T4SP (Limited to a 1 month supply per fill )

13



ERY-TAB T4SP (Limited to a 1 month supply per fill)

ERYTHROCIN STEARATE ORAL TABLET 250 MG

T4SP (Limited to a 1 month supply per fill)

erythromycin base oral T4SP (Limited to a 1 month supply per fill)

erythromycin ethylsuccinate oral suspension reconstituted 200 mg5ml



T4SP (Limited to a 1 month supply per fill )

erythromycin ethylsuccinate oral tablet T4SP (Limited to a 1 month supply per fill)

Fluorocyclines

XERAVA INTRAVENOUS SOLUTION RECONSTITUTED 50 MG

T9

Glycopeptide Antibiotics

FIRVANQ T2

VANCOCIN HCL T9

VANCOCIN ORAL CAPSULE 125 MG T9

vancomycin hcl intravenous solution reconstituted 500 mg

T1

vancomycin hcl oral T9

Hcv Polymerase Inhibitor Antivirals

EPCLUSA T9

HARVONI ORAL PACKET T9

HARVONI ORAL TABLET 45-200 MG T9

HARVONI ORAL TABLET 90-400 MG T9SP ()

ledipasvir-sofosbuvir T5PA SP (Limited to a 1 month supply per fill )

sofosbuvir-velpatasvir T5PA SP (Limited to a 1 month supply per fill )

SOVALDI ORAL PACKET T5PA SP (Limited to a 1 month supply per fill )

SOVALDI ORAL TABLET 200 MG T5PA SP (Limited to a 1 month supply per fill )


14


VIEKIRA PAK T5PA SP (Limited to a 1 month supply per fill ) QL (112 tablets per 28 days)

VOSEVI T5PA SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)

Hcv Protease Inhibitor Antivirals

MAVYRET ORAL PACKET T4SP (Limited to a 1 month supply per fill) QL (140 packets per 28 days)

MAVYRET ORAL TABLET T4SP (Limited to a 1 month supply per fill ) QL (84 tablets per 28 days)



ZEPATIER T4SP (Limited to a 1 month supply per fill ) QL (28 tablets per 28 days)

Hcv Replication Complex Inhibitors

EPCLUSA T9











15


Hiv Entry And Fusion Inhibitors

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED


maraviroc T4SP (Limited to a 1 month supply per fill )

RUKOBIA T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

SELZENTRY ORAL SOLUTION T4SP (Limited to a 1 month supply per fill)

SELZENTRY ORAL TABLET 150 MG 300 MG T5SP (Limited to a 1 month supply per fill)


Hiv Integrase Inhibitor Antiretrovirals

BIKTARVY ORAL TABLET 30-120-15 MG T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 Days)

BIKTARVY ORAL TABLET 50-200-25 MG T4SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)

DOVATO T4SP (Limited to a 1 month supply per fill) QL (30 tablet per 30 days)

GENVOYA T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

ISENTRESS T4SP (Limited to a 1 month supply per fill)

ISENTRESS HD T4SP (Limited to a 1 month supply per fill)

JULUCA T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

STRIBILD T4SP (Limited to a 1 month supply per fill)

TIVICAY ORAL TABLET 10 MG 25 MG T4SP (Limited to a 1 month supply per fill)

TIVICAY ORAL TABLET 50 MG T4SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

TIVICAY PD T4SP (Limited to a 1 month supply per fill)

TRIUMEQ T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

16


TRIUMEQ PD T4SP (Limited to a 1 month supply per fill) QL (180 tablets per 30 days)

vocabria T9

Hiv Nonnucleoside RevTranscrip Inhib

ATRIPLA T5SP (Limited to a 1 month supply per fill)



COMPLERA T4SP (Limited to a 1 month supply per fill)

DELSTRIGO T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

EDURANT T2

efavirenz T2

efavirenz-emtricitab-tenofovir T4SP (Limited to a 1 month supply per fill)

efavirenz-lamivudine-tenofovir T4SP (Max of 31 day supply per dispensing) QL (30 tablets per 30 Days)

etravirine oral tablet 100 mg T4SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 Days)


INTELENCE ORAL TABLET 100 MG T5SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)




methocarbamol oral tablet 500 mg T1

nevirapine er T3 QL (30 tablets per 30 days)

nevirapine oral suspension T1 QL (1200 ML per 30 days)

17


nevirapine oral tablet T1 QL (60 tablets per 30 days)

ODEFSEY T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

PIFELTRO T4SP (Max of 31 days supply per dispensing ) QL (30 tablets per 30 days)

SUSTIVA T5SP (Limited to a 1 month supply per fill )

SYMFI T5SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

SYMFI LO T5SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

VIRAMUNE ORAL SUSPENSION T3 QL (1200 ML per 30 days)

VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 400 MG

T3 QL (30 tablets per 30 days)

Hiv Nucleoside Nucleotide Rt Inhibitors

abacavir sulfate oral solution T1 AL

abacavir sulfate oral tablet T2

abacavir-lamivudine-zidovudine T4SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)




CIMDUO T9

COMBIVIR T5SP (Limited to a 1 month supply per fill)



DESCOVY T9

didanosine oral capsule delayed release 200 mg 250 mg 400 mg

T1


18




emtricitabine T3

emtricitabine-tenofovir df oral tablet 100-150 mg 133-200 mg 167-250 mg


emtricitabine-tenofovir df oral tablet 200-300 mg T2

EMTRIVA ORAL CAPSULE T5

SP (Limited to a 1 month supply per fill

)

EMTRIVA ORAL SOLUTION T2SP ()

EPIVIR T3

EPIVIR HBV ORAL SOLUTION T2

EPIVIR HBV ORAL TABLET T3

EPZICOM T4SP (Limited to a 1 month supply per fill)


lamivudine oral solution T1

lamivudine oral tablet T2

lamivudine-zidovudine T2


RETROVIR ORAL CAPSULE T3

RETROVIR ORAL SYRUP T3

stavudine oral capsule T1




SYMTUZA T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

TEMIXYS T9

tenofovir disoproxil fumarate T1

19




TRIZIVIR T5SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

TRUVADA T5SP (Limited to a 1 month supply per fill )

VIDEX EC T3

VIDEX ORAL SOLUTION RECONSTITUTED 2 GM

T2

VIREAD ORAL POWDER T4SP (Limited to a 1 month supply per fill)

VIREAD ORAL TABLET 150 MG 200 MG 250 MG


VIREAD ORAL TABLET 300 MG T5SP (Limited to a 1 month supply per fill)

ZIAGEN ORAL SOLUTION T2

ZIAGEN ORAL TABLET T3

zidovudine oral capsule T2

zidovudine oral syrup T1

zidovudine oral tablet T2

Hiv Protease Inhibitor Antiretrovirals

APTIVUS T4ST SP (Limited to a 1 month supply per fill)

atazanavir sulfate T4SP (Limited to a 1 month supply per fill)

CRIXIVAN ORAL CAPSULE 200 MG 400 MG T2

EVOTAZ T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

fosamprenavir calcium T4SP (Limited to a 1 month supply per fill)

INVIRASE ORAL TABLET T4SP (Limited to a 1 month supply per fill)

KALETRA ORAL SOLUTION T5SP (Limited to a 1 month supply per fill)

KALETRA ORAL TABLET T5SP (Limited to a 1 month supply per fill)

LEXIVA ORAL SUSPENSION T4SP (Limited to a 1 month supply per fill)

20


LEXIVA ORAL TABLET T5SP (Limited to a 1 month supply per fill)

lopinavir-ritonavir T4SP (Limited to a 1 month supply per fill)

NORVIR ORAL SOLUTION T4SP (Limited to a 1 month supply per fill)

NORVIR ORAL TABLET T9

PREZCOBIX T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

PREZISTA ORAL SUSPENSION T4SP (Limited to a 1 month supply per fill)

PREZISTA ORAL TABLET 150 MG 600 MG 75 MG 800 MG


REYATAZ ORAL CAPSULE 150 MG 200 MG 300 MG


REYATAZ ORAL PACKET T4SP (Limited to a 1 month supply per fill)

ritonavir T1


VIRACEPT ORAL TABLET T4SP (Limited to a 1 month supply per fill)

Interferon Antivirals

BESREMI T5PA SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)

INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT 18000000 UNIT


INTRON A INJECTION SOLUTION RECONSTITUTED 50000000 UNIT


PEGASYS SUBCUTANEOUS SOLUTION 180 MCGML

T4SP (Limited to a 1 month supply per fill ) QL (48 Weeks per 1 Lifetime)

PEGASYS SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T4SP (Limited to a 1 month supply per fill ) QL (48 weeks per 1 lifetime)

Lincomycin Antibiotics

CLEOCIN ORAL CAPSULE 150 MG 300 MG T3

CLEOCIN ORAL CAPSULE 75 MG T2

CLEOCIN ORAL SOLUTION RECONSTITUTED T2

clindamycin hcl oral T1

clindamycin palmitate hcl T1

21


Monobactam Antibiotics

CAYSTON T4PA SP (Limited to a 1 month supply per fill )

Natural Penicillin Antibiotics

penicillin v potassium T1

Neuraminidase Inhibitor Antivirals

oseltamivir phosphate oral capsule T1 QL (10 capsules per 1 fill)

oseltamivir phosphate oral suspension reconstituted

T1 QL (120 ML per 1 fill)

RELENZA DISKHALER T3

TAMIFLU ORAL CAPSULE T3 QL (10 capsules per 1 fill)

TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MGML


Nucleoside And Nucleotide Antivirals

acyclovir oral T1

adefovir dipivoxil T4SP (Limited to a 1 month supply per fill)

BARACLUDE ORAL SOLUTION T5SP (Limited to a 1 month supply per fill)

BARACLUDE ORAL TABLET T5SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

entecavir T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

famciclovir oral T1 QL (120 tablets per 30 days)

HEPSERA T5SP (Limited to a 1 month supply per fill)

LAGEVRIO T2

molnupiravir T2

ribavirin oral capsule T4SP (Limited to a 1 month supply per fill )

ribavirin oral tablet 200 mg T4SP (Limited to a 1 month supply per fill )

SITAVIG T9

valacyclovir hcl oral T1

VALCYTE ORAL SOLUTION RECONSTITUTED

T5SP (Max of 31 days per dispensing) QL (540 ML per 30 days) AL

VALCYTE ORAL TABLET T9

22


valganciclovir hcl oral solution reconstituted T4SP (Limited to a 1 month supply per fill) QL (540 ML per 30 days) AL

valganciclovir hcl oral tablet T4SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

VALTREX ORAL TABLET 1 GM T2

VALTREX ORAL TABLET 500 MG T3

VEMLIDY T4SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

ZOVIRAX ORAL T3

Other Macrolide Antibiotics


azithromycin oral suspension reconstituted T1

azithromycin oral tablet 250 mg 500 mg 600 mg T1



DIFICID ORAL TABLET T5ST SP (Limited to a 1 month supply per fill) QL (20 tablets per 30 days)

ZITHROMAX ORAL PACKET T2

ZITHROMAX ORAL SUSPENSION RECONSTITUTED

T3

ZITHROMAX ORAL TABLET 600 MG T3

ZITHROMAX TRI-PAK T3

ZITHROMAX Z-PAK T3

Oxazolidinone Antibiotics

linezolid oral suspension reconstituted T4SP (Limited to one 14 day supply per 6 months (180 days)) AL

linezolid oral tablet T2 QL (28 tablets per 14 days)

SIVEXTRO ORAL T4PA SP (Limited to a 1 month supply per fill )

ZYVOX ORAL SUSPENSION RECONSTITUTED

T5SP (Limited to one 14 day supply per 6 months (180 days)) AL

ZYVOX ORAL TABLET T5SP (Limited to one 14 day supply per 6 months (180 days)) QL (28 tablets per 14 days)

Penicillinase-Resistant Penicillins

dicloxacillin sodium T1

Pleuromutilins

XENLETA ORAL T9

23


Polyene Antifungals

nystatin mouththroat T1

nystatin oral tablet T1

Polymyxin Antibiotics

colistimethate sodium (cba) T9

Quinolone Antibiotics

AVELOX ORAL T3

BAXDELA T9





T1





ofloxacin oral tablet 300 mg 400 mg T1

Rifamycin Antibiotics

AEMCOLO T2 QL (12 tablets per 30 Days) AL

MYCOBUTIN T2

PRIFTIN T2


RIFADIN ORAL T3

rifampin oral T1

XIFAXAN ORAL TABLET 200 MG T4SP (Max of 31 day supply per dispensing ) QL (9 tablets per 30 days)

XIFAXAN ORAL TABLET 550 MG T4PA SP (Limited to a 14 or 30 day supply per fill depending on diagnosis)

Sulfonamide Antibiotics (Systemic)

AZULFIDINE T3

AZULFIDINE EN-TABS T3

BACTRIM T3

BACTRIM DS T3

sulfadiazine oral T2


T1


24


sulfasalazine oral T1

Tetracycline Antibiotics

ACTICLATE T9

demeclocycline hcl oral T3

DORYX MPC T9


T9

doxycycline T9





T9



T9


T1


T9


T1

LYMEPAK T9


minocycline hcl er oral tablet extended release 24 hour 115 mg 135 mg 45 mg 55 mg 65 mg 90 mg

T9




MINOLIRA T9

MONDOXYNE NL T9

MORGIDOX COMBINATION T9

ORACEA T9

PYLERA T9

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR 105 MG 115 MG 55 MG 65 MG 80 MG

T9

TARGADOX T9



25



T3


XIMINO T9

Urinary Anti-Infectives

BACTRIM T3

BACTRIM DS T3

fosfomycin tromethamine T1 QL (1 packet per 30 days)

FURADANTIN T5SP (Limited to a 1 month supply per fill)

HYOPHEN T9

MACROBID T3

MACRODANTIN ORAL CAPSULE 100 MG 50 MG

T3

MACRODANTIN ORAL CAPSULE 25 MG T2

methenamine hippurate T1

MONUROL T3 QL (1 packet per 30 days)

nitrofurantoin macrocrystal oral capsule 100 mg 50 mg

T1

nitrofurantoin monohyd macro T1

nitrofurantoin oral suspension T4SP (Limited to a 1 month supply per fill)

PRIMSOL T9


T1


trimethoprim oral T1

URIBEL T9

Antineoplastic Agents


abiraterone acetate oral tablet 250 mg T4PA SP (Max of 14 day supply per fill)

abiraterone acetate oral tablet 500 mg T9

AFINITOR T5PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

AFINITOR DISPERZ T5PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

ALECENSA T5PA SP (Max of 14 day supply per fill)

ALKERAN ORAL T3

26


ALUNBRIG ORAL TABLET 180 MG T5PA SP (Max of 14 day supply per fill) QL (1 tablet per 1 day)

ALUNBRIG ORAL TABLET 30 MG T5PA SP (Max of 14 day supply per fill) QL (42 tablets per 14 days)


ALUNBRIG ORAL TABLET THERAPY PACK T5PA SP (Max of 14 day supply per fill) QL (1 tablet per 1 day)

anastrozole oral T1

ARIMIDEX T3

AROMASIN T3

AYVAKIT ORAL TABLET 100 MG 200 MG 300 MG

T4PA SP (Max of 14 day supply per fill) QL (14 Tablets per 14 days)

AYVAKIT ORAL TABLET 25 MG 50 MG T4PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

BALVERSA ORAL TABLET 3 MG 4 MG T4PA SP (Max of 14 day supply per fill) QL (28 tablets per 14 days)

BALVERSA ORAL TABLET 5 MG T4PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)


bexarotene oral T4PA SP (Max of 14 day supply per fill )

bicalutamide T1

BOSULIF ORAL TABLET 100 MG T5PA SP (Max of 14 day supply per fill )

BOSULIF ORAL TABLET 400 MG 500 MG T5PA SP (Max of 14 day supply per fill)

BRAFTOVI T5PA SP (Max of 15 day supply per fill)

BRUKINSA T5PA SP (Max of 14 day supply per fill) QL (56 tablets per 14 days)

CABOMETYX T4PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

CALQUENCE T5PA SP (Max of 14 day supply per fill) QL (28 capsules per 14 days)

capecitabine oral tablet 150 mg T4SP (Limited to a 1 month supply per fill)

capecitabine oral tablet 500 mg T4SP (Limited to a 1 month supply per fill )

27


CAPRELSA T4PA SP (Max of 14 day supply per fill) QL (14 tablet per 14 days)

CASODEX T3

COMETRIQ (100 MG DAILY DOSE) ORAL KIT80 amp 20 MG

T4PA SP (Max of 14 day supply per fill)

COMETRIQ (140 MG DAILY DOSE) ORAL KIT3 X 20 MG amp 80 MG


COMETRIQ (60 MG DAILY DOSE) T4PA SP (Max of 14 day supply per fill )

COPIKTRA ORAL CAPSULE 15 MG T5PA SP (Limited to a 1 month supply per fill) QL (60 capsules per 30 days)


COTELLIC T4PA SP (Limited to a 1 month supply per fill)

cyclophosphamide oral T3

DAURISMO ORAL TABLET 100 MG T5PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

DAURISMO ORAL TABLET 25 MG T5PA SP (Max of 14 day supply per fill ) QL (14 tablets per 14 days)

DROXIA T3

EMCYT T2

ERIVEDGE T4PA SP (Limited to a 1 month supply per fill )

ERLEADA T4PA SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)

erlotinib hcl T4PA SP (Max of 14 day supply per fill)

etoposide oral T4SP (Limited to a 1 month supply per fill)

everolimus oral tablet 10 mg 25 mg 5 mg 75 mg

T4PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

everolimus oral tablet soluble T4PA SP (Max of 14 day supply per fill) QL (14 tablets per 14 days)

exemestane T2

EXKIVITY T4PA SP (Max of 14 day supply per fill) QL (56 capsules per 14 days)

FARESTON T9

28


FARYDAK ORAL CAPSULE 10 MG 20 MG T5PA SP (Max of 14 day supply per fill) QL (6 capsules per 1 fill)

FARYDAK ORAL CAPSULE 15 MG T5

PA SP (Max of 14 day supply per fill

) QL (6 capsules per 1 fill)

FEMARA T3

flutamide T1

FOTIVDA T5PA SP (Limited to a 1 month supply per fill ) QL (28 capsules per 28 days)

GAVRETO T4PA SP (Limited to a 1 month supply per fill) QL (120 capsules per 30 days)

GILOTRIF ORAL TABLET 20 MG T4PA SP (Limited to a 1 month supply per fill) QL (30 tablet per 30 days)

GILOTRIF ORAL TABLET 30 MG T4PA SP (Limited to a 1 month supply per fill ) QL (30 tablet per 30 days)


GLEEVEC T9

GLEOSTINE ORAL CAPSULE 10 MG 100 MG 40 MG

T3

HYCAMTIN ORAL T4SP (Limited to a 1 month supply per fill)

HYDREA T3

hydroxyurea oral T1

IBRANCE ORAL CAPSULE 100 MG 125 MG T4PA SP (Limited to a 1 month supply per fill) QL (21 tablets per 28 days)

IBRANCE ORAL CAPSULE 75 MG T4PA SP (Limited to a 1 month supply per fill ) QL (21 tablets per 28 days)

IBRANCE ORAL TABLET T4PA SP (Limited to a 1 month supply per fill) QL (21 tablets per 28 days)

ICLUSIG ORAL TABLET 10 MG T5PA SP (Max of 14 day supply per fill)

ICLUSIG ORAL TABLET 15 MG 45 MG T5PA SP (Max of 14 day supply per fill)

29


ICLUSIG ORAL TABLET 30 MG T5PA SP (Max of 14 day supply per fill )

IDHIFA T4PA SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)

imatinib mesylate oral tablet 100 mg T4PA SP (Max of 14 day supply per fill) QL (90 tablets per 30 days)


IMBRUVICA ORAL CAPSULE 140 MG T5PA SP (Limited to a 1 month supply per fill) QL (90 capsules per 30 days)


IMBRUVICA ORAL TABLET 140 MG 560 MG T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)


INLYTA ORAL TABLET 1 MG T4PA SP (Max of 14 day supply per fill)


INQOVI T5PA SP (Limited to a 1 month supply per fill ) QL (5 tablets per 28 days)

INREBIC T5PA SP (Limited to a 1 month supply per fill ) QL (120 capsules per 30 days)





IRESSA T4PA SP (Max of 14 day supply per fill)

JAKAFI ORAL TABLET 10 MG 15 MG 20 MG T4PA SP (Limited to a 1 month supply per fill )

JAKAFI ORAL TABLET 25 MG 5 MG T4PA SP (Limited to a 1 month supply per fill )

30


KISQALI (200 MG DOSE) T5PA SP (Limited to a 1 month supply per fill) QL (63 tablets per 28 days)



KISQALI FEMARA (400 MG DOSE) T4PA SP (Limited to a 1 month supply per fill) QL (91 tablets per 28 days)


KISQALI FEMARA(200 MG DOSE) T4PA SP (Limited to a 1 month supply per fill) QL (91 tablets per 28 days)

KOSELUGO T4PA SP (Limited to a 1 month supply per fill)

lapatinib ditosylate T4PA SP (Max of 14 day supply per fill Limited Distribution medication )

lenalidomide T4SP (Limited to a 1 month supply per fill ) QL (30 capsules per 30 days)

LENVIMA (10 MG DAILY DOSE) T4PA SP (Max of 15 day supply per fill)






LENVIMA (4 MG DAILY DOSE) T4PA SP (Max of 15 day supply per fill )


31


letrozole oral T1

LEUKERAN T4SP (Limited to a 1 month supply per fill)

leuprolide acetate injection T4SP (Limited to a 1 month supply per fill)

LONSURF T5PA SP (Limited to a 1 month supply per fill )

LORBRENA T5PA SP (Max of 14 day supply per fill)

LUMAKRAS T4PA SP (Max of 14 day supply per fill ) QL (112 tablets per 14 days)

LYNPARZA ORAL TABLET T4PA SP (Max of 14 days per dispensing ) QL (56 tablets per 14 days)

LYSODREN T4PA SP (Max of 14 day supply per fill)

MATULANE T4PA SP (Max of 14 day supply per fill)

MEGACE ES T3 ST

megestrol acetate oral suspension 40 mgml T1

megestrol acetate oral suspension 625 mg5ml T9

megestrol acetate oral tablet T1

MEKINIST T5PA SP (Limited to a 1 month supply per fill )

MEKTOVI T5PA SP (Max of 15 day supply per fill)

melphalan T2

mercaptopurine oral T1

methotrexate oral T1

methotrexate sodium injection solution reconstituted

T1

MYLERAN T3

NERLYNX T4PA SP (Limited to a 1 month supply per fill )

NEXAVAR T5PA SP (Max of 14 day supply per fill)

nilutamide T1

32


NINLARO ORAL CAPSULE 23 MG 4 MG T4PA SP (Limited to a 1 month supply per fill ) QL (3 capsules per 28 days)

NINLARO ORAL CAPSULE 3 MG T4PA SP (Limited to a 1 month supply per fill ) QL (3 capsules per 28 days)

NUBEQA T4PA SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)

ODOMZO T5PA SP (Max of 14 day supply per fill) QL (14 capsules per 14 days)

OGIVRI T9

ONUREG T5PA SP (Limited to a 1 month supply per fill) QL (14 tablets per 28 days)

ORGOVYX T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

PEMAZYRE T4PA SP (Limited to a 1 month supply per fill ) QL (14 Tablets per 21 days)

PIQRAY (200 MG DAILY DOSE) T4PA SP (Limited to a 1 month supply per fill ) QL (28 tablets per 28 days)



POMALYST ORAL CAPSULE 1 MG T5PA SP (Limited to a 1 month supply per fill )

POMALYST ORAL CAPSULE 2 MG 3 MG 4 MG

T5PA SP (Limited to a 1 month supply per fill )

PURIXAN T5SP (Limited to a 1 month supply per fill)

QINLOCK T5PA SP (Limited to a 1 month supply per fill) QL (90 Tablets per 30 days)

RETEVMO T4PA SP (Max of 14 day supply per fill) QL (56 capsules per 14 days)

REVLIMID ORAL CAPSULE 10 MG 25 MG T4SP (Limited to a 1 month supply per fill ) QL (30 capsules per 30 days)

33


REVLIMID ORAL CAPSULE 15 MG 20 MG 5 MG

T4SP (Limited to a 1 month supply per fill ) QL (30 capsules per 30 days)

REVLIMID ORAL CAPSULE 25 MG T4SP (Limited to a 1 month supply per fill ) QL (30 capsules per 30 days)

ROZLYTREK T4PA SP (Max of 14 day supply per fill) QL (42 capsules per 14 days) AL

RUBRACA ORAL TABLET 200 MG 250 MG T4PA SP (Max of 14 day supply per fill)

RUBRACA ORAL TABLET 300 MG T4PA SP (Max of 14 day supply per fill )

RYDAPT T4PA SP (Limited to a 1 month supply per fill) QL (56 tablets per 21 days)

SCEMBLIX T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

SIKLOS T9

SOLTAMOX T9

sorafenib tosylate T4PA SP (Max of 14 day supply per fill)

SPRYCEL T4PA SP (Max of 14 day supply per fill)

STIVARGA T5PA SP (Limited to a 1 month supply per fill)

sunitinib malate T4PA SP (Limited to a 1 month supply per fill)

SUTENT ORAL CAPSULE 125 MG 25 MG 375 MG

T5PA SP (Max of 14 day supply per fill )

SUTENT ORAL CAPSULE 50 MG T5PA SP (Max of 14 day supply per fill)

TABLOID T5SP (Limited to a 1 month supply per fill)

TABRECTA T5PA SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)

TAFINLAR T5PA SP (Max of 14 day supply per fill)

TAGRISSO T4PA SP (Max of 15 day supply per fill) QL (15 tablets per 15 days)

34


TALZENNA ORAL CAPSULE 025 MG 1 MG T5PA SP (Max of 14 day supply per fill) QL (14 capsules per 14 days)

TALZENNA ORAL CAPSULE 05 MG 075 MG T5


) QL (14 capsules per 14 days)

tamoxifen citrate oral T1

TARCEVA ORAL TABLET 100 MG T5PA SP (Max of 14 day supply per fill)

TARCEVA ORAL TABLET 150 MG 25 MG T5PA SP (Max of 14 day supply per fill)

TARGRETIN ORAL T5PA SP (Max of 14 day supply per fill)

TASIGNA T4PA SP (Max of 14 day supply per fill) QL (56 capsule per 14 days)

TAZVERIK T4PA SP (Max of 14 day supply per fill) QL (112 Tablets per 14 days)

TEMODAR ORAL CAPSULE 100 MG 180 MG 250 MG


TEMODAR ORAL CAPSULE 140 MG T5PA SP (Limited to a 1 month supply per fill )

temozolomide T4PA SP (Limited to a 1 month supply per fill )

TEPMETKO T5PA SP (Max of 15 day supply per fill) QL (30 tablets per 15 days)

TIBSOVO T4PA SP (Max of 14 day supply per fill)

toremifene citrate T4ST SP (Max day supply up to 31 days) QL (30 tablets per 30 days)

tretinoin oral T4PA SP (Limited to a 14 day supply per fill)

TREXALL T3 ST

TRUSELTIQ (100MG DAILY DOSE) T4PA SP (Limited to a 1 month supply per fill) QL (21 capsules per 28 days)




35


TUKYSA T4PA SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)

TURALIO T5PA SP (Max of 14 day supply per fill) QL (56 capsules per 14 days) AL

TYKERB T5PA SP (Max of 14 day supply per fill Limited Distribution Medication )

UKONIQ T5PA SP (Max of 14 day supply per fill) QL (56 tablets per 14 days)

VENCLEXTA ORAL TABLET 10 MG T5PA SP (Max of 14 day supply per fill)

VENCLEXTA ORAL TABLET 100 MG 50 MG T5PA SP (Max of 14 day supply per fill)

VENCLEXTA STARTING PACK T5PA SP (Max of 14 day supply per fill)

VERZENIO ORAL TABLET 100 MG 200 MG 50 MG

T4PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

VERZENIO ORAL TABLET 150 MG T4PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

VITRAKVI ORAL CAPSULE 100 MG T4PA SP (Max of 14 day supply per fill) QL (28 capsules per 14 days)


VITRAKVI ORAL SOLUTION T4PA SP (Max of 14 day supply per fill) QL (48 ML per 14 days)

VIZIMPRO ORAL TABLET 15 MG T5PA SP (Max of 14 day supply per fill)

VIZIMPRO ORAL TABLET 30 MG 45 MG T5PA SP (Max of 14 day supply per fill )

VONJO T4PA SP (Limited to a 1 month supply per fill) QL (120 capsules per 30 days)

VOTRIENT T4PA SP (Max of 14 day supply per fill)

WELIREG T4PA SP (Max of 14 day supply per fill) QL (42 tablets per 14 days)

36


XALKORI ORAL CAPSULE 200 MG T4PA SP (Max of 14 day supply per fill) QL (28 capsules per 14 days)

XALKORI ORAL CAPSULE 250 MG T4



XATMEP T3 AL

XELODA T5SP (Limited to a 1 month supply per fill )

XOSPATA T4PA SP (Max of 14 day supply per fill) QL (42 tablets per 14 days)

XPOVIO (100 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK 20 MG




XPOVIO (40 MG TWICE WEEKLY) ORAL TABLET THERAPY PACK 20 MG




XPOVIO (60 MG TWICE WEEKLY) T5PA SP (Limited to a 1 month supply per fill ) QL (24 tablets per 28 days)


T5PA SP (Limited to a 1 month supply per fill ) QL (16 EA per 28 days)


XTANDI ORAL CAPSULE T4PA SP (Max of 14 day supply per fill) QL (56 capsules per 14 days)

XTANDI ORAL TABLET 40 MG T4PA SP (Max of 14 day supply per fill) QL (56 tablets per 14 days)


YONSA T9

ZEJULA T4PA SP (Max of 14 day supply per fill ) QL (42 capsules per 14 days)

37


ZELBORAF T4PA SP (Max of 14 day supply per fill )

ZOLINZA T4PA SP (Max of 14 day supply per fill)

ZYDELIG T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

ZYKADIA ORAL TABLET T5PA SP (Max of 14 day supply per fill)

ZYTIGA T9

AntitoxinsImmune GlobToxoidsVaccines

Allergenic Extracts (Therapeutic)

GRASTEK T3 AL

ODACTRA T3 AL

ORALAIR T3 AL

PALFORZIA (12 MG DAILY DOSE) T4PA SP (Limited to a 1 month supply per fill)







PALFORZIA (300 MG MAINTENANCE) T4PA SP (Limited to a 1 month supply per fill) QL (30 packets per 30 days)

PALFORZIA (300 MG TITRATION) T4PA SP (Limited to a 1 month supply per fill) QL (30 packets per 30 days)


38




PALFORZIA INITIAL ESCALATION T4PA SP (Limited to a 1 month supply per fill)

RAGWITEK T3 AL

Antitoxins And Immune Globulins

ZINPLAVA T9

Toxoids

ADACEL INTRAMUSCULAR SUSPENSION 5-2-155 LF-MCG05

T6 - $0 Copay QL (1 Dose per 1 Lifetime)

BOOSTRIX INTRAMUSCULAR SUSPENSION5-25-185 LF-MCG05

T6 - $0 Copay QL (1 dose per 1 lifetime)

BOOSTRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE


diphtheria-tetanus toxoids dt T9

KINRIX INTRAMUSCULAR SUSPENSION T6 - $0 Copay

KINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

T6 - $0 Copay

PENTACEL T6 - $0 Copay

QUADRACEL INTRAMUSCULAR SUSPENSION

T6 - $0 Copay

QUADRACEL INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

T6 - $0 Copay

TDVAX T6 - $0 Copay QL (1 injection per 10 yearss)

TENIVAC T6 - $0 Copay QL (1 dose per 10 years)

tetanus-diphtheria toxoids td T6 - $0 Copay QL (1 dose per 10 years)

VAXELIS T6 - $0 Copay

Vaccines

ACTHIB T9



AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION

T6 - $0 Copay QL (1 injection per 180 days)

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 025 ML



T6 - $0 Copay QL (1 Injection per 180 days)

bcg vaccine T6 - $0 Copay

BEXSERO T6 - $0 Copay QL (2 ML per 1 Lifetime)

39


BIOTHRAX T9





COMIRNATY T6 - $0 Copay

DENGVAXIA T9

ENGERIX-B INJECTION SUSPENSION 10 MCG05ML 20 MCGML

T6 - $0 Copay QL (3 Doses per 1 Lifetime)

FLUAD T6 - $0 Copay QL (1 injection per 180 days)

FLUAD QUADRIVALENT T6 - $0 Copay QL (1 injection per 180 days)

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE


FLUBLOK QUADRIVALENT T6 - $0 Copay QL (1 injection per 180 days)

FLUCELVAX QUADRIVALENT T6 - $0 Copay QL (1 injection per 180 days)

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE


FLUMIST QUADRIVALENT T6 - $0 Copay QL (1 inhalation per 180 days)

FLUZONE HIGH-DOSE QUADRIVALENT T6 - $0 Copay QL (1 injection per 180 days)

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION 05 ML


FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 05 ML


GARDASIL 9 INTRAMUSCULAR SUSPENSION T6 - $0 Copay QL (3 Doses per 1 Lifetime) AL

GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

T6 - $0 Copay QL (3 doses per 1 lifetime) AL

HAVRIX INTRAMUSCULAR SUSPENSION1440 EL UML 720 EL U05ML


HEPLISAV-B INTRAMUSCULAR SOLUTION PREFILLED SYRINGE


HIBERIX INJECTION T9

IMOVAX RABIES T6 - $0 Copay

IPOL INJECTION INJECTABLE T6 - $0 Copay QL (3 Doses per 1 Lifetime)

IXIARO T9

janssen covid-19 vaccine T6 - $0 Copay



T6 - $0 Copay

MENACTRA T6 - $0 Copay QL (1 Dose per 1 Lifetime)

MENQUADFI INTRAMUSCULAR SOLUTION T6 - $0 Copay QL (1 dose per 1 lifetime)

MENVEO T6 - $0 Copay QL (1 Dose per 1 Lifetime)

M-M-R II INJECTION T6 - $0 Copay QL (2 doses per 1 Lifetime)

40


moderna covid-19 vac (booster) intramuscular suspension 50 mcg05ml

T6 - $0 Copay

moderna covid-19 vaccine T6 - $0 Copay

PEDVAX HIB INTRAMUSCULAR SUSPENSION

T9


pfizer covid-19 vac-tris 5-11y T6 - $0 Copay

pfizer-biontech covid-19 vacc T6 - $0 Copay

PNEUMOVAX 23 T6 - $0 Copay QL (3 Doses per 1 Lifetime)

prehevbrio T6 - $0 Copay QL (3 doses per 1 lifetime) AL

PREVNAR 13 T6 - $0 Copay QL (2 Doses per 1 Lifetime)

PREVNAR 20 T6 - $0 Copay


T6 - $0 Copay


T6 - $0 Copay

RABAVERT T6 - $0 Copay

RECOMBIVAX HB INJECTION SUSPENSION10 MCGML 40 MCGML 5 MCG05ML


SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG05ML


SPIKEVAX COVID-19 VACCINE T6 - $0 Copay

stamaril T9

TICOVAC INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 24 MCG05ML

T9

TRUMENBA T6 - $0 Copay QL (3 ML per 1 Lifetime)

TWINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE


TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG05ML

T9

TYPHIM VI INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

T9

VAQTA INTRAMUSCULAR SUSPENSION 25 UNIT05ML 50 UNITML



VAXNEUVANCE T6 - $0 Copay

VIVOTIF T9

YF-VAX T9

ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED

T6 - $0 Copay QL (1 Dose per 1 Lifetime) AL

Autonomic Drugs

Alpha- And Beta-Adrenergic Agonists

ADRENALIN NASAL T9

41




AUVI-Q INJECTION SOLUTION AUTO-INJECTOR

T9

BROMFED DM T9





droxidopa oral capsule 100 mg T5PA SP (Limited to a 1 month supply per fill) QL (180 capsules per 30 days)

droxidopa oral capsule 200 mg 300 mg T5PA SP (Limited to a 1 month supply per fill ) QL (180 capsules per 30 days)

epinephrine hcl (nasal) T9

epinephrine injection solution auto-injector T2 QL (4 pens per 30 days)

EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR

T9

EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR

T9


T9


NORTHERA ORAL CAPSULE 100 MG T9SP ()

NORTHERA ORAL CAPSULE 200 MG 300 MG T9


T1

pseudoephedrine hcl oral tablet 60 mg T9

SEMPREX-D T9

SYMJEPI INJECTION SOLUTION PREFILLED SYRINGE 015 MG03ML

T2 QL (4 syringes per 31 Days)


T2 QL (4 syringes per 30 days)


Alpha-Adrenergic Agonists

CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

clonidine T1

clonidine hcl er T2

42


clonidine hcl oral T1

HISTEX-AC T9

KAPVAY ORAL TABLET EXTENDED RELEASE 12 HOUR

T3

LUCEMYRA T9

maxi-tuss cd T9

methyldopa oral T1

midodrine hcl T1

NEXICLON XR ORAL TABLET EXTENDED RELEASE 24 HOUR

T9


AntimuscarinicsAntispasmodics

ANASPAZ T3

ANORO ELLIPTA T2 QL (1 inhaler per 30 days)

atropine sulfate injection solution prefilled syringe025 mg5ml

T1

ATROVENT HFA T2

belladonna alkaloids-opium rectal suppository162-60 mg

T9

BEVESPI AEROSPHERE T3 ST QL (1 inhaler per 30 days)

BREZTRI AEROSPHERE T9

chlordiazepoxide-clidinium T2

COMBIVENT RESPIMAT T2 QL (2 inhaler per 40 days)

CUVPOSA T3 AL

DARTISLA ODT T9

dicyclomine hcl oral T1

diphenoxylate-atropine oral liquid T1

diphenoxylate-atropine oral tablet 25-0025 mg T1

DONNATAL T9

DUAKLIR PRESSAIR T9

GLYCATE T9

glycopyrrolate injection solution 02 mgml 04 mg2ml

T9

glycopyrrolate oral solution T3 AL

glycopyrrolate oral tablet 1 mg 2 mg T1

HYCODAN T9

hydrocodone bit-homatrop mbr oral solution T1

hydrocodone-homatropine oral syrup T1

hydromet T1

HYOPHEN T9

43


hyoscyamine sulfate er oral tablet extended release 12 hour

T1

hyoscyamine sulfate oral T1

hyoscyamine sulfate sublingual T1

INCRUSE ELLIPTA T2 QL (30 Blisters per 30 Day(s)s)

ipratropium bromide inhalation T1

ipratropium bromide nasal T1

ipratropium-albuterol T1 QL (540 ML per 30 days)

LEVSIN ORAL TABLET T3

LEVSINSL T3

LIBRAX T9

LOMOTIL ORAL TABLET T3

LONHALA MAGNAIR REFILL KIT T9

LONHALA MAGNAIR STARTER KIT T9

methscopolamine bromide oral T2

NULEV T1

oscimin sr T1

pb-hyoscy-atropine-scopolamine oral tablet T9

propantheline bromide oral T1

QBREXZA T9

scopolamine T1

SEEBRI NEOHALER T3 QL (1 inhaler per 30 days)

SPIRIVA HANDIHALER T2

SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 125 MCGACT

T2 QL (1 Inhaler per 30 Days)


T2 QL (1 Inhaler per 30 days)

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 25-25 MCGACT

T2 QL (1 inhaler per 30 days)

SYMAX DUOTAB T3

TRANSDERM-SCOP (15 MG) T3

TRANSDERM-SCOP TRANSDERMAL PATCH 72 HOUR

T3

TRELEGY ELLIPTA T2

TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED 400 MCGACT

T9

URIBEL T9

UTIBRON NEOHALER T3 QL (1 inhaler per 30 days)

YUPELRI T9

Antiparkinsonian Agents

benztropine mesylate oral T1

44






trihexyphenidyl hcl T1

Autonomic Drugs Miscellaneous

apo-varenicline T2 PV QL (60 tablets per 30 Days)

goodsense nicotine mouththroat lozenge 4 mg T1 PV

KLS QUIT2 T3 PV

KLS QUIT4 T3 PV

NICODERM CQ T9

NICORETTE T9

nicotine polacrilex mouththroat gum T1 PV

nicotine polacrilex mouththroat lozenge 2 mg T1 PV

nicotine transdermal patch 24 hour T1 PV

NICOTROL T2 PV QL (1 box per 30 days)

NICOTROL NS T3 PV QL (40 mls per 30 days)

varenicline tartrate oral T2 PV

varenicline tartrate oral tablet T2 PV QL (60 tablets per 30 Days)

Centrally Acting Skeletal Muscle Relaxnt

AMRIX T9

carisoprodol oral tablet 350 mg T9

carisoprodol-aspirin T9

carisoprodol-aspirin-codeine T9

chlorzoxazone oral tablet 250 mg 375 mg 750 mg

T9

chlorzoxazone oral tablet 500 mg T2

cyclobenzaprine hcl er T9

cyclobenzaprine hcl oral tablet 10 mg 5 mg T1

cyclobenzaprine hcl oral tablet 75 mg T9

FEXMID T9

LORZONE T9

metaxalone oral tablet 800 mg T1 ST

methocarbamol oral T1

ROBAXIN ORAL T3

ROBAXIN-750 T3

SKELAXIN T9

SOMA ORAL TABLET 350 MG T9

tizanidine hcl oral T1

ZANAFLEX T3

45


Direct-Acting Skeletal Muscle Relaxants

DANTRIUM ORAL CAPSULE 25 MG 50 MG T3

dantrolene sodium oral T1

Gaba-Derivative Skeletal Muscle Relaxant

baclofen oral solution T9

baclofen oral tablet T1

FLEQSUVY T9

GABLOFEN INTRATHECAL SOLUTION 10000 MCG20ML 20000 MCG20ML 40000 MCG20ML

T9

LYVISPAH T9

OZOBAX T9

Non-Sel Beta-Adrenergic Blocking Agents

BETAPACE ORAL TABLET 120 MG 160 MG 80 MG

T3

BYSTOLIC T3

carvedilol T1

carvedilol phosphate er T2 ST

COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9

labetalol hcl oral T1

nadolol oral tablet 20 mg 40 mg 80 mg T1

nebivolol hcl T1

pindolol T1

propranolol hcl er T1

propranolol hcl oral T1

SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

timolol maleate oral T1

Non-SelAlpha-1-Adrenergic Blocking Agts

CARDURA T3

CARDURA XL T3 ST

doxazosin mesylate oral T1

MINIPRESS T3

46


prazosin hcl oral T1

terazosin hcl oral T1

Non-SelAlpha-Adrenergic Blocking Agents

CAFERGOT T9

DIBENZYLINE T9

dihydroergotamine mesylate injection T9

dihydroergotamine mesylate nasal T9

ergoloid mesylates oral T1

ERGOMAR T3

ergotamine-caffeine T3 QL (40 tablets per 30 days)

MIGERGOT T9

MIGRANAL T9

phenoxybenzamine hcl oral T9

TRUDHESA T9

Parasympathomimetic (Cholinergic Agents)

ADLARITY T9

ARICEPT T3

bethanechol chloride oral T1

cevimeline hcl T1 QL (90 Capsules per 30 days)

donepezil hcl T1

EVOXAC T2 QL (90 capslues per 30 days)

EXELON TRANSDERMAL T3 QL (30 patches per 30 days)

galantamine hydrobromide T1

galantamine hydrobromide er T1

MESTINON ORAL SYRUP T2

MESTINON ORAL TABLET T3

MESTINON ORAL TABLET EXTENDED RELEASE

T9

NAMZARIC T3ST QL (30 capsules per 30 days) AL

pilocarpine hcl oral T1 QL (120 tablets per 30 days)

pyridostigmine bromide er T9

pyridostigmine bromide oral tablet 60 mg T1

RAZADYNE ER T3SP (Drug name has been changed from Reminyl)

RAZADYNE ORAL TABLET T3

rivastigmine T3 QL (30 patches per 30 days)

rivastigmine tartrate T1 QL (60 capsules per 30 days)

SALAGEN T3

47


Selective Alpha-1-Adrenergic BlockAgent

alfuzosin hcl er T1

carvedilol T1


COREG T3

COREG CR T3 ST

dutasteride-tamsulosin hcl T2 ST

FLOMAX T3

JALYN T3 ST


RAPAFLO T3 ST

silodosin T2 ST

tamsulosin hcl T1

UROXATRAL T3

Selective Beta-2-Adrenergic Agonists

ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9

AIRDUO RESPICLICK 11314 T9



albuterol sulfate er T1

albuterol sulfate hfa inhalation aerosol solution108 (90 base) mcgact

T1 QL (2 inhalers per 30 days)

albuterol sulfate inhalation nebulization solution(25 mg3ml) 0083 (5 mgml) 05 063 mg3ml 125 mg3ml

T1

albuterol sulfate oral T1


ARCAPTA NEOHALER T3

arformoterol tartrate T3 AL


BREO ELLIPTA T9


BROVANA T5SP (Limited to a 1 month supply per fill) AL

budesonide-formoterol fumarate T9


DUAKLIR PRESSAIR T9

DULERA T2 QL (1 inhaler per 31 days)

fluticasone furoate-vilanterol T9

48


fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcgact 100-50 mcgdose 250-50 mcgact 250-50 mcgdose 500-50 mcgact 500-50 mcgdose

T3

fluticasone-salmeterol inhalation aerosol powder breath activated 113-14 mcgact 232-14 mcgact 55-14 mcgact


formoterol fumarate inhalation T4ST SP (Limited to a 1 month supply per fill) AL


levalbuterol hcl inhalation nebulization solution031 mg3ml 063 mg3ml 125 mg05ml 125 mg3ml

T1

levalbuterol tartrate hfa T2

metaproterenol sulfate oral syrup T1

PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9

PROAIR RESPICLICK T9

PROVENTIL HFA T9

SEREVENT DISKUS T2



STRIVERDI RESPIMAT T2 QL (1 inhaler per 30 days) AL

SYMBICORT T2 QL (1 inhaler per 30 days)

terbutaline sulfate oral T1

TRELEGY ELLIPTA T2


VENTOLIN HFA T2 QL (2 inhalers per 25 days)

WIXELA INHUB T3

XOPENEX T3

XOPENEX CONCENTRATE T3

XOPENEX HFA T9

Selective Beta-Adrenergic Blocking Agent

acebutolol hcl oral T1

atenolol oral T1

betaxolol hcl oral T1

bisoprolol fumarate oral T1

KAPSPARGO SPRINKLE T3

LOPRESSOR ORAL T3

metoprolol succinate er T1

metoprolol tartrate oral T1

49


TENORMIN T3

TOPROL XL T3

Skeletal Muscle Relaxants Miscellaneous

norgesic forte T9

orphenadrine citrate er T1

orphenadrine-aspirin-caffeine oral tablet 25-385-30 mg

T9

ORPHENGESIC FORTE ORAL TABLET 770-60-50 MG

T9

Blood Formation Coagulation Thrombosis

Antianemia Drugs

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCGML 200 MCGML 25 MCGML 40 MCGML 60 MCGML


ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG04ML 100 MCG05ML 150 MCG03ML 200 MCG04ML


ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 25 MCG042ML 300 MCG06ML 40 MCG04ML 500 MCGML 60 MCG03ML


EPOGEN INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNITML 3000 UNITML 4000 UNITML


PROCRIT T4SP (Limited to a 1 month supply per fill )

RETACRIT INJECTION SOLUTION 10000 UNITML 2000 UNITML 20000 UNIT2ML 20000 UNITML 3000 UNITML 4000 UNITML 40000 UNITML


Anticoagulants Miscellaneous

ARIXTRA T5SP (Max of 31 days per dispensing )

CEPROTIN T3

fondaparinux sodium T4SP (Max of 31 days per dispensing )

Antithrombotic Agents Miscellaneous

CABLIVI T4

PA SP (Limited to a 1 month supply per fill Limited to 2 fills per 720 days) QL (30 kits per 30 days)

Blood FormCoagThrombosis Agents Misc

OXBRYTA T9

50


PYRUKYND T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

PYRUKYND TAPER PACK T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

TAVALISSE T9

Coumarin Derivatives

COUMADIN ORAL T2

JANTOVEN T1

warfarin sodium oral T1

Direct Factor Xa Inhibitors

BEVYXXA T9

ELIQUIS DVTPE STARTER PACK ORAL TABLET THERAPY PACK


ELIQUIS ORAL TABLET 25 MG T2 QL (60 tablets per 30 days)


SAVAYSA T3 ST QL (30 tablets per 30 days)

XARELTO ORAL SUSPENSION RECONSTITUTED

T2 QL (310 ML per 30 days)

XARELTO ORAL TABLET 10 MG 20 MG T2 QL (30 tablets per 30 days)

XARELTO ORAL TABLET 15 MG T2 QL (42 tablets per 21 days)


XARELTO STARTER PACK T2 QL (1 pack per 180 days)

Direct Thrombin Inhibitors

PRADAXA T3 ST QL (62 tablets per 31 days)

Hematopoietic Agents







DOPTELET ORAL TABLET 20 MG T9



51


FULPHILA T4SP (Limited to a 1 month supply per fill )

GRANIX T5SP (Limited to a 1 month supply per fill )

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 100 MCG03ML 200 MCG03ML 50 MCG03ML 75 MCG03ML

T4SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE 150 MCG03ML 30 MCG03ML


MULPLETA T9

NEULASTA ONPRO T4SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


NEUPOGEN INJECTION SOLUTION 300 MCGML 480 MCG16ML


NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE


NIVESTYM T4SP (Limited to a 1 month supply per fill )

NYVEPRIA T4SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)


PROMACTA ORAL PACKET 125 MG T4PA SP (Limited to a 1 month supply per fill) QL (30 packets per 30 days)


PROMACTA ORAL TABLET T4PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

RELEUKO INJECTION SOLUTION 300 MCGML

T5

releuko injection solution 480 mcg16ml T5

releuko subcutaneous T5

52




UDENYCA T9

ZARXIO T4SP (Limited to a 1 month supply per fill )

ZIEXTENZO T9

Hemorrheologic Agents

pentoxifylline er T1

Hemostatics

ADVATE T4SP (Limited to a 1 month supply per fill )

adynovate T4SP (Limited to a 1 month supply per fill )

AFSTYLA T4SP (Limited to a 1 month supply per fill )

ALPHANATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1500 UNIT 2000 UNIT 250 UNIT 500 UNIT


ALPHANINE SD T5SP (Limited to a 1 month supply per fill )

ALPROLIX T5SP (Limited to a 1 month supply per fill )

AMICAR ORAL SOLUTION T5SP (Limited to a 1 month supply per fill)

AMICAR ORAL TABLET T5SP (Limited to a 1 month supply per fill)

aminocaproic acid oral solution T4SP (Limited to a 1 month supply per fill)

aminocaproic acid oral tablet T4SP (Limited to a 1 month supply per fill)

BENEFIX INTRAVENOUS KIT T4SP (Limited to a 1 month supply per fill )

COAGADEX T4SP (Limited to a 1 month supply per fill)

DDAVP ORAL T3

DDAVP RHINAL TUBE T3

desmopressin ace spray refrig T2 ST QL (10 ML per 30 days)

desmopressin acetate oral tablet 01 mg T1 QL (180 tablets per 30 days)

53


desmopressin acetate oral tablet 02 mg T1

desmopressin acetate spray T2 ST QL (10 ML per 30 days)

ELOCTATE T5SP (Limited to a 1 month supply per fill )

ESPEROCT T5SP (Limited to a 1 month supply per fill )

FEIBA NF INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2500 UNIT 500 UNIT


GELFOAM COMPRESSED SIZE 100 T9

GELFOAM-JMI SPONGE T9

HEMLIBRA T4PA SP (Limited to a 1 month supply per fill)

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 1700 UNIT 250 UNIT 500 UNIT


HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT 250-600 UNIT 500-1200 UNIT


IDELVION T5SP (Limited to a 1 month supply per fill )

IXINITY T4SP (Limited to a 1 month supply per fill )

JIVI T5SP (Limited to a 1 month supply per fill )

KOATE T4SP (Limited to a 1 month supply per fill )

KOGENATE FS T4SP (Limited to a 1 month supply per fill )

KOVALTRY T4SP (Limited to a 1 month supply per fill )

LYSTEDA T3

MONONINE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT


NOCDURNA T9

NOVOEIGHT T4SP (Limited to a 1 month supply per fill )

54


NOVOSEVEN RT T4SP (Limited to a 1 month supply per fill )

NUWIQ INTRAVENOUS KIT 1500 UNIT T4

NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT 2000 UNIT 250 UNIT 2500 UNIT 3000 UNIT 4000 UNIT 500 UNIT


NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1500 UNIT


PROFILNINE T5SP (Limited to a 1 month supply per fill)

REBINYN T5SP (Limited to a 1 month supply per fill )

RECOMBINATE T4SP (Limited to a 1 month supply per fill )

rixubis T5SP (Limited to a 1 month supply per fill ) AL

SEVENFACT T4SP (Limited to a 1 month supply per fill)

STIMATE T4SP (Limited to a 1 month supply per fill )

tranexamic acid oral T1

TRETTEN T5SP (Limited to a 1 month supply per fill )

VONVENDI T5SP (Limited to a 1 month supply per fill )

WILATE INTRAVENOUS KIT T4SP (Limited to a 1 month supply per fill )

XYNTHA INTRAVENOUS KIT 1000 UNIT 2000 UNIT 250 UNIT 500 UNIT


XYNTHA SOLOFUSE T4SP (Limited to a 1 month supply per fill)

Heparins

enoxaparin sodium injection solution T3SP (Limited to a 1 month supply per fill)

enoxaparin sodium injection solution prefilled syringe 100 mgml 120 mg08ml 150 mgml 30 mg03ml 60 mg06ml 80 mg08ml

T4SP (Limited to a 1 month supply per fill) QL (2 syringes per 1 day)

55


enoxaparin sodium injection solution prefilled syringe 40 mg04ml

T4SP (Limited to a 1 month supply per fill) QL (2 syrings per 1 day)

FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNITML


FRAGMIN SUBCUTANEOUS SOLUTION 12500 UNIT05ML 15000 UNIT06ML 18000 UNT072ML


FRAGMIN SUBCUTANEOUS SOLUTION 2500 UNIT02ML 5000 UNIT02ML 7500 UNIT03ML

T5


)

FRAGMIN SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10000 UNITML


FRAGMIN SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 12500 UNIT05ML 15000 UNIT06ML 18000 UNT072ML


FRAGMIN SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 2500 UNIT02ML 5000 UNIT02ML 7500 UNIT03ML

T5


)

heparin sodium (porcine) injection solution 1000 unitml 10000 unitml 5000 unitml

T1

LOVENOX INJECTION SOLUTION T3

LOVENOX INJECTION SOLUTION PREFILLED SYRINGE


Iron Preparations

ACCRUFER T5PA SP (Limited to a 1 month supply per fill ) QL (60 capsules per 30 days)

active fe T9

CENTRATEX T9

CITRANATAL 90 DHA ORAL 90-1 amp 300 MG T3 QL (60 tablets per 30 days)

CITRANATAL ASSURE ORAL 35-1 amp 300 MG T3

CITRANATAL B-CALM T3

CITRANATAL BLOOM T3

CITRANATAL DHA T3

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG

T3

CITRANATAL RX T3

complete natal dha T1

completenate T1

CORVITA 150 T9

CORVITE 150 T9

56


corvite fe T9

DIALYVITE 800IRON T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9

FERREX 150 T9

FERREX 150 FORTE ORAL CAPSULE 150-1-25 MG-MG-MCG

T9

FERREX 150 FORTE PLUS T9

FERREX 150 PLUS T9

FERREX 28 T9

FERROCITE PLUS ORAL TABLET T9

ferrous sulfate oral solution 75 (15 fe) mgml T1 PV AL

FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

FUSION SPRINKLES T9

hematinic plus vitminerals T9

hematinicfolic acid T9

HEMATOGEN T9

HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

HEMATRON-AF T9

HEMAX ORAL TABLET T9

hemetab T9

HEMOCYTE T9

HEMOCYTE PLUS T9

HEMOCYTE-F ORAL TABLET T9

hemocyte-plus oral tablet 106-1 mg T9

ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9

57


MAXARON FORTE ORAL TABLET T9

MAXFE ORAL TABLET T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9

M-VIT T9

myferon 150 forte T9

MYKIDZ IRON FL T9

MYNATAL ORAL TABLET T1

mynatal plus T1

mynatal-z T1

mynate 90 plus T1

NATACHEW ORAL TABLET CHEWABLE 28-1 MG


NATALVIRT FLT T9

NEEVO DHA ORAL CAPSULE 27-113 MG T3

neonatal + dha T9

neonatal complete oral tablet 29-1 mg T9

NEONATAL PLUS T9

NEPHRON FA T9

NEXA PLUS T3

NIVA-PLUS T9

NUFERA T9

O-CAL FA T9

pnv prenatal plus multivitamin T1

pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1

poly-iron 150 forte T9

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1

prenatal (wiron amp fa) T1 PV

prenatal 19 oral tablet 29-1 mg T3 QL (30 tablets per 30 days)

prenatal 19 oral tablet chewable 29-1 mg T1 QL (30 tablets per 30 days)

prenatal low iron oral tablet 27-08 mg T1 PV

prenatal one daily T1 PV

58


prenatal oral tablet 27-08 mg 28-08 mg T1 PV

prenatal plus T1

prenatal plus iron T1

prenatal plus vitaminmineral T3

prenataliron oral tablet T1 PV

PRENATE ESSENTIAL ORAL CAPSULE 18-06-04-300 MG

T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

purefe plus T9

purevit dualfe plus T9

QUFLORA FE T9

SELECT-OB ORAL TABLET CHEWABLE 29-1 MG

T1

se-natal 19 oral tablet chewable T1 QL (30 tablets per 30 days)

se-tan plus T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2

thrivite 19 oral tablet 29-1 mg T9

tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

tristart dha T9

TRIVEEN-DUO DHA T1

VINATE DHA RF T3 QL (30 tablets per 30 days)

VINATE M T1

VINATE ONE T1

VITAFOL ORAL TABLET T9

VITAFOL-NANO T3 QL (30 tablets per 30 days)

VITAFOL-OB T3

VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3

wee care T1 PV AL

59


Liver And Stomach Preparations

cyanocobalamin injection solution 1000 mcgml T1

NASCOBAL T9

neurin-sl T9

Platelet-Aggregation Inhibitors

AGGRENOX T3

ASCRIPTIN ORAL TABLET 325 MG T1

aspirin ec low dose T1 PV AL

aspirin ec oral tablet delayed release 325 mg T1 PV AL

aspirin-dipyridamole er T1

BRILINTA T2

BUFFERIN T3 PV AL

BUFFERIN LOW DOSE ORAL TABLET T3 AL

cilostazol T1

clopidogrel bisulfate oral T1

dipyridamole oral T1

DURLAZA T9

EFFIENT T3 QL (31 tablets per 31 days)

goodsense aspirin oral tablet chewable T1 PV AL

PLAVIX ORAL TABLET 75 MG T3

prasugrel hcl T1 QL (31 tablets per 31 days)

YOSPRALA T9

ZONTIVITY T3 ST QL (30 tablets per 30 days)

Platelet-Reducing Agents

AGRYLIN T3

anagrelide hcl T1

Thrombolytic Agents




BUFFERIN T3 PV AL



Cardiovascular Drugs

Alpha-Adrenergic Blocking Agents

CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

60


COREG CR T3 ST



MINIPRESS T3



Alpha-Adrenergic Blocking Agt(Hypoten)

CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST



MINIPRESS T3



Angiotensin Ii Receptor Antagon(Hypotn)

ATACAND T3

AVAPRO T3

BENICAR T3

candesartan cilexetil T1

COZAAR T3

DIOVAN T3 QL (60 tablets per 30 days)

EDARBI T3 ST

irbesartan T1

losartan potassium oral T1

MICARDIS T3

olmesartan medoxomil oral T1

telmisartan T1

valsartan oral solution T9

valsartan oral tablet T1

Angiotensin Ii Receptor Antagonists

amlodipine besylate-valsartan T1

amlodipine-olmesartan T1

amlodipine-valsartan-hctz T1

ATACAND T3

ATACAND HCT T3

61


AVALIDE ORAL TABLET 150-125 MG 300-125 MG

T3

AVAPRO T3

AZOR T3 ST

BENICAR T3

BENICAR HCT T3

BYVALSON T3 ST


candesartan cilexetil-hctz T1

COZAAR T3


DIOVAN HCT T3

EDARBI T3 ST

EDARBYCLOR T3 ST

ENTRESTO T2 QL (60 tablets per 30 days)

EXFORGE T3

EXFORGE HCT T3

HYZAAR T3

irbesartan T1

irbesartan-hydrochlorothiazide T1


losartan potassium-hctz T1

MICARDIS T3

MICARDIS HCT T3


olmesartan medoxomil-hctz T1

olmesartan-amlodipine-hctz T1

telmisartan T1

telmisartan-amlodipine T1

telmisartan-hctz T1

TRIBENZOR T3

TWYNSTA T3



valsartan-hydrochlorothiazide T1

Angiotensin-ConvertEnzyme Inhib(Hypotn)

ACCUPRIL T3

ALTACE ORAL CAPSULE T3

benazepril hcl oral T1

captopril oral T1

62


enalapril maleate oral solution T2 AL

enalapril maleate oral tablet T1

EPANED ORAL SOLUTION T2 AL

fosinopril sodium T1

lisinopril oral T1

LOTENSIN ORAL TABLET 10 MG 20 MG 40 MG

T3

MAVIK ORAL TABLET 4 MG T3

moexipril hcl T1SP (The generic version is preferred)

perindopril erbumine T1

PRESTALIA T3 ST

PRINIVIL T3

quinapril hcl T1

ramipril T1

trandolapril T1

VASOTEC T3

ZESTRIL T3

Angiotensin-Converting Enzyme Inhibitors

ACCUPRIL T3

ACCURETIC T3


amlodipine besy-benazepril hcl T1


benazepril-hydrochlorothiazide T1

captopril oral T1

captopril-hydrochlorothiazide T1



enalapril-hydrochlorothiazide T1



fosinopril sodium-hctz T1

lisinopril oral T1

lisinopril-hydrochlorothiazide T1

LOTENSIN HCT ORAL TABLET 10-125 MG 20-125 MG 20-25 MG

T3


T3

LOTREL ORAL CAPSULE 10-20 MG 5-10 MG 5-20 MG

T3SP (Generic substitution mandatory)

63


LOTREL ORAL CAPSULE 10-40 MG T3




PRINIVIL T3

QBRELIS T3 AL

quinapril hcl T1

quinapril-hydrochlorothiazide T1

ramipril T1

TARKA ORAL TABLET EXTENDED RELEASE2-180 MG 2-240 MG 4-240 MG

T3

trandolapril T1

trandolapril-verapamil hcl er T1

VASERETIC T3

VASOTEC T3

ZESTORETIC T3

ZESTRIL T3

Antiarrhythmics Miscellaneous

DIGITEK T1

DIGOX T1

digoxin oral solution T1 AL

digoxin oral tablet 125 mcg 250 mcg T1

digoxin oral tablet 625 mcg T9

LANOXIN ORAL TABLET 125 MCG 250 MCG T3

LANOXIN ORAL TABLET 1875 MCG 625 MCG

T9

Antilipemic Agents Miscellaneous

icosapent ethyl T2 PA

JUXTAPID ORAL CAPSULE 10 MG T9SP ( )

JUXTAPID ORAL CAPSULE 20 MG 40 MG 5 MG 60 MG

T9SP ()

JUXTAPID ORAL CAPSULE 30 MG T9

LOVAZA T3

NEXLETOL T3 PA QL (30 tablets per 30 days)

NEXLIZET T3 PA QL (30 tablets per 30 days)

niacin er (antihyperlipidemic) T1

NIASPAN T3

omega-3-acid ethyl esters T1

VASCEPA ORAL CAPSULE 05 GM T3 PA

64



Beta-Adrenergic Blocking Agents


atenolol oral T1

atenolol-chlorthalidone T1


T3



bisoprolol-hydrochlorothiazide T1

BYSTOLIC T3

BYVALSON T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

CORZIDE T3

DUTOPROL T9

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR HCT ORAL TABLET 50-25 MG T3

LOPRESSOR ORAL T3



metoprolol-hctz er T9

metoprolol-hydrochlorothiazide T1


nadolol-bendroflumethiazide oral tablet 80-5 mg T1

nebivolol hcl T1

pindolol T1



propranolol-hctz T1

SORINE T1

sotalol hcl oral T1

65


SOTYLIZE T3

TENORETIC 100 T3

TENORETIC 50 T3

TENORMIN T3


TOPROL XL T3

ZIAC T3

Beta-Adrenergic Blocking Agt(Hypoten)


atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3




pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3

Bile Acid Sequestrants

cholestyramine light T1

66


cholestyramine oral T1

colesevelam hcl oral packet T3 QL (1 packet per 1 day)

colesevelam hcl oral tablet T1 QL (180 tablets per 30 days)

COLESTID T3

colestipol hcl T1

PREVALITE T1

QUESTRAN LIGHT ORAL POWDER T3

QUESTRAN ORAL POWDER T3

WELCHOL ORAL PACKET T3 QL (30 packets per 30 days)

WELCHOL ORAL TABLET T3 QL (180 tablets per 30 days)

Calcium-Channel BlockAgtMisc(Hypoten)

CALAN ORAL TABLET 120 MG T3

CALAN SR ORAL TABLET EXTENDED RELEASE 180 MG 240 MG

T3

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 180 MG 240 MG 300 MG

T3

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 360 MG

T9

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG

T2

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 180 MG 240 MG 300 MG 360 MG 420 MG

T9

CARDIZEM ORAL TABLET 120 MG 30 MG 60 MG

T3

CARTIA XT T1

diltiazem hcl er beads oral capsule extended release 24 hour 360 mg 420 mg

T1

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

T1

diltiazem hcl er coated beads oral capsule extended release 24 hour 360 mg

T9

diltiazem hcl er coated beads oral tablet extended release 24 hour

T9

diltiazem hcl er oral capsule extended release 12 hour

T9

diltiazem hcl oral T1

dilt-xr T1

MATZIM LA T9

TAZTIA XT T1

67


TIADYLT ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG 180 MG 240 MG 300 MG 420 MG

T1

TIAZAC T3

verapamil hcl er oral capsule extended release 24 hour 100 mg 200 mg 240 mg 300 mg 360 mg

T1

verapamil hcl er oral tablet extended release 180 mg 240 mg

T1

verapamil hcl oral T1

VERELAN T3

VERELAN PM T3

Calcium-Channel Blocking Agents Misc



T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9


T3

68


TAZTIA XT T1


T1

TIAZAC T3



T1


T1


VERELAN T3

VERELAN PM T3

Carbonic Anhydrase Inhibitors(Hypoten)

acetazolamide er T1

acetazolamide oral T1

methazolamide oral T2

Cardiac Drugs Miscellaneous

CORLANOR T3 ST

RANEXA T3

ranolazine er T1

VYNDAMAX T4PA SP (Limited to a 1 month supply per fill) QL (30 capsules per 30 days)

VYNDAQEL T4PA SP (Limited to a 1 month supply per fill) QL (120 capsules per 30 days)

Cardiotonic Agents

DIGITEK T1

DIGOX T1






T9

Central Alpha-Agonists

CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

69


clonidine T1

clonidine hcl er T2


guanfacine hcl oral T1


T3

methyldopa oral T1

methyldopa-hydrochlorothiazide T1


T9

Cholesterol Absorption Inhibitors

ezetimibe T1

ezetimibe-rosuvastatin T9

ezetimibe-simvastatin T1


ROSZET T9

VYTORIN T3

ZETIA T3

Class Ia Antiarrhythmics

disopyramide phosphate oral T1

NORPACE T3

NORPACE CR T2



Class Ib Antiarrhythmics

DILANTIN INFATABS T2

DILANTIN ORAL CAPSULE 100 MG T3


DILANTIN ORAL SUSPENSION T3

mexiletine hcl oral T1

PHENYTEK T2

phenytoin oral suspension 125 mg5ml T1

phenytoin oral tablet chewable T1

phenytoin sodium extended oral capsule 100 mg T1



Class Ic Antiarrhythmics

flecainide acetate T1

propafenone hcl T1

70


propafenone hcl er T3

RYTHMOL SR T3 QL (60 capsules per 30 days)

Class Ii Antiarrhythmics


atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3



pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3

Class Iii Antiarrhythmics

amiodarone hcl oral tablet 100 mg T1 QL (30 tablets per 30 days)

amiodarone hcl oral tablet 200 mg T1



T3

dofetilide T2

MULTAQ T3

PACERONE ORAL TABLET 100 MG T2 QL (30 tablets per 30 days)

71


PACERONE ORAL TABLET 200 MG T1


SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TIKOSYN T3

Class Iv Antiarrhythmics



T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1


T1

TIAZAC T3

72



T1


T1


VERELAN T3

VERELAN PM T3

Dihydropyridines (Antihypertensive)

ADALAT CC T3

AFEDITAB CR T1

amlodipine besylate oral T1

CONJUPRI T9

felodipine er T1

isradipine T1

KATERZIA T3 QL (150 ML per 30 yers) AL

levamlodipine maleate oral tablet 5 mg T9

nicardipine hcl oral T2

NIFEDICAL XL ORAL TABLET EXTENDED RELEASE 24 HOUR 60 MG

T1

nifedipine er osmotic release T1

nifedipine oral T1

nimodipine oral T2 QL (21 day supply per 365 days)

nisoldipine er T2

NORLIQVA T3 QL (150 ML per 30 Days) AL

NORVASC T3SP (Generic substitution mandatory)

NYMALIZE ORAL SOLUTION 6 MGML T5ST SP (Limited to a 1 month supply per fill)

PROCARDIA XL T3

SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR 17 MG 34 MG 85 MG

T3

Dihydropyridines

ADALAT CC T3

AFEDITAB CR T1




amlodipine-atorvastatin T9



73


AZOR T3 ST

CADUET ORAL TABLET 10-10 MG 5-10 MG T3

CONJUPRI T9

CONSENSI T9

EXFORGE T3

EXFORGE HCT T3

felodipine er T1

isradipine T1








T1


nifedipine oral T1


nisoldipine er T2





PRESTALIA T3 ST

PROCARDIA XL T3


T3


TRIBENZOR T3

TWYNSTA T3

Direct Vasodilators

BIDIL T3

hydralazine hcl oral T1

isosorb dinitrate-hydralazine T2

minoxidil oral T1

Diuretics Miscellaneous (Hypotensive)

ELIXOPHYLLIN T3

THEO-24 T2

74


theophylline er oral tablet extended release 12 hour 300 mg 450 mg

T1

theophylline er oral tablet extended release 24 hour

T1

Fibric Acid Derivatives

ANTARA ORAL CAPSULE 30 MG 90 MG T9

fenofibrate micronized oral capsule 130 mg 30 mg 90 mg

T9

fenofibrate micronized oral capsule 134 mg 200 mg 43 mg 67 mg

T1

fenofibrate oral capsule 150 mg 50 mg T9

fenofibrate oral tablet 120 mg 40 mg T9

fenofibrate oral tablet 145 mg 160 mg 48 mg 54 mg

T1

fenofibric acid oral capsule delayed release T1

fenofibric acid oral tablet T9

FENOGLIDE T9

FIBRICOR T9

gemfibrozil oral T1

LIPOFEN T9

LOPID T3

TRICOR T3

TRIGLIDE ORAL TABLET 160 MG T9

TRILIPIX T3

Hmg-Coa Reductase Inhibitors

ALTOPREV T9


atorvastatin calcium oral T1


CRESTOR T3

EZALLOR SPRINKLE T9



flolipid T9

fluvastatin sodium T9

fluvastatin sodium er T9

LESCOL XL T9

LIPITOR T3

LIVALO T9

lovastatin oral T1

75


PRAVACHOL ORAL TABLET 20 MG 40 MG 80 MG

T3

pravastatin sodium T1

rosuvastatin calcium T1

ROSZET T9

simvastatin oral suspension T9

simvastatin oral tablet T1

VYTORIN T3

ZOCOR T3 QL (31 tablets per 31 days)

ZYPITAMAG T9

Hypotensive Agents Miscellaneous

DIBENZYLINE T9


VECAMYL T4SP (Limited to a 1 month supply per fill)

Loop Diuretics (Hypotensive Agents)

bumetanide oral T1

DEMADEX ORAL TABLET 10 MG T3

EDECRIN T9

ethacrynic acid oral T9

furosemide oral solution 10 mgml 8 mgml T1

furosemide oral tablet T1

LASIX T3

SOAANZ T9

torsemide oral T1

Mineralocorticoid (Aldosterone) Antagnts

ALDACTAZIDE ORAL TABLET 25-25 MG T3


ALDACTONE T3

CAROSPIR T9

eplerenone T1

INSPRA T3

KERENDIA T4PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

spironolactone oral T1

spironolactone-hctz T1

Mineralocorticoid(Aldoster)Antag(Hypot)

ALDACTONE T3

CAROSPIR T9

eplerenone T1

76


INSPRA T3


Nitrates And Nitrites

BIDIL T3

GONITRO T9

ISORDIL TITRADOSE T9


isosorbide dinitrate oral tablet 10 mg 20 mg 30 mg 5 mg

T1

isosorbide dinitrate oral tablet 40 mg T9

isosorbide mononitrate T1

isosorbide mononitrate er T1

MINITRAN T1

NITRO-BID T1

NITRO-DUR TRANSDERMAL PATCH 24 HOUR01 MGHR 02 MGHR 04 MGHR 06 MGHR

T3

NITRO-DUR TRANSDERMAL PATCH 24 HOUR03 MGHR 08 MGHR

T2

nitroglycerin er T1

nitroglycerin sublingual T1

nitroglycerin transdermal patch 24 hour T1

nitroglycerin translingual solution T2

NITROLINGUAL T3

NITROMIST T3

NITROSTAT T1

NITRO-TIME T1

Pcsk9 Inhibitors

PRALUENT SUBCUTANEOUS SOLUTION AUTO-INJECTOR

T3 PA QL (2 pens per 28 days)

REPATHA T3 PA QL (2 pens per 28 days)

REPATHA PUSHTRONEX SYSTEM T3 PA QL (1 cartridge per 30 days)

REPATHA SURECLICK T3 PA QL (2 pens per 28 days)

Phosphodiesterase Type 5 Inhibitors

ADCIRCA T9

CIALIS T9

cilostazol T1

LEVITRA ORAL TABLET 10 MG 20 MG 5 MG T9

REVATIO ORAL SUSPENSION RECONSTITUTED

T5PA SP (Limited to a 1 month supply per fill) QL (180 ML per 30 days) AL

77


REVATIO ORAL TABLET T5PA SP (Limited to a 1 month supply per fill)

sildenafil citrate oral suspension reconstituted T4PA SP (Limited to a 1 month supply per fill) QL (180 ML per 30 days) AL

sildenafil citrate oral tablet 100 mg 25 mg 50 mg T1 QL (6 tablets per 30 days)

sildenafil citrate oral tablet 20 mg T3 PA

STAXYN T9

STENDRA T9

tadalafil (pah) T9SP ()

tadalafil oral tablet 10 mg 20 mg T1 QL (6 tablets per 30 days)


vardenafil hcl oral T9

VIAGRA T9

Potassium-Sparing Diuretics (Hypoten)

ALDACTONE T3

amiloride hcl oral T1

CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3


Renin Inhibitors

aliskiren fumarate T2 ST

TEKTURNA T9

TEKTURNA HCT T2 ST

Renin-Angioten-Aldost Sys Inhib Misc


Thiazide Diuretics(Hypotensive Agents)

DIURIL T2

hydrochlorothiazide oral T1

Thiazide-Like Diuretics(Hypotensive Agt)

chlorthalidone oral tablet 25 mg 50 mg T1

indapamide oral T1

metolazone T1

THALITONE T9

Vasodilating Agents Miscellaneous

ADALAT CC T3

AFEDITAB CR T1


78




T3


T3


T9


T2


T9


T3

CARTIA XT T1

CAVERJECT T3 QL (6 injections per 30 days)

CAVERJECT IMPULSE T3 QL (6 injections per 30 days)

CONJUPRI T9

CORLANOR T3 ST


T1


T1


T9


T9


T9


dilt-xr T1


EDEX T3 QL (6 units per 30 days)



MATZIM LA T9

MUSE T2 QL (6 pellets per 30 days)



T1


79


nifedipine oral T1





PROCARDIA XL T3

TAZTIA XT T1


T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3

VERQUVO T3 PA QL (30 tablets per 30 days)

Central Nervous System Agents

Adamantanes (Cns)


GOCOVRI T9

OSMOLEX ER T9

Amphetamine Derivatives

diethylpropion hcl er T1

diethylpropion hcl oral T1

LOMAIRA T3 ST

phendimetrazine tartrate T1

phentermine hcl oral capsule 15 mg 30 mg T1

phentermine hcl oral tablet T1

Amphetamines

ADDERALL T3 AL

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 15 MG 5 MG

T3 QL (30 capsules per 30 days) AL



ADZENYS ER T9

ADZENYS XR-ODT T9

80


amphetamine er T9

amphetamine sulfate T3ST QL (180 tablets per 30 days) AL

amphetamine-dextroamphet er T1 QL (60 capsules per 30 days) AL

amphetamine-dextroamphetamine T1 AL

benzphetamine hcl oral tablet 50 mg T1

DESOXYN T9

DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 15 MG

T3 QL (120 capsules per 30 days)

DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG


dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg 15 mg


dextroamphetamine sulfate er oral capsule extended release 24 hour 5 mg


dextroamphetamine sulfate oral solution T1

dextroamphetamine sulfate oral tablet 10 mg T1 QL (180 tablets per 30 days) AL

dextroamphetamine sulfate oral tablet 15 mg 20 mg 30 mg

T1 QL (60 tablets per 30 days) AL


DYANAVEL XR T9

EVEKEO T3ST QL (180 tablets per 30 days) AL

EVEKEO ODT T9

methamphetamine hcl T9

MYDAYIS T9

PROCENTRA T1

VYVANSE ORAL CAPSULE T2 QL (30 capsules per 30 days) AL

VYVANSE ORAL TABLET CHEWABLE T2 QL (30 tablets per 30 days) AL

ZENZEDI ORAL TABLET 10 MG T3 QL (180 tablets per 30 days) AL

ZENZEDI ORAL TABLET 15 MG 25 MG 20 MG 30 MG 75 MG

T9


Analgesics And Antipyretics Misc

acetaminophen-codeine 2 T1



acetaminophen-codeine oral solution T1

ALLZITAL T9

APADAZ T9

apap-caff-dihydrocodeine oral tablet 325-30-16 mg

T9

81


BUPAP ORAL TABLET 50-300 MG T9

butalbital-acetaminophen oral tablet 50-300 mg T9

butalbital-acetaminophen oral tablet 50-325 mg T1 QL (180 tablets per 30 days)

butalbital-apap-caff-cod oral capsule 50-300-40-30 mg

T9



butalbital-apap-caffeine oral capsule 50-300-40 mg

T9

butalbital-apap-caffeine oral tablet 50-325-40 mg T1 QL (180 tablets per 30 days)

ESGIC ORAL TABLET T3

FIORICET ORAL CAPSULE T9

FIORICETCODEINE ORAL CAPSULE 50-300-40-30 MG

T9

gabapentin oral capsule T1

gabapentin oral solution 250 mg5ml T1

gabapentin oral tablet T1

GRALISE ORAL TABLET T3 PA QL (90 tablets per 30 days)

hydrocodoneacetaminophen T1

hydrocodone-acetaminophen oral solution 10-325 mg15ml 25-108 mg5ml 5-217 mg10ml 75-325 mg15ml

T1

hydrocodone-acetaminophen oral tablet 10-300 mg 5-300 mg 75-300 mg

T9

hydrocodone-acetaminophen oral tablet 10-325 mg 25-325 mg 5-325 mg 75-325 mg

T1

HYOPHEN T9

LORTAB ORAL ELIXIR 10-300 MG15ML T9

LYRICA CR T9

NEURONTIN T3

NORCO T3

oxycodone-acetaminophen oral solution T9

oxycodone-acetaminophen oral tablet 10-300 mg 25-300 mg 5-300 mg 75-300 mg

T9


T1

PERCOCET ORAL TABLET 10-325 MG 25-325 MG 5-325 MG 75-325 MG

T3

pregabalin er T9

PRIMLEV T9

PROLATE T9

tramadol-acetaminophen T1

82


TREZIX ORAL CAPSULE 3205-30-16 MG T1 QL (10 capsules per 1 day)

ULTRACET T3

URIBEL T9

VANATOL LQ T9

VICODIN ES ORAL TABLET 75-300 MG T9

VICODIN HP ORAL TABLET 10-300 MG T9

VICODIN ORAL TABLET 5-300 MG T9

VTOL LQ T9

Anorexigenic Agents And Stimulants Misc

QSYMIA T3 ST

Anorexigenic Agents Miscellaneous

CONTRAVE T3 ST

IMCIVREE T9

Anticholinergic Agents (Cns)








Anticonvulsants Miscellaneous

acetazolamide er T1


APTIOM T3 PA QL (60 tablets per 30 days)

BANZEL ORAL SUSPENSION T5PA SP (Limited to a 1 month supply per fill ) QL (2300 ML per 28 days)

BANZEL ORAL TABLET T5PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

BRIVIACT ORAL SOLUTION T3 QL (300 ML per 30 days)

BRIVIACT ORAL TABLET T3 QL (60 tablets per 30 days)

carbamazepine er oral capsule extended release 12 hour

T1 ST

carbamazepine er oral tablet extended release 12 hour 100 mg 200 mg

T1 ST QL (60 tablets per 30 days)

carbamazepine er oral tablet extended release 12 hour 400 mg


carbamazepine oral T1

CARBATROL T3 ST

83


DEPAKOTE T3

DEPAKOTE ER T3

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE

T3

DIACOMIT ORAL CAPSULE 250 MG T5PA SP (Limited to a 1 month supply per fill ) QL (180 capsules per 30 days)


DIACOMIT ORAL PACKET T5PA SP (Limited to a 1 month supply per fill) QL (180 packets per 30 days)

divalproex sodium er oral tablet extended release 24 hour

T1

divalproex sodium oral capsule delayed release sprinkle

T1

divalproex sodium oral tablet delayed release T1

ELEPSIA XR T9

EPIDIOLEX T5PA SP (Limited to a 1 month supply per fill) QL (2 bottles per 30 days)

EPITOL T1

EPRONTIA T9

EQUETRO T3 ST

felbamate oral suspension T2 QL (900 ml per 30 days)

felbamate oral tablet 400 mg T2 QL (210 tablets per 30 days)


FELBATOL ORAL SUSPENSION T3 QL (900 ml per 30 days)

FELBATOL ORAL TABLET 400 MG T3 QL (210 tablets per 30 days)


FINTEPLA T5PA SP (Limited to a 1 month supply per fill) QL (360 ML per 30 days)

FYCOMPA ORAL SUSPENSION T3 QL (680 ML per 30 days) AL

FYCOMPA ORAL TABLET T3ST QL (31 tablets per 31 days) AL




GABITRIL ORAL TABLET 12 MG 4 MG T3 QL (120 tablets per 30 days)

GABITRIL ORAL TABLET 16 MG T3 QL (90 tablets per 30 days)


84



HORIZANT ORAL TABLET EXTENDED RELEASE 300 MG




KEPPRA ORAL T3

KEPPRA XR T3

lacosamide oral solution T2

lacosamide oral tablet T2 QL (60 tablets per 30 days)

LAMICTAL ODT T9

LAMICTAL ORAL TABLET T3

LAMICTAL ORAL TABLET CHEWABLE 25 MG 5 MG

T3

LAMICTAL STARTER T3 QL (1 kit per 365 days)

LAMICTAL XR ORAL KIT T3 ST QL (1 kit per 365 days)

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG 25 MG 50 MG




lamotrigine er oral tablet extended release 24 hour 100 mg 25 mg 50 mg




lamotrigine oral kit 25 amp 50 amp 100 mg T9

lamotrigine oral tablet T1

lamotrigine oral tablet chewable T1

lamotrigine oral tablet dispersible T9

lamotrigine starter kit-blue T1 QL (1 kit per 365 days)

lamotrigine starter kit-green T1 QL (1 kit per 365 days)

lamotrigine starter kit-orange T1 QL (1 kit per 365 days)

lamotrigine titration T9

levetiracetam er T1

levetiracetam oral T1

LYRICA ORAL CAPSULE 100 MG 150 MG 200 MG 25 MG 50 MG 75 MG

T3 ST QL (90 capsules per 30 days)

LYRICA ORAL CAPSULE 225 MG 300 MG T3 ST QL (60 capsules per 30 days)

LYRICA ORAL SOLUTION T3 ST QL (473 ML per 30 days)

NEURONTIN T3

oxcarbazepine T1

OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG 300 MG

T3 PA QL (30 tablets per 30 days)

85


OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HOUR 600 MG


pregabalin oral capsule 100 mg 150 mg 200 mg 25 mg 50 mg 75 mg

T1 QL (90 CAPSULES per 30 days)

pregabalin oral capsule 225 mg T1 QL (60 capsules per 30 days)

pregabalin oral capsule 300 mg T1 QL (60 CAPSULES per 30 days)

pregabalin oral solution T1 QL (473 ML per 30 days)

QUDEXY XR T9

rufinamide oral suspension T4PA SP (Limited to a 1 month supply per fill ) QL (2300 ML per 28 days)

rufinamide oral tablet T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

SABRIL T9

SPRITAM T3 ST QL (60 tablets per 30 Days)

SUBVENITE STARTER KIT-BLUE T3 QL (1 kit per 365 Days)

SUBVENITE STARTER KIT-GREEN T3 QL (1 kit per 365 Days)

SUBVENITE STARTER KIT-ORANGE T3 QL (1 kit per 365 Days)

TEGRETOL ORAL SUSPENSION T3

TEGRETOL ORAL TABLET T3

TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG 200 MG


TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 12 HOUR 400 MG


tiagabine hcl oral tablet 12 mg 4 mg T3 QL (120 tablets per 30 days)

tiagabine hcl oral tablet 16 mg T3 QL (90 tablets per 30 days)


TOPAMAX T3

TOPAMAX SPRINKLE T3 ST

topiramate er T3 ST QL (30 capsules per 30 days)

topiramate oral capsule sprinkle T1 ST

topiramate oral tablet T1

TRILEPTAL T3

TROKENDI XR T9

valproate sodium oral solution T1

valproic acid oral capsule T1

vigabatrin oral packet T5PA SP (Limited to a 1 month supply per fill) QL (180 packets per 30 days) AL

vigabatrin oral tablet T5PA SP (Limited to a 1 month supply per fill) QL (180 tablets per 30 days) AL

86


VIGADRONE T5PA SP (Limited to a 1 month supply per fill) QL (180 packets per 30 days) AL

VIMPAT ORAL SOLUTION T3

VIMPAT ORAL TABLET T3 QL (60 tablets per 30 days)

XCOPRI (250 MG DAILY DOSE) T3 PA QL (60 tablets per 30 days)

XCOPRI (350 MG DAILY DOSE) T3 PA QL (60 Tablets per 30 days)

XCOPRI ORAL TABLET 100 MG 50 MG T3 PA QL (30 Tablets per 30 days)


XCOPRI ORAL TABLET THERAPY PACK T3 PA QL (1 Pack per 30 days)

ZONEGRAN T3

zonisamide oral T1

Antidepressants Miscellaneous

APLENZIN T9

bupropion hcl er (smoking det) T1 PV

bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg 150 mg


bupropion hcl er (sr) oral tablet extended release 12 hour 200 mg


bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg



T1


T9

bupropion hcl oral T1

FORFIVO XL T9

mirtazapine oral T1

REMERON ORAL TABLET 15 MG 30 MG T3

REMERON SOLTAB T3

WELLBUTRIN SR ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG 150 MG


WELLBUTRIN SR ORAL TABLET EXTENDED RELEASE 12 HOUR 200 MG


WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG



T3

Antimanic Agents

ABILIFY MYCITE T9

ABILIFY MYCITE MAINTENANCE KIT T9

ABILIFY MYCITE STARTER KIT T9

87


ABILIFY ORAL TABLET 10 MG 15 MG 2 MG 20 MG


ABILIFY ORAL TABLET 30 MG 5 MG T3 QL (30 EA per 30 days)

aripiprazole oral solution T1

aripiprazole oral tablet T1 QL (60 tablets per 30 days)

aripiprazole oral tablet dispersible T9

asenapine maleate sublingual tablet sublingual10 mg 5 mg


asenapine maleate sublingual tablet sublingual25 mg



T1 ST






CARBATROL T3 ST

DEPAKOTE T3

DEPAKOTE ER T3


T3


T1


T1


EPITOL T1

EQUETRO T3 ST

GEODON ORAL T3

LAMICTAL ODT T9



T3









88












lithium T1

lithium carbonate er T1

lithium carbonate oral T1

LITHOBID T3

olanzapine oral tablet T1

olanzapine oral tablet dispersible T2

quetiapine fumarate er oral tablet extended release 24 hour 150 mg 200 mg 50 mg


quetiapine fumarate er oral tablet extended release 24 hour 300 mg 400 mg


quetiapine fumarate oral tablet 100 mg 200 mg 25 mg 300 mg 50 mg

T1

quetiapine fumarate oral tablet 400 mg T1 QL (60 tablets per 30 days)

RISPERDAL ORAL SOLUTION T3

RISPERDAL ORAL TABLET 05 MG 1 MG 2 MG 3 MG 4 MG

T3

risperidone oral solution T1

risperidone oral tablet T1

risperidone oral tablet dispersible 025 mg T1

risperidone oral tablet dispersible 05 mg 1 mg 2 mg 3 mg 4 mg

T2

SAPHRIS T9

SECUADO T4ST SP (Limited to a 1 month supply per fill) QL (30 Patches per 30 days) AL

SEROQUEL T3

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG 200 MG 50 MG


SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 300 MG 400 MG




89











ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3

Antimigraine Agents Miscellaneous

ANAPROX DS T3




BUFFERIN T3 PV AL


butorphanol tartrate nasal T2

CAFERGOT T9

caffeine citrate oral solution 60 mg3ml T1 AL

CAMBIA T9

DEPAKOTE T3

DEPAKOTE ER T3


T3




T1


T1


EC-NAPROSYN ORAL TABLET DELAYED RELEASE 375 MG

T3

ELYXYB T9

EPRONTIA T9

ERGOMAR T3



90


HEMANGEOL T3 AL

ibuprofen oral tablet 400 mg 600 mg 800 mg T1

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9

ketoprofen er T2 QL (30 capsules per 30 days)

MIGERGOT T9

MIGRANAL T9

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG 500 MG 750 MG

T9

NAPROSYN ORAL TABLET 250 MG 500 MG T3

naproxen oral suspension T1 QL (473 ML per 30 days) AL

naproxen oral tablet T1

naproxen oral tablet delayed release T9

naproxen sodium er T9

naproxen sodium oral tablet 220 mg T9

naproxen sodium oral tablet 275 mg 550 mg T1




TOPAMAX T3




TROKENDI XR T9

TRUDHESA T9



Antipsychotics Miscellaneous

ADASUVE T9

loxapine succinate oral T1

pimozide oral tablet 1 mg T1 QL (300 tablets per 30 days)


AnxiolyticsSedativesAnd HypnoticsMisc

AMBIEN T3 QL (30 tablets per 30 days) AL

AMBIEN CR T3 QL (30 tablets per 30 days) AL

BELSOMRA T3ST QL (30 tablets per 30 days) AL

buspirone hcl oral T1

91


DAYVIGO T3ST QL (30 Tablets per 30 days) AL





EDLUAR T9

eszopiclone T1 QL (30 tablets per 30 days) AL

HETLIOZ T5PA SP (Limited to a 1 month supply per fill )

HETLIOZ LQ T9




T1

INTERMEZZO T9

LUNESTA T3 QL (30 tablets per 30 days) AL

meprobamate T9




T1


T3


T9

ramelteon T1 AL

ROZEREM T3 AL

VISTARIL T3

zaleplon T1 QL (30 capsules per 30 days) AL

zolpidem tartrate er T1 QL (30 tablets per 30 days) AL

zolpidem tartrate oral T1 QL (30 tablets per 30 days) AL

zolpidem tartrate sublingual T9

ZOLPIMIST T3 ST QL (1 bottle per 30 days)

Atypical Antipsychotics

ABILIFY MYCITE T9






92









CAPLYTA T5ST SP (Limited to a 1 month supply per fill) QL (30 Capsules per 30 days)

clozapine oral tablet T1

clozapine oral tablet dispersible T3

CLOZARIL ORAL TABLET 100 MG 25 MG T3


FANAPT T5ST SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

FANAPT TITRATION PACK T5ST SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

FAZACLO ORAL TABLET DISPERSIBLE 100 MG 125 MG 25 MG

T3

GEODON ORAL T3

INVEGA T9

LATUDA T2 QL (30 tablets per 30 days)

LYBALVI T9

NUPLAZID ORAL CAPSULE T9

NUPLAZID ORAL TABLET 10 MG T9



olanzapine-fluoxetine hcl T9

paliperidone er oral tablet extended release 24 hour 15 mg 3 mg 9 mg


paliperidone er oral tablet extended release 24 hour 6 mg







T1


93


REXULTI T5ST SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)



T3





T2

SAPHRIS T9


SEROQUEL T3





SYMBYAX ORAL CAPSULE 12-50 MG 6-25 MG 6-50 MG

T9

VERSACLOZ T5ST SP (Limited to a 1 month supply per fill)

VRAYLAR T5ST SP (Limited to a 1 month supply per fill) QL (30 capsules per 30 days)

ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3

Barbiturates (Anticonvulsants)

MYSOLINE ORAL TABLET 50 MG T3

phenobarbital oral elixir T1

phenobarbital oral tablet T1

primidone oral T1

Barbiturates (Anxiolytic SedativeHyp)

ALLZITAL T9

ASCOMP-CODEINE T2





T9

94





T9


butalbital-asa-caff-codeine T2 QL (180 capsules per 30 days)

butalbital-aspirin-caffeine oral capsule T1 QL (180 tablets per 30 days)

DONNATAL T9




T9

FIORINAL T3 QL (180 capsules per 30 days)




SECONAL T3 QL (28 capsules per 14 days) AL

VANATOL LQ T9

VTOL LQ T9

Benzodiazepines (Anticonvulsants)

ATIVAN ORAL T3

clobazam oral suspension T3 ST

clobazam oral tablet T2 ST

clonazepam oral T1

clorazepate dipotassium T1

DIASTAT ACUDIAL T2

DIASTAT PEDIATRIC T2

DIAZEPAM INTENSOL T2

diazepam oral solution 5 mg5ml T1

diazepam oral tablet T1

diazepam rectal T3

KLONOPIN T3

LORAZEPAM INTENSOL T1

lorazepam oral concentrate 2 mgml T1

lorazepam oral tablet T1

LOREEV XR T9

NAYZILAM T3 QL (4 doses per 30 Days)

ONFI ORAL SUSPENSION T3 ST QL (240 ML per 30 days)

ONFI ORAL TABLET 10 MG 20 MG T3 ST

SYMPAZAN T9

95


TRANXENE-T ORAL TABLET 75 MG T3

VALIUM T3

VALTOCO 10 MG DOSE T3 QL (4 units per 30 days)




Benzodiazepines (AnxiolyticSedativHyp)

alprazolam er oral tablet extended release 24 hour 05 mg 1 mg




ALPRAZOLAM INTENSOL T1 QL (120 ML per 30 days)

alprazolam oral tablet T1

alprazolam oral tablet dispersible T2

ATIVAN ORAL T3

chlordiazepoxide hcl T1

chlordiazepoxide-amitriptyline T1




clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3

estazolam T1 QL (30 tablets per 30 days) AL

flurazepam hcl T1 QL (30 capsules per 30 days) AL

HALCION T3 QL (60 tablets per 30 days) AL

KLONOPIN T3

LIBRAX T9




LOREEV XR T9

midazolam hcl oral T1



96


oxazepam T1

quazepam T9

RESTORIL T3 QL (30 capsules per 30 days) AL

SYMPAZAN T9

temazepam oral capsule 15 mg 30 mg T1 QL (30 capsules per 30 days) AL

temazepam oral capsule 225 mg 75 mg T9


triazolam oral tablet 0125 mg T1 QL (30 tablets per 30 days) AL


VALIUM T3

XANAX T3

XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 05 MG 1 MG




Butyrophenones

haloperidol lactate injection solution 5 mgml T1

haloperidol oral T1

Calcitonin Gene-Related Peptide Antag

AIMOVIG T4PA SP (Limited to a 1 month supply per fill) QL (1 Auto-injector per 30 days) AL

AJOVY T4PA SP (Limited to a 1 month supply per fill) AL

EMGALITY (300 MG DOSE) T4PA SP (Limited to a 1 month supply per fill) QL (3 syringes per 30 days) AL

EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR

T4PA SP (Limited to a 1 month supply per fill) QL (1 Auto-injector per 30 days) AL

EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T4PA SP (Limited to a 1 month supply per fill ) QL (1 syringe per 30 days) AL

NURTEC T5PA SP (Limited to a 1 month supply per fill) QL (8 tablets per 30 days)

QULIPTA T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

UBRELVY T4PA SP (Limited to a 1 month supply per fill) QL (10 tablets per 30 days)

97


Catechol-O-Methyltransferase(Comt)Inhib

carbidopa-levodopa-entacapone oral tablet 125-50-200 mg 1875-75-200 mg 25-100-200 mg 3125-125-200 mg 375-150-200 mg 50-200-200 mg

T1

COMTAN T3

entacapone T1

ONGENTYS T3 ST

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3

TASMAR ORAL TABLET 100 MG T3

tolcapone T5SP (Limited to a 1 month supply per fill)

Central Nervous System Agents Misc

acamprosate calcium T1

ADDYI T3 QL (30 tablets per 30 days)

atomoxetine hcl oral capsule 10 mg 18 mg 25 mg 40 mg


atomoxetine hcl oral capsule 100 mg 60 mg 80 mg


EXSERVAN T9

guanfacine hcl er T1 QL (60 tablets per 30 days)


INTUNIV T3 QL (30 tablets per 30 days)

memantine hcl er T2 QL (30 capsules per 30 days) AL

memantine hcl oral solution 2 mgml T3 QL (300 ML per 30 days) AL

memantine hcl oral tablet 10 mg 5 mg T1 QL (60 tablets per 30 days) AL

memantine hcl oral tablet 28 x 5 mg amp 21 x 10 mg

T1 QL (1 pak per 365 days) AL

NAMENDA ORAL TABLET T3 QL (60 tablets per 30 days) AL

NAMENDA TITRATION PAK T3 QL (1 pak per 365 days) AL

NAMENDA XR T3 QL (30 capsules per 30 days) AL

NAMENDA XR TITRATION PACK T3 AL


NOURIANZ T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

98


NUEDEXTA T4PA SP (Limited to a 1 month supply per fill) QL (60 capsules per 30 days)

QELBREE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG

T3ST QL (30 capsules per 30 days) AL

QELBREE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 150 MG 200 MG


RILUTEK T9

riluzole T1 QL (60 tablets per 30 days)

STRATTERA ORAL CAPSULE 10 MG 18 MG 25 MG 40 MG


STRATTERA ORAL CAPSULE 100 MG 80 MG T3 QL (30 capsules per 30 days) AL

STRATTERA ORAL CAPSULE 60 MG T3 QL (31 capsules per 31 days) AL

TIGLUTIK T9

VYLEESI T9


XYREM T4PA SP (Limited to a 1 month supply per fill) QL (540 ML per 30 days)

XYWAV T9

Cyclooxygenase-2 (Cox-2) Inhibitors

CELEBREX T3 QL (60 capsules per 30 days)

celecoxib oral T1 QL (60 capsules per 30 days)

CONSENSI T9

ELYXYB T9

SEGLENTIS T9

Dopamine Precursors

carbidopa oral T9

carbidopa-levodopa T1

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

T1


T1

DHIVY T3

INBRIJA T9

LODOSYN T3 QL (150 tablets per 30 days)

RYTARY ORAL CAPSULE EXTENDED RELEASE 2375-95 MG 4875-195 MG

T5PA SP (Limited to a 1 month supply per fill) QL (360 capsules per 30 days)

99


RYTARY ORAL CAPSULE EXTENDED RELEASE 3625-145 MG




SINEMET CR T3

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3

Ergot-Deriv Dopamine Receptor Agonists

bromocriptine mesylate oral T1

cabergoline T1

PARLODEL T3

Fibromyalgia Agents

CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 20 MG 60 MG


CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 30 MG


duloxetine hcl oral capsule delayed release particles 20 mg 60 mg


duloxetine hcl oral capsule delayed release particles 30 mg













SAVELLA T2 ST QL (60 tablets per 30 days)

SAVELLA TITRATION PACK T2 ST QL (60 pack per 30 days)

General Anesthetics Miscellaneous

ketamine hcl injection solution 10 mgml 100 mgml 50 mgml

T9

100


Hydantoins





PHENYTEK T2






Monoamine Oxidase B Inhibitors

AZILECT T3 ST QL (30 tablets per 30 days)

EMSAM T3 ST

rasagiline mesylate oral T3 ST QL (30 tablets per 30 days)

selegiline hcl oral tablet T2

XADAGO T3 ST QL (30 tablets per 30 days)

Monoamine Oxidase Inhibitors


EMSAM T3 ST

MARPLAN T2 QL (180 tablets per 30 days)

NARDIL T3

PARNATE T3

phenelzine sulfate oral T1



tranylcypromine sulfate T2


Nonergot-DerivDopamine Receptor Agonist

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE

T9

apomorphine hcl subcutaneous T9

KYNMOBI T4PA SP (Limited to a 1 month supply per fill) QL (150 films per 30 days)

MIRAPEX T3

MIRAPEX ER T3 ST QL (30 tablets per 30 days)

NEUPRO T3 ST QL (30 patches per 30 days)

pramipexole dihydrochloride T1

pramipexole dihydrochloride er T3 ST QL (30 tablets per 30 days)

101


REQUIP ORAL TABLET 025 MG 3 MG 5 MG T3

REQUIP XL ORAL TABLET EXTENDED RELEASE 24 HOUR 12 MG 2 MG 6 MG

T3 ST

ropinirole hcl T1

ropinirole hcl er T1 ST

Opiate Agonists





ACTIQ T9

APADAZ T9


T9

ASCOMP-CODEINE T2


T9


T9





codeine sulfate oral tablet T1

CONZIP T9

DILAUDID ORAL TABLET 2 MG T3 QL (32 tablets per 1 day)



DOLOPHINE T3

DSUVIA T9

DURAGESIC-100 T3 QL (15 patches per 30 days)





fentanyl citrate buccal lozenge on a handle T4PA SP (Limited to a 1 month supply per fill )

fentanyl transdermal patch 72 hour 100 mcghr 12 mcghr 25 mcghr 50 mcghr 75 mcghr

T1 QL (20 patches per 30 days)

fentanyl transdermal patch 72 hour 375 mcghr 625 mcghr 875 mcghr

T9

102


FENTORA BUCCAL TABLET 100 MCG 200 MCG 400 MCG 600 MCG 800 MCG

T9


T9

hydrocodone bitartrate er oral capsule extended release 12 hour


hydrocodone bitartrate er oral tablet er 24 hour abuse-deterrent

T3ST QL (30 tablets per 30 days) AL



T1


T9


T1

hydrocodone-ibuprofen oral tablet 10-200 mg 5-200 mg 75-200 mg

T1

hydromorphone hcl er oral tablet er 24 hour abuse-deterrent


hydromorphone hcl oral liquid T1

hydromorphone hcl oral tablet 2 mg T1 QL (32 tablets per 1 day)



hydromorphone hcl rectal T1

HYSINGLA ER T3ST QL (30 tablets per 30 days) AL

IBUDONE ORAL TABLET 10-200 MG T9

KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 100 MG 20 MG 200 MG 30 MG 40 MG 50 MG 60 MG 80 MG

T9

LAZANDA T9

levorphanol tartrate oral T9


meperidine hcl oral solution T1

meperidine hcl oral tablet 50 mg T1

METHADONE HCL INTENSOL T1

methadone hcl oral concentrate T1

methadone hcl oral solution T1

methadone hcl oral tablet T1

METHADOSE ORAL CONCENTRATE 10 MGML

T1

MORPHABOND ER T9

103


morphine sulfate (concentrate) oral solution 100 mg5ml

T1

morphine sulfate er beads T9

morphine sulfate er oral capsule extended release 24 hour 10 mg 100 mg 20 mg 30 mg 50 mg 60 mg 80 mg

T9

morphine sulfate er oral tablet extended release T1

morphine sulfate oral T1

morphine sulfate rectal T1

MS CONTIN ORAL TABLET EXTENDED RELEASE

T3

NORCO T3

NUCYNTA T3 ST

NUCYNTA ER T3 ST QL (62 tablets per 31 days)

OXAYDO ORAL TABLET ABUSE-DETERRENT T3 ST

oxycodone hcl er oral tablet er 12 hour abuse-deterrent


oxycodone hcl oral capsule T9

oxycodone hcl oral solution T1

oxycodone hcl oral tablet T1



T9


T1

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT


oxymorphone hcl T2 ST

oxymorphone hcl er T2 ST QL (60 tablets per 30 days)


T3

PRIMLEV T9

PROLATE T9

QDOLO T9

SEGLENTIS T9

SUBSYS SUBLINGUAL LIQUID 100 MCG T5PA SP (Limited to a 1 month supply per fill ) QL (120 units per 30 days)

SUBSYS SUBLINGUAL LIQUID 1200 (600 X 2) MCG 1600 (800 X 2) MCG 200 MCG 400 MCG 600 MCG

T5PA SP (Limited to a 1 month supply per fill) QL (120 units per 30 days)

104


SUBSYS SUBLINGUAL LIQUID 800 MCG T5PA SP (Limited to a 1 month supply per fill) QL (120 untis per 30 days)

tramadol hcl er oral capsule extended release 24 hour 100 mg 200 mg 300 mg

T9

tramadol hcl er oral tablet extended release 24 hour


tramadol hcl oral solution T9

tramadol hcl oral tablet 100 mg T9

tramadol hcl oral tablet 50 mg T1 QL (240 tablets per 30 days)



ULTRACET T3

ULTRAM T3 QL (240 tablets per 30 days)




XTAMPZA ER T3 ST QL (60 capsules per 30 days)

ZOHYDRO ER ORAL CAPSULE EXTENDED RELEASE 12 HOUR


Opiate Antagonists

BUNAVAIL BUCCAL FILM 21-03 MG 63-1 MG

T3 ST QL (30 films per 30 days)

buprenorphine hcl-naloxone hcl sublingual film12-3 mg

T1 QL (60 films per 30 days)

buprenorphine hcl-naloxone hcl sublingual film 2-05 mg 8-2 mg


buprenorphine hcl-naloxone hcl sublingual film 4-1 mg


buprenorphine hcl-naloxone hcl sublingual tablet sublingual


KLOXXADO T3 QL (2 doses per 365 days)

naloxone hcl injection solution 04 mgml T1 QL (2 Vials per 1 year)

naloxone hcl injection solution cartridge T1 QL (2 cartridges per 1 year)

naloxone hcl injection solution prefilled syringe T1 QL (2 Syringes per 1 year)

naloxone hcl nasal T1 QL (1 box per 1 year)

naltrexone hcl oral T1

NARCAN T1 QL (2 units per 365 days)

pentazocine-naloxone hcl T2 ST

RELISTOR ORAL T5PA SP (Limited to a 1 month supply per fill)

RELISTOR SUBCUTANEOUS SOLUTION 12 MG06ML

T5PA SP (Limited to a 1 month supply per fill)

105




SUBOXONE SUBLINGUAL FILM 12-3 MG T3 QL (60 films per 30 days)

SUBOXONE SUBLINGUAL FILM 2-05 MG 8-2 MG



ZIMHI T2 QL (1 box per 1 year)

ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 07-018 MG 14-036 MG 114-29 MG 29-071 MG 57-14 MG


ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 86-21 MG


Opiate Partial Agonists

BELBUCA T3 ST QL (60 films per 30 days)



buprenorphine hcl sublingual T1 QL (90 tablets per 30 days)









buprenorphine transdermal T3 ST QL (4 patches per 28 days)


BUTRANS T9


PROBUPHINE IMPLANT KIT T9









Orexin Receptor Antagonists



106


Other Nonsteroidal Anti-Inflam Agents

ANAPROX DS T3

ARTHROTEC ORAL TABLET DELAYED RELEASE

T9

CAMBIA T9

DAYPRO T3

diclofenac T9

diclofenac epolamine external T3 ST QL (60 patches per 30 days)

diclofenac potassium oral capsule T9

diclofenac potassium oral tablet 25 mg T9


diclofenac sodium er T1

diclofenac sodium oral T1

diclofenac-misoprostol oral tablet delayed release T9

diflunisal oral T1

DUEXIS T9


T3

etodolac er T2

etodolac oral T1

FELDENE T3

fenoprofen calcium oral T9

FENORTHO ORAL CAPSULE 200 MG T9

FLECTOR EXTERNAL T9

flurbiprofen oral T1


T1



ibuprofen-famotidine T9

INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1

indomethacin oral capsule 20 mg T9

indomethacin oral capsule 25 mg 50 mg T1


ketorolac tromethamine nasal T9

ketorolac tromethamine oral T1 QL (20 tablets per 30 days)

LICART TRANSDERMAL T9

LOFENA T9

107


meclofenamate sodium oral T9

mefenamic acid oral T9

meloxicam oral capsule T9

meloxicam oral tablet T1

MOBIC ORAL TABLET T3

nabumetone oral T1

NALFON ORAL CAPSULE 400 MG T9


T9








naproxen-esomeprazole T9

oxaprozin T2

piroxicam oral T1

QMIIZ ODT T9

RELAFEN DS T9

SPRIX T9

sulindac oral T1

sumatriptan-naproxen sodium T9

TIVORBEX T9

tolmetin sodium T2

TREXIMET ORAL TABLET 85-500 MG T9

VIMOVO T9

VIVLODEX T9

ZIPSOR T9

ZORVOLEX T9

Phenothiazines

chlorpromazine hcl oral concentrate 100 mgml T3 QL (180 ML per 30 days)

chlorpromazine hcl oral tablet T2 QL (180 tablets per 30 days)

COMPRO T1

fluphenazine hcl oral concentrate T1

fluphenazine hcl oral elixir T1

fluphenazine hcl oral tablet T2 QL (60 tablets per 30 days)

perphenazine oral tablet 2 mg 4 mg 8 mg T1

perphenazine-amitriptyline T1

108


prochlorperazine T1

prochlorperazine maleate oral T1

thioridazine hcl oral T1

trifluoperazine hcl oral T1

Respiratory And Cns Stimulants

ADHANSIA XR T9


T9

APTENSIO XR T3 QL (30 capsules per 30 days)

ASCOMP-CODEINE T2

AZSTARYS T9


T9




T9




CAFERGOT T9


CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG 27 MG




COTEMPLA XR-ODT T9

DAYTRANA T3ST QL (30 patches per 30 days) AL

dexmethylphenidate hcl T1 AL

dexmethylphenidate hcl er T1 QL (30 capsules per 30 days) AL

ELIXOPHYLLIN T3





T9


FOCALIN T3 AL

FOCALIN XR T3 QL (30 capsules per 30 days) AL

JORNAY PM T9

109


METADATE ER ORAL TABLET EXTENDED RELEASE 20 MG

T1 AL

METHYLIN ORAL SOLUTION T3 AL

methylphenidate hcl er (cd) T1 QL (30 capsules per 30 days) AL

methylphenidate hcl er (la) oral capsule extended release 24 hour 10 mg 20 mg 30 mg 40 mg


methylphenidate hcl er (osm) oral tablet extended release 18 mg 27 mg




methylphenidate hcl er (osm) oral tablet extended release 72 mg


methylphenidate hcl er (xr) oral capsule extended release 24 hour 10 mg

T3 QL (30 capdules per 30 days)

methylphenidate hcl er (xr) oral capsule extended release 24 hour 15 mg 20 mg 30 mg 40 mg 50 mg 60 mg


methylphenidate hcl er oral tablet extended release 20 mg

T1 AL

methylphenidate hcl oral solution T1 AL

methylphenidate hcl oral tablet T1 AL

methylphenidate hcl oral tablet chewable T1 AL

MIGERGOT T9

norgesic forte T9


T9


T9

QUILLICHEW ER T3ST QL (30 tablets per 30 days) AL

QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED ER

T3 ST QL (600 ML per 30 days) AL

RELEXXII T9

RITALIN T3 AL

RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG 20 MG 30 MG 40 MG


THEO-24 T2


T1


T1


VANATOL LQ T9

110


VTOL LQ T9

Salicylates

AGGRENOX T3

ASCOMP-CODEINE T2





BUFFERIN T3 PV AL






choline-mag trisalicylate T1

DOANS PILLS T1

DURLAZA T9



norgesic forte T9


T9


T9

salsalate oral T1

SelSerotoninNorepi Reuptake Inhibitor





desvenlafaxine er T2 QL (30 tablets per 30 days)

desvenlafaxine succinate er oral tablet extended release 24 hour 100 mg 50 mg


desvenlafaxine succinate er oral tablet extended release 24 hour 25 mg


DRIZALMA SPRINKLE T9







111


EFFEXOR XR T3

FETZIMA T3ST QL (30 capsules per 30 days) AL

FETZIMA TITRATION T3ST QL (30 capsules per 30 days) AL

PRISTIQ T3 QL (31 EA per 31 days) AL



venlafaxine hcl T1

venlafaxine hcl er oral capsule extended release 24 hour

T1

venlafaxine hcl er oral tablet extended release 24 hour

T9

Selective Serotonin Agonists

almotriptan malate T3 ST QL (12 tablets per 30 days)

AMERGE T3 QL (12 tablets per 30 days)

eletriptan hydrobromide T3 ST QL (12 tablets per 30 days)

FROVA T9

frovatriptan succinate T9

IMITREX NASAL SOLUTION 20 MGACT T3SP (Quantity Limit 1 box per 15 days)

IMITREX NASAL SOLUTION 5 MGACT T3SP (Quantity Limit 2 boxes per 15 days)

IMITREX ORAL T3 QL (12 tablets per 30 days)

IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE 4 MG05ML

T9

IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR 4 MG05ML

T9


T3

IMITREX SUBCUTANEOUS T3

MAXALT ORAL TABLET 10 MG T3 QL (12 tablet per 30 days)

MAXALT-MLT ORAL TABLET DISPERSIBLE10 MG

T3 QL (12 tablet per 30 days)

naratriptan hcl T1 QL (12 tablets per 30 days)

ONZETRA XSAIL T9

RELPAX T9

REYVOW T5PA SP (Limited to a 1 month supply per fill) QL (4 tablets per 30 days)

112


rizatriptan benzoate T1 QL (12 tablets per 30 days)

sumatriptan nasal T3 QL (8 units per 30 days)

sumatriptan succinate oral T1 QL (12 tablets per 30 days)

sumatriptan succinate refill subcutaneous solution cartridge 4 mg05ml

T9


T1 QL (8 cartridges per 30 days)

sumatriptan succinate subcutaneous solution 6 mg05ml

T1

sumatriptan succinate subcutaneous solution auto-injector 4 mg05ml

T9


T3 QL (8 pens per 30 days)

sumatriptan succinate subcutaneous solution prefilled syringe 6 mg05ml

T1


TOSYMRA T9


ZEMBRACE SYMTOUCH T9

zolmitriptan nasal T3 ST QL (12 units per 30 days)

zolmitriptan oral T2 QL (12 tablets per 30 days)

ZOMIG NASAL SOLUTION 25 MG T3 ST QL (12 units per 30 days)

ZOMIG NASAL SOLUTION 5 MG T9

ZOMIG ORAL T3 QL (12 tablets per 30 days)

Selective-Serotonin Reuptake Inhibitors

BRISDELLE T9

CELEXA ORAL TABLET 10 MG T3 QL (90 tablet per 30 days) AL

CELEXA ORAL TABLET 20 MG T3 QL (60 tablets per 30 days) AL


citalopram hydrobromide oral capsule T9

citalopram hydrobromide oral solution T1

citalopram hydrobromide oral tablet 10 mg T1 QL (90 tablets per 30 days)


citalopram hydrobromide oral tablet 40 mg T1

escitalopram oxalate oral T1

fluoxetine hcl (pmdd) capsule 10 mg oral T9


fluoxetine hcl (pmdd) oral tablet T9

fluoxetine hcl oral capsule T1

fluoxetine hcl oral capsule delayed release T2 ST

fluoxetine hcl oral solution T1

113


fluoxetine hcl oral tablet T9

fluvoxamine maleate T1

fluvoxamine maleate er T3 QL (60 capsules per 30 days)

LEXAPRO ORAL TABLET T3


paroxetine hcl er oral tablet extended release 24 hour 125 mg 375 mg


paroxetine hcl er oral tablet extended release 24 hour 25 mg


paroxetine hcl oral suspension T2

paroxetine hcl oral tablet T1

paroxetine mesylate T9

PAXIL T3

PAXIL CR ORAL TABLET EXTENDED RELEASE 24 HOUR 125 MG 375 MG


PAXIL CR ORAL TABLET EXTENDED RELEASE 24 HOUR 25 MG


PEXEVA T9

PROZAC ORAL CAPSULE T3

SARAFEM ORAL TABLET 10 MG 20 MG T9

sertraline hcl oral capsule T9

sertraline hcl oral concentrate T1

sertraline hcl oral tablet T1


T9

ZOLOFT ORAL TABLET 100 MG T3 QL (60 tablets per 30 days)



Serotonin Modulators

nefazodone hcl T1

trazodone hcl oral T1

TRINTELLIX T3ST QL (30 tablets per 30 days) AL

VIIBRYD ORAL TABLET T3 ST QL (30 tablets per 30 days)

VIIBRYD STARTER PACK T3 ST QL (30 tablets per 30 days)

vilazodone hcl T2 ST QL (30 tablets per 30 Days)

Succinimides

CELONTIN T2

ethosuximide oral T1

ZARONTIN T3

114


Thioxanthenes

thiothixene oral T1

Tricyclics Other Norepi-Ru Inhibitors

amitriptyline hcl oral T1

amoxapine T1

ANAFRANIL ORAL CAPSULE 25 MG T3 QL (30 capsules per 30 Days)




clomipramine hcl oral capsule 25 mg T2 QL (30 capsules per 30 days)



desipramine hcl oral T2 QL (60 tablets per 30 days)

doxepin hcl oral capsule T1

doxepin hcl oral concentrate T1

doxepin hcl oral tablet T2 ST QL (30 tablets per 30 days)

imipramine hcl oral T1

imipramine pamoate oral capsule 100 mg 150 mg


imipramine pamoate oral capsule 125 mg T3 ST QL (60 capsules per 30 days)


maprotiline hcl T1

NORPRAMIN ORAL TABLET 10 MG 25 MG T3 QL (60 tablets per 30 days)

nortriptyline hcl oral capsule T1

PAMELOR ORAL CAPSULE T3SP (Generic substitution mandatory)


protriptyline hcl T2

SILENOR T3 ST QL (31 tablets per 31 days)

SURMONTIL T3

TOFRANIL T3

trimipramine maleate oral T2

Vesicular Monoamine Transport2 Inhibitor

AUSTEDO ORAL TABLET 12 MG T5PA SP (Limited to a 1 month supply per fill ) QL (120 tablets per 30 days)



115


INGREZZA ORAL CAPSULE 40 MG 80 MG T5PA SP (Limited to a 1 month supply per fill ) QL (30 capsules per 30 days)

INGREZZA ORAL CAPSULE 60 MG T5PA SP (Limited to a 1 month supply per fill) QL (30 capsules per 30 days)

INGREZZA ORAL CAPSULE THERAPY PACK T5PA SP (Limited to a 1 month supply per fill ) QL (1 dose pack per 28 days)

tetrabenazine oral tablet 125 mg T4PA SP (Limited to a 1 month supply per fill) QL (90 tablets per 30 days)


XENAZINE T9

Wakefulness-Promoting Agents

armodafinil T1 QL (30 tablets per 30 days)

diclofenac sodium oral tablet delayed release 75 mg

T1

modafinil T1 QL (60 tablets per 30 days)

NUVIGIL ORAL TABLET 150 MG 250 MG T3 QL (30 tablets per 30 days)

NUVIGIL ORAL TABLET 200 MG 50 MG T9

PROVIGIL ORAL TABLET 100 MG T3 QL (31 tablets per 31 days)


SUNOSI T3 ST QL (30 tablets per 30 days)

WAKIX T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

Dental Agents

Dental Agents

FLUORIDEX SENSITIVITY RELIEF DENTAL PASTE

T3

sodium fluoride 5000 sensitive T1

Devices

Devices

10 SERIES BP MONITORUPPER ARM T2 QL (2 EA per 730 days)

10 SERIES+ BP MONITRUPPER ARM T2 QL (2 EA per 730 days)


3 SERIES BP MONITORWRIST T2 QL (2 EA per 730 days)

5 SERIES BP MONITOR T2 QL (1 monitor per 2 years)

5 SERIES BP MONITORUPPER ARM T2 QL (1 monitor per 2 years)


116



ACCU-CHEK FASTCLIX LANCET T2

ACCU-CHEK MULTICLIX LANCET DEV T2

ACCU-CHEK SOFTCLIX LANCET DEV KIT T2

adult blood pressure cuff lg T2 QL (1 monitor per 2 years)

AEROCHAMBER PLUS FLO-VU T2 QL (4 EA per 365 days)

AEROCHAMBER PLUS FLO-VU LARGE T2 QL (4 EA per 365 days)

AEROCHAMBER PLUS FLO-VU SMALL T2 QL (4 EA per 365 days)

AEROCHAMBER PLUS FLO-VU WMASK T2 QL (4 EA per 365 days)

BD INSULIN SYRINGE MICROFINE 28G X 12 05 ML

T2

BD INSULIN SYRINGE UF 30G X 12 1 ML 31G X 516 1 ML

T2

BD PEN NEEDLE MINI UF T2

blood pressure monitor T2 QL (1 monitor per 2 years)

BLOOD PRESSURE MONITOR 3 T2 QL (1 monitor per 2 years)


blood pressure monitor kit T2 QL (1 monitor per 2 years)

BREATHERITE T2 QL (4 EA per 365 days)

BREATHERITE COLL SPACER ADULT T2 QL (4 EA per 365 days)

BREATHERITE COLL SPACER CHILD T2 QL (4 EA per 365 days)

BREATHERITE COLL SPACER INFANT T2 QL (4 EA per 365 days)

BREATHERITE RIGID SPACERMASK T2 QL (4 EA per 365 days)

BREATHERITE SPACER NEONATE T2 QL (4 EA per 365 days)

BREATHERITE SPACER SMALL CHILD T2 QL (4 EA per 365 days)

BREATHERITELARGE MASK T2 QL (4 EA per 365 days)

BREATHERITEMEDIUM MASK T2 QL (4 EA per 365 days)

BREATHERITESMALL MASK T2 QL (4 EA per 365 days)

DEXCOM G6 RECEIVER T2 QL (1 receiver per 365 days)

DEXCOM G6 SENSOR T2 QL (1 box per 30 days)

DEXCOM G6 TRANSMITTER T2 QL (1 transmitter per 90 days)

EASIVENT T2 QL (4 EA per 365 days)

EASIVENT MASK LARGE T2 QL (4 EA per 365 days)

EASIVENT MASK MEDIUM T2 QL (4 EA per 365 days)

EASIVENT MASK SMALL T2 QL (4 EA per 365 days)

easy talk control in vitro solution high low T3

FREESTYLE CONTROL SOLUTION T3

FREESTYLE LIBRE 14 DAY READER T2 QL (2 kits per 28 days)

FREESTYLE LIBRE 14 DAY SENSOR T2 QL (3 sensors per 30 days)

FREESTYLE LIBRE 2 READER T2 QL (2 kits per 28 days)

117


FREESTYLE LIBRE 2 SENSOR T2 QL (3 sensors per 30 days)

HYPOLANCE AST LANCING T2

INPEN 100-BLUE-LILLY T9

INPEN 100-BLUE-LILLY-HUMALOG T9

INPEN 100-BLUE-NOVO T9

INPEN 100-BLUE-NOVOLOG-FIASP T9

INPEN 100-GRAY-LILLY T9

INPEN 100-GREY-LILLY-HUMALOG T9

INPEN 100-GREY-NOVO T9

INPEN 100-GREY-NOVOLOG-FIASP T9

INPEN 100-PINK-LILLY T9

INPEN 100-PINK-LILLY-HUMALOG T9

INPEN 100-PINK-NOVO T9

INPEN 100-PINK-NOVOLOG-FIASP T9

MONOJECT MAGELLAN SYRINGE 21G X 1-12 6 ML

T2

MONOJECT PISTON SYRINGE T2

MONOJECT SYRINGE 21G X 1-12 6 ML T2

MONOJECT SYRINGE LUER-LOCK TIP 140 ML

T2

NOVOFINE 32G X 6 MM T2

NOVOFINE AUTOCOVER T2

NOVOFINE AUTOCOVER PEN NEEDLE T2

NOVOFINE PEN NEEDLE T2

NOVOFINE PLUS T2

NOVOFINE PLUS PEN NEEDLE T2

OMNIPOD DASH PODS (GEN 4) T5SP (Limited to a 1 month supply per fill) QL (2 packs per 30 days)

OPTICHAMBER ADVANTAGE-LG MASK T2 QL (4 EA per 365 days)

OPTICHAMBER ADVANTAGE-MED MASK T2 QL (4 EA per 365 days)

OPTICHAMBER ADVANTAGE-SM MASK T2 QL (4 EA per 365 days)

OPTICHAMBER DIAMOND T2

OPTICHAMBER FACE MASK-LARGE T2 QL (4 EA per 365 days)

OPTICHAMBER FACE MASK-MEDIUM T2 QL (4 EA per 365 days)

OPTICHAMBER FACE MASK-SMALL T2 QL (4 EA per 365 days)

self-taking blood pressure T2 QL (2 EA per 730 days)

ULTICARE INSULIN SYRINGE 30G X 12 03 ML 30G X 12 05 ML 30G X 12 1 ML

T1

ULTICARE INSULIN SYRINGE 31G X 516 1 ML

T2

valved holding chamber T1 QL (4 EA per 365 days)

118


V-GO 20 T2

V-GO 30 T2

V-GO 40 T2

VIVAGUARD INO CONTROL SOLUTION T3

Diagnostic Agents

Adrenocortical Insufficiency

ACTHAR T4PA SP (Limited to a 1 month supply per fill )

CORTROPHIN T9

Diabetes Mellitus

ACCU-CHEK AVIVA PLUS IN VITRO T3 ST QL (200 strips per 30 days)

ACCU-CHEK COMPACT PLUS T3 ST QL (200 strips per 30 days)

ACCU-CHEK SMARTVIEW T3 ST QL (200 strips per 30 days)

AGAMATRIX AMP TEST T3 ST QL (200 strips per 30 days)

ASSURE 4 TEST T3 ST QL (200 strips per 30 days)

ASSURE PLATINUM T3 ST QL (200 strips per 30 days)

ASSURE PRISM MULTI TEST T3 ST QL (200 strips per 30 days)

BAYER BREEZE 2 TEST T3 ST

BAYER CONTOUR TEST T3 ST QL (200 strips per 30 days)

CONTOUR NEXT TEST T3 ST QL (200 strips per 30 days)

easy talk plus ii test strips T3 ST QL (200 strips per 30 Days)

easy trak ii glucose test T3 ST QL (200 strips per 30 Days)

EVENCARE PROVIEW GLUCOSE TEST T3 ST

FORA 6 CONNECT T3 ST

FORTISCARE G1 TEST STRIP T3 ST QL (200 strips per 30 days)

FREESTYLE INSULINX TEST T3 ST QL (200 strips per 30 days)

FREESTYLE LITE TEST T3 ST QL (200 strips per 30 days)

FREESTYLE PRECISION NEO TEST T3 ST QL (200 strips per 30 days)

FREESTYLE TEST T3 ST QL (200 strips per 30 days)

GLUCOCARD 01 SENSOR PLUS T3 ST QL (200 strips per 30 days)

GLUCOCARD EXPRESSION TEST T3 ST QL (200 strips per 30 days)

GLUCOCARD VITAL TEST T3 ST QL (200 strips per 30 days)

GLUCOCARD X-SENSOR T3 ST QL (200 strips per 30 days)

GOJJI BLOOD GLUCOSE TEST T3 ST QL (200 strips per 30 Days)

HARMONY BLOOD GLUCOSE TEST T3 ST

MICRODOT TEST T3 ST

ONETOUCH ULTRA BLUE T1 QL (200 strips per 30 days)

ONETOUCH VERIO IN VITRO STRIP T1 QL (200 strips per 30 days)

PRECISION PCX PLUS TEST T3 ST QL (200 strips per 30 days)

119


PRECISION POINT OF CARE TEST T3 ST QL (200 strips per 30 days)

PRECISION QID TEST T3 ST QL (200 strips per 30 days)

PRECISION XTRA BLOOD GLUCOSE T3 ST QL (200 strips per 30 days)

RELION BLOOD GLUCOSE TEST T3 ST QL (200 strips per 30 days)

TRUETRACK TEST T3 ST QL (200 strips per 30 days)

UNISTRIP1 GENERIC T3 ST QL (200 strips per 30 days)

Diagnostic Agents

toxicology saliva collection T9

Drug Hypersensitivity

CANDIN T9

Ketones

KETOSTIX T3

Tuberculosis

APLISOL T9

Electrolytic Caloric And Water Balance

Alkalinizing Agents

cytra k crystals T1

cytra-2 T9

CYTRA-3 T9

cytra-k T9

ORACIT T3

pot amp sod cit-cit ac T1

potassium citrate er T1

potassium citrate-citric acid oral solution T1

sod citrate-citric acid T1

tricitrates T9

UROCIT-K 10 T3

UROCIT-K 15 T3

UROCIT-K 5 T3

virtrate-2 T9

virtrate-3 T9

virtrate-k T9

Ammonia Detoxicants

BUPHENYL ORAL POWDER 3 GMTSP T5PA SP (Limited to a 1 month supply per fill )

BUPHENYL ORAL TABLET T5PA SP (Limited to a 1 month supply per fill )

CARBAGLU T5PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

120


carglumic acid T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

enulose T1

generlac T1

KRISTALOSE T9

lactulose oral packet T9

lactulose oral solution 10 gm15ml T1

LITHOSTAT T9

RAVICTI T4PA SP (Limited to a 1 month supply per fill ) QL (525 ML per 30 days)

sodium phenylbutyrate oral powder 3 gmtsp T4PA SP (Limited to a 1 month supply per fill )

sodium phenylbutyrate oral tablet T4PA SP (Limited to a 1 month supply per fill )

Caloric Agents

DOJOLVI T9

ENLYTE T9


FERREX 150 PLUS T9

FOLBEE AR T9

l-leucine T9

macuvex T9

macuzin T9

METAFOLBIC PLUS T9

methaver T9

methazel T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9

PURALOR CI T9

SUPERVITE T9

zyvit T9

Carbonic Anhydrase Inhibitors

acetazolamide er T1


Diuretics Miscellaneous

ELIXOPHYLLIN T3

THEO-24 T2


T1

121



T1

Irrigating Solutions

sodium chloride irrigation solution 09 T1

Loop Diuretics

bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1

Phosphate-Removing Agents

AURYXIA T5PA SP (Limited to a 1 month supply per fill ) QL (360 tablets per 30 days)

calcium acetate (phos binder) oral capsule T1

FOSRENOL ORAL PACKET T5SP (Limited to a 1 month supply per fill) QL (180 packets per 30 days)

FOSRENOL ORAL TABLET CHEWABLE 1000 MG

T5SP (Limited to a 1 month supply per fill) QL (90 tablets per 30 days)





lanthanum carbonate oral tablet chewable 1000 mg






MAGNEBIND 400 ORAL TABLET 400-200-1 MG

T9

PHOSLO T3

PHOSLYRA T3 ST

122


RENAGEL ORAL TABLET 800 MG T5ST SP (Limited to a 1 month supply per fill) QL (180 tablets per 30 days)

RENVELA T9

sevelamer carbonate oral packet T5SP (Limited to a 1 month supply per fill )

sevelamer carbonate oral tablet T2 QL (510 tablets per 30 days)

sevelamer hcl T4ST SP (Limited to a 1 month supply per fill ) QL (180 tablets per 30 days)

VELPHORO T5ST SP (Limited to a 1 month supply per fill) QL (180 tablets per 30 days)

Potassium-Removing Agents

KIONEX ORAL SUSPENSION T1

LOKELMA T4SP (Limited to a 1 month supply per fill) QL (30 packets per 30 days)

sodium polystyrene sulfonate oral powder T1

SPS T1

VELTASSA ORAL PACKET 168 GM 252 GM T5ST SP (Limited to a 1 month supply per fill) QL (30 packets per 30 days)

VELTASSA ORAL PACKET 84 GM T5ST SP (Limited to a 1 month supply per fill) QL (30 packets per 30 days)

Potassium-Sparing Diuretics

ALDACTONE T3


amiloride-hydrochlorothiazide T1

CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3

MAXZIDE T3

MAXZIDE-25 T3


triamterene-hctz oral capsule 375-25 mg T1

triamterene-hctz oral tablet T1

Replacement Preparations

active fe T9

av-phos 250 neutral T9

BACMIN T9

123



calcium-folic acid plus d T9

CENTRATEX T9

choice-tabs T9


CORVITA 150 T9

CORVITA ORAL TABLET 125 MG T9

CORVITE 150 ORAL TABLET 150-125 MG T9

CORVITE FREE T9

CORVITE ORAL TABLET 125 MG T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

DIALYVITE SUPREME D ORAL TABLET 3 MG T9

DIALYVITEZINC T9

EFFER-K ORAL TABLET EFFERVESCENT 25 MEQ

T1

FERIVA 217 T9

FERIVAFA T9


FOLBEE PLUS CZ T9

FORTAVIT ORAL CAPSULE T9

GALZIN T9


HEMATRON T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


IROSPAN 246 T9

KLOR-CON 10 T1

KLOR-CON M10 T1

KLOR-CON M15 T1

KLOR-CON M20 T1

KLOR-CON ORAL PACKET 20 MEQ T9

KLOR-CON ORAL TABLET EXTENDED RELEASE

T3

KLOR-CONEF T1

K-PHOS-NEUTRAL T9

K-TAB ORAL TABLET EXTENDED RELEASE10 MEQ

T3

124


LYSIPLEX PLUS ORAL TABLET T9

MAGNEBIND 400 ORAL TABLET 80-115 MG T9


multivitamins oral tablet chewable T9

multivitamins pediatric T9

neonatal + dha T9

NEPHPLEX RX T9

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9

OCUVEL ORAL CAPSULE 05 MG T9

PHOSLO T3

PHOSLYRA T3 ST

phos-nak T9

PHOSPHA 250 NEUTRAL T9

pnv-dha T1

pnv-select T1

potassium chloride crys er oral tablet extended release 15 meq 20 meq

T1

potassium chloride er oral capsule extended release

T1

potassium chloride er oral tablet extended release 10 meq 8 meq

T1

potassium chloride oral packet T9

potassium chloride oral solution 20 meq15ml (10)

T3



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1



PRENATE AM T3


T3

PRENATE PIXIE T3

purefe plus T9

125



QUFLORA FE T9

REQ 49+ T9

se-tan plus T9

SIDEROL ORAL LIQUIDdagger T9

STROVITE FORTE ORAL TABLET T9

STROVITE ONE T9

SUPERVITE T9

TANDEM PLUS T9

tl-hem 150 T9

tristart dha T9

TRIVEEN-DUO DHA T1

tri-zel T9

UDAMIN SP ORAL TABLET 1 MG T9

v-c forte T9

VIC-FORTE T9

VINATE M T1

virt-phos 250 neutral T9

VITACEL T1

VITAFOL-ONE T3

VITAL-D RX T9

VITATRUE T3

zinc sulfate oral capsule 220 (50 zn) mg T9

Thiazide Diuretics

ACCURETIC T3





ATACAND HCT T3


T3


BENICAR HCT T3




CORZIDE T3

DIOVAN HCT T3

DIURIL T2

126


DUTOPROL T9

EDARBYCLOR T3 ST


EXFORGE HCT T3



HYZAAR T3






T3

MAXZIDE T3

MAXZIDE-25 T3




MICARDIS HCT T3




propranolol-hctz T1



TEKTURNA HCT T2 ST

telmisartan-hctz T1



TRIBENZOR T3


VASERETIC T3

ZESTORETIC T3

ZIAC T3

Thiazide-Like Diuretics



indapamide oral T1

metolazone T1

TENORETIC 100 T3

127


TENORETIC 50 T3

THALITONE T9

Uricosuric Agents

colchicine-probenecid T1

probenecid oral T1

Vasopressin Antagonists

JYNARQUE ORAL TABLET 15 MG T4PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)


JYNARQUE ORAL TABLET THERAPY PACK T4PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

SAMSCA ORAL TABLET 15 MG T5PA SP (Limited to a 1 month supply per fill)


tolvaptan T4PA SP (Limited to a 1 month supply per fill)

Enzymes

Enzymes

CREON T4SP (Max day supply up to 31 days)

PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10 MG05ML 25 MG05ML

T5PA SP (Limited to a 1 month supply per fill ) QL (30 syringes per 30 days)

PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MGML

T5PA SP (Limited to a 1 month supply per fill ) QL (30 syinges per 30 days)

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 10500-35500 UNIT 16800-56800 UNIT 21000-54700 UNIT 2600-8800 UNIT 4200-14200 UNIT

T5ST SP (Limited to a 1 month supply per fill )

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 37000-97300 UNIT

T5ST SP (Limited to a 1 month supply per fill)

PERTZYE T5ST SP (Limited to a 1 month supply per fill)

PULMOZYME INHALATION SOLUTION 25 MG25ML

T4SP (Limited to a 1 month supply per fill ) QL (60 ampules per 30 days)

REVCOVI T4PA SP (Limited to a 1 month supply per fill )

128


SANTYL T3 QL (60 GM per 30 days)

STRENSIQ T4PA SP (Limited to a 1 month supply per fill)

SUCRAID T4SP (Limited to a 1 month supply per fill)

VIOKACE T5ST SP (Max of 31 days per dispensing )

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT 15000-47000 UNIT 20000-63000 UNIT 25000-79000 UNIT 3000-10000 UNIT 40000-126000 UNIT 5000-24000 UNIT


Eye Ear Nose And Throat (Eent) Preps

Alpha-Adrenergic Agonists (Eent)

ALPHAGAN P T3

brimonidine tartrate ophthalmic solution 015 T2


brimonidine tartrate-timolol T1

brimonidine-dorzolamide T9

COMBIGAN T9

SIMBRINZA T2

Antiallergic Agents

ALAWAY T1

ALOCRIL T3 ST

ALOMIDE T2

ASTEPRO NASAL SOLUTION 015 T3

azelastine hcl nasal solution 01 015 T1

azelastine hcl ophthalmic T1

azelastine-fluticasone T1 ST

bepotastine besilate T2 ST QL (5 ML per 30 Days)

BEPREVE T9

cromolyn sodium inhalation T9

cromolyn sodium ophthalmic T1

DYMISTA T3 ST

ELESTAT T3

epinastine hcl T1



NAPHCON-A T9



129




PATANASE T3

PATANOL T3

PAZEO T3 ST

TICALAST T9

ZADITOR T1

ZERVIATE T9

Antibacterials (Eent)

AZASITE T3 ST

bacitracin-polymyxin b ophthalmic ointment 500-10000 unitgm

T1

bacitra-neomycin-polymyxin-hc T1

BESIVANCE T3 QL (5 ML per 30 days)

BLEPH-10 T3

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

CETRAXAL T3

CILOXAN T3

CIPRO HC T2

CIPRODEX T3

ciprofloxacin hcl ophthalmic T1

ciprofloxacin hcl otic T1

ciprofloxacin-dexamethasone T1

ciprofloxacin-fluocinolone pf T2 AL

COLY-MYCIN S T3

erythromycin ophthalmic T1

gatifloxacin ophthalmic T1

GENTAK OPHTHALMIC OINTMENT T1

gentamicin sulfate ophthalmic solution T1

levofloxacin ophthalmic T1

MAXITROL T3

MOXEZA T3

moxifloxacin hcl (2x day) T1

moxifloxacin hcl ophthalmic solution T1

neomycin-bacitracin zn-polymyx ophthalmic ointment 5-400-10000

T1

neomycin-polymyxin-dexameth ophthalmic ointment

T1

neomycin-polymyxin-dexameth ophthalmic suspension 35-10000-01

T1

130


neomycin-polymyxin-gramicidin ophthalmic solution 175-10000-025

T1

neomycin-polymyxin-hc otic solution 35-10000-1 T1

OCUFLOX T3

ofloxacin ophthalmic T1

ofloxacin otic T1

OTOVEL T2 AL

polymyxin b-trimethoprim T1

POLYTRIM T3

PRED-G T2

PRED-G SOP T3

prednisolone-gatifloxacin ophthalmic solution T9

prednisolon-gatiflox-bromfenac ophthalmic solution

T9

sulfacetamide sodium ophthalmic T1

sulfacetamide-prednisolone ophthalmic solution T1

TOBRADEX OPHTHALMIC OINTMENT T3 ST

TOBRADEX OPHTHALMIC SUSPENSION T3

TOBRADEX ST T3 ST

tobramycin ophthalmic T1

tobramycin-dexamethasone T1

TOBREX OPHTHALMIC OINTMENT T2

TOBREX OPHTHALMIC SOLUTION T3

VIGAMOX T3

ZYLET T3 ST

ZYMAXID T3 ST

Antifungals (Eent)

NATACYN T3

Antivirals (Eent)

trifluridine ophthalmic T1

VIROPTIC T3

ZIRGAN T3

Beta-Adrenergic Blocking Agents (Eent)

betaxolol hcl ophthalmic T2

BETIMOL T3

BETOPTIC-S T3 ST


carteolol hcl T1

COMBIGAN T9

COSOPT T3

131


dorzolamide hcl-timolol mal T1

ISTALOL T9

levobunolol hcl ophthalmic solution 05 T1

timolol maleate (once-daily) T9

timolol maleate ophthalmic gel forming solution T2

timolol maleate ophthalmic solution T1

timolol maleate pf T3

TIMOPTIC T3

TIMOPTIC OCUDOSE T3

TIMOPTIC-XE T3

Carbonic Anhydrase Inhibitors (Eent)

acetazolamide er T1


AZOPT T3


brinzolamide T2

COSOPT T3

dorzolamide hcl ophthalmic T1



SIMBRINZA T2

TRUSOPT T3

Corticosteroids (Eent)

ALREX T3 ST



BECONASE AQ T9

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

budesonide nasal T9

CIPRO HC T2

CIPRODEX T3



COLY-MYCIN S T3

CORTANE-B OTIC T3

dexamethasone sodium phosphate ophthalmic T1

DEXYCU T9

difluprednate T1 ST

DUREZOL T3 ST

132


DYMISTA T3 ST

EYSUVIS T3 ST QL (4 bottles per 1 year)

FLAREX T2

flunisolide nasal solution 25 mcgact (0025) T3

fluorometholone ophthalmic T1

fluticasone propionate nasal T3

FML T2

FML FORTE T3

FML LIQUIFILM T3

INVELTYS T3 ST

LOTEMAX T9

LOTEMAX SM T3 ST

loteprednol etabonate T2 ST

MAXIDEX T3

MAXITROL T3

mometasone furoate nasal T3 ST

NASACORT ALLERGY 24HR T3

NASONEX T9


T1


T1


OMNARIS T9

OTOVEL T2 AL

PRED FORTE T3

PRED MILD T3

PRED-G T2

PRED-G SOP T3

prednisolone acetate ophthalmic T1

prednisolone sodium phosphate ophthalmic T1

prednisolone-bromfenac ophthalmic solution T9



T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9


TICALAST T9

133




TOBRADEX ST T3 ST


triamcinolone acetonide nasal aerosol T3

XHANCE T9

ZETONNA T9

ZYLET T3 ST

Eent Anti-Infectives Miscellaneous

chlorhexidine gluconate mouththroat T1

CORTANE-B OTIC T3

PERIDEX T3

Eent Anti-Inflammatory Agents Misc

CEQUA T9

cyclosporine ophthalmic T3 QL (64 vials per 30 days)

RESTASIS T2 QL (64 vials per 30 days)

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 005

T2 QL (1 bottle per 30 days)

XIIDRA T2 QL (60 vials per 30 days)

Eent Drugs Miscellaneous

acetic acid otic T1

ALZAIR ALLERGY NASAL SPRAY T9

apraclonidine hcl T1

BSS T1

BSS PLUS T3


cromolyn sodium oral T3

CYSTADROPS T4SP (Limited to a 1 month supply per dispensing) QL (20 ML per 30 days)

CYSTARAN T4SP (Limited to a 1 month supply per fill) QL (60 ML per 30 days)

GASTROCROM T3

IOPIDINE OPHTHALMIC SOLUTION 1 T4ST SP (Limited to a 1 month supply per fill )

LACRISERT T4SP (Limited to a 1 month supply per fill)

MUCOSITISRX T9

134


OXERVATE T4

PA SP (Limited to a 1 month supply per fill Limited to 8 weeks of treatment

) QL (28 mls per 30 days)

TICALAST T9

TYRVAYA T9

Eent Nonsteroidal Anti-Inflam Agents

ACULAR T3

ACULAR LS T3

ACUVAIL T3 ST

bromfenac sodium (once-daily) T2 ST QL (17 ML per 30 days)

BROMSITE T3 ST QL (5 ML per 30 days)

diclofenac sodium ophthalmic T1

flurbiprofen sodium T1

ILEVRO T3 ST QL (3 ML per 30 days)

ketorolac tromethamine ophthalmic T1

NEVANAC T3 ST



T9

PROLENSA T3 ST QL (3 ML per 30 days)

Local Anesthetics (Eent)

CORTANE-B OTIC T3


lidocaine viscous T1

Miotics

ISOPTO CARPINE T3

PHOSPHOLINE IODIDE T2

pilocarpine hcl ophthalmic solution 1 2 4 T1

VUITY T9

Mydriatics

atropine sulfate ophthalmic solution 1 T1

CYCLOGYL OPHTHALMIC SOLUTION 05 T2

CYCLOGYL OPHTHALMIC SOLUTION 1 2

T3

CYCLOMYDRIL T3

cyclopentolate hcl ophthalmic T1

HOMATROPAIRE T1

ISOPTO ATROPINE T3

135


phenylephrine hcl ophthalmic solution 10 25

T1

tropicamide-cyclopentolate-pe T9

Prostaglandin Analogs

bimatoprost ophthalmic T1

latanoprost ophthalmic T1

LUMIGAN OPHTHALMIC SOLUTION 001 T2 ST

ROCKLATAN T3 ST

TRAVATAN Z T3

travoprost (bak free) T2 ST

VYZULTA T9

XALATAN T3

XELPROS T2

ZIOPTAN T3

Rho Kinase Inhibitors

RHOPRESSA T3 ST

ROCKLATAN T3 ST

Vasoconstrictors

ADRENALIN NASAL T9

CYCLOMYDRIL T3


NAPHCON-A T9


T1


UPNEEQ T9

Gastrointestinal Drugs

5-Ht3 Receptor Antagonists

AKYNZEO ORAL T9

ANZEMET ORAL TABLET 50 MG T9

granisetron hcl oral T2 QL (20 tablets per 30 days)

ondansetron T1

ondansetron hcl oral T1

SANCUSO T4ST SP (Max day supply up to 31 days) QL (1 patch per 28 days)

SUSTOL T9

ZUPLENZ T2 ST QL (20 films per 30 days)

Antacids And Adsorbents


BUFFERIN T3 PV AL

136




omeprazole-sodium bicarbonate oral capsule T9

PLENITY T9

ZEGERID T9

ZEGERID OTC T3

Antidiarrhea Agents

acidophilus lactobacillus powder T9



FUSION SPRINKLES T9


loperamide hcl oral capsule T9

MYTESI T9

opium T9

paregoric T9

PYLERA T9

RESTORA RX T9

RESTORA SPRINKLES T9

XERMELO T4PA SP (Limited to a 1 month supply per fill)

Antiemetics Miscellaneous

dronabinol oral capsule 10 mg T4SP (Limited to a 1 month supply per fill) QL (60 Capsules per 30 days)

dronabinol oral capsule 25 mg 5 mg T3 QL (60 Capsules per 30 days)

MARINOL ORAL CAPSULE 10 MG T4SP (Limited to a 1 month supply per fill) QL (60 capsules per 30 days)

MARINOL ORAL CAPSULE 25 MG 5 MG T3 QL (60 capsules per 30 days)




T1


T3


T9

scopolamine T1

SYNDROS T9


137



T3

Antiflatulents


Antihistamines (Gi Drugs)


BONJESTA T9

COMPRO T1

DICLEGIS T9

doxylamine-pyridoxine T9


prochlorperazine T1


TIGAN ORAL T3

trimethobenzamide hcl oral T1

Anti-Inflammatory Agents (Gi Drugs)

alosetron hcl T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

APRISO T9

ASACOL HD T5ST SP (Limited to a 1 month supply per fill) QL (180 tablets per 30 days)

AZULFIDINE T3


balsalazide disodium T1

CANASA T5SP (Max day supply up to 31 days)

COLAZAL T5SP (Max day supply up to 31 days)

DELZICOL T3 QL (180 capsules per 30 days)

DIPENTUM T3

LIALDA T3 QL (120 tablets per 30 days)

LOTRONEX T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

mesalamine er oral capsule extended release T5ST SP (Limited to a 1 month supply per fill) QL (240 capsules per 30 days)

mesalamine er oral capsule extended release 24 hour


mesalamine oral capsule delayed release T3SP () QL (180 capsules per 30 days)

138


mesalamine oral tablet delayed release 12 gm T3SP () QL (120 tablets per 30 days)

mesalamine oral tablet delayed release 800 mg T5ST SP (Limited to a 1 month supply per fill ) QL (180 tablets per 30 days)

mesalamine rectal enema T1

mesalamine rectal suppository T5SP (Limited to a 1 month supply per fill )

PENTASA T5ST SP (Limited to a 1 month supply per fill) QL (240 capsules per 30 days)

ROWASA RECTAL T3

SFROWASA T3 QL (30 bottles per 30 days)


Antiulcer Agents And Acid SuppressMisc

PYLERA T9

TALICIA T9

Antiulcer Agents And Acid Suppressants







FLAGYL T3




Cathartics And Laxatives


bisacodyl oral T3

bisacodyl rectal T9

BUFFERIN T3 PV AL




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3

139


CLENPIQ T3

COLYTE WITH FLAVOR PACKS ORAL SOLUTION RECONSTITUTED 240 GM

T3

ENEMEEZ MINI T3 QL (90 tubes per 30 days)

ENEMEEZ PLUS T3 QL (90 tubes per 30 days)

fe 90 plus T9

FERIVA 217 T9

FERIVAFA T9

FERRALET 90 T9

ferraplus 90 T9


GAVILYTE-C T1 PV

GAVILYTE-G T1 PV

GAVILYTE-N WITH FLAVOR PACK T1 PV

GLYCOLAX T9

GOLYTELY T3

HEMATRON-AF T9


INATAL GT T1


MIRALAX ORAL POWDER T9

MOVIPREP T3


mynate 90 plus T1

NATALVIRT FLT T9

NEPHRON FA T9

NEXA PLUS T3

NULYTELY LEMON-LIME T3

OSMOPREP T3

peg 3350 oral powder T9

peg 3350-kcl-na bicarb-nacl T1 PV

peg-3350electrolytes T1 PV

peg-3350electrolytesascorbat T1 PV

PEG-PREP T1 PV

PLENVU T3

pnv-dha+docusate T1

polyethylene glycol 3350 oral T9


SMOOTH LAX ORAL POWDER T9

SUPREP BOWEL PREP KIT T3

140


SUTAB T9

TARON-PREX T2


tl-hem 150 T9

TRILYTE T1 PV

Cholelitholytic Agents

ACTIGALL T3

RELTONE T9

URSO 250 T3

URSO FORTE T3

ursodiol oral capsule 200 mg 400 mg T9

ursodiol oral capsule 300 mg T2

ursodiol oral tablet T2

Digestants










Gi Drugs Miscellaneous

ALLI T3 ST

AMITIZA T3 ST QL (60 capsules per 30 days)

BYLVAY T9

BYLVAY (PELLETS) T9

BYNFEZIA PEN T9

CHOLBAM T4PA SP (Limited to a 1 month supply per fill )

CIMZIA PREFILLED T5PA SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)

141


CIMZIA STARTER KIT T5 PA

CIMZIA SUBCUTANEOUS KIT 2 X 200 MG T5PA SP (Limited to a 1 month supply per fill)

GATTEX T5PA SP (Limited to a 1 month supply per fill)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT80 MG08ML

T4PA SP (Limited to a 1 month supply per fill) QL (1 Kit per 2 years)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT80 MG08ML amp 40MG04ML

T4PA SP (Limited to a 1 month supply per fill ) QL (1 Kit per 2 years)

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG04ML 80 MG08ML

T4PA SP (Limited to a 1 month supply per fill) QL (2 pens per 28 days)

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML

T4PA SP (Limited to a 1 month supply per fill ) QL (2 pens per 28 days)

HUMIRA PEN-CDUCHS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML



T4PA SP (Limited to a 1 month supply per fill) QL (1 kit per 2 years)

HUMIRA PEN-PEDIATRIC UC START T4PA SP (Limited to a 1 month supply per fill) QL (1 kit per 2 years)

HUMIRA PEN-PSUVADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG08ML


HUMIRA PEN-PSORUVEIT STARTER T4PA SP (Limited to a 1 month supply per fill) QL (1 kit per 2 years)

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG01ML 40 MG08ML

T4PA SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 20 MG02ML




IBSRELA T9

LINZESS T2 QL (30 capsules per 30 days)

LIVMARLI T9

lubiprostone T3 ST QL (60 capsules per 30 Days)

MOTEGRITY T3 ST QL (30 tablets per 30 days)

142


MOVANTIK T3 ST QL (30 tablets per 30 days)

MYCAPSSA T9

OCALIVA ORAL TABLET 10 MG T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

OCALIVA ORAL TABLET 5 MG T5

PA SP (Limited to a 1 month supply per fill

) QL (30 tablets per 30 days)

octreotide acetate injection solution 100 mcgml 1000 mcgml 200 mcgml 50 mcgml 500 mcgml


octreotide acetate subcutaneous T4SP (Limited to a 1 month supply per fill )






REMICADE T9

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 100 MGML

T5PA SP (Limited to a 1 month supply per fill) QL (1 ML per 28 days)

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG05ML


SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML


SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 50 MG05ML

T5PA SP (Limited to a 1 month supply per fill ) QL (05 ML per 28 days)

SYMPROIC T3 ST QL (30 tablets per 30 days)

TRULANCE T2 QL (30 tablets per 30 days)

VIBERZI T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

XENICAL T9

Histamine H2-Antagonists




DUEXIS T9

143






nizatidine T3









Neurokinin-1 Receptor Antagonists

AKYNZEO ORAL T9

aprepitant oral T1 QL (6 capsules per 30 days)

aprepitant oral capsule T1 QL (7 capsules per 30 days)

EMEND ORAL CAPSULE 125 MG 40 MG 80 MG

T9

EMEND TRI-PACK T9

VARUBI ORAL T9

Prokinetic Agents

GIMOTI T9

metoclopramide hcl oral solution 10 mg10ml 5 mg5ml

T1

metoclopramide hcl oral tablet T1

metoclopramide hcl oral tablet dispersible T3 ST

REGLAN ORAL T3

ZELNORM T3 ST QL (60 tablets per 30 days)

Prostaglandins


T9

CYTOTEC T3


misoprostol oral T1

Protectants

CARAFATE T3 ST

sucralfate oral suspension T2

sucralfate oral tablet T1

144


Proton-Pump Inhibitors

ACIPHEX T9

ACIPHEX SPRINKLE ORAL CAPSULE SPRINKLE 5 MG

T9


DEXILANT T9

dexlansoprazole T9

esomeprazole magnesium oral packet T9

esomeprazole strontium oral capsule delayed release 493 mg

T9

FIRST-LANSOPRAZOLE T3

FIRST-OMEPRAZOLE T3

lansoprazole oral capsule delayed release T3


NEXIUM T9

NEXIUM 24HR ORAL CAPSULE DELAYED RELEASE

T9

NEXIUM 24HR ORAL TABLET DELAYED RELEASE

T3

omeprazole oral capsule delayed release T3

omeprazole oral tablet delayed release T3


pantoprazole sodium oral packet T9

pantoprazole sodium oral tablet delayed release T3

PREVACID T9

PREVACID 24HR T3

PRILOSEC OTC T3

PROTONIX ORAL T9

rabeprazole sodium oral tablet delayed release T3

VIMOVO T9

YOSPRALA T9

ZEGERID T9

ZEGERID OTC T3

Gold Compounds

Gold Compounds

RIDAURA T9

Heavy Metal Antagonists


CHEMET T4SP (Limited to a 1 month supply per fill)

CUPRIMINE ORAL CAPSULE 250 MG T9

145


deferasirox granules T4SP (Limited to a 1 month supply per fill)

deferasirox oral tablet T4SP (Limited to a 1 month supply per fill)

deferasirox oral tablet soluble T4SP (Limited to a 1 month supply per fill)

deferiprone T4SP (Limited to a 1 month supply per fill )

DEPEN TITRATABS T9

EXJADE T5

SP (Limited to a 1 month supply per fill Only available through the EPASS program Please call 888 90-EPASS for more information )

FERRIPROX ORAL SOLUTION T4SP (Limited to a 1 month supply per fill )

FERRIPROX ORAL TABLET 1000 MG T9

FERRIPROX ORAL TABLET 500 MG T5SP (Limited to a 1 month supply per fill )

FERRIPROX TWICE-A-DAY T5SP (Limited to a 1 month supply per fill )

JADENU T5SP (Limited to a 1 month supply per fill )

JADENU SPRINKLE ORAL PACKET 180 MG T9

JADENU SPRINKLE ORAL PACKET 360 MG 90 MG

T9SP ()

penicillamine oral capsule T9

penicillamine oral tablet T4PA SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)

SYPRINE T9

trientine hcl T5PA SP (Limited to a 1 month supply per fill ) QL (150 capsules per 30 days)

Hormones And Synthetic Substitutes

Adrenals

ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9

146





ALKINDI SPRINKLE T9

ALVESCO T9

ARMONAIR DIGIHALER T9

ARNUITY ELLIPTA T1 QL (1 Inhaler per 30 days) AL

ASMANEX (120 METERED DOSES) T9





ASMANEX HFA T9

BREO ELLIPTA T9


budesonide er oral tablet extended release 24 hour

T5ST SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)

budesonide inhalation suspension 025 mg2ml 1 mg2ml


budesonide inhalation suspension 05 mg2ml T2 QL (240 ML per 30 days)

budesonide oral T3 QL (90 capsules per 30 days)


CORTEF T3

cortisone acetate oral T1

dexabliss T9

DEXAMETHASONE INTENSOL T2

dexamethasone oral elixir T1

dexamethasone oral solution T1

dexamethasone oral tablet T1

dexamethasone oral tablet therapy pack 15 mg (21)

T9

DEXONTO 04 T3

DEXPAK 6 DAY ORAL TABLET THERAPY PACK

T9


EMFLAZA T9

ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES


FLOVENT DISKUS T1 QL (1 Inhaler per 30 Day(s)s)

FLOVENT HFA T1 QL (1 Inhaler per 30 Day(s)s)

147


fludrocortisone acetate oral T1



fluticasone propionate hfa T9



T3



HEMADY T9

HIDEX 6-DAY T9

hydrocortisone oral T1

INTRAROSA T3 PA

MEDROL T3

methylprednisolone oral T1

MILLIPRED T9


NASONEX T9

ORAPRED ODT T9

ORTIKOS T9

prednisolone oral solution T1

prednisolone sodium phosphate oral solution 15 mg5ml 25 mg5ml 67 (5 base) mg5ml

T1

prednisolone sodium phosphate oral solution 20 mg5ml

T9

PREDNISONE INTENSOL T2

prednisone oral solution T2

prednisone oral tablet 1 mg 10 mg 25 mg 20 mg 5 mg

T1

prednisone oral tablet 50 mg T2

PULMICORT FLEXHALER T9

PULMICORT INHALATION SUSPENSION 025 MG2ML 05 MG2ML

T3

PULMICORT INHALATION SUSPENSION 1 MG2ML


QVAR REDIHALER T1

RAYOS T9

SINUVA T9

148


SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 100 MG

T2 QL (2 vials per 1 year)


TAPERDEX 12-DAY T9

TAPERDEX 6-DAY ORAL TABLET THERAPY PACK 15 MG (21)

T9

TARPEYO T9

TRELEGY ELLIPTA T2

UCERIS ORAL T5ST SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

WIXELA INHUB T3

XHANCE T9

zcort 7-day T9

ZILRETTA T9

Alpha-Glucosidase Inhibitors

acarbose oral T1

GLYSET T3

PRECOSE T3

Amylinomimetics

SYMLINPEN 120 SUBCUTANEOUS SOLUTION PEN-INJECTOR



T4SP (Limited to a 1 month supply per fill ) QL (6 ML per 30 days)

Androgens

ANADROL-50 T9

ANDRODERM TRANSDERMAL PATCH 24 HOUR

T9

ANDROGEL PUMP TRANSDERMAL GEL2025 MGACT (162)

T9

ANDROGEL TRANSDERMAL GEL 2025 MG125GM (162) 25 MG25GM (1) 50 MG5GM (1)

T9

COVARYX T9

COVARYX HS T9

danazol oral capsule 100 mg 50 mg T3 QL (60 capsules per 30 days)

danazol oral capsule 200 mg T3 QL (120 capsules per 30 days)

DEPO-TESTOSTERONE INTRAMUSCULAR SOLUTION

T9

est estrogens-methyltest ds T9

est estrogens-methyltest hs T9

149


est estrogens-methyltest oral tablet 125-25 mg T9

FORTESTA T9

JATENZO T9

methitest T9

methyltestosterone oral T4PA SP (Limited to a 1 month supply per fill)

NATESTO T9

OXANDRIN T3

oxandrolone oral T3

STRIANT T9

TESTIM T9

testosterone cypionate intramuscular solution100 mgml 200 mgml

T1

testosterone enanthate intramuscular solution T1

testosterone transdermal gel 10 mgact (2) 2025 mg125gm (162)

T9

testosterone transdermal gel 125 mgact (1) T2 PA QL (300 GM per 30 days)

testosterone transdermal gel 2025 mgact (162)

T2 PA QL (150 GM per 30 days)

testosterone transdermal gel 25 mg25gm (1) T2 PA

testosterone transdermal gel 50 mg5gm (1) T2 PA QL (300 ML per 30 days)

testosterone transdermal solution T9

TLANDO T9

VOGELXO PUMP T9

VOGELXO TRANSDERMAL GEL 50 MG5GM (1)

T9

XYOSTED T9

Antidiabetic Agents Miscellaneous



CYCLOSET T3

KORLYM T5PA SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days)



Antiestrogens

anastrozole oral T1

ARIMIDEX T3

AROMASIN T3

exemestane T2

150


FEMARA T3




letrozole oral T1

Antigonadtropins

CETROTIDE SUBCUTANEOUS KIT 025 MG T2

ganirelix acetate subcutaneous solution prefilled syringe


MYFEMBREE T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)


ORIAHNN T4PA SP (Limited to a 1 month supply per fill) QL (56 capsules per 28 days)

ORILISSA ORAL TABLET 150 MG T4PA SP (Limited to a 1 month supply per fill) QL (28 tablets per 28 days)


Antihypoglycemic Agents Miscellaneous

diazoxide oral T4SP (Limited to a 1 month supply per fill)

PROGLYCEM T9

Antiparathyroid Agents

calcitonin (salmon) injection T9

calcitonin (salmon) nasal T1

cinacalcet hcl T4SP (Limited to a 1 month supply per fill)

MIACALCIN NASAL T3

SENSIPAR T5SP (Limited to a 1 month supply per fill)

Antithyroid Agents

methimazole oral T1

151


propylthiouracil oral T1

TAPAZOLE T3

Biguanides

ACTOPLUS MET T3

ACTOPLUS MET XR T2 QL (60 tablets per 30 days)

alogliptin-metformin hcl T3 ST QL (60 tablets per 30 days)

FORTAMET T9

glipizide-metformin hcl T1

GLUCOPHAGE T3

GLUCOPHAGE XR T3

GLUMETZA T9

glyburide-metformin T1

INVOKAMET T3 ST QL (60 tablets per 30 days)

INVOKAMET XR T3 ST QL (60 tablets per 30 days)

JANUMET T2 QL (60 tablets per 30 days)

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG


JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 50-1000 MG 50-500 MG


JENTADUETO T3 ST QL (60 tablets per 30 days)

JENTADUETO XR T3 ST QL (30 tablets per 30 days)

KAZANO T9

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 25-1000 MG


KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR 5-1000 MG 5-500 MG


metformin hcl er T1

metformin hcl er (mod) oral tablet extended release 24 hour 1000 mg

T9

metformin hcl oral solution T9

metformin hcl oral tablet 1000 mg 500 mg 850 mg

T1

metformin hcl oral tablet 625 mg T9

pioglitazone hcl-metformin hcl T1

RIOMET T9

SEGLUROMET T3 ST QL (60 tablets per 30 days)

SYNJARDY T2 QL (60 tablets per 30 days)

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG 25-1000 MG




152


TRIJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-5-1000 MG 25-5-1000 MG

T2 QL (30 Tablets per 30 days)



XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG 10-500 MG


XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 25-1000 MG

T2



Contraceptives

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9

BALZIVA T1SP (Contraceptive Management rider is required) PV

BEYAZ T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MGML

T3 PV

153


DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SUSPENSION PREFILLED SYRINGE

T3 PV

ECONTRA EZ T1 PV

ECONTRA ONE-STEP T1 PV

ELLA T1

ELURYNG T2 PV QL (1 ring per 28 days)

EMOQUETTE T1

ENPRESSE-28 T1 PV

ERRIN T1 PV

ESTROSTEP FE T3

etonogestrel-ethinyl estradiol T2 QL (1 ring per 28 days)

FALMINA T1 PV

FAYOSIM T9

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV

GILDESS FE 1530 T1 PV


HAILEY 24 FE T1 PV

HAILEY FE 1530 T1 PV

HEATHER T1 PV

JENCYCLA T1 PV

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9

levonorgest-eth est amp eth est T1 PV

levonorgest-eth estrad 91-day oral tablet 01-002 amp 001 mg

T1 PV

levonorgestrel oral tablet 15 mg T1 PV

154


levonorgestrel-ethinyl estrad oral tablet 015-30 mg-mcg

T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV

LO LOESTRIN FE T3 ST

LOESTRIN 1530 (21) T9

LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV

medroxyprogesterone acetate intramuscular suspension

T1 PV

MELODETTA 24 FE T9

MIBELAS 24 FE T9

MICROGESTIN 1530 T1 PV


MICROGESTIN FE 1530 T1 PV


MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV

NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV

NEXT CHOICE ONE DOSE T1 PV

NEXTSTELLIS T9

NORA-BE T1 PV

norethin ace-eth estrad-fe oral capsule T9

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg(24) 15-30 mg-mcg

T1 PV

norethindrone acet-ethinyl est oral tablet 15-30 mg-mcg

T1 PV

norethindrone oral T1 PV

norethin-eth estradiol-fe oral tablet chewable 08-25 mg-mcg

T9

norgestim-eth estrad triphasic oral tablet0180215025 mg-25 mcg

T1 PV

155


NORLYDA T1 PV

NORTREL 0535 (28) T1 PV


NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV

OPCICON ONE-STEP T1 PV

OPTION 2 T1 PV

PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV

TRI-LO-ESTARYLLA T1 PV

TRI-LO-SPRINTEC T1 PV

TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV

XULANE T2 PV QL (4 patches per 28 days)

YASMIN 28 T9

YAZ T9

156


ZAFEMY T1 PV QL (4 patches per 28 days)

ZOVIA 135E (28) T1 PV

Dipeptidyl Peptidase-4(Dpp-4) Inhibitors

alogliptin benzoate T3 ST QL (30 tablets per 30 days)


alogliptin-pioglitazone T3 QL (30 tablets per 30 days)

GLYXAMBI T2 QL (30 tablets per 30 days)






JANUVIA T2 QL (30 tablets per 30 days)



KAZANO T9





NESINA T9

ONGLYZA T3 ST QL (30 tablets per 30 days)

OSENI T9

QTERN T3 ST QL (30 tablets per 30 days)

STEGLUJAN T3 ST QL (30 tablets per 30 days)

TRADJENTA T3 ST QL (30 tablets per 30 days)





Estrogen Agonist-Antagonists

clomiphene citrate oral T1

DUAVEE T3 QL (30 tablets per 30 days)

EVISTA T3

FARESTON T9

OSPHENA T2 PA

raloxifene hcl T1

SOLTAMOX T9


157



Estrogens

ACTIVELLA T3

ALORA T2

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA T9

CLIMARA PRO T9

COMBIPATCH T2

COVARYX T9

COVARYX HS T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DELESTROGEN T3

DIVIGEL TRANSDERMAL GEL 025 MG025GM 05 MG05GM 1 MGGM

T2 QL (30 packets per 30 days)

DIVIGEL TRANSDERMAL GEL 125 MG125GM

T2 QL (30 packets per 30 Days)

DOTTI T1

158



ELESTRIN T3


EMOQUETTE T1

ENPRESSE-28 T1 PV




ESTRACE ORAL T3

ESTRACE VAGINAL T9

estradiol implant pellet 6 mg T9

estradiol oral T1

estradiol transdermal T1

estradiol vaginal cream T1 QL (425 GM per 30 days)

estradiol vaginal tablet T1

estradiol valerate intramuscular oil 20 mgml 40 mgml

T2

estradiol-norethindrone acet oral tablet 1-05 mg T1

ESTRING T3

ESTROGEL T2 QL (50 GM per 31 days)

ESTROSTEP FE T3


EVAMIST T2

FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

FEMRING T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


IMVEXXY MAINTENANCE PACK T3 PA QL (8 inserts per 28 days)

IMVEXXY STARTER PACK T3 PA QL (18 inserts per 360 days)

JINTELI T1

JOLESSA T1 PV

JULEBER T1

159


JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYLLANA T1

marlissa T1 PV

MELODETTA 24 FE T9

MENEST ORAL TABLET 03 MG 0625 MG 125 MG

T2

MENOSTAR T3 QL (4 patches per 28 days)

MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

160


MINIVELLE TRANSDERMAL PATCH TWICE WEEKLY 00375 MG24HR 005 MG24HR 0075 MG24HR 01 MG24HR

T3

MIRCETTE T9


NATAZIA T9

NECON 0535 (28) T1 PV

NEXTSTELLIS T9



T1 PV


T1 PV

norethindrone-eth estradiol oral tablet 05-25 mg-mcg

T1


T9


T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


PORTIA-28 T1 PV

PREFEST T3

PREMARIN ORAL T2 QL (30 tablets per 30 days)

PREMARIN VAGINAL T3 ST

PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

161


SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TWIRLA T9

TYDEMY T9

VAGIFEM VAGINAL TABLET 10 MCG T3

VELIVET T1 PV

VIVELLE-DOT T3


YASMIN 28 T9

YAZ T9

YUVAFEM T1



Glycogenolytic Agents

BAQSIMI ONE PACK T2 QL (2 devices per 30 Days)

BAQSIMI TWO PACK T2 QL (2 devices per 30 Days)

GLUCAGEN HYPOKIT T2 QL (2 Kits per 30 days)

glucagon emergency injection kit T2 QL (2 Kits per 30 days)

GVOKE HYPOPEN 1-PACK T2


GVOKE KIT T2 QL (2 vials per 30 days)

GVOKE PFS T2 QL (2 syringes per 30 days)

ZEGALOGUE T3 QL (2 kits per 30 days)

Gonadotropins

chorionic gonadotropin intramuscular T3

FOLLISTIM AQ SUBCUTANEOUS T3 ST

GONAL-F T2 QL (13500 units per 30 days)

GONAL-F RFF T2 QL (13500 units per 30 days)

GONAL-F RFF REDIJECT T2 QL (13500 units per 30 days)

162



MENOPUR T2

NOVAREL T3 ST

OVIDREL T2

PREGNYL T1

SYNAREL T9

Incretin Mimetics

ADLYXIN T3 ST

ADLYXIN STARTER PACK T3 ST

BYDUREON BCISE T3 ST

BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

T3 ST


T3 ST

OZEMPIC (025 OR 05 MGDOSE) T2 QL (15 ML per 28 days)

OZEMPIC (1 MGDOSE) SUBCUTANEOUS SOLUTION PEN-INJECTOR 4 MG3ML

T2 QL (3 ML per 28 Days)

OZEMPIC (2 MGDOSE) T2 QL (3 ML per 28 days)

RYBELSUS T9

SAXENDA T9

SOLIQUA T2 QL (15 ML per 25 days)

TRULICITY T2 QL (2 ML per 28 days)

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR

T2

WEGOVY T9

XULTOPHY T2 QL (15 ML per 30 days)

Intermediate-Acting Insulins

HUMULIN 7030 T1

HUMULIN 7030 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

T1

HUMULIN N T1

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

T1

NOVOLIN 7030 T3 ST

NOVOLIN 7030 FLEXPEN T3 ST

NOVOLIN N T3 ST

NOVOLIN N FLEXPEN T3 ST

163


Leptins

MYALEPT T5


)

Long-Acting Insulins

BASAGLAR KWIKPEN T9

insulin glargine-yfgn T9

LANTUS T1

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

T1

LEVEMIR T3 ST

LEVEMIR FLEXTOUCH T3 ST

SEMGLEE T9

SEMGLEE (YFGN) T9


TOUJEO MAX SOLOSTAR T1

TOUJEO SOLOSTAR T1

TRESIBA T9

TRESIBA FLEXTOUCH T9


Meglitinides

nateglinide T1

PRANDIN ORAL TABLET 1 MG 2 MG T3

repaglinide T1

STARLIX T3

Parathyroid Agents

FORTEO SUBCUTANEOUS SOLUTION PEN-INJECTOR 600 MCG24ML

T9

NATPARA SUBCUTANEOUS CARTRIDGE 100 MCG


NATPARA SUBCUTANEOUS CARTRIDGE 25 MCG 50 MCG 75 MCG


teriparatide (recombinant) T5PA SP (Limited to a 1 month supply per fill)

TYMLOS T4PA SP (Limited to a 1 month supply per fill ) QL (1 pen per 30 days)

164


Pituitary


CORTROPHIN T9

DDAVP ORAL T3






GENOTROPIN MINIQUICK SUBCUTANEOUS PREFILLED SYRINGE

T9

GENOTROPIN SUBCUTANEOUS CARTRIDGE T9

HUMATROPE INJECTION CARTRIDGE T9

HUMATROPE INJECTION SOLUTION RECONSTITUTED 12 MG 24 MG 6 MG

T9

NOCDURNA T9

NOCTIVA T9

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION PEN-INJECTOR


NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION PEN-INJECTOR

T9


T9


T9

OMNITROPE SUBCUTANEOUS SOLUTION CARTRIDGE

T9

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED

T9SP ()

SAIZEN T9SP ()

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED 4 MG 5 MG 6 MG


SKYTROFA T9


ZOMACTON T9

ZORBTIVE T5PA SP (Limited to a 1 month supply per fill)

165


Progestins

ACTIVELLA T3

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYGESTIN T3

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA PRO T9

COMBIPATCH T2

CRINONE T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV


T3 PV

ECONTRA EZ T1 PV


166


ELLA T1


EMOQUETTE T1

ENDOMETRIN T4SP (Limited to a 1 month supply per fill )

ENPRESSE-28 T1 PV

ERRIN T1 PV


ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JINTELI T1

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9


167



T1 PV



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV

medroxyprogesterone acetate oral T1

MEGACE ES T3 ST




MELODETTA 24 FE T9

MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV


NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV

168



NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV

norethindrone acetate oral T1


T1 PV



T1


T9


T1 PV

NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV


PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREFEST T3

PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV

progesterone intramuscular T1

progesterone oral T1

PROMETRIUM T3

PROVERA T3

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

169


SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9



Rapid-Acting Insulins

ADMELOG T3 ST

ADMELOG SOLOSTAR T3 ST

AFREZZA INHALATION POWDER 12 UNIT 4 amp 8 amp 12 UNIT 4 UNIT 60X4 amp60X8 amp 60X12 UNIT 8 UNIT 90 X 4 UNIT amp 90X8 UNIT 90 X 8 UNIT amp 90X12 UNIT

T3 ST

APIDRA T3 ST

APIDRA SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

T3 ST

FIASP T3 ST

FIASP FLEXTOUCH T3 ST

FIASP PENFILL T3 ST

HUMALOG T1

170


HUMALOG JUNIOR KWIKPEN T1

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNITML 200 UNITML

T1

HUMALOG MIX 5050 T1

HUMALOG MIX 5050 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

T1

HUMALOG MIX 7525 T1


T1

insulin asp prot amp asp flexpen T3 ST

insulin aspart T3 ST

insulin aspart flexpen T3 ST

insulin aspart penfill T3 ST

insulin aspart prot amp aspart T3 ST

insulin lispro T9

insulin lispro (1 unit dial) T9

insulin lispro junior kwikpen T9

insulin lispro prot amp lispro T9

LYUMJEV T1

LYUMJEV KWIKPEN T1

NOVOLOG T9

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

T9

NOVOLOG MIX 7030 T9

NOVOLOG MIX 7030 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

T9

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE

T9

Short-Acting Insulins

HUMULIN 7030 T1


T1

HUMULIN R T1

HUMULIN R U-500 (CONCENTRATED) T1

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

T1

NOVOLIN 7030 T3 ST


NOVOLIN R T3 ST

171


NOVOLIN R FLEXPEN T3 ST

Sodium-Gluc Cotransport 2 (Sglt2) Inhib

FARXIGA T2 QL (31 tablets per 31 days)




INVOKANA T3 ST QL (31 tablets per 31 days)

JARDIANCE T2 QL (30 tablets per 30 days)



STEGLATRO T3 ST QL (30 tablets per 30 days)














T2



Somatostatin Agonists

BYNFEZIA PEN T9

MYCAPSSA T9




SIGNIFOR T5PA SP (Limited to a 1 month supply per fill )

SOMATULINE DEPOT T4SP (Limited to a 1 month supply per fill )

172


Somatotropin Agonists


T9




T9

INCRELEX T4PA SP (Limited to a 1 month supply per fill )




T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



ZOMACTON T9


Somatotropin Antagonists

SOMAVERT SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG




SOMAVERT SUBCUTANEOUS SOLUTION RECONSTITUTED 20 MG 30 MG




Sulfonylureas

AMARYL T3

DUETACT T9

glimepiride T1

173


glipizide er T1

glipizide oral T1

glipizide xl oral tablet extended release 24 hour10 mg 25 mg

T1


GLUCOTROL T3

GLUCOTROL XL T3

glyburide micronized T1

glyburide oral T1


GLYNASE T3

pioglitazone hcl-glimepiride T9

Thiazolidinediones

ACTOPLUS MET T3


ACTOS T3


AVANDIA ORAL TABLET 2 MG 4 MG T2

DUETACT T9

OSENI T9

pioglitazone hcl T1



Thyroid Agents

ARMOUR THYROID T2

CYTOMEL T2

EUTHYROX T3

LEVO-T T3

levothyroxine sodium intravenous solution reconstituted 100 mcg 500 mcg


levothyroxine sodium oral capsule T9

levothyroxine sodium oral tablet T1

LEVOXYL T1

liothyronine sodium oral T1

NP THYROID T1

SYNTHROID T3

THYQUIDITY T9

THYROLAR-1 ORAL TABLET 60 (125-50) MG (MCG)

T2


T2

174



T2


T2


T2

TIROSINT ORAL CAPSULE 100 MCG 112 MCG 125 MCG 13 MCG 137 MCG 150 MCG 25 MCG 50 MCG 75 MCG 88 MCG

T9

TIROSINT-SOL ORAL SOLUTION 375 MCGML 44 MCGML 625 MCGML

T9

UNITHROID ORAL TABLET 100 MCG 112 MCG 125 MCG 150 MCG 175 MCG 200 MCG 25 MCG 300 MCG 50 MCG 75 MCG 88 MCG

T1

WESTHROID ORAL TABLET 130 MG 195 MG 325 MG 65 MG 975 MG

T1

Local Anesthetics (Parenteral)


ZTLIDO T9

Miscellaneous Therapeutic Agents

5-Alpha-Reductase Inhibitors

AVODART T3

dutasteride oral T1 QL (30 tablets per 30 days)


finasteride oral tablet 1 mg T9


JALYN T3 ST

PROPECIA T9

PROSCAR T3

Alcohol Deterrents

ANTABUSE T3

disulfiram oral T1


Antidotes

acetylcysteine inhalation T1


T1




175






















leucovorin calcium oral T1

MEPHYTON T3 QL (3 tablets per 30 days)





phytonadione oral T1 QL (3 tablets per 30 Days)


RENVELA T9



176




SPS T1

VISTOGARD T4SP (Limited to a 1 month supply per fill) QL (20 packets per 5 days)



Antigout Agents

allopurinol oral T1

ANAPROX DS T3

colchicine oral capsule T2 QL (120 capsules per 30 days)

colchicine oral tablet T2 QL (120 tablets per 30 days)


COLCRYS T9


T3

febuxostat T1 QL (30 tablets per 30 days)

GLOPERBA T9

INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1


MITIGARE T9


T9








probenecid oral T1

ULORIC T3 QL (30 tablets per 30 days)

ZYLOPRIM T3

Antisense Oligonucleotides

EXONDYS 51 T9

177


TEGSEDI T4PA SP (Limited to a 1 month supply per fill) QL (4 syringes per 30 days)

VILTEPSO T9

Bone Anabolic Agents


T9







Bone Resorption Inhibitors

ACTONEL ORAL TABLET 150 MG T3 QL (1 tablet per 30 days)

ACTONEL ORAL TABLET 35 MG 5 MG T3

alendronate sodium T1

ALORA T2

ATELVIA T3

BINOSTO T3 ST

BONIVA ORAL TABLET 150 MG T3



CLIMARA T9

DELESTROGEN T3





DOTTI T1

ELESTRIN T3

ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1




178



T2

ESTRING T3


etidronate disodium oral tablet 200 mg T3 ST

EVAMIST T2

EVISTA T3

FEMRING T3

FOSAMAX ORAL TABLET 70 MG T3

FOSAMAX PLUS D T3 ST QL (4 tablets per 28 days)

ibandronate sodium oral T1

LYLLANA T1


T2


MIACALCIN NASAL T3


T3



raloxifene hcl T1

risedronate sodium oral tablet 150 mg T1 ST QL (1 tablet per 30 days)

risedronate sodium oral tablet 30 mg T4ST SP (Limited to a 1 month supply per fill)

risedronate sodium oral tablet 35 mg 5 mg T1 ST

risedronate sodium oral tablet delayed release T2 ST


VIVELLE-DOT T3

YUVAFEM T1

Bradykinin Receptor Antagonists

FIRAZYR T9

icatibant acetate T5PA SP (Limited apply see quantity limitations) QL (3 syinges per 1 fill) AL

SAJAZIR T5PA SP (Limited to a 1 month supply per fill) QL (3 syringes per 1 fill) AL

Carbonic Anhydrase Inhibitors (Misc)

KEVEYIS T4PA SP (Limited to a 1 month supply per fill ) QL (120 tablets per 30 days)

179


Cariostatic Agents

DENTA 5000 PLUS T1

DENTAGEL T1

FLORIVA ORAL LIQUID T9

FLORIVA ORAL TABLET CHEWABLE 05 MG T9

FLORIVA PLUS T9


T3

LUDENT T1

multi-vitfluoride oral solution 025 mgml T1 AL

multivitaminfluoride oral tablet chewable 025 mg 05 mg

T1 AL

multivitaminsfluoride oral tablet chewable 05 mg T1 AL

MYKIDZ IRON FL T9

PREVIDENT T3

PREVIDENT 5000 ORTHO DEFENSE T3

PREVIDENT 5000 PLUS T3

QUFLORA FE T9

QUFLORA PEDIATRIC ORAL SOLUTION 025 MGML

T9

sf T1

sf 5000 plus T1

sodium fluoride 5000 plus T1

sodium fluoride 5000 ppm dental gel T1

sodium fluoride 5000 ppm dental paste T1


sodium fluoride dental gel 11 T1

sodium fluoride mouththroat T1

sodium fluoride oral solution 11 (05 f) mgml T1

sodium fluoride oral tablet chewable T1

TRI-VI-FLOR T9

tri-vitaminfluoride oral solution 025 mgml T1

Complement Inhibitors

BERINERT T4PA SP (Limited to a 1 month supply per fill )

EMPAVELI T4PA SP (Limited to a 1 month supply per fill)

HAEGARDA T5PA SP (Limited to a 1 month supply per fill )

RUCONEST T9

180


TAVNEOS T4PA SP (Limited to a 1 month supply per fill) QL (180 capsules per 30 years)

Disease-Modifying Antirheumatic Agents

ACTEMRA ACTPEN T4PA SP (Limited to a 1 month supply per fill) QL (4 pens per 28 days)

ACTEMRA SUBCUTANEOUS T4PA SP (Limited to a 1 month supply per fill) QL (4 syringes per 28 days)

ARAVA T5SP (Max of 31 days per dispensing )

AZASAN T9

azathioprine oral tablet 100 mg 75 mg T9

azathioprine oral tablet 50 mg T1

AZULFIDINE T3


CIBINQO T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)




COSENTYX T4

PA SP (Limited to a 1 month supply per fill Allowed one time fill of 5 syringes for inductionstarting dose only ) QL (1 syringe per 28 days)

COSENTYX (300 MG DOSE) T4

PA SP (Limited to a 1 month supply per fill Allowed one time fill of 5 dose packs for inductionstarting dose only ) QL (1 dose pack per 28 days)

COSENTYX SENSOREADY (300 MG) T4


COSENTYX SENSOREADY PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 150 MGML

T4

PA SP (Limited to a 1 month supply per fill Allowed one time fill of 5 pens for inductionstarting dose only ) QL (1 pen per 28 days)

181



cyclosporine modified oral capsule 100 mg 25 mg


cyclosporine modified oral capsule 50 mg T1

cyclosporine modified oral solution T1

cyclosporine oral capsule T1

DEPEN TITRATABS T9

ENBREL MINI T4PA SP (Limited to a 1 month supply per fill) QL (4 ML per 28 days)

ENBREL SUBCUTANEOUS SOLUTION 25 MG05ML

T4PA SP (Limited to a 1 month supply per fill) QL (8 vials per 28 days)

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG05ML


ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 50 MGML


ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED


ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

T4

PA SP (Limited to a 1 month supply per fill ) QL (4 Auto-Injectors per 28 days)

GENGRAF ORAL CAPSULE 100 MG 25 MG T1

GENGRAF ORAL SOLUTION T1













182













T9


IMURAN T3

KEVZARA SUBCUTANEOUS SOLUTION AUTO-INJECTOR


KEVZARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG114ML




KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T5PA SP (Max of 31 days per dispensing ) QL (28 syringes per 28 days)

leflunomide oral T1



T1

NEORAL T3

OLUMIANT ORAL TABLET 1 MG 2 MG T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

ORENCIA CLICKJECT T5PA SP (Limited to a 1 month supply per fill) QL (4 ML per 28 days)

183


ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 125 MGML


ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 50 MG04ML




OTEZLA ORAL TABLET T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days) AL

OTEZLA ORAL TABLET THERAPY PACK T4PA SP (Limited to a 1 month supply per fill ) QL (1 pack per 1 year) AL

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG04ML 125 MG04ML 15 MG04ML 175 MG04ML 20 MG04ML 225 MG04ML 25 MG04ML

T9



PLAQUENIL T3

RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG02ML 125 MG025ML 15 MG03ML 175 MG035ML 20 MG04ML 225 MG045ML 25 MG05ML 30 MG06ML 75 MG015ML

T9

REDITREX T3 ST

REMICADE T9

RIDAURA T9

RINVOQ ORAL TABLET EXTENDED RELEASE 24 HOUR 15 MG 30 MG

T4PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

RINVOQ ORAL TABLET EXTENDED RELEASE 24 HOUR 45 MG

T4PA SP (Limited to one fill per 2 years) QL (30 tablets per 30 days)

SANDIMMUNE ORAL CAPSULE T4SP (Limited to a 1 month supply per fill)

SANDIMMUNE ORAL SOLUTION T3





184







TREXALL T3 ST

XATMEP T3 AL

XELJANZ ORAL SOLUTION T4PA SP (Limited to a 1 month supply per fill) QL (240 ML per 30 days)

XELJANZ ORAL TABLET T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

XELJANZ XR T4PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

Immunomodulatory Agents



ACTIMMUNE T4SP (Limited to a 1 month supply per fill)


AUBAGIO ORAL TABLET 14 MG T5ST SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)


AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT

T4ST SP (Limited to a 1 month supply per fill ) QL (4 pens per 28 days)

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT

T4ST SP (Limited to a 1 month supply per fill ) QL (4 syringes per 28 days)

AZASAN T9



AZULFIDINE T3

185



BAFIERTAM T9


BETASERON SUBCUTANEOUS KIT T4ST SP (Limited to a 1 month supply per fill ) QL (14 vials per 30 days)




COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T9






dimethyl fumarate oral T1SP (Limited to a 1 month supply per fill )

dimethyl fumarate starter pack T1SP (Limited to a 1 month supply per fill )











T4


186


ENSPRYNG T4PA SP (Limited to a 1 month supply per fill) QL (1 syringe per 30 days)

EXTAVIA SUBCUTANEOUS KIT T5ST SP (Limited to a 1 month supply per fill) QL (1 kit per 30 days)



GILENYA ORAL CAPSULE 05 MG T4

ST SP (Limited to a 1 month supply per fill Not covered in combination with other immunomodulatory drugs) QL (30 capsules per 30 days)

glatiramer acetate subcutaneous solution prefilled syringe 20 mgml

T4

SP (Limited to a 1 month supply per fill Not covered in combination with other immunomodulatory drugs

) QL (30 ML per 30 days)


T4



GLATOPA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MGML

T4




T4











187

















T9


IMURAN T3





KESIMPTA T4

ST SP (Limited to a 1 month supply per fill Allowed 3 pens for first month of therapy only ) QL (1 pen per 28 days)



leflunomide oral T1


MAYZENT ORAL TABLET 025 MG T4ST SP (Limited to a 1 month supply per fill ) QL (120 tablets per 30 days)

188




MAYZENT STARTER PACK T4ST SP (Limited to one fill per 2 years) QL (1 pack per 30 days)



T1

NEORAL T3










PLAQUENIL T3

PLEGRIDY INTRAMUSCULAR T4ST SP (Limited to a 1 month supply per fill) QL (2 syringes per 28 days)

PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PEN-INJECTOR


PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


PLEGRIDY SUBCUTANEOUS SOLUTION PEN-INJECTOR


PLEGRIDY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE



189




PONVORY T4ST SP (Limited to a 1 month supply per fill)

PONVORY STARTER PACK T4ST SP (Limited to a 1 month supply per fill)

REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR 22 MCG05ML

T4ST SP (Limited to a 1 month supply per fill ) QL (6 ML per 28 days)



REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

T4ST SP (Limited to a 1 month supply per fill) QL (6 ML per 28 days)

REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


REMICADE T9





RIDAURA T9









190





TECFIDERA T5ST SP (Limited to a 1 month supply per fill)

THALOMID T4SP (Limited to a 1 month supply per fill)

TREXALL T3 ST

VUMERITY T9

XATMEP T3 AL

ZEPOSIA T4PA ST SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)

ZEPOSIA 7-DAY STARTER PACK T4PA ST SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

ZEPOSIA STARTER KIT T4PA ST SP (Limited to a 1 month supply per fill ) QL (30 tablets per 30 days)

Immunosuppressive Agents


ASTAGRAF XL T3 ST

AZASAN T9



BENLYSTA SUBCUTANEOUS T4PA SP (Limited to a 1 month supply per fill) QL (4 ML per 28 days)

CELLCEPT ORAL CAPSULE T3

CELLCEPT ORAL SUSPENSION RECONSTITUTED

T3 AL

CELLCEPT ORAL TABLET T3







ELIDEL T3 ST QL (30 GM per 30 days)

ENVARSUS XR T3 ST

191


everolimus oral tablet 025 mg 05 mg 075 mg T4SP (Limited to a 1 month supply per fill)

everolimus oral tablet 1 mg T4SP (Limited to a 1 month supply per fill)



IMURAN T3

leflunomide oral T1

LUPKYNIS T5PA SP (Limited to a 1 month supply per fill) QL (180 capsules per 30 days)

MAVENCLAD (10 TABS) T5

PA SP (Limited to a 1 month supply per fill Limited to 2 years of treatment) QL (20 tablets per 1 year)
















T1

mycophenolate mofetil oral capsule T1

mycophenolate mofetil oral suspension reconstituted

T1 AL

192


mycophenolate mofetil oral tablet T1

mycophenolate sodium oral tablet delayed release 180 mg




MYFORTIC ORAL TABLET DELAYED RELEASE 180 MG




NEORAL T3

pimecrolimus T1 ST QL (30 GM per 30 days)

PROGRAF ORAL CAPSULE T3

PROGRAF ORAL PACKET T3 AL

PROTOPIC T3 ST QL (30 GM per 30 days)


RAPAMUNE ORAL SOLUTION T5SP (Limited to a 1 month supply per fill)

RAPAMUNE ORAL TABLET 05 MG 1 MG T5SP (Limited to a 1 month supply per fill)

RAPAMUNE ORAL TABLET 2 MG T4SP (Limited to a 1 month supply per fill)



sirolimus oral T4SP (Limited to a 1 month supply per fill)

tacrolimus external ointment T1 QL (30 GM per 30 days)

tacrolimus oral T1

TREXALL T3 ST

XATMEP T3 AL

ZORTRESS T5SP (Limited to a 1 month supply per fill)

Kallikrein Inhibitors

KALBITOR T5PA SP (Limited to a 1 month supply per fill ) AL

ORLADEYO T5PA SP (Limited to a 1 month supply per fill) QL (30 capsules per 30 days) AL

TAKHZYRO SUBCUTANEOUS SOLUTION T4PA SP (Limited to a 1 month supply per fill )

TAKHZYRO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


193


Kallikrein-Kinin System Inhibitors



FIRAZYR T9





RUCONEST T9




Other Miscellaneous Therapeutic Agents

AMPYRA T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

ARCALYST T4SP (Limited to a 1 month supply per fill)

betaine T3

bp vit 3 T9

CARDIOVID PLUS T9

CARNITOR ORAL T3

CARNITOR SF T3

CERDELGA T4SP (Limited to a 1 month supply per fill ) QL (60 capsules per 30 days)



CITRANATAL DHA T3

194



T3

coenzyme q10 T2

coenzyme q-10 oral capsule 100 mg T9


CYSTADANE T9

dalfampridine er T5PA SP (Limited to a 1 month supply per fill )

DEMSER T9

ELMIRON T5SP (Limited to a 1 month supply per fill) QL (90 capsules per 30 days)

ENDARI T9

EUFLEXXA INTRA-ARTICULAR SOLUTION PREFILLED SYRINGE

T9


EVRYSDI T5PA SP (Limited to a 1 month supply per fill) QL (240 ML per 30 days)

FERIVA 217 T9


FERREX 28 T9

FIRDAPSE T4PA SP (Limited to a 1 month supply per fill) QL (240 tablets per 30 days)

FOLBEE AR T9

GALAFOLD T4PA SP (Limited to a 1 month supply per fill) QL (14 capsules per 28 days)

IROSPAN 246 T9

ISTURISA ORAL TABLET 1 MG T5PA SP (Limited to a 1 month supply per fill ) QL (120 Tablets per 30 days)

ISTURISA ORAL TABLET 10 MG 5 MG T5PA SP (Limited to a 1 month supply per fill ) QL (60 Tablets per 30 days)

KUVAN ORAL PACKET T9

KUVAN ORAL TABLET T9

levocarnitine oral solution T1

levocarnitine oral tablet T1

levocarnitine sf T1

195


maca T9

METAFOLBIC PLUS T9

metyrosine T9

miglustat T5PA SP (Limited to a 1 month supply per fill)

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


neonatal + dha T9

NEXA PLUS T3

nitisinone T9

NITYR T9

ORFADIN T9

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATE AM T3


T3

PRENATE PIXIE T3


PROCYSBI ORAL CAPSULE DELAYED RELEASE

T9

RECORLEV T9

REZUROCK T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

RUZURGI T4PA SP (Limited to a 1 month supply per fill)

sapropterin dihydrochloride T4PA SP (Limited to a 1 month supply per fill)

SOLESTA T3


196



TARON-PREX T2

THIOLA T9

THIOLA EC ORAL TABLET DELAYED RELEASE 100 MG




tiopronin oral T4PA SP (Limited to a 1 month supply per fill) QL (240 tablets per 30 days)

tristart dha T9

TRIVEEN-DUO DHA T1

TYBOST T2 QL (30 tablets per 30 days)

URIBEL T9


VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3

VOXZOGO T5PA SP (Limited to a 1 month supply per fill) QL (3 boxes per 30 days)



XURIDEN T9

ZAVESCA T9

ZOKINVY T9

Protective Agents

MESNEX ORAL T4SP (Limited to a 1 month supply per fill )

Nonhormonal Contraceptives


CAYA T3

PHEXXI T3 QL (12 tubes per 30 days)

197


Oxytocics

Oxytocics

METHERGINE ORAL T3 QL (28 tablets per 365 days)

methylergonovine maleate oral T3 QL (28 tablets per 365 days)

PREPIDIL T3

Pharmaceutical Aids

Pharmaceutical Aids

ALPAWASH T9

FREEDOM DERMA-D T9

Respiratory Tract Agents

Alpha And Beta Adrenergic Agonist(Respr)

ADRENALIN NASAL T9


T9




T9


T9






Anticholinergic Agents (RespirTract)


T1

ATROVENT HFA T2













198


Antifibrotic Agents

ESBRIET ORAL CAPSULE T4PA SP (Limited to a 1 month supply per fill) QL (270 capsules per 30 days)

ESBRIET ORAL TABLET 267 MG T5PA SP (Limited to a 1 month supply per fill ) QL (270 tablets per 30 days)

ESBRIET ORAL TABLET 801 MG T5PA SP (Limited to a 1 month supply per fill) QL (90 capsules per 30 days)

OFEV ORAL CAPSULE 100 MG T4


) QL (60 capsules per 30 days) AL




pirfenidone oral tablet 267 mg T4PA SP (Limited to a 1 month supply per fill) QL (270 tablets per 30 days)


Anti-Inflammatory Agents (Respiratory)

NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

T5PA SP (Limited to a 1 month supply per fill) QL (1 Auto-injector per 30 days)

NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MGML

T5PA SP (Limited to a 1 month supply per fill) QL (1 syringe per 30 days)

Antitussives

benzonatate oral capsule 100 mg 200 mg T1

benzonatate oral capsule 150 mg T9

BROMFED DM T9

cheratussin ac oral syrup T1






guaifenesin-codeine oral solution T1

guaifenesin-dm oral syrup T9

199


HISTEX-AC T9

HYCODAN T9


T1



hydromet T1

maxi-tuss cd T9





T1

TESSALON PERLES T3


T9

Cystic Fibrosis (Cftr) Correctors

ORKAMBI ORAL PACKET 100-125 MG T4PA SP (Limited to a 1 month supply per fill) QL (56 packets per 28 days) AL

ORKAMBI ORAL PACKET 150-188 MG T4


) QL (56 packets per 28 days) AL

ORKAMBI ORAL TABLET 100-125 MG T4


) QL (112 tablets per 28 days) AL

ORKAMBI ORAL TABLET 200-125 MG T4PA SP (Limited to a 1 month supply per fill) QL (112 tablets per 28 days) AL

SYMDEKO T4PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

TRIKAFTA T4PA SP (Limited to a 1 month supply per fill) QL (84 tablets per 28 days)

Cystic Fibrosis (Cftr) Potentiators

KALYDECO ORAL PACKET 25 MG T4PA SP (Limited to a 1 month supply per fill ) QL (60 packets per 30 days) AL

KALYDECO ORAL PACKET 50 MG 75 MG T4PA SP (Limited to a 1 month supply per fill ) QL (60 packets per 30 days) AL

200


KALYDECO ORAL TABLET T4PA SP (Limited to a 1 month supply per fill ) QL (2 tablets per 30 days) AL











Expectorants


guaifenesin oral solution 100 mg5ml T9

guaifenesin oral tablet 400 mg T9



potassium iodide oral solution T2

SSKI T3

First Generation Antihist(Respir Tract)













201



T9




T1


T3


T9


RYVENT T9

Interleukin Antagonists

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 100 MG067ML 200 MG114ML

T4

PA SP (Limited to a 1 month supply per fill Allowed one time fill of 3 syringes for inductionstarting dose only ) QL (2 syringes per 28 days)

FASENRA PEN T4PA SP (Limited to 1 pen per 28 days for inductionstarting dose only ) QL (1 ML per 56 days)

Leukotriene Modifiers

ACCOLATE T3

montelukast sodium oral T1

SINGULAIR T3

zafirlukast T1

zileuton er T5ST SP (Limited to a 1 month supply per fill) QL (120 tablets per 30 days) AL

ZYFLO T9

ZYFLO CR T9

Mast-Cell Stabilizers

ALOCRIL T3 ST




GASTROCROM T3

Mucolytic Agents


HYPERSAL T2 QL (240 ML per 30 days)



202


sodium chloride inhalation nebulization solution 7

T1

Nasal Preparations (Steroids)


BECONASE AQ T9

budesonide nasal T9

DYMISTA T3 ST





NASONEX T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9

TICALAST T9


XHANCE T9

Orally Inhaled Preparations (Steroids)











T3



QVAR REDIHALER T1


DALIRESP ORAL TABLET 250 MCG T3 PA QL (1 Fill per 1 Lifetime)

DALIRESP ORAL TABLET 500 MCG T3 PA

Respiratory Tract Agents Miscellaneous

BRONCHITOL T9

XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


203


Second Generation Antihist(Respir Tract)


ALLEGRA ALLERGY T9


T9












CLARITIN REDITABS ORAL TABLET DISPERSIBLE 10 MG

T9


DYMISTA T3 ST



QUZYTTIR T9

TICALAST T9

ZERVIATE T9


SelectBeta-2-Adrenergic Agonist(Respir)





T1


ARCAPTA NEOHALER T3



T1



204


PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2




XOPENEX T3


XOPENEX HFA T9

Vasodilating Agents (Respiratory Tract)

ADCIRCA T9

ADEMPAS ORAL TABLET 05 MG 15 MG 2 MG 25 MG


ADEMPAS ORAL TABLET 1 MG T4PA SP (Limited to a 1 month supply per fill ) QL (90 tablets per 30 days)

ambrisentan T4PA SP (Limited to a 1 month supply per fill)

bosentan T4PA SP (Limited to a 1 month supply per fill)

LETAIRIS ORAL TABLET 10 MG T9SP ()

LETAIRIS ORAL TABLET 5 MG T9

OPSUMIT T5PA SP (Limited to a 1 month supply per fill) QL (30 tablets per 30 days)

ORENITRAM ORAL TABLET EXTENDED RELEASE 0125 MG





T5




T5



205



T5










TRACLEER ORAL TABLET T9SP ()

TRACLEER ORAL TABLET SOLUBLE T9

TYVASO T4PA SP (Limited to a 1 month supply per fill)

TYVASO REFILL T4PA SP (Limited to a 1 month supply per fill )

TYVASO STARTER T4PA SP (Limited to a 1 month supply per fill)

UPTRAVI ORAL TABLET 1000 MCG 1200 MCG 1600 MCG 400 MCG 600 MCG 800 MCG


UPTRAVI ORAL TABLET 1400 MCG T5PA SP (Limited to a 1 month supply per fill) QL (60 tablets per 30 days)

UPTRAVI ORAL TABLET 200 MCG T5PA SP (Limited to a 1 month supply per fill ) QL (60 tablets per 30 days)

UPTRAVI ORAL TABLET THERAPY PACK T5PA SP (Limited to a 1 month supply per fill) QL (200 tablets per 30 days)

VENTAVIS T4 PA

VIAGRA T9

Xanthine Derivatives

ELIXOPHYLLIN T3

THEO-24 T2

206



T1


T1

Skin And Mucous Membrane Agents

Allylamines (Skin And Mucous Membrane)

naftifine hcl external cream 1 T3 ST QL (90 GM per 30 days)

naftifine hcl external cream 2 T9

NAFTIN EXTERNAL CREAM 2 T9

NAFTIN EXTERNAL GEL T9

Antibacterials (Skin Mucous Membrane)

ACANYA T9

ACZONE T9

AKTIPAK T9

ALTABAX T3 ST

AMZEEQ T9

AVAR CLEANSER T9

AVAR EXTERNAL PAD T9

AVAR LS CLEANSER T9

AVAR LS EXTERNAL PAD T9

AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

BENZACLIN T9

BENZACLIN WITH PUMP T9

benzoyl peroxide-erythromycin T2

bp 10-1 T9

bp cleansing wash T1

CENTANY T3

CLENIA PLUS T9

CLEOCIN VAGINAL CREAM T3

CLEOCIN VAGINAL SUPPOSITORY T9

CLEOCIN-T EXTERNAL GEL T3

CLEOCIN-T EXTERNAL LOTION T3

CLEOCIN-T EXTERNAL SOLUTION T9

CLEOCIN-T EXTERNAL SWAB T3

CLINDAGEL T9

clindamycin phos-benzoyl perox external gel 12-25

T9


T1 QL (45 gm per 30 days)

207



T2 QL (50 GM per 30 days)

clindamycin phosphate external gel T1

clindamycin phosphate external lotion T1

clindamycin phosphate external solution T1 QL (180 ML per 30 days)

clindamycin phosphate external swab T1

clindamycin phosphate vaginal T1

clindamycin-tretinoin T3

CLINDESSE T3 ST

CORTISPORIN EXTERNAL T2

dapsone external T9

DUAC T9

ery T1

ERYGEL T1

erythromycin external gel T1

erythromycin external solution T1

gentamicin sulfate external T1

KLARON T3

METROCREAM T3

METROGEL EXTERNAL GEL T3

METROGEL-VAGINAL T3

METROLOTION T3

metronidazole external T1


mupirocin calcium T9

mupirocin external T1 QL (22 gm per 30 days)

NEO-SYNALAR EXTERNAL CREAM T9

NEUAC EXTERNAL GEL T1 QL (45 GM per 30 days)

NEUAC EXTERNAL KIT T9

NORITATE T9

NUVESSA T9

ONEXTON T9

OVACE PLUS T9

OVACE PLUS WASH T9

OVACE WASH T9

PLEXION CLEANSER EXTERNAL LIQUID T9

PLEXION CLEANSING CLOTH EXTERNAL PAD

T9

PLEXION EXTERNAL CREAM T9

PLEXION NS T9

208


sodium sulfacetamide external shampoo T9

sodium sulfacetamide wash T9

sulfacetamide sodium (acne) T2

sulfacetamide sodium (cleans) T1

sulfacetamide sodium external liquid T1

sulfacetamide sodium-sulfur external cream 98-48

T9

sulfacetamide sodium-sulfur external emulsion T1

sulfacetamide sodium-sulfur external liquid 10-5

T1

sulfacetamide sodium-sulfur external liquid 9-4 98-48

T9

sulfacetamide sodium-sulfur external lotion 10-5

T9

sulfacetamide sodium-sulfur external pad 98-48

T9

sulfacetamide sodium-sulfur external suspension10-5 9-425

T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

VANDAZOLE T1

VELTIN T9

XEPI T9

ZIANA T9

ZILXI T9

Antifulgals (Skin Mucous Membrane)Misc

ALA-QUIN T9

bensal hp external ointment 3-6 T9

Anti-Inflammatory Agents Misc (Skin)

EUCRISA T3 ST QL (60 GM per 30 days)

Antipruritics And Local Anesthetics

ANALPRAM-HC EXTERNAL LOTION T9

CETACAINE EXTERNAL AEROSOL T9

CORTANE-B EXTERNAL T3

DERMACINRX PRIZOPAK T9

doxepin hcl external T9

EPIFOAM T9

ethyl chloride T9

209



GEBAUERS PAIN EASE T3

GEBAUERS SPRAY AND STRETCH T3

GLYDO EXTERNAL GEL T3

hydrocortisone ace-pramoxine external cream25-1

T2

hydrocortisone ace-pramoxine rectal suppository T9

lidocaine external cream 4 T9

lidocaine external ointment 5 T1

lidocaine external patch 5 T9

lidocaine hcl external cream 3 4 T9

lidocaine hcl external gel 2 T1

lidocaine hcl external solution T1

lidocaine-hydrocortisone ace rectal gel T9

lidocaine-hydrocortisone ace rectal kit T9

lidocaine-prilocaine external cream T1

LIDODERM T9

lidopin external cream 3 T1

lidopril external kit T9

lidorx T9

LIDOTRANS 5 PAK T9

LIVIXIL PAK T9

NOVACORT EXTERNAL GEL 1-2 T9

phenazopyridine hcl oral tablet 100 mg 200 mg T1

PLIAGLIS EXTERNAL CREAM T9

PRAMOSONE T9

pramoxine-hc external cream T9

prilovixil T9

PRUDOXIN T9

PYRIDIUM T3

RELADOR PAK EXTERNAL KIT T9

RELADOR PAK PLUS T9

SYNERA T9

XRYLIDERM T9

ZONALON T9

Antivirals (Skin And Mucous Membrane)

acyclovir external T9

DENAVIR T9

XERESE T9

ZOVIRAX EXTERNAL T9

210


Astringents

DOMEBORO EXTERNAL PACKET T9

DRYSOL T1

VUSION T9

XERAC AC T1

Azoles (Skin And Mucous Membrane)

clotrimazole external cream T9

clotrimazole external solution T9

clotrimazole mouththroat troche T1

clotrimazole-betamethasone external cream T1

clotrimazole-betamethasone external lotion T1 QL (30 gm per 30 days)

econazole nitrate external T1 QL (90 GM per 30 days)

ECOZA T9

ERTACZO T3 ST

EXELDERM T9

EXTINA T9

GYNAZOLE-1 T3

JUBLIA T9

ketoconazole external cream T1 QL (60 gm per 30 days)

ketoconazole external foam T9

ketoconazole external shampoo 2 T1 QL (120 ml per 30 days)

LOTRIMIN AF EXTERNAL CREAM T9

LOTRISONE EXTERNAL CREAM T3

luliconazole T9

LUZU T9

NIZORAL T3

ORAVIG T4ST SP (Limited to a 1 month supply per fill)

oxiconazole nitrate T9

OXISTAT EXTERNAL CREAM T3 ST

OXISTAT EXTERNAL LOTION T9

sulconazole nitrate T9

TERAZOL 7 T3

terconazole vaginal cream 04 T1

terconazole vaginal suppository T1

VUSION T9

XOLEGEL T9

Basic Lotions And Liniments

ammonium lactate external T9

GERI-HYDROLAC 12 T9

211


GERI-HYDROLAC 5 T9

LAC-HYDRIN EXTERNAL CREAM T9

lactic acid external lotion T9

ULTRAVATE X (OINTMENT) T9

urea hydrating T9

Basic Oils And Other Solvents

lactic acid e T9

Basic Ointments And Protectants

ALCORTIN A T9

DERMASORB XM T9

iodoquimez-hc T9

lactic acid e T9


VYTONE T9

Benzylamines (Skin And Mucous Membrane)

MENTAX T9

Cell Stimulants And Proliferants

ALTRENO T1 QL (45 grams per 30 days) AL

ATRALIN T3 ST AL

AVITA T9


REFISSA T9

RENOVA T9

RENOVA PUMP T9

RETIN-A T3 AL

RETIN-A MICRO T9

RETIN-A MICRO PUMP T9

tretinoin (emollient) T9

tretinoin external cream 0025 T1 AL

tretinoin external cream 005 01 T2 AL

tretinoin external gel 001 0025 T1 AL

tretinoin external gel 005 T2 AL

tretinoin microsphere T9

tretinoin microsphere pump T9

TRI-LUMA T9

TWYNEO T9

VELTIN T9

ZIANA T9

Corticosteroids (Skin Mucous Membrane)

ALA SCALP T9

212


ala-cort external cream 1 T9

ALA-QUIN T9

alclometasone dipropionate T1

ALCORTIN A T9

amcinonide T9


ANUSOL-HC RECTAL SUPPOSITORY T9

APEXICON E T9

AQUANIL HC T1

betamethasone dipropionate aug external cream T1

betamethasone dipropionate aug external gel T1 QL (50 GM per 30 days)

betamethasone dipropionate aug external lotion T2 QL (60 ML per 30 days)

betamethasone dipropionate aug external ointment


betamethasone dipropionate external cream T1

betamethasone dipropionate external lotion T1

betamethasone dipropionate external ointment T2

betamethasone valerate external cream T1

betamethasone valerate external foam T9

betamethasone valerate external lotion T1 QL (60 ML per 30 days)

betamethasone valerate external ointment T1

BRYHALI T3 ST

calcipotriene-betameth diprop external ointment T5SP (Max of 31 day supply per dispensing) QL (100 GM per 30 days)

calcipotriene-betameth diprop external suspension

T5SP (Max of 31 day supply per dispensing)

CAPEX T9

clobetasol prop emollient base T1

clobetasol propionate external cream T1

clobetasol propionate external foam T9

clobetasol propionate external gel T1

clobetasol propionate external liquid T9

clobetasol propionate external lotion T3 ST QL (118 ML per 30 days)

clobetasol propionate external ointment T1 QL (60 GM per 30 days)

clobetasol propionate external shampoo T2 ST QL (118 ML per 30 days)

clobetasol propionate external solution T1

CLOBEX T3 ST QL (118 ML per 30 days)

CLOBEX SPRAY T9

clocortolone pivalate T9

clocortolone pivalate pump T9

213


CLODAN EXTERNAL KIT T3

CLODERM T9

CLODERM PUMP T9



CORDRAN T9


CORTENEMA T3

CORTIFOAM EXTERNAL T3 ST


DERMA-SMOOTHEFS BODY T3

DERMA-SMOOTHEFS SCALP T3

DERMASORB HC T9

DERMASORB TA T9

DERMAZENE T9

DESONATE T9

desonide external cream T1

desonide external gel T9

desonide external lotion T2 ST

desonide external ointment T1

DESOWEN EXTERNAL CREAM T3 ST

DESOWEN EXTERNAL LOTION T3 ST

desoximetasone external cream 005 T9


desoximetasone external gel T9

desoximetasone external liquid T9

desoximetasone external ointment 005 T9


diflorasone diacetate external T9

DIPROLENE AF T3

DIPROLENE EXTERNAL OINTMENT T3

DUOBRII T9

ELOCON EXTERNAL CREAM T3

ELOCON EXTERNAL OINTMENT T3

ENSTILAR T9

EPIFOAM T9

fluocinolone acetonide body T1

fluocinolone acetonide external cream 001 T1 ST

fluocinolone acetonide external cream 0025 T1

fluocinolone acetonide external ointment T1

214


fluocinolone acetonide external solution T1 ST QL (180 ML per 30 days)

fluocinolone acetonide scalp T1

fluocinonide emulsified base T1

fluocinonide external cream 005 T1


fluocinonide external gel T1

fluocinonide external ointment T1

fluocinonide external solution T1 QL (60 ML per 30 days)

flurandrenolide T9

fluticasone propionate external cream T1

fluticasone propionate external lotion T9

fluticasone propionate external ointment T1

halobetasol propionate external cream T2 ST QL (50 GM per 30 days)

halobetasol propionate external foam T9

halobetasol propionate external ointment T2 QL (50 GM per 30 days)

HALOG T9

HEMMOREX-HC RECTAL SUPPOSITORY 25 MG

T1


T9


T2


hydrocortisone acetate rectal suppository 25 mg T1


hydrocortisone butyr lipo base T9

hydrocortisone butyrate external cream T9

hydrocortisone butyrate external lotion T9

hydrocortisone butyrate external ointment T9

hydrocortisone butyrate external solution T1

hydrocortisone external cream 1 T9


hydrocortisone external lotion 1 T9


hydrocortisone external ointment 05 1 T9

hydrocortisone external ointment 25 T1

hydrocortisone rectal enema T1

hydrocortisone valerate external cream T1 QL (120 GM per 30 days)

hydrocortisone valerate external ointment T2 ST

hydrocortisone-iodoquinol external cream 1-1 T9

215


IMPEKLO T9

IMPOYZ T9

iodoquimez-hc T9

KENALOG EXTERNAL T9



LOCOID EXTERNAL CREAM T9

LOCOID EXTERNAL LOTION T9

LOCOID EXTERNAL SOLUTION T3

LOCOID LIPOCREAM T9


LUXIQ T9

mometasone furoate external T1


NOBLE FORMULA HC EXTERNAL SOLUTION T9


NUCORT T3

nystatin-triamcinolone T1

OLUX T9

OLUX-E T3

ORALONE T3

PANDEL T9

PRAMOSONE T9


prednicarbate T1

PROCTOCORT RECTAL SUPPOSITORY T9

SCALPICIN MAXIMUM STRENGTH T9

SERNIVO T9

SYNALAR T9

SYNALAR TS T9

TACLONEX EXTERNAL OINTMENT T5SP (Max of 31 day supply per dispensing) QL (100 GM per 30 days)

TACLONEX EXTERNAL SUSPENSION T9

TEMOVATE EXTERNAL OINTMENT T3

TEXACORT T9

TOPICORT EXTERNAL CREAM 005 T9


TOPICORT EXTERNAL GEL T9

TOPICORT EXTERNAL OINTMENT 025 T3

216


TOPICORT SPRAY T9

triamcinolone acetonide external aerosol solution T9

triamcinolone acetonide external cream T1

triamcinolone acetonide external lotion 01 T1

triamcinolone acetonide external ointment 0025 01

T1

triamcinolone acetonide external ointment 005 T9

triamcinolone acetonide mouththroat T1

TRIANEX T9

TRIDERM EXTERNAL CREAM T1

TRI-LUMA T9

UCERIS RECTAL T3 QL (2 packages per 180 days)

ULTRAVATE EXTERNAL CREAM T9

ULTRAVATE EXTERNAL LOTION T9


VANOS T9

VANOXIDE-HC T9

VERDESO T9

VYTONE T9

WYNZORA T9

XERESE T9

Depigmenting Agents

ESOTERICA DAYTIME T9

ESOTERICA FACIAL T9

ESOTERICA FADE NIGHTTIME T9

hydroquinone T9

hydroquinone external cream T9

TRI-LUMA T9

Detergents


Emollients Demulcents And Protectants

VUSION T9

Hydroxypyridones (Skin Mucous Membrane)

ciclopirox external T1

ciclopirox olamine external T1

ciclopirox treatment T9

LOPROX EXTERNAL SHAMPOO T3

Keratolytic Agents

AVAR CLEANSER T9


217


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

bensal hp T9

bp 10-1 T9


CLENIA PLUS T9

DERMASORB XM T9

KERALAC EXTERNAL CREAM 47 T9

KERALYT EXTERNAL SHAMPOO T9



T9


PROMISEB T9

PROMISEB COMPLETE T9

rynoderm T9

SALEX EXTERNAL SHAMPOO T9

salicylic acid er T9

salicylic acid external cream T9

salicylic acid external foam T9

salicylic acid external liquid 275 T9

salicylic acid external lotion T9

salicylic acid external shampoo T9

salicylic acid wart remover T9

salicylic acid-cleanser T9

SALVAX T9

selenium sulfide external shampoo 225 T1


SELRX T9


T9



T1


T9


T9

218



T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

ULTRASAL-ER T9

urea external cream 40 45 T9

urea external lotion 40 T9

urea hydrating T9

urea nail external gel 45 T9

UTOPIC T9

XALIX T9

xurea T9

Keratoplastic Agents

coal tar external solution T2

Local Anti-Infectives Miscellaneous

ACANYA T9

acne medication 10 external gel T1


adapalene-benzoyl peroxide external gel 01-25

T1


T9

AKTIPAK T9

ALCORTIN A T9

BENZAC AC WASH EXTERNAL LIQUID T9

BENZACLIN T9


BENZEFOAM T9

BENZEFOAMULTRA T9

BENZEPRO CREAMY WASH T9

BENZEPRO EXTERNAL FOAM 53 T9

BENZEPRO FOAMING CLOTHS T9

BENZEPRO SHORT CONTACT T9

benzoyl peroxide cleanser external liquid T9

benzoyl peroxide external foam 98 T9

benzoyl peroxide external gel 10 25 5 T9

219


benzoyl peroxide external pad 95 T9

benzoyl peroxide wash external liquid T9


bp foam external foam 98 T9

bp gel external gel 10 5 T9

bp wash external liquid 10 25 5 7 T9

bpo T9

bpo foaming cloths external 6 T9



T9






DERMAZENE T9

DUAC T9

EPIDUO T3

EPIDUO FORTE T9

EPSOLAY T9


iodoquimez-hc T9



ONEXTON T9

PERIDEX T3

PR BENZOYL PEROXIDE WASH T9

RIAX EXTERNAL FOAM T3 QL (1 GM per 30 days)

selenium sulfide external lotion T1



SELRX T9

SILVADENE T3

silver sulfadiazine external T1

SSD T1

SSD (SILVER SULFADIAZINE) T1

SULFAMYLON T3

TWYNEO T9

VANOXIDE-HC T9

220


VYTONE T9

Nonsteroidal Anti-InflammatAgents(Skin)

diclofenac sodium external gel 1 T1

diclofenac sodium external gel 3 T2 ST QL (100 GM per 30 days)

diclofenac sodium external solution T9

PENNSAID TRANSDERMAL SOLUTION 2 T9

PROFINAC T9

VOLTAREN TRANSDERMAL T3

Oxaboroles

KERYDIN T9

tavaborole T9

Pigmenting Agents

methoxsalen rapid T4SP (Limited to a 1 month supply per fill )

Polyenes (Skin And Mucous Membrane)

NYAMYC T1 QL (60 GM per 30 Days)

nystatin external cream T1SP (Generic substitution mandatory)

nystatin external ointment T1

nystatin external powder T1 QL (60 GM per 30 Days)


NYSTOP T1 QL (60 GM per 30 days)

Scabicides And Pediculicides

EURAX T9

ivermectin external cream T2 ST QL (45 GM per 30 days)

ivermectin external lotion T1

lindane external shampoo T1

malathion external T1

NATROBA T9

OVIDE T3

permethrin external cream T1

SKLICE T3

SOOLANTRA T3 ST QL (45 GM per 30 days)

spinosad T1

ULESFIA T3

Skin And Mucous Membrane Agents Misc

ABSORICA T9

ABSORICA LD T9

ACCUTANE T2 QL (6 fills per 2 years)

221


acitretin T4SP (Limited to a 1 month supply per fill)

ACUICYN EXTERNAL LIQUID T9

ACZONE T9

adapalene external cream T9

adapalene external gel 01 T9


adapalene external lotion T9

adapalene external solution T9


T1


T9

ADBRY T4PA SP (Limited to a 1 month supply per fill) QL (4 syringes per 28 days)

AKLIEF T9

ALDARA T3

AMNESTEEM T2 QL (6 fills per 2 years)

ARAZLO T9

ATRAPRO HYDROGEL T9

AVO CREAM T9

azelaic acid external T2 ST

AZELEX T3 ST QL (50 GM per 30 days)

bexarotene external T9

BIAFINE T9

bimatoprost external T9

BIONECT EXTERNAL CREAM T9

BIONECT EXTERNAL FOAM T9

BIONECT EXTERNAL GEL T9

calcipotriene external cream T1 QL (120 GM per 30 days)

calcipotriene external foam T9

calcipotriene external ointment T2 QL (120 GM per 30 days)

calcipotriene external solution T1




calcitriol external T1 ST QL (100 GM per 30 days)

CARAC T9

CELACYN T9

222


CELACYN POST-PROCEDURE PACK T9

CERACADE T9

CLARAVIS T2 QL (6 fills per 2 years)


CONDYLOX EXTERNAL GEL T3 ST

COSENTYX T4







T4


dapsone external T9

DERMASORB HC T9

DERMULCERA T9



DIFFERIN EXTERNAL CREAM T9

DIFFERIN EXTERNAL GEL 01 T1


DIFFERIN EXTERNAL LOTION T9

DOVONEX EXTERNAL CREAM T3 QL (120 GM per 30 days)

doxycycline T9

DRITHO-CREME HP T9

DUOBRII T9

DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 200 MG114ML

T4

PA SP (Limited to a 1 month supply per fill Allowed one time fill of 3 pens for inductionstarting dose only ) QL (2 pens per 28 days)

223



T4


DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MG2ML

T4


EFUDEX EXTERNAL CREAM T3

ELETONE T9


EMULSION SB T9

ENSTILAR T9

ENTTY SPRAY EMULSION T9

EPICERAM T9

EPIDUO T3

EPIDUO FORTE T9

FABIOR T9

FINACEA EXTERNAL FOAM T3 ST

FINACEA EXTERNAL GEL T9


FLUOROPLEX T4ST SP (Limited to a 1 month supply per fill)

fluorouracil external cream 05 T5ST SP (Limited to a 1 month supply per fill) QL (30 grams per 30 days)

fluorouracil external cream 5 T1 QL (40 GM per 30 days)

fluorouracil external solution T1

GELCLAIR T9

hair regrowth treatment men external solution T9

HYDROFERA BLUE FOAM DRESSING T9

HYLATOPIC PLUS EXTERNAL FOAM T9

imiquimod external cream 375 T9


imiquimod pump T9

isotretinoin oral capsule 10 mg 20 mg 30 mg 40 mg

T2 QL (6 fills per 2 years)

isotretinoin oral capsule 25 mg 35 mg T9

KAMDOY T9

KELO-COTE EXTERNAL GEL T9

224


KLISYRI T5ST SP (Limited to a 1 month supply per fill) QL (5 packets per 1 yer)

LATISSE T9

LOYON T9

LUXAMEND T9


T9

MINOLIRA T9

minoxidil for men external solution 2 T9

MIRVASO T9


MUGARD T9

MYORISAN T2 QL (6 fills per 2 years)

NEOSALUS EXTERNAL FOAM T9

NIVATOPIC PLUS T9

NUVAIL T9

OPZELURA T9

ORACEA T9

ORAMAGICRX T9




PHLAG SPRAY T9


podocon T9

PODOCON-25 T9

podofilox external T1

PRESERA T9

PROFINAC T9

PROPECIA T9


PRUCLAIR T9

PRUMYX T9

PRUTECT T9

QBREXZA T9

RECEDO T9

225


RECTIV T9

REGRANEX T4ST SP (Limited to a 1 month supply per fill)

REMICADE T9

RHOFADE T3 QL (60 GM per 30 days) AL

ROGAINE T9

ROGAINE MENS T9

ROGAINE MENS EXTRA STRENGTH T9

ROGAINE WOMENS EXTERNAL SOLUTION T9


SILIQ T5

PA SP (Limited to a 1 month supply per fill Limited to 4 syringes for the first fill) QL (2 syringes per 28 days)

SKYRIZI (150 MG DOSE) T4PA SP (Limited to 4 syringes for the first fill ) QL (2 syringes per 12 weeks)

SKYRIZI PEN T4PA SP (Limited to a 12 week supply per fill) QL (1 pen per 12 weeks)

SKYRIZI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T4PA SP (Limited to a 12 week supply per fill) QL (1 syringe per 12 weeks)


T9

SONAFINE T9

SORILUX T9

STELARA SUBCUTANEOUS SOLUTION 45 MG05ML

T4PA SP (Allowed 2 vials for first month starting dose)

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 45 MG05ML

T4PA SP (Allowed 2 syringes for first month starting dose )

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 90 MGML

T4PA SP (Allowed 2 syringes for first month starting dose)

suvicort T9

SYNALAR TS T9

SYNERDERM T9




226


TALTZ SUBCUTANEOUS SOLUTION AUTO-INJECTOR

T5PA SP (Limited to a 1 month supply per fill) QL (1 autoinjector per 28 days)

TALTZ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T5PA SP (Limited to a 1 month supply per fill) QL (1 syringe per 28 dayss)

TARGRETIN EXTERNAL T9

tazarotene external cream T2 ST

tazarotene external foam T3 ST QL (50 GM per 30 days)

TAZORAC EXTERNAL CREAM T3 ST

TAZORAC EXTERNAL GEL T9

TETRIX EXTERNAL CREAM T9

TOLAK T2 QL (1 tube per 30 days)

TREMFYA SUBCUTANEOUS SOLUTION PEN-INJECTOR

T4PA SP (Limited to 2 pens on first fill) QL (1 pen per 8 weeks)

TREMFYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

T4PA SP (Limit of 2 syringes on first fill) QL (1 syringe per 8 weeks)

VALCHLOR T4PA SP (Limited to a 15 day supply per fill) QL (60 GM per 15 days)

VANIQA T9

VECTICAL T3 ST QL (100 GM per 30 days)

VELTIN T9

VENELEX T9

VEREGEN T4ST SP (Limited to a 1 month supply per fill) QL (30 grams per 30 days)


WINLEVI T9

WYNZORA T9

XIMINO T9

ZENATANE T2 QL (6 fills per 2 years)

ZIANA T9

ZITHRANOL T3 ST

ZYCLARA T9

ZYCLARA PUMP EXTERNAL CREAM 25 T3 ST

ZYCLARA PUMP EXTERNAL CREAM 375 T9

Smooth Muscle Relaxants

Antimuscarinics

darifenacin hydrobromide er T2 QL (30 tablets per 30 days)

DETROL T3

DETROL LA T3 QL (30 capsules per 30 days)

227


DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 10 MG 5 MG

T3

ENABLEX T3 QL (30 tablets per 30 days)

flavoxate hcl T1

GELNIQUE TRANSDERMAL GEL 10 T9

oxybutynin chloride er T1

oxybutynin chloride oral T1

OXYTROL T9

solifenacin succinate T2 ST QL (30 tablets per 30 days)

tolterodine tartrate T1

tolterodine tartrate er T2

TOVIAZ T3 ST QL (30 tablets per 30 days)

trospium chloride T1 QL (60 capsules per 30 days)

trospium chloride er T3 QL (30 capsules per 30 days)

VESICARE T3 ST QL (30 tablets per 30 days)

VESICARE LS T3 ST QL (150 ML per 30 days) AL

Respiratory Smooth Muscle Relaxants

ELIXOPHYLLIN T3






THEO-24 T2


T1


T1


GEMTESA T9

MYRBETRIQ ORAL SUSPENSION RECONSTITUTED ER


MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR


Vitamins

Multivitamin Preparations

BACMIN T9

choice-tabs T9

228





CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1


CORVITE FREE T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


FLORIVA PLUS T9

folbee plus T9

FOLBEE PLUS CZ T9


INATAL GT T1




T1 AL

multivitamins oral capsule T9




M-VIT T9

MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

229





neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRO-VITE RX T9

NEXA PLUS T3

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9

NIVA-PLUS T9

O-CAL FA T9



pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

230


PRENATE PIXIE T3

PROVIDA OB T3

QUFLORA FE T9


T9

RENAL ORAL CAPSULE T9

rena-vite T3

rena-vite rx T9

reno caps T9

REQ 49+ T9


T1




STROVITE ONE T9

SUPERVITE T9

TARON-PREX T2


TRICARE T1

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9


tri-zel T9


v-c forte T9

VIC-FORTE T9


VINATE M T1

VINATE ONE T1

virt-caps T9

virt-vite plus T9

VITACEL T1



VITAFOL-OB T3

231


VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITATRUE T3

vp-vite rx T9

Vitamin A

active fe T9

MYKIDZ IRON FL T9

pnv-select T1

TRI-VI-FLOR T9


Vitamin B Complex

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

BEYAZ T9

bp vit 3 T9


CARDIOVID PLUS T9

CENTRATEX T9

CIFEREX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9





DERMACINRX PUREFOLIX T9

DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

232




DIALYVITEZINC T9

durachol T9

fabb T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


T9


FERREX 28 T9


folbee T9

FOLBEE AR T9

folbee plus T9

FOLBEE PLUS CZ T9

FOLBIC T9

folic acid oral capsule T9

folic acid oral tablet 1 mg T1

folic acid oral tablet 400 mcg 800 mcg T1 PV AL

folic acid-vit b6-vit b12 T9

FOLIVANE-F T9

FOLIVANE-PLUS T9

FOLIXAPURE T9

folplex 22 T9

FOLTANX T9

FOLTRATE T9

FOLTX ORAL TABLET 113-25-2 MG T3

FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

233


HEMATRON-AF T9


hemetab T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9


l-methylfolate-b6-b12 oral tablet 3-35-2 mg T9



METAFOLBIC PLUS T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


T1 AL

M-VIT T9



mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

NASCOBAL T9



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9

234


neurin-sl T9

NEXA PLUS T3

niacin oral tablet 500 mg T9

NIACOR T1

NICOMIDE T9

NIVA-FOL T9

NIVA-PLUS T9

noxifol-d T9

O-CAL FA T9


ortho df T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1


POTABA ORAL CAPSULE T9

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

235


purefe plus T9


QUFLORA FE T9


rena-vite T3

rena-vite rx T9

reno caps T9

RESTORA RX T9


revesta T9

roxifol-d T9

SAFYRAL T9


T1


se-tan plus T9


SUPERVITE T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl gard rx T9

tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9

TYDEMY T9



VINATE M T1

VINATE ONE T1

virt-caps T9

236


VIRT-GARD T9

virt-vite T9

virt-vite forte T9

virt-vite plus T9


VITAFOL-OB T3

VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITA-RESPA T9

VITATRUE T3

vp-vite rx T9

zavara T9

Vitamin C

active fe T9

CENTRATEX T9

CITRANATAL BLOOM T3

CORVITA 150 T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


FERREX 150 PLUS T9

FERREX 28 T9


folbee plus T9

FOLBEE PLUS CZ T9

FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

237


FUSION SPRINKLES T9


HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


ICAR-C PLUS T9

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9



MOVIPREP T3

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


MYKIDZ IRON FL T9

mynephrocaps T9

MYNEPHRON T9

NATALVIRT FLT T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9


PLENVU T3

pnv-select T1

purefe plus T9



rena-vite T3

rena-vite rx T9

reno caps T9

se-tan plus T9

TANDEM PLUS T9

taron forte T9

tl icon T9

tl-hem 150 T9

TRICON T9

238


trigels-f forte T9

triphrocaps T9

TRI-VI-FLOR T9


virt-caps T9

virt-vite plus T9

VITAL-D RX T9

vp-vite rx T9

Vitamin D

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

calcitriol oral capsule T1

calcitriol oral solution T1 AL


CIFEREX T9

DECARA ORAL CAPSULE 125 MG (50000 UT) T1


doxercalciferol oral capsule 05 mcg 25 mcg T9

doxercalciferol oral capsule 1 mcg T4SP (Limited to a 1 month supply per fill)

DRISDOL ORAL CAPSULE T3

durachol T9


FOLIXAPURE T9


MYKIDZ IRON FL T9

noxifol-d T9

ortho df T9

paricalcitol oral T2

pnv-select T1

RAYALDEE T9

REPLESTA T9

REPLESTA CHILDRENS T9

REPLESTA NX T9

revesta T9

ROCALTROL T3

roxifol-d T9

TRI-VI-FLOR T9


239


VITAL-D RX T9

vitamin d (ergocalciferol) oral capsule 125 mg (50000 ut)

T1

vitamin d3 oral capsule 25 mcg (1000 ut) T1 PV AL

vitamin d3 oral liquid 400 unitml T1 PV AL

vitamin d3 oral tablet 25 mcg (1000 ut) T1 PV AL

zavara T9

ZEMPLAR ORAL CAPSULE 1 MCG 2 MCG T3

Vitamin E

active fe T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

HEMATRON-AF T9


pnv-select T1

tl-hem 150 T9

Vitamin K Activity



240

241

Index

10 SERIES BP MONITORUPPER ARM 11610 SERIES+ BP MONITRUPPER ARM 1163 SERIES BP MONITORUPPER ARM 1163 SERIES BP MONITORWRIST 1165 SERIES BP MONITOR 1165 SERIES BP MONITORUPPER ARM 1167 SERIES BP MONITORUPPER ARM 1167 SERIES BP MONITORWRIST 117abacavir sulfate 18abacavir-lamivudine-zidovudine 18ABILIFY 88 92ABILIFY MYCITE 87 92ABILIFY MYCITE MAINTENANCE KIT 87 92ABILIFY MYCITE STARTER KIT 87 92abiraterone acetate 26ABSORICA 221ABSORICA LD 221acamprosate calcium 98ACANYA 207 219acarbose 149ACCOLATE 202ACCRUFER 56ACCU-CHEK AVIVA PLUS 119ACCU-CHEK COMPACT PLUS 119ACCU-CHEK FASTCLIX LANCET 117ACCU-CHEK MULTICLIX LANCET DEV 117ACCU-CHEK SMARTVIEW 119ACCU-CHEK SOFTCLIX LANCET DEV 117ACCUPRIL 62 63ACCURETIC 63 126ACCUTANE 221acebutolol hcl 49 65 66 71acetaminophen-codeine 81 102acetaminophen-codeine 2 81 102acetaminophen-codeine 3 81 102acetaminophen-codeine 4 81 102acetazolamide 69 83 121 132acetazolamide er 69 83 121 132acetic acid 134acetylcysteine 175 202acidophilus lactobacillus 137

ACIPHEX 145ACIPHEX SPRINKLE 145acitretin 222acne medication 10 219acne medication 5 219ACTEMRA 181 185ACTEMRA ACTPEN 181 185ACTHAR 119 165ACTHIB 39ACTICLATE 9 25ACTIGALL 141ACTIMMUNE 185ACTIQ 102active fe56 123 232 237 239 240ACTIVELLA 158 166ACTONEL 178ACTOPLUS MET 152 174ACTOPLUS MET XR 152 174ACTOS 174ACUICYN 222ACULAR 135ACULAR LS 135ACUVAIL 135acyclovir 22 210ACZONE 207 222ADACEL 39ADALAT CC 73 78adapalene 222adapalene-benzoyl peroxide219 222ADASUVE 91ADBRY 222ADCIRCA 77 205ADDERALL 80ADDERALL XR 80ADDYI 98adefovir dipivoxil 22ADEMPAS 205ADHANSIA XR 109ADLARITY 47ADLYXIN 163ADLYXIN STARTER PACK 163ADMELOG 170ADMELOG SOLOSTAR 170ADRENALIN 41 136 198adult blood pressure cuff lg 117ADVAIR DISKUS 48 146ADVAIR HFA 48 146ADVATE 53adynovate 53ADZENYS ER 80ADZENYS XR-ODT 80AEMCOLO 24

AEROCHAMBER PLUS FLO-VU 117AEROCHAMBER PLUS FLO-VU LARGE 117AEROCHAMBER PLUS FLO-VU SMALL 117AEROCHAMBER PLUS FLO-VU WMASK 117AFEDITAB CR 73 78AFINITOR 26AFINITOR DISPERZ 26AFLURIA QUADRIVALENT 39AFREZZA 170AFSTYLA 53AFTERA 153 166AGAMATRIX AMP TEST 119AGGRENOX 60 111AGRYLIN 60AIMOVIG 97AIRDUO DIGIHALER 48 146AIRDUO RESPICLICK 1131448 147AIRDUO RESPICLICK 2321448 147AIRDUO RESPICLICK 551448 147AJOVY 97AKLIEF 222AKTIPAK 207 219AKYNZEO 136 144ALA SCALP 212ala-cort 213ALA-QUIN 209 213ALAVERT 6 204ALAVERT ALLERGYSINUS 6 42ALAWAY 5 129albendazole 9ALBENZA 9albuterol sulfate 48 204albuterol sulfate er 48 204albuterol sulfate hfa 48 204alclometasone dipropionate 213ALCORTIN A 212 213 219ALDACTAZIDE 76 126ALDACTONE 76 78 123ALDARA 222ALECENSA 26alendronate sodium 178alfuzosin hcl er 48ALINIA 11aliskiren fumarate 78ALKERAN 26ALKINDI SPRINKLE 147ALLEGRA ALLERGY 6 204

242

ALLEGRA ALLERGY CHILDRENS 6 204ALLEGRA-D ALLERGY amp CONGESTION 6 42ALLI 141allopurinol 177ALLZITAL 81 94almotriptan malate 112ALOCRIL 129 202alogliptin benzoate 157alogliptin-metformin hcl 152 157alogliptin-pioglitazone 157 174ALOMIDE 6 129ALORA 158 178alosetron hcl 138ALPAWASH 198ALPHAGAN P 129ALPHANATE 53ALPHANINE SD 53alprazolam 96alprazolam er 96ALPRAZOLAM INTENSOL 96ALPROLIX 53ALREX 132ALTABAX 207ALTACE 62 63ALTAVERA 153 158 166ALTOPREV 75ALTRENO 212ALUNBRIG 27ALVESCO 147alyacen 135 153 158 166ALZAIR ALLERGY NASAL SPRAY 134amantadine hcl 8 80AMARYL 173AMBIEN 91AMBIEN CR 91ambrisentan 205amcinonide 213AMERGE 112AMETHIA 153 158 166AMETHIA LO 153 158 166AMICAR 53amiloride hcl 78 123amiloride-hydrochlorothiazide123 126aminocaproic acid 53amiodarone hcl 71AMITIZA 141amitriptyline hcl 115amlodipine besy-benazepril hcl63 73amlodipine besylate 73 78

amlodipine besylate-valsartan61 73amlodipine-atorvastatin 73 75amlodipine-olmesartan 61 73amlodipine-valsartan-hctz61 73 126ammonium lactate 211AMNESTEEM 222amoxapine 115amoxicill-clarithro-lansopraz9 23 145amoxicillin 9 139amoxicillin-pot clavulanate 9amoxicillin-pot clavulanate er 9amphetamine er 81amphetamine sulfate 81amphetamine-dextroamphet er 81amphetamine-dextroamphetamine 81ampicillin 9AMPYRA 194AMRIX 45AMZEEQ 207ANADROL-50 149ANAFRANIL 115anagrelide hcl 60ANALPRAM-HC 209 213ANAPROX DS 90 107 177ANASPAZ 43anastrozole 27 150ANDRODERM 149ANDROGEL 149ANDROGEL PUMP 149ANGELIQ 158 166ANIMI-3 194 232 239ANIMI-3VITAMIN D 194 232 239ANNOVERA 153 158 166ANORO ELLIPTA 43 48ANTABUSE 175ANTARA 75ANTIVERT 4 138ANUSOL-HC 213ANZEMET 136APADAZ 81 102apap-caff-dihydrocodeine81 102 109APEXICON E 213APIDRA 170APIDRA SOLOSTAR 170APLENZIN 87APLISOL 120APOKYN 101apomorphine hcl 101apo-varenicline 45apraclonidine hcl 134

aprepitant 144APRI 153 158 166APRISO 138APTENSIO XR 109APTIOM 83APTIVUS 20AQUANIL HC 213ARAKODA 9ARANESP (ALBUMIN FREE)50 51ARAVA 181 185 191ARAZLO 222ARCALYST 194ARCAPTA NEOHALER 48 204arformoterol tartrate 48ARICEPT 47ARIKAYCE 8ARIMIDEX 27 150aripiprazole 88 93ARIXTRA 50armodafinil 116ARMONAIR DIGIHALER 147 203ARMOUR THYROID 174ARNUITY ELLIPTA 147 203AROMASIN 27 150ARTHROTEC 107 144ASACOL HD 138ASCOMP-CODEINE94 102 109 111ASCRIPTIN 60 90 111 136 139asenapine maleate 88 93ASMANEX (120 METERED DOSES) 147ASMANEX (14 METERED DOSES) 147ASMANEX (30 METERED DOSES) 147ASMANEX (60 METERED DOSES) 147ASMANEX (7 METERED DOSES) 147ASMANEX HFA 147aspirin ec 60 90 111aspirin ec low dose 60 90 111aspirin-dipyridamole er 60 111ASSURE 4 TEST 119ASSURE PLATINUM 119ASSURE PRISM MULTI TEST 119ASTAGRAF XL 191ASTEPRO 129 204ATACAND 61ATACAND HCT 61 126atazanavir sulfate 20ATELVIA 178atenolol 49 65 66 71

243

atenolol-chlorthalidone 65 127ATIVAN 95 96atomoxetine hcl 98atorvastatin calcium 75atovaquone 11atovaquone-proguanil hcl 9ATRALIN 212ATRAPRO HYDROGEL 222ATRIPLA 17 18atropine sulfate 43 135 175 198ATROVENT HFA 43 198AUBAGIO 185AUBRA 153 158 166AUBRA EQ 153 158 166AUGMENTIN 9AUGMENTIN XR 9AURYXIA 122AUSTEDO 115AUVI-Q 42 198AVALIDE 62 126AVANDIA 174AVAPRO 61 62AVAR 207 217AVAR CLEANSER 207 217AVAR LS 207 218AVAR LS CLEANSER 207 218AVAR-E EMOLLIENT 207 218AVAR-E GREEN 207 218AVAR-E LS 207 218AVELOX 11 24AVIANE 153 158 166AVITA 212AVO CREAM 222AVODART 175AVONEX PEN 185AVONEX PREFILLED 185av-phos 250 neutral 123AYGESTIN 166AYUNA 153 158 166AYVAKIT 27AZASAN 181 185 191AZASITE 130azathioprine 181 185 191azelaic acid 222azelastine hcl 129 204azelastine-fluticasone129 132 203 204AZELEX 222AZILECT 101azithromycin 23AZOPT 132AZOR 62 74AZSTARYS 109AZULFIDINE 24 138 181 185

AZULFIDINE EN-TABS24 138 181 186AZURETTE 153 158 166bacitracin-polymyxin b 130bacitra-neomycin-polymyxin-hc130 132baclofen 46BACMIN 123 228BACTRIM 11 24 26BACTRIM DS 11 24 26BAFIERTAM 186BALCOLTRA 153 158 166balsalazide disodium 138BALVERSA 27BALZIVA 153 158 166BANZEL 83BAQSIMI ONE PACK 162 175BAQSIMI TWO PACK 162 175BARACLUDE 22BASAGLAR KWIKPEN 164BAXDELA 24BAYER BREEZE 2 TEST 119BAYER CONTOUR TEST 119bcg vaccine 39BD INSULIN SYRINGE MICROFINE 117BD INSULIN SYRINGE UF 117BD PEN NEEDLE MINI UF 117BECONASE AQ 132 203BELBUCA 106belladonna alkaloids-opium 43 102BELSOMRA 91 106benazepril hcl 62 63benazepril-hydrochlorothiazide63 126BENEFIX 53BENICAR 61 62BENICAR HCT 62 126BENLYSTA 191bensal hp 209 218BENZAC AC WASH 219BENZACLIN 207 219BENZACLIN WITH PUMP207 219BENZEFOAM 219BENZEFOAMULTRA 219BENZEPRO 219BENZEPRO CREAMY WASH 219BENZEPRO FOAMING CLOTHS 219BENZEPRO SHORT CONTACT 219benznidazole 11benzonatate 199benzoyl peroxide 219 220

benzoyl peroxide cleanser 219benzoyl peroxide wash 220benzoyl peroxide-erythromycin207 220benzphetamine hcl 81benztropine mesylate 44 83bepotastine besilate 129BEPREVE 129BERINERT 180 194BESIVANCE 130BESREMI 21 27 186betaine 194betamethasone dipropionate 213betamethasone dipropionate aug 213betamethasone valerate 213BETAPACE 46 65 66 71BETASERON 186betaxolol hcl 49 65 66 71 131bethanechol chloride 47BETHKIS 8BETIMOL 131BETOPTIC-S 131BEVESPI AEROSPHERE 43 48BEVYXXA 51bexarotene 27 222BEXSERO 39BEYAZ 153 158 166 232BIAFINE 222bicalutamide 27BIDIL 74 77BIJUVA 158 166BIKTARVY 16 17 18BILTRICIDE 9bimatoprost 136 222BINOSTO 178BIONECT 222BIOTHRAX 40bisacodyl 139bisoprolol fumarate 49 65 66 71bisoprolol-hydrochlorothiazide65 126BLEPH-10 130BLEPHAMIDE 130 132BLEPHAMIDE SOP 130 132BLISOVI 24 FE 153 158 166blood pressure monitor 117BLOOD PRESSURE MONITOR 3 117BLOOD PRESSURE MONITOR 7 117BONIVA 178BONJESTA 138BOOSTRIX 39 40bosentan 205

244

BOSULIF 27bp 10-1 207 218bp cleansing wash 207 218bp foam 220bp gel 220bp vit 3 194 232bp wash 220bpo 220bpo foaming cloths 220BRAFTOVI 27BREATHERITE 117BREATHERITE COLL SPACER ADULT 117BREATHERITE COLL SPACER CHILD 117BREATHERITE COLL SPACER INFANT 117BREATHERITE RIGID SPACERMASK 117BREATHERITE SPACER NEONATE 117BREATHERITE SPACER SMALL CHILD 117BREATHERITELARGE MASK117BREATHERITEMEDIUM MASK 117BREATHERITESMALL MASK117BREO ELLIPTA 48 147BREXAFEMME 9BREZTRI AEROSPHERE43 48 147BRILINTA 60brimonidine tartrate 129brimonidine tartrate-timolol129 131brimonidine-dorzolamide 129 132brinzolamide 132BRISDELLE 113BRIVIACT 83BROMFED DM 6 42 199bromfenac sodium (once-daily) 135bromocriptine mesylate 100BROMSITE 135BRONCHITOL 203BROVANA 48BRUKINSA 27BRYHALI 213BSS 134BSS PLUS 134budesonide 132 147 203budesonide er 147budesonide-formoterol fumarate 48 147

BUFFERIN 60 90 111 136 139BUFFERIN LOW DOSE60 90 111 137 139bumetanide 76 122BUNAVAIL 105 106BUPAP 82 94BUPHENYL 120buprenorphine 106buprenorphine hcl 106buprenorphine hcl-naloxone hcl105 106bupropion hcl 87bupropion hcl er (smoking det) 87bupropion hcl er (sr) 87bupropion hcl er (xl) 87buspirone hcl 91butalbital-acetaminophen 82 94butalbital-apap-caff-cod82 94 95 102 109butalbital-apap-caffeine 82 95 109butalbital-asa-caff-codeine95 102 109 111butalbital-aspirin-caffeine95 109 111butorphanol tartrate 90 106BUTRANS 106BYDUREON BCISE 163BYETTA 10 MCG PEN 163BYETTA 5 MCG PEN 163BYLVAY 141BYLVAY (PELLETS) 141BYNFEZIA PEN 141 172BYSTOLIC 46 65BYVALSON 62 65cabergoline 100CABLIVI 50CABOMETYX 27CADUET 74 75CAFERGOT 47 90 109caffeine citrate 90 109CALAN 67 68 72 79CALAN SR 67 68 72 79calcipotriene 222calcipotriene-betameth diprop213 222calcitonin (salmon) 151 178calcitriol 222 239calcium acetate (phos binder)122 124calcium-folic acid plus d124 232 239CALQUENCE 27CAMBIA 90 107CAMILA 153 166CAMRESE 153 158 166

CAMRESE LO 153 158 166CANASA 138candesartan cilexetil 61 62candesartan cilexetil-hctz 62 126CANDIN 120capecitabine 27CAPEX 213CAPLYTA 93CAPRELSA 28captopril 62 63captopril-hydrochlorothiazide63 126CARAC 222CARAFATE 144CARBAGLU 120carbamazepine 83 88carbamazepine er 83 88CARBATROL 83 88carbidopa 99carbidopa-levodopa 99carbidopa-levodopa er 99carbidopa-levodopa-entacapone 98 99carbinoxamine maleate 4 201CARDIOVID PLUS 194 232CARDIZEM 67 68 72 79CARDIZEM CD 67 68 72 79CARDIZEM LA 67 68 72 79CARDURA 46 60 61CARDURA XL 46 60 61carglumic acid 121carisoprodol 45carisoprodol-aspirin 45 111carisoprodol-aspirin-codeine45 102 111CARNITOR 194CARNITOR SF 194CAROSPIR 76 78 123carteolol hcl 131CARTIA XT 67 68 72 79carvedilol 46 48 60 61 65 66 71carvedilol phosphate er46 48 60 61 65 66 71CASODEX 28CATAPRES 42 69CATAPRES-TTS-1 42 69CATAPRES-TTS-2 42 69CATAPRES-TTS-3 42 69CAVERJECT 79CAVERJECT IMPULSE 79CAYA 197CAYSTON 22cefaclor 7cefaclor er 7cefadroxil 7

245

cefdinir 7cefditoren pivoxil 7cefixime 7cefpodoxime proxetil 7cefprozil 7cefuroxime axetil 7CELACYN 222CELACYN POST-PROCEDURE PACK 223CELEBREX 99celecoxib 99CELEXA 113CELLCEPT 191CELONTIN 114CENTANY 207CENTRATEX 56 124 232 237cephalexin 7CEPROTIN 50CEQUA 134CERACADE 223CERDELGA 194CETACAINE 209cetirizine hcl 6 204cetirizine hcl childrens alrgy 6 204cetirizine-pseudoephedrine er 6 42CETRAXAL 130CETROTIDE 151cevimeline hcl 47CHATEAL 153 158 166CHATEAL EQ 153 158 166CHEMET 145 175cheratussin ac 199 201childrens loratadine 7 204chlordiazepoxide hcl 96chlordiazepoxide-amitriptyline96 115chlordiazepoxide-clidinium 43 96chlorhexidine gluconate 134 220chloroquine phosphate 9chlorpheniramine maleate er4 6 201chlorpromazine hcl 108chlorthalidone 78 127chlorzoxazone 45choice-tabs 124 228CHOLBAM 141cholestyramine 67cholestyramine light 66choline-mag trisalicylate 111chorionic gonadotropin 162CIALIS 77CIBINQO 181ciclopirox 217ciclopirox olamine 217ciclopirox treatment 217

CIFEREX 232 239cilostazol 60 77CILOXAN 130CIMDUO 18cimetidine 5 143cimetidine hcl 5 143CIMZIA 142 181 186CIMZIA PREFILLED 141 181 186CIMZIA STARTER KIT142 181 186cinacalcet hcl 151CIPRO 11 24CIPRO HC 130 132CIPRODEX 130 132ciprofloxacin 12 24ciprofloxacin hcl 11 24 130ciprofloxacin-ciproflox hcl er 12 24ciprofloxacin-dexamethasone130 132ciprofloxacin-fluocinolone pf130 132citalopram hydrobromide 113CITRANATAL 90 DHA56 139 194 229 232CITRANATAL ASSURE56 139 194 229 232CITRANATAL B-CALM56 229 232CITRANATAL BLOOM56 139 232 237CITRANATAL DHA56 139 194 229 232CITRANATAL HARMONY56 139 195 229 232CITRANATAL RX56 139 229 232CLARAVIS 223CLARINEX 7 204CLARINEX-D 12 HOUR 7 42clarithromycin 12 23 139clarithromycin er 12 23 139CLARITIN 7 204CLARITIN REDITABS 7 204CLARITIN-D 12 HOUR 7 42CLARITIN-D 24 HOUR 7 42clemastine fumarate 4 201CLENIA PLUS 207 218CLENPIQ 140CLEOCIN 21 207CLEOCIN-T 207CLIMARA 158 178CLIMARA PRO 158 166CLINDAGEL 207clindamycin hcl 21clindamycin palmitate hcl 21

clindamycin phos-benzoyl perox 207 208 220clindamycin phosphate 208clindamycin-tretinoin 208 212 223CLINDESSE 208clobazam 95 96clobetasol prop emollient base 213clobetasol propionate 213CLOBEX 213CLOBEX SPRAY 213clocortolone pivalate 213clocortolone pivalate pump 213CLODAN 214 217CLODERM 214CLODERM PUMP 214clomiphene citrate 157clomipramine hcl 115clonazepam 95 96clonidine 42 70clonidine hcl 43 70clonidine hcl er 42 70clopidogrel bisulfate 60clorazepate dipotassium 95 96clotrimazole 211clotrimazole-betamethasone211 214clozapine 93CLOZARIL 93COAGADEX 53coal tar 219COARTEM 9codeine sulfate 102 199coenzyme q10 195coenzyme q-10 195COLAZAL 138colchicine 177colchicine-probenecid 128 177COLCRYS 177colesevelam hcl 67 150COLESTID 67colestipol hcl 67colistimethate sodium (cba) 24COLY-MYCIN S 130 132COLYTE WITH FLAVOR PACKS 140COMBIGAN 129 131COMBIPATCH 158 166COMBIVENT RESPIMAT43 48 198COMBIVIR 18COMETRIQ (100 MG DAILY DOSE) 28COMETRIQ (140 MG DAILY DOSE) 28

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COMETRIQ (60 MG DAILY DOSE) 28COMIRNATY 40COMPLERA 17 18complete natal dha56 124 195 229 232completenate 56 229 232COMPRO 108 138COMTAN 98CONCERTA 109CONDYLOX 223CONJUPRI 73 74 79CONSENSI 74 99CONTOUR NEXT TEST 119CONTRAVE 83CONZIP 102COPAXONE 186COPIKTRA 28CORDRAN 214COREG 46 48 60 61 65 66 71COREG CR 46 48 61 65 66 71CORGARD 46 65 66CORLANOR 69 79CORTANE-B132 134 135 209 214 220CORTEF 147CORTENEMA 214CORTIFOAM 214cortisone acetate 147CORTISPORIN 208 214CORTROPHIN 119 165CORVITA 124 229 232CORVITA 150 56 124 232 237CORVITE 124 229 232CORVITE 150 56 124 232 237corvite fe 57CORVITE FREE 124 229CORZIDE 65 126COSENTYX 181 223COSENTYX (300 MG DOSE)181 223COSENTYX SENSOREADY (300 MG) 181 223COSENTYX SENSOREADY PEN 181 223COSOPT 131 132COTELLIC 28COTEMPLA XR-ODT 109COUMADIN 51COVARYX 149 158COVARYX HS 149 158COZAAR 61 62CREON 128 141CRESEMBA 12CRESTOR 75

CRINONE 166CRIXIVAN 20cromolyn sodium 129 134 202CRYSELLE-28 153 158 166CUPRIMINE 145 182CUVPOSA 43cyanocobalamin 60 232CYCLAFEM 135 153 158 166CYCLAFEM 777 153 158 166cyclobenzaprine hcl 45cyclobenzaprine hcl er 45CYCLOGYL 135CYCLOMYDRIL 135 136cyclopentolate hcl 135cyclophosphamide 28 191cycloserine 12CYCLOSET 150cyclosporine 134 182 186 191cyclosporine modified182 186 191CYMBALTA 100 111cyproheptadine hcl 4 201CYSTADANE 195CYSTADROPS 134CYSTARAN 134CYTOMEL 174CYTOTEC 144cytra k crystals 120cytra-2 120CYTRA-3 120cytra-k 120dalfampridine er 195DALIRESP 203danazol 149DANTRIUM 46dantrolene sodium 46dapsone 11 208 223DARAPRIM 9darifenacin hydrobromide er 227DARTISLA ODT 43DAURISMO 28DAYPRO 107DAYTRANA 109DAYVIGO 92 106DDAVP 53 165DDAVP RHINAL TUBE 53 165DEBLITANE 153 166DECARA 239deferasirox 146deferasirox granules 146deferiprone 146DELESTROGEN 158 178DELSTRIGO 17 18DELZICOL 138DEMADEX 76 122

demeclocycline hcl 25DEMSER 195DENAVIR 210DENGVAXIA 40DENTA 5000 PLUS 180DENTAGEL 180DEPAKOTE 84 88 90DEPAKOTE ER 84 88 90DEPAKOTE SPRINKLES84 88 90DEPEN TITRATABS 146 182DEPO-PROVERA 153 166DEPO-SUBQ PROVERA 104154 166DEPO-TESTOSTERONE 149DERMACINRX PRIZOPAK 209DERMACINRX PUREFOLIX232 239DERMA-SMOOTHEFS BODY 214DERMA-SMOOTHEFS SCALP 214DERMASORB HC 214 223DERMASORB TA 214DERMASORB XM 212 218DERMAZENE 214 220DERMULCERA 223DESCOVY 18desipramine hcl 115desloratadine 7 204desmopressin ace spray refrig53 165desmopressin acetate 53 54 165desmopressin acetate spray54 165DESONATE 214desonide 214DESOWEN 214desoximetasone 214DESOXYN 81desvenlafaxine er 111desvenlafaxine succinate er 111DETROL 227DETROL LA 227dexabliss 147dexamethasone 147DEXAMETHASONE INTENSOL 147dexamethasone sodium phosphate 132DEXCOM G6 RECEIVER 117DEXCOM G6 SENSOR 117DEXCOM G6 TRANSMITTER 117DEXEDRINE 81DEXILANT 145dexlansoprazole 145

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dexmethylphenidate hcl 109dexmethylphenidate hcl er 109DEXONTO 04 147DEXPAK 6 DAY 147dextroamphetamine sulfate 81dextroamphetamine sulfate er 81DEXYCU 132DHIVY 99DIACOMIT 84DIALYVITE 229 232 237DIALYVITE 3000124 229 232 237 240DIALYVITE 5000124 229 232 237 240DIALYVITE 800IRON57 233 237DIALYVITE SUPREME D124 229 233DIALYVITEZINC124 229 233 237DIASTAT ACUDIAL 95 96DIASTAT PEDIATRIC 95 96diazepam 95 96DIAZEPAM INTENSOL 95 96diazoxide 151DIBENZYLINE 47 76DICLEGIS 138diclofenac 107diclofenac epolamine 107diclofenac potassium 107diclofenac sodium107 116 135 221 223diclofenac sodium er 107diclofenac-misoprostol 107 144dicloxacillin sodium 23DICOPANOL FUSEPAQ4 45 83 92 199 201dicyclomine hcl 43didanosine 18diethylpropion hcl 80diethylpropion hcl er 80DIFFERIN 223DIFICID 23diflorasone diacetate 214DIFLUCAN 13diflunisal 107difluprednate 132DIGITEK 64 69DIGOX 64 69digoxin 64 69dihydroergotamine mesylate 47 90DILANTIN 70 101DILANTIN INFATABS 70 101DILAUDID 102diltiazem hcl 67 68 72 79diltiazem hcl er 67 68 72 79

diltiazem hcl er beads67 68 72 79diltiazem hcl er coated beads67 68 72 79dilt-xr 67 68 72 79dimethyl fumarate 186dimethyl fumarate starter pack 186DIOVAN 61 62DIOVAN HCT 62 126DIPENTUM 138diphenhydramine hcl4 45 83 92 199 201diphenoxylate-atropine 43 137diphtheria-tetanus toxoids dt 39DIPROLENE 214DIPROLENE AF 214dipyridamole 60 79disopyramide phosphate 70disulfiram 175DITROPAN XL 228DIURIL 78 126divalproex sodium 84 88 90divalproex sodium er 84 88 90DIVIGEL 158 178DOANS PILLS 111dofetilide 71DOJOLVI 121DOLOPHINE 102DOMEBORO 211donepezil hcl 47DONNATAL 43 95DOPTELET 51DORYX 10 25DORYX MPC 10 25dorzolamide hcl 132dorzolamide hcl-timolol mal 132DOTTI 158 178DOVATO 16 18DOVONEX 223doxazosin mesylate 46 61doxepin hcl 115 209doxercalciferol 239doxycycline 25 223doxycycline hyclate 10 25doxycycline monohydrate 10 25doxylamine-pyridoxine 138DRISDOL 239DRITHO-CREME HP 223DRIZALMA SPRINKLE 111dronabinol 137DROXIA 28droxidopa 42DRYSOL 211DSUVIA 102DUAC 208 220

DUAKLIR PRESSAIR 43 48DUAVEE 157 159DUETACT 173 174DUEXIS 107 143DULERA 48 147duloxetine hcl 100 111DUOBRII 214 223DUPIXENT 202 223 224durachol 233 239DURAGESIC-100 102DURAGESIC-12 102DURAGESIC-25 102DURAGESIC-50 102DURAGESIC-75 102DUREZOL 132DURLAZA 60 111dutasteride 175dutasteride-tamsulosin hcl 48 175DUTOPROL 65 127DYANAVEL XR 81DYMISTA 129 133 203 204DYRENIUM 78 123EES 400 13EES GRANULES 13EASIVENT 117EASIVENT MASK LARGE 117EASIVENT MASK MEDIUM 117EASIVENT MASK SMALL 117easy talk control 117easy talk plus ii test strips 119easy trak ii glucose test 119EC-NAPROSYN 90 107 177econazole nitrate 211ECONTRA EZ 154 166ECONTRA ONE-STEP 154 166ECOZA 211EDARBI 61 62EDARBYCLOR 62 127EDECRIN 76 122EDEX 79EDLUAR 92EDURANT 17efavirenz 17efavirenz-emtricitab-tenofovir17 19efavirenz-lamivudine-tenofovir17 19EFFER-K 124EFFEXOR XR 112EFFIENT 60EFUDEX 224ELEPSIA XR 84ELESTAT 129ELESTRIN 159 178ELETONE 224

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eletriptan hydrobromide 112ELIDEL 191 224ELIQUIS 51ELIQUIS DVTPE STARTER PACK 51ELIXOPHYLLIN74 109 121 206 228ELLA 154 167ELMIRON 195ELOCON 214ELOCTATE 54ELURYNG 154 159 167ELYXYB 90 99EMCYT 28EMEND 144EMEND TRI-PACK 144EMFLAZA 147EMGALITY 97EMGALITY (300 MG DOSE) 97EMOQUETTE 154 159 167EMPAVELI 180 194EMSAM 101emtricitabine 19emtricitabine-tenofovir df 19EMTRIVA 19EMULSION SB 224EMVERM 9ENABLEX 228enalapril maleate 63enalapril-hydrochlorothiazide63 127ENBREL 182 186ENBREL MINI 182 186ENBREL SURECLICK 182 186ENDARI 195ENDOMETRIN 167ENEMEEZ MINI 140ENEMEEZ PLUS 140ENGERIX-B 40ENLYTE 121enoxaparin sodium 55 56ENPRESSE-28 154 159 167ENSPRYNG 187ENSTILAR 214 224entacapone 98entecavir 22ENTOCORT EC 147ENTRESTO 62 78ENTTY SPRAY EMULSION 224enulose 121ENVARSUS XR 191EPANED 63EPCLUSA 14 15EPICERAM 224EPIDIOLEX 84

EPIDUO 220 224EPIDUO FORTE 220 224EPIFOAM 209 214epinastine hcl 129epinephrine 42 198epinephrine hcl (nasal)42 136 198EPIPEN 2-PAK 42 198EPIPEN JR 2-PAK 42 198EPITOL 84 88EPIVIR 19EPIVIR HBV 19eplerenone 76 78 123EPOGEN 50 51EPRONTIA 84 90EPSOLAY 220EPZICOM 19EQUETRO 84 88ergoloid mesylates 47ERGOMAR 47 90ergotamine-caffeine 47 90 109ERIVEDGE 28ERLEADA 28erlotinib hcl 28ERRIN 154 167ERTACZO 211ery 208ERYGEL 208ERYPED 200 13ERYPED 400 14ERY-TAB 14ERYTHROCIN STEARATE 14erythromycin 130 208erythromycin base 14erythromycin ethylsuccinate 14ESBRIET 199escitalopram oxalate 113ESGIC 82 95 109esomeprazole magnesium 145esomeprazole strontium 145ESOTERICA DAYTIME 217ESOTERICA FACIAL 217ESOTERICA FADE NIGHTTIME 217ESPEROCT 54est estrogens-methyltest 150 159est estrogens-methyltest ds149 159est estrogens-methyltest hs149 159estazolam 96ESTRACE 159 178estradiol 159 178estradiol valerate 159 179

estradiol-norethindrone acet159 167ESTRING 159 179ESTROGEL 159 179ESTROSTEP FE 154 159 167eszopiclone 92ethacrynic acid 76 122ethambutol hcl 12ethosuximide 114ethyl chloride 209etidronate disodium 179etodolac 107etodolac er 107etonogestrel-ethinyl estradiol154 159 167etoposide 28etravirine 17EUCRISA 209EUFLEXXA 195EURAX 221EUTHYROX 174EVAMIST 159 179EVEKEO 81EVEKEO ODT 81EVENCARE PROVIEW GLUCOSE TEST 119everolimus 28 192EVISTA 157 179EVOTAZ 20 195EVOXAC 47EVRYSDI 195EXELDERM 211EXELON 47exemestane 28 150EXFORGE 62 74EXFORGE HCT 62 74 127EXJADE 146EXKIVITY 28EXONDYS 51 177EXSERVAN 98EXTAVIA 187EXTINA 211EYSUVIS 133EZALLOR SPRINKLE 75ezetimibe 70ezetimibe-rosuvastatin 70 75ezetimibe-simvastatin 70 75fabb 233FABIOR 224FALMINA 154 159 167famciclovir 22famotidine 5 144FANAPT 93FANAPT TITRATION PACK 93FARESTON 28 157

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FARXIGA 172FARYDAK 29FASENRA PEN 202FAYOSIM 154 159 167FAZACLO 93fe 90 plus 57 140 233 237FE C PLUS 57 233 237febuxostat 177FEIBA NF 54felbamate 84FELBATOL 84FELDENE 107felodipine er 73 74FEMARA 29 151FEMHRT 159 167FEMHRT LOW DOSE 159 167FEMRING 159 179fenofibrate 75fenofibrate micronized 75fenofibric acid 75FENOGLIDE 75fenoprofen calcium 107FENORTHO 107fentanyl 102fentanyl citrate 102FENTORA 103FERIVA 21757 124 140 195 233 237FERIVAFA 57 124 140 233 237ferocon 57 233 237FERRALET 90 57 140 233 237ferraplus 90 57 140 233 237FERREX 150 57FERREX 150 FORTE 57 233FERREX 150 FORTE PLUS57 121 195 233 237FERREX 150 PLUS 57 121 237FERREX 28 57 195 233 237FERRIPROX 146FERRIPROX TWICE-A-DAY 146FERROCITE PLUS57 124 233 237ferrous sulfate 57FETZIMA 112FETZIMA TITRATION 112FEXMID 45fexofenadine hcl 7 204fexofenadine-pseudoephed er7 42FIASP 170FIASP FLEXTOUCH 170FIASP PENFILL 170FIBRICOR 75FINACEA 224finasteride 175 224FINTEPLA 84

FIORICET 82 95 109FIORICETCODEINE82 95 103 109FIORINAL 95 109 111FIRAZYR 179 194FIRDAPSE 195FIRST-LANSOPRAZOLE 145FIRST-MOUTHWASH BLM4 135 137 138 140 210FIRST-OMEPRAZOLE 145FIRVANQ 14FLAGYL 8 11 139FLAREX 133flavoxate hcl 228flecainide acetate 70FLECTOR 107FLEQSUVY 46flolipid 75FLOMAX 48FLORIVA 180 229 239FLORIVA PLUS 180 229FLOVENT DISKUS 147 203FLOVENT HFA 147 203FLUAD 40FLUAD QUADRIVALENT 40FLUARIX QUADRIVALENT 40FLUBLOK QUADRIVALENT 40FLUCELVAX QUADRIVALENT 40fluconazole 13fludrocortisone acetate 148FLULAVAL QUADRIVALENT 40FLUMIST QUADRIVALENT 40flunisolide 133 148 203fluocinolone acetonide 214 215fluocinolone acetonide body 214fluocinolone acetonide scalp 215fluocinonide 215fluocinonide emulsified base 215FLUORIDEX SENSITIVITY RELIEF 116 180fluorometholone 133FLUOROPLEX 224fluorouracil 224fluoxetine hcl 113 114fluoxetine hcl (pmdd) 113fluphenazine hcl 108flurandrenolide 215flurazepam hcl 96flurbiprofen 107flurbiprofen sodium 135flutamide 29fluticasone furoate-vilanterol48 148

fluticasone propionate133 148 203 215fluticasone propionate hfa 148 203fluticasone-salmeterol 49 148fluvastatin sodium 75fluvastatin sodium er 75fluvoxamine maleate 114fluvoxamine maleate er 114FLUZONE HIGH-DOSE QUADRIVALENT 40FLUZONE QUADRIVALENT 40FML 133FML FORTE 133FML LIQUIFILM 133FOCALIN 109FOCALIN XR 109folbee 233FOLBEE AR 121 195 233folbee plus 229 233 237FOLBEE PLUS CZ124 229 233 237FOLBIC 233folic acid 233folic acid-vit b6-vit b12 233FOLIVANE-F 57 233 237FOLIVANE-PLUS 57 233 237FOLIXAPURE 233 239FOLLISTIM AQ 162folplex 22 233FOLTANX 233FOLTRATE 233FOLTX 233fondaparinux sodium 50FORA 6 CONNECT 119FORFIVO XL 87formoterol fumarate 49 204FORTAMET 152FORTAVIT 124 229FORTEO 164 178FORTESTA 150FORTISCARE G1 TEST STRIP119FOSAMAX 179FOSAMAX PLUS D 179 239fosamprenavir calcium 20fosfomycin tromethamine 26fosinopril sodium 63fosinopril sodium-hctz 63 127FOSRENOL 122 176FOTIVDA 29FRAGMIN 56FREEDOM DERMA-D 198FREESTYLE CONTROL SOLUTION 117FREESTYLE INSULINX TEST 119

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FREESTYLE LIBRE 14 DAY READER 117FREESTYLE LIBRE 14 DAY SENSOR 117FREESTYLE LIBRE 2 READER 117FREESTYLE LIBRE 2 SENSOR 118FREESTYLE LITE TEST 119FREESTYLE PRECISION NEO TEST 119FREESTYLE TEST 119FROVA 112frovatriptan succinate 112FULPHILA 52FURADANTIN 26furosemide 76 122FUSION PLUS 57 233 237FUSION SPRINKLES57 137 233 238FUZEON 16FYCOMPA 84gabapentin 82 84GABITRIL 84GABLOFEN 46GALAFOLD 195galantamine hydrobromide 47galantamine hydrobromide er 47GALZIN 124ganirelix acetate 151GARDASIL 9 40GASTROCROM 134 202gatifloxacin 130GATTEX 142GAVILYTE-C 140GAVILYTE-G 140GAVILYTE-N WITH FLAVOR PACK 140GAVRETO 29GEBAUERS PAIN EASE 210GEBAUERS SPRAY AND STRETCH 210GELCLAIR 224GELFOAM COMPRESSED SIZE 100 54GELFOAM-JMI SPONGE 54GELNIQUE 228gemfibrozil 75GEMMILY 154 159 167GEMTESA 228GENERESS FE 154 159 167generlac 121GENGRAF 182 187 192GENOTROPIN 165 173

GENOTROPIN MINIQUICK165 173GENTAK 130gentamicin sulfate 130 208GENVOYA 16 19GEODON 88 93GERI-HYDROLAC 12 211GERI-HYDROLAC 5 212GIANVI 154 159 167GILDESS FE 1530 154 159 167GILDESS FE 120 154 159 167GILENYA 187GILOTRIF 29GIMOTI 144glatiramer acetate 187GLATOPA 187GLEEVEC 29GLEOSTINE 29glimepiride 173glipizide 174glipizide er 174glipizide xl 174glipizide-metformin hcl 152 174GLOPERBA 177GLUCAGEN HYPOKIT 162 176glucagon emergency 162 176GLUCOCARD 01 SENSOR PLUS 119GLUCOCARD EXPRESSION TEST 119GLUCOCARD VITAL TEST 119GLUCOCARD X-SENSOR 119GLUCOPHAGE 152GLUCOPHAGE XR 152GLUCOTROL 174GLUCOTROL XL 174GLUMETZA 152glyburide 174glyburide micronized 174glyburide-metformin 152 174GLYCATE 43GLYCOLAX 140glycopyrrolate 43GLYDO 210GLYNASE 174GLYSET 149GLYXAMBI 157 172GOCOVRI 8 80GOJJI BLOOD GLUCOSE TEST 119GOLYTELY 140GONAL-F 162GONAL-F RFF 162GONAL-F RFF REDIJECT 162GONITRO 77

goodsense aspirin 60 90 111goodsense nicotine 45GRALISE 82 85granisetron hcl 136GRANIX 52GRASTEK 38griseofulvin microsize 9griseofulvin ultramicrosize 9guaifenesin 201guaifenesin-codeine 199 201guaifenesin-dm 199 201guanfacine hcl 70 98guanfacine hcl er 98GVOKE HYPOPEN 1-PACK162 176GVOKE HYPOPEN 2-PACK162 176GVOKE KIT 162 176GVOKE PFS 162 176GYNAZOLE-1 211HAEGARDA 180 194HAILEY 24 FE 154 159 167HAILEY FE 1530 154 159 167hair regrowth treatment men 224HALCION 96halobetasol propionate 215HALOG 215haloperidol 97haloperidol lactate 97HARMONY BLOOD GLUCOSE TEST 119HARVONI 14 15HAVRIX 40HEATHER 154 167HEMADY 148HEMANGEOL 46 65 66 71 91hematinic plus vitminerals57 124 233 238hematinicfolic acid 57 233HEMATOGEN 57HEMATOGEN FA 57 233 238HEMATOGEN FORTE57 233 238HEMATRON 57 124 233HEMATRON-AF57 124 140 234 238 240HEMAX57 124 140 234 238 240hemetab 57 234HEMLIBRA 54HEMMOREX-HC 215HEMOCYTE 57HEMOCYTE PLUS57 124 234 238HEMOCYTE-F 57 234

251

hemocyte-plus 57 124 234 238HEMOFIL M 54heparin sodium (porcine) 56HEPLISAV-B 40HEPSERA 22HETLIOZ 92HETLIOZ LQ 92HIBERIX 40HIDEX 6-DAY 148HISTEX-AC 6 43 200HOMATROPAIRE 135HORIZANT 85HUMALOG 170HUMALOG JUNIOR KWIKPEN 171HUMALOG KWIKPEN 171HUMALOG MIX 5050 171HUMALOG MIX 5050 KWIKPEN 171HUMALOG MIX 7525 171HUMALOG MIX 7525 KWIKPEN 171HUMATE-P 54HUMATROPE 165 173HUMIRA 142 183 188HUMIRA PEDIATRIC CROHNS START 142 182 187HUMIRA PEN 142 182 187HUMIRA PEN-CDUCHS STARTER 142 182 188HUMIRA PEN-PEDIATRIC UC START 142 183 188HUMIRA PEN-PSUVADOL HS START 142 183 188HUMIRA PEN-PSORUVEIT STARTER 142 183 188HUMULIN 7030 163 171HUMULIN 7030 KWIKPEN163 171HUMULIN N 163HUMULIN N KWIKPEN 163HUMULIN R 171HUMULIN R U-500 (CONCENTRATED) 171HUMULIN R U-500 KWIKPEN 171HYCAMTIN 29HYCODAN 43 200hydralazine hcl 74HYDREA 29hydrochlorothiazide 78 127hydrocod polst-cpm polst er 6 200hydrocodone bitartrate er 103hydrocodone bit-homatrop mbr43 200

hydrocodoneacetaminophen82 103hydrocodone-acetaminophen82 103hydrocodone-homatropine 43 200hydrocodone-ibuprofen 103 107hydrocortisone 148 215hydrocortisone ace-pramoxine210 215hydrocortisone acetate 215hydrocortisone butyr lipo base 215hydrocortisone butyrate 215hydrocortisone valerate 215hydrocortisone-iodoquinol 215 220HYDROFERA BLUE FOAM DRESSING 224hydromet 43 200hydromorphone hcl 103hydromorphone hcl er 103hydroquinone 217hydroxychloroquine sulfate10 183 188hydroxyurea 29hydroxyzine hcl 4 5 92hydroxyzine pamoate 4 5 92HYLATOPIC PLUS 224HYOPHEN 26 43 82hyoscyamine sulfate 44hyoscyamine sulfate er 44HYPERSAL 202HYPOLANCE AST LANCING 118HYSINGLA ER 103HYZAAR 62 127ibandronate sodium 179IBRANCE 29IBSRELA 142IBUDONE 103 107ibuprofen 91 107ibuprofen-famotidine 107 144ICAR-C PLUS 57 234 238icatibant acetate 179 194ICLUSIG 29 30icosapent ethyl 64IDELVION 54IDHIFA 30IFEREX 150 FORTE 57 234ILEVRO 135imatinib mesylate 30IMBRUVICA 30IMCIVREE 83imipramine hcl 115imipramine pamoate 115imiquimod 224imiquimod pump 224IMITREX 112

IMITREX STATDOSE REFILL 112IMITREX STATDOSE SYSTEM112IMOVAX RABIES 40IMPAVIDO 11IMPEKLO 216IMPOYZ 216IMURAN 183 188 192IMVEXXY MAINTENANCE PACK 159IMVEXXY STARTER PACK 159INATAL GT 57 140 229 234INBRIJA 99INCRELEX 173INCRUSE ELLIPTA 44indapamide 78 127INDERAL LA 46 65 66 71 91INDERAL XL 46 65 66 71 91INDOCIN 107 177indomethacin 107 177indomethacin er 107 177INGREZZA 116INLYTA 30INNOPRAN XL 46 65 66 71 91INPEN 100-BLUE-LILLY 118INPEN 100-BLUE-LILLY-HUMALOG 118INPEN 100-BLUE-NOVO 118INPEN 100-BLUE-NOVOLOG-FIASP 118INPEN 100-GRAY-LILLY 118INPEN 100-GREY-LILLY-HUMALOG 118INPEN 100-GREY-NOVO 118INPEN 100-GREY-NOVOLOG-FIASP 118INPEN 100-PINK-LILLY 118INPEN 100-PINK-LILLY-HUMALOG 118INPEN 100-PINK-NOVO 118INPEN 100-PINK-NOVOLOG-FIASP 118INQOVI 30INREBIC 30INSPRA 76 77 78 123insulin asp prot amp asp flexpen 171insulin aspart 171insulin aspart flexpen 171insulin aspart penfill 171insulin aspart prot amp aspart 171insulin glargine-yfgn 164insulin lispro 171insulin lispro (1 unit dial) 171insulin lispro junior kwikpen 171insulin lispro prot amp lispro 171

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INTEGRA F 57 234 238INTEGRA PLUS 57 234 238INTELENCE 17INTERMEZZO 92INTRAROSA 148INTRON A 21 30 188INTUNIV 98INVEGA 93INVELTYS 133INVIRASE 20INVOKAMET 152 172INVOKAMET XR 152 172INVOKANA 172iodoquimez-hc 212 216 220IOPIDINE 134IPOL 40ipratropium bromide 44 198ipratropium-albuterol 44 49 198irbesartan 61 62irbesartan-hydrochlorothiazide62 127IRESSA 30IROSPAN 24657 124 195 234 238ISENTRESS 16ISENTRESS HD 16isoniazid 12ISOPTO ATROPINE 135ISOPTO CARPINE 135ISORDIL TITRADOSE 77isosorb dinitrate-hydralazine 74 77isosorbide dinitrate 77isosorbide mononitrate 77isosorbide mononitrate er 77isotretinoin 224isradipine 73 74ISTALOL 132ISTURISA 195itraconazole 13ivermectin 9 221IXIARO 40IXINITY 54JADENU 146JADENU SPRINKLE 146JAKAFI 30JALYN 48 175janssen covid-19 vaccine 40JANTOVEN 51JANUMET 152 157JANUMET XR 152 157JANUVIA 157JARDIANCE 172JATENZO 150JENCYCLA 154 167JENTADUETO 152 157

JENTADUETO XR 152 157JINTELI 159 167JIVI 54JOLESSA 154 159 167JORNAY PM 109JUBLIA 211JULEBER 154 159 167JULUCA 16 17JUNEL 1530 154 160 167JUNEL 120 154 160 167JUNEL FE 1530 154 160 167JUNEL FE 120 154 160 167JUNEL FE 24 154 160 167JUXTAPID 64JYNARQUE 128KADIAN 103KAITLIB FE 154 160 167KALBITOR 193 194KALETRA 20KALYDECO 200 201KAMDOY 224KAPSPARGO SPRINKLE49 65 66 71KAPVAY 43 70KARBINAL ER 4 5 202KARIVA 154 160 167KATERZIA 73 74 79KAZANO 152 157KEFLEX 7KELNOR 135 154 160 167KELO-COTE 224KENALOG 216KEPPRA 85KEPPRA XR 85KERALAC 218KERALYT 218KERENDIA 76KERYDIN 221KESIMPTA 188ketamine hcl 100ketoconazole 13 211ketoprofen er 91 107ketorolac tromethamine 107 135KETOSTIX 120ketotifen fumarate 5 129KEVEYIS 179KEVZARA 183KINERET 183 188KINRIX 39 40KIONEX 123 176KISQALI (200 MG DOSE) 31KISQALI (400 MG DOSE) 31KISQALI (600 MG DOSE) 31KISQALI FEMARA (400 MG DOSE) 31 151

KISQALI FEMARA (600 MG DOSE) 31 151KISQALI FEMARA(200 MG DOSE) 31 151KITABIS PAK 8KLARON 208KLISYRI 225KLONOPIN 95 96KLOR-CON 124KLOR-CON 10 124KLOR-CON M10 124KLOR-CON M15 124KLOR-CON M20 124KLOR-CONEF 124KLOXXADO 105KLS QUIT2 45KLS QUIT4 45KOATE 54KOGENATE FS 54KOMBIGLYZE XR 152 157KORLYM 150KOSELUGO 31KOVALTRY 54K-PHOS-NEUTRAL 124KRINTAFEL 10KRISTALOSE 121K-TAB 124KURVELO 154 160 167KUVAN 195KYNMOBI 101labetalol hcl 46 48 61 65 66 71LAC-HYDRIN 212lacosamide 85LACRISERT 134lactic acid 212lactic acid e 212lactulose 121LAGEVRIO 22LAMICTAL 85 88LAMICTAL ODT 85 88LAMICTAL STARTER 85 88LAMICTAL XR 85 88LAMISIL 8lamivudine 19lamivudine-zidovudine 19lamotrigine 85 89lamotrigine er 85 88 89lamotrigine starter kit-blue 85 89lamotrigine starter kit-green 85 89lamotrigine starter kit-orange85 89lamotrigine titration 85 89LAMPIT 11LANOXIN 64 69lansoprazole 145lanthanum carbonate 122 176

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LANTUS 164LANTUS SOLOSTAR 164lapatinib ditosylate 31LARIN 24 FE 154 160 167LASIX 76 122LASTACAFT 5 129latanoprost 136LATISSE 225LATUDA 93LAYOLIS FE 154 160 167LAZANDA 103ledipasvir-sofosbuvir 14 15leflunomide 183 188 192lenalidomide 31 188LENVIMA (10 MG DAILY DOSE) 31LENVIMA (12 MG DAILY DOSE) 31LENVIMA (14 MG DAILY DOSE) 31LENVIMA (18 MG DAILY DOSE) 31LENVIMA (20 MG DAILY DOSE) 31LENVIMA (24 MG DAILY DOSE) 31LENVIMA (4 MG DAILY DOSE) 31LENVIMA (8 MG DAILY DOSE) 31LESCOL XL 75LETAIRIS 205letrozole 32 151leucovorin calcium 176 234LEUKERAN 32leuprolide acetate 32 163levalbuterol hcl 49 204levalbuterol tartrate hfa 49 204levamlodipine maleate 73 74 79LEVAQUIN 12 24LEVEMIR 164LEVEMIR FLEXTOUCH 164levetiracetam 85levetiracetam er 85LEVITRA 77levobunolol hcl 132levocarnitine 195levocarnitine sf 195levocetirizine dihydrochloride 7levofloxacin 12 24 130levonorgest-eth est amp eth est154 160 167levonorgest-eth estrad 91-day154 160 168levonorgestrel 154 168

levonorgestrel-ethinyl estrad155 160 168LEVORA 01530 (28)155 160 168levorphanol tartrate 103LEVO-T 174levothyroxine sodium 174LEVOXYL 174LEVSIN 44LEVSINSL 44LEXAPRO 114LEXIVA 20 21LIALDA 138LIBRAX 44 96LICART 107lidocaine 210lidocaine hcl 210lidocaine viscous 135lidocaine-hydrocortisone ace210 216lidocaine-prilocaine 210LIDODERM 210lidopin 210lidopril 210lidorx 210LIDOTRANS 5 PAK 210LILLOW 155 160 168lindane 221linezolid 23LINZESS 142liothyronine sodium 174LIPITOR 75LIPOFEN 75lisinopril 63lisinopril-hydrochlorothiazide63 127lithium 89lithium carbonate 89lithium carbonate er 89LITHOBID 89LITHOSTAT 121LIVALO 75LIVIXIL PAK 210LIVMARLI 142LIVTENCITY 12l-leucine 121l-methylfolate-b6-b12 234LO LOESTRIN FE 155 160 168LOCOID 216LOCOID LIPOCREAM 216LODOSYN 99LOESTRIN 1530 (21)155 160 168

LOESTRIN FE 1530155 160 168LOESTRIN FE 120 155 160 168LOFENA 107LOKELMA 123LOMAIRA 80LOMOTIL 44 137LONHALA MAGNAIR REFILL KIT 44 198LONHALA MAGNAIR STARTER KIT 44 198LONSURF 32loperamide hcl 137LOPID 75lopinavir-ritonavir 21LOPRESSOR 49 65 66 71LOPRESSOR HCT 65 127LOPROX 217loratadine 7 204loratadine-d 24hr 7 42lorazepam 95 96LORAZEPAM INTENSOL 95 96LORBRENA 32LOREEV XR 95 96LORTAB 82 103LORZONE 45losartan potassium 61 62losartan potassium-hctz 62 127LOSEASONIQUE 155 160 168LOTEMAX 133LOTEMAX SM 133LOTENSIN 63LOTENSIN HCT 63 127loteprednol etabonate 133LOTREL 63 64 74LOTRIMIN AF 211LOTRISONE 211 216LOTRONEX 138lovastatin 75LOVAZA 64LOVENOX 56LOW-OGESTREL 155 160 168loxapine succinate 91LOYON 225lubiprostone 142LUCEMYRA 43LUDENT 180luliconazole 211LUMAKRAS 32LUMIGAN 136LUNESTA 92LUPKYNIS 192LUTERA 155 160 168LUXAMEND 225LUXIQ 216

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LUZU 211LYBALVI 93LYLLANA 160 179LYMEPAK 10 25LYNPARZA 32LYRICA 85 100LYRICA CR 82LYSIPLEX PLUS 125 229LYSODREN 32LYSTEDA 54LYUMJEV 171LYUMJEV KWIKPEN 171LYVISPAH 46LYZA 155 168maca 196MACROBID 26MACRODANTIN 26macuvex 121macuzin 121MAGNEBIND 400 122 125MALARONE 10malathion 221maprotiline hcl 115maraviroc 16MARINOL 137marlissa 155 160 168MARPLAN 101MATULANE 32MATZIM LA 67 68 72 79MAVENCLAD (10 TABS) 192MAVENCLAD (4 TABS) 192MAVENCLAD (5 TABS) 192MAVENCLAD (6 TABS) 192MAVENCLAD (7 TABS) 192MAVENCLAD (8 TABS) 192MAVENCLAD (9 TABS) 192MAVIK 63 64MAVYRET 15MAXALT 112MAXALT-MLT 112MAXARON FORTE 58 234 238MAXFE 58 125 140 234 238MAXIDEX 133MAXITROL 130 133maxi-tuss cd 6 43 200MAXZIDE 123 127MAXZIDE-25 123 127MAYZENT 188 189MAYZENT STARTER PACK 189meclizine hcl 5 138meclofenamate sodium 108MEDROL 148medroxyprogesterone acetate155 168mefenamic acid 108

mefloquine hcl 10MEGACE ES 32 168megestrol acetate 32 168MEKINIST 32MEKTOVI 32MELODETTA 24 FE 155 160 168meloxicam 108melphalan 32memantine hcl 98memantine hcl er 98MENACTRA 40MENEST 160 179MENOPUR 163MENOSTAR 160 179MENQUADFI 40MENTAX 212MENVEO 40meperidine hcl 103MEPHYTON 176 240meprobamate 92MEPRON 11mercaptopurine 32 192mesalamine 138 139mesalamine er 138MESNEX 197MESTINON 47METADATE ER 110METAFOLBIC PLUS121 196 234metaproterenol sulfate 49 204metaxalone 45metformin hcl 152metformin hcl er 152metformin hcl er (mod) 152methadone hcl 103METHADONE HCL INTENSOL103METHADOSE 103methamphetamine hcl 81methaver 121methazel 121methazolamide 69 132methenamine hippurate 26METHERGINE 198methimazole 151methitest 150methocarbamol 17 45methotrexate 32 183 189 192methotrexate sodium32 183 189 192methoxsalen rapid 221methscopolamine bromide 44methyldopa 43 70

methyldopa-hydrochlorothiazide70 127methylergonovine maleate 198METHYLIN 110methylphenidate hcl 110methylphenidate hcl er 110methylphenidate hcl er (cd) 110methylphenidate hcl er (la) 110methylphenidate hcl er (osm) 110methylphenidate hcl er (xr) 110methylprednisolone 148methyltestosterone 150metoclopramide hcl 144metolazone 78 127metoprolol succinate er49 65 66 71metoprolol tartrate 49 65 66 71metoprolol-hctz er 65 127metoprolol-hydrochlorothiazide65 127METROCREAM 208METROGEL 208METROGEL-VAGINAL 8 208METROLOTION 208metronidazole 8 11 139 208metronidazole benzoate 8 11 139metyrosine 196mexiletine hcl 70MIACALCIN 151 179MIBELAS 24 FE 155 160 168MICARDIS 61 62MICARDIS HCT 62 127MICRODOT TEST 119MICROGESTIN 1530155 160 168MICROGESTIN 120 155 160 168MICROGESTIN FE 1530155 160 168MICROGESTIN FE 120155 160 168midazolam hcl 96midodrine hcl 43MIGERGOT 47 91 110miglustat 196MIGRANAL 47 91MILLIPRED 148MIMVEY 160 168MIMVEY LO 160 168MINASTRIN 24 FE 155 160 168MINIPRESS 46 61MINITRAN 77MINIVELLE 161 179MINOCIN 10 25minocycline hcl 10 25minocycline hcl er 25 225

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MINOLIRA 25 225minoxidil 74minoxidil for men 225MIRALAX 140MIRAPEX 101MIRAPEX ER 101MIRCERA 52MIRCETTE 155 161 168mirtazapine 87MIRVASO 225misoprostol 144MITIGARE 177M-M-R II 40MOBIC 108modafinil 116moderna covid-19 vac (booster) 41moderna covid-19 vaccine 41moexipril hcl 63 64molnupiravir 22mometasone furoate133 148 203 216MONDOXYNE NL 10 25MONOJECT MAGELLAN SYRINGE 118MONOJECT PISTON SYRINGE 118MONOJECT SYRINGE 118MONOJECT SYRINGE LUER-LOCK TIP 118MONONINE 54montelukast sodium 202MONUROL 26MORGIDOX 25 225MORPHABOND ER 103morphine sulfate 104morphine sulfate (concentrate) 104morphine sulfate er 104morphine sulfate er beads 104MOTEGRITY 142MOVANTIK 143MOVIPREP 140 238MOXEZA 130moxifloxacin hcl 12 24 130moxifloxacin hcl (2x day) 130MS CONTIN 104MUCOSITISRX 134MUGARD 225MULPLETA 52MULTAQ 71MULTIGEN FOLIC58 121 196 234 238MULTIGEN PLUS58 121 196 234 238multi-vitfluoride 180 229multivitaminfluoride 180 229 234

multivitamins 125 229multivitamins pediatric125 229 238multivitaminsfluoride 180 229mupirocin 208mupirocin calcium 208MUSE 79M-VIT 58 229 234MY CHOICE 155 168MY WAY 155 168MYALEPT 164MYCAPSSA 143 172MYCOBUTIN 12 24mycophenolate mofetil 192 193mycophenolate sodium 193MYDAYIS 81MYFEMBREE 151 161 168myferon 150 forte 58 234MYFORTIC 193MYKIDZ IRON FL58 180 229 232 238 239MYLERAN 32MYNATAL 58 140 229 234mynatal plus 58 229 234mynatal-z 58 229 234mynate 90 plus 58 140 229 234mynephrocaps 229 234 238MYNEPHRON 229 234 238MYORISAN 225MYRBETRIQ 228MYSOLINE 94MYTESI 137nabumetone 108nadolol 46 65 66nadolol-bendroflumethiazide65 127naftifine hcl 207NAFTIN 207NALFON 108naloxone hcl 105 176naltrexone hcl 105 175 176NAMENDA 98NAMENDA TITRATION PAK 98NAMENDA XR 98NAMENDA XR TITRATION PACK 98NAMZARIC 47 98NAPHCON-A 129 136NAPRELAN 91 108 177NAPROSYN 91 108 177naproxen 91 108 177naproxen sodium 91 108 177naproxen sodium er 91 108 177naproxen-esomeprazole 108 145naratriptan hcl 112

NARCAN 105NARDIL 101NASACORT ALLERGY 24HR133 203NASCOBAL 60 234NASONEX 133 148 203NATACHEW 58 230 234NATACYN 131NATALVIRT FLT58 140 234 238NATAZIA 155 161 168nateglinide 164NATESTO 150NATPARA 164 178NATROBA 221NAYZILAM 95nebivolol hcl 46 65NEBUPENT 11NECON 0535 (28) 155 161 168NEEVO DHA 58 196 230 234nefazodone hcl 114neomycin-bacitracin zn-polymyx 130neomycin-polymyxin-dexameth130 133neomycin-polymyxin-gramicidin131neomycin-polymyxin-hc 131 133neonatal + dha58 125 196 230 234neonatal complete 58 230 234NEONATAL PLUS 58 230 234NEORAL 183 189 193NEOSALUS 225NEO-SYNALAR 208 216NEPHPLEX RX 125 230 234 238NEPHRON FA 58 140 234 238NEPHRO-VITE RX 230 234 238NERLYNX 32NESINA 157NEUAC 208 212 220NEULASTA 52NEULASTA ONPRO 52NEUPOGEN 52NEUPRO 101neurin-sl 60 235NEURONTIN 82 85NEVANAC 135nevirapine 17 18nevirapine er 17NEW DAY 155 168NEXA PLUS58 140 196 230 235NEXAVAR 32NEXICLON XR 43 70NEXIUM 145

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NEXIUM 24HR 145NEXLETOL 64NEXLIZET 64 70NEXT CHOICE ONE DOSE155 169NEXTSTELLIS 155 161 169niacin 235niacin er (antihyperlipidemic) 64NIACOR 235NIASPAN 64NICADAN 125 230nicardipine hcl 73 74 79NICAZEL 125 230NICAZEL FORTE 125 230NICODERM CQ 45NICOMIDE 125 230 235NICORETTE 45nicotine 45nicotine polacrilex 45NICOTROL 45NICOTROL NS 45NIFEDICAL XL 73 74 79nifedipine 73 74 80nifedipine er osmotic release73 74 79nilutamide 32nimodipine 73 74 80NINLARO 33nisoldipine er 73 74nitazoxanide 11nitisinone 196NITRO-BID 77NITRO-DUR 77nitrofurantoin 26nitrofurantoin macrocrystal 26nitrofurantoin monohyd macro 26nitroglycerin 77nitroglycerin er 77NITROLINGUAL 77NITROMIST 77NITROSTAT 77NITRO-TIME 77NITYR 196NIVA-FOL 235NIVA-PLUS 58 230 235NIVATOPIC PLUS 225NIVESTYM 52nizatidine 5 144NIZORAL 211NOBLE FORMULA HC 216NOCDURNA 54 165NOCTIVA 165NORA-BE 155 169NORCO 82 104

NORDITROPIN FLEXPRO165 173norethin ace-eth estrad-fe155 161 169norethindrone 155 169norethindrone acetate 169norethindrone acet-ethinyl est155 161 169norethindrone-eth estradiol161 169norethin-eth estradiol-fe155 161 169norgesic forte 50 110 111norgestim-eth estrad triphasic155 161 169NORITATE 208NORLIQVA 73 74 80NORLYDA 156 169NORPACE 70NORPACE CR 70NORPRAMIN 115NORTHERA 42NORTREL 0535 (28)156 161 169NORTREL 135 (28) 156 161 169NORTREL 777 156 161 169nortriptyline hcl 115NORVASC 73 74 80NORVIR 21NOURIANZ 98NOVACORT 210 216NOVAREL 163NOVOEIGHT 54NOVOFINE 118NOVOFINE AUTOCOVER 118NOVOFINE AUTOCOVER PEN NEEDLE 118NOVOFINE PEN NEEDLE 118NOVOFINE PLUS 118NOVOFINE PLUS PEN NEEDLE 118NOVOLIN 7030 163 171NOVOLIN 7030 FLEXPEN163 171NOVOLIN N 163NOVOLIN N FLEXPEN 163NOVOLIN R 171NOVOLIN R FLEXPEN 172NOVOLOG 171NOVOLOG FLEXPEN 171NOVOLOG MIX 7030 171NOVOLOG MIX 7030 FLEXPEN 171NOVOLOG PENFILL 171NOVOSEVEN RT 55

NOXAFIL 13noxifol-d 235 239NP THYROID 174NUBEQA 33NUCALA 199NUCORT 216NUCYNTA 104NUCYNTA ER 104NUEDEXTA 99NUFERA 58NULEV 44NULYTELY LEMON-LIME 140NUPLAZID 93NURTEC 97NUTROPIN AQ NUSPIN 10165 173NUTROPIN AQ NUSPIN 20165 173NUTROPIN AQ NUSPIN 5165 173NUVAIL 225NUVARING 156 161 169NUVESSA 8 208NUVIGIL 116NUWIQ 55NUZYRA 8NYAMYC 221NYLIA 135 156 161 169NYMALIZE 73 74 80nystatin 24 221nystatin-triamcinolone 216 221NYSTOP 221NYVEPRIA 52O-CAL FA 58 230 235OCALIVA 143OCELLA 156 161 169octreotide acetate 143 172OCUFLOX 131OCUVEL 125 230 235ODACTRA 38ODEFSEY 18 19ODOMZO 33OFEV 199ofloxacin 24 131OGIVRI 33olanzapine 89 93olanzapine-fluoxetine hcl 93 114olmesartan medoxomil 61 62olmesartan medoxomil-hctz62 127olmesartan-amlodipine-hctz62 74 127olopatadine hcl 5 129 130OLUMIANT 183OLUX 216OLUX-E 216

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omega-3-acid ethyl esters 64omeprazole 145omeprazole-sodium bicarbonate 137 145OMNARIS 133OMNIPOD DASH PODS (GEN 4) 118OMNITROPE 165 173ondansetron 136ondansetron hcl 136ONETOUCH ULTRA BLUE 119ONETOUCH VERIO 119ONEXTON 208 220ONFI 95 96ONGENTYS 98ONGLYZA 157ONUREG 33ONZETRA XSAIL 112OPCICON ONE-STEP 156 169opium 137OPSUMIT 205OPTICHAMBER ADVANTAGE-LG MASK 118OPTICHAMBER ADVANTAGE-MED MASK 118OPTICHAMBER ADVANTAGE-SM MASK 118OPTICHAMBER DIAMOND 118OPTICHAMBER FACE MASK-LARGE 118OPTICHAMBER FACE MASK-MEDIUM 118OPTICHAMBER FACE MASK-SMALL 118OPTION 2 156 169OPZELURA 225ORACEA 25 225ORACIT 120ORALAIR 38ORALONE 216ORAMAGICRX 225ORAPRED ODT 148ORAVIG 211ORENCIA 184 189ORENCIA CLICKJECT 183 189ORENITRAM 205 206ORFADIN 196ORGOVYX 33 151ORIAHNN 151 161 169ORILISSA 151ORKAMBI 200 201ORLADEYO 193 194orphenadrine citrate er 50 83

orphenadrine-aspirin-caffeine50 110 111ORPHENGESIC FORTE50 110 111ortho df 235 239ORTIKOS 148oscimin sr 44oseltamivir phosphate 22OSENI 157 174OSMOLEX ER 8 80OSMOPREP 140OSPHENA 157OTEZLA 184 189 225OTOVEL 131 133OTREXUP 184OVACE PLUS 208OVACE PLUS WASH 208OVACE WASH 208OVIDE 221OVIDREL 163OXANDRIN 150oxandrolone 150oxaprozin 108OXAYDO 104oxazepam 97OXBRYTA 50oxcarbazepine 85OXERVATE 135oxiconazole nitrate 211OXISTAT 211OXTELLAR XR 85 86oxybutynin chloride 228oxybutynin chloride er 228oxycodone hcl 104oxycodone hcl er 104oxycodone-acetaminophen 82 104OXYCONTIN 104oxymorphone hcl 104oxymorphone hcl er 104OXYTROL 228OZEMPIC (025 OR 05 MGDOSE) 163OZEMPIC (1 MGDOSE) 163OZEMPIC (2 MGDOSE) 163OZOBAX 46PACERONE 71 72PALFORZIA (12 MG DAILY DOSE) 38PALFORZIA (120 MG DAILY DOSE) 38PALFORZIA (160 MG DAILY DOSE) 38PALFORZIA (20 MG DAILY DOSE) 38

PALFORZIA (200 MG DAILY DOSE) 38PALFORZIA (240 MG DAILY DOSE) 38PALFORZIA (3 MG DAILY DOSE) 38PALFORZIA (300 MG MAINTENANCE) 38PALFORZIA (300 MG TITRATION) 38PALFORZIA (40 MG DAILY DOSE) 38PALFORZIA (6 MG DAILY DOSE) 39PALFORZIA (80 MG DAILY DOSE) 39PALFORZIA INITIAL ESCALATION 39paliperidone er 93PALYNZIQ 128PAMELOR 115PANCREAZE 128 141PANDEL 216pantoprazole sodium 145paregoric 137paricalcitol 239PARLODEL 100PARNATE 101paromomycin sulfate 8paroxetine hcl 114paroxetine hcl er 114paroxetine mesylate 114PATADAY 5 130PATANASE 5 130PATANOL 5 130PAXIL 114PAXIL CR 114PAXLOVID 12PAZEO 5 130pb-hyoscy-atropine-scopolamine 44 95PEDVAX HIB 41peg 3350 140peg 3350-kcl-na bicarb-nacl 140peg-3350electrolytes 140peg-3350electrolytesascorbat140 238PEGASYS 21PEG-PREP 140PEMAZYRE 33penicillamine 146 184penicillin v potassium 22PENNSAID 221 225PENTACEL 39 41pentamidine isethionate 11

258

PENTASA 139pentazocine-naloxone hcl 105 106pentoxifylline er 53PEPCID 5 144PERCOCET 82 104PERFOROMIST 49 205PERIDEX 134 220perindopril erbumine 63 64permethrin 221perphenazine 108perphenazine-amitriptyline108 115PERTZYE 128 141PEXEVA 114pfizer covid-19 vac-tris 5-11y 41pfizer-biontech covid-19 vacc 41phenazopyridine hcl 210phendimetrazine tartrate 80phenelzine sulfate 101phenobarbital 94 95phenoxybenzamine hcl 47 76phentermine hcl 80phenylephrine hcl 136PHENYTEK 70 101phenytoin 70 101phenytoin sodium extended70 101PHEXXI 197PHLAG SPRAY 225PHOSLO 122 125PHOSLYRA 122 125phos-nak 125PHOSPHA 250 NEUTRAL 125PHOSPHOLINE IODIDE 135phytonadione 176 240PIFELTRO 18pilocarpine hcl 47 135pimecrolimus 193 225pimozide 91pindolol 46 65 66 71pioglitazone hcl 174pioglitazone hcl-glimepiride 174pioglitazone hcl-metformin hcl152 174PIQRAY (200 MG DAILY DOSE) 33PIQRAY (250 MG DAILY DOSE) 33PIQRAY (300 MG DAILY DOSE) 33pirfenidone 199piroxicam 108PLAN B ONE-STEP 156 169PLAQUENIL 10 184 189PLAVIX 60PLEGRIDY 189

PLEGRIDY STARTER PACK 189PLENITY 137PLENVU 140 238PLEXION 208 218PLEXION CLEANSER 208 218PLEXION CLEANSING CLOTH 208 218PLEXION NS 208PLIAGLIS 210PNEUMOVAX 23 41pnv prenatal plus multivitamin58 230 235pnv tabs 29-1 58 230 235pnv-dha 58 125 196 230 235pnv-dha+docusate58 140 196 230 235pnv-omega 58 196 230 235pnv-select58 125 230 232 235 238 239 240podocon 225PODOCON-25 225podofilox 225polyethylene glycol 3350 140poly-iron 150 forte 58 235polymyxin b-trimethoprim 131POLYTRIM 131POMALYST 33 189 190PONVORY 190PONVORY STARTER PACK 190PORTIA-28 156 161 169posaconazole 13pot amp sod cit-cit ac 120POTABA 235potassium chloride 125potassium chloride crys er 125potassium chloride er 125potassium citrate er 120potassium citrate-citric acid 120potassium iodide 201PR BENZOYL PEROXIDE WASH 220PR NATAL 40058 125 196 230 235PR NATAL 400 EC58 125 196 230 235PR NATAL 43058 125 196 230 235PR NATAL 430 EC58 125 196 230 235PRADAXA 51PRALUENT 77pramipexole dihydrochloride 101pramipexole dihydrochloride er 101PRAMOSONE 210 216

pramoxine-hc 210 216PRANDIN 164prasugrel hcl 60PRAVACHOL 76pravastatin sodium 76prazosin hcl 47 61PRECISION PCX PLUS TEST 119PRECISION POINT OF CARE TEST 120PRECISION QID TEST 120PRECISION XTRA BLOOD GLUCOSE 120PRECOSE 149PRED FORTE 133PRED MILD 133PRED-G 131 133PRED-G SOP 131 133prednicarbate 216prednisolone 148prednisolone acetate 133prednisolone sodium phosphate133 148prednisolone-bromfenac 133 135prednisolone-gatifloxacin 131 133prednisolon-gatiflox-bromfenac131 133 135prednisone 148PREDNISONE INTENSOL 148PREFEST 161 169pregabalin 86 100pregabalin er 82PREGNYL 163prehevbrio 41PREMARIN 161 179PREMPHASE 161 169PREMPRO 161 169PRENATABS RX 58 230 235prenatal 59 230 235prenatal (wiron amp fa)58 125 230 235prenatal 19 58 140 230 235prenatal low iron 58 230 235prenatal one daily 58 230 235prenatal plus 59 230 235prenatal plus iron 59 230 235prenatal plus vitaminmineral59 230 235prenataliron 59 125 230 235PRENATE AM 125 196 230 235PRENATE ESSENTIAL59 125 196 230 235PRENATE PIXIE59 125 196 231 235PREPIDIL 198PRESERA 225

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PRESTALIA 63 74pretomanid 12PREVACID 145PREVACID 24HR 145PREVALITE 67PREVIDENT 180PREVIDENT 5000 ORTHO DEFENSE 180PREVIDENT 5000 PLUS 180PREVIFEM 156 161 169PREVNAR 13 41PREVNAR 20 41PREVYMIS 12PREZCOBIX 21 196PREZISTA 21PRIFTIN 12 24PRILOSEC OTC 145prilovixil 210primaquine phosphate 10primidone 94PRIMLEV 82 104PRIMSOL 26PRINIVIL 63 64PRISTIQ 112PROAIR DIGIHALER 49 205PROAIR HFA 49 205PROAIR RESPICLICK 49 205probenecid 128 177PROBUPHINE IMPLANT KIT 106PROCARDIA XL 73 74 80PROCENTRA 81prochlorperazine 109 138prochlorperazine maleate 109 138PROCRIT 50 52PROCTOCORT 216PROCYSBI 196PROFERRIN-FORTE 59 235PROFILNINE 55PROFINAC 221 225progesterone 169PROGLYCEM 151PROGRAF 193PROLATE 82 104PROLENSA 135PROMACTA 52promethazine hcl4 5 6 92 137 202promethazine vccodeine6 43 200promethazine-codeine 6 200promethazine-dm 6 200PROMETHEGAN5 6 92 137 202PROMETRIUM 169PROMISEB 218PROMISEB COMPLETE 218

propafenone hcl 70propafenone hcl er 71propantheline bromide 44PROPECIA 175 225propranolol hcl 46 65 66 71 91propranolol hcl er46 65 66 71 91propranolol-hctz 65 127propylthiouracil 152PROSCAR 175PROTONIX 145PROTOPIC 193 225protriptyline hcl 115PROVENTIL HFA 49 205PROVERA 169PROVIDA OB 59 231 235PROVIGIL 116PROZAC 114PRUCLAIR 225PRUDOXIN 210PRUMYX 225PRUTECT 225pseudoeph-bromphen-dm6 42 200pseudoephedrine hcl 42 198PULMICORT 148 203PULMICORT FLEXHALER148 203PULMOZYME 128 202PURALOR CI 121purefe plus 59 125 236 238purevit dualfe plus59 126 236 238PURIXAN 33 193PYLERA 9 11 25 137 139pyrazinamide 12PYRIDIUM 210pyridostigmine bromide 47pyridostigmine bromide er 47pyrimethamine 10PYRUKYND 51PYRUKYND TAPER PACK 51QBRELIS 64QBREXZA 44 225QDOLO 104QELBREE 99QINLOCK 33QMIIZ ODT 108QNASL 133 203QNASL CHILDRENS 133 203QSYMIA 83QTERN 157 172QUADRACEL 39 41QUALAQUIN 10QUARTETTE 156 161 169quazepam 97

QUDEXY XR 86QUESTRAN 67QUESTRAN LIGHT 67quetiapine fumarate 89 93quetiapine fumarate er 89 93QUFLORA FE59 126 180 231 236QUFLORA PEDIATRIC 180 231QUILLICHEW ER 110QUILLIVANT XR 110quinapril hcl 63 64quinapril-hydrochlorothiazide64 127quinidine gluconate er 10 70quinidine sulfate 10 70quinine sulfate 10QULIPTA 97QUZYTTIR 7 204QVAR REDIHALER 148 203RABAVERT 41rabeprazole sodium 145RAGWITEK 39raloxifene hcl 157 179ramelteon 92ramipril 63 64RANEXA 69ranitidine hcl 5 6 144ranolazine er 69RAPAFLO 48RAPAMUNE 193rasagiline mesylate 101RASUVO 184RAVICTI 121RAYALDEE 239RAYOS 148RAZADYNE 47RAZADYNE ER 47REBIF 190REBIF REBIDOSE 190REBIF REBIDOSE TITRATION PACK 190REBIF TITRATION PACK 190REBINYN 55RECEDO 225RECLIPSEN 156 161 169RECOMBINATE 55RECOMBIVAX HB 41RECORLEV 196RECTIV 226REDITREX 184REFISSA 212REGLAN 144REGRANEX 226RELADOR PAK 210RELADOR PAK PLUS 210

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RELAFEN DS 108RELENZA DISKHALER 22RELEUKO 52releuko 52RELEXXII 110RELION BLOOD GLUCOSE TEST 120RELISTOR 105 106 143RELPAX 112RELTONE 141REMERON 87REMERON SOLTAB 87REMICADE 143 184 190 226RENAGEL 123 176RENAL 231 236 238rena-vite 231 236 238rena-vite rx 231 236 238reno caps 231 236 238RENOVA 212RENOVA PUMP 212RENVELA 123 176repaglinide 164REPATHA 77REPATHA PUSHTRONEX SYSTEM 77REPATHA SURECLICK 77REPLESTA 239REPLESTA CHILDRENS 239REPLESTA NX 239REQ 49+ 126 231REQUIP 102REQUIP XL 102RESTASIS 134RESTASIS MULTIDOSE 134RESTORA RX 137 236RESTORA SPRINKLES 137 236RESTORIL 97RETACRIT 50 53RETEVMO 33RETIN-A 212RETIN-A MICRO 212RETIN-A MICRO PUMP 212RETROVIR 19REVATIO 77 78 206 228REVCOVI 128revesta 236 239REVLIMID 33 34 190REXULTI 94REYATAZ 21REYVOW 112REZUROCK 196RHOFADE 226RHOPRESSA 136RIAX 220ribavirin 22

RIDAURA 145 184 190rifabutin 12 24RIFADIN 12 24rifampin 12 24RILUTEK 99riluzole 99rimantadine hcl 8RINVOQ 184RIOMET 152risedronate sodium 179RISPERDAL 89 94risperidone 89 94RITALIN 110RITALIN LA 110ritonavir 21rivastigmine 47rivastigmine tartrate 47RIVELSA 156 161 169rixubis 55rizatriptan benzoate 113ROBAXIN 45ROBAXIN-750 45ROCALTROL 239ROCKLATAN 136ROGAINE 226ROGAINE MENS 226ROGAINE MENS EXTRA STRENGTH 226ROGAINE WOMENS 226ropinirole hcl 102ropinirole hcl er 102rosuvastatin calcium 76ROSZET 70 76ROWASA 139roxifol-d 236 239ROZEREM 92ROZLYTREK 34RUBRACA 34RUCONEST 180 194rufinamide 86RUKOBIA 16RUZURGI 196RYBELSUS 163RYCLORA 5 6 202RYDAPT 34rynoderm 218RYTARY 99 100RYTHMOL SR 71RYVENT 4 5 202SABRIL 86SAFYRAL 156 161 170 236SAIZEN 165 173SAJAZIR 179 194SALAGEN 47SALEX 218

salicylic acid 218salicylic acid er 218salicylic acid wart remover 218salicylic acid-cleanser 218salsalate 111SALVAX 218SAMSCA 128SANCUSO 136SANDIMMUNE 184 190 193SANTYL 129 226SAPHRIS 89 94sapropterin dihydrochloride 196SARAFEM 114SAVAYSA 51SAVELLA 100 112SAVELLA TITRATION PACK100 112SAXENDA 163SCALPICIN MAXIMUM STRENGTH 216SCEMBLIX 34scopolamine 44 137SEASONIQUE 156 161 170SECONAL 95SECUADO 89 94SEEBRI NEOHALER 44 198SEGLENTIS 99 104SEGLUROMET 152 172SELECT-OB 59 231 236selegiline hcl 101selenium sulfide 218 220self-taking blood pressure 118SELRX 218 220SELZENTRY 16SEMGLEE 164SEMGLEE (YFGN) 164SEMPREX-D 7 42se-natal 19 59 231 236SENSIPAR 151SEREVENT DISKUS 49 205SERNIVO 216SEROQUEL 89 94SEROQUEL XR 89 94SEROSTIM 165 173sertraline hcl 114se-tan plus 59 126 236 238sevelamer carbonate 123 176sevelamer hcl 123 177SEVENFACT 55SEYSARA 8sf 180sf 5000 plus 180SFROWASA 139SHAROBEL 156 170SHINGRIX 41

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SIDEROL 126 231 236SIGNIFOR 172SIKLOS 34sildenafil citrate 78 206 228SILENOR 115SILIQ 226silodosin 48SILVADENE 220silver sulfadiazine 220SIMBRINZA 129 132SIMPONI 143 184 185 190 191simvastatin 76SINEMET CR 100SINGULAIR 202SINUVA 133 148 203sirolimus 193SIRTURO 12SITAVIG 22SIVEXTRO 23SKELAXIN 45SKLICE 221SKYRIZI 226SKYRIZI (150 MG DOSE) 226SKYRIZI PEN 226SKYTROFA 165SLYND 156 170SMOOTH LAX 140SOAANZ 76 122sod citrate-citric acid 120sodium chloride 122 203sodium fluoride 180sodium fluoride 5000 plus 180sodium fluoride 5000 ppm 180sodium fluoride 5000 sensitive116 180sodium phenylbutyrate 121sodium polystyrene sulfonate123 177sodium sulfacetamide 209sodium sulfacetamide wash 209sofosbuvir-velpatasvir 14 15SOLESTA 196solifenacin succinate 228SOLIQUA 163 164SOLODYN 25 226SOLOSEC 11SOLTAMOX 34 157SOLU-CORTEF 149SOMA 45SOMATULINE DEPOT 172SOMAVERT 173SONAFINE 226SOOLANTRA 221sorafenib tosylate 34SORILUX 226

SORINE 46 65 66 71 72sotalol hcl 46 65 66 71 72SOTYLIZE 46 66 71 72SOVALDI 14SPECTRACEF 7SPIKEVAX COVID-19 VACCINE 41spinosad 221SPIRIVA HANDIHALER 44 198SPIRIVA RESPIMAT 44 198spironolactone 76 77 78 123spironolactone-hctz 76 127SPORANOX 13SPORANOX PULSEPAK 13SPRINTEC 28 156 162 170SPRITAM 86SPRIX 108SPRYCEL 34SPS 123 177SRONYX 156 162 170SSD 220SSD (SILVER SULFADIAZINE) 220SSKI 201STALEVO 100 98 100STALEVO 125 98 100STALEVO 150 98 100STALEVO 200 98 100STALEVO 50 98 100STALEVO 75 98 100stamaril 41STARLIX 164stavudine 19STAXYN 78STEGLATRO 172STEGLUJAN 157 172STELARA 226STENDRA 78STIMATE 55 165STIOLTO RESPIMAT 44 49STIVARGA 34STRATTERA 99STRENSIQ 129STRIANT 150STRIBILD 16 19 196STRIVERDI RESPIMAT 49 205STROMECTOL 9STROVITE FORTE 126 231STROVITE ONE 126 231SUBOXONE 106SUBSYS 104 105SUBVENITE STARTER KIT-BLUE 86 89SUBVENITE STARTER KIT-GREEN 86 89

SUBVENITE STARTER KIT-ORANGE 86 90SUCRAID 129sucralfate 144SULAR 73 74sulconazole nitrate 211sulfacetamide sodium 131 209sulfacetamide sodium (acne) 209sulfacetamide sodium (cleans) 209sulfacetamide sodium-sulfur209 218 219sulfacetamide-prednisolone131 133sulfadiazine 24sulfamethoxazole-trimethoprim11 24 26SULFAMYLON 220sulfasalazine 25 139 185 191sulindac 108SUMADAN 209 219SUMADAN WASH 209 219sumatriptan 113sumatriptan succinate 113sumatriptan succinate refill 113sumatriptan-naproxen sodium108 113SUMAXIN 209 219SUMAXIN CP 209 219SUMAXIN WASH 209 219sunitinib malate 34SUNOSI 116SUPERVITE 121 126 231 236SUPRAX 7 8SUPREP BOWEL PREP KIT 140SURMONTIL 115SUSTIVA 18SUSTOL 136SUTAB 141SUTENT 34suvicort 226SYEDA 156 162 170SYMAX DUOTAB 44SYMBICORT 49 149SYMBYAX 94 114SYMDEKO 200 201SYMFI 18 19SYMFI LO 18 19SYMJEPI 42 198SYMLINPEN 120 149SYMLINPEN 60 149SYMPAZAN 95 97SYMPROIC 143SYMTUZA 19 21 197SYNALAR 216SYNALAR TS 216 226

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SYNAREL 163SYNDROS 137SYNERA 210SYNERDERM 226SYNJARDY 152 172SYNJARDY XR 152 172SYNTHROID 174SYPRINE 146TABLOID 34TABRECTA 34TACLONEX 216 226tacrolimus 193 226tadalafil 78tadalafil (pah) 78 206TAFINLAR 34TAGRISSO 34TAKE ACTION 156 170TAKHZYRO 193 194TALICIA 139TALTZ 227TALZENNA 35TAMIFLU 22tamoxifen citrate 35 157tamsulosin hcl 48TANDEM PLUS 59 126 236 238TAPAZOLE 152TAPERDEX 12-DAY 149TAPERDEX 6-DAY 149TARCEVA 35TARGADOX 10 25TARGRETIN 35 227TARKA 64 68taron forte 59 236 238TARON-PREX59 141 197 231 236TARPEYO 149TASIGNA 35TASMAR 98tavaborole 221TAVALISSE 51TAVNEOS 181 194TAYTULLA 156 162 170tazarotene 227TAZORAC 227TAZTIA XT 67 69 72 80TAZVERIK 35TDVAX 39TECFIDERA 191TEGRETOL 86 90TEGRETOL-XR 86 90TEGSEDI 178TEKTURNA 78TEKTURNA HCT 78 127telmisartan 61 62telmisartan-amlodipine 62 74

telmisartan-hctz 62 127temazepam 97TEMIXYS 19TEMODAR 35TEMOVATE 216temozolomide 35TENIVAC 39tenofovir disoproxil fumarate 19TENORETIC 100 66 127TENORETIC 50 66 128TENORMIN 50 66 71TEPMETKO 35TERAZOL 7 211terazosin hcl 47 61terbinafine hcl 8terbutaline sulfate 49 205terconazole 211teriparatide (recombinant) 164 178TESSALON PERLES 200TESTIM 150testosterone 150testosterone cypionate 150testosterone enanthate 150tetanus-diphtheria toxoids td 39tetrabenazine 116tetracycline hcl 10 25 139TETRIX 227TEXACORT 216THALITONE 78 128THALOMID 191THEO-24 74 110 121 206 228theophylline er75 110 121 122 207 228THIOLA 197THIOLA EC 197thioridazine hcl 109thiothixene 115thrivite 19 59 141 231 236THYQUIDITY 174THYROLAR-1 174THYROLAR-12 174THYROLAR-14 175THYROLAR-2 175THYROLAR-3 175TIADYLT ER 68 69 72 80tiagabine hcl 86TIAZAC 68 69 72 80TIBSOVO 35TICALAST130 133 135 203 204TICOVAC 41TIGAN 138TIGLUTIK 99TIKOSYN 72timolol maleate 46 66 71 91 132timolol maleate (once-daily) 132

timolol maleate pf 132TIMOPTIC 132TIMOPTIC OCUDOSE 132TIMOPTIC-XE 132tinidazole 11tiopronin 197TIROSINT 175TIROSINT-SOL 175TIVICAY 16TIVICAY PD 16TIVORBEX 108tizanidine hcl 45tl gard rx 236tl icon 59 236 238TLANDO 150tl-hem 15059 126 141 236 238 240TOBI 8TOBI PODHALER 8TOBRADEX 131 134TOBRADEX ST 131 134tobramycin 8 131tobramycin sulfate 8tobramycin-dexamethasone131 134TOBREX 131TOFRANIL 115TOLAK 227tolcapone 98tolmetin sodium 108tolsura 13tolterodine tartrate 228tolterodine tartrate er 228tolvaptan 128TOPAMAX 86 91TOPAMAX SPRINKLE 86 91TOPICORT 216TOPICORT SPRAY 217topiramate 86 91topiramate er 86TOPROL XL 50 66 71toremifene citrate 35 158torsemide 76 122TOSYMRA 113TOUJEO MAX SOLOSTAR 164TOUJEO SOLOSTAR 164TOVIAZ 228toxicology saliva collection 120TRACLEER 206TRADJENTA 157tramadol hcl 105tramadol hcl er 105tramadol-acetaminophen 82 105trandolapril 63 64trandolapril-verapamil hcl er 64 69

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tranexamic acid 55TRANSDERM-SCOP 44 138TRANSDERM-SCOP (15 MG)44 137TRANXENE-T 96 97tranylcypromine sulfate 101TRAVATAN Z 136travoprost (bak free) 136trazodone hcl 114TRELEGY ELLIPTA 44 49 149TREMFYA 227TRESIBA 164TRESIBA FLEXTOUCH 164tretinoin 35 212tretinoin (emollient) 212tretinoin microsphere 212tretinoin microsphere pump 212TRETTEN 55TREXALL 35 185 191 193TREXIMET 108 113TREZIX 83 105 110triamcinolone acetonide134 203 217triamterene-hctz 123 127TRIANEX 217triazolam 97TRIBENZOR 62 74 127TRICARE 59 231 236tricitrates 120TRICON 59 236 238TRICOR 75TRIDERM 217trientine hcl 146TRI-ESTARYLLA 156 162 170trifluoperazine hcl 109trifluridine 131trigels-f forte 59 236 239TRIGLIDE 75trihexyphenidyl hcl 45 83TRIJARDY XR 153 157 172TRIKAFTA 200 201TRI-LEGEST FE 156 162 170TRILEPTAL 86TRI-LINYAH 156 162 170TRILIPIX 75TRI-LO-ESTARYLLA156 162 170TRI-LO-SPRINTEC 156 162 170TRI-LUMA 212 217TRILYTE 141trimethobenzamide hcl 138trimethoprim 26trimipramine maleate 115trinatal rx 1 59 231 236TRINATE 59 231 236

TRI-NORINYL (28) 156 162 170TRINTELLIX 114triphrocaps 231 236 239TRI-PREVIFEM 156 162 170TRI-SPRINTEC 156 162 170tristart dha 59 126 197 231 236TRIUMEQ 16 20TRIUMEQ PD 17 20TRIVEEN-DUO DHA59 126 197 231 236TRI-VI-FLOR180 231 232 236 239tri-vitaminfluoride180 231 232 239TRIVORA (28) 156 162 170tri-zel 126 231TRIZIVIR 20TROKENDI XR 86 91tropicamide-cyclopentolate-pe 136trospium chloride 228trospium chloride er 228TRUDHESA 47 91TRUETRACK TEST 120TRULANCE 143TRULICITY 163TRUMENBA 41TRUSELTIQ (100MG DAILY DOSE) 35TRUSELTIQ (125MG DAILY DOSE) 35TRUSELTIQ (50MG DAILY DOSE) 35TRUSELTIQ (75MG DAILY DOSE) 35TRUSOPT 132TRUVADA 20TUDORZA PRESSAIR 44TUKYSA 36TULANA 156 170TURALIO 36TUZISTRA XR 6 200TWINRIX 41TWIRLA 156 162 170TWYNEO 212 220TWYNSTA 62 74TYBOST 197TYDEMY 156 162 170 236TYKERB 36TYMLOS 164 178TYPHIM VI 41TYRVAYA 135TYVASO 206TYVASO REFILL 206TYVASO STARTER 206UBRELVY 97

UCERIS 149 217UDAMIN SP 126 231 236UDENYCA 53UKONIQ 36ULESFIA 221ULORIC 177ULTICARE INSULIN SYRINGE118ULTRACET 83 105ULTRAM 105ULTRASAL-ER 219ULTRAVATE 217ULTRAVATE X (OINTMENT)212 217UNISTRIP1 GENERIC 120UNITHROID 175UPNEEQ 136UPTRAVI 206urea 219urea hydrating 212 219urea nail 219URIBEL 26 44 83 197UROCIT-K 10 120UROCIT-K 15 120UROCIT-K 5 120UROXATRAL 48URSO 250 141URSO FORTE 141ursodiol 141UTIBRON NEOHALER 44 49UTOPIC 219VAGIFEM 162 179valacyclovir hcl 22VALCHLOR 227VALCYTE 22valganciclovir hcl 23VALIUM 96 97valproate sodium 86 90 91valproic acid 86 90 91valsartan 61 62valsartan-hydrochlorothiazide62 127VALTOCO 10 MG DOSE 96VALTOCO 15 MG DOSE 96VALTOCO 20 MG DOSE 96VALTOCO 5 MG DOSE 96VALTREX 23valved holding chamber 118VANATOL LQ 83 95 110VANCOCIN 14VANCOCIN HCL 14vancomycin hcl 14VANDAZOLE 8 209VANIQA 227VANOS 217

264

VANOXIDE-HC 217 220VAQTA 41vardenafil hcl 78varenicline tartrate 45VARUBI 144VASCEPA 64 65VASERETIC 64 127VASOTEC 63 64VAXELIS 39 41VAXNEUVANCE 41v-c forte 126 231VECAMYL 76VECTICAL 227VELIVET 156 162 170VELPHORO 123VELTASSA 123VELTIN 209 212 227VEMLIDY 23VENCLEXTA 36VENCLEXTA STARTING PACK 36VENELEX 227venlafaxine hcl 112venlafaxine hcl er 112VENTAVIS 206VENTOLIN HFA 49 205verapamil hcl 68 69 73 80verapamil hcl er 68 69 73 80VERDESO 217VEREGEN 227VERELAN 68 69 73 80VERELAN PM 68 69 73 80VERQUVO 80VERSACLOZ 94VERZENIO 36VESICARE 228VESICARE LS 228VFEND 13V-GO 20 119V-GO 30 119V-GO 40 119VIAGRA 78 206VIBERZI 143VIBRAMYCIN 10 11 25 26VIC-FORTE 126 231VICODIN 83 105VICODIN ES 83 105VICODIN HP 83 105VICTOZA 163VIDEX 20VIDEX EC 20VIEKIRA PAK 15vigabatrin 86VIGADRONE 87VIGAMOX 131

VIIBRYD 114VIIBRYD STARTER PACK 114vilazodone hcl 114VILTEPSO 178VIMOVO 108 145VIMPAT 87VINATE DHA RF59 197 231 236VINATE M 59 126 231 236VINATE ONE 59 231 236VIOKACE 129 141VIRACEPT 21VIRAMUNE 18VIRAMUNE XR 18VIREAD 20VIROPTIC 131virt-caps 231 236 239VIRT-GARD 237virt-phos 250 neutral 126virtrate-2 120virtrate-3 120virtrate-k 120virt-vite 237virt-vite forte 237virt-vite plus 231 237 239VISTARIL 5 6 92VISTOGARD 177VITACEL 126 231VITAFOL 59 231VITAFOL-NANO 59 231 237VITAFOL-OB 59 231 237VITAFOL-ONE59 126 197 232 237VITAL-D RX126 232 237 239 240vitamin d (ergocalciferol) 240vitamin d3 240VITAPEARL 59 197 232 237VITA-RESPA 237VITATRUE 59 126 197 232 237VITRAKVI 36VIVAGUARD INO CONTROL SOLUTION 119VIVELLE-DOT 162 179VIVLODEX 108VIVOTIF 41VIZIMPRO 36vocabria 17VOGELXO 150VOGELXO PUMP 150VOLTAREN 221 227VONJO 36VONVENDI 55voriconazole 13VOSEVI 15VOTRIENT 36

VOXZOGO 197vp-vite rx 232 237 239VRAYLAR 94VTOL LQ 83 95 111VUITY 135VUMERITY 191VUSION 211 217VYLEESI 99VYNDAMAX 69 99 197VYNDAQEL 69 197VYTONE 212 217 221VYTORIN 70 76VYVANSE 81VYZULTA 136WAKIX 116warfarin sodium 51wee care 59WEGOVY 163WELCHOL 67 150WELIREG 36WELLBUTRIN SR 87WELLBUTRIN XL 87WESTHROID 175WILATE 55WINLEVI 227WIXELA INHUB 49 149WYNZORA 217 227XADAGO 101XALATAN 136XALIX 219XALKORI 37XANAX 97XANAX XR 97XARELTO 51XARELTO STARTER PACK 51XATMEP 37 185 191 193XCOPRI 87XCOPRI (250 MG DAILY DOSE) 87XCOPRI (350 MG DAILY DOSE) 87XELJANZ 185XELJANZ XR 185XELODA 37XELPROS 136XENAZINE 116XENICAL 143XENLETA 23XEPI 209XERAC AC 211XERAVA 14XERESE 210 217XERMELO 137XHANCE 134 149 203XIFAXAN 24

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XIGDUO XR 153 172XIIDRA 134XIMINO 26 227XOFLUZA (40 MG DOSE) 12XOFLUZA (80 MG DOSE) 12XOLAIR 203XOLEGEL 211XOPENEX 49 205XOPENEX CONCENTRATE49 205XOPENEX HFA 49 205XOSPATA 37XPOVIO (100 MG ONCE WEEKLY) 37XPOVIO (40 MG ONCE WEEKLY) 37XPOVIO (40 MG TWICE WEEKLY) 37XPOVIO (60 MG ONCE WEEKLY) 37XPOVIO (60 MG TWICE WEEKLY) 37XPOVIO (80 MG ONCE WEEKLY) 37XPOVIO (80 MG TWICE WEEKLY) 37XRYLIDERM 210XTAMPZA ER 105XTANDI 37XULANE 156 162 170XULTOPHY 163 164xurea 219XURIDEN 197XYNTHA 55XYNTHA SOLOFUSE 55XYOSTED 150XYREM 99XYWAV 99YASMIN 28 156 162 170YAZ 156 162 170YF-VAX 41YONSA 37YOSPRALA 60 145YUPELRI 44YUVAFEM 162 179ZADITOR 6 130ZAFEMY 157 162 170zafirlukast 202zaleplon 92ZANAFLEX 45ZANTAC 6 144ZANTAC 150 MAXIMUM STRENGTH 6 144ZARONTIN 114ZARXIO 53

zavara 237 240ZAVESCA 197zcort 7-day 149ZEGALOGUE 162 177ZEGERID 137 145ZEGERID OTC 137 145ZEJULA 37ZELBORAF 38ZELNORM 144ZEMBRACE SYMTOUCH 113ZEMDRI 8ZEMPLAR 240ZENATANE 227ZENPEP 129 141ZENZEDI 81ZEPATIER 15ZEPOSIA 191ZEPOSIA 7-DAY STARTER PACK 191ZEPOSIA STARTER KIT 191ZERVIATE 130 204ZESTORETIC 64 127ZESTRIL 63 64ZETIA 70ZETONNA 134ZIAC 66 127ZIAGEN 20ZIANA 209 212 227zidovudine 20ZIEXTENZO 53zileuton er 202ZILRETTA 149ZILXI 209ZIMHI 106 177zinc sulfate 126ZINPLAVA 39ZIOPTAN 136ziprasidone hcl 90 94ZIPSOR 108ZIRGAN 131ZITHRANOL 227ZITHROMAX 23ZITHROMAX TRI-PAK 23ZITHROMAX Z-PAK 23ZOCOR 76ZOHYDRO ER 105ZOKINVY 197ZOLINZA 38zolmitriptan 113ZOLOFT 114zolpidem tartrate 92zolpidem tartrate er 92ZOLPIMIST 92ZOMACTON 165 173ZOMIG 113

ZONALON 210ZONEGRAN 87zonisamide 87ZONTIVITY 60ZORBTIVE 165 173ZORTRESS 193ZORVOLEX 108ZOSTAVAX 41ZOVIA 135E (28) 157 162 170ZOVIRAX 23 210ZTLIDO 175ZUBSOLV 106ZUPLENZ 136ZYCLARA 227ZYCLARA PUMP 227ZYDELIG 38ZYFLO 202ZYFLO CR 202ZYKADIA 38ZYLET 131 134ZYLOPRIM 177ZYMAXID 131ZYPITAMAG 76ZYPREXA 90 94ZYPREXA ZYDIS 90 94ZYRTEC ALLERGY 7 204ZYRTEC-D ALLERGY amp CONGESTION 7 42ZYTIGA 38zyvit 121ZYVOX 23

266

Notice of Nondiscrimination and Language Assistance Services

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ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia en su idioma Consulte al nuacutemero de Servicio al Cliente que estaacute en la parte de atraacutes de su tarjeta de identificacioacuten de miembro (TTY 711)

يرجى الاتصال برقم خدمة العملاء على بالمجان لك تتوافر اللغوية المساعدة خدمات فإن العربية تحدثت كنت ملاحظة إذا(117والبكم الصم هاتف الشخصية )رقمالجانب الخلفي من بطاقة عضويتك

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ܚܬܘܢ ܐܢ ܢܘܗܪܐ ܡܙܡܝܬܘܢܟܐܐ ܡܨܝܬܘܢ ( ܐܬܘܪܝܐ)ܣܘܪܝܝܐܠܫܢܐܗܒܠܝܬܘܢ ܬܐܩ ܪܬܐܚܠܡ ܝ ܓܢܐܝܬܒܠܫܢܐܕܗ ܠܘܟܘܢ ܐܢ ܡ ܣܡ ܖܩܪܘܢ ܒ ܡܢ ܠܚܖܡܐ ܝܪܢܐܗ ܬܐܡܗ ܠܖܚܠܡ ܐܖܐܝܠܗ ܡܢܝܢܐܥ ܝܘܬܐܖܦܬܩܐܠܚܨܐܟܬܝܒ ܖܗܝ

ܖܡܘܬܐ (TTY 711) ܖܗ

CHUacute Yacute Nếu quyacute vị noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho quyacute vị Xin hatildey gọi tới số điện thoại của bộ phận dịch vụ khaacutech hagraveng coacute ở mặt sau thẻ ID thagravenh viecircn của quyacute vị (TTY 711)

KUJDES Neumlse flisni shqip peumlr ju ka neuml dispozicion sheumlrbime teuml asistenceumls gjuheumlsore pa pageseuml Ju lutem kontaktoni qendreumln e sheumlrbimit peumlr klient neuml pjeseumln e pasme teuml ID karteumls tuaj teuml aneumltaresimit (TTY 711)

주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 멤버쉽 ID카드의 뒷면에 있는 고객 서비스 번호로 전화해 주십시오 (TTY 711)

লকষয করনঃ আপনন বাাংলায় কথা বলতে পারতল আপনার জনয ননঃখরচায় ভাষা সহায়ো সসবা সলভ রতয়তেঅনগরহ কতর আপনার সদসযপদ আইনি কাতিে র সপেতন থাকা গরাহক সসবা নমবতর কল করন (TTY 711)

UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer telefonicznej obsługi klienta wskazany na odwrocie Twojej legitymacji członkowskiej (TTY 711)

ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienste zur Verfuumlgung Bitte rufen Sie die Kundendienstnummer auf der Ruumlckseite Ihrer Mitgliedskarte an (TTY 711)

ATTENZIONE se parla italiano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero sul retro della tessera identificativa di membro (TTY 711)

注意事項日本語を話される場合無料の言語支援をご利用いただけますメンバーシップIDカードの

裏面にあるお客様サービスセンターの番号までお電話にてご連絡ください(TTY 711)

ВНИМАНИЕ Если Вы говорите на русском языке то Вам доступны услуги бесплатной языковой поддержки Пожалуйста позвоните в службу поддержки клиентов по номеру указанному на обратной стороне Вашей идентификационной карточки участника (телетайп (TTY 711)

OBAVJEŠTENJE Ako govorite srpsko-hrvatski usluge jezičke pomoći dostupne su vam besplatno Molimo nazovite broj službe za korisnike na pozadini vaše članske iskaznice (TTY 711)

Kung nagsasalita ka ng Tagalogmga serbisyo ng tulong sa wika ng libre ay available para sa iyo Pakitawan ang numero ng customer service sa likod ng iyong ID card ng pagiging miyembro (TTY 711)

copy2021 Priority Health

T1 - $

T2 - $$

T3 - $$$

T4 - $$$$

T5 - $$$$$

T6 - Vaccine Coverage

T9 - $$$$$$$$$

Coverage Levels

AL Age Limits

PA Prior Authorization

PV Preventative

QL Quantity Limits

QL Quantity Limits

SP Limited to a 1 month supply per fill

ST Step Therapy

Below is a list of drug name formatting patterns that may appear in the following pages

List of Patterns

lowercase italics Generic drugs

UPPERCASE BOLD Brand name drugs

2

3



Antihistamine Drugs

Antihistamine Drugs















T9

RYVENT T9




















T1

4



T9





T1


T3


T9


RYVENT T9

VISTARIL T3


ALAWAY T1










T1



nizatidine T3





PATANASE T3

PATANOL T3

PAZEO T3 ST






5



VISTARIL T3

ZADITOR T1







T1





T3


T9


BROMFED DM T9


HISTEX-AC T9


T1

maxi-tuss cd T9


T1



T9




ALLEGRA ALLERGY T9


T9


ALOMIDE T2





6













T9




QUZYTTIR T9

SEMPREX-D T9





cefadroxil T1




KEFLEX T3


cefaclor er T1


cefprozil T1



cefdinir T1







T3

7



T2




GOCOVRI T9

OSMOLEX ER T9

rimantadine hcl T1




Amebicides

FLAGYL T3

METROGEL-VAGINAL T3




NUVESSA T9


VANDAZOLE T1










ZEMDRI T9

Aminomethylcyclines



SEYSARA T9

8










T1


T1




T3


T3

AUGMENTIN XR T3

Anthelmintics


ALBENZA T9


EMVERM T9




BREXAFEMME T9




PYLERA T9

Antimalarials

ACTICLATE T9

ARAKODA T3



COARTEM T2

DARAPRIM T9

9


DORYX MPC T9


T9





T9



T9


T1


T9


T1


T9



LYMEPAK T9

MALARONE T3

mefloquine hcl T1





MONDOXYNE NL T9

PLAQUENIL T3



QUALAQUIN T3 PA




TARGADOX T9



10



T3



dapsone oral T1






BACTRIM T3

BACTRIM DS T3



dapsone oral T1

FLAGYL T3



MEPRON T3



NEBUPENT T3



PYLERA T9

SOLOSEC T9


T1


tinidazole oral T1


AVELOX ORAL T3




11



T1




cycloserine oral T1


isoniazid oral T1




MYCOBUTIN T2


PRIFTIN T2



RIFADIN ORAL T3

rifampin oral T1





T2










Azole Antifungals


12


DIFLUCAN T3

fluconazole oral T1









tolsura T9












13












Fluorocyclines


T9


FIRVANQ T2

VANCOCIN HCL T9



T1



EPCLUSA T9









14











EPCLUSA T9











15























16



vocabria T9







EDURANT T2

efavirenz T2












17


















CIMDUO T9




DESCOVY T9


T1


18




emtricitabine T3






)


EPIVIR T3
















TEMIXYS T9


19






VIDEX EC T3


T2




















20













ritonavir T1



















21















acyclovir oral T1







LAGEVRIO T2

molnupiravir T2



SITAVIG T9





22







ZOVIRAX ORAL T3










T3



ZITHROMAX Z-PAK T3










Pleuromutilins

XENLETA ORAL T9

23


Polyene Antifungals






AVELOX ORAL T3

BAXDELA T9





T1








MYCOBUTIN T2

PRIFTIN T2


RIFADIN ORAL T3

rifampin oral T1




AZULFIDINE T3


BACTRIM T3

BACTRIM DS T3



T1


24




ACTICLATE T9


DORYX MPC T9


T9

doxycycline T9





T9



T9


T1


T9


T1

LYMEPAK T9



T9




MINOLIRA T9

MONDOXYNE NL T9


ORACEA T9

PYLERA T9


T9

TARGADOX T9



25



T3


XIMINO T9


BACTRIM T3

BACTRIM DS T3



HYOPHEN T9

MACROBID T3


T3





T1



PRIMSOL T9


T1



URIBEL T9








ALKERAN ORAL T3

26






anastrozole oral T1

ARIMIDEX T3

AROMASIN T3








bicalutamide T1









27



CASODEX T3












DROXIA T3

EMCYT T2








exemestane T2


FARESTON T9

28






FEMARA T3

flutamide T1






GLEEVEC T9


T3


HYDREA T3

hydroxyurea oral T1






29





















30



















31


letrozole oral T1









MEGACE ES T3 ST






melphalan T2




T1

MYLERAN T3



nilutamide T1

32






OGIVRI T9














33










SIKLOS T9

SOLTAMOX T9












34




















TREXALL T3 ST





35




















36






XATMEP T3 AL


















YONSA T9


37






ZYTIGA T9



GRASTEK T3 AL

ODACTRA T3 AL

ORALAIR T3 AL











38





RAGWITEK T3 AL


ZINPLAVA T9

Toxoids










T6 - $0 Copay



T6 - $0 Copay


T6 - $0 Copay





Vaccines

ACTHIB T9











39


BIOTHRAX T9






DENGVAXIA T9



























IXIARO T9




T6 - $0 Copay





40



T6 - $0 Copay



T9









T6 - $0 Copay


T6 - $0 Copay







stamaril T9


T9





T9


T9





VIVOTIF T9

YF-VAX T9



Autonomic Drugs


ADRENALIN NASAL T9

41





T9

BROMFED DM T9










T9


T9


T9





T1


SEMPREX-D T9







CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

clonidine T1

clonidine hcl er T2

42



HISTEX-AC T9


T3

LUCEMYRA T9

maxi-tuss cd T9

methyldopa oral T1

midodrine hcl T1


T9



ANASPAZ T3



T1

ATROVENT HFA T2


T9





CUVPOSA T3 AL

DARTISLA ODT T9




DONNATAL T9

DUAKLIR PRESSAIR T9

GLYCATE T9


T9



HYCODAN T9



hydromet T1

HYOPHEN T9

43



T1








LEVSINSL T3

LIBRAX T9





NULEV T1

oscimin sr T1



QBREXZA T9

scopolamine T1









SYMAX DUOTAB T3



T3

TRELEGY ELLIPTA T2


T9

URIBEL T9


YUPELRI T9



44










KLS QUIT2 T3 PV

KLS QUIT4 T3 PV

NICODERM CQ T9

NICORETTE T9









AMRIX T9





T9





FEXMID T9

LORZONE T9



ROBAXIN ORAL T3

ROBAXIN-750 T3

SKELAXIN T9



ZANAFLEX T3

45








FLEQSUVY T9


T9

LYVISPAH T9

OZOBAX T9



T3

BYSTOLIC T3

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



nebivolol hcl T1

pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3



CARDURA T3

CARDURA XL T3 ST


MINIPRESS T3

46





CAFERGOT T9

DIBENZYLINE T9




ERGOMAR T3


MIGERGOT T9

MIGRANAL T9


TRUDHESA T9


ADLARITY T9

ARICEPT T3



donepezil hcl T1








T9









SALAGEN T3

47



alfuzosin hcl er T1

carvedilol T1


COREG T3

COREG CR T3 ST


FLOMAX T3

JALYN T3 ST


RAPAFLO T3 ST

silodosin T2 ST

tamsulosin hcl T1

UROXATRAL T3


ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9








T1



ARCAPTA NEOHALER T3



BREO ELLIPTA T9





DUAKLIR PRESSAIR T9



48



T3






T1



PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2






TRELEGY ELLIPTA T2



WIXELA INHUB T3

XOPENEX T3


XOPENEX HFA T9



atenolol oral T1




LOPRESSOR ORAL T3



49


TENORMIN T3

TOPROL XL T3


norgesic forte T9



T9


T9


Antianemia Drugs














CEPROTIN T3



CABLIVI T4



OXBRYTA T9

50




TAVALISSE T9


COUMADIN ORAL T2

JANTOVEN T1



BEVYXXA T9
























51








MULPLETA T9















T5



52




UDENYCA T9


ZIEXTENZO T9



Hemostatics














DDAVP ORAL T3




53





















LYSTEDA T3



NOCDURNA T9


54





















Heparins




55









T5


)






