unitedhealthcare & affiliated companies
TRANSCRIPT
2015 Prescription Drug List
UnitedHealthcare & Affiliated Companies
1
Table of Contents
2015 Prescription Drug List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Prescription Drug List Medication Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Tier Designations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Over-the-Counter and Therapeutically Equivalent Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Keys to Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Generic Medication Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Specialty Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Medications Requiring Notification and Other Pharmacy Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
How to Obtain Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Chapters
Anti-Infectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Antineoplastic & Immunosuppressant Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Autonomic & CNS Drugs, Neurology & Psych . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Cardiovascular, Hypertension & Lipids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Dermatologicals/Topical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Ear, Nose & Throat Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Endocrine/Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Gastroenterology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Immunology, Vaccines & Biotechnology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Musculoskeletal & Inflammatory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Obstetrics & Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Respiratory, Allergy, Cough & Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Urologicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Vitamins, Hematinics & Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Diagnostics & Miscellaneous Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Brand Only Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
November 2014
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IntroductionThe UnitedHealthcare Prescription Drug List (PDL)1 provides a list of medications in various therapeutic classes for use in meeting the prescription medication needs of your patients who are our members . This list is intended for use with UnitedHealthcare health plans and affiliated companies’ pharmacy benefit plan designs . The PDL applies only to prescription medications dispensed to outpatients and does not include inpatient medications or medications obtained or administered in a physician’s office . The PDL does not define benefit coverage . Benefit coverage is determined by the member’s pharmacy benefit plan .2 This means that there may be medications listed on the PDL that are not covered under a particular member’s pharmacy benefit plan .
You may also access PDL information by visiting our website at UnitedHealthcareOnline.com .
Prescription Drug List Medication OverviewTier decisions are made by our PDL Management Committee based on clinical, economic, and other factors . The PDL Management Committee is comprised of senior UnitedHealth Group physician and business leaders . The UnitedHealth Group National Pharmacy & Therapeutics (P&T) Committee, comprised of physicians and pharmacists, reviews new and existing medications and provides clinical guidance to the PDL Management Committee . Guidance is based on similarities and differences compared with other medications that treat the same disease or condition .
The Tier placement of a medication on the PDL may change . While medications change Tiers infrequently, such changes generally occur two times per calendar year . Additionally, when a brand-name medication becomes available as a generic, the Tier status of the brand-name medication and its corresponding generic will be evaluated . When a medication changes Tiers, your patient may be required to pay more or less for that medication . These changes may occur without prior notice to you or your patient . However, you may visit our website at UnitedHealthcareOnline.com for the most up-to-date information for a particular medication . And your patient can find the most up-to-date Tier status and cost* information for a particular medication by visiting our member website at myuhc .com® and/or calling the toll-free member phone number located on his or her health care ID card .
Tier DesignationsPrescription medications are categorized within three Tiers on the PDL .3 Each Tier is assigned a cost,* which is determined by the member’s pharmacy benefit plan . You may refer to the PDL as a guide to select the most appropriate medication with the lowest member cost for your patients .
Tier 1 Tier 1 medications are your patient’s lowest-cost option . Members can maximize their cost savings when you prescribe Tier 1 medications, if you decide they are appropriate for your patient’s treatment .
Tier 2 Tier 2 medications are your patient’s midrange-cost option . Consider Tier 2 medications if no Tier 1 medication is appropriate to treat your patient’s condition .
Tier 3 Tier 3 medications are your patient’s highest-cost option . If your patient is currently taking a medication in Tier 3, you may want to determine if there is an appropriate alternative in Tier 1 or Tier 2 .
You and your patient make decisions about health care and medication treatments .
Note: If the member has a “closed” pharmacy benefit (a two-Tier pharmacy benefit plan that does not cover medications classified in Tier 3 of this PDL), medications in Tier 3 are generally not covered, except under certain processes consistent with applicable law . Compounded medications, those medications containing one or more ingredients that are prepared onsite by a pharmacist, are classified at the Tier 3 level, provided that the individual ingredients used in compounding are covered under the pharmacy benefit .
Note: Some members have a four-Tier prescription plan and these are noted as T4 throughout the document . Members with a four-Tier prescription plan should refer to their enrollment materials, check the Medication Pricing / Coverage information on our member website or call the toll-free member phone number provided on their health care ID card for more information about their benefit plan .
Note: Not all medications are represented in this PDL . Only the most commonly prescribed medications are included .
2015 Prescription Drug List
* UnitedHealthcare operates a wide number of benefit programs and products, and some benefit programs may have alternative benefit designs . Physicians should always check the member’s specific benefit prior to prescribing medications .
Tier 1 Tier 2 Tier 3Your patient’s Your patient’s Your patient’slowest-cost midrange-cost highest-costmedications medications medications
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Over-the-Counter and Therapeutically Equivalent MedicationsFor some conditions, you and your patient may decide that an over-the-counter (OTC) medication is the most appropriate treatment . According to UnitedHealthcare benefit design, OTC medications are defined as medications that do not require a prescription by federal or state law to be dispensed . In some instances, OTC medications are listed on the PDL for reference purposes only . OTC medications may cost less than the member’s out-of-pocket expense for prescription medications .
Therapeutically equivalent means that medications can be expected to produce essentially the same therapeutic outcome and toxicity or adverse event .
If the patient or physician requests a therapeutically equivalent product or an OTC product, the patient may be required to pay the entire cost of the product as they may not be covered under the member’s pharmacy benefit . Please refer to the member’s pharmacy benefit plan .
Keys To Symbols
Generic Medication Policy While there are exceptions, generic medications are generally included on the PDL in Tier 1 . If a generic medication does not offer significant financial savings over the brand, it may be placed in the same Tier as the brand or in a higher Tier . Generic medications are noted in italics font .
Note that when a brand-name medication becomes available as a generic, that brand-name product may move to a higher Tier . Members may be required to pay more for a prescription when a higher-Tier brand-name product is dispensed . The member’s payment is determined by the pharmacy benefit plan . When generic substitution conflicts with state regulations or restrictions, the pharmacist must obtain approval from the prescribing physician or other health care professional to substitute the generic equivalent .
Specialty MedicationsSome members may have coverage for self-administered injectable and oral specialty medications through their pharmacy benefit plan . You will find these medications included in the body of this document within the appropriate therapeutic categories . UnitedHealthcare has developed a Specialty Pharmacy Program including requiring the majority of specialty medications be obtained through a designated specialty pharmacy . These medications are noted by DSP throughout the document . The specialty pharmacy program includes specialty pharmacies, each selected based on their clinical expertise for the targeted therapeutic classes, quality of services and cost . Their pharmacists are trained to help educate members and create personalized plans, if needed, for these specialty medications, which may help improve treatment adherence .
Participating members should be instructed to call the toll-free member number on the back of their ID card where a representative will answer questions about our program and then transfer them to a specialty pharmacy based on their particular specialty medication prescription .
* UnitedHealthcare operates a wide number of benefit programs and products, and some benefit programs may have alternative benefit designs . Physicians should always check the member’s specific benefit prior to prescribing medications .
Symbols
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copayN Notification or Prior Authorization required**RS May be eligible for the Refill and Save ProgramSDP Select Designated PharmacySL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
** Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit .
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Medications Requiring Notification and Other Pharmacy Programs Selected medications may require prior authorization and review to be eligible for coverage under the member’s pharmacy benefit plan . Such medications have a notation “N” in this booklet . Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit . The pharmacy benefit may exclude coverage of medications for certain uses .
The medications requiring prior authorization are noted throughout the document with an “N” notation and the clinical criteria are available on our website at UnitedHealthcareOnline.com . The criteria reflect UnitedHealth Group National Pharmacy and Therapeutics Committee decisions . For a member to receive benefit coverage for a medication requiring notification, the physician or the physician’s designee must provide information to the prior authorization department .
Some benefit plans may include our Step Therapy program . Step Therapy offers a “stepwise” approach to therapy for certain high-cost medications and requires that a member first try a more cost-effective medication before another high-cost medication . Such medications have a notation “ST” (for Step Therapy) .
Supply limits define the maximum supply of medication per copayment or period of time . Supply limits are based on several factors that may include FDA-approved dosing guidelines as defined in the product package insert, medical literature, guidelines or supportive data . Such medications have a notation “SL” (for supply limit) .
The Refill and Save Program (also known as Adherence Incentive) encourages members to adhere to their treatment regimen by rewarding them with a discount on their copayment/coinsurance for refilling their prescription within the defined time period . Eligible medications have an “RS” notation (RS for Refill and Save) .
To receive pharmacy benefit coverage on some medications, a member is required to fill their prescription through a designated Mail Order Pharmacy or stay at retail with a lower-Tier alternative . Such medications have an “SDP” notation in this booklet .
How to Obtain Authorization?The Online Prior Authorization tool (available through UnitedHealthCareOnline .com) is easy to use . The majority of online prior authorizations are approved in real time, and an auto-population feature provides 95 percent of a member’s information . The OptumRx Prior Authorization team is also available by phone at 800-711-4555 . Prior authorizations can also be submitted online by logging into www .optumrx .com > Healthcare Professionals > Prior Authorizations .
1 In certain documents the Prescription Drug List (PDL) was referred to as the “Preferred Drug List (PDL) .” This change in descriptive terms does not affect your patient’s benefit coverage .
2 Where differences are noted, the benefit plan documents will govern .
3 In certain documents Tier 1 was referred to as “generics;” Tier 2 was referred to as “preferred brands” or “brand-name” on the PDL; and Tier 3 was referred to as “non-preferred brands,” “not on the PDL,” or “brand-name not on the PDL .” These changes in descriptive terms do not affect your patient’s benefit coverage .
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Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Anti-Infectives
PenicillinsTier 1Amoxicillin Trihydrate Capsule,
Chewable Tablet, Suspension, Tablet (Amoxil)Amoxicillin Trihydrate/Potassium
Clavulanate (Augmentin Chewable Tablet, Tablet, Suspension)
Dicloxacillin Sodium Capsule (Dynapen)Penicillin V Potassium (Pen-V K)
Tier 3Amoxicillin Clavulanate ER Tablet,
Sustained-Release 12 Hour (Augmentin XR)*** E T4
TetracyclinesTier 1Doxycycline Hyclate Tablet 20 mg (Periostat)Doxycycline Monohydrate 50, 100 mg Capsule
(Monodox)Minocycline HCl Capsule (Minocin)
Tier 2Doxycycline Hyclate 50, 75, 100, 150 mg
(Morgidox, Vibra-Tabs, Vibramycin)**
Tier 3Adoxa E T4Doxycycline Hyclate Tablet, Enteric-Coated
(Doryx)*** E T4Doxycycline Monohydrate 75 mg Capsule
(Monodox)*** E T4Doxycycline Monohydrate Capsule
(Adoxa 150 mg)*** E T4Oracea T4Minocycline HCl Tablet (Dynacin)***Minocycline HCl Tablet, Extended-Release
24 Hour (Solodyn 45, 90, 135 mg)***Solodyn T4Tetracycline HCl (Achromycin V)***Vibramycin Suspension
CephalosporinsFIRST GENERATION CEPHALOSPORINS
Tier 1Cefadroxil Hydrate (Duricef)Cephalexin Monohydrate (Keflex)
SECOND GENERATION CEPHALOSPORINS
Tier 1Cefaclor (Ceclor, Ceclor CD)Cefpodoxime Tablet (Vantin)Cefprozil (Cefzil)Cefuroxime Axetil Suspension, Tablet (Ceftin)
Tier 3Ceftin Suspension
THIRD GENERATION CEPHALOSPORINS
Tier 1Cefditoren Pivoxil (Spectracef)
Tier 2Cefdinir (Omnicef)**
Tier 3CedaxSuprax Tablet, Capsule, Suspension T4
Erythromycins & Other MacrolidesTier 1Azithromycin (Zithromax)Clarithromycin Tablet (Biaxin)Erythromycin Base Capsule,
Delayed-Release (Eryc)Erythromycin Base Tablet, Enteric-Coated
250, 333 mg (E-Mycin, Ery-Tab)Erythromycin Ethylsuccinate (E .E .S .)Erythromycin Ethylsuccinate/Sulfisoxazole
Acetyl (Pediazole)
Tier 2Clarithromycin Suspension (Biaxin)**Clarithromycin Sustained-Release Tablet
(Biaxin XL)**
Tier 3PCE Zmax
8© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Anti-Infectives
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
QuinolonesTier 1Ciprofloxacin Tablet (Cipro)Levofloxacin (Levaquin Tablet, Solution)Ofloxacin (Floxin)
Tier 2Ciprofloxacin Oral Suspension
(Cipro Suspension)**
Tier 3Ciprofloxacin Tablet, Sustained-Release
24 Hour (Cipro XR)***FactiveMoxifloxacin Tablet (Avelox)***Noroxin
Sulfas & Related AgentsTier 1Sulfadiazine (Sulfadiazine)Sulfamethoxazole/Trimethoprim
(Bactrim, Bactrim DS, Septra, Septra DS)
Urinary Tract AgentsTier 1Methenamine Mandelate
(Methenamine Mandelate)Nitrofurantoin Macrocrystal
(Macrodantin 50, 100 mg)Nitrofurantoin Suspension, Oral (Furadantin)Nitrofurantoin/Nitrofurantoin Macrocrystal
(Macrobid)Trimethoprim (Proloprim)
Tier 2Macrodantin 25 mg
Tier 3MonurolPrimsol
AntiviralsMISCELLANEOUS ANTIVIRALS
Tier 1Acyclovir (Zovirax)Adefovir (Hepsera) DSPAmantadine HCl (Symmetrel)Ganciclovir (Cytovene) Lamivudine (Epivir HBV) DSPRibavirin (Copegus) DSPRibavirin (Rebetol Capsules) DSPRimantadine HCl Tablet (Flumadine)
Tier 2Entecavir (Baraclude)** DSPFamciclovir (Famvir)** SLOlysio DSP N SLRebetol Solution DSPValacyclovir HCl (Valtrex)** SLValcyte SL
Tier 3Relenza SL Ribapak*** DSP E T4 Tamiflu SL Tyzeka DSP
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Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Anti-Infectives
HIV/AIDS THERAPY
Tier 1Abacavir Sulfate Tablet (Ziagen) DSPAbacavir/Lamivudine/Zidovudine (Trizivir) DSPDidanosine Capsule, Enteric-Coated (Videx EC) DSPLamivudine Tablet (Epivir)Nevirapine (Viramune) DSPStavudine (Zerit) DSPZidovudine (Retrovir) DSPZidovudine/Lamivudine (Combivir) DSP
Tier 2Aptivus DSPAtripla DSPComplera DSPCrixivan DSPEmtriva DSPEdurant DSPEpivir DSPEpzicom DSPFuzeon DSPIntelence DSPInvirase DSPIsentress DSPKaletra DSPLexiva DSPNevirapine Extended-Release (Viramune XR) DSP Norvir DSPPrezista DSPRescriptor DSPReyataz DSPSelzentry DSP NSustiva DSPTruvada DSP NViracept DSPViread DSPZiagen DSP
Tier 3Stribild DSP N
Antifungal AgentsTier 1Clotrimazole Troche (Mycelex)Fluconazole (Diflucan)Flucytosine (Ancobon)Griseofulvin Microsize (Grifulvin V)Griseofulvin Ultramicrosize (Gris-Peg)Itraconazole Capsule (Sporanox Capsule) SLKetoconazole (Nizoral)Nystatin (Mycostatin)Terbinafine HCl Tablet (Lamisil) SLVoriconazole (Vfend) SL
Tier 2Noxafil SuspensionSporanox Solution, Oral
Tier 3Lamisil Granules SLOnmel E SL T4
VancomycinTier 1Vancomycin HCl (Vancocin HCl) SL
Miscellaneous Anti-infectivesTier 1Clindamycin HCl (Cleocin HCl 150, 300 mg)Neomycin Sulfate (Neomycin Sulfate)
Tier 2Bethkis** DSP N SLCayston N SLCleocin HCl 75 mgClindamycin Palmitate HCl (Cleocin Palmitate)**DapsoneZyvox SL
Tier 3Dificid SL KetekTobi Podhaler DSP N SLTobramycin Nebulized Solution (Tobi)*** DSP E N
SL T4Xifaxan N SL
10© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Anti-Infectives
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
ANTIPARASITICS
Tier 1Atovaquone (Mepron)Metronidazole (Flagyl)Paromomycin Sulfate (Humatin)
Tier 2AlbenzaAlinia SLBiltricide NebuPent Stromectol
Tier 3Flagyl ER TabletTinidazole (Tindamax)***
ANTIMALARIALS
Tier 1Chloroquine Phosphate (Aralen Phosphate)Hydroxychloroquine Sulfate (Plaquenil)Mefloquine HCl (Lariam)Quinine Sulfate (Qualaquin) SL
Tier 2Atovaquone/Proguanil HCl (Malarone)**CoartemDaraprimPrimaquine
ANTIMYCOBACTERIALS
Tier 1Ethambutol HCl (Myambutol)Isoniazid (Isoniazid)Pyrazinamide (Pyrazinamide)Rifampin (Rifadin)Rifampin/Isoniazid (Rifamate)
Tier 2PriftinRifaterSituro N
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Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Antineoplastic & Immunosuppressant Drugs
Antineoplastic & Immunosuppressant DrugsALKYLATING AGENTS
Tier 1Cyclophosphamide (Cytoxan)Temozolamide (Temodar) DSP N
Tier 2AlkeranLeukeranMyleran
ANTIMETABOLITES
Tier 1Capecitabine (Xeloda) DSP SLMercaptopurine (Purinethol)Methotrexate Sodium (Methotrexate)
Tier 2Rheumatrex, Trexall
ANDROGENS, ESTROGENS, HORMONES & RELATED DRUGS
ANDROGENS
Tier 2Oxandrolone (Oxandrin)**
HORMONES
Tier 1Megestrol Acetate (Megace)
Tier 3Megestrol Acetate Suspension (Megace ES)***
ANTIESTROGENS
Tier 1Anastrozole (Arimidex)Letrozole (Femara)Tamoxifen (Nolvadex)
Tier 2Exemestane (Aromasin)**Fareston
ANTIANDROGENS
Tier 1Bicalutamide (Casodex)Flutamide (Eulexin)
Tier 2Nilandron
IMMUNOSUPPRESSANT DRUGS
Tier 1Azathioprine (Imuran)Cyclosporine, Modified (Gengraf) DSPMycophenolate Mofetil Capsule, Tablet
(CellCept) DSPSirolimus (Rapamune) DSPTacrolimus Anhydrous (Prograf) DSP
Tier 2CellCept DSPMycophenolic Acid (Myfortic)** DSP
Tier 3Astagraf XL DSP E T4AzasanNeoral DSP T4Sandimmune DSP T4
MISCELLANEOUS ANTINEOPLASTIC DRUGS
Tier 1Etoposide (VePesid)Hydroxyurea (Hydrea)Leuprolide Acetate (Lupron 1 mg/0 .2 ml) NOctreotide Acetate (Sandostatin) DSP N
Tier 2Afinitor DSP N SLBosulif DSP N SL STCaprelsa DSP N SLCometriq DSP N SLDroxiaEmcytErivedge DSP N SLGleevec DSP N SLHexalenHycamtin DSP N SLJakafi DSP N SLLysodrenMatulane Mekinist DSP N SLNexavar DSP N SLRevlimid DSP N SLStivarga DSP N SLSutent DSP N SLSylatron DSP N SLTafinlar DSP N SLTarceva DSP N SLTasigna DSP N SLThalomid DSP N SLTretinoin (Vesanoid)** DSP SLTykerb DSP N SLVotrient DSP N SLXalkori DSP N SLZelboraf DSP N SLZolinza DSP SLZytiga DSP N SL
12© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Antineoplastic & Immunosuppressant Drugs
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Tier 3Pomalyst DSP N SLSomatuline Depot DSP N T4Sprycel DSP N SL STXtandi DSP N SL STZykadia N SL
Adjunctive AgentsTier 1Leucovorin Calcium
(Leucovorin Calcium 5, 25 mg)
Tier 2Leucovorin Calcium 10, 15 mg
(Leucovorin Calcium)Leukine DSPNeupogen DSP
13
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
Narcotic AnalgesicsNARCOTICS
Tier 1Codeine Sulfate (Codeine Sulfate) Hydromorphone HCl (Dilaudid)Levorphanol Tartrate (Levo-Dromoran)Methadone HCl (Dolophine HCl)Meperidine HCl (Demerol)Morphine Sulfate Solution, Oral
(MSIR 20 mg/ml, Roxanol)Morphine Sulfate Tablet, Sustained-Action
(MS Contin) SLOxycodone HCl (Roxicodone, OxyIR)Oxycodone HCl Concentrate, Oral (OxyFAST)
Tier 2Fentanyl Citrate Lollipop (Actiq)** N SL Fentanyl Transdermal (Duragesic)** SLOpana ER N SLOxyContin N SLOxymorphone Tablet (Opana)** SL
Tier 3Abstral E N SL T4Butrans SL ST T4Exalgo N SL T4Fentora E N SL T4Hydromorphone Extended-Release Tablet
(Exalgo)*** N SLLazanda N SL Morphine Sulfate Capsule, Extended-Release
(Avinza)*** N SL T4Morphine Sulfate Capsule, Extended-Release
Pellets (Kadian)*** E N SL T4Oxymorphone HCl Tablet,
Sustained-Release 12 Hour (Opana ER)*** N SLSubsys N SLZohydro ER N SL T4
COMBINATION NARCOTIC /ANALGESICS
Tier 1Acetaminophen/Caffeine/Butalbital
325-50-40 mg (Fioricet) SLAcetaminophen/Caffeine/Butalbital/Codeine
325-50-40-30 mg SL Aspirin/Caffeine/Butalbital (Fiorinal)Aspirin/Caffeine/Dihydrocodone
(Synalgos-DC) Codeine Phosphate/Acetaminophen
(Tylenol w/Codeine) SLCodeine Phosphate/Aspirin/Caffeine/
Butalbital (Fiorinal w/Codeine 30 mg)Hydrocodone Bit/Acetaminophen (Norco) SLIbuprofen/Hydrocodone (Vicoprofen)Oxycodone HCl/Acetaminophen Tablet
(Percocet) SLOxycodone HCl/Ibuprofen (Combunox)Oxycodone/Aspirin (Percodan)
Tier 2Hydrocodone Bit/Acetaminophen
Solution, Oral (Hycet)** SL
Tier 3Codeine Phosphate/Acetaminophen/
Caffeine/Butalbital 50-300-40-30 mg (Fioricet w/Codeine)*** E T4
Hydrocodone/Acetaminophen (Xodol, Vicodin, Vicodin ES, Vicodin HP)*** E SL T4
14© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Non-Narcotic AnalgesicsMISCELLANEOUS ANALGESICS
Tier 1Pentazocine HCl/Naloxone HCl (Talwin NX)Tramadol HCl (Ultram)Tramadol HCl/Acetaminophen (Ultracet) SL
Tier 2Butorphanol Tartrate Aerosol, Spray (Stadol)** SLTramadol HCl Tablet, Sustained-Release
24 Hour (Ultram ER)** SL
Tier 3Conzip E SL T4Nucynta SL T4Nucynta ER N SL T4Tramadol HCl Tablet, Extended-Release
Multiphase 24 Hour (Ryzolt)*** E SL T4
NARCOTIC ANTAGONISTS/OPIOID DEPENDENCE
Tier 1Buphrenorphine Hydrochloride (Subutex) N SLNaltrexone HCl (ReVia)
Tier 2Zubsolv** N SL
Tier 3Buphrenorphine HCl/Naloxone HCl Tablet,
Sublingual (Suboxone)** E N SL T4Suboxone Film E N SL T4
Migraine & Cluster Headache TherapyTier 1Dihydroergotamine Mesylate (D .H .E .45)Dihydroergotamine Mesylate Aerosol,
Spray with Pump (Migranal)Isometheptene Mucate/Acetaminophen/
Dichloralphenazone (Midrin)Naratriptan HCl (Amerge) SLSumatriptan Succinate Injection
(Imitrex Injection) SLSumatriptan Succinate Tablet (Imitrex Tablet) SL
Tier 2ErgomarRelpax SLRizatriptan Benzoate Tablet (Maxalt)** SLSumatriptan Succinate Nasal Spray
(Imitrex Nasal Spray)** SL
Tier 3Alsuma E SL T4Axert SDP SL CafergotFrova SDP SL Rizatriptan Benzoate Tablet, Disintegrating
(Maxalt MLT)*** SLSumavel Dosepro SLTreximet E SL T4Zolmitriptan (Zomig)*** SLZolmitriptan Orally Disintegrating Tablet
(Zomig-ZMT)*** SLZomig Nasal Spray SL
15
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
Antiparkinsonism AgentsTier 1Amantadine HCl (Symmetrel)Benztropine Mesylate (Cogentin)Bromocriptine Mesylate (Parlodel)Carbidopa/Levodopa (Sinemet)Carbidopa/Levodopa/Entacapone (Stalevo)Carbidopa/Levodopa Tablet, Rapid Dissolve (Parcopa)Carbidopa/Levodopa Tablet, Sustained-Action
(Sinemet CR)Entacapone (Comtan)Pramipexole Di-HCl (Mirapex)Ropinirole HCl (Requip)Selegiline HCl (Eldepryl)Trihexyphenidyl HCl (Artane)
Tier 2Apokyn DSPTasmar
Tier 3AzilectMirapex ER E T4Ropinirole HCl Tablet, Extended-Release
24 Hour (Requip XL)*** E T4Zelapar
AnticonvulsantsTier 1Carbamazepine (Tegretol)Clonazepam (Klonopin)Diazepam, Rectal (Diastat Acudial) SLDivalproex Sodium Tablet (Depakote)Divalproex Sodium Tablet, Sustained-Release
(Depakote ER)Ethosuximide (Zarontin)Felbamate (Felbatol)Gabapentin (Neurontin)Lamotrigine 5, 25 mg Chewable Tablet
(Lamictal Chewable)Lamotrigine Tablet (Lamictal)Levetiracetam (Keppra)Oxcarbazepine (Trileptal)Phenobarbital (Phenobarbital)Phenytoin (Dilantin)Phenytoin Sodium Extended-Release
(Dilantin, Phenytek)Primidone (Mysoline)Tiagabine HCl (Gabitril)Topiramate Capsule, Sprinkle (Topamax)Topiramate Tablet (Topamax)Valproic Acid (Depakene)Zonisamide (Zonegran)
Tier 2Carbamazepine Tablet, Sustained-Release
12 Hour (Tegretol XR)**CelontinDilantinDivalproex Sodium (Depakote Sprinkle)**Levetiracetam Tablet, Extended-Release
24 Hour (Keppra XR)**MysolinePeganoneSabrilTegretol
16© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Tier 3Banzel NCarbamazepine Capsule, Extended-Release
Multiphase 12 Hour (Carbatrol)***Depakote N ST T4Depakote ER N ST T4Equetro Fycompa NKeppra N ST T4Keppra XR N ST T4Lamictal N ST T4Lamictal Dose Pack N STLamictal ODT N ST T4Lamictal XR N ST T4 Lamotrigine Orally Disintegrating Tablet
(Lamictal ODT)*** STLamotrigine Tablet, Extended-Release 24 Hour
(Lamictal XR)*** STLyrica SDP SL T4 Neurontin N ST T4Onfi N Oxtellar XR E N ST T4Potiga N Stavzor N ST Topamax N ST T4Trileptal N ST T4Trokendi XR E N ST T4Vimpat NZonegran N ST T4
Miscellaneous Neurological TherapyTier 1Donepezil HCl Tablet (Aricept)Galantamine Capsule 24 Hour
Sustained-Release Pellets (Razadyne ER)Galantamine Tablet, Solution (Razadyne)Nimodipine (Nimotop)Rivastigmine Tartrate Capsule (Exelon)
Tier 2Donepezil HCl Tablet, Rapid Dissolve
(Aricept ODT)**MytelaseNuedexta
Tier 3Donepezil 23 mg (Aricept 23 mg)*** E T4Exelon SolutionGralise E SL T4Horizant E SL T4Namenda XR T4Savella SL T4
Muscle Relaxants & Antispasmodic TherapyMYASTHENIA GRAVIS
Tier 1Pyridostigmine Bromide Tablet (Mestinon 60 mg)
Tier 2MestinonProstigmin
Multiple SclerosisTier 2Ampyra DSP N SLAvonex DSP N SLBetaseron DSP N SLCopaxone DSP N SLTecfidera DSP N SL
Tier 3Aubagio DSP N SL
ST T4Extavia DSP E N SL
ST T4Gilenya DSP N SL STRebif DSP N SL
ST T4
17
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
Psychotherapeutic DrugsHYPNOTIC AGENTS
Tier 1Chloral Hydrate (Chloral Hydrate)Flurazepam HCl (Dalmane)Temazepam (Restoril)Triazolam (Halcion)Zaleplon (Sonata) SLZolpidem Tartrate (Ambien) SL
Tier 3Edluar E SL ST T4Eszopiclone (Lunesta)*** SL ST Intermezzo E SL ST T4Rozerem SL ST Sonata SL ST Silenor E SL T4Zolpidem Tartrate Tablet, Multiphasic-Release
(Ambien CR)*** E SL ST T4Zolpimist SL ST T4
ANTIDEPRESSANT AGENTS
TRICYCLICS
Tier 1Amitriptyline HCl (Elavil)Amoxapine (Asendin 50, 100 mg)Clomipramine HCl (Anafranil)Desipramine HCl (Norpramin)Doxepin HCl (Sinequan)Imipramine Pamoate (Tofranil-PM)Nortriptyline HCl (Pamelor)Protriptyline HCl (Vivactil)
MISCELLANEOUS ANTIDEPRESSANTS
Tier 1Bupropion HCl (Wellbutrin)Bupropion HCl Tablet, Sustained-Action
(Wellbutrin SR)Bupropion HCl Tablet, Sustained-Release
24 Hour (Wellbutrin XL)Maprotiline HCl (Ludiomil)Mirtazapine (Remeron)Mirtazapine Dispersible Tablet
(Remeron SolTab)Nefazodone HCl (Serzone)Trazodone HCl (Desyrel)Venlafaxine HCl Capsule, Sustained-Release
24 Hour (Effexor XR)
Tier 3Aplenzin E SL T4 Desvenlafaxine E SL T4Duloxetine (Cymbalta)*** SLForfivo XL E SL T4Khedezla E SL T4Oleptro ER E SL T4 Pristiq RS SL Venlafaxine HCl Tablet, Extended-Release
24 Hour (Venlafaxine HCl ER)*** E SL T4Viibryd SL T4
MAO INHIBITORS
Tier 1Phenelzine Sulfate (Nardil)Tranylcypromine Sulfate (Parnate)
Tier 3EmsamMarplan
18© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
Tier 1Citalopram Hydrobromide (Celexa)Escitalopram Tablet (Lexapro)Fluoxetine Capsule, Delayed-Release
(Prozac Weekly) SLFluoxetine HCl Capsule (Prozac)Fluoxetine HCl Tablet (Sarafem)Fluvoxamine Maleate (Luvox)Paroxetine HCl Tablet (Paxil)Sertraline HCl (Zoloft)
Tier 3Escitalopram Solution, Oral (Lexapro)***Fluvoxamine Maleate Capsule, Extended-Release
24 Hour (Luvox CR)*** SLParoxetine HCl Sustained-Release, 24 Hour
(Paxil CR)*** SLPexeva E SL T4
ANTIPSYCHOTICS
PHENOTHIAZINES
Tier 1Chlorpromazine HCl Tablet (Thorazine 200 mg)Fluphenazine HCl (Prolixin)Perphenazine (Trilafon)Thioridazine HCl (Mellaril)Trifluoperazine HCl (Stelazine)
BUTYROPHENONES
Tier 1Haloperidol (Haldol)Haloperidol Lactate Concentrate, Oral (Haldol)
MISCELLANEOUS ANTIPSYCHOTICS
Tier 1Clozapine (Clozaril)Clozapine Orally Disintegrating Tablet
(FazaClo)Olanzapine Tablet (Zyprexa) SLRisperidone Tablet, Rapid Dissolve
(Risperdal M-Tab)Risperidone Solution (Risperdal)Risperidone Tablet (Risperdal)Thiothixene (Navane)
Tier 2Olanzapine/Fluoxetine (Symbyax)** SLQuetiapine Fumarate (Seroquel)** SLZiprasidone (Geodon)** SL
Tier 3Abilify SL T4Fanapt SL T4Invega SL T4Latuda SL T4Olanzapine Tablet, Rapid Dissolve
(Zyprexa Zydis)*** SLSaphris SL T4Seroquel XR SL T4
19
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Autonomic & CNS Drugs, Neurology & Psych
MISCELLANEOUS PSYCHOTHERAPEUTIC AGENTS
Tier 1Amphetamine Aspartate/Amphetamine
Sulfate/Dextroamphetamine (Adderall) NLithium Carbonate (Eskalith)Lithium Carbonate, Sustained-Action
(Eskalith CR)Lithium Carbonate Tablet, Sustained-Action
(Lithobid)Methamphetamine HCl (Desoxyn) NMethylphenidate HCl
(Methylin Solution, Oral) NMethylphenidate HCl
(Ritalin, Ritalin SR) NMethylphenidate HCl Tablet, Sustained-Action
(Metadate ER) N
Tier 2Adderall XR** N SLConcerta** N SLMetadate CD** N SLVyvanse N SL
Tier 3Amphetamine Aspartate/Amphetamine
Sulfate/Dextroamphetamine Capsule, Sustained-Release 24 Hour (Adderall XR) E N SL T4
Clonidine Extended-Release (Kapvay)*** E T4D-Amphetamine Capsule, Extended-Release
(Dexedrine)*** ND-Amphetamine Sulfate Tablet, Capsule,
(Dexedrine)*** NDaytrana E N SL T4Dexmethylphenidate Extended-Release
(Focalin XR)*** E N SL T4Intuniv E SL T4Methylin Tablet, Chewable NMethylphenidate HCl Capsule,
Extended-Release Multiphase (Ritalin LA)*** E N SL T4
Methylphenidate HCl Capsule, Extended-Release Multiphase 30-70 (Metadate CD) E N SL T4
Methylphenidate HCl Tablet, Extended-Release 24 Hour (Concerta) E N SL T4
Modafinil (Provigil)*** E N SL T4Nuvigil N SL T4Quillivant XR E N SL T4Strattera SL T4Xyrem N SL T4Zenzedi E N T4
ANXIOLYTICS
Tier 1Alprazolam (Xanax)Alprazolam Tablet, Rapid Dissolve (Niravam)Alprazolam Tablet, Sustained-Release
24 Hour (Xanax XR)Buspirone HCl (Buspar)Chlordiazepoxide HCl (Librium)Diazepam (Valium)Lorazepam (Ativan)Oxazepam (Serax)
20© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Cardiovascular, Hypertension & Lipids
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Antiarrhythmic AgentsTier 1Amiodarone HCl (Cordarone)2
Disopyramide Phosphate Capsule (Norpace)Flecainide Acetate (Tambocor)2
Mexiletine HCl (Mexitil)Propafenone HCl (Rythmol)Quinidine Gluconate (Quinidine Gluconate)Quinidine Sulfate (Quinidine Sulfate)Quinidine Sulfate Tablet, Sustained-Action
(Quinidex)Sotalol HCl (Betapace, Betapace AF)
Tier 2MultaqNorpace CRTikosyn1, 2
Tier 3Propafenone Capsule, Sustained-Release
12 Hour (Rythmol SR)***1 This drug is only available to hospitals and prescribers who have received appropriate
education in the initiation and dosing of Tikosyn .
2 Cardiologist consultation suggested .
Cardiac GlycosidesTier 1Digoxin (Lanoxin)
Tier 2Lanoxin (Digoxin)
NitratesRAPID ACTING NITRATES
Tier 2Nitrostat (Nitroglycerin)Tier 3Nitroglycerin Spray (Nitromist)*** SL Nitroglycerin Spray, Non-Aerosol
(Nitrolingual)*** E SL T4
LONG ACTING NITRATES
Tier 1Isosorbide Dinitrate Tablet
(Isordil 5, 10, 20, 30 mg)Isosorbide Dinitrate Tablet, Sublingual
(Isordil 2 .5, 5 mg)Isosorbide Mononitrate (ISMO)Isosorbide Mononitrate Tablet,
Sustained-Release 24 Hour (Imdur)Nitroglycerin Capsule, Sustained-Action
(Nitro-Bid)Nitroglycerin Patch, Transdermal 24 Hour
(Transderm-Nitro)
Tier 2Isordil 40 mg
Tier 3Dilatrate-SRNitro-Dur
Coagulation TherapyANTICOAGULANTS
Tier 1Warfarin Sodium (Coumadin)
Tier 2CoumadinPradaxa SLXarelto SL
Tier 3Eliquis SL T4
ANTIPLATELET DRUGS
Tier 1Cilostazol (Pletal)Clopidogrel Bisulfate (Plavix)Dipyridamole (Persantine)Ticlopidine HCl (Ticlid)
Tier 3AggrenoxBrilinta N SL T4Effient SL T4
HEPARIN
Tier 1Heparin Sodium (Heparin)
Tier 2Fondaparinux Sodium (Arixtra)** SLEnoxaparin (Lovenox)** SL
Tier 3Fragmin SL T4
21
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Cardiovascular, Hypertension & Lipids
VITAMIN K
Tier 2Mephyton (Phytonadione)
HEMOSTATICS
Tier 1Aminocaproic Acid Solution (Amicar)Aminocaproic Acid Tablet (Amicar 500 mg)
Tier 2Aminocaproic Acid Tablet 1000 mg
(Aminocaproic Acid)Tier 3Promacta DSP N T4
MISCELLANEOUS COAGULATION AGENTS
Tier 2Advate DSPAlphanate vonWillebrand DSPAlphanine SD DSPBebulin DSPBeneFix DSPFeiba DSPHelixate FS DSPHemofil-M DSPHumate-P DSPKoate-DVI DSPKogenate FS DSPMonoclate-P DSPMononine DSPNovoseven DSPProfilnine SD DSPRecombinate DSPXyntha DSP
Antihypertensive TherapyTHIAZIDE & RELATED DIURETICS
Tier 1Amiloride HCl (Midamor)Amiloride HCl/Hydrochlorothiazide (Moduretic)Bumetanide (Bumex)Chlorothiazide Tablet (Diuril)Furosemide (Lasix)Hydrochlorothiazide (HydroDIURIL, Microzide)Metolazone (Zaroxolyn)Spironolactone (Aldactone)Spironolactone/Hydrochlorothiazide
(Aldactazide 25-25 mg)Triamterene/Hydrochlorothiazide
(Dyazide, Maxzide)
Tier 2Aldactazide 50-50 mgDiuril 250 mg/5 mlEplerenone (Inspra)**
Tier 3Dyrenium Edecrin
BETA BLOCKERS
Tier 1Acebutolol HCl (Sectral)Atenolol (Tenormin)Betaxolol HCl (Kerlone)Carvedilol (Coreg)Labetalol HCl (Normodyne)Metoprolol Succinate Tablet, Sustained-Release
24 Hour (Toprol XL 25 mg)Metoprolol Tartrate (Lopressor)Nadolol (Corgard)Pindolol (Visken)Propranolol HCl Tablet (Inderal)
Tier 2BystolicMetoprolol Succinate Tablet, Sustained-Release
24 Hour (Toprol XL 50, 100, 200 mg)**Propranolol HCl Sustained-Action Capsule
(Inderal LA)**
Tier 3Coreg CR E SL T4Innopran XLLevatol
22© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Cardiovascular, Hypertension & Lipids
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
CALCIUM CHANNEL BLOCKERS
CALCIUM CHANNEL BLOCKERS/NON-DIHYDROPYRIDINES
Tier 1Diltiazem HCl (Cardizem)Diltiazem HCl Capsule, Controlled-Release
(Dilacor XR)Diltiazem HCl Capsule, Sustained-Release
12 Hour (Cardizem SR)Verapamil HCl (Calan)Verapamil HCl (Verelan)Verapamil HCl Tablet, Sustained-Action
(Calan SR)
Tier 2Cardizem LA 120 mgDiltiazem HCl Capsule, Sustained-Action
(Tiazac)**Diltiazem HCl Capsule, Sustained-Release
24 Hour (Cardizem CD)**Diltiazem HCl Tablet, Sustained-Release 24 Hour
(Cardizem LA 180, 240, 300, 360, 420 mg)**
Tier 3Verapamil HCl Capsule, 24 Hour
Sustained-Release Pellets (Verelan PM)***
CALCIUM CHANNEL BLOCKERS/DIHYDROPYRIDINES
Tier 1Amlodipine Besylate (Norvasc)Felodipine (Plendil)Nicardipine HCl (Cardene)Nifedipine (Procardia)Nifedipine Tablet, Osmotic Laser-Drilled Formulation
(Procardia XL)
Tier 2Nisoldipine (Sular)**
Tier 3Cardene SR
ACE INHIBITORS
Tier 1Benazepril HCl (Lotensin)Enalapril Maleate (Vasotec)Lisinopril (Prinivil, Zestril)Moexipril HCl (Univasc) Ramipril (Altace)Trandolapril (Mavik)
Tier 2Perindopril (Aceon)**
Tier 3Epaned N
ADRENERGIC ANTAGONISTS & RELATED DRUGS
Tier 1Clonidine HCl (Catapres)Doxazosin Mesylate (Cardura)Guanfacine HCl (Tenex)Prazosin HCl (Minipress)Terazosin HCl (Hytrin)
Tier 3Cardura XLClonidine Patch, Transdermal Weekly
(Catapres-TTS)***Nexiclon XR E T4
AGENTS FOR PHEOCHROMOCYTOMA
Tier 2Dibenzyline
VASODILATORS
Tier 1Hydralazine HCl (Apresoline)
Tier 2BiDil
23
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Cardiovascular, Hypertension & Lipids
OTHER ANTIHYPERTENSIVE COMBINATIONS
Tier 1Benazepril/Hydrochlorothiazide (Lotensin HCT)Bisoprolol Fumarate/Hydrochlorothiazide (Ziac)Captopril/Hydrochlorothiazide (Capozide)Enalapril Maleate/Hydrochlorothiazide
(Vaseretic)Lisinopril/Hydrochlorothiazide
(Prinzide, Zestoretic)Losartan Potassium/Hydrochlorothiazide
(Hyzaar)Metoprolol/Hydrochlorothiazide
(Lopressor HCT)Nadolol/Bendroflumethiazide (Corzide)Propranolol HCl/Hydrochlorothiazide (Inderide)
Tier 2Amlodipine/Benazepril (Lotrel)** SLBenicar HCT SLClorpresDutoprol SLIrbesartan/Hydrochlorothiazide (Avalide)** SLQuinapril HCl/Hydrochlorothiazide
(Accuretic)**Telmisartan/Hydrochlorothiazide
(Micardis HCT)** SL Valsartan/Hydrochlorothiazide (Diovan HCT)** SL
Tier 3Amlodipine/Telmisartan (Twysta)*** E SL T4Amlodpine/Valsartan (Exforge)*** E SL T4Amturnide E SL T4Azor E SL T4Candesartan/Hydrochlorothiazide
(Atacand HCT)*** SLEdarbyclor SLExforge HCT E SL T4Tekamlo E SL T4Tekturna HCT SDP SLTeveten HCT SLTrandolapril/Verapamil (Tarka)***Tribenzor E SL T4
ANGIOTENSIN II RECEPTOR BLOCKERS AND RENIN INHIBITOR
Tier 1Eprosartan Hydrochloride (Teveten) SLLosartan Potassium (Cozaar)
Tier 2Benicar SLIrbesartan (Avapro)** SLTelmisartan (Micardis)** SL
Tier 3Candesartan (Atacand) SL Diovan*** SLEdarbi SLTekturna SDP SLValsartan (Diovan)*** SL
24© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Cardiovascular, Hypertension & Lipids
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Lipid/Cholesterol Lowering AgentsTier 1Atorvastatin Calcium (Lipitor) SLCholestyramine/Aspartame (Questran Light)Cholestyramine/Sucrose (Questran)Colestipol HCl (Colestid)Fluvastatin Sodium (Lescol) SLGemfibrozil (Lopid)Lovastatin (Mevacor)Pravastatin (Pravachol) Simvastatin (Zocor)
Tier 2Crestor SLFenofibrate 54, 160 mg (Lofibra)**NiaspanWelchol
Tier 3Advicor SLAltoprev E SL T4Amlodipine/Atorvastatin (Caduet)*** E SL T4Antara E T4Choline Fenofibrate (Trilipix)*** E T4 Fenofibrate 50, 150 mg (Lipofen)*** E T4Fenofibrate 67, 134, 200 mg (Lofibra)*** E T4Fenofibrate Micronized 43, 130 mg (Antara)*** E T4Fenofibrate Nanocrystallized 48, 145 mg
(Tricor)*** E T4Fenofibric Acid (Fibricor)*** E T4Fenoglide E T4Juxtapid DSP N SL T4Kynamro DSP N SL T4Lescol XL SLLiptruzet E SL T4Livalo SL T4Niacin Extended-Release (Niaspan)*** T4Omega-3-Acid Ethyl Esters (Lovaza)*** N Simcor SL T4Triglide E T4Vascepa N T4Vytorin SL T4Zetia SL T4
Miscellaneous Cardiovascular AgentsTier 2Ranexa
25
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Dermatologicals/Topical Therapy
Topical CorticosteroidsTOPICAL CORTICOSTEROIDS VERY HIGH POTENCY
Tier 1Clobetasol Propionate Cream (Temovate E)Clobetasol Propionate Cream, Gel, Ointment,
Solution (Temovate)
Tier 3Betamethasone Dipropionate/Propylene
Glycol Lotion, Ointment (Diprolene)***Clobetasol Propionate Foam (Olux)*** E SL T4Clobetasol Propionate Foam (Olux-E)*** E SL T4Clobetasol Propionate Lotion (Clobex)*** E SL T4Clobetasol Propionate Shampoo (Clobex)*** E SL T4Diflorasone Diacetate Ointment
(Psorcon, Apexicon, Florone)***Halobetasol Propionate Cream, Ointment
(Ultravate)*** SL
TOPICAL CORTICOSTEROIDS HIGH POTENCY
Tier 1Amcinonide Ointment (Cyclocort) Betamethasone Dipropionate Lotion
(Diprosone, Maxivate)Betamethasone Dipropionate/Propylene
Glycol Gel (Diprolene)Betamethasone DP Augmented Cream
(Diprolene AF Cream)Betamethasone Valerate Ointment (Valisone)Desoximetasone Cream (Topicort) SLFluocinonide Cream, Gel, Ointment,
Solution, Non-Oral (Lidex)Triamcinolone Acetonide Cream
(Aristocort, Kenalog)Triamcinolone Acetonide Ointment
(Aristocort HP)
Tier 2Betamethasone Dipropionate Cream, Ointment
(Diprosone, Maxivate)**
Tier 3Amcinonide Cream, Lotion (Cyclocort)***Betamethasone Dipropionate Augmented,
Lotion, Ointment (Diprolene)***Desoximetasone Gel, Ointment (Topicort)*** SLDiflorasone Diacetate Cream (Apexicon E)*** SLFlucinonide 0.1% Cream (Vanos)*** E SL T4Halog Cream, Ointment SL STTopicort Spray E T4
TOPICAL CORTICOSTEROIDS MEDIUM POTENCY
Tier 1Betamethasone Valerate Cream, Lotion
(Valisone)Desoximetasone Cream (Topicort)Flucinolone Acetonide Ointment SL Fluticasone Propionate Cream, Ointment
(Cutivate)Hydrocortisone Butyrate Ointment, Solution,
Non-Oral (Locoid)Mometasone Furoate Cream, Ointment,
Solution (Elocon)Prednicarbate Cream (Dermatop)Triamcinolone Acetonide Cream, Ointment,
Lotion (Aristocort, Kenalog)
Tier 3Betamethasone Valerate Foam (Luxiq)*** E SL T4Clocortolone (Cloderm)*** SL STCordran Lotion SL STCordran Ointment Cordran SP Cream SL STFluocinolone Acetonide Cream (Synalar)*** SLFluticasone Propionate (Cutivate Lotion)*** MC SLHydrocortisone Butyrate Cream
(Locoid Lipocream) E SL T4Hydrocortisone Valerate Cream, Ointment
(Westcort)*** SLLocoid Lotion E SL T4Pandel Cream Trianex E SL T4
TOPICAL CORTICOSTEROIDS LOW POTENCY
Tier 1Alclometasone Dipropionate Cream, Ointment
(Aclovate)Hydrocortisone 2.5% Cream, Ointment, Lotion
(Hytone)
Tier 3Desonate SL STDesonide Cream, Ointment, Lotion
(DesOwen, Tridesilon)*** SLFluocinolone Acetonide Body Oil
(Derma-Smoothe/FS)*** SLFluocinolone Acetonide Scalp Oil
(Derma-Smoothe/FS)*** SLFluocinolone Acetonide Solution Non-Oral
(Synalar)*** SLVerdeso E SL T4
26© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Dermatologicals/Topical Therapy
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Topical AnestheticsLocal and Topical Anesthetics No prescription local or topical anesthetics administered in hospital or office environments are covered under the outpatient prescription drug benefit plan .
Tier 1Lidocaine HCL Gel, Solution (Xylocaine)Lidocaine HCL Ointment SLLidocaine/Prilocaine Cream (Emla)
Tier 2Lidocaine Adhesive Patch (Lidoderm)** SL
Therapy For AcneSome prescription non-combination benzoyl peroxide products are not covered . Numerous benzoyl peroxide products in various forms and strengths are available over-the-counter .
Tier 1Clindamycin Phosphate Cream, Solution, Swab
(Cleocin T)Erythromycin Base/Benzoyl Peroxide
(Benzamycin) SLErythromycin Base/Ethyl Alcohol
(Emgel, Erygel)Erythromycin Base/Ethyl Alcohol Swab,
Medicated (Erycette)Metronidazole (Metrolotion)Metronidazole Cream (Metrocream)Metronidazole Gel (Metrogel 0 .75%)Tretinoin Cream (Avita) N SLTretinoin Cream, Gel (Retin-A) N SL
Tier 2Amnesteem (Accutane)** NClaravis (Accutane)** NDifferin Cream, Gel 0 .1%^^ N SLMyorisan (Accutane)** NSotret (Accutane)** NZenatane (Accutane)** N
Tier 3Absorica E N T4Acanya E SL T4Aczone SL T4Adapalene (Differin Cream, Gel 0 .1%)*** N SLAdapalene (Differin Gel 0 .3%)*** N SLAtralin E MC N SL T4Avita Gel N SLAzelex SLBenzaclin 1%-5% E SL T4Clindagel E SL T4Clindamycin Phosphate Foam 1% (Evoclin)*** SLClindamycin Phosphate Gel (Cleocin T)*** SLClindamycin Phosphate Lotion (Cleocin T)***Clindamycin Phosphate/Benzoyl Peroxide Gel
(Benzaclin 1%-5%)*** E SLClindamycin Phosphate/Benzoyl Peroxide
Gel 1.2%-5% (Duac)*** SLDifferin Lotion N SLEpiduo SLFabior E SL T4Finacea T4Metronidazole Gel 1% (Metrogel 1%)*** E MC T4Mirvaso SL T4Noritate E MC T4Retin-A Micro E N SL T4Tazorac N SL T4Tretin-X E N SLTretinoin Microspheres (Retin-A Micro)*** E N SL T4Veltin E SL T4Ziana E SL T4
Topical AntibacterialsTier 1Gentamicin Sulfate (Garamycin)Mupirocin Ointment (Bactroban) SLSulfacetamide Sodium Suspension, Topical
(Klaron)
Tier 3Altabax SLCentany E T4Mupirocin Calcium Cream (Bactroban)***
27
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Dermatologicals/Topical Therapy
Topical AntifungalsTier 1Ciclopirox Cream, Gel, Lotion (Loprox 0 .77%) Ciclopirox Solution, Non-Oral (Penlac)Clotrimazole/Betamethasone Dipropionate
(Lotrisone) SLEconazole Nitrate (Spectazole 1%)Ketoconazole Cream, Shampoo (Nizoral 2%)Nystatin (Mycostatin)
Tier 2Ciclopirox Shampoo (Loprox 1%)**
Tier 3Ertaczo E T4ExeldermKetoconazole Foam (Extina)*** SLLoprox Shampoo MCLuzu E SL T4MentaxNaftin E T4Nystatin/Triamcinolone Acetonide
(Mycolog II)*** E T4Oxistat Cream N SL ST T4 Oxistat Lotion E SL T4Vusion E MC T4Xolegel MC
Topical AntiviralsTier 3Acyclovir Ointment (Zovirax)*** N SL ST T4Denavir E T4Xerese E T4Zovirax Cream E SL T4
Burn TherapyTier 1Silver Sulfadiazine (Silvadene)
Topical EnzymesTier 3OptaseSantylXenaderm
KeratolyticsTier 3Keralyt Scalp E T4
Antipsoriatic/AntiseborrheicTier 1Acitretin (Soriatane) Calcipotriene Solution, Topical (Dovonex) SLCalcitrol Ointment (Vectical) SLHydrocortisone Acetate/Pramoxine Cream
(Pramosone 2 .5%-1%)
Tier 2Calcipotriene Cream, Ointment (Dovonex)** SL
Tier 3Betamethasone/Calcipotriene Ointment
(Taclonex)*** SL T4Sorilux E SL T4Taclonex Suspension SL T4
Topical Scabicides/PediculicidesTier 1Lindane (Lindane Lotion, Shampoo) SLMalathion (Ovide)Permethrin (Elimite)
Tier 2Eurax
Tier 3Sklice SL T4 Spinosad (Natroba)***
28© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Dermatologicals/Topical Therapy
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Miscellaneous DermatologicalsNote: OTC medications are not on the Prescription Drug List, but are listed for information purposes .
AmLactin (Ammonium Lactate) - OTCTier 1Doxepin Cream (Zonalon)Fluorouracil (Efudex)Podofilox Liquid (Condylox Liquid)Urea 40% Emulsion (Umecta)
Tier 2Imiquimod (Aldara)** SLOxsoralen-UltraProtopic N SLRegranex N
Tier 3Carmol HC CreamCondylox Gel Diclofenac 3% Gel (Solaraze) Elidel N SLPanretin GelPicato SLVeregen SLZyclara E SL T4
29
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Ear, Nose & Throat Medications
Miscellaneous Otic PreparationsTier 1Acetic Acid (VoSol)Acetic Acid/Hydrocortisone (VoSol HC)Ofloxacin (Floxin Otic)
Tier 3Cetraxal
Otic Steroid/AntibioticTier 1Neomycin Sulfate/Polymyxin B Sulfate/
Hydrocortisone (Cortisporin)
Tier 2Ciprodex
Tier 3Cipro HC Suspension, DropsColy-Mycin S Suspension, DropsCortisporin-TC Suspension, Drops
Miscellaneous AgentsTier 1Cevimeline HCl (Evoxac)Chlorhexidine Gluconate (Peridex)Pilocarpine HCl (Salagen 5 mg)Sodium Fluoride Gel (Prevident 1 .1%)Triamcinolone Acetonide (Kenalog in Orabase)
Tier 3Glycate E T4Tyzine
30© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Endocrine/Diabetes
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Antithyroid AgentsTier 1Methimazole (Tapazole)Propylthiouracil (Propylthiouracil)
Thyroid HormonesTier 1Levothyroxine (Levothroid)
Tier 2Levothyroxine Sodium (Levoxyl)**Liothyronine Sodium (Cytomel)**SynthroidTirosint
Tier 3Armour Thyroid Thyrolar
Adrenal HormonesTier 1Dexamethasone (Decadron)Fludrocortisone Acetate (Florinef Acetate)Hydrocortisone Tablet (Cortef)Methylprednisolone Tablet, Dose Pack
(Medrol 4, 16, 32 mg)OrapredPrednisolone Sodium Phosphate Solution, Oral
(Pediapred)Prednisolone Syrup (Prelone)Prednisone (Meticorten)
Tier 2Medrol 2, 8, 24 mgPediapred
Tier 3Acthar H .P . DSP N SL
ST T4Celestone Oral SolutionOrapred ODT Flo-Pred E T4Rayos E T4
Miscellaneous HormonesANDROGENS
Tier 1Danazol (Danocrine)
Tier 2Androderm N SLAndroidOxandrolone (Oxandrin)**Testim N SL
Tier 3Androgel E N SL T4Axiron E N SL T4Fortesta E N SL T4Striant N SLTestosterone Topical Gel (Testim)*** E N SL T4
MISCELLANEOUS AGENTS
Tier 1Calcitriol (Rocaltrol)Desmopressin Acetate (DDAVP)Doxercalciferol (Hectorol)Octreotide Acetate (Octreotide Acetate) DSP NParicalcitol (Zemplar) DSP
Tier 2Cabergoline (Dostinex)**Calcitonin Salmon Nasal Spray (Miacalcin)**Calcitonin, Salmon, Synthetic Nasal Spray
(Fortical)**Kuvan DSP N SLSamsca DSP SL Synarel N
Tier 3Ravicti T4Sensipar DSP T4Syprine N
31
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Endocrine/Diabetes
GONADOTROPIN & RELATED AGENTS
Coverage is determined by the consumer’s prescription drug benefit plan .
Tier 2Cetrotide DSP N
Tier 3Ganirelix Acetate DSP N
Diabetes TherapyINSULIN THERAPY
Tier 1Humalog Mix 50-50 VialHumalog Mix 75-25 Vial Humalog VialHumulin 70-30 VialHumulin N VialHumulin R VialLevemir FlexpenLevemir Vial
Tier 2Humalog KwikPenHumalog Mix 50/50 KwikPenHumalog Mix 75/25 KwikPenHumulin 70-30 KwikPenHumulin N KwikPen
Tier 3Apidra Solostar SDP T4Apidra Vial SDP T4Lantus Solostar Pen/CartridgeLantus VialNovolin Vial SDP T4NovoLog 70-30 Flexpen SDP T4NovoLog 70-30 Vial SDP T4NovoLog Flexpen SDP T4NovoLog Vial SDP T4
NON-INSULIN HYPOGLYCEMIC AGENTS
Tier 1Acarbose (Precose)Glimepiride (Amaryl)Glipizide (Glucotrol)Glipizide Tablet, Osmotic Laser-Drilled
Formulation (Glucotrol XL)Glyburide (DiaBeta)Glyburide, Micronized (Glynase)Glyburide/Metformin HCl (Glucovance)Metformin HCl (Glucophage)Metformin HCl Sustained-Release
(Glucophage XR)Pioglitazone HCl/Glimepiride (Duetact) SL
Tier 2Byetta SLGlipizide/Metformin HCl (Metaglip)**Invokamet SLInvokana SL STGlyset Jentadueto SLKazano SLKombiglyze XR SLNateglinide (Starlix)** SLNesina SLOnglyza SLOseni SLPioglitazone HCl (Actos)** SLPioglitazone HCl/Metformin HCl
(Actoplus Met)** SLRepaglinide (Prandin)** SLTanzeum SLTradjenta SL
Tier 3Actoplus Met XR SDP SLAvandamet SLAvandaryl SLAvandia SLBydureon SLFarxiga SL ST T4Glumetza N T4Janumet SL ST T4Janumet XR SL ST T4Januvia SL ST T4Metformin HCl Tablet, Extended-Release
24 Hour (Fortamet)*** NRiomet Solution, OralSymlinPen SLVictoza SL
32© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Endocrine/Diabetes
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
GLUCOSE ELEVATING AGENTS
Tier 2Glucagen SLGlucagon (Glucagon, Human Recombinant) SLGlucagon Emergency Kit (Glucagon Kit) SL
INSULIN SYRINGES/MISCELLANEOUS DURABLE MEDICAL EQUIPMENT
Tier 1Accu-Chek Aviva PlusAccu-Chek Nano SmartViewOne Touch Ultra 2 SystemOne Touch Ultra Mini SystemOne Touch Verio IQ SystemOne Touch Verio Sync
BLOOD GLUCOSE MONITORING SUPPLIES
Tier 1Accu-Chek Aviva Plus Test Strips SLAccu-Chek Compact Test Strips SLAccu-Chek SmartView SLOne Touch Ultra Blue Test Strips SLOne Touch Verio IQ Test Strips SL
Tier 3Ascensia Autodisc Test Strips SDP SL T4Ascensia Breeze 2 Test Strips SDP SL T4Contour Next Test Strips SDP SL T4Contour Test Strips SDP SL T4Freestyle Insulinx SDP SL T4Freestyle Lite Test Strips SDP SL T4Freestyle Test Strips SDP SL T4Precision Xtra Test Strips SDP SL T4
Diabetic supplies may not be covered . This is determined by the consumer’s prescription drug benefit plan .
33
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Gastroenterology
Ulcer TherapyH2 ANTAGONISTS
Tier 1Cimetidine Tablet, Liquid (Tagamet)Famotidine Suspension, Oral (Pepcid)Ranitidine HCl Syrup (Zantac Syrup)
Tier 2Nizatidine Solution, Oral (Axid Oral Solution)**
PROSTAGLANDINS
Tier 1Misoprostol (Cytotec)
OTHER ULCER THERAPY
Tier 1Sucralfate Tablet (Carafate)
Tier 2Lansoprazole/Amoxicillin/Clarithromycin
(Prevpac) SL E
Tier 3Carafate Oral SuspensionHelidac E SL T4Omeclamox Pak SLPrevpac E SL T4Pylera SL
PROTON PUMP INHIBITORS
Tier 1Omeprazole (Prilosec)Pantoprazole (Protonix)
Tier 3Aciphex Sprinkle E SL T4 Dexilant SLLansoprazole Capsule, Delayed-Release
(Prevacid)*** E SL T4Nexium Capsule E SL T4Nexium Suspension N SL STOmeprazole/Sodium Bicarbonate Capsule
(Zegerid)*** E SL T4Prevacid Solutab N SL ST Prilosec Suspension E T4 Protonix Suspension E T4 Rabeprazole (Aciphex)*** SLZegerid Capsule E SL T4Zegerid Packet SL
Antidiarrheals & AntispasmodicsANTIDIARRHEALS
Tier 1Diphenoxylate HCl/Atropine Sulfate (Lomotil)
Tier 3Fulyzaq N T4Motofen
ANTISPASMODICS
Tier 1Dicyclomine HCl Tablet (Bentyl)Glycopyrrolate (Robinul, Robinul Forte)Hyoscyamine Sulfate (Levsin, Levsin/SL)Hyoscyamine Sulfate Capsule, Sustained-Release
12 Hour (Levsinex)Hyoscyamine Sulfate Drops (Spasdel)Hyoscyamine Sulfate Tablet, Rapid Dissolve
(Nulev)Hyoscyamine Sulfate Tablet, Sustained-Release
12 Hour (Levbid)
Tier 3Cantil Symax Duotab
COMBINATION ANTICHOLINERGICS
Tier 1Belladonna Alkaloids/Phenobarbital (Donnatal)
Tier 3Donnatal Tablet, Sustained-Action
34© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Gastroenterology
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Miscellaneous Gastrointestinal AgentsBILE ACIDS
Tier 1Ursodiol (Actigall, URSO 250, URSO Forte)
DIGESTIVE ENZYMES
Tier 2CreonSucraidZenpep
Tier 3Pancreaze STPertzye ST T4Ultresa ST T4Viokace ST T4
MISCELLANEOUS GASTROINTESTINAL AGENTS
Tier 1Balsalazide Disodium (Colazal)Cromolyn Sodium (Gastrocrom)Hydrocortisone (Cortenema)Hydrocortisone Acetate Suppository, Rectal
(Anusol-HC)Hydrocortisone Acetate/Pramoxine HCl
(Analpram-HC)Hydrocortisone Cream
(ProctoCream-HC 2 .5%, Anusol-HC 2 .5%)Lactulose (Cephulac, Chronulac)Mesalamine Enema (Rowasa) SLMetoclopramide HCl (Reglan)Sulfasalazine Tablet (Azulfidine)Sulfasalazine Tablet, Enteric-Coated (Azulfidine)
Tier 2AprisoBudesonide Capsule, Sustained-Release
(Entocort EC)**CanasaCortifoamLialdaLinzess N SLLotronex N SLRelistor
Tier 3Amitiza N SL ST T4Asacol HD E T4Delzicol E T4DipentumKristalose Metoclopramide Orally Disintegrating Tablet
(Metozolv ODT)*** E T4Pentasa E T4Rectiv N SLUceris
ANTIVERTIGO & ANTIEMETIC AGENTS
Tier 1Dronabinol (Marinol)Ondansetron HCl (Zofran)Ondansetron HCl Tablet, Rapid Dissolve
(Zofran ODT)Prochlorperazine Maleate Tablet
(Compazine)Promethazine HCl (Phenergan)Trimethobenzamide HCl Capsule
(Tigan 250, 300 mg)
Tier 2Antivert 50 mgEmend SLGranisetron HCl Tablet (Kytril)** SL
Tier 3Anzemet SLCesamet Sancuso E SL T4Transderm-Scop
BOWEL EVACUANTS
Tier 1Bisacodyl Tab & Peg 3350-KCL-
Sod Bicarb-NACL for Solution Kit (Halflytely) Sod Chloride/NaHCO3/KCl/PEGs
(Nulytely w/Flavor Packs)Sodium Sulfate/Sodium/Sodium Bicarbonate/
Potassium Chloride/Polyethylene Glycols (Colyte)
Sodium Sulfate/Sodium/Sodium Bicarbonate/ Potassium Chloride/Polyethylene Glycols Solution, Reconstituted, Oral (GoLYTELY)
Tier 2GoLYTELYPolyethylene Glycol 3350 Powder (Glycolax)**
Tier 3MoviprepOsmoprep PrepopikSuclearSuprepVisicol
35
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Immunology, Vaccines & Biotechnology
Biotechnology DrugsERYTHROID STIMULANTS
Tier 2Aranesp DSP SLEpogen DSP SLProcrit DSP SL
MYELOID STIMULANTS
Tier 2Leukine DSPMozobil DSPNeupogen DSP
Tier 3Neulasta DSP
INTERFERONS
Tier 2Actimmune DSP N SLAlferon NPegasys DSP N SL
Tier 3Infergen DSP N SL T4Intron A DSP N T4Peg-Intron DSP N
SL ST T4
GROWTH HORMONES
Tier 2Increlex DSP N SLNutropin DSP N SLNutropin AQ DSP N SLNutropin AQ NuSpin DSP N SLSaizen DSP N SLTev-Tropin DSP N SL
Tier 3Egrifta DSP N T4Genotropin DSP E N SL T4Humatrope DSP E N SL T4Norditropin DSP E N SL T4Omnitrope DSP E N SL T4Serostim DSP N SL T4Zorbtive DSP N SL
INTERLEUKINS
Tier 2Arcalyst N SLNeumega DSP
36© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Musculoskeletal & Inflammatory
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Nsaid AgentsNSAIDS
Tier 1Diclofenac Potassium (Cataflam)Diclofenac Sodium (Voltaren)Diclofenac Sodium Tablet, Sustained-Release
24 Hour (Voltaren-XR)Etodolac (Lodine)Etodolac Tablet, Sustained-Release 24 Hour
(Lodine XL)Flurbiprofen (Ansaid)Ibuprofen (Motrin)Indomethacin (Indocin)Indomethacin Capsule, Sustained-Action
(Indocin SR)Ketoprofen (Orudis)Ketoprofen Capsule, 24 Hour Sustained-Release
(Oruvail 200 mg)Ketorolac Tromethamine (Toradol)Meclofenamate Sodium (Meclomen)Meloxicam (Mobic)Nabumetone (Relafen)Naproxen (EC-Naprosyn)Naproxen (Naprosyn)Naproxen Sodium (Anaprox, Anaprox DS)Oxaprozin (Daypro)Piroxicam (Feldene)Sulindac (Clinoril)
Tier 2Tolmetin Sodium (Tolectin)**Tolmetin Sodium (Tolectin DS)**Voltaren Gel
Tier 3Cambia E SL T4Diclofenac Sodium/Misoprostol (Arthrotec)***Diclofenac Topical Solution (Pennsaid 1 .5%)*** E T4Duexis E SL T4Flector E T4Mefenamic Acid (Ponstel)***Naprelan E T4SprixVimovo E SL T4Zipsor E T4Zorvolex E T4
NSAIDS - SPECIFIC COX-II INHIBITORS
Tier 3Celebrex SL T4
SALICYLATES
Tier 1Salsalate (Salflex)
Gout TherapyTier 1Allopurinol (Zyloprim)Probenecid (Benemid)
Tier 2Colcrys
Tier 3Uloric SL T4
Other Inflammatory Conditions: Rheumatoid Arthritis, Crohn’s Disease, Psoriasis, Ulcerative ColitisTier 1Azathioprine (Imuran)Hydroxychloroquine Sulfate (Plaquenil)Leflunomide (Arava)Methotrexate Sodium (Methotrexate)Sulfasalazine Tablet (Azulfidine)Sulfasalazine Tablet, Enteric-Coated (Azulfidine)
Tier 2Cimzia DSP N SLCuprimineHumira DSP N SLSimponi DSP N SLStelara DSP N SL
Tier 3Actemra DSP N SL
ST T4Enbrel DSP N SL
ST T4Kineret DSP N SLOrencia DSP N SL
ST T4Otezla DSP N SL
ST T4Xeljanz DSP N SL
ST T4
37
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Musculoskeletal & Inflammatory
MUSCLE RELAXANTS & ANTISPASMODIC THERAPY
Tier 1Baclofen (Lioresal)Carisoprodol (Soma 350 mg)Chlorzoxazone (Parafon Forte DSC)Cyclobenzaprine HCl (Flexeril)Dantrolene Sodium (Dantrium)Diazepam (Valium)Methocarbamol (Robaxin)Tizanidine HCl Tablet (Zanaflex)
Tier 2Orphenadrine (Norflex)**Orphenadrine/Aspirin/Caffeine
(Norgesic, Norgesic Forte)**
Tier 3Carisoprodol (Soma 250 mg)*** E T4Cyclobenzaprine Capsule, Extended-Release
24 Hour (Amrix)*** E T4Lorzone E T4Metaxalone (Skelaxin 800 mg)***Tizanidine HCl Capsule (Zanaflex)***
Osteoporosis TherapyTier 1Alendronate Sodium (Fosamax) SL
Tier 2Calcitonin Salmon Nasal Spray
(Miacalcin)**Calcitonin, Salmon, Synthetic Nasal Spray
(Fortical)**Forteo DSP NIbandronate Sodium (Boniva)** SLRaloxifene (Evista)**
Tier 3Actonel SL T4Atelvia E SL T4Binosto E SL T4Fosamax Plus D SLRisedronate 150 mg (generic Actonel)*** SL
38© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Obstetrics & Gynecology
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Contraceptives & Related AgentsMONOPHASIC/BIPHASIC/TRIPHASIC AGENTS
Tier 1Desogestrel-Ethinyl Estradiol (Desogen)Ethinyl Estradiol/Desogestrel (Cyclessa)Ethynodiol D-Ethinyl Estradiol (Demulen)Levonorgestrel-Ethinyl Estradiol (Alesse)Levonorgestrel-Ethinyl Estradiol (Nordette)Levonorgestrel-Ethinyl Estradiol (Triphasil)Natazia Norethindrone A-E Estradiol/Ferrous Fumarate
(Loestrin Fe)Norethindrone-Ethinyl Estradiol (Modicon)Norethindrone-Ethinyl Estradiol
(Ortho-Novum 1-0 .035 mg)Norethindrone-Ethinyl Estradiol
(Ortho-Novum 10-11)Norethindrone-Ethinyl Estradiol (TriNorinyl)Norethindrone-Mestranol
(Ortho-Novum 1-0 .05 mg)Norethindrone-Mestranol
(Ortho-Novum 2-0 .1 mg)Norgestrel-Ethinyl Estradiol (Lo/Ovral)Ortho Tri-Cyclen* Ortho-Cyclen* Ortho-Novum 7/7/7*Plan BYasmin*
Tier 2Desogestrel-Ethinyl Estradiol/Ethinyl
Estradiol (Mircette)**Levonorgestrel-Eth Estr/Ethinyl Estradiol
(LoSeasonique)** MCLevonorgestrel-Ethinyl Estradiol Tablet,
Dosepak, 3 month (Seasonale)** MCNorethindrone A-E Estradiol (Loestrin)**Norethindrone-Ethinyl Estradiol (Ovcon 35)**Norgestrel-Ethinyl Estradiol (Ovral)**NuvaringYaz^^
Tier 3Beyaz E T4Ethinyl Estradiol/Drospirenone
(Yasmin)***Ethinyl Estradiol/Drospirenone (Yaz)***Generess Fe E T4Levonorgestrel-Eth Estr/Ethinyl Estradiol
(Seasonique)*** MCLevonorgestrel-Ethinyl Estradiol (Lybrel)*** Lo Loestrin FeLo Minastrin Fe E T4LoMedia 24 FE (Loestrin 24 FE)***Norelgestromin/Ethinyl Estradiol Patch
(Ortho Evra)*** E T4 Norethindrone A-E Estradiol/Ferrous
Fumarate (Estrostep Fe)***Norethindrone-Ethinyl Estradiol
(Ortho-Novum 7/7/7)***Norethindrone-Ethinyl Estradiol /Iron
Tablet, Chewable (Femcon Fe)***Norgestimate-Ethinyl Estradiol (Ortho Tri-Cyclen)***Norgestimate-Ethinyl Estradiol (Ortho-Cyclen)***Ortho Tri-Cyclen LoOvconQuartette E T4Safyral E T4
OxytocicsTier 1Methylergonovine Maleate (Methergine)
Estrogens & ProgestinsPROGESTINS
Tier 1Medroxyprogesterone Acet
(Depo-Provera 150 mg/ml) MCMedroxyprogesterone Acet (Provera)Norethindrone Acetate (Aygestin)Ortho Micronor*
Tier 2Crinone1 NDepo-SubQ Provera MCProgesterone, Micronized (Prometrium)**
Tier 3Endometrin NNorethindrone (Ortho Micronor)***Nor-Q-D
1Benefit determines coverage of treatment of infertility .
39
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Obstetrics & Gynecology
ESTROGENS
Tier 1Estradiol (Estrace)Estradiol Patch, Transdermal Weekly (Climara) SLEstropipate Tablet (Ogen)
Tier 2Climara SLDivigelEstring MC SLEvamistVagifemVivelle-Dot SL
Tier 3Alora SLCenestin E T4ElestrinEnjuviaEstrace Cream with ApplicatorEstrasorb SLEstrogel SLFemring MC SLMenest Menostar Patch, Transdermal Weekly SLMinivelle SLPremarin
ESTROGEN COMBINATIONS
Tier 2Estradiol/Norethindrone Acetate (Activella)**Prefest (Estradiol/Norgestimate)Tier 3AngeliqClimara Pro SLCombipatch SLNorethindrone Acetate/Ethinyl Estradiol
(Femhrt)***PremphasePrempro
Miscellaneous OB/GYNDRUGS TO TREAT INFERTILITY /IVF AGENTS
Coverage is determined by the consumer’s prescription drug benefit plan .
Tier 1Clomiphene Citrate (Clomid) NClomiphene Citrate (Serophene) NLeuprolide Acetate (Lupron 1 mg/0 .2 ml) N
Tier 2Cetrotide DSPGonal-F DSP NGonal-F RFF DSP N
Tier 3Bravelle DSP N ST T4Follistim AQ DSP N ST T4Menopur DSP N T4Ovidrel DSP NRepronex DSP N T4
VAGINAL CLEANSER/ANTI-INFECTIVES
Tier 1Clindamycin Phosphate Cream w/Applicator
(Cleocin Phosphate)Metronidazole Vaginal Gel (Metrogel Vaginal)
Tier 2AVCCleocin PhosphateClindesse
VAGINAL ANTIFUNGALS
Tier 1Fluconazole (Diflucan 150 mg)Terconazole Cream w/Applicator (Terazol)Terconazole Suppository, Vaginal (Terazol)
Tier 3Gynazole-1
SPECIALIZED OB/GYN DRUGS
Tier 1Terbutaline Sulfate (Brethine)
Tier 2Synarel NTranexamic Acid (Lysteda)** SL
Tier 3Brisdelle E SL T4Diclegis N SL T4
40© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Ophthalmology
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Beta-BlockersTier 1Betaxolol HCl (Betoptic)Carteolol HCl (Ocupress)Levobunolol HCl (Betagan)Metipranolol (OptiPranolol)Timolol Maleate (Timoptic-XE)Timolol Maleate Drops (Timoptic)
Tier 2Betimol SL
Tier 3Betoptic SIstalol
Direct Acting MioticsTier 1Pilocarpine HCl
(Isopto Carpine 0 .5%, 1%, 2%, 4%, 6%)
Tier 2Pilopine HS
Other Glaucoma DrugsTier 1Dorzolamide HCl (Trusopt)Latanoprost (Xalatan)
Tier 2Azopt SLCombigan SLDorzolamide HCl/Timolol Maleate (Cosopt)**Lumigan SLTravatan Z SL
Tier 3Cosopt PF E SL T4Rescula SL STSimbrinza E SL T4 Travoprost (Travatan)*** STZioptan SL ST
Oral Drugs For GlaucomaTier 1Acetazolamide (Diamox)Acetazolamide Capsule, Sustained-Action
(Diamox Sequel)Methazolamide (Neptazane)
Cycloplegic MydriaticsTier 1Atropine Sulfate (Isopto Atropine)Cyclopentolate HCl (Cyclogyl 1%, 2%)Tropicamide (Mydriacyl)
Tier 2Isopto Homatropine (Homatropine HBr)Tier 3Cyclogyl 0 .5%Paremyd
Non-Steroidal Anti-Inflammatory AgentsTier 1Diclofenac Sodium (Voltaren)Flurbiprofen Sodium (Ocufen)Ketorolac Tromethamine (Acular)Ketorolac Tromethamine (Acular LS)
Tier 3Acuvail E SL T4Bromfenac Sodium (Bromday)*** E SL T4Bromfenac Sodium (Xibrom)*** SLIlevro E SL T4Nevanac SL T4Prolensa E SL T4
Vasoconstrictor DecongestantsTier 1Naphazoline HCl (Albalon)Phenylephrine HCl (Neo-Synephrine)
41
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Ophthalmology
AntibioticsTier 1Bacitracin/Polymyxin B Sulfate (Polysporin)Ciprofloxacin HCl Drops (Ciloxan)Erythromycin Base (Ilotycin)Gentamicin Sulfate (Garamycin)Levofloxacin (Quixin)Neomycin Sulfate/Bacitracin/Polymyxin B
Ointment (Neosporin)Neomycin Sulfate/Gramicidin D/Polymyxin B
Drops (Neosporin)Ofloxacin (Ocuflox)Polymyxin B Sulfate/Trimethoprim
(Polytrim)Tobramycin Sulfate Drops (Tobrex)
Tier 3Azasite SLCiloxan Ointment Gatifloxacin (generic Zymaxid) SLMoxeza T4Moxifloxacin (Vigamox)*** T4NatacynTobrex Ointment
SulfonamidesTier 1Sulfacetamide Sodium (Bleph-10, Sodium Sulamyd)
SteroidsTier 1Fluorometholone (FML)Prednisolone Acetate (Pred Forte)Prednisolone Sodium Phosphate
(Inflamase Forte)
Tier 2FML ForteMaxidexPred MildVexol
Tier 3Alrex SL T4Durezol T4Lotemax Gel E SL T4Lotemax Ointment, Suspension SL T4
Steroid-Antibiotic CombinationsTier 1Neomycin Sulfate/Bacitracin Zinc/Polymyxin B/
Hydrocortisone Ointment (Cortisporin)Neomycin Sulfate/Polymyxin B Sulfate/
Hydrocortisone Suspension, Drops (Cortisporin)
Neomycin/Polymyxin B Sulfate/Dexamethasone (Maxitrol)
Tier 2Tobramycin/Dexamethasone Suspension
(Tobradex)**
Tier 3Pred-G Tobradex ST E SL T4Zylet
Steroid-Sulfonamide CombinationsTier 1Sulfacetamide Sodium/Prednisolone Sodium
Phosphate (Vasocidin)
Tier 2Blephamide S .O .P .
Tier 3Blephamide Suspension, Drops
SympathomimeticsTier 1Apraclonidine HCl Drops (Iopidine 0 .5%)
Tier 2Alphagan P SLBrimonidine Tartrate 0.15% (Alphagan P)*** SL
Tier 3Iopidine 1%
42© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Ophthalmology
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Miscellaneous OphthalmologicsTier 1Cromolyn Sodium (Crolom)
Tier 2Lacrisert
Tier 3AlocrilAlomideAzelastine HCl Drops (Optivar)*** SLBepreve E SL T4Emadine E T4Epinastine HCl Drops (Elestat)*** E SL T4Lastacaft SLPataday E SL T4Patanol E SL T4Restasis N SL T4
AntiviralsTier 1Trifluridine (Viroptic)
Tier 3Zirgan SL
43
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Respiratory, Allergy, Cough & Cold
Antihistamine & Antiallergenic AgentsNote: OTC medications are not on the Prescription Drug List, but are listed for information purposes . If a prescription product is identical to an OTC product in strength and dosage form, the prescription product is not included in the drug list .
Claritin (Loratadine Tablet, Syrup) - OTC
ANTIHISTAMINES
Tier 1Cyproheptadine HCl (Periactin)Hydroxyzine HCl (Atarax)Hydroxyzine Pamoate (Vistaril)Levocetirizine Dihydrochloride Tablet (Xyzal) SLPromethazine HCl (Phenergan)
Tier 3Desloratadine (Clarinex)*** E SLLevocetirizine Dihydrochloride Solution, Oral
(Xyzal)*** SL
ADRENERGICS
Tier 2Epipen SLEpipen Jr SL
Tier 3Auvi-Q E SL T4
ANGIOEDEMA
Tier 2Berinert DSP N SL
Tier 3Firazyr DSP N SL T4
INTRANASAL ANTIHISTAMINES
Tier 3Azelastine (Astepro)*** E SL T4Azelastine (Astelin)*** SLOlpatadine (Patanase)*** SL
Cough & Cold TherapyAntitussive and Expectorant Drugs Only prescription antitussive and expectorant drugs are included in the Prescription Drug List . The use of OTC antitussive and expectorant products is recommended when possible . While not all comparable OTC alternatives to prescription products are provided below, where applicable at least one is listed for informational purposes .
ANTITUSSIVE COMBINATIONS
Tier 1Codeine/Promethazine HCl
(Phenergan w/Codeine)Dextromethorphan HBr/Pseudoephedrine
HCl/Brompheniramine (Bromfed-DM)Guaifenesin/Codeine Phosphate
(Robitussin A-C)Guaifenesin/Pseudoephedrine HCl/Codeine
(Robitussin-DAC)Phenylephrine HCl/Codeine/Promethazine
(Phenergan VC w/Codeine)
Tier 3Chlorpheniramine/Hydrocodone
Pseudoephedrine (Zutripro)*** SL Hydrocodone/Chlorpheniramine Suspension,
Sustained-Release 12 Hour (Tussionex)*** SL
Antihistamine/Decongestant Combinations Only prescription antihistamine/decongestants are included in the Prescription Drug List . The use of OTC antihistamine/decongestant products is recommended when possible . While not all comparable OTC alternatives to prescription products are provided below, where applicable at least one is listed for informational purposes . Strength is listed in mg .
Claritin-D (Pseudoephedrine Sulfate/Loratadine) - OTC
BIOLOGIC RESPONSE MODIFIERS
Tier 3Grastek N SL T4Oralair N SL T4Ragwitek N SL T4
DECONGESTANT/ANTIHISTAMINES
Tier 1Phenylephrine HCl/Promethazine HCl
(Phenergan VC)
Tier 3Clarinex-D E SL
44© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Respiratory, Allergy, Cough & Cold
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Pulmonary AgentsXANTHINES
Tier 1Theophylline Anhydrous Tablet,
Extended-Release 12 Hour (Theochron)
Tier 3Elixophyllin ElixirLufyllin Tablet Theo-24
BETA AGONISTS ORAL
Tier 1Albuterol Sulfate (Proventil, Ventolin)Terbutaline Sulfate (Brethine)
INHALED BETA AGONISTS
Tier 1Albuterol Sulfate Solution (AccuNeb, Proventil)Metaproterenol Sulfate Solution, Non-Oral
(Alupent)Ventolin HFA (Albuterol Sulfate HFA Aerosol) SL
Tier 2Foradil SL
Tier 3Arcapta Neohaler SL Brovana SLPerforomist SLProair HFA SLProventil HFA SLSerevent Diskus SLXopenex HFA SLLevalbuterol HCl (Xopenex Vial, Nebulizer)*** E SL T4
INHALED CORTICOSTEROIDS
Tier 1Alvesco SLAsmanex SLQVAR SL
Tier 2Budesonide Inhalation Suspension
(Pulmicort Respules 0 .25 mg/2 ml, 0 .5 mg/2 ml)** SL
Pulmicort Respules 1 mg/2 ml SL
Tier 3Aerospan SL Flovent Diskus SLFlovent HFA SLPulmicort Flexhaler SDP SL T4
INTRANASAL STEROIDS
Tier 2Fluticasone Propionate (Flonase)** SL
Tier 3Beconase AQ E SL T4Budesonide (Rhinocort Aqua)*** E SL T4Dymista E SL T4Flunisolide Nasonex E SL T4Omnaris E SL T4Qnasl E SL T4Triamcinolone Acetonide (Nasacort AQ)*** E SL T4Veramyst E SL T4Zetonna SL
MISCELLANEOUS PULMONARY AGENTS
Tier 1Acetylcysteine Vial, Nebulizer (Mucomyst)Cromolyn Sodium Ampul for Nebulization
(Intal)Ipratropium Bromide Solution, Non-Oral
(Atrovent)Montelukast Sodium (Singulair) SLSildenafil Citrate (Revatio) DSP N SLZafirlukast (Accolate) SL
Tier 2Albuterol Sulfate/Ipratropium Solution,
Non-Oral (Duoneb)**Letairis DSP N SLPulmozyme DSP N SLSpiriva SLTracleer DSP N SLTudorza Pressair SLTyvaso DSP NVentavis DSP N
Tier 3Adcirca DSP N SL T4Advair Diskus RS SLAdvair HFA RS SLAtrovent HFA SLAtrovent Nasal Spray Breo Ellipta RS SL Combivent Respimat SLDaliresp N SLDulera RS SLSymbicort E SL T4ZyfloZyflo CR SL
45
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Urologicals
Cholinergic StimulantsTier 1Bethanechol Chloride (Urecholine)
Anticholinergics Tier 1Oxybutynin Chloride (Ditropan)
Tier 2Oxybutynin Chloride Tablet, Sustained-Release
(Ditropan XL)**
Tier 3Enablex E T4Gelnique E T4Myrbetriq E T4Oxytrol E T4Tolterodine Extended-Release (Detrol LA)*** E T4Tolterodine Tartrate (Detrol)*** E T4ToviazTrospium Chloride (Sanctura)*** E T4Trospium Chloride Capsule, Sustained-Release
24 Hour (Sanctura XR)*** E T4Vesicare E T4
Urinary AnestheticsTier 1Phenazopyridine HCl (Pyridium)
Miscellaneous UrologicalsTier 1Citric Acid/Sodium Citrate (Bicitra)
Tier 2Cystagon DSP ElmironK-Phos M .F . K-Phos OriginalOracitRenacidin
Tier 3Procysbi DSP N T4
Erectile DysfunctionTier 3Caverject SLCialis1 SL T4Edex SLLevitra1 SL T4Muse SLStaxyn1 E SL T4Viagra1 SL T4
1 Patient must be an adult male (over 18 years of age) and should not be using concomitant nitrate products (e .g ., nitroglycerin) nor be receiving other drugs for treatment of sexual dysfunction (e .g ., Caverject, Muse) .
Benign Prostatic Hyperplasia (BPH) TherapyTier 1Alfuzosin HCl (Uroxatral)Doxazosin Mesylate (Cardura)Finasteride (Proscar)Tamsulosin HCl (Flomax)Terazosin HCl (Hytrin)
Tier 3Avodart N SDP T4Cialis SL ST T4Jalyn E T4 Rapaflo T4
46© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Vitamins, Hematinics & Electrolytes
****Depending on your patients’ benefit and/or medication, notification or medical necessity criteria will be applied to determine if covered under the pharmacy benefit.
N Notification or Prior Authorization required****RS May be eligible for the Refill and Save ProgramSDP Select Designated Pharmacy
SL Supply limitST Step TherapyT4 May be covered on Tier 4 in selected benefits
DSP Designated Specialty ProgramE May be excluded from coverageMC Multiple copay
Vitamins & HematinicsInjectable vitamins are not included in the Prescription Drug List .
Multivitamins are NOT included in the Prescription Drug List as various OTC products are available .
Tier 1Fluoride Ion/Iron/Multivitamins (Poly-Vi-Flor w/Iron)Fluoride Ion/Iron/Vitamins A,C, and D
(Tri-Vi-Flor w/Iron)Fluoride Ion/Multivitamins (Poly-Vi-Flor)Fluoride Ion/Vitamins A,C, and D (Tri-Vi-Flor)Prenatal Vit/Fe Fumarate/FA (Prenatal)Sodium Fluoride (Luride)
Tier 3Brand Prenatal VitaminsNascobal
ElectrolytesPOTASSIUM
Tier 1Potassium Chloride (K-Dur)Potassium Chloride Capsule, Sustained-Action
(Micro-K)Potassium Chloride Packet (Klor-Con 25mEq)Potassium Chloride Tablet, Sustained-Action
(K-Tab, Slow-K)
Tier 3K-Tab
47
Please refer to page 4 for a definition of notations/symbols.
* Products listed in Tier 1 may be covered in Tier 3 in a non-standard Prescription Drug List *** Products listed in Tier 3 may be covered in Tier 1 in a non-standard Prescription Drug List ** Products listed in Tier 2 may be covered in Tier 1 in a non-standard Prescription Drug List ^̂ Products listed in Tier 2 may be covered in Tier 3 in a non-standard Prescription Drug List
© 2014 UnitedHealthCare Services, Inc. All rights reserved. 1/15
Diagnostics & Miscellaneous Agents
Miscellaneous AgentsTier 1Acamprosate (Campral) Anagrelide HCl (Agrylin)Calcium Acetate (PhosLo) Disulfiram (Antabuse)Etidronate Disodium (Didronel)Levocarnitine (Carnitor)Midodrine HCl (ProAmatine)Pilocarpine HCl (Salagen)Riluzole (Rilutek) Sodium Polystyrene Sulfonate (Kayexalate)
Tier 2CarbagluChemetExjade DSP NFosrenolRenagelRenvela Sevelamer (Renvela)Tier 3Ferriprox DSP N SL T4
Smoking DeterrentsTier 1Bupropion HCl Tablet, Sustained-Action
(Zyban) NNicotine Patch, Transdermal 24 Hour
(Habitrol) N
Tier 3Chantix N T4Nicotrol Inhaler N T4Nicotrol NS N T4
AnorexiantsAppetite Suppressants (e .g . Ionamin, Meridia, Xenical, etc ., and amphetamines when used as appetite suppressants) are Tier 3 . Coverage is determined by the consumer’s prescription drug benefit plan .
48
Common Brand medications excluded from coverage under many benefit plans
Lower-cost option(s)
AciphexOmeprazole (generic Prilosec), Pantoprazole (generic Protonix), Rabeprazole (generic Aciphex), Dexilant
Actiq Fentanyl Lozenge (generic Actiq)Actos Pioglitazone (generic Actos)
AdderallAmphetamine/Dextroamphetamine Immediate-Release (generic Adderall)
Adoxa TabletDoxycycline Hyclate (generic Vibra-Tab), Doxycycline Monohydrate Tablet (generic Adoxa Tablet)
Ambien Zolpidem (generic Ambien)Arimidex Anastrozole (generic Arimidex)Astelin Azelastine Nasal Spray (generic Astelin)Ativan Lorazepam (generic Ativan)Avelox Moxifloxacin Tablets (generic Avelox)
AvinzaMorphine Sulfate Extended-Release Tablet (generic MS Contin), Morphine Sulfate Extended-Release Capsule (generic Avinza)
Benzaclin Jar Clindamycin 1%/Benzoyl Peroxide 5% Gel (generic Benzaclin)Celexa Citalopram (generic Celexa)Cipro Suspension Ciprofloxacin Oral Suspension (generic Cipro Suspension)
ClodermClocortolone 0 .1% Cream (generic Cloderm), Mometasone Furoate 0 .1% Cream (generic Elocon)
Cymbalta Duloxetine (generic Cymbalta)Diovan HCT Valsartan/Hydrochlorothiazide (generic Diovan HCT)Duac Clindamycin/Benzoyl Peroxide 1 .2-5% Gel (generic Duac)Duragesic Fentanyl Transdermal Patch (generic Duragesic)Effexor XR Venlafaxine Extended-Release Capsule (generic Effexor XR)Entocort EC Budesonide (generic Entocort EC)Evista Raloxifene (generic Evista)Femara Letrozole (generic Femara)Fioricet with Codeine 50-325-40-30 mg
Butalbital/Acetaminophen/Caffeine/Codeine Phosphate 50-325-40-30 mg (generic Fioricet with Codeine)
Flomax Tamsulosin (generic Flomax)Geodon Ziprasidone (generic Geodon)Imitrex Injection & Tablets Sumatriptan Injection, Tablet (generic Imitrex)Lexapro Escitalopram (generic Lexapro)Lidoderm Lidocaine Transdermal Patch (generic Lidoderm)Lipitor Atorvastatin (generic Lipitor)Lofibra 54, 160 mg Fenofibrate 54, 160 mg (generic Lofibra)Lovaza Omega-3-Acid Ethyl Esters (generic Lovaza), VascepaLunesta Eszopiclone (generic Lunesta), Zaleplon (generic Sonata), Zolpidem (generic Ambien)Maxalt Rizatriptan (generic Maxalt)Maxalt-MLT Rizatriptan (generic Maxalt), Rizatriptan Orally Disintegrating Tablet (generic Maxalt MLT)Mepron Atovaquone Suspension (generic Mepron)Micardis Losartan (generic Cozaar), Telmisartan (generic Micardis)
Micardis HCTLosartan/Hydrochlorothiazide (generic Hyzaar), Telmisartan/Hydrochlorothiazide (generic Micardis HCT)
Monodox Doxycycline Hyclate (generic Vibramycin), Doxycycline Monohydrate (generic Monodox)Natroba Malathion (generic Ovide), Permethrin (generic Elimite), Spinosad (generic Natroba)Optivar Azelastine (generic Optivar), LastacaftOrtho Evra Norelgestromin/Ethinyl Estradiol Topical Patch, Xulane (generic Ortho Evra)Percocet Acetaminophen/Oxycodone (generic Percocet)Plavix Clopidogrel (generic Plavix)Prilosec Omeprazole (generic Prilosec)Protonix Pantoprazole (generic Protonix)
49
Common Brand medications excluded from coverage under many benefit plans
Lower-cost option(s)
Prozac Fluoxetine (generic Prozac)Revatio Sildenafil (generic Revatio)Risperdal Risperidone (generic Risperdal)Seroquel Quetiapine (generic Seroquel)Singulair Chewable Tablet Montelukast Chewable Tablet (generic Singulair)Singulair Tablet Montelukast (generic Singulair)Skelaxin Metaxalone (generic Skelaxin)Taclonex Ointment Betamethasone/Calcipotriene Ointment (generic Taclonex)Valium Diazepam (generic Valium)Valtrex Valacyclovir (generic Valtrex)Viramune XR 400 mg Nevirapine Extended-Release (generic Viramune XR)Wellbutrin SR Bupropion Extended-Release (generic Wellbutrin SR)Wellbutrin XL Bupropion Extended-Release (generic Wellbutrin XL)Xanax Alprazolam (generic Xanax)Xanax XR Alprazolam Extended-Release (generic Xanax XR)Zoloft Sertraline (generic Zoloft)Zovirax Ointment Acyclovir Ointment (generic Zovirax)Zutripro Chlorpheniramine/Hydrocodone/Pseudoephedrine (generic Zutripro)Zyprexa Olanzapine (generic Zyprexa)Zyprexa Zydis Olanzapine (generic Zyprexa), Olanzapine Orally Disintegrating Tablet (generic Zyprexa Zydis)
50
2015 Prescription Drug List Medication Index
AAbacavir/Lamivudine/Zidovudine . . . . . 9Abacavir Sulfate Tablet . . . . . . . . . . . . . 9Abilify . . . . . . . . . . . . . . . . . . . . . . . . . . 18Absorica . . . . . . . . . . . . . . . . . . . . . . . . 26Abstral . . . . . . . . . . . . . . . . . . . . . . . . . . 13Acamprosate . . . . . . . . . . . . . . . . . . . . 47Acanya . . . . . . . . . . . . . . . . . . . . . . . . . 26Acarbose . . . . . . . . . . . . . . . . . . . . . . . 31Accolate . . . . . . . . . . . . . . . . . . . . . . . . 44Accu-Chek Aviva Plus . . . . . . . . . . . . . 32Accu-Chek Aviva Plus Test Strips . . . 32Accu-Chek Compact Test Strips . . . . 32Accu-Chek Nano SmartView . . . . . . . 32Accu-Chek SmartView . . . . . . . . . . . . 32AccuNeb, Proventil . . . . . . . . . . . . . . . 44Accuretic . . . . . . . . . . . . . . . . . . . . . . . 23Accutane . . . . . . . . . . . . . . . . . . . . . . . 26Acebutolol HCl . . . . . . . . . . . . . . . . . . 21Aceon . . . . . . . . . . . . . . . . . . . . . . . . . . 22Acetaminophen/Caffeine/Butalbital/
Codeine 325-50-40-30 mg . . . . . . 13Acetaminophen/Caffeine/Butalbital
325-50-40 mg . . . . . . . . . . . . . . . . . 13Acetaminophen/Oxycodone . . . . . . . . 48Acetazolamide . . . . . . . . . . . . . . . . . . . 40Acetazolamide Capsule,
Sustained-Action . . . . . . . . . . . . . . . 40Acetic Acid . . . . . . . . . . . . . . . . . . . . . . 29Acetic Acid/Hydrocortisone . . . . . . . . 29Acetylcysteine Vial, Nebulizer . . . . . . . 44Achromycin V . . . . . . . . . . . . . . . . . . . . . 7Aciphex . . . . . . . . . . . . . . . . . . . . . . 33, 48Aciphex Sprinkle . . . . . . . . . . . . . . . . . 33Acitretin . . . . . . . . . . . . . . . . . . . . . . . . 27Aclovate . . . . . . . . . . . . . . . . . . . . . . . . 25Actemra . . . . . . . . . . . . . . . . . . . . . . . . 36Acthar H .P . . . . . . . . . . . . . . . . . . . . . . . 30Actigall . . . . . . . . . . . . . . . . . . . . . . . . . 34Actimmune . . . . . . . . . . . . . . . . . . . . . . 35Actiq . . . . . . . . . . . . . . . . . . . . . . . . 13, 48Activella . . . . . . . . . . . . . . . . . . . . . . . . 39Actonel . . . . . . . . . . . . . . . . . . . . . . . . . 37Actoplus Met . . . . . . . . . . . . . . . . . . . . 31Actoplus Met XR . . . . . . . . . . . . . . . . . 31Actos . . . . . . . . . . . . . . . . . . . . . . . . 31, 48Acular . . . . . . . . . . . . . . . . . . . . . . . . . . 40Acular LS . . . . . . . . . . . . . . . . . . . . . . . 40Acuvail . . . . . . . . . . . . . . . . . . . . . . . . . 40Acyclovir . . . . . . . . . . . . . . . . . . . 8, 27, 49Acyclovir Ointment . . . . . . . . . . . . 27, 49Aczone . . . . . . . . . . . . . . . . . . . . . . . . . 26Adapalene . . . . . . . . . . . . . . . . . . . . . . 26Adcirca . . . . . . . . . . . . . . . . . . . . . . . . . 44
Adderall . . . . . . . . . . . . . . . . . . . . . 19, 48Adderall XR . . . . . . . . . . . . . . . . . . . . . 19Adefovir . . . . . . . . . . . . . . . . . . . . . . . . . 8Adoxa . . . . . . . . . . . . . . . . . . . . . . . . 7, 48Adoxa 150 mg . . . . . . . . . . . . . . . . . . . . 7Adoxa Tablet . . . . . . . . . . . . . . . . . . . . . 48Advair Diskus . . . . . . . . . . . . . . . . . . . . 44Advair HFA . . . . . . . . . . . . . . . . . . . . . . 44Advate . . . . . . . . . . . . . . . . . . . . . . . . . . 21Advicor . . . . . . . . . . . . . . . . . . . . . . . . . 24Aerospan . . . . . . . . . . . . . . . . . . . . . . . 44Afinitor . . . . . . . . . . . . . . . . . . . . . . . . . 11Aggrenox . . . . . . . . . . . . . . . . . . . . . . . 20Agrylin . . . . . . . . . . . . . . . . . . . . . . . . . . 47Albalon . . . . . . . . . . . . . . . . . . . . . . . . . 40Albenza . . . . . . . . . . . . . . . . . . . . . . . . . 10Albuterol Sulfate . . . . . . . . . . . . . . . . . 44Albuterol Sulfate/Ipratropium
Solution, Non-Oral . . . . . . . . . . . . . . 44Albuterol Sulfate HFA Aerosol . . . . . . 44Albuterol Sulfate Solution . . . . . . . . . . 44Alclometasone Dipropionate Cream,
Ointment . . . . . . . . . . . . . . . . . . . . . . 25Aldactazide 25-25 mg . . . . . . . . . . . . 21Aldactazide 50-50 mg . . . . . . . . . . . . 21Aldactone . . . . . . . . . . . . . . . . . . . . . . . 21Aldara . . . . . . . . . . . . . . . . . . . . . . . . . . 28Alendronate Sodium . . . . . . . . . . . . . . 37Alesse . . . . . . . . . . . . . . . . . . . . . . . . . . 38Alferon N . . . . . . . . . . . . . . . . . . . . . . . 35Alfuzosin HCl . . . . . . . . . . . . . . . . . . . . 45Alinia . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Alkeran . . . . . . . . . . . . . . . . . . . . . . . . . 11Allopurinol . . . . . . . . . . . . . . . . . . . . . . . 36Alocril . . . . . . . . . . . . . . . . . . . . . . . . . . 42Alomide . . . . . . . . . . . . . . . . . . . . . . . . . 42Alora . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Alphagan P . . . . . . . . . . . . . . . . . . . . . . 41Alphanate vonWillebrand . . . . . . . . . . 21Alphanine SD . . . . . . . . . . . . . . . . . . . . 21Alprazolam . . . . . . . . . . . . . . . . . . . 19, 49Alprazolam Extended-Release . . . . . . 49Alprazolam Tablet, Rapid Dissolve . . . 19Alprazolam Tablet,
Sustained-Release 24 Hour . . . . . . 19Alrex . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Alsuma . . . . . . . . . . . . . . . . . . . . . . . . . 14Altabax . . . . . . . . . . . . . . . . . . . . . . . . . 26Altace . . . . . . . . . . . . . . . . . . . . . . . . . . 22Altoprev . . . . . . . . . . . . . . . . . . . . . . . . 24Alupent . . . . . . . . . . . . . . . . . . . . . . . . . 44Alvesco . . . . . . . . . . . . . . . . . . . . . . . . . 44Amantadine HCl . . . . . . . . . . . . . . . 8, 15Amaryl . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Ambien . . . . . . . . . . . . . . . . . . . . . . 17, 48Ambien CR . . . . . . . . . . . . . . . . . . . . . . 17Amcinonide Cream, Lotion . . . . . . . . . 25Amcinonide Ointment . . . . . . . . . . . . . 25Amerge . . . . . . . . . . . . . . . . . . . . . . . . . 14Amicar . . . . . . . . . . . . . . . . . . . . . . . . . . 21Amicar 500 mg . . . . . . . . . . . . . . . . . . 21Amiloride HCl . . . . . . . . . . . . . . . . . . . . 21Amiloride HCl/Hydrochlorothiazide . . 21Aminocaproic Acid . . . . . . . . . . . . . . . 21Aminocaproic Acid Solution . . . . . . . . 21Aminocaproic Acid Tablet . . . . . . . . . . 21Aminocaproic Acid Tablet 1000 mg . 21Amiodarone HCl . . . . . . . . . . . . . . . . . 20Amitiza . . . . . . . . . . . . . . . . . . . . . . . . . 34Amitriptyline HCl . . . . . . . . . . . . . . . . . 17AmLactin . . . . . . . . . . . . . . . . . . . . . . . . 28Amlodipine/Atorvastatin . . . . . . . . . . . 24Amlodipine/Benazepril . . . . . . . . . . . . 23Amlodipine/Telmisartan . . . . . . . . . . . . 23Amlodipine Besylate . . . . . . . . . . . . . . 22Amlodpine/Valsartan . . . . . . . . . . . . . . 23Ammonium Lactate . . . . . . . . . . . . . . . 28Amnesteem . . . . . . . . . . . . . . . . . . . . . 26Amoxapine . . . . . . . . . . . . . . . . . . . . . . 17Amoxicillin Clavulanate ER Tablet,
Sustained-Release 12 Hour . . . . . . . 7Amoxicillin Trihydrate/Potassium
Clavulanate . . . . . . . . . . . . . . . . . . . . . 7Amoxicillin Trihydrate Capsule,
Chewable Tablet, Suspension, Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Amoxil . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Amphetamine/Dextroamphetamine
Immediate-Release . . . . . . . . . . . . . 48Amphetamine Aspartate/
Amphetamine Sulfate/Dextroamphetamine . . . . . . . . . . . . . 19
Amphetamine Aspartate/ Amphetamine Sulfate/Dextroamphetamine Capsule, Sustained-Release 24 Hour . . . . . . 19
Ampyra . . . . . . . . . . . . . . . . . . . . . . . . . 16Amrix . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Amturnide . . . . . . . . . . . . . . . . . . . . . . . 23Anafranil . . . . . . . . . . . . . . . . . . . . . . . . 17Anagrelide HCl . . . . . . . . . . . . . . . . . . 47Analpram-HC . . . . . . . . . . . . . . . . . . . . 34Anaprox, Anaprox DS . . . . . . . . . . . . . 36Anastrozole . . . . . . . . . . . . . . . . . . . 11, 48Ancobon . . . . . . . . . . . . . . . . . . . . . . . . . 9Androderm . . . . . . . . . . . . . . . . . . . . . . 30Androgel . . . . . . . . . . . . . . . . . . . . . . . . 30Android . . . . . . . . . . . . . . . . . . . . . . . . . 30
51
2015 Prescription Drug List Medication Index
Angeliq . . . . . . . . . . . . . . . . . . . . . . . . . 39Ansaid . . . . . . . . . . . . . . . . . . . . . . . . . . 36Antabuse . . . . . . . . . . . . . . . . . . . . . . . 47Antara . . . . . . . . . . . . . . . . . . . . . . . . . . 24Antivert 50 mg . . . . . . . . . . . . . . . . . . . 34Anusol-HC . . . . . . . . . . . . . . . . . . . . . . 34Anusol-HC 2 .5% . . . . . . . . . . . . . . . . . 34Anzemet . . . . . . . . . . . . . . . . . . . . . . . . 34Apexicon . . . . . . . . . . . . . . . . . . . . . . . . 25Apexicon E . . . . . . . . . . . . . . . . . . . . . . 25Apidra Solostar . . . . . . . . . . . . . . . . . . 31Apidra Vial . . . . . . . . . . . . . . . . . . . . . . 31Aplenzin . . . . . . . . . . . . . . . . . . . . . . . . 17Apokyn . . . . . . . . . . . . . . . . . . . . . . . . . 15Apraclonidine HCl Drops . . . . . . . . . . 41Apresoline . . . . . . . . . . . . . . . . . . . . . . 22Apriso . . . . . . . . . . . . . . . . . . . . . . . . . . 34Aptivus . . . . . . . . . . . . . . . . . . . . . . . . . . 9Aralen Phosphate . . . . . . . . . . . . . . . . 10Aranesp . . . . . . . . . . . . . . . . . . . . . . . . 35Arava . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Arcalyst . . . . . . . . . . . . . . . . . . . . . . . . . 35Arcapta Neohaler . . . . . . . . . . . . . . . . . 44Aricept . . . . . . . . . . . . . . . . . . . . . . . . . 16Aricept 23 mg . . . . . . . . . . . . . . . . . . . 16Aricept ODT . . . . . . . . . . . . . . . . . . . . . 16Arimidex . . . . . . . . . . . . . . . . . . . . . 11, 48Aristocort . . . . . . . . . . . . . . . . . . . . . . . 25Aristocort HP . . . . . . . . . . . . . . . . . . . . 25Arixtra . . . . . . . . . . . . . . . . . . . . . . . . . . 20Armour Thyroid . . . . . . . . . . . . . . . . . . . 30Aromasin . . . . . . . . . . . . . . . . . . . . . . . . 11Artane . . . . . . . . . . . . . . . . . . . . . . . . . . 15Arthrotec . . . . . . . . . . . . . . . . . . . . . . . . 36Asacol HD . . . . . . . . . . . . . . . . . . . . . . 34Ascensia Autodisc Test Strips . . . . . . 32Ascensia Breeze 2 Test Strips . . . . . . 32Asendin 50, 100 mg . . . . . . . . . . . . . . 17Asmanex . . . . . . . . . . . . . . . . . . . . . . . . 44Aspirin/Caffeine/Butalbital . . . . . . . . . 13Aspirin/Caffeine/Dihydrocodone . . . . 13Astagraf XL . . . . . . . . . . . . . . . . . . . . . 11Astelin . . . . . . . . . . . . . . . . . . . . . . . 43, 48Astepro . . . . . . . . . . . . . . . . . . . . . . . . . 43Atacand . . . . . . . . . . . . . . . . . . . . . . . . 23Atacand HCT . . . . . . . . . . . . . . . . . . . . 23Atarax . . . . . . . . . . . . . . . . . . . . . . . . . . 43Atelvia . . . . . . . . . . . . . . . . . . . . . . . . . . 37Atenolol . . . . . . . . . . . . . . . . . . . . . . . . . 21Ativan . . . . . . . . . . . . . . . . . . . . . . . 19, 48Atorvastatin . . . . . . . . . . . . . . . . . . 24, 48Atorvastatin Calcium . . . . . . . . . . . . . . 24Atovaquone . . . . . . . . . . . . . . . . . . 10, 48Atovaquone/Proguanil HCl . . . . . . . . . 10
Atovaquone Suspension . . . . . . . . . . . 48Atralin . . . . . . . . . . . . . . . . . . . . . . . . . . 26Atripla . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Atropine Sulfate . . . . . . . . . . . . . . . 33, 40Atrovent . . . . . . . . . . . . . . . . . . . . . . . . 44Atrovent HFA . . . . . . . . . . . . . . . . . . . . 44Atrovent Nasal Spray . . . . . . . . . . . . . 44Aubagio . . . . . . . . . . . . . . . . . . . . . . . . 16Augmentin Chewable Tablet, Tablet,
Suspension . . . . . . . . . . . . . . . . . . . . . 7Augmentin XR . . . . . . . . . . . . . . . . . . . . 7Auvi-Q . . . . . . . . . . . . . . . . . . . . . . . . . . 43Avalide . . . . . . . . . . . . . . . . . . . . . . . . . 23Avandamet . . . . . . . . . . . . . . . . . . . . . . 31Avandaryl . . . . . . . . . . . . . . . . . . . . . . . 31Avandia . . . . . . . . . . . . . . . . . . . . . . . . . 31Avapro . . . . . . . . . . . . . . . . . . . . . . . . . . 23AVC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Avelox . . . . . . . . . . . . . . . . . . . . . . . . 8, 48Avinza . . . . . . . . . . . . . . . . . . . . . . . 13, 48Avita . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Avita Gel . . . . . . . . . . . . . . . . . . . . . . . . 26Avodart . . . . . . . . . . . . . . . . . . . . . . . . . 45Avonex . . . . . . . . . . . . . . . . . . . . . . . . . 16Axert . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Axid Oral Solution . . . . . . . . . . . . . . . . 33Axiron . . . . . . . . . . . . . . . . . . . . . . . . . . 30Aygestin . . . . . . . . . . . . . . . . . . . . . . . . 38Azasan . . . . . . . . . . . . . . . . . . . . . . . . . 11Azasite . . . . . . . . . . . . . . . . . . . . . . . . . 41Azathioprine . . . . . . . . . . . . . . . . . . 11, 36Azelastine . . . . . . . . . . . . . . . . .42, 43, 48Azelastine HCl Drops . . . . . . . . . . . . . 42Azelastine Nasal Spray . . . . . . . . . . . . 48Azelex . . . . . . . . . . . . . . . . . . . . . . . . . . 26Azilect . . . . . . . . . . . . . . . . . . . . . . . . . . 15Azithromycin . . . . . . . . . . . . . . . . . . . . . . 7Azopt . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Azor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Azulfidine . . . . . . . . . . . . . . . . . . . . 34, 36BBacitracin/Polymyxin B Sulfate . . . . . 41Baclofen . . . . . . . . . . . . . . . . . . . . . . . . 37Bactrim . . . . . . . . . . . . . . . . . . . . . . . . . . 8Bactrim DS . . . . . . . . . . . . . . . . . . . . . . . 8Bactroban . . . . . . . . . . . . . . . . . . . . . . . 26Balsalazide Disodium . . . . . . . . . . . . . 34Banzel . . . . . . . . . . . . . . . . . . . . . . . . . . 16Baraclude . . . . . . . . . . . . . . . . . . . . . . . . 8Bebulin . . . . . . . . . . . . . . . . . . . . . . . . . 21Beconase AQ . . . . . . . . . . . . . . . . . . . 44Belladonna Alkaloids/Phenobarbital . 33Benazepril/Hydrochlorothiazide . . . . . 23Benazepril HCl . . . . . . . . . . . . . . . . . . . 22
BeneFix . . . . . . . . . . . . . . . . . . . . . . . . . 21Benemid . . . . . . . . . . . . . . . . . . . . . . . . 36Benicar . . . . . . . . . . . . . . . . . . . . . . . . . 23Benicar HCT . . . . . . . . . . . . . . . . . . . . 23Bentyl . . . . . . . . . . . . . . . . . . . . . . . . . . 33Benzaclin . . . . . . . . . . . . . . . . . . . . 26, 48Benzaclin 1%-5% . . . . . . . . . . . . . . . . 26Benzaclin Jar . . . . . . . . . . . . . . . . . . . . 48Benzamycin . . . . . . . . . . . . . . . . . . . . . 26Benztropine Mesylate . . . . . . . . . . . . . 15Bepreve . . . . . . . . . . . . . . . . . . . . . . . . 42Berinert . . . . . . . . . . . . . . . . . . . . . . . . . 43Betagan . . . . . . . . . . . . . . . . . . . . . . . . 40Betamethasone/Calcipotriene
Ointment . . . . . . . . . . . . . . . . . . . 27, 49Betamethasone Dipropionate/
Propylene Glycol Gel . . . . . . . . . . . . 25Betamethasone Dipropionate/
Propylene Glycol Lotion, Ointment . 25Betamethasone Dipropionate
Augmented, Lotion, Ointment . . . . . 25Betamethasone Dipropionate
Cream, Ointment . . . . . . . . . . . . . . . 25Betamethasone Dipropionate
Lotion . . . . . . . . . . . . . . . . . . . . . . . . . 25Betamethasone DP Augmented
Cream . . . . . . . . . . . . . . . . . . . . . . . . 25Betamethasone Valerate Cream,
Lotion . . . . . . . . . . . . . . . . . . . . . . . . . 25Betamethasone Valerate Foam . . . . . 25Betamethasone Valerate Ointment . . 25Betapace, Betapace AF . . . . . . . . . . . 20Betaseron . . . . . . . . . . . . . . . . . . . . . . . 16Betaxolol HCl . . . . . . . . . . . . . . . . . 21, 40Bethanechol Chloride . . . . . . . . . . . . . 45Bethkis . . . . . . . . . . . . . . . . . . . . . . . . . . 9Betimol . . . . . . . . . . . . . . . . . . . . . . . . . 40Betoptic . . . . . . . . . . . . . . . . . . . . . . . . 40Betoptic S . . . . . . . . . . . . . . . . . . . . . . 40Beyaz . . . . . . . . . . . . . . . . . . . . . . . . . . 38Biaxin . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Biaxin XL . . . . . . . . . . . . . . . . . . . . . . . . . 7Bicalutamide . . . . . . . . . . . . . . . . . . . . 11Bicitra . . . . . . . . . . . . . . . . . . . . . . . . . . 45BiDil . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Biltricide . . . . . . . . . . . . . . . . . . . . . . . . 10Binosto . . . . . . . . . . . . . . . . . . . . . . . . . 37Bisacodyl Tab & Peg 3350-KCL-Sod
Bicarb-NACL for Solution Kit . . . . . 34Bisoprolol Fumarate/
Hydrochlorothiazide . . . . . . . . . . . . . 23Bleph-10, Sodium Sulamyd . . . . . . . . 41Blephamide S .O .P . . . . . . . . . . . . . . . . 41Blephamide Suspension, Drops . . . . . 41
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2015 Prescription Drug List Medication Index
Boniva . . . . . . . . . . . . . . . . . . . . . . . . . . 37Bosulif . . . . . . . . . . . . . . . . . . . . . . . . . . 11Brand Prenatal Vitamins . . . . . . . . . . . 46Bravelle . . . . . . . . . . . . . . . . . . . . . . . . . 39Breo Ellipta . . . . . . . . . . . . . . . . . . . . . . 44Brethine . . . . . . . . . . . . . . . . . . . . . 39, 44Brilinta . . . . . . . . . . . . . . . . . . . . . . . . . . 20Brimonidine Tartrate 0 .15% . . . . . . . . 41Brisdelle . . . . . . . . . . . . . . . . . . . . . . . . 39Bromday . . . . . . . . . . . . . . . . . . . . . . . . 40Bromfed-DM . . . . . . . . . . . . . . . . . . . . 43Bromfenac Sodium . . . . . . . . . . . . . . . 40Bromocriptine Mesylate . . . . . . . . . . . 15Brovana . . . . . . . . . . . . . . . . . . . . . . . . 44Budesonide . . . . . . . . . . . . . . .34, 44, 48Budesonide Capsule,
Sustained-Release . . . . . . . . . . . . . . 34Budesonide Inhalation Suspension . . 44Bumetanide . . . . . . . . . . . . . . . . . . . . . 21Bumex . . . . . . . . . . . . . . . . . . . . . . . . . . 21Buphrenorphine HCl/Naloxone
HCl Tablet, Sublingual . . . . . . . . . . . 14Buphrenorphine Hydrochloride . . . . . 14Bupropion Extended-Release . . . . . . 49Bupropion HCl . . . . . . . . . . . . . . . . 17, 47Bupropion HCl Tablet,
Sustained-Action . . . . . . . . . . . . 17, 47Bupropion HCl Tablet,
Sustained-Release 24 Hour . . . . . . 17Buspar . . . . . . . . . . . . . . . . . . . . . . . . . 19Buspirone HCl . . . . . . . . . . . . . . . . . . . 19Butalbital/Acetaminophen/Caffeine/
Codeine Phosphate 50-325-40-30 mg . . . . . . . . . . . . . . 48
Butorphanol Tartrate Aerosol, Spray . 14Butrans . . . . . . . . . . . . . . . . . . . . . . . . . 13Bydureon . . . . . . . . . . . . . . . . . . . . . . . 31Byetta . . . . . . . . . . . . . . . . . . . . . . . . . . 31Bystolic . . . . . . . . . . . . . . . . . . . . . . . . . 21CCabergoline . . . . . . . . . . . . . . . . . . . . . 30Caduet . . . . . . . . . . . . . . . . . . . . . . . . . 24Cafergot . . . . . . . . . . . . . . . . . . . . . . . . 14Calan . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Calan SR . . . . . . . . . . . . . . . . . . . . . . . 22Calcipotriene Cream, Ointment . . . . . 27Calcipotriene Solution, Topical . . . . . . 27Calcitonin, Salmon, Synthetic
Nasal Spray . . . . . . . . . . . . . . . . 30, 37Calcitonin Salmon Nasal Spray . . 30, 37Calcitriol . . . . . . . . . . . . . . . . . . . . . . . . 30Calcitrol Ointment . . . . . . . . . . . . . . . . 27Calcium Acetate . . . . . . . . . . . . . . . . . 47Cambia . . . . . . . . . . . . . . . . . . . . . . . . . 36
Campral . . . . . . . . . . . . . . . . . . . . . . . . 47Canasa . . . . . . . . . . . . . . . . . . . . . . . . . 34Candesartan . . . . . . . . . . . . . . . . . . . . 23Candesartan/Hydrochlorothiazide . . . 23Cantil . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Capecitabine . . . . . . . . . . . . . . . . . . . . 11Capozide . . . . . . . . . . . . . . . . . . . . . . . 23Caprelsa . . . . . . . . . . . . . . . . . . . . . . . . 11Captopril/Hydrochlorothiazide . . . . . . 23Carafate . . . . . . . . . . . . . . . . . . . . . . . . 33Carafate Oral Suspension . . . . . . . . . 33Carbaglu . . . . . . . . . . . . . . . . . . . . . . . . 47Carbamazepine . . . . . . . . . . . . . . . 15, 16Carbamazepine Capsule,
Extended-Release Multiphase 12 Hour . . . . . . . . . . . . . . . . . . . . . . . 16
Carbamazepine Tablet, Sustained-Release 12 Hour . . . . . . 15
Carbatrol . . . . . . . . . . . . . . . . . . . . . . . . 16Carbidopa/Levodopa . . . . . . . . . . . . . 15Carbidopa/Levodopa/Entacapone . . 15Carbidopa/Levodopa Tablet,
Rapid Dissolve . . . . . . . . . . . . . . . . . 15Carbidopa/Levodopa Tablet,
Sustained-Action . . . . . . . . . . . . . . . 15Cardene . . . . . . . . . . . . . . . . . . . . . . . . 22Cardene SR . . . . . . . . . . . . . . . . . . . . . 22Cardizem . . . . . . . . . . . . . . . . . . . . . . . 22Cardizem CD . . . . . . . . . . . . . . . . . . . . 22Cardizem LA 120 mg . . . . . . . . . . . . . 22Cardizem LA 180, 240, 300,
360, 420 mg . . . . . . . . . . . . . . . . . . . 22Cardizem SR . . . . . . . . . . . . . . . . . . . . 22Cardura . . . . . . . . . . . . . . . . . . . . . . 22, 45Cardura XL . . . . . . . . . . . . . . . . . . . . . . 22Carisoprodol . . . . . . . . . . . . . . . . . . . . 37Carmol HC Cream . . . . . . . . . . . . . . . 28Carnitor . . . . . . . . . . . . . . . . . . . . . . . . . 47Carteolol HCl . . . . . . . . . . . . . . . . . . . . 40Carvedilol . . . . . . . . . . . . . . . . . . . . . . . 21Casodex . . . . . . . . . . . . . . . . . . . . . . . . 11Cataflam . . . . . . . . . . . . . . . . . . . . . . . . 36Catapres . . . . . . . . . . . . . . . . . . . . . . . . 22Catapres-TTS . . . . . . . . . . . . . . . . . . . 22Caverject . . . . . . . . . . . . . . . . . . . . . . . 45Cayston . . . . . . . . . . . . . . . . . . . . . . . . . 9Ceclor, Ceclor CD . . . . . . . . . . . . . . . . . 7Cedax . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Cefaclor . . . . . . . . . . . . . . . . . . . . . . . . . 7Cefadroxil Hydrate . . . . . . . . . . . . . . . . . 7Cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . . 7Cefditoren Pivoxil . . . . . . . . . . . . . . . . . . 7Cefpodoxime Tablet . . . . . . . . . . . . . . . . 7Cefprozil . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ceftin . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Ceftin Suspension . . . . . . . . . . . . . . . . . 7Cefuroxime Axetil Suspension,
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 7Cefzil . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Celebrex . . . . . . . . . . . . . . . . . . . . . . . . 36Celestone Oral Solution . . . . . . . . . . . 30Celexa . . . . . . . . . . . . . . . . . . . . . . . 18, 48CellCept . . . . . . . . . . . . . . . . . . . . . . . . 11Celontin . . . . . . . . . . . . . . . . . . . . . . . . 15Cenestin . . . . . . . . . . . . . . . . . . . . . . . . 39Centany . . . . . . . . . . . . . . . . . . . . . . . . 26Cephalexin Monohydrate . . . . . . . . . . . 7Cephulac . . . . . . . . . . . . . . . . . . . . . . . 34Cesamet . . . . . . . . . . . . . . . . . . . . . . . . 34Cetraxal . . . . . . . . . . . . . . . . . . . . . . . . 29Cetrotide . . . . . . . . . . . . . . . . . . . . 31, 39Cevimeline HCl . . . . . . . . . . . . . . . . . . 29Chantix . . . . . . . . . . . . . . . . . . . . . . . . . 47Chemet . . . . . . . . . . . . . . . . . . . . . . . . . 47Chloral Hydrate . . . . . . . . . . . . . . . . . . 17Chlordiazepoxide HCl . . . . . . . . . . . . . 19Chlorhexidine Gluconate . . . . . . . . . . 29Chloroquine Phosphate . . . . . . . . . . . 10Chlorothiazide Tablet . . . . . . . . . . . . . . 21Chlorpheniramine/Hydrocodone/
Pseudoephedrine . . . . . . . . . . . . 43, 49Chlorpheniramine/Hydrocodone
Pseudoephedrine . . . . . . . . . . . . 43, 49Chlorpromazine HCl Tablet . . . . . . . . 18Chlorzoxazone . . . . . . . . . . . . . . . . . . . 37Cholestyramine/Aspartame . . . . . . . . 24Cholestyramine/Sucrose . . . . . . . . . . 24Choline Fenofibrate . . . . . . . . . . . . . . . 24Chronulac . . . . . . . . . . . . . . . . . . . . . . . 34Cialis . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Ciclopirox Cream, Gel, Lotion . . . . . . 27Ciclopirox Shampoo . . . . . . . . . . . . . . 27Ciclopirox Solution, Non-Oral . . . . . . 27Cilostazol . . . . . . . . . . . . . . . . . . . . . . . 20Ciloxan . . . . . . . . . . . . . . . . . . . . . . . . . 41Ciloxan Ointment . . . . . . . . . . . . . . . . . 41Cimetidine Tablet, Liquid . . . . . . . . . . . 33Cimzia . . . . . . . . . . . . . . . . . . . . . . . . . . 36Cipro . . . . . . . . . . . . . . . . . . . . . . 8, 29, 48Cipro HC Suspension, Drops . . . . . . 29Cipro Suspension . . . . . . . . . . . . . . 8, 48Cipro XR . . . . . . . . . . . . . . . . . . . . . . . . . 8Ciprodex . . . . . . . . . . . . . . . . . . . . . . . . 29Ciprofloxacin HCl Drops . . . . . . . . . . . 41Ciprofloxacin Oral Suspension . . . . 8, 48Ciprofloxacin Tablet . . . . . . . . . . . . . . . . 8Ciprofloxacin Tablet,
Sustained-Release 24 Hour . . . . . . . 8
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2015 Prescription Drug List Medication Index
Citalopram . . . . . . . . . . . . . . . . . . . 18, 48Citalopram Hydrobromide . . . . . . . . . 18Citric Acid/Sodium Citrate . . . . . . . . . 45Claravis . . . . . . . . . . . . . . . . . . . . . . . . . 26Clarinex . . . . . . . . . . . . . . . . . . . . . . . . . 43Clarinex-D . . . . . . . . . . . . . . . . . . . . . . 43Clarithromycin Suspension . . . . . . . . . . 7Clarithromycin Sustained-Release
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 7Clarithromycin Tablet . . . . . . . . . . . . . . . 7Claritin . . . . . . . . . . . . . . . . . . . . . . . . . 43Claritin-D . . . . . . . . . . . . . . . . . . . . . . . 43Cleocin HCl 150, 300 mg . . . . . . . . . . 9Cleocin HCl 75 mg . . . . . . . . . . . . . . . . 9Cleocin Palmitate . . . . . . . . . . . . . . . . . 9Cleocin Phosphate . . . . . . . . . . . . . . . 39Cleocin T . . . . . . . . . . . . . . . . . . . . . . . 26Climara . . . . . . . . . . . . . . . . . . . . . . . . . 39Climara Pro . . . . . . . . . . . . . . . . . . . . . 39Clindagel . . . . . . . . . . . . . . . . . . . . . . . 26Clindamycin/Benzoyl Peroxide
1 .2-5% Gel . . . . . . . . . . . . . . . . . . . . 48Clindamycin 1%/Benzoyl Peroxide
5% Gel . . . . . . . . . . . . . . . . . . . . . . . 48Clindamycin HCl . . . . . . . . . . . . . . . . . . 9Clindamycin Palmitate HCl . . . . . . . . . . 9Clindamycin Phosphate/Benzoyl
Peroxide Gel . . . . . . . . . . . . . . . . . . . 26Clindamycin Phosphate/Benzoyl
Peroxide Gel 1 .2%-5% . . . . . . . . . . 26Clindamycin Phosphate Cream,
Solution, Swab . . . . . . . . . . . . . . . . . 26Clindamycin Phosphate Cream
w/Applicator . . . . . . . . . . . . . . . . . . . 39Clindamycin Phosphate Foam 1% . . . 26Clindamycin Phosphate Gel . . . . . . . . 26Clindamycin Phosphate Lotion . . . . . . 26Clindesse . . . . . . . . . . . . . . . . . . . . . . . 39Clinoril . . . . . . . . . . . . . . . . . . . . . . . . . . 36Clobetasol Propionate Cream . . . . . . 25Clobetasol Propionate Cream, Gel,
Ointment, Solution . . . . . . . . . . . . . . 25Clobetasol Propionate Foam . . . . . . . 25Clobetasol Propionate Lotion . . . . . . . 25Clobetasol Propionate Shampoo . . . . 25Clobex . . . . . . . . . . . . . . . . . . . . . . . . . . 25Clocortolone . . . . . . . . . . . . . . . . . 25, 48Clocortolone 0 .1% Cream . . . . . . . . . 48Cloderm . . . . . . . . . . . . . . . . . . . . . 25, 48Clomid . . . . . . . . . . . . . . . . . . . . . . . . . 39Clomiphene Citrate . . . . . . . . . . . . . . . 39Clomipramine HCl . . . . . . . . . . . . . . . . 17Clonazepam . . . . . . . . . . . . . . . . . . . . . 15Clonidine Extended-Release . . . . . . . 19
Clonidine HCl . . . . . . . . . . . . . . . . . . . 22Clonidine Patch, Transdermal
Weekly . . . . . . . . . . . . . . . . . . . . . . . . 22Clopidogrel . . . . . . . . . . . . . . . . . . . 20, 48Clopidogrel Bisulfate . . . . . . . . . . . . . . 20Clorpres . . . . . . . . . . . . . . . . . . . . . . . . 23Clotrimazole/Betamethasone
Dipropionate . . . . . . . . . . . . . . . . . . . 27Clotrimazole Troche . . . . . . . . . . . . . . . . 9Clozapine . . . . . . . . . . . . . . . . . . . . . . . 18Clozapine Orally Disintegrating
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 18Clozaril . . . . . . . . . . . . . . . . . . . . . . . . . 18Coartem . . . . . . . . . . . . . . . . . . . . . . . . 10Codeine/Promethazine HCl . . . . . . . . 43Codeine Phosphate/
Acetaminophen . . . . . . . . . . . . . . . . 13Codeine Phosphate/
Acetaminophen/Caffeine/ Butalbital 50-300-40-30 mg . . . . . 13
Codeine Phosphate/Aspirin/ Caffeine/Butalbital . . . . . . . . . . . . . . 13
Codeine Sulfate . . . . . . . . . . . . . . . . . . 13Cogentin . . . . . . . . . . . . . . . . . . . . . . . . 15Colazal . . . . . . . . . . . . . . . . . . . . . . . . . 34Colcrys . . . . . . . . . . . . . . . . . . . . . . . . . 36Colestid . . . . . . . . . . . . . . . . . . . . . . . . 24Colestipol HCl . . . . . . . . . . . . . . . . . . . 24Coly-Mycin S Suspension, Drops . . . 29Colyte . . . . . . . . . . . . . . . . . . . . . . . . . . 34Combigan . . . . . . . . . . . . . . . . . . . . . . . 40Combipatch . . . . . . . . . . . . . . . . . . . . . 39Combivent Respimat . . . . . . . . . . . . . . 44Combivir . . . . . . . . . . . . . . . . . . . . . . . . . 9Combunox . . . . . . . . . . . . . . . . . . . . . . 13Cometriq . . . . . . . . . . . . . . . . . . . . . . . . 11Compazine . . . . . . . . . . . . . . . . . . . . . . 34Complera . . . . . . . . . . . . . . . . . . . . . . . . 9Comtan . . . . . . . . . . . . . . . . . . . . . . . . . 15Concerta . . . . . . . . . . . . . . . . . . . . . . . 19Condylox Gel . . . . . . . . . . . . . . . . . . . . 28Condylox Liquid . . . . . . . . . . . . . . . . . . 28Contour Next Test Strips . . . . . . . . . . 32Contour Test Strips . . . . . . . . . . . . . . . 32Conzip . . . . . . . . . . . . . . . . . . . . . . . . . 14Copaxone . . . . . . . . . . . . . . . . . . . . . . . 16Copegus . . . . . . . . . . . . . . . . . . . . . . . . . 8Cordarone . . . . . . . . . . . . . . . . . . . . . . 20Cordran Lotion . . . . . . . . . . . . . . . . . . . 25Cordran Ointment . . . . . . . . . . . . . . . . 25Cordran SP Cream . . . . . . . . . . . . . . . 25Coreg . . . . . . . . . . . . . . . . . . . . . . . . . . 21Coreg CR . . . . . . . . . . . . . . . . . . . . . . . 21Corgard . . . . . . . . . . . . . . . . . . . . . . . . 21
Cortef . . . . . . . . . . . . . . . . . . . . . . . . . . 30Cortenema . . . . . . . . . . . . . . . . . . . . . . 34Cortifoam . . . . . . . . . . . . . . . . . . . . . . . 34Cortisporin . . . . . . . . . . . . . . . . . . . 29, 41Cortisporin-TC Suspension, Drops . . 29Corzide . . . . . . . . . . . . . . . . . . . . . . . . . 23Cosopt . . . . . . . . . . . . . . . . . . . . . . . . . 40Cosopt PF . . . . . . . . . . . . . . . . . . . . . . 40Coumadin . . . . . . . . . . . . . . . . . . . . . . . 20Cozaar . . . . . . . . . . . . . . . . . . . . . . 23, 48Creon . . . . . . . . . . . . . . . . . . . . . . . . . . 34Crestor . . . . . . . . . . . . . . . . . . . . . . . . . 24Crinone . . . . . . . . . . . . . . . . . . . . . . . . . 38Crixivan . . . . . . . . . . . . . . . . . . . . . . . . . . 9Crolom . . . . . . . . . . . . . . . . . . . . . . . . . 42Cromolyn Sodium . . . . . . . . . .34, 42, 44Cromolyn Sodium Ampul for
Nebulization . . . . . . . . . . . . . . . . . . . 44Cuprimine . . . . . . . . . . . . . . . . . . . . . . . 36Cutivate . . . . . . . . . . . . . . . . . . . . . . . . 25Cutivate Lotion . . . . . . . . . . . . . . . . . . . 25Cyclessa . . . . . . . . . . . . . . . . . . . . . . . . 38Cyclobenzaprine Capsule,
Extended-Release 24 Hour . . . . . . . 37Cyclobenzaprine HCl . . . . . . . . . . . . . 37Cyclocort . . . . . . . . . . . . . . . . . . . . . . . 25Cyclogyl 0 .5% . . . . . . . . . . . . . . . . . . . 40Cyclogyl 1%, 2% . . . . . . . . . . . . . . . . . 40Cyclopentolate HCl . . . . . . . . . . . . . . . 40Cyclophosphamide . . . . . . . . . . . . . . . 11Cyclosporine, Modified . . . . . . . . . . . . 11Cymbalta . . . . . . . . . . . . . . . . . . . . 17, 48Cyproheptadine HCl . . . . . . . . . . . . . . 43Cystagon . . . . . . . . . . . . . . . . . . . . . . . 45Cytomel . . . . . . . . . . . . . . . . . . . . . . . . 30Cytotec . . . . . . . . . . . . . . . . . . . . . . . . . 33Cytovene . . . . . . . . . . . . . . . . . . . . . . . . 8Cytoxan . . . . . . . . . . . . . . . . . . . . . . . . . 11DD-Amphetamine Capsule,
Extended-Release . . . . . . . . . . . . . . 19D-Amphetamine Sulfate Tablet,
Capsule, . . . . . . . . . . . . . . . . . . . . . . 19D .H .E .45 . . . . . . . . . . . . . . . . . . . . . . . . 14Daliresp . . . . . . . . . . . . . . . . . . . . . . . . 44Dalmane . . . . . . . . . . . . . . . . . . . . . . . . 17Danazol . . . . . . . . . . . . . . . . . . . . . . . . . 30Danocrine . . . . . . . . . . . . . . . . . . . . . . . 30Dantrium . . . . . . . . . . . . . . . . . . . . . . . . 37Dantrolene Sodium . . . . . . . . . . . . . . . 37Dapsone . . . . . . . . . . . . . . . . . . . . . . . . . 9Daraprim . . . . . . . . . . . . . . . . . . . . . . . . 10Daypro . . . . . . . . . . . . . . . . . . . . . . . . . 36Daytrana . . . . . . . . . . . . . . . . . . . . . . . . 19
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2015 Prescription Drug List Medication Index
DDAVP . . . . . . . . . . . . . . . . . . . . . . . . . 30Decadron . . . . . . . . . . . . . . . . . . . . . . . 30Delzicol . . . . . . . . . . . . . . . . . . . . . . . . . 34Demerol . . . . . . . . . . . . . . . . . . . . . . . . 13Demulen . . . . . . . . . . . . . . . . . . . . . . . . 38Denavir . . . . . . . . . . . . . . . . . . . . . . . . . 27Depakene . . . . . . . . . . . . . . . . . . . . . . . 15Depakote . . . . . . . . . . . . . . . . . . . . 15, 16Depakote ER . . . . . . . . . . . . . . . . . 15, 16Depakote Sprinkle . . . . . . . . . . . . . . . . 15Depo-Provera 150 mg/ml . . . . . . . . . . 38Depo-SubQ Provera . . . . . . . . . . . . . . 38Derma-Smoothe/FS . . . . . . . . . . . . . . 25Dermatop . . . . . . . . . . . . . . . . . . . . . . . 25Desipramine HCl . . . . . . . . . . . . . . . . . 17Desloratadine . . . . . . . . . . . . . . . . . . . . 43Desmopressin Acetate . . . . . . . . . . . . 30Desogen . . . . . . . . . . . . . . . . . . . . . . . . 38Desogestrel-Ethinyl Estradiol . . . . . . . 38Desogestrel-Ethinyl Estradiol/
Ethinyl Estradiol . . . . . . . . . . . . . . . . 38Desonate . . . . . . . . . . . . . . . . . . . . . . . 25Desonide Cream, Ointment, Lotion . . 25DesOwen . . . . . . . . . . . . . . . . . . . . . . . 25Desoximetasone Cream . . . . . . . . . . . 25Desoximetasone Gel, Ointment . . . . . 25Desoxyn . . . . . . . . . . . . . . . . . . . . . . . . 19Desvenlafaxine . . . . . . . . . . . . . . . . . . . 17Desyrel . . . . . . . . . . . . . . . . . . . . . . . . . 17Detrol . . . . . . . . . . . . . . . . . . . . . . . . . . 45Detrol LA . . . . . . . . . . . . . . . . . . . . . . . 45Dexamethasone . . . . . . . . . . . . . . . 30, 41Dexedrine . . . . . . . . . . . . . . . . . . . . . . . 19Dexilant . . . . . . . . . . . . . . . . . . . . . . 33, 48Dexmethylphenidate
Extended-Release . . . . . . . . . . . . . . 19Dextromethorphan HBr/
Pseudoephedrine HCl/Brompheniramine . . . . . . . . . . . . . . . 43
DiaBeta . . . . . . . . . . . . . . . . . . . . . . . . . 31Diamox . . . . . . . . . . . . . . . . . . . . . . . . . 40Diamox Sequel . . . . . . . . . . . . . . . . . . . 40Diastat Acudial . . . . . . . . . . . . . . . . . . . 15Diazepam . . . . . . . . . . . . . 15, 19, 37, 49Diazepam, Rectal . . . . . . . . . . . . . . . . . 15Dibenzyline . . . . . . . . . . . . . . . . . . . . . . 22Diclegis . . . . . . . . . . . . . . . . . . . . . . . . . 39Diclofenac 3% Gel . . . . . . . . . . . . . . . 28Diclofenac Potassium . . . . . . . . . . . . . 36Diclofenac Sodium . . . . . . . . . . . . 36, 40Diclofenac Sodium/Misoprostol . . . . . 36Diclofenac Sodium Tablet,
Sustained-Release 24 Hour . . . . . . 36Diclofenac Topical Solution . . . . . . . . 36
Dicloxacillin Sodium Capsule . . . . . . . . 7Dicyclomine HCl Tablet . . . . . . . . . . . . 33Didanosine Capsule, Enteric-Coated . 9Didronel . . . . . . . . . . . . . . . . . . . . . . . . 47Differin Cream, Gel 0 .1% . . . . . . . . . . 26Differin Gel 0 .3% . . . . . . . . . . . . . . . . . 26Differin Lotion . . . . . . . . . . . . . . . . . . . . 26Dificid . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Diflorasone Diacetate Cream . . . . . . . 25Diflorasone Diacetate Ointment . . . . . 25Diflucan . . . . . . . . . . . . . . . . . . . . . . . 9, 39Diflucan 150 mg . . . . . . . . . . . . . . . . . 39Digoxin . . . . . . . . . . . . . . . . . . . . . . . . . 20Dihydroergotamine Mesylate . . . . . . . 14Dihydroergotamine Mesylate Aerosol,
Spray with Pump . . . . . . . . . . . . . . . 14Dilacor XR . . . . . . . . . . . . . . . . . . . . . . 22Dilantin . . . . . . . . . . . . . . . . . . . . . . . . . 15Dilatrate-SR . . . . . . . . . . . . . . . . . . . . . 20Dilaudid . . . . . . . . . . . . . . . . . . . . . . . . . 13Diltiazem HCl . . . . . . . . . . . . . . . . . . . . 22Diltiazem HCl Capsule,
Controlled-Release . . . . . . . . . . . . . 22Diltiazem HCl Capsule,
Sustained-Action . . . . . . . . . . . . . . . 22Diltiazem HCl Capsule,
Sustained-Release 12 Hour . . . . . . 22Diltiazem HCl Capsule,
Sustained-Release 24 Hour . . . . . . 22Diltiazem HCl Tablet,
Sustained-Release 24 Hour . . . . . . 22Diovan . . . . . . . . . . . . . . . . . . . . . . . 23, 48Diovan HCT . . . . . . . . . . . . . . . . . . 23, 48Dipentum . . . . . . . . . . . . . . . . . . . . . . . 34Diphenoxylate HCl/Atropine Sulfate . 33Diprolene . . . . . . . . . . . . . . . . . . . . . . . 25Diprolene AF Cream . . . . . . . . . . . . . . 25Diprosone . . . . . . . . . . . . . . . . . . . . . . . 25Diprosone, Maxivate . . . . . . . . . . . . . . 25Dipyridamole . . . . . . . . . . . . . . . . . . . . 20Disopyramide Phosphate Capsule . . 20Disulfiram . . . . . . . . . . . . . . . . . . . . . . . 47Ditropan . . . . . . . . . . . . . . . . . . . . . . . . 45Ditropan XL . . . . . . . . . . . . . . . . . . . . . 45Diuril . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Diuril 250 mg/5 ml . . . . . . . . . . . . . . . . 21Divalproex Sodium . . . . . . . . . . . . . . . . 15Divalproex Sodium Tablet . . . . . . . . . . 15Divalproex Sodium Tablet,
Sustained-Release . . . . . . . . . . . . . . 15Divigel . . . . . . . . . . . . . . . . . . . . . . . . . . 39Dolophine HCl . . . . . . . . . . . . . . . . . . . 13Donepezil 23 mg . . . . . . . . . . . . . . . . . 16Donepezil HCl Tablet . . . . . . . . . . . . . 16
Donepezil HCl Tablet, Rapid Dissolve . . . . . . . . . . . . . . . . . 16
Donnatal . . . . . . . . . . . . . . . . . . . . . . . . 33Donnatal Tablet, Sustained-Action . . 33Doryx . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Dorzolamide HCl . . . . . . . . . . . . . . . . . 40Dorzolamide HCl/Timolol Maleate . . . 40Dostinex . . . . . . . . . . . . . . . . . . . . . . . . 30Dovonex . . . . . . . . . . . . . . . . . . . . . . . . 27Doxazosin Mesylate . . . . . . . . . . . . 22, 45Doxepin Cream . . . . . . . . . . . . . . . . . . 28Doxepin HCl . . . . . . . . . . . . . . . . . . . . . 17Doxercalciferol . . . . . . . . . . . . . . . . . . . 30Doxycycline Hyclate . . . . . . . . . . . . . 7, 48Doxycycline Hyclate
50, 75, 100, 150 mg . . . . . . . . . . . . . 7Doxycycline Hyclate Tablet 20 mg . . . . 7Doxycycline Hyclate Tablet,
Enteric-Coated . . . . . . . . . . . . . . . . . . 7Doxycycline Monohydrate . . . . . . . . 7, 48Doxycycline Monohydrate
50, 100 mg Capsule . . . . . . . . . . . . . 7Doxycycline Monohydrate
75 mg Capsule . . . . . . . . . . . . . . . . . . 7Doxycycline Monohydrate Capsule . . . 7Doxycycline Monohydrate Tablet . . . . 48Dronabinol . . . . . . . . . . . . . . . . . . . . . . 34Droxia . . . . . . . . . . . . . . . . . . . . . . . . . . 11Duac . . . . . . . . . . . . . . . . . . . . . . . . 26, 48Duetact . . . . . . . . . . . . . . . . . . . . . . . . . 31Duexis . . . . . . . . . . . . . . . . . . . . . . . . . . 36Dulera . . . . . . . . . . . . . . . . . . . . . . . . . . 44Duloxetine . . . . . . . . . . . . . . . . . . . . 17, 48Duoneb . . . . . . . . . . . . . . . . . . . . . . . . . 44Duragesic . . . . . . . . . . . . . . . . . . . . 13, 48Durezol . . . . . . . . . . . . . . . . . . . . . . . . . 41Duricef . . . . . . . . . . . . . . . . . . . . . . . . . . 7Dutoprol . . . . . . . . . . . . . . . . . . . . . . . . 23Dyazide . . . . . . . . . . . . . . . . . . . . . . . . . 21Dymista . . . . . . . . . . . . . . . . . . . . . . . . . 44Dynacin . . . . . . . . . . . . . . . . . . . . . . . . . . 7Dynapen . . . . . . . . . . . . . . . . . . . . . . . . . 7Dyrenium . . . . . . . . . . . . . . . . . . . . . . . 21EE-Mycin . . . . . . . . . . . . . . . . . . . . . . . . . . 7E .E .S . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7EC-Naprosyn . . . . . . . . . . . . . . . . . . . . 36Econazole Nitrate . . . . . . . . . . . . . . . . . 27Edarbi . . . . . . . . . . . . . . . . . . . . . . . . . . 23Edarbyclor . . . . . . . . . . . . . . . . . . . . . . 23Edecrin . . . . . . . . . . . . . . . . . . . . . . . . . 21Edex . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Edluar . . . . . . . . . . . . . . . . . . . . . . . . . . 17Edurant . . . . . . . . . . . . . . . . . . . . . . . . . . 9
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2015 Prescription Drug List Medication Index
Effexor XR . . . . . . . . . . . . . . . . . . . 17, 48Effient . . . . . . . . . . . . . . . . . . . . . . . . . . 20Efudex . . . . . . . . . . . . . . . . . . . . . . . . . . 28Egrifta . . . . . . . . . . . . . . . . . . . . . . . . . . 35Elavil . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Eldepryl . . . . . . . . . . . . . . . . . . . . . . . . . 15Elestat . . . . . . . . . . . . . . . . . . . . . . . . . . 42Elestrin . . . . . . . . . . . . . . . . . . . . . . . . . 39Elidel . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Elimite . . . . . . . . . . . . . . . . . . . . . . . 27, 48Eliquis . . . . . . . . . . . . . . . . . . . . . . . . . . 20Elixophyllin Elixir . . . . . . . . . . . . . . . . . . 44Elmiron . . . . . . . . . . . . . . . . . . . . . . . . . 45Elocon . . . . . . . . . . . . . . . . . . . . . . . 25, 48Emadine . . . . . . . . . . . . . . . . . . . . . . . . 42Emcyt . . . . . . . . . . . . . . . . . . . . . . . . . . 11Emend . . . . . . . . . . . . . . . . . . . . . . . . . . 34Emgel . . . . . . . . . . . . . . . . . . . . . . . . . . 26Emla . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Emsam . . . . . . . . . . . . . . . . . . . . . . . . . 17Emtriva . . . . . . . . . . . . . . . . . . . . . . . . . . 9Enablex . . . . . . . . . . . . . . . . . . . . . . . . . 45Enalapril Maleate . . . . . . . . . . . . . . 22, 23Enalapril Maleate/
Hydrochlorothiazide . . . . . . . . . . . . . 23Enbrel . . . . . . . . . . . . . . . . . . . . . . . . . . 36Endometrin . . . . . . . . . . . . . . . . . . . . . . 38Enjuvia . . . . . . . . . . . . . . . . . . . . . . . . . . 39Enoxaparin . . . . . . . . . . . . . . . . . . . . . . 20Entacapone . . . . . . . . . . . . . . . . . . . . . 15Entecavir . . . . . . . . . . . . . . . . . . . . . . . . . 8Entocort EC . . . . . . . . . . . . . . . . . . 34, 48Epaned . . . . . . . . . . . . . . . . . . . . . . . . . 22Epiduo . . . . . . . . . . . . . . . . . . . . . . . . . 26Epinastine HCl Drops . . . . . . . . . . . . . 42Epipen . . . . . . . . . . . . . . . . . . . . . . . . . . 43Epipen Jr . . . . . . . . . . . . . . . . . . . . . . . . 43Epivir . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9Epivir HBV . . . . . . . . . . . . . . . . . . . . . . . 8Eplerenone . . . . . . . . . . . . . . . . . . . . . . 21Epogen . . . . . . . . . . . . . . . . . . . . . . . . . 35Eprosartan Hydrochloride . . . . . . . . . . 23Epzicom . . . . . . . . . . . . . . . . . . . . . . . . . 9Equetro . . . . . . . . . . . . . . . . . . . . . . . . . 16Ergomar . . . . . . . . . . . . . . . . . . . . . . . . 14Erivedge . . . . . . . . . . . . . . . . . . . . . . . . 11Ertaczo . . . . . . . . . . . . . . . . . . . . . . . . . 27Ery-Tab . . . . . . . . . . . . . . . . . . . . . . . . . . 7Eryc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Erycette . . . . . . . . . . . . . . . . . . . . . . . . 26Erygel . . . . . . . . . . . . . . . . . . . . . . . . . . 26Erythromycin Base . . . . . . . . . . . 7, 26, 41Erythromycin Base/Benzoyl
Peroxide . . . . . . . . . . . . . . . . . . . . . . . 26
Erythromycin Base/Ethyl Alcohol . . . . 26Erythromycin Base/Ethyl Alcohol
Swab, Medicated . . . . . . . . . . . . . . . 26Erythromycin Base Capsule,
Delayed-Release . . . . . . . . . . . . . . . . 7Erythromycin Base Tablet,
Enteric-Coated 250, 333 mg . . . . . . 7Erythromycin Ethylsuccinate . . . . . . . . . 7Erythromycin Ethylsuccinate/
Sulfisoxazole Acetyl . . . . . . . . . . . . . . 7Escitalopram . . . . . . . . . . . . . . . . . 18, 48Escitalopram Solution, Oral . . . . . . . . 18Escitalopram Tablet . . . . . . . . . . . . . . . 18Eskalith . . . . . . . . . . . . . . . . . . . . . . . . . 19Eskalith CR . . . . . . . . . . . . . . . . . . . . . 19Estrace . . . . . . . . . . . . . . . . . . . . . . . . . 39Estrace Cream with Applicator . . . . . 39Estradiol . . . . . . . . . . . . