requirements/ drug name requirements/ limits analgesics

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2014 601 4T Copper BvD Comm_NT (Effective November 1) NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 1 Drug Name Requirements/ Limits ANALGESICS GOUT allopurinol tab (generic of ZYLOPRIM) ALOPRIM colchicine w/ probenecid COLCRYS probenecid ULORIC ZYLOPRIM MISCELLANEOUS ARTHROTEC diclofenac w/ misoprostol (generic of ARTHROTEC 50) diclofenac w/ misoprostol (generic of ARTHROTEC 75) DUEXIS VIMOVO NSAIDS ANAPROX ANAPROX DS CATAFLAM CELEBREX DAYPRO diclofenac potassium (generic of CATAFLAM) diclofenac sodium (generic of VOLTAREN-XR) TB24 diclofenac sodium TBEC diflunisal EC-NAPROSYN etodolac etodolac er FELDENE fenoprofen calcium TABS flurbiprofen TABS ibuprofen SUSP ibuprofen TABS 400mg, 600mg, 800mg ketoprofen CAPS; CP24 mefenamic acid (generic of PONSTEL) CAPS MELOXICAM SUSP 7.5 MG/5ML meloxicam tabs (generic of MOBIC) MOBIC Drug Name Requirements/ Limits nabumetone TABS NALFON NAPRELAN NAPROSYN naproxen (generic of NAPROSYN) SUSP; TABS naproxen (generic of EC-NAPROSYN) TBEC naproxen sodium (generic of ANAPROX) TABS 275mg naproxen sodium (generic of ANAPROX DS) TABS 550mg oxaprozin (generic of DAYPRO) piroxicam (generic of FELDENE) CAPS PONSTEL NM sulindac TABS tolmetin sodium VOLTAREN-XR ZIPSOR ZORVOLEX OPIOID ANALGESICS acetaminophen w/ codeine SOLN acetaminophen w/ codeine TABS acetaminophen w/ codeine (generic of TYLENOL/CODEINE #3) TABS acetaminophen w/ codeine (generic of TYLENOL/CODEINE #4) TABS butorphanol nasal spray butorphanol tartrate SOLN BUTRANS DIS 5MCG/HR BUTRANS DIS 10MCG/HR BUTRANS DIS 15MCG/HR BUTRANS DIS 20MCG/HR capital and codeine CONZIP 100mg CONZIP 200mg CONZIP 300mg hycet hydrocodone-acetaminophen 2.5-325mg hydrocodone-acetaminophen 5-300mg (generic of XODOL)

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2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 1

Drug Name Requirements/Limits

ANALGESICS GOUT allopurinol tab (generic of ZYLOPRIM)

ALOPRIM

colchicine w/ probenecid

COLCRYS

probenecid

ULORIC

ZYLOPRIM

MISCELLANEOUS ARTHROTEC

diclofenac w/ misoprostol (generic of ARTHROTEC 50)

diclofenac w/ misoprostol (generic of ARTHROTEC 75)

DUEXIS

VIMOVO

NSAIDS ANAPROX

ANAPROX DS

CATAFLAM

CELEBREX

DAYPRO

diclofenac potassium (generic of CATAFLAM)

diclofenac sodium (generic of VOLTAREN-XR) TB24

diclofenac sodium TBEC

diflunisal

EC-NAPROSYN

etodolac

etodolac er

FELDENE

fenoprofen calcium TABS

flurbiprofen TABS

ibuprofen SUSP

ibuprofen TABS 400mg, 600mg, 800mg

ketoprofen CAPS; CP24

mefenamic acid (generic of PONSTEL) CAPS

MELOXICAM SUSP 7.5 MG/5ML

meloxicam tabs (generic of MOBIC)

MOBIC

Drug Name Requirements/Limits

nabumetone TABS

NALFON

NAPRELAN

NAPROSYN

naproxen (generic of NAPROSYN) SUSP; TABS

naproxen (generic of EC-NAPROSYN) TBEC

naproxen sodium (generic of ANAPROX) TABS 275mg

naproxen sodium (generic of ANAPROX DS) TABS 550mg

oxaprozin (generic of DAYPRO)

piroxicam (generic of FELDENE) CAPS

PONSTEL NM

sulindac TABS

tolmetin sodium

VOLTAREN-XR

ZIPSOR

ZORVOLEX

OPIOID ANALGESICS acetaminophen w/ codeine SOLN

acetaminophen w/ codeine TABS

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #3) TABS

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #4) TABS

butorphanol nasal spray

butorphanol tartrate SOLN

BUTRANS DIS 5MCG/HR

BUTRANS DIS 10MCG/HR

BUTRANS DIS 15MCG/HR

BUTRANS DIS 20MCG/HR

capital and codeine

CONZIP 100mg

CONZIP 200mg

CONZIP 300mg

hycet

hydrocodone-acetaminophen 2.5-325mg

hydrocodone-acetaminophen 5-300mg (generic of XODOL)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 2

Drug Name Requirements/Limits

hydrocodone-acetaminophen 5-325mg (generic of NORCO)

hydrocodone-acetaminophen 7.5-300mg (generic of XODOL)

hydrocodone-acetaminophen 7.5-325 mg/15ml (generic of HYCET)

hydrocodone-acetaminophen 7.5-325mg (generic of NORCO)

hydrocodone-acetaminophen 10-300mg (generic of XODOL)

hydrocodone-acetaminophen tab 10-325mg (generic of NORCO)

hydrocodone-ibuprofen 2.5-200mg (generic of REPREXAIN)

hydrocodone-ibuprofen 7.5-200mg (generic of VICOPROFEN)

ibudone tab 5-200mg (generic of REPREXAIN)

lorcet hd tab 10-325mg (generic of NORCO)

lorcet plus tab 7.5-325 (generic of NORCO)

lorcet tab 5-325mg (generic of NORCO)

lortab (generic of NORCO)

lortab elx 10-300mg

norco 5/325

norco 7.5/325

norco 10/325

reprexain 2.5/200

reprexain 5/200

reprexain 10/200

SYNALGOS-DC

tramadol hcl er (generic of ULTRAM ER) TB24 100mg

tramadol hcl er (generic of ULTRAM ER) TB24 200mg

TRAMADOL HCL ER TB24 300mg

TRAMADOL HCL ER (BIPHASIC) 100MG

TRAMADOL HCL ER (BIPHASIC) 200MG

tramadol hcl er (biphasic) 300mg

Drug Name Requirements/Limits

tramadol hcl tab 50 mg (generic of ULTRAM)

tramadol-acetaminophen (generic of ULTRACET)

tylenol with codeine #3

tylenol with codeine #4

ULTRACET

ULTRAM

ULTRAM ER 100mg

ULTRAM ER 200mg

ULTRAM ER 300mg

vicodin (generic of XODOL)

vicodin es (generic of XODOL)

vicodin hp (generic of XODOL)

VICOPROFEN

xodol 5/300

xodol 7.5/300

xodol 10/300

zamicet

OPIOID ANALGESICS, CII ABSTRAL NM

ACTIQ NM

AVINZA

CODEINE SULFATE TABS

DILAUDID INJ B/D

DILAUDID TAB

DILAUDID-5 ORAL LIQD

DILAUDID-HP INJ B/D

DOLOPHINE

DURAGESIC 12mcg/hr, 25mcg/hr, 50mcg/hr

DURAGESIC 75mcg/hr, 100mcg/hr

NM

DURAMORPH B/D

endocet 5/325 (generic of PERCOCET)

endocet 7.5/325 (generic of PERCOCET)

endocet 10/325 (generic of PERCOCET)

ENDODAN

EXALGO 8mg, 12mg

EXALGO 16mg, 32mg NM

fentanyl citrate (generic of ACTIQ) LPOP

NM

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 3

Drug Name Requirements/Limits

fentanyl patch (generic of DURAGESIC)

FENTORA NM

hydromorphone hcl (generic of DILAUDID) LIQD

hydromorphone hcl (generic of DILAUDID-HP) SOLN 500mg/50ml

B/D

hydromorphone hcl (generic of EXALGO) T24A 8mg, 12mg, 16mg

HYDROMORPHONE HCL T24A 32mg

hydromorphone hcl (generic of DILAUDID) TABS

INFUMORPH 200 B/D

INFUMORPH 500 B/D

KADIAN

LAZANDA NM

levorphanol tartrate TABS

methadone hcl (generic of METHADOSE) CONC

methadone hcl SOLN

methadone hcl (generic of DOLOPHINE HCL) TABS 5mg

methadone hcl (generic of DOLOPHINE) TABS 10mg

METHADONE INJ 10MG/ML

METHADOSE CONC

MORPHINE SUL 20MG/ML ORAL SOL

morphine sulfate (generic of KADIAN) CP24

MORPHINE SULFATE SOLN 2mg/ml

B/D

MORPHINE SULFATE SOLN 10mg/5ml, 20mg/5ml

MORPHINE SULFATE TABS

morphine sulfate beads cap sr (generic of AVINZA)

morphine sulfate ext-rel tab (generic of MS CONTIN) 15mg, 30mg, 60mg, 100mg

morphine sulfate ext-rel tab (generic of MS CONTIN) 200mg

MORPHINE SULFATE INJ 1mg/ml, 4mg/ml, 8mg/ml, 10mg/ml, 15mg/ml

B/D

Drug Name Requirements/Limits

morphine sulfate inj .5mg/ml, 1mg/ml

B/D

MS CONTIN 15mg, 30mg, 60mg

MS CONTIN 100mg NM

MS CONTIN 200mg NM

NUCYNTA

NUCYNTA ER 50mg, 100mg

NUCYNTA ER 150mg, 200mg, 250mg

OPANA TABS

OPANA ER (CRUSH RESISTANT

OXECTA

OXYCODONE HCL CAPS

OXYCODONE HCL CONC

OXYCODONE HCL SOLN

oxycodone hcl (generic of ROXICODONE) TABS 5mg, 15mg, 30mg

oxycodone hcl TABS 10mg, 20mg

oxycodone w/ acetaminophen 2.5-325mg (generic of PERCOCET)

oxycodone w/ acetaminophen 5-325mg (generic of PERCOCET)

oxycodone w/ acetaminophen 7.5-325mg (generic of PERCOCET)

oxycodone w/ acetaminophen 10-325mg (generic of PERCOCET)

oxycodone-aspirin (generic of PERCODAN)

oxycodone-ibuprofen

OXYCONTIN

oxymorphone hcl (generic of OPANA) TABS

percocet 2.5/325

percocet 5/325

percocet 7.5/325

percocet 10/325 NM

PERCODAN

roxicet soln

roxicet tab 5-325mg (generic of PERCOCET)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 4

Drug Name Requirements/Limits

ROXICODONE

SUBSYS NM

XARTEMIS XR

ANESTHETICS LOCAL ANESTHETICS lidocaine hcl (local anesth.) (generic of XYLOCAINE-MPF) 4%

lidocaine hcl (local anesth.) (generic of XYLOCAINE) .5%

B/D

lidocaine inj 0.5% (generic of XYLOCAINE-MPF)

B/D

lidocaine inj 1% (generic of XYLOCAINE) 1%

B/D

lidocaine inj 1% (generic of XYLOCAINE-MPF) 1%

B/D

lidocaine inj 1.5% (generic of XYLOCAINE-MPF)

B/D

lidocaine inj 2% (generic of XYLOCAINE) 2%

B/D

lidocaine inj 2% (generic of XYLOCAINE-MPF) 2%

B/D

XYLOCAINE .5%, 2% B/D

XYLOCAINE INJ 1% B/D

XYLOCAINE-MPF B/D

ANTI-INFECTIVES ANTI-BACTERIALS - MISCELLANEOUS amikacin sulfate SOLN

BETHKIS B/D NM

gentamicin in saline 0.9mg/ml

gentamicin in saline 1.4mg/ml

gentamicin in saline 60mg

gentamicin in saline 80mg

gentamicin in saline 100mg

gentamicin sulfate SOLN

neomycin sulfate TABS

paromomycin sulfate CAPS

streptomycin sulfate SOLR

sulfadiazine TABS

TOBI NEB B/D NM

TOBI PODHALER NM

tobramycin (generic of TOBI) NEBU

B/D NM

tobramycin sulfate SOLN; SOLR

tobramycin sulfate in saline

ANTI-INFECTIVES - MISCELLANEOUS ALBENZA

Drug Name Requirements/Limits

ALINIA SUSR

ALINIA TABS

atovaquone (generic of MEPRON) SUSP

NM

AZACTAM

AZACTAM/DEX INJ 1GM

AZACTAM/DEX INJ 2GM NM

aztreonam (generic of AZACTAM)

BACTRIM

BACTRIM DS

BILTRICIDE

CLEOCIN CAPS

cleocin SOLR

CLEOCIN CAP 75MG

CLEOCIN IN D5W

CLEOCIN INJ

CLEOCIN PHOSPHATE

clindamycin hcl (generic of CLEOCIN) CAPS

clindamycin palmitate hydrochloride (generic of CLEOCIN PEDIATRIC GRANULE)

clindamycin phosphate SOLN 150mg/ml

clindamycin phosphate (generic of CLEOCIN PHOSPHATE) SOLN 150mg/ml, 300mg/2ml, 600mg/4ml, 900mg/6ml, 9000mg/60ml

clindamycin phosphate in d5w (generic of CLEOCIN IN D5W)

colistimethate sodium (generic of COLY-MYCIN M) SOLR

COLY-MYCIN M

CUBICIN B/D NM

dapsone TABS

DARAPRIM

DORIBAX

erythromycin-sulfisoxazole for susp 200-600 mg/5ml

FLAGYL

FLAGYL ER

FURADANTIN NM

HIPREX

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 5

Drug Name Requirements/Limits

imipenem-cilastatin (generic of PRIMAXIN IV)

INVANZ

MACROBID

MACRODANTIN

MEPRON NM

meropenem (generic of MERREM)

MERREM

methenamine hippurate (generic of HIPREX)

METRO IV

metronidazole (generic of FLAGYL) CAPS; TABS

metronidazole inj

NEBUPENT B/D

nitrofurantoin (generic of FURADANTIN) SUSP

nitrofurantoin macrocrystal (generic of MACRODANTIN)

nitrofurantoin monohyd macro (generic of MACROBID)

PENTAM 300

polymyxin b sulfate SOLR

PRIMAXIN

PRIMSOL SOL 50MG/5ML

SIVEXTRO NM

STROMECTOL

sulfamethoxazole-trimethoprim SUSP

sulfamethoxazole-trimethoprim (generic of BACTRIM) TABS

sulfamethoxazole-trimethoprim (generic of BACTRIM DS) TABS

sulfamethoxazole-trimethoprim inj

SYNERCID NM

trimethoprim TABS

TYGACIL NM

VANCOCIN HCL NM

vancomycin hcl (generic of VANCOCIN HCL) CAPS

NM

vancomycin hcl SOLR 10gm, 500mg, 1000mg, 5000mg

B/D

vancomycin hcl SOLR 750mg B/D

VIBATIV

XIFAXAN TAB 200MG NM

ZYVOX NM

Drug Name Requirements/Limits

ANTIFUNGALS ABELCET B/D NM

AMBISOME B/D NM

AMPHOTEC B/D

amphotericin b SOLR B/D

ANCOBON NM

CANCIDAS NM

DIFLUCAN

ERAXIS NM

fluconazole (generic of DIFLUCAN) SUSR; TABS

fluconazole in dextrose

fluconazole in nacl 100mg

fluconazole in nacl 200mg

fluconazole in nacl 400mg

flucytosine (generic of ANCOBON) CAPS

NM

GRIS-PEG

griseofulvin microsize SUSP

griseofulvin microsize (generic of GRIFULVIN V) TABS

griseofulvin ultramicrosize (generic of GRIS-PEG)

itraconazole (generic of SPORANOX) CAPS

ketoconazole TABS

LAMISIL PACK

LAMISIL TABS

MYCAMINE 50mg

MYCAMINE 100mg NM

NOXAFIL NM

nystatin TABS

ONMEL

SPORANOX NM

SPORANOX PULSEPAK NM

SPORANOX SOL 10MG/ML NM

terbinafine hcl (generic of LAMISIL) TABS

VFEND NM

VFEND IV

VFEND SUS 40MG/ML NM

voriconazole (generic of VFEND) SUSR; TABS

NM

voriconazole inj 200mg (generic of VFEND IV)

ANTIMALARIALS

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 6

Drug Name Requirements/Limits

atovaquone-proguanil hcl tab 62.5-25 mg (generic of MALARONE)

atovaquone-proguanil hcl tab 250-100 mg (generic of MALARONE)

chloroquine phosphate TABS 250mg

chloroquine phosphate (generic of ARALEN) TABS 500mg

COARTEM

MALARONE

mefloquine hcl

PRIMAQUINE PHOSPHATE

QUALAQUIN

quinine sulfate (generic of QUALAQUIN) CAPS

ANTIRETROVIRAL AGENTS abacavir sulfate (generic of ZIAGEN)

APTIVUS NM

CRIXIVAN

didanosine (generic of VIDEX EC)

EDURANT NM

EMTRIVA

EPIVIR SOL 10MG/ML

EPIVIR TABS

FUZEON NM

INTELENCE 25mg

INTELENCE 100mg, 200mg NM

INVIRASE CAPS

INVIRASE TABS NM

ISENTRESS CHEW 25mg

ISENTRESS CHEW 100mg NM

ISENTRESS PACK

ISENTRESS TABS NM

lamivudine (generic of EPIVIR) 150mg, 300mg

LEXIVA SUSP

LEXIVA TABS NM

NEVIRAPINE SUSP

nevirapine (generic of VIRAMUNE) TABS

nevirapine (generic of VIRAMUNE XR) TB24

NORVIR

Drug Name Requirements/Limits

PREZISTA SUSP NM

PREZISTA TABS 75mg, 150mg

PREZISTA TABS 600mg, 800mg

NM

RESCRIPTOR

RETROVIR CAPS

RETROVIR IV INFUSION

RETROVIR SYRP

REYATAZ 100mg

REYATAZ 150mg, 200mg, 300mg

NM

SELZENTRY NM

stavudine (generic of ZERIT)

SUSTIVA

TIVICAY NM

VIDEX EC

VIDEX PEDIATRIC

VIRACEPT NM

VIRAMUNE

VIRAMUNE XR

VIREAD NM

ZERIT

ZIAGEN SOLN

ZIAGEN TABS

zidovudine (generic of RETROVIR) CAPS; SYRP

zidovudine TABS

ANTIRETROVIRAL COMBINATION AGENTS abacavir sulfate-lamivudine-zidovudine (generic of TRIZIVIR)

NM

ATRIPLA NM

COMBIVIR NM

COMPLERA NM

EPZICOM NM

KALETRA SOL NM

KALETRA TAB 100-25MG

KALETRA TAB 200-50MG NM

lamivudine-zidovudine (generic of COMBIVIR)

NM

STRIBILD NM

TRIZIVIR NM

TRUVADA NM

ANTITUBERCULAR AGENTS CAPASTAT SULFATE NM

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 7

Drug Name Requirements/Limits

cycloserine CAPS

ethambutol hcl (generic of MYAMBUTOL) TABS

isoniazid SOLN; SYRP

isoniazid tabs

MYAMBUTOL

MYCOBUTIN

paser d/r

PRIFTIN

pyrazinamide

rifabutin (generic of MYCOBUTIN)

rifadin CAPS 150mg

RIFADIN CAPS 300mg

RIFADIN SOLR

rifamate

rifampin (generic of RIFADIN) CAPS; SOLR

RIFATER

seromycin

SIRTURO NM LA

TRECATOR

ANTIVIRALS acyclovir (generic of ZOVIRAX) CAPS; SUSP; TABS

acyclovir sodium B/D

adefovir dipivoxil (generic of HEPSERA)

NM

BARACLUDE SOLN

BARACLUDE TABS NM

cidofovir (generic of VISTIDE)

COPEGUS NM

CYTOVENE B/D

entecavir (generic of BARACLUDE)

NM

EPIVIR HBV

EPIVIR HBV TAB 100MG

famciclovir (generic of FAMVIR) TABS

FAMVIR

FLUMADINE

foscarnet sodium

ganciclovir inj 500mg (generic of CYTOVENE)

B/D

HEPSERA NM

INCIVEK TAB 375MG NM

Drug Name Requirements/Limits

lamivudine (generic of EPIVIR HBV) 100mg

moderiba pak NM

moderiba tab 200mg (generic of COPEGUS)

NM

OLYSIO NM

REBETOL NM

REBETOL SOL 40MG/ML NM

RELENZA DISKHALER

ribapak mis 600/day NM

ribasphere (generic of REBETOL) CAPS

NM

ribasphere (generic of COPEGUS) TABS 200mg

NM

ribasphere TABS 400mg NM

ribasphere TABS 600mg NM

ribasphere ribapak 800 NM

ribasphere ribapak 1000 NM

ribasphere ribapak 1200 NM

ribavirin cap 200mg (generic of REBETOL)

NM

ribavirin tab 200mg (generic of COPEGUS)

NM

rimantadine hydrochloride (generic of FLUMADINE)

SOVALDI NM

TAMIFLU

TYZEKA NM

valacyclovir hcl (generic of VALTREX) TABS

VALCYTE NM

VALTREX

VICTRELIS CAP 200MG NM

VISTIDE

ZOVIRAX CAPS

ZOVIRAX SUSP

ZOVIRAX TABS 400mg

CEPHALOSPORINS CEDAX

cefaclor

cefaclor monohydrate

cefadroxil

cefazolin inj

cefazolin sodium 1gm, 20gm

cefazolin/dextrose

cefdinir

CEFEPIME 1GM SOLN

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 8

Drug Name Requirements/Limits

CEFEPIME 2GM SOLN

cefepime inj 1gm (generic of MAXIPIME)

cefepime inj 2gm (generic of MAXIPIME)

cefotaxime sodium (generic of CLAFORAN)

cefotetan disodium

cefoxitin sodium

CEFOXITIN SODIUM IN DEXTROSE

cefpodoxime proxetil

cefprozil

ceftazidime (generic of FORTAZ) 1gm

ceftazidime solr (generic of FORTAZ)

CEFTAZIDIME/DEXTROSE

ceftibuten

CEFTIN

ceftriaxone sodium SOLR 1gm, 2gm, 10gm, 250mg

ceftriaxone sodium (generic of ROCEPHIN) SOLR 1gm, 500mg

cefuroxime axetil SUSR

cefuroxime axetil (generic of CEFTIN) TABS

cefuroxime sodium (generic of ZINACEF) 1.5gm, 7.5gm, 750mg

cefuroxime sodium 7.5gm

cephalexin (generic of KEFLEX) CAPS

cephalexin SUSR; TABS

claforan 1gm, 2gm

CLAFORAN 1gm, 2gm, 10gm, 500mg

FORTAZ

KEFLEX

MAXIPIME

rocephin

SUPRAX CAPS

suprax CHEW

suprax SUSR 100mg/5ml, 200mg/5ml

SUPRAX SUSR 500mg/5ml

Drug Name Requirements/Limits

suprax TABS

tazicef vial (generic of FORTAZ)

TEFLARO

ZINACEF SOLR

ERYTHROMYCINS/MACROLIDES AZITHROMYCIN PACK

azithromycin (generic of ZITHROMAX) SOLR 500mg

azithromycin (generic of ZITHROMAX) SUSR

azithromycin (generic of ZITHROMAX) TABS

BIAXIN

BIAXIN XL

BIAXIN XL PAC

clarithromycin SUSR 125mg/5ml

clarithromycin (generic of BIAXIN) SUSR 250mg/5ml

clarithromycin (generic of BIAXIN) TABS

clarithromycin (generic of BIAXIN XL) TB24

DIFICID NM

e.e.s.

E.E.S. GRANULES

ery-tab

ERYPED 200

ERYPED 400

erythrocin lactobionate 500mg

erythrocin stearate

erythromycin base

erythromycin ethylsuccinate

PCE

ZITHROMAX

ZITHROMAX TRI-PAK

ZITHROMAX Z-PAK

ZMAX

FLUOROQUINOLONES AVELOX

AVELOX ABC PACK

CIPRO SUSR

CIPRO TABS

CIPRO I.V.-IN D5W

ciprofloxacin SOLN 200mg/20ml

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 9

Drug Name Requirements/Limits

ciprofloxacin (generic of CIPRO) SUSR

ciprofloxacin er (generic of CIPRO XR)

ciprofloxacin hcl TABS 100mg, 750mg

ciprofloxacin hcl (generic of CIPRO) TABS 250mg, 500mg

ciprofloxacin in d5w (generic of CIPRO I.V.-IN D5W)

ciprofloxacn inj

FACTIVE

LEVAQUIN

LEVAQUIN INJ

levofloxacin SOLN 25mg/ml

levofloxacin (generic of LEVAQUIN) SOLN 25mg/ml

levofloxacin (generic of LEVAQUIN) TABS

levofloxacin in d5w (generic of LEVAQUIN)

moxifloxacin hcl (generic of AVELOX)

NOROXIN

PENICILLINS amoxicillin

amoxicillin & pot clavulanate CHEW

amoxicillin & pot clavulanate (generic of AUGMENTIN) CHEW

amoxicillin & pot clavulanate SUSR

amoxicillin & pot clavulanate (generic of AUGMENTIN) SUSR

amoxicillin & pot clavulanate (generic of AUGMENTIN ES-600) SUSR

amoxicillin & pot clavulanate TABS

amoxicillin & pot clavulanate (generic of AUGMENTIN) TABS

amoxicillin & pot clavulanate (generic of AUGMENTIN XR) TB12

ampicillin

ampicillin & sulbactam sodium

Drug Name Requirements/Limits

ampicillin & sulbactam sodium (generic of UNASYN)

ampicillin & sulbactam sodium (generic of UNASYN BULK PACK)

ampicillin inj

ampicillin sodium

AUGMENTIN

AUGMENTIN ES-600

AUGMENTIN XR

BACTOCILL IN DEXTROSE

BICILLIN C-R

BICILLIN L-A

dicloxacillin sodium

MOXATAG

nafcillin sodium 1gm

nafcillin sodium 2gm, 10gm NM

NALLPEN ISO-OSMOTIC IN DE

NALLPEN/DEXTROSE

oxacillin sodium 1gm, 2gm

oxacillin sodium 10gm NM

PENICILLIN G POT IN DEXTROSE

PENICILLIN G POTASSIUM SOLN

penicillin g potassium SOLR

penicillin g procaine

penicillin g sodium

penicillin v potassium

pfizerpen

piperacillin sodium-tazobactam sodium (generic of ZOSYN)

TIMENTIN

TIMENTIN INJ 3.1GM

UNASYN

UNASYN BULK PACK

ZOSYN

TETRACYCLINES adoxa CAPS

demeclocycline hcl

DORYX

doxycycline (monohydrate) CAPS 50mg

doxycycline (monohydrate) (generic of MONODOX) CAPS 75mg, 100mg

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 10

Drug Name Requirements/Limits

doxycycline (monohydrate) (generic of ADOXA) CAPS 150mg

doxycycline (monohydrate) (generic of VIBRAMYCIN) SUSR

doxycycline (monohydrate) (generic of ADOXA) TABS 50mg, 75mg, 100mg

doxycycline (monohydrate) (generic of ADOXA PAK 1/150) TABS 150mg

doxycycline hyclate CAPS 50mg

doxycycline hyclate (generic of VIBRAMYCIN) CAPS 100mg

doxycycline hyclate SOLR

doxycycline hyclate TABS

doxycycline hyclate TBEC 75mg, 100mg

doxycycline hyclate (generic of DORYX) TBEC 150mg

dynacin

MINOCIN CAPS 50mg, 100mg

MINOCIN KIT 100mg

minocycline hcl (generic of MINOCIN) CAPS

minocycline hcl TABS; TB24

SOLODYN NM

TETRACYCLINE HCL CAPS

VIBRAMYCIN CAPS; SUSR

VIBRAMYCIN SYRP

ANTINEOPLASTIC AGENTS ALKYLATING AGENTS ALKERAN SOLR B/D

BICNU B/D

BUSULFEX B/D

CEENU CAP 10MG

CEENU CAP 40MG

CYCLOPHOSPHAMIDE CAPS B/D

cyclophosphamide SOLR B/D

cyclophosphamide TABS B/D

dacarbazine 200mg B/D

EMCYT

HEXALEN NM

IFEX INJ 1GM B/D

IFEX INJ 3GM B/D

Drug Name Requirements/Limits

ifosfamide (generic of IFOSFAMIDE) 1gm/20ml, 3gm/60ml

B/D

ifosfamide 3gm/60ml B/D

ifosfamide for inj 1 gm (generic of IFEX)

B/D

IFOSFAMIDE FOR INJ 3 GM B/D

ifosfamide inj 1gm/20ml B/D

LEUKERAN

LOMUSTINE

melphalan hcl (generic of ALKERAN)

B/D NM

MUSTARGEN B/D

TREANDA B/D NM

ZANOSAR B/D

ANTHRACYCLINES adriamycin 20mg B/D

daunorubicin hcl B/D

daunorubicin hcl for inj 20 mg B/D

DOXIL B/D NM

doxorubicin hcl SOLN B/D

doxorubicin hcl SOLR 50mg B/D

doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml (generic of DOXIL)

B/D NM

ELLENCE B/D NM

EPIRUBICIN INJ 50MG B/D

epirubicin inj 50mg/25ml (generic of ELLENCE)

B/D

epirubicin inj 200mg (generic of ELLENCE)

B/D

IDAMYCIN PFS B/D

idarubicin hcl (generic of IDAMYCIN PFS)

B/D NM

ANTIBIOTICS bleomycin sulfate B/D

COSMEGEN B/D NM

mitomycin SOLR B/D

mitomycin solr 20mg B/D

ANTIMETABOLITES adrucil B/D

ALIMTA B/D NM

ARRANON B/D

azacitidine (generic of VIDAZA) B/D NM

cladribine B/D NM

CLOLAR B/D

cytarabine inj B/D

DACOGEN B/D NM

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 11

Drug Name Requirements/Limits

decitabine (generic of DACOGEN)

B/D NM

fludarabine phosphate SOLN B/D

fludarabine phosphate (generic of FLUDARA) SOLR

B/D

fluorouracil SOLN B/D

GEMCITABINE B/D NM

gemcitabine hcl (generic of GEMZAR) 1gm, 200mg

B/D NM

gemcitabine hcl 2gm B/D NM

GEMZAR B/D NM

mercaptopurine (generic of PURINETHOL) TABS

methotrexate sodium inj B/D

NIPENT B/D NM

PURINETHOL

TABLOID

VIDAZA B/D NM

ANTIMITOTIC, TAXOIDS ABRAXANE B/D NM

DOCETAXEL CONC 20mg/0.5ml

B/D NM

DOCETAXEL CONC 20mg/ml, 80mg/4ml

B/D NM

docetaxel CONC 140mg/7ml B/D NM

DOCETAXEL SOLN 80mg/8ml B/D NM

paclitaxel B/D

TAXOTERE B/D NM

ANTIMITOTIC, VINCA ALKALOIDS vinblastine sulfate SOLN B/D

vincasar B/D

vincristine sulfate B/D

vinorelbine tartrate (generic of NAVELBINE)

B/D

BIOLOGIC RESPONSE MODIFIERS AVASTIN B/D NM

ERBITUX B/D NM

ERIVEDGE NM LA

HERCEPTIN B/D NM

ISTODAX B/D NM

KADCYLA B/D NM

PROLEUKIN B/D NM

RITUXAN NM

TORISEL B/D NM

VECTIBIX B/D NM

VELCADE B/D NM

ZOLINZA NM

HORMONAL ANTINEOPLASTIC AGENTS

Drug Name Requirements/Limits

anastrozole tab 1mg (generic of ARIMIDEX)

ARIMIDEX TAB 1MG

AROMASIN TAB 25MG

ARZERRA B/D NM

bicalutamide (generic of CASODEX)

CASODEX

DEPO-PROVERA INJ 400/ML B/D

ELIGARD 7.5mg, 22.5mg, 30mg B/D NM

ELIGARD 45mg B/D NM

exemestane tab 25mg (generic of AROMASIN)

FARESTON NM

FASLODEX B/D NM

FEMARA TAB 2.5MG

FIRMAGON 80mg B/D NM

FIRMAGON 120mg B/D NM

flutamide

letrozole tab 2.5mg (generic of FEMARA)

leuprolide acetate KIT NM

LUPR DEP-PED INJ 11.25MG (3-MONTH)

NM

LUPR DEP-PED INJ 30MG (3-MONTH)

NM

LUPRON DEPOT 3.75mg, 7.5mg, 11.25mg

NM

LUPRON DEPOT INJ 22.5MG (3-MONTH)

NM

LUPRON DEPOT INJ 30MG (3-MONTH)

NM

LUPRON DEPOT-PED NM

LYSODREN

MEGACE ES

MEGACE ORAL

megestrol acetate (generic of MEGACE ORAL) SUSP

megestrol acetate TABS

NILANDRON NM

SOLTAMOX

tamoxifen citrate TABS

TRELSTAR DEPOT MIXJECT NM

TRELSTAR LA MIXJECT NM

TRELSTAR MIXJECT NM

XTANDI NM LA

ZYTIGA NM

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 12

Drug Name Requirements/Limits

KINASE INHIBITORS AFINITOR NM

AFINITOR DISPERZ NM

BOSULIF NM

CAPRELSA NM LA

COMETRIQ NM

GILOTRIF NM

GLEEVEC NM

ICLUSIG NM LA

IMBRUVICA NM

INLYTA NM LA

IRESSA NM

JAKAFI NM LA

MEKINIST NM

NEXAVAR NM LA

SPRYCEL NM

STIVARGA NM LA

SUTENT NM

TAFINLAR NM

TARCEVA NM

TASIGNA NM

TYKERB NM LA

VOTRIENT NM

XALKORI NM LA

ZELBORAF NM LA

ZYDELIG NM LA

ZYKADIA NM LA

MISCELLANEOUS DROXIA

HALAVEN B/D NM

HYDREA

hydroxyurea (generic of HYDREA) CAPS

IXEMPRA KIT B/D NM

MATULANE NM

mitoxantrone hcl B/D NM

POMALYST CAP NM LA

SYLATRON NM

TARGRETIN CAPS NM

tretinoin CAPS NM

TRISENOX B/D NM

UVADEX B/D

PLATINUM-BASED AGENTS carboplatin SOLN B/D

cisplatin soln B/D

ELOXATIN B/D NM

oxaliplatin B/D NM

Drug Name Requirements/Limits

PROTECTIVE AGENTS amifostine crystalline (generic of ETHYOL)

B/D NM

dexrazoxane (generic of ZINECARD) 250mg

B/D NM

ELITEK B/D NM

KEPIVANCE B/D NM

leucovor ca inj B/D

leucovorin calcium SOLR 50mg, 200mg

B/D

leucovorin calcium SOLR 500mg

B/D

leucovorin calcium TABS

leucovorin calcium inj 10 mg/ml B/D

mesna (generic of MESNEX) B/D

MESNEX SOLN B/D

MESNEX TABS NM

ZINECARD B/D

TOPOISOMERASE INHIBITORS CAMPTOSAR B/D

ETOPOPHOS B/D

etoposide SOLN 500mg/25ml B/D

HYCAMTIN SOLR B/D NM

irinotecan hcl (generic of CAMPTOSAR) 40mg/2ml, 100mg/5ml

B/D NM

irinotecan hcl 500mg/25ml B/D NM

toposar 1gm/50ml B/D

topotecan hcl (generic of HYCAMTIN) SOLR

B/D NM

CARDIOVASCULAR ACE INHIBITOR COMBINATIONS ACCURETIC

amlodipine besylate-benazepril hcl (generic of LOTREL)

benazepril & hydrochlorothiazide

benazepril & hydrochlorothiazide (generic of LOTENSIN HCT)

captopril & hydrochlorothiazide

enalapril maleate & hydrochlorothiazide

enalapril maleate & hydrochlorothiazide (generic of VASERETIC)

fosinopril sodium & hydrochlorothiazide

lisinopril & hydrochlorothiazide (generic of ZESTORETIC)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 13

Drug Name Requirements/Limits

LOTENSIN HCT

LOTREL

moexipril-hydrochlorothiazide

quinapril-hydrochlorothiazide (generic of ACCURETIC)

TARKA

UNIRETIC

VASERETIC

ZESTORETIC

ACE INHIBITORS ACCUPRIL

ALTACE

benazepril hcl TABS 5mg

benazepril hcl (generic of LOTENSIN) TABS 10mg, 20mg, 40mg

captopril TABS

enalapril maleate (generic of VASOTEC) TABS

fosinopril sodium

lisinopril (generic of ZESTRIL) TABS 2.5mg, 30mg, 40mg

lisinopril (generic of PRINIVIL) TABS 5mg, 10mg, 20mg

LOTENSIN 20mg, 40mg

MAVIK

moexipril hcl (generic of UNIVASC)

perindopril erbumine 2mg

perindopril erbumine (generic of ACEON) 4mg, 8mg

PRINIVIL

quinapril hcl (generic of ACCUPRIL)

ramipril (generic of ALTACE)

trandolapril (generic of MAVIK)

UNIVASC

VASOTEC

ZESTRIL

ALDOSTERONE RECEPTOR ANTAGONISTS ALDACTONE

eplerenone tab 25mg (generic of INSPRA)

eplerenone tab 50mg (generic of INSPRA)

Drug Name Requirements/Limits

INSPRA TAB 25MG

INSPRA TAB 50MG

spironolactone (generic of ALDACTONE) TABS

ALPHA BLOCKERS CARDURA

doxazosin mesylate (generic of CARDURA)

MINIPRESS

prazosin hcl (generic of MINIPRESS)

terazosin hcl

ANGIOTENSIN II RECEPTOR ANTAGONIST COMBINATIONS ATACAND HCT

AVALIDE

AZOR

BENICAR HCT

candesartan cilexetil-hydrochlorothiazide (generic of ATACAND HCT)

DIOVAN HCT

EDARBYCLOR

EXFORGE

EXFORGE HCT

HYZAAR

irbesartan-hydrochlorothiazide (generic of AVALIDE)

losartan potassium & hydrochlorothiazide (generic of HYZAAR)

MICARDIS HCT

telmisartan-amlodipine (generic of TWYNSTA)

telmisartan-hydrochlorothiazide (generic of MICARDIS HCT)

TEVETEN HCT

TRIBENZOR

TWYNSTA

valsartan-hydrochlorothiazide (generic of DIOVAN HCT)

ANGIOTENSIN II RECEPTOR ANTAGONISTS ATACAND

AVAPRO

BENICAR

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 14

Drug Name Requirements/Limits

candesartan cilexetil (generic of ATACAND)

COZAAR

DIOVAN

EDARBI

eprosartan mesylate (generic of TEVETEN)

irbesartan (generic of AVAPRO)

losartan potassium (generic of COZAAR)

MICARDIS

telmisartan tab (generic of MICARDIS)

TEVETEN

valsartan tab 40 mg (generic of DIOVAN)

valsartan tab 80 mg (generic of DIOVAN)

valsartan tab 160 mg (generic of DIOVAN)

valsartan tab 320 mg (generic of DIOVAN)

ANTIARRHYTHMICS amiodarone hcl

amiodarone inj 50mg/ml

amiodarone tab 200mg (generic of CORDARONE)

amiodarone tab 400mg

BETAPACE

BETAPACE AF

disopyramide phosphate (generic of NORPACE)

flecainide acetate

mexiletine hcl

MULTAQ

NORPACE

NORPACE CR

pacerone 100mg, 400mg

pacerone (generic of CORDARONE) 200mg

propafenone hcl (generic of RYTHMOL SR) CP12

propafenone hcl (generic of RYTHMOL) TABS 150mg, 225mg

propafenone hcl TABS 300mg

quinidine gluconate er

Drug Name Requirements/Limits

quinidine sulfate TABS; TBCR

RYTHMOL

RYTHMOL SR

sorine (generic of BETAPACE) 80mg, 120mg, 160mg

sorine 240mg

sotalol hcl (generic of BETAPACE) 80mg, 120mg, 160mg

sotalol hcl 240mg

sotalol hcl (afib/afl) (generic of BETAPACE AF)

TAMBOCOR

TIKOSYN CAP 125MCG NM

TIKOSYN CAP 250MCG NM

TIKOSYN CAP 500MCG NM

ANTILIPEMICS, HMG-CoA REDUCTASE INHIBITORS ALTOPREV

atorvastatin calcium (generic of LIPITOR)

CRESTOR

fluvastatin sodium (generic of LESCOL)

LESCOL

LESCOL XL

LIPITOR

LIVALO

lovastatin 10mg

lovastatin (generic of MEVACOR) 20mg, 40mg

MEVACOR 20mg

PRAVACHOL

pravastatin sodium 10mg

pravastatin sodium (generic of PRAVACHOL) 20mg, 40mg, 80mg

simvastatin (generic of ZOCOR) TABS 5mg, 10mg, 20mg, 40mg

simvastatin (generic of ZOCOR) TABS 80mg

ZOCOR 5mg, 10mg, 20mg, 40mg

ZOCOR 80mg

ANTILIPEMICS, MISCELLANEOUS ADVICOR

ANTARA

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 15

Drug Name Requirements/Limits

cholestyramine (generic of QUESTRAN)

cholestyramine light

choline fenofibrate (generic of TRILIPIX)

COLESTID

colestipol hcl (generic of COLESTID)

FENOFIBRATE

FENOFIBRATE CAP

FENOFIBRATE MICRONIZED 43mg, 130mg

fenofibrate micronized (generic of LOFIBRA) 67mg, 134mg, 200mg

fenofibrate tab (generic of TRICOR) 48mg, 145mg

fenofibrate tab (generic of LOFIBRA) 54mg, 160mg

FENOFIBRIC ACID

FENOGLIDE

FIBRICOR

gemfibrozil (generic of LOPID) TABS

LIPOFEN

LIPTRUZET

lofibra

LOPID

LOVAZA

niacin er (generic of NIASPAN) TBCR

niacor

NIASPAN TAB 500MG ER

NIASPAN TAB 750MG ER

NIASPAN TAB 1000 ER

omega-3-acid ethyl esters

prevalite (generic of QUESTRAN LIGHT)

questran

questran light

SIMCOR

TRICOR

TRIGLIDE

TRILIPIX

VASCEPA

VYTORIN

Drug Name Requirements/Limits

WELCHOL

ZETIA

BETA-BLOCKER/DIURETIC COMBINATIONS atenolol & chlorthalidone (generic of TENORETIC 50)

atenolol & chlorthalidone (generic of TENORETIC 100)

bisoprolol & hydrochlorothiazide (generic of ZIAC)

CORZIDE

DUTOPROL

LOPRESSOR HCT

metoprolol & hctz tab 50-25mg (generic of LOPRESSOR HCT)

metoprolol & hctz tab 100-25mg (generic of LOPRESSOR HCT)

metoprolol & hctz tab 100-50mg

nadolol & bendroflumethiazide (generic of CORZIDE)

propranolol & hydrochlorothiazide

TENORETIC

ZIAC

BETA-BLOCKERS acebutolol hcl (generic of SECTRAL) CAPS

atenolol (generic of TENORMIN) TABS

betaxolol hcl (generic of KERLONE)

bisoprolol fumarate (generic of ZEBETA)

BYSTOLIC

carvedilol (generic of COREG)

COREG

COREG CR

CORGARD

INDERAL LA

labetalol hcl SOLN

labetalol hcl (generic of TRANDATE) TABS

LOPRESSOR

metoprolol succinate (generic of TOPROL XL)

metoprolol tartrate (generic of LOPRESSOR) SOLN

metoprolol tartrate TABS 25mg

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 16

Drug Name Requirements/Limits

metoprolol tartrate (generic of LOPRESSOR) TABS 50mg, 100mg

nadolol (generic of CORGARD) TABS

pindolol

propranolol hcl er (generic of INDERAL LA)

propranolol inj 1mg/ml

propranolol sol

propranolol tab

SECTRAL

TENORMIN

timolol maleate TABS

TOPROL XL

TRANDATE

ZEBETA

CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS amlodipine besylate/atorv (generic of CADUET)

CADUET

CALCIUM CHANNEL BLOCKERS ADALAT CC

afeditab cr (generic of ADALAT CC)

amlodipine besylate (generic of NORVASC) TABS

CALAN

CALAN SR

CARDIZEM

CARDIZEM CD

CARDIZEM LA

cartia xt (generic of CARDIZEM CD)

dilacor

dilt-cd (generic of CARDIZEM CD)

dilt-cd cap 120mg (generic of CARDIZEM CD)

dilt-cd cap 180mg (generic of CARDIZEM CD)

dilt-cd cap 300mg (generic of CARDIZEM CD)

dilt-xr cap 120mg

dilt-xr cap 180mg

Drug Name Requirements/Limits

dilt-xr cap 240mg

diltiazem cap 60mg er

diltiazem cap 90mg er

diltiazem cap 120mg er

diltiazem cap 120mg/24 (generic of TIAZAC)

diltiazem hcl SOLN

diltiazem hcl SOLR

diltiazem hcl coated beads (generic of CARDIZEM CD)

DILTIAZEM HCL ER

diltiazem hcl extended release beads (generic of TIAZAC)

diltiazem inj 50/10ml

diltiazem tab 30mg (generic of CARDIZEM)

diltiazem tab 60mg (generic of CARDIZEM)

diltiazem tab 90mg

diltiazem tab 120mg (generic of CARDIZEM)

diltzac (generic of TIAZAC)

felodipine

isradipine

matzim la (generic of CARDIZEM LA)

nicardipine hcl CAPS

nifedical (generic of PROCARDIA XL)

nifedipine (generic of ADALAT CC) TB24

nifedipine er (generic of PROCARDIA XL)

nimodipine CAPS

nisoldipine (generic of SULAR) 8.5mg, 17mg, 34mg

nisoldipine 20mg, 25.5mg, 30mg, 40mg

NORVASC

NYMALIZE NM

PROCARDIA XL

SULAR

taztia xt (generic of TIAZAC)

TIAZAC

verapamil hcl (generic of VERELAN PM) CP24 100mg, 200mg, 300mg

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 17

Drug Name Requirements/Limits

verapamil hcl (generic of VERELAN) CP24 120mg, 180mg, 240mg

VERAPAMIL HCL CP24 360mg

verapamil hcl SOLN

verapamil hcl TABS 40mg

verapamil hcl (generic of CALAN) TABS 80mg, 120mg

verapamil hcl (generic of CALAN SR) TBCR

VERELAN

VERELAN PM

DIGITALIS GLYCOSIDES digoxin inj (generic of LANOXIN)

DIGOXIN SOL 50MCG/ML

digoxin tab 0.25mg (generic of LANOXIN)

digoxin tab 0.125mg (generic of LANOXIN)

LANOXIN INJ 0.25MG/ML

LANOXIN PEDIATRIC

LANOXIN TAB

LANOXIN TAB 0.25MG

LANOXIN TAB 0.125MG

DIRECT RENIN INHIBITORS/COMBINATIONS AMTURNIDE

TEKAMLO

TEKTURNA

TEKTURNA HCT

DIURETICS acetazolamide (generic of DIAMOX) CP12

acetazolamide TABS

acetazolamide sodium

ALDACTAZIDE

amiloride & hydrochlorothiazide

amiloride hcl

bumetanide

chlorothiazide

chlorthalidone 25mg, 50mg

DEMADEX

DIAMOX

DIURIL SUS 250/5ML

DYAZIDE

Drug Name Requirements/Limits

DYRENIUM

EDECRIN

furosemide SOLN

furosemide (generic of LASIX) TABS

furosemide inj

furosemide oral soln 8 mg/ml

hydrochlorothiazide (generic of MICROZIDE) CAPS

hydrochlorothiazide TABS

indapamide

LASIX

MAXZIDE

MAXZIDE-25

methazolamide (generic of NEPTAZANE) TABS

methyclothiazide

metolazone (generic of ZAROXOLYN) 2.5mg, 5mg

metolazone 10mg

MICROZIDE

SODIUM DIURIL

spironolactone & hydrochlorothiazide (generic of ALDACTAZIDE)

torsemide inj

torsemide tabs (generic of DEMADEX)

triamterene & hydrochlorothiazide

triamterene & hydrochlorothiazide cap 37.5-25 mg (generic of DYAZIDE)

triamterene & hydrochlorothiazide tab 37.5-25 mg (generic of MAXZIDE-25)

triamterene & hydrochlorothiazide tab 75-50 mg (generic of MAXZIDE)

ZAROXOLYN

MISCELLANEOUS BIDIL

CATAPRES

CATAPRES-TTS

clonidine hcl (generic of CATAPRES-TTS-1) PTWK .1mg/24hr

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 18

Drug Name Requirements/Limits

clonidine hcl (generic of CATAPRES-TTS-2) PTWK .2mg/24hr

clonidine hcl (generic of CATAPRES-TTS-3) PTWK .3mg/24hr

clonidine hcl (generic of CATAPRES) TABS

clorpres 0.1/15

clorpres 0.2/15

clorpres 0.3/15

DEMSER NM

DIBENZYLINE

guanfacine hcl (generic of TENEX)

hydralazine hcl soln

hydralazine hcl tabs

midodrine hcl

minoxidil TABS

RANEXA

TENEX

NITRATES DILATRATE SR

imdur

ISORDIL TITRADOSE

isosorbide dinitrate (generic of ISORDIL TITRADOSE) TABS 5mg

isosorbide dinitrate TABS 10mg, 20mg, 30mg

isosorbide dinitrate TBCR

isosorbide dinitrate sl tab 2.5 mg

isosorbide mononitrate TABS

isosorbide mononitrate (generic of IMDUR) TB24

minitran (generic of NITRO-DUR)

nitro-bid

NITRO-DUR

nitroglycerin (generic of NITROLINGUAL PUMPSPRAY) .4mg/spray

NITROGLYCERIN LINGUAL

nitroglycerin patches

NITROLINGUAL SPR PUMPSPRA

NITROMIST

Drug Name Requirements/Limits

NITROSTAT

PULMONARY ARTERIAL HYPERTENSION ADCIRCA NM

ADEMPAS NM

LETAIRIS NM LA

OPSUMIT NM

ORENITRAM .25mg, 1mg, 2.5mg

NM

ORENITRAM .125mg NM

REMODULIN B/D NM LA

REVATIO TABS NM

sildenafil citrate (pulmonary hypertension) (generic of REVATIO)

NM

TRACLEER NM LA

VENTAVIS B/D NM

CENTRAL NERVOUS SYSTEM ANTIANXIETY alprazolam CONC

alprazolam (generic of XANAX) TABS 1mg

alprazolam (generic of XANAX) TABS 2mg

alprazolam (generic of XANAX) TABS .5mg

alprazolam (generic of XANAX) TABS .25mg

ATIVAN SOLN

ATIVAN TABS

buspirone hcl TABS

fluvoxamine maleate

fluvoxamine maleate er (generic of LUVOX CR)

fluvoxamine tabs

lorazepam CONC

lorazepam (generic of ATIVAN) SOLN

lorazepam (generic of ATIVAN) TABS

LUVOX CR

XANAX 1mg

XANAX .5mg

XANAX .25mg

XANAX TAB 2MG

ANTICONVULSANTS APTIOM TAB 200MG

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 19

Drug Name Requirements/Limits

APTIOM TAB 400MG

APTIOM TAB 600MG

APTIOM TAB 800MG

BANZEL SUSP NM

BANZEL TABS 200mg

BANZEL TABS 400mg NM

carbamazepine CHEW

carbamazepine (generic of CARBATROL) CP12

carbamazepine (generic of TEGRETOL) SUSP; TABS

carbamazepine (generic of TEGRETOL-XR) TB12

CARBATROL

CELONTIN

clonazepam (generic of KLONOPIN) TABS 1mg

clonazepam (generic of KLONOPIN) TABS 2mg

clonazepam (generic of KLONOPIN) TABS .5mg

clonazepam TBDP 1mg

clonazepam TBDP 2mg

clonazepam TBDP .5mg

clonazepam TBDP .25mg

clonazepam TBDP .125mg

clorazepate dipotassium (generic of TRANXENE T) 3.75mg, 7.5mg

clorazepate dipotassium (generic of TRANXENE T) 15mg

DEPACON

DEPAKENE

DEPAKOTE

DEPAKOTE ER

DEPAKOTE SPRINKLES

DIASTAT ACUDIAL

DIASTAT PEDIATRIC

diazepam CONC

diazepam SOLN

diazepam (generic of VALIUM) TABS

DIAZEPAM GEL

diazepam inj

dilantin CAPS; CHEW

DILANTIN SUSP

Drug Name Requirements/Limits

divalproex sodium (generic of DEPAKOTE SPRINKLES) CPSP

divalproex sodium (generic of DEPAKOTE ER) TB24

divalproex sodium (generic of DEPAKOTE) TBEC

epitol (generic of TEGRETOL)

ethosuximide (generic of ZARONTIN) CAPS; SOLN

felbamate (generic of FELBATOL) SUSP

NM

felbamate (generic of FELBATOL) TABS 400mg

felbamate (generic of FELBATOL) TABS 600mg

NM

FELBATOL NM

FYCOMPA

gabapentin (generic of NEURONTIN) CAPS 100mg

gabapentin (generic of NEURONTIN) CAPS 300mg

gabapentin (generic of NEURONTIN) CAPS 400mg

gabapentin (generic of NEURONTIN) SOLN

gabapentin (generic of NEURONTIN) TABS 600mg

gabapentin (generic of NEURONTIN) TABS 800mg

GABITRIL

KEPPRA SOLN 100mg/ml

KEPPRA SOLN 500mg/5ml NM

KEPPRA TABS 250mg, 500mg

KEPPRA TABS 750mg, 1000mg

NM

KEPPRA XR 500mg

KEPPRA XR 750mg NM

KLONOPIN 1mg

KLONOPIN 2mg

KLONOPIN .5mg

LAMICTAL TABS

LAMICTAL CHEWABLE DISPERS 5mg

LAMICTAL CHEWABLE DISPERS 25mg

NM

LAMICTAL ODT

LAMICTAL STARTER

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 20

Drug Name Requirements/Limits

LAMICTAL XR

lamotrigine (generic of LAMICTAL CHEWABLE DISPERS) CHEW

lamotrigine (generic of LAMICTAL) TABS

lamotrigine (generic of LAMICTAL XR) TB24

levetiracetam (generic of KEPPRA) SOLN; TABS

levetiracetam (generic of KEPPRA XR) TB24

LYRICA CAPS 25mg, 50mg, 75mg, 100mg, 150mg

LYRICA CAPS 200mg

LYRICA CAPS 225mg, 300mg

LYRICA SOLN

MYSOLINE

NEURONTIN CAPS 100mg

NEURONTIN CAPS 300mg

NEURONTIN CAPS 400mg

NEURONTIN SOLN

NEURONTIN TABS 600mg

NEURONTIN TABS 800mg

ONFI SUS 2.5MG/ML

ONFI TAB 10MG

ONFI TAB 20MG

oxcarbazepine (generic of TRILEPTAL)

OXTELLAR XR

PEGANONE

phenobarbital ELIX; TABS

PHENOBARBITAL SODIUM 65mg/ml

phenobarbital sodium 130mg/ml

phenytek

phenytoin (generic of DILANTIN INFATABS) CHEW

phenytoin (generic of DILANTIN) SUSP

phenytoin inj 50mg/ml

phenytoin sodium extended (generic of DILANTIN) 100mg

phenytoin sodium extended (generic of PHENYTEK) 200mg, 300mg

POTIGA

Drug Name Requirements/Limits

primidone (generic of MYSOLINE) TABS

QUDEXY XR

SABRIL NM LA

STAVZOR

TEGRETOL

TEGRETOL-XR

tiagabine hcl (generic of GABITRIL)

TOPAMAX 25mg, 50mg, 100mg

TOPAMAX 200mg NM

TOPAMAX SPRINKLE 15mg

TOPAMAX SPRINKLE 25mg NM

topiramate (generic of TOPAMAX SPRINKLE) CPSP

topiramate (generic of TOPAMAX) TABS

TOPIRAMATE ER

TRANXENE T 3.75mg, 7.5mg

TRANXENE T 15mg

TRILEPTAL

TRILEPTAL SUSP

TROKENDI XR

VALIUM

valproate sodium (generic of DEPACON) SOLN

valproate sodium (generic of DEPAKENE) SYRP

valproic acid (generic of DEPAKENE) CAPS

VIMPAT

ZARONTIN CAPS

zarontin SOLN

ZONEGRAN

zonisamide (generic of ZONEGRAN) 25mg, 100mg

zonisamide 50mg

ANTIDEMENTIA ARICEPT

ARICEPT ODT

donepezil odt 5mg

donepezil odt 10mg (generic of ARICEPT ODT)

donepezil tab hcl 23mg (generic of ARICEPT)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 21

Drug Name Requirements/Limits

donepezil tabs 5mg (generic of ARICEPT)

donepezil tabs 10mg (generic of ARICEPT)

EXELON CAP

EXELON PATCHES

galantamine hydrobromide (generic of RAZADYNE ER) CP24

galantamine hydrobromide (generic of RAZADYNE) SOLN; TABS

NAMENDA

NAMENDA TITRATION PAK

NAMENDA XR CAP 7MG

NAMENDA XR CAP 14MG

NAMENDA XR CAP 21MG

NAMENDA XR CAP 28MG

NAMENDA XR CAP TITRATIO

RAZADYNE

RAZADYNE ER

rivastigmine tartrate (generic of EXELON)

ANTIDEPRESSANTS amitriptyline hcl TABS

amoxapine

ANAFRANIL NM

APLENZIN

BRINTELLIX 5mg

BRINTELLIX 10mg

BRINTELLIX 20mg

budeprion tab 150 mg sr (generic of WELLBUTRIN SR)

bupropion hcl (generic of WELLBUTRIN) TABS

bupropion hcl (generic of WELLBUTRIN SR) TB12

bupropion hcl (generic of WELLBUTRIN XL) TB24

CELEXA

citalopram hydrobromide SOLN

citalopram hydrobromide (generic of CELEXA) TABS

clomipramine hcl (generic of ANAFRANIL) CAPS

CYMBALTA CAP 20MG

CYMBALTA CAP 30MG

Drug Name Requirements/Limits

CYMBALTA CAP 60MG

desipramine hcl (generic of NORPRAMIN) TABS

doxepin hcl CAPS; CONC

duloxetine hcl (generic of CYMBALTA) CPEP

EFFEXOR XR

EMSAM

escitalopram oxalate (generic of LEXAPRO)

FETZIMA 20mg

FETZIMA 40mg

FETZIMA 80mg, 120mg

FETZIMA TITRATION PACK

fluoxetine hcl (generic of PROZAC) CAPS

fluoxetine hcl (generic of PROZAC WEEKLY) CPDR

fluoxetine hcl SOLN

fluoxetine hcl TABS 10mg, 20mg

FLUOXETINE HCL TABS 60mg

FORFIVO XL

imipramine hcl (generic of TOFRANIL) TABS

imipramine pamoate (generic of TOFRANIL-PM)

LEXAPRO

maprotiline hcl

MARPLAN

mirtazapine TABS 7.5mg

mirtazapine (generic of REMERON) TABS 15mg, 30mg, 45mg

mirtazapine (generic of REMERON SOLTAB) TBDP

NARDIL

nefazodone hcl

NORPRAMIN

nortriptyline hcl (generic of PAMELOR) CAPS

nortriptyline hcl SOLN

OLEPTRO

PAMELOR NM

PARNATE

paroxetine er tab (generic of PAXIL CR)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

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Drug Name Requirements/Limits

paroxetine hcl (generic of PAXIL)

PAXIL

PAXIL CR

PEXEVA

phenelzine sulfate (generic of NARDIL) TABS

PRISTIQ

protriptyline hcl (generic of VIVACTIL)

PROZAC

PROZAC WEEKLY

REMERON

REMERON SOLTAB

sertraline hcl (generic of ZOLOFT) CONC; TABS

SURMONTIL

tofranil

TOFRANIL-PM

tranylcypromine sulfate (generic of PARNATE)

trazodone hcl TABS

trimipramine maleate

venlafaxine cap er (generic of EFFEXOR XR)

VENLAFAXINE HCL ER TAB (VERT)

venlafaxine tab

VENLAFAXINE TAB 225MG ER

venlafaxine tab er (generic of VENLAFAXINE HCL ER)

VIIBRYD

vivactil

WELLBUTRIN

WELLBUTRIN SR

WELLBUTRIN XL

ZOLOFT

ANTIPARKINSONIAN AGENTS amantadine hcl CAPS; SYRP; TABS

APOKYN NM LA

AZILECT

benztropine mesylate (generic of COGENTIN) SOLN

benztropine mesylate TABS

bromocriptine mesylate (generic of PARLODEL) CAPS

Drug Name Requirements/Limits

bromocriptine mesylate TABS

carbidopa (generic of LODOSYN) TABS

carbidopa-levodopa (generic of SINEMET) TABS

carbidopa-levodopa (generic of SINEMET CR) TBCR

carbidopa-levodopa TBDP

CARBIDOPA/LEVODOPA/ENTACAPONE

CARBIDOPA/LEVODOPA/ENTACAPONE

CARBIDOPA/LEVODOPA/ENTACAPONE

CARBIDOPA/LEVODOPA/ENTACAPONE

CARBIDOPA/LEVODOPA/ENTACAPONE

CARBIDOPA/LEVODOPA/ENTACAPONE

COGENTIN

COMTAN

ELDEPRYL

ENTACAPONE

LODOSYN

MIRAPEX

MIRAPEX ER TAB 0.75MG

MIRAPEX ER TAB 0.375MG

MIRAPEX ER TAB 1.5MG

MIRAPEX ER TAB 2.25MG

MIRAPEX ER TAB 3.75MG

MIRAPEX ER TAB 3MG

MIRAPEX ER TAB 4.5MG

NEUPRO

parcopa 10/100

parcopa 25/100

parcopa 25/250

PARLODEL

pramipexole dihydrochloride .75mg

pramipexole dihydrochloride (generic of MIRAPEX) .125mg, .25mg, .5mg, 1mg, 1.5mg

REQUIP

REQUIP XL

ropinirole hydrochloride (generic of REQUIP) TABS

2014 601 4T Copper BvD Comm_NT (Effective November 1)

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Drug Name Requirements/Limits

ropinirole hydrochloride (generic of REQUIP XL) TB24

selegiline hcl (generic of ELDEPRYL) CAPS

selegiline hcl TABS

SINEMET

SINEMET CR

STALEVO

trihexyphenidyl hcl

ZELAPAR TAB 1.25MG

ANTIPSYCHOTICS ABILIFY SOLN NM

ABILIFY TABS 2mg, 5mg, 10mg, 15mg

ABILIFY TABS 20mg, 30mg NM

ABILIFY DISCMELT NM

ABILIFY INJ

ABILIFY MAINTENA NM

chlorpromaz inj 25mg/ml

chlorpromazine hcl TABS

CLOZAPINE ODT

clozapine tab (generic of CLOZARIL) 25mg, 100mg

clozapine tab 50mg, 200mg

CLOZARIL 25mg

CLOZARIL 100mg NM

FANAPT

FANAPT TITRATION PACK

FAZACLO

fluphenazine decanoate SOLN

fluphenazine hcl

GEODON

GEODON INJ

HALDOL

HALDOL DECANOATE 50

HALDOL DECANOATE 100

haloperidol TABS

haloperidol decanoate (generic of HALDOL DECANOATE 50) SOLN 50mg/ml

haloperidol decanoate (generic of HALDOL DECANOATE 100) SOLN 100mg/ml

haloperidol lactate CONC

haloperidol lactate (generic of HALDOL) SOLN

Drug Name Requirements/Limits

INVEGA

INVEGA SUSTENNA 39mg/0.25ml, 78mg/0.5ml

INVEGA SUSTENNA 117mg/0.75ml, 156mg/ml, 234mg/1.5ml

NM

LATUDA TAB 20MG

LATUDA TAB 40MG

LATUDA TAB 60MG

LATUDA TAB 80MG

LATUDA TAB 120MG

loxapine succinate

loxitane

NAVANE

olanzapine (generic of ZYPREXA) SOLR

olanzapine (generic of ZYPREXA) TABS

olanzapine odt (generic of ZYPREXA ZYDIS) 5mg, 10mg, 15mg

olanzapine odt (generic of ZYPREXA ZYDIS) 20mg

NM

ORAP

perphenazine TABS

quetiapine fumarate (generic of SEROQUEL)

RISPERDAL

RISPERDAL CONSTA 12.5mg, 25mg

RISPERDAL CONSTA 37.5mg, 50mg

NM

RISPERDAL M-TAB

risperidone (generic of RISPERDAL)

risperidone odt (generic of RISPERDAL M-TAB) .5mg, 1mg, 2mg, 3mg, 4mg

risperidone odt .25mg

SAPHRIS

SEROQUEL

SEROQUEL XR

thioridazine hcl TABS

thiothixene

trifluoperazine hcl

VERSACLOZ NM

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 24

Drug Name Requirements/Limits

ziprasidone hcl (generic of GEODON)

ZYPREXA SOLR

ZYPREXA TABS 2.5mg, 5mg, 7.5mg, 10mg

ZYPREXA TABS 15mg, 20mg NM

ZYPREXA ZYDIS 5mg

ZYPREXA ZYDIS 10mg, 15mg, 20mg

NM

ATTENTION DEFICIT HYPERACTIVITY DISORDER adderall tab 5mg

adderall tab 7.5mg

adderall tab 10mg

adderall tab 12.5mg

adderall tab 15mg

adderall tab 20mg

adderall tab 30mg

ADDERALL XR CAP 5MG

ADDERALL XR CAP 10MG

ADDERALL XR CAP 15MG

ADDERALL XR CAP 20MG

ADDERALL XR CAP 25MG

ADDERALL XR CAP 30MG

amphetamine-dextroamphetamine cap sr 24hr 5 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 10 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 15 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 20 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 25 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 30 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine tab 5 mg (generic of ADDERALL)

Drug Name Requirements/Limits

amphetamine-dextroamphetamine tab 7.5 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 10 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 12.5 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 15 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 20 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 30 mg (generic of ADDERALL)

CONCERTA 18mg, 27mg, 36mg

CONCERTA 54mg

DAYTRANA

INTUNIV

METADATE CD 10mg, 20mg, 30mg

METADATE CD 40mg, 50mg, 60mg

metadate tab 20mg er (generic of RITALIN SR)

METHYLIN 5mg/5ml

METHYLIN 10mg/5ml

METHYLIN CHEW TAB

methylphenidate hcl (generic of RITALIN LA) CP24 20mg, 30mg

methylphenidate hcl (generic of RITALIN LA) CP24 40mg

methylphenidate hcl (generic of METADATE CD) CPCR 10mg, 20mg, 30mg

methylphenidate hcl (generic of METADATE CD) CPCR 40mg, 50mg, 60mg

methylphenidate hcl (generic of METHYLIN) SOLN 5mg/5ml

methylphenidate hcl (generic of METHYLIN) SOLN 10mg/5ml

methylphenidate hcl (generic of RITALIN) TABS 5mg, 10mg

2014 601 4T Copper BvD Comm_NT (Effective November 1)

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Drug Name Requirements/Limits

methylphenidate hcl (generic of RITALIN) TABS 20mg

methylphenidate hcl er (generic of CONCERTA) 18mg, 27mg, 36mg

methylphenidate hcl er (generic of CONCERTA) 54mg

methylphenidate tab 10mg er

methylphenidate tab 20mg er (generic of RITALIN SR)

QUILLIVANT XR

RITALIN 5mg, 10mg

RITALIN 20mg

RITALIN LA 10mg, 20mg, 30mg

RITALIN LA 40mg

RITALIN SR

STRATTERA 10mg, 18mg, 25mg

STRATTERA 40mg

STRATTERA 60mg, 80mg, 100mg

VYVANSE 20mg, 30mg

VYVANSE 40mg, 50mg, 60mg, 70mg

HYPNOTICS AMBIEN

AMBIEN CR

EDLUAR

eszopiclone (generic of LUNESTA)

INTERMEZZO

LUNESTA

RESTORIL 7.5mg

RESTORIL 15mg

ROZEREM

SILENOR TAB 3MG

SILENOR TAB 6MG

SONATA

temazepam (generic of RESTORIL) 7.5mg

temazepam (generic of RESTORIL) 15mg

zaleplon (generic of SONATA)

zolpidem tartrate (generic of AMBIEN) TABS

zolpidem tartrate (generic of AMBIEN CR) TBCR

Drug Name Requirements/Limits

ZOLPIMIST

MIGRAINE ALSUMA

AMERGE

AXERT

cafergot tab 1-100mg

D.H.E. 45 NM

dihydroergotamine mesylate (generic of D.H.E. 45) 1mg/ml

DIHYDROERGOTAMINE MESYLATE 4mg/ml

ergomar

FROVA TAB 2.5MG

IMITREX SOLN 5mg/act, 20mg/act

IMITREX SOLN 6mg/0.5ml

IMITREX TABS

IMITREX STATDOSE REFILL

IMITREX STATDOSE SYSTEM

MAXALT

MAXALT-MLT

migergot

MIGRANAL NM

naratriptan hcl (generic of AMERGE)

RELPAX TAB 20MG

RELPAX TAB 40MG

rizatriptan benzoate (generic of MAXALT) TABS

rizatriptan benzoate (generic of MAXALT-MLT) TBDP

SUMATRIPTAN SUCCINATE SOLN 5mg/act, 20mg/act

sumatriptan succinate (generic of IMITREX) TABS

SUMATRIPTAN SUCCINATE INJ SOAJ 4mg/0.5ml

sumatriptan succinate inj (generic of IMITREX STATDOSE SYSTEM) SOAJ 6mg/0.5ml

SUMATRIPTAN SUCCINATE INJ SOCT 4mg/0.5ml

SUMATRIPTAN SUCCINATE INJ SOCT 6mg/0.5ml

sumatriptan succinate inj (generic of IMITREX) SOLN

sumatriptan succinate inj SOSY

2014 601 4T Copper BvD Comm_NT (Effective November 1)

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Drug Name Requirements/Limits

SUMAVEL DOSEPRO 6mg/0.5ml

TREXIMET

zolmitriptan (generic of ZOMIG) TABS

zolmitriptan odt (generic of ZOMIG ZMT)

ZOMIG

ZOMIG NASAL SPRAY

ZOMIG ZMT

MISCELLANEOUS BRISDELLE

EQUETRO

GRALISE 300mg

GRALISE 600mg

GRALISE STARTER

HORIZANT

LITHIUM

lithium carbonate CAPS

lithium carbonate TABS

lithium carbonate (generic of LITHOBID) TBCR 300mg

lithium carbonate TBCR 450mg

LITHOBID

MESTINON SYRUP

MESTINON TAB

MESTINON TIMESPAN

NUEDEXTA

pyridostigmine bromide (generic of MESTINON) TABS

RILUTEK NM

riluzole (generic of RILUTEK)

SAVELLA 12.5mg

SAVELLA 25mg

SAVELLA 50mg

SAVELLA 100mg

SAVELLA TITRATION PACK

XENAZINE NM LA

MULTIPLE SCLEROSIS AGENTS AMPYRA NM LA

AUBAGIO NM

AVONEX NM

AVONEX PEN NM

BETASERON NM

COPAXONE INJ 40MG/ML NM

COPAXONE KIT 20MG/ML NM

Drug Name Requirements/Limits

EXTAVIA NM

GILENYA NM

REBIF NM

REBIF TITRATION PACK NM

TECFIDERA CAP 120MG NM

TECFIDERA CAP 240MG NM

TECFIDERA MIS STARTER NM

TYSABRI NM LA

MUSCULOSKELETAL THERAPY AGENTS AMRIX 15mg

AMRIX 30mg

baclofen TABS

carisoprodol (generic of SOMA) TABS 350mg

chlorzoxazone (generic of PARAFON FORTE DSC)

cyclobenzaprine hcl TABS 5mg, 10mg

cyclobenzaprine hcl (generic of FEXMID) TABS 7.5mg

DANTRIUM

dantrolene sodium (generic of DANTRIUM) CAPS 25mg, 50mg

dantrolene sodium CAPS 100mg

fexmid

methocarbamol (generic of ROBAXIN) TABS 500mg

methocarbamol (generic of ROBAXIN-750) TABS 750mg

PARAFON FORTE DSC

SOMA 350mg

tizanidine (generic of ZANAFLEX) CAPS

tizanidine TABS 2mg

tizanidine (generic of ZANAFLEX) TABS 4mg

ZANAFLEX CAPS

ZANAFLEX TABS

NARCOLEPSY/CATAPLEXY modafinil (generic of PROVIGIL) 100mg

modafinil (generic of PROVIGIL) 200mg

NM

NUVIGIL

PROVIGIL NM

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 27

Drug Name Requirements/Limits

XYREM NM LA

PSYCHOTHERAPEUTIC-MISC acamprosate calcium (generic of CAMPRAL)

antabuse

buprenorphine hcl SUBL

buprenorphine hcl-naloxone hcl sl

buproban (generic of ZYBAN)

CAMPRAL TAB 333MG

CHANTIX PAK 0.5& 1MG

CHANTIX TAB 0.5MG

CHANTIX TAB 1MG

disulfiram (generic of ANTABUSE) TABS

naloxone hcl SOLN

naltrexone hcl (generic of REVIA) TABS

NICOTROL INHALER

NICOTROL NS

revia

SARAFEM

SUBOXONE MIS 2-0.5MG

SUBOXONE MIS 4-1MG

SUBOXONE MIS 8-2MG

SUBOXONE MIS 12-3MG

VIVITROL NM

ZUBSOLV

ZYBAN

ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM

ANDROGEL 1%

ANDROGEL 1.62%

androxy

AXIRON

DELATESTRYL

depo-testosterone

FORTESTA

oxandrolone (generic of OXANDRIN) TABS

STRIANT

TESTIM

testosterone cypionate SOLN 100mg/ml

Drug Name Requirements/Limits

testosterone cypionate (generic of DEPO-TESTOSTERONE) SOLN 200mg/ml

testosterone enanthate SOLN

VOGELXO

VOGELXO PUMP

ANTIDIABETICS, INJECTABLE ALCOHOL PREPS PADS

APIDRA

APIDRA SOLOSTAR

BYDUREON PEN

BYDUREON SUSR

BYETTA INJ 5MCG

BYETTA INJ 10MCG

GAUZE PADS 2X2

HUMALOG

HUMALOG KWIKPEN

HUMALOG MIX 50/50

HUMALOG MIX 50/50 KWIKPEN

HUMALOG MIX 75/25

HUMALOG MIX 75/25 KWIKPEN

HUMULIN 70/30

HUMULIN 70/30 PEN

HUMULIN N

HUMULIN N U-100 PEN

HUMULIN R

HUMULIN R U-500 (CONCENTRATE)

B/D NM

INSULIN PEN NEEDLES

INSULIN SAFETY NEEDLES

INSULIN SYRINGES

LANTUS

LANTUS SOLOSTAR

LEVEMIR

LEVEMIR FLEXPEN

LEVEMIR FLEXTOUCH

NOVOLIN 70/30

NOVOLIN 70/30 RELION

NOVOLIN N

NOVOLIN N RELION

NOVOLIN R

NOVOLIN R RELION

NOVOLOG

NOVOLOG FLEXPEN

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 28

Drug Name Requirements/Limits

NOVOLOG MIX 70/30

NOVOLOG MIX 70/30 PREFILL

NOVOLOG PENFILL

SYMLINPEN 60

SYMLINPEN 120

TANZEUM

VICTOZA

ANTIDIABETICS, ORAL acarbose (generic of PRECOSE)

ACTOPLUS MET TAB 15-500MG

ACTOPLUS MET TAB 15-850MG

ACTOPLUS MET XR 15-1000MG

ACTOPLUS MET XR 30-1000MG

ACTOS

AMARYL 1mg

AMARYL 2mg

AMARYL 4mg

DIABETA 1.25mg

DIABETA 2.5mg

DIABETA 5mg

DUETACT

FARXIGA 5mg

FARXIGA 10mg

FORTAMET 500mg

FORTAMET 1000mg

glimepiride (generic of AMARYL) 1mg

glimepiride (generic of AMARYL) 2mg

glimepiride (generic of AMARYL) 4mg

glipizide (generic of GLUCOTROL) TABS 5mg

glipizide (generic of GLUCOTROL) TABS 10mg

glipizide er (generic of GLUCOTROL XL) 2.5mg

glipizide er (generic of GLUCOTROL XL) 5mg

glipizide er (generic of GLUCOTROL XL) 10mg

glipizide-metformin 2.5-250mg

glipizide-metformin 2.5-500mg

glipizide-metformin 5-500mg

GLUCOPHAGE 500mg

GLUCOPHAGE 850mg

Drug Name Requirements/Limits

GLUCOPHAGE 1000mg

GLUCOPHAGE XR 500mg

GLUCOPHAGE XR 750mg

GLUCOTROL 5mg

GLUCOTROL 10mg

GLUCOTROL XL 2.5mg

GLUCOTROL XL 5mg

GLUCOTROL XL 10mg

GLUCOVANCE 1.25-250MG

GLUCOVANCE 2.5-500MG

GLUCOVANCE 5-500MG

GLUMETZA 500mg

GLUMETZA 1000mg

glyburide 1.25mg

glyburide 2.5mg

glyburide 5mg

glyburide micronized (generic of GLYNASE) 1.5mg

glyburide micronized (generic of GLYNASE) 3mg

glyburide micronized (generic of GLYNASE) 6mg

glyburide-metformin 1.25-250mg (generic of GLUCOVANCE)

glyburide-metformin 2.5-500mg (generic of GLUCOVANCE)

glyburide-metformin 5-500mg (generic of GLUCOVANCE)

GLYNASE 1.5mg

GLYNASE 3mg

GLYNASE 6mg

GLYSET

INVOKAMET TAB 50-500 MG

INVOKAMET TAB 50-1000 MG

INVOKAMET TAB 150-500 MG

INVOKAMET TAB 150-1000 MG

INVOKANA TAB 100MG

INVOKANA TAB 300MG

JANUMET

JANUMET XR TAB 50-500MG

JANUMET XR TAB 50-1000

JANUMET XR TAB 100-1000

JANUVIA

JENTADUETO

KAZANO

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 29

Drug Name Requirements/Limits

KOMBIGLYZE XR 2.5-1000MG

KOMBIGLYZE XR 5-500MG

KOMBIGLYZE XR 5-1000MG

metformin er (generic of GLUCOPHAGE XR) 500mg

metformin er (generic of GLUCOPHAGE XR) 750mg

metformin hcl (generic of GLUCOPHAGE) TABS 500mg

metformin hcl (generic of GLUCOPHAGE) TABS 850mg

metformin hcl (generic of GLUCOPHAGE) TABS 1000mg

metformin hcl (generic of FORTAMET) TB24 500mg

metformin hcl (generic of FORTAMET) TB24 1000mg

nateglinide (generic of STARLIX)

NESINA 6.25mg

NESINA 12.5mg

NESINA 25mg

ONGLYZA

OSENI TAB 12.5-15MG

OSENI TAB 12.5-30MG

OSENI TAB 12.5-45MG

OSENI TAB 25-15MG

OSENI TAB 25-30MG

OSENI TAB 25-45MG

pioglitazone hcl (generic of ACTOS)

pioglitazone hcl-glimepiride (generic of DUETACT)

pioglitazone hcl-metformin hcl (generic of ACTOPLUS MET)

PRANDIMET

PRANDIN 2mg

PRANDIN .5mg, 1mg

PRECOSE

repaglinide (generic of PRANDIN) 2mg

repaglinide (generic of PRANDIN) .5mg, 1mg

RIOMET

STARLIX

TRADJENTA

BISPHOSPHONATES

Drug Name Requirements/Limits

ACTONEL

alendronate sodium SOLN

alendronate sodium TABS 5mg, 10mg, 35mg, 40mg

alendronate sodium (generic of FOSAMAX) TABS 70mg

ATELVIA

BINOSTO

BONIVA SOLN B/D

BONIVA TABS B/D

FOSAMAX

FOSAMAX PLUS D

ibandronate sodium (generic of BONIVA)

B/D

pamidronate disodium SOLN 6mg/ml

B/D

pamidronate disodium SOLN 30mg/10ml, 90mg/10ml

B/D

risedronate sodium (generic of ACTONEL)

zoledronic inj 4mg/5ml (generic of ZOMETA)

B/D NM

ZOMETA B/D NM

CALCIUM RECEPTOR ANTAGONISTS SENSIPAR 30mg NM

SENSIPAR 60mg, 90mg NM

CHELATING AGENTS CHEMET

EXJADE NM LA

FERRIPROX NM

KAYEXALATE

kionex (generic of KAYEXALATE) POWD

kionex SUSP

sodium polystyrene sulfonate

sps sus 15gm/60ml

SYPRINE NM

CONTRACEPTIVES altavera

amethia 91 day (generic of SEASONIQUE)

amethyst 28 day

apri 28 day (generic of DESOGEN)

aranelle 28 (generic of TRI-NORINYL 28)

aubra 28 day

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 30

Drug Name Requirements/Limits

aviane 28

balziva 28 day (generic of OVCON-35)

BEYAZ

BREVICON-28

briellyn 28 day (generic of OVCON-35)

camila 28 day (generic of NOR-QD)

CAMRESE LO TAB

cryselle 28

cyclafem 1/35 28 day (generic of NORINYL 1+35)

cyclafem 7/7/7 28 day (generic of ORTHO-NOVUM 7/7/7)

CYCLESSA

delyla 28 day

DEPO-PROVERA CONTRACEPTIV

DEPO-SUBQ PROVERA 104

DESOGEN

drospirenone-ethinyl estradiol (generic of YASMIN 28)

ELLA

emoquette (generic of DESOGEN)

enpresse 28 day

errin 28 day (generic of ORTHO MICRONOR)

ESTROSTEP FE

falmina 28 day

FEMCON FE

GENERESS FE

GIANVI

gildagia (generic of OVCON-35)

gildess 1.5/30 21 day (generic of LOESTRIN 1.5/30-21)

heather tab 0.35mg (generic of NOR-QD)

introvale 91 day

JOLIVETTE

junel 1.5/30 21 day (generic of LOESTRIN 1.5/30-21)

junel 1/20 21 day (generic of LOESTRIN 1/20-21)

junel fe 1.5/30 28 day (generic of LOESTRIN FE 1.5/30)

Drug Name Requirements/Limits

junel fe 1/20 28 day (generic of LOESTRIN FE 1/20)

kariva 28 day (generic of MIRCETTE)

kelnor 1/35 28 day

larin 1.5/30 (generic of LOESTRIN 1.5/30-21)

larin 1/20 (generic of LOESTRIN 1/20-21)

larin fe 1.5/30 (generic of LOESTRIN FE 1.5/30)

larin fe 1/20 (generic of LOESTRIN FE 1/20)

LEENA

lessina 28 day

levonest 28 day

levonorgestrel (emergency oc) (generic of PLAN B ONE-STEP) 1.5mg

levonorgestrel (emergency oc) (generic of PLAN B) .75mg

levonorgestrel-ethinyl estradiol (91-day)

levora 0.15/30 28 day

LO LOESTRIN FE

LO MINASTRIN FE

loestrin 1.5/30-21

loestrin 1/20-21

LOESTRIN 24 FE

loestrin fe 1.5/30

loestrin fe 1/20

lomedia 24 fe

loryna 28 day (generic of YAZ)

LOSEASONIQUE

low-ogestrel 28 day

lutera 28 day

lyza (generic of ORTHO MICRONOR)

marlissa 28 day

medroxyprogesterone acetate (contraceptive) (generic of DEPO-PROVERA CONTRACEPTIV)

MICROGESTIN TAB 1.5/30

MICROGESTIN TAB 1/20

MINASTRIN 24 CHW FE

MODICON

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 31

Drug Name Requirements/Limits

MONONESSA

my way (generic of PLAN B ONE-STEP)

myzilra

necon 0.5/35 28 day (generic of BREVICON-28)

necon 1/35 28 day (generic of NORINYL 1+35)

NECON 7/7/7

necon 10/11 28 day

NECON TAB 1/50-28

next choice tab 1.5mg (generic of PLAN B ONE-STEP)

nikki 28 day (generic of YAZ)

NOR-QD

NORA-BE

norethindrone (contraceptive) (generic of NOR-QD)

norgestimate-ethinyl estradiol (triphasic) (generic of ORTHO TRI-CYCLEN)

NORINYL 1+35

NORINYL 1+50

norlyroc 28 day (generic of NOR-QD)

nortrel 0.5/35 28 day (generic of BREVICON-28)

nortrel 1/35 21 day (generic of NORINYL 1+35)

nortrel 1/35 28 day (generic of NORINYL 1+35)

nortrel 7/7/7 28 day (generic of ORTHO-NOVUM 7/7/7)

NUVARING

OCELLA

ogestrel 28 day

orsythia 28 day

ORTHO EVRA

ORTHO MICRONOR

ORTHO TRI-CYCLEN LO

ORTHO-CEPT

ORTHO-CYCLEN

ORTHO-NOVUM 1/35

ORTHO-NOVUM 7/7/7

ovcon 35 28 day

philith (generic of OVCON-35)

Drug Name Requirements/Limits

pimtrea pack (generic of MIRCETTE)

pirmella 1/35 28 day (generic of NORINYL 1+35)

portia 28 day

previfem 28 day (generic of ORTHO-CYCLEN)

QUARTETTE

quasense 91 day

reclipsen 28 day (generic of DESOGEN)

SEASONIQUE

SOLIA

sprintec 28 day (generic of ORTHO-CYCLEN)

sronyx 28 day

syeda (generic of YASMIN 28)

tri-legest 28 day (generic of ESTROSTEP FE)

TRI-NORINYL 28

tri-previfem 28 day (generic of ORTHO TRI-CYCLEN)

tri-sprintec 28 day (generic of ORTHO TRI-CYCLEN)

TRINESSA

trivora 28 day

velivet 28 day (generic of CYCLESSA)

vestura (generic of YAZ)

viorele (generic of MIRCETTE)

vyfemla (generic of OVCON-35)

xulane (generic of ORTHO EVRA)

YASMIN 28

YAZ

zarah (generic of YASMIN 28)

zenchent 28 day (generic of OVCON-35)

zenchent fe 28 day (generic of FEMCON FE)

zovia 1/35e 28 day

zovia 1/50e 28 day

ENDOMETRIOSIS danazol CAPS

LUPANETA PACK NM

SYNAREL NM

ENZYME REPLACEMENTS

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 32

Drug Name Requirements/Limits

ADAGEN NM LA

ALDURAZYME NM LA

BUPHENYL NM

BUPHENYL TAB 500MG NM

CARBAGLU NM LA

CARNITOR SOLN 1gm/10ml B/D

CARNITOR SOLN 200mg/ml B/D

CARNITOR TABS B/D

CEREZYME NM

CYSTADANE NM

CYSTAGON NM

ELAPRASE NM

ELELYSO NM

FABRAZYME NM

KUVAN NM

levocarnitine (metabolic modifiers) (generic of CARNITOR)

B/D

LUMIZYME NM

MYOZYME NM

NAGLAZYME NM LA

ORFADIN NM LA

PROCYSBI NM LA

sodium phenylbutyrate (generic of BUPHENYL)

NM

VIMIZIM NM

VPRIV NM

ZAVESCA NM LA

ESTROGEN/PROGESTINS estradiol & norethindrone acetate (generic of ACTIVELLA)

jinteli

mimvey lo 28 day (generic of ACTIVELLA)

ESTROGENS ALORA

CLIMARA

COMBIPATCH

DELESTROGEN

depo-estradiol

estrace CREA

estrace TABS

estradiol (generic of CLIMARA) PTWK

estradiol (generic of ESTRACE) TABS

Drug Name Requirements/Limits

ESTRADIOL VALERATE OIL 10mg/ml

estradiol valerate (generic of DELESTROGEN) OIL 20mg/ml, 40mg/ml

ESTRING

estropipate

FEMRING

menest

MENOSTAR

MINIVELLE DIS 0.1MG

MINIVELLE DIS 0.05MG

MINIVELLE DIS 0.075MG

MINIVELLE DIS 0.0375MG

PREMARIN

PREMARIN CREAM

PREMARIN INJ

PREMPHASE

PREMPRO

VAGIFEM

VIVELLE-DOT

GLUCOCORTICOIDS a-hydrocort inj 100mg

CORTEF

cortisone acetate TABS

DEPO-MEDROL

dexamethasone CONC

dexamethasone ELIX; SOLN; TABS

dexamethasone sodium phosphate

dexpak taperpak 13 day

FLO-PRED

fludrocortisone acetate TABS

hydrocortisone (generic of CORTEF) TABS

MEDROL

MEDROL DOSEPAK

methylprednisolone (generic of MEDROL DOSEPAK) TABS 4mg

methylprednisolone (generic of MEDROL) TABS 4mg, 8mg, 16mg, 32mg

methylprednisolone acetate (generic of DEPO-MEDROL)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 33

Drug Name Requirements/Limits

methylprednisolone sod succ (generic of SOLU-MEDROL)

millipred

orapred

ORAPRED ODT

pediapred

prednisolone (generic of PRELONE)

prednisolone sodium phosphate (generic of PEDIAPRED) 5mg/5ml

prednisolone sodium phosphate 15mg/5ml, 25mg/5ml

prednisone CONC

prednisone SOLN; TABS

RAYOS

SOLU-CORTEF 100MG

SOLU-CORTEF 250MG

SOLU-CORTEF 500MG

SOLU-CORTEF 1000MG

SOLU-MEDROL

veripred

GLUCOSE ELEVATING AGENTS GLUCAGEN HYPOKIT

GLUCAGON EMERGENCY KIT

PROGLYCEM NM

HUMAN GROWTH HORMONES GENOTROPIN NM

GENOTROPIN MINIQUICK .2mg

NM

GENOTROPIN MINIQUICK .4mg, .6mg, .8mg, 1mg, 1.2mg, 1.4mg, 1.6mg, 1.8mg, 2mg

NM

HUMATROPE NM

HUMATROPE COMBO PACK NM

NORDITROPIN FLEXPRO NM

NORDITROPIN NORDIFLEX PEN

NM

NUTROPIN NM

NUTROPIN AQ NUSPIN NM

NUTROPIN AQ PEN NM

OMNITROPE 5.8MG NM

OMNITROPE 5MG NM

OMNITROPE 10MG NM

SAIZEN NM

SAIZEN CLICK.EASY NM

SEROSTIM NM

Drug Name Requirements/Limits

TEV-TROPIN NM

ZORBTIVE NM

MISCELLANEOUS cabergoline

calcitonin (salmon) nasal spray (generic of MIACALCIN)

CHORIONIC GONADOTROPIN SOLR

NM

EGRIFTA NM

FORTICAL SPR 200/ACT

H.P. ACTHAR NM

INCRELEX NM LA

methylergonovine maleate (generic of METHERGINE) TABS

MIACALCIN INJ 200U/ML B/D

MIACALCIN SPR 200/ACT

NOVAREL INJ 10000UNT NM

octreotide acetate (generic of SANDOSTATIN) 50mcg/ml, 100mcg/ml, 200mcg/ml

NM

octreotide acetate (generic of SANDOSTATIN) 500mcg/ml, 1000mcg/ml

NM

PREGNYL W/DILUENT BENZYL NM

PROLIA NM

SAMSCA NM

SANDOSTATIN 50mcg/ml, 500mcg/ml

NM

SANDOSTATIN 100mcg/ml, 200mcg/ml, 1000mcg/ml

NM

SANDOSTATIN LAR DEPOT NM

SIGNIFOR NM

SOMATULINE DEPOT NM

SOMAVERT 10mg, 15mg, 20mg

NM LA

XGEVA NM

PARATHYROID HORMONES FORTEO NM

PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) (generic of PHOSLO) CAPS

calcium acetate (phosphate binder) (generic of ELIPHOS) TABS

eliphos

FOSRENOL

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 34

Drug Name Requirements/Limits

PHOSLO

PHOSLYRA

RENAGEL

RENVELA

VELPHORO NM

PROGESTINS aygestin

CRINONE

ENDOMETRIN

medroxyprogesterone acetate (generic of PROVERA)

norethindrone acetate (generic of AYGESTIN) TABS

progesterone micronized (generic of PROMETRIUM) CAPS

PROMETRIUM

PROVERA

SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA

raloxifene hcl (generic of EVISTA)

THYROID AGENTS CYTOMEL

levothyroxine sodium (generic of SYNTHROID) TABS

LEVOXYL

liothyronine sodium (generic of TRIOSTAT) SOLN

liothyronine sodium (generic of CYTOMEL) TABS

methimazole (generic of TAPAZOLE) TABS

propylthiouracil TABS

SYNTHROID

tapazole

TIROSINT

TRIOSTAT

UNITHROID

VASOPRESSINS DDAVP SOLN 4mcg/ml NM

DDAVP SOLN .01%

DDAVP TABS

DESMOPRESSIN ACETATE SOLN

Drug Name Requirements/Limits

desmopressin acetate (generic of DDAVP) TABS

desmopressin acetate inj (generic of DDAVP)

desmopressin acetate spray (generic of DDAVP)

desmopressin acetate spray refrigerated

STIMATE NM

GASTROINTESTINAL ANTIEMETICS ALOXI NM

ANTIVERT

CESAMET B/D NM

compro supp

dronabinol (generic of MARINOL) 2.5mg, 5mg

B/D

dronabinol (generic of MARINOL) 10mg

B/D NM

EMEND CAPS 40mg

EMEND CAPS 80mg B/D

EMEND CAPS 125mg B/D

EMEND PAK 80 & 125 B/D

granisetron hcl SOLN

granisetron hcl TABS B/D

MARINOL 2.5mg B/D

MARINOL 5mg, 10mg B/D NM

meclizine hcl TABS

metoclopramide hcl SOLN

metoclopramide hcl (generic of REGLAN) TABS

metoclopramide hcl inj 5 mg/ml

METOZOLV ODT

ondansetron hcl (generic of ZOFRAN) TABS 4mg, 8mg

B/D

ondansetron hcl TABS 24mg B/D

ondansetron hcl inj

ondansetron hcl oral soln (generic of ZOFRAN)

B/D

ondansetron odt (generic of ZOFRAN ODT)

B/D

phenadoz

phenergan

prochlorperazine inj 5 mg/ml

prochlorperazine maleate (generic of COMPAZINE) TABS

prochlorperazine supp

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 35

Drug Name Requirements/Limits

promethazine hcl (generic of PHENERGAN) SOLN

promethazine hcl SUPP; SYRP; TABS

promethegan

REGLAN

SANCUSO NM

TRANSDERM-SCOP

ZOFRAN SOLN 4mg/5ml B/D NM

ZOFRAN SOLN 40mg/20ml

ZOFRAN TABS B/D NM

ZOFRAN ODT B/D NM

ANTISPASMODICS ATROPINE SULFATE SOLN .05mg/ml, .1mg/ml

BENTYL CAPS; TABS

BENTYL SOLN

CANTIL

CUVPOSA

dicyclomine hcl (generic of BENTYL) CAPS; TABS

dicyclomine hcl SOLN

glycate

glycopyrrolate (generic of ROBINUL) SOLN

glycopyrrolate (generic of ROBINUL) TABS 1mg

glycopyrrolate (generic of ROBINUL FORTE) TABS 2mg

methscopolamine bromide (generic of PAMINE) TABS 2.5mg

methscopolamine bromide (generic of PAMINE FORTE) TABS 5mg

PAMINE

PAMINE FORTE

ROBINUL

ROBINUL FORTE

H2-RECEPTOR ANTAGONISTS AXID SOLN

cimetidine TABS

cimetidine sol 300/5ml

famotidine SOLN

famotidine (generic of PEPCID) SUSR

Drug Name Requirements/Limits

famotidine (generic of PEPCID) TABS 20mg, 40mg

famotidine inj

nizatidine CAPS 150mg

nizatidine (generic of AXID) CAPS 300mg

nizatidine (generic of AXID) SOLN

PEPCID

ranitidine hcl CAPS

ranitidine hcl (generic of ZANTAC) SOLN

ranitidine hcl SYRP

ranitidine hcl (generic of ZANTAC) TABS 150mg, 300mg

ZANTAC

INFLAMMATORY BOWEL DISEASE APRISO

ASACOL HD

AZULFIDINE

AZULFIDINE EN-TABS

balsalazide disodium (generic of COLAZAL)

budesonide (generic of ENTOCORT EC) CP24

NM

CANASA

COLAZAL

colocort (generic of CORTENEMA)

CORTENEMA

DELZICOL

DIPENTUM NM

ENTOCORT EC NM

ENTYVIO NM

GIAZO

HYDROCORTISONE (INTRARECTAL)

LIALDA

mesalamine enema

mesalamine enema kit (generic of ROWASA)

PENTASA

ROWASA

SF-ROWASA

sulfasalazine dr (generic of AZULFIDINE EN-TABS)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 36

Drug Name Requirements/Limits

sulfasalazine ir (generic of AZULFIDINE)

UCERIS

LAXATIVES COLYTE-FLAVOR PACKS

constulose

enulose

gaviltye-g (generic of GOLYTELY)

gavilyte-c (generic of COLYTE-FLAVOR PACKS)

gavilyte-n (generic of NULYTELY/FLAVOR PACKS)

generlac

GOLYTELY

HALFLYTELY BOWEL PREP/FLA

kristalose

lactulose

lactulose (encephalopathy)

MOVIPREP

NULYTELY/FLAVOR PACKS

OSMOPREP

PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of GOLYTELY)

peg 3350-potassium chloride-sod bicarbonate-sod chloride (generic of NULYTELY/FLAVOR PACKS)

polyethylene glycol 3350 PACK; POWD

PREPOPIK

RELISTOR

SUCLEAR KIT

SUPREP BOWEL PREP

trilyte (generic of NULYTELY/FLAVOR PACKS)

VISICOL

MISCELLANEOUS ACTIGALL

AMITIZA

amoxicillin-clarithromycin w/ lansoprazole (generic of PREVPAC)

Drug Name Requirements/Limits

CARAFATE

cromolyn sodium (mastocytosis) (generic of GASTROCROM)

NM

CYTOTEC

diphenoxylate w/ atropine LIQD

diphenoxylate w/ atropine (generic of LOMOTIL) TABS

GASTROCROM NM

GATTEX NM LA

LINZESS CAP 145MCG

LINZESS CAP 290MCG

LOMOTIL

loperamide hcl CAPS

LOTRONEX NM

misoprostol (generic of CYTOTEC) TABS

OMECLAMOX-PAK

PREVPAC MIS

PYLERA

SUCRAID NM

sucralfate (generic of CARAFATE) TABS

URSO 250

URSO FORTE

ursodiol (generic of ACTIGALL) CAPS

ursodiol (generic of URSO 250) TABS 250mg

ursodiol (generic of URSO FORTE) TABS 500mg

XIFAXAN TAB 550MG NM

PANCREATIC ENZYMES CREON

PANCREAZE

PERTZYE

ULTRESA

VIOKACE 10440 UNIT

VIOKACE 20880 UNIT NM

ZENPEP

PROTON PUMP INHIBITORS ACIPHEX

ACIPHEX SPR CAP 5MG

ACIPHEX SPR CAP 10MG

DEXILANT

esomeprazole sodium inj 20mg

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 37

Drug Name Requirements/Limits

esomeprazole sodium inj (generic of NEXIUM I.V.) 40mg

lansoprazole (generic of PREVACID) CPDR

NEXIUM

NEXIUM CAPS

NEXIUM GRANULES 2.5MG DR

NEXIUM GRANULES 5MG DR

NEXIUM GRANULES 10MG DR

NEXIUM GRANULES 20MG DR

NEXIUM GRANULES 40MG DR

NEXIUM I.V.

omeprazole cap 10mg (generic of PRILOSEC)

omeprazole cap 20mg (generic of PRILOSEC)

omeprazole cap 40mg (generic of PRILOSEC)

pantoprazole sodium (generic of PROTONIX) SOLR

pantoprazole sodium (generic of PROTONIX) TBEC

PREVACID

PREVACID SOLUTAB

PRILOSEC CAP 10MG

PRILOSEC CAP 20MG

PRILOSEC CAP 40MG

PROTONIX

PROTONIX INJ

rabeprazole sodium (generic of ACIPHEX)

ZEGERID PACK

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin hcl (generic of UROXATRAL)

AVODART

CARDURA XL

finasteride (generic of PROSCAR) TABS 5mg

FLOMAX

JALYN

PROSCAR

RAPAFLO

tamsulosin hcl (generic of FLOMAX)

Drug Name Requirements/Limits

UROXATRAL

MISCELLANEOUS bethanechol chloride (generic of URECHOLINE) TABS

ELMIRON

POTASSIUM CITRATE (ALKALINIZER) TAB 15meq

POTASSIUM CITRATE (ALKALINIZER) TAB 540mg

POTASSIUM CITRATE (ALKALINIZER) TAB 1080mg

urecholine

UROCIT-K

URINARY ANTISPASMODICS DETROL

DETROL LA

DITROPAN XL

ENABLEX

GELNIQUE

MYRBETRIQ

oxybutynin chloride SYRP; TABS

oxybutynin chloride (generic of DITROPAN XL) TB24

OXYTROL

SANCTURA

SANCTURA XR

tolterodine tartrate er (generic of DETROL LA)

tolterodine tartrate tab 1 mg (generic of DETROL)

tolterodine tartrate tab 2 mg (generic of DETROL)

TOVIAZ

trospium chloride

VESICARE

VAGINAL ANTI-INFECTIVES CLEOCIN CREA

CLEOCIN VAG SUPP 100MG

clindamycin cre 2% vag (generic of CLEOCIN)

METROGEL-VAGINAL

metronidazole vaginal (generic of METROGEL-VAGINAL)

miconazole nitrate vaginal

TERAZOL 3

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 38

Drug Name Requirements/Limits

TERAZOL 7

terconazole vaginal (generic of TERAZOL 7) CREA .4%

terconazole vaginal (generic of TERAZOL 3) CREA .8%

terconazole vaginal SUPP

VANDAZOLE

zazole (generic of TERAZOL 7) .4%

ZAZOLE .8%

HEMATOLOGIC ANTICOAGULANTS ARIXTRA 2.5mg/0.5ml

ARIXTRA 5mg/0.4ml, 7.5mg/0.6ml, 10mg/0.8ml

NM

COUMADIN

COUMADIN INJ

ELIQUIS TAB 2.5MG

ELIQUIS TAB 5MG

enoxaparin sodium (generic of LOVENOX) 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml, 300mg/3ml

enoxaparin sodium (generic of LOVENOX) 100mg/ml, 120mg/0.8ml, 150mg/ml

NM

fondaparinux sodium (generic of ARIXTRA) 2.5mg/0.5ml

fondaparinux sodium (generic of ARIXTRA) 5mg/0.4ml, 7.5mg/0.6ml, 10mg/0.8ml

NM

FRAGMIN 2500unit/0.2ml, 5000unit/0.2ml

FRAGMIN 7500unit/0.3ml, 10000unit/ml, 12500unit/0.5ml, 15000unit/0.6ml, 18000unt/0.72ml, 25000unit/ml