T5


)


T1




Iron Preparations


active fe T9

CENTRATEX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9

CORVITE 150 T9

56


corvite fe T9


fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9

FERREX 150 T9


T9


FERREX 150 PLUS T9

FERREX 28 T9



FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN T9

HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

HEMATRON-AF T9


hemetab T9

HEMOCYTE T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9

57




MULTIGEN FOLIC T9

MULTIGEN PLUS T9

M-VIT T9


MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHRON FA T9

NEXA PLUS T3

NIVA-PLUS T9

NUFERA T9

O-CAL FA T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1


PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1






58



prenatal plus T1





T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

purefe plus T9


QUFLORA FE T9


T1


se-tan plus T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

tristart dha T9

TRIVEEN-DUO DHA T1


VINATE M T1

VINATE ONE T1



VITAFOL-OB T3

VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3

wee care T1 PV AL

59




NASCOBAL T9

neurin-sl T9


AGGRENOX T3





BRILINTA T2

BUFFERIN T3 PV AL


cilostazol T1



DURLAZA T9





YOSPRALA T9



AGRYLIN T3

anagrelide hcl T1

Thrombolytic Agents




BUFFERIN T3 PV AL





CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

60


COREG CR T3 ST



MINIPRESS T3




CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST



MINIPRESS T3




ATACAND T3

AVAPRO T3

BENICAR T3


COZAAR T3


EDARBI T3 ST

irbesartan T1


MICARDIS T3


telmisartan T1







ATACAND T3

ATACAND HCT T3

61



T3

AVAPRO T3

AZOR T3 ST

BENICAR T3

BENICAR HCT T3

BYVALSON T3 ST



COZAAR T3


DIOVAN HCT T3

EDARBI T3 ST

EDARBYCLOR T3 ST


EXFORGE T3

EXFORGE HCT T3

HYZAAR T3

irbesartan T1




MICARDIS T3

MICARDIS HCT T3




telmisartan T1


telmisartan-hctz T1

TRIBENZOR T3

TWYNSTA T3





ACCUPRIL T3



captopril oral T1

62






lisinopril oral T1


T3




PRESTALIA T3 ST

PRINIVIL T3

quinapril hcl T1

ramipril T1

trandolapril T1

VASOTEC T3

ZESTRIL T3


ACCUPRIL T3

ACCURETIC T3





captopril oral T1








lisinopril oral T1



T3


T3



63






PRINIVIL T3

QBRELIS T3 AL

quinapril hcl T1


ramipril T1


T3

trandolapril T1


VASERETIC T3

VASOTEC T3

ZESTORETIC T3

ZESTRIL T3


DIGITEK T1

DIGOX T1






T9





T9SP ()


LOVAZA T3




NIASPAN T3



64





atenolol oral T1



T3




BYSTOLIC T3

BYVALSON T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

CORZIDE T3

DUTOPROL T9

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9




LOPRESSOR ORAL T3







nebivolol hcl T1

pindolol T1



propranolol-hctz T1

SORINE T1

sotalol hcl oral T1

65


SOTYLIZE T3

TENORETIC 100 T3

TENORETIC 50 T3

TENORMIN T3


TOPROL XL T3

ZIAC T3



atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3




pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3



66





COLESTID T3

colestipol hcl T1

PREVALITE T1








T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1

67



T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9


T3

68


TAZTIA XT T1


T1

TIAZAC T3



T1


T1


VERELAN T3

VERELAN PM T3


acetazolamide er T1




CORLANOR T3 ST

RANEXA T3

ranolazine er T1



Cardiotonic Agents

DIGITEK T1

DIGOX T1






T9


CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

69


clonidine T1

clonidine hcl er T2




T3

methyldopa oral T1



T9


ezetimibe T1




ROSZET T9

VYTORIN T3

ZETIA T3



NORPACE T3

NORPACE CR T2









PHENYTEK T2








propafenone hcl T1

70






atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3



pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3






T3

dofetilide T2

MULTAQ T3


71




SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TIKOSYN T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1


T1

TIAZAC T3

72



T1


T1


VERELAN T3

VERELAN PM T3


ADALAT CC T3

AFEDITAB CR T1


CONJUPRI T9

felodipine er T1

isradipine T1





T1


nifedipine oral T1


nisoldipine er T2




PROCARDIA XL T3


T3

Dihydropyridines

ADALAT CC T3

AFEDITAB CR T1







73


AZOR T3 ST


CONJUPRI T9

CONSENSI T9

EXFORGE T3

EXFORGE HCT T3

felodipine er T1

isradipine T1








T1


nifedipine oral T1


nisoldipine er T2





PRESTALIA T3 ST

PROCARDIA XL T3


T3


TRIBENZOR T3

TWYNSTA T3

Direct Vasodilators

BIDIL T3



minoxidil oral T1


ELIXOPHYLLIN T3

THEO-24 T2

74



T1


T1




T9


T1




T1



FENOGLIDE T9

FIBRICOR T9

gemfibrozil oral T1

LIPOFEN T9

LOPID T3

TRICOR T3


TRILIPIX T3


ALTOPREV T9




CRESTOR T3

EZALLOR SPRINKLE T9



flolipid T9



LESCOL XL T9

LIPITOR T3

LIVALO T9

lovastatin oral T1

75



T3



ROSZET T9



VYTORIN T3


ZYPITAMAG T9


DIBENZYLINE T9




bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1




ALDACTONE T3

CAROSPIR T9

eplerenone T1

INSPRA T3





ALDACTONE T3

CAROSPIR T9

eplerenone T1

76


INSPRA T3



BIDIL T3

GONITRO T9




T1




MINITRAN T1

NITRO-BID T1


T3


T2

nitroglycerin er T1




NITROLINGUAL T3

NITROMIST T3

NITROSTAT T1

NITRO-TIME T1

Pcsk9 Inhibitors







ADCIRCA T9

CIALIS T9

cilostazol T1




77






STAXYN T9

STENDRA T9





VIAGRA T9


ALDACTONE T3


CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3


Renin Inhibitors


TEKTURNA T9

TEKTURNA HCT T2 ST




DIURIL T2




indapamide oral T1

metolazone T1

THALITONE T9


ADALAT CC T3

AFEDITAB CR T1


78




T3


T3


T9


T2


T9


T3

CARTIA XT T1



CONJUPRI T9

CORLANOR T3 ST


T1


T1


T9


T9


T9


dilt-xr T1





MATZIM LA T9




T1


79


nifedipine oral T1





PROCARDIA XL T3

TAZTIA XT T1


T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3



Adamantanes (Cns)


GOCOVRI T9

OSMOLEX ER T9




LOMAIRA T3 ST




Amphetamines

ADDERALL T3 AL





ADZENYS ER T9

ADZENYS XR-ODT T9

80


amphetamine er T9





DESOXYN T9














DYANAVEL XR T9


EVEKEO ODT T9


MYDAYIS T9

PROCENTRA T1





T9







ALLZITAL T9

APADAZ T9


T9

81






T9




T9





T9







T1


T9


T1

HYOPHEN T9


LYRICA CR T9

NEURONTIN T3

NORCO T3



T9


T1


T3

pregabalin er T9

PRIMLEV T9

PROLATE T9


82



ULTRACET T3

URIBEL T9

VANATOL LQ T9




VTOL LQ T9


QSYMIA T3 ST


CONTRAVE T3 ST

IMCIVREE T9










acetazolamide er T1








T1 ST






CARBATROL T3 ST

83


DEPAKOTE T3

DEPAKOTE ER T3


T3





T1


T1


ELEPSIA XR T9


EPITOL T1

EPRONTIA T9

EQUETRO T3 ST
















84







KEPPRA ORAL T3

KEPPRA XR T3



LAMICTAL ODT T9



T3



















levetiracetam er T1






NEURONTIN T3

oxcarbazepine T1



85









QUDEXY XR T9



SABRIL T9














TOPAMAX T3





TRILEPTAL T3

TROKENDI XR T9





86










ZONEGRAN T3

zonisamide oral T1


APLENZIN T9









T1


T9


FORFIVO XL T9

mirtazapine oral T1


REMERON SOLTAB T3








T3

Antimanic Agents

ABILIFY MYCITE T9



87













T1 ST






CARBATROL T3 ST

DEPAKOTE T3

DEPAKOTE ER T3


T3


T1


T1


EPITOL T1

EQUETRO T3 ST

GEODON ORAL T3

LAMICTAL ODT T9



T3









88












lithium T1



LITHOBID T3








T1




T3





T2

SAPHRIS T9


SEROQUEL T3







89











ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3


ANAPROX DS T3




BUFFERIN T3 PV AL



CAFERGOT T9


CAMBIA T9

DEPAKOTE T3

DEPAKOTE ER T3


T3




T1


T1



T3

ELYXYB T9

EPRONTIA T9

ERGOMAR T3



90


HEMANGEOL T3 AL


INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9


MIGERGOT T9

MIGRANAL T9


T9











TOPAMAX T3




TROKENDI XR T9

TRUDHESA T9




ADASUVE T9









91







EDLUAR T9



HETLIOZ LQ T9




T1

INTERMEZZO T9


meprobamate T9




T1


T3


T9

ramelteon T1 AL

ROZEREM T3 AL

VISTARIL T3







ABILIFY MYCITE T9






92

















T3

GEODON ORAL T3

INVEGA T9


LYBALVI T9















T1


93





T3





T2

SAPHRIS T9


SEROQUEL T3






T9



ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3





primidone oral T1


ALLZITAL T9

ASCOMP-CODEINE T2





T9

94





T9




DONNATAL T9




T9






VANATOL LQ T9

VTOL LQ T9


ATIVAN ORAL T3



clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3

KLONOPIN T3




LOREEV XR T9




SYMPAZAN T9

95



VALIUM T3













ATIVAN ORAL T3






clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3




KLONOPIN T3

LIBRAX T9




LOREEV XR T9




96


oxazepam T1

quazepam T9


SYMPAZAN T9






VALIUM T3

XANAX T3





Butyrophenones


haloperidol oral T1












97




T1

COMTAN T3

entacapone T1

ONGENTYS T3 ST

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3










EXSERVAN T9















98







RILUTEK T9






TIGLUTIK T9

VYLEESI T9



XYWAV T9




CONSENSI T9

ELYXYB T9

SEGLENTIS T9

Dopamine Precursors

carbidopa oral T9



T1


T1

DHIVY T3

INBRIJA T9




99






SINEMET CR T3

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3



cabergoline T1

PARLODEL T3

Fibromyalgia Agents
























T9

100


Hydantoins





PHENYTEK T2








EMSAM T3 ST






EMSAM T3 ST


NARDIL T3

PARNATE T3








T9



MIRAPEX T3





101




T3 ST

ropinirole hcl T1


Opiate Agonists





ACTIQ T9

APADAZ T9


T9

ASCOMP-CODEINE T2


T9


T9






CONZIP T9




DOLOPHINE T3

DSUVIA T9










T9

102



T9


T9







T1


T9


T1


T1











T9

LAZANDA T9










T1

MORPHABOND ER T9

103



T1



T9





T3

NORCO T3

NUCYNTA T3 ST










T9


T1






T3

PRIMLEV T9

PROLATE T9

QDOLO T9

SEGLENTIS T9




104




T9








ULTRACET T3








Opiate Antagonists






















105




























BUTRANS T9














106



ANAPROX DS T3


T9

CAMBIA T9

DAYPRO T3

diclofenac T9








diflunisal oral T1

DUEXIS T9


T3

etodolac er T2

etodolac oral T1

FELDENE T3



FLECTOR EXTERNAL T9



T1




INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1







LOFENA T9

107







nabumetone oral T1



T9









oxaprozin T2

piroxicam oral T1

QMIIZ ODT T9

RELAFEN DS T9

SPRIX T9

sulindac oral T1


TIVORBEX T9

tolmetin sodium T2


VIMOVO T9

VIVLODEX T9

ZIPSOR T9

ZORVOLEX T9

Phenothiazines



COMPRO T1






108


prochlorperazine T1





ADHANSIA XR T9


T9


ASCOMP-CODEINE T2

AZSTARYS T9


T9




T9




CAFERGOT T9






COTEMPLA XR-ODT T9




ELIXOPHYLLIN T3





T9


FOCALIN T3 AL


JORNAY PM T9

109



T1 AL
















T1 AL




MIGERGOT T9

norgesic forte T9


T9


T9




RELEXXII T9

RITALIN T3 AL



THEO-24 T2


T1


T1


VANATOL LQ T9

110


VTOL LQ T9

Salicylates

AGGRENOX T3

ASCOMP-CODEINE T2





BUFFERIN T3 PV AL







DOANS PILLS T1

DURLAZA T9



norgesic forte T9


T9


T9

salsalate oral T1


















111


EFFEXOR XR T3






venlafaxine hcl T1


T1


T9





FROVA T9






T9


T9


T3






ONZETRA XSAIL T9

RELPAX T9


112






T9




T1


T9




T1


TOSYMRA T9









BRISDELLE T9
















113














PAXIL T3





PEXEVA T9







T9





nefazodone hcl T1






Succinimides

CELONTIN T2


ZARONTIN T3

114


Thioxanthenes

thiothixene oral T1



amoxapine T1

















maprotiline hcl T1







SURMONTIL T3

TOFRANIL T3






115







XENAZINE T9




T1








Dental Agents

Dental Agents


T3


Devices

Devices








116












T2


T2




























117

















T2




T2





NOVOFINE PLUS T2












T1


T2


118


V-GO 20 T2

V-GO 30 T2

V-GO 40 T2


Diagnostic Agents



CORTROPHIN T9

Diabetes Mellitus


























MICRODOT TEST T3 ST




119








Diagnostic Agents



CANDIN T9

Ketones

KETOSTIX T3

Tuberculosis

APLISOL T9


Alkalinizing Agents

cytra k crystals T1

cytra-2 T9

CYTRA-3 T9

cytra-k T9

ORACIT T3





tricitrates T9

UROCIT-K 10 T3

UROCIT-K 15 T3

UROCIT-K 5 T3

virtrate-2 T9

virtrate-3 T9

virtrate-k T9

Ammonia Detoxicants




120



enulose T1

generlac T1

KRISTALOSE T9



LITHOSTAT T9




Caloric Agents

DOJOLVI T9

ENLYTE T9


FERREX 150 PLUS T9

FOLBEE AR T9

l-leucine T9

macuvex T9

macuzin T9

METAFOLBIC PLUS T9

methaver T9

methazel T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9

PURALOR CI T9

SUPERVITE T9

zyvit T9


acetazolamide er T1



ELIXOPHYLLIN T3

THEO-24 T2


T1

121



T1



Loop Diuretics

bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1


















T9

PHOSLO T3

PHOSLYRA T3 ST

122



RENVELA T9









SPS T1




ALDACTONE T3



CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3

MAXZIDE T3

MAXZIDE-25 T3





active fe T9


BACMIN T9

123




CENTRATEX T9

choice-tabs T9


CORVITA 150 T9



CORVITE FREE T9


DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


T1

FERIVA 217 T9

FERIVAFA T9


FOLBEE PLUS CZ T9


GALZIN T9


HEMATRON T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


IROSPAN 246 T9

KLOR-CON 10 T1

KLOR-CON M10 T1

KLOR-CON M15 T1

KLOR-CON M20 T1



T3

KLOR-CONEF T1

K-PHOS-NEUTRAL T9


T3

124







neonatal + dha T9

NEPHPLEX RX T9

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9


PHOSLO T3

PHOSLYRA T3 ST

phos-nak T9


pnv-dha T1

pnv-select T1


T1


T1


T1



T3



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1



PRENATE AM T3


T3

PRENATE PIXIE T3

purefe plus T9

125



QUFLORA FE T9

REQ 49+ T9

se-tan plus T9



STROVITE ONE T9

SUPERVITE T9

TANDEM PLUS T9

tl-hem 150 T9

tristart dha T9

TRIVEEN-DUO DHA T1

tri-zel T9


v-c forte T9

VIC-FORTE T9

VINATE M T1


VITACEL T1

VITAFOL-ONE T3

VITAL-D RX T9

VITATRUE T3


Thiazide Diuretics

ACCURETIC T3





ATACAND HCT T3


T3


BENICAR HCT T3




CORZIDE T3

DIOVAN HCT T3

DIURIL T2

126


DUTOPROL T9

EDARBYCLOR T3 ST


EXFORGE HCT T3



HYZAAR T3






T3

MAXZIDE T3

MAXZIDE-25 T3




MICARDIS HCT T3




propranolol-hctz T1



TEKTURNA HCT T2 ST

telmisartan-hctz T1



TRIBENZOR T3


VASERETIC T3

ZESTORETIC T3

ZIAC T3




indapamide oral T1

metolazone T1

TENORETIC 100 T3

127


TENORETIC 50 T3

THALITONE T9

Uricosuric Agents


probenecid oral T1








Enzymes

Enzymes














128










ALPHAGAN P T3





COMBIGAN T9

SIMBRINZA T2

Antiallergic Agents

ALAWAY T1

ALOCRIL T3 ST

ALOMIDE T2






BEPREVE T9



DYMISTA T3 ST

ELESTAT T3

epinastine hcl T1



NAPHCON-A T9



129




PATANASE T3

PATANOL T3

PAZEO T3 ST

TICALAST T9

ZADITOR T1

ZERVIATE T9


AZASITE T3 ST


T1



BLEPH-10 T3

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

CETRAXAL T3

CILOXAN T3

CIPRO HC T2

CIPRODEX T3





COLY-MYCIN S T3






MAXITROL T3

MOXEZA T3




T1


T1


T1

130



T1


OCUFLOX T3


ofloxacin otic T1

OTOVEL T2 AL


POLYTRIM T3

PRED-G T2

PRED-G SOP T3



T9





TOBRADEX ST T3 ST





VIGAMOX T3

ZYLET T3 ST

ZYMAXID T3 ST

Antifungals (Eent)

NATACYN T3

Antivirals (Eent)


VIROPTIC T3

ZIRGAN T3



BETIMOL T3

BETOPTIC-S T3 ST


carteolol hcl T1

COMBIGAN T9

COSOPT T3

131



ISTALOL T9






TIMOPTIC T3

TIMOPTIC OCUDOSE T3

TIMOPTIC-XE T3


acetazolamide er T1


AZOPT T3


brinzolamide T2

COSOPT T3




SIMBRINZA T2

TRUSOPT T3


ALREX T3 ST



BECONASE AQ T9

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

budesonide nasal T9

CIPRO HC T2

CIPRODEX T3



COLY-MYCIN S T3

CORTANE-B OTIC T3


DEXYCU T9

difluprednate T1 ST

DUREZOL T3 ST

132


DYMISTA T3 ST


FLAREX T2




FML T2

FML FORTE T3

FML LIQUIFILM T3

INVELTYS T3 ST

LOTEMAX T9

LOTEMAX SM T3 ST


MAXIDEX T3

MAXITROL T3



NASONEX T9


T1


T1


OMNARIS T9

OTOVEL T2 AL

PRED FORTE T3

PRED MILD T3

PRED-G T2

PRED-G SOP T3






T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9


TICALAST T9

133




TOBRADEX ST T3 ST



XHANCE T9

ZETONNA T9

ZYLET T3 ST



CORTANE-B OTIC T3

PERIDEX T3


CEQUA T9







acetic acid otic T1



BSS T1

BSS PLUS T3





GASTROCROM T3



MUCOSITISRX T9

134


OXERVATE T4



TICALAST T9

TYRVAYA T9


ACULAR T3

ACULAR LS T3

ACUVAIL T3 ST







NEVANAC T3 ST



T9



CORTANE-B OTIC T3



Miotics

ISOPTO CARPINE T3



VUITY T9

Mydriatics




T3

CYCLOMYDRIL T3


HOMATROPAIRE T1

ISOPTO ATROPINE T3

135



T1






ROCKLATAN T3 ST

TRAVATAN Z T3


VYZULTA T9

XALATAN T3

XELPROS T2

ZIOPTAN T3


RHOPRESSA T3 ST

ROCKLATAN T3 ST

Vasoconstrictors

ADRENALIN NASAL T9

CYCLOMYDRIL T3


NAPHCON-A T9


T1


UPNEEQ T9



AKYNZEO ORAL T9



ondansetron T1



SUSTOL T9




BUFFERIN T3 PV AL

136





PLENITY T9

ZEGERID T9

ZEGERID OTC T3

Antidiarrhea Agents




FUSION SPRINKLES T9



MYTESI T9

opium T9

paregoric T9

PYLERA T9

RESTORA RX T9











T1


T3


T9

scopolamine T1

SYNDROS T9


137



T3

Antiflatulents




BONJESTA T9

COMPRO T1

DICLEGIS T9



prochlorperazine T1


TIGAN ORAL T3




APRISO T9


AZULFIDINE T3






DIPENTUM T3







138







ROWASA RECTAL T3




PYLERA T9

TALICIA T9








FLAGYL T3






bisacodyl oral T3

bisacodyl rectal T9

BUFFERIN T3 PV AL




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3

139


CLENPIQ T3


T3



fe 90 plus T9

FERIVA 217 T9

FERIVAFA T9

FERRALET 90 T9

ferraplus 90 T9


GAVILYTE-C T1 PV

GAVILYTE-G T1 PV


GLYCOLAX T9

GOLYTELY T3

HEMATRON-AF T9


INATAL GT T1



MOVIPREP T3


mynate 90 plus T1

NATALVIRT FLT T9

NEPHRON FA T9

NEXA PLUS T3


OSMOPREP T3





PEG-PREP T1 PV

PLENVU T3

pnv-dha+docusate T1





140


SUTAB T9

TARON-PREX T2


tl-hem 150 T9

TRILYTE T1 PV


ACTIGALL T3

RELTONE T9

URSO 250 T3

URSO FORTE T3




Digestants











ALLI T3 ST


BYLVAY T9

BYLVAY (PELLETS) T9

BYNFEZIA PEN T9



141



























IBSRELA T9


LIVMARLI T9



142



MYCAPSSA T9













REMICADE T9












XENICAL T9





DUEXIS T9

143






nizatidine T3










AKYNZEO ORAL T9




T9

EMEND TRI-PACK T9

VARUBI ORAL T9

Prokinetic Agents

GIMOTI T9


T1



REGLAN ORAL T3


Prostaglandins


T9

CYTOTEC T3


misoprostol oral T1

Protectants

CARAFATE T3 ST



144



ACIPHEX T9


T9


DEXILANT T9

dexlansoprazole T9



T9


FIRST-OMEPRAZOLE T3



NEXIUM T9


T9


T3






PREVACID T9

PREVACID 24HR T3

PRILOSEC OTC T3

PROTONIX ORAL T9


VIMOVO T9

YOSPRALA T9

ZEGERID T9

ZEGERID OTC T3

Gold Compounds

Gold Compounds

RIDAURA T9





145






DEPEN TITRATABS T9

EXJADE T5









T9SP ()



SYPRINE T9



Adrenals

ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9

146





ALKINDI SPRINKLE T9

ALVESCO T9








ASMANEX HFA T9

BREO ELLIPTA T9









CORTEF T3


dexabliss T9






T9

DEXONTO 04 T3


T9


EMFLAZA T9





147








T3



HEMADY T9

HIDEX 6-DAY T9


INTRAROSA T3 PA

MEDROL T3


MILLIPRED T9


NASONEX T9

ORAPRED ODT T9

ORTIKOS T9



T1


T9




T1




T3



QVAR REDIHALER T1

RAYOS T9

SINUVA T9

148





TAPERDEX 12-DAY T9


T9

TARPEYO T9

TRELEGY ELLIPTA T2


WIXELA INHUB T3

XHANCE T9

zcort 7-day T9

ZILRETTA T9


acarbose oral T1

GLYSET T3

PRECOSE T3

Amylinomimetics





Androgens

ANADROL-50 T9


T9


T9


T9

COVARYX T9

COVARYX HS T9




T9



149



FORTESTA T9

JATENZO T9

methitest T9


NATESTO T9

OXANDRIN T3

oxandrolone oral T3

STRIANT T9

TESTIM T9


T1



T9







TLANDO T9

VOGELXO PUMP T9


T9

XYOSTED T9




CYCLOSET T3




Antiestrogens

anastrozole oral T1

ARIMIDEX T3

AROMASIN T3

exemestane T2

150


FEMARA T3




letrozole oral T1

Antigonadtropins











PROGLYCEM T9





MIACALCIN NASAL T3


Antithyroid Agents

methimazole oral T1

151



TAPAZOLE T3

Biguanides

ACTOPLUS MET T3



FORTAMET T9


GLUCOPHAGE T3

GLUCOPHAGE XR T3

GLUMETZA T9











KAZANO T9





metformin hcl er T1


T9



T1



RIOMET T9







152









T2



Contraceptives

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV

153



T3 PV

ECONTRA EZ T1 PV


ELLA T1


EMOQUETTE T1

ENPRESSE-28 T1 PV

ERRIN T1 PV

ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


154



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV

MELODETTA 24 FE T9

MIBELAS 24 FE T9





MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV

NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV


NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV


T1 PV



T9


T1 PV

155


NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV

PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9

156

















KAZANO T9





NESINA T9


OSENI T9











EVISTA T3

FARESTON T9

OSPHENA T2 PA

raloxifene hcl T1

SOLTAMOX T9


157



Estrogens

ACTIVELLA T3

ALORA T2

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA T9

CLIMARA PRO T9

COMBIPATCH T2

COVARYX T9

COVARYX HS T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DELESTROGEN T3





DOTTI T1

158



ELESTRIN T3


EMOQUETTE T1

ENPRESSE-28 T1 PV




ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1





T2


ESTRING T3


ESTROSTEP FE T3


EVAMIST T2

FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

FEMRING T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV




JINTELI T1

JOLESSA T1 PV

JULEBER T1

159


JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYLLANA T1

marlissa T1 PV

MELODETTA 24 FE T9


T2


MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

160



T3

MIRCETTE T9


NATAZIA T9

NECON 0535 (28) T1 PV

NEXTSTELLIS T9



T1 PV


T1 PV


T1


T9


T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


PORTIA-28 T1 PV

PREFEST T3



PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

161


SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TWIRLA T9

TYDEMY T9


VELIVET T1 PV

VIVELLE-DOT T3


YASMIN 28 T9

YAZ T9

YUVAFEM T1













Gonadotropins






162



MENOPUR T2

NOVAREL T3 ST

OVIDREL T2

PREGNYL T1

SYNAREL T9

Incretin Mimetics

ADLYXIN T3 ST




T3 ST


T3 ST





RYBELSUS T9

SAXENDA T9




T2

WEGOVY T9



HUMULIN 7030 T1


T1

HUMULIN N T1


T1

NOVOLIN 7030 T3 ST


NOVOLIN N T3 ST


163


Leptins

MYALEPT T5


)


BASAGLAR KWIKPEN T9


LANTUS T1


T1

LEVEMIR T3 ST


SEMGLEE T9

SEMGLEE (YFGN) T9



TOUJEO SOLOSTAR T1

TRESIBA T9



Meglitinides

nateglinide T1


repaglinide T1

STARLIX T3

Parathyroid Agents


T9







164


Pituitary


CORTROPHIN T9

DDAVP ORAL T3







T9




T9

NOCDURNA T9

NOCTIVA T9




T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



SKYTROFA T9


ZOMACTON T9


165


Progestins

ACTIVELLA T3

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYGESTIN T3

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA PRO T9

COMBIPATCH T2

CRINONE T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV


T3 PV

ECONTRA EZ T1 PV


166


ELLA T1


EMOQUETTE T1


ENPRESSE-28 T1 PV

ERRIN T1 PV


ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JINTELI T1

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9


167



T1 PV



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV


MEGACE ES T3 ST




MELODETTA 24 FE T9

MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV


NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV

168



NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV



T1 PV



T1


T9


T1 PV

NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV


PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREFEST T3

PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV



PROMETRIUM T3

PROVERA T3

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

169


SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9




ADMELOG T3 ST



T3 ST

APIDRA T3 ST


T3 ST

FIASP T3 ST


FIASP PENFILL T3 ST

HUMALOG T1

170




T1

HUMALOG MIX 5050 T1


T1

HUMALOG MIX 7525 T1


T1






insulin lispro T9




LYUMJEV T1

LYUMJEV KWIKPEN T1

NOVOLOG T9


T9

NOVOLOG MIX 7030 T9


T9


T9


HUMULIN 7030 T1


T1

HUMULIN R T1



T1

NOVOLIN 7030 T3 ST


NOVOLIN R T3 ST

171


























T2




BYNFEZIA PEN T9

MYCAPSSA T9






172




T9




T9





T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



ZOMACTON T9











Sulfonylureas

AMARYL T3

DUETACT T9

glimepiride T1

173


glipizide er T1

glipizide oral T1


T1


GLUCOTROL T3

GLUCOTROL XL T3


glyburide oral T1


GLYNASE T3


Thiazolidinediones

ACTOPLUS MET T3


ACTOS T3



DUETACT T9

OSENI T9

pioglitazone hcl T1



Thyroid Agents

ARMOUR THYROID T2

CYTOMEL T2

EUTHYROX T3

LEVO-T T3





LEVOXYL T1


NP THYROID T1

SYNTHROID T3

THYQUIDITY T9


T2


T2

174



T2


T2


T2


T9


T9


T1


T1



ZTLIDO T9



AVODART T3





JALYN T3 ST

PROPECIA T9

PROSCAR T3

Alcohol Deterrents

ANTABUSE T3

disulfiram oral T1


Antidotes



T1




175






























RENVELA T9



176




SPS T1




Antigout Agents

allopurinol oral T1

ANAPROX DS T3




COLCRYS T9


T3


GLOPERBA T9

INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1


MITIGARE T9


T9








probenecid oral T1


ZYLOPRIM T3


EXONDYS 51 T9

177



VILTEPSO T9



T9











ALORA T2

ATELVIA T3

BINOSTO T3 ST




CLIMARA T9

DELESTROGEN T3





DOTTI T1

ELESTRIN T3

ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1




178



T2

ESTRING T3



EVAMIST T2

EVISTA T3

FEMRING T3




LYLLANA T1


T2


MIACALCIN NASAL T3


T3



raloxifene hcl T1






VIVELLE-DOT T3

YUVAFEM T1


FIRAZYR T9





179


Cariostatic Agents

DENTA 5000 PLUS T1

DENTAGEL T1



FLORIVA PLUS T9


T3

LUDENT T1



T1 AL


MYKIDZ IRON FL T9

PREVIDENT T3



QUFLORA FE T9


T9

sf T1

sf 5000 plus T1









TRI-VI-FLOR T9






RUCONEST T9

180







AZASAN T9



AZULFIDINE T3






COSENTYX T4







T4


181








DEPEN TITRATABS T9











T4
















182













T9


IMURAN T3









leflunomide oral T1



T1

NEORAL T3



183











T9



PLAQUENIL T3


T9

REDITREX T3 ST

REMICADE T9

RIDAURA T9











184







TREXALL T3 ST

XATMEP T3 AL















AZASAN T9



AZULFIDINE T3

185



BAFIERTAM T9







T9


















T4


186









T4




T4




T4




T4











187

















T9


IMURAN T3





KESIMPTA T4




leflunomide oral T1



188







T1

NEORAL T3










PLAQUENIL T3











189
















REMICADE T9





RIDAURA T9









190







TREXALL T3 ST

VUMERITY T9

XATMEP T3 AL






ASTAGRAF XL T3 ST

AZASAN T9






T3 AL









ENVARSUS XR T3 ST

191






IMURAN T3

leflunomide oral T1



















T1



T1 AL

192











NEORAL T3













tacrolimus oral T1

TREXALL T3 ST

XATMEP T3 AL








193





FIRAZYR T9





RUCONEST T9





AMPYRA T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9


betaine T3

bp vit 3 T9

CARDIOVID PLUS T9

CARNITOR ORAL T3

CARNITOR SF T3




CITRANATAL DHA T3

194



T3

coenzyme q10 T2



CYSTADANE T9


DEMSER T9


ENDARI T9


T9



FERIVA 217 T9


FERREX 28 T9


FOLBEE AR T9


IROSPAN 246 T9







levocarnitine sf T1

195


maca T9

METAFOLBIC PLUS T9

metyrosine T9


MULTIGEN FOLIC T9

MULTIGEN PLUS T9


neonatal + dha T9

NEXA PLUS T3

nitisinone T9

NITYR T9

ORFADIN T9

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATE AM T3


T3

PRENATE PIXIE T3



T9

RECORLEV T9




SOLESTA T3


196



TARON-PREX T2

THIOLA T9






tristart dha T9

TRIVEEN-DUO DHA T1


URIBEL T9


VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3




XURIDEN T9

ZAVESCA T9

ZOKINVY T9

Protective Agents




CAYA T3


197


Oxytocics

Oxytocics



PREPIDIL T3

Pharmaceutical Aids

Pharmaceutical Aids

ALPAWASH T9

FREEDOM DERMA-D T9



ADRENALIN NASAL T9


T9




T9


T9








T1

ATROVENT HFA T2













198


Antifibrotic Agents

















Antitussives



BROMFED DM T9









199


HISTEX-AC T9

HYCODAN T9


T1



hydromet T1

maxi-tuss cd T9





T1

TESSALON PERLES T3


T9















200













Expectorants







SSKI T3














201



T9




T1


T3


T9


RYVENT T9



T4




ACCOLATE T3


SINGULAIR T3

zafirlukast T1


ZYFLO T9

ZYFLO CR T9


ALOCRIL T3 ST




GASTROCROM T3

Mucolytic Agents





202



T1



BECONASE AQ T9

budesonide nasal T9

DYMISTA T3 ST





NASONEX T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9

TICALAST T9


XHANCE T9












T3



QVAR REDIHALER T1





BRONCHITOL T9



203




ALLEGRA ALLERGY T9


T9













T9


DYMISTA T3 ST



QUZYTTIR T9

TICALAST T9

ZERVIATE T9







T1


ARCAPTA NEOHALER T3



T1



204


PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2




XOPENEX T3


XOPENEX HFA T9


ADCIRCA T9














T5




T5



205



T5




















VENTAVIS T4 PA

VIAGRA T9


ELIXOPHYLLIN T3

THEO-24 T2

206



T1


T1








ACANYA T9

ACZONE T9

AKTIPAK T9

ALTABAX T3 ST

AMZEEQ T9

AVAR CLEANSER T9


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

BENZACLIN T9



bp 10-1 T9


CENTANY T3

CLENIA PLUS T9







CLINDAGEL T9


T9



207










CLINDESSE T3 ST


dapsone external T9

DUAC T9

ery T1

ERYGEL T1




KLARON T3

METROCREAM T3


METROGEL-VAGINAL T3

METROLOTION T3








NORITATE T9

NUVESSA T9

ONEXTON T9

OVACE PLUS T9

OVACE PLUS WASH T9

OVACE WASH T9



T9


PLEXION NS T9

208








T9



T1


T9


T9


T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

VANDAZOLE T1

VELTIN T9

XEPI T9

ZIANA T9

ZILXI T9


ALA-QUIN T9










EPIFOAM T9

ethyl chloride T9

209







T2











LIDODERM T9



lidorx T9

LIDOTRANS 5 PAK T9

LIVIXIL PAK T9




PRAMOSONE T9


prilovixil T9

PRUDOXIN T9

PYRIDIUM T3


RELADOR PAK PLUS T9

SYNERA T9

XRYLIDERM T9

ZONALON T9



DENAVIR T9

XERESE T9

ZOVIRAX EXTERNAL T9

210


Astringents


DRYSOL T1

VUSION T9

XERAC AC T1








ECOZA T9

ERTACZO T3 ST

EXELDERM T9

EXTINA T9

GYNAZOLE-1 T3

JUBLIA T9






luliconazole T9

LUZU T9

NIZORAL T3






TERAZOL 7 T3



VUSION T9

XOLEGEL T9



GERI-HYDROLAC 12 T9

211


GERI-HYDROLAC 5 T9




urea hydrating T9


lactic acid e T9


ALCORTIN A T9

DERMASORB XM T9

iodoquimez-hc T9

lactic acid e T9


VYTONE T9


MENTAX T9



ATRALIN T3 ST AL

AVITA T9


REFISSA T9

RENOVA T9

RENOVA PUMP T9

RETIN-A T3 AL

RETIN-A MICRO T9









TRI-LUMA T9

TWYNEO T9

VELTIN T9

ZIANA T9


ALA SCALP T9

212



ALA-QUIN T9


ALCORTIN A T9

amcinonide T9



APEXICON E T9

AQUANIL HC T1













BRYHALI T3 ST




CAPEX T9











CLOBEX SPRAY T9



213



CLODERM T9

CLODERM PUMP T9



CORDRAN T9


CORTENEMA T3





DERMASORB HC T9

DERMASORB TA T9

DERMAZENE T9

DESONATE T9














DIPROLENE AF T3


DUOBRII T9



ENSTILAR T9

EPIFOAM T9





214










flurandrenolide T9







HALOG T9


T1


T9


T2



















215


IMPEKLO T9

IMPOYZ T9

iodoquimez-hc T9

KENALOG EXTERNAL T9






LOCOID LIPOCREAM T9


LUXIQ T9





NUCORT T3


OLUX T9

OLUX-E T3

ORALONE T3

PANDEL T9

PRAMOSONE T9


prednicarbate T1



SERNIVO T9

SYNALAR T9

SYNALAR TS T9




TEXACORT T9





216


TOPICORT SPRAY T9





T1



TRIANEX T9


TRI-LUMA T9





VANOS T9

VANOXIDE-HC T9

VERDESO T9

VYTONE T9

WYNZORA T9

XERESE T9

Depigmenting Agents


ESOTERICA FACIAL T9


hydroquinone T9


TRI-LUMA T9

Detergents



VUSION T9






Keratolytic Agents

AVAR CLEANSER T9


217


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

bensal hp T9

bp 10-1 T9


CLENIA PLUS T9

DERMASORB XM T9





T9


PROMISEB T9


rynoderm T9










SALVAX T9



SELRX T9


T9



T1


T9


T9

218



T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

ULTRASAL-ER T9



urea hydrating T9


UTOPIC T9

XALIX T9

xurea T9




ACANYA T9




T1


T9

AKTIPAK T9

ALCORTIN A T9


BENZACLIN T9


BENZEFOAM T9

BENZEFOAMULTRA T9








219








bpo T9




T9






DERMAZENE T9

DUAC T9

EPIDUO T3

EPIDUO FORTE T9

EPSOLAY T9


iodoquimez-hc T9



ONEXTON T9

PERIDEX T3






SELRX T9

SILVADENE T3


SSD T1


SULFAMYLON T3

TWYNEO T9

VANOXIDE-HC T9

220


VYTONE T9






PROFINAC T9


Oxaboroles

KERYDIN T9

tavaborole T9

Pigmenting Agents










EURAX T9





NATROBA T9

OVIDE T3


SKLICE T3


spinosad T1

ULESFIA T3


ABSORICA T9

ABSORICA LD T9


221




ACZONE T9







T1


T9


AKLIEF T9

ALDARA T3


ARAZLO T9

ATRAPRO HYDROGEL T9

AVO CREAM T9




BIAFINE T9













CARAC T9

CELACYN T9

222



CERACADE T9




COSENTYX T4







T4


dapsone external T9

DERMASORB HC T9

DERMULCERA T9








doxycycline T9

DRITHO-CREME HP T9

DUOBRII T9


T4


223



T4



T4



ELETONE T9


EMULSION SB T9

ENSTILAR T9


EPICERAM T9

EPIDUO T3

EPIDUO FORTE T9

FABIOR T9








GELCLAIR T9






imiquimod pump T9




KAMDOY T9


224



LATISSE T9

LOYON T9

LUXAMEND T9


T9

MINOLIRA T9


MIRVASO T9


MUGARD T9



NIVATOPIC PLUS T9

NUVAIL T9

OPZELURA T9

ORACEA T9

ORAMAGICRX T9




PHLAG SPRAY T9


podocon T9

PODOCON-25 T9


PRESERA T9

PROFINAC T9

PROPECIA T9


PRUCLAIR T9

PRUMYX T9

PRUTECT T9

QBREXZA T9

RECEDO T9

225


RECTIV T9


REMICADE T9


ROGAINE T9

ROGAINE MENS T9




SILIQ T5







T9

SONAFINE T9

SORILUX T9







suvicort T9

SYNALAR TS T9

SYNERDERM T9




226


















VANIQA T9


VELTIN T9

VENELEX T9



WINLEVI T9

WYNZORA T9

XIMINO T9


ZIANA T9

ZITHRANOL T3 ST

ZYCLARA T9




Antimuscarinics


DETROL T3


227



T3


flavoxate hcl T1




OXYTROL T9










ELIXOPHYLLIN T3






THEO-24 T2


T1


T1


GEMTESA T9





Vitamins


BACMIN T9

choice-tabs T9

228





CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1


CORVITE FREE T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


FLORIVA PLUS T9

folbee plus T9

FOLBEE PLUS CZ T9


INATAL GT T1




T1 AL





M-VIT T9

MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

229





neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRO-VITE RX T9

NEXA PLUS T3

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9

NIVA-PLUS T9

O-CAL FA T9



pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

230


PRENATE PIXIE T3

PROVIDA OB T3

QUFLORA FE T9


T9


rena-vite T3

rena-vite rx T9

reno caps T9

REQ 49+ T9


T1




STROVITE ONE T9

SUPERVITE T9

TARON-PREX T2


TRICARE T1

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9


tri-zel T9


v-c forte T9

VIC-FORTE T9


VINATE M T1

VINATE ONE T1

virt-caps T9

virt-vite plus T9

VITACEL T1



VITAFOL-OB T3

231


VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITATRUE T3

vp-vite rx T9

Vitamin A

active fe T9

MYKIDZ IRON FL T9

pnv-select T1

TRI-VI-FLOR T9


Vitamin B Complex

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

BEYAZ T9

bp vit 3 T9


CARDIOVID PLUS T9

CENTRATEX T9

CIFEREX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9






DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

232




DIALYVITEZINC T9

durachol T9

fabb T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


T9


FERREX 28 T9


folbee T9

FOLBEE AR T9

folbee plus T9

FOLBEE PLUS CZ T9

FOLBIC T9





FOLIVANE-F T9

FOLIVANE-PLUS T9

FOLIXAPURE T9

folplex 22 T9

FOLTANX T9

FOLTRATE T9


FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

233


HEMATRON-AF T9


hemetab T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9





METAFOLBIC PLUS T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


T1 AL

M-VIT T9



mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

NASCOBAL T9



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9

234


neurin-sl T9

NEXA PLUS T3


NIACOR T1

NICOMIDE T9

NIVA-FOL T9

NIVA-PLUS T9

noxifol-d T9

O-CAL FA T9


ortho df T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

235


purefe plus T9


QUFLORA FE T9


rena-vite T3

rena-vite rx T9

reno caps T9

RESTORA RX T9


revesta T9

roxifol-d T9

SAFYRAL T9


T1


se-tan plus T9


SUPERVITE T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl gard rx T9

tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9

TYDEMY T9



VINATE M T1

VINATE ONE T1

virt-caps T9

236


VIRT-GARD T9

virt-vite T9

virt-vite forte T9

virt-vite plus T9


VITAFOL-OB T3

VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITA-RESPA T9

VITATRUE T3

vp-vite rx T9

zavara T9

Vitamin C

active fe T9

CENTRATEX T9

CITRANATAL BLOOM T3

CORVITA 150 T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


FERREX 150 PLUS T9

FERREX 28 T9


folbee plus T9

FOLBEE PLUS CZ T9

FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

237


FUSION SPRINKLES T9


HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


ICAR-C PLUS T9

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9



MOVIPREP T3

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


MYKIDZ IRON FL T9

mynephrocaps T9

MYNEPHRON T9

NATALVIRT FLT T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9


PLENVU T3

pnv-select T1

purefe plus T9



rena-vite T3

rena-vite rx T9

reno caps T9

se-tan plus T9

TANDEM PLUS T9

taron forte T9

tl icon T9

tl-hem 150 T9

TRICON T9

238


trigels-f forte T9

triphrocaps T9

TRI-VI-FLOR T9


virt-caps T9

virt-vite plus T9

VITAL-D RX T9

vp-vite rx T9

Vitamin D

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9




CIFEREX T9






durachol T9


FOLIXAPURE T9


MYKIDZ IRON FL T9

noxifol-d T9

ortho df T9


pnv-select T1

RAYALDEE T9

REPLESTA T9


REPLESTA NX T9

revesta T9

ROCALTROL T3

roxifol-d T9

TRI-VI-FLOR T9


239


VITAL-D RX T9


T1




zavara T9


Vitamin E

active fe T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

HEMATRON-AF T9


pnv-select T1

tl-hem 150 T9

Vitamin K Activity



240

241

Index




242




243




244




245




246




247




248




249




250




251




252




253




254




255




256




257




258




259




260




261




262




263




264




265




266
















8003681019 8005377697 (TDD)








(TTY 711）
















3



Antihistamine Drugs

Antihistamine Drugs















T9

RYVENT T9




















T1

4



T9





T1


T3


T9


RYVENT T9

VISTARIL T3


ALAWAY T1










T1



nizatidine T3





PATANASE T3

PATANOL T3

PAZEO T3 ST






5



VISTARIL T3

ZADITOR T1







T1





T3


T9


BROMFED DM T9


HISTEX-AC T9


T1

maxi-tuss cd T9


T1



T9




ALLEGRA ALLERGY T9


T9


ALOMIDE T2





6













T9




QUZYTTIR T9

SEMPREX-D T9





cefadroxil T1




KEFLEX T3


cefaclor er T1


cefprozil T1



cefdinir T1







T3

7



T2




GOCOVRI T9

OSMOLEX ER T9

rimantadine hcl T1




Amebicides

FLAGYL T3

METROGEL-VAGINAL T3




NUVESSA T9


VANDAZOLE T1










ZEMDRI T9

Aminomethylcyclines



SEYSARA T9

8










T1


T1




T3


T3

AUGMENTIN XR T3

Anthelmintics


ALBENZA T9


EMVERM T9




BREXAFEMME T9




PYLERA T9

Antimalarials

ACTICLATE T9

ARAKODA T3



COARTEM T2

DARAPRIM T9

9


DORYX MPC T9


T9





T9



T9


T1


T9


T1


T9



LYMEPAK T9

MALARONE T3

mefloquine hcl T1





MONDOXYNE NL T9

PLAQUENIL T3



QUALAQUIN T3 PA




TARGADOX T9



10



T3



dapsone oral T1






BACTRIM T3

BACTRIM DS T3



dapsone oral T1

FLAGYL T3



MEPRON T3



NEBUPENT T3



PYLERA T9

SOLOSEC T9


T1


tinidazole oral T1


AVELOX ORAL T3




11



T1




cycloserine oral T1


isoniazid oral T1




MYCOBUTIN T2


PRIFTIN T2



RIFADIN ORAL T3

rifampin oral T1





T2










Azole Antifungals


12


DIFLUCAN T3

fluconazole oral T1









tolsura T9












13












Fluorocyclines


T9


FIRVANQ T2

VANCOCIN HCL T9



T1



EPCLUSA T9









14











EPCLUSA T9











15























16



vocabria T9







EDURANT T2

efavirenz T2












17


















CIMDUO T9




DESCOVY T9


T1


18




emtricitabine T3






)


EPIVIR T3
















TEMIXYS T9


19






VIDEX EC T3


T2




















20













ritonavir T1



















21















acyclovir oral T1







LAGEVRIO T2

molnupiravir T2



SITAVIG T9





22







ZOVIRAX ORAL T3










T3



ZITHROMAX Z-PAK T3










Pleuromutilins

XENLETA ORAL T9

23


Polyene Antifungals






AVELOX ORAL T3

BAXDELA T9





T1








MYCOBUTIN T2

PRIFTIN T2


RIFADIN ORAL T3

rifampin oral T1




AZULFIDINE T3


BACTRIM T3

BACTRIM DS T3



T1


24




ACTICLATE T9


DORYX MPC T9


T9

doxycycline T9





T9



T9


T1


T9


T1

LYMEPAK T9



T9




MINOLIRA T9

MONDOXYNE NL T9


ORACEA T9

PYLERA T9


T9

TARGADOX T9



25



T3


XIMINO T9


BACTRIM T3

BACTRIM DS T3



HYOPHEN T9

MACROBID T3


T3





T1



PRIMSOL T9


T1



URIBEL T9








ALKERAN ORAL T3

26






anastrozole oral T1

ARIMIDEX T3

AROMASIN T3








bicalutamide T1









27



CASODEX T3












DROXIA T3

EMCYT T2








exemestane T2


FARESTON T9

28






FEMARA T3

flutamide T1






GLEEVEC T9


T3


HYDREA T3

hydroxyurea oral T1






29





















30



















31


letrozole oral T1









MEGACE ES T3 ST






melphalan T2




T1

MYLERAN T3



nilutamide T1

32






OGIVRI T9














33










SIKLOS T9

SOLTAMOX T9












34




















TREXALL T3 ST





35




















36






XATMEP T3 AL


















YONSA T9


37






ZYTIGA T9



GRASTEK T3 AL

ODACTRA T3 AL

ORALAIR T3 AL











38





RAGWITEK T3 AL


ZINPLAVA T9

Toxoids










T6 - $0 Copay



T6 - $0 Copay


T6 - $0 Copay





Vaccines

ACTHIB T9











39


BIOTHRAX T9






DENGVAXIA T9



























IXIARO T9




T6 - $0 Copay





40



T6 - $0 Copay



T9









T6 - $0 Copay


T6 - $0 Copay







stamaril T9


T9





T9


T9





VIVOTIF T9

YF-VAX T9



Autonomic Drugs


ADRENALIN NASAL T9

41





T9

BROMFED DM T9










T9


T9


T9





T1


SEMPREX-D T9







CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

clonidine T1

clonidine hcl er T2

42



HISTEX-AC T9


T3

LUCEMYRA T9

maxi-tuss cd T9

methyldopa oral T1

midodrine hcl T1


T9



ANASPAZ T3



T1

ATROVENT HFA T2


T9





CUVPOSA T3 AL

DARTISLA ODT T9




DONNATAL T9

DUAKLIR PRESSAIR T9

GLYCATE T9


T9



HYCODAN T9



hydromet T1

HYOPHEN T9

43



T1








LEVSINSL T3

LIBRAX T9





NULEV T1

oscimin sr T1



QBREXZA T9

scopolamine T1









SYMAX DUOTAB T3



T3

TRELEGY ELLIPTA T2


T9

URIBEL T9


YUPELRI T9



44










KLS QUIT2 T3 PV

KLS QUIT4 T3 PV

NICODERM CQ T9

NICORETTE T9









AMRIX T9





T9





FEXMID T9

LORZONE T9



ROBAXIN ORAL T3

ROBAXIN-750 T3

SKELAXIN T9



ZANAFLEX T3

45








FLEQSUVY T9


T9

LYVISPAH T9

OZOBAX T9



T3

BYSTOLIC T3

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



nebivolol hcl T1

pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3



CARDURA T3

CARDURA XL T3 ST


MINIPRESS T3

46





CAFERGOT T9

DIBENZYLINE T9




ERGOMAR T3


MIGERGOT T9

MIGRANAL T9


TRUDHESA T9


ADLARITY T9

ARICEPT T3



donepezil hcl T1








T9









SALAGEN T3

47



alfuzosin hcl er T1

carvedilol T1


COREG T3

COREG CR T3 ST


FLOMAX T3

JALYN T3 ST


RAPAFLO T3 ST

silodosin T2 ST

tamsulosin hcl T1

UROXATRAL T3


ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9








T1



ARCAPTA NEOHALER T3



BREO ELLIPTA T9





DUAKLIR PRESSAIR T9



48



T3






T1



PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2






TRELEGY ELLIPTA T2



WIXELA INHUB T3

XOPENEX T3


XOPENEX HFA T9



atenolol oral T1




LOPRESSOR ORAL T3



49


TENORMIN T3

TOPROL XL T3


norgesic forte T9



T9


T9


Antianemia Drugs














CEPROTIN T3



CABLIVI T4



OXBRYTA T9

50




TAVALISSE T9


COUMADIN ORAL T2

JANTOVEN T1



BEVYXXA T9
























51








MULPLETA T9















T5



52




UDENYCA T9


ZIEXTENZO T9



Hemostatics














DDAVP ORAL T3




53





















LYSTEDA T3



NOCDURNA T9


54





















Heparins




55









T5


)






T5


)


T1




Iron Preparations


active fe T9

CENTRATEX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9

CORVITE 150 T9

56


corvite fe T9


fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9

FERREX 150 T9


T9


FERREX 150 PLUS T9

FERREX 28 T9



FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN T9

HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

HEMATRON-AF T9


hemetab T9

HEMOCYTE T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9

57




MULTIGEN FOLIC T9

MULTIGEN PLUS T9

M-VIT T9


MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHRON FA T9

NEXA PLUS T3

NIVA-PLUS T9

NUFERA T9

O-CAL FA T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1


PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1






58



prenatal plus T1





T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

purefe plus T9


QUFLORA FE T9


T1


se-tan plus T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

tristart dha T9

TRIVEEN-DUO DHA T1


VINATE M T1

VINATE ONE T1



VITAFOL-OB T3

VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3

wee care T1 PV AL

59




NASCOBAL T9

neurin-sl T9


AGGRENOX T3





BRILINTA T2

BUFFERIN T3 PV AL


cilostazol T1



DURLAZA T9





YOSPRALA T9



AGRYLIN T3

anagrelide hcl T1

Thrombolytic Agents




BUFFERIN T3 PV AL





CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

60


COREG CR T3 ST



MINIPRESS T3




CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST



MINIPRESS T3




ATACAND T3

AVAPRO T3

BENICAR T3


COZAAR T3


EDARBI T3 ST

irbesartan T1


MICARDIS T3


telmisartan T1







ATACAND T3

ATACAND HCT T3

61



T3

AVAPRO T3

AZOR T3 ST

BENICAR T3

BENICAR HCT T3

BYVALSON T3 ST



COZAAR T3


DIOVAN HCT T3

EDARBI T3 ST

EDARBYCLOR T3 ST


EXFORGE T3

EXFORGE HCT T3

HYZAAR T3

irbesartan T1




MICARDIS T3

MICARDIS HCT T3




telmisartan T1


telmisartan-hctz T1

TRIBENZOR T3

TWYNSTA T3





ACCUPRIL T3



captopril oral T1

62






lisinopril oral T1


T3




PRESTALIA T3 ST

PRINIVIL T3

quinapril hcl T1

ramipril T1

trandolapril T1

VASOTEC T3

ZESTRIL T3


ACCUPRIL T3

ACCURETIC T3





captopril oral T1








lisinopril oral T1



T3


T3



63






PRINIVIL T3

QBRELIS T3 AL

quinapril hcl T1


ramipril T1


T3

trandolapril T1


VASERETIC T3

VASOTEC T3

ZESTORETIC T3

ZESTRIL T3


DIGITEK T1

DIGOX T1






T9





T9SP ()


LOVAZA T3




NIASPAN T3



64





atenolol oral T1



T3




BYSTOLIC T3

BYVALSON T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

CORZIDE T3

DUTOPROL T9

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9




LOPRESSOR ORAL T3







nebivolol hcl T1

pindolol T1



propranolol-hctz T1

SORINE T1

sotalol hcl oral T1

65


SOTYLIZE T3

TENORETIC 100 T3

TENORETIC 50 T3

TENORMIN T3


TOPROL XL T3

ZIAC T3



atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3




pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3



66





COLESTID T3

colestipol hcl T1

PREVALITE T1








T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1

67



T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9


T3

68


TAZTIA XT T1


T1

TIAZAC T3



T1


T1


VERELAN T3

VERELAN PM T3


acetazolamide er T1




CORLANOR T3 ST

RANEXA T3

ranolazine er T1



Cardiotonic Agents

DIGITEK T1

DIGOX T1






T9


CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

69


clonidine T1

clonidine hcl er T2




T3

methyldopa oral T1



T9


ezetimibe T1




ROSZET T9

VYTORIN T3

ZETIA T3



NORPACE T3

NORPACE CR T2









PHENYTEK T2








propafenone hcl T1

70






atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3



pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3






T3

dofetilide T2

MULTAQ T3


71




SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TIKOSYN T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1


T1

TIAZAC T3

72



T1


T1


VERELAN T3

VERELAN PM T3


ADALAT CC T3

AFEDITAB CR T1


CONJUPRI T9

felodipine er T1

isradipine T1





T1


nifedipine oral T1


nisoldipine er T2




PROCARDIA XL T3


T3

Dihydropyridines

ADALAT CC T3

AFEDITAB CR T1







73


AZOR T3 ST


CONJUPRI T9

CONSENSI T9

EXFORGE T3

EXFORGE HCT T3

felodipine er T1

isradipine T1








T1


nifedipine oral T1


nisoldipine er T2





PRESTALIA T3 ST

PROCARDIA XL T3


T3


TRIBENZOR T3

TWYNSTA T3

Direct Vasodilators

BIDIL T3



minoxidil oral T1


ELIXOPHYLLIN T3

THEO-24 T2

74



T1


T1




T9


T1




T1



FENOGLIDE T9

FIBRICOR T9

gemfibrozil oral T1

LIPOFEN T9

LOPID T3

TRICOR T3


TRILIPIX T3


ALTOPREV T9




CRESTOR T3

EZALLOR SPRINKLE T9



flolipid T9



LESCOL XL T9

LIPITOR T3

LIVALO T9

lovastatin oral T1

75



T3



ROSZET T9



VYTORIN T3


ZYPITAMAG T9


DIBENZYLINE T9




bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1




ALDACTONE T3

CAROSPIR T9

eplerenone T1

INSPRA T3





ALDACTONE T3

CAROSPIR T9

eplerenone T1

76


INSPRA T3



BIDIL T3

GONITRO T9




T1




MINITRAN T1

NITRO-BID T1


T3


T2

nitroglycerin er T1




NITROLINGUAL T3

NITROMIST T3

NITROSTAT T1

NITRO-TIME T1

Pcsk9 Inhibitors







ADCIRCA T9

CIALIS T9

cilostazol T1




77






STAXYN T9

STENDRA T9





VIAGRA T9


ALDACTONE T3


CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3


Renin Inhibitors


TEKTURNA T9

TEKTURNA HCT T2 ST




DIURIL T2




indapamide oral T1

metolazone T1

THALITONE T9


ADALAT CC T3

AFEDITAB CR T1


78




T3


T3


T9


T2


T9


T3

CARTIA XT T1



CONJUPRI T9

CORLANOR T3 ST


T1


T1


T9


T9


T9


dilt-xr T1





MATZIM LA T9




T1


79


nifedipine oral T1





PROCARDIA XL T3

TAZTIA XT T1


T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3



Adamantanes (Cns)


GOCOVRI T9

OSMOLEX ER T9




LOMAIRA T3 ST




Amphetamines

ADDERALL T3 AL





ADZENYS ER T9

ADZENYS XR-ODT T9

80


amphetamine er T9





DESOXYN T9














DYANAVEL XR T9


EVEKEO ODT T9


MYDAYIS T9

PROCENTRA T1





T9







ALLZITAL T9

APADAZ T9


T9

81






T9




T9





T9







T1


T9


T1

HYOPHEN T9


LYRICA CR T9

NEURONTIN T3

NORCO T3



T9


T1


T3

pregabalin er T9

PRIMLEV T9

PROLATE T9


82



ULTRACET T3

URIBEL T9

VANATOL LQ T9




VTOL LQ T9


QSYMIA T3 ST


CONTRAVE T3 ST

IMCIVREE T9










acetazolamide er T1








T1 ST






CARBATROL T3 ST

83


DEPAKOTE T3

DEPAKOTE ER T3


T3





T1


T1


ELEPSIA XR T9


EPITOL T1

EPRONTIA T9

EQUETRO T3 ST
















84







KEPPRA ORAL T3

KEPPRA XR T3



LAMICTAL ODT T9



T3



















levetiracetam er T1






NEURONTIN T3

oxcarbazepine T1



85









QUDEXY XR T9



SABRIL T9














TOPAMAX T3





TRILEPTAL T3

TROKENDI XR T9





86










ZONEGRAN T3

zonisamide oral T1


APLENZIN T9









T1


T9


FORFIVO XL T9

mirtazapine oral T1


REMERON SOLTAB T3








T3

Antimanic Agents

ABILIFY MYCITE T9



87













T1 ST






CARBATROL T3 ST

DEPAKOTE T3

DEPAKOTE ER T3


T3


T1


T1


EPITOL T1

EQUETRO T3 ST

GEODON ORAL T3

LAMICTAL ODT T9



T3









88












lithium T1



LITHOBID T3








T1




T3





T2

SAPHRIS T9


SEROQUEL T3







89











ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3


ANAPROX DS T3




BUFFERIN T3 PV AL



CAFERGOT T9


CAMBIA T9

DEPAKOTE T3

DEPAKOTE ER T3


T3




T1


T1



T3

ELYXYB T9

EPRONTIA T9

ERGOMAR T3



90


HEMANGEOL T3 AL


INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9


MIGERGOT T9

MIGRANAL T9


T9











TOPAMAX T3




TROKENDI XR T9

TRUDHESA T9




ADASUVE T9









91







EDLUAR T9



HETLIOZ LQ T9




T1

INTERMEZZO T9


meprobamate T9




T1


T3


T9

ramelteon T1 AL

ROZEREM T3 AL

VISTARIL T3







ABILIFY MYCITE T9






92

















T3

GEODON ORAL T3

INVEGA T9


LYBALVI T9















T1


93





T3





T2

SAPHRIS T9


SEROQUEL T3






T9



ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3





primidone oral T1


ALLZITAL T9

ASCOMP-CODEINE T2





T9

94





T9




DONNATAL T9




T9






VANATOL LQ T9

VTOL LQ T9


ATIVAN ORAL T3



clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3

KLONOPIN T3




LOREEV XR T9




SYMPAZAN T9

95



VALIUM T3













ATIVAN ORAL T3






clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3




KLONOPIN T3

LIBRAX T9




LOREEV XR T9




96


oxazepam T1

quazepam T9


SYMPAZAN T9






VALIUM T3

XANAX T3





Butyrophenones


haloperidol oral T1












97




T1

COMTAN T3

entacapone T1

ONGENTYS T3 ST

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3










EXSERVAN T9















98







RILUTEK T9






TIGLUTIK T9

VYLEESI T9



XYWAV T9




CONSENSI T9

ELYXYB T9

SEGLENTIS T9

Dopamine Precursors

carbidopa oral T9



T1


T1

DHIVY T3

INBRIJA T9




99






SINEMET CR T3

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3



cabergoline T1

PARLODEL T3

Fibromyalgia Agents
























T9

100


Hydantoins





PHENYTEK T2








EMSAM T3 ST






EMSAM T3 ST


NARDIL T3

PARNATE T3








T9



MIRAPEX T3





101




T3 ST

ropinirole hcl T1


Opiate Agonists





ACTIQ T9

APADAZ T9


T9

ASCOMP-CODEINE T2


T9


T9






CONZIP T9




DOLOPHINE T3

DSUVIA T9










T9

102



T9


T9







T1


T9


T1


T1











T9

LAZANDA T9










T1

MORPHABOND ER T9

103



T1



T9





T3

NORCO T3

NUCYNTA T3 ST










T9


T1






T3

PRIMLEV T9

PROLATE T9

QDOLO T9

SEGLENTIS T9




104




T9








ULTRACET T3








Opiate Antagonists






















105




























BUTRANS T9














106



ANAPROX DS T3


T9

CAMBIA T9

DAYPRO T3

diclofenac T9








diflunisal oral T1

DUEXIS T9


T3

etodolac er T2

etodolac oral T1

FELDENE T3



FLECTOR EXTERNAL T9



T1




INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1







LOFENA T9

107







nabumetone oral T1



T9









oxaprozin T2

piroxicam oral T1

QMIIZ ODT T9

RELAFEN DS T9

SPRIX T9

sulindac oral T1


TIVORBEX T9

tolmetin sodium T2


VIMOVO T9

VIVLODEX T9

ZIPSOR T9

ZORVOLEX T9

Phenothiazines



COMPRO T1






108


prochlorperazine T1





ADHANSIA XR T9


T9


ASCOMP-CODEINE T2

AZSTARYS T9


T9




T9




CAFERGOT T9






COTEMPLA XR-ODT T9




ELIXOPHYLLIN T3





T9


FOCALIN T3 AL


JORNAY PM T9

109



T1 AL
















T1 AL




MIGERGOT T9

norgesic forte T9


T9


T9




RELEXXII T9

RITALIN T3 AL



THEO-24 T2


T1


T1


VANATOL LQ T9

110


VTOL LQ T9

Salicylates

AGGRENOX T3

ASCOMP-CODEINE T2





BUFFERIN T3 PV AL







DOANS PILLS T1

DURLAZA T9



norgesic forte T9


T9


T9

salsalate oral T1


















111


EFFEXOR XR T3






venlafaxine hcl T1


T1


T9





FROVA T9






T9


T9


T3






ONZETRA XSAIL T9

RELPAX T9


112






T9




T1


T9




T1


TOSYMRA T9









BRISDELLE T9
















113














PAXIL T3





PEXEVA T9







T9





nefazodone hcl T1






Succinimides

CELONTIN T2


ZARONTIN T3

114


Thioxanthenes

thiothixene oral T1



amoxapine T1

















maprotiline hcl T1







SURMONTIL T3

TOFRANIL T3






115







XENAZINE T9




T1








Dental Agents

Dental Agents


T3


Devices

Devices








116












T2


T2




























117

















T2




T2





NOVOFINE PLUS T2












T1


T2


118


V-GO 20 T2

V-GO 30 T2

V-GO 40 T2


Diagnostic Agents



CORTROPHIN T9

Diabetes Mellitus


























MICRODOT TEST T3 ST




119








Diagnostic Agents



CANDIN T9

Ketones

KETOSTIX T3

Tuberculosis

APLISOL T9


Alkalinizing Agents

cytra k crystals T1

cytra-2 T9

CYTRA-3 T9

cytra-k T9

ORACIT T3





tricitrates T9

UROCIT-K 10 T3

UROCIT-K 15 T3

UROCIT-K 5 T3

virtrate-2 T9

virtrate-3 T9

virtrate-k T9

Ammonia Detoxicants




120



enulose T1

generlac T1

KRISTALOSE T9



LITHOSTAT T9




Caloric Agents

DOJOLVI T9

ENLYTE T9


FERREX 150 PLUS T9

FOLBEE AR T9

l-leucine T9

macuvex T9

macuzin T9

METAFOLBIC PLUS T9

methaver T9

methazel T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9

PURALOR CI T9

SUPERVITE T9

zyvit T9


acetazolamide er T1



ELIXOPHYLLIN T3

THEO-24 T2


T1

121



T1



Loop Diuretics

bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1


















T9

PHOSLO T3

PHOSLYRA T3 ST

122



RENVELA T9









SPS T1




ALDACTONE T3



CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3

MAXZIDE T3

MAXZIDE-25 T3





active fe T9


BACMIN T9

123




CENTRATEX T9

choice-tabs T9


CORVITA 150 T9



CORVITE FREE T9


DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


T1

FERIVA 217 T9

FERIVAFA T9


FOLBEE PLUS CZ T9


GALZIN T9


HEMATRON T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


IROSPAN 246 T9

KLOR-CON 10 T1

KLOR-CON M10 T1

KLOR-CON M15 T1

KLOR-CON M20 T1



T3

KLOR-CONEF T1

K-PHOS-NEUTRAL T9


T3

124







neonatal + dha T9

NEPHPLEX RX T9

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9


PHOSLO T3

PHOSLYRA T3 ST

phos-nak T9


pnv-dha T1

pnv-select T1


T1


T1


T1



T3



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1



PRENATE AM T3


T3

PRENATE PIXIE T3

purefe plus T9

125



QUFLORA FE T9

REQ 49+ T9

se-tan plus T9



STROVITE ONE T9

SUPERVITE T9

TANDEM PLUS T9

tl-hem 150 T9

tristart dha T9

TRIVEEN-DUO DHA T1

tri-zel T9


v-c forte T9

VIC-FORTE T9

VINATE M T1


VITACEL T1

VITAFOL-ONE T3

VITAL-D RX T9

VITATRUE T3


Thiazide Diuretics

ACCURETIC T3





ATACAND HCT T3


T3


BENICAR HCT T3




CORZIDE T3

DIOVAN HCT T3

DIURIL T2

126


DUTOPROL T9

EDARBYCLOR T3 ST


EXFORGE HCT T3



HYZAAR T3






T3

MAXZIDE T3

MAXZIDE-25 T3




MICARDIS HCT T3




propranolol-hctz T1



TEKTURNA HCT T2 ST

telmisartan-hctz T1



TRIBENZOR T3


VASERETIC T3

ZESTORETIC T3

ZIAC T3




indapamide oral T1

metolazone T1

TENORETIC 100 T3

127


TENORETIC 50 T3

THALITONE T9

Uricosuric Agents


probenecid oral T1








Enzymes

Enzymes














128










ALPHAGAN P T3





COMBIGAN T9

SIMBRINZA T2

Antiallergic Agents

ALAWAY T1

ALOCRIL T3 ST

ALOMIDE T2






BEPREVE T9



DYMISTA T3 ST

ELESTAT T3

epinastine hcl T1



NAPHCON-A T9



129




PATANASE T3

PATANOL T3

PAZEO T3 ST

TICALAST T9

ZADITOR T1

ZERVIATE T9


AZASITE T3 ST


T1



BLEPH-10 T3

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

CETRAXAL T3

CILOXAN T3

CIPRO HC T2

CIPRODEX T3





COLY-MYCIN S T3






MAXITROL T3

MOXEZA T3




T1


T1


T1

130



T1


OCUFLOX T3


ofloxacin otic T1

OTOVEL T2 AL


POLYTRIM T3

PRED-G T2

PRED-G SOP T3



T9





TOBRADEX ST T3 ST





VIGAMOX T3

ZYLET T3 ST

ZYMAXID T3 ST

Antifungals (Eent)

