OptumRx Vigilant Drug Program

Non-essential medications strategy

Thousands of medications are available today with even more entering the market — sometimes at a higher cost without additional value. OptumRx can help ensure that your pharmacy benefit dollars cover only the most clinically appropriate and affordable medications.

Non-essential medications strategy* — Excludes select products that are available in the market but may not be approved by the U.S. Food and Drug Administration (FDA) or are deemed non-essential by the OptumRx Pharmacy & Therapeutics (P&T) Committee. These high-dollar products offer little clinical value versus other well-tested, FDA-approved agents.

*Programs are also available for clients who prefer prior authorization rather than an exclusion strategy. Effective January 1, 2020

Drug Name

1ST MEDX-PATCH/ LIDOCAINE EXTERNAL PATCH 4-0.0375-5-20 %

7T LIDO

ACACIA SUBCUTANEOUS

ACCUCAINE

ACREMONIUM

ACTICOAT 7 2"X2"

ACTICOAT 7 4"X5"

ACTICOAT ABSORBENT 4"X5"

ACTICOAT ANTIMICROBIAL 2"X2"

ACTICOAT ANTIMICROBIAL 4"X4"

ACTICOAT FLEX 3 4"X4"

ACTIVE FE

ACTIVE INJECTION BLM-1

ACTIVE INJECTION BM

ACTIVE INJECTION D

ACTIVE INJECTION DL

ACTIVE INJECTION DLM

ACTIVE INJECTION KET-L

ACTIVE INJECTION KETMARC-L

ACTIVE INJECTION KIT L

ACTIVE INJECTION KL-3

ACTIVE INJECTION KM

ACTIVE INJECTION LM-2

ACTIVE INJECTION LM-DEP-1

ACTIVE INJECTION LM-DEP-2

ACTIVE INJECTION M-1

ACUICYN

ACUNOL

ADRENALIN NASAL

ADVANCED ALLERGY COLLECTION

ADVANCED BASE PLUS

ADYPHREN

ADYPHREN AMP

ADYPHREN AMP II

ADYPHREN II

agoneaze

AKOVAZ

ALA-QUIN

Drug Name

ALBA-DERM

alcohol injection

ALCORTIN A

ALDER

ALEVAMAX

ALEVICYN ANTIPRURITIC

ALEVICYN ANTIPRURITIC SG EXTERNAL GEL

alevicyn dermal spray

ALMOND (DIAGNOSTIC)

ALPAWASH

altacaine

ALTADERM

altafluor

ALTERNARIA

ALZAIR ALLERGY NASAL SPRAY

AMELUZ

AMERICAN BEECH

AMERICAN COCKROACH

AMERICAN ELM

AMERICAN SYCAMORE

aminoamrms

aminobenzoate potassium oral packet

aminoreliefrms

AMMONIA N 13

AMYTAL SODIUM

ANACAINE

ana-lex

ANALPRAM HC

ANALPRAM HC SINGLES

ANDEXXA

ANIMI-3

ANIMI-3/VITAMIN D

anodyne lpt

anucort-hc

anusol-hc rectal suppository

APPLE (DIAGNOSTIC)

APRIZIO PAK

AQUORAL MOUTH/THROAT SOLUTION

2

Drug Name

ARESTIN

argatroban in sodium chloride intravenous solution 50 mg/50ml

argatroban intravenous solution 125 mg/125ml

ARIZONA CYPRESS

arzol silver nit applicators

ASCOR

ascorbic acid injection

ASCORBIC ACID INTRAVENOUS

ASTERO

ATOPADERM

ATOPICLAIR

ATRAPRO CP

ATRAPRO HYDROGEL

atropine sulfate injection solution 0.4 mg/ml, 1 mg/ml, 8 mg/20ml

atropine sulfate injection solution prefilled syringe 0.5 mg/5ml, 1 mg/10ml

ATROPINE SULFATE OPHTHALMIC EMULSION

AUREOBASIDIUM

AUSTRALIAN PINE

AUXIPRO VANISHING

avar cleanser

AVAR EXTERNAL PAD

AVAR LS

AVAR LS CLEANSER

avar-e emollient

avar-e green

AVAR-E LS

AVENOVA

AVIDOXY DK

AVOCADO (DIAGNOSTIC)

AXIFOL

AZEDRA DOSIMETRIC

AZEDRA THERAPEUTIC

B-12 COMPLIANCE INJECTION

BACMIN

BAHIA

BAL-CARE DHA

Drug Name

BALD CYPRESS

BANANA (DIAGNOSTIC)

BASE W301

BAYBERRY (WAX MYRTLE)

BEEF (DIAGNOSTIC)