NM

HEP SOD/NACL INJ 25000

HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML

heparin sod inj 1000u/ml B/D

HEPARIN SOD INJ 2000U/ML B/D

HEPARIN SOD INJ 2500U/ML B/D

heparin sod inj 5000u/0.5ml B/D

heparin sod inj 5000u/ml B/D

heparin sod inj 10000u/ml B/D

heparin sod inj 20000u/ml B/D

HEPARIN SODIUM/D5W

Drug Name Requirements/Limits

HEPARIN SODIUM/SODIUM CHL

jantoven (generic of COUMADIN)

LOVENOX 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 300mg/3ml

LOVENOX 80mg/0.8ml, 100mg/ml, 120mg/0.8ml, 150mg/ml

NM

PRADAXA

warfarin sodium (generic of COUMADIN)

XARELTO

HEMATOPOIETIC GROWTH FACTORS ARANESP ALBUMIN FREE 25mcg/0.42ml, 25mcg/ml, 40mcg/0.4ml, 40mcg/ml, 60mcg/0.3ml, 60mcg/ml

NM

ARANESP ALBUMIN FREE 100mcg/0.5ml, 100mcg/ml, 150mcg/0.3ml, 150mcg/0.75ml, 200mcg/0.4ml, 200mcg/ml, 300mcg/0.6ml, 300mcg/ml, 500mcg/ml

NM

EPOGEN NM

GRANIX NM

LEUKINE NM

MOZOBIL NM

NEULASTA NM

NEUMEGA NM

NEUPOGEN NM

PROCRIT 2000unit/ml, 3000unit/ml, 4000unit/ml, 10000unit/ml

NM

PROCRIT 20000unit/ml, 40000unit/ml

NM

MISCELLANEOUS AGRYLIN

anagrelide hcl 1mg

anagrelide hcl (generic of AGRYLIN) .5mg

cilostazol (generic of PLETAL)

CYKLOKAPRON

LYSTEDA

pentoxifylline TBCR

PLETAL

PROMACTA NM LA

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 39

Drug Name Requirements/Limits

tranexamic acid (generic of CYKLOKAPRON) SOLN

tranexamic acid (generic of LYSTEDA) TABS

PLATELET AGGREGATION INHIBITORS AGGRENOX

BRILINTA

clopidogrel bisulfate (generic of PLAVIX)

dipyridamole (generic of PERSANTINE) TABS

EFFIENT

PERSANTINE

PLAVIX

ZONTIVITY

IMMUNOLOGIC AGENTS DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS) ACTEMRA INJ 80MG/4ML NM

ACTEMRA INJ 162/0.9 NM

ACTEMRA INJ 200/10ML NM

ACTEMRA INJ 400/20ML NM

ARAVA 10mg

ARAVA 20mg NM

CIMZIA KIT NM

CIMZIA KIT STARTER NM

CIMZIA PREFL KIT 200MG/ML NM

ENBREL INJ 25/0.5ML NM

ENBREL INJ 25MG NM

ENBREL INJ 50MG/ML NM

ENBREL SURECLICK NM

HUMIRA KIT 20MG/0.4 NM

HUMIRA KIT 40MG/0.8 NM

HUMIRA PEN KIT 40MG/0.8 NM

HUMIRA PEN KIT CROHNS NM

HUMIRA PEN KIT PSORIASI NM

hydroxychloroquine sulfate (generic of PLAQUENIL)

KINERET INJ NM

leflunomide (generic of ARAVA) TABS

methotrexate sodium tabs

ORENCIA INJ 125MG/ML NM

ORENCIA INJ 250MG NM

OTEZLA NM

PLAQUENIL

REMICADE INJ 100MG NM

Drug Name Requirements/Limits

RHEUMATREX

SIMPONI SOSY NM

SIMPONI ARIA NM

trexall B/D

XELJANZ NM

IMMUNOGLOBULINS BIVIGAM 10gm/100ml NM

CARIMUNE NF INJ 6GM NM

CARIMUNE NF INJ 12GM NM

FLEBOGAMMA NM

FLEBOGAMMA DIF NM

GAMASTAN S/D B/D NM

GAMMAGARD LIQUID NM

GAMMAGARD S/D NM

GAMMAKED NM

GAMMAPLEX 2.5gm/50ml, 5gm/100ml, 10gm/200ml

NM

GAMUNEX NM

GAMUNEX-C 1GM/10ML NM

GAMUNEX-C 2.5GM/25ML NM

GAMUNEX-C 5GM/50ML NM

GAMUNEX-C 10GM/100ML NM

GAMUNEX-C 20GM/200ML NM

OCTAGAM 1gm/20ml, 2.5gm/50ml, 5gm/100ml, 10gm/200ml, 25gm/500ml

NM

PRIVIGEN NM

IMMUNOMODULATORS ACTIMMUNE NM LA

ARCALYST NM

GRASTEK

INFERGEN INJ 9MCG NM

INTRON-A B/D NM

INTRON-A W/DILUENT B/D NM

PEG-INTRON NM

PEG-INTRON KIT 50MCG NM

PEG-INTRON KIT 50MCG RP NM

PEG-INTRON KIT 80MCG RP NM

PEG-INTRON KIT 150 RP NM

PEGASYS INJ NM

PEGASYS INJ 180MCG/M NM

PEGASYS INJ PROCLICK NM

PEGASYS KIT NM

RAGWITEK

REVLIMID NM LA

THALOMID NM

IMMUNOSUPPRESSANTS

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 40

Drug Name Requirements/Limits

ASTAGRAF XL 5mg B/D NM

ASTAGRAF XL .5mg, 1mg B/D

ATGAM B/D

azasan B/D

azathioprine (generic of IMURAN) TABS

B/D

CELLCEPT B/D NM

CELLCEPT INTRAVENOUS B/D

cyclosporine (generic of SANDIMMUNE) CAPS; SOLN

B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) CAPS 25mg, 100mg

B/D

cyclosporine modified (for microemulsion) CAPS 50mg

B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) SOLN

B/D

gengraf (generic of NEORAL) B/D

IMURAN B/D

mycophenolate mofetil (generic of CELLCEPT)

B/D

mycophenolic tab 180mg dr (generic of MYFORTIC)

B/D

mycophenolic tab 360mg dr (generic of MYFORTIC)

B/D NM

MYFORTIC TAB 180MG B/D

MYFORTIC TAB 360MG B/D NM

NEORAL B/D

NULOJIX B/D NM

PROGRAF CAPS 5mg B/D NM

PROGRAF CAPS .5mg, 1mg B/D

PROGRAF SOLN B/D

RAPAMUNE SOLN B/D NM

RAPAMUNE TABS 1mg, 2mg B/D NM

RAPAMUNE TABS .5mg B/D

SANDIMMUNE CAPS B/D

SANDIMMUNE INJ B/D

SANDIMMUNE SOLN B/D

SIMULECT B/D

sirolimus tab 0.5 mg (generic of RAPAMUNE)

B/D

tacrolimus (generic of PROGRAF) CAPS 5mg

B/D NM

tacrolimus (generic of PROGRAF) CAPS .5mg, 1mg

B/D

THYMOGLOBULIN B/D NM

ZORTRESS B/D NM

Drug Name Requirements/Limits

VACCINES ACTHIB

ADACEL

BCG VACCINE

BOOSTRIX

CERVARIX

COMVAX

DAPTACEL

DECAVAC B/D

DIPHTHERIA/TETANUS TOXOID

B/D

ENGERIX-B SUSP B/D

GARDASIL

HAVRIX

HIBERIX

IMOVAX RABIES (H.D.C.V.)

INFANRIX

IPOL INACTIVATED IPV

IXIARO

M-M-R II W/DILUENT 10 DOS

MENACTRA

MENHIBRIX

MENOMUNE-A/C/Y/W-135

MENVEO

PEDVAX HIB

PROQUAD

RABAVERT

RECOMBIVAX HB B/D

ROTARIX

ROTATEQ

SYNAGIS NM

TENIVAC B/D

TETANUS TOXOID ADSORBED B/D

TETANUS/DIPHTHERIA TOXOID

B/D

TWINRIX INJ

TYPHIM VI

VAQTA

VARIVAX

YF-VAX

ZOSTAVAX

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES ammonium chloride SOLN

K-TAB 10meq

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 41

Drug Name Requirements/Limits

K-TAB 20meq

KLOR-CON 8

KLOR-CON 10

klor-con m15

klor-con m20

klor-con pow 20meq

MAGNESIUM SULFATE SOLN 40mg/ml, 80mg/ml

magnesium sulfate SOLN 50%

MAGNESIUM SULFATE IN D5W 1%

MAGNESIUM SULFATE IN D5W 2%

MICRO-K

potassium chloride LIQD

POTASSIUM CHLORIDE TBCR

potassium chloride caps er (generic of MICRO-K)

potassium chloride microencapsulated crystals cr

SOD FLUORIDE 2.2MG TAB

SODIUM CHLORIDE SOLN 2.5meq/ml

TPN ELECTROLYTES B/D

IV NUTRITION AMINOSYN B/D

AMINOSYN 7%/ELECTROLYTES

B/D

AMINOSYN II B/D

AMINOSYN II 8.5%/ELECTROL B/D

AMINOSYN INJ 8.5/LYTE B/D

AMINOSYN M B/D

AMINOSYN-HBC B/D

AMINOSYN-PF B/D

AMINOSYN-PF 7% B/D

AMINOSYN-RF B/D

CLINIMIX 2.75%/DEXTROSE 5% B/D

CLINIMIX 4.25%/DEXTROSE 5% B/D

CLINIMIX 4.25%/DEXTROSE 10%

B/D

CLINIMIX 4.25%/DEXTROSE 20%

B/D

CLINIMIX 4.25%/DEXTROSE 25%

B/D

CLINIMIX 5%/DEXTROSE 15% B/D

CLINIMIX 5%/DEXTROSE 20% B/D

CLINIMIX 5%/DEXTROSE 25% B/D

Drug Name Requirements/Limits

CLINIMIX E 2.75%/DEXTROSE 5%

B/D

CLINIMIX E 2.75%/DEXTROSE 10%

B/D

CLINIMIX E 4.25%/DEXTROSE 5%

B/D

CLINIMIX E 4.25%/DEXTROSE 10%

B/D

CLINIMIX E 4.25%/DEXTROSE 25%

B/D

CLINIMIX E 5%/DEXTROSE 15%

B/D

CLINIMIX E 5%/DEXTROSE 20%

B/D

CLINIMIX E 5%/DEXTROSE 25%

B/D

clinisol 15 B/D

FREAMINE HBC 6.9% B/D

FREAMINE III B/D

HEPATAMINE B/D

INTRALIPID INJ 20% B/D

INTRALIPID INJ 30% B/D

LIPOSYN II B/D

LIPOSYN III B/D

NEPHRAMINE B/D

premasol 6% B/D

premasol 10% B/D

PROCALAMINE B/D

PROSOL B/D

travasol 10 B/D

TROPHAMINE B/D

IV REPLACEMENT SOLUTIONS DEXTROSE SOLN 50%

dextrose SOLN 70%

DEXTROSE 2.5%/NACL 0.45%

DEXTROSE 5%

DEXTROSE 5% /ELECTROLYTE

DEXTROSE 5%/LACTATED RING

DEXTROSE 5%/NACL 0.2%

DEXTROSE 5%/NACL 0.3%

DEXTROSE 5%/NACL 0.9%

DEXTROSE 5%/NACL 0.33%

DEXTROSE 5%/NACL 0.45%

DEXTROSE 5%/NACL 0.225%

DEXTROSE 5%/POTASSIUM CHL

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 42

Drug Name Requirements/Limits

DEXTROSE 10% FLEX CONTAIN

DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%

DEXTROSE 10%/NACL 0.45%

ELECTROLYTE-R IN DEXTROSE

IONOSOL-B/DEXTROSE 5%

IONOSOL-MB/DEXTROSE 5%

ISOLYTE P

isolyte s

KCL0.15%/D5W/NACL0.2%

KCL0.15%/D5W/NACL0.225%

kcl 0.3%/d5w/lr iv lac ri

KCL 0.3%/D5W/NACL 0.9%

KCL 0.3%/D5W/NACL 0.45%

KCL 0.15%/D5W/LR

KCL 0.15%/D5W/NACL 0.9%

KCL 0.075%/D5W/NACL 0.45%

KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ

kcl 20 meq/l (0.15%) in nacl 0.45% inj

KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ

KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ

KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ

KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ

LACTATED RINGERS VIAFLEX

normosol-m

NORMOSOL-R

PLASMA-LYTE A

PLASMA-LYTE-56/D5W

PLASMA-LYTE-148

POTASSIUM CHLORIDE SOLN 10meq/100ml, 20meq/100ml

potassium chloride SOLN .4meq/ml, 2meq/ml, 10meq/50ml, 40meq/100ml

POTASSIUM CHLORIDE 0.3%/D

POTASSIUM CHLORIDE 0.15%

Drug Name Requirements/Limits

POTASSIUM CHLORIDE 0.22%

POTASSIUM CHLORIDE INJ 30 MEQ/100 ML

RINGER'S

SODIUM CHLORIDE SOLN .9%, 3%, 5%

SODIUM CHLORIDE 0.45% VIA

VITAMINS calcitriol (generic of ROCALTROL) CAPS

B/D

calcitriol SOLN 1mcg/ml B/D

calcitriol (generic of ROCALTROL) SOLN 1mcg/ml

B/D

doxercalciferol (generic of HECTOROL)

B/D

HECTOROL CAPS B/D

HECTOROL SOLN 4mcg/2ml B/D

paricalcitol (generic of ZEMPLAR)

B/D

paricalcitol cap 4 mcg (generic of ZEMPLAR)

B/D

PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC)

ROCALTROL B/D

ZEMPLAR CAP 1MCG B/D

ZEMPLAR CAP 2MCG B/D

ZEMPLAR CAP 4MCG B/D NM

ZEMPLAR INJ B/D

OPHTHALMIC ANTI-INFECTIVE/ANTI-INFLAMMATORY bacitracin-poly-neomycin-hc

blephamide OINT

BLEPHAMIDE SUSP

MAXITROL

neomycin-polymy-dexameth (generic of MAXITROL)

neomycin-polymyxin-hc (ophth)

PRED-G

PRED-G S.O.P.

sulfacetamide sod-prednisolone

TOBRADEX

TOBRADEX ST

tobramycin-dexamethasone (generic of TOBRADEX)

ZYLET

ANTI-INFECTIVES AZASITE

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 43

Drug Name Requirements/Limits

bacitracin (ophthalmic)

bacitracin-polymyxin b (ophth)

BESIVANCE

BLEPH-10

CILOXAN OIN 0.3% OP

CILOXAN SOL 0.3% OP

ciprofloxacin hcl (ophth) (generic of CILOXAN)

erythromycin (ophth)

garamycin

gatifloxacin (ophth) (generic of ZYMAXID)

gentak

gentamicin sulfate (ophth) OINT

gentamicin sulfate (ophth) (generic of GARAMYCIN) SOLN

levofloxacin (ophth)

MOXEZA

NATACYN

neomycin-bacitracin zn-polymyxin

neomycin-polymy-gramicid (generic of NEOSPORIN)

neosporin solution

OCUFLOX

ofloxacin (ophth) (generic of OCUFLOX)

polymyxin b-trimethoprim (generic of POLYTRIM)

POLYTRIM

sulfacetamide sodium (ophth) OINT

sulfacetamide sodium (ophth) (generic of BLEPH-10) SOLN

tobramycin sulfate (ophth) (generic of TOBREX)

TOBREX OINT 0.3%

TOBREX SOL 0.3% OP

trifluridine (generic of VIROPTIC) SOLN

VIGAMOX

VIROPTIC

ZIRGAN

ZYMAXID

ANTI-INFLAMMATORIES ACULAR

ACULAR LS

Drug Name Requirements/Limits

ACUVAIL

ALREX

BROMDAY

bromfenac sodium (ophth)

BROMFENAC SODIUM (OPHTH)(ONCE-DAILY)

dexamethasone sodium phosphate (ophth)

diclofenac sodium (ophth)

DUREZOL

FLAREX

FLUOROMETHOLONE (OPHTH)

flurbiprofen sodium (generic of OCUFEN)

FML

FML FORTE

FML LIQUIFILM

ILEVRO

ketorolac tromethamine (ophth) (generic of ACULAR LS) .4%

ketorolac tromethamine (ophth) (generic of ACULAR) .5%

LOTEMAX

MAXIDEX

NEVANAC

OCUFEN

OMNIPRED

PRED FORTE

PRED MILD

PREDNISOLONE ACETATE SUSP

prednisolone sodium phosphate (ophth)

VEXOL

ANTIALLERGICS ALOCRIL

ALOMIDE

azelastine hcl (ophth) (generic of OPTIVAR)

BEPREVE

cromolyn sodium (ophth)

ELESTAT

EMADINE

epinastine hcl (ophth) (generic of ELESTAT)

LASTACAFT

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 44

Drug Name Requirements/Limits

OPTIVAR

PATADAY

PATANOL SOL 0.1% OP

ANTIGLAUCOMA ALPHAGAN P 0.1%

ALPHAGAN P 0.15%

AZOPT

BETAGAN

betaxolol hcl (ophth)

BETIMOL

BETOPTIC-S

brimonidine sol 0.2%

BRIMONIDINE SOL 0.15%

carteolol hcl (ophth)

COMBIGAN

COSOPT

COSOPT PF

dorzolamide hcl (generic of TRUSOPT)

dorzolamide hcl-timolol maleate (generic of COSOPT)

ISOPTO CARPINE

ISTALOL

latanoprost (generic of XALATAN)

levobunolol hcl (generic of BETAGAN) .5%

LEVOBUNOLOL HCL .25%

LUMIGAN

metipranolol

OPTIPRANOLOL

PHOSPHOLINE IODIDE

PILOCARPINE HCL SOLN

SIMBRINZA

timolol maleate (ophth) (generic of TIMOPTIC)

TIMOLOL MALEATE GEL

TIMOPTIC

TIMOPTIC OCUDOSE

TIMOPTIC-XE

TRAVATAN Z

TRUSOPT

XALATAN

ZIOPTAN

MISCELLANEOUS

Drug Name Requirements/Limits

alcaine

BOTOX NM

LACRISERT

naphazoline 0.1%

PROLENSA

proparacaine hcl (generic of ALCAINE) SOLN

RESTASIS

XEOMIN NM

RESPIRATORY ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ANORO ELLIPTA

COMBIVENT RESPIMAT

DUONEB B/D

ipratropium-albuterol B/D

ANTICHOLINERGICS ATROVENT

ATROVENT HFA

ipratropium bromide (nasal) (generic of ATROVENT)

ipratropium sol inhal B/D

SPIRIVA HANDIHALER

TUDORZA PRESSAIR

ANTIHISTAMINE/DECONGESTANT COMBINATIONS CLARINEX-D 12

SEMPREX-D

ANTIHISTAMINES ASTELIN

ASTEPRO

azelastine hcl SOLN

azelastine hcl nasal spray 0.15% (205.5 mcg/spray) (generic of ASTEPRO)

cetirizine syrup

CLARINEX

cyproheptadine hcl SYRP; TABS

desloratadine (generic of CLARINEX) TABS

desloratadine (generic of CLARINEX REDITABS) TBDP

diphenhydram inj 50mg/ml

hydroxyzine hcl SOLN; TABS

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 45

Drug Name Requirements/Limits

hydroxyzine pamoate (generic of VISTARIL) CAPS 25mg, 50mg

hydroxyzine pamoate CAPS 100mg

levocetirizine soln 2.5mg/5ml (generic of XYZAL)

levocetirizine tab 5 mg (generic of XYZAL)

PATANASE SPR 0.6%

VISTARIL

XYZAL

BETA AGONISTS albuterol sulfate NEBU B/D

albuterol sulfate SYRP; TABS

albuterol sulfate er (generic of VOSPIRE ER)

ARCAPTA NEOHALER

BROVANA B/D

FORADIL AEROLIZER

levalbuterol conc 1.25mg/0.5ml B/D

LEVALBUTEROL HCL NEBU B/D

PERFOROMIST B/D

PROAIR HFA

PROVENTIL HFA

SEREVENT DISKUS

terbutaline sulfate SOLN; TABS

VENTOLIN HFA

vospire

XOPENEX B/D

XOPENEX CONCENTRATE B/D

XOPENEX HFA

LEUKOTRIENE RECEPTOR ANTAGONISTS ACCOLATE

montelukast sodium (generic of SINGULAIR) CHEW; PACK; TABS

SINGULAIR

zafirlukast (generic of ACCOLATE)

ZYFLO CR NM

MAST CELL STABILIZERS cromolyn sodium NEBU B/D

MISCELLANEOUS acetylcysteine SOLN 10%, 20% B/D

ADRENACLICK

Drug Name Requirements/Limits

ARALAST NP NM LA

AUVI-Q INJ 0.3MG

AUVI-Q INJ 0.15MG

CAYSTON NM LA

DALIRESP

DYMISTA

EPINEPHRINE INJ 0.3MG

EPINEPHRINE INJ 0.15MG

EPIPEN 2-PAK

EPIPEN-JR 2-PAK

GLASSIA NM LA

PROLASTIN-C NM LA

PULMOZYME B/D NM

tyzine .05%

XOLAIR NM LA

ZEMAIRA NM LA

NASAL STEROIDS BECONASE AQ

budesonide (nasal) (generic of RHINOCORT AQUA)

FLONASE

flunisolide spr 0.025%

fluticasone propionate (nasal) (generic of FLONASE)

NASACORT AQ

NASONEX

OMNARIS

QNASL

RHINOCORT AQUA

triamcinolone acetonide (nasal)

VERAMYST

ZETONNA

STEROID INHALANTS AEROSPAN

ALVESCO

ASMANEX

ASMANEX 14 METERED DOSES

budesonide (inhalation) (generic of PULMICORT)

B/D

FLOVENT DISKUS 50mcg/blist, 100mcg/blist

FLOVENT DISKUS 250mcg/blist

FLOVENT HFA

PULMICORT FLEXHALER

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 46

Drug Name Requirements/Limits

PULMICORT INH SUSP 1mg/2ml

B/D NM

PULMICORT INH SUSP .25mg/2ml, .5mg/2ml

B/D

QVAR 40mcg/act

QVAR 80mcg/act

STEROID/BETA-AGONIST COMBINATIONS ADVAIR DISKUS

ADVAIR HFA

BREO ELLIPTA

DULERA

SYMBICORT

XANTHINES aminophylline inj

elixophyllin

LUFYLLIN

theo-24

theophylline TB12; TB24

TOPICAL DERMATOLOGY, ACNE ABSORICA NM

ACANYA

ACZONE

adapalene (generic of DIFFERIN) CREA

adapalene (generic of DIFFERIN) GEL .1%

ADAPALENE GEL .3%

AKNE-MYCIN

amnesteem

ATRALIN

AVITA CREA

AVITA GEL

AZELEX

BENZACLIN

BENZAMYCIN

benzoyl peroxide-erythromycin (generic of BENZAMYCIN)

claravis

CLEOCIN-T

CLINDAGEL

clindamycin phosphate (topical) (generic of EVOCLIN) FOAM

Drug Name Requirements/Limits

clindamycin phosphate (topical) (generic of CLEOCIN-T) GEL; LOTN; SOLN; SWAB

clindamycin phosphate-benzoyl peroxide (generic of BENZACLIN)

DIFFERIN

EPIDUO

erygel

erythromycin (acne aid) (generic of ERYGEL) GEL

erythromycin (acne aid) PADS; SOLN

EVOCLIN

FABIOR

KLARON

myorisan

neuac (generic of DUAC)

RETIN-A

RETIN-A MICRO

RETIN-A MICRO PUMP

sulfacetamide sodium (acne) (generic of KLARON)

tretin-x

tretinoin (generic of RETIN-A) CREA; GEL

TRETINOIN MICROSPHERE

VELTIN

zenatane

ZIANA

DERMATOLOGY, ACTINIC KERATOSIS CARAC

diclofenac sodium (actinic keratoses) (generic of SOLARAZE)

EFUDEX

fluorouracil (topical) (generic of EFUDEX) CREA

fluorouracil (topical) SOLN

PICATO

SOLARAZE

DERMATOLOGY, ANTIBIOTICS ALTABAX

BACTROBAN

BACTROBAN NASAL

CENTANY

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 47

Drug Name Requirements/Limits

CORTISPORIN CREA; OINT

gentamicin sulfate (topical)

mafenide acetate (generic of SULFAMYLON) PACK

mupirocin (generic of BACTROBAN) OINT

mupirocin calcium (topical) (generic of BACTROBAN)

PHISOHEX

SILVADENE

SILVER SULFADIAZINE CREA

SSD

SULFAMYLON

THERMAZENE

DERMATOLOGY, ANTIFUNGALS ciclopirox GEL

ciclopirox cre 0.77%

ciclopirox shampoo 1% (generic of LOPROX SHAMPOO)

ciclopirox sus 0.77%

clotrimazole (topical)

econazole nitrate CREA

ERTACZO

EXELDERM

EXTINA

ketoconazole (topical) CREA

ketoconazole (topical) (generic of EXTINA) FOAM

LOPROX SHAMPOO

LUZU

MENTAX

NAFTIN

nyamyc

nystatin (topical)

nystatin pow 100000

nystop

OXISTAT

pedi-dri

DERMATOLOGY, ANTIPRURITIC anusol hc

CORTIFOAM

procto-pak

proctocream (generic of ANUSOL-HC)

Drug Name Requirements/Limits

proctosol (generic of ANUSOL-HC)

proctozone hc (generic of ANUSOL-HC)

PRUDOXIN CRE 5%

ZONALON

DERMATOLOGY, ANTIPSORIATICS acitretin (generic of SORIATANE) NM

calcipotriene (generic of DOVONEX) CREA

calcipotriene OINT; SOLN

CALCITRIOL OINT

DOVONEX

methoxsalen rapid (generic of OXSORALEN ULTRA)

NM

8-MOP

OXSORALEN ULTRA NM

SORIATANE NM

SORILUX

STELARA INJ 45MG/0.5 NM

STELARA INJ 90MG/ML NM

TAZORAC

VECTICAL NM

DERMATOLOGY, ANTISEBORRHEICS ketoconazole shampoo (generic of NIZORAL)

NIZORAL

selenium sulfide LOTN

DERMATOLOGY, ANTIVIRALS acyclovir topical (generic of ZOVIRAX)

DENAVIR

XERESE

ZOVIRAX CREA

ZOVIRAX OINT

DERMATOLOGY, CORTICOSTEROIDS aclovate

ala-cort

ala-scalp

alclometasone dipropionate (generic of ACLOVATE) CREA

alclometasone dipropionate OINT

amcinonide CREA; LOTN

amcinonide OINT

apexicon

2014 601 4T Copper BvD Comm_NT (Effective November 1)

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 48

Drug Name Requirements/Limits

betamethasone dipropionate (topical)

betamethasone dipropionate augmented (generic of DIPROLENE AF) CREA

betamethasone dipropionate augmented GEL

betamethasone dipropionate augmented (generic of DIPROLENE) LOTN; OINT

betamethasone valerate CREA; LOTN; OINT

betamethasone valerate (generic of LUXIQ) FOAM

calcipotriene-betamethasone dipropionate (generic of TACLONEX)

CAPEX

clobetasol propionate (generic of TEMOVATE) CREA; GEL; OINT; SOLN

clobetasol propionate (generic of OLUX) FOAM

clobetasol propionate (generic of CLOBEX) LOTN; SHAM

clobetasol propionate emollient base (generic of TEMOVATE E)

clobetasol propionate emulsion (generic of OLUX-E)

CLOBEX LIQD

CLOBEX LOTN; SHAM

CLOCORTOLONE PIVALATE

clodan (generic of CLOBEX)

CLODERM PUMP

CORDRAN TAPE

CUTIVATE CREA

CUTIVATE LOTN NM

CUTIVATE OINT

DERMA-SMOOTHE/FS BODY OIL

DERMATOP

DESONATE

DESONIDE CREA

desonide (generic of DESOWEN) LOTN; OINT

DESOWEN CREA

desowen LOTN

Drug Name Requirements/Limits

desowen oint kit 0.05%

desoximetasone (generic of TOPICORT) CREA

desoximetasone (generic of TOPICORT) GEL

DESOXIMETASONE OINT .05%

desoximetasone (generic of TOPICORT) OINT .25%

diflorasone diacetate

DIPROLENE LOTN

DIPROLENE OINT

DIPROLENE AF

ELOCON CREA; LOTN

ELOCON OINT

fluocinolone acetonide CREA .01%

fluocinolone acetonide (generic of SYNALAR) CREA .025%

fluocinolone acetonide (generic of DERMA-SMOOTHE/FS BODY) OIL

fluocinolone acetonide (generic of SYNALAR) OINT

fluocinolone acetonide (generic of SYNALAR) SOLN

fluocinonide (generic of VANOS) CREA .1%

fluocinonide CREA .05%

fluocinonide GEL

fluocinonide OINT

fluocinonide SOLN

fluocinonide emulsified base

fluticasone propionate (generic of CUTIVATE) CREA; LOTN; OINT

halobetasol propionate (generic of ULTRAVATE)

HALOG

hydrocortisone (topical)

hydrocortisone butyrate (generic of LOCOID)

hydrocortisone butyrate hydrophilic lipo base (generic of LOCOID LIPOCREAM)

hydrocortisone valerate CREA

2014 601 4T Copper BvD Comm_NT (Effective November 1)

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Drug Name Requirements/Limits

hydrocortisone valerate (generic of WESTCORT) OINT

KENALOG

LOCOID LOTN

LOCOID LIPOCREAM

LOKARA LOTN 0.05%

LUXIQ

mometasone furoate (generic of ELOCON) CREA; OINT; SOLN

OLUX

OLUX-E

PANDEL

PREDNICARBATE CREA

prednicarbate (generic of DERMATOP) OINT

SYNALAR CREA; OINT

SYNALAR SOLN

TACLONEX

TEMOVATE CREA; GEL; OINT

TEMOVATE SOLN

TEMOVATE E

texacort

topicort CREA

topicort GEL

TOPICORT LIQD

TOPICORT OINT .05%

topicort OINT .25%

triamcinolone acetonide (topical)

triderm

u-cort

ULTRAVATE

VANOS

DERMATOLOGY, LOCAL ANESTHETICS EMLA B/D

lidocaine OINT

lidocaine (generic of LIDODERM) PTCH

lidocaine hcl GEL

lidocaine hcl (generic of XYLOCAINE) SOLN 4%

lidocaine-prilocaine (generic of EMLA)

B/D

LIDODERM DIS 5%

SYNERA

XYLOCAINE 4%

Drug Name Requirements/Limits

DERMATOLOGY, MISCELLANEOUS SKIN AND MUCOUS MEMBRANE ALDARA

ammonium lactate (generic of LAC-HYDRIN) CREA; LOTN

CONDYLOX

diclofenac sodium (topical) (generic of PENNSAID)

ELIDEL CRE 1%

FINACEA

imiquimod (generic of ALDARA) CREA

LAC-HYDRIN

laclotion lotn 12% (generic of LAC-HYDRIN)

METROCREAM

METROGEL

METROLOTION

metronidazole (topical) (generic of METROCREAM) CREA

metronidazole (topical) (generic of METROGEL) GEL 1%

metronidazole (topical) GEL .75%

metronidazole (topical) (generic of METROLOTION) LOTN

NORITATE

ORACEA

OXSORALEN

PANRETIN NM

PENNSAID

podofilox (generic of CONDYLOX) SOLN

PROTOPIC OIN 0.1%

PROTOPIC OIN 0.03%

RECTIV

rosadan cre 0.75% (generic of METROCREAM)

TARGRETIN GEL NM

VALCHLOR NM LA

VOLTAREN GEL 1%

ZYCLARA NM

DERMATOLOGY, SCABICIDES AND PEDICULIDES EURAX

malathion (generic of OVIDE)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

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Drug Name Requirements/Limits

OVIDE

permethrin (generic of ELIMITE) CREA

SKLICE

ULESFIA

DERMATOLOGY, WOUND CARE AGENTS acetic acid .25%

neomycin/polymyxin b gu (generic of NEOSPORIN GU IRRIGANT)

REGRANEX NM

SANTYL

SODIUM CHLORIDE 0.9%

STERILE WATER IRRIGATION

MOUTH/THROAT/DENTAL AGENTS cevimeline hcl (generic of EVOXAC)

chlorhexidine gluconate (mouth-throat) (generic of PERIDEX)

clotrimazole TROC

EVOXAC

lidocaine hcl (mouth-throat)

nystatin (mouth-throat)

periogard sol 0.12% (generic of PERIDEX)

pilocarpine hcl (oral) (generic of SALAGEN)

SALAGEN

triamcinolone acetonide (mouth)

OTIC acetasol hc (generic of VOSOL HC)

acetic acid (otic)

acetic acid sol/hc (generic of VOSOL HC)

acetic acid-aluminum acetate

CIPRO HC

CIPRODEX

COLY-MYCIN S

CORTISPORIN SOLN

CORTISPORIN-TC

DERMOTIC

fluocinolone acetonide (otic) (generic of DERMOTIC)

Drug Name Requirements/Limits

neomycin-polymyxin-hc (otic) (generic of CORTISPORIN) SOLN

neomycin-polymyxin-hc (otic) SUSP

ofloxacin (otic)

2014 601 4T Copper BvD Comm_NT (Effective November 1)

51

Index 8 8-MOP .............................. 47 A abacavir sulfate ...................6 abacavir sulfate-lamivudine-zidovudine ..........................................6 ABELCET............................5 ABILIFY............................. 23 ABILIFY DISCMELT ......... 23 ABILIFY INJ ...................... 23 ABILIFY MAINTENA ......... 23 ABRAXANE ...................... 11 ABSORICA ....................... 46 ABSTRAL............................2 acamprosate calcium ........ 27 ACANYA ........................... 46 acarbose ........................... 28 ACCOLATE ....................... 45

see zafirlukast ............... 45 ACCUPRIL ........................ 13

see quinapril hcl ............ 13 ACCURETIC ..................... 12

see quinapril-hydrochlorothiazide .................................. 13

acebutolol hcl .................... 15 ACEON

see perindopril erbumine ...................................... 13

acetaminophen w/ codeine .1 acetasol hc ........................ 50 acetazolamide ................... 17 acetazolamide sodium ...... 17 acetic acid ......................... 50 acetic acid (otic) ................ 50 acetic acid sol/hc ............... 50 acetic acid-aluminum acetate .......................................... 50 acetylcysteine ................... 45 ACIPHEX .......................... 36

see rabeprazole sodium 37 ACIPHEX SPR CAP 10MG .......................................... 36 ACIPHEX SPR CAP 5MG . 36 acitretin ............................. 47 aclovate............................. 47

ACLOVATE see alclometasone dipropionate .................. 47

ACTEMRA INJ 162/0.9 ..... 39 ACTEMRA INJ 200/10ML . 39 ACTEMRA INJ 400/20ML . 39 ACTEMRA INJ 80MG/4ML .......................................... 39 ACTHIB ............................. 40 ACTIGALL ........................ 36

see ursodiol ................... 36 ACTIMMUNE .................... 39 ACTIQ ................................. 2

see fentanyl citrate .......... 2 ACTIVELLA

see estradiol & norethindrone acetate ... 32 see mimvey lo 28 day .... 32

ACTONEL ......................... 29 see risedronate sodium . 29

ACTOPLUS MET see pioglitazone hcl-metformin hcl ........... 29

ACTOPLUS MET TAB 15-500MG ......................... 28 ACTOPLUS MET TAB 15-850MG ......................... 28 ACTOPLUS MET XR 15-1000MG ....................... 28 ACTOPLUS MET XR 30-1000MG ....................... 28 ACTOS ............................. 28

see pioglitazone hcl ....... 29 ACULAR ........................... 43

see ketorolac tromethamine (ophth) .... 43

ACULAR LS ...................... 43 see ketorolac tromethamine (ophth) .... 43

ACUVAIL .......................... 43 acyclovir .............................. 7 acyclovir sodium ................. 7 acyclovir topical ................ 47 ACZONE ........................... 46 ADACEL ........................... 40 ADAGEN ........................... 32 ADALAT CC ...................... 16

see afeditab cr............... 16 see nifedipine ................ 16

adapalene ......................... 46 ADAPALENE .................... 46 ADCIRCA ......................... 18 ADDERALL

see amphetamine-dextroamphetamine tab 10 mg ........ 24 see amphetamine-dextroamphetamine tab 12.5 mg ..... 24 see amphetamine-dextroamphetamine tab 15 mg ........ 24 see amphetamine-dextroamphetamine tab 20 mg ........ 24 see amphetamine-dextroamphetamine tab 30 mg ........ 24 see amphetamine-dextroamphetamine tab 5 mg .......... 24 see amphetamine-dextroamphetamine tab 7.5 mg ....... 24

adderall tab 10mg ............. 24 adderall tab 12.5mg .......... 24 adderall tab 15mg ............. 24 adderall tab 20mg ............. 24 adderall tab 30mg ............. 24 adderall tab 5mg ............... 24 adderall tab 7.5mg ............ 24 ADDERALL XR

see amphetamine-dextroamphetamine cap sr 24hr 10 mg ...................................... 24 see amphetamine-dextroamphetamine cap sr 24hr 15 mg ...................................... 24 see amphetamine-dextroamphetamine cap sr 24hr 20 mg ...................................... 24

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see amphetamine-dextroamphetamine cap sr 24hr 25 mg ...................................... 24 see amphetamine-dextroamphetamine cap sr 24hr 30 mg ...................................... 24 see amphetamine-dextroamphetamine cap sr 24hr 5 mg ...................................... 24

ADDERALL XR CAP 10MG .......................................... 24 ADDERALL XR CAP 15MG .......................................... 24 ADDERALL XR CAP 20MG .......................................... 24 ADDERALL XR CAP 25MG .......................................... 24 ADDERALL XR CAP 30MG .......................................... 24 ADDERALL XR CAP 5MG 24 adefovir dipivoxil .................7 ADEMPAS ........................ 18 adoxa ..................................9 ADOXA

see doxycycline (monohydrate) ............... 10

ADOXA PAK 1/150 see doxycycline (monohydrate) ............... 10

ADRENACLICK ................ 45 adriamycin......................... 10 adrucil ............................... 10 ADVAIR DISKUS .............. 46 ADVAIR HFA .................... 46 ADVICOR.......................... 14 AEROSPAN ...................... 45 afeditab cr ......................... 16 AFINITOR ......................... 12 AFINITOR DISPERZ ......... 12 AGGRENOX ..................... 39 AGRYLIN .......................... 38

see anagrelide hcl ......... 38 a-hydrocort inj 100mg ....... 32 AKNE-MYCIN ................... 46 ala-cort .............................. 47

ala-scalp ........................... 47 ALBENZA ........................... 4 albuterol sulfate ................ 45 albuterol sulfate er ............ 45 alcaine .............................. 44 ALCAINE

see proparacaine hcl ..... 44 alclometasone dipropionate .......................................... 47 ALCOHOL PREPS ........... 27 ALDACTAZIDE ................. 17

see spironolactone & hydrochlorothiazide ....... 17

ALDACTONE .................... 13 see spironolactone ........ 13

ALDARA ........................... 49 see imiquimod ............... 49

ALDURAZYME ................. 32 alendronate sodium .......... 29 alfuzosin hcl ...................... 37 ALIMTA ............................. 10 ALINIA ................................ 4 ALKERAN ......................... 10

see melphalan hcl ......... 10 allopurinol tab ..................... 1 ALOCRIL .......................... 43 ALOMIDE .......................... 43 ALOPRIM ............................ 1 ALORA .............................. 32 ALOXI ............................... 34 ALPHAGAN P 0.1% .......... 44 ALPHAGAN P 0.15% ........ 44 alprazolam ........................ 18 ALREX .............................. 43 ALSUMA ........................... 25 ALTABAX .......................... 46 ALTACE ............................ 13

see ramipril .................... 13 altavera ............................. 29 ALTOPREV ....................... 14 ALVESCO ......................... 45 amantadine hcl ................. 22 AMARYL ........................... 28

see glimepiride .............. 28 AMBIEN ............................ 25

see zolpidem tartrate ..... 25 AMBIEN CR ...................... 25

see zolpidem tartrate ..... 25

AMBISOME ........................ 5 amcinonide ....................... 47 AMERGE .......................... 25

see naratriptan hcl ......... 25 amethia 91 day ................. 29 amethyst 28 day ............... 29 amifostine crystalline ........ 12 amikacin sulfate .................. 4 amiloride & hydrochlorothiazide ........... 17 amiloride hcl ..................... 17 aminophylline inj ............... 46 AMINOSYN ...................... 41 AMINOSYN 7%/ELECTROLYTES ....... 41 AMINOSYN II ................... 41 AMINOSYN II 8.5%/ELECTROL.............. 41 AMINOSYN INJ 8.5/LYTE 41 AMINOSYN M .................. 41 AMINOSYN-HBC .............. 41 AMINOSYN-PF ................. 41 AMINOSYN-PF 7% ........... 41 AMINOSYN-RF................. 41 amiodarone hcl ................. 14 amiodarone inj 50mg/ml ... 14 amiodarone tab 200mg ..... 14 amiodarone tab 400mg ..... 14 AMITIZA ........................... 36 amitriptyline hcl ................. 21 amlodipine besylate .......... 16 amlodipine besylate/atorv . 16 amlodipine besylate-benazepril hcl ..... 12 ammonium chloride .......... 40 ammonium lactate ............ 49 amnesteem ....................... 46 amoxapine ........................ 21 amoxicillin ........................... 9 amoxicillin & pot clavulanate............................................ 9 amoxicillin-clarithromycin w/ lansoprazole ..................... 36 amphetamine-dextroamphetamine cap sr 24hr 10 mg .. 24 amphetamine-dextroamphetamine cap sr 24hr 15 mg .. 24 amphetamine-dextroamphet

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amine cap sr 24hr 20 mg .. 24 amphetamine-dextroamphetamine cap sr 24hr 25 mg .. 24 amphetamine-dextroamphetamine cap sr 24hr 30 mg .. 24 amphetamine-dextroamphetamine cap sr 24hr 5 mg .... 24 amphetamine-dextroamphetamine tab 10 mg ............... 24 amphetamine-dextroamphetamine tab 12.5 mg ............ 24 amphetamine-dextroamphetamine tab 15 mg ............... 24 amphetamine-dextroamphetamine tab 20 mg ............... 24 amphetamine-dextroamphetamine tab 30 mg ............... 24 amphetamine-dextroamphetamine tab 5 mg ................. 24 amphetamine-dextroamphetamine tab 7.5 mg .............. 24 AMPHOTEC ........................5 amphotericin b ....................5 ampicillin .............................9 ampicillin & sulbactam sodium ................................9 ampicillin inj .........................9 ampicillin sodium .................9 AMPYRA ........................... 26 AMRIX .............................. 26 AMTURNIDE ..................... 17 ANAFRANIL ...................... 21

see clomipramine hcl ..... 21 anagrelide hcl .................... 38 ANAPROX ..........................1

see naproxen sodium ......1 ANAPROX DS ....................1

see naproxen sodium ......1 anastrozole tab 1mg ......... 11 ANCOBON ..........................5

see flucytosine .................5 ANDRODERM .................. 27 ANDROGEL 1% ................ 27 ANDROGEL 1.62% ........... 27 androxy ............................. 27 ANORO ELLIPTA ............. 44 antabuse ........................... 27 ANTABUSE

see disulfiram ................ 27 ANTARA ........................... 14 ANTIVERT ........................ 34 anusol hc .......................... 47 ANUSOL-HC

see proctocream ........... 47 see proctosol ................. 47 see proctozone hc ......... 47

apexicon ........................... 47 APIDRA ............................ 27 APIDRA SOLOSTAR ........ 27 APLENZIN ........................ 21 APOKYN ........................... 22 apri 28 day ........................ 29 APRISO ............................ 35 APTIOM TAB 200MG ....... 18 APTIOM TAB 400MG ....... 19 APTIOM TAB 600MG ....... 19 APTIOM TAB 800MG ....... 19 APTIVUS ............................ 6 ARALAST NP ................... 45 ARALEN

see chloroquine phosphate ....................... 6

aranelle 28 ........................ 29 ARANESP ALBUMIN FREE .......................................... 38 ARAVA .............................. 39

see leflunomide ............. 39 ARCALYST ....................... 39 ARCAPTA NEOHALER .... 45 ARICEPT .......................... 20

see donepezil tab hcl 23mg ............................. 20 see donepezil tabs 10mg ...................................... 21 see donepezil tabs 5mg 21

ARICEPT ODT .................. 20 see donepezil odt 10mg 20

ARIMIDEX see anastrozole tab 1mg ...................................... 11

ARIMIDEX TAB 1MG ........ 11 ARIXTRA .......................... 38

see fondaparinux sodium ...................................... 38

AROMASIN see exemestane tab 25mg

...................................... 11 AROMASIN TAB 25MG .... 11 ARRANON ........................ 10 ARTHROTEC ..................... 1 ARTHROTEC 50

see diclofenac w/ misoprostol ...................... 1

ARTHROTEC 75 see diclofenac w/ misoprostol ...................... 1

ARZERRA ........................ 11 ASACOL HD ..................... 35 ASMANEX ........................ 45 ASMANEX 14 METERED DOSES ............................. 45 ASTAGRAF XL ................. 40 ASTELIN ........................... 44 ASTEPRO ........................ 44

see azelastine hcl nasal spray 0.15% (205.5 mcg/spray) .................... 44

ATACAND ........................ 13 see candesartan cilexetil ...................................... 14

ATACAND HCT ................ 13 see candesartan cilexetil-hydrochlorothiazide .................................... 13

ATELVIA ........................... 29 atenolol ............................. 15 atenolol & chlorthalidone .. 15 ATGAM ............................. 40 ATIVAN ............................. 18

see lorazepam............... 18 atorvastatin calcium .......... 14 atovaquone ......................... 4 atovaquone-proguanil hcl tab 250-100 mg ........................ 6 atovaquone-proguanil hcl tab 62.5-25 mg ......................... 6 ATRALIN .......................... 46 ATRIPLA ............................. 6 ATROPINE SULFATE ...... 35 ATROVENT ...................... 44

see ipratropium bromide (nasal) ........................... 44

ATROVENT HFA .............. 44 AUBAGIO ......................... 26

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54

aubra 28 day ..................... 29 AUGMENTIN ......................9

see amoxicillin & pot clavulanate ......................9

AUGMENTIN ES-600 .........9 see amoxicillin & pot clavulanate ......................9

AUGMENTIN XR ................9 see amoxicillin & pot clavulanate ......................9

AUVI-Q INJ 0.15MG ......... 45 AUVI-Q INJ 0.3MG ........... 45 AVALIDE ........................... 13

see irbesartan-hydrochlorothiazide ................................ 13

AVAPRO ........................... 13 see irbesartan ................ 14

AVASTIN........................... 11 AVELOX..............................8

see moxifloxacin hcl ........9 AVELOX ABC PACK ..........8 aviane 28 .......................... 30 AVINZA ...............................2

see morphine sulfate beads cap sr ....................3

AVITA ............................... 46 AVODART ......................... 37 AVONEX ........................... 26 AVONEX PEN ................... 26 AXERT .............................. 25 AXID ................................. 35

see nizatidine ................ 35 AXIRON ............................ 27 aygestin............................. 34 AYGESTIN

see norethindrone acetate ...................................... 34

azacitidine ......................... 10 AZACTAM ...........................4

see aztreonam .................4 AZACTAM/DEX INJ 1GM ...4 AZACTAM/DEX INJ 2GM ...4 azasan .............................. 40 AZASITE ........................... 42 azathioprine ...................... 40 azelastine hcl .................... 44 azelastine hcl (ophth) ........ 43

azelastine hcl nasal spray 0.15% (205.5 mcg/spray) .. 44 AZELEX ............................ 46 AZILECT ........................... 22 azithromycin ........................ 8 AZITHROMYCIN ................ 8 AZOPT .............................. 44 AZOR ................................ 13 aztreonam ........................... 4 AZULFIDINE ..................... 35

see sulfasalazine ir ........ 36 AZULFIDINE EN-TABS .... 35

see sulfasalazine dr....... 35 B bacitracin (ophthalmic) ...... 43 bacitracin-polymyxin b (ophth) .............................. 43 bacitracin-poly-neomycin-hc .......................................... 42 baclofen ............................ 26 BACTOCILL IN DEXTROSE ............................................ 9 BACTRIM ............................ 4

see sulfamethoxazole-trimethoprim ................................. 5

BACTRIM DS ...................... 4 see sulfamethoxazole-trimethoprim ................................. 5

BACTROBAN ................... 46 see mupirocin ................ 47 see mupirocin calcium (topical) ......................... 47

BACTROBAN NASAL ....... 46 balsalazide disodium......... 35 balziva 28 day ................... 30 BANZEL ............................ 19 BARACLUDE ...................... 7

see entecavir ................... 7 BCG VACCINE ................. 40 BECONASE AQ ................ 45 benazepril & hydrochlorothiazide ........... 12 benazepril hcl .................... 13 BENICAR .......................... 13 BENICAR HCT ................. 13 BENTYL ............................ 35

see dicyclomine hcl ....... 35 BENZACLIN ..................... 46

see clindamycin phosphate-benzoyl peroxide ........................ 46

BENZAMYCIN .................. 46 see benzoyl peroxide-erythromycin ... 46

benzoyl peroxide-erythromycin ...... 46 benztropine mesylate ........ 22 BEPREVE ......................... 43 BESIVANCE ..................... 43 BETAGAN ........................ 44

see levobunolol hcl ........ 44 betamethasone dipropionate (topical) ............................. 48 betamethasone dipropionate augmented ........................ 48 betamethasone valerate ... 48 BETAPACE ...................... 14

see sorine ..................... 14 see sotalol hcl ............... 14

BETAPACE AF ................. 14 see sotalol hcl (afib/afl) . 14

BETASERON ................... 26 betaxolol hcl ...................... 15 betaxolol hcl (ophth) ......... 44 bethanechol chloride ......... 37 BETHKIS ............................ 4 BETIMOL .......................... 44 BETOPTIC-S .................... 44 BEYAZ .............................. 30 BIAXIN ................................ 8

see clarithromycin ........... 8 BIAXIN XL .......................... 8

see clarithromycin ........... 8 BIAXIN XL PAC .................. 8 bicalutamide ..................... 11 BICILLIN C-R ...................... 9 BICILLIN L-A ...................... 9 BICNU .............................. 10 BIDIL ................................. 17 BILTRICIDE ........................ 4 BINOSTO ......................... 29 bisoprolol & hydrochlorothiazide ........... 15 bisoprolol fumarate ........... 15

2014 601 4T Copper BvD Comm_NT (Effective November 1)

55

BIVIGAM ........................... 39 bleomycin sulfate .............. 10 BLEPH-10 ......................... 43

see sulfacetamide sodium (ophth) ........................... 43

blephamide ....................... 42 BLEPHAMIDE ................... 42 BONIVA ............................ 29

see ibandronate sodium 29 BOOSTRIX ....................... 40 BOSULIF........................... 12 BOTOX ............................. 44 BREO ELLIPTA ................ 46 BREVICON-28 .................. 30

see necon 0.5/35 28 day ...................................... 31 see nortrel 0.5/35 28 day ...................................... 31

briellyn 28 day ................... 30 BRILINTA .......................... 39 BRIMONIDINE SOL 0.15% .......................................... 44 brimonidine sol 0.2% ......... 44 BRINTELLIX ..................... 21 BRISDELLE ...................... 26 BROMDAY ........................ 43 bromfenac sodium (ophth) 43 BROMFENAC SODIUM (OPHTH)(ONCE-DAILY) ... 43 bromocriptine mesylate ..... 22 BROVANA ........................ 45 budeprion tab 150 mg sr ... 21 budesonide ....................... 35 budesonide (inhalation) ..... 45 budesonide (nasal) ........... 45 bumetanide ....................... 17 BUPHENYL ....................... 32

see sodium phenylbutyrate ...................................... 32

BUPHENYL TAB 500MG .. 32 buprenorphine hcl ............. 27 buprenorphine hcl-naloxone hcl sl .................................. 27 buproban ........................... 27 bupropion hcl .................... 21 buspirone hcl ..................... 18 BUSULFEX ....................... 10 butorphanol nasal spray ......1

butorphanol tartrate ............ 1 BUTRANS DIS 10MCG/HR 1 BUTRANS DIS 15MCG/HR 1 BUTRANS DIS 20MCG/HR 1 BUTRANS DIS 5MCG/HR .. 1 BYDUREON ..................... 27 BYETTA INJ 10MCG ........ 27 BYETTA INJ 5MCG .......... 27 BYSTOLIC ........................ 15 C cabergoline ....................... 33 CADUET ........................... 16

see amlodipine besylate/atorv ................ 16

cafergot tab 1-100mg ........ 25 CALAN .............................. 16

see verapamil hcl .......... 17 CALAN SR ........................ 16

see verapamil hcl .......... 17 calcipotriene ...................... 47 calcipotriene-betamethasone dipropionate ...................... 48 calcitonin (salmon) nasal spray ................................. 33 calcitriol ............................. 42 CALCITRIOL ..................... 47 calcium acetate (phosphate binder) ............................... 33 camila 28 day .................... 30 CAMPRAL

see acamprosate calcium ...................................... 27

CAMPRAL TAB 333MG .... 27 CAMPTOSAR ................... 12

see irinotecan hcl .......... 12 CAMRESE LO TAB .......... 30 CANASA ........................... 35 CANCIDAS ......................... 5 candesartan cilexetil ......... 14 candesartan cilexetil-hydrochlorothiazide .......................................... 13 CANTIL ............................. 35 CAPASTAT SULFATE ........ 6 CAPEX .............................. 48 capital

and codeine ..................... 1 CAPRELSA ....................... 12

captopril ............................ 13 captopril & hydrochlorothiazide ........... 12 CARAC ............................. 46 CARAFATE ...................... 36

see sucralfate ................ 36 CARBAGLU ...................... 32 carbamazepine ................. 19 CARBATROL .................... 19

see carbamazepine ....... 19 carbidopa .......................... 22 CARBIDOPA/LEVODOPA/ENTACAPONE ................... 22 carbidopa-levodopa .......... 22 carboplatin ........................ 12 CARDIZEM ....................... 16

see diltiazem tab 120mg 16 see diltiazem tab 30mg . 16 see diltiazem tab 60mg . 16

CARDIZEM CD ................. 16 see cartia xt ................... 16 see dilt-cd ...................... 16 see dilt-cd cap 120mg ... 16 see dilt-cd cap 180mg ... 16 see dilt-cd cap 300mg ... 16 see diltiazem hcl coated beads ............................ 16

CARDIZEM LA.................. 16 see matzim la ................ 16

CARDURA ........................ 13 see doxazosin mesylate 13

CARDURA XL .................. 37 CARIMUNE NF INJ 12GM 39 CARIMUNE NF INJ 6GM .. 39 carisoprodol ...................... 26 CARNITOR ....................... 32

see levocarnitine (metabolic modifiers) ..... 32

carteolol hcl (ophth) .......... 44 cartia xt ............................. 16 carvedilol .......................... 15 CASODEX ........................ 11

see bicalutamide ........... 11 CATAFLAM ........................ 1

see diclofenac potassium 1 CATAPRES ...................... 17

see clonidine hcl ............ 18 CATAPRES-TTS .............. 17

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CATAPRES-TTS-1 see clonidine hcl ............ 17

CATAPRES-TTS-2 see clonidine hcl ............ 18

CATAPRES-TTS-3 see clonidine hcl ............ 18

CAYSTON ......................... 45 CEDAX ...............................7 CEENU CAP 10MG .......... 10 CEENU CAP 40MG .......... 10 cefaclor ...............................7 cefaclor monohydrate .........7 cefadroxil.............................7 cefazolin inj .........................7 cefazolin sodium .................7 cefazolin/dextrose ...............7 cefdinir ................................7 CEFEPIME 1GM SOLN ......7 CEFEPIME 2GM SOLN ......8 cefepime inj 1gm .................8 cefepime inj 2gm .................8 cefotaxime sodium ..............8 cefotetan disodium ..............8 cefoxitin sodium ..................8 CEFOXITIN SODIUM IN DEXTROSE ........................8 cefpodoxime proxetil ...........8 cefprozil...............................8 ceftazidime ..........................8 ceftazidime solr ...................8 CEFTAZIDIME/DEXTROSE ............................................8 ceftibuten ............................8 CEFTIN ...............................8

see cefuroxime axetil .......8 ceftriaxone sodium ..............8 cefuroxime axetil .................8 cefuroxime sodium ..............8 CELEBREX .........................1 CELEXA ............................ 21

see citalopram hydrobromide ................ 21

CELLCEPT ....................... 40 see mycophenolate mofetil ...................................... 40

CELLCEPT INTRAVENOUS .......................................... 40 CELONTIN ........................ 19

CENTANY ......................... 46 cephalexin ........................... 8 CEREZYME ...................... 32 CERVARIX ....................... 40 CESAMET ........................ 34 cetirizine syrup .................. 44 cevimeline hcl ................... 50 CHANTIX PAK 0.5& 1MG . 27 CHANTIX TAB 0.5MG ...... 27 CHANTIX TAB 1MG ......... 27 CHEMET ........................... 29 chlorhexidine gluconate (mouth-throat) ................... 50 chloroquine phosphate........ 6 chlorothiazide .................... 17 chlorpromaz inj 25mg/ml ... 23 chlorpromazine hcl ............ 23 chlorthalidone ................... 17 chlorzoxazone ................... 26 cholestyramine .................. 15 cholestyramine light .......... 15 choline fenofibrate ............ 15 CHORIONIC GONADOTROPIN ............ 33 ciclopirox ........................... 47 ciclopirox cre 0.77% .......... 47 ciclopirox shampoo 1% ..... 47 ciclopirox sus 0.77% ......... 47 cidofovir .............................. 7 cilostazol ........................... 38 CILOXAN

see ciprofloxacin hcl (ophth) ........................... 43

CILOXAN OIN 0.3% OP ... 43 CILOXAN SOL 0.3% OP ... 43 cimetidine .......................... 35 cimetidine sol 300/5ml ...... 35 CIMZIA KIT ....................... 39 CIMZIA KIT STARTER ..... 39 CIMZIA PREFL KIT 200MG/ML ........................ 39 CIPRO ................................ 8

see ciprofloxacin ............. 9 see ciprofloxacin hcl ........ 9

CIPRO HC ........................ 50 CIPRO I.V.-IN D5W ............ 8

see ciprofloxacin in d5w .. 9 CIPRO XR

see ciprofloxacin er ......... 9 CIPRODEX ....................... 50 ciprofloxacin .................... 8, 9 ciprofloxacin er ................... 9 ciprofloxacin hcl .................. 9 ciprofloxacin hcl (ophth) .... 43 ciprofloxacin in d5w ............ 9 ciprofloxacn inj .................... 9 cisplatin soln ..................... 12 citalopram hydrobromide .. 21 cladribine .......................... 10 claforan ............................... 8 CLAFORAN ........................ 8

see cefotaxime sodium ... 8 claravis ............................. 46 CLARINEX ........................ 44

see desloratadine .......... 44 CLARINEX REDITABS

see desloratadine .......... 44 CLARINEX-D 12 ............... 44 clarithromycin ..................... 8 cleocin ................................ 4 CLEOCIN ...................... 4, 37

see clindamycin cre 2% vag ................................ 37 see clindamycin hcl ......... 4

CLEOCIN CAP 75MG ......... 4 CLEOCIN IN D5W .............. 4

see clindamycin phosphate in d5w ............ 4

CLEOCIN INJ ..................... 4 CLEOCIN PEDIATRIC GRANULE

see clindamycin palmitate hydrochloride................... 4

CLEOCIN PHOSPHATE ..... 4 see clindamycin phosphate ....................... 4

CLEOCIN VAG SUPP 100MG .............................. 37 CLEOCIN-T ...................... 46

see clindamycin phosphate (topical) ........ 46

CLIMARA .......................... 32 see estradiol .................. 32

CLINDAGEL ..................... 46 clindamycin cre 2% vag .... 37 clindamycin hcl ................... 4

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clindamycin palmitate hydrochloride ......................4 clindamycin phosphate .......4 clindamycin phosphate (topical) ............................. 46 clindamycin phosphate in d5w .....................................4 clindamycin phosphate-benzoyl peroxide .......................................... 46 CLINIMIX 2.75%/DEXTROSE 5% ..... 41 CLINIMIX 4.25%/DEXTROSE 10% ... 41 CLINIMIX 4.25%/DEXTROSE 20% ... 41 CLINIMIX 4.25%/DEXTROSE 25% ... 41 CLINIMIX 4.25%/DEXTROSE 5% ..... 41 CLINIMIX 5%/DEXTROSE 15% ................................... 41 CLINIMIX 5%/DEXTROSE 20% ................................... 41 CLINIMIX 5%/DEXTROSE 25% ................................... 41 CLINIMIX E 2.75%/DEXTROSE 10% ... 41 CLINIMIX E 2.75%/DEXTROSE 5% ..... 41 CLINIMIX E 4.25%/DEXTROSE 10% ... 41 CLINIMIX E 4.25%/DEXTROSE 25% ... 41 CLINIMIX E 4.25%/DEXTROSE 5% ..... 41 CLINIMIX E 5%/DEXTROSE 15% ................................... 41 CLINIMIX E 5%/DEXTROSE 20% ................................... 41 CLINIMIX E 5%/DEXTROSE 25% ................................... 41 clinisol 15 .......................... 41 clobetasol propionate ........ 48 clobetasol propionate emollient base ................... 48 clobetasol propionate emulsion............................ 48

CLOBEX ........................... 48 see clobetasol propionate ...................................... 48 see clodan ..................... 48

CLOCORTOLONE PIVALATE ......................... 48 clodan ............................... 48 CLODERM PUMP ............ 48 CLOLAR ........................... 10 clomipramine hcl ............... 21 clonazepam ...................... 19 clonidine hcl ................ 17, 18 clopidogrel bisulfate .......... 39 clorazepate dipotassium ... 19 clorpres 0.1/15 .................. 18 clorpres 0.2/15 .................. 18 clorpres 0.3/15 .................. 18 clotrimazole ....................... 50 clotrimazole (topical) ......... 47 CLOZAPINE ODT ............. 23 clozapine tab ..................... 23 CLOZARIL ........................ 23

see clozapine tab .......... 23 COARTEM .......................... 6 codeine

and capital ....................... 1 CODEINE SULFATE .......... 2 COGENTIN ....................... 22

see benztropine mesylate ...................................... 22

COLAZAL ......................... 35 see balsalazide disodium ...................................... 35

colchicine w/ probenecid ..... 1 COLCRYS .......................... 1 COLESTID ........................ 15

see colestipol hcl ........... 15 colestipol hcl ..................... 15 colistimethate sodium ......... 4 colocort ............................. 35 COLY-MYCIN M ................. 4

see colistimethate sodium ........................................ 4

COLY-MYCIN S ................ 50 COLYTE-FLAVOR PACKS .......................................... 36

see gavilyte-c ................ 36 COMBIGAN ...................... 44

COMBIPATCH .................. 32 COMBIVENT RESPIMAT . 44 COMBIVIR .......................... 6

see lamivudine-zidovudine ........................................ 6

COMETRIQ ...................... 12 COMPAZINE

see prochlorperazine maleate ......................... 34

COMPLERA ....................... 6 compro supp ..................... 34 COMTAN .......................... 22 COMVAX .......................... 40 CONCERTA ..................... 24

see methylphenidate hcl er ...................................... 25

CONDYLOX ..................... 49 see podofilox ................. 49

constulose ........................ 36 CONZIP .............................. 1 COPAXONE INJ 40MG/ML.......................................... 26 COPAXONE KIT 20MG/ML.......................................... 26 COPEGUS .......................... 7

see moderiba tab 200mg 7 see ribasphere ................ 7 see ribavirin tab 200mg ... 7

CORDARONE see amiodarone tab 200mg ........................... 14 see pacerone ................ 14

CORDRAN ....................... 48 COREG ............................ 15

see carvedilol ................ 15 COREG CR ...................... 15 CORGARD ....................... 15

see nadolol .................... 16 CORTEF ........................... 32

see hydrocortisone ........ 32 CORTENEMA ................... 35

see colocort ................... 35 CORTIFOAM .................... 47 cortisone acetate .............. 32 CORTISPORIN ........... 47, 50

see neomycin-polymyxin-hc (otic) .............................. 50

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CORTISPORIN-TC ........... 50 CORZIDE .......................... 15

see nadolol & bendroflumethiazide ...... 15

COSMEGEN ..................... 10 COSOPT ........................... 44

see dorzolamide hcl-timolol maleate ........ 44

COSOPT PF ..................... 44 COUMADIN ...................... 38

see jantoven .................. 38 see warfarin sodium ...... 38

COUMADIN INJ ................ 38 COZAAR ........................... 14

see losartan potassium.. 14 CREON ............................. 36 CRESTOR ........................ 14 CRINONE ......................... 34 CRIXIVAN ...........................6 cromolyn sodium ............... 45 cromolyn sodium (mastocytosis) ................... 36 cromolyn sodium (ophth) .. 43 cryselle 28 ......................... 30 CUBICIN .............................4 CUTIVATE ........................ 48

see fluticasone propionate ...................................... 48

CUVPOSA ........................ 35 cyclafem 1/35 28 day ........ 30 cyclafem 7/7/7 28 day ....... 30 CYCLESSA ....................... 30

see velivet 28 day .......... 31 cyclobenzaprine hcl .......... 26 cyclophosphamide ............ 10 CYCLOPHOSPHAMIDE ... 10 cycloserine ..........................7 cyclosporine ...................... 40 cyclosporine modified (for microemulsion) .................. 40 CYKLOKAPRON ............... 38

see tranexamic acid ...... 39 CYMBALTA

see duloxetine hcl .......... 21 CYMBALTA CAP 20MG ... 21 CYMBALTA CAP 30MG ... 21 CYMBALTA CAP 60MG ... 21 cyproheptadine hcl ............ 44

CYSTADANE .................... 32 CYSTAGON ...................... 32 cytarabine inj ..................... 10 CYTOMEL ........................ 34

see liothyronine sodium . 34 CYTOTEC ......................... 36

see misoprostol ............. 36 CYTOVENE ........................ 7

see ganciclovir inj 500mg 7 D D.H.E. 45 .......................... 25

see dihydroergotamine mesylate ........................ 25

dacarbazine ...................... 10 DACOGEN ........................ 10

see decitabine ............... 11 DALIRESP ........................ 45 danazol ............................. 31 DANTRIUM ....................... 26

see dantrolene sodium .. 26 dantrolene sodium ............ 26 dapsone .............................. 4 DAPTACEL ....................... 40 DARAPRIM ......................... 4 daunorubicin hcl ................ 10 daunorubicin hcl for inj 20 mg ..................................... 10 DAYPRO ............................. 1

see oxaprozin .................. 1 DAYTRANA ...................... 24 DDAVP ............................. 34

see desmopressin acetate ...................................... 34 see desmopressin acetate inj................................... 34 see desmopressin acetate spray ............................. 34

DECAVAC ........................ 40 decitabine ......................... 11 DELATESTRYL ................ 27 DELESTROGEN ............... 32

see estradiol valerate .... 32 delyla 28 day ..................... 30 DELZICOL ........................ 35 DEMADEX ........................ 17

see torsemide tabs ........ 17 demeclocycline hcl .............. 9 DEMSER .......................... 18

DENAVIR .......................... 47 DEPACON ........................ 19

see valproate sodium .... 20 DEPAKENE ...................... 19

see valproate sodium .... 20 see valproic acid ........... 20

DEPAKOTE ...................... 19 see divalproex sodium .. 19

DEPAKOTE ER ................ 19 see divalproex sodium .. 19

DEPAKOTE SPRINKLES . 19 see divalproex sodium .. 19

depo-estradiol ................... 32 DEPO-MEDROL ............... 32

see methylprednisolone acetate .......................... 32

DEPO-PROVERA CONTRACEPTIV .............. 30

see medroxyprogesterone acetate (contraceptive) .. 30

DEPO-PROVERA INJ 400/ML .............................. 11 DEPO-SUBQ PROVERA 104 .................................... 30 depo-testosterone ............. 27 DEPO-TESTOSTERONE

see testosterone cypionate ...................................... 27

DERMA-SMOOTHE/FS BODY

see fluocinolone acetonide ...................................... 48

DERMA-SMOOTHE/FS BODY OIL ......................... 48 DERMATOP ..................... 48

see prednicarbate ......... 49 DERMOTIC ...................... 50

see fluocinolone acetonide (otic) .............................. 50

desipramine hcl................. 21 desloratadine .................... 44 desmopressin acetate ....... 34 DESMOPRESSIN ACETATE.......................................... 34 desmopressin acetate inj .. 34 desmopressin acetate spray.......................................... 34 desmopressin acetate spray

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refrigerated ........................ 34 DESOGEN ........................ 30

see apri 28 day .............. 29 see emoquette ............... 30 see reclipsen 28 day ..... 31

DESONATE ...................... 48 desonide ........................... 48 DESONIDE ....................... 48 desowen............................ 48 DESOWEN ....................... 48

see desonide ................. 48 desowen oint kit 0.05% ..... 48 desoximetasone ................ 48 DESOXIMETASONE ........ 48 DETROL ........................... 37

see tolterodine tartrate tab 1 mg .............................. 37 see tolterodine tartrate tab 2 mg .............................. 37

DETROL LA ...................... 37 see tolterodine tartrate er ...................................... 37

dexamethasone ................ 32 dexamethasone sodium phosphate ......................... 32 dexamethasone sodium phosphate (ophth) ............. 43 DEXILANT ........................ 36 dexpak taperpak 13 day .... 32 dexrazoxane ..................... 12 dextrose ............................ 41 DEXTROSE ...................... 41 DEXTROSE 10% FLEX CONTAIN .......................... 42 DEXTROSE 10% W/ SODIUM CHLORIDE 0.2% .......................................... 42 DEXTROSE 10%/NACL 0.45% ................................ 42 DEXTROSE 2.5%/NACL 0.45% ................................ 41 DEXTROSE 5% ................ 41 DEXTROSE 5% /ELECTROLYTE ............... 41 DEXTROSE 5%/LACTATED RING ................................. 41 DEXTROSE 5%/NACL 0.2% .......................................... 41

DEXTROSE 5%/NACL 0.225% .............................. 41 DEXTROSE 5%/NACL 0.3% .......................................... 41 DEXTROSE 5%/NACL 0.33%................................ 41 DEXTROSE 5%/NACL 0.45%................................ 41 DEXTROSE 5%/NACL 0.9% .......................................... 41 DEXTROSE 5%/POTASSIUM CHL ...... 41 DIABETA .......................... 28 DIAMOX ............................ 17

see acetazolamide ........ 17 DIASTAT ACUDIAL .......... 19 DIASTAT PEDIATRIC....... 19 diazepam .......................... 19 DIAZEPAM GEL ............... 19 diazepam inj ...................... 19 DIBENZYLINE .................. 18 diclofenac potassium .......... 1 diclofenac sodium ............... 1 diclofenac sodium (actinic keratoses) ......................... 46 diclofenac sodium (ophth) . 43 diclofenac sodium (topical) 49 diclofenac w/ misoprostol .... 1 dicloxacillin sodium ............. 9 dicyclomine hcl ................. 35 didanosine .......................... 6 DIFFERIN ......................... 46

see adapalene ............... 46 DIFICID ............................... 8 diflorasone diacetate ......... 48 DIFLUCAN .......................... 5

see fluconazole ............... 5 diflunisal .............................. 1 digoxin inj .......................... 17 DIGOXIN SOL 50MCG/ML .......................................... 17 digoxin tab 0.125mg ......... 17 digoxin tab 0.25mg ........... 17 dihydroergotamine mesylate .......................................... 25 DIHYDROERGOTAMINE MESYLATE ....................... 25 dilacor ............................... 16

dilantin .............................. 19 DILANTIN ......................... 19

see phenytoin ................ 20 see phenytoin sodium extended ....................... 20

DILANTIN INFATABS see phenytoin ................ 20

DILATRATE SR ................ 18 DILAUDID

see hydromorphone hcl ... 3 DILAUDID INJ .................... 2 DILAUDID TAB ................... 2 DILAUDID-5 ORAL LIQD .... 2 DILAUDID-HP

see hydromorphone hcl ... 3 DILAUDID-HP INJ .............. 2 dilt-cd ................................ 16 dilt-cd cap 120mg ............. 16 dilt-cd cap 180mg ............. 16 dilt-cd cap 300mg ............. 16 diltiazem cap 120mg er ..... 16 diltiazem cap 120mg/24 .... 16 diltiazem cap 60mg er ....... 16 diltiazem cap 90mg er ....... 16 diltiazem hcl ...................... 16 diltiazem hcl coated beads 16 DILTIAZEM HCL ER ......... 16 diltiazem hcl extended release beads ................... 16 diltiazem inj 50/10ml ......... 16 diltiazem tab 120mg .......... 16 diltiazem tab 30mg ............ 16 diltiazem tab 60mg ............ 16 diltiazem tab 90mg ............ 16 dilt-xr cap 120mg .............. 16 dilt-xr cap 180mg .............. 16 dilt-xr cap 240mg .............. 16 diltzac ............................... 16 DIOVAN ............................ 14

see valsartan tab 160 mg ...................................... 14 see valsartan tab 320 mg ...................................... 14 see valsartan tab 40 mg 14 see valsartan tab 80 mg 14

DIOVAN HCT ................... 13 see valsartan-hydrochlorothiazi

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de .................................. 13 DIPENTUM ....................... 35 diphenhydram inj 50mg/ml 44 diphenoxylate w/ atropine . 36 DIPHTHERIA/TETANUS TOXOID ............................ 40 DIPROLENE ..................... 48

see betamethasone dipropionate augmented 48

DIPROLENE AF ................ 48 see betamethasone dipropionate augmented 48

dipyridamole ...................... 39 disopyramide phosphate ... 14 disulfiram........................... 27 DITROPAN XL .................. 37

see oxybutynin chloride . 37 DIURIL SUS 250/5ML ....... 17 divalproex sodium ............. 19 docetaxel........................... 11 DOCETAXEL .................... 11 DOLOPHINE .......................2

see methadone hcl ..........3 DOLOPHINE HCL

see methadone hcl ..........3 donepezil odt 10mg ........... 20 donepezil odt 5mg ............. 20 donepezil tab hcl 23mg ..... 20 donepezil tabs 10mg ......... 21 donepezil tabs 5mg ........... 21 DORIBAX ............................4 DORYX ...............................9

see doxycycline hyclate . 10 dorzolamide hcl ................. 44 dorzolamide hcl-timolol maleate ............................. 44 DOVONEX ........................ 47

see calcipotriene ........... 47 doxazosin mesylate .......... 13 doxepin hcl ........................ 21 doxercalciferol ................... 42 DOXIL ............................... 10

see doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml ........... 10

doxorubicin hcl .................. 10 doxorubicin hcl liposomal inj (for iv infusion) 2 mg/ml ..... 10

doxycycline (monohydrate) 9, 10 doxycycline hyclate ........... 10 dronabinol ......................... 34 drospirenone-ethinyl estradiol ............................ 30 DROXIA ............................ 12 DUAC

see neuac ...................... 46 DUETACT ......................... 28

see pioglitazone hcl-glimepiride ............... 29

DUEXIS .............................. 1 DULERA ........................... 46 duloxetine hcl .................... 21 DUONEB .......................... 44 DURAGESIC ...................... 2

see fentanyl patch ........... 3 DURAMORPH .................... 2 DUREZOL ......................... 43 DUTOPROL ...................... 15 DYAZIDE .......................... 17

see triamterene & hydrochlorothiazide cap 37.5-25 mg .................... 17

DYMISTA .......................... 45 dynacin ............................. 10 DYRENIUM ....................... 17 E e.e.s. ................................... 8 E.E.S. GRANULES ............. 8 EC-NAPROSYN ................. 1

see naproxen .................. 1 econazole nitrate .............. 47 EDARBI ............................ 14 EDARBYCLOR ................. 13 EDECRIN .......................... 17 EDLUAR ........................... 25 EDURANT .......................... 6 EFFEXOR XR ................... 21

see venlafaxine cap er .. 22 EFFIENT ........................... 39 EFUDEX ........................... 46

see fluorouracil (topical) 46 EGRIFTA .......................... 33 ELAPRASE ....................... 32 ELDEPRYL ....................... 22

see selegiline hcl ........... 23

ELECTROLYTE-R IN DEXTROSE ...................... 42 ELELYSO ......................... 32 ELESTAT .......................... 43

see epinastine hcl (ophth) ...................................... 43

ELIDEL CRE 1%............... 49 ELIGARD .......................... 11 ELIMITE

see permethrin .............. 50 eliphos .............................. 33 ELIPHOS

see calcium acetate (phosphate binder) ........ 33

ELIQUIS TAB 2.5MG ........ 38 ELIQUIS TAB 5MG ........... 38 ELITEK ............................. 12 elixophyllin ........................ 46 ELLA ................................. 30 ELLENCE ......................... 10

see epirubicin inj 200mg 10 see epirubicin inj 50mg/25ml .................... 10

ELMIRON ......................... 37 ELOCON .......................... 48

see mometasone furoate ...................................... 49

ELOXATIN ........................ 12 EMADINE ......................... 43 EMCYT ............................. 10 EMEND ............................. 34 EMEND PAK 80 & 125 ..... 34 EMLA ................................ 49

see lidocaine-prilocaine . 49 emoquette ......................... 30 EMSAM ............................ 21 EMTRIVA ............................ 6 ENABLEX ......................... 37 enalapril maleate .............. 13 enalapril maleate & hydrochlorothiazide ........... 12 ENBREL INJ 25/0.5ML ..... 39 ENBREL INJ 25MG .......... 39 ENBREL INJ 50MG/ML .... 39 ENBREL SURECLICK ...... 39 endocet 10/325 ................... 2 endocet 5/325 ..................... 2 endocet 7.5/325 .................. 2

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ENDODAN ..........................2 ENDOMETRIN .................. 34 ENGERIX-B ...................... 40 enoxaparin sodium ............ 38 enpresse 28 day ............... 30 ENTACAPONE ................. 22 entecavir .............................7 ENTOCORT EC ................ 35

see budesonide ............. 35 ENTYVIO .......................... 35 enulose ............................. 36 EPIDUO ............................ 46 epinastine hcl (ophth) ........ 43 EPINEPHRINE INJ 0.15MG .......................................... 45 EPINEPHRINE INJ 0.3MG 45 EPIPEN 2-PAK ................. 45 EPIPEN-JR 2-PAK ............ 45 epirubicin inj 200mg .......... 10 EPIRUBICIN INJ 50MG .... 10 epirubicin inj 50mg/25ml ... 10 epitol ................................. 19 EPIVIR

see lamivudine ................6 EPIVIR HBV ........................7

see lamivudine ................7 EPIVIR HBV TAB 100MG ...7 EPIVIR SOL 10MG/ML .......6 EPIVIR TABS ......................6 eplerenone tab 25mg ........ 13 eplerenone tab 50mg ........ 13 EPOGEN........................... 38 eprosartan mesylate ......... 14 EPZICOM............................6 EQUETRO ........................ 26 ERAXIS ...............................5 ERBITUX .......................... 11 ergomar............................. 25 ERIVEDGE ....................... 11 errin 28 day ....................... 30 ERTACZO ......................... 47 erygel ................................ 46 ERYGEL

see erythromycin (acne aid) ................................ 46

ERYPED 200 ......................8 ERYPED 400 ......................8 ery-tab .................................8

erythrocin lactobionate ........ 8 erythrocin stearate .............. 8 erythromycin (acne aid) .... 46 erythromycin (ophth) ......... 43 erythromycin base .............. 8 erythromycin ethylsuccinate 8 erythromycin-sulfisoxazole for susp 200-600 mg/5ml .... 4 escitalopram oxalate ......... 21 esomeprazole sodium inj . 36, 37 estrace .............................. 32 ESTRACE

see estradiol .................. 32 estradiol ............................ 32 estradiol & norethindrone acetate .............................. 32 estradiol valerate .............. 32 ESTRADIOL VALERATE .. 32 ESTRING .......................... 32 estropipate ........................ 32 ESTROSTEP FE .............. 30

see tri-legest 28 day ...... 31 eszopiclone ....................... 25 ethambutol hcl .................... 7 ethosuximide ..................... 19 ETHYOL

see amifostine crystalline ...................................... 12

etodolac .............................. 1 etodolac er .......................... 1 ETOPOPHOS ................... 12 etoposide .......................... 12 EURAX ............................. 49 EVISTA ............................. 34

see raloxifene hcl .......... 34 EVOCLIN .......................... 46

see clindamycin phosphate (topical) ........ 46

EVOXAC ........................... 50 see cevimeline hcl ......... 50

EXALGO ............................. 2 see hydromorphone hcl ... 3

EXELDERM ...................... 47 EXELON

see rivastigmine tartrate 21 EXELON CAP ................... 21 EXELON PATCHES ......... 21

exemestane tab 25mg ...... 11 EXFORGE ........................ 13 EXFORGE HCT ................ 13 EXJADE ............................ 29 EXTAVIA .......................... 26 EXTINA ............................. 47

see ketoconazole (topical) ...................................... 47

F FABIOR ............................ 46 FABRAZYME .................... 32 FACTIVE ............................ 9 falmina 28 day .................. 30 famciclovir ........................... 7 famotidine ......................... 35 famotidine inj .................... 35 FAMVIR .............................. 7

see famciclovir ................ 7 FANAPT ........................... 23 FANAPT TITRATION PACK.......................................... 23 FARESTON ...................... 11 FARXIGA .......................... 28 FASLODEX ...................... 11 FAZACLO ......................... 23 felbamate .......................... 19 FELBATOL ....................... 19

see felbamate................ 19 FELDENE ........................... 1

see piroxicam .................. 1 felodipine .......................... 16 FEMARA

see letrozole tab 2.5mg . 11 FEMARA TAB 2.5MG ....... 11 FEMCON FE .................... 30

see zenchent fe 28 day . 31 FEMRING ......................... 32 FENOFIBRATE................. 15 FENOFIBRATE CAP ........ 15 fenofibrate micronized ...... 15 FENOFIBRATE MICRONIZED ................... 15 fenofibrate tab ................... 15 FENOFIBRIC ACID .......... 15 FENOGLIDE ..................... 15 fenoprofen calcium ............. 1 fentanyl citrate .................... 2 fentanyl patch ..................... 3

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FENTORA ...........................3 FERRIPROX ..................... 29 FETZIMA........................... 21 FETZIMA TITRATION PACK .......................................... 21 fexmid ............................... 26 FEXMID

see cyclobenzaprine hcl 26 FIBRICOR ......................... 15 FINACEA .......................... 49 finasteride ......................... 37 FIRMAGON ....................... 11 FLAGYL ..............................4

see metronidazole ...........5 FLAGYL ER ........................4 FLAREX ............................ 43 FLEBOGAMMA ................. 39 FLEBOGAMMA DIF .......... 39 flecainide acetate .............. 14 FLOMAX ........................... 37

see tamsulosin hcl ......... 37 FLONASE ......................... 45

see fluticasone propionate (nasal) ........................... 45

FLO-PRED ........................ 32 FLOVENT DISKUS ........... 45 FLOVENT HFA ................. 45 fluconazole ..........................5 fluconazole in dextrose .......5 fluconazole in nacl 100mg...5 fluconazole in nacl 200mg...5 fluconazole in nacl 400mg...5 flucytosine ...........................5 FLUDARA

see fludarabine phosphate ...................................... 11

fludarabine phosphate ...... 11 fludrocortisone acetate ...... 32 FLUMADINE .......................7

see rimantadine hydrochloride ...................7

flunisolide spr 0.025% ....... 45 fluocinolone acetonide ...... 48 fluocinolone acetonide (otic) .......................................... 50 fluocinonide ....................... 48 fluocinonide emulsified base .......................................... 48

FLUOROMETHOLONE (OPHTH) ........................... 43 fluorouracil ........................ 11 fluorouracil (topical) .......... 46 fluoxetine hcl ..................... 21 FLUOXETINE HCL ........... 21 fluphenazine decanoate .... 23 fluphenazine hcl ................ 23 flurbiprofen .......................... 1 flurbiprofen sodium ........... 43 flutamide ........................... 11 fluticasone propionate ....... 48 fluticasone propionate (nasal) ............................... 45 fluvastatin sodium ............. 14 fluvoxamine maleate ......... 18 fluvoxamine maleate er ..... 18 fluvoxamine tabs ............... 18 FML................................... 43 FML FORTE ..................... 43 FML LIQUIFILM ................ 43 fondaparinux sodium......... 38 FORADIL AEROLIZER ..... 45 FORFIVO XL .................... 21 FORTAMET ...................... 28

see metformin hcl .......... 29 FORTAZ ............................. 8

see ceftazidime ............... 8 see ceftazidime solr......... 8 see tazicef vial ................. 8

FORTEO ........................... 33 FORTESTA ....................... 27 FORTICAL SPR 200/ACT . 33 FOSAMAX ........................ 29

see alendronate sodium 29 FOSAMAX PLUS D .......... 29 foscarnet sodium ................ 7 fosinopril sodium ............... 13 fosinopril sodium & hydrochlorothiazide ........... 12 FOSRENOL ...................... 33 FRAGMIN ......................... 38 FREAMINE HBC 6.9% ...... 41 FREAMINE III ................... 41 FROVA TAB 2.5MG .......... 25 FURADANTIN ..................... 4

see nitrofurantoin ............ 5 furosemide ........................ 17

furosemide inj ................... 17 furosemide oral soln 8 mg/ml.......................................... 17 FUZEON ............................. 6 FYCOMPA ........................ 19 G gabapentin ........................ 19 GABITRIL ......................... 19

see tiagabine hcl ........... 20 galantamine hydrobromide 21 GAMASTAN S/D............... 39 GAMMAGARD LIQUID ..... 39 GAMMAGARD S/D ........... 39 GAMMAKED ..................... 39 GAMMAPLEX ................... 39 GAMUNEX ....................... 39 GAMUNEX-C 10GM/100ML.......................................... 39 GAMUNEX-C 1GM/10ML . 39 GAMUNEX-C 2.5GM/25ML.......................................... 39 GAMUNEX-C 20GM/200ML.......................................... 39 GAMUNEX-C 5GM/50ML . 39 ganciclovir inj 500mg .......... 7 garamycin ......................... 43 GARAMYCIN

see gentamicin sulfate (ophth) ........................... 43

GARDASIL ....................... 40 GASTROCROM................ 36

see cromolyn sodium (mastocytosis) ............... 36

gatifloxacin (ophth) ........... 43 GATTEX ........................... 36 GAUZE PADS 2X2 ........... 27 gaviltye-g .......................... 36 gavilyte-c .......................... 36 gavilyte-n .......................... 36 GELNIQUE ....................... 37 GEMCITABINE ................. 11 gemcitabine hcl ................. 11 gemfibrozil ........................ 15 GEMZAR .......................... 11

see gemcitabine hcl ...... 11 GENERESS FE ................ 30 generlac ............................ 36 gengraf ............................. 40

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GENOTROPIN .................. 33 GENOTROPIN MINIQUICK .......................................... 33 gentak ............................... 43 gentamicin in saline 0.9mg/ml .............................4 gentamicin in saline 1.4mg/ml .............................4 gentamicin in saline 100mg.4 gentamicin in saline 60mg...4 gentamicin in saline 80mg...4 gentamicin sulfate ...............4 gentamicin sulfate (ophth) . 43 gentamicin sulfate (topical) .......................................... 47 GEODON .......................... 23

see ziprasidone hcl ........ 24 GEODON INJ .................... 23 GIANVI .............................. 30 GIAZO ............................... 35 gildagia ............................. 30 gildess 1.5/30 21 day ........ 30 GILENYA .......................... 26 GILOTRIF ......................... 12 GLASSIA........................... 45 GLEEVEC ......................... 12 glimepiride......................... 28 glipizide ............................. 28 glipizide er ......................... 28 glipizide-metformin 2.5-250mg ......................... 28 glipizide-metformin 2.5-500mg ......................... 28 glipizide-metformin 5-500mg .......................................... 28 GLUCAGEN HYPOKIT ..... 33 GLUCAGON EMERGENCY KIT .................................... 33 GLUCOPHAGE ................. 28

see metformin hcl .......... 29 GLUCOPHAGE XR ........... 28

see metformin er ........... 29 GLUCOTROL .................... 28

see glipizide ................... 28 GLUCOTROL XL .............. 28

see glipizide er .............. 28 GLUCOVANCE

see glyburide-metformin

1.25-250mg ................... 28 see glyburide-metformin 2.5-500mg ..................... 28 see glyburide-metformin 5-500mg ........................ 28

GLUCOVANCE 1.25-250MG .......................................... 28 GLUCOVANCE 2.5-500MG .......................................... 28 GLUCOVANCE 5-500MG . 28 GLUMETZA ...................... 28 glyburide ........................... 28 glyburide micronized ......... 28 glyburide-metformin 1.25-250mg ....................... 28 glyburide-metformin 2.5-500mg ......................... 28 glyburide-metformin 5-500mg ............................ 28 glycate .............................. 35 glycopyrrolate ................... 35 GLYNASE ......................... 28

see glyburide micronized ...................................... 28

GLYSET ............................ 28 GOLYTELY ....................... 36

see gaviltye-g ................ 36 see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 36

GRALISE .......................... 26 GRALISE STARTER......... 26 granisetron hcl .................. 34 GRANIX ............................ 38 GRASTEK ......................... 39 GRIFULVIN V

see griseofulvin microsize ........................................ 5

griseofulvin microsize.......... 5 griseofulvin ultramicrosize ... 5 GRIS-PEG .......................... 5

see griseofulvin ultramicrosize .................. 5

guanfacine hcl ................... 18 H H.P. ACTHAR ................... 33 HALAVEN ......................... 12 HALDOL ........................... 23

see haloperidol lactate .. 23 HALDOL DECANOATE 100.......................................... 23

see haloperidol decanoate ...................................... 23

HALDOL DECANOATE 50.......................................... 23

see haloperidol decanoate ...................................... 23

HALFLYTELY BOWEL PREP/FLA ........................ 36 halobetasol propionate ..... 48 HALOG ............................. 48 haloperidol ........................ 23 haloperidol decanoate ...... 23 haloperidol lactate............. 23 HAVRIX ............................ 40 heather tab 0.35mg ........... 30 HECTOROL ...................... 42

see doxercalciferol ........ 42 HEP SOD/NACL INJ 25000.......................................... 38 HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML ........................... 38 heparin sod inj 10000u/ml . 38 heparin sod inj 1000u/ml ... 38 heparin sod inj 20000u/ml . 38 HEPARIN SOD INJ 2000U/ML ......................... 38 HEPARIN SOD INJ 2500U/ML ......................... 38 heparin sod inj 5000u/0.5ml.......................................... 38 heparin sod inj 5000u/ml ... 38 HEPARIN SODIUM/D5W . 38 HEPARIN SODIUM/SODIUM CHL .... 38 HEPATAMINE .................. 41 HEPSERA .......................... 7

see adefovir dipivoxil ....... 7 HERCEPTIN ..................... 11 HEXALEN ......................... 10 HIBERIX ........................... 40 HIPREX .............................. 4

see methenamine hippurate ......................... 5

HORIZANT ....................... 26

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HUMALOG ........................ 27 HUMALOG KWIKPEN ...... 27 HUMALOG MIX 50/50 ...... 27 HUMALOG MIX 50/50 KWIKPEN ......................... 27 HUMALOG MIX 75/25 ...... 27 HUMALOG MIX 75/25 KWIKPEN ......................... 27 HUMATROPE ................... 33 HUMATROPE COMBO PACK ................................ 33 HUMIRA KIT 20MG/0.4 .... 39 HUMIRA KIT 40MG/0.8 .... 39 HUMIRA PEN KIT 40MG/0.8 .......................................... 39 HUMIRA PEN KIT CROHNS .......................................... 39 HUMIRA PEN KIT PSORIASI ......................... 39 HUMULIN 70/30 ................ 27 HUMULIN 70/30 PEN ....... 27 HUMULIN N ...................... 27 HUMULIN N U-100 PEN ... 27 HUMULIN R ...................... 27 HUMULIN R U-500 (CONCENTRATE) ............ 27 HYCAMTIN ....................... 12

see topotecan hcl .......... 12 hycet ...................................1 HYCET

see hydrocodone-acetaminophen 7.5-325 mg/15ml ........2

hydralazine hcl soln .......... 18 hydralazine hcl tabs .......... 18 HYDREA ........................... 12

see hydroxyurea ............ 12 hydrochlorothiazide ........... 17 hydrocodone-acetaminophen 10-300mg ............................2 hydrocodone-acetaminophen 2.5-325mg ...........................1 hydrocodone-acetaminophen 5-300mg ..............................1 hydrocodone-acetaminophen 5-325mg ..............................2 hydrocodone-acetaminophen 7.5-300mg ...........................2

hydrocodone-acetaminophen 7.5-325 mg/15ml ................. 2 hydrocodone-acetaminophen 7.5-325mg ........................... 2 hydrocodone-acetaminophen tab 10-325mg ...................... 2 hydrocodone-ibuprofen 2.5-200mg ........................... 2 hydrocodone-ibuprofen 7.5-200mg ........................... 2 hydrocortisone .................. 32 HYDROCORTISONE (INTRARECTAL) .............. 35 hydrocortisone (topical) ..... 48 hydrocortisone butyrate .... 48 hydrocortisone butyrate hydrophilic lipo base ......... 48 hydrocortisone valerate.... 48, 49 hydromorphone hcl ............. 3 HYDROMORPHONE HCL .. 3 hydroxychloroquine sulfate .......................................... 39 hydroxyurea ...................... 12 hydroxyzine hcl ................. 44 hydroxyzine pamoate ........ 45 HYZAAR ........................... 13

see losartan potassium & hydrochlorothiazide ....... 13

I ibandronate sodium .......... 29 ibudone tab 5-200mg .......... 2 ibuprofen ............................. 1 ICLUSIG ........................... 12 IDAMYCIN PFS ................ 10

see idarubicin hcl .......... 10 idarubicin hcl ..................... 10 IFEX

see ifosfamide for inj 1 gm ...................................... 10

IFEX INJ 1GM ................... 10 IFEX INJ 3GM ................... 10 ifosfamide ......................... 10 IFOSFAMIDE

see ifosfamide ............... 10 ifosfamide for inj 1 gm ....... 10 IFOSFAMIDE FOR INJ 3 GM .................................... 10

ifosfamide inj 1gm/20ml .... 10 ILEVRO ............................ 43 IMBRUVICA ...................... 12 imdur ................................. 18 IMDUR

see isosorbide mononitrate ................... 18

imipenem-cilastatin ............. 5 imipramine hcl .................. 21 imipramine pamoate ......... 21 imiquimod ......................... 49 IMITREX ........................... 25

see sumatriptan succinate ...................................... 25 see sumatriptan succinate inj .................................. 25

IMITREX STATDOSE REFILL ............................. 25 IMITREX STATDOSE SYSTEM ........................... 25

see sumatriptan succinate inj .................................. 25

IMOVAX RABIES (H.D.C.V.).......................................... 40 IMURAN ........................... 40

see azathioprine ............ 40 INCIVEK TAB 375MG ......... 7 INCRELEX ........................ 33 indapamide ....................... 17 INDERAL LA ..................... 15

see propranolol hcl er .... 16 INFANRIX ......................... 40 INFERGEN INJ 9MCG ..... 39 INFUMORPH 200 ............... 3 INFUMORPH 500 ............... 3 INLYTA ............................. 12 INSPRA

see eplerenone tab 25mg ...................................... 13 see eplerenone tab 50mg ...................................... 13

INSPRA TAB 25MG .......... 13 INSPRA TAB 50MG .......... 13 INSULIN PEN NEEDLES . 27 INSULIN SAFETY NEEDLES ......................... 27 INSULIN SYRINGES ........ 27 INTELENCE ....................... 6

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INTERMEZZO ................... 25 INTRALIPID INJ 20% ........ 41 INTRALIPID INJ 30% ........ 41 INTRON-A ......................... 39 INTRON-A W/DILUENT .... 39 introvale 91 day ................. 30 INTUNIV............................ 24 INVANZ ...............................5 INVEGA ............................ 23 INVEGA SUSTENNA ........ 23 INVIRASE ...........................6 INVOKAMET TAB 150-1000 MG .................................... 28 INVOKAMET TAB 150-500 MG .................................... 28 INVOKAMET TAB 50-1000 MG .................................... 28 INVOKAMET TAB 50-500 MG .................................... 28 INVOKANA TAB 100MG ... 28 INVOKANA TAB 300MG ... 28 IONOSOL-B/DEXTROSE 5% ..................................... 42 IONOSOL-MB/DEXTROSE 5% ..................................... 42 IPOL INACTIVATED IPV .. 40 ipratropium bromide (nasal) .......................................... 44 ipratropium sol inhal .......... 44 ipratropium-albuterol ......... 44 irbesartan .......................... 14 irbesartan-hydrochlorothiazide ........................................ 13 IRESSA ............................. 12 irinotecan hcl ..................... 12 ISENTRESS ........................6 ISOLYTE P ....................... 42 isolyte s ............................. 42 isoniazid ..............................7 isoniazid tabs ......................7 ISOPTO CARPINE ........... 44 ISORDIL TITRADOSE ...... 18

see isosorbide dinitrate . 18 isosorbide dinitrate ............ 18 isosorbide dinitrate sl tab 2.5 mg ..................................... 18 isosorbide mononitrate ...... 18 isradipine........................... 16

ISTALOL ........................... 44 ISTODAX .......................... 11 itraconazole ........................ 5 IXEMPRA KIT ................... 12 IXIARO .............................. 40 J JAKAFI .............................. 12 JALYN ............................... 37 jantoven ............................ 38 JANUMET ......................... 28 JANUMET XR TAB 100-1000 ........................... 28 JANUMET XR TAB 50-1000 .......................................... 28 JANUMET XR TAB 50-500MG ......................... 28 JANUVIA ........................... 28 JENTADUETO .................. 28 jinteli.................................. 32 JOLIVETTE ....................... 30 junel 1.5/30 21 day ........... 30 junel 1/20 21 day .............. 30 junel fe 1.5/30 28 day........ 30 junel fe 1/20 28 day .......... 30 K KADCYLA ......................... 11 KADIAN .............................. 3

see morphine sulfate ....... 3 KALETRA SOL ................... 6 KALETRA TAB 100-25MG .. 6 KALETRA TAB 200-50MG .. 6 kariva 28 day .................... 30 KAYEXALATE .................. 29

see kionex ..................... 29 KAZANO ........................... 28 KCL 0.075%/D5W/NACL 0.45%................................ 42 KCL 0.15%/D5W/LR ......... 42 KCL 0.15%/D5W/NACL 0.9%.................................. 42 kcl 0.3%/d5w/lr iv lac ri ...... 42 KCL 0.3%/D5W/NACL 0.45%................................ 42 KCL 0.3%/D5W/NACL 0.9% .......................................... 42 KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 42

kcl 20 meq/l (0.15%) in nacl 0.45% inj ........................... 42 KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ............... 42 KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 42 KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 42 KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ................. 42 KCL0.15%/D5W/NACL0.2%.......................................... 42 KCL0.15%/D5W/NACL0.225% ...................................... 42 KEFLEX .............................. 8

see cephalexin ................ 8 kelnor 1/35 28 day ............ 30 KENALOG ........................ 49 KEPIVANCE ..................... 12 KEPPRA ........................... 19

see levetiracetam .......... 20 KEPPRA XR ..................... 19

see levetiracetam .......... 20 KERLONE

see betaxolol hcl ........... 15 ketoconazole ...................... 5 ketoconazole (topical) ....... 47 ketoconazole shampoo ..... 47 ketoprofen ........................... 1 ketorolac tromethamine (ophth) .............................. 43 KINERET INJ .................... 39 kionex ............................... 29 KLARON ........................... 46

see sulfacetamide sodium (acne) ............................ 46

KLONOPIN ....................... 19 see clonazepam ............ 19

KLOR-CON 10 .................. 41 KLOR-CON 8 .................... 41 klor-con m15 ..................... 41 klor-con m20 ..................... 41 klor-con pow 20meq ......... 41 KOMBIGLYZE XR 2.5-1000MG ...................... 29 KOMBIGLYZE XR

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5-1000MG ......................... 29 KOMBIGLYZE XR 5-500MG .......................................... 29 kristalose ........................... 36 K-TAB ......................... 40, 41 KUVAN ............................. 32 L labetalol hcl ....................... 15 LAC-HYDRIN .................... 49

see ammonium lactate .. 49 see laclotion lotn 12% ... 49

laclotion lotn 12% .............. 49 LACRISERT ...................... 44 LACTATED RINGERS VIAFLEX ........................... 42 lactulose ............................ 36 lactulose (encephalopathy) .......................................... 36 LAMICTAL ........................ 19

see lamotrigine .............. 20 LAMICTAL CHEWABLE DISPERS .......................... 19

see lamotrigine .............. 20 LAMICTAL ODT ................ 19 LAMICTAL STARTER ....... 19 LAMICTAL XR .................. 20

see lamotrigine .............. 20 LAMISIL ..............................5

see terbinafine hcl ...........5 lamivudine ....................... 6, 7 lamivudine-zidovudine ........6 lamotrigine ........................ 20 LANOXIN

see digoxin inj ................ 17 see digoxin tab 0.125mg ...................................... 17 see digoxin tab 0.25mg . 17

