example part d usp class salt/ester eligible drugs* · celecoxib diclofenac potassium diflunisal...

USP Medicare Model Guidelines v6.0 of 30

* This list is illustrative of Part D eligible drugs only, and does not infer CMS coverage

USP Category USP Class Example Part D Eligible Drugs* Salt/Ester

AnalgesicsNonsteroidal Anti-inflammatory Drugs

CelecoxibDiclofenac PotassiumDiflunisalEtodolacFenoprofen CalciumFlurbiprofenIbuprofenIndomethacinKetoprofenKetorolac TromethamineMeclofenamateMefenamic AcidMeloxicamNabumetoneNaproxenOxaprozinPiroxicamSulindacTolmetin

Opioid Analgesics, Long-actingHydromorphoneFentanylLevorphanol TartrateMethadone HydrochlorideMorphine SulfateOxycodone HydrochlorideOxymorphone HydrochlorideTramadol Hydrochloride

Opioid Analgesics, Short-actingButorphanol TartrateCodeine PhosphateFentanyl CitrateHydromorphone HydrochlorideMeperidine HydrochlorideNalbuphine HydrochlorideOxycodone HydrochlorideOxymorphone HydrochloridePentazocine LactateTapentadolTramadol Hydrochloride

AnestheticsLocal Anesthetics

Lidocaine HydrochlorideLidocaine and Prilocaine

Anti-Addiction/ Substance Abuse Treatment Agents

Alcohol Deterrents/Anti-cravingAcamprosate CalciumDisulfiramNaltrexone Hydrochloride

Opioid Dependence TreatmentsBuprenorphineBuprenorphine/NaloxoneNaltrexone Hydrochloride

Opioid Reversal Agents




Naloxone HydrochlorideSmoking Cessation Agents

Bupropion HydrochlorideNicotineVarenicline Tartrate

AntibacterialsAminoglycosides

Amikacin SulfateGentamicin SulfateKanamycin SulfateNeomycin SulfateParomomycin SulfateStreptomycin SulfateTobramycin SulfateTobramycin and Dexamethasone

Beta-lactam, Cephalosporins

CefadroxilCefazolinCephalexin

CefaclorCefoxitinCefprozilCefuroxime Axetil

CefdinirCefditoren PivoxilCefiximeCefotaximeCefpodoxime ProxetilCeftazidimeCeftibuten DihydrateCeftriaxone Sodium

Cefepime HydrochlorideCeftaroline Fosamil

Beta-lactam, Penicillins

AmoxicillinAmoxicillin and Clavulanate PotassiumAmpicillinAmpicillin Sodium and Sulbactam Sodium

Piperacillin SodiumPiperacillin Sodium and Tazobactam SodiumTicarcillin Disodium and Clavulanate Potassium

Penicillin G BenzathinePotassiumProcaineSodium

Penicillin V Potassium

Dicloxacillin SodiumNafcillin Sodium




Oxacillin SodiumBeta-lactam, Other

AztreonamDoripenemErtapenem SodiumImipenem and Cilastatin SodiumMeropenem

MacrolidesAzithromycinClarithromycinErythromycin Estolate

Ethylsuccinate Lactobionate Stearate

FidaxomicinTelithromycin

QuinolonesBesifloxacinCiprofloxacinGatifloxacinGemifloxacin MesylateLevofloxacinMoxifloxacin HydrochlorideNorfloxacinOfloxacin

SulfonamidesSulfacetamide SodiumSulfadiazineSulfamethoxazole and Trimethoprim

TetracyclinesDemeclocycline HydrochlorideDoxycycline Calcium

HyclateMinocycline HydrochlorideTetracycline Hydrochloride

Antibacterials, Other

Trimethoprim

Vancomycin Hydrochloride

Clindamycin HydrochloridePalmitate

Lincomycin Hydrochloride

Nitrofurantoin

Linezolid

Acetic AcidBacitracinChloramphenicol Sodium SuccinateDaptomycinFosfomycin TromethamineGramicidinMafenide AcetateMethenamine Hippurate

MandelateMetronidazole HydrochlorideMupirocin Calcium




Polymyxin B SulfateRetapamulinRifaximinTelavancinTinidazole Tigecycline

Anticonvulsants

Calcium Channel Modifying AgentsEthosuximideMethsuximidePregabalinZonisamide

Gamma-aminobutyric Acid (GABA) Augmenting Agents

ClobazamClonazepamClorazepate DipotassiumDiazepamLorazepam

MephobarbitalPhenobarbitalPrimidone

Divalproex SodiumGabapentinTiagabine HydrochlorideValproate SodiumVigabatrin

Glutamate Reducing Agents Felbamate

LamotriginePerampanelTopiramate

Sodium Channel AgentsCarbamazepineEslicarbazepine Acetate EthotoinFosphenytoin SodiumOxcarbazepinePhenytoin SodiumRufinamide

