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1 | Page Maintenance Medication Drug List Drug Level_136217_Updated June 2015 The Express Scripts Maintenance Drug List contains medications that are generally taken on a long-term or maintenance basis for conditions such as high blood pressure or high cholesterol. Through the Express Scripts PharmacySM home delivery, you can get up to a 90-day supply of your medications for the same cost as two 30-day fills at a participating retail pharmacy. For the PPO Plan only: You may purchase maintenance medications from a participating retail pharmacy three times, after which you must use the home delivery pharmacy for the medications to be covered under the PPO Plan. If you continue to purchase your maintenance medications at a retail pharmacy after the third fill, you will be responsible for the entire cost of the medication. Note: This list (1) does not include all maintenance medications, (2) is subject to change, (3) may include medications not covered by your health plan and (4) may include medications that are subject to additional coverage rules as determined by your health plan.

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Page 1: Maintenance Medication Drug List - My Benefits...advair diskus advair hfa advicor advil advil liqui-gels advil migraine advocate pen needles advocate syringes aerospan afeditab cr

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

1ST CHOICE LANCETS

1ST TIER UNIFINE PENTIPS

1ST TIER UNILET COMFORTOUCH

2TEK

3M NEXCARE STOMASEAL

ACARBOSE

The Express Scripts Maintenance Drug List contains medications that are generally taken on a long-term or maintenance basis for conditions such as high blood pressure or high cholesterol. Through the Express Scripts PharmacySM home delivery, you can get up to a 90-day supply of your medications for the same cost as two 30-day fills at a participating retail pharmacy. For the PPO Plan only: You may purchase maintenance medications from a participating retail pharmacy three times, after which you must use the home delivery pharmacy for the medications to be covered under the PPO Plan. If you continue to purchase your maintenance medications at a retail pharmacy after the third fill, you will be responsible for the entire cost of the medication. Note: This list (1) does not include all maintenance medications, (2) is subject to change, (3) may include medications not covered by your health plan and (4) may include medications that are subject to additional coverage rules as determined by your health plan.