NATACYN T3

Antivirals (Eent)


VIROPTIC T3

ZIRGAN T3



BETIMOL T3

BETOPTIC-S T3 ST


carteolol hcl T1

COMBIGAN T9

COSOPT T3

131



ISTALOL T9






TIMOPTIC T3

TIMOPTIC OCUDOSE T3

TIMOPTIC-XE T3


acetazolamide er T1


AZOPT T3


brinzolamide T2

COSOPT T3




SIMBRINZA T2

TRUSOPT T3


ALREX T3 ST



BECONASE AQ T9

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

budesonide nasal T9

CIPRO HC T2

CIPRODEX T3



COLY-MYCIN S T3

CORTANE-B OTIC T3


DEXYCU T9

difluprednate T1 ST

DUREZOL T3 ST

132


DYMISTA T3 ST


FLAREX T2




FML T2

FML FORTE T3

FML LIQUIFILM T3

INVELTYS T3 ST

LOTEMAX T9

LOTEMAX SM T3 ST


MAXIDEX T3

MAXITROL T3



NASONEX T9


T1


T1


OMNARIS T9

OTOVEL T2 AL

PRED FORTE T3

PRED MILD T3

PRED-G T2

PRED-G SOP T3






T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9


TICALAST T9

133




TOBRADEX ST T3 ST



XHANCE T9

ZETONNA T9

ZYLET T3 ST



CORTANE-B OTIC T3

PERIDEX T3


CEQUA T9







acetic acid otic T1



BSS T1

BSS PLUS T3





GASTROCROM T3



MUCOSITISRX T9

134


OXERVATE T4



TICALAST T9

TYRVAYA T9


ACULAR T3

ACULAR LS T3

ACUVAIL T3 ST







NEVANAC T3 ST



T9



CORTANE-B OTIC T3



Miotics

ISOPTO CARPINE T3



VUITY T9

Mydriatics




T3

CYCLOMYDRIL T3


HOMATROPAIRE T1

ISOPTO ATROPINE T3

135



T1






ROCKLATAN T3 ST

TRAVATAN Z T3


VYZULTA T9

XALATAN T3

XELPROS T2

ZIOPTAN T3


RHOPRESSA T3 ST

ROCKLATAN T3 ST

Vasoconstrictors

ADRENALIN NASAL T9

CYCLOMYDRIL T3


NAPHCON-A T9


T1


UPNEEQ T9



AKYNZEO ORAL T9



ondansetron T1



SUSTOL T9




BUFFERIN T3 PV AL

136





PLENITY T9

ZEGERID T9

ZEGERID OTC T3

Antidiarrhea Agents




FUSION SPRINKLES T9



MYTESI T9

opium T9

paregoric T9

PYLERA T9

RESTORA RX T9











T1


T3


T9

scopolamine T1

SYNDROS T9


137



T3

Antiflatulents




BONJESTA T9

COMPRO T1

DICLEGIS T9



prochlorperazine T1


TIGAN ORAL T3




APRISO T9


AZULFIDINE T3






DIPENTUM T3







138







ROWASA RECTAL T3




PYLERA T9

TALICIA T9








FLAGYL T3






bisacodyl oral T3

bisacodyl rectal T9

BUFFERIN T3 PV AL




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3

139


CLENPIQ T3


T3



fe 90 plus T9

FERIVA 217 T9

FERIVAFA T9

FERRALET 90 T9

ferraplus 90 T9


GAVILYTE-C T1 PV

GAVILYTE-G T1 PV


GLYCOLAX T9

GOLYTELY T3

HEMATRON-AF T9


INATAL GT T1



MOVIPREP T3


mynate 90 plus T1

NATALVIRT FLT T9

NEPHRON FA T9

NEXA PLUS T3


OSMOPREP T3





PEG-PREP T1 PV

PLENVU T3

pnv-dha+docusate T1





140


SUTAB T9

TARON-PREX T2


tl-hem 150 T9

TRILYTE T1 PV


ACTIGALL T3

RELTONE T9

URSO 250 T3

URSO FORTE T3




Digestants











ALLI T3 ST


BYLVAY T9

BYLVAY (PELLETS) T9

BYNFEZIA PEN T9



141



























IBSRELA T9


LIVMARLI T9



142



MYCAPSSA T9













REMICADE T9












XENICAL T9





DUEXIS T9

143






nizatidine T3










AKYNZEO ORAL T9




T9

EMEND TRI-PACK T9

VARUBI ORAL T9

Prokinetic Agents

GIMOTI T9


T1



REGLAN ORAL T3


Prostaglandins


T9

CYTOTEC T3


misoprostol oral T1

Protectants

CARAFATE T3 ST



144



ACIPHEX T9


T9


DEXILANT T9

dexlansoprazole T9



T9


FIRST-OMEPRAZOLE T3



NEXIUM T9


T9


T3






PREVACID T9

PREVACID 24HR T3

PRILOSEC OTC T3

PROTONIX ORAL T9


VIMOVO T9

YOSPRALA T9

ZEGERID T9

ZEGERID OTC T3

Gold Compounds

Gold Compounds

RIDAURA T9





145






DEPEN TITRATABS T9

EXJADE T5









T9SP ()



SYPRINE T9



Adrenals

ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9

146





ALKINDI SPRINKLE T9

ALVESCO T9








ASMANEX HFA T9

BREO ELLIPTA T9









CORTEF T3


dexabliss T9






T9

DEXONTO 04 T3


T9


EMFLAZA T9





147








T3



HEMADY T9

HIDEX 6-DAY T9


INTRAROSA T3 PA

MEDROL T3


MILLIPRED T9


NASONEX T9

ORAPRED ODT T9

ORTIKOS T9



T1


T9




T1




T3



QVAR REDIHALER T1

RAYOS T9

SINUVA T9

148





TAPERDEX 12-DAY T9


T9

TARPEYO T9

TRELEGY ELLIPTA T2


WIXELA INHUB T3

XHANCE T9

zcort 7-day T9

ZILRETTA T9


acarbose oral T1

GLYSET T3

PRECOSE T3

Amylinomimetics





Androgens

ANADROL-50 T9


T9


T9


T9

COVARYX T9

COVARYX HS T9




T9



149



FORTESTA T9

JATENZO T9

methitest T9


NATESTO T9

OXANDRIN T3

oxandrolone oral T3

STRIANT T9

TESTIM T9


T1



T9







TLANDO T9

VOGELXO PUMP T9


T9

XYOSTED T9




CYCLOSET T3




Antiestrogens

anastrozole oral T1

ARIMIDEX T3

AROMASIN T3

exemestane T2

150


FEMARA T3




letrozole oral T1

Antigonadtropins











PROGLYCEM T9





MIACALCIN NASAL T3


Antithyroid Agents

methimazole oral T1

151



TAPAZOLE T3

Biguanides

ACTOPLUS MET T3



FORTAMET T9


GLUCOPHAGE T3

GLUCOPHAGE XR T3

GLUMETZA T9











KAZANO T9





metformin hcl er T1


T9



T1



RIOMET T9







152









T2



Contraceptives

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV

153



T3 PV

ECONTRA EZ T1 PV


ELLA T1


EMOQUETTE T1

ENPRESSE-28 T1 PV

ERRIN T1 PV

ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


154



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV

MELODETTA 24 FE T9

MIBELAS 24 FE T9





MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV

NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV


NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV


T1 PV



T9


T1 PV

155


NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV

PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9

156

















KAZANO T9





NESINA T9


OSENI T9











EVISTA T3

FARESTON T9

OSPHENA T2 PA

raloxifene hcl T1

SOLTAMOX T9


157



Estrogens

ACTIVELLA T3

ALORA T2

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA T9

CLIMARA PRO T9

COMBIPATCH T2

COVARYX T9

COVARYX HS T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DELESTROGEN T3





DOTTI T1

158



ELESTRIN T3


EMOQUETTE T1

ENPRESSE-28 T1 PV




ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1





T2


ESTRING T3


ESTROSTEP FE T3


EVAMIST T2

FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

FEMRING T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV




JINTELI T1

JOLESSA T1 PV

JULEBER T1

159


JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYLLANA T1

marlissa T1 PV

MELODETTA 24 FE T9


T2


MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

160



T3

MIRCETTE T9


NATAZIA T9

NECON 0535 (28) T1 PV

NEXTSTELLIS T9



T1 PV


T1 PV


T1


T9


T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


PORTIA-28 T1 PV

PREFEST T3



PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

161


SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TWIRLA T9

TYDEMY T9


VELIVET T1 PV

VIVELLE-DOT T3


YASMIN 28 T9

YAZ T9

YUVAFEM T1













Gonadotropins






162



MENOPUR T2

NOVAREL T3 ST

OVIDREL T2

PREGNYL T1

SYNAREL T9

Incretin Mimetics

ADLYXIN T3 ST




T3 ST


T3 ST





RYBELSUS T9

SAXENDA T9




T2

WEGOVY T9



HUMULIN 7030 T1


T1

HUMULIN N T1


T1

NOVOLIN 7030 T3 ST


NOVOLIN N T3 ST


163


Leptins

MYALEPT T5


)


BASAGLAR KWIKPEN T9


LANTUS T1


T1

LEVEMIR T3 ST


SEMGLEE T9

SEMGLEE (YFGN) T9



TOUJEO SOLOSTAR T1

TRESIBA T9



Meglitinides

nateglinide T1


repaglinide T1

STARLIX T3

Parathyroid Agents


T9







164


Pituitary


CORTROPHIN T9

DDAVP ORAL T3







T9




T9

NOCDURNA T9

NOCTIVA T9




T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



SKYTROFA T9


ZOMACTON T9


165


Progestins

ACTIVELLA T3

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYGESTIN T3

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA PRO T9

COMBIPATCH T2

CRINONE T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV


T3 PV

ECONTRA EZ T1 PV


166


ELLA T1


EMOQUETTE T1


ENPRESSE-28 T1 PV

ERRIN T1 PV


ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JINTELI T1

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9


167



T1 PV



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV


MEGACE ES T3 ST




MELODETTA 24 FE T9

MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV


NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV

168



NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV



T1 PV



T1


T9


T1 PV

NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV


PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREFEST T3

PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV



PROMETRIUM T3

PROVERA T3

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

169


SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9




ADMELOG T3 ST



T3 ST

APIDRA T3 ST


T3 ST

FIASP T3 ST


FIASP PENFILL T3 ST

HUMALOG T1

170




T1

HUMALOG MIX 5050 T1


T1

HUMALOG MIX 7525 T1


T1






insulin lispro T9




LYUMJEV T1

LYUMJEV KWIKPEN T1

NOVOLOG T9


T9

NOVOLOG MIX 7030 T9


T9


T9


HUMULIN 7030 T1


T1

HUMULIN R T1



T1

NOVOLIN 7030 T3 ST


NOVOLIN R T3 ST

171


























T2




BYNFEZIA PEN T9

MYCAPSSA T9






172




T9




T9





T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



ZOMACTON T9











Sulfonylureas

AMARYL T3

DUETACT T9

glimepiride T1

173


glipizide er T1

glipizide oral T1


T1


GLUCOTROL T3

GLUCOTROL XL T3


glyburide oral T1


GLYNASE T3


Thiazolidinediones

ACTOPLUS MET T3


ACTOS T3



DUETACT T9

OSENI T9

pioglitazone hcl T1



Thyroid Agents

ARMOUR THYROID T2

CYTOMEL T2

EUTHYROX T3

LEVO-T T3





LEVOXYL T1


NP THYROID T1

SYNTHROID T3

THYQUIDITY T9


T2


T2

174



T2


T2


T2


T9


T9


T1


T1



ZTLIDO T9



AVODART T3





JALYN T3 ST

PROPECIA T9

PROSCAR T3

Alcohol Deterrents

ANTABUSE T3

disulfiram oral T1


Antidotes



T1




175






























RENVELA T9



176




SPS T1




Antigout Agents

allopurinol oral T1

ANAPROX DS T3




COLCRYS T9


T3


GLOPERBA T9

INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1


MITIGARE T9


T9








probenecid oral T1


ZYLOPRIM T3


EXONDYS 51 T9

177



VILTEPSO T9



T9











ALORA T2

ATELVIA T3

BINOSTO T3 ST




CLIMARA T9

DELESTROGEN T3





DOTTI T1

ELESTRIN T3

ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1




178



T2

ESTRING T3



EVAMIST T2

EVISTA T3

FEMRING T3




LYLLANA T1


T2


MIACALCIN NASAL T3


T3



raloxifene hcl T1






VIVELLE-DOT T3

YUVAFEM T1


FIRAZYR T9





179


Cariostatic Agents

DENTA 5000 PLUS T1

DENTAGEL T1



FLORIVA PLUS T9


T3

LUDENT T1



T1 AL


MYKIDZ IRON FL T9

PREVIDENT T3



QUFLORA FE T9


T9

sf T1

sf 5000 plus T1









TRI-VI-FLOR T9






RUCONEST T9

180







AZASAN T9



AZULFIDINE T3






COSENTYX T4







T4


181








DEPEN TITRATABS T9











T4
















182













T9


IMURAN T3









leflunomide oral T1



T1

NEORAL T3



183











T9



PLAQUENIL T3


T9

REDITREX T3 ST

REMICADE T9

RIDAURA T9











184







TREXALL T3 ST

XATMEP T3 AL















AZASAN T9



AZULFIDINE T3

185



BAFIERTAM T9







T9


















T4


186









T4




T4




T4




T4











187

















T9


IMURAN T3





KESIMPTA T4




leflunomide oral T1



188







T1

NEORAL T3










PLAQUENIL T3











189
















REMICADE T9





RIDAURA T9









190







TREXALL T3 ST

VUMERITY T9

XATMEP T3 AL






ASTAGRAF XL T3 ST

AZASAN T9






T3 AL









ENVARSUS XR T3 ST

191






IMURAN T3

leflunomide oral T1



















T1



T1 AL

192











NEORAL T3













tacrolimus oral T1

TREXALL T3 ST

XATMEP T3 AL








193





FIRAZYR T9





RUCONEST T9





AMPYRA T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9


betaine T3

bp vit 3 T9

CARDIOVID PLUS T9

CARNITOR ORAL T3

CARNITOR SF T3




CITRANATAL DHA T3

194



T3

coenzyme q10 T2



CYSTADANE T9


DEMSER T9


ENDARI T9


T9



FERIVA 217 T9


FERREX 28 T9


FOLBEE AR T9


IROSPAN 246 T9







levocarnitine sf T1

195


maca T9

METAFOLBIC PLUS T9

metyrosine T9


MULTIGEN FOLIC T9

MULTIGEN PLUS T9


neonatal + dha T9

NEXA PLUS T3

nitisinone T9

NITYR T9

ORFADIN T9

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATE AM T3


T3

PRENATE PIXIE T3



T9

RECORLEV T9




SOLESTA T3


196



TARON-PREX T2

THIOLA T9






tristart dha T9

TRIVEEN-DUO DHA T1


URIBEL T9


VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3




XURIDEN T9

ZAVESCA T9

ZOKINVY T9

Protective Agents




CAYA T3


197


Oxytocics

Oxytocics



PREPIDIL T3

Pharmaceutical Aids

Pharmaceutical Aids

ALPAWASH T9

FREEDOM DERMA-D T9



ADRENALIN NASAL T9


T9




T9


T9








T1

ATROVENT HFA T2













198


Antifibrotic Agents

















Antitussives



BROMFED DM T9









199


HISTEX-AC T9

HYCODAN T9


T1



hydromet T1

maxi-tuss cd T9





T1

TESSALON PERLES T3


T9















200













Expectorants







SSKI T3














201



T9




T1


T3


T9


RYVENT T9



T4




ACCOLATE T3


SINGULAIR T3

zafirlukast T1


ZYFLO T9

ZYFLO CR T9


ALOCRIL T3 ST




GASTROCROM T3

Mucolytic Agents





202



T1



BECONASE AQ T9

budesonide nasal T9

DYMISTA T3 ST





NASONEX T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9

TICALAST T9


XHANCE T9












T3



QVAR REDIHALER T1





BRONCHITOL T9



203




ALLEGRA ALLERGY T9


T9













T9


DYMISTA T3 ST



QUZYTTIR T9

TICALAST T9

ZERVIATE T9







T1


ARCAPTA NEOHALER T3



T1



204


PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2




XOPENEX T3


XOPENEX HFA T9


ADCIRCA T9














T5




T5



205



T5




















VENTAVIS T4 PA

VIAGRA T9


ELIXOPHYLLIN T3

THEO-24 T2

206



T1


T1








ACANYA T9

ACZONE T9

AKTIPAK T9

ALTABAX T3 ST

AMZEEQ T9

AVAR CLEANSER T9


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

BENZACLIN T9



bp 10-1 T9


CENTANY T3

CLENIA PLUS T9







CLINDAGEL T9


T9



207










CLINDESSE T3 ST


dapsone external T9

DUAC T9

ery T1

ERYGEL T1




KLARON T3

METROCREAM T3


METROGEL-VAGINAL T3

METROLOTION T3








NORITATE T9

NUVESSA T9

ONEXTON T9

OVACE PLUS T9

OVACE PLUS WASH T9

OVACE WASH T9



T9


PLEXION NS T9

208








T9



T1


T9


T9


T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

VANDAZOLE T1

VELTIN T9

XEPI T9

ZIANA T9

ZILXI T9


ALA-QUIN T9










EPIFOAM T9

ethyl chloride T9

209







T2











LIDODERM T9



lidorx T9

LIDOTRANS 5 PAK T9

LIVIXIL PAK T9




PRAMOSONE T9


prilovixil T9

PRUDOXIN T9

PYRIDIUM T3


RELADOR PAK PLUS T9

SYNERA T9

XRYLIDERM T9

ZONALON T9



DENAVIR T9

XERESE T9

ZOVIRAX EXTERNAL T9

210


Astringents


DRYSOL T1

VUSION T9

XERAC AC T1








ECOZA T9

ERTACZO T3 ST

EXELDERM T9

EXTINA T9

GYNAZOLE-1 T3

JUBLIA T9






luliconazole T9

LUZU T9

NIZORAL T3






TERAZOL 7 T3



VUSION T9

XOLEGEL T9



GERI-HYDROLAC 12 T9

211


GERI-HYDROLAC 5 T9




urea hydrating T9


lactic acid e T9


ALCORTIN A T9

DERMASORB XM T9

iodoquimez-hc T9

lactic acid e T9


VYTONE T9


MENTAX T9



ATRALIN T3 ST AL

AVITA T9


REFISSA T9

RENOVA T9

RENOVA PUMP T9

RETIN-A T3 AL

RETIN-A MICRO T9









TRI-LUMA T9

TWYNEO T9

VELTIN T9

ZIANA T9


ALA SCALP T9

212



ALA-QUIN T9


ALCORTIN A T9

amcinonide T9



APEXICON E T9

AQUANIL HC T1













BRYHALI T3 ST




CAPEX T9











CLOBEX SPRAY T9



213



CLODERM T9

CLODERM PUMP T9



CORDRAN T9


CORTENEMA T3





DERMASORB HC T9

DERMASORB TA T9

DERMAZENE T9

DESONATE T9














DIPROLENE AF T3


DUOBRII T9



ENSTILAR T9

EPIFOAM T9





214










flurandrenolide T9







HALOG T9


T1


T9


T2



















215


IMPEKLO T9

IMPOYZ T9

iodoquimez-hc T9

KENALOG EXTERNAL T9






LOCOID LIPOCREAM T9


LUXIQ T9





NUCORT T3


OLUX T9

OLUX-E T3

ORALONE T3

PANDEL T9

PRAMOSONE T9


prednicarbate T1



SERNIVO T9

SYNALAR T9

SYNALAR TS T9




TEXACORT T9





216


TOPICORT SPRAY T9





T1



TRIANEX T9


TRI-LUMA T9





VANOS T9

VANOXIDE-HC T9

VERDESO T9

VYTONE T9

WYNZORA T9

XERESE T9

Depigmenting Agents


ESOTERICA FACIAL T9


hydroquinone T9


TRI-LUMA T9

Detergents



VUSION T9






Keratolytic Agents

AVAR CLEANSER T9


217


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

bensal hp T9

bp 10-1 T9


CLENIA PLUS T9

DERMASORB XM T9





T9


PROMISEB T9


rynoderm T9










SALVAX T9



SELRX T9


T9



T1


T9


T9

218



T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

ULTRASAL-ER T9



urea hydrating T9


UTOPIC T9

XALIX T9

xurea T9




ACANYA T9




T1


T9

AKTIPAK T9

ALCORTIN A T9


BENZACLIN T9


BENZEFOAM T9

BENZEFOAMULTRA T9








219








bpo T9




T9






DERMAZENE T9

DUAC T9

EPIDUO T3

EPIDUO FORTE T9

EPSOLAY T9


iodoquimez-hc T9



ONEXTON T9

PERIDEX T3






SELRX T9

SILVADENE T3


SSD T1


SULFAMYLON T3

TWYNEO T9

VANOXIDE-HC T9

220


VYTONE T9






PROFINAC T9


Oxaboroles

KERYDIN T9

tavaborole T9

Pigmenting Agents










EURAX T9





NATROBA T9

OVIDE T3


SKLICE T3


spinosad T1

ULESFIA T3


ABSORICA T9

ABSORICA LD T9


221




ACZONE T9







T1


T9


AKLIEF T9

ALDARA T3


ARAZLO T9

ATRAPRO HYDROGEL T9

AVO CREAM T9




BIAFINE T9













CARAC T9

CELACYN T9

222



CERACADE T9




COSENTYX T4







T4


dapsone external T9

DERMASORB HC T9

DERMULCERA T9








doxycycline T9

DRITHO-CREME HP T9

DUOBRII T9


T4


223



T4



T4



ELETONE T9


EMULSION SB T9

ENSTILAR T9


EPICERAM T9

EPIDUO T3

EPIDUO FORTE T9

FABIOR T9








GELCLAIR T9






imiquimod pump T9




KAMDOY T9


224



LATISSE T9

LOYON T9

LUXAMEND T9


T9

MINOLIRA T9


MIRVASO T9


MUGARD T9



NIVATOPIC PLUS T9

NUVAIL T9

OPZELURA T9

ORACEA T9

ORAMAGICRX T9




PHLAG SPRAY T9


podocon T9

PODOCON-25 T9


PRESERA T9

PROFINAC T9

PROPECIA T9


PRUCLAIR T9

PRUMYX T9

PRUTECT T9

QBREXZA T9

RECEDO T9

225


RECTIV T9


REMICADE T9


ROGAINE T9

ROGAINE MENS T9




SILIQ T5







T9

SONAFINE T9

SORILUX T9







suvicort T9

SYNALAR TS T9

SYNERDERM T9




226


















VANIQA T9


VELTIN T9

VENELEX T9



WINLEVI T9

WYNZORA T9

XIMINO T9


ZIANA T9

ZITHRANOL T3 ST

ZYCLARA T9




Antimuscarinics


DETROL T3


227



T3


flavoxate hcl T1




OXYTROL T9










ELIXOPHYLLIN T3






THEO-24 T2


T1


T1


GEMTESA T9





Vitamins


BACMIN T9

choice-tabs T9

228





CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1


CORVITE FREE T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


FLORIVA PLUS T9

folbee plus T9

FOLBEE PLUS CZ T9


INATAL GT T1




T1 AL





M-VIT T9

MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

229





neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRO-VITE RX T9

NEXA PLUS T3

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9

NIVA-PLUS T9

O-CAL FA T9



pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

230


PRENATE PIXIE T3

PROVIDA OB T3

QUFLORA FE T9


T9


rena-vite T3

rena-vite rx T9

reno caps T9

REQ 49+ T9


T1




STROVITE ONE T9

SUPERVITE T9

TARON-PREX T2


TRICARE T1

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9


tri-zel T9


v-c forte T9

VIC-FORTE T9


VINATE M T1

VINATE ONE T1

virt-caps T9

virt-vite plus T9

VITACEL T1



VITAFOL-OB T3

231


VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITATRUE T3

vp-vite rx T9

Vitamin A

active fe T9

MYKIDZ IRON FL T9

pnv-select T1

TRI-VI-FLOR T9


Vitamin B Complex

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

BEYAZ T9

bp vit 3 T9


CARDIOVID PLUS T9

CENTRATEX T9

CIFEREX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9






DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

232




DIALYVITEZINC T9

durachol T9

fabb T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


T9


FERREX 28 T9


folbee T9

FOLBEE AR T9

folbee plus T9

FOLBEE PLUS CZ T9

FOLBIC T9





FOLIVANE-F T9

FOLIVANE-PLUS T9

FOLIXAPURE T9

folplex 22 T9

FOLTANX T9

FOLTRATE T9


FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

233


HEMATRON-AF T9


hemetab T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9





METAFOLBIC PLUS T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


T1 AL

M-VIT T9



mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

NASCOBAL T9



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9

234


neurin-sl T9

NEXA PLUS T3


NIACOR T1

NICOMIDE T9

NIVA-FOL T9

NIVA-PLUS T9

noxifol-d T9

O-CAL FA T9


ortho df T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

235


purefe plus T9


QUFLORA FE T9


rena-vite T3

rena-vite rx T9

reno caps T9

RESTORA RX T9


revesta T9

roxifol-d T9

SAFYRAL T9


T1


se-tan plus T9


SUPERVITE T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl gard rx T9

tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9

TYDEMY T9



VINATE M T1

VINATE ONE T1

virt-caps T9

236


VIRT-GARD T9

virt-vite T9

virt-vite forte T9

virt-vite plus T9


VITAFOL-OB T3

VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITA-RESPA T9

VITATRUE T3

vp-vite rx T9

zavara T9

Vitamin C

active fe T9

CENTRATEX T9

CITRANATAL BLOOM T3

CORVITA 150 T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


FERREX 150 PLUS T9

FERREX 28 T9


folbee plus T9

FOLBEE PLUS CZ T9

FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

237


FUSION SPRINKLES T9


HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


ICAR-C PLUS T9

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9



MOVIPREP T3

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


MYKIDZ IRON FL T9

mynephrocaps T9

MYNEPHRON T9

NATALVIRT FLT T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9


PLENVU T3

pnv-select T1

purefe plus T9



rena-vite T3

rena-vite rx T9

reno caps T9

se-tan plus T9

TANDEM PLUS T9

taron forte T9

tl icon T9

tl-hem 150 T9

TRICON T9

238


trigels-f forte T9

triphrocaps T9

TRI-VI-FLOR T9


virt-caps T9

virt-vite plus T9

VITAL-D RX T9

vp-vite rx T9

Vitamin D

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9




CIFEREX T9






durachol T9


FOLIXAPURE T9


MYKIDZ IRON FL T9

noxifol-d T9

ortho df T9


pnv-select T1

RAYALDEE T9

REPLESTA T9


REPLESTA NX T9

revesta T9

ROCALTROL T3

roxifol-d T9

TRI-VI-FLOR T9


239


VITAL-D RX T9


T1




zavara T9


Vitamin E

active fe T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

HEMATRON-AF T9


pnv-select T1

tl-hem 150 T9

Vitamin K Activity



240

241

Index




242




243




244




245




246




247




248




249




250




251




252




253




254




255




256




257




258




259




260




261




262




263




264




265




266
















8003681019 8005377697 (TDD)








(TTY 711）


















Antihistamine Drugs

Antihistamine Drugs















T9

RYVENT T9




















T1

4



T9





T1


T3


T9


RYVENT T9

VISTARIL T3


ALAWAY T1










T1



nizatidine T3





PATANASE T3

PATANOL T3

PAZEO T3 ST






5



VISTARIL T3

ZADITOR T1







T1





T3


T9


BROMFED DM T9


HISTEX-AC T9


T1

maxi-tuss cd T9


T1



T9




ALLEGRA ALLERGY T9


T9


ALOMIDE T2





6













T9




QUZYTTIR T9

SEMPREX-D T9





cefadroxil T1




KEFLEX T3


cefaclor er T1


cefprozil T1



cefdinir T1







T3

7



T2




GOCOVRI T9

OSMOLEX ER T9

rimantadine hcl T1




Amebicides

FLAGYL T3

METROGEL-VAGINAL T3




NUVESSA T9


VANDAZOLE T1










ZEMDRI T9

Aminomethylcyclines



SEYSARA T9

8










T1


T1




T3


T3

AUGMENTIN XR T3

Anthelmintics


ALBENZA T9


EMVERM T9




BREXAFEMME T9




PYLERA T9

Antimalarials

ACTICLATE T9

ARAKODA T3



COARTEM T2

DARAPRIM T9

9


DORYX MPC T9


T9





T9



T9


T1


T9


T1


T9



LYMEPAK T9

MALARONE T3

mefloquine hcl T1





MONDOXYNE NL T9

PLAQUENIL T3



QUALAQUIN T3 PA




TARGADOX T9



10



T3



dapsone oral T1






BACTRIM T3

BACTRIM DS T3



dapsone oral T1

FLAGYL T3



MEPRON T3



NEBUPENT T3



PYLERA T9

SOLOSEC T9


T1


tinidazole oral T1


AVELOX ORAL T3




11



T1




cycloserine oral T1


isoniazid oral T1




MYCOBUTIN T2


PRIFTIN T2



RIFADIN ORAL T3

rifampin oral T1





T2










Azole Antifungals


12


DIFLUCAN T3

fluconazole oral T1









tolsura T9












13












Fluorocyclines


T9


FIRVANQ T2

VANCOCIN HCL T9



T1



EPCLUSA T9









14











EPCLUSA T9











15























16



vocabria T9







EDURANT T2

efavirenz T2












17


















CIMDUO T9




DESCOVY T9


T1


18




emtricitabine T3






)


EPIVIR T3
















TEMIXYS T9


19






VIDEX EC T3


T2




















20













ritonavir T1



















21















acyclovir oral T1







LAGEVRIO T2

molnupiravir T2



SITAVIG T9





22







ZOVIRAX ORAL T3










T3



ZITHROMAX Z-PAK T3










Pleuromutilins

XENLETA ORAL T9

23


Polyene Antifungals






AVELOX ORAL T3

BAXDELA T9





T1








MYCOBUTIN T2

PRIFTIN T2


RIFADIN ORAL T3

rifampin oral T1




AZULFIDINE T3


BACTRIM T3

BACTRIM DS T3



T1


24




ACTICLATE T9


DORYX MPC T9


T9

doxycycline T9





T9



T9


T1


T9


T1

LYMEPAK T9



T9




MINOLIRA T9

MONDOXYNE NL T9


ORACEA T9

PYLERA T9


T9

TARGADOX T9



25



T3


XIMINO T9


BACTRIM T3

BACTRIM DS T3



HYOPHEN T9

MACROBID T3


T3





T1



PRIMSOL T9


T1



URIBEL T9








ALKERAN ORAL T3

26






anastrozole oral T1

ARIMIDEX T3

AROMASIN T3








bicalutamide T1









27



CASODEX T3












DROXIA T3

EMCYT T2








exemestane T2


FARESTON T9

28






FEMARA T3

flutamide T1






GLEEVEC T9


T3


HYDREA T3

hydroxyurea oral T1






29





















30



















31


letrozole oral T1









MEGACE ES T3 ST






melphalan T2




T1

MYLERAN T3



nilutamide T1

32






OGIVRI T9














33










SIKLOS T9

SOLTAMOX T9












34




















TREXALL T3 ST





35




















36






XATMEP T3 AL


















YONSA T9


37






ZYTIGA T9



GRASTEK T3 AL

ODACTRA T3 AL

ORALAIR T3 AL











38





RAGWITEK T3 AL


ZINPLAVA T9

Toxoids










T6 - $0 Copay



T6 - $0 Copay


T6 - $0 Copay





Vaccines

ACTHIB T9











39


BIOTHRAX T9






DENGVAXIA T9



























IXIARO T9




T6 - $0 Copay





40



T6 - $0 Copay



T9









T6 - $0 Copay


T6 - $0 Copay







stamaril T9


T9





T9


T9





VIVOTIF T9

YF-VAX T9



Autonomic Drugs


ADRENALIN NASAL T9

41





T9

BROMFED DM T9










T9


T9


T9





T1


SEMPREX-D T9







CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

clonidine T1

clonidine hcl er T2

42



HISTEX-AC T9


T3

LUCEMYRA T9

maxi-tuss cd T9

methyldopa oral T1

midodrine hcl T1


T9



ANASPAZ T3



T1

ATROVENT HFA T2


T9





CUVPOSA T3 AL

DARTISLA ODT T9




DONNATAL T9

DUAKLIR PRESSAIR T9

GLYCATE T9


T9



HYCODAN T9



hydromet T1

HYOPHEN T9

43



T1








LEVSINSL T3

LIBRAX T9





NULEV T1

oscimin sr T1



QBREXZA T9

scopolamine T1









SYMAX DUOTAB T3



T3

TRELEGY ELLIPTA T2


T9

URIBEL T9


YUPELRI T9



44










KLS QUIT2 T3 PV

KLS QUIT4 T3 PV

NICODERM CQ T9

NICORETTE T9









AMRIX T9





T9





FEXMID T9

LORZONE T9



ROBAXIN ORAL T3

ROBAXIN-750 T3

SKELAXIN T9



ZANAFLEX T3

45








FLEQSUVY T9


T9

LYVISPAH T9

OZOBAX T9



T3

BYSTOLIC T3

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



nebivolol hcl T1

pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3



CARDURA T3

CARDURA XL T3 ST


MINIPRESS T3

46





CAFERGOT T9

DIBENZYLINE T9




ERGOMAR T3


MIGERGOT T9

MIGRANAL T9


TRUDHESA T9


ADLARITY T9

ARICEPT T3



donepezil hcl T1








T9









SALAGEN T3

47



alfuzosin hcl er T1

carvedilol T1


COREG T3

COREG CR T3 ST


FLOMAX T3

JALYN T3 ST


RAPAFLO T3 ST

silodosin T2 ST

tamsulosin hcl T1

UROXATRAL T3


ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9








T1



ARCAPTA NEOHALER T3



BREO ELLIPTA T9





DUAKLIR PRESSAIR T9



48



T3






T1



PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2






TRELEGY ELLIPTA T2



WIXELA INHUB T3

XOPENEX T3


XOPENEX HFA T9



atenolol oral T1




LOPRESSOR ORAL T3



49


TENORMIN T3

TOPROL XL T3


norgesic forte T9



T9


T9


Antianemia Drugs














CEPROTIN T3



CABLIVI T4



OXBRYTA T9

50




TAVALISSE T9


COUMADIN ORAL T2

JANTOVEN T1



BEVYXXA T9
























51








MULPLETA T9















T5



52




UDENYCA T9


ZIEXTENZO T9



Hemostatics














DDAVP ORAL T3




53





















LYSTEDA T3



NOCDURNA T9


54





















Heparins




55









T5


)






T5


)


T1




Iron Preparations


active fe T9

CENTRATEX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9

CORVITE 150 T9

56


corvite fe T9


fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9

FERREX 150 T9


T9


FERREX 150 PLUS T9

FERREX 28 T9



FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN T9

HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

HEMATRON-AF T9


hemetab T9

HEMOCYTE T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9

57




MULTIGEN FOLIC T9

MULTIGEN PLUS T9

M-VIT T9


MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHRON FA T9

NEXA PLUS T3

NIVA-PLUS T9

NUFERA T9

O-CAL FA T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1


PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1






58



prenatal plus T1





T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

purefe plus T9


QUFLORA FE T9


T1


se-tan plus T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

tristart dha T9

TRIVEEN-DUO DHA T1


VINATE M T1

VINATE ONE T1



VITAFOL-OB T3

VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3

wee care T1 PV AL

59




NASCOBAL T9

neurin-sl T9


AGGRENOX T3





BRILINTA T2

BUFFERIN T3 PV AL


cilostazol T1



DURLAZA T9





YOSPRALA T9



AGRYLIN T3

anagrelide hcl T1

Thrombolytic Agents




BUFFERIN T3 PV AL





CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

60


COREG CR T3 ST



MINIPRESS T3




CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST



MINIPRESS T3




ATACAND T3

AVAPRO T3

BENICAR T3


COZAAR T3


EDARBI T3 ST

irbesartan T1


MICARDIS T3


telmisartan T1







ATACAND T3

ATACAND HCT T3

61



T3

AVAPRO T3

AZOR T3 ST

BENICAR T3

BENICAR HCT T3

BYVALSON T3 ST



COZAAR T3


DIOVAN HCT T3

EDARBI T3 ST

EDARBYCLOR T3 ST


EXFORGE T3

EXFORGE HCT T3

HYZAAR T3

irbesartan T1




MICARDIS T3

MICARDIS HCT T3




telmisartan T1


telmisartan-hctz T1

TRIBENZOR T3

TWYNSTA T3





ACCUPRIL T3



captopril oral T1

62






lisinopril oral T1


T3




PRESTALIA T3 ST

PRINIVIL T3

quinapril hcl T1

ramipril T1

trandolapril T1

VASOTEC T3

ZESTRIL T3


ACCUPRIL T3

ACCURETIC T3





captopril oral T1








lisinopril oral T1



T3


T3



63






PRINIVIL T3

QBRELIS T3 AL

quinapril hcl T1


ramipril T1


T3

trandolapril T1


VASERETIC T3

VASOTEC T3

ZESTORETIC T3

ZESTRIL T3


DIGITEK T1

DIGOX T1






T9





T9SP ()


LOVAZA T3




NIASPAN T3



64





atenolol oral T1



T3




BYSTOLIC T3

BYVALSON T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

CORZIDE T3

DUTOPROL T9

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9




LOPRESSOR ORAL T3







nebivolol hcl T1

pindolol T1



propranolol-hctz T1

SORINE T1

sotalol hcl oral T1

65


SOTYLIZE T3

TENORETIC 100 T3

TENORETIC 50 T3

TENORMIN T3


TOPROL XL T3

ZIAC T3



atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3




pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3



66





COLESTID T3

colestipol hcl T1

PREVALITE T1








T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1

67



T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9


T3

68


TAZTIA XT T1


T1

TIAZAC T3



T1


T1


VERELAN T3

VERELAN PM T3


acetazolamide er T1




CORLANOR T3 ST

RANEXA T3

ranolazine er T1



Cardiotonic Agents

DIGITEK T1

DIGOX T1






T9


CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

69


clonidine T1

clonidine hcl er T2




T3

methyldopa oral T1



T9


ezetimibe T1




ROSZET T9

VYTORIN T3

ZETIA T3



NORPACE T3

NORPACE CR T2









PHENYTEK T2








propafenone hcl T1

70






atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3



pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3






T3

dofetilide T2

MULTAQ T3


71




SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TIKOSYN T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1


T1

TIAZAC T3

72



T1


T1


VERELAN T3

VERELAN PM T3


ADALAT CC T3

AFEDITAB CR T1


CONJUPRI T9

felodipine er T1

isradipine T1





T1


nifedipine oral T1


nisoldipine er T2




PROCARDIA XL T3


T3

Dihydropyridines

ADALAT CC T3

AFEDITAB CR T1







73


AZOR T3 ST


CONJUPRI T9

CONSENSI T9

EXFORGE T3

EXFORGE HCT T3

felodipine er T1

isradipine T1








T1


nifedipine oral T1


nisoldipine er T2





PRESTALIA T3 ST

PROCARDIA XL T3


T3


TRIBENZOR T3

TWYNSTA T3

Direct Vasodilators

BIDIL T3



minoxidil oral T1


ELIXOPHYLLIN T3

THEO-24 T2

74



T1


T1




T9


T1




T1



FENOGLIDE T9

FIBRICOR T9

gemfibrozil oral T1

LIPOFEN T9

LOPID T3

TRICOR T3


TRILIPIX T3


ALTOPREV T9




CRESTOR T3

EZALLOR SPRINKLE T9



flolipid T9



LESCOL XL T9

LIPITOR T3

LIVALO T9

lovastatin oral T1

75



T3



ROSZET T9



VYTORIN T3


ZYPITAMAG T9


DIBENZYLINE T9




bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1




ALDACTONE T3

CAROSPIR T9

eplerenone T1

INSPRA T3





ALDACTONE T3

CAROSPIR T9

eplerenone T1

76


INSPRA T3



BIDIL T3

GONITRO T9




T1




MINITRAN T1

NITRO-BID T1


T3


T2

nitroglycerin er T1




NITROLINGUAL T3

NITROMIST T3

NITROSTAT T1

NITRO-TIME T1

Pcsk9 Inhibitors







ADCIRCA T9

CIALIS T9

cilostazol T1




77






STAXYN T9

STENDRA T9





VIAGRA T9


ALDACTONE T3


CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3


Renin Inhibitors


TEKTURNA T9

TEKTURNA HCT T2 ST




DIURIL T2




indapamide oral T1

metolazone T1

THALITONE T9


ADALAT CC T3

AFEDITAB CR T1


78




T3


T3


T9


T2


T9


T3

CARTIA XT T1



CONJUPRI T9

CORLANOR T3 ST


T1


T1


T9


T9


T9


dilt-xr T1





MATZIM LA T9




T1


79


nifedipine oral T1





PROCARDIA XL T3

TAZTIA XT T1


T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3



Adamantanes (Cns)


GOCOVRI T9

OSMOLEX ER T9




LOMAIRA T3 ST




Amphetamines

ADDERALL T3 AL





ADZENYS ER T9

ADZENYS XR-ODT T9

80


amphetamine er T9





DESOXYN T9














DYANAVEL XR T9


EVEKEO ODT T9


MYDAYIS T9

PROCENTRA T1





T9







ALLZITAL T9

APADAZ T9


T9

81






T9




T9





T9







T1


T9


T1

HYOPHEN T9


LYRICA CR T9

NEURONTIN T3

NORCO T3



T9


T1


T3

pregabalin er T9

PRIMLEV T9

PROLATE T9


82



ULTRACET T3

URIBEL T9

VANATOL LQ T9




VTOL LQ T9


QSYMIA T3 ST


CONTRAVE T3 ST

IMCIVREE T9










acetazolamide er T1








T1 ST






CARBATROL T3 ST

83


DEPAKOTE T3

DEPAKOTE ER T3


T3





T1


T1


ELEPSIA XR T9


EPITOL T1

EPRONTIA T9

EQUETRO T3 ST
















84







KEPPRA ORAL T3

KEPPRA XR T3



LAMICTAL ODT T9



T3



















levetiracetam er T1






NEURONTIN T3

oxcarbazepine T1



85









QUDEXY XR T9



SABRIL T9














TOPAMAX T3





TRILEPTAL T3

TROKENDI XR T9





86










ZONEGRAN T3

zonisamide oral T1


APLENZIN T9









T1


T9


FORFIVO XL T9

mirtazapine oral T1


REMERON SOLTAB T3








T3

Antimanic Agents

ABILIFY MYCITE T9



87













T1 ST






CARBATROL T3 ST

DEPAKOTE T3

DEPAKOTE ER T3


T3


T1


T1


EPITOL T1

EQUETRO T3 ST

GEODON ORAL T3

LAMICTAL ODT T9



T3









88












lithium T1



LITHOBID T3








T1




T3





T2

SAPHRIS T9


SEROQUEL T3







89











ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3


ANAPROX DS T3




BUFFERIN T3 PV AL



CAFERGOT T9


CAMBIA T9

DEPAKOTE T3

DEPAKOTE ER T3


T3




T1


T1



T3

ELYXYB T9

EPRONTIA T9

ERGOMAR T3



90


HEMANGEOL T3 AL


INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9


MIGERGOT T9

MIGRANAL T9


T9











TOPAMAX T3




TROKENDI XR T9

TRUDHESA T9




ADASUVE T9









91







EDLUAR T9



HETLIOZ LQ T9




T1

INTERMEZZO T9


meprobamate T9




T1


T3


T9

ramelteon T1 AL

ROZEREM T3 AL

VISTARIL T3







ABILIFY MYCITE T9






92

















T3

GEODON ORAL T3

INVEGA T9


LYBALVI T9















T1


93





T3





T2

SAPHRIS T9


SEROQUEL T3






T9



ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3





primidone oral T1


ALLZITAL T9

ASCOMP-CODEINE T2





T9

94





T9




DONNATAL T9




T9






VANATOL LQ T9

VTOL LQ T9


ATIVAN ORAL T3



clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3

KLONOPIN T3




LOREEV XR T9




SYMPAZAN T9

95



VALIUM T3













ATIVAN ORAL T3






clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3




KLONOPIN T3

LIBRAX T9




LOREEV XR T9




96


oxazepam T1

quazepam T9


SYMPAZAN T9






VALIUM T3

XANAX T3





Butyrophenones


haloperidol oral T1












97




T1

COMTAN T3

entacapone T1

ONGENTYS T3 ST

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3










EXSERVAN T9















98







RILUTEK T9






TIGLUTIK T9

VYLEESI T9



XYWAV T9




CONSENSI T9

ELYXYB T9

SEGLENTIS T9

Dopamine Precursors

carbidopa oral T9



T1


T1

DHIVY T3

INBRIJA T9




99






SINEMET CR T3

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3



cabergoline T1

PARLODEL T3

Fibromyalgia Agents
























T9

100


Hydantoins





PHENYTEK T2








EMSAM T3 ST






EMSAM T3 ST


NARDIL T3

PARNATE T3








T9



MIRAPEX T3





101




T3 ST

ropinirole hcl T1


Opiate Agonists





ACTIQ T9

APADAZ T9


T9

ASCOMP-CODEINE T2


T9


T9






CONZIP T9




DOLOPHINE T3

DSUVIA T9










T9

102



T9


T9







T1


T9


T1


T1











T9

LAZANDA T9










T1

MORPHABOND ER T9

103



T1



T9





T3

NORCO T3

NUCYNTA T3 ST










T9


T1






T3

PRIMLEV T9

PROLATE T9

QDOLO T9

SEGLENTIS T9




104




T9








ULTRACET T3








Opiate Antagonists






















105




























BUTRANS T9














106



ANAPROX DS T3


T9

CAMBIA T9

DAYPRO T3

diclofenac T9








diflunisal oral T1

DUEXIS T9


T3

etodolac er T2

etodolac oral T1

FELDENE T3



FLECTOR EXTERNAL T9



T1




INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1







LOFENA T9

107







nabumetone oral T1



T9









oxaprozin T2

piroxicam oral T1

QMIIZ ODT T9

RELAFEN DS T9

SPRIX T9

sulindac oral T1


TIVORBEX T9

tolmetin sodium T2


VIMOVO T9

VIVLODEX T9

ZIPSOR T9

ZORVOLEX T9

Phenothiazines



COMPRO T1






108


prochlorperazine T1





ADHANSIA XR T9


T9


ASCOMP-CODEINE T2

AZSTARYS T9


T9




T9




CAFERGOT T9






COTEMPLA XR-ODT T9




ELIXOPHYLLIN T3





T9


FOCALIN T3 AL


JORNAY PM T9

109



T1 AL
















T1 AL




MIGERGOT T9

norgesic forte T9


T9


T9




RELEXXII T9

RITALIN T3 AL



THEO-24 T2


T1


T1


VANATOL LQ T9

110


VTOL LQ T9

Salicylates

AGGRENOX T3

ASCOMP-CODEINE T2





BUFFERIN T3 PV AL







DOANS PILLS T1

DURLAZA T9



norgesic forte T9


T9


T9

salsalate oral T1


















111


EFFEXOR XR T3






venlafaxine hcl T1


T1


T9





FROVA T9






T9


T9


T3






ONZETRA XSAIL T9

RELPAX T9


112






T9




T1


T9




T1


TOSYMRA T9









BRISDELLE T9
















113














PAXIL T3





PEXEVA T9







T9





nefazodone hcl T1






Succinimides

CELONTIN T2


ZARONTIN T3

114


Thioxanthenes

thiothixene oral T1



amoxapine T1

















maprotiline hcl T1







SURMONTIL T3

TOFRANIL T3






115







XENAZINE T9




T1








Dental Agents

Dental Agents


T3


Devices

Devices








116












T2


T2




























117

















T2




T2





NOVOFINE PLUS T2












T1


T2


118


V-GO 20 T2

V-GO 30 T2

V-GO 40 T2


Diagnostic Agents



CORTROPHIN T9

Diabetes Mellitus


























MICRODOT TEST T3 ST




119








Diagnostic Agents



CANDIN T9

Ketones

KETOSTIX T3

Tuberculosis

APLISOL T9


Alkalinizing Agents

cytra k crystals T1

cytra-2 T9

CYTRA-3 T9

cytra-k T9

ORACIT T3





tricitrates T9

UROCIT-K 10 T3

UROCIT-K 15 T3

UROCIT-K 5 T3

virtrate-2 T9

virtrate-3 T9

virtrate-k T9

Ammonia Detoxicants




120



enulose T1

generlac T1

KRISTALOSE T9



LITHOSTAT T9




Caloric Agents

DOJOLVI T9

ENLYTE T9


FERREX 150 PLUS T9

FOLBEE AR T9

l-leucine T9

macuvex T9

macuzin T9

METAFOLBIC PLUS T9

methaver T9

methazel T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9

PURALOR CI T9

SUPERVITE T9

zyvit T9


acetazolamide er T1



ELIXOPHYLLIN T3

THEO-24 T2


T1

121



T1



Loop Diuretics

bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1


















T9

PHOSLO T3

PHOSLYRA T3 ST

122



RENVELA T9









SPS T1




ALDACTONE T3



CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3

MAXZIDE T3

MAXZIDE-25 T3





active fe T9


BACMIN T9

123




CENTRATEX T9

choice-tabs T9


CORVITA 150 T9



CORVITE FREE T9


DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


T1

FERIVA 217 T9

FERIVAFA T9


FOLBEE PLUS CZ T9


GALZIN T9


HEMATRON T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


IROSPAN 246 T9

KLOR-CON 10 T1

KLOR-CON M10 T1

KLOR-CON M15 T1

KLOR-CON M20 T1



T3

KLOR-CONEF T1

K-PHOS-NEUTRAL T9


T3

124







neonatal + dha T9

NEPHPLEX RX T9

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9


PHOSLO T3

PHOSLYRA T3 ST

phos-nak T9


pnv-dha T1

pnv-select T1


T1


T1


T1



T3



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1



PRENATE AM T3


T3

PRENATE PIXIE T3

purefe plus T9

125



QUFLORA FE T9

REQ 49+ T9

se-tan plus T9



STROVITE ONE T9

SUPERVITE T9

TANDEM PLUS T9

tl-hem 150 T9

tristart dha T9

TRIVEEN-DUO DHA T1

tri-zel T9


v-c forte T9

VIC-FORTE T9

VINATE M T1


VITACEL T1

VITAFOL-ONE T3

VITAL-D RX T9

VITATRUE T3


Thiazide Diuretics

ACCURETIC T3





ATACAND HCT T3


T3


BENICAR HCT T3




CORZIDE T3

DIOVAN HCT T3

DIURIL T2

126


DUTOPROL T9

EDARBYCLOR T3 ST


EXFORGE HCT T3



HYZAAR T3






T3

MAXZIDE T3

MAXZIDE-25 T3




MICARDIS HCT T3




propranolol-hctz T1



TEKTURNA HCT T2 ST

telmisartan-hctz T1



TRIBENZOR T3


VASERETIC T3

ZESTORETIC T3

ZIAC T3




indapamide oral T1

metolazone T1

TENORETIC 100 T3

127


TENORETIC 50 T3

THALITONE T9

Uricosuric Agents


probenecid oral T1








Enzymes

Enzymes














128










ALPHAGAN P T3





COMBIGAN T9

SIMBRINZA T2

Antiallergic Agents

ALAWAY T1

ALOCRIL T3 ST

ALOMIDE T2






BEPREVE T9



DYMISTA T3 ST

ELESTAT T3

epinastine hcl T1



NAPHCON-A T9



129




PATANASE T3

PATANOL T3

PAZEO T3 ST

TICALAST T9

ZADITOR T1

ZERVIATE T9


AZASITE T3 ST


T1



BLEPH-10 T3

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

CETRAXAL T3

CILOXAN T3

CIPRO HC T2

CIPRODEX T3





COLY-MYCIN S T3






MAXITROL T3

MOXEZA T3




T1


T1


T1

130



T1


OCUFLOX T3


ofloxacin otic T1

OTOVEL T2 AL


POLYTRIM T3

PRED-G T2

PRED-G SOP T3



T9





TOBRADEX ST T3 ST





VIGAMOX T3

ZYLET T3 ST

ZYMAXID T3 ST

Antifungals (Eent)

NATACYN T3

Antivirals (Eent)


VIROPTIC T3

ZIRGAN T3



BETIMOL T3

BETOPTIC-S T3 ST


carteolol hcl T1

COMBIGAN T9

COSOPT T3

131



ISTALOL T9






TIMOPTIC T3

TIMOPTIC OCUDOSE T3

TIMOPTIC-XE T3


acetazolamide er T1


AZOPT T3


brinzolamide T2

COSOPT T3




SIMBRINZA T2

TRUSOPT T3


ALREX T3 ST



BECONASE AQ T9

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

budesonide nasal T9

CIPRO HC T2

CIPRODEX T3



COLY-MYCIN S T3

CORTANE-B OTIC T3


DEXYCU T9

difluprednate T1 ST

DUREZOL T3 ST

132


DYMISTA T3 ST


FLAREX T2




FML T2

FML FORTE T3

FML LIQUIFILM T3

INVELTYS T3 ST

LOTEMAX T9

LOTEMAX SM T3 ST


MAXIDEX T3

MAXITROL T3



NASONEX T9


T1


T1


OMNARIS T9

OTOVEL T2 AL

PRED FORTE T3

PRED MILD T3

PRED-G T2

PRED-G SOP T3






T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9


TICALAST T9

133




TOBRADEX ST T3 ST



XHANCE T9

ZETONNA T9

ZYLET T3 ST



CORTANE-B OTIC T3

PERIDEX T3


CEQUA T9







acetic acid otic T1



BSS T1

BSS PLUS T3





GASTROCROM T3



MUCOSITISRX T9

134


OXERVATE T4



TICALAST T9

TYRVAYA T9


ACULAR T3

ACULAR LS T3

ACUVAIL T3 ST







NEVANAC T3 ST



T9



CORTANE-B OTIC T3



Miotics

ISOPTO CARPINE T3



VUITY T9

Mydriatics




T3

CYCLOMYDRIL T3


HOMATROPAIRE T1

ISOPTO ATROPINE T3

135



T1






ROCKLATAN T3 ST

TRAVATAN Z T3


VYZULTA T9

XALATAN T3

XELPROS T2

ZIOPTAN T3


RHOPRESSA T3 ST

ROCKLATAN T3 ST

Vasoconstrictors

ADRENALIN NASAL T9

CYCLOMYDRIL T3


NAPHCON-A T9


T1


UPNEEQ T9



AKYNZEO ORAL T9



ondansetron T1



SUSTOL T9




BUFFERIN T3 PV AL

136





PLENITY T9

ZEGERID T9

ZEGERID OTC T3

Antidiarrhea Agents




FUSION SPRINKLES T9



MYTESI T9

opium T9

paregoric T9

PYLERA T9

RESTORA RX T9











T1


T3


T9

scopolamine T1

SYNDROS T9


137



T3

Antiflatulents




BONJESTA T9

COMPRO T1

DICLEGIS T9



prochlorperazine T1


TIGAN ORAL T3




APRISO T9


AZULFIDINE T3






DIPENTUM T3







138







ROWASA RECTAL T3




PYLERA T9

TALICIA T9








FLAGYL T3






bisacodyl oral T3

bisacodyl rectal T9

BUFFERIN T3 PV AL




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3

139


CLENPIQ T3


T3



fe 90 plus T9

FERIVA 217 T9

FERIVAFA T9

FERRALET 90 T9

ferraplus 90 T9


GAVILYTE-C T1 PV

GAVILYTE-G T1 PV


GLYCOLAX T9

GOLYTELY T3

HEMATRON-AF T9


INATAL GT T1



MOVIPREP T3


mynate 90 plus T1

NATALVIRT FLT T9

NEPHRON FA T9

NEXA PLUS T3


OSMOPREP T3





PEG-PREP T1 PV

PLENVU T3

pnv-dha+docusate T1





140


SUTAB T9

TARON-PREX T2


tl-hem 150 T9

TRILYTE T1 PV


ACTIGALL T3

RELTONE T9

URSO 250 T3

URSO FORTE T3




Digestants











ALLI T3 ST


BYLVAY T9

BYLVAY (PELLETS) T9

BYNFEZIA PEN T9



141



























IBSRELA T9


LIVMARLI T9



142



MYCAPSSA T9













REMICADE T9












XENICAL T9





DUEXIS T9

143






nizatidine T3










AKYNZEO ORAL T9




T9

EMEND TRI-PACK T9

VARUBI ORAL T9

Prokinetic Agents

GIMOTI T9


T1



REGLAN ORAL T3


Prostaglandins


T9

CYTOTEC T3


misoprostol oral T1

Protectants

CARAFATE T3 ST



144



ACIPHEX T9


T9


DEXILANT T9

dexlansoprazole T9



T9


FIRST-OMEPRAZOLE T3



NEXIUM T9


T9


T3






PREVACID T9

PREVACID 24HR T3

PRILOSEC OTC T3

PROTONIX ORAL T9


VIMOVO T9

YOSPRALA T9

ZEGERID T9

ZEGERID OTC T3

Gold Compounds

Gold Compounds

RIDAURA T9





145






DEPEN TITRATABS T9

EXJADE T5









T9SP ()



SYPRINE T9



Adrenals

ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9

146





ALKINDI SPRINKLE T9

ALVESCO T9








ASMANEX HFA T9

BREO ELLIPTA T9









CORTEF T3


dexabliss T9






T9

DEXONTO 04 T3


T9


EMFLAZA T9





147








T3



HEMADY T9

HIDEX 6-DAY T9


INTRAROSA T3 PA

MEDROL T3


MILLIPRED T9


NASONEX T9

ORAPRED ODT T9

ORTIKOS T9



T1


T9




T1




T3



QVAR REDIHALER T1

RAYOS T9

SINUVA T9

148





TAPERDEX 12-DAY T9


T9

TARPEYO T9

TRELEGY ELLIPTA T2


WIXELA INHUB T3

XHANCE T9

zcort 7-day T9

ZILRETTA T9


acarbose oral T1

GLYSET T3

PRECOSE T3

Amylinomimetics





Androgens

ANADROL-50 T9


T9


T9


T9

COVARYX T9

COVARYX HS T9




T9



149



FORTESTA T9

JATENZO T9

methitest T9


NATESTO T9

OXANDRIN T3

oxandrolone oral T3

STRIANT T9

TESTIM T9


T1



T9







TLANDO T9

VOGELXO PUMP T9


T9

XYOSTED T9




CYCLOSET T3




Antiestrogens

anastrozole oral T1

ARIMIDEX T3

AROMASIN T3

exemestane T2

150


FEMARA T3




letrozole oral T1

Antigonadtropins











PROGLYCEM T9





MIACALCIN NASAL T3


Antithyroid Agents

methimazole oral T1

151



TAPAZOLE T3

Biguanides

ACTOPLUS MET T3



FORTAMET T9


GLUCOPHAGE T3

GLUCOPHAGE XR T3

GLUMETZA T9











KAZANO T9





metformin hcl er T1


T9



T1



RIOMET T9







152









T2



Contraceptives

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV

153



T3 PV

ECONTRA EZ T1 PV


ELLA T1


EMOQUETTE T1

ENPRESSE-28 T1 PV

ERRIN T1 PV

ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


154



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV

MELODETTA 24 FE T9

MIBELAS 24 FE T9





MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV

NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV


NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV


T1 PV



T9


T1 PV

155


NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV

PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9

156

















KAZANO T9





NESINA T9


OSENI T9











EVISTA T3

FARESTON T9

OSPHENA T2 PA

raloxifene hcl T1

SOLTAMOX T9


157



Estrogens

ACTIVELLA T3

ALORA T2

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA T9

CLIMARA PRO T9

COMBIPATCH T2

COVARYX T9

COVARYX HS T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DELESTROGEN T3





DOTTI T1

158



ELESTRIN T3


EMOQUETTE T1

ENPRESSE-28 T1 PV




ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1





T2


ESTRING T3


ESTROSTEP FE T3


EVAMIST T2

FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

FEMRING T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV




JINTELI T1

JOLESSA T1 PV

JULEBER T1

159


JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYLLANA T1

marlissa T1 PV

MELODETTA 24 FE T9


T2


MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

160



T3

MIRCETTE T9


NATAZIA T9

NECON 0535 (28) T1 PV

NEXTSTELLIS T9



T1 PV


T1 PV


T1


T9


T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


PORTIA-28 T1 PV

PREFEST T3



PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

161


SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TWIRLA T9

TYDEMY T9


VELIVET T1 PV

VIVELLE-DOT T3


YASMIN 28 T9

YAZ T9

YUVAFEM T1













Gonadotropins






162



MENOPUR T2

NOVAREL T3 ST

OVIDREL T2

PREGNYL T1

SYNAREL T9

Incretin Mimetics

ADLYXIN T3 ST




T3 ST


T3 ST





RYBELSUS T9

SAXENDA T9




T2

WEGOVY T9



HUMULIN 7030 T1


T1

HUMULIN N T1


T1

NOVOLIN 7030 T3 ST


NOVOLIN N T3 ST


163


Leptins

MYALEPT T5


)