LacosamideAnticonvulsants, Other

Levetiracetam

Ezogabine

Antidementia AgentsCholinesterase Inhibitors

Donepezil HydrochlorideGalantamine HydrochlorideRivastigmine Tartrate

N-methyl-D-aspartate (NMDA) Receptor Antagonist

Memantine HydrochlorideAntidementia Agents, Other




Ergoloid Mesylates

AntidepressantsMonoamine Oxidase Inhibitors

Phenelzine SulfateSelegilineTranylcypromine Sulfate

SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/ Serotonin and Norepinephrine Reuptake Inhibitors)

Citalopram HydrobromideDesvenlafaxineDuloxetine HydrochlorideEscitalopram OxalateFluoxetine HydrochlorideFluvoxamine MaleateLevomilnacipran HydrochlorideMaprotiline HydrochlorideNefazodone HydrochlorideParoxetine HydrochlorideSertraline HydrochlorideTrazodone HydrochlorideVenlafaxine HydrochlorideVilazodone HydrochlorideVortioxetine

TricyclicsAmitriptyline HydrochlorideAmoxapineClomipramine HydrochlorideDesipramine HydrochlorideDoxepin HydrochlorideImipramine Hydrochloride

PamoateNortriptyline HydrochlorideProtriptyline HydrochlorideTrimipramine Maleate

Antidepressants, OtherBupropion HydrochlorideMirtazapine

AripiprazoleQuetiapine Fumarate

AntiemeticsEmetogenic Therapy Adjuncts

Dolasetron MesylateGranisetron HydrochlorideOndansetron HydrochloridePalonosetron Hydrochloride

Aprepitant

DronabinolNabilone

Antiemetics, OtherChlorpromazine HydrochlorideDiphenhydramine HydrochlorideDoxylamine Succinate/ Pyridoxine HydrochlorideHydroxyzine Pamoate




Meclizine HydrochlorideMetoclopramidePerphenazineProchlorperazine Edisylate

MaleatePromethazine HydrochlorideScopolamineTrimethobenzamide Hydrochloride

Antifungals

Naftifine HydrochlorideTerbinafine Hydrochloride

Butoconazole NitrateClotrimazoleEconazole NitrateFluconazoleItraconazoleKetoconazoleLuliconazoleMiconazole NitrateOxiconazole NitratePosaconazoleSertaconazole NitrateSulconazole NitrateTerconazoleVoriconazole

AnidulafunginCaspofungin AcetateMicafungin Sodium

NatamycinNystatin

Butenafine HydrochlorideCiclopiroxFlucytosineGriseofulvin

Antigout Agents

Probenecid

AllopurinolFebuxostat

Colchicine

Anti-inflammatory Agents

GlucocorticoidsNonsteroidal Anti-inflammatory Drugs

CelecoxibDiclofenac PotassiumDiflunisalEtodolacFenoprofen CalciumFlurbiprofenIbuprofenIndomethacin




KetoprofenKetorolac TromethamineMeclofenamate SodiumMefenamic AcidMeloxicamNabumetoneNaproxen SodiumOxaprozinPiroxicamSulindacTolmetin Sodium

Antimigraine AgentsErgot Alkaloids

Dihydroergotamine MesylateErgotamine Tartrate

Serotonin (5-HT) 1b/1d Receptor Agonists

Almotriptan MalateEletriptanFrovatriptan SuccinateNaratriptan HydrochlorideRizatriptan BenzoateSumatriptanZolmitriptan

Prophylactic

Timolol Maleate

Divalproex SodiumTopiramateValproic Acid

Antimyasthenic AgentsParasympathomimetics

Ambenonium ChlorideGuanidine HydrochloridePyridostigmine Bromide

AntimycobacterialsAntituberculars

Bedaquiline FumarateCapreomycin SulfateCycloserineEthambutol HydrochlorideEthionamideIsoniazidPyrazinamideRifampinRifampin and IsoniazidRifampin, Isoniazid, and PyrazinamideRifapentine