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

NULL

1ST TIER UNIFINE PENTIPS

1ST TIER UNIFINE PENTIPS PLUS A ACARBOSE

ACCOLATE

ACCUPRIL

ACCURETIC

ACEBUTOLOL HCL

ACEON

ACETAZOLAMIDE

ACID CONTROL

ACID CONTROLLER

ACID REDUCER

ACID REDUCER 150

ACID RELIEF

ACIPHEX

ACIPHEX SPRINKLE

ACTIGALL

ACTIVELLA

ACTONEL

ACTOPLUS MET

ACTOPLUS MET XR

ACTOS

ADALAT CC

ADDED STRENGTH HEADACHE

ADDED STRENGTH PAIN RELIEVER

ADEMPAS

ADVAIR DISKUS

ADVAIR HFA

ADVICOR

ADVIL

ADVIL LIQUI-GELS

ADVIL MIGRAINE

ADVOCATE PEN NEEDLES

ADVOCATE SYRINGES

AEROSPAN

AFEDITAB CR

AFREZZA

AGGRENOX

AGRYLIN

AIMSCO MINI ULTRA-THIN II

AIMSCO ULTRA THIN II

AK-PENTOLATE

ALBUTEROL SULFATE

ALDACTAZIDE

ALDACTONE

ALENDRONATE SODIUM

ALEVE

ALFUZOSIN HCL ER

ALKA-SELTZER

ALKA-SELTZER ORIGINAL

ALKA-SELTZER PM

ALL DAY PAIN RELIEF

ALL DAY RELIEF

ALLOPURINOL

ALORA

ALPHAGAN P

ALTACE

ALTAVERA

ALTOPREV

ALVESCO

ALYACEN

AMANTADINE

AMARYL

AMETHIA

AMETHIA LO

AMETHYST

AMILORIDE HCL

AMILORIDE-HYDROCHLOROTHIAZIDE

AMINOPHYLLINE

AMIODARONE HCL

AMLODIPINE BESYLATE

AMLODIPINE BESYLATE-BENAZEPRIL

AMLODIPINE-ATORVASTATIN

AMLODIPINE-VALSARTAN

AMLODIPINE-VALSARTAN-HCTZ

AMTURNIDE

ANABAR

ANACIN

ANAGRELIDE HCL

ANAPROX

ANAPROX DS

ANGELIQ

ANORO ELLIPTA

ANSAID

ANTACID & PAIN RELIEF

ANTARA

ANTIBIOTIC

ANTIBIOTIC + PAIN RELIEF

ANTICAVITY FLUORIDE

APIDRA

APIDRA SOLOSTAR

APLENZIN

APPEAREX

APRACLONIDINE HCL

APRI

APRISO

ARANELLE

ARCAPTA NEOHALER

ARICEPT

ARICEPT ODT

ARMOUR THYROID

ARNUITY ELLIPTA

ARTHROTEC 50

ARTHROTEC 75

ASACOL

ASACOL HD

ASCRIPTIN

ASCRIPTIN MAXIMUM STRENGTH

ASHLYNA

ASMANEX

ASMANEX HFA

ASPIRIN

ASPIRIN BUFFERED

ASPIRIN-CAFFEINE

ASSURE ID INSULIN SAFETY

ATACAND

ATACAND HCT

ATELVIA

ATENOLOL

ATENOLOL-CHLORTHALIDONE

ATORVASTATIN CALCIUM

ATROPINE CARE

ATROPINE SULFATE

ATROVENT HFA

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

AUBRA

AUTOSHIELD DUO PEN NEEDLE

AUTOSHIELD PEN NEEDLE

AVALIDE

AVAPRO

AVIANE

AVODART

AXID

AYGESTIN

AZILECT

AZOPT

AZOR

AZULFIDINE

AZURETTE B BACK & BODY PAIN RELIEVER

BACK PAIN-OFF

BACLOFEN

BALZIVA

BAYER BACK & BODY

BAYER MIGRAINE

BAYER PLUS

BC

BC ARTHRITIS

BD ULTRA-FINE PEN NEEDLE

BENAZEPRIL HCL

BENAZEPRIL-HYDROCHLOROTHIAZIDE

BENICAR

BENICAR HCT

BETAGAN

BETAPACE

BETAPACE AF

BETAXOLOL HCL

BETIMOL

BETOPTIC S

BEYAZ

BIDIL

BIMATOPROST

BINOSTO

BIOTIN

BISOPROLOL FUMARATE

BISOPROLOL-HYDROCHLOROTHIAZIDE

BLUNT NEEDLE

BONIVA

BREO ELLIPTA

BREVICON

BRIELLYN

BRILINTA

BRIMONIDINE TARTRATE

BRISDELLE

BRONKAID DUAL ACTION

BROVANA

BUDEPRION SR

BUDEPRION XL

BUDESONIDE

BUFFERED ASPIRIN

BUFFERIN

BUMETANIDE

BUPROBAN

BUPROPION HCL

BUPROPION HCL SR

BUPROPION XL

BUSPIRONE HCL

BYDUREON

BYDUREON PEN

BYETTA

BYSTOLIC C CABERGOLINE

CADUET

CALAN

CALAN SR

CALCITONIN-SALMON

CALCITRIOL

CAMILA