BASAGLAR KWIKPEN T9


LANTUS T1


T1

LEVEMIR T3 ST


SEMGLEE T9

SEMGLEE (YFGN) T9



TOUJEO SOLOSTAR T1

TRESIBA T9



Meglitinides

nateglinide T1


repaglinide T1

STARLIX T3

Parathyroid Agents


T9







164


Pituitary


CORTROPHIN T9

DDAVP ORAL T3







T9




T9

NOCDURNA T9

NOCTIVA T9




T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



SKYTROFA T9


ZOMACTON T9


165


Progestins

ACTIVELLA T3

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYGESTIN T3

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA PRO T9

COMBIPATCH T2

CRINONE T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV


T3 PV

ECONTRA EZ T1 PV


166


ELLA T1


EMOQUETTE T1


ENPRESSE-28 T1 PV

ERRIN T1 PV


ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JINTELI T1

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9


167



T1 PV



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV


MEGACE ES T3 ST




MELODETTA 24 FE T9

MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV


NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV

168



NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV



T1 PV



T1


T9


T1 PV

NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV


PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREFEST T3

PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV



PROMETRIUM T3

PROVERA T3

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

169


SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9




ADMELOG T3 ST



T3 ST

APIDRA T3 ST


T3 ST

FIASP T3 ST


FIASP PENFILL T3 ST

HUMALOG T1

170




T1

HUMALOG MIX 5050 T1


T1

HUMALOG MIX 7525 T1


T1






insulin lispro T9




LYUMJEV T1

LYUMJEV KWIKPEN T1

NOVOLOG T9


T9

NOVOLOG MIX 7030 T9


T9


T9


HUMULIN 7030 T1


T1

HUMULIN R T1



T1

NOVOLIN 7030 T3 ST


NOVOLIN R T3 ST

171


























T2




BYNFEZIA PEN T9

MYCAPSSA T9






172




T9




T9





T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



ZOMACTON T9











Sulfonylureas

AMARYL T3

DUETACT T9

glimepiride T1

173


glipizide er T1

glipizide oral T1


T1


GLUCOTROL T3

GLUCOTROL XL T3


glyburide oral T1


GLYNASE T3


Thiazolidinediones

ACTOPLUS MET T3


ACTOS T3



DUETACT T9

OSENI T9

pioglitazone hcl T1



Thyroid Agents

ARMOUR THYROID T2

CYTOMEL T2

EUTHYROX T3

LEVO-T T3





LEVOXYL T1


NP THYROID T1

SYNTHROID T3

THYQUIDITY T9


T2


T2

174



T2


T2


T2


T9


T9


T1


T1



ZTLIDO T9



AVODART T3





JALYN T3 ST

PROPECIA T9

PROSCAR T3

Alcohol Deterrents

ANTABUSE T3

disulfiram oral T1


Antidotes



T1




175






























RENVELA T9



176




SPS T1




Antigout Agents

allopurinol oral T1

ANAPROX DS T3




COLCRYS T9


T3


GLOPERBA T9

INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1


MITIGARE T9


T9








probenecid oral T1


ZYLOPRIM T3


EXONDYS 51 T9

177



VILTEPSO T9



T9











ALORA T2

ATELVIA T3

BINOSTO T3 ST




CLIMARA T9

DELESTROGEN T3





DOTTI T1

ELESTRIN T3

ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1




178



T2

ESTRING T3



EVAMIST T2

EVISTA T3

FEMRING T3




LYLLANA T1


T2


MIACALCIN NASAL T3


T3



raloxifene hcl T1






VIVELLE-DOT T3

YUVAFEM T1


FIRAZYR T9





179


Cariostatic Agents

DENTA 5000 PLUS T1

DENTAGEL T1



FLORIVA PLUS T9


T3

LUDENT T1



T1 AL


MYKIDZ IRON FL T9

PREVIDENT T3



QUFLORA FE T9


T9

sf T1

sf 5000 plus T1









TRI-VI-FLOR T9






RUCONEST T9

180







AZASAN T9



AZULFIDINE T3






COSENTYX T4







T4


181








DEPEN TITRATABS T9











T4
















182













T9


IMURAN T3









leflunomide oral T1



T1

NEORAL T3



183











T9



PLAQUENIL T3


T9

REDITREX T3 ST

REMICADE T9

RIDAURA T9











184







TREXALL T3 ST

XATMEP T3 AL















AZASAN T9



AZULFIDINE T3

185



BAFIERTAM T9







T9


















T4


186









T4




T4




T4




T4











187

















T9


IMURAN T3





KESIMPTA T4




leflunomide oral T1



188







T1

NEORAL T3










PLAQUENIL T3











189
















REMICADE T9





RIDAURA T9









190







TREXALL T3 ST

VUMERITY T9

XATMEP T3 AL






ASTAGRAF XL T3 ST

AZASAN T9






T3 AL









ENVARSUS XR T3 ST

191






IMURAN T3

leflunomide oral T1



















T1



T1 AL

192











NEORAL T3













tacrolimus oral T1

TREXALL T3 ST

XATMEP T3 AL








193





FIRAZYR T9





RUCONEST T9





AMPYRA T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9


betaine T3

bp vit 3 T9

CARDIOVID PLUS T9

CARNITOR ORAL T3

CARNITOR SF T3




CITRANATAL DHA T3

194



T3

coenzyme q10 T2



CYSTADANE T9


DEMSER T9


ENDARI T9


T9



FERIVA 217 T9


FERREX 28 T9


FOLBEE AR T9


IROSPAN 246 T9







levocarnitine sf T1

195


maca T9

METAFOLBIC PLUS T9

metyrosine T9


MULTIGEN FOLIC T9

MULTIGEN PLUS T9


neonatal + dha T9

NEXA PLUS T3

nitisinone T9

NITYR T9

ORFADIN T9

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATE AM T3


T3

PRENATE PIXIE T3



T9

RECORLEV T9




SOLESTA T3


196



TARON-PREX T2

THIOLA T9






tristart dha T9

TRIVEEN-DUO DHA T1


URIBEL T9


VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3




XURIDEN T9

ZAVESCA T9

ZOKINVY T9

Protective Agents




CAYA T3


197


Oxytocics

Oxytocics



PREPIDIL T3

Pharmaceutical Aids

Pharmaceutical Aids

ALPAWASH T9

FREEDOM DERMA-D T9



ADRENALIN NASAL T9


T9




T9


T9








T1

ATROVENT HFA T2













198


Antifibrotic Agents

















Antitussives



BROMFED DM T9









199


HISTEX-AC T9

HYCODAN T9


T1



hydromet T1

maxi-tuss cd T9





T1

TESSALON PERLES T3


T9















200













Expectorants







SSKI T3














201



T9




T1


T3


T9


RYVENT T9



T4




ACCOLATE T3


SINGULAIR T3

zafirlukast T1


ZYFLO T9

ZYFLO CR T9


ALOCRIL T3 ST




GASTROCROM T3

Mucolytic Agents





202



T1



BECONASE AQ T9

budesonide nasal T9

DYMISTA T3 ST





NASONEX T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9

TICALAST T9


XHANCE T9












T3



QVAR REDIHALER T1





BRONCHITOL T9



203




ALLEGRA ALLERGY T9


T9













T9


DYMISTA T3 ST



QUZYTTIR T9

TICALAST T9

ZERVIATE T9







T1


ARCAPTA NEOHALER T3



T1



204


PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2




XOPENEX T3


XOPENEX HFA T9


ADCIRCA T9














T5




T5



205



T5




















VENTAVIS T4 PA

VIAGRA T9


ELIXOPHYLLIN T3

THEO-24 T2

206



T1


T1








ACANYA T9

ACZONE T9

AKTIPAK T9

ALTABAX T3 ST

AMZEEQ T9

AVAR CLEANSER T9


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

BENZACLIN T9



bp 10-1 T9


CENTANY T3

CLENIA PLUS T9







CLINDAGEL T9


T9



207










CLINDESSE T3 ST


dapsone external T9

DUAC T9

ery T1

ERYGEL T1




KLARON T3

METROCREAM T3


METROGEL-VAGINAL T3

METROLOTION T3








NORITATE T9

NUVESSA T9

ONEXTON T9

OVACE PLUS T9

OVACE PLUS WASH T9

OVACE WASH T9



T9


PLEXION NS T9

208








T9



T1


T9


T9


T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

VANDAZOLE T1

VELTIN T9

XEPI T9

ZIANA T9

ZILXI T9


ALA-QUIN T9










EPIFOAM T9

ethyl chloride T9

209







T2











LIDODERM T9



lidorx T9

LIDOTRANS 5 PAK T9

LIVIXIL PAK T9




PRAMOSONE T9


prilovixil T9

PRUDOXIN T9

PYRIDIUM T3


RELADOR PAK PLUS T9

SYNERA T9

XRYLIDERM T9

ZONALON T9



DENAVIR T9

XERESE T9

ZOVIRAX EXTERNAL T9

210


Astringents


DRYSOL T1

VUSION T9

XERAC AC T1








ECOZA T9

ERTACZO T3 ST

EXELDERM T9

EXTINA T9

GYNAZOLE-1 T3

JUBLIA T9






luliconazole T9

LUZU T9

NIZORAL T3






TERAZOL 7 T3



VUSION T9

XOLEGEL T9



GERI-HYDROLAC 12 T9

211


GERI-HYDROLAC 5 T9




urea hydrating T9


lactic acid e T9


ALCORTIN A T9

DERMASORB XM T9

iodoquimez-hc T9

lactic acid e T9


VYTONE T9


MENTAX T9



ATRALIN T3 ST AL

AVITA T9


REFISSA T9

RENOVA T9

RENOVA PUMP T9

RETIN-A T3 AL

RETIN-A MICRO T9









TRI-LUMA T9

TWYNEO T9

VELTIN T9

ZIANA T9


ALA SCALP T9

212



ALA-QUIN T9


ALCORTIN A T9

amcinonide T9



APEXICON E T9

AQUANIL HC T1













BRYHALI T3 ST




CAPEX T9











CLOBEX SPRAY T9



213



CLODERM T9

CLODERM PUMP T9



CORDRAN T9


CORTENEMA T3





DERMASORB HC T9

DERMASORB TA T9

DERMAZENE T9

DESONATE T9














DIPROLENE AF T3


DUOBRII T9



ENSTILAR T9

EPIFOAM T9





214










flurandrenolide T9







HALOG T9


T1


T9


T2



















215


IMPEKLO T9

IMPOYZ T9

iodoquimez-hc T9

KENALOG EXTERNAL T9






LOCOID LIPOCREAM T9


LUXIQ T9





NUCORT T3


OLUX T9

OLUX-E T3

ORALONE T3

PANDEL T9

PRAMOSONE T9


prednicarbate T1



SERNIVO T9

SYNALAR T9

SYNALAR TS T9




TEXACORT T9





216


TOPICORT SPRAY T9





T1



TRIANEX T9


TRI-LUMA T9





VANOS T9

VANOXIDE-HC T9

VERDESO T9

VYTONE T9

WYNZORA T9

XERESE T9

Depigmenting Agents


ESOTERICA FACIAL T9


hydroquinone T9


TRI-LUMA T9

Detergents



VUSION T9






Keratolytic Agents

AVAR CLEANSER T9


217


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

bensal hp T9

bp 10-1 T9


CLENIA PLUS T9

DERMASORB XM T9





T9


PROMISEB T9


rynoderm T9










SALVAX T9



SELRX T9


T9



T1


T9


T9

218



T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

ULTRASAL-ER T9



urea hydrating T9


UTOPIC T9

XALIX T9

xurea T9




ACANYA T9




T1


T9

AKTIPAK T9

ALCORTIN A T9


BENZACLIN T9


BENZEFOAM T9

BENZEFOAMULTRA T9








219








bpo T9




T9






DERMAZENE T9

DUAC T9

EPIDUO T3

EPIDUO FORTE T9

EPSOLAY T9


iodoquimez-hc T9



ONEXTON T9

PERIDEX T3






SELRX T9

SILVADENE T3


SSD T1


SULFAMYLON T3

TWYNEO T9

VANOXIDE-HC T9

220


VYTONE T9






PROFINAC T9


Oxaboroles

KERYDIN T9

tavaborole T9

Pigmenting Agents










EURAX T9





NATROBA T9

OVIDE T3


SKLICE T3


spinosad T1

ULESFIA T3


ABSORICA T9

ABSORICA LD T9


221




ACZONE T9







T1


T9


AKLIEF T9

ALDARA T3


ARAZLO T9

ATRAPRO HYDROGEL T9

AVO CREAM T9




BIAFINE T9













CARAC T9

CELACYN T9

222



CERACADE T9




COSENTYX T4







T4


dapsone external T9

DERMASORB HC T9

DERMULCERA T9








doxycycline T9

DRITHO-CREME HP T9

DUOBRII T9


T4


223



T4



T4



ELETONE T9


EMULSION SB T9

ENSTILAR T9


EPICERAM T9

EPIDUO T3

EPIDUO FORTE T9

FABIOR T9








GELCLAIR T9






imiquimod pump T9




KAMDOY T9


224



LATISSE T9

LOYON T9

LUXAMEND T9


T9

MINOLIRA T9


MIRVASO T9


MUGARD T9



NIVATOPIC PLUS T9

NUVAIL T9

OPZELURA T9

ORACEA T9

ORAMAGICRX T9




PHLAG SPRAY T9


podocon T9

PODOCON-25 T9


PRESERA T9

PROFINAC T9

PROPECIA T9


PRUCLAIR T9

PRUMYX T9

PRUTECT T9

QBREXZA T9

RECEDO T9

225


RECTIV T9


REMICADE T9


ROGAINE T9

ROGAINE MENS T9




SILIQ T5







T9

SONAFINE T9

SORILUX T9







suvicort T9

SYNALAR TS T9

SYNERDERM T9




226


















VANIQA T9


VELTIN T9

VENELEX T9



WINLEVI T9

WYNZORA T9

XIMINO T9


ZIANA T9

ZITHRANOL T3 ST

ZYCLARA T9




Antimuscarinics


DETROL T3


227



T3


flavoxate hcl T1




OXYTROL T9










ELIXOPHYLLIN T3






THEO-24 T2


T1


T1


GEMTESA T9





Vitamins


BACMIN T9

choice-tabs T9

228





CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1


CORVITE FREE T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


FLORIVA PLUS T9

folbee plus T9

FOLBEE PLUS CZ T9


INATAL GT T1




T1 AL





M-VIT T9

MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

229





neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRO-VITE RX T9

NEXA PLUS T3

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9

NIVA-PLUS T9

O-CAL FA T9



pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

230


PRENATE PIXIE T3

PROVIDA OB T3

QUFLORA FE T9


T9


rena-vite T3

rena-vite rx T9

reno caps T9

REQ 49+ T9


T1




STROVITE ONE T9

SUPERVITE T9

TARON-PREX T2


TRICARE T1

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9


tri-zel T9


v-c forte T9

VIC-FORTE T9


VINATE M T1

VINATE ONE T1

virt-caps T9

virt-vite plus T9

VITACEL T1



VITAFOL-OB T3

231


VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITATRUE T3

vp-vite rx T9

Vitamin A

active fe T9

MYKIDZ IRON FL T9

pnv-select T1

TRI-VI-FLOR T9


Vitamin B Complex

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

BEYAZ T9

bp vit 3 T9


CARDIOVID PLUS T9

CENTRATEX T9

CIFEREX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9






DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

232




DIALYVITEZINC T9

durachol T9

fabb T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


T9


FERREX 28 T9


folbee T9

FOLBEE AR T9

folbee plus T9

FOLBEE PLUS CZ T9

FOLBIC T9





FOLIVANE-F T9

FOLIVANE-PLUS T9

FOLIXAPURE T9

folplex 22 T9

FOLTANX T9

FOLTRATE T9


FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

233


HEMATRON-AF T9


hemetab T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9





METAFOLBIC PLUS T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


T1 AL

M-VIT T9



mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

NASCOBAL T9



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9

234


neurin-sl T9

NEXA PLUS T3


NIACOR T1

NICOMIDE T9

NIVA-FOL T9

NIVA-PLUS T9

noxifol-d T9

O-CAL FA T9


ortho df T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

235


purefe plus T9


QUFLORA FE T9


rena-vite T3

rena-vite rx T9

reno caps T9

RESTORA RX T9


revesta T9

roxifol-d T9

SAFYRAL T9


T1


se-tan plus T9


SUPERVITE T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl gard rx T9

tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9

TYDEMY T9



VINATE M T1

VINATE ONE T1

virt-caps T9

236


VIRT-GARD T9

virt-vite T9

virt-vite forte T9

virt-vite plus T9


VITAFOL-OB T3

VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITA-RESPA T9

VITATRUE T3

vp-vite rx T9

zavara T9

Vitamin C

active fe T9

CENTRATEX T9

CITRANATAL BLOOM T3

CORVITA 150 T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


FERREX 150 PLUS T9

FERREX 28 T9


folbee plus T9

FOLBEE PLUS CZ T9

FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

237


FUSION SPRINKLES T9


HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


ICAR-C PLUS T9

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9



MOVIPREP T3

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


MYKIDZ IRON FL T9

mynephrocaps T9

MYNEPHRON T9

NATALVIRT FLT T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9


PLENVU T3

pnv-select T1

purefe plus T9



rena-vite T3

rena-vite rx T9

reno caps T9

se-tan plus T9

TANDEM PLUS T9

taron forte T9

tl icon T9

tl-hem 150 T9

TRICON T9

238


trigels-f forte T9

triphrocaps T9

TRI-VI-FLOR T9


virt-caps T9

virt-vite plus T9

VITAL-D RX T9

vp-vite rx T9

Vitamin D

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9




CIFEREX T9






durachol T9


FOLIXAPURE T9


MYKIDZ IRON FL T9

noxifol-d T9

ortho df T9


pnv-select T1

RAYALDEE T9

REPLESTA T9


REPLESTA NX T9

revesta T9

ROCALTROL T3

roxifol-d T9

TRI-VI-FLOR T9


239


VITAL-D RX T9


T1




zavara T9


Vitamin E

active fe T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

HEMATRON-AF T9


pnv-select T1

tl-hem 150 T9

Vitamin K Activity



240

241

Index




242




243




244




245




246




247




248




249




250




251




252




253




254




255




256




257




258




259




260




261




262




263




264




265




266
















8003681019 8005377697 (TDD)








(TTY 711）


















T9





T1


T3


T9


RYVENT T9

VISTARIL T3


ALAWAY T1










T1



nizatidine T3





PATANASE T3

PATANOL T3

PAZEO T3 ST






5



VISTARIL T3

ZADITOR T1







T1





T3


T9


BROMFED DM T9


HISTEX-AC T9


T1

maxi-tuss cd T9


T1



T9




ALLEGRA ALLERGY T9


T9


ALOMIDE T2





6













T9




QUZYTTIR T9

SEMPREX-D T9





cefadroxil T1




KEFLEX T3


cefaclor er T1


cefprozil T1



cefdinir T1







T3

7



T2




GOCOVRI T9

OSMOLEX ER T9

rimantadine hcl T1




Amebicides

FLAGYL T3

METROGEL-VAGINAL T3




NUVESSA T9


VANDAZOLE T1










ZEMDRI T9

Aminomethylcyclines



SEYSARA T9

8










T1


T1




T3


T3

AUGMENTIN XR T3

Anthelmintics


ALBENZA T9


EMVERM T9




BREXAFEMME T9




PYLERA T9

Antimalarials

ACTICLATE T9

ARAKODA T3



COARTEM T2

DARAPRIM T9

9


DORYX MPC T9


T9





T9



T9


T1


T9


T1


T9



LYMEPAK T9

MALARONE T3

mefloquine hcl T1





MONDOXYNE NL T9

PLAQUENIL T3



QUALAQUIN T3 PA




TARGADOX T9



10



T3



dapsone oral T1






BACTRIM T3

BACTRIM DS T3



dapsone oral T1

FLAGYL T3



MEPRON T3



NEBUPENT T3



PYLERA T9

SOLOSEC T9


T1


tinidazole oral T1


AVELOX ORAL T3




11



T1




cycloserine oral T1


isoniazid oral T1




MYCOBUTIN T2


PRIFTIN T2



RIFADIN ORAL T3

rifampin oral T1





T2










Azole Antifungals


12


DIFLUCAN T3

fluconazole oral T1









tolsura T9












13












Fluorocyclines


T9


FIRVANQ T2

VANCOCIN HCL T9



T1



EPCLUSA T9









14











EPCLUSA T9











15























16



vocabria T9







EDURANT T2

efavirenz T2












17


















CIMDUO T9




DESCOVY T9


T1


18




emtricitabine T3






)


EPIVIR T3
















TEMIXYS T9


19






VIDEX EC T3


T2




















20













ritonavir T1



















21















acyclovir oral T1







LAGEVRIO T2

molnupiravir T2



SITAVIG T9





22







ZOVIRAX ORAL T3










T3



ZITHROMAX Z-PAK T3










Pleuromutilins

XENLETA ORAL T9

23


Polyene Antifungals






AVELOX ORAL T3

BAXDELA T9





T1








MYCOBUTIN T2

PRIFTIN T2


RIFADIN ORAL T3

rifampin oral T1




AZULFIDINE T3


BACTRIM T3

BACTRIM DS T3



T1


24




ACTICLATE T9


DORYX MPC T9


T9

doxycycline T9





T9



T9


T1


T9


T1

LYMEPAK T9



T9




MINOLIRA T9

MONDOXYNE NL T9


ORACEA T9

PYLERA T9


T9

TARGADOX T9



25



T3


XIMINO T9


BACTRIM T3

BACTRIM DS T3



HYOPHEN T9

MACROBID T3


T3





T1



PRIMSOL T9


T1



URIBEL T9








ALKERAN ORAL T3

26






anastrozole oral T1

ARIMIDEX T3

AROMASIN T3








bicalutamide T1









27



CASODEX T3












DROXIA T3

EMCYT T2








exemestane T2


FARESTON T9

28






FEMARA T3

flutamide T1






GLEEVEC T9


T3


HYDREA T3

hydroxyurea oral T1






29





















30



















31


letrozole oral T1









MEGACE ES T3 ST






melphalan T2




T1

MYLERAN T3



nilutamide T1

32






OGIVRI T9














33










SIKLOS T9

SOLTAMOX T9












34




















TREXALL T3 ST





35




















36






XATMEP T3 AL


















YONSA T9


37






ZYTIGA T9



GRASTEK T3 AL

ODACTRA T3 AL

ORALAIR T3 AL











38





RAGWITEK T3 AL


ZINPLAVA T9

Toxoids










T6 - $0 Copay



T6 - $0 Copay


T6 - $0 Copay





Vaccines

ACTHIB T9











39


BIOTHRAX T9






DENGVAXIA T9



























IXIARO T9




T6 - $0 Copay





40



T6 - $0 Copay



T9









T6 - $0 Copay


T6 - $0 Copay







stamaril T9


T9





T9


T9





VIVOTIF T9

YF-VAX T9



Autonomic Drugs


ADRENALIN NASAL T9

41





T9

BROMFED DM T9










T9


T9


T9





T1


SEMPREX-D T9







CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

clonidine T1

clonidine hcl er T2

42



HISTEX-AC T9


T3

LUCEMYRA T9

maxi-tuss cd T9

methyldopa oral T1

midodrine hcl T1


T9



ANASPAZ T3



T1

ATROVENT HFA T2


T9





CUVPOSA T3 AL

DARTISLA ODT T9




DONNATAL T9

DUAKLIR PRESSAIR T9

GLYCATE T9


T9



HYCODAN T9



hydromet T1

HYOPHEN T9

43



T1








LEVSINSL T3

LIBRAX T9





NULEV T1

oscimin sr T1



QBREXZA T9

scopolamine T1









SYMAX DUOTAB T3



T3

TRELEGY ELLIPTA T2


T9

URIBEL T9


YUPELRI T9



44










KLS QUIT2 T3 PV

KLS QUIT4 T3 PV

NICODERM CQ T9

NICORETTE T9









AMRIX T9





T9





FEXMID T9

LORZONE T9



ROBAXIN ORAL T3

ROBAXIN-750 T3

SKELAXIN T9



ZANAFLEX T3

45








FLEQSUVY T9


T9

LYVISPAH T9

OZOBAX T9



T3

BYSTOLIC T3

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



nebivolol hcl T1

pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3



CARDURA T3

CARDURA XL T3 ST


MINIPRESS T3

46





CAFERGOT T9

DIBENZYLINE T9




ERGOMAR T3


MIGERGOT T9

MIGRANAL T9


TRUDHESA T9


ADLARITY T9

ARICEPT T3



donepezil hcl T1








T9









SALAGEN T3

47



alfuzosin hcl er T1

carvedilol T1


COREG T3

COREG CR T3 ST


FLOMAX T3

JALYN T3 ST


RAPAFLO T3 ST

silodosin T2 ST

tamsulosin hcl T1

UROXATRAL T3


ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9








T1



ARCAPTA NEOHALER T3



BREO ELLIPTA T9





DUAKLIR PRESSAIR T9



48



T3






T1



PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2






TRELEGY ELLIPTA T2



WIXELA INHUB T3

XOPENEX T3


XOPENEX HFA T9



atenolol oral T1




LOPRESSOR ORAL T3



49


TENORMIN T3

TOPROL XL T3


norgesic forte T9



T9


T9


Antianemia Drugs














CEPROTIN T3



CABLIVI T4



OXBRYTA T9

50




TAVALISSE T9


COUMADIN ORAL T2

JANTOVEN T1



BEVYXXA T9
























51








MULPLETA T9















T5



52




UDENYCA T9


ZIEXTENZO T9



Hemostatics














DDAVP ORAL T3




53





















LYSTEDA T3



NOCDURNA T9


54





















Heparins




55









T5


)






T5


)


T1




Iron Preparations


active fe T9

CENTRATEX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9

CORVITE 150 T9

56


corvite fe T9


fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9

FERREX 150 T9


T9


FERREX 150 PLUS T9

FERREX 28 T9



FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN T9

HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

HEMATRON-AF T9


hemetab T9

HEMOCYTE T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9

57




MULTIGEN FOLIC T9

MULTIGEN PLUS T9

M-VIT T9


MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHRON FA T9

NEXA PLUS T3

NIVA-PLUS T9

NUFERA T9

O-CAL FA T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1


PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1






58



prenatal plus T1





T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

purefe plus T9


QUFLORA FE T9


T1


se-tan plus T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

tristart dha T9

TRIVEEN-DUO DHA T1


VINATE M T1

VINATE ONE T1



VITAFOL-OB T3

VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3

wee care T1 PV AL

59




NASCOBAL T9

neurin-sl T9


AGGRENOX T3





BRILINTA T2

BUFFERIN T3 PV AL


cilostazol T1



DURLAZA T9





YOSPRALA T9



AGRYLIN T3

anagrelide hcl T1

Thrombolytic Agents




BUFFERIN T3 PV AL





CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

60


COREG CR T3 ST



MINIPRESS T3




CARDURA T3

CARDURA XL T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST



MINIPRESS T3




ATACAND T3

AVAPRO T3

BENICAR T3


COZAAR T3


EDARBI T3 ST

irbesartan T1


MICARDIS T3


telmisartan T1







ATACAND T3

ATACAND HCT T3

61



T3

AVAPRO T3

AZOR T3 ST

BENICAR T3

BENICAR HCT T3

BYVALSON T3 ST



COZAAR T3


DIOVAN HCT T3

EDARBI T3 ST

EDARBYCLOR T3 ST


EXFORGE T3

EXFORGE HCT T3

HYZAAR T3

irbesartan T1




MICARDIS T3

MICARDIS HCT T3




telmisartan T1


telmisartan-hctz T1

TRIBENZOR T3

TWYNSTA T3





ACCUPRIL T3



captopril oral T1

62






lisinopril oral T1


T3




PRESTALIA T3 ST

PRINIVIL T3

quinapril hcl T1

ramipril T1

trandolapril T1

VASOTEC T3

ZESTRIL T3


ACCUPRIL T3

ACCURETIC T3





captopril oral T1








lisinopril oral T1



T3


T3



63






PRINIVIL T3

QBRELIS T3 AL

quinapril hcl T1


ramipril T1


T3

trandolapril T1


VASERETIC T3

VASOTEC T3

ZESTORETIC T3

ZESTRIL T3


DIGITEK T1

DIGOX T1






T9





T9SP ()


LOVAZA T3




NIASPAN T3



64





atenolol oral T1



T3




BYSTOLIC T3

BYVALSON T3 ST

carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

CORZIDE T3

DUTOPROL T9

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9




LOPRESSOR ORAL T3







nebivolol hcl T1

pindolol T1



propranolol-hctz T1

SORINE T1

sotalol hcl oral T1

65


SOTYLIZE T3

TENORETIC 100 T3

TENORETIC 50 T3

TENORMIN T3


TOPROL XL T3

ZIAC T3



atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

CORGARD T3

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3




pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3



66





COLESTID T3

colestipol hcl T1

PREVALITE T1








T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1

67



T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9


T3

68


TAZTIA XT T1


T1

TIAZAC T3



T1


T1


VERELAN T3

VERELAN PM T3


acetazolamide er T1




CORLANOR T3 ST

RANEXA T3

ranolazine er T1



Cardiotonic Agents

DIGITEK T1

DIGOX T1






T9


CATAPRES T3

CATAPRES-TTS-1 T3

CATAPRES-TTS-2 T3

CATAPRES-TTS-3 T3

69


clonidine T1

clonidine hcl er T2




T3

methyldopa oral T1



T9


ezetimibe T1




ROSZET T9

VYTORIN T3

ZETIA T3



NORPACE T3

NORPACE CR T2









PHENYTEK T2








propafenone hcl T1

70






atenolol oral T1


T3



carvedilol T1


COREG T3

COREG CR T3 ST

HEMANGEOL T3 AL

INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9



LOPRESSOR ORAL T3



pindolol T1



SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TENORMIN T3


TOPROL XL T3






T3

dofetilide T2

MULTAQ T3


71




SORINE T1

sotalol hcl oral T1

SOTYLIZE T3

TIKOSYN T3




T3


T3


T9


T2


T9


T3

CARTIA XT T1


T1


T1


T9


T9


T9


dilt-xr T1

MATZIM LA T9

TAZTIA XT T1


T1

TIAZAC T3

72



T1


T1


VERELAN T3

VERELAN PM T3


ADALAT CC T3

AFEDITAB CR T1


CONJUPRI T9

felodipine er T1

isradipine T1





T1


nifedipine oral T1


nisoldipine er T2




PROCARDIA XL T3


T3

Dihydropyridines

ADALAT CC T3

AFEDITAB CR T1







73


AZOR T3 ST


CONJUPRI T9

CONSENSI T9

EXFORGE T3

EXFORGE HCT T3

felodipine er T1

isradipine T1








T1


nifedipine oral T1


nisoldipine er T2





PRESTALIA T3 ST

PROCARDIA XL T3


T3


TRIBENZOR T3

TWYNSTA T3

Direct Vasodilators

BIDIL T3



minoxidil oral T1


ELIXOPHYLLIN T3

THEO-24 T2

74



T1


T1




T9


T1




T1



FENOGLIDE T9

FIBRICOR T9

gemfibrozil oral T1

LIPOFEN T9

LOPID T3

TRICOR T3


TRILIPIX T3


ALTOPREV T9




CRESTOR T3

EZALLOR SPRINKLE T9



flolipid T9



LESCOL XL T9

LIPITOR T3

LIVALO T9

lovastatin oral T1

75



T3



ROSZET T9



VYTORIN T3


ZYPITAMAG T9


DIBENZYLINE T9




bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1




ALDACTONE T3

CAROSPIR T9

eplerenone T1

INSPRA T3





ALDACTONE T3

CAROSPIR T9

eplerenone T1

76


INSPRA T3



BIDIL T3

GONITRO T9




T1




MINITRAN T1

NITRO-BID T1


T3


T2

nitroglycerin er T1




NITROLINGUAL T3

NITROMIST T3

NITROSTAT T1

NITRO-TIME T1

Pcsk9 Inhibitors







ADCIRCA T9

CIALIS T9

cilostazol T1




77






STAXYN T9

STENDRA T9





VIAGRA T9


ALDACTONE T3


CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3


Renin Inhibitors


TEKTURNA T9

TEKTURNA HCT T2 ST




DIURIL T2




indapamide oral T1

metolazone T1

THALITONE T9


ADALAT CC T3

AFEDITAB CR T1


78




T3


T3


T9


T2


T9


T3

CARTIA XT T1



CONJUPRI T9

CORLANOR T3 ST


T1


T1


T9


T9


T9


dilt-xr T1





MATZIM LA T9




T1


79


nifedipine oral T1





PROCARDIA XL T3

TAZTIA XT T1


T1

TIAZAC T3


T1


T1


VERELAN T3

VERELAN PM T3



Adamantanes (Cns)


GOCOVRI T9

OSMOLEX ER T9




LOMAIRA T3 ST




Amphetamines

ADDERALL T3 AL





ADZENYS ER T9

ADZENYS XR-ODT T9

80


amphetamine er T9





DESOXYN T9














DYANAVEL XR T9


EVEKEO ODT T9


MYDAYIS T9

PROCENTRA T1





T9







ALLZITAL T9

APADAZ T9


T9

81






T9




T9





T9







T1


T9


T1

HYOPHEN T9


LYRICA CR T9

NEURONTIN T3

NORCO T3



T9


T1


T3

pregabalin er T9

PRIMLEV T9

PROLATE T9


82



ULTRACET T3

URIBEL T9

VANATOL LQ T9




VTOL LQ T9


QSYMIA T3 ST


CONTRAVE T3 ST

IMCIVREE T9










acetazolamide er T1








T1 ST






CARBATROL T3 ST

83


DEPAKOTE T3

DEPAKOTE ER T3


T3





T1


T1


ELEPSIA XR T9


EPITOL T1

EPRONTIA T9

EQUETRO T3 ST
















84







KEPPRA ORAL T3

KEPPRA XR T3



LAMICTAL ODT T9



T3



















levetiracetam er T1






NEURONTIN T3

oxcarbazepine T1



85









QUDEXY XR T9



SABRIL T9














TOPAMAX T3





TRILEPTAL T3

TROKENDI XR T9





86










ZONEGRAN T3

zonisamide oral T1


APLENZIN T9









T1


T9


FORFIVO XL T9

mirtazapine oral T1


REMERON SOLTAB T3








T3

Antimanic Agents

ABILIFY MYCITE T9



87













T1 ST






CARBATROL T3 ST

DEPAKOTE T3

DEPAKOTE ER T3


T3


T1


T1


EPITOL T1

EQUETRO T3 ST

GEODON ORAL T3

LAMICTAL ODT T9



T3









88












lithium T1



LITHOBID T3








T1




T3





T2

SAPHRIS T9


SEROQUEL T3







89











ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3


ANAPROX DS T3




BUFFERIN T3 PV AL



CAFERGOT T9


CAMBIA T9

DEPAKOTE T3

DEPAKOTE ER T3


T3




T1


T1



T3

ELYXYB T9

EPRONTIA T9

ERGOMAR T3



90


HEMANGEOL T3 AL


INDERAL LA T9

INDERAL XL T9

INNOPRAN XL T9


MIGERGOT T9

MIGRANAL T9


T9











TOPAMAX T3




TROKENDI XR T9

TRUDHESA T9




ADASUVE T9









91







EDLUAR T9



HETLIOZ LQ T9




T1

INTERMEZZO T9


meprobamate T9




T1


T3


T9

ramelteon T1 AL

ROZEREM T3 AL

VISTARIL T3







ABILIFY MYCITE T9






92

















T3

GEODON ORAL T3

INVEGA T9


LYBALVI T9















T1


93





T3





T2

SAPHRIS T9


SEROQUEL T3






T9



ziprasidone hcl T1

ZYPREXA ORAL T3

ZYPREXA ZYDIS T3





primidone oral T1


ALLZITAL T9

ASCOMP-CODEINE T2





T9

94





T9




DONNATAL T9




T9






VANATOL LQ T9

VTOL LQ T9


ATIVAN ORAL T3



clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3

KLONOPIN T3




LOREEV XR T9




SYMPAZAN T9

95



VALIUM T3













ATIVAN ORAL T3






clonazepam oral T1


DIASTAT ACUDIAL T2





diazepam rectal T3




KLONOPIN T3

LIBRAX T9




LOREEV XR T9




96


oxazepam T1

quazepam T9


SYMPAZAN T9






VALIUM T3

XANAX T3





Butyrophenones


haloperidol oral T1












97




T1

COMTAN T3

entacapone T1

ONGENTYS T3 ST

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3










EXSERVAN T9















98







RILUTEK T9






TIGLUTIK T9

VYLEESI T9



XYWAV T9




CONSENSI T9

ELYXYB T9

SEGLENTIS T9

Dopamine Precursors

carbidopa oral T9



T1


T1

DHIVY T3

INBRIJA T9




99






SINEMET CR T3

STALEVO 100 T3

STALEVO 125 T3

STALEVO 150 T3

STALEVO 200 T3

STALEVO 50 T3

STALEVO 75 T3



cabergoline T1

PARLODEL T3

Fibromyalgia Agents
























T9

100


Hydantoins





PHENYTEK T2








EMSAM T3 ST






EMSAM T3 ST


NARDIL T3

PARNATE T3








T9



MIRAPEX T3





101




T3 ST

ropinirole hcl T1


Opiate Agonists





ACTIQ T9

APADAZ T9


T9

ASCOMP-CODEINE T2


T9


T9






CONZIP T9




DOLOPHINE T3

DSUVIA T9










T9

102



T9


T9







T1


T9


T1


T1











T9

LAZANDA T9










T1

MORPHABOND ER T9

103



T1



T9





T3

NORCO T3

NUCYNTA T3 ST










T9


T1






T3

PRIMLEV T9

PROLATE T9

QDOLO T9

SEGLENTIS T9




104




T9








ULTRACET T3








Opiate Antagonists






















105




























BUTRANS T9














106



ANAPROX DS T3


T9

CAMBIA T9

DAYPRO T3

diclofenac T9








diflunisal oral T1

DUEXIS T9


T3

etodolac er T2

etodolac oral T1

FELDENE T3



FLECTOR EXTERNAL T9



T1




INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1







LOFENA T9

107







nabumetone oral T1



T9









oxaprozin T2

piroxicam oral T1

QMIIZ ODT T9

RELAFEN DS T9

SPRIX T9

sulindac oral T1


TIVORBEX T9

tolmetin sodium T2


VIMOVO T9

VIVLODEX T9

ZIPSOR T9

ZORVOLEX T9

Phenothiazines



COMPRO T1






108


prochlorperazine T1





ADHANSIA XR T9


T9


ASCOMP-CODEINE T2

AZSTARYS T9


T9




T9




CAFERGOT T9






COTEMPLA XR-ODT T9




ELIXOPHYLLIN T3





T9


FOCALIN T3 AL


JORNAY PM T9

109



T1 AL
















T1 AL




MIGERGOT T9

norgesic forte T9


T9


T9




RELEXXII T9

RITALIN T3 AL



THEO-24 T2


T1


T1


VANATOL LQ T9

110


VTOL LQ T9

Salicylates

AGGRENOX T3

ASCOMP-CODEINE T2





BUFFERIN T3 PV AL







DOANS PILLS T1

DURLAZA T9



norgesic forte T9


T9


T9

salsalate oral T1


















111


EFFEXOR XR T3






venlafaxine hcl T1


T1


T9





FROVA T9






T9


T9


T3






ONZETRA XSAIL T9

RELPAX T9


112






T9




T1


T9




T1


TOSYMRA T9









BRISDELLE T9
















113














PAXIL T3





PEXEVA T9







T9





nefazodone hcl T1






Succinimides

CELONTIN T2


ZARONTIN T3

114


Thioxanthenes

thiothixene oral T1



amoxapine T1

















maprotiline hcl T1







SURMONTIL T3

TOFRANIL T3






115







XENAZINE T9




T1








Dental Agents

Dental Agents


T3


Devices

Devices








116












T2


T2




























117

















T2




T2





NOVOFINE PLUS T2












T1


T2


118


V-GO 20 T2

V-GO 30 T2

V-GO 40 T2


Diagnostic Agents



CORTROPHIN T9

Diabetes Mellitus


























MICRODOT TEST T3 ST




119








Diagnostic Agents



CANDIN T9

Ketones

KETOSTIX T3

Tuberculosis

APLISOL T9


Alkalinizing Agents

cytra k crystals T1

cytra-2 T9

CYTRA-3 T9

cytra-k T9

ORACIT T3





tricitrates T9

UROCIT-K 10 T3

UROCIT-K 15 T3

UROCIT-K 5 T3

virtrate-2 T9

virtrate-3 T9

virtrate-k T9

Ammonia Detoxicants




120



enulose T1

generlac T1

KRISTALOSE T9



LITHOSTAT T9




Caloric Agents

DOJOLVI T9

ENLYTE T9


FERREX 150 PLUS T9

FOLBEE AR T9

l-leucine T9

macuvex T9

macuzin T9

METAFOLBIC PLUS T9

methaver T9

methazel T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9

PURALOR CI T9

SUPERVITE T9

zyvit T9


acetazolamide er T1



ELIXOPHYLLIN T3

THEO-24 T2


T1

121



T1



Loop Diuretics

bumetanide oral T1


EDECRIN T9




LASIX T3

SOAANZ T9

torsemide oral T1


















T9

PHOSLO T3

PHOSLYRA T3 ST

122



RENVELA T9









SPS T1




ALDACTONE T3



CAROSPIR T9

DYRENIUM T9

eplerenone T1

INSPRA T3

MAXZIDE T3

MAXZIDE-25 T3





active fe T9


BACMIN T9

123




CENTRATEX T9

choice-tabs T9


CORVITA 150 T9



CORVITE FREE T9


DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


T1

FERIVA 217 T9

FERIVAFA T9


FOLBEE PLUS CZ T9


GALZIN T9


HEMATRON T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


IROSPAN 246 T9

KLOR-CON 10 T1

KLOR-CON M10 T1

KLOR-CON M15 T1

KLOR-CON M20 T1



T3

KLOR-CONEF T1

K-PHOS-NEUTRAL T9


T3

124







neonatal + dha T9

NEPHPLEX RX T9

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9


PHOSLO T3

PHOSLYRA T3 ST

phos-nak T9


pnv-dha T1

pnv-select T1


T1


T1


T1



T3



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1



PRENATE AM T3


T3

PRENATE PIXIE T3

purefe plus T9

125



QUFLORA FE T9

REQ 49+ T9

se-tan plus T9



STROVITE ONE T9

SUPERVITE T9

TANDEM PLUS T9

tl-hem 150 T9

tristart dha T9

TRIVEEN-DUO DHA T1

tri-zel T9


v-c forte T9

VIC-FORTE T9

VINATE M T1


VITACEL T1

VITAFOL-ONE T3

VITAL-D RX T9

VITATRUE T3


Thiazide Diuretics

ACCURETIC T3





ATACAND HCT T3


T3


BENICAR HCT T3




CORZIDE T3

DIOVAN HCT T3

DIURIL T2

126


DUTOPROL T9

EDARBYCLOR T3 ST


EXFORGE HCT T3



HYZAAR T3






T3

MAXZIDE T3

MAXZIDE-25 T3




MICARDIS HCT T3




propranolol-hctz T1



TEKTURNA HCT T2 ST

telmisartan-hctz T1



TRIBENZOR T3


VASERETIC T3

ZESTORETIC T3

ZIAC T3




indapamide oral T1

metolazone T1

TENORETIC 100 T3

127


TENORETIC 50 T3

THALITONE T9

Uricosuric Agents


probenecid oral T1








Enzymes

Enzymes














128










ALPHAGAN P T3





COMBIGAN T9

SIMBRINZA T2

Antiallergic Agents

ALAWAY T1

ALOCRIL T3 ST

ALOMIDE T2






BEPREVE T9



DYMISTA T3 ST

ELESTAT T3

epinastine hcl T1



NAPHCON-A T9



129




PATANASE T3

PATANOL T3

PAZEO T3 ST

TICALAST T9

ZADITOR T1

ZERVIATE T9


AZASITE T3 ST


T1



BLEPH-10 T3

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

CETRAXAL T3

CILOXAN T3

CIPRO HC T2

CIPRODEX T3





COLY-MYCIN S T3






MAXITROL T3

MOXEZA T3




T1


T1


T1

130



T1


OCUFLOX T3


ofloxacin otic T1

OTOVEL T2 AL


POLYTRIM T3

PRED-G T2

PRED-G SOP T3



T9





TOBRADEX ST T3 ST





VIGAMOX T3

ZYLET T3 ST

ZYMAXID T3 ST

Antifungals (Eent)

NATACYN T3

Antivirals (Eent)


VIROPTIC T3

ZIRGAN T3



BETIMOL T3

BETOPTIC-S T3 ST


carteolol hcl T1

COMBIGAN T9

COSOPT T3

131



ISTALOL T9






TIMOPTIC T3

TIMOPTIC OCUDOSE T3

TIMOPTIC-XE T3


acetazolamide er T1


AZOPT T3


brinzolamide T2

COSOPT T3




SIMBRINZA T2

TRUSOPT T3


ALREX T3 ST



BECONASE AQ T9

BLEPHAMIDE T3 ST

BLEPHAMIDE SOP T3

budesonide nasal T9

CIPRO HC T2

CIPRODEX T3



COLY-MYCIN S T3

CORTANE-B OTIC T3


DEXYCU T9

difluprednate T1 ST

DUREZOL T3 ST

132


DYMISTA T3 ST


FLAREX T2




FML T2

FML FORTE T3

FML LIQUIFILM T3

INVELTYS T3 ST

LOTEMAX T9

LOTEMAX SM T3 ST


MAXIDEX T3

MAXITROL T3



NASONEX T9


T1


T1


OMNARIS T9

OTOVEL T2 AL

PRED FORTE T3

PRED MILD T3

PRED-G T2

PRED-G SOP T3






T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9


TICALAST T9

133




TOBRADEX ST T3 ST



XHANCE T9

ZETONNA T9

ZYLET T3 ST



CORTANE-B OTIC T3

PERIDEX T3


CEQUA T9







acetic acid otic T1



BSS T1

BSS PLUS T3





GASTROCROM T3



MUCOSITISRX T9

134


OXERVATE T4



TICALAST T9

TYRVAYA T9


ACULAR T3

ACULAR LS T3

ACUVAIL T3 ST







NEVANAC T3 ST



T9



CORTANE-B OTIC T3



Miotics

ISOPTO CARPINE T3



VUITY T9

Mydriatics




T3

CYCLOMYDRIL T3


HOMATROPAIRE T1

ISOPTO ATROPINE T3

135



T1






ROCKLATAN T3 ST

TRAVATAN Z T3


VYZULTA T9

XALATAN T3

XELPROS T2

ZIOPTAN T3


RHOPRESSA T3 ST

ROCKLATAN T3 ST

Vasoconstrictors

ADRENALIN NASAL T9

CYCLOMYDRIL T3


NAPHCON-A T9


T1


UPNEEQ T9



AKYNZEO ORAL T9



ondansetron T1



SUSTOL T9




BUFFERIN T3 PV AL

136





PLENITY T9

ZEGERID T9

ZEGERID OTC T3

Antidiarrhea Agents




FUSION SPRINKLES T9



MYTESI T9

opium T9

paregoric T9

PYLERA T9

RESTORA RX T9











T1


T3


T9

scopolamine T1

SYNDROS T9


137



T3

Antiflatulents




BONJESTA T9

COMPRO T1

DICLEGIS T9



prochlorperazine T1


TIGAN ORAL T3




APRISO T9


AZULFIDINE T3






DIPENTUM T3







138







ROWASA RECTAL T3




PYLERA T9

TALICIA T9








FLAGYL T3






bisacodyl oral T3

bisacodyl rectal T9

BUFFERIN T3 PV AL




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3

139


CLENPIQ T3


T3



fe 90 plus T9

FERIVA 217 T9

FERIVAFA T9

FERRALET 90 T9

ferraplus 90 T9


GAVILYTE-C T1 PV

GAVILYTE-G T1 PV


GLYCOLAX T9

GOLYTELY T3

HEMATRON-AF T9


INATAL GT T1



MOVIPREP T3


mynate 90 plus T1

NATALVIRT FLT T9

NEPHRON FA T9

NEXA PLUS T3


OSMOPREP T3





PEG-PREP T1 PV

PLENVU T3

pnv-dha+docusate T1





140


SUTAB T9

TARON-PREX T2


tl-hem 150 T9

TRILYTE T1 PV


ACTIGALL T3

RELTONE T9

URSO 250 T3

URSO FORTE T3




Digestants











ALLI T3 ST


BYLVAY T9

BYLVAY (PELLETS) T9

BYNFEZIA PEN T9



141



























IBSRELA T9


LIVMARLI T9



142



MYCAPSSA T9













REMICADE T9












XENICAL T9





DUEXIS T9

143






nizatidine T3










AKYNZEO ORAL T9




T9

EMEND TRI-PACK T9

VARUBI ORAL T9

Prokinetic Agents

GIMOTI T9


T1



REGLAN ORAL T3


Prostaglandins


T9

CYTOTEC T3


misoprostol oral T1

Protectants

CARAFATE T3 ST



144



ACIPHEX T9


T9


DEXILANT T9

dexlansoprazole T9



T9


FIRST-OMEPRAZOLE T3



NEXIUM T9


T9


T3






PREVACID T9

PREVACID 24HR T3

PRILOSEC OTC T3

PROTONIX ORAL T9


VIMOVO T9

YOSPRALA T9

ZEGERID T9

ZEGERID OTC T3

Gold Compounds

Gold Compounds

RIDAURA T9





145






DEPEN TITRATABS T9

EXJADE T5









T9SP ()



SYPRINE T9



Adrenals

ADVAIR DISKUS T9

ADVAIR HFA T9

AIRDUO DIGIHALER T9

146





ALKINDI SPRINKLE T9

ALVESCO T9








ASMANEX HFA T9

BREO ELLIPTA T9









CORTEF T3


dexabliss T9






T9

DEXONTO 04 T3


T9


EMFLAZA T9





147








T3



HEMADY T9

HIDEX 6-DAY T9


INTRAROSA T3 PA

MEDROL T3


MILLIPRED T9


NASONEX T9

ORAPRED ODT T9

ORTIKOS T9



T1


T9




T1




T3



QVAR REDIHALER T1

RAYOS T9

SINUVA T9

148





TAPERDEX 12-DAY T9


T9

TARPEYO T9

TRELEGY ELLIPTA T2


WIXELA INHUB T3

XHANCE T9

zcort 7-day T9

ZILRETTA T9


acarbose oral T1

GLYSET T3

PRECOSE T3

Amylinomimetics





Androgens

ANADROL-50 T9


T9


T9


T9

COVARYX T9

COVARYX HS T9




T9



149



FORTESTA T9

JATENZO T9

methitest T9


NATESTO T9

OXANDRIN T3

oxandrolone oral T3

STRIANT T9

TESTIM T9


T1



T9







TLANDO T9

VOGELXO PUMP T9


T9

XYOSTED T9




CYCLOSET T3




Antiestrogens

anastrozole oral T1

ARIMIDEX T3

AROMASIN T3

exemestane T2

150


FEMARA T3




letrozole oral T1

Antigonadtropins











PROGLYCEM T9





MIACALCIN NASAL T3


Antithyroid Agents

methimazole oral T1

151



TAPAZOLE T3

Biguanides

ACTOPLUS MET T3



FORTAMET T9


GLUCOPHAGE T3

GLUCOPHAGE XR T3

GLUMETZA T9











KAZANO T9





metformin hcl er T1


T9



T1



RIOMET T9







152









T2



Contraceptives

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV

153



T3 PV

ECONTRA EZ T1 PV


ELLA T1


EMOQUETTE T1

ENPRESSE-28 T1 PV

ERRIN T1 PV

ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


154



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV

MELODETTA 24 FE T9

MIBELAS 24 FE T9





MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV

NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV


NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV


T1 PV



T9


T1 PV

155


NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV

PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9

156

















KAZANO T9





NESINA T9


OSENI T9











EVISTA T3

FARESTON T9

OSPHENA T2 PA

raloxifene hcl T1

SOLTAMOX T9


157



Estrogens

ACTIVELLA T3

ALORA T2

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA T9

CLIMARA PRO T9

COMBIPATCH T2

COVARYX T9

COVARYX HS T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DELESTROGEN T3





DOTTI T1

158



ELESTRIN T3


EMOQUETTE T1

ENPRESSE-28 T1 PV




ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1





T2


ESTRING T3


ESTROSTEP FE T3


EVAMIST T2

FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

FEMRING T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV




JINTELI T1

JOLESSA T1 PV

JULEBER T1

159


JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9



T1 PV


T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYLLANA T1

marlissa T1 PV

MELODETTA 24 FE T9


T2


MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

160



T3

MIRCETTE T9


NATAZIA T9

NECON 0535 (28) T1 PV

NEXTSTELLIS T9



T1 PV


T1 PV


T1


T9


T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


PORTIA-28 T1 PV

PREFEST T3



PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

SAFYRAL T9

SEASONIQUE T9

161


SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TWIRLA T9

TYDEMY T9


VELIVET T1 PV

VIVELLE-DOT T3


YASMIN 28 T9

YAZ T9

YUVAFEM T1













Gonadotropins






162



MENOPUR T2

NOVAREL T3 ST

OVIDREL T2

PREGNYL T1

SYNAREL T9

Incretin Mimetics

ADLYXIN T3 ST




T3 ST


T3 ST





RYBELSUS T9

SAXENDA T9




T2

WEGOVY T9



HUMULIN 7030 T1


T1

HUMULIN N T1


T1

NOVOLIN 7030 T3 ST


NOVOLIN N T3 ST


163


Leptins

MYALEPT T5


)


BASAGLAR KWIKPEN T9


LANTUS T1


T1

LEVEMIR T3 ST


SEMGLEE T9

SEMGLEE (YFGN) T9



TOUJEO SOLOSTAR T1

TRESIBA T9



Meglitinides

nateglinide T1


repaglinide T1

STARLIX T3

Parathyroid Agents


T9







164


Pituitary


CORTROPHIN T9

DDAVP ORAL T3







T9




T9

NOCDURNA T9

NOCTIVA T9




T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



SKYTROFA T9


ZOMACTON T9


165


Progestins

ACTIVELLA T3

AFTERA T1

ALTAVERA T1 PV

alyacen 135 T1 PV

AMETHIA T1 PV

AMETHIA LO T1 PV

ANGELIQ T3 ST

ANNOVERA T9

APRI T1 PV

AUBRA T1 PV

AUBRA EQ T1 PV

AVIANE T1 PV

AYGESTIN T3

AYUNA T1 PV

AZURETTE T1 PV

BALCOLTRA T9


BEYAZ T9

BIJUVA T9

BLISOVI 24 FE T1 PV

CAMILA T1 PV

CAMRESE T1 PV

CAMRESE LO T1 PV

CHATEAL T1 PV

CHATEAL EQ T1 PV

CLIMARA PRO T9

COMBIPATCH T2

CRINONE T9

CRYSELLE-28 T1 PV

CYCLAFEM 135 T1 PV

CYCLAFEM 777 T1 PV

DEBLITANE T1 PV


T3 PV


T3 PV

ECONTRA EZ T1 PV


166


ELLA T1


EMOQUETTE T1


ENPRESSE-28 T1 PV

ERRIN T1 PV


ESTROSTEP FE T3


FALMINA T1 PV

FAYOSIM T9

FEMHRT T3

FEMHRT LOW DOSE T3

GEMMILY T9

GENERESS FE T9

GIANVI T1 PV



HAILEY 24 FE T1 PV


HEATHER T1 PV

JENCYCLA T1 PV

JINTELI T1

JOLESSA T1 PV

JULEBER T1

JUNEL 1530 T1 PV

JUNEL 120 T1 PV

JUNEL FE 1530 T1 PV

JUNEL FE 120 T1 PV

JUNEL FE 24 T1 PV

KAITLIB FE T9

KARIVA T1 PV

KELNOR 135 T1 PV

KURVELO T1 PV

LARIN 24 FE T1 PV

LAYOLIS FE T9


167



T1 PV



T1 PV

LEVORA 01530 (28) T1 PV

LILLOW T1 PV



LOESTRIN FE 1530 T3

LOESTRIN FE 120 T3

LOSEASONIQUE T9

LOW-OGESTREL T1 PV

LUTERA T1 PV

LYZA T1 PV

marlissa T1 PV


T1 PV


MEGACE ES T3 ST




MELODETTA 24 FE T9

MIBELAS 24 FE T9





MIMVEY T1

MIMVEY LO T1

MINASTRIN 24 FE T9

MIRCETTE T9

MY CHOICE T1 PV

MY WAY T1 PV


NATAZIA T9

NECON 0535 (28) T1 PV

NEW DAY T1 PV

168



NEXTSTELLIS T9

NORA-BE T1 PV



T1 PV



T1 PV



T1


T9


T1 PV

NORLYDA T1 PV



NORTREL 777 T1 PV

NUVARING T9

NYLIA 135 T1 PV

OCELLA T1 PV


OPTION 2 T1 PV


PLAN B ONE-STEP T1

PORTIA-28 T1 PV

PREFEST T3

PREMPHASE T2

PREMPRO T2

PREVIFEM T1 PV



PROMETRIUM T3

PROVERA T3

QUARTETTE T9

RECLIPSEN T1 PV

RIVELSA T9

169


SAFYRAL T9

SEASONIQUE T9

SHAROBEL T1 PV

SLYND T9

SPRINTEC 28 T1 PV

SRONYX T1 PV

SYEDA T1

TAKE ACTION T1

TAYTULLA T9

TRI-ESTARYLLA T1 PV

TRI-LEGEST FE T1 PV

TRI-LINYAH T1 PV



TRI-NORINYL (28) T3

TRI-PREVIFEM T1 PV

TRI-SPRINTEC T1 PV

TRIVORA (28) T1 PV

TULANA T1 PV

TWIRLA T9

TYDEMY T9

VELIVET T1 PV


YASMIN 28 T9

YAZ T9




ADMELOG T3 ST



T3 ST

APIDRA T3 ST


T3 ST

FIASP T3 ST


FIASP PENFILL T3 ST

HUMALOG T1

170




T1

HUMALOG MIX 5050 T1


T1

HUMALOG MIX 7525 T1


T1






insulin lispro T9




LYUMJEV T1

LYUMJEV KWIKPEN T1

NOVOLOG T9


T9

NOVOLOG MIX 7030 T9


T9


T9


HUMULIN 7030 T1


T1

HUMULIN R T1



T1

NOVOLIN 7030 T3 ST


NOVOLIN R T3 ST

171


























T2




BYNFEZIA PEN T9

MYCAPSSA T9






172




T9




T9





T9


T9


T9


T9


T9SP ()

SAIZEN T9SP ()



ZOMACTON T9











Sulfonylureas

AMARYL T3

DUETACT T9

glimepiride T1

173


glipizide er T1

glipizide oral T1


T1


GLUCOTROL T3

GLUCOTROL XL T3


glyburide oral T1


GLYNASE T3


Thiazolidinediones

ACTOPLUS MET T3


ACTOS T3



DUETACT T9

OSENI T9

pioglitazone hcl T1



Thyroid Agents

ARMOUR THYROID T2

CYTOMEL T2

EUTHYROX T3

LEVO-T T3





LEVOXYL T1


NP THYROID T1

SYNTHROID T3

THYQUIDITY T9


T2


T2

174



T2


T2


T2


T9


T9


T1


T1



ZTLIDO T9



AVODART T3





JALYN T3 ST

PROPECIA T9

PROSCAR T3

Alcohol Deterrents

ANTABUSE T3

disulfiram oral T1


Antidotes



T1




175






























RENVELA T9



176




SPS T1




Antigout Agents

allopurinol oral T1

ANAPROX DS T3




COLCRYS T9


T3


GLOPERBA T9

INDOCIN ORAL T9

INDOCIN RECTAL T9

indomethacin er T1


MITIGARE T9


T9








probenecid oral T1


ZYLOPRIM T3


EXONDYS 51 T9

177



VILTEPSO T9



T9











ALORA T2

ATELVIA T3

BINOSTO T3 ST




CLIMARA T9

DELESTROGEN T3





DOTTI T1

ELESTRIN T3

ESTRACE ORAL T3

ESTRACE VAGINAL T9


estradiol oral T1




178



T2

ESTRING T3



EVAMIST T2

EVISTA T3

FEMRING T3




LYLLANA T1


T2


MIACALCIN NASAL T3


T3



raloxifene hcl T1






VIVELLE-DOT T3

YUVAFEM T1


FIRAZYR T9





179


Cariostatic Agents

DENTA 5000 PLUS T1

DENTAGEL T1



FLORIVA PLUS T9


T3

LUDENT T1



T1 AL


MYKIDZ IRON FL T9

PREVIDENT T3



QUFLORA FE T9


T9

sf T1

sf 5000 plus T1









TRI-VI-FLOR T9






RUCONEST T9

180







AZASAN T9



AZULFIDINE T3






COSENTYX T4







T4


181








DEPEN TITRATABS T9











T4
















182













T9


IMURAN T3









leflunomide oral T1



T1

NEORAL T3



183











T9



PLAQUENIL T3


T9

REDITREX T3 ST

REMICADE T9

RIDAURA T9











184







TREXALL T3 ST

XATMEP T3 AL















AZASAN T9



AZULFIDINE T3

185



BAFIERTAM T9







T9


















T4


186









T4




T4




T4




T4











187

















T9


IMURAN T3





KESIMPTA T4




leflunomide oral T1



188







T1

NEORAL T3










PLAQUENIL T3











189
















REMICADE T9





RIDAURA T9









190







TREXALL T3 ST

VUMERITY T9

XATMEP T3 AL






ASTAGRAF XL T3 ST

AZASAN T9






T3 AL









ENVARSUS XR T3 ST

191






IMURAN T3

leflunomide oral T1



















T1



T1 AL

192











NEORAL T3













tacrolimus oral T1

TREXALL T3 ST

XATMEP T3 AL








193





FIRAZYR T9





RUCONEST T9





AMPYRA T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9


betaine T3

bp vit 3 T9

CARDIOVID PLUS T9

CARNITOR ORAL T3

CARNITOR SF T3




CITRANATAL DHA T3

194



T3

coenzyme q10 T2



CYSTADANE T9


DEMSER T9


ENDARI T9


T9



FERIVA 217 T9


FERREX 28 T9


FOLBEE AR T9


IROSPAN 246 T9







levocarnitine sf T1

195


maca T9

METAFOLBIC PLUS T9

metyrosine T9


MULTIGEN FOLIC T9

MULTIGEN PLUS T9


neonatal + dha T9

NEXA PLUS T3

nitisinone T9

NITYR T9

ORFADIN T9

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATE AM T3


T3

PRENATE PIXIE T3



T9

RECORLEV T9




SOLESTA T3


196



TARON-PREX T2

THIOLA T9






tristart dha T9

TRIVEEN-DUO DHA T1


URIBEL T9


VITAFOL-ONE T3

VITAPEARL T3

VITATRUE T3




XURIDEN T9

ZAVESCA T9

ZOKINVY T9

Protective Agents




CAYA T3


197


Oxytocics

Oxytocics



PREPIDIL T3

Pharmaceutical Aids

Pharmaceutical Aids

ALPAWASH T9

FREEDOM DERMA-D T9



ADRENALIN NASAL T9


T9




T9


T9








T1

ATROVENT HFA T2













198


Antifibrotic Agents

















Antitussives



BROMFED DM T9









199


HISTEX-AC T9

HYCODAN T9


T1



hydromet T1

maxi-tuss cd T9





T1

TESSALON PERLES T3


T9















200













Expectorants







SSKI T3














201



T9




T1


T3


T9


RYVENT T9



T4




ACCOLATE T3


SINGULAIR T3

zafirlukast T1


ZYFLO T9

ZYFLO CR T9


ALOCRIL T3 ST




GASTROCROM T3

Mucolytic Agents





202



T1



BECONASE AQ T9

budesonide nasal T9

DYMISTA T3 ST





NASONEX T9

QNASL T9

QNASL CHILDRENS T9

SINUVA T9

TICALAST T9


XHANCE T9












T3



QVAR REDIHALER T1





BRONCHITOL T9



203




ALLEGRA ALLERGY T9


T9













T9


DYMISTA T3 ST



QUZYTTIR T9

TICALAST T9

ZERVIATE T9







T1


ARCAPTA NEOHALER T3



T1



204


PERFOROMIST T9

PROAIR DIGIHALER T9

PROAIR HFA T9


PROVENTIL HFA T9

SEREVENT DISKUS T2




XOPENEX T3


XOPENEX HFA T9


ADCIRCA T9














T5




T5



205



T5




















VENTAVIS T4 PA

VIAGRA T9


ELIXOPHYLLIN T3

THEO-24 T2

206



T1


T1








ACANYA T9

ACZONE T9

AKTIPAK T9

ALTABAX T3 ST

AMZEEQ T9

AVAR CLEANSER T9


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

BENZACLIN T9



bp 10-1 T9


CENTANY T3

CLENIA PLUS T9







CLINDAGEL T9


T9



207










CLINDESSE T3 ST


dapsone external T9

DUAC T9

ery T1

ERYGEL T1




KLARON T3

METROCREAM T3


METROGEL-VAGINAL T3

METROLOTION T3








NORITATE T9

NUVESSA T9

ONEXTON T9

OVACE PLUS T9

OVACE PLUS WASH T9

OVACE WASH T9



T9


PLEXION NS T9

208








T9



T1


T9


T9


T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

VANDAZOLE T1

VELTIN T9

XEPI T9

ZIANA T9

ZILXI T9


ALA-QUIN T9










EPIFOAM T9

ethyl chloride T9

209







T2











LIDODERM T9



lidorx T9

LIDOTRANS 5 PAK T9

LIVIXIL PAK T9




PRAMOSONE T9


prilovixil T9

PRUDOXIN T9

PYRIDIUM T3


RELADOR PAK PLUS T9

SYNERA T9

XRYLIDERM T9

ZONALON T9



DENAVIR T9

XERESE T9

ZOVIRAX EXTERNAL T9

210


Astringents


DRYSOL T1

VUSION T9

XERAC AC T1








ECOZA T9

ERTACZO T3 ST

EXELDERM T9

EXTINA T9

GYNAZOLE-1 T3

JUBLIA T9






luliconazole T9

LUZU T9

NIZORAL T3






TERAZOL 7 T3



VUSION T9

XOLEGEL T9



GERI-HYDROLAC 12 T9

211


GERI-HYDROLAC 5 T9




urea hydrating T9


lactic acid e T9


ALCORTIN A T9

DERMASORB XM T9

iodoquimez-hc T9

lactic acid e T9


VYTONE T9


MENTAX T9



ATRALIN T3 ST AL

AVITA T9


REFISSA T9

RENOVA T9

RENOVA PUMP T9

RETIN-A T3 AL

RETIN-A MICRO T9









TRI-LUMA T9

TWYNEO T9

VELTIN T9

ZIANA T9


ALA SCALP T9

212



ALA-QUIN T9


ALCORTIN A T9

amcinonide T9



APEXICON E T9

AQUANIL HC T1













BRYHALI T3 ST




CAPEX T9











CLOBEX SPRAY T9



213



CLODERM T9

CLODERM PUMP T9



CORDRAN T9


CORTENEMA T3





DERMASORB HC T9

DERMASORB TA T9

DERMAZENE T9

DESONATE T9














DIPROLENE AF T3


DUOBRII T9



ENSTILAR T9

EPIFOAM T9





214










flurandrenolide T9







HALOG T9


T1


T9


T2



















215


IMPEKLO T9

IMPOYZ T9

iodoquimez-hc T9

KENALOG EXTERNAL T9






LOCOID LIPOCREAM T9


LUXIQ T9





NUCORT T3


OLUX T9

OLUX-E T3

ORALONE T3

PANDEL T9

PRAMOSONE T9


prednicarbate T1



SERNIVO T9

SYNALAR T9

SYNALAR TS T9




TEXACORT T9





216


TOPICORT SPRAY T9





T1



TRIANEX T9


TRI-LUMA T9





VANOS T9

VANOXIDE-HC T9

VERDESO T9

VYTONE T9

WYNZORA T9

XERESE T9

Depigmenting Agents


ESOTERICA FACIAL T9


hydroquinone T9


TRI-LUMA T9

Detergents



VUSION T9






Keratolytic Agents

AVAR CLEANSER T9


217


AVAR LS CLEANSER T9


AVAR-E EMOLLIENT T9

AVAR-E GREEN T9

AVAR-E LS T9

bensal hp T9

bp 10-1 T9


CLENIA PLUS T9

DERMASORB XM T9





T9


PROMISEB T9


rynoderm T9










SALVAX T9



SELRX T9


T9



T1


T9


T9

218



T9


T9

SUMADAN T3

SUMADAN WASH T3

SUMAXIN T9

SUMAXIN CP T9

SUMAXIN WASH T9

ULTRASAL-ER T9



urea hydrating T9


UTOPIC T9

XALIX T9

xurea T9




ACANYA T9




T1


T9

AKTIPAK T9

ALCORTIN A T9


BENZACLIN T9


BENZEFOAM T9

BENZEFOAMULTRA T9








219








bpo T9




T9






DERMAZENE T9

DUAC T9

EPIDUO T3

EPIDUO FORTE T9

EPSOLAY T9


iodoquimez-hc T9



ONEXTON T9

PERIDEX T3






SELRX T9

SILVADENE T3


SSD T1


SULFAMYLON T3

TWYNEO T9

VANOXIDE-HC T9

220


VYTONE T9






PROFINAC T9


Oxaboroles

KERYDIN T9

tavaborole T9

Pigmenting Agents










EURAX T9





NATROBA T9

OVIDE T3


SKLICE T3


spinosad T1

ULESFIA T3


ABSORICA T9

ABSORICA LD T9


221




ACZONE T9







T1


T9


AKLIEF T9

ALDARA T3


ARAZLO T9

ATRAPRO HYDROGEL T9

AVO CREAM T9




BIAFINE T9













CARAC T9

CELACYN T9

222



CERACADE T9




COSENTYX T4







T4


dapsone external T9

DERMASORB HC T9

DERMULCERA T9








doxycycline T9

DRITHO-CREME HP T9

DUOBRII T9


T4


223



T4



T4



ELETONE T9


EMULSION SB T9

ENSTILAR T9


EPICERAM T9

EPIDUO T3

EPIDUO FORTE T9

FABIOR T9








GELCLAIR T9






imiquimod pump T9




KAMDOY T9


224



LATISSE T9

LOYON T9

LUXAMEND T9


T9

MINOLIRA T9


MIRVASO T9


MUGARD T9



NIVATOPIC PLUS T9

NUVAIL T9

OPZELURA T9

ORACEA T9

ORAMAGICRX T9




PHLAG SPRAY T9


podocon T9

PODOCON-25 T9


PRESERA T9

PROFINAC T9

PROPECIA T9


PRUCLAIR T9

PRUMYX T9

PRUTECT T9

QBREXZA T9

RECEDO T9

225


RECTIV T9


REMICADE T9


ROGAINE T9

ROGAINE MENS T9




SILIQ T5







T9

SONAFINE T9

SORILUX T9







suvicort T9

SYNALAR TS T9

SYNERDERM T9




226


















VANIQA T9


VELTIN T9

VENELEX T9



WINLEVI T9

WYNZORA T9

XIMINO T9


ZIANA T9

ZITHRANOL T3 ST

ZYCLARA T9




Antimuscarinics


DETROL T3


227



T3


flavoxate hcl T1




OXYTROL T9










ELIXOPHYLLIN T3






THEO-24 T2


T1


T1


GEMTESA T9





Vitamins


BACMIN T9

choice-tabs T9

228





CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1


CORVITE FREE T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9


FLORIVA PLUS T9

folbee plus T9

FOLBEE PLUS CZ T9


INATAL GT T1




T1 AL





M-VIT T9

MYKIDZ IRON FL T9


mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

229





neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRO-VITE RX T9

NEXA PLUS T3

NICADAN T9

NICAZEL T9

NICAZEL FORTE T9

NICOMIDE T9

NIVA-PLUS T9

O-CAL FA T9



pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1

PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

230


PRENATE PIXIE T3

PROVIDA OB T3

QUFLORA FE T9


T9


rena-vite T3

rena-vite rx T9

reno caps T9

REQ 49+ T9


T1




STROVITE ONE T9

SUPERVITE T9

TARON-PREX T2


TRICARE T1

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9


tri-zel T9


v-c forte T9

VIC-FORTE T9


VINATE M T1

VINATE ONE T1

virt-caps T9

virt-vite plus T9

VITACEL T1



VITAFOL-OB T3

231


VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITATRUE T3

vp-vite rx T9

Vitamin A

active fe T9

MYKIDZ IRON FL T9

pnv-select T1

TRI-VI-FLOR T9


Vitamin B Complex

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9

BEYAZ T9

bp vit 3 T9


CARDIOVID PLUS T9

CENTRATEX T9

CIFEREX T9




CITRANATAL BLOOM T3

CITRANATAL DHA T3


T3

CITRANATAL RX T3


completenate T1

CORVITA 150 T9






DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

232




DIALYVITEZINC T9

durachol T9

fabb T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


T9


FERREX 28 T9


folbee T9

FOLBEE AR T9

folbee plus T9

FOLBEE PLUS CZ T9

FOLBIC T9





FOLIVANE-F T9

FOLIVANE-PLUS T9

FOLIXAPURE T9

folplex 22 T9

FOLTANX T9

FOLTRATE T9


FUSION PLUS T9

FUSION SPRINKLES T9



HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON T9

233


HEMATRON-AF T9


hemetab T9

HEMOCYTE PLUS T9



ICAR-C PLUS T9

IFEREX 150 FORTE T9

INATAL GT T1

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9





METAFOLBIC PLUS T9

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


T1 AL

M-VIT T9



mynatal plus T1

mynatal-z T1

mynate 90 plus T1

mynephrocaps T9

MYNEPHRON T9

NASCOBAL T9



NATALVIRT FLT T9


neonatal + dha T9


NEONATAL PLUS T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9

234


neurin-sl T9

NEXA PLUS T3


NIACOR T1

NICOMIDE T9

NIVA-FOL T9

NIVA-PLUS T9

noxifol-d T9

O-CAL FA T9


ortho df T9


pnv tabs 29-1 T1

pnv-dha T1

pnv-dha+docusate T1

pnv-omega T1

pnv-select T1



PR NATAL 400 T1

PR NATAL 400 EC T1

PR NATAL 430 T1

PR NATAL 430 EC T1

PRENATABS RX T1







prenatal plus T1




PRENATE AM T3


T3

PRENATE PIXIE T3

PROFERRIN-FORTE T9

PROVIDA OB T3

235


purefe plus T9


QUFLORA FE T9


rena-vite T3

rena-vite rx T9

reno caps T9

RESTORA RX T9


revesta T9

roxifol-d T9

SAFYRAL T9


T1


se-tan plus T9


SUPERVITE T9

TANDEM PLUS T9

taron forte T9

TARON-PREX T2


tl gard rx T9

tl icon T9

tl-hem 150 T9

TRICARE T1

TRICON T9

trigels-f forte T9

trinatal rx 1 T1

TRINATE T2

triphrocaps T9

tristart dha T9

TRIVEEN-DUO DHA T1

TRI-VI-FLOR T9

TYDEMY T9



VINATE M T1

VINATE ONE T1

virt-caps T9

236


VIRT-GARD T9

virt-vite T9

virt-vite forte T9

virt-vite plus T9


VITAFOL-OB T3

VITAFOL-ONE T3

VITAL-D RX T9

VITAPEARL T3

VITA-RESPA T9

VITATRUE T3

vp-vite rx T9

zavara T9

Vitamin C

active fe T9

CENTRATEX T9

CITRANATAL BLOOM T3

CORVITA 150 T9


DIALYVITE T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9


DIALYVITEZINC T9

fe 90 plus T9

FE C PLUS T9

FERIVA 217 T9

FERIVAFA T9

ferocon T9

FERRALET 90 T9

ferraplus 90 T9


FERREX 150 PLUS T9

FERREX 28 T9


folbee plus T9

FOLBEE PLUS CZ T9

FOLIVANE-F T9

FOLIVANE-PLUS T9

FUSION PLUS T9

237


FUSION SPRINKLES T9


HEMATOGEN FA T9

HEMATOGEN FORTE T9

HEMATRON-AF T9


HEMOCYTE PLUS T9


ICAR-C PLUS T9

INTEGRA F T9

INTEGRA PLUS T9

IROSPAN 246 T9



MOVIPREP T3

MULTIGEN FOLIC T9

MULTIGEN PLUS T9


MYKIDZ IRON FL T9

mynephrocaps T9

MYNEPHRON T9

NATALVIRT FLT T9

NEPHPLEX RX T9

NEPHRON FA T9

NEPHRO-VITE RX T9


PLENVU T3

pnv-select T1

purefe plus T9



rena-vite T3

rena-vite rx T9

reno caps T9

se-tan plus T9

TANDEM PLUS T9

taron forte T9

tl icon T9

tl-hem 150 T9

TRICON T9

238


trigels-f forte T9

triphrocaps T9

TRI-VI-FLOR T9


virt-caps T9

virt-vite plus T9

VITAL-D RX T9

vp-vite rx T9

Vitamin D

active fe T9

ANIMI-3 T9

ANIMI-3VITAMIN D T9




CIFEREX T9






durachol T9


FOLIXAPURE T9


MYKIDZ IRON FL T9

noxifol-d T9

ortho df T9


pnv-select T1

RAYALDEE T9

REPLESTA T9


REPLESTA NX T9

revesta T9

ROCALTROL T3

roxifol-d T9

TRI-VI-FLOR T9


239


VITAL-D RX T9


T1




zavara T9


Vitamin E

active fe T9

DIALYVITE 3000 T9

DIALYVITE 5000 T9

HEMATRON-AF T9


pnv-select T1

tl-hem 150 T9

Vitamin K Activity



240

241

Index




242




243




244




245




246




247




248




249




250




251




252




253




254




255




256




257




258




259




260




261




262




263




264




265




266
















8003681019 8005377697 (TDD)








(TTY 711）
















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