requirements/ drug name requirements/ limits analgesics
TRANSCRIPT
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)
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 22
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)
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 23
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)
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 25
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)
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 26
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)
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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)
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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)
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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)
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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)
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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)
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 49
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)
NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 50
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
2014 601 4T Copper BvD Comm_NT (Effective November 1)
53
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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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
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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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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