CAMRESE

CAMRESE LO

CANASA

CANDESARTAN CILEXETIL

CANDESARTAN-HYDROCHLOROTHIAZID

CAPTOPRIL

CAPTOPRIL-HYDROCHLOROTHIAZIDE

CARAFATE

CARBIDOPA

CARBIDOPA-LEVODOPA

CARBIDOPA-LEVODOPA ER

CARBIDOPA-LEVODOPA-ENTACAPONE

CARDENE SR

CARDIZEM

CARDIZEM CD

CARDIZEM LA

CARDURA

CARDURA XL

CAREFINE PEN NEEDLE

CAREONE

CARNITOR

CARNITOR SF

CARTEOLOL HCL

CARTIA XT

CARVEDILOL

CATAPRES

CATAPRES-TTS 1

CATAPRES-TTS 2

CATAPRES-TTS 3

CAZIANT

CELEBREX

CELECOXIB

CELEXA

CENESTIN

CEREFOLIN NAC

CEVIMELINE HCL

CHATEAL

CHILD IBUPROFEN

CHILDREN'S ADVIL

CHILDREN'S IBUPROFEN

CHILDREN'S MEDI-PROFEN

CHILDREN'S MOTRIN

CHILDREN'S PROFEN IB

CHILDREN'S PROFENIB

CHLOROTHIAZIDE

CHLORPROPAMIDE

CHLORTHALIDONE

CHOLESTYRAMINE

CHOLESTYRAMINE LIGHT

CIFEREX

CILOSTAZOL

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

CIMETIDINE

CITALOPRAM HBR

CLICKFINE

CLIMARA

CLIMARA PRO

CLINORIL

CLINPRO 5000

CLONIDINE

CLONIDINE HCL

CLOPIDOGREL

CLORPRES

COLESTID

COLESTIPOL HCL

COMBIGAN

COMBIPATCH

COMFORT EZ

COMPLETE FORMULATION D3000

COMPLETE FORMULATION PEDIATRIC

COMTAN

CORDARONE

COREG

COREG CR

CORGARD

CORLANOR

CORTEF

CORZIDE

COSOPT

COSOPT PF

COVERA-HS

COZAAR

CRESTOR

CROMOLYN SODIUM

CRYSELLE

CUPRIMINE

CYANOCOBAL-LEVOMEF-PYRIDOXINE

CYCLAFEM

CYCLESSA

CYCLOGYL

CYCLOMYDRIL

CYCLOPENTOLATE HCL

CYCLOSET

CYLATE

CYMBALTA

CYTO B7

CYTOMEL

CYTOTEC D DANTRIUM

DANTROLENE SODIUM

DAPSONE

DASETTA

DAYPRO

DAYSEE

DDAVP

DEBLITANE

DELYLA

DELZICOL

DEMADEX

DEMULEN 1-50-28

DENTA 5000 PLUS

DENTAGEL

DEPEN

DEPLIN

DEPLIN-ALGAL OIL

DESMOPRESSIN ACETATE

DESOGEN

DESOGESTR-ETH ESTRAD ETH ESTRA

DESOGESTREL-ETHINYL ESTRADIOL

DESVENLAFAXINE ER

DESVENLAFAXINE FUMARATE ER

DETROL

DETROL LA

DEXILANT

DIABETA

DIAMOX SEQUELS

DICLOFENAC SODIUM

DICLOFENAC SODIUM ER

DICLOFENAC SODIUM-MISOPROSTOL

DIDRONEL

DIFIL-G 400

DIFLUNISAL

DIGITEK

DIGOX

DIGOXIN

DILACOR XR

DILATRATE-SR

DILT-CD

DILT-XR

DILTIA XT

DILTIAZEM 12HR ER

DILTIAZEM 24HR CD

DILTIAZEM 24HR ER

DILTIAZEM ER

DILTIAZEM HCL

DILTZAC ER

DIOVAN

DIOVAN HCT

DIPENTUM

DIPYRIDAMOLE

DISOPYRAMIDE PHOSPHATE

DITROPAN XL

DIURIL

DIVIGEL

DOAN'S PM BACK PAIN RELIEF

DONEPEZIL HCL

DONEPEZIL HCL ODT

DORZOLAMIDE HCL

DORZOLAMIDE-TIMOLOL

DOXAZOSIN MESYLATE

DOXERCALCIFEROL

DROSPIRENONE-ETHINYL ESTRADIOL

DUETACT

DUEXIS

DULERA

DULOXETINE HCL

DUOPA

DURACHOL

DURAXIN

DUTOPROL

DYAZIDE

DYLIX

DYNACIRC CR

DYRENIUM E EASY COMFORT INSULIN SYRINGE

EASY COMFORT PEN NEEDLES

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

EASY TOUCH

EASY TOUCH INSULIN SAFETY

EASY TOUCH INSULIN SYRINGE

EASY TOUCH PEN NEEDLE

EASY-TOUCH INSULIN SYRINGE

EC-NAPROSYN

ECLIPSE NEEDLE

ECLIPSE SYRINGE

EDARBI

EDARBYCLOR

EDECRIN

EFFER-K

EFFERVESCENT

EFFERVESCENT ANTACID

EFFERVESCENT PAIN RELIEF

EFFEXOR XR

EFFIENT

ELDEPRYL

ELESTRIN