LANOXIN INJ 0.25MG/ML 17 LANOXIN PEDIATRIC ...... 17 LANOXIN TAB .................. 17 LANOXIN TAB 0.125MG .. 17 LANOXIN TAB 0.25MG .... 17 lansoprazole ...................... 37 LANTUS ............................ 27 LANTUS SOLOSTAR ....... 27 larin 1.5/30 ........................ 30 larin 1/20 ........................... 30 larin fe 1.5/30 .................... 30

larin fe 1/20 ....................... 30 LASIX................................ 17

see furosemide .............. 17 LASTACAFT ..................... 43 latanoprost ........................ 44 LATUDA TAB 120MG ....... 23 LATUDA TAB 20MG ......... 23 LATUDA TAB 40MG ......... 23 LATUDA TAB 60MG ......... 23 LATUDA TAB 80MG ......... 23 LAZANDA ........................... 3 LEENA .............................. 30 leflunomide ....................... 39 LESCOL ............................ 14

see fluvastatin sodium ... 14 LESCOL XL ...................... 14 lessina 28 day ................... 30 LETAIRIS .......................... 18 letrozole tab 2.5mg ........... 11 leucovor ca inj ................... 12 leucovorin calcium ............ 12 leucovorin calcium inj 10 mg/ml ................................ 12 LEUKERAN ...................... 10 LEUKINE .......................... 38 leuprolide acetate ............. 11 levalbuterol conc 1.25mg/0.5ml .................... 45 LEVALBUTEROL HCL NEBU ................................ 45 LEVAQUIN .......................... 9

see levofloxacin ............... 9 see levofloxacin in d5w ... 9

LEVAQUIN INJ ................... 9 LEVEMIR .......................... 27 LEVEMIR FLEXPEN ......... 27 LEVEMIR FLEXTOUCH ... 27 levetiracetam .................... 20 levobunolol hcl .................. 44 LEVOBUNOLOL HCL ....... 44 levocarnitine (metabolic modifiers) .......................... 32 levocetirizine soln 2.5mg/5ml .......................................... 45 levocetirizine tab 5 mg ...... 45 levofloxacin ......................... 9 levofloxacin (ophth) ........... 43 levofloxacin in d5w .............. 9

levonest 28 day ................ 30 levonorgestrel (emergency oc) ..................................... 30 levonorgestrel-ethinyl estradiol (91-day) .............. 30 levora 0.15/30 28 day ....... 30 levorphanol tartrate ............. 3 levothyroxine sodium ........ 34 LEVOXYL ......................... 34 LEXAPRO ......................... 21

see escitalopram oxalate ...................................... 21

LEXIVA ............................... 6 LIALDA ............................. 35 lidocaine ........................... 49 lidocaine hcl ...................... 49 lidocaine hcl (local anesth.) 4 lidocaine hcl (mouth-throat).......................................... 50 lidocaine inj 0.5% ................ 4 lidocaine inj 1% ................... 4 lidocaine inj 1.5% ................ 4 lidocaine inj 2% ................... 4 lidocaine-prilocaine ........... 49 LIDODERM

see lidocaine ................. 49 LIDODERM DIS 5% .......... 49 LINZESS CAP 145MCG ... 36 LINZESS CAP 290MCG ... 36 liothyronine sodium ........... 34 LIPITOR ............................ 14

see atorvastatin calcium 14 LIPOFEN .......................... 15 LIPOSYN II ....................... 41 LIPOSYN III ...................... 41 LIPTRUZET ...................... 15 lisinopril ............................. 13 lisinopril & hydrochlorothiazide ........... 12 LITHIUM ........................... 26 lithium carbonate .............. 26 LITHOBID ......................... 26

see lithium carbonate .... 26 LIVALO ............................. 14 LO LOESTRIN FE ............ 30 LO MINASTRIN FE ........... 30 LOCOID ............................ 49

see hydrocortisone

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butyrate ......................... 48 LOCOID LIPOCREAM ...... 49

see hydrocortisone butyrate hydrophilic lipo base .............................. 48

LODOSYN ........................ 22 see carbidopa ................ 22

loestrin 1.5/30-21 .............. 30 LOESTRIN 1.5/30-21

see gildess 1.5/30 21 day ...................................... 30 see junel 1.5/30 21 day . 30 see larin 1.5/30 .............. 30

loestrin 1/20-21 ................. 30 LOESTRIN 1/20-21

see junel 1/20 21 day .... 30 see larin 1/20 ................. 30

LOESTRIN 24 FE ............. 30 loestrin fe 1.5/30 ............... 30 LOESTRIN FE 1.5/30

see junel fe 1.5/30 28 day ...................................... 30 see larin fe 1.5/30 .......... 30

loestrin fe 1/20 .................. 30 LOESTRIN FE 1/20

see junel fe 1/20 28 day 30 see larin fe 1/20 ............. 30

lofibra ................................ 15 LOFIBRA

see fenofibrate micronized ...................................... 15 see fenofibrate tab ......... 15

LOKARA LOTN 0.05% ...... 49 lomedia 24 fe .................... 30 LOMOTIL .......................... 36

see diphenoxylate w/ atropine ......................... 36

LOMUSTINE ..................... 10 loperamide hcl ................... 36 LOPID ............................... 15

see gemfibrozil .............. 15 LOPRESSOR .................... 15

see metoprolol tartrate .15, 16

LOPRESSOR HCT ........... 15 see metoprolol & hctz tab 100-25mg ...................... 15 see metoprolol & hctz tab

50-25mg ........................ 15 LOPROX SHAMPOO........ 47

see ciclopirox shampoo 1% ................................. 47

lorazepam ......................... 18 lorcet hd tab 10-325mg ....... 2 lorcet plus tab 7.5-325 ........ 2 lorcet tab 5-325mg .............. 2 lortab ................................... 2 lortab elx 10-300mg ............ 2 loryna 28 day .................... 30 losartan potassium ............ 14 losartan potassium & hydrochlorothiazide ........... 13 LOSEASONIQUE ............. 30 LOTEMAX ......................... 43 LOTENSIN ........................ 13

see benazepril hcl ......... 13 LOTENSIN HCT ............... 13

see benazepril & hydrochlorothiazide ....... 12

LOTREL ............................ 13 see amlodipine besylate-benazepril hcl .. 12

LOTRONEX ...................... 36 lovastatin ........................... 14 LOVAZA ............................ 15 LOVENOX ........................ 38

see enoxaparin sodium . 38 low-ogestrel 28 day ........... 30 loxapine succinate ............ 23 loxitane ............................. 23 LUFYLLIN ......................... 46 LUMIGAN ......................... 44 LUMIZYME ....................... 32 LUNESTA ......................... 25

see eszopiclone ............ 25 LUPANETA PACK ............ 31 LUPR DEP-PED INJ 11.25MG (3-MONTH) ....... 11 LUPR DEP-PED INJ 30MG (3-MONTH) ....................... 11 LUPRON DEPOT ............. 11 LUPRON DEPOT INJ 22.5MG (3-MONTH) ......... 11 LUPRON DEPOT INJ 30MG (3-MONTH) ....................... 11 LUPRON DEPOT-PED ..... 11

lutera 28 day ..................... 30 LUVOX CR ....................... 18

see fluvoxamine maleate er ................................... 18

LUXIQ ............................... 49 see betamethasone valerate ......................... 48

LUZU ................................ 47 LYRICA ............................. 20 LYSODREN ...................... 11 LYSTEDA ......................... 38

see tranexamic acid ...... 39 lyza ................................... 30 M MACROBID ........................ 5

see nitrofurantoin monohyd macro .............. 5

MACRODANTIN ................. 5 see nitrofurantoin macrocrystal .................... 5

mafenide acetate .............. 47 magnesium sulfate ............ 41 MAGNESIUM SULFATE .. 41 MAGNESIUM SULFATE IN D5W 1% ........................... 41 MAGNESIUM SULFATE IN D5W 2% ........................... 41 MALARONE ....................... 6

see atovaquone-proguanil hcl tab 250-100 mg ......... 6 see atovaquone-proguanil hcl tab 62.5-25 mg .......... 6

malathion .......................... 49 maprotiline hcl .................. 21 MARINOL ......................... 34

see dronabinol............... 34 marlissa 28 day................. 30 MARPLAN ........................ 21 MATULANE ...................... 12 matzim la .......................... 16 MAVIK .............................. 13

see trandolapril.............. 13 MAXALT ........................... 25

see rizatriptan benzoate 25 MAXALT-MLT ................... 25

see rizatriptan benzoate 25 MAXIDEX ......................... 43 MAXIPIME .......................... 8

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see cefepime inj 1gm ......8 see cefepime inj 2gm ......8

MAXITROL ........................ 42 see neomycin-polymy-dexameth .................................... 42

MAXZIDE .......................... 17 see triamterene & hydrochlorothiazide tab 75-50 mg ....................... 17

MAXZIDE-25 ..................... 17 see triamterene & hydrochlorothiazide tab 37.5-25 mg .................... 17

meclizine hcl ..................... 34 MEDROL........................... 32

see methylprednisolone 32 MEDROL DOSEPAK ........ 32

see methylprednisolone 32 medroxyprogesterone acetate .............................. 34 medroxyprogesterone acetate (contraceptive) ..... 30 mefenamic acid ...................1 mefloquine hcl .....................6 MEGACE ES ..................... 11 MEGACE ORAL ................ 11

see megestrol acetate ... 11 megestrol acetate ............. 11 MEKINIST ......................... 12 MELOXICAM SUSP 7.5 MG/5ML ..............................1 meloxicam tabs ...................1 melphalan hcl .................... 10 MENACTRA ...................... 40 menest .............................. 32 MENHIBRIX ...................... 40 MENOMUNE-A/C/Y/W-135 .......................................... 40 MENOSTAR ...................... 32 MENTAX ........................... 47 MENVEO .......................... 40 MEPRON ............................5

see atovaquone ...............4 mercaptopurine ................. 11 meropenem .........................5 MERREM ............................5

see meropenem ..............5

mesalamine enema .......... 35 mesalamine enema kit ...... 35 mesna ............................... 12 MESNEX ........................... 12

see mesna ..................... 12 MESTINON

see pyridostigmine bromide ......................... 26

MESTINON SYRUP.......... 26 MESTINON TAB ............... 26 MESTINON TIMESPAN .... 26 METADATE CD ................ 24

see methylphenidate hcl 24 metadate tab 20mg er ....... 24 metformin er ...................... 29 metformin hcl .................... 29 methadone hcl .................... 3 METHADONE INJ 10MG/ML ............................................ 3 METHADOSE ..................... 3

see methadone hcl .......... 3 methazolamide ................. 17 methenamine hippurate ...... 5 METHERGINE

see methylergonovine maleate ......................... 33

methimazole ..................... 34 methocarbamol ................. 26 methotrexate sodium inj .... 11 methotrexate sodium tabs . 39 methoxsalen rapid ............ 47 methscopolamine bromide 35 methyclothiazide ............... 17 methylergonovine maleate 33 METHYLIN ........................ 24

see methylphenidate hcl 24 METHYLIN CHEW TAB .... 24 methylphenidate hcl .... 24, 25 methylphenidate hcl er ...... 25 methylphenidate tab 10mg er .......................................... 25 methylphenidate tab 20mg er .......................................... 25 methylprednisolone ........... 32 methylprednisolone acetate .......................................... 32 methylprednisolone sod succ .......................................... 33

metipranolol ...................... 44 metoclopramide hcl ........... 34 metoclopramide hcl inj 5 mg/ml ................................ 34 metolazone ....................... 17 metoprolol & hctz tab 100-25mg ......................... 15 metoprolol & hctz tab 100-50mg ......................... 15 metoprolol & hctz tab 50-25mg ........................... 15 metoprolol succinate ......... 15 metoprolol tartrate....... 15, 16 METOZOLV ODT ............. 34 METRO IV .......................... 5 METROCREAM ................ 49

see metronidazole (topical) ......................... 49 see rosadan cre 0.75% . 49

METROGEL ..................... 49 see metronidazole (topical) ......................... 49

METROGEL-VAGINAL ..... 37 see metronidazole vaginal ...................................... 37

METROLOTION ............... 49 see metronidazole (topical) ......................... 49

metronidazole ..................... 5 metronidazole (topical) ..... 49 metronidazole inj................. 5 metronidazole vaginal ....... 37 MEVACOR ....................... 14

see lovastatin ................ 14 mexiletine hcl .................... 14 MIACALCIN

see calcitonin (salmon) nasal spray .................... 33

MIACALCIN INJ 200U/ML 33 MIACALCIN SPR 200/ACT.......................................... 33 MICARDIS ........................ 14

see telmisartan tab ........ 14 MICARDIS HCT ................ 13

see telmisartan-hydrochlorothiazide ............................. 13

miconazole nitrate vaginal 37

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MICROGESTIN TAB 1.5/30 .......................................... 30 MICROGESTIN TAB 1/20 . 30 MICRO-K .......................... 41

see potassium chloride caps er........................... 41

MICROZIDE ...................... 17 see hydrochlorothiazide 17

midodrine hcl ..................... 18 migergot ............................ 25 MIGRANAL ....................... 25 millipred............................. 33 mimvey lo 28 day .............. 32 MINASTRIN 24 CHW FE .. 30 MINIPRESS ...................... 13

see prazosin hcl ............ 13 minitran ............................. 18 MINIVELLE DIS 0.0375MG .......................................... 32 MINIVELLE DIS 0.05MG .. 32 MINIVELLE DIS 0.075MG. 32 MINIVELLE DIS 0.1MG .... 32 MINOCIN .......................... 10

see minocycline hcl ....... 10 MINOCIN KIT .................... 10 minocycline hcl .................. 10 minoxidil ............................ 18 MIRAPEX .......................... 22

see pramipexole dihydrochloride .............. 22

MIRAPEX ER TAB 0.375MG .......................................... 22 MIRAPEX ER TAB 0.75MG .......................................... 22 MIRAPEX ER TAB 1.5MG 22 MIRAPEX ER TAB 2.25MG .......................................... 22 MIRAPEX ER TAB 3.75MG .......................................... 22 MIRAPEX ER TAB 3MG ... 22 MIRAPEX ER TAB 4.5MG 22 MIRCETTE

see kariva 28 day .......... 30 see pimtrea pack ........... 31 see viorele ..................... 31

mirtazapine ....................... 21 misoprostol ........................ 36 mitomycin .......................... 10

mitomycin solr 20mg ......... 10 mitoxantrone hcl ............... 12 M-M-R II W/DILUENT 10 DOS .................................. 40 MOBIC ................................ 1

see meloxicam tabs......... 1 modafinil ........................... 26 moderiba pak ...................... 7 moderiba tab 200mg ........... 7 MODICON ........................ 30 moexipril hcl ...................... 13 moexipril-hydrochlorothiazide ........................................ 13 mometasone furoate ......... 49 MONODOX

see doxycycline (monohydrate) ................. 9

MONONESSA .................. 31 montelukast sodium .......... 45 MORPHINE SUL 20MG/ML ORAL SOL .......................... 3 morphine sulfate ................. 3 MORPHINE SULFATE ....... 3 morphine sulfate beads cap sr ......................................... 3 morphine sulfate ext-rel tab 3 morphine sulfate inj ............. 3 MORPHINE SULFATE INJ . 3 MOVIPREP ....................... 36 MOXATAG .......................... 9 MOXEZA ........................... 43 moxifloxacin hcl .................. 9 MOZOBIL .......................... 38 MS CONTIN ........................ 3

see morphine sulfate ext-rel tab ........................ 3

MULTAQ ........................... 14 mupirocin .......................... 47 mupirocin calcium (topical) 47 MUSTARGEN ................... 10 my way .............................. 31 MYAMBUTOL ..................... 7

see ethambutol hcl .......... 7 MYCAMINE ........................ 5 MYCOBUTIN ...................... 7

see rifabutin ..................... 7 mycophenolate mofetil ...... 40 mycophenolic tab 180mg dr

.......................................... 40 mycophenolic tab 360mg dr.......................................... 40 MYFORTIC

see mycophenolic tab 180mg dr ....................... 40 see mycophenolic tab 360mg dr ....................... 40

MYFORTIC TAB 180MG .. 40 MYFORTIC TAB 360MG .. 40 myorisan ........................... 46 MYOZYME ....................... 32 MYRBETRIQ .................... 37 MYSOLINE ....................... 20

see primidone................ 20 myzilra .............................. 31 N nabumetone ........................ 1 nadolol .............................. 16 nadolol & bendroflumethiazide ......... 15 nafcillin sodium ................... 9 NAFTIN ............................. 47 NAGLAZYME ................... 32 NALFON ............................. 1 NALLPEN ISO-OSMOTIC IN DE ....................................... 9 NALLPEN/DEXTROSE ....... 9 naloxone hcl ..................... 27 naltrexone hcl ................... 27 NAMENDA ........................ 21 NAMENDA TITRATION PAK.......................................... 21 NAMENDA XR CAP 14MG.......................................... 21 NAMENDA XR CAP 21MG.......................................... 21 NAMENDA XR CAP 28MG.......................................... 21 NAMENDA XR CAP 7MG . 21 NAMENDA XR CAP TITRATIO ......................... 21 naphazoline 0.1% ............. 44 NAPRELAN ........................ 1 NAPROSYN ....................... 1

see naproxen .................. 1 naproxen ............................. 1 naproxen sodium ................ 1

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naratriptan hcl ................... 25 NARDIL ............................. 21

see phenelzine sulfate ... 22 NASACORT AQ ................ 45 NASONEX ........................ 45 NATACYN ......................... 43 nateglinide......................... 29 NAVANE ........................... 23 NAVELBINE

see vinorelbine tartrate .. 11 NEBUPENT ........................5 necon 0.5/35 28 day ......... 31 necon 1/35 28 day ............ 31 necon 10/11 28 day .......... 31 NECON 7/7/7 .................... 31 NECON TAB 1/50-28 ........ 31 nefazodone hcl .................. 21 neomycin sulfate .................4 neomycin/polymyxin b gu .. 50 neomycin-bacitracin zn-polymyxin ..................... 43 neomycin-polymy-dexameth .......................................... 42 neomycin-polymy-gramicid .......................................... 43 neomycin-polymyxin-hc (ophth) .............................. 42 neomycin-polymyxin-hc (otic) .......................................... 50 NEORAL ........................... 40

see cyclosporine modified (for microemulsion) ........ 40 see gengraf ................... 40

NEOSPORIN see neomycin-polymy-gramicid ...................................... 43

NEOSPORIN GU IRRIGANT see neomycin/polymyxin b gu .................................. 50

neosporin solution ............. 43 NEPHRAMINE .................. 41 NEPTAZANE

see methazolamide ....... 17 NESINA............................. 29 neuac ................................ 46 NEULASTA ....................... 38 NEUMEGA ........................ 38

NEUPOGEN ..................... 38 NEUPRO .......................... 22 NEURONTIN .................... 20

see gabapentin .............. 19 NEVANAC ........................ 43 nevirapine ........................... 6 NEVIRAPINE ...................... 6 NEXAVAR ......................... 12 NEXIUM ............................ 37 NEXIUM CAPS ................. 37 NEXIUM GRANULES 10MG DR..................................... 37 NEXIUM GRANULES 2.5MG DR..................................... 37 NEXIUM GRANULES 20MG DR..................................... 37 NEXIUM GRANULES 40MG DR..................................... 37 NEXIUM GRANULES 5MG DR..................................... 37 NEXIUM I.V. ..................... 37

see esomeprazole sodium inj................................... 37

next choice tab 1.5mg ....... 31 niacin er ............................ 15 niacor ................................ 15 NIASPAN

see niacin er .................. 15 NIASPAN TAB 1000 ER ... 15 NIASPAN TAB 500MG ER 15 NIASPAN TAB 750MG ER 15 nicardipine hcl ................... 16 NICOTROL INHALER ....... 27 NICOTROL NS ................. 27 nifedical ............................. 16 nifedipine .......................... 16 nifedipine er ...................... 16 nikki 28 day ....................... 31 NILANDRON ..................... 11 nimodipine ........................ 16 NIPENT ............................. 11 nisoldipine ......................... 16 nitro-bid ............................. 18 NITRO-DUR ...................... 18

see minitran ................... 18 nitrofurantoin ....................... 5 nitrofurantoin macrocrystal .. 5 nitrofurantoin monohyd

macro .................................. 5 nitroglycerin ...................... 18 NITROGLYCERIN LINGUAL.......................................... 18 nitroglycerin patches ......... 18 NITROLINGUAL PUMPSPRAY

see nitroglycerin ............ 18 NITROLINGUAL SPR PUMPSPRA ..................... 18 NITROMIST ...................... 18 NITROSTAT ..................... 18 nizatidine .......................... 35 NIZORAL .......................... 47

see ketoconazole shampoo ....................... 47

NORA-BE ......................... 31 NORCO

see hydrocodone-acetaminophen 5-325mg ..................... 2 see hydrocodone-acetaminophen 7.5-325mg .................. 2 see hydrocodone-acetaminophen tab 10-325mg ............. 2 see lorcet hd tab 10-325mg ........................ 2 see lorcet plus tab 7.5-325 ........................................ 2 see lorcet tab 5-325mg ... 2 see lortab ........................ 2

norco 10/325 ....................... 2 norco 5/325 ......................... 2 norco 7.5/325 ...................... 2 NORDITROPIN FLEXPRO.......................................... 33 NORDITROPIN NORDIFLEX PEN ............. 33 norethindrone (contraceptive) .................. 31 norethindrone acetate ....... 34 norgestimate-ethinyl estradiol (triphasic) ........... 31 NORINYL 1+35 ................. 31

see cyclafem 1/35 28 day ...................................... 30

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see necon 1/35 28 day .. 31 see nortrel 1/35 21 day .. 31 see nortrel 1/35 28 day .. 31 see pirmella 1/35 28 day ...................................... 31

NORINYL 1+50 ................. 31 NORITATE ........................ 49 norlyroc 28 day ................. 31 normosol-m ....................... 42 NORMOSOL-R ................. 42 NOROXIN ...........................9 NORPACE ........................ 14

see disopyramide phosphate ...................... 14

NORPACE CR .................. 14 NORPRAMIN .................... 21

see desipramine hcl ...... 21 NOR-QD ........................... 31

see camila 28 day ......... 30 see heather tab 0.35mg 30 see norethindrone (contraceptive) ............... 31 see norlyroc 28 day ....... 31

nortrel 0.5/35 28 day ......... 31 nortrel 1/35 21 day ............ 31 nortrel 1/35 28 day ............ 31 nortrel 7/7/7 28 day ........... 31 nortriptyline hcl .................. 21 NORVASC ........................ 16

see amlodipine besylate 16 NORVIR ..............................6 NOVAREL INJ 10000UNT 33 NOVOLIN 70/30 ................ 27 NOVOLIN 70/30 RELION.. 27 NOVOLIN N ...................... 27 NOVOLIN N RELION ........ 27 NOVOLIN R ...................... 27 NOVOLIN R RELION ........ 27 NOVOLOG ........................ 27 NOVOLOG FLEXPEN ...... 27 NOVOLOG MIX 70/30 ...... 28 NOVOLOG MIX 70/30 PREFILL ........................... 28 NOVOLOG PENFILL ........ 28 NOXAFIL.............................5 NUCYNTA ...........................3 NUCYNTA ER .....................3 NUEDEXTA ...................... 26

NULOJIX ........................... 40 NULYTELY/FLAVOR PACKS .............................. 36

see gavilyte-n ................ 36 see peg 3350-potassium chloride-sod bicarbonate-sod chloride ...................................... 36 see trilyte ....................... 36

NUTROPIN ....................... 33 NUTROPIN AQ NUSPIN .. 33 NUTROPIN AQ PEN......... 33 NUVARING ....................... 31 NUVIGIL ........................... 26 nyamyc ............................. 47 NYMALIZE ........................ 16 nystatin ............................... 5 nystatin (mouth-throat) ...... 50 nystatin (topical) ................ 47 nystatin pow 100000 ......... 47 nystop ............................... 47 O OCELLA ............................ 31 OCTAGAM ........................ 39 octreotide acetate ............. 33 OCUFEN ........................... 43

see flurbiprofen sodium . 43 OCUFLOX ........................ 43

see ofloxacin (ophth) ..... 43 ofloxacin (ophth) ............... 43 ofloxacin (otic) ................... 50 ogestrel 28 day ................. 31 olanzapine ........................ 23 olanzapine odt .................. 23 OLEPTRO ......................... 21 OLUX ................................ 49

see clobetasol propionate ...................................... 48

OLUX-E ............................ 49 see clobetasol propionate emulsion ........................ 48

OLYSIO .............................. 7 OMECLAMOX-PAK .......... 36 omega-3-acid ethyl esters . 15 omeprazole cap 10mg ...... 37 omeprazole cap 20mg ...... 37 omeprazole cap 40mg ...... 37 OMNARIS ......................... 45

OMNIPRED ...................... 43 OMNITROPE 10MG ......... 33 OMNITROPE 5.8MG ........ 33 OMNITROPE 5MG ........... 33 ondansetron hcl ................ 34 ondansetron hcl inj............ 34 ondansetron hcl oral soln .. 34 ondansetron odt ................ 34 ONFI SUS 2.5MG/ML ....... 20 ONFI TAB 10MG .............. 20 ONFI TAB 20MG .............. 20 ONGLYZA ........................ 29 ONMEL ............................... 5 OPANA ............................... 3

see oxymorphone hcl ...... 3 OPANA ER (CRUSH RESISTANT ....................... 3 OPSUMIT ......................... 18 OPTIPRANOLOL .............. 44 OPTIVAR .......................... 44

see azelastine hcl (ophth) ...................................... 43

ORACEA .......................... 49 ORAP ............................... 23 orapred ............................. 33 ORAPRED ODT ............... 33 ORENCIA INJ 125MG/ML 39 ORENCIA INJ 250MG ...... 39 ORENITRAM .................... 18 ORFADIN ......................... 32 orsythia 28 day ................. 31 ORTHO EVRA .................. 31

see xulane ..................... 31 ORTHO MICRONOR ........ 31

see errin 28 day ............ 30 see lyza ......................... 30

ORTHO TRI-CYCLEN see norgestimate-ethinyl estradiol (triphasic) ........ 31 see tri-previfem 28 day .. 31 see tri-sprintec 28 day ... 31

ORTHO TRI-CYCLEN LO 31 ORTHO-CEPT .................. 31 ORTHO-CYCLEN ............. 31

see previfem 28 day ...... 31 see sprintec 28 day ....... 31

ORTHO-NOVUM 1/35 ...... 31 ORTHO-NOVUM 7/7/7 ..... 31

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see cyclafem 7/7/7 28 day ...................................... 30 see nortrel 7/7/7 28 day . 31

OSENI TAB 12.5-15MG .... 29 OSENI TAB 12.5-30MG .... 29 OSENI TAB 12.5-45MG .... 29 OSENI TAB 25-15MG ....... 29 OSENI TAB 25-30MG ....... 29 OSENI TAB 25-45MG ....... 29 OSMOPREP ..................... 36 OTEZLA ............................ 39 ovcon 35 28 day ................ 31 OVCON-35

see balziva 28 day ......... 30 see briellyn 28 day ........ 30 see gildagia ................... 30 see philith ...................... 31 see vyfemla ................... 31 see zenchent 28 day ..... 31

OVIDE ............................... 50 see malathion ................ 49

oxacillin sodium ...................9 oxaliplatin .......................... 12 OXANDRIN

see oxandrolone ............ 27 oxandrolone ...................... 27 oxaprozin ............................1 oxcarbazepine ................... 20 OXECTA .............................3 OXISTAT........................... 47 OXSORALEN .................... 49 OXSORALEN ULTRA ....... 47

see methoxsalen rapid .. 47 OXTELLAR XR ................. 20 oxybutynin chloride ........... 37 oxycodone hcl .....................3 OXYCODONE HCL ............3 oxycodone w/ acetaminophen 10-325mg ..3 oxycodone w/ acetaminophen 2.5-325mg .3 oxycodone w/ acetaminophen 5-325mg ....3 oxycodone w/ acetaminophen 7.5-325mg .3 oxycodone-aspirin ...............3 oxycodone-ibuprofen ..........3 OXYCONTIN .......................3

oxymorphone hcl ................ 3 OXYTROL ......................... 37 P pacerone ........................... 14 paclitaxel ........................... 11 PAMELOR ........................ 21

see nortriptyline hcl ....... 21 pamidronate disodium....... 29 PAMINE ............................ 35

see methscopolamine bromide ......................... 35

PAMINE FORTE ............... 35 see methscopolamine bromide ......................... 35

PANCREAZE .................... 36 PANDEL ........................... 49 PANRETIN ........................ 49 pantoprazole sodium......... 37 PARAFON FORTE DSC ... 26

see chlorzoxazone ........ 26 parcopa 10/100 ................. 22 parcopa 25/100 ................. 22 parcopa 25/250 ................. 22 paricalcitol ......................... 42 paricalcitol cap 4 mcg ....... 42 PARLODEL ....................... 22

see bromocriptine mesylate ........................ 22

PARNATE ......................... 21 see tranylcypromine sulfate ............................ 22

paromomycin sulfate ........... 4 paroxetine er tab ............... 21 paroxetine hcl ................... 22 paser d/r .............................. 7 PATADAY ......................... 44 PATANASE SPR 0.6% ..... 45 PATANOL SOL 0.1% OP .. 44 PAXIL................................ 22

see paroxetine hcl ......... 22 PAXIL CR ......................... 22

see paroxetine er tab..... 21 PCE .................................... 8 pediapred .......................... 33 PEDIAPRED

see prednisolone sodium phosphate ..................... 33

pedi-dri .............................. 47

PEDVAX HIB .................... 40 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ........... 36 PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE.......................................... 36 peg 3350-potassium chloride-sod bicarbonate-sod chloride ............................. 36 PEGANONE ..................... 20 PEGASYS INJ .................. 39 PEGASYS INJ 180MCG/M.......................................... 39 PEGASYS INJ PROCLICK.......................................... 39 PEGASYS KIT .................. 39 PEG-INTRON ................... 39 PEG-INTRON KIT 150 RP 39 PEG-INTRON KIT 50MCG 39 PEG-INTRON KIT 50MCG RP ..................................... 39 PEG-INTRON KIT 80MCG RP ..................................... 39 PENICILLIN G POT IN DEXTROSE ........................ 9 penicillin g potassium .......... 9 PENICILLIN G POTASSIUM............................................ 9 penicillin g procaine ............ 9 penicillin g sodium .............. 9 penicillin v potassium .......... 9 PENNSAID ....................... 49

see diclofenac sodium (topical) ......................... 49

PENTAM 300 ...................... 5 PENTASA ......................... 35 pentoxifylline ..................... 38 PEPCID ............................ 35

see famotidine ............... 35 PERCOCET

see endocet 10/325 ......... 2 see endocet 5/325 ........... 2 see endocet 7.5/325 ........ 2 see oxycodone w/ acetaminophen 10-325mg ........................................ 3 see oxycodone w/

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acetaminophen 2.5-325mg ........................................3 see oxycodone w/ acetaminophen 5-325mg .3 see oxycodone w/ acetaminophen 7.5-325mg ........................................3 see roxicet tab 5-325mg ..3

percocet 10/325 ..................3 percocet 2.5/325 .................3 percocet 5/325 ....................3 percocet 7.5/325 .................3 PERCODAN ........................3

see oxycodone-aspirin ....3 PERFOROMIST ................ 45 PERIDEX

see chlorhexidine gluconate (mouth-throat) ...................................... 50 see periogard sol 0.12% 50

perindopril erbumine ......... 13 periogard sol 0.12% .......... 50 permethrin ......................... 50 perphenazine .................... 23 PERSANTINE ................... 39

see dipyridamole ........... 39 PERTZYE ......................... 36 PEXEVA............................ 22 pfizerpen .............................9 phenadoz .......................... 34 phenelzine sulfate ............. 22 phenergan ......................... 34 PHENERGAN

see promethazine hcl .... 35 phenobarbital .................... 20 phenobarbital sodium ........ 20 PHENOBARBITAL SODIUM .......................................... 20 phenytek ........................... 20 PHENYTEK

see phenytoin sodium extended........................ 20

phenytoin .......................... 20 phenytoin inj 50mg/ml ....... 20 phenytoin sodium extended .......................................... 20 philith ................................ 31 PHISOHEX ....................... 47

PHOSLO ........................... 34 see calcium acetate (phosphate binder) ........ 33

PHOSLYRA ...................... 34 PHOSPHOLINE IODIDE ... 44 PICATO ............................ 46 PILOCARPINE HCL.......... 44 pilocarpine hcl (oral).......... 50 pimtrea pack ..................... 31 pindolol ............................. 16 pioglitazone hcl ................. 29 pioglitazone hcl-glimepiride .......................................... 29 pioglitazone hcl-metformin hcl ..................................... 29 piperacillin sodium-tazobactam sodium 9 pirmella 1/35 28 day ......... 31 piroxicam ............................ 1 PLAN B

see levonorgestrel (emergency oc) ............. 30

PLAN B ONE-STEP see levonorgestrel (emergency oc) ............. 30 see my way ................... 31 see next choice tab 1.5mg ...................................... 31

PLAQUENIL ...................... 39 see hydroxychloroquine sulfate ............................ 39

PLASMA-LYTE A .............. 42 PLASMA-LYTE-148 .......... 42 PLASMA-LYTE-56/D5W ... 42 PLAVIX ............................. 39

see clopidogrel bisulfate 39 PLETAL ............................ 38

see cilostazol ................. 38 podofilox ........................... 49 polyethylene glycol 3350 ... 36 polymyxin b sulfate ............. 5 polymyxin b-trimethoprim .. 43 POLYTRIM ....................... 43

see polymyxin b-trimethoprim ............... 43

POMALYST CAP .............. 12 PONSTEL ........................... 1

see mefenamic acid ........ 1

portia 28 day ..................... 31 potassium chloride ...... 41, 42 POTASSIUM CHLORIDE 41, 42 POTASSIUM CHLORIDE 0.15% ............................... 42 POTASSIUM CHLORIDE 0.22% ............................... 42 POTASSIUM CHLORIDE 0.3%/D .............................. 42 potassium chloride caps er.......................................... 41 POTASSIUM CHLORIDE INJ 30 MEQ/100 ML ......... 42 potassium chloride microencapsulated crystals cr ....................................... 41 POTASSIUM CITRATE (ALKALINIZER) TAB ........ 37 POTIGA ............................ 20 PRADAXA ........................ 38 pramipexole dihydrochloride.......................................... 22 PRANDIMET .................... 29 PRANDIN ......................... 29

see repaglinide .............. 29 PRAVACHOL ................... 14

see pravastatin sodium . 14 pravastatin sodium ............ 14 prazosin hcl ...................... 13 PRECOSE ........................ 29

see acarbose................. 28 PRED FORTE .................. 43 PRED MILD ...................... 43 PRED-G ............................ 42 PRED-G S.O.P. ................ 42 prednicarbate .................... 49 PREDNICARBATE ........... 49 prednisolone ..................... 33 PREDNISOLONE ACETATE.......................................... 43 prednisolone sodium phosphate ......................... 33 prednisolone sodium phosphate (ophth)............. 43 prednisone ........................ 33 PREGNYL W/DILUENT BENZYL ............................ 33

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PRELONE see prednisolone ........... 33

PREMARIN ....................... 32 PREMARIN CREAM ......... 32 PREMARIN INJ ................. 32 premasol 10% ................... 41 premasol 6% ..................... 41 PREMPHASE ................... 32 PREMPRO ........................ 32 PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) .......................................... 42 PREPOPIK ........................ 36 PREVACID ........................ 37

see lansoprazole ........... 37 PREVACID SOLUTAB ...... 37 prevalite ............................ 15 previfem 28 day ................ 31 PREVPAC

see amoxicillin-clarithromycin w/ lansoprazole ............. 36

PREVPAC MIS ................. 36 PREZISTA ..........................6 PRIFTIN ..............................7 PRILOSEC

see omeprazole cap 10mg ...................................... 37 see omeprazole cap 20mg ...................................... 37 see omeprazole cap 40mg ...................................... 37

PRILOSEC CAP 10MG ..... 37 PRILOSEC CAP 20MG ..... 37 PRILOSEC CAP 40MG ..... 37 PRIMAQUINE PHOSPHATE ............................................6 PRIMAXIN ...........................5 PRIMAXIN IV

see imipenem-cilastatin ...5 primidone .......................... 20 PRIMSOL SOL 50MG/5ML .5 PRINIVIL ........................... 13

see lisinopril ................... 13 PRISTIQ............................ 22 PRIVIGEN ......................... 39 PROAIR HFA .................... 45 probenecid ..........................1