Antimycobacterials, OtherDapsoneRifabutin

AntineoplasticsAlkylating Agents

Altretamine

ChlorambucilMechlorethamine Hydrochloride




Melphalan

Lomustine

BusulfanCyclophosphamideProcarbazine Hydrochloride

Antiandrogens

EnzalutamideBicalutamideFlutamideNilutamide

Abiraterone AcetateAntiangiogenic Agents

LenalidomidePomalidomideThalidomide

Antiestrogens/Modifiers

Estramustine Phosphate Sodium

Tamoxifen CitrateToremifene Citrate

Antimetabolites

MercaptopurineThioguanine

Hydroxyurea

Aromatase Inhibitors, 3rd GenerationAnastrozoleExemestaneLetrozole

Enzyme InhibitorsEtoposideTopotecan

Molecular Target Inhibitors

VemurafenibDabrafenibTrametinib

Ibrutinib

Afatinib DimaleateErlotinib Hydrochloride

Vismodegib

Ruxolitinib

Everolimus

Crizotinib




BosutinibDasatinibImatinib MesylateNilotinibPonatinib Hydrochloride

Lapatinib

AxitinibCabozantinib

PazopanibRegorafenibSorafenib TosylateSunitinib MalateVandetanib

Monoclonal Antibodies

RituximabOfatumumab

RetinoidsAlitretinoinBexaroteneTretinoin

Antineoplastics, OtherFludarabineLeucovorinMitoxantrone HydrochlorideVorinostat

AntiparasiticsAnthelmintics

AlbendazoleIvermectinMebendazolePraziquantel

Antiprotozoals

Artemether and LumefantrineAtovaquone and Proguanil HydrochlorideChloroquine PhosphateHydroxychloroquine SulfateMefloquine HydrochloridePrimaquine PhosphatePyrimethamineQuinine Sulfate

AtovaquoneNitazoxanidePentamidine Isethionate

Pediculicides/ScabicidesBenzyl alcoholCrotamitonLindaneMalathionPermethrinSpinosad

Antiparkinson AgentsAnticholinergics

Benztropine MesylateDiphenhydramine Hydrochloride




Trihexyphenidyl HydrochlorideDopamine Agonists

Apomorphine HydrochlorideBromocriptine MesylatePramipexole Dihydrochloride

MonohydrateRopinirole HydrochlorideRotigotine

Dopamine Precursors/ L-Amino Acid Decarboxylase Inhibitors

CarbidopaCarbidopa and Levodopa

Monoamine Oxidase B (MAO-B) Inhibitors

Rasagiline MesylateSelegiline Hydrochloride

Antiparkinson Agents, Other

EntacaponeTolcapone

Amantadine Hydrochloride

Antipsychotics1st Generation/Typical

Chlorpromazine HydrochlorideFluphenazine HydrochlorideHaloperidol LactateLoxapine SuccinatePerphenazinePimozideProchlorperazine Edisylate

MaleateThioridazine HydrochlorideThiothixene HydrochlorideTrifluoperazine Hydrochloride

2nd Generation/AtypicalAripiprazoleAsenapineIloperidoneLurasidoneOlanzapineQuetiapine FumaratePaliperidoneRisperidoneZiprasidone Hydrochloride

MesylateTreatment-Resistant

Clozapine

Antispasticity AgentsBaclofenDantrolene SodiumTizanidine Hydrochloride

Antivirals

Anti-cytomegalovirus (CMV) AgentsCidofovirFoscarnet SodiumGanciclovir SodiumValganciclovir Hydrochloride




Anti-hepatitis B (HBV) AgentsAdefovir DipivoxilEntecavirLamivudineRibavirinTelbivudineTenofovir Disoproxil Fumarate

Interferon Alfa-2b, RecombinantInterferon Alfa-2b and RibavirinInterferon Alfa-n3Peginterferon Alfa-2aPeginterferon Alfa-2b

Anti-hepatitis C (HCV) AgentsRibavirin

Interferon Alfa-2b, RecombinantInterferon Alfa-2b and RibavirinInterferon Alfa-n3Interferon Alfacon-1Peginterferon Alfa-2aPeginterferon Alfa-2b

BoceprevirSimeprevirTelaprevir

Sofosbuvir Antiherpetic Agents

AcyclovirFamciclovirFoscarnet SodiumIdoxuridineTrifluridinePenciclovir SodiumValacyclovir Hydrochloride

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Delavirdine MesylateEfavirenzEtravirineNevirapineRilpivirine Efavirenz/ Emtricitabine/ Tenofovir disoproxil fumarateEmtricitabine/ Rilpivirine / Tenofovir disoproxil fumarate