ELIGEN B12

ELINEST

ELIXOPHYLLIN

EMOQUETTE

EMSAM

ENABLEX

ENALAPRIL MALEATE

ENALAPRIL-HYDROCHLOROTHIAZIDE

ENJUVIA

ENLYTE

ENPRESSE

ENSKYCE

ENTACAPONE

EPANED

EPLERENONE

EPROSARTAN MESYLATE

ERGOLOID MESYLATES

ERRIN

ESCAVITE D

ESCAVITE LQ

ESCITALOPRAM OXALATE

ESOMEPRAZOLE MAGNESIUM

ESOMEPRAZOLE STRONTIUM

ESTARYLLA

ESTRACE

ESTRADIOL

ESTRADIOL TRANSDERMAL PATCH

ESTRADIOL-NORETHINDRONE ACETAT

ESTRASORB

ESTRING

ESTROGEL

ESTROPIPATE

ESTROSTEP FE

ETIDRONATE DISODIUM

ETODOLAC

ETODOLAC ER

EVISTA

EVOXAC

EXCEDRIN EXTRA STRENGTH

EXCEDRIN MENSTRUAL COMPLETE

EXCEDRIN MIGRAINE

EXEL HUBER

EXEL HUBER NEEDLE

EXEL HYPODERMIC NEEDLE

EXEL INSULIN SYRINGE

EXEL MTI DRAWING NEEDLE

EXELON

EXFORGE

EXFORGE HCT F FALESSA

FALMINA

FAMOTIDINE

FARXIGA

FELDENE

FELODIPINE ER

FEMCON FE

FEMHRT

FEMRING

FEMTRACE

FENOFIBRATE

FENOFIBRIC ACID

FENOGLIDE

FENOPROFEN CALCIUM

FETZIMA

FIBRICOR

FIFTY50 RESERVOIR

FILTER ASPIRATOR NEEDLE

FILTER NEEDLE

FINASTERIDE

FIRST AID ANTIBIOTIC

FLANAX

FLAVOXATE HCL

FLECAINIDE ACETATE

FLOMAX

FLORIVA

FLOVENT DISKUS

FLOVENT HFA

FLOW-EZE

FLUDROCORTISONE ACETATE

FLUOR-A-DAY

FLUORABON

FLUORIDE

FLUORIDEX DAILY DEFENSE

FLUORIDEX SENSITIVITY RELIEF

FLUORITAB

FLUOXETINE DR

FLUOXETINE HCL

FLURA-DROPS

FLURBIPROFEN

FLUVASTATIN SODIUM

FLUVOXAMINE MALEATE

FLUVOXAMINE MALEATE ER

FOLBIC RF

FOLIC ACID

FOLTANX RF

FOLTX

FORFIVO XL

FORTAMET

FORTICAL

FOSAMAX

FOSAMAX PLUS D

FOSINOPRIL SODIUM

FOSINOPRIL-HYDROCHLOROTHIAZIDE

FREESTYLE PRECISION

FUROSEMIDE

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

G GALANTAMINE HBR

GALANTAMINE HYDROBROMIDE

GEL-KAM

GELNIQUE

GEMFIBROZIL

GIANVI

GILDAGIA

GILDESS

GILDESS 24 FE

GILDESS FE

GLIMEPIRIDE

GLIPIZIDE

GLIPIZIDE ER

GLIPIZIDE XL

GLIPIZIDE-METFORMIN

GLUCOPHAGE

GLUCOPHAGE XR

GLUCOPRO

GLUCOTROL

GLUCOTROL XL

GLUCOVANCE

GLUMETZA

GLYBURIDE

GLYBURIDE MICRONIZED

GLYBURIDE-METFORMIN HCL

GLYNASE

GLYSET

GLYXAMBI

GOODY'S EXTRA STRENGTH

GOODY'S HEADACHE POWDER

GUANFACINE HCL H HARD NAILS

HEADACHE FORMULA

HEADACHE PAIN

HEADACHE RELIEF

HEALTHY ACCENTS UNIFINE PENTIP

HEARTBURN PREVENTION

HEARTBURN RELIEF

HEARTBURN RELIEF 150

HEARTBURN RELIEF 24 HOUR

HEARTBURN TREATMENT 24 HOUR

HEATHER

HECTOROL

HEMANGEOL

HOMATROPAIRE

HOMATROPINE HYDROBROMIDE

HUMALOG

HUMALOG KWIKPEN

HUMALOG MIX 50-50

HUMALOG MIX 50-50 KWIKPEN

HUMALOG MIX 75-25

HUMALOG MIX 75-25 KWIKPEN

HUMULIN 70-30

HUMULIN 70/30 KWIKPEN

HUMULIN N

HUMULIN N KWIKPEN

HUMULIN R

HUMULIN R U-500

HYDRALAZINE HCL

HYDROCHLOROTHIAZIDE

HYDROCORTISONE

HYDROXYCHLOROQUINE SULFATE

HYPODERMIC NEEDLE

HYZAAR I I-PRIN

IBANDRONATE SODIUM

IBU-DROPS

IBUPROFEN

IBUPROFEN IB

IBUPROFEN JR

IMDUR

IN CONTROL PEN NEEDLE

INCONTROL

INCRUSE ELLIPTA

INDAPAMIDE

INDERAL LA

INDERAL XL

INFANT'S IBUPROFEN

INFANT'S MOTRIN

