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Prescribing Guide - Standard Opt Out

03/01/2020

INTRODUCTION....................................................................................................................................................................................................... 4 PREFACE ................................................................................................................................................................................................................. 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ...................................................................................................................................... 4 DRUG LIST PRODUCT DESCRIPTIONS ................................................................................................................................................................ 5 GENERIC SUBSTITUTION ...................................................................................................................................................................................... 5 SPECIALTY PHARMACY ........................................................................................................................................................................................ 6 LEGEND ................................................................................................................................................................................................................... 9 NOTICE ................................................................................................................................................................................................................... 10 ANALGESICS......................................................................................................................................................................................................... 11

ANALGESICS, OTHER ................................................................................................................................................................................ 11 NSAIDs ......................................................................................................................................................................................................... 11 NSAIDs, COMBINATIONS ........................................................................................................................................................................... 11 NSAIDs, TOPICAL ....................................................................................................................................................................................... 11 COX-2 INHIBITORS ..................................................................................................................................................................................... 11 GOUT ........................................................................................................................................................................................................... 11 OPIOID ANALGESICS ................................................................................................................................................................................. 11 NON-OPIOID ANALGESICS ........................................................................................................................................................................ 12 VISCOSUPPLEMENTS ............................................................................................................................................................................... 12

ANTI-INFECTIVES ................................................................................................................................................................................................. 12 ANTIBACTERIALS ....................................................................................................................................................................................... 13 ANTIFUNGALS ............................................................................................................................................................................................ 13 ANTIMALARIALS ......................................................................................................................................................................................... 13 ANTIRETROVIRAL AGENTS ...................................................................................................................................................................... 14 ANTITUBERCULAR AGENTS ..................................................................................................................................................................... 14 ANTIVIRALS................................................................................................................................................................................................. 15 MISCELLANEOUS ....................................................................................................................................................................................... 15

ANTINEOPLASTIC AGENTS ................................................................................................................................................................................ 15 ALKYLATING AGENTS ............................................................................................................................................................................... 15 ANTIMETABOLITES .................................................................................................................................................................................... 16 HORMONAL ANTINEOPLASTIC AGENTS ................................................................................................................................................. 16 IMMUNOMODULATORS ............................................................................................................................................................................. 16 KINASE INHIBITORS ................................................................................................................................................................................... 16 TOPOISOMERASE INHIBITORS ................................................................................................................................................................ 17 MISCELLANEOUS ....................................................................................................................................................................................... 17

CARDIOVASCULAR .............................................................................................................................................................................................. 17 ACE INHIBITORS......................................................................................................................................................................................... 17 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ........................................................................................................ 17 ACE INHIBITOR/DIURETIC COMBINATIONS ............................................................................................................................................ 17 ADRENOLYTICS, CENTRAL ....................................................................................................................................................................... 18 ALDOSTERONE RECEPTOR ANTAGONISTS .......................................................................................................................................... 18 ALPHA BLOCKERS ..................................................................................................................................................................................... 18 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ........................................................................................... 18 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ......................................................... 18 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ....................................... 18 ANTIARRHYTHMICS ................................................................................................................................................................................... 18 ANTILIPEMICS............................................................................................................................................................................................. 19 BETA-BLOCKERS ....................................................................................................................................................................................... 19 BETA-BLOCKER/DIURETIC COMBINATIONS ........................................................................................................................................... 20 CALCIUM CHANNEL BLOCKERS .............................................................................................................................................................. 20 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS ............................................................................................................ 20 DIGITALIS GLYCOSIDES ............................................................................................................................................................................ 20 DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS ....................................................................................................................... 20 DIURETICS .................................................................................................................................................................................................. 20 HEART FAILURE ......................................................................................................................................................................................... 21 NITRATES .................................................................................................................................................................................................... 21 PULMONARY ARTERIAL HYPERTENSION .............................................................................................................................................. 21 MISCELLANEOUS ....................................................................................................................................................................................... 21

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CENTRAL NERVOUS SYSTEM ............................................................................................................................................................................ 21 ANTIANXIETY .............................................................................................................................................................................................. 21 ANTICONVULSANTS .................................................................................................................................................................................. 22 ANTIDEMENTIA ........................................................................................................................................................................................... 22 ANTIDEPRESSANTS .................................................................................................................................................................................. 23 ANTIPARKINSONIAN AGENTS .................................................................................................................................................................. 23 ANTIPSYCHOTICS ...................................................................................................................................................................................... 24 ATTENTION DEFICIT HYPERACTIVITY DISORDER ................................................................................................................................ 24 FIBROMYALGIA........................................................................................................................................................................................... 24 HYPNOTICS................................................................................................................................................................................................. 25 MIGRAINE .................................................................................................................................................................................................... 25 MOOD STABILIZERS .................................................................................................................................................................................. 25 MOVEMENT DISORDERS .......................................................................................................................................................................... 26 MULTIPLE SCLEROSIS AGENTS .............................................................................................................................................................. 26 MUSCULOSKELETAL THERAPY AGENTS ............................................................................................................................................... 26 MYASTHENIA GRAVIS ............................................................................................................................................................................... 26 NARCOLEPSY ............................................................................................................................................................................................. 26 POSTHERPETIC NEURALGIA (PHN) ......................................................................................................................................................... 26 PSYCHOTHERAPEUTIC-MISCELLANEOUS ............................................................................................................................................. 26

ENDOCRINE AND METABOLIC ........................................................................................................................................................................... 27 ACROMEGALY ............................................................................................................................................................................................ 27 ANDROGENS .............................................................................................................................................................................................. 27 ANTIDIABETICS .......................................................................................................................................................................................... 27 ANTIOBESITY .............................................................................................................................................................................................. 29 CALCIUM RECEPTOR ANTAGONISTS ..................................................................................................................................................... 29 CALCIUM REGULATORS ........................................................................................................................................................................... 29 CARNITINE DEFICIENCY AGENTS ........................................................................................................................................................... 29 CONTRACEPTIVES .................................................................................................................................................................................... 30 ENDOMETRIOSIS ....................................................................................................................................................................................... 31 ESTROGENS ............................................................................................................................................................................................... 31 ESTROGEN/PROGESTINS ......................................................................................................................................................................... 31 ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS ............................................................................. 31 FERTILITY REGULATORS .......................................................................................................................................................................... 31 GAUCHER DISEASE ................................................................................................................................................................................... 32 GLUCOCORTICOIDS .................................................................................................................................................................................. 32 GLUCOSE ELEVATING AGENTS ............................................................................................................................................................... 32 HUMAN GROWTH HORMONES ................................................................................................................................................................. 32 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ................................................................................................................. 32 PHENYLKETONURIA TREATMENT AGENTS ........................................................................................................................................... 32 PHOSPHATE BINDER AGENTS ................................................................................................................................................................. 32 POTASSIUM-REMOVING AGENTS............................................................................................................................................................ 32 PROGESTINS .............................................................................................................................................................................................. 32 SELECTIVE ESTROGEN RECEPTOR MODULATORS ............................................................................................................................. 33 THYROID AGENTS ..................................................................................................................................................................................... 33 VASOPRESSINS ......................................................................................................................................................................................... 33 MISCELLANEOUS ....................................................................................................................................................................................... 33

GASTROINTESTINAL ........................................................................................................................................................................................... 33 ANTIDIARRHEALS ...................................................................................................................................................................................... 33 ANTIEMETICS ............................................................................................................................................................................................. 33 ANTISPASMODICS ..................................................................................................................................................................................... 33 CHOLELITHOLYTICS .................................................................................................................................................................................. 34 H2 RECEPTOR ANTAGONISTS .................................................................................................................................................................. 34 INFLAMMATORY BOWEL DISEASE .......................................................................................................................................................... 34 IRRITABLE BOWEL SYNDROME ............................................................................................................................................................... 34 LAXATIVES .................................................................................................................................................................................................. 34 OPIOID-INDUCED CONSTIPATION ........................................................................................................................................................... 34 PANCREATIC ENZYMES ............................................................................................................................................................................ 34 PROSTAGLANDINS .................................................................................................................................................................................... 34 PROTON PUMP INHIBITORS ..................................................................................................................................................................... 35 SALIVA STIMULANTS ................................................................................................................................................................................. 35 STEROIDS, RECTAL ................................................................................................................................................................................... 35 ULCER THERAPY COMBINATIONS .......................................................................................................................................................... 35 MISCELLANEOUS ....................................................................................................................................................................................... 35

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GENITOURINARY .................................................................................................................................................................................................. 35 BENIGN PROSTATIC HYPERPLASIA ........................................................................................................................................................ 35 ERECTILE DYSFUNCTION ......................................................................................................................................................................... 35 URINARY ANTISPASMODICS .................................................................................................................................................................... 35 VAGINAL ANTI-INFECTIVES ...................................................................................................................................................................... 36 MISCELLANEOUS ....................................................................................................................................................................................... 36

HEMATOLOGIC ..................................................................................................................................................................................................... 36 ANTICOAGULANTS .................................................................................................................................................................................... 36 HEMATOPOIETIC GROWTH FACTORS .................................................................................................................................................... 36 HEMOPHILIA A AGENTS ............................................................................................................................................................................ 36 HEMOPHILIA B AGENTS ............................................................................................................................................................................ 37 HEREDITARY ANGIOEDEMA ..................................................................................................................................................................... 37 IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS ...................................................................................................................... 37 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS ........................................................................................................ 37 PLATELET AGGREGATION INHIBITORS .................................................................................................................................................. 37 PLATELET SYNTHESIS INHIBITORS ........................................................................................................................................................ 37 STEM CELL MOBILIZERS ........................................................................................................................................................................... 37 THROMBOCYTOPENIA AGENTS .............................................................................................................................................................. 37 MISCELLANEOUS ....................................................................................................................................................................................... 37

IMMUNOLOGIC AGENTS ...................................................................................................................................................................................... 37 ALLERGENIC EXTRACTS .......................................................................................................................................................................... 37 AUTOIMMUNE AGENTS ‡ ........................................................................................................................................................................... 37 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ................................................................................................................. 38 IMMUNOMODULATORS ............................................................................................................................................................................. 38 IMMUNOSUPPRESSANTS ......................................................................................................................................................................... 38

NUTRITIONAL/SUPPLEMENTS ............................................................................................................................................................................ 38 ELECTROLYTES ......................................................................................................................................................................................... 38 VITAMINS AND MINERALS ........................................................................................................................................................................ 38

RESPIRATORY ...................................................................................................................................................................................................... 39 ANAPHYLAXIS TREATMENT AGENTS ..................................................................................................................................................... 39 ANTICHOLINERGICS .................................................................................................................................................................................. 39 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ............................................................................................................................ 39 ANTICHOLINERGIC/BETA AGONIST/STEROID INHALANT COMBINATIONS ........................................................................................ 39 ANTIHISTAMINES, LOW SEDATING.......................................................................................................................................................... 39 ANTIHISTAMINES, NONSEDATING ........................................................................................................................................................... 39 ANTIHISTAMINES, SEDATING ................................................................................................................................................................... 39 ANTIHISTAMINE/DECONGESTANT COMBINATIONS .............................................................................................................................. 40 ANTITUSSIVES............................................................................................................................................................................................ 40 ANTITUSSIVE COMBINATIONS ................................................................................................................................................................. 40 BETA AGONISTS ........................................................................................................................................................................................ 40 CYSTIC FIBROSIS ...................................................................................................................................................................................... 40 LEUKOTRIENE MODULATORS .................................................................................................................................................................. 41 MAST CELL STABILIZERS ......................................................................................................................................................................... 41 NASAL ANTIHISTAMINES .......................................................................................................................................................................... 41 NASAL STEROIDS/COMBINATIONS ......................................................................................................................................................... 41 PHOSPHODIESTERASE-4 INHIBITORS .................................................................................................................................................... 41 PULMONARY ENZYME DEFICIENCY AGENTS ........................................................................................................................................ 41 PULMONARY FIBROSIS AGENTS ............................................................................................................................................................. 41 SEVERE ASTHMA AGENTS ....................................................................................................................................................................... 41 STEROID/BETA AGONIST COMBINATIONS ............................................................................................................................................. 41 STEROID INHALANTS ................................................................................................................................................................................ 41 XANTHINES ................................................................................................................................................................................................. 41 MISCELLANEOUS ....................................................................................................................................................................................... 41

TOPICAL ................................................................................................................................................................................................................ 42 DERMATOLOGY.......................................................................................................................................................................................... 42 MOUTH/THROAT/DENTAL AGENTS ......................................................................................................................................................... 44 OPHTHALMIC .............................................................................................................................................................................................. 45 OTIC ............................................................................................................................................................................................................. 47

SPECIALTY DRUGS .............................................................................................................................................................................................. 47 WEBSITES ............................................................................................................................................................................................................. 52 INDEX ..................................................................................................................................................................................................................... 54

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INTRODUCTION

We are pleased to provide the 2020 Prescribing Guide - Standard Opt Out as a useful reference and informational tool. The Prescribing Guide - Standard Opt Out can assist practitioners in selecting clinically appropriate and cost-effective products for their patients.

The drugs represented have been reviewed by a National Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The Prescribing Guide - Standard Opt Out is reflective of current medical practice as of the date of review.

The information contained in this Prescribing Guide - Standard Opt Out and its appendices is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This Prescribing Guide - Standard Opt Out is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. All the information in the Prescribing Guide - Standard Opt Out is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable.

We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.

National guidelines can be found on the National Guideline Clearinghouse site at https://www.ahrq.gov/gam/, on the websites listed under each therapeutic class and on the sites listed in the WEBSITES section of this publication.

PREFACE

The Prescribing Guide - Standard Opt Out is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless exceptions are noted, generally all applicable dosage forms and strengths of the drug cited are included in the Prescribing Guide - Standard Opt Out. Generics should be considered the first line of prescribing.

Individual pharmacy benefit plans may impose restrictions or not reimburse some products. In addition, over-the-counter (OTC) products, with the exception of insulin and diabetes monitoring products, are usually not included in the pharmacy benefit. Pharmacy law requires a valid prescription for purchase of needles and syringes in certain states. OTC products are listed for informational purposes. If covered in the pharmacy benefit, OTC products require a valid prescription.

Drugs represented in the Prescribing Guide - Standard Opt Out may have varying cost to the plan member. Prescription benefit plan may alter coverage of certain products or vary copay amounts based on the condition being treated. Generic medications typically are available at the lowest cost, brand-name medications on the Prescribing Guide - Standard Opt Out will generally cost more than generics, and brand-name medications not on the list will generally cost the most.

PHARMACY AND THERAPEUTICS (P&T) COMMITTEE

The services of an independent National Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an external advisory body of clinical professionals from across the United States. The P&T Committee's voting members include physicians, pharmacists, a pharmacoeconomist and a medical ethicist, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Employees with significant clinical expertise are invited to meet with the P&T Committee, but no CVS Caremark® employee may vote on issues before the P&T Committee. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.

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DRUG LIST PRODUCT DESCRIPTIONS

To assist in understanding which specific strengths and dosage forms are on the Prescribing Guide - Standard Opt Out, examples are noted below. The general principles shown in the examples can usually be extended to other entries in the book. Any exceptions are noted. Products on the Prescribing Guide - Standard Opt Out include all strengths and dosage forms of the cited brand-name product. pregabalin Lyrica Oral capsules, oral solution and all strengths of Lyrica would be included in this listing. When a strength or dosage form is specified, only the specified strength and dosage form is on the Prescribing Guide - Standard Opt Out. Other strengths/dosage forms of the reference product are not. acyclovir caps, tabs Zovirax The capsules and tablets of Zovirax are on the Prescribing Guide - Standard Opt Out. From this entry, the cream and ointment cannot be assumed to be on the list unless there is a specific entry. Extended-release and delayed-release products require their own entry. sitagliptin/metformin Janumet The immediate-release product listing of Janumet alone would not include the extended-release product Janumet XR. sitagliptin/metformin ext-rel Janumet XR A separate entry for Janumet XR confirms that the extended-release product is on the Prescribing Guide - Standard Opt Out. Dosage forms on the Prescribing Guide - Standard Opt Out will be consistent with the category and use where listed. neomycin/polymyxin B/hydrocortisone Cortisporin Since Cortisporin is listed only in the OTIC section, it is limited to the otic solution and suspension. From this entry the topical cream cannot be assumed to be on the list unless there is an entry for this product in the DERMATOLOGY section of the Prescribing Guide - Standard Opt Out.

GENERIC SUBSTITUTION

Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In addition, boldface type may indicate that the brand name cited is a generic. Examples of the latter include Levoxyl and Trivora. One way to reduce out-of-pocket cost is by requesting a generic drug. Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:

Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs.

Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug.

Manufactured in the same strength and dosage form as the brand-name drugs.

When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug.

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SPECIALTY PHARMACY

CVS Specialty™ is a full-service specialty pharmaceutical provider. Specialty pharmaceuticals or products are used in the management of specific chronic or genetic conditions and certain catastrophic diseases such as cancer. They are often injectable or infused medications, but may also include oral agents.

CVS Caremark offers these services combined with professional pharmaceutical care management.

Medications distributed through CVS Specialty program are listed below. A member's specific prescription benefit plan may have different coverage or copayments for specific specialty products.

Medications Available through CVS Specialty (Alpha List)

abacavir tab (ZIAGEN)1 abacavir/lamivudine (EPZICOM)1 abacavir/lamivudine/ zidovudine tab (TRIZIVIR)1 abiraterone acetate (ZYTIGA)1 Actemra Acthar H.P. Gel Actimmune Adakveo Adcetris Adcirca adefovir (HEPSERA)1 Adempas Advate Adynovate Afinitor Afstyla Aimovig Ajovy Aldurazyme Alecensa Alferon N Alphanate AlphaNine SD Alprolix Alunbrig alyq (ADCIRCA, tadalafil)1 ambrisentan (LETAIRIS)1 Ampyra Apokyn Aptivus Aralast NP Aranesp Arcalyst Arzerra Asceniv Asparlas Astagraf XL atazanavir sulfate (REYATAZ)1 Atripla Aubagio Austedo Avastin Aveed Avonex azacitidine (VIDAZA)1

Baraclude Bavencio Bebulin Beleodaq Belrapzo Bendamustine Hydrochloride Bendeka BeneFIX Benlysta Beovu Berinert Besponsa Betaseron Bethkis bexarotene (TARGRETIN)1 Biktarvy Bivigam Blincyto Bortezomib bosentan (TRACLEER)1 Bosulif Botox Buphenyl Cabometyx capecitabine (XELODA)1 Cayston CellCept Ceprotin Cerdelga Cerezyme Cetrotide Chorionic Gonadotropin Cimduo Cimzia cinacalcet hydrochloride (SENSIPAR)1 Cinqair Cinryze Coagadex Combivir Cometriq Complera Copaxone Corifact Cosentyx Cotellic Crixivan

Crysvita Cuvitru cyclosporine (gengraf, NEORAL, SANDIMMUNE)1 Cyramza Cystagon Cytogam Dacogen dalfampridine ER (AMPYRA)1 Darzalex Daurismo decitabine (DACOGEN)1 deferasirox (EXJADE, JADENU)1 deferoxamine (DESFERAL)1 Delstrigo Descovy Desferal didanosine (VIDEX, VIDEX EC)1 dofetilide (TIKOSYN)1 Doptelet Dovato Dupixent Durolane Dysport Edurant efavirenz (SUSTIVA)1 Egrifta Elaprase Elelyso Eligard Eloctate Emgality Empliciti Emtriva Enbrel entecavir (BARACLUDE)1 Entyvio Envarsus XR Epclusa Epidiolex Epivir Epivir HBV Epogen

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epoprostenol sodium (FLOLAN, VELETRI)1 Epzicom Erbitux Erivedge Erleada erlotinib hydrochloride (TARCEVA)1 Esbriet Euflexxa Evenity everolimus (AFINITOR)1 Evomela Evotaz Exjade Extavia Eylea Fabrazyme Farydak Fasenra Feiba Fibryga Firazyr Firmagon Flolan Follistim AQ Folotyn Forteo fosamprenavir (LEXIVA)1 Fulphila Fusilev Fuzeon GamaSTAN GamaSTAN S/D Gamifant Gammagard Liquid Gammagard S/D Gammaked Gammaplex Gamunex C Ganirelix acetate Gattex Gazyva Gel-One Gelsyn-3 gengraf1 Genotropin Genvisc 850 Genvoya Gilenya Glassia glatiramer acetate (COPAXONE, glatopa)1 Gleevec Gonal-F Granix H.P. Acthar Gel

Haegarda Halaven Harvoni Helixate FS Hemlibra Hemofil M HepaGam B Hepsera Herceptin Herceptin Hylecta Hizentra Humate-P Humatrope Humira Hyalgan Hycamtin hydroxyprogesterone capro (MAKENA)1 Hymovis HyperHEP B HyperRHO S/D HyQvia Ibrance icatibant acetate (FIRAZYR)1 Idelvion Idhifa Ilaris Ilumya Iluvien imatinib mesylate (GLEEVEC)1 Imfinzi Inbrija Increlex Inflectra Inlyta Inrebic Intelence Intron A Invirase Iressa Isentress Istodax Ixempra Ixinity Jadenu Jakafi Jevtana Jivi Juluca Kadcyla Kalbitor Kaletra Kanjinti Kanuma Kevzara Keytruda Khapzory

Kisqali Kisqali Femara Kitabis Pak Koate Koate-DVI Kogenate FS Kovaltry Krystexxa Kuvan Kyleena Kyprolis lamivudine (EPIVIR, EPIVIR HBV)1 lamivudine/zidovudine (COMBIVIR)1 Ledipasvir/Sofosbuvir Lemtrada Lenvima Letairis Leukine leuprolide acetate (LUPRON)1 Levoleucovorin Lexiva Liletta Lonsurf lopinavir/ritonavir soln (KALETRA)1 Lorbrena Lucentis Lumizyme Lumoxiti Lupaneta Pack Lupron Lupron Depot Lynparza Macrilen Macugen Makena Mavenclad Mavyret Mayzent Mekinist Menopur MICRhoGAM miglustat1 Mirena mitoxantrone hcl1 Moderiba Mononine Monovisc Mozobil Mugard Mulpleta Mvasi mycophenolate mofetil (CELLCEPT)1

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mycophenolic acid dr (MYFORTIC)1 Myfortic Mylotarg Myobloc Nabi-HB Naglazyme Natpara Neoral Nerlynx Neulasta Neupogen nevirapine (VIRAMUNE)1 Nexavar Nexplanon Ninlaro Nivestym Norditropin Northera Norvir Nourianz Novarel Novoeight NovoSeven RT Nplate Nubeqa Nucala Nulojix Nuplazid Nutropin Nuwiq Nuzyra Obizur Ocaliva Ocrevus Octagam octreotide acetate (SANDOSTATIN)1 Odefsey Odomzo Ofev Ogivri Olumiant Omnitrope Oncaspar Onpattro Opdivo Opsumit Oralair Orencia Orenitram Orthovisc Otezla Otrexup Ovidrel Oxbryta Ozurdex

Palynziq Panzyga Parsabiv Pegasys PegIntron Perjeta Pifeltro Piqray Plegridy Polivy Pomalyst Portrazza Poteligeo Pregnyl Prezcobix Prezista Privigen Probuphine Implant Kit Procrit Profilnine Profilnine SD Prograf Proleukin Prolia Promacta Pulmozyme Purixan Radicava Rapamune Rasuvo Ravicti Rebetol Rebif Rebinyn Reblozyl Reclast Recombinate Remicade Remodulin Renflexis Rescriptor Retacrit Retisert Retrovir Retrovir inj Revatio Revlimid Reyataz RhoGAM Rhophylac RiaSTAP ribasphere1 Ribasphere Ribapak ribavirin caps (ribasphere, REBETOL)1 ribavirin tabs (ribasphere, MODERIBA)1

Rinvoq ritonavir (NORVIR)1 Rituxan Rituxan Hycela Rixubis Romidepsin Rozlytrek Rubraca Ruconest Rydapt Sabril pwd Sabril tabs Saizen Samsca Sandimmune Sandostatin Sandostatin LAR Selzentry Sensipar Serostim sildenafil citrate (REVATIO)1 Siliq Simponi Simponi ARIA sirolimus tab (RAPAMUNE)1 Skyla Skyrizi Sodium Hyaluronate sodium phenylbutyrate (BUPHENYL)1 Sofosbuvir/Velpatasvir Solesta Soliris Somatuline Depot Somavert Sovaldi Sprycel stavudine (ZERIT)1 Stelara Stimate Stivarga Stribild Supartz Supprelin LA Sustiva Sutent Sylatron Sylvant Symfi Symfi Lo Symtuza Synagis Synvisc tacrolimus (PROGRAF)1 tadalafil (ADCIRCA, alyq)1 Tafinlar Tagrisso

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Takhzyro Taltz Talzenna Tarceva Targretin Tasigna Tecentriq Tecfidera Temixys Temodar temozolomide (TEMODAR)1 temsirolimus (TORISEL)1 tenofovir disoproxil fumarate (VIREAD)1 Tepadina tetrabenazine (XENAZINE)1 Thalomid Thyrogen Tikosyn Tivicay TOBI TOBI Podhaler tobramycin nebulizer (TOBI)1 Torisel Tracleer Treanda Trelstar Tremfya treprostinil sodium (REMODULIN)1 Tretten Triluron Triumeq Trivisc Trizivir Trogarzo Truvada Truxima Tybost Tykerb

Tymlos Tysabri Tyvaso Udenyca Ultomiris Uptravi valrubicin (VALSTAR)1 Valstar Vantas Varizig Vectibix Velcade Veletri Vemlidy Ventavis Verzenio Vidaza Videx Videx EC Viekira Pak vigabatrin pwd (SABRIL PWD)1 vigabatrin tabs (SABRIL TABS)1 Vimizim Viracept Viramune Viramune XR Viread Visco-3 Visudyne Vitrakvi Vivitrol Vizimpro Vonvendi Vosevi Votrient VPRIV Vumerity Vyndamax Vyndaqel

Wakix Wilate WinRho SDF Xalkori Xeljanz Xeloda Xembify Xenazine Xenleta Xeomin Xgeva Xolair Xtandi Xyntha Yervoy Yondelis Yonsa Zaltrap Zarxio Zelboraf Zemaira Zepatier Zerit Ziagen zidovudine (RETROVIR)1 Ziextenzo Zoladex zoledronic acid (RECLAST, ZOMETA)1 Zolinza Zomacton Zometa Zorbtive Zortress Zulresso Zydelig Zykadia Zytiga

1 Bold lowercase type indicates generic name and availability; nonbold lowercase type within parentheses indicates trademark

generics. Products in all capital letters within parentheses indicate brand names of generic products.

This list is current as of January 2020. Products distributed by CVS Caremark and therapies may change.

To learn more about how CVS Specialty can help you or your patients, please visit our website https://www.CVSspecialty.com or call 1-800-237-2767.

LEGEND

OTC Over the counter

boldface Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name

delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification

ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification

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NOTICE

The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2020 CVS Caremark. All rights reserved.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. CVS Caremark does not operate the websites/organizations listed here, nor is it responsible for the availability or reliability of the websites' content. These listings do not imply or constitute an endorsement, sponsorship or recommendation by CVS Caremark.

When viewing the Prescribing Guide - Standard Opt Out via the Internet, please be advised that the Prescribing Guide - Standard Opt Out is updated periodically and changes may appear prior to their effective date to allow for client notification.

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ANALGESICS

Practice guidelines of pain management are available at: https://www.asahq.org ANALGESICS, OTHER Treatment recommendations for osteoarthritis are available at: https://www.rheumatology.org

OTC acetaminophen (generic of TYLENOL) NSAIDs

diclofenac sodium delayed-rel diflunisal

etodolac

ibuprofen OTC ibuprofen (generic of ADVIL)

meloxicam (generic of MOBIC)

nabumetone

naproxen OTC naproxen sodium (generic of ALEVE)

naproxen sodium tabs

oxaprozin (generic of DAYPRO) sulindac

NSAIDs, COMBINATIONS diclofenac sodium delayed-rel/misoprostol

NSAIDs, TOPICAL diclofenac sodium gel 1%

diclofenac sodium soln

COX-2 INHIBITORS celecoxib (generic of CELEBREX)

GOUT allopurinol (generic of ZYLOPRIM)

colchicine

febuxostat (generic of ULORIC) probenecid

OPIOID ANALGESICS Practice Guidelines for Cancer Pain Management (includes WHO analgesic ladder) are available at: https://www.asahq.org https://www.nccn.org Opioid guidelines in the management of chronic non-malignant pain are available at: https://www.asipp.org/ASIPP-Guidelines.html

buprenorphine (BELBUCA) codeine/acetaminophen

fentanyl sublingual spray (SUBSYS)

fentanyl transdermal

fentanyl transmucosal lozenge hydrocodone ext-rel (HYSINGLA ER)

hydrocodone/acetaminophen (generic of NORCO)

hydromorphone (generic of DILAUDID) hydromorphone ext-rel

methadone

12

morphine

morphine ext-rel morphine ext-rel (generic of KADIAN)

morphine ext-rel (generic of MS CONTIN)

morphine supp

morphine/naltrexone ext-rel (EMBEDA) oxycodone caps, tabs 5 mg

oxycodone concentrate 20 mg/mL

oxycodone ext-rel (OXYCONTIN) oxycodone tabs 15 mg, 30 mg, soln 5 mg/5 mL (generic of ROXICODONE)

oxycodone/acetaminophen 5/325 (generic of PERCOCET)

oxycodone/acetaminophen soln (generic of ROXICET)

tapentadol (NUCYNTA) tapentadol ext-rel (NUCYNTA ER)

tramadol (generic of ULTRAM)

tramadol ext-rel NON-OPIOID ANALGESICS

butalbital/acetaminophen/caffeine tabs (generic of ESGIC) butalbital/aspirin/caffeine (generic of FIORINAL)

VISCOSUPPLEMENTS sodium hyaluronate (GEL-ONE)

sodium hyaluronate (GELSYN-3)

sodium hyaluronate (SUPARTZ FX)

sodium hyaluronate (VISCO-3)

ANTI-INFECTIVES

Practice guidelines and statements developed and endorsed by the Infectious Diseases Society of America are available at: https://www.idsociety.org Hepatitis: CDC recommendations on the treatment of hepatitis are available at: https://www.cdc.gov/hepatitis/Resources/ Guidelines for the management of chronic hepatitis by the American Association for the Study of Liver Disease are available at: https://www.aasld.org HIV/AIDS: Guidelines for the treatment of HIV patients by the U.S. Department of Health and Human Services are available at: https://www.aidsinfo.nih.gov Infective Endocarditis: American Heart Association recommendations for the prevention of bacterial endocarditis are available at: https://professional.heart.org Influenza: Recommendations of the Advisory Committee on Immunization Practices are available at: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html International Travel: CDC recommendations for international travel are available at: https://wwwnc.cdc.gov/travel Respiratory Tract Infection/Antibiotic Use/Community Acquired Pneumonia/Other: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infection in adults are available at: https://www.cdc.gov/pneumonia/management-prevention-guidelines.html Sexually Transmitted Diseases: CDC Sexually Transmitted Diseases Guidelines are available at: https://www.cdc.gov/std/treatment/default.htm

13

ANTIBACTERIALS Cephalosporins First Generation

cefadroxil

cephalexin (generic of KEFLEX) Second Generation

cefprozil cefuroxime axetil

Third Generation cefdinir

cefixime (generic of SUPRAX)

Erythromycins/Macrolides

azithromycin (generic of ZITHROMAX)

clarithromycin

clarithromycin ext-rel erythromycin delayed-rel

erythromycin ethylsuccinate

erythromycin stearate fidaxomicin (DIFICID)

Fluoroquinolones ciprofloxacin (generic of CIPRO)

levofloxacin (generic of LEVAQUIN)

moxifloxacin (generic of AVELOX)

Penicillins

amoxicillin

amoxicillin/clavulanate (generic of AUGMENTIN) amoxicillin/clavulanate ext-rel

ampicillin

dicloxacillin penicillin VK

Tetracyclines doxycycline hyclate (generic of VIBRAMYCIN)

doxycycline hyclate 20 mg

minocycline

tetracycline ANTIFUNGALS

clotrimazole troches fluconazole (generic of DIFLUCAN)

griseofulvin ultramicrosize

itraconazole nystatin

terbinafine tabs

voriconazole (generic of VFEND)

ANTIMALARIALS

atovaquone/proguanil (generic of MALARONE)

chloroquine mefloquine

14

ANTIRETROVIRAL AGENTS Antiretroviral Combinations abacavir/dolutegravir/lamivudine (TRIUMEQ)

abacavir/lamivudine (generic of EPZICOM)

atazanavir/cobicistat (EVOTAZ) bictegravir/emtricitabine/tenofovir alafenamide (BIKTARVY)

darunavir/cobicistat (PREZCOBIX)

darunavir/cobicistat/emtricitabine/tenofovir alafenamide (SYMTUZA)

efavirenz/emtricitabine/tenofovir disoproxil fumarate (ATRIPLA) efavirenz/lamivudine/tenofovir disoproxil fumarate (SYMFI)

efavirenz/lamivudine/tenofovir disoproxil fumarate (SYMFI LO)

elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (GENVOYA) elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (STRIBILD)

emtricitabine/rilpivirine/tenofovir alafenamide (ODEFSEY)

emtricitabine/rilpivirine/tenofovir disoproxil fumarate (COMPLERA) emtricitabine/tenofovir alafenamide (DESCOVY)

emtricitabine/tenofovir disoproxil fumarate (TRUVADA)

lamivudine/tenofovir disoproxil fumarate (CIMDUO)

lamivudine/tenofovir disoproxil fumarate (TEMIXYS) lamivudine/zidovudine (generic of COMBIVIR)

Fusion Inhibitors enfuvirtide (FUZEON)

Integrase Inhibitors dolutegravir (TIVICAY)

raltegravir (ISENTRESS)

Non-nucleoside Reverse Transcriptase Inhibitors

efavirenz

etravirine (INTELENCE)

nevirapine nevirapine ext-rel

rilpivirine (EDURANT)

Nucleoside Reverse Transcriptase Inhibitors

abacavir tabs (generic of ZIAGEN)

didanosine delayed-rel (generic of VIDEX EC) emtricitabine (EMTRIVA)

lamivudine (generic of EPIVIR)

stavudine zidovudine (generic of RETROVIR)

Nucleotide Reverse Transcriptase Inhibitors

tenofovir disoproxil fumarate (generic of VIREAD) Protease Inhibitors

atazanavir darunavir (PREZISTA)

lopinavir/ritonavir soln (generic of KALETRA)

lopinavir/ritonavir tabs (KALETRA) ritonavir (generic of NORVIR)

ANTITUBERCULAR AGENTS ethambutol (generic of MYAMBUTOL)

isoniazid

pyrazinamide

rifampin (generic of RIFADIN)

15

ANTIVIRALS Cytomegalovirus Agents valganciclovir

Hepatitis Agents Hepatitis B

entecavir soln (BARACLUDE)

entecavir tabs lamivudine

tenofovir alafenamide (VEMLIDY)

Hepatitis C † ledipasvir/sofosbuvir (HARVONI)

ribavirin caps (generic of REBETOL)

ribavirin oral soln (REBETOL) ribavirin tabs † sofosbuvir/velpatasvir (EPCLUSA) † sofosbuvir/velpatasvir/voxilaprevir (VOSEVI) † HARVONI only for genotypes 1, 4, 5, and 6 EPCLUSA for genotypes 1, 2, 3, 4, 5, 6 VOSEVI for use in patients previously treated with an HCV regimen containing an NS5A inhibitor (for genotypes 1-6) or sofosbuvir without an NS5A inhibitor (for genotypes 1a or 3). Herpes Agents

acyclovir caps, tabs (generic of ZOVIRAX) famciclovir

valacyclovir

Influenza Agents oseltamivir

zanamivir (RELENZA)

MISCELLANEOUS

clindamycin (generic of CLEOCIN)

dapsone ivermectin (generic of STROMECTOL)

linezolid

mebendazole chewable (EMVERM) metronidazole (generic of FLAGYL)

nitrofurantoin ext-rel (generic of MACROBID)

nitrofurantoin macrocrystals

nitrofurantoin susp (generic of FURADANTIN) rifaximin 550 mg (XIFAXAN)

sulfamethoxazole/trimethoprim

sulfamethoxazole/trimethoprim DS tinidazole

trimethoprim

vancomycin (generic of VANCOCIN)

ANTINEOPLASTIC AGENTS

Clinical practice guidelines in oncology are available at: https://www.asco.org https://www.nccn.org ALKYLATING AGENTS

busulfan (MYLERAN) chlorambucil (LEUKERAN)

16

cyclophosphamide caps

melphalan (generic of ALKERAN) temozolomide (generic of TEMODAR)

ANTIMETABOLITES

capecitabine (generic of XELODA) mercaptopurine

methotrexate (TREXALL)

thioguanine (TABLOID) HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens abiraterone

abiraterone (YONSA)

apalutamide (ERLEADA) bicalutamide (generic of CASODEX)

darolutamide (NUBEQA)

enzalutamide (XTANDI)

flutamide Antiestrogens

tamoxifen Aromatase Inhibitors

anastrozole (generic of ARIMIDEX) exemestane (generic of AROMASIN)

letrozole (generic of FEMARA)

Luteinizing Hormone-Releasing Hormone (LHRH) Agonists

leuprolide acetate

leuprolide acetate (ELIGARD) leuprolide acetate (LUPRON DEPOT)

Progestins megestrol acetate tabs

IMMUNOMODULATORS

lenalidomide (REVLIMID) pomalidomide (POMALYST)

thalidomide (THALOMID)

KINASE INHIBITORS

bosutinib (BOSULIF)

cabozantinib (CABOMETYX) dasatinib (SPRYCEL)

erlotinib

everolimus (generic of AFINITOR) gefitinib (IRESSA)

imatinib mesylate

lapatinib (TYKERB)

midostaurin (RYDAPT) palbociclib (IBRANCE)

pazopanib (VOTRIENT)

ribociclib (KISQALI) ribociclib + letrozole (KISQALI FEMARA CO-PACK)

sunitinib (SUTENT)

17

TOPOISOMERASE INHIBITORS

topotecan caps (HYCAMTIN) MISCELLANEOUS

bexarotene caps (generic of TARGRETIN) etoposide

hydroxyurea (generic of HYDREA)

mitotane (LYSODREN)

niraparib (ZEJULA) olaparib (LYNPARZA)

procarbazine (MATULANE)

rucaparib (RUBRACA) sonidegib (ODOMZO)

tretinoin caps

uridine triacetate (VISTOGARD) vorinostat (ZOLINZA)

CARDIOVASCULAR

The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 Guidelines for the evaluation and management of cardiovascular diseases in adults are available at: https://www.acc.org https://professional.heart.org ACE INHIBITORS Guidelines for the use of ACE inhibitors are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://professional.diabetes.org https://www.acc.org https://professional.heart.org benazepril (generic of LOTENSIN)

captopril

enalapril (generic of VASOTEC)

fosinopril lisinopril (generic of ZESTRIL)

perindopril

quinapril (generic of ACCUPRIL) ramipril (generic of ALTACE)

trandolapril

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS

amlodipine/benazepril (generic of LOTREL)

trandolapril/verapamil ext-rel (generic of TARKA) ACE INHIBITOR/DIURETIC COMBINATIONS

benazepril/hydrochlorothiazide (generic of LOTENSIN HCT)

captopril/hydrochlorothiazide enalapril/hydrochlorothiazide (generic of VASERETIC)

fosinopril/hydrochlorothiazide

lisinopril/hydrochlorothiazide (generic of ZESTORETIC) quinapril/hydrochlorothiazide (generic of ACCURETIC)

18

ADRENOLYTICS, CENTRAL

clonidine (generic of CATAPRES) clonidine transdermal (generic of CATAPRES-TTS)

guanfacine

ALDOSTERONE RECEPTOR ANTAGONISTS

eplerenone (generic of INSPRA)

spironolactone (generic of ALDACTONE)

ALPHA BLOCKERS Guidelines for the use of alpha blockers in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497

doxazosin (generic of CARDURA) terazosin

ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS Guidelines for the use of angiotensin II receptor antagonists in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://professional.diabetes.org

candesartan

candesartan/hydrochlorothiazide eprosartan

irbesartan

irbesartan/hydrochlorothiazide losartan (generic of COZAAR)

losartan/hydrochlorothiazide (generic of HYZAAR)

olmesartan

olmesartan/hydrochlorothiazide telmisartan (generic of MICARDIS)

telmisartan/hydrochlorothiazide (generic of MICARDIS HCT)

valsartan valsartan/hydrochlorothiazide

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/olmesartan (generic of AZOR)

amlodipine/telmisartan

amlodipine/valsartan

ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS

amlodipine/valsartan/hydrochlorothiazide

olmesartan/amlodipine/hydrochlorothiazide (generic of TRIBENZOR) ANTIARRHYTHMICS Guidelines for the use of antiarrhythmics and cardiac glycosides in various patient populations are available at: https://www.acc.org

amiodarone disopyramide (generic of NORPACE)

disopyramide ext-rel (NORPACE CR)

dofetilide (generic of TIKOSYN) dronedarone (MULTAQ)

flecainide

propafenone propafenone ext-rel (generic of RYTHMOL SR)

sotalol

19

ANTILIPEMICS The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol is available at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625 Bile Acid Resins

cholestyramine (generic of QUESTRAN/QUESTRAN LIGHT)

colesevelam colestipol (generic of COLESTID)

Cholesterol Absorption Inhibitors ezetimibe (generic of ZETIA)

Fibrates fenofibrate

fenofibrate (ANTARA)

fenofibrate (generic of LIPOFEN) fenofibric acid delayed-rel (generic of TRILIPIX)

gemfibrozil (generic of LOPID)

HMG-CoA Reductase Inhibitors/Combinations

atorvastatin

ezetimibe/simvastatin (generic of VYTORIN)

fluvastatin lovastatin

pravastatin (generic of PRAVACHOL)

rosuvastatin simvastatin (generic of ZOCOR)

Niacins niacin ext-rel (generic of NIASPAN)

Omega-3 Fatty Acids icosapent ethyl (VASCEPA)

omega-3 acid ethyl esters (generic of LOVAZA)

PCSK9 Inhibitors

alirocumab (PRALUENT)

evolocumab (REPATHA)

BETA-BLOCKERS Guidelines for the use of beta-blockers and beta-blocker combinations in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org atenolol

bisoprolol

carvedilol (generic of COREG)

carvedilol phosphate ext-rel labetalol

metoprolol succinate ext-rel (generic of TOPROL-XL)

metoprolol tartrate (generic of LOPRESSOR) nadolol (generic of CORGARD)

nebivolol (BYSTOLIC)

pindolol propranolol

propranolol ext-rel (generic of INDERAL LA)

20

BETA-BLOCKER/DIURETIC COMBINATIONS Guidelines for the use of beta-blockers and diuretic combinations in various patient populations are available at: https://jamanetwork.com/journals/jama/fullarticle/1791497 https://www.acc.org

atenolol/chlorthalidone

bisoprolol/hydrochlorothiazide (generic of ZIAC)

metoprolol/hydrochlorothiazide (generic of LOPRESSOR HCT) CALCIUM CHANNEL BLOCKERS Dihydropyridines amlodipine

felodipine ext-rel

nifedipine ext-rel (generic of ADALAT CC) nifedipine ext-rel (generic of PROCARDIA XL)

Nondihydropyridines * diltiazem ext-rel

diltiazem ext-rel (generic of TIAZAC)

verapamil ext-rel (generic of CALAN SR)

* Listing does not include generic CARDIZEM LA CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS

amlodipine/atorvastatin (generic of CADUET)

DIGITALIS GLYCOSIDES

digoxin 0.0625 mg, 0.1875 mg (LANOXIN)

digoxin 0.125 mg, 0.25 mg

digoxin ped elixir DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS

aliskiren aliskiren/hydrochlorothiazide (TEKTURNA HCT)

DIURETICS Carbonic Anhydrase Inhibitors

acetazolamide

acetazolamide ext-rel methazolamide

Loop Diuretics bumetanide

furosemide (generic of LASIX)

torsemide (generic of DEMADEX) Potassium-sparing Diuretics

amiloride

Thiazides and Thiazide-like Diuretics

chlorthalidone

hydrochlorothiazide indapamide

metolazone

Diuretic Combinations

amiloride/hydrochlorothiazide

spironolactone/hydrochlorothiazide (generic of ALDACTAZIDE)

21

triamterene/hydrochlorothiazide (generic of DYAZIDE)

triamterene/hydrochlorothiazide (generic of MAXZIDE) HEART FAILURE

isosorbide dinitrate/hydralazine (BIDIL)

ivabradine (CORLANOR) sacubitril/valsartan (ENTRESTO)

NITRATES Oral

isosorbide dinitrate ext-rel tabs

isosorbide dinitrate oral (generic of ISORDIL) isosorbide mononitrate

isosorbide mononitrate ext-rel (generic of IMDUR)

Sublingual/Translingual

nitroglycerin lingual spray (generic of NITROLINGUAL)

nitroglycerin sublingual (generic of NITROSTAT) Transdermal

nitroglycerin transdermal nitroglycerin transdermal (generic of NITRO-DUR)

PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists

ambrisentan

bosentan

macitentan (OPSUMIT) Phosphodiesterase Inhibitors

sildenafil (generic of REVATIO) tadalafil

Prostacyclin Receptor Agonists selexipag (UPTRAVI)

Prostaglandin Vasodilators epoprostenol sodium (generic of FLOLAN)

treprostinil ext-rel (ORENITRAM)

Soluble Guanylate Cyclase Stimulators

riociguat (ADEMPAS)

MISCELLANEOUS

hydralazine

methyldopa

midodrine ranolazine ext-rel

CENTRAL NERVOUS SYSTEM

Practice guidelines for psychiatric disorders are available at: https://www.psychiatry.org ANTIANXIETY Benzodiazepines

alprazolam

clonazepam (generic of KLONOPIN) diazepam (generic of VALIUM)

22

lorazepam (generic of ATIVAN)

oxazepam Miscellaneous

buspirone

clomipramine (generic of ANAFRANIL) fluvoxamine

ANTICONVULSANTS Practice guidelines for the treatment of epilepsy are available at: https://www.aan.com

carbamazepine (generic of TEGRETOL)

carbamazepine ext-rel

carbamazepine ext-rel (generic of CARBATROL) clobazam

diazepam rectal gel (generic of DIASTAT)

divalproex sodium delayed-rel (generic of DEPAKOTE) divalproex sodium ext-rel (generic of DEPAKOTE ER)

ethosuximide (generic of ZARONTIN)

gabapentin (generic of NEURONTIN) lacosamide (VIMPAT)

lamotrigine (generic of LAMICTAL)

lamotrigine ext-rel (generic of LAMICTAL XR)

lamotrigine orally disintegrating tabs (generic of LAMICTAL ODT) levetiracetam (generic of KEPPRA)

levetiracetam ext-rel (generic of KEPPRA XR)

oxcarbazepine (generic of TRILEPTAL) oxcarbazepine ext-rel (OXTELLAR XR)

perampanel (FYCOMPA)

phenobarbital

phenytoin (generic of DILANTIN INFATABS) phenytoin sodium extended (generic of DILANTIN)

primidone (generic of MYSOLINE)

tiagabine topiramate (generic of TOPAMAX)

topiramate ext-rel

topiramate ext-rel (TROKENDI XR) valproic acid (generic of DEPAKENE)

vigabatrin

zonisamide

ANTIDEMENTIA Practice guidelines for the management of dementia are available at: https://www.aan.com

donepezil (generic of ARICEPT) galantamine (generic of RAZADYNE)

galantamine ext-rel (generic of RAZADYNE ER)

memantine (generic of NAMENDA)

memantine ext-rel memantine/donepezil (NAMZARIC)

rivastigmine

rivastigmine transdermal (generic of EXELON)

23

ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder. Guidelines for the evaluation and management of bipolar and depressive disorders are available at: https://www.psychiatry.org Monoamine Oxidase Inhibitors (MAOIs)

phenelzine (generic of NARDIL)

tranylcypromine (generic of PARNATE) Selective Serotonin Reuptake Inhibitors (SSRIs)

citalopram (generic of CELEXA) escitalopram (generic of LEXAPRO)

fluoxetine (generic of PROZAC)

fluoxetine 60 mg

paroxetine HCl (generic of PAXIL) paroxetine HCl ext-rel (generic of PAXIL CR)

sertraline (generic of ZOLOFT)

vilazodone (VIIBRYD) vortioxetine (TRINTELLIX)

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) desvenlafaxine ext-rel (generic of PRISTIQ)

duloxetine delayed-rel

levomilnacipran ext-rel (FETZIMA)

venlafaxine venlafaxine ext-rel (generic of EFFEXOR XR)

Tricyclic Antidepressants (TCAs) amitriptyline

desipramine (generic of NORPRAMIN)

doxepin imipramine HCl (generic of TOFRANIL)

nortriptyline (generic of PAMELOR)

Miscellaneous Agents

bupropion

bupropion ext-rel (generic of WELLBUTRIN SR)

bupropion ext-rel (generic of WELLBUTRIN XL) mirtazapine (generic of REMERON)

trazodone

ANTIPARKINSONIAN AGENTS Practice guidelines for the diagnosis and treatment of Parkinson's disease are available at: https://www.aan.com

amantadine

benztropine bromocriptine (generic of PARLODEL)

carbidopa/levodopa (generic of SINEMET)

carbidopa/levodopa ext-rel (generic of SINEMET CR) carbidopa/levodopa orally disintegrating tabs

carbidopa/levodopa/entacapone (generic of STALEVO)

entacapone (generic of COMTAN)

pramipexole (generic of MIRAPEX) pramipexole ext-rel

rasagiline

24

ropinirole

ropinirole ext-rel (generic of REQUIP XL) rotigotine transdermal (NEUPRO)

selegiline

trihexyphenidyl

ANTIPSYCHOTICS Atypicals

aripiprazole aripiprazole ext-rel inj (ABILIFY MAINTENA)

aripiprazole lauroxil ext-rel inj (ARISTADA)

aripiprazole lauroxil ext-rel inj (ARISTADA INITIO) cariprazine (VRAYLAR)

clozapine (generic of CLOZARIL)

lurasidone (LATUDA) olanzapine (generic of ZYPREXA)

quetiapine (generic of SEROQUEL)

quetiapine ext-rel

risperidone (generic of RISPERDAL) risperidone long-acting injection (RISPERDAL CONSTA)

ziprasidone (generic of GEODON)

Miscellaneous

chlorpromazine

fluphenazine haloperidol

perphenazine

thiothixene

trifluoperazine ATTENTION DEFICIT HYPERACTIVITY DISORDER Guidelines for the evaluation and management of attention deficit disorder are available at: https://www.aacap.org https://www.aap.org

amphetamine/dextroamphetamine mixed salts

amphetamine/dextroamphetamine mixed salts ext-rel

amphetamine/dextroamphetamine mixed salts ext-rel (MYDAYIS) atomoxetine (generic of STRATTERA)

dexmethylphenidate (generic of FOCALIN)

dexmethylphenidate ext-rel (generic of FOCALIN XR) dextroamphetamine

dextroamphetamine ext-rel (generic of DEXEDRINE SPANSULE)

guanfacine ext-rel lisdexamfetamine (VYVANSE)

methylphenidate (generic of METHYLIN)

methylphenidate (generic of RITALIN)

methylphenidate ext-rel methylphenidate ext-rel (generic of CONCERTA)

FIBROMYALGIA milnacipran (SAVELLA)

pregabalin (generic of LYRICA)

25

HYPNOTICS Practice parameters for the treatment of sleep disorders and clinical guidelines for the evaluation and management of chronic insomnia in adults are available at: https://aasm.org Benzodiazepines

temazepam (generic of RESTORIL)

Nonbenzodiazepines

eszopiclone

suvorexant (BELSOMRA) zolpidem (generic of AMBIEN)

zolpidem ext-rel (generic of AMBIEN CR)

zolpidem sublingual Tricyclics

doxepin (generic of SILENOR) MIGRAINE Guidelines for prevention and management of migraine headaches are available at: https://www.aan.com Ergotamine Derivatives dihydroergotamine inj (generic of D.H.E. 45)

dihydroergotamine spray

ergotamine/caffeine Monoclonal Antibodies

erenumab-aooe (AIMOVIG) fremanezumab-vfrm (AJOVY)

galcanezumab-gnlm (EMGALITY)

Selective Serotonin Agonists

eletriptan (generic of RELPAX)

naratriptan

rizatriptan (generic of MAXALT) sumatriptan (generic of IMITREX)

sumatriptan inj (generic of IMITREX)

sumatriptan inj (ZEMBRACE SYMTOUCH) sumatriptan nasal powder (ONZETRA XSAIL)

sumatriptan nasal spray (generic of IMITREX)

zolmitriptan (generic of ZOMIG) zolmitriptan nasal spray (ZOMIG)

Selective Serotonin Agonist/Nonsteroidal Anti-inflammatory Drug (NSAID) Combinations sumatriptan/naproxen sodium (generic of TREXIMET)

Miscellaneous

OTC acetaminophen/aspirin/caffeine (generic of EXCEDRIN MIGRAINE) MOOD STABILIZERS

lithium carbonate lithium carbonate ext-rel tabs 300 mg (generic of LITHOBID)

lithium carbonate ext-rel tabs 450 mg

26

MOVEMENT DISORDERS

deutetrabenazine (AUSTEDO) tetrabenazine

valbenazine (INGREZZA)

MULTIPLE SCLEROSIS AGENTS Practice guidelines for multiple sclerosis are available at: https://www.aan.com

dimethyl fumarate delayed-rel (TECFIDERA)

fingolimod (GILENYA) glatiramer (generic of COPAXONE)

interferon beta-1a (REBIF)

interferon beta-1b (BETASERON)

natalizumab (TYSABRI) siponimod (MAYZENT)

teriflunomide (AUBAGIO)

MUSCULOSKELETAL THERAPY AGENTS

baclofen

carisoprodol chlorzoxazone

cyclobenzaprine

dantrolene (generic of DANTRIUM)

metaxalone (generic of SKELAXIN) methocarbamol (generic of ROBAXIN)

orphenadrine/aspirin/caffeine

tizanidine tabs (generic of ZANAFLEX) MYASTHENIA GRAVIS

pyridostigmine pyridostigmine ext-rel

NARCOLEPSY armodafinil (generic of NUVIGIL)

solriamfetol (SUNOSI)

POSTHERPETIC NEURALGIA (PHN)

gabapentin ext-rel (GRALISE)

pregabalin ext-rel (LYRICA CR)

PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents acamprosate calcium (generic of CAMPRAL)

disulfiram (generic of ANTABUSE)

Opioid Antagonists naloxone inj

naloxone nasal spray (NARCAN)

naltrexone Partial Opioid Agonist/Opioid Antagonist Combinations

buprenorphine/naloxone (BUNAVAIL) buprenorphine/naloxone (ZUBSOLV)

buprenorphine/naloxone sublingual

Pseudobulbar Affect Agents

dextromethorphan/quinidine (NUEDEXTA)

27

Smoking Deterrents Treating Tobacco Use and Dependence: 2008 Update-Clinical Practice Guideline is available at: https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/index.html

bupropion ext-rel (generic of ZYBAN) OTC nicotine polacrilex gum (generic of NICORETTE)

OTC nicotine polacrilex lozenge (NICORETTE)

OTC nicotine transdermal (generic of NICODERM CQ) varenicline (CHANTIX)

Vasomotor Symptom Agents paroxetine mesylate

ENDOCRINE AND METABOLIC

ACROMEGALY

lanreotide acetate (SOMATULINE DEPOT) pegvisomant (SOMAVERT)

ANDROGENS Clinical practice guidelines for the treatment of hypogonadism are available at: https://www.aace.com testosterone cypionate

testosterone enanthate

testosterone gel testosterone soln

testosterone transdermal (ANDRODERM)

ANTIDIABETICS Guidelines of treatment and management of diabetes are available at: https://professional.diabetes.org Alpha-glucosidase Inhibitors

acarbose (generic of PRECOSE) Amylin Analogs

pramlintide (SYMLINPEN) Biguanides

metformin (generic of GLUCOPHAGE) metformin ext-rel (generic of GLUCOPHAGE XR)

Biguanide/Sulfonylurea Combinations glipizide/metformin

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors linagliptin (TRADJENTA)

sitagliptin phosphate (JANUVIA)

Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations

linagliptin/metformin (JENTADUETO)

linagliptin/metformin ext-rel (JENTADUETO XR)

sitagliptin/metformin (JANUMET) sitagliptin/metformin ext-rel (JANUMET XR)

28

Incretin Mimetic Agents

dulaglutide (TRULICITY) liraglutide (VICTOZA)

semaglutide (OZEMPIC)

Incretin Mimetic Agent/Insulin Combinations

liraglutide/insulin degludec (XULTOPHY)

lixisenatide/insulin glargine (SOLIQUA)

Insulins

insulin aspart (FIASP)

insulin aspart (NOVOLOG) insulin aspart protamine 70%/insulin aspart 30% (NOVOLOG MIX 70/30)

insulin degludec (TRESIBA)

insulin detemir (LEVEMIR) insulin glargine (BASAGLAR)

insulin glargine (LANTUS)

insulin glargine (TOUJEO)

insulin human (HUMULIN R) insulin human (HUMULIN R U-500)

OTC insulin human (NOVOLIN R)

insulin isophane human (HUMULIN N) OTC insulin isophane human (NOVOLIN N)

insulin isophane human 70%/regular 30% (HUMULIN 70/30)

OTC insulin isophane human 70%/regular 30% (NOVOLIN 70/30) insulin lispro (HUMALOG)

insulin lispro (INSULIN LISPRO)

insulin lispro protamine/insulin lispro (HUMALOG MIX)

Insulin Sensitizers

pioglitazone

Insulin Sensitizer/Biguanide Combinations

pioglitazone/metformin (generic of ACTOPLUS MET)

Insulin Sensitizer/Sulfonylurea Combinations

pioglitazone/glimepiride (generic of DUETACT)

Meglitinides

nateglinide

repaglinide (generic of PRANDIN) Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

canagliflozin (INVOKANA) dapagliflozin (FARXIGA)

empagliflozin (JARDIANCE)

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor/Biguanide Combinations

canagliflozin/metformin (INVOKAMET)

canagliflozin/metformin ext-rel (INVOKAMET XR)

dapagliflozin/metformin ext-rel (XIGDUO XR) empagliflozin/metformin (SYNJARDY)

empagliflozin/metformin ext-rel (SYNJARDY XR)

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor / Dipeptidyl Peptidase-4 (DPP-4) Inhibitor Combinations

dapagliflozin/saxagliptin (QTERN)

empagliflozin/linagliptin (GLYXAMBI)

29

Sulfonylureas

glimepiride (generic of AMARYL) glipizide (generic of GLUCOTROL)

glipizide ext-rel (generic of GLUCOTROL XL)

glyburide

Supplies

blood glucose continuous monitoring receivers, sensors (FREESTYLE LIBRE CONTINUOUS GLUCOSE MONITORING SYSTEM)

blood glucose continuous monitoring receivers, sensors, transmitters (DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM)

blood glucose monitoring kits, test strips (ACCU-CHEK AVIVA PLUS kits and test strips) blood glucose monitoring kits, test strips (ACCU-CHEK COMPACT PLUS kits and test strips)

blood glucose monitoring kits, test strips (ACCU-CHEK GUIDE kits and test strips)

blood glucose monitoring kits, test strips (ACCU-CHEK SMARTVIEW kits and test strips) blood glucose monitoring kits, test strips (ONETOUCH ULTRA kits and test strips)

blood glucose monitoring kits, test strips (ONETOUCH VERIO kits and test strips)

insulin infusion disposable pump (OMNIPOD INSULIN INFUSION PUMP) insulin infusion disposable pump (V-GO INSULIN INFUSION PUMP)

OTC insulin syringes, needles (BD ULTRAFINE insulin syringes and needles)

OTC lancets

ANTIOBESITY Guidelines of treatment and management of obesity are available at: https://www.aace.com https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults liraglutide (SAXENDA)

CALCIUM RECEPTOR ANTAGONISTS cinacalcet (generic of SENSIPAR)

CALCIUM REGULATORS Guidelines of treatment and management of osteoporosis are available at: https://www.aace.com https://www.nof.org Bisphosphonates

alendronate (generic of FOSAMAX) ibandronate (generic of BONIVA)

risedronate (generic of ACTONEL)

risedronate delayed-rel (generic of ATELVIA) Calcitonins

calcitonin-salmon spray Parathyroid Hormones

teriparatide (FORTEO) abaloparatide (TYMLOS)

Miscellaneous denosumab (PROLIA)

CARNITINE DEFICIENCY AGENTS levocarnitine

30

CONTRACEPTIVES EE = ethinyl estradiol ME = mestranol Monophasic 20 mcg Estrogen

drospirenone/EE 3/20 (generic of YAZ)

drospirenone/EE/levomefolate 3/20 and levomefolate levonorgestrel/EE 0.1/20 - Lessina

norethindrone acetate/EE 1/20 (generic of LOESTRIN 1/20)

norethindrone acetate/EE 1/20 and iron (generic of LOESTRIN FE 1/20) norethindrone acetate/EE 1/20 and iron (TAYTULLA)

norethindrone acetate/EE 1/20 and iron chewable

30 mcg Estrogen

desogestrel/EE 0.15/30

drospirenone/EE 3/30 (generic of YASMIN) drospirenone/EE/levomefolate 3/30 and levomefolate

levonorgestrel/EE 0.15/30 - Levora

norethindrone acetate/EE 1.5/30 (generic of LOESTRIN 1.5/30)

norethindrone acetate/EE 1.5/30 and iron (generic of LOESTRIN FE 1.5/30) norgestrel/EE 0.3/30 - Low-Ogestrel

35 mcg Estrogen ethynodiol diacetate/EE 1/35 - Zovia 1/35

norethindrone/EE 0.5/35

norethindrone/EE 1/35 norethindrone/EE 1/35 (generic of ORTHO-NOVUM 1/35)

norgestimate/EE 0.25/35

Biphasic

desogestrel/EE (generic of MIRCETTE)

norethindrone acetate/EE 1/10 and EE 10 and iron (LO LOESTRIN FE)

Triphasic

desogestrel/EE

levonorgestrel/EE - Trivora norethindrone/EE (generic of ORTHO-NOVUM 7/7/7)

norgestimate/EE

norgestimate/EE (generic of ORTHO TRI-CYCLEN LO) Four Phase

estradiol valerate and dienogest/estradiol valerate (NATAZIA) Extended Cycle

levonorgestrel/EE 0.1/20 and EE 10 (generic of LOSEASONIQUE)

levonorgestrel/EE 0.15/30 levonorgestrel/EE 0.15/30 and EE 10 (generic of SEASONIQUE)

Progestin Only norethindrone

norethindrone (generic of ORTHO MICRONOR)

Injectable

medroxyprogesterone acetate 150 mg/mL (generic of DEPO-PROVERA)

Progestin Intrauterine Devices levonorgestrel releasing IUD (KYLEENA)

levonorgestrel releasing IUD (MIRENA)

31

levonorgestrel releasing IUD (SKYLA)

Transdermal

norelgestromin/EE

Vaginal

etonogestrel/EE ring (generic of NUVARING)

ENDOMETRIOSIS

danazol

elagolix (ORILISSA)

ESTROGENS Guidelines of treatment and management of hormone therapy and menopause are available at: https://www.menopause.org https://www.aace.com/files/menopause.pdf Oral

estradiol (generic of ESTRACE)

estrogens, conjugated (PREMARIN) Transdermal

estradiol estradiol (generic of CLIMARA)

estradiol (DIVIGEL)

estradiol (EVAMIST)

estradiol (generic of VIVELLE-DOT) Vaginal

estradiol vaginal crm estradiol vaginal ring (ESTRING)

estradiol vaginal tabs (generic of VAGIFEM)

estrogens, conjugated crm (PREMARIN) ESTROGEN/PROGESTINS Oral estradiol/norethindrone

estrogens, conjugated/medroxyprogesterone (PREMPHASE)

estrogens, conjugated/medroxyprogesterone (PREMPRO) EE/norethindrone acetate - Jinteli

Transdermal

estradiol/levonorgestrel (CLIMARA PRO) estradiol/norethindrone acetate (COMBIPATCH)

ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS conjugated estrogens/bazedoxifene (DUAVEE)

FERTILITY REGULATORS GNRH/LHRH Antagonists

cetrorelix (CETROTIDE)

ganirelix acetate

32

Ovulation Stimulants, Gonadotropins

choriogonadotropin alfa (OVIDREL) follitropin alfa (GONAL-F)

Ovulation Stimulants, Synthetic clomiphene

GAUCHER DISEASE eliglustat (CERDELGA)

imiglucerase (CEREZYME)

GLUCOCORTICOIDS dexamethasone

fludrocortisone

hydrocortisone (generic of CORTEF) methylprednisolone (generic of MEDROL)

prednisolone

prednisone GLUCOSE ELEVATING AGENTS

glucagon, human recombinant (GLUCAGEN HYPOKIT) glucagon, human recombinant (GLUCAGON EMERGENCY KIT)

HUMAN GROWTH HORMONES Guidelines for use of growth hormone are available at: https://www.aace.com/publications/guidelines somatropin (HUMATROPE)

somatropin (NORDITROPIN)

HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS

calcitriol (1,25-D3) (generic of ROCALTROL)

doxercalciferol (generic of HECTOROL)

paricalcitol (generic of ZEMPLAR) PHENYLKETONURIA TREATMENT AGENTS

sapropterin (KUVAN) PHOSPHATE BINDER AGENTS

calcium acetate calcium acetate (PHOSLYRA)

lanthanum carbonate

sevelamer carbonate sucroferric oxyhydroxide (VELPHORO)

POTASSIUM-REMOVING AGENTS patiromer sorbitex (VELTASSA)

sodium zirconium cyclosilicate (LOKELMA)

PROGESTINS Oral

medroxyprogesterone acetate (generic of PROVERA) megestrol acetate susp (generic of MEGACE ES)

norethindrone acetate (generic of AYGESTIN)

progesterone, micronized (generic of PROMETRIUM)

33

Vaginal

progesterone gel (CRINONE) progesterone vaginal inserts (ENDOMETRIN)

SELECTIVE ESTROGEN RECEPTOR MODULATORS ospemifene (OSPHENA)

raloxifene (generic of EVISTA)

THYROID AGENTS Antithyroid Agents

methimazole (generic of TAPAZOLE)

propylthiouracil Thyroid Supplements

levothyroxine levothyroxine (generic of SYNTHROID)

levothyroxine - Levoxyl

liothyronine (generic of CYTOMEL) VASOPRESSINS

desmopressin spray, tabs (generic of DDAVP) MISCELLANEOUS

cabergoline

GASTROINTESTINAL

Guidelines for the treatment and management of various gastrointestinal diseases/conditions are available at: https://gi.org https://www.gastro.org ANTIDIARRHEALS diphenoxylate/atropine (generic of LOMOTIL)

loperamide

OTC loperamide (generic of IMODIUM A-D)

ANTIEMETICS

doxylamine/pyridoxine delayed-rel

dronabinol (generic of MARINOL) granisetron

granisetron transdermal (SANCUSO)

meclizine metoclopramide (generic of REGLAN)

ondansetron (generic of ZOFRAN)

prochlorperazine

promethazine rolapitant (VARUBI)

scopolamine transdermal

trimethobenzamide (generic of TIGAN) ANTISPASMODICS

dicyclomine (generic of BENTYL) hyoscyamine sulfate (generic of LEVSIN)

hyoscyamine sulfate ext-rel (generic of LEVBID)

hyoscyamine sulfate ext-rel caps hyoscyamine sulfate orally disintegrating tabs

34

CHOLELITHOLYTICS

ursodiol (generic of ACTIGALL) ursodiol (generic of URSO)

H2 RECEPTOR ANTAGONISTS cimetidine

OTC cimetidine (generic of TAGAMET HB 200)

famotidine (generic of PEPCID)

OTC famotidine (generic of PEPCID AC) ranitidine (generic of ZANTAC)

OTC ranitidine (generic of ZANTAC 75, ZANTAC 150)

INFLAMMATORY BOWEL DISEASE Oral Agents

balsalazide budesonide delayed-rel caps

budesonide ext-rel

mesalamine delayed-rel tabs (generic of LIALDA) mesalamine ext-rel caps (generic of APRISO)

mesalamine ext-rel caps (PENTASA)

sulfasalazine (generic of AZULFIDINE)

sulfasalazine delayed-rel (generic of AZULFIDINE EN-TABS) Rectal Agents

hydrocortisone acetate foam (CORTIFOAM) hydrocortisone enema

mesalamine supp

mesalamine susp (generic of ROWASA) IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation linaclotide (LINZESS)

lubiprostone (AMITIZA)

Irritable Bowel Syndrome with Diarrhea

alosetron

eluxadoline (VIBERZI)

LAXATIVES

lactulose

peg 3350/electrolytes (generic of GOLYTELY) peg 3350/electrolytes (generic of NULYTELY)

OTC polyethylene glycol 3350 (generic of MIRALAX)

sodium sulfate/potassium sulfate/magnesium sulfate (SUPREP) OPIOID-INDUCED CONSTIPATION

naloxegol (MOVANTIK) PANCREATIC ENZYMES

pancrelipase (VIOKACE) pancrelipase delayed-rel (CREON)

pancrelipase delayed-rel (ZENPEP)

PROSTAGLANDINS

misoprostol (generic of CYTOTEC)

35

PROTON PUMP INHIBITORS

dexlansoprazole delayed-rel (DEXILANT) esomeprazole delayed-rel

lansoprazole delayed-rel

omeprazole delayed-rel (generic of PRILOSEC)

OTC omeprazole magnesium delayed-rel (PRILOSEC OTC) pantoprazole delayed-rel

SALIVA STIMULANTS cevimeline (generic of EVOXAC)

pilocarpine tabs (generic of SALAGEN)

STEROIDS, RECTAL

hydrocortisone acetate/pramoxine foam (PROCTOFOAM-HC)

hydrocortisone crm (generic of ANUSOL-HC) ULCER THERAPY COMBINATIONS

bismuth/metronidazole/tetracycline (PYLERA) lansoprazole + amoxicillin + clarithromycin

MISCELLANEOUS sucralfate

GENITOURINARY

BENIGN PROSTATIC HYPERPLASIA Guidelines for the management of BPH are available at: https://www.auanet.org/guidelines

alfuzosin ext-rel dutasteride (generic of AVODART)

dutasteride/tamsulosin

finasteride (generic of PROSCAR) silodosin

tamsulosin (generic of FLOMAX)

ERECTILE DYSFUNCTION Guidelines for the management of erectile dysfunction are available at: https://www.auanet.org/guidelines Alprostadil Agents

alprostadil supp (MUSE) Phosphodiesterase Inhibitors

sildenafil tadalafil

URINARY ANTISPASMODICS darifenacin ext-rel

fesoterodine ext-rel (TOVIAZ)

mirabegron ext-rel (MYRBETRIQ) oxybutynin

oxybutynin ext-rel (generic of DITROPAN XL)

solifenacin

tolterodine (generic of DETROL) tolterodine ext-rel

trospium

trospium ext-rel

36

VAGINAL ANTI-INFECTIVES

clindamycin crm (generic of CLEOCIN) OTC clotrimazole (generic of GYNE-LOTRIMIN)

metronidazole (generic of METROGEL-VAGINAL)

OTC miconazole (generic of MONISTAT)

terconazole OTC tioconazole (generic of VAGISTAT-1)

MISCELLANEOUS bethanechol (generic of URECHOLINE)

OTC phenazopyridine

potassium citrate ext-rel (generic of UROCIT-K)

HEMATOLOGIC

Guidelines of treatment and management of hemophilia are available at: https://www.hemophilia.org ANTICOAGULANTS CHEST guidelines are available at: https://www.chestnet.org/Guidelines-and-Resources/CHEST-Guideline-Topic-Areas/Pulmonary-Vascular Injectable dalteparin (FRAGMIN)

enoxaparin (generic of LOVENOX)

Oral

apixaban (ELIQUIS)

rivaroxaban (XARELTO) warfarin (generic of COUMADIN)

Synthetic Heparinoid-like Agents fondaparinux (generic of ARIXTRA)

HEMATOPOIETIC GROWTH FACTORS Guidelines for the management of neutropenia are available at: https://www.asco.org Guidelines for the management of anemia associated with chronic kidney disease are available at: https://www.kidney.org/professionals/guidelines#guidelines

darbepoetin alfa (ARANESP)

epoetin alfa (PROCRIT)

epoetin alfa-epbx (RETACRIT) filgrastim (NEUPOGEN)

filgrastim-aafi (NIVESTYM)

filgrastim-sndz (ZARXIO) pegfilgrastim (NEULASTA)

pegfilgrastim-cbqv (UDENYCA)

tbo-filgrastim (GRANIX)

HEMOPHILIA A AGENTS

antihemophilic factor (recombinant) (KOGENATE FS)

antihemophilic factor (recombinant) (KOVALTRY) antihemophilic factor (recombinant) (NOVOEIGHT)

antihemophilic factor (recombinant) pegylated (ADYNOVATE)

antihemophilic factor (recombinant) pegylated-aucl (JIVI) human coagulation factor VIII (rDNA) simoctocog alfa (NUWIQ)

37

HEMOPHILIA B AGENTS

coagulation factor IX (recombinant) glycopegylated (REBINYN) HEREDITARY ANGIOEDEMA

C1 esterase inhibitor, recombinant (RUCONEST) icatibant (generic of FIRAZYR)

IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS eltrombopag (PROMACTA)

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS

eculizumab (SOLIRIS) PLATELET AGGREGATION INHIBITORS

OTC aspirin clopidogrel

dipyridamole

dipyridamole ext-rel/aspirin (generic of AGGRENOX) prasugrel

ticagrelor (BRILINTA)

PLATELET SYNTHESIS INHIBITORS

anagrelide (generic of AGRYLIN)

STEM CELL MOBILIZERS

plerixafor (MOZOBIL)

THROMBOCYTOPENIA AGENTS

lusutrombopag (MULPLETA)

MISCELLANEOUS

cilostazol

IMMUNOLOGIC AGENTS

Guidelines for the management of rheumatic diseases are available at: https://www.rheumatology.org ALLERGENIC EXTRACTS grass mixed pollen allergen extract (ORALAIR)

ragweed pollen allergen extract (RAGWITEK)

timothy grass pollen allergen extract (GRASTEK) AUTOIMMUNE AGENTS ‡

adalimumab (HUMIRA) apremilast (OTEZLA)

etanercept (ENBREL)

golimumab (SIMPONI)

ixekizumab (TALTZ) risankizumab-rzaa (SKYRIZI)

sarilumab (KEVZARA)

secukinumab (COSENTYX) tofacitinib (XELJANZ)

tofacitinib ext-rel (XELJANZ XR)

upadacitinib (RINVOQ) ustekinumab (STELARA SUBCUTANEOUS)

‡ Coverage may be altered or copay amounts may vary based on the condition being treated (e.g., psoriasis).

38

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)

hydroxychloroquine (generic of PLAQUENIL) leflunomide (generic of ARAVA)

methotrexate

methotrexate auto-injector (RASUVO)

IMMUNOMODULATORS CDC recommendations on the treatment of hepatitis are available at: https://www.cdc.gov/hepatitis/Resources/ Guidelines for the management of hepatitis are available at: https://www.aasld.org Interferons

interferon alfa-2b (INTRON A)

peginterferon alfa-2a (PEGASYS)

peginterferon alfa-2b (SYLATRON) Miscellaneous

canakinumab (ILARIS) IMMUNOSUPPRESSANTS Antimetabolites azathioprine (AZASAN)

azathioprine (generic of IMURAN)

mycophenolate mofetil mycophenolate sodium delayed-rel

Calcineurin Inhibitors cyclosporine

cyclosporine, modified

tacrolimus

Rapamycin Derivatives

sirolimus

NUTRITIONAL/SUPPLEMENTS

ELECTROLYTES Potassium

potassium chloride ext-rel potassium chloride liquid

Miscellaneous OTC electrolyte soln, oral (generic of PEDIALYTE)

VITAMINS AND MINERALS Folic Acid/Combinations

folic acid

folic acid/vitamin B6/vitamin B12

Prenatal Vitamins

prenatal vitamins/DHA/docusate/folic acid (CITRANATAL 90 DHA)

prenatal vitamins/DHA/docusate/folic acid (CITRANATAL DHA) prenatal vitamins/DHA/docusate/folic acid (CITRANATAL HARMONY)

prenatal vitamins/docusate/folic acid (CITRANATAL RX)

prenatal vitamins/docusate/folic acid + DHA (CITRANATAL ASSURE) prenatal vitamins/folic acid + pyridoxine (CITRANATAL B-CALM)

prenatal vitamins

39

Miscellaneous

OTC calcium carbonate (generic of OS-CAL) cyanocobalamin inj

ergocalciferol (D2)

OTC ferrous sulfate (generic of FEOSOL)

fluoride drops fluoride tabs

multivitamins/fluoride drops, tabs

multivitamins/fluoride/iron drops, tabs OTC multivitamins/minerals (generic of CENTRUM)

vitamin ADC/fluoride drops

vitamin ADC/fluoride/iron drops

RESPIRATORY

Guidelines to the management, prevention, or treatment of COPD and asthma are available at: https://www.aaaai.org https://ginasthma.org https://goldcopd.org https://www.nhlbi.nih.gov The Allergy Report and guidelines for allergy-related conditions are available at: https://www.aaaai.org ANAPHYLAXIS TREATMENT AGENTS

epinephrine auto-injector epinephrine auto-injector (generic of EPIPEN)

epinephrine auto-injector (generic of EPIPEN JR.)

ANTICHOLINERGICS

ipratropium soln

ipratropium, CFC-free aerosol (ATROVENT HFA) tiotropium (SPIRIVA)

umeclidinium (INCRUSE ELLIPTA)

ANTICHOLINERGIC/BETA AGONIST COMBINATIONS Short Acting

ipratropium/albuterol soln Long Acting

glycopyrrolate/formoterol (BEVESPI AEROSPHERE)

tiotropium/olodaterol (STIOLTO RESPIMAT) umeclidinium/vilanterol (ANORO ELLIPTA)

ANTICHOLINERGIC/BETA AGONIST/STEROID INHALANT COMBINATIONS fluticasone/umeclidinium/vilanterol (TRELEGY ELLIPTA)

ANTIHISTAMINES, LOW SEDATING OTC cetirizine (generic of ZYRTEC)

levocetirizine

ANTIHISTAMINES, NONSEDATING

OTC fexofenadine (generic of ALLEGRA)

OTC loratadine (generic of CLARITIN) ANTIHISTAMINES, SEDATING

OTC chlorpheniramine 4 mg (generic of CHLOR-TRIMETON ALLERGY) OTC clemastine 1.34 mg

clemastine 2.68 mg

40

cyproheptadine

OTC diphenhydramine (generic of BENADRYL) hydroxyzine HCl

ANTIHISTAMINE/DECONGESTANT COMBINATIONS

OTC cetirizine/pseudoephedrine ext-rel (generic of ZYRTEC-D 12 Hour) OTC dexbrompheniramine/pseudoephedrine ext-rel 6 mg/120 mg (generic of DRIXORAL)

OTC loratadine/pseudoephedrine ext-rel (generic of CLARITIN-D)

ANTITUSSIVES Clinical practice guidelines are available at: https://journal.chestnet.org/article/S0012-3692(15)52856-0/pdf

benzonatate (generic of TESSALON)

ANTITUSSIVE COMBINATIONS Opioid codeine/guaifenesin liquid

codeine/guaifenesin/pseudoephedrine

codeine/promethazine

codeine/promethazine/phenylephrine hydrocodone/homatropine

Non-opioid dextromethorphan/brompheniramine/pseudoephedrine

OTC dextromethorphan/guaifenesin (generic of ROBITUSSIN-DM)

dextromethorphan/promethazine BETA AGONISTS Inhalants Short Acting

albuterol soln

albuterol sulfate, CFC-free aerosol levalbuterol tartrate, CFC-free aerosol

Long Acting Hand-held Active Inhalation

olodaterol, CFC-free aerosol (STRIVERDI RESPIMAT)

salmeterol xinafoate (SEREVENT) Nebulized Passive Inhalation

formoterol inhalation soln (PERFOROMIST)

Oral Agents

albuterol

albuterol ext-rel terbutaline

CYSTIC FIBROSIS dornase alfa (PULMOZYME)

tobramycin inhalation powder (TOBI PODHALER)

tobramycin inhalation soln tobramycin inhalation soln (BETHKIS)

tobramycin inhalation soln (generic of KITABIS PAK)

41

LEUKOTRIENE MODULATORS

montelukast (generic of SINGULAIR) zafirlukast

zileuton ext-rel

MAST CELL STABILIZERS

cromolyn soln

NASAL ANTIHISTAMINES

azelastine spray

azelastine spray (generic of ASTEPRO)

olopatadine spray (generic of PATANASE) NASAL STEROIDS/COMBINATIONS

azelastine/fluticasone spray (DYMISTA) flunisolide spray

fluticasone spray

mometasone spray triamcinolone acetonide spray

PHOSPHODIESTERASE-4 INHIBITORS roflumilast (DALIRESP)

PULMONARY ENZYME DEFICIENCY AGENTS

alpha-1 proteinase inhibitor (PROLASTIN-C) PULMONARY FIBROSIS AGENTS

nintedanib (OFEV) pirfenidone (ESBRIET)

SEVERE ASTHMA AGENTS benralizumab (FASENRA)

dupilumab (DUPIXENT)

mepolizumab (NUCALA) omalizumab (XOLAIR)

STEROID/BETA AGONIST COMBINATIONS budesonide/formoterol (SYMBICORT)

fluticasone/salmeterol (ADVAIR DISKUS)

fluticasone/salmeterol, CFC-free aerosol (ADVAIR HFA)

fluticasone/vilanterol (BREO ELLIPTA) STEROID INHALANTS

beclomethasone breath-activated aerosol (QVAR REDIHALER) budesonide (PULMICORT FLEXHALER)

budesonide inhalation susp (generic of PULMICORT RESPULES)

fluticasone (ARNUITY ELLIPTA) fluticasone (FLOVENT DISKUS)

fluticasone, CFC-free aerosol (FLOVENT HFA)

mometasone (ASMANEX)

XANTHINES

theophylline ext-rel tabs

MISCELLANEOUS

ipratropium spray

42

TOPICAL

DERMATOLOGY Acne Guidelines for the care and treatment of acne vulgaris are available at: https://www.aad.org/practicecenter/quality/clinical-guidelines Oral

isotretinoin

isotretinoin (ABSORICA) Topical

adapalene adapalene/benzoyl peroxide (generic of EPIDUO)

adapalene/benzoyl peroxide (EPIDUO FORTE)

OTC benzoyl peroxide

benzoyl peroxide (generic of BENZAC AC) clindamycin gel

clindamycin gel, lotion, soln (generic of CLEOCIN T)

clindamycin/benzoyl peroxide clindamycin/benzoyl peroxide (generic of DUAC)

clindamycin/benzoyl peroxide (ONEXTON)

clindamycin/tretinoin erythromycin gel 2%

erythromycin soln

erythromycin/benzoyl peroxide (generic of BENZAMYCIN)

sulfacetamide lotion 10% (generic of KLARON) tazarotene (generic of TAZORAC)

tretinoin

tretinoin (generic of RETIN-A) tretinoin - Avita

tretinoin gel microsphere

Actinic Keratosis

fluorouracil crm 4% (TOLAK)

fluorouracil crm 5%, soln 5%, soln 2%

imiquimod (generic of ZYCLARA) ingenol mebutate (PICATO)

Antibiotics OTC bacitracin

gentamicin

mupirocin oint OTC neomycin/polymyxin B/bacitracin (generic of NEOSPORIN)

OTC polymyxin B/bacitracin (generic of POLYSPORIN)

silver sulfadiazine (generic of SILVADENE)

Antifungals

ciclopirox (generic of LOPROX)

clotrimazole OTC clotrimazole (generic of LOTRIMIN AF)

econazole

ketoconazole luliconazole

OTC miconazole (generic of MICATIN)

43

naftifine (generic of NAFTIN)

nystatin OTC terbinafine (LAMISIL AT)

OTC tolnaftate (generic of TINACTIN)

Antipsoriatics Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: https://www.aad.org Oral

acitretin (generic of SORIATANE) methoxsalen oral (generic of OXSORALEN-ULTRA)

Topical calcipotriene

calcipotriene/betamethasone (ENSTILAR)

calcipotriene/betamethasone (generic of TACLONEX SUSPENSION)

Antiseborrheics

ketoconazole shampoo 2% (generic of NIZORAL)

selenium sulfide shampoo 2.5% Atopic Dermatitis Guidelines for the treatment of atopic dermatitis are available at: https://www.aad.org/practicecenter/quality/clinical-guidelines Injectable

dupilumab (DUPIXENT)

Topical

crisaborole (EUCRISA)

pimecrolimus

tacrolimus Corticosteroids Low Potency alclometasone crm, oint 0.05%

desonide crm, lotion, oint 0.05% (generic of DESOWEN)

fluocinolone acetonide soln 0.01% hydrocortisone crm 2.5%

OTC hydrocortisone crm, oint 0.5%, 1% (generic of CORTIZONE)

hydrocortisone lotion 1% Medium Potency

betamethasone valerate crm, lotion, oint 0.1% desoximetasone crm, oint 0.05%

fluocinolone acetonide crm, oint 0.025%

fluticasone propionate crm, lotion 0.05%, oint 0.005% (generic of CUTIVATE)

hydrocortisone butyrate crm, oint, soln 0.1% hydrocortisone valerate crm, oint 0.2%

mometasone crm, lotion, oint 0.1% (generic of ELOCON)

triamcinolone acetonide crm, lotion 0.025% triamcinolone acetonide crm, lotion, oint 0.1%

High Potency betamethasone dipropionate augmented crm 0.05% (generic of DIPROLENE AF)

betamethasone dipropionate augmented lotion 0.05% (generic of DIPROLENE)

betamethasone dipropionate crm, lotion, oint 0.05%

44

desoximetasone crm, oint 0.25%, gel 0.05%

diflorasone diacetate crm 0.05% fluocinonide crm, gel, oint, soln 0.05%

triamcinolone acetonide crm 0.5%

Very High Potency betamethasone dipropionate augmented gel, oint 0.05% (generic of DIPROLENE)

clobetasol propionate crm, gel, oint, soln 0.05% (generic of TEMOVATE)

clobetasol propionate foam 0.05% clobetasol propionate lotion, shampoo 0.05% (generic of CLOBEX)

diflorasone diacetate oint 0.05%

halobetasol propionate crm, oint 0.05% (generic of ULTRAVATE) Emollients

ammonium lactate 12% (generic of LAC-HYDRIN) Local Analgesics

lidocaine patch (generic of LIDODERM)

Local Anesthetics

OTC lidocaine (generic of LMX-4)

lidocaine/prilocaine Rosacea

azelaic acid foam (FINACEA FOAM) azelaic acid gel

doxycycline monohydrate delayed-rel caps

ivermectin (generic of SOOLANTRA) metronidazole crm 0.75% (generic of METROCREAM)

metronidazole gel 0.75%

metronidazole gel 1% (generic of METROGEL)

metronidazole lotion 0.75% (generic of METROLOTION) Scabicides and Pediculicides

malathion (generic of OVIDE) permethrin 5%

OTC permethrin creme rinse 1% (generic of NIX)

OTC pyrethrins/piperonyl butoxide shampoo 4% (generic of A-200) OTC pyrethrins/piperonyl butoxide shampoo 4% (generic of RID)

Miscellaneous Skin and Mucous Membrane imiquimod (generic of ALDARA)

podofilox (generic of CONDYLOX)

OTC salicylic acid 17%/collodion (generic of DUOFILM)

MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous

Protectants - Mouth/Throat

benzyl alcohol/carbomer 941/glycerin (MUGARD) soy phospholipid/glycerol dioleate (EPISIL)

Steroids - Mouth/Throat triamcinolone paste

45

OPHTHALMIC Preferred Practice Pattern Guidelines for the treatment of various ophthalmic conditions are available at: https://one.aao.org Antiallergics

alcaftadine (LASTACAFT)

azelastine

cromolyn sodium OTC ketotifen (generic of ZADITOR)

olopatadine (generic of PATADAY)

olopatadine (generic of PATANOL) olopatadine (PAZEO)

Anti-infectives bacitracin

besifloxacin (BESIVANCE)

ciprofloxacin oint (CILOXAN)

ciprofloxacin soln (generic of CILOXAN) erythromycin

gentamicin

levofloxacin moxifloxacin (MOXEZA)

moxifloxacin (generic of VIGAMOX)

neomycin/polymyxin B/gramicidin

ofloxacin (generic of OCUFLOX) polymyxin B/bacitracin

polymyxin B/trimethoprim (generic of POLYTRIM)

sulfacetamide oint 10% sulfacetamide soln 10% (generic of BLEPH-10)

tobramycin (generic of TOBREX)

Anti-infective/Anti-inflammatory Combinations

neomycin/polymyxin B/bacitracin/hydrocortisone oint

neomycin/polymyxin B/dexamethasone (generic of MAXITROL) neomycin/polymyxin B/hydrocortisone susp

sulfacetamide/prednisolone phosphate 10%/0.25%

tobramycin/dexamethasone oint 0.3%/0.1% (TOBRADEX)

tobramycin/dexamethasone susp 0.3%/0.05% (TOBRADEX ST) tobramycin/dexamethasone susp 0.3%/0.1% (generic of TOBRADEX)

Anti-inflammatories Nonsteroidal

bromfenac sodium

diclofenac sodium ketorolac (generic of ACULAR)

ketorolac (ACUVAIL)

nepafenac (ILEVRO) nepafenac (NEVANAC)

Steroidal

dexamethasone (MAXIDEX) dexamethasone sodium phosphate

difluprednate (DUREZOL)

fluorometholone fluorometholone (FML FORTE)

fluorometholone (FML S.O.P.)

loteprednol prednisolone acetate (PRED MILD)

46

prednisolone acetate 1%

prednisolone phosphate 1% Antivirals

trifluridine

Beta-blockers Nonselective levobunolol

timolol hemihydrate (BETIMOL)

timolol maleate (generic of TIMOPTIC)

timolol maleate gel Selective

betaxolol (BETOPTIC S) Carbonic Anhydrase Inhibitors Topical brinzolamide (AZOPT)

dorzolamide (generic of TRUSOPT)

Carbonic Anhydrase Inhibitor/Beta-blocker Combinations

dorzolamide/timolol maleate (generic of COSOPT)

Carbonic Anhydrase Inhibitor/Sympathomimetic Combinations

brinzolamide/brimonidine (SIMBRINZA)

Dry Eye Disease

cyclosporine, emulsion (RESTASIS)

lifitegrast (XIIDRA) Prostaglandins

bimatoprost (LUMIGAN)

latanoprost (generic of XALATAN) travoprost (generic of TRAVATAN Z)

Retinal Disorders aflibercept (EYLEA)

ranibizumab (LUCENTIS)

Rho Kinase Inhibitors

netarsudil (RHOPRESSA)

Rho Kinase Inhibitor/Prostaglandin Combinations

netarsudil/latanoprost (ROCKLATAN)

Sympathomimetics

brimonidine (generic of ALPHAGAN P)

brimonidine 0.2% Sympathomimetic/Beta-blocker Combinations

brimonidine/timolol (COMBIGAN)

47

OTIC Clinical practice guidelines for the treatment of otitis media are available at: https://www.aap.org Anti-infectives

acetic acid

ofloxacin otic

Anti-infective/Anti-inflammatory Combinations

ciprofloxacin/dexamethasone (CIPRODEX)

neomycin/polymyxin B/hydrocortisone (generic of CORTISPORIN OTIC) Miscellaneous

OTC carbamide peroxide 6.5% (generic of DEBROX)

SPECIALTY DRUGS

CVS Specialty is a leading provider of specialty pharmaceuticals to individuals with chronic or genetic conditions throughout the United States. CVS Specialty is dedicated to helping individuals by providing services for the following:

ACROMEGALY octreotide acetate (SANDOSTATIN)1 Sandostatin Sandostatin LAR Somatuline Depot Somavert ALCOHOL/OPIOID DEPENDENCY Probuphine Implant Kit Vivitrol ALLERGEN IMMUNOTHERAPY Oralair ALPHA-1 ANTITRYPSIN DEFICIENCY Aralast NP Glassia Zemaira AMYLOIDOSIS Onpattro Vyndamax Vyndaqel ANEMIA Aranesp Epogen Procrit Reblozyl Retacrit ASTHMA Cinqair Dupixent Fasenra

Nucala Xolair ATOPIC DERMATITIS Dupixent BOTULINUM TOXINS Botox Dysport Myobloc Xeomin CARDIAC DISORDERS dofetilide (TIKOSYN)1 Tikosyn COAGULATION DISORDERS Ceprotin CONTRACEPTIVES Kyleena Liletta Mirena Nexplanon Skyla CRYOPYRIN-ASSOCIATED PERIODIC SYNDROMES Arcalyst Ilaris CYSTIC FIBROSIS Bethkis Cayston Kitabis Pak Pulmozyme TOBI

TOBI Podhaler tobramycin nebulizer (TOBI)1 ELECTROLYTE DISORDERS Samsca GASTROINTESTINAL DISORDERS-OTHER Gattex Ocaliva Solesta GOUT Krystexxa GROWTH HORMONE & RELATED DISORDERS Growth Hormone Disorders Genotropin Humatrope Macrilen Norditropin Nutropin AQ Omnitrope Saizen Serostim Zomacton Zorbtive GROWTH HORMONE & RELATED DISORDERS IGF-1 Deficiency Increlex HEMATOPOIETICS Mozobil

48

HEMOPHILIA, VON WILLEBRAND DISEASE & RELATED BLEEDING DISORDERS Advate Adynovate Afstyla Alphanate AlphaNine SD Alprolix Bebulin BeneFIX Coagadex Corifact Eloctate Feiba Fibryga Helixate FS Hemlibra Hemofil M Humate-P Idelvion Ixinity Jivi Koate Koate-DVI Kogenate FS Kovaltry Mononine Novoeight NovoSeven RT Nuwiq Obizur Profilnine Profilnine SD Rebinyn Recombinate RiaSTAP Rixubis Stimate Tretten Vonvendi Wilate Xyntha HEPATITIS adefovir dipivoxil (HEPSERA)1 Baraclude entecavir (BARACLUDE)1 Epclusa Epivir Epivir HBV Harvoni Hepsera Intron A lamivudine (EPIVIR, EPIVIR HBV)1 Ledipasvir/Sofosbuvir Mavyret

Moderiba Pegasys PegIntron Rebetol ribasphere1 Ribasphere Ribapak ribavirin caps (ribasphere, REBETOL)1 ribavirin tabs (ribasphere, MODERIBA)1 Sofosbuvir/Velpatasvir Sovaldi tenofovir disoproxil fumarate (VIREAD)1 Vemlidy Viekira Pak Viread Vosevi Zepatier HEREDITARY ANGIOEDEMA Berinert Cinryze Firazyr Haegarda icatibant acetate (FIRAZYR)1 Kalbitor Ruconest Takhzyro HIV MEDICATIONS abacavir tab (ZIAGEN)1 abacavir/lamivudine (EPZICOM)1 abacavir/lamivudine/ zidovudine tab (TRIZIVIR)1 Aptivus atazanavir sulfate (REYATAZ)1 Atripla Biktarvy Cimduo Combivir Complera Crixivan Delstrigo Descovy didanosine (VIDEX, VIDEX EC)1 Dovato Edurant efavirenz (SUSTIVA)1 Egrifta Emtriva Epivir Epzicom Evotaz fosamprenavir (LEXIVA)1 Fuzeon

Genvoya Intelence Invirase Isentress Juluca Kaletra lamivudine (EPIVIR)1 lamivudine/zidovudine (COMBIVIR)1 Lexiva lopinavir/ritonavir soln (KALETRA)1 nevirapine (VIRAMUNE, VIRAMUNE XR)1 Norvir Odefsey Pifeltro Prezcobix Prezista Rescriptor Retrovir Retrovir Injectable Reyataz ritonavir (NORVIR)1 Selzentry stavudine (ZERIT)1 Stribild Sustiva Symfi Symfi Lo Symtuza Temixys tenofovir disoproxil fumarate (VIREAD)1 Tivicay Triumeq Trizivir Trogarzo Truvada Tybost Videx Videx EC Viracept Viramune Viramune XR Viread Zerit Ziagen zidovudine (RETROVIR)1 HORMONAL THERAPIES Aveed Eligard Firmagon leuprolide acetate (LUPRON)1 Lupaneta Pack Lupron

49

Lupron Depot Natpara Supprelin LA Trelstar Vantas Zoladex IMMUNE DEFICIENCIES & RELATED DISORDERS Asceniv Bivigam Cuvitru Cytogam GamaSTAN GamaSTAN S/D Gammagard Liquid Gammagard S/D Gammaked Gammaplex Gamunex C HepaGam B Hizentra HyperHEP B HyperRHO S/D HyQvia MICRhoGAM Nabi-HB Octagam Panzyga Privigen RhoGAM Rhophylac Varizig WinRho SDF Xembify INFECTIOUS DISEASE - OTHER Actimmune Alferon N Nuzyra Xenleta INFERTILITY Cetrotide Chorionic Gonadotropin Follistim AQ Ganirelix acetate Gonal-F Menopur Novarel Ovidrel Pregnyl INFLAMMATORY BOWEL DISEASE Cimzia Entyvio

Humira Inflectra Remicade Renflexis Simponi Stelara Tysabri Xeljanz IRON OVERLOAD deferasirox (EXJADE, JADENU)1 deferoxamine (DESFERAL)1 Desferal Exjade Jadenu LYSOSOMAL STORAGE DISORDERS Aldurazyme Cerdelga Cerezyme Cystagon Elaprase Elelyso Fabrazyme Kanuma Lumizyme miglustat1 Naglazyme Vimizim VPRIV MENTAL HEALTH CONDITIONS Zulresso MIGRAINE Aimovig Ajovy Emgality MOVEMENT DISORDERS Apokyn Austedo Inbrija Northera Nourianz Nuplazid Radicava Soliris tetrabenazine (XENAZINE)1 Xenazine MULTIPLE SCLEROSIS Ampyra Aubagio Avonex Betaseron

Copaxone dalfampridine ER (AMPYRA)1 Extavia Gilenya glatiramer acetate (COPAXONE, glatopa)1 Lemtrada Mavenclad Mayzent mitoxantrone hcl1 Ocrevus Plegridy Rebif2 Tecfidera Tysabri Vumerity NEUTROPENIA Fulphila Granix Leukine Neulasta Neupogen Nivestym Udenyca Zarxio Ziextenzo OCULAR DISORDERS Beovu Eylea Iluvien Lucentis Macugen Ozurdex Retisert Visudyne ONCOLOGY - INJECTABLE2 Adcetris Arzerra Asparlas Avastin azacitidine (VIDAZA)1 Bavencio Beleodaq Belrapzo Bendamustine Hydrochloride Bendeka Besponsa Blincyto Bortezomib Cyramza Dacogen Darzalex decitabine (DACOGEN)1 Empliciti

50

Erbitux Evomela Folotyn Fusilev Gazyva Halaven Herceptin Herceptin Hylecta Imfinzi Intron A Istodax Ixempra Jevtana Kadcyla Kanjinti Keytruda Khapzory Kyprolis Levoleucovorin Lumoxiti mitoxantrone hcl1 Mvasi Mylotarg Ogivri Oncaspar Opdivo Perjeta Polivy Portrazza Poteligeo Proleukin Rituxan Rituxan Hycela Romidepsin Sylatron Sylvant Tecentriq Temodar temsirolimus (TORISEL)1 Tepadina Thyrogen Torisel Treanda Truxima valrubicin (VALSTAR)1 Valstar Vectibix Velcade Vidaza Xgeva Yervoy Yondelis Zaltrap zoledronic acid (ZOMETA)1 Zometa

ONCOLOGY - ORAL/TOPICAL abiraterone acetate (ZYTIGA)1 Afinitor Alecensa Alunbrig bexarotene (TARGRETIN)1 Bosulif Cabometyx capecitabine (XELODA)1 Cometriq Cotellic Daurismo Erivedge Erleada erlotinib hydrochloride (TARCEVA)1 everolimus (AFINITOR)1 Farydak Gleevec Hycamtin Ibrance Idhifa imatinib mesylate (GLEEVEC)1 Inlyta Inrebic Iressa Jakafi Kisqali Kisqali Femara Lenvima Lonsurf Lorbrena Lynparza Mekinist Mugard Nerlynx Nexavar Ninlaro Nubeqa Odomzo Piqray Pomalyst Purixan Revlimid Rozlytrek Rubraca Rydapt Sprycel Stivarga Sutent Tafinlar Tagrisso Talzenna Tarceva Targretin Tasigna Temodar

temozolomide (TEMODAR)1 Thalomid Tykerb Verzenio Vitrakvi Vizimpro Votrient Xalkori Xeloda Xtandi Yonsa Zelboraf Zolinza Zydelig Zykadia Zytiga OSTEOARTHRITIS Durolane Euflexxa Gel-One Gelsyn-3 Genvisc 850 Hyalgan Hymovis Monovisc Orthovisc Sodium Hyaluronate Supartz Synvisc Synvisc-One Triluron Trivisc Visco-3 OSTEOPOROSIS Evenity Forteo Prolia Reclast Tymlos zoledronic acid (RECLAST)1 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA Soliris Ultomiris PHENYLKETONURIA Kuvan Palynziq PRE-TERM BIRTH hydroxyprogesterone capro (MAKENA)1 Makena

51

PSORIASIS Cimzia Cosentyx Enbrel Humira Ilumya Inflectra Otezla Otrexup Rasuvo Remicade Renflexis Siliq Skyrizi Stelara Taltz Tremfya Xeljanz PULMONARY ARTERIAL HYPERTENSION Adcirca Adempas ambrisentan (LETAIRIS)1 bosentan (TRACLEER)1 epoprostenol sodium (FLOLAN, VELETRI)1 Flolan Letairis Opsumit Orenitram Remodulin Revatio sildenafil citrate (REVATIO)1 tadalafil (ADCIRCA, alyq)1 Tracleer treprostinil sodium (REMODULIN)1 Tyvaso Uptravi Veletri Ventavis

PULMONARY DISORDERS - OTHER Esbriet Ofev RARE DISORDERS - OTHER Crysvita Gamifant RENAL DISEASE cinacalcet hydrochloride (SENSIPAR)1 Parsabiv Sensipar RESPIRATORY SYNCYTIAL VIRUS Synagis RHEUMATOID ARTHRITIS Actemra Cimzia Enbrel Humira Inflectra Kevzara Olumiant Orencia Otrexup Rasuvo Remicade Renflexis Rinvoq Rituxan Simponi Simponi ARIA Xeljanz SEIZURE DISORDERS Epidiolex H.P. Acthar Gel Sabril pwd Sabril tabs vigabatrin pwd (SABRIL PWD)1 vigabatrin tabs (SABRIL TABS)1

SICKLE CELL DISEASE Adakveo Oxbryta SLEEP DISORDERS Wakix SYSTEMIC LUPUS ERYTHEMATOSUS Benlysta THROMBOCYTOPENIA Doptelet Mulpleta Nplate Promacta TRANSPLANT Astagraf XL CellCept CellCept injectable cyclosporine (gengraf, NEORAL, SANDIMMUNE)1 Envarsus XR mycophenolate mofetil (CELLCEPT, CELLCEPT INJECTABLE)1 mycophenolic acid dr (MYFORTIC)1 Myfortic Neoral Nulojix Prograf Prograf injectable Rapamune Sandimmune sirolimus tab (RAPAMUNE)1 tacrolimus (PROGRAF)1 Zortress UREA CYCLE DISORDERS Buphenyl Ravicti sodium phenylbutyrate (BUPHENYL)1

1 Bold lowercase type indicates generic name and availability; nonbold lowercase type within parentheses indicates trademark

generics. Products in all capital letters within parentheses indicate brand names of generic products. 2 Call CVS Caremark for specific medications available through CVS Specialty.

52

WEBSITES

Agency for Healthcare Research and Quality https://www.ahrq.gov Alzheimer's Association https://www.alz.org American Academy of Allergy, Asthma and Immunology https://www.aaaai.org American Academy of Child & Adolescent Psychiatry https://www.aacap.org American Academy of Dermatology https://www.aad.org American Academy of Neurology https://www.aan.com American Academy of Ophthalmology https://www.aao.org American Academy of Pediatrics https://www.aap.org American Association for the Study of Liver Disease https://www.aasld.org American Association of Clinical Endocrinologists https://www.aace.com American Association of Diabetes Educators https://www.diabeteseducator.org American Cancer Society https://www.cancer.org American College of Allergy, Asthma and Immunology https://www.acaai.org American College of Cardiology https://www.acc.org American College of Chest Physicians https://www.chestnet.org American College of Gastroenterology https://gi.org American College of Physicians https://www.acponline.org American College of Rheumatology https://www.rheumatology.org

American Congress of Obstetricians and Gynecologists https://www.acog.org American Diabetes Association http://www.diabetes.org American Gastroenterological Association https://www.gastro.org American Headache Society Committee for Headache Education https://americanheadachesociety.org American Heart Association https://professional.heart.org American Lung Association https://www.lung.org American Medical Association https://www.ama-assn.org American Psychiatric Association https://www.psychiatry.org American Society of Anesthesiologists https://www.asahq.org American Society of Clinical Oncology https://www.asco.org American Society of Interventional Pain Physicians https://www.asipp.org American Urological Association https://www.auanet.org Centers for Disease Control and Prevention https://www.cdc.gov Centers for Disease Control and Prevention Guideline topics: AIDS https://www.cdc.gov/hiv/default.html Centers for Disease Control and Prevention Guideline topics: Sexually Transmitted Diseases https://www.cdc.gov/std/treatment/default.htm CVS Caremark https://www.caremark.com The Food and Drug Administration https://www.fda.gov

53

Global Initiative for Asthma https://ginasthma.org Infectious Diseases Society of America https://www.idsociety.org Institute for Safe Medication Practices https://www.ismp.org Johns Hopkins AIDS Service https://www.thebody.com/content/art12096.html Juvenile Diabetes Research Foundation International https://www.jdrf.org MedWatch https://www.fda.gov/Safety/MedWatch/default.htm National Agricultural Library https://www.nal.usda.gov National Cancer Institute https://www.cancer.gov/about-cancer National Comprehensive Cancer Network https://www.nccn.org

National Foundation for Infectious Diseases http://www.nfid.org National Guideline Clearinghouse https://www.ahrq.gov National Heart, Lung and Blood Institute https://www.nhlbi.nih.gov National Institutes of Health https://www.nih.gov National Kidney Foundation https://www.kidney.org National Osteoporosis Foundation https://www.nof.org North American Menopause Society https://www.menopause.org United States Department of Health and Human Services https://www.hhs.gov World Health Organization https://www.who.int

54

INDEX

A A-200, 44 abacavir tabs, 14 abacavir/dolutegravir/lamivudine, 14 abacavir/lamivudine, 14 abaloparatide, 29 ABILIFY MAINTENA, 24 abiraterone, 16 ABSORICA, 42 acamprosate calcium, 26 acarbose, 27 ACCU-CHEK AVIVA PLUS kits and test strips, 29 ACCU-CHEK COMPACT PLUS kits and test strips, 29 ACCU-CHEK GUIDE kits and test strips, 29 ACCU-CHEK SMARTVIEW kits and test strips, 29 ACCUPRIL, 17 ACCURETIC, 17 acetaminophen, 11 acetaminophen/aspirin/caffeine, 25 acetazolamide, 20 acetazolamide ext-rel, 20 acetic acid, 47 acitretin, 43 ACTIGALL, 34 ACTONEL, 29 ACTOPLUS MET, 28 ACULAR, 45 ACUVAIL, 45 acyclovir caps, tabs, 15 ADALAT CC, 20 adalimumab, 37 adapalene, 42 adapalene/benzoyl peroxide, 42 ADEMPAS, 21 ADVAIR DISKUS, 41 ADVAIR HFA, 41 ADVIL, 11 ADYNOVATE, 36 AFINITOR, 16 aflibercept, 46 AGGRENOX, 37 AGRYLIN, 37 AIMOVIG, 25 AJOVY, 25 albuterol, 40 albuterol ext-rel, 40 albuterol soln, 40 albuterol sulfate, CFC-free aerosol, 40 alcaftadine, 45 alclometasone crm, oint 0.05%, 43 ALDACTAZIDE, 20 ALDACTONE, 18 ALDARA, 44 alendronate, 29 ALEVE, 11 alfuzosin ext-rel, 35 alirocumab, 19 aliskiren, 20 aliskiren/hydrochlorothiazide, 20 ALKERAN, 16 ALLEGRA, 39 allopurinol, 11

alosetron, 34 alpha-1 proteinase inhibitor, 41 ALPHAGAN P, 46 alprazolam, 21 alprostadil supp, 35 ALTACE, 17 amantadine, 23 AMARYL, 29 AMBIEN, 25 AMBIEN CR, 25 ambrisentan, 21 amiloride, 20 amiloride/hydrochlorothiazide, 20 amiodarone, 18 AMITIZA, 34 amitriptyline, 23 amlodipine, 20 amlodipine/atorvastatin, 20 amlodipine/benazepril, 17 amlodipine/olmesartan, 18 amlodipine/telmisartan, 18 amlodipine/valsartan, 18 amlodipine/valsartan/hydrochlorothiazide, 18 ammonium lactate 12%, 44 amoxicillin, 13 amoxicillin/clavulanate, 13 amoxicillin/clavulanate ext-rel, 13 amphetamine/dextroamphetamine mixed salts, 24 amphetamine/dextroamphetamine mixed salts ext-rel, 24 ampicillin, 13 ANAFRANIL, 22 anagrelide, 37 anastrozole, 16 ANDRODERM, 27 ANORO ELLIPTA, 39 ANTABUSE, 26 ANTARA, 19 antihemophilic factor (recombinant), 36 antihemophilic factor (recombinant) pegylated, 36 antihemophilic factor (recombinant) pegylated-aucl, 36 ANUSOL-HC, 35 apalutamide, 16 apixaban, 36 apremilast, 37 APRISO, 34 ARANESP, 36 ARAVA, 38 ARICEPT, 22 ARIMIDEX, 16 aripiprazole, 24 aripiprazole ext-rel inj, 24 aripiprazole lauroxil ext-rel inj, 24 ARISTADA, 24 ARISTADA INITIO, 24 ARIXTRA, 36 armodafinil, 26 ARNUITY ELLIPTA, 41 AROMASIN, 16 ASMANEX, 41 aspirin, 37 ASTEPRO, 41 atazanavir, 14 atazanavir/cobicistat, 14

55

ATELVIA, 29 atenolol, 19 atenolol/chlorthalidone, 20 ATIVAN, 22 atomoxetine, 24 atorvastatin, 19 atovaquone/proguanil, 13 ATRIPLA, 14 ATROVENT HFA, 39 AUBAGIO, 26 AUGMENTIN, 13 AUSTEDO, 26 AVELOX, 13 AVODART, 35 AYGESTIN, 32 AZASAN, 38 azathioprine, 38 azelaic acid foam, 44 azelaic acid gel, 44 azelastine, 45 azelastine spray, 41 azelastine/fluticasone spray, 41 azithromycin, 13 AZOPT, 46 AZOR, 18 AZULFIDINE, 34 AZULFIDINE EN-TABS, 34

B bacitracin, 42, 45 baclofen, 26 balsalazide, 34 BARACLUDE, 15 BASAGLAR, 28 BD ULTRAFINE insulin syringes and needles, 29 beclomethasone breath-activated aerosol, 41 BELBUCA, 11 BELSOMRA, 25 BENADRYL, 40 benazepril, 17 benazepril/hydrochlorothiazide, 17 benralizumab, 41 BENTYL, 33 BENZAC AC, 42 BENZAMYCIN, 42 benzonatate, 40 benzoyl peroxide, 42 benztropine, 23 benzyl alcohol/carbomer 941/glycerin, 44 besifloxacin, 45 BESIVANCE, 45 betamethasone dipropionate augmented crm 0.05%, 43 betamethasone dipropionate augmented gel, oint 0.05%, 44 betamethasone dipropionate augmented lotion 0.05%, 43 betamethasone dipropionate crm, lotion, oint 0.05%, 43 betamethasone valerate crm, lotion, oint 0.1%, 43 BETASERON, 26 betaxolol, 46 bethanechol, 36 BETHKIS, 40 BETIMOL, 46 BETOPTIC S, 46 BEVESPI AEROSPHERE, 39 bexarotene caps, 17 bicalutamide, 16 bictegravir/emtricitabine/tenofovir alafenamide, 14

BIDIL, 21 BIKTARVY, 14 bimatoprost, 46 bismuth/metronidazole/tetracycline, 35 bisoprolol, 19 bisoprolol/hydrochlorothiazide, 20 BLEPH-10, 45 blood glucose continuous monitoring receivers, sensors, 29 blood glucose continuous monitoring receivers, sensors,

transmitters, 29 blood glucose monitoring kits, test strips, 29 BONIVA, 29 bosentan, 21 BOSULIF, 16 bosutinib, 16 BREO ELLIPTA, 41 BRILINTA, 37 brimonidine, 46 brimonidine 0.2%, 46 brimonidine/timolol, 46 brinzolamide, 46 brinzolamide/brimonidine, 46 bromfenac sodium, 45 bromocriptine, 23 budesonide, 41 budesonide delayed-rel caps, 34 budesonide ext-rel, 34 budesonide inhalation susp, 41 budesonide/formoterol, 41 bumetanide, 20 BUNAVAIL, 26 buprenorphine, 11 buprenorphine/naloxone, 26 buprenorphine/naloxone sublingual, 26 bupropion, 23 bupropion ext-rel, 23, 27 buspirone, 22 busulfan, 15 butalbital/acetaminophen/caffeine tabs, 12 butalbital/aspirin/caffeine, 12 BYSTOLIC, 19

C C1 esterase inhibitor, recombinant, 37 cabergoline, 33 CABOMETYX, 16 cabozantinib, 16 CADUET, 20 CALAN SR, 20 calcipotriene, 43 calcipotriene/betamethasone, 43 calcitonin-salmon spray, 29 calcitriol (1,25-D3), 32 calcium acetate, 32 calcium carbonate, 39 CAMPRAL, 26 canagliflozin, 28 canagliflozin/metformin, 28 canagliflozin/metformin ext-rel, 28 canakinumab, 38 candesartan, 18 candesartan/hydrochlorothiazide, 18 capecitabine, 16 captopril, 17 captopril/hydrochlorothiazide, 17 carbamazepine, 22

56

carbamazepine ext-rel, 22 carbamide peroxide 6.5%, 47 CARBATROL, 22 carbidopa/levodopa, 23 carbidopa/levodopa ext-rel, 23 carbidopa/levodopa orally disintegrating tabs, 23 carbidopa/levodopa/entacapone, 23 CARDURA, 18 cariprazine, 24 carisoprodol, 26 carvedilol, 19 carvedilol phosphate ext-rel, 19 CASODEX, 16 CATAPRES, 18 CATAPRES-TTS, 18 cefadroxil, 13 cefdinir, 13 cefixime, 13 cefprozil, 13 cefuroxime axetil, 13 CELEBREX, 11 celecoxib, 11 CELEXA, 23 CENTRUM, 39 cephalexin, 13 CERDELGA, 32 CEREZYME, 32 cetirizine, 39 cetirizine/pseudoephedrine ext-rel, 40 cetrorelix, 31 CETROTIDE, 31 cevimeline, 35 CHANTIX, 27 chlorambucil, 15 chloroquine, 13 chlorpheniramine 4 mg, 39 chlorpromazine, 24 chlorthalidone, 20 CHLOR-TRIMETON ALLERGY, 39 chlorzoxazone, 26 cholestyramine, 19 choriogonadotropin alfa, 32 ciclopirox, 42 cilostazol, 37 CILOXAN, 45 CIMDUO, 14 cimetidine, 34 cinacalcet, 29 CIPRO, 13 CIPRODEX, 47 ciprofloxacin, 13 ciprofloxacin oint, 45 ciprofloxacin soln, 45 ciprofloxacin/dexamethasone, 47 citalopram, 23 CITRANATAL 90 DHA, 38 CITRANATAL ASSURE, 38 CITRANATAL B-CALM, 38 CITRANATAL DHA, 38 CITRANATAL HARMONY, 38 CITRANATAL RX, 38 clarithromycin, 13 clarithromycin ext-rel, 13 CLARITIN, 39 CLARITIN-D, 40 clemastine 1.34 mg, 39

clemastine 2.68 mg, 39 CLEOCIN, 15, 36 CLEOCIN T, 42 CLIMARA, 31 CLIMARA PRO, 31 clindamycin, 15 clindamycin crm, 36 clindamycin gel, 42 clindamycin gel, lotion, soln, 42 clindamycin/benzoyl peroxide, 42 clindamycin/tretinoin, 42 clobazam, 22 clobetasol propionate crm, gel, oint, soln 0.05%, 44 clobetasol propionate foam 0.05%, 44 clobetasol propionate lotion, shampoo 0.05%, 44 CLOBEX, 44 clomiphene, 32 clomipramine, 22 clonazepam, 21 clonidine, 18 clonidine transdermal, 18 clopidogrel, 37 clotrimazole, 36, 42 clotrimazole troches, 13 clozapine, 24 CLOZARIL, 24 coagulation factor IX (recombinant) glycopegylated, 37 codeine/acetaminophen, 11 codeine/guaifenesin liquid, 40 codeine/guaifenesin/pseudoephedrine, 40 codeine/promethazine, 40 codeine/promethazine/phenylephrine, 40 colchicine, 11 colesevelam, 19 COLESTID, 19 colestipol, 19 COMBIGAN, 46 COMBIPATCH, 31 COMBIVIR, 14 COMPLERA, 14 COMTAN, 23 CONCERTA, 24 CONDYLOX, 44 conjugated estrogens/bazedoxifene, 31 COPAXONE, 26 COREG, 19 CORGARD, 19 CORLANOR, 21 CORTEF, 32 CORTIFOAM, 34 CORTISPORIN OTIC, 47 CORTIZONE, 43 COSENTYX, 37 COSOPT, 46 COUMADIN, 36 COZAAR, 18 CREON, 34 CRINONE, 33 crisaborole, 43 cromolyn sodium, 45 cromolyn soln, 41 CUTIVATE, 43 cyanocobalamin inj, 39 cyclobenzaprine, 26 cyclophosphamide caps, 16 cyclosporine, 38

57

cyclosporine, emulsion, 46 cyclosporine, modified, 38 cyproheptadine, 40 CYTOMEL, 33 CYTOTEC, 34

D D.H.E. 45, 25 DALIRESP, 41 dalteparin, 36 danazol, 31 DANTRIUM, 26 dantrolene, 26 dapagliflozin, 28 dapagliflozin/metformin ext-rel, 28 dapagliflozin/saxagliptin, 28 dapsone, 15 darbepoetin alfa, 36 darifenacin ext-rel, 35 darolutamide, 16 darunavir, 14 darunavir/cobicistat, 14 darunavir/cobicistat/emtricitabine/tenofovir alafenamide, 14 dasatinib, 16 DAYPRO, 11 DDAVP, 33 DEBROX, 47 DEMADEX, 20 denosumab, 29 DEPAKENE, 22 DEPAKOTE, 22 DEPAKOTE ER, 22 DEPO-PROVERA, 30 DESCOVY, 14 desipramine, 23 desmopressin spray, tabs, 33 desogestrel/EE, 30 desogestrel/EE 0.15/30, 30 desonide crm, lotion, oint 0.05%, 43 DESOWEN, 43 desoximetasone crm, oint 0.05%, 43 desoximetasone crm, oint 0.25%, gel 0.05%, 44 desvenlafaxine ext-rel, 23 DETROL, 35 deutetrabenazine, 26 dexamethasone, 32, 45 dexamethasone sodium phosphate, 45 dexbrompheniramine/pseudoephedrine ext-rel 6 mg/120 mg, 40 DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM, 29 DEXEDRINE SPANSULE, 24 DEXILANT, 35 dexlansoprazole delayed-rel, 35 dexmethylphenidate, 24 dexmethylphenidate ext-rel, 24 dextroamphetamine, 24 dextroamphetamine ext-rel, 24 dextromethorphan/brompheniramine/pseudoephedrine, 40 dextromethorphan/guaifenesin, 40 dextromethorphan/promethazine, 40 dextromethorphan/quinidine, 26 DIASTAT, 22 diazepam, 21 diazepam rectal gel, 22 diclofenac sodium, 45 diclofenac sodium delayed-rel, 11 diclofenac sodium delayed-rel/misoprostol, 11

diclofenac sodium gel 1%, 11 diclofenac sodium soln, 11 dicloxacillin, 13 dicyclomine, 33 didanosine delayed-rel, 14 DIFICID, 13 diflorasone diacetate crm 0.05%, 44 diflorasone diacetate oint 0.05%, 44 DIFLUCAN, 13 diflunisal, 11 difluprednate, 45 digoxin 0.0625 mg, 0.1875 mg, 20 digoxin 0.125 mg, 0.25 mg, 20 digoxin ped elixir, 20 dihydroergotamine inj, 25 dihydroergotamine spray, 25 DILANTIN, 22 DILANTIN INFATABS, 22 DILAUDID, 11 diltiazem ext-rel, 20 dimethyl fumarate delayed-rel, 26 diphenhydramine, 40 diphenoxylate/atropine, 33 DIPROLENE, 43, 44 DIPROLENE AF, 43 dipyridamole, 37 dipyridamole ext-rel/aspirin, 37 disopyramide, 18 disopyramide ext-rel, 18 disulfiram, 26 DITROPAN XL, 35 divalproex sodium delayed-rel, 22 divalproex sodium ext-rel, 22 DIVIGEL, 31 dofetilide, 18 dolutegravir, 14 donepezil, 22 dornase alfa, 40 dorzolamide, 46 dorzolamide/timolol maleate, 46 doxazosin, 18 doxepin, 23, 25 doxercalciferol, 32 doxycycline hyclate, 13 doxycycline hyclate 20 mg, 13 doxycycline monohydrate delayed-rel caps, 44 doxylamine/pyridoxine delayed-rel, 33 DRIXORAL, 40 dronabinol, 33 dronedarone, 18 drospirenone/EE 3/20, 30 drospirenone/EE 3/30, 30 drospirenone/EE/levomefolate 3/20 and levomefolate, 30 drospirenone/EE/levomefolate 3/30 and levomefolate, 30 DUAC, 42 DUAVEE, 31 DUETACT, 28 dulaglutide, 28 duloxetine delayed-rel, 23 DUOFILM, 44 dupilumab, 41, 43 DUPIXENT, 41, 43 DUREZOL, 45 dutasteride, 35 dutasteride/tamsulosin, 35 DYAZIDE, 21

58

DYMISTA, 41

E econazole, 42 eculizumab, 37 EDURANT, 14 EE/norethindrone acetate - Jinteli, 31 efavirenz, 14 efavirenz/emtricitabine/tenofovir disoproxil fumarate, 14 efavirenz/lamivudine/tenofovir disoproxil fumarate, 14 EFFEXOR XR, 23 elagolix, 31 electrolyte soln, oral, 38 eletriptan, 25 ELIGARD, 16 eliglustat, 32 ELIQUIS, 36 ELOCON, 43 eltrombopag, 37 eluxadoline, 34 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, 14 elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate, 14 EMBEDA, 12 EMGALITY, 25 empagliflozin, 28 empagliflozin/linagliptin, 28 empagliflozin/metformin, 28 empagliflozin/metformin ext-rel, 28 emtricitabine, 14 emtricitabine/rilpivirine/tenofovir alafenamide, 14 emtricitabine/rilpivirine/tenofovir disoproxil fumarate, 14 emtricitabine/tenofovir alafenamide, 14 emtricitabine/tenofovir disoproxil fumarate, 14 EMTRIVA, 14 EMVERM, 15 enalapril, 17 enalapril/hydrochlorothiazide, 17 ENBREL, 37 ENDOMETRIN, 33 enfuvirtide, 14 enoxaparin, 36 ENSTILAR, 43 entacapone, 23 entecavir soln, 15 entecavir tabs, 15 ENTRESTO, 21 enzalutamide, 16 EPCLUSA, 15 EPIDUO, 42 EPIDUO FORTE, 42 epinephrine auto-injector, 39 EPIPEN, 39 EPIPEN JR., 39 EPISIL, 44 EPIVIR, 14 eplerenone, 18 epoetin alfa, 36 epoetin alfa-epbx, 36 epoprostenol sodium, 21 eprosartan, 18 EPZICOM, 14 erenumab-aooe, 25 ergocalciferol (D2), 39 ergotamine/caffeine, 25 ERLEADA, 16 erlotinib, 16

erythromycin, 45 erythromycin delayed-rel, 13 erythromycin ethylsuccinate, 13 erythromycin gel 2%, 42 erythromycin soln, 42 erythromycin stearate, 13 erythromycin/benzoyl peroxide, 42 ESBRIET, 41 escitalopram, 23 ESGIC, 12 esomeprazole delayed-rel, 35 ESTRACE, 31 estradiol, 31 estradiol vaginal crm, 31 estradiol vaginal ring, 31 estradiol vaginal tabs, 31 estradiol valerate and dienogest/estradiol valerate, 30 estradiol/levonorgestrel, 31 estradiol/norethindrone, 31 estradiol/norethindrone acetate, 31 ESTRING, 31 estrogens, conjugated, 31 estrogens, conjugated crm, 31 estrogens, conjugated/medroxyprogesterone, 31 eszopiclone, 25 etanercept, 37 ethambutol, 14 ethosuximide, 22 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 30 etodolac, 11 etonogestrel/EE ring, 31 etoposide, 17 etravirine, 14 EUCRISA, 43 EVAMIST, 31 everolimus, 16 EVISTA, 33 evolocumab, 19 EVOTAZ, 14 EVOXAC, 35 EXCEDRIN MIGRAINE, 25 EXELON, 22 exemestane, 16 EYLEA, 46 ezetimibe, 19 ezetimibe/simvastatin, 19

F famciclovir, 15 famotidine, 34 FARXIGA, 28 FASENRA, 41 febuxostat, 11 felodipine ext-rel, 20 FEMARA, 16 fenofibrate, 19 fenofibric acid delayed-rel, 19 fentanyl sublingual spray, 11 fentanyl transdermal, 11 fentanyl transmucosal lozenge, 11 FEOSOL, 39 ferrous sulfate, 39 fesoterodine ext-rel, 35 FETZIMA, 23 fexofenadine, 39 FIASP, 28

59

fidaxomicin, 13 filgrastim, 36 filgrastim-aafi, 36 filgrastim-sndz, 36 FINACEA FOAM, 44 finasteride, 35 fingolimod, 26 FIORINAL, 12 FIRAZYR, 37 FLAGYL, 15 flecainide, 18 FLOLAN, 21 FLOMAX, 35 FLOVENT DISKUS, 41 FLOVENT HFA, 41 fluconazole, 13 fludrocortisone, 32 flunisolide spray, 41 fluocinolone acetonide crm, oint 0.025%, 43 fluocinolone acetonide soln 0.01%, 43 fluocinonide crm, gel, oint, soln 0.05%, 44 fluoride drops, 39 fluoride tabs, 39 fluorometholone, 45 fluorouracil crm 4%, 42 fluorouracil crm 5%, soln 5%, soln 2%, 42 fluoxetine, 23 fluoxetine 60 mg, 23 fluphenazine, 24 flutamide, 16 fluticasone, 41 fluticasone propionate crm, lotion 0.05%, oint 0.005%, 43 fluticasone spray, 41 fluticasone, CFC-free aerosol, 41 fluticasone/salmeterol, 41 fluticasone/salmeterol, CFC-free aerosol, 41 fluticasone/umeclidinium/vilanterol, 39 fluticasone/vilanterol, 41 fluvastatin, 19 fluvoxamine, 22 FML FORTE, 45 FML S.O.P., 45 FOCALIN, 24 FOCALIN XR, 24 folic acid, 38 folic acid/vitamin B6/vitamin B12, 38 follitropin alfa, 32 fondaparinux, 36 formoterol inhalation soln, 40 FORTEO, 29 FOSAMAX, 29 fosinopril, 17 fosinopril/hydrochlorothiazide, 17 FRAGMIN, 36 FREESTYLE LIBRE CONTINUOUS

GLUCOSE MONITORING SYSTEM, 29 fremanezumab-vfrm, 25 FURADANTIN, 15 furosemide, 20 FUZEON, 14 FYCOMPA, 22

G gabapentin, 22 gabapentin ext-rel, 26 galantamine, 22

galantamine ext-rel, 22 galcanezumab-gnlm, 25 ganirelix acetate, 31 gefitinib, 16 GEL-ONE, 12 GELSYN-3, 12 gemfibrozil, 19 gentamicin, 42, 45 GENVOYA, 14 GEODON, 24 GILENYA, 26 glatiramer, 26 glimepiride, 29 glipizide, 29 glipizide ext-rel, 29 glipizide/metformin, 27 GLUCAGEN HYPOKIT, 32 GLUCAGON EMERGENCY KIT, 32 glucagon, human recombinant, 32 GLUCOPHAGE, 27 GLUCOPHAGE XR, 27 GLUCOTROL, 29 GLUCOTROL XL, 29 glyburide, 29 glycopyrrolate/formoterol, 39 GLYXAMBI, 28 golimumab, 37 GOLYTELY, 34 GONAL-F, 32 GRALISE, 26 granisetron, 33 granisetron transdermal, 33 GRANIX, 36 grass mixed pollen allergen extract, 37 GRASTEK, 37 griseofulvin ultramicrosize, 13 guanfacine, 18 guanfacine ext-rel, 24 GYNE-LOTRIMIN, 36

H halobetasol propionate crm, oint 0.05%, 44 haloperidol, 24 HARVONI, 15 HECTOROL, 32 HUMALOG, 28 HUMALOG MIX, 28 human coagulation factor VIII (rDNA) simoctocog alfa, 36 HUMATROPE, 32 HUMIRA, 37 HUMULIN 70/30, 28 HUMULIN N, 28 HUMULIN R, 28 HUMULIN R U-500, 28 HYCAMTIN, 17 hydralazine, 21 HYDREA, 17 hydrochlorothiazide, 20 hydrocodone ext-rel, 11 hydrocodone/acetaminophen, 11 hydrocodone/homatropine, 40 hydrocortisone, 32 hydrocortisone acetate foam, 34 hydrocortisone acetate/pramoxine foam, 35 hydrocortisone butyrate crm, oint, soln 0.1%, 43 hydrocortisone crm, 35

60

hydrocortisone crm 2.5%, 43 hydrocortisone crm, oint 0.5%, 1%, 43 hydrocortisone enema, 34 hydrocortisone lotion 1%, 43 hydrocortisone valerate crm, oint 0.2%, 43 hydromorphone, 11 hydromorphone ext-rel, 11 hydroxychloroquine, 38 hydroxyurea, 17 hydroxyzine HCl, 40 hyoscyamine sulfate, 33 hyoscyamine sulfate ext-rel, 33 hyoscyamine sulfate ext-rel caps, 33 hyoscyamine sulfate orally disintegrating tabs, 33 HYSINGLA ER, 11 HYZAAR, 18

I ibandronate, 29 IBRANCE, 16 ibuprofen, 11 icatibant, 37 icosapent ethyl, 19 ILARIS, 38 ILEVRO, 45 imatinib mesylate, 16 IMDUR, 21 imiglucerase, 32 imipramine HCl, 23 imiquimod, 42, 44 IMITREX, 25 IMODIUM A-D, 33 IMURAN, 38 INCRUSE ELLIPTA, 39 indapamide, 20 INDERAL LA, 19 ingenol mebutate, 42 INGREZZA, 26 INSPRA, 18 insulin aspart, 28 insulin aspart protamine 70%/insulin aspart 30%, 28 insulin degludec, 28 insulin detemir, 28 insulin glargine, 28 insulin human, 28 insulin infusion disposable pump, 29 insulin isophane human, 28 insulin isophane human 70%/regular 30%, 28 insulin lispro, 28 INSULIN LISPRO, 28 insulin lispro protamine/insulin lispro, 28 insulin syringes, needles, 29 INTELENCE, 14 interferon alfa-2b, 38 interferon beta-1a, 26 interferon beta-1b, 26 INTRON A, 38 INVOKAMET, 28 INVOKAMET XR, 28 INVOKANA, 28 ipratropium soln, 39 ipratropium spray, 41 ipratropium, CFC-free aerosol, 39 ipratropium/albuterol soln, 39 irbesartan, 18 irbesartan/hydrochlorothiazide, 18

IRESSA, 16 ISENTRESS, 14 isoniazid, 14 ISORDIL, 21 isosorbide dinitrate ext-rel tabs, 21 isosorbide dinitrate oral, 21 isosorbide dinitrate/hydralazine, 21 isosorbide mononitrate, 21 isosorbide mononitrate ext-rel, 21 isotretinoin, 42 itraconazole, 13 ivabradine, 21 ivermectin, 15, 44 ixekizumab, 37

J JANUMET, 27 JANUMET XR, 27 JANUVIA, 27 JARDIANCE, 28 JENTADUETO, 27 JENTADUETO XR, 27 JIVI, 36

K KADIAN, 12 KALETRA, 14 KEFLEX, 13 KEPPRA, 22 KEPPRA XR, 22 ketoconazole, 42 ketoconazole shampoo 2%, 43 ketorolac, 45 ketotifen, 45 KEVZARA, 37 KISQALI, 16 KISQALI FEMARA CO-PACK, 16 KITABIS PAK, 40 KLARON, 42 KLONOPIN, 21 KOGENATE FS, 36 KOVALTRY, 36 KUVAN, 32 KYLEENA, 31

L labetalol, 19 LAC-HYDRIN, 44 lacosamide, 22 lactulose, 34 LAMICTAL, 22 LAMICTAL ODT, 22 LAMICTAL XR, 22 LAMISIL AT, 43 lamivudine, 14, 15 lamivudine/tenofovir disoproxil fumarate, 14 lamivudine/zidovudine, 14 lamotrigine, 22 lamotrigine ext-rel, 22 lamotrigine orally disintegrating tabs, 22 lancets, 29 LANOXIN, 20 lanreotide acetate, 27 lansoprazole + amoxicillin + clarithromycin, 35 lansoprazole delayed-rel, 35 lanthanum carbonate, 32 LANTUS, 28

61

lapatinib, 16 LASIX, 20 LASTACAFT, 45 latanoprost, 46 LATUDA, 24 ledipasvir/sofosbuvir, 15 leflunomide, 38 lenalidomide, 16 letrozole, 16 LEUKERAN, 15 leuprolide acetate, 16 levalbuterol tartrate, CFC-free aerosol, 40 LEVAQUIN, 13 LEVBID, 33 LEVEMIR, 28 levetiracetam, 22 levetiracetam ext-rel, 22 levobunolol, 46 levocarnitine, 30 levocetirizine, 39 levofloxacin, 13, 45 levomilnacipran ext-rel, 23 levonorgestrel releasing IUD, 31 levonorgestrel/EE - Trivora, 30 levonorgestrel/EE 0.1/20 - Lessina, 30 levonorgestrel/EE 0.1/20 and EE 10, 30 levonorgestrel/EE 0.15/30, 30 levonorgestrel/EE 0.15/30 - Levora, 30 levonorgestrel/EE 0.15/30 and EE 10, 30 levothyroxine, 33 levothyroxine - Levoxyl, 33 LEVSIN, 33 LEXAPRO, 23 LIALDA, 34 lidocaine, 44 lidocaine patch, 44 lidocaine viscous, 44 lidocaine/prilocaine, 44 LIDODERM, 44 lifitegrast, 46 linaclotide, 34 linagliptin, 27 linagliptin/metformin, 27 linagliptin/metformin ext-rel, 27 linezolid, 15 LINZESS, 34 liothyronine, 33 LIPOFEN, 19 liraglutide, 28, 29 liraglutide/insulin degludec, 28 lisdexamfetamine, 24 lisinopril, 17 lisinopril/hydrochlorothiazide, 17 lithium carbonate, 25 lithium carbonate ext-rel tabs 300 mg, 25 lithium carbonate ext-rel tabs 450 mg, 25 LITHOBID, 25 lixisenatide/insulin glargine, 28 LMX-4, 44 LO LOESTRIN FE, 30 LOESTRIN 1.5/30, 30 LOESTRIN 1/20, 30 LOESTRIN FE 1.5/30, 30 LOESTRIN FE 1/20, 30 LOKELMA, 32 LOMOTIL, 33

loperamide, 33 LOPID, 19 lopinavir/ritonavir soln, 14 lopinavir/ritonavir tabs, 14 LOPRESSOR, 19 LOPRESSOR HCT, 20 LOPROX, 42 loratadine, 39 loratadine/pseudoephedrine ext-rel, 40 lorazepam, 22 lorcaserin, 29 lorcaserin ext-rel, 29 losartan, 18 losartan/hydrochlorothiazide, 18 LOSEASONIQUE, 30 LOTENSIN, 17 LOTENSIN HCT, 17 loteprednol, 45 LOTREL, 17 LOTRIMIN AF, 42 lovastatin, 19 LOVAZA, 19 LOVENOX, 36 lubiprostone, 34 LUCENTIS, 46 luliconazole, 42 LUMIGAN, 46 LUPRON DEPOT, 16 lurasidone, 24 lusutrombopag, 37 LYNPARZA, 17 LYRICA, 24 LYRICA CR, 26 LYSODREN, 17

M macitentan, 21 MACROBID, 15 MALARONE, 13 malathion, 44 MARINOL, 33 MATULANE, 17 MAXALT, 25 MAXIDEX, 45 MAXITROL, 45 MAXZIDE, 21 MAYZENT, 26 mebendazole chewable, 15 meclizine, 33 MEDROL, 32 medroxyprogesterone acetate, 32 medroxyprogesterone acetate 150 mg/mL, 30 mefloquine, 13 MEGACE ES, 32 megestrol acetate susp, 32 megestrol acetate tabs, 16 meloxicam, 11 melphalan, 16 memantine, 22 memantine ext-rel, 22 memantine/donepezil, 22 mepolizumab, 41 mercaptopurine, 16 mesalamine delayed-rel tabs, 34 mesalamine ext-rel caps, 34 mesalamine supp, 34

62

mesalamine susp, 34 metaxalone, 26 metformin, 27 metformin ext-rel, 27 methadone, 11 methazolamide, 20 methimazole, 33 methocarbamol, 26 methotrexate, 16, 38 methotrexate auto-injector, 38 methoxsalen oral, 43 methyldopa, 21 METHYLIN, 24 methylphenidate, 24 methylphenidate ext-rel, 24 methylprednisolone, 32 metoclopramide, 33 metolazone, 20 metoprolol succinate ext-rel, 19 metoprolol tartrate, 19 metoprolol/hydrochlorothiazide, 20 METROCREAM, 44 METROGEL, 44 METROGEL-VAGINAL, 36 METROLOTION, 44 metronidazole, 15, 36 metronidazole crm 0.75%, 44 metronidazole gel 0.75%, 44 metronidazole gel 1%, 44 metronidazole lotion 0.75%, 44 MICARDIS, 18 MICARDIS HCT, 18 MICATIN, 42 miconazole, 36, 42 midodrine, 21 midostaurin, 16 milnacipran, 24 minocycline, 13 mirabegron ext-rel, 35 MIRALAX, 34 MIRAPEX, 23 MIRCETTE, 30 MIRENA, 31 mirtazapine, 23 misoprostol, 34 mitotane, 17 MOBIC, 11 mometasone, 41 mometasone crm, lotion, oint 0.1%, 43 mometasone spray, 41 MONISTAT, 36 montelukast, 41 morphine, 12 morphine ext-rel, 12 morphine supp, 12 morphine/naltrexone ext-rel, 12 MOVANTIK, 34 MOXEZA, 45 moxifloxacin, 13, 45 MOZOBIL, 37 MS CONTIN, 12 MUGARD, 44 MULPLETA, 37 MULTAQ, 18 multivitamins/fluoride drops, tabs, 39 multivitamins/fluoride/iron drops, tabs, 39

multivitamins/minerals, 39 mupirocin oint, 42 MUSE, 35 MYAMBUTOL, 14 mycophenolate mofetil, 38 mycophenolate sodium delayed-rel, 38 MYDAYIS, 24 MYLERAN, 15 MYRBETRIQ, 35 MYSOLINE, 22