PROCALAMINE ................ 41 PROCARDIA XL ............... 16

see nifedical .................. 16 see nifedipine er ............ 16

prochlorperazine inj 5 mg/ml .......................................... 34 prochlorperazine maleate . 34 prochlorperazine supp ...... 34 PROCRIT .......................... 38 proctocream ...................... 47 procto-pak ......................... 47 proctosol ........................... 47 proctozone hc ................... 47 PROCYSBI ....................... 32 progesterone micronized .. 34 PROGLYCEM ................... 33 PROGRAF ........................ 40

see tacrolimus ............... 40 PROLASTIN-C .................. 45 PROLENSA ...................... 44 PROLEUKIN ..................... 11 PROLIA ............................. 33 PROMACTA ..................... 38 promethazine hcl .............. 35 promethegan ..................... 35 PROMETRIUM ................. 34

see progesterone micronized ..................... 34

propafenone hcl ................ 14 proparacaine hcl ............... 44 propranolol & hydrochlorothiazide ........... 15 propranolol hcl er .............. 16 propranolol inj 1mg/ml....... 16 propranolol sol .................. 16 propranolol tab .................. 16 propylthiouracil .................. 34 PROQUAD ........................ 40 PROSCAR ........................ 37

see finasteride ............... 37 PROSOL ........................... 41 PROTONIX ....................... 37

see pantoprazole sodium ...................................... 37

PROTONIX INJ ................. 37 PROTOPIC OIN 0.03% ..... 49 PROTOPIC OIN 0.1%....... 49 protriptyline hcl .................. 22

PROVENTIL HFA ............. 45 PROVERA ........................ 34

see medroxyprogesterone acetate .......................... 34

PROVIGIL ......................... 26 see modafinil ................. 26

PROZAC ........................... 22 see fluoxetine hcl .......... 21

PROZAC WEEKLY ........... 22 see fluoxetine hcl .......... 21

PRUDOXIN CRE 5% ........ 47 PULMICORT

see budesonide (inhalation) .................... 45

PULMICORT FLEXHALER.......................................... 45 PULMICORT INH SUSP ... 46 PULMOZYME ................... 45 PURINETHOL .................. 11

see mercaptopurine ...... 11 PYLERA ........................... 36 pyrazinamide ...................... 7 pyridostigmine bromide ..... 26 Q QNASL ............................. 45 QUALAQUIN ...................... 6

see quinine sulfate .......... 6 QUARTETTE .................... 31 quasense 91 day .............. 31 QUDEXY XR .................... 20 questran ............................ 15 QUESTRAN

see cholestyramine ....... 15 questran light .................... 15 QUESTRAN LIGHT

see prevalite .................. 15 quetiapine fumarate .......... 23 QUILLIVANT XR ............... 25 quinapril hcl ...................... 13 quinapril-hydrochlorothiazide.......................................... 13 quinidine gluconate er ....... 14 quinidine sulfate ................ 14 quinine sulfate .................... 6 QVAR ............................... 46 R RABAVERT ...................... 40 rabeprazole sodium .......... 37

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RAGWITEK ....................... 39 raloxifene hcl ..................... 34 ramipril .............................. 13 RANEXA ........................... 18 ranitidine hcl ...................... 35 RAPAFLO ......................... 37 RAPAMUNE ...................... 40

see sirolimus tab 0.5 mg 40 RAYOS ............................. 33 RAZADYNE ...................... 21

see galantamine hydrobromide ................ 21

RAZADYNE ER ................ 21 see galantamine hydrobromide ................ 21

REBETOL ...........................7 see ribasphere .................7 see ribavirin cap 200mg ..7

REBETOL SOL 40MG/ML ..7 REBIF ............................... 26 REBIF TITRATION PACK . 26 reclipsen 28 day ................ 31 RECOMBIVAX HB ............ 40 RECTIV ............................. 49 REGLAN ........................... 35

see metoclopramide hcl. 34 REGRANEX ...................... 50 RELENZA DISKHALER ......7 RELISTOR ........................ 36 RELPAX TAB 20MG ......... 25 RELPAX TAB 40MG ......... 25 REMERON ........................ 22

see mirtazapine ............. 21 REMERON SOLTAB ........ 22

see mirtazapine ............. 21 REMICADE INJ 100MG .... 39 REMODULIN .................... 18 RENAGEL ......................... 34 RENVELA ......................... 34 repaglinide ........................ 29 REPREXAIN

see hydrocodone-ibuprofen 2.5-200mg .......................2 see ibudone tab 5-200mg 2

reprexain 10/200 .................2 reprexain 2.5/200 ................2 reprexain 5/200 ...................2

REQUIP ............................ 22 see ropinirole hydrochloride ................. 22

REQUIP XL ....................... 22 see ropinirole hydrochloride ................. 23

RESCRIPTOR .................... 6 RESTASIS ........................ 44 RESTORIL ........................ 25

see temazepam ............. 25 RETIN-A ........................... 46

see tretinoin ................... 46 RETIN-A MICRO .............. 46 RETIN-A MICRO PUMP ... 46 RETROVIR

see zidovudine ................ 6 RETROVIR CAPS .............. 6 RETROVIR IV INFUSION ... 6 RETROVIR SYRP .............. 6 REVATIO .......................... 18

see sildenafil citrate (pulmonary hypertension) ...................................... 18

revia .................................. 27 REVIA

see naltrexone hcl ......... 27 REVLIMID ......................... 39 REYATAZ ........................... 6 RHEUMATREX ................. 39 RHINOCORT AQUA ......... 45

see budesonide (nasal) . 45 ribapak mis 600/day ............ 7 ribasphere ........................... 7 ribasphere ribapak 1000 ..... 7 ribasphere ribapak 1200 ..... 7 ribasphere ribapak 800 ....... 7 ribavirin cap 200mg ............ 7 ribavirin tab 200mg ............. 7 rifabutin ............................... 7 rifadin .................................. 7 RIFADIN ............................. 7

see rifampin ..................... 7 rifamate ............................... 7 rifampin ............................... 7 RIFATER ............................ 7 RILUTEK ........................... 26

see riluzole .................... 26 riluzole .............................. 26

rimantadine hydrochloride .. 7 RINGER'S ......................... 42 RIOMET ............................ 29 risedronate sodium ........... 29 RISPERDAL ..................... 23

see risperidone.............. 23 RISPERDAL CONSTA ..... 23 RISPERDAL M-TAB ......... 23

see risperidone odt ........ 23 risperidone ........................ 23 risperidone odt .................. 23 RITALIN ............................ 25

see methylphenidate hcl ................................ 24, 25

RITALIN LA ...................... 25 see methylphenidate hcl 24

RITALIN SR ...................... 25 see metadate tab 20mg er ...................................... 24 see methylphenidate tab 20mg er ......................... 25

RITUXAN .......................... 11 rivastigmine tartrate .......... 21 rizatriptan benzoate .......... 25 ROBAXIN

see methocarbamol ....... 26 ROBAXIN-750

see methocarbamol ....... 26 ROBINUL .......................... 35

see glycopyrrolate ......... 35 ROBINUL FORTE ............. 35

see glycopyrrolate ......... 35 ROCALTROL .................... 42

see calcitriol .................. 42 rocephin .............................. 8 ROCEPHIN

see ceftriaxone sodium ... 8 ropinirole hydrochloride ... 22, 23 rosadan cre 0.75% ............ 49 ROTARIX .......................... 40 ROTATEQ ........................ 40 ROWASA .......................... 35

see mesalamine enema kit ...................................... 35

roxicet soln ......................... 3 roxicet tab 5-325mg ............ 3 ROXICODONE ................... 4

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see oxycodone hcl ...........3 ROZEREM ........................ 25 RYTHMOL ........................ 14

see propafenone hcl ...... 14 RYTHMOL SR .................. 14

see propafenone hcl ...... 14 S SABRIL ............................. 20 SAIZEN ............................. 33 SAIZEN CLICK.EASY ....... 33 SALAGEN ......................... 50

see pilocarpine hcl (oral) ...................................... 50

SAMSCA ........................... 33 SANCTURA ...................... 37 SANCTURA XR ................ 37 SANCUSO ........................ 35 SANDIMMUNE

see cyclosporine ............ 40 SANDIMMUNE CAPS ....... 40 SANDIMMUNE INJ ........... 40 SANDIMMUNE SOLN ....... 40 SANDOSTATIN ................ 33

see octreotide acetate ... 33 SANDOSTATIN LAR DEPOT ............................. 33 SANTYL ............................ 50 SAPHRIS .......................... 23 SARAFEM ......................... 27 SAVELLA .......................... 26 SAVELLA TITRATION PACK ................................ 26 SEASONIQUE .................. 31

see amethia 91 day ....... 29 SECTRAL ......................... 16

see acebutolol hcl .......... 15 selegiline hcl ..................... 23 selenium sulfide ................ 47 SELZENTRY .......................6 SEMPREX-D ..................... 44 SENSIPAR ........................ 29 SEREVENT DISKUS ........ 45 seromycin............................7 SEROQUEL ...................... 23

see quetiapine fumarate 23 SEROQUEL XR ................ 23 SEROSTIM ....................... 33 sertraline hcl ...................... 22

SF-ROWASA .................... 35 SIGNIFOR ........................ 33 sildenafil citrate (pulmonary hypertension) .................... 18 SILENOR TAB 3MG ......... 25 SILENOR TAB 6MG ......... 25 SILVADENE ...................... 47 SILVER SULFADIAZINE .. 47 SIMBRINZA ...................... 44 SIMCOR ........................... 15 SIMPONI ........................... 39 SIMPONI ARIA ................. 39 SIMULECT ........................ 40 simvastatin ........................ 14 SINEMET .......................... 23

see carbidopa-levodopa 22 SINEMET CR .................... 23

see carbidopa-levodopa 22 SINGULAIR ...................... 45

see montelukast sodium 45 sirolimus tab 0.5 mg .......... 40 SIRTURO ............................ 7 SIVEXTRO .......................... 5 SKLICE ............................. 50 SOD FLUORIDE 2.2MG TAB ................................... 41 SODIUM CHLORIDE .. 41, 42 SODIUM CHLORIDE 0.45% VIA .................................... 42 SODIUM CHLORIDE 0.9% .......................................... 50 SODIUM DIURIL ............... 17 sodium phenylbutyrate ...... 32 sodium polystyrene sulfonate .......................................... 29 SOLARAZE ....................... 46

see diclofenac sodium (actinic keratoses) ......... 46

SOLIA ............................... 31 SOLODYN ........................ 10 SOLTAMOX ...................... 11 SOLU-CORTEF 1000MG . 33 SOLU-CORTEF 100MG ... 33 SOLU-CORTEF 250MG ... 33 SOLU-CORTEF 500MG ... 33 SOLU-MEDROL ............... 33

see methylprednisolone sod succ ........................ 33

SOMA ............................... 26 see carisoprodol ............ 26

SOMATULINE DEPOT ..... 33 SOMAVERT ..................... 33 SONATA ........................... 25

see zaleplon .................. 25 SORIATANE ..................... 47

see acitretin ................... 47 SORILUX .......................... 47 sorine ................................ 14 sotalol hcl .......................... 14 sotalol hcl (afib/afl) ............ 14 SOVALDI ............................ 7 SPIRIVA HANDIHALER ... 44 spironolactone .................. 13 spironolactone & hydrochlorothiazide ........... 17 SPORANOX ....................... 5

see itraconazole .............. 5 SPORANOX PULSEPAK ... 5 SPORANOX SOL 10MG/ML............................................ 5 sprintec 28 day ................. 31 SPRYCEL ......................... 12 sps sus 15gm/60ml ........... 29 sronyx 28 day ................... 31 SSD .................................. 47 STALEVO ......................... 23 STARLIX ........................... 29

see nateglinide .............. 29 stavudine ............................ 6 STAVZOR ......................... 20 STELARA INJ 45MG/0.5 .. 47 STELARA INJ 90MG/ML .. 47 STERILE WATER IRRIGATION ..................... 50 STIMATE .......................... 34 STIVARGA ....................... 12 STRATTERA .................... 25 streptomycin sulfate ............ 4 STRIANT .......................... 27 STRIBILD ........................... 6 STROMECTOL ................... 5 SUBOXONE MIS 12-3MG 27 SUBOXONE MIS 2-0.5MG.......................................... 27 SUBOXONE MIS 4-1MG .. 27 SUBOXONE MIS 8-2MG .. 27

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SUBSYS .............................4 SUCLEAR KIT .................. 36 SUCRAID .......................... 36 sucralfate .......................... 36 SULAR .............................. 16

see nisoldipine ............... 16 sulfacetamide sodium (acne) .......................................... 46 sulfacetamide sodium (ophth) .............................. 43 sulfacetamide sod-prednisolone .............. 42 sulfadiazine .........................4 sulfamethoxazole-trimethoprim .........................................5 sulfamethoxazole-trimethoprim inj ....................................5 SULFAMYLON .................. 47

see mafenide acetate .... 47 sulfasalazine dr ................. 35 sulfasalazine ir .................. 36 sulindac ...............................1 sumatriptan succinate ....... 25 SUMATRIPTAN SUCCINATE ..................... 25 sumatriptan succinate inj .. 25 SUMATRIPTAN SUCCINATE INJ ............... 25 SUMAVEL DOSEPRO ...... 26 suprax .................................8 SUPRAX .............................8 SUPREP BOWEL PREP... 36 SURMONTIL ..................... 22 SUSTIVA.............................6 SUTENT............................ 12 syeda ................................ 31 SYLATRON ....................... 12 SYMBICORT ..................... 46 SYMLINPEN 120 .............. 28 SYMLINPEN 60 ................ 28 SYNAGIS .......................... 40 SYNALAR ......................... 49

see fluocinolone acetonide ...................................... 48

SYNALGOS-DC ..................2 SYNAREL ......................... 31 SYNERA ........................... 49 SYNERCID .........................5

SYNTHROID ..................... 34 see levothyroxine sodium ...................................... 34

SYPRINE .......................... 29 T TABLOID .......................... 11 TACLONEX ...................... 49

see calcipotriene-betamethasone dipropionate ............. 48

tacrolimus ......................... 40 TAFINLAR ........................ 12 TAMBOCOR ..................... 14 TAMIFLU ............................ 7 tamoxifen citrate ............... 11 tamsulosin hcl ................... 37 TANZEUM ........................ 28 tapazole ............................ 34 TAPAZOLE

see methimazole ........... 34 TARCEVA ......................... 12 TARGRETIN ............... 12, 49 TARKA .............................. 13 TASIGNA .......................... 12 TAXOTERE ...................... 11 tazicef vial ........................... 8 TAZORAC ......................... 47 taztia xt ............................. 16 TECFIDERA CAP 120MG 26 TECFIDERA CAP 240MG 26 TECFIDERA MIS STARTER .......................................... 26 TEFLARO ........................... 8 TEGRETOL ...................... 20

see carbamazepine ....... 19 see epitol ....................... 19

TEGRETOL-XR ................ 20 see carbamazepine ....... 19

TEKAMLO ......................... 17 TEKTURNA ...................... 17 TEKTURNA HCT .............. 17 telmisartan tab .................. 14 telmisartan-amlodipine ...... 13 telmisartan-hydrochlorothiazide ...................................... 13 temazepam ....................... 25 TEMOVATE ...................... 49

see clobetasol propionate

...................................... 48 TEMOVATE E .................. 49

see clobetasol propionate emollient base ............... 48

TENEX .............................. 18 see guanfacine hcl ........ 18

TENIVAC .......................... 40 TENORETIC ..................... 15 TENORETIC 100

see atenolol & chlorthalidone ................ 15

TENORETIC 50 see atenolol & chlorthalidone ................ 15

TENORMIN ...................... 16 see atenolol ................... 15

TERAZOL 3 ...................... 37 see terconazole vaginal 38

TERAZOL 7 ...................... 38 see terconazole vaginal 38 see zazole ..................... 38

terazosin hcl ..................... 13 terbinafine hcl ..................... 5 terbutaline sulfate ............. 45 terconazole vaginal ........... 38 TESTIM ............................ 27 testosterone cypionate ...... 27 testosterone enanthate ..... 27 TETANUS TOXOID ADSORBED ..................... 40 TETANUS/DIPHTHERIA TOXOID ............................ 40 TETRACYCLINE HCL ...... 10 TEVETEN ......................... 14

see eprosartan mesylate ...................................... 14

TEVETEN HCT ................. 13 TEV-TROPIN .................... 33 texacort ............................. 49 THALOMID ....................... 39 theo-24 ............................. 46 theophylline ...................... 46 THERMAZENE ................. 47 thioridazine hcl .................. 23 thiothixene ........................ 23 THYMOGLOBULIN ........... 40 tiagabine hcl ..................... 20 TIAZAC ............................. 16

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see diltiazem cap 120mg/24 ...................... 16 see diltiazem hcl extended release beads ................ 16 see diltzac ..................... 16 see taztia xt ................... 16

TIKOSYN CAP 125MCG .. 14 TIKOSYN CAP 250MCG .. 14 TIKOSYN CAP 500MCG .. 14 TIMENTIN ...........................9 TIMENTIN INJ 3.1GM .........9 timolol maleate .................. 16 timolol maleate (ophth) ..... 44 TIMOLOL MALEATE GEL 44 TIMOPTIC ......................... 44

see timolol maleate (ophth) ........................... 44

TIMOPTIC OCUDOSE ...... 44 TIMOPTIC-XE ................... 44 TIROSINT ......................... 34 TIVICAY ..............................6 tizanidine ........................... 26 TOBI

see tobramycin ................4 TOBI NEB ...........................4 TOBI PODHALER ...............4 TOBRADEX ...................... 42

see tobramycin-dexamethasone .................................... 42

TOBRADEX ST ................. 42 tobramycin ..........................4 tobramycin sulfate ...............4 tobramycin sulfate (ophth). 43 tobramycin sulfate in saline .4 tobramycin-dexamethasone .......................................... 42 TOBREX

see tobramycin sulfate (ophth) ........................... 43

TOBREX OINT 0.3% ........ 43 TOBREX SOL 0.3% OP .... 43 tofranil ............................... 22 TOFRANIL

see imipramine hcl ........ 21 TOFRANIL-PM .................. 22

see imipramine pamoate ...................................... 21

tolmetin sodium ................... 1 tolterodine tartrate er......... 37 tolterodine tartrate tab 1 mg .......................................... 37 tolterodine tartrate tab 2 mg .......................................... 37 TOPAMAX ........................ 20

see topiramate .............. 20 TOPAMAX SPRINKLE ...... 20

see topiramate .............. 20 topicort .............................. 49 TOPICORT ....................... 49

see desoximetasone ..... 48 topiramate ......................... 20 TOPIRAMATE ER ............ 20 toposar .............................. 12 topotecan hcl .................... 12 TOPROL XL ...................... 16

see metoprolol succinate ...................................... 15

TORISEL .......................... 11 torsemide inj ..................... 17 torsemide tabs .................. 17 TOVIAZ ............................. 37 TPN ELECTROLYTES ..... 41 TRACLEER ....................... 18 TRADJENTA ..................... 29 tramadol hcl er .................... 2 TRAMADOL HCL ER .......... 2 TRAMADOL HCL ER (BIPHASIC) 100MG ............ 2 TRAMADOL HCL ER (BIPHASIC) 200MG ............ 2 tramadol hcl er (biphasic) 300mg ................................. 2 tramadol hcl tab 50 mg ....... 2 tramadol-acetaminophen .... 2 TRANDATE ...................... 16

see labetalol hcl ............ 15 trandolapril ........................ 13 tranexamic acid ................. 39 TRANSDERM-SCOP ........ 35 TRANXENE T ................... 20

see clorazepate dipotassium ................... 19

tranylcypromine sulfate ..... 22 travasol 10 ........................ 41 TRAVATAN Z ................... 44

trazodone hcl .................... 22 TREANDA ........................ 10 TRECATOR ........................ 7 TRELSTAR DEPOT MIXJECT .......................... 11 TRELSTAR LA MIXJECT . 11 TRELSTAR MIXJECT ....... 11 tretinoin ....................... 12, 46 TRETINOIN MICROSPHERE ............... 46 tretin-x ............................... 46 trexall ................................ 39 TREXIMET ....................... 26 triamcinolone acetonide (mouth) ............................. 50 triamcinolone acetonide (nasal) ............................... 45 triamcinolone acetonide (topical) ............................. 49 triamterene & hydrochlorothiazide ........... 17 triamterene & hydrochlorothiazide cap 37.5-25 mg ....................... 17 triamterene & hydrochlorothiazide tab 37.5-25 mg ....................... 17 triamterene & hydrochlorothiazide tab 75-50 mg .......................... 17 TRIBENZOR ..................... 13 TRICOR ............................ 15

see fenofibrate tab ........ 15 triderm .............................. 49 trifluoperazine hcl.............. 23 trifluridine .......................... 43 TRIGLIDE ......................... 15 trihexyphenidyl hcl ............ 23 tri-legest 28 day ................ 31 TRILEPTAL ...................... 20

see oxcarbazepine ........ 20 TRILEPTAL SUSP ............ 20 TRILIPIX ........................... 15

see choline fenofibrate .. 15 trilyte ................................. 36 trimethoprim ........................ 5 trimipramine maleate ........ 22 TRINESSA ........................ 31

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TRI-NORINYL 28 .............. 31 see aranelle 28 .............. 29

TRIOSTAT ........................ 34 see liothyronine sodium . 34

tri-previfem 28 day ............ 31 TRISENOX ........................ 12 tri-sprintec 28 day ............. 31 trivora 28 day .................... 31 TRIZIVIR .............................6

see abacavir sulfate-lamivudine-zidovudine ...................................6

TROKENDI XR ................. 20 TROPHAMINE .................. 41 trospium chloride ............... 37 TRUSOPT ......................... 44

see dorzolamide hcl ...... 44 TRUVADA ...........................6 TUDORZA PRESSAIR ..... 44 TWINRIX INJ .................... 40 TWYNSTA ........................ 13

see telmisartan-amlodipine ...................................... 13

TYGACIL.............................5 TYKERB............................ 12 tylenol with codeine #3 ........2 tylenol with codeine #4 ........2 TYLENOL/CODEINE #3

see acetaminophen w/ codeine ............................1

TYLENOL/CODEINE #4 see acetaminophen w/ codeine ............................1

TYPHIM VI ........................ 40 TYSABRI........................... 26 TYZEKA ..............................7 tyzine ................................ 45 U UCERIS ............................ 36 u-cort ................................. 49 ULESFIA ........................... 50 ULORIC ..............................1 ULTRACET .........................2

see tramadol-acetaminophen .2

ULTRAM .............................2 see tramadol hcl tab 50 mg ...................................2

ULTRAM ER ....................... 2 see tramadol hcl er .......... 2

ULTRAVATE ..................... 49 see halobetasol propionate ..................... 48

ULTRESA ......................... 36 UNASYN ............................. 9

see ampicillin & sulbactam sodium ............................. 9

UNASYN BULK PACK ........ 9 see ampicillin & sulbactam sodium ............................. 9

UNIRETIC ......................... 13 UNITHROID ...................... 34 UNIVASC .......................... 13

see moexipril hcl ........... 13 urecholine ......................... 37 URECHOLINE

see bethanechol chloride ...................................... 37

UROCIT-K ........................ 37 UROXATRAL .................... 37

see alfuzosin hcl ............ 37 URSO 250 ........................ 36

see ursodiol ................... 36 URSO FORTE .................. 36

see ursodiol ................... 36 ursodiol ............................. 36 UVADEX ........................... 12 V VAGIFEM .......................... 32 valacyclovir hcl .................... 7 VALCHLOR ...................... 49 VALCYTE ........................... 7 VALIUM ............................ 20

see diazepam ................ 19 valproate sodium .............. 20 valproic acid ...................... 20 valsartan tab 160 mg ........ 14 valsartan tab 320 mg ........ 14 valsartan tab 40 mg .......... 14 valsartan tab 80 mg .......... 14 valsartan-hydrochlorothiazide ........................................ 13 VALTREX ........................... 7

see valacyclovir hcl ......... 7 VANCOCIN HCL ................. 5

see vancomycin hcl ......... 5

vancomycin hcl ................... 5 VANDAZOLE .................... 38 VANOS ............................. 49

see fluocinonide ............ 48 VAQTA ............................. 40 VARIVAX .......................... 40 VASCEPA ......................... 15 VASERETIC ..................... 13

see enalapril maleate & hydrochlorothiazide ....... 12

VASOTEC ........................ 13 see enalapril maleate .... 13

VECTIBIX ......................... 11 VECTICAL ........................ 47 VELCADE ......................... 11 velivet 28 day .................... 31 VELPHORO ...................... 34 VELTIN ............................. 46 venlafaxine cap er............. 22 VENLAFAXINE HCL ER

see venlafaxine tab er ... 22 VENLAFAXINE HCL ER TAB (VERT) ...................... 22 venlafaxine tab ................. 22 VENLAFAXINE TAB 225MG ER ..................................... 22 venlafaxine tab er ............. 22 VENTAVIS ........................ 18 VENTOLIN HFA................ 45 VERAMYST ...................... 45 verapamil hcl .............. 16, 17 VERAPAMIL HCL ............. 17 VERELAN ......................... 17

see verapamil hcl .......... 17 VERELAN PM .................. 17

see verapamil hcl .......... 16 veripred ............................. 33 VERSACLOZ .................... 23 VESICARE ....................... 37 vestura .............................. 31 VEXOL .............................. 43 VFEND ............................... 5

see voriconazole ............. 5 VFEND IV ........................... 5

see voriconazole inj 200mg ............................. 5

VFEND SUS 40MG/ML ...... 5 VIBATIV .............................. 5

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VIBRAMYCIN .................... 10 see doxycycline (monohydrate) ............... 10 see doxycycline hyclate . 10

vicodin .................................2 vicodin es ............................2 vicodin hp ............................2 VICOPROFEN ....................2

see hydrocodone-ibuprofen 7.5-200mg .......................2

VICTOZA .......................... 28 VICTRELIS CAP 200MG ....7 VIDAZA ............................. 11

see azacitidine ............... 10 VIDEX EC ...........................6

see didanosine ................6 VIDEX PEDIATRIC .............6 VIGAMOX ......................... 43 VIIBRYD............................ 22 VIMIZIM ............................ 32 VIMOVO..............................1 VIMPAT............................. 20 vinblastine sulfate ............. 11 vincasar............................. 11 vincristine sulfate .............. 11 vinorelbine tartrate ............ 11 VIOKACE 10440 UNIT ...... 36 VIOKACE 20880 UNIT ...... 36 viorele ............................... 31 VIRACEPT ..........................6 VIRAMUNE .........................6

see nevirapine .................6 VIRAMUNE XR ...................6

see nevirapine .................6 VIREAD...............................6 VIROPTIC ......................... 43

see trifluridine ................ 43 VISICOL ............................ 36 VISTARIL .......................... 45

see hydroxyzine pamoate ...................................... 45

VISTIDE ..............................7 see cidofovir ....................7

vivactil ............................... 22 VIVACTIL

see protriptyline hcl ....... 22 VIVELLE-DOT ................... 32

VIVITROL ......................... 27 VOGELXO ........................ 27 VOGELXO PUMP ............. 27 VOLTAREN GEL 1% ........ 49 VOLTAREN-XR .................. 1

see diclofenac sodium ..... 1 voriconazole ........................ 5 voriconazole inj 200mg ....... 5 VOSOL HC

see acetasol hc ............. 50 see acetic acid sol/hc .... 50

vospire .............................. 45 VOSPIRE ER

see albuterol sulfate er .. 45 VOTRIENT ........................ 12 VPRIV ............................... 32 vyfemla ............................. 31 VYTORIN .......................... 15 VYVANSE ......................... 25 W warfarin sodium ................ 38 WELCHOL ........................ 15 WELLBUTRIN ................... 22

see bupropion hcl .......... 21 WELLBUTRIN SR ............. 22

see budeprion tab 150 mg sr ................................... 21 see bupropion hcl .......... 21

WELLBUTRIN XL ............. 22 see bupropion hcl .......... 21

WESTCORT see hydrocortisone valerate ......................... 49

X XALATAN ......................... 44

see latanoprost .............. 44 XALKORI .......................... 12 XANAX .............................. 18

see alprazolam .............. 18 XANAX TAB 2MG ............. 18 XARELTO ......................... 38 XARTEMIS XR ................... 4 XELJANZ .......................... 39 XENAZINE ........................ 26 XEOMIN ............................ 44 XERESE ........................... 47 XGEVA ............................. 33 XIFAXAN TAB 200MG ........ 5

XIFAXAN TAB 550MG ...... 36 XODOL

see hydrocodone-acetaminophen 10-300mg ................... 2 see hydrocodone-acetaminophen 5-300mg ..................... 1 see hydrocodone-acetaminophen 7.5-300mg .................. 2 see vicodin ...................... 2 see vicodin es ................. 2 see vicodin hp ................. 2

xodol 10/300 ....................... 2 xodol 5/300 ......................... 2 xodol 7.5/300 ...................... 2 XOLAIR ............................ 45 XOPENEX ........................ 45 XOPENEX CONCENTRATE.......................................... 45 XOPENEX HFA ................ 45 XTANDI ............................ 11 xulane ............................... 31 XYLOCAINE ................. 4, 49

see lidocaine hcl ............ 49 see lidocaine hcl (local anesth.) ........................... 4 see lidocaine inj 1% ........ 4 see lidocaine inj 2% ........ 4

XYLOCAINE INJ 1% ........... 4 XYLOCAINE-MPF .............. 4

see lidocaine hcl (local anesth.) ........................... 4 see lidocaine inj 0.5% ..... 4 see lidocaine inj 1% ........ 4 see lidocaine inj 1.5% ..... 4 see lidocaine inj 2% ........ 4

XYREM ............................. 27 XYZAL .............................. 45

see levocetirizine soln 2.5mg/5ml ..................... 45 see levocetirizine tab 5 mg ...................................... 45

Y YASMIN 28 ....................... 31

see drospirenone-ethinyl estradiol ........................ 30

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81

see syeda ...................... 31 see zarah ....................... 31

YAZ ................................... 31 see loryna 28 day .......... 30 see nikki 28 day ............. 31 see vestura .................... 31

YF-VAX ............................. 40 Z zafirlukast .......................... 45 zaleplon ............................ 25 zamicet ...............................2 ZANAFLEX ....................... 26

see tizanidine ................ 26 ZANOSAR ......................... 10 ZANTAC............................ 35

see ranitidine hcl ........... 35 zarah ................................. 31 zarontin ............................. 20 ZARONTIN ........................ 20

see ethosuximide .......... 19 ZAROXOLYN .................... 17

see metolazone ............. 17 ZAVESCA ......................... 32 zazole ............................... 38 ZAZOLE ............................ 38 ZEBETA ............................ 16

see bisoprolol fumarate . 15 ZEGERID .......................... 37 ZELAPAR TAB 1.25MG .... 23 ZELBORAF ....................... 12 ZEMAIRA .......................... 45 ZEMPLAR

see paricalcitol ............... 42 see paricalcitol cap 4 mcg ...................................... 42

ZEMPLAR CAP 1MCG ..... 42 ZEMPLAR CAP 2MCG ..... 42 ZEMPLAR CAP 4MCG ..... 42 ZEMPLAR INJ ................... 42 zenatane ........................... 46 zenchent 28 day ................ 31 zenchent fe 28 day ............ 31 ZENPEP............................ 36 ZERIT .................................6

see stavudine .................. 6 ZESTORETIC ................... 13

see lisinopril & hydrochlorothiazide ....... 12

ZESTRIL ........................... 13 see lisinopril .................. 13

ZETIA ................................ 15 ZETONNA ......................... 45 ZIAC.................................. 15

see bisoprolol & hydrochlorothiazide ....... 15

ZIAGEN .............................. 6 see abacavir sulfate ........ 6

ZIANA ............................... 46 zidovudine ........................... 6 ZINACEF ............................ 8

see cefuroxime sodium ... 8 ZINECARD ....................... 12

see dexrazoxane ........... 12 ZIOPTAN .......................... 44 ziprasidone hcl .................. 24 ZIPSOR .............................. 1 ZIRGAN ............................ 43 ZITHROMAX ....................... 8

see azithromycin ............. 8 ZITHROMAX TRI-PAK ........ 8 ZITHROMAX Z-PAK ........... 8 ZMAX .................................. 8 ZOCOR ............................. 14

see simvastatin ............. 14 ZOFRAN ........................... 35

see ondansetron hcl ...... 34 see ondansetron hcl oral soln ................................ 34

ZOFRAN ODT .................. 35 see ondansetron odt...... 34

zoledronic inj 4mg/5ml ...... 29 ZOLINZA ........................... 11 zolmitriptan ....................... 26 zolmitriptan odt ................. 26 ZOLOFT ............................ 22

see sertraline hcl ........... 22 zolpidem tartrate ............... 25 ZOLPIMIST ....................... 25

ZOMETA ........................... 29 see zoledronic inj 4mg/5ml ...................................... 29

ZOMIG .............................. 26 see zolmitriptan ............. 26

ZOMIG NASAL SPRAY .... 26 ZOMIG ZMT ..................... 26

see zolmitriptan odt ....... 26 ZONALON ........................ 47 ZONEGRAN ..................... 20

see zonisamide ............. 20 zonisamide ....................... 20 ZONTIVITY ....................... 39 ZORBTIVE ........................ 33 ZORTRESS ...................... 40 ZORVOLEX ........................ 1 ZOSTAVAX ...................... 40 ZOSYN ............................... 9

see piperacillin sodium-tazobactam sodium ............................ 9

zovia 1/35e 28 day............ 31 zovia 1/50e 28 day............ 31 ZOVIRAX ...................... 7, 47

see acyclovir ................... 7 see acyclovir topical ...... 47

ZUBSOLV ......................... 27 ZYBAN .............................. 27

see buproban ................ 27 ZYCLARA ......................... 49 ZYDELIG .......................... 12 ZYFLO CR ........................ 45 ZYKADIA .......................... 12 ZYLET .............................. 42 ZYLOPRIM ......................... 1

see allopurinol tab ........... 1 ZYMAXID .......................... 43

see gatifloxacin (ophth) . 43 ZYPREXA ......................... 24

see olanzapine .............. 23 ZYPREXA ZYDIS ............. 24

see olanzapine odt ........ 23 ZYTIGA ............................. 11 ZYVOX ............................... 5