INFANTS IBU-DROPS

INFANTS IBUPROFEN

INFANTS MEDI-PROFEN

INFANTS PROFENIB

INFANTS' IBUPROFEN

INNOPRAN XL

INSPRA

INSTA-GLUCOSE

INSULIN CARTRIDGE

INSULIN PEN NEEDLE

INSULIN SYRINGE

INSUPEN

INTEGRA NEEDLE

INTEGRA SYRINGE

INTRAVENOUS,ARTERIAL & BLOOD

INTROVALE

INVOKAMET

INVOKANA

IOPIDINE

IPRATROPIUM BROMIDE

IRBESARTAN

IRBESARTAN-HYDROCHLOROTHIAZIDE

ISOCHRON

ISOPTIN SR

ISOPTO ATROPINE

ISOPTO CARBACHOL

ISOPTO CARPINE

ISOPTO HOMATROPINE

ISOPTO HYOSCINE

ISORDIL

ISORDIL TITRADOSE

ISOSORBIDE DINITRATE

ISOSORBIDE MONONITRATE

ISOSORBIDE MONONITRATE ER

ISOXSUPRINE HCL

ISRADIPINE

ISTALOL J JALYN

JANUMET

JANUMET XR

JANUVIA

JARDIANCE

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

JENCYCLA

JENTADUETO

JEVANTIQUE

JINTELI

JOLESSA

JOLIVETTE

JUNEL

JUNEL FE

JUVISYNC K K EFFERVESCENT

K-SOL

K-TAB

K-TAB ER

KARIVA

KAZANO

KELNOR 1-35

KERLONE

KETOPROFEN

KHEDEZLA

KLOR-CON

KLOR-CON 10

KLOR-CON 8

KLOR-CON M10

KLOR-CON M15

KLOR-CON M20

KLOR-CON-EF

KOMBIGLYZE XR

KRISTALOSE

KURVELO L L-METHYLFOLATE

L-METHYLFOLATE CA P-5-P ME-CBL

L-METHYLFOLATE CALCIUM

L-METHYLFOLATE FORMULA

L-METHYLFOLATE FORTE

L-METHYLFOLATE-MECOBALAMIN-NAC

LABETALOL HCL

LANOXIN

LANSOPRAZOLE

LANTUS

LANTUS SOLOSTAR

LARIN

LARIN FE

LASIX

LATANOPROST

LEENA

LESCOL

LESCOL XL

LESSINA

LETAIRIS

LEVATOL

LEVEMIR

LEVEMIR FLEXPEN

LEVEMIR FLEXTOUCH

LEVOBUNOLOL HCL

LEVOCARNITINE

LEVOMEFOL-PYRIDOXAL-MEC-ALGAL

LEVOMEFOLA-NAC-MECOBALM-ALGAL

LEVOMEFOLATE CALCIUM-ALGAL

LEVOMEFOLATE-NAC-MECOBAL-ALGAL

LEVONEST

LEVONORG-ETH ESTRAD ETH ESTRAD

LEVONORGESTREL

LEVONORGESTREL-ETH ESTRADIOL

LEVORA-28

LEVOTHROID

LEVOTHYROXINE SODIUM

LEVOXYL

LEXAPRO

LIALDA

LIFESHIELD BLUNT CANNULA

LIOTHYRONINE SODIUM

LIPICHOL 540

LIPITOR

LIPOFEN

LIPTRUZET

LISINOPRIL

LISINOPRIL-HYDROCHLOROTHIAZIDE

LITE TOUCH

LIVALO

LMTHF-PYRIDOXINE-CYANOCOBAL

LO LOESTRIN FE

LO MINASTRIN FE

LO-OVRAL-28

LO-OVRAL-8

LODOSYN

LOESTRIN

LOESTRIN 24 FE

LOESTRIN FE

LOFIBRA

LOMEDIA 24 FE

LOPID

LOPREEZA

LOPRESSOR

LOPRESSOR HCT

LORYNA

LOSARTAN POTASSIUM

LOSARTAN-HYDROCHLOROTHIAZIDE

LOSEASONIQUE

LOTENSIN

LOTENSIN HCT

LOTREL

LOTRONEX

LOVASTATIN

LOVAZA

LOW-OGESTREL

LOZI-FLUR

LUDENT FLUORIDE

LUER-LOK SYRINGE

LUFYLLIN

LUMIGAN

LUTERA

LUVOX CR

LYZA M MACUVEX

MACUZIN

MAGELLAN INSULIN SAFETY SYRNG

MAGELLAN INSULIN SYRINGE

MARLISSA

MARPLAN

MATZIM LA

MAVIK

MAXI-COMFORT

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

MAXZIDE

MAXZIDE-25 MG

MECLOFENAMATE SODIUM

MEDI-LYTE

MEDI-PROFEN

MEDI-SELTZER

MEDIPROXEN

MEDROXYPROGESTERONE ACETATE

MEGA BIOTIN

MELOXICAM

MENEST

MENOSTAR

MERIBIN

MESTINON

METAFOLBIC PLUS RF

METANX

METAPROTERENOL SULFATE

METFORMIN HCL

METFORMIN HCL ER

METHAZOLAMIDE

METHIMAZOLE

METHYCLOTHIAZIDE

METHYLDOPA

METHYLDOPA-HYDROCHLOROTHIAZIDE

METIPRANOLOL

METOLAZONE

METOPROLOL SUCCINATE

METOPROLOL TARTRATE

METOPROLOL-HYDROCHLOROTHIAZIDE

MEVACOR

MEXILETINE HCL

MIACALCIN

MICARDIS

MICARDIS HCT

MICRO-K

MICROGESTIN

MICROGESTIN FE

MICROZIDE

MIDAMOR

MIDOL

MIGRAINE FORMULA

MIGRAINE PAIN-RELIEVER

MIGRAINE RELIEF

MIMVEY

MIMVEY LO

MINASTRIN 24 FE

MINI ULTRA-THIN II

MINIMED RESERVOIR

MINIPRESS

MINITRAN

MINIVELLE

MINOXIDIL

MIRAPEX

MIRAPEX ER

MIRCETTE

MISOPROSTOL

MOBIC

MODICON

MOEXIPRIL HCL

MOEXIPRIL-HYDROCHLOROTHIAZIDE

MONO-LINYAH

MONOJECT

MONOJECT BLOOD COLLECTION

MONOJECT INSULIN SAFETY SYRNG

MONOJECT INSULIN SYRINGE

MONOJECT MAGELLAN

MONOKET

MONONESSA

MONTELUKAST SODIUM

MOTRIN

MOTRIN IB

MULTAQ

MULTIVITAMINS-A,B,D,E,K,ZN

MYDRAL

MYDRIACYL

MYRBETRIQ

MYZILRA N NABUMETONE

NADOLOL

NADOLOL-BENDROFLUMETHIAZIDE

NAFRINSE DAILY-NEUTRAL

NALFON

NAMENDA

NAMENDA XR

NAPRELAN

NAPROSYN

NAPROXEN

NAPROXEN SODIUM

NAPROXEN SODIUM CR

NAPROXEN SODIUM ER

NARDIL

NASCOBAL

NATAZIA

NATEGLINIDE

NATURE-THROID

NECON

NEEDLE

NEEDLES

NEFAZODONE HCL

NEO-POLYCIN

NEOMYCIN-BACITRACIN-POLYMYXIN

NEOSPORIN

NEOSPORIN + PAIN RELIEF

NEPTAZANE

NESINA

NEUPRO

NEXIUM

NEXIUM 24HR

NEXT CHOICE

NIACIN

NIACIN ER

NIACOR

NIASPAN

NICARDIPINE HCL

NICODERM CQ

NICOMIDE

NICOTINE PATCH

NIFEDIAC CC

NIFEDICAL XL

NIFEDIPINE

NIFEDIPINE ER

NIFEDIPINE XL

NIKKI

NISOLDIPINE

NITRO-BID

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

NITRO-DUR

NITRO-TIME

NITROGLYCERIN

NITROGLYCERIN PATCH

NIZATIDINE

NOKOR ADMIX NEEDLE

NOKOR NEEDLE

NOR-Q-D

NORA-BE

NORDETTE-28

NORETHIN-ETH ESTRA FERROUS FUM

NORETHINDRON-ETHINYL ESTRADIOL

NORETHINDRONE

NORETHINDRONE ACETATE

NORETHINDRONE-ETHIN ESTRADIOL

NORGESTIMATE-ETHINYL ESTRADIOL

NORGESTREL-ETHINY ESTRA

NORINYL 1+35

NORINYL 1+50

NORLYROC

NORPACE

NORPACE CR

NORTREL

NORVASC

NOVOFINE

NOVOFINE 32

NOVOFINE AUTOCOVER

NOVOFINE PLUS

NOVOLIN 70-30

NOVOLIN N

NOVOLIN R

NOVOLOG

NOVOLOG FLEXPEN

NOVOLOG MIX 70-30

NOVOLOG MIX 70-30 FLEXPEN

NOVOTWIST

NP THYROID

NTS

NUVARING O OCELLA

OCUVEL

OGESTREL

OMEGA-3 ACID ETHYL ESTERS

OMEPRAZOLE

OMEPRAZOLE MAGNESIUM

OMEPRAZOLE-SODIUM BICARBONATE

ONGLYZA

OPSUMIT

ORENITRAM ER

ORSINI INSULIN SYRINGE

ORSYTHIA

ORTHO EVRA

ORTHO MICRONOR

ORTHO TRI-CYCLEN

ORTHO TRI-CYCLEN LO

ORTHO-CEPT

ORTHO-CYCLEN

ORTHO-NOVUM

ORTHO-PREFEST

OSENI

OVCON-35

OVCON-50

OXAPROZIN

OXYBUTYNIN CHLORIDE

OXYBUTYNIN CHLORIDE ER

OXYTROL

OXYTROL FOR WOMEN P PACERONE

PAIN RELIEF EXTRA STRENGTH

PAIN RELIEVER

PAIN RELIEVER PLUS

PAIN-OFF

PAMPRIN MAX

PANTOPRAZOLE SODIUM

PAPAVERINE HCL

PARADIGM

PARCOPA

PARICALCITOL

PARNATE

PAROXETINE HCL

PAXIL

PAXIL CR

PEN NEEDLE

PEN NEEDLES

PENNSAID

PENTASA

PENTOXIFYLLINE

PEPCID

PEPCID AC

PERFOROMIST

PERINDOPRIL ERBUMINE

PERIO MED

PERIOMED

PERSANTINE

PEXEVA

PHASEAL PROTECTOR

PHENELZINE SULFATE

PHILITH

PHOS-FLUR

PHOSPHOLINE IODIDE

PILOCARPINE HCL

PILOPINE HS

PIMTREA

PINDOLOL

PIOGLITAZONE HCL

PIOGLITAZONE-GLIMEPIRIDE

PIOGLITAZONE-METFORMIN

PIRMELLA

PIROXICAM

PLAQUENIL

PLAVIX

PLETAL

PODIAPN

POLY HUB NEEDLE

POLY-VI-FLOR FS

POLYFIN

PORTIA

POTABA

POTASSIUM

POTASSIUM BICARBONATE

POTASSIUM CHLORIDE

POTASSIUM CITRATE ER

POTASSIUM GLUCONATE

PRADAXA

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PRAMIPEXOLE DIHYDROCHLORIDE

PRAMIPEXOLE ER

PRANDIMET

PRANDIN

PRAVACHOL

PRAVASTATIN SODIUM

PRAZOSIN HCL

PRECISIONGLIDE

PRECOSE

PREFEST

PREMARIN

PREMPHASE

PREMPRO

PREVACID

PREVACID 24HR

PREVALITE

PREVIDENT

PREVIDENT 5000

PREVIDENT 5000 ENAMEL PROTECT

PREVIDENT 5000 PLUS

PREVIDENT 5000 SENSITIVE

PREVIFEM

PRILOSEC

PRILOSEC OTC

PRIMAQUINE

PRIMAQUINE PHOSPHATE

PRINIVIL

PRINZIDE

PRISTIQ ER

PROBENECID

PROCARDIA

PROCARDIA XL

PRODIGY INSULIN SYRINGE

PRODIGY PEN NEEDLE

PROGESTERONE

PROGLYCEM

PROMETRIUM

PROPAFENONE HCL

PROPAFENONE HCL ER

PROPRANOLOL HCL

PROPRANOLOL HCL ER

PROPRANOLOL-HYDROCHLOROTHIAZID

PROPYLTHIOURACIL

PROSCAR

PROTONIX

PROVERA

PROVIL

PROZAC

PROZAC WEEKLY

PULMICORT

PULMICORT FLEXHALER

PURALOR CI

PYRIDOSTIGMINE BROMIDE Q Q-TABS

QUARTETTE

QUASENSE

QUESTRAN

QUESTRAN LIGHT

QUFLORA

QUINAPRIL HCL

QUINAPRIL-HYDROCHLOROTHIAZIDE

QUINIDINE GLUCONATE

QUINIDINE SULFATE

QVAR R RABEPRAZOLE SODIUM

RALOXIFENE HCL

RAMIPRIL

RANEXA

RANITIDINE HCL

RAPAFLO

RAZADYNE

RAZADYNE ER

RECLIPSEN

REGULAR BEVEL NEEDLES

RELION

RELION PEN NEEDLES

REPAGLINIDE

REQUIP

REQUIP XL

RESCULA

RESERPINE

RESTASIS

REVESTA

RIDAURA

RIOMET

RISEDRONATE SODIUM

RISEDRONATE SODIUM DR

RIVASTIGMINE

ROCALTROL

ROPINIROLE HCL

RYTARY

RYTHMOL

RYTHMOL SR S SAFESNAP INSULIN SYRINGE

SAFETYGLIDE INSULIN SYRINGE

SAFETYGLIDE NEEDLE

SAFETYGLIDE SYRINGE

SAFYRAL

SANCTURA

SANCTURA XR

SARAFEM

SAVAYSA

SAVELLA

SEASONALE

SEASONIQUE

SECTRAL

SELEGILINE HCL

SEREVENT DISKUS

SERTRALINE HCL

SF

SF 5000 PLUS

SHAROBEL

SHORT BEVEL NEEDLES

SIMBRINZA

SIMCOR

SIMVASTATIN

SINEMET 10-100

SINEMET 25-100

SINEMET 25-250

SINEMET CR

SINGULAIR

SKELID

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SLO-NIACIN

SODIUM FLUORIDE

SORINE

SOTALOL

SOTALOL AF

SOTYLIZE

SPECIAL NEEDLE

SPECIALTY USE NEEDLES

SPIRIVA

SPIRIVA RESPIMAT

SPIRONOLACTONE

SPIRONOLACTONE-HCTZ

SPRINTEC

SRONYX

SSKI

STALEVO 100

STALEVO 125

STALEVO 150

STALEVO 200

STALEVO 50

STALEVO 75

STANBACK

STANNOUS FLUORIDE

STARLIX

STENDRA

STERILE TWO-FER NEEDLE

STIMATE

STRIVERDI RESPIMAT

SUCRALFATE

SULAR

SULFASALAZINE

SULFASALAZINE DR

SULFAZINE

SULFAZINE EC

SULINDAC

SUPER PAIN RELIEF

SURE COMFORT

SURE-FINE PEN NEEDLES

SURE-JECT INSULIN SYRINGE

SYEDA

SYMBICORT

SYMLIN

SYMLINPEN 120

SYMLINPEN 60

SYNTHROID T TAGAMET HB

TAMBOCOR

TAMSULOSIN HCL

TANZEUM

TAPAZOLE

TARINA FE

TARKA

TASMAR

TAZTIA XT

TEKAMLO

TEKTURNA

TEKTURNA HCT

TELMISARTAN

TELMISARTAN-AMLODIPINE

TELMISARTAN-HYDROCHLOROTHIAZID

TENEX

TENORETIC 100

TENORETIC 50

TENORMIN

TERAZOSIN HCL

TERBUTALINE SULFATE

TERUMO INSULIN SYRINGE

TERUMO SURGUARD2

TEVETEN

TEVETEN HCT

THALITONE

THEO-24

THEOCHRON

THEOPHYLLINE

THEOPHYLLINE ANHYDROUS

THIN WALL NEEDLES

THINPRO INSULIN SYRINGE

THINSET

THYROLAR-1

THYROLAR-1/2

THYROLAR-1/4

THYROLAR-2

THYROLAR-3

THYROSAFE

TIAZAC

TICLOPIDINE HCL

TILIA FE

TIMOLOL MALEATE

TIMOPTIC

TIMOPTIC OCUDOSE

TIMOPTIC-XE

TIROSINT

TIVORBEX

TIZANIDINE HCL

TOLAZAMIDE

TOLBUTAMIDE

TOLCAPONE

TOLMETIN SODIUM

TOLTERODINE TARTRATE

TOLTERODINE TARTRATE ER

TOPCARE CLICKFINE

TOPCARE ULTRA COMFORT

TOPROL XL

TORSEMIDE

TOUJEO SOLOSTAR

TOVIAZ

TRACLEER

TRANDATE

TRANDOLAPRIL

TRANDOLAPRIL-VERAPAMIL

TRANDOLAPRIL-VERAPAMIL ER

TRANSFER NEEDLE

TRANYLCYPROMINE SULFATE

TRAVATAN Z

TRAVOPROST

TRENTAL

TRI-BIOZENE

TRI-BUFFERED ASPIRIN

TRI-ESTARYLLA

TRI-LEGEST FE

TRI-LINYAH

TRI-NORINYL

TRI-PREVIFEM

TRI-SPRINTEC

TRIAMTERENE-HCTZ

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TRIAMTERENE-HYDROCHLOROTHIAZID

TRIBENZOR

TRICOR

TRIGLIDE

TRILIPIX

TRINESSA

TRIPLE ANTIBIOTIC

TRIPLE ANTIBIOTIC EXTRA

TRIPLE ANTIBIOTIC PLUS

TRIPLE ANTIBIOTIC-PAIN RELIEF

TRIVORA-28

TROPICAMIDE

TROSPIUM CHLORIDE

TROSPIUM CHLORIDE ER

TRUEPLUS GLUCOSE

TRUEPLUS INSULIN SYRINGE

TRULICITY

TRUSOPT

TUDORZA PRESSAIR

TWYNSTA U ULORIC

ULTICARE

ULTILET INSULIN SYRINGE

ULTILET PEN NEEDLE

ULTRA COMFORT

ULTRA-THIN II

ULTRACOMFORT

UNIFINE PENTIPS

UNIFINE PENTIPS PLUS

UNIRETIC

UNITHROID

UNIVASC

UROCIT-K

UROXATRAL

URSO

URSO FORTE

URSODIOL V VAGIFEM

VALSARTAN

VALSARTAN-HYDROCHLOROTHIAZIDE

VALTURNA

VANISHPOINT

VANQUISH

VASCEPA

VASERETIC

VASOSTRICT

VASOTEC

VELIVET

VENLAFAXINE HCL

VENLAFAXINE HCL ER

VERAPAMIL ER

VERAPAMIL ER PM

VERAPAMIL HCL

VERAPAMIL SR

VERELAN

VERELAN PM

VESICARE

VESTURA

VICTOZA 2-PAK

VICTOZA 3-PAK

VIIBRYD

VIMOVO

VIORELE

VIRT-VITE PLUS

VIVELLE

VIVELLE-DOT

VOLTAREN

VOLTAREN-XR

VOSPIRE ER

VYFEMLA

VYTORIN W WAL-PROFEN

WAL-PROXEN

WAL-ZAN 150

WAL-ZAN 75

WELCHOL

WELLBUTRIN

WELLBUTRIN SR

WELLBUTRIN XL

WERA

WESTHROID

WESTHROID-P

WOMEN'S ASPIRIN

WP THYROID

WYMZYA FE X XALATAN

XIGDUO XR

XULANE Y YALE NEEDLE

YALE NEEDLE HUBER BEVEL

YALE NEEDLE REGULAR BEVEL

YALE NEEDLE SHORT BEVEL

YALE NEEDLES

YASMIN 28

YAZ Z ZAFIRLUKAST

ZANAFLEX

ZANTAC

ZANTAC 25

ZANTAC 75

ZARAH

ZAROXOLYN

ZEBETA

ZEGERID

ZEGERID OTC

ZELAPAR

ZEMPLAR

ZENCHENT

ZENCHENT FE

ZEOSA

ZESTORETIC

ZESTRIL

ZETIA

ZIAC

ZIOPTAN

ZOCOR

ZOLOFT

ZONTIVITY

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Maintenance Medication Drug List Drug Level_136217_Updated June 2015

ZORVOLEX

ZOVIA 1-35E

ZOVIA 1-50E

ZYBAN

ZYFLO

ZYFLO CR

ZYLOPRIM