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

Abacavir SulfateAbacavir and LamivudineAbacavir, Lamivudine, and ZidovudineDidanosine

EmtricitabineEmtricitabine and Tenofovir Disoproxil Fumarate




LamivudineLamivudine and ZidovudineStavudineTenofovir Disoproxil Fumarate

Zidovudine

Anti-HIV Agents, Protease InhibitorsAtazanavir SulfateDarunavir EthanolateFosamprenavir CalciumIndinavir SulfateLopinavir and RitonavirNelfinavir MesylateRitonavirSaquinavir MesylateTipranavir

Anti-HIV Agents, Integrase Inhibitors (INSTI)

Dolutegravir SodiumElvitegravir/ Cobicistat/ Emtricitabine/ Tenofovir disoproxil fumarateRaltegravir

Anti-HIV Agents, OtherEnfuvirtideMaraviroc

Anti-influenza AgentsAmantadine HydrochlorideOseltamivir PhosphateRimantadine HydrochlorideZanamivir

Anxiolytics

SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/ Serotonin and Norepinephrine Reuptake Inhibitors)

Duloxetine HydrochlorideEscitalopram OxalateParoxetine HydrochlorideSertraline HydrochlorideVenlafaxine Hydrochloride

Benzodiazepines AlprazolamChlordiazepoxideClonazepamClorazepate DipotassiumDiazepamLorazepamOxazepam

Anxiolytics, OtherBuspirone HydrochlorideDoxepin HydrochlorideHydroxyzine Hydrochloride

Bipolar AgentsMood Stabilizers

CarbamazepineDivalproex SodiumLamotrigineLithium Carbonate




Valproic AcidBipolar Agents, Other

AripiprazoleAsenapineOlanzapineQuetiapine FumarateRisperidoneZiprasidone Hydrochloride

Mesylate

Blood Glucose Regulators

Antidiabetic Agents

AcarboseMiglitol

Pramlintide Acetate

Metformin Hydrochloride

Colesevelam Hydrochloride

Alogliptin Linagliptin SaxagliptinSitagliptin Phosphate

Bromocriptine Mesylate

ExenatideLiraglutide

NateglinideRepaglinide

Canagliflozin

ChlorpropamideGlimepirideGlipizideGlyburideTolazamideTolbutamide

Pioglitazone HydrochlorideRosiglitazone Maleate

Glycemic AgentsDiazoxideDiazoxideGlucagon

Insulins

Insulin AspartInsulin GlulisineInsulin Lispro

Insulin Human (Regular)

Isophane Insulin (Human)




Insulin DetemirInsulin Glargine

Insulin Aspart Rapid-acting and Insulin Aspart ProtamineInsulin Lispro Rapid-acting and Insulin Lispro Protamine

Insulin Human Regular and Isophane Insulin

Blood Products/Modifiers/ Volume Expanders

Anticoagulants

Dabigatran

Apixaban Rivaroxaban

Fondaparinux Sodium

Dalteparin SodiumEnoxaparin Sodium

Warfarin SodiumBlood Formation Modifiers

FilgrastimPegfilgrastimSargramostim

Darbepoetin AlfaEpoetin Alfa

Anagrelide

Eltrombopag OlamineRomiplostim

PlerixaforCoagulants

Tranexamic AcidPlatelet Modifying Agents

Clopidogrel BisulfatePrasugrelTiclopidine HydrochlorideTicagrelor

DipyridamoleDipyridamole and Aspirin

Cilostazol

Cardiovascular AgentsAlpha-adrenergic Agonists

Clonidine HydrochlorideGuanfacine HydrochlorideMethyldopaMethyldopate Hydrochloride




Midodrine HydrochloridePhenylephrine Hydrochloride

Alpha-adrenergic Blocking AgentsDoxazosin MesylatePhenoxybenzamine HydrochloridePrazosin HydrochlorideTerazosin Hydrochloride

Angiotensin-converting Enzyme (ACE) Inhibitors

Benazepril HydrochlorideCaptoprilEnalapril MaleateFosinopril SodiumLisinoprilMoexipril HydrochloridePerindopril ErbumineQuinapril HydrochlorideRamiprilTrandolapril

Angiotensin II Receptor AntagonistsAzilsartan MedoxomilCandesartan CilexetilEprosartan MesylateIrbesartanLosartan PotassiumOlmesartan MedoxomilTelmisartanValsartan

AntiarrhythmicsAmiodarone HydrochlorideDisopyramide PhosphateDofetilideDronedaroneFlecainide AcetateMexiletine HydrochlorideProcainamide HydrochloridePropafenone HydrochlorideQuinidine HydrochlorideSotalol Hydrochloride

Beta-adrenergic Blocking AgentsAcebutolol HydrochlorideAtenololBetaxolol HydrochlorideBisoprolol FumarateCarvedilol PhosphateLabetalol HydrochlorideMetoprolol Succinate

TartrateNadololNebivololPenbutolol SulfatePindololPropranolol HydrochlorideTimolol Maleate

Calcium Channel Blocking Agents

Amlodipine




FelodipineIsradipineNicardipine HydrochlorideNifedipineNimodipineNisoldipine

Diltiazem HydrochlorideVerapamil Hydrochloride

Diuretics, Carbonic Anhydrase Inhibitors

Acetazolamide SodiumMethazolamide

Diuretics, LoopBumetanideEthacrynate SodiumEthacrynic AcidFurosemideTorsemide

Diuretics, Potassium-sparingAmiloride HydrochlorideEplerenoneSpironolactoneTriamterene

Diuretics, ThiazideBendroflumethiazideChlorothiazide SodiumChlorthalidoneHydrochlorothiazideIndapamideMethyclothiazideMetolazone

Dyslipidemics, Fibric Acid Derivatives

Choline FenofibrateFenofibrateFenofibric AcidGemfibrozil

Dyslipidemics, HMG CoA Reductase Inhibitors

Atorvastatin CalciumFluvastatin SodiumLovastatinPitavastatinPravastatin SodiumRosuvastatin CalciumSimvastatin

Dyslipidemics, OtherCholestyramineColesevelam HydrochlorideColestipol HydrochlorideEzetimibeIcosapent ethyl Lomitapide MesylateMipomersen SodiumNiacinOmega-3-acid Ethyl Esters

Vasodilators, Direct-acting ArterialHydralazine Hydrochloride




MinoxidilVasodilators, Direct-acting Arterial/Venous

Isosorbide DinitrateIsosorbide MononitrateNitroglycerin

Cardiovascular Agents, OtherAliskirenDigoxinPentoxifyllineRanolazine

Central Nervous System Agents

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

Dextroamphetamine SulfateDextroamphetamine and Amphetamine

Mixed Salts

LisdexamfetamineMethamphetamine Hydrochloride

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

Atomoxetine HydrochlorideClonidine HydrochlorideDexmethylphenidate HydrochlorideGuanfacine HydrochlorideMethylphenidate Hydrochloride

Fibromyalgia AgentsDuloxetine HydrochlorideMilnacipranPregabalin

Multiple Sclerosis Agents

Interferon Beta-1aInterferon Beta-1b

Dalfampridine

Teriflunomide

Fingolimod

Dimethyl fumarate Glatiramer AcetateMitoxantrone HydrochlorideNatalizumab

Central Nervous System, OtherGabapentin enacarbil TetrabenazineRiluzoleDextromethorphan/ Quinidine

Dental and Oral AgentsCevimeline HydrochlorideChlorhexidine GluconateDoxycycline HyclateMinocycline HydrochloridePaliferminPilocarpine HydrochloridePrilocaine Hydrochloride




Triamcinolone AcetonideDermatological Agents

Isotretinoin

AdapaleneAzelaic AcidBenzoyl PeroxideDapsone Tazarotene

Doxycycline CalciumHyclate

Doxepin Hydrochloride

PimecrolimusTacrolimus

Podofilox

Ammonium Lactate

ImiquimodSinecatechins

Selenium Sulfide

Diclofenac SodiumFluorouracilImiquimodIngenol mebutate

Methoxsalen

AcitretinCalcitriolUstekinumab

Calcipotriene

BecaplerminCollagenase

Brimonidine TartrateEnzyme Replacement/ Modifiers

Cysteamine Bitartrate

Agalsidase Beta

AlgluceraseImigluceraseTaliglucerase alfa Velaglucerase alfa

Miglustat

Nitisinone




Betaine Anhydrous

Idursulfase

GalsulfaseLaronidase

Pancrelipase

Sapropterin

Pegademase Bovine

Sacrosidase

Sodium PhenylbutyrateGlycerol Phenylbutyrate

Gastrointestinal AgentsAntispasmodics, Gastrointestinal

Atropine SulfateDicyclomine HydrochlorideGlycopyrrolateMepenzolate BromideMethscopolamine BromideScopolamine