belladonna alkaloids-opium

BENSAL HP

BENZAC AC WASH EXTERNAL LIQUID

benzepro creamy wash

BENZEPRO EXTERNAL

BENZEPRO EXTERNAL FOAM 5.2 %, 9.7 %

benzepro external foam 5.3 %

BENZEPRO EXTERNAL LIQUID

benzepro foaming cloths

benzepro short contact

BENZIQ

BENZIQ LS

BENZIQ WASH

BENZODOX

benzoin compound

benzoin external tincture

BENZOYL PEROX-HYDROCORTISONE

benzoyl peroxide external foam 9.8 %

BENZOYL PEROXIDE EXTERNAL GEL 6.5 %, 8 %

BENZOYL PEROXIDE FORTE- HC

BERMUDA GRASS

BESER EXTERNAL KIT

BETA 1 KIT

BETALIDO

BETALOAN SUIK

BETAMETHASONE COMBO

BETAMETHASONE SOD PHOS & ACET

BETAMETHASONE SODIUM PHOSPHATE INJECTION

BEVACIZUMAB

BHI URI-CONTROL

bio glo

BIOFREQUENCY INSOLES

3

Drug Name

bio-statin oral powder

BIVALIRUDIN-SODIUM CHLORIDE

BLACK WALNUT POLLEN

BLACK WILLOW

BOCASAL

BOTRYTIS

BOX ELDER

bp 10-1

BP CLEANSING WASH

bp foam

bp wash external liquid 2.5 %, 7 %

bpo

BRIDION

BRIMONIDINE-DORZOLAMIDE

BROME

BROMPHENIRAMINE MALEATE INTRAMUSCULAR

BUPIVACAINE HCL INJECTION SOLUTION 312.5 MG/10ML

BUPIVILOG

CADIRAMD

CAFFEINE-SODIUM BENZOATE

calcium chloride

CALCIUM GLUCONATE SOLUTION 10 % INTRAVENOUS

calcium gluconate solution 10 % intravenous

CALCIUM GLUCONATE-NACL INTRAVENOUS SOLUTION 2-0.675 GM/100ML-%

CALCIUM-FOLIC ACID PLUS D

CALIFORNIA PEPPER TREE

CANDIDA ALBICANS EXTRACT

CANTALOUPE (DIAGNOSTIC)

CANTHARIDIN EXTERNAL

CAPHOSOL MOUTH/THROAT SOLUTION

CAPSFENAC PAK

CARDIOVID PLUS

CARRASYN HYDROGEL WOUND DRESS

CASEIN (DIAGNOSTIC)

CAT HAIR EXTRACT

Drug Name

CATTLE EPITHELIUM

CEDAR ELM

CEFUROXIME SODIUM-NACL

CELA BASE

celacyn gel external

CELACYN GEL EXTERNAL

CELLPAD

cem-urea

CENTANY AT

CERACADE

ceramax external cream

CERAMAX EXTERNAL LOTION

cerovel external lotion

cervical specimen collection

CETACAINE EXTERNAL AEROSOL

CETACAINE EXTERNAL LIQUID

CHEW-HESIVE

CHICKEN MEAT (DIAGNOSTIC)

choline-mag trisalicylate

CHONDROITIN SULFATE OPHTHALMIC

CHRYSADERM DAY

CHRYSADERM NIGHT

cicatrace pad

ciclopirox treatment

CIFEREX

CIFRAZOL

CITRANATAL 90 DHA ORAL 90-1 & 300 MG

CITRANATAL ASSURE ORAL 35-1 & 300 MG

CITRANATAL B-CALM

CITRANATAL DHA

CITRANATAL HARMONY ORAL CAPSULE 27-1-260 MG

CITRANATAL MEDLEY

CITRANATAL RX

CLADOSPORIUM CLADOSPORIOIDES

CLADOSPORIUM SPHAEROSPERMUM

CLINDACIN ETZ EXTERNAL KIT

CLINDACIN PAC

CLINIMIX N9G20E

4

Drug Name

clinpro 5000

CLODAN EXTERNAL KIT

cocaine hcl external solution 4 %

COCAINE HCL NASAL

COCKLEBUR

COCOA BEAN (DIAGNOSTIC)

COLCIGEL

COLLATYL

COMPACT SPACE CHAMBER/SM MASK

CONTRAST ALLERGY PREMED PACK

CONVENIENCE PAK

COPASIL EXTERNAL

CORN POLLEN

CORTANE-B EXTERNAL

covaryx

covaryx hs

CRAB (DIAGNOSTIC)

CREAM BASE

CREAM BASE NIOSOMES

CREAM CONCENTRATE

CREAM-HEAVY BASE NIOSOMES

CURVULARIA

CUTIS PLUS

cyclobenzaprine hcl oral tablet 10 mg

CYCLOSPORINE IN KLARITY

CYSTADANE

cytra k crystals

DEBACTEROL

DEFITELIO

dehydrated alcohol injection

DELUO

DERMACINRX ANALGESIC COMBOPAK

DERMACINRX AZENASE PAK

DERMACINRX CLORHEXACIN

DERMACINRX DUOPATCH PHARMAPAK

dermacinrx empricaine

DERMACINRX LEXITRAL PHARMAPAK

DERMACINRX NEUROTRAL PHARMAPAK

DERMACINRX PHN

Drug Name

dermacinrx prizopak

DERMACINRX PUREFOLIX

DERMACINRX SURGICAL COMBOPAK

DERMACINRX SURGICAL PHARMAPAK

DERMACINRX THERAZOLE PAK

DERMACINRX TICANASE PAK

DERMACINRX TOPICAL BASE

DERMACINRX ZRM

dermazene

DEXAMETHASONE ACE & SOD PHOS

DEXAMETHASONE SOD PHOS-BUPIV

DEXAMETHASONE-MOXIFLOXACIN

DEXAMETH-MOXIFLOX-KETOROLAC

DEXERYL

DEXLIDO

DEXLIDO-M

DEXOPIN

DEXTENZA

dextrose intravenous solution 50 %

DFS DR/MS/MENTH/CAP PAK

DFS/MS/MENTH/CAP PAK

DIAB EXTERNAL GEL

DIAB F.D.G. FREEZE-DRIED

DIALYVITE SUPREME D

diclofenac sodium transdermal gel 3 %

diclofex dc combination therapy pack 1.5-0.025 %

DICLOFONO

diclopak

DICLOPR

diclosaicin

DICLOVIX

DICLOZOR

DMT SUIK

DOG EPITHELIUM

DOG FENNEL

DONNATAL

DOUBLEDEX

DRECHSLERA

5

Drug Name

DRITHO-CREME HP

DSUVIA

DUET DHA 400

DUET DHA BALANCED ORAL 25-1 & 267 MG

DURACHOL

DUST MITE MIXED ALLERGEN EXT

DYNABAC 5.0

DYURAL-40

DYURAL-80

DYURAL-L

DYURAL-LM

EASTERN COTTONWOOD

ECZEMOL

eemt

eemt hs

EGG WHITE (DIAGNOSTIC)

EHA

ELCYS

ELETONE

ELETONE TWINPACK

ELLZIA PAK

EMOLIVAN

EMOLLIENT BASE

EMULSION SB

ENBRACE HR

ENGLISH PLANTAIN

ENGYSTOL INJECTION

ENLYTE

ENTERO VU ORAL SUSPENSION 24 %

ENTTY SPRAY EMULSION

ENZADYNE

ENZOCLEAR

ephedrine sulfate injection

EPICERAM

EPICOCCUM

EPICYN

epinephrine injection solution 30 mg/30ml

epinephrine pf

EPINEPHRINE PROFESSIONAL

Drug Name

EPINEPHRINESNAP-EMS

EPINEPHRINESNAP-V

EPISNAP

EQUAPAX/ATORVASTATIN/COQ10

EQUAPAX/IBUPROFEN/MINREX

ERGOCAL

ESCAVITE D

escavite lq oral liquid

ESKATA

ESOMEP-EZS

est estrogens-methyltest

est estrogens-methyltest ds

est estrogens-methyltest hs

EXYDERM

E-Z-DISK

E-Z-HD

E-Z-PAQUE

E-Z-PASTE

FAGRON LS PLUS

FAGRON NATURAL

FAGRON SUPREME

FALESSA ORAL KIT 20-1-0.1 MCG-MG

FEM PH

FENTANYL CITRATE INTRAVENOUS SOLUTION PREFILLED SYRINGE 100 MCG/2ML

FENTANYL CITRATE-NACL EPIDURAL

FENTANYL CITRATE-NACL INTRAVENOUS SOLUTION 5-0.9 MG/250ML-%

FENTANYL CIT-ROPIVACAINE-NACL EPIDURAL SOLUTION 0.2-0.15-0.9 MG/100ML-%, 0.4-0.2-0.9 MG/200ML-%

FENTANYL-BUPIVACAINE-NACL EPIDURAL SOLUTION 0.6-0.125-0.9 MG/200ML-%

FERIVAFA

FIRE ANT

FITALITE

FLEXIN

FLEXIPAK

FLEXIZOL COMBIPAK

6

Drug Name

FLORIVA ORAL LIQUID

FLORIVA ORAL TABLET CHEWABLE 0.5 MG, 1 MG

flucaine

FLUOVIX

FOLET DHA

FOLET ONE

FOLI-D

FOLIKA-D

FOLITE

FOLVITE-D

formaldehyde external solution 10 %

FREEDOM ADAPTADERM EXTERNAL

FREEDOM DERMA SERUM

FREEDOM DERMA-D

FREEDOM DERMA-N

FUL-GLO OPHTHALMIC STRIP 0.6 MG

ful-glo ophthalmic strip 1 mg

FUNGIMEZ

FUSARIUM

FUSION SPRINKLES

GATIFLOXACIN-DEXAMETHASONE

GELCLAIR

GELFILM OPHTHALMIC

GEL-FLOW

GELFOAM-JMI POWDER

GELFOAM-JMI SPONGE

GENADUR

GENICIN VITA-D

GENICIN VITA-Q

GENICIN VITA-S

GERMAN COCKROACH

GHRP2-GHRP6-SERMORELIN

GHRP2-SERMORELIN

GIAPREZA

glycolic acid solution

GLYTACTIN RTD 10

GOLDENROD

GOPRELTO

Drug Name

grafco silver nit applicator

GRAFIX CORE 1.5CM X 2CM

GRAFIX CORE 16MM

GRAFIX CORE 2CM X 3CM

GRAFIX CORE 3CM X 4CM

GRAFIX CORE 5CM X 5CM

GRAFIX PRIME 1.5CM X 2CM

GRAFIX PRIME 16MM

GRAFIX PRIME 2CM X 3CM

GRAFIX PRIME 3CM X 4CM

GRAFIX PRIME 5CM X 5CM

GRAFIX XC 7.5CM X 15CM

green glo lissamine green

HACKBERRY

HEMATOGEN FA

HEMETAB

hemmorex-hc rectal suppository 25 mg

HEPMED

HONEY BEE VENOM PROTEIN

HONEY BEE VENOM SUBCUTANEOUS

HORMONE CR HEAVY BASE NIOSOMES

HORMONE CREAM BASE NIOSOMES

HORSE EPITHELIUM

HPR

HPR PLUS

HPR PLUS HYDROGEL

HPR PLUS-MB HYDROGEL

HYCLODEX

HYDRO 35

HYDRO 40

hydrocortisone ace-pramoxine cream 2.5-1 % external

hydrocortisone ace-pramoxine cream 2.5-1 % rectal

hydrocortisone ace-pramoxine rectal cream 2.5-1 %

hydrocortisone acetate rectal

hydrocortisone-iodoquinol external cream 1-1 %

HYDROGEL

7

Drug Name

HYDROMORPHONE HCL INJECTION SOLUTION 1 MG/ML

hydromorphone hcl injection solution 2 mg/ml

hydromorphone hcl rectal

HYDROMORPHONE HCL-NACL INTRAVENOUS SOLUTION 10-0.9 MG/100ML-%, 25-0.9 MG/50ML-%, 5-0.9 MG/50ML-%, 50-0.9 MG/50ML-%, 6-0.9 MG/30ML-%

hydroquinone external cream

HYLATOPIC PLUS

HYLIRA

hyophen

hyoscyamine sulfate er oral tablet extended release 12 hour

HYPERLYTE-CR

HYPERRAB S/D INJECTION SOLUTION 300 UNIT/2ML

HYPOCYN

IFE-BIMIX 30/1

IFE-PG20

ILUVIEN INTRAVITREAL

inflammacin

INFLAMMATION REDUCTION PACK

INFLATHERM COMBINATION THERAPY PACK

INOVA

INOVA 4/1 ACNE CONTROL THERAPY

INOVA 8/2 ACNE CONTROL THERAPY

IODOQUIMEZ-HC

iodoquinol-hc-aloe polysacch

iodoquinol-hydrocortisone-aloe

IONSYS

IPAMORELIN ACETATE

IROSPAN 24/6

isoxsuprine hcl oral

JOHNSON GRASS

JTT PHYSICIANS

JUNE GRASS POLLEN STANDARDIZED

KAMDOY

KAPOK

Drug Name

KCL (IN NACL 0.9%) INTRAVENOUS SOLUTION 40 MEQ/500ML

KEDRAB INJECTION

KELARX

KENDALL AMORPHOUS WOUND

KERAGEL

KERAGELT

KERALAC EXTERNAL CREAM 47 %

KERALYT EXTERNAL GEL 6 %

KERALYT SCALP

KETOROCAINE-L

KETOROCAINE-LM

KETOROLAC-BUPIV-KETAMINE

KETOROLAC-ROPIV-KETAMINE

KIVIK

KLARITY-A

KLARITY-B

KLARITY-L

klor-con/ef

KOCHIA

K-PHOS

K-PHOS NO 2

K-PHOS-NEUTRAL

KYBELLA

LAMBS QUARTERS

LATANOPROST-TIMOLOL MALEATE

LATRIX XM

LAVARE WOUND WASH

l-cysteine hcl intravenous

LDO PLUS

lecithin oral granules

LENSCALE

LEU TECHNELITE

LEVATIO

LEVBID

LEVICYN

levicyn dermal spray

LEVSIN INJECTION

LEVSIN ORAL TABLET

8

Drug Name

LEVSIN/SL

lido bdk

lidocaine external ointment

lidocaine hcl external cream 3 %

LIDOCAINE HCL EXTERNAL CREAM 4.12 %

lidocaine hcl external lotion

LIDOCAINE-EPINEPHRINE INTRAOCULAR

LIDOCAINE-HYDROCORTISONE ACE EXTERNAL CREAM 1-1 %

lidocaine-hydrocortisone ace rectal

LIDOCAINE-PHENYLEPHRINE

LIDOCAINE-PHENYLEPHRINE-BSS

lidocaine-prilocaine external kit

LIDOCIDEX I

LIDOCILONE I

LIDO-EPINEPHRINE-TETRACAINE

lidolog

LIDOPAC

lidopin external cream 3 %

LIDOPIN EXTERNAL CREAM 3.25 %

lidopril external kit

lidopril xr

lido-prilo caine pack

LIDOPURE PATCH

LIDORX

LIDO-SORB

LIDOTHOL

LIDOTRAL

LIDOTREX

LIDOZION

LIOPEN ABSORPTION ENHANCING

LIPO CREAM BASE

LIPOFOAM RX

LIPOPEN ULTRA BASE

LIPOSOMAL HEAVY

LIPOSOMAL REGULAR

LIPOZYME

LIQUID E-Z-PAQUE

LIQUID POLIBAR PLUS

Drug Name

LIQUIVIDA HYDRATION

livixil pak

LMA MAD NASAL

LMR PLUS

LOPROX EXTERNAL KIT

LORID

LOUTREX

LOYON

LT INJECTION KIT

lugols external

LUMASON

LUTATHERA

LUXAMEND

LYMPHOMYOSOT X

MACI

manganese sulfate intravenous

MARBETA-25

MARBETA-L

MARDEX-25

marlido

MARLIDO-25

MARNATAL-F

MARVONA SUIK

MAS CARE-PAK

MB HYDROGEL

me/naphos/mb/hyo1

MEADOW FESCUE GRASS POLLEN

MEDIDERM

MEDI-DERM/L-RX

MEDI-DERM-RX

MEDI-PATCH RX

MEDROLOAN II SUIK

MEDROLOAN SUIK

MELALEUCA

MESQUITE

METAXALL CP

METHAVER

METHAZEL

methenamine mandelate oral

9

Drug Name

methyl salicylate external liquid

methylene blue injection

METHYLPREDNISOLONE ACE-LIDO

MICROCYN EXTERNAL GEL

MICROCYN SKIN AND WOUND

MIDAZOLAM HCL-NACL

MIDAZOLAM HCL-SODIUM CHLORIDE INTRAVENOUS SOLUTION 100-0.9 MG/100ML-%

MIDAZOLAM-KETAMINE-ONDANSETRON

MIGRAINE PACK

MIGRANOW

MIMYX

MIRODERM BIOLOGIC MATRIX FENES

MIRODERM BIOLOGIC WOUND MATRIX

MITE (D. FARINAE)

MITE (D. PTERONYSSINUS)

MITOMYCIN INTRAVESICAL

MIXED ASPERGILLUS

MIXED FEATHERS

MIXED RAGWEED

MIXED VESPID VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED

MIXED VESPID VENOM PROTEIN SUBCUTANEOUS

MKO MELT DOSE PACK

mlk f1

mlk f2

mlk f3

MLK F4

MONSELS FERRIC SUBSULFATE EXTERNAL

MORCIN

MORGIDOX COMBINATION

morphine sulfate intravenous solution 1 mg/ml, 25 mg/ml, 50 mg/ml

morphine sulfate rectal

MOSQUITO (DIAGNOSTIC)

MOUNTAIN CEDAR

MOUSE EPITHELIUM

Drug Name

MOXIFLOXACIN HCL INTRAOCULAR SOLUTION 5 MG/ML

MOXIFLOXACIN HCL INTRAOCULAR SOLUTION PREFILLED SYRINGE

MOXIFLOXACIN HCL-BSS

MUCOR

MUCOSITISRX

MUGARD

MUGWORT

MULTIBASE

MULTI-SPECIALTY

MULTITRACE-4

multitrace-4 concentrate

MULTITRACE-4 NEONATAL

MULTITRACE-4 PEDIATRIC

MULTITRACE-5

multitrace-5 concentrate

multivitamin/fluoride oral solution

MY MDI FINGER PULSE OXIMETER

MY MDI PORTABLE NEBULISER

myferon 150 forte

mynephrocaps

NALTREXONE SUBCUTANEOUS

NANDROLONE-TESTOSTERONE CYP

NATACHEW ORAL TABLET CHEWABLE 28-1 MG

NATELLE ONE ORAL CAPSULE 28-1-250 MG

NEOCERA

NEOSALUS

NEOSALUS CP

NEO-SYNALAR EXTERNAL KIT

NEPHPLEX RX

NESTABS DHA

NETSPOT

NEUAC EXTERNAL KIT

NEURALGO-RHEUM

NEUT

NEUTRASAL

NIACIN

10

Drug Name

NIPRIDE RTU INTRAVENOUS SOLUTION 20-0.9 MG/100ML-%, 50-0.9 MG/100ML-%

nitroglycerin er oral capsule extended release 2.5 mg

nitro-time

NIVATOPIC PLUS

NOURILITE

NOURIVAN ANTIOX BASE

NOVACORT EXTERNAL GEL 1-2 %

NUCARACLINPAK

NUCARARXPAK

NUCORT

NUDERMRXPAK 120

NUDERMRXPAK 60

nudiclo solupak

nudiclo tabpak

NUDROXIPAK

NUDROXIPAK DSDR-50

NUDROXIPAK DSDR-75

NUDROXIPAK E-400

NUDROXIPAK I-800

NUDROXIPAK M-15

NUDROXIPAK N-500

NUMOISYN

NUSURGEPAK SURGICAL PREP/CARE

NUTRASEB

NUTRIARX CREAMPAK

NUTRIDOX

NUVAIL

NUVAKAAN

NUVAZIL

OASIS ULTRA MATRIX FENESTRATED EXTERNAL SHEET 3X7CM

OASIS ULTRA TRI-LAYER MATRIX EXTERNAL SHEET 7X10CM

OASIS WOUND MATRIX FENESTRATED EXTERNAL SHEET 3X7CM

OAT GRAIN (DIAGNOSTIC)

OCUVEL ORAL CAPSULE 0.5 MG

OLIVE TREE

Drug Name

OMEGA-3 RX COMPLETE

OMEGA-3/D-3 WELLNESS PACK

OMEGAVEN

opium

ORACIT

ORAFATE

ORANGE (DIAGNOSTIC)

ORCHARD GRASS POLLEN

ORMECA

ORTHO DF

oscimin sr

OTIPRIO

OVACE PLUS

OVACE PLUS WASH

OVACE WASH

PAINGO KFT

papaverine hcl injection

PAPAVERINE-PHENTOLAMINE

PAPAV-PHENTOLAMINE-ALPROSTADIL

paregoric

P-CARE 100MX

P-CARE D40

P-CARE D40G

P-CARE D40MX

P-CARE D80

P-CARE D80G COMBINATION

P-CARE D80MX

P-CARE K40

P-CARE K40G

P-CARE K40MX

P-CARE K80

P-CARE K80G

P-CARE K80MX

P-CARE M

P-CARE MG

P-CARE X

PCCA ALADERM BASE

PCCA ANHYDROUS LIPODERM BASE

PCCA BIOPEPTIDE BASE

11

Drug Name

PCCA LIPODERM BASE

PCCA MVC BASE

PCCA NATACREAM

PCCA POLYPEG BASE

PCCA VANISHING CREAM BASE

PCCA VANISHING CREAM LIGHT

PCCA VANPEN BASE

PCP 100

PEANUT (DIAGNOSTIC)

PECAN NUT (DIAGNOSTIC)

PECAN POLLEN

PENCREAM

PENDERM

PENICILLIUM NOTATUM

PENLEN

PENTAPHENE BASE

PERENNIAL RYE GRASS POLLEN

PHARMABASE COSMETIC

PHARMABASE HEAVY

phenazopyridine hcl oral tablet 200 mg

phenobarbital sodium injection

phenobarbital-belladonna alk

phenohytro

PHENYLBUTAZONE

PHENYLEPHRINE HCL-NACL INTRAVENOUS SOLUTION 50-0.9 MG/500ML-%

PHLAG SPRAY

PHOMA EXIGUA

phospha 250 neutral

phosphasal

phospho-trin 250 neutral

PHYSICIANS EZ USE B-12

PHYSICIANS EZ USE JOINT/TUNNEL

PHYSICIANS EZ USE M-PRED

PHYSOSTIGMINE SALICYLATE INJECTION

PHYTOBASE

PICO WOUND THERAPY SYSTEM

PISTACHIO NUT (DIAGNOSTIC)

Drug Name

PLEXION

PLEXION CLEANSER EXTERNAL LIQUID

PLEXION CLEANSING CLOTH EXTERNAL PAD

pnv folic acid + iron

pnv-dha

pnv-select

POD-CARE 100C

POD-CARE 100CG

POD-CARE 100CMX

POD-CARE 100K

POD-CARE 100KG

POD-CARE 100KMX

podocon

POINT OF CARE KM

POINT OF CARE L.2

POINT OF CARE L.5

POINT OF CARE LM DEP 2

POINT OF CARE LM-2.2

POINT OF CARE LM-2.5

POLIDOCANOL

POLYOXYL 40 STEARATE PELLET

PORK (DIAGNOSTIC)

POTABA ORAL CAPSULE

potassium bicarbonate oral

POTASSIUM CHLORIDE IN D5W INTRAVENOUS SOLUTION 20 MEQ/250ML

potassium chloride oral packet

potassium citrate-citric acid oral solution

potassium phosphates

PR BENZOYL PEROXIDE

pr benzoyl peroxide wash

PR CREAM

pr natal 400

pr natal 400 ec

pr natal 430

PRAMOSONE EXTERNAL CREAM 1-2.5 %

PRAMOSONE EXTERNAL OINTMENT

pramox

12

Drug Name

PRASTERA

PRAXBIND

PRE & POST SX POUCH

PREDNISOL ACE-MOXIFLOX-BROMFEN

prednisolone acetate p-f

PREDNISOLONE ACETATE-NEPAFENAC

PREDNISOLONE ACET-MOXIFLOXACIN

PREDNISOLONE-BROMFENAC

PREDNISOLONE-GATIFLOXACIN

PREDNISOLONE-MOXIFLOXACIN

PREDNISOLON-GATIFLOX-BROMFENAC

PREDNISOLON-MOXIFLOX-BROMFENAC OPHTHALMIC SOLUTION 1-0.5-0.075 %

PREDNISOLON-MOXIFLOX-NEPAFENAC

premium lidocaine

PREMIUM SCAR

PRENAISSANCE

PRENAISSANCE PLUS

prenatal 19 oral tablet chewable 29-1 mg

prenatal oral tablet 27-1 mg

prenatal vitamin plus low iron

PRENATE

PRENATE AM

PRENATE DHA ORAL CAPSULE 18-0.6-0.4-300 MG

PRENATE ELITE ORAL TABLET 20-0.6-0.4 MG

PRENATE ENHANCE

PRENATE ESSENTIAL ORAL CAPSULE 18-0.6-0.4-300 MG

PRENATE MINI ORAL CAPSULE 18-0.6-0.4-350 MG

PRENATE PIXIE

PRENATE RESTORE

PRESERA

PREVELEAK SURGICAL SEALANT

PREVIDOLRX ANALGESIC

previdolrx plus analgesic

prilolid

prilovix

Drug Name

PRILOVIX LITE

prilovix plus

prilovix ultralite

priloxx lp

PRIMACARE ORAL CAPSULE

PRIVET

PRIZOTRAL

PRO-C-DURE 5

PRO-C-DURE 6

PROCORT

PROCTOCORT RECTAL SUPPOSITORY

PRODIGEN

PROMACTIN AA PLUS 20PE

PROMISEB

PROPEL

PROPEL MINI

PROTHELIAL

PROTYL AG

PROVAD

PRUCLAIR

PRUMYX

P-SILOXAN DS

PSORIZIDE FORTE

PSORIZIDE ULTRA

PYRIDIUM

QUEEN PALM

QUFLORA FE PEDIATRIC

QUFLORA GUMMIES

quflora pediatric oral solution 0.5 mg/ml

quflora pediatric oral tablet chewable 0.25 mg

QUINIXIL

QUINJA

QUTENZA

QUTENZA (2 PATCH)

RABBIT EPITHELIUM

RADIAGEL

RADIAPLEXRX

RAPID GEL RX

READYSHARP ANESTH + BETAMETH

13

Drug Name

READYSHARP ANESTH + DEXAMETH

READYSHARP ANESTH + KETOROLAC

READYSHARP ANESTH + METHYLPRED

READYSHARP BETAMETHASONE

READYSHARP DEXAMETHASONE

READYSHARP KETOROLAC

READYSHARP LIDOCAINE

READYSHARP-A

RECK

RECURA

RED BIRCH

RED CEDAR

RED MAPLE

RED MULBERRY

RED TOP GRASS POLLEN

relador pak external kit

relador pak plus

RELIZORB

REMIGEN

RENOVO

RESET FOR ANDROID APP

RESET FOR IOS APP

RESET-O FOR ANDROID APP

RESET-O FOR IOS APP

RESORCINOL-SULFUR

RETISERT INTRAVITREAL

REVESTA

REXAPHENAC

REXASIL PATCH & VITAMIN E LIQ

RHIZOPUS

RICE (DIAGNOSTIC)