N nabumetone, 11 nadolol, 19 naftifine, 43 NAFTIN, 43 naloxegol, 34 naloxone inj, 26 naloxone nasal spray, 26 naltrexone, 26 NAMENDA, 22 NAMZARIC, 22 naproxen, 11 naproxen sodium, 11 naproxen sodium tabs, 11 naratriptan, 25 NARCAN, 26 NARDIL, 23 natalizumab, 26 NATAZIA, 30 nateglinide, 28 nebivolol, 19 neomycin/polymyxin B/bacitracin, 42 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 45 neomycin/polymyxin B/dexamethasone, 45 neomycin/polymyxin B/gramicidin, 45 neomycin/polymyxin B/hydrocortisone, 47 neomycin/polymyxin B/hydrocortisone susp, 45 NEOSPORIN, 42 nepafenac, 45 netarsudil, 46 netarsudil/latanoprost, 46 NEULASTA, 36 NEUPOGEN, 36 NEUPRO, 24 NEURONTIN, 22 NEVANAC, 45 nevirapine, 14 nevirapine ext-rel, 14 niacin ext-rel, 19 NIASPAN, 19 NICODERM CQ, 27 NICORETTE, 27 nicotine polacrilex gum, 27 nicotine polacrilex lozenge, 27 nicotine transdermal, 27 nifedipine ext-rel, 20 nintedanib, 41 niraparib, 17 NITRO-DUR, 21 nitrofurantoin ext-rel, 15 nitrofurantoin macrocrystals, 15 nitrofurantoin susp, 15 nitroglycerin lingual spray, 21 nitroglycerin sublingual, 21 nitroglycerin transdermal, 21

63

NITROLINGUAL, 21 NITROSTAT, 21 NIVESTYM, 36 NIX, 44 NIZORAL, 43 NORCO, 11 NORDITROPIN, 32 norelgestromin/EE, 31 norethindrone, 30 norethindrone acetate, 32 norethindrone acetate/EE 1.5/30, 30 norethindrone acetate/EE 1.5/30 and iron, 30 norethindrone acetate/EE 1/10 and EE 10 and iron, 30 norethindrone acetate/EE 1/20, 30 norethindrone acetate/EE 1/20 and iron, 30 norethindrone acetate/EE 1/20 and iron chewable, 30 norethindrone/EE, 30 norethindrone/EE 0.5/35, 30 norethindrone/EE 1/35, 30 norgestimate/EE, 30 norgestimate/EE 0.25/35, 30 norgestrel/EE 0.3/30 - Low-Ogestrel, 30 NORPACE, 18 NORPACE CR, 18 NORPRAMIN, 23 nortriptyline, 23 NORVIR, 14 NOVOEIGHT, 36 NOVOLIN 70/30, 28 NOVOLIN N, 28 NOVOLIN R, 28 NOVOLOG, 28 NOVOLOG MIX 70/30, 28 NUBEQA, 16 NUCALA, 41 NUCYNTA, 12 NUCYNTA ER, 12 NUEDEXTA, 26 NULYTELY, 34 NUVARING, 31 NUVIGIL, 26 NUWIQ, 36 nystatin, 13, 43

O OCUFLOX, 45 ODEFSEY, 14 ODOMZO, 17 OFEV, 41 ofloxacin, 45 ofloxacin otic, 47 olanzapine, 24 olaparib, 17 olmesartan, 18 olmesartan/amlodipine/hydrochlorothiazide, 18 olmesartan/hydrochlorothiazide, 18 olodaterol, CFC-free aerosol, 40 olopatadine, 45 olopatadine spray, 41 omalizumab, 41 omega-3 acid ethyl esters, 19 omeprazole delayed-rel, 35 omeprazole magnesium delayed-rel, 35 OMNIPOD INSULIN INFUSION PUMP, 29 ondansetron, 33 ONETOUCH ULTRA kits and test strips, 29

ONETOUCH VERIO kits and test strips, 29 ONEXTON, 42 ONZETRA XSAIL, 25 OPSUMIT, 21 ORALAIR, 37 ORENITRAM, 21 ORILISSA, 31 orphenadrine/aspirin/caffeine, 26 ORTHO MICRONOR, 30 ORTHO TRI-CYCLEN LO, 30 ORTHO-NOVUM 1/35, 30 ORTHO-NOVUM 7/7/7, 30 OS-CAL, 39 oseltamivir, 15 ospemifene, 33 OSPHENA, 33 OTEZLA, 37 OVIDE, 44 OVIDREL, 32 oxaprozin, 11 oxazepam, 22 oxcarbazepine, 22 oxcarbazepine ext-rel, 22 OXSORALEN-ULTRA, 43 OXTELLAR XR, 22 oxybutynin, 35 oxybutynin ext-rel, 35 oxycodone caps, tabs 5 mg, 12 oxycodone concentrate 20 mg/mL, 12 oxycodone ext-rel, 12 oxycodone tabs 15 mg, 30 mg, soln 5 mg/5 mL, 12 oxycodone/acetaminophen 5/325, 12 oxycodone/acetaminophen soln, 12 OXYCONTIN, 12 OZEMPIC, 28

P palbociclib, 16 PAMELOR, 23 pancrelipase, 34 pancrelipase delayed-rel, 34 pantoprazole delayed-rel, 35 paricalcitol, 32 PARLODEL, 23 PARNATE, 23 paroxetine HCl, 23 paroxetine HCl ext-rel, 23 paroxetine mesylate, 27 PATADAY, 45 PATANASE, 41 PATANOL, 45 patiromer sorbitex, 32 PAXIL, 23 PAXIL CR, 23 PAZEO, 45 pazopanib, 16 PEDIALYTE, 38 peg 3350/electrolytes, 34 PEGASYS, 38 pegfilgrastim, 36 pegfilgrastim-cbqv, 36 peginterferon alfa-2a, 38 peginterferon alfa-2b, 38 pegvisomant, 27 penicillin VK, 13 PENTASA, 34

64

PEPCID, 34 PEPCID AC, 34 perampanel, 22 PERCOCET, 12 PERFOROMIST, 40 perindopril, 17 permethrin 5%, 44 permethrin creme rinse 1%, 44 perphenazine, 24 phenazopyridine, 36 phenelzine, 23 phenobarbital, 22 phenytoin, 22 phenytoin sodium extended, 22 PHOSLYRA, 32 PICATO, 42 pilocarpine tabs, 35 pimecrolimus, 43 pindolol, 19 pioglitazone, 28 pioglitazone/glimepiride, 28 pioglitazone/metformin, 28 pirfenidone, 41 PLAQUENIL, 38 plerixafor, 37 podofilox, 44 polyethylene glycol 3350, 34 polymyxin B/bacitracin, 42, 45 polymyxin B/trimethoprim, 45 POLYSPORIN, 42 POLYTRIM, 45 pomalidomide, 16 POMALYST, 16 potassium chloride ext-rel, 38 potassium chloride liquid, 38 potassium citrate ext-rel, 36 PRALUENT, 19 pramipexole, 23 pramipexole ext-rel, 23 pramlintide, 27 PRANDIN, 28 prasugrel, 37 PRAVACHOL, 19 pravastatin, 19 PRECOSE, 27 PRED MILD, 45 prednisolone, 32 prednisolone acetate, 45 prednisolone acetate 1%, 46 prednisolone phosphate 1%, 46 prednisone, 32 pregabalin, 24 pregabalin ext-rel, 26 PREMARIN, 31 PREMPHASE, 31 PREMPRO, 31 prenatal vitamins, 38 prenatal vitamins/DHA/docusate/folic acid, 38 prenatal vitamins/docusate/folic acid, 38 prenatal vitamins/docusate/folic acid + DHA, 38 prenatal vitamins/folic acid + pyridoxine, 38 PREZCOBIX, 14 PREZISTA, 14 PRILOSEC, 35 PRILOSEC OTC, 35 primidone, 22

PRISTIQ, 23 probenecid, 11 procarbazine, 17 PROCARDIA XL, 20 prochlorperazine, 33 PROCRIT, 36 PROCTOFOAM-HC, 35 progesterone gel, 33 progesterone vaginal inserts, 33 progesterone, micronized, 32 PROLASTIN-C, 41 PROLIA, 29 PROMACTA, 37 promethazine, 33 PROMETRIUM, 32 propafenone, 18 propafenone ext-rel, 18 propranolol, 19 propranolol ext-rel, 19 propylthiouracil, 33 PROSCAR, 35 PROVERA, 32 PROZAC, 23 PULMICORT FLEXHALER, 41 PULMICORT RESPULES, 41 PULMOZYME, 40 PYLERA, 35 pyrazinamide, 14 pyrethrins/piperonyl butoxide shampoo 4%, 44 pyridostigmine, 26 pyridostigmine ext-rel, 26

Q QTERN, 28 QUESTRAN/QUESTRAN LIGHT, 19 quetiapine, 24 quetiapine ext-rel, 24 quinapril, 17 quinapril/hydrochlorothiazide, 17 QVAR REDIHALER, 41

R ragweed pollen allergen extract, 37 RAGWITEK, 37 raloxifene, 33 raltegravir, 14 ramipril, 17 ranibizumab, 46 ranitidine, 34 ranolazine ext-rel, 21 rasagiline, 23 RASUVO, 38 RAZADYNE, 22 RAZADYNE ER, 22 REBETOL, 15 REBIF, 26 REBINYN, 37 REGLAN, 33 RELENZA, 15 RELPAX, 25 REMERON, 23 repaglinide, 28 REPATHA, 19 REQUIP XL, 24 RESTASIS, 46 RESTORIL, 25 RETACRIT, 36

65

RETIN-A, 42 RETROVIR, 14 REVATIO, 21 REVLIMID, 16 RHOPRESSA, 46 ribavirin caps, 15 ribavirin oral soln, 15 ribavirin tabs, 15 ribociclib, 16 ribociclib + letrozole, 16 RID, 44 RIFADIN, 14 rifampin, 14 rifaximin 550 mg, 15 rilpivirine, 14 RINVOQ, 37 riociguat, 21 risankizumab-rzaa, 37 risedronate, 29 risedronate delayed-rel, 29 RISPERDAL, 24 RISPERDAL CONSTA, 24 risperidone, 24 risperidone long-acting injection, 24 RITALIN, 24 ritonavir, 14 rivaroxaban, 36 rivastigmine, 22 rivastigmine transdermal, 22 rizatriptan, 25 ROBAXIN, 26 ROBITUSSIN-DM, 40 ROCALTROL, 32 ROCKLATAN, 46 roflumilast, 41 rolapitant, 33 ropinirole, 24 ropinirole ext-rel, 24 rosuvastatin, 19 rotigotine transdermal, 24 ROWASA, 34 ROXICET, 12 ROXICODONE, 12 RUBRACA, 17 rucaparib, 17 RUCONEST, 37 RYDAPT, 16 RYTHMOL SR, 18

S sacubitril/valsartan, 21 SALAGEN, 35 salicylic acid 17%/collodion, 44 salmeterol xinafoate, 40 SANCUSO, 33 sapropterin, 32 sarilumab, 37 SAVELLA, 24 SAXENDA, 29 scopolamine transdermal, 33 SEASONIQUE, 30 secukinumab, 37 selegiline, 24 selenium sulfide shampoo 2.5%, 43 selexipag, 21 semaglutide, 28

SENSIPAR, 29 SEREVENT, 40 SEROQUEL, 24 sertraline, 23 sevelamer carbonate, 32 sildenafil, 21, 35 SILENOR, 25 silodosin, 35 SILVADENE, 42 silver sulfadiazine, 42 SIMBRINZA, 46 SIMPONI, 37 simvastatin, 19 SINEMET, 23 SINEMET CR, 23 SINGULAIR, 41 siponimod, 26 sirolimus, 38 sitagliptin phosphate, 27 sitagliptin/metformin, 27 sitagliptin/metformin ext-rel, 27 SKELAXIN, 26 SKYLA, 31 SKYRIZI, 37 sodium hyaluronate, 12 sodium sulfate/potassium sulfate/magnesium sulfate, 34 sodium zirconium cyclosilicate, 32 sofosbuvir/velpatasvir, 15 sofosbuvir/velpatasvir/voxilaprevir, 15 solifenacin, 35 SOLIQUA, 28 SOLIRIS, 37 solriamfetol, 26 somatropin, 32 SOMATULINE DEPOT, 27 SOMAVERT, 27 sonidegib, 17 SOOLANTRA, 44 SORIATANE, 43 sotalol, 18 soy phospholipid/glycerol dioleate, 44 SPIRIVA, 39 spironolactone, 18 spironolactone/hydrochlorothiazide, 20 SPRYCEL, 16 STALEVO, 23 stavudine, 14 STELARA SUBCUTANEOUS, 37 STIOLTO RESPIMAT, 39 STRATTERA, 24 STRIBILD, 14 STRIVERDI RESPIMAT, 40 STROMECTOL, 15 SUBSYS, 11 sucralfate, 35 sucroferric oxyhydroxide, 32 sulfacetamide lotion 10%, 42 sulfacetamide oint 10%, 45 sulfacetamide soln 10%, 45 sulfacetamide/prednisolone phosphate 10%/0.25%, 45 sulfamethoxazole/trimethoprim, 15 sulfamethoxazole/trimethoprim DS, 15 sulfasalazine, 34 sulfasalazine delayed-rel, 34 sulindac, 11 sumatriptan, 25

66

sumatriptan inj, 25 sumatriptan nasal powder, 25 sumatriptan nasal spray, 25 sumatriptan/naproxen sodium, 25 sunitinib, 16 SUNOSI, 26 SUPARTZ FX, 12 SUPRAX, 13 SUPREP, 34 SUTENT, 16 suvorexant, 25 SYLATRON, 38 SYMBICORT, 41 SYMFI, 14 SYMFI LO, 14 SYMLINPEN, 27 SYMTUZA, 14 SYNJARDY, 28 SYNJARDY XR, 28 SYNTHROID, 33

T TABLOID, 16 TACLONEX SUSPENSION, 43 tacrolimus, 38, 43 tadalafil, 21, 35 TAGAMET HB 200, 34 TALTZ, 37 tamoxifen, 16 tamsulosin, 35 TAPAZOLE, 33 tapentadol, 12 tapentadol ext-rel, 12 TARGRETIN, 17 TARKA, 17 TAYTULLA, 30 tazarotene, 42 TAZORAC, 42 tbo-filgrastim, 36 TECFIDERA, 26 TEGRETOL, 22 TEKTURNA HCT, 20 telmisartan, 18 telmisartan/hydrochlorothiazide, 18 temazepam, 25 TEMIXYS, 14 TEMODAR, 16 TEMOVATE, 44 temozolomide, 16 tenofovir alafenamide, 15 tenofovir disoproxil fumarate, 14 terazosin, 18 terbinafine, 43 terbinafine tabs, 13 terbutaline, 40 terconazole, 36 teriflunomide, 26 teriparatide, 29 TESSALON, 40 testosterone cypionate, 27 testosterone enanthate, 27 testosterone gel, 27 testosterone soln, 27 testosterone transdermal, 27 tetrabenazine, 26 tetracycline, 13

thalidomide, 16 THALOMID, 16 theophylline ext-rel tabs, 41 thioguanine, 16 thiothixene, 24 tiagabine, 22 TIAZAC, 20 ticagrelor, 37 TIGAN, 33 TIKOSYN, 18 timolol hemihydrate, 46 timolol maleate, 46 timolol maleate gel, 46 TIMOPTIC, 46 timothy grass pollen allergen extract, 37 TINACTIN, 43 tinidazole, 15 tioconazole, 36 tiotropium, 39 tiotropium/olodaterol, 39 TIVICAY, 14 tizanidine tabs, 26 TOBI PODHALER, 40 TOBRADEX, 45 TOBRADEX ST, 45 tobramycin, 45 tobramycin inhalation powder, 40 tobramycin inhalation soln, 40 tobramycin/dexamethasone oint 0.3%/0.1%, 45 tobramycin/dexamethasone susp 0.3%/0.05%, 45 tobramycin/dexamethasone susp 0.3%/0.1%, 45 TOBREX, 45 tofacitinib, 37 tofacitinib ext-rel, 37 TOFRANIL, 23 TOLAK, 42 tolnaftate, 43 tolterodine, 35 tolterodine ext-rel, 35 TOPAMAX, 22 topiramate, 22 topiramate ext-rel, 22 topotecan caps, 17 TOPROL-XL, 19 torsemide, 20 TOUJEO, 28 TOVIAZ, 35 TRADJENTA, 27 tramadol, 12 tramadol ext-rel, 12 trandolapril, 17 trandolapril/verapamil ext-rel, 17 tranylcypromine, 23 TRAVATAN Z, 46 travoprost, 46 trazodone, 23 TRELEGY ELLIPTA, 39 treprostinil ext-rel, 21 TRESIBA, 28 tretinoin, 42 tretinoin - Avita, 42 tretinoin caps, 17 tretinoin gel microsphere, 42 TREXALL, 16 TREXIMET, 25 triamcinolone acetonide crm 0.5%, 44

67

triamcinolone acetonide crm, lotion 0.025%, 43 triamcinolone acetonide crm, lotion, oint 0.1%, 43 triamcinolone acetonide spray, 41 triamcinolone paste, 44 triamterene/hydrochlorothiazide, 21 TRIBENZOR, 18 trifluoperazine, 24 trifluridine, 46 trihexyphenidyl, 24 TRILEPTAL, 22 TRILIPIX, 19 trimethobenzamide, 33 trimethoprim, 15 TRINTELLIX, 23 TRIUMEQ, 14 TROKENDI XR, 22 trospium, 35 trospium ext-rel, 35 TRULICITY, 28 TRUSOPT, 46 TRUVADA, 14 TYKERB, 16 TYLENOL, 11 TYMLOS, 29 TYSABRI, 26

U UDENYCA, 36 ULORIC, 11 ULTRAM, 12 ULTRAVATE, 44 umeclidinium, 39 umeclidinium/vilanterol, 39 upadacitinib, 37 UPTRAVI, 21 URECHOLINE, 36 uridine triacetate, 17 UROCIT-K, 36 URSO, 34 ursodiol, 34 ustekinumab, 37

V VAGIFEM, 31 VAGISTAT-1, 36 valacyclovir, 15 valbenazine, 26 valganciclovir, 15 VALIUM, 21 valproic acid, 22 valsartan, 18 valsartan/hydrochlorothiazide, 18 VANCOCIN, 15 vancomycin, 15 varenicline, 27 VARUBI, 33 VASCEPA, 19 VASERETIC, 17 VASOTEC, 17 VELPHORO, 32 VELTASSA, 32 VEMLIDY, 15 venlafaxine, 23 venlafaxine ext-rel, 23 verapamil ext-rel, 20 VFEND, 13 V-GO INSULIN INFUSION PUMP, 29

VIBERZI, 34 VIBRAMYCIN, 13 VICTOZA, 28 VIDEX EC, 14 vigabatrin, 22 VIGAMOX, 45 VIIBRYD, 23 vilazodone, 23 VIMPAT, 22 VIOKACE, 34 VIREAD, 14 VISCO-3, 12 VISTOGARD, 17 vitamin ADC/fluoride drops, 39 vitamin ADC/fluoride/iron drops, 39 VIVELLE-DOT, 31 voriconazole, 13 vorinostat, 17 vortioxetine, 23 VOSEVI, 15 VOTRIENT, 16 VRAYLAR, 24 VYTORIN, 19 VYVANSE, 24

W warfarin, 36 WELLBUTRIN SR, 23 WELLBUTRIN XL, 23

X XALATAN, 46 XARELTO, 36 XELJANZ, 37 XELJANZ XR, 37 XELODA, 16 XIFAXAN, 15 XIGDUO XR, 28 XIIDRA, 46 XOLAIR, 41 XTANDI, 16 XULTOPHY, 28

Y YASMIN, 30 YAZ, 30 YONSA, 16

Z ZADITOR, 45 zafirlukast, 41 ZANAFLEX, 26 zanamivir, 15 ZANTAC, 34 ZANTAC 75, ZANTAC 150, 34 ZARONTIN, 22 ZARXIO, 36 ZEJULA, 17 ZEMBRACE SYMTOUCH, 25 ZEMPLAR, 32 ZENPEP, 34 ZESTORETIC, 17 ZESTRIL, 17 ZETIA, 19 ZIAC, 20 ZIAGEN, 14 zidovudine, 14 zileuton ext-rel, 41

68

ziprasidone, 24 ZITHROMAX, 13 ZOCOR, 19 ZOFRAN, 33 ZOLINZA, 17 zolmitriptan, 25 zolmitriptan nasal spray, 25 ZOLOFT, 23 zolpidem, 25 zolpidem ext-rel, 25 zolpidem sublingual, 25

ZOMIG, 25 zonisamide, 22 ZOVIRAX, 15 ZUBSOLV, 26 ZYBAN, 27 ZYCLARA, 42 ZYLOPRIM, 11 ZYPREXA, 24 ZYRTEC, 39 ZYRTEC-D 12 Hour, 40