Histamine2 (H2) Receptor Antagonists

Cimetidine HydrochlorideFamotidineNizatidineRanitidine Hydrochloride

Irritable Bowel Syndrome Agents

Alosetron Hydrochloride Linaclotide

LubiprostoneLaxatives

LactulosePolyethylene Glycol 3350 NFSodium picosulfate, magnesium oxide and citric acid

ProtectantsMisoprostolSucralfate

Proton Pump InhibitorsDexlansoprazoleEsomeprazole MagnesiumLansoprazoleOmeprazolePantoprazole SodiumRabeprazole Sodium

Gastrointestinal Agents, OtherAlvimopanCrofelemer Difenoxin Hydrochloride and Atropine SulfateDiphenoxylate Hydrochloride and Atropine Sulfate




Loperamide HydrochlorideMethylnaltrexoneMetoclopramideRifaximinUrsodiol

GlutamineSomatropinTeduglutide

Genitourinary AgentsAntispasmodics, Urinary

Mirabegron

Darifenacin HydrobromideFesoterodine FumarateFlavoxate HydrochlorideOxybutynin ChlorideSolifenacin SuccinateTolterodine TartrateTrospium Chloride

Benign Prostatic Hypertrophy Agents

Alfuzosin HydrochlorideDoxazosin MesylatePrazosin HydrochlorideSilodosinTamsulosin HydrochlorideTerazosin Hydrochloride

DutasterideFinasteride

TadalafilPhosphate Binders

Calcium AcetateLanthanum CarbonateSevelamer HydrochlorideSucroferric Oxyhydroxide

Genitourinary Agents, OtherBethanecholPenicillaminePentosan Polysulfate

Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal)

Corticotropin

Betamethasone Sodium Phosphate

BudesonideCortisone AcetateDexamethasone Acetate

Sodium Phosphate

Hydrocortisone AcetateSodium Succinate

Methylprednisolone Acetate




Sodium SuccinatePrednisolone Acetate

Sodium Phosphate

PrednisoneTriamcinolone Acetonide

DiacetateHexacetonide

Alclometasone DipropionateClocortolone PivalateDesonideDexamethasone Sodium Phosphate

Hydrocortisone

Betamethasone ValerateDesoximetasoneFluocinolone AcetonideFlurandrenolideFluticasone PropionateHydrocortisone Butyrate

ProbutateValerate

Mometasone FuroatePrednicarbateTriamcinolone Acetonide

AmcinonideBetamethasone DipropionateDesoximetasoneDiflorasone DiacetateFluocinolone AcetonideFluocinonideHalcinonideTriamcinolone Acetonide

Betamethasone DipropionateClobetasol PropionateDiflorasone DiacetateHalobetasol Propionate

Fludrocortisone AcetateHormonal Agents, Stimulant/Replacement/ Modifying (Pituitary)

Chorionic Gonadotropin

Somatropin, RecombinantTesamorelin

Mecasermin Rinfabate

Desmopressin Acetate




Hormonal Agents, Stimulant/ Replacement/ Modifying (Prostaglandins)

AlprostadilCarboprost TromethamineMisoprostol

Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)

Anabolic SteroidsOxandrolone

AndrogensDanazolFluoxymesteroneMethyltestosteroneTestosterone Cypionate

EnanthatePropionate

EstrogensEstradiol Acetate

CypionateHemihydrateValerate

Estrogens, ConjugatedEstrogens, Conjugated Synthetic

Estrogens, EsterifiedEstroneEstropipateEthinyl Estradiol

Progesterone Agonists/AntagonistsUlipristal

ProgestinsLevonorgestrelMedroxyprogesterone AcetateMegestrol AcetateNorethindrone AcetateNorgestrelProgesterone

Selective Estrogen Receptor Modifying Agents

Raloxifene HydrochlorideOspemifeneBazedoxifene/ conjugated estrogens

Hormonal Agents, Stimulant/Replacement/ Modifying (Thyroid)

Levothyroxine SodiumLiothyronine SodiumLiotrix

Hormonal Agents, Suppressant (Adrenal)

Mitotane




Hormonal Agents, Suppressant (Parathyroid)

Cinacalcet HydrochlorideHormonal Agents, Suppressant (Pituitary)

Bromocriptine MesylateCabergoline

Leuprolide AcetateNafarelin AcetateTriptorelin Pamoate

Degarelix

Pegvisomant

LanreotideOctreotidePasireotide

Hormonal Agents, Suppressant (Thyroid)

Antithyroid AgentsMethimazolePropylthiouracil

Immunological AgentsAngioedema (HAE) Agents

Icatibant Acetate

C1 esterase inhibitor (human)Immune Suppressants

Mycophenolic Acid

TacrolimusCyclosporine

Tofacitinib

Sirolimus

6- mercaptopurineAbataceptAnakinraEverolimusMethotrexate SodiumPenicillaminePimecrolimus

Azathioprine

AdalimumabCertolizumab PegolEtanerceptGolimumab




InfliximabImmunizing Agents, Passive

Anti-thymocyte GlobulinImmune Globulin Intramuscular (Human)Immune Globulin Intravenous (Human)

Immunomodulators

Belimumab

Interferon Gamma-1b, Recombinant

CanakinumabRilonaceptTocilizumab

AuranofinLeflunomideNatalizumab

Vaccines

Diphtheria and Tetanus Toxoids Adsorbed (DT)Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed (DTaP)Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine

Diphtheria and Tetanus Toxoids and Acellular Pertussis Absorbed and Inactivated Poliovirus (DTaP-IPV) Vaccine

Tetanus and Diphtheria Toxoids Adsorbed for Adult Use (Td)Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed (Tdap)

Haemophilus B Conjugate Vaccine

Haemophilus B Conjugate Vaccine and Hepatitis B Vaccine (Recombinant)

Hepatitis A Vaccine InactivatedHepatitis A Virus Vaccine Inactivated and Hepatitis B Virus Vaccine Recombinant

Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine

Haemophilus B Conjugate Vaccine and Hepatitis B Vaccine (Recombinant)

Hepatitis B Virus Vaccine Recombinant

Japanese Encephalitis Virus Vaccine Inactivated

Measles Virus Vaccine LiveMeasles, Mumps, and Rubella Virus Vaccine LiveMeasles, Mumps, Rubella, and Varicella Virus Vaccine Live




Meningococcal Oligosaccharide Diphtheria CRM197 Conjugate VaccineMeningococcal Polysaccharide VaccineMeningococcal Polysaccharide Diphtheria Toxoid Conjugate Vaccine

Measles, Mumps, and Rubella Virus Vaccine LiveMeasles, Mumps, Rubella, and Varicella Virus Vaccine Live

Human Papillomavirus Bivalent (type 16 and 18) Vaccine RecombinantHuman Papillomavirus Quadrivalent (types 6, 11, 16 and 18) Vaccine Recombinant

Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed (DTaP)Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus


Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine, Adsorbed (Tdap)

Diphtheria and Tetanus Toxoids and Acellular Pertussis Absorbed and Inactivated Poliovirus (DTaP-IPV) VaccineDiphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus

Poliovirus Vaccine Inactivated

Rabies Vaccine

Rotavirus Vaccine Live

Measles, Mumps, and Rubella Virus Vaccine LiveMeasles, Mumps, Rubella, and Varicella Virus Vaccine LiveRubella Virus Vaccine

Diphtheria and Tetanus Toxoids Adsorbed (DT)Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed (DTaP)Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine


Tetanus and Diphtheria Toxoids Adsorbed for Adult Use (Td)Tetanus ToxoidTetanus Toxoid AdsorbedTetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine, Adsorbed (Tdap)

Typhoid Vaccine Live OralTyphoid Vi Polysaccharide Vaccine

Measles, Mumps, Rubella, and Varicella Virus Vaccine Live




Varicella Virus Vaccine

Yellow Fever Vaccine

Zoster Virus Vaccine Live

Inflammatory Bowel Disease Agents

GlucocorticoidsBetamethasoneBudesonideCortisone AcetateDexamethasone Acetate

Sodium Phosphate

Hydrocortisone Sodium SuccinateMethylprednisolone Acetate

Sodium SuccinatePrednisolone Acetate

Sodium SuccinatePrednisoneTriamcinolone Acetonide

DiacetateAminosalicylates

Balsalazide DisodiumMesalamineOlsalazine Sodium

SulfonamidesSulfasalazine

Metabolic Bone Disease Agents

Alendronate SodiumEtidronate DisodiumIbandronate SodiumRisedronate SodiumTiludronate Disodium

Ibandronate SodiumPamidronate DisodiumZoledronic Acid

Calcitonin, Salmon

Teriparatide

Denosumab

CalcitriolDoxercalciferolParicalcitol

Ophthalmic AgentsOphthalmic Anti-allergy Agents

Azelastine HydrochlorideBepotastineCromolyn SodiumEmedastine DifumarateEpinastine HydrochlorideLodoxamide Tromethamine




Nedocromil SodiumOlopatadine Hydrochloride

Ophthalmic Antiglaucoma Agents

Apraclonidine HydrochlorideBrimonidine Tartrate

Betaxolol HydrochlorideCarteolol HydrochlorideLevobunolol HydrochlorideMetipranolol HydrochlorideTimolol Hemihydrate

Maleate

AcetazolamideBrinzolamideDorzolamide HydrochlorideMethazolamide

Echothiophate IodidePilocarpine Hydrochloride

NitrateOphthalmic Anti-inflammatories

DexamethasoneDifluprednateFluorometholone AcetateLoteprednol EtabonatePrednisolone Acetate

Sodium Phosphate

Rimexolone

Bromfenac SodiumDiclofenac SodiumFlurbiprofen SodiumKetorolac TromethamineNepafenac

Ophthalmic Prostaglandin and Prostamide Analogs

BimatoprostLatanoprostTafluprost Travoprost

Ophthalmic Agents, OtherHydroxypropyl CelluloseNaphazoline Hydrochloride

Cyclosporine

Otic Agents

Fluocinolone Acetonide

Respiratory Tract/ Pulmonary Agents

Antihistamines




Azelastine HydrochlorideCetirizine HydrochlorideDesloratadineLevocetirizineOlopatadine Hydrochloride

CarbinoxamineClemastine FumarateCyproheptadine HydrochlorideDiphenhydramine HydrochlorideHydroxyzine Hydrochloride

PamoatePromethazine Hydrochloride

Anti-inflammatories, Inhaled Corticosteroids

Beclomethasone DipropionateDipropionate Monohydrate

BudesonideCiclesonideFlunisolideFluticasone PropionateMometasone Furoate

MonohydrateTriamcinolone Acetonide

AntileukotrienesMontelukast SodiumZafirlukastZileuton

Bronchodilators, AnticholinergicAclidinium BromideIpratropium BromideTiotropium Bromide

Monohydrate

Bronchodilators, SympathomimeticAlbuterol SulfateArformoterol TartrateEpinephrine BitartrateFormoterol Fumarate Dihydrate

Indacaterol MaleateLevalbuterol HydrochlorideMetaproterenol SulfateSalmeterol XinafoateTerbutaline Sulfate

Cystic Fibrosis Agents

Ivacaftor

Tobramycin dry-powder inhalerAztreonam inhalant solution

Mast Cell StabilizersCromolyn Sodium

Phosphodiesterase Inhibitors, Airways Disease

Aminophylline DihydrateDyphyllineTheophylline




Roflumilast Pulmonary Antihypertensives

AmbrisentanBosentanMacitentan

Sildenafil CitrateTadalafil

EpoprostenolIloprostTreprostinil

RiociguatRespiratory Tract Agents, Other

AcetylcysteineAlpha-1 Proteinase Inhibitor, HumanBudesonide/ Formoterol fumarate

Fluticasone furoate/ Vilanterol trifenatateFluticasone propionate/ Salmeterol

Mometasone furoate/ Formoterol fumarate dihydrateTetrahydrozoline Hydrochloride

Skeletal Muscle Relaxants

CarisoprodolChlorzoxazoneCyclobenzaprine HydrochlorideMetaxaloneMethocarbamolOrphenadrine Citrate

Hydrochloride

Sleep Disorder AgentsGABA Receptor Modulators

FlurazepamTemazepam

EszopicloneZaleplonZolpidem Tartrate

Sleep Disorders, OtherArmodafinilDoxepin HydrochlorideModafinilRamelteonSodium Oxybate

Therapeutic Nutrients/ Minerals/ Electrolytes

Electrolyte/Mineral Modifiers

DeferasiroxDeferiprone

Penicillamine




Sodium Polystyrene SulfonateSuccimerTolvaptanTrientine Hydrochloride

Electrolyte/Mineral ReplacementAmmonium ChlorideCarglumic AcidChromic ChlorideCitric Acid, Potassium Citrate, and Sodium CitrateFluoride Sodium

StannousMagnesium Chloride

SulfateManganese ChloridePotassium Acetate

BicarbonateChlorideCitrateGluconatePhosphates

Potassium Bicarbonate and Potassium CitratePotassium Citrate and Citric Acid

Potassium Citrate and Sodium CitratePotassium Gluconate and Potassium ChloridePotassium Gluconate and Potassium CitratePotassium Phosphate and Sodium PhosphateSeleniumSodium Acetate

BicarbonateLactateChlorideFerric Gluconate ComplexPhosphate

Vitamins

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