ROPIDEX

ROPIVACAINE HCL INJECTION SOLUTION 33.4 MG/ML

ROPIVACAINE HCL INJECTION SOLUTION PREFILLED SYRINGE

ROPIVACAINE HCL-NACL INJECTION SOLUTION 0.2-0.9 %

ROPIV-CLONIDINE-KETOROLAC

ROSADAN EXTERNAL KIT

Drug Name

ROUGH MARSH ELDER

ROUGH PIGWEED

RUSSIAN THISTLE

SA3 DERM

SACCHAROMYCES CEREVISIAE

SAGEBRUSH

SALEX EXTERNAL SHAMPOO

salicylic acid er

salicylic acid external cream

salicylic acid external foam

salicylic acid external gel

salicylic acid external liquid 27.5 %

salicylic acid external lotion

salicylic acid external shampoo

salicylic acid external solution 26 %

salicylic acid wart remover

salicylic acid-cleanser

salimez

SALIMEZ FORTE

saline bacteriostatic

SALIVAMAX

salsalate oral

SALT DURABLE CREAM

SALT STABLE LS ADVANCED

SALTSTABLE LO

SALVAX

SALVAX DUO PLUS

SANADERMRX SKIN REPAIR

SANARE SCAR THERAPY

SCALACORT DK

SCARCARE GEL-PAD KIT/LARGE

SCARCIN EXTERNAL GEL

SCARCIN EXTERNAL LIQUID

SCARSILK EXTERNAL

SCARZEN SKIN REPAIR

SEBUDERM

SEDANARE

SELECT-OB

SELECT-OB+DHA

14

Drug Name

SELENIOUS ACID INTRAVENOUS

SELENIUM INTRAVENOUS

selenium sulfide external shampoo

SELRX

SERAQUA

SESAME SEED (DIAGNOSTIC)

SHAGBARK HICKORY

SHEEP SORREL

SHORT RAGWEED POLLEN EXT

SHRIMP (DIAGNOSTIC)

SILIPAC

SILPROTEX PLUS

SILTREX

silver nitrate external solution

sod citrate-citric acid

sodium acetate intravenous solution 4 meq/ml

sodium bicarbonate intravenous solution 4.2 %, 8.4 %

sodium chloride injection solution 0.9 %

sodium chloride intravenous solution 4 meq/ml

SODIUM CITRATE-GENTAMICIN SULF

sodium hyaluronate external gel

sodium phosphates intravenous solution 15 mmole/5ml, 45 mmole/15ml

sodium sulfacetamide external shampoo

sodium sulfacetamide wash liquid 10 % external

SODIUM SULFACETAMIDE WASH LIQUID 10 % EXTERNAL

SOLYDRA

SOOTHEE EXTERNAL PATCH 0.5-0.0375-5-2 %

SORREL/DOCK MIX

SOYBEAN (DIAGNOSTIC)

SPASCUPREEL INJECTION

SPEEDGEL RX

SPINY PIGWEED

SSKI

sss 10-5 external cream

SSS 10-5 EXTERNAL FOAM

Drug Name

STEMPHYLIUM

sterile water for injection injection

STRAWBERRY (DIAGNOSTIC)

STROVITE FORTE ORAL TABLET

STROVITE ONE

sulfacetamide sodium external gel

sulfacetamide sodium external liquid

sulfacetamide sodium-sulfur external cream

sulfacetamide sodium-sulfur external emulsion

sulfacetamide sodium-sulfur external liquid

sulfacetamide sodium-sulfur external lotion

sulfacetamide sodium-sulfur external pad 10-4 %

sulfacetamide sodium-sulfur external suspension

sulfacetamide sod-sulfur wash external kit

sulfacetamide-sulfur in urea external emulsion

sulfacleanse 8/4

sulfamez wash

SUMADAN

SUMADAN WASH

SUMADAN XLT

SUMAXIN

SUMAXIN CP

SUMAXIN WASH

sure result dss premium pack

SURE RESULT O3D3 SYSTEM

SUVICORT

SWEET CORN (DIAGNOSTIC)

SWEET GUM

SWEET VERNAL GRASS POLLEN

SX1 MEDICATED POST-OPERATIVE

SYMAX DUOTAB

symax-sl

symax-sr

SYNALAR (CREAM)

SYNALAR (OINTMENT)

SYNALAR TS

SYNERDERM

15

Drug Name

SYNVEXIA TC

TALL RAGWEED

taron-crystals

TECHNELITE

TESTONE CIK

TESTOSTERONE CYPIONATE & PROP

TESTOSTERONE CYPIONATE INJECTION

TESTOSTERONE CYPIONATE INTRAMUSCULAR SOLUTION 200 MG/ML

TESTOSTERONE ENANTHATE INJECTION

TESTOSTERONE IMPLANT PELLET 100 MG, 200 MG, 25 MG, 50 MG

TESTOSTERONE PROPIONATE INJECTION

tetracaine hcl injection

tetravisc

tetravisc forte

TETRIX EXTERNAL CREAM

TEXAVITE LQ

THERAHONEY EXTERNAL GEL

THRIVACIN 30

THRIVACIN DETOX

TIGHTENING BASE

TIMOLOL-BRIMON-DORZOL-LATANOPR

TIMOLOL-BRIMONIDINE-DORZOLAMID

TIMOLOL-DORZOLAMID-LATANOPROST

TIMOTHY GRASS POLLEN ALLERGEN

TOMATO (DIAGNOSTIC)

TOPIDEX

TORONOVA II SUIK

TORONOVA SUIK

TRACE ELEMENTS 4/PEDIATRIC

TRANZGEL

TRAUMEEL EXTERNAL OINTMENT

TRAUMEEL INJECTION

TRAUMEEL ORAL TABLET

TRIAMCINOLONE ACETONIDE INJECTION SUSPENSION 40 MG/ML, 50 MG/ML

TRIAMCINOLONE DIACETATE INJECTION SUSPENSION 40 MG/ML

Drug Name

TRIAMCINOLONE DIACETATE PF INJECTION SUSPENSION 80 MG/2ML

TRIAMCINOLONE-MOXIFLOXACIN

TRIAMSIL COMBIPAK EXTERNAL THERAPY PACK

TRIAMSIL MULTIPAK

TRI-CHLOR

TRICHOPHYTON SUBCUTANEOUS

tricitrates

TRILOAN II SUIK

TRILOAN SUIK

TRI-MIX

TRIMO-SAN VAGINAL GEL 0.025-0.01 %

TRINAZ

TROPICAMIDE-CYCLOPENTOLATE-PE

TROPICAMIDE-PHENYLEPHRINE

TROPIC-PROPARACA-PE-KETOROLAC

TRUSKIN

tryptophan oral

turpentine external

ULTRADERM

ULTRASAL-ER

umecta mousse

URAMAXIN EXTERNAL GEL

urea external cream 39 %, 40 %, 41 %, 45 %, 47 %

UREA EXTERNAL FOAM

urea external lotion 40 %

urea external suspension 40 %

urea hydrating

urea in zn undecyl-lactic acid

urea nail external gel 45 %

urea-c40

uredeb

urelle

uremez-40

URESOL

uribel

URIMAR-T

uro-458

16

Drug Name

UROGESIC-BLUE

uro-mp

uryl

ustell

uticap

utira-c

UTOPIC

VANISHING

VANISHING CREAM BOTANICAL BASE

VANISH-PEN

VANOXIDE-HC

VARIBAR HONEY

VARIBAR NECTAR

VARIBAR PUDDING

VARIBAR THIN HONEY

VARIBAR THIN LIQUID

VAROPHEN

VASCUDERM HYDROGEL

VENOMIL HONEY BEE VENOM

VENOMIL MIXED VESPID VENOM

VENOMIL WASP VENOM

VENOMIL WHITE FACED HORNET

VENOMIL YELLOW HORNET VENOM

VENOMIL YELLOW JACKET VENOM

VERSAPRO EXTERNAL CREAM

VEXASYN

vexatrol

vilamit mb

vilevev mb

VIRASAL

VIRGINIA LIVE OAK

VITAFOL ORAL TABLET

VITAFOL ULTRA

VITAFOL-NANO

vitafol-ob

VITAFOL-OB+DHA

VITAFOL-ONE

vitamin b-complex 100

VITAMIN DEFICIENCY SYSTEM-B12

Drug Name

VITA-RX DIABETIC VITAMIN

VIZAMYL

VOLUMEN

VP DERMABASE

VSL#3 DS

VYTONE

WASP VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300 MCG, 550 MCG

WASP VENOM PROTEIN SUBCUTANEOUS

WESTERN JUNIPER

wheat germ oil oral oil

WHITE ASH

WHITE BIRCH

WHITE FACED HORNET VENOM

WHITE MULBERRY

WHITE OAK

WHITE PINE

WHITE-FACED HORNET VENOM

WHOLE EGG (DIAGNOSTIC)

WPR PLUS WOUND HEALING SYSTEM

XALIX

XAQUIL XR

XEMATOP BASE

XERALUX

XEROSTOMIA RELIEF SPRAY

XOLEGEL COREPAK

XOLEGEL DUO/HEAD & SHOULDERS

XOLEGEL DUO/XOLEX

XRYLIX

YELLOW DOCK

YELLOW HORNET VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 550 MCG

YELLOW HORNET VENOM PROTEIN SUBCUTANEOUS

YELLOW JACKET VENOM PROTEIN INJECTION SOLUTION RECONSTITUTED 1300 MCG, 550 MCG

YELLOW JACKET VENOM PROTEIN SUBCUTANEOUS

17

Drug Name

YUTIQ

ZACARE

ZACLIR CLEANSING EXTERNAL LOTION 8 %

ZANABIN HYDROGEL

ZEEL INJECTION

ZELAC

ZENEVIX

zeruvia

ZILACAINE PATCH

ZINC SULFATE INTRAVENOUS

ZITHRANOL

ZOE SCRIPTS IDEALBASE

18

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OptumRx is a pharmacy care services company helping clients and more than 65 million members achieve better health outcomes and lower overall costs through innovative prescription drug benefit services, including network claims processing, clinical programs, formulary management and specialty pharmacy care. OptumRx is part of Optum®, a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. For more information, visit optum.com/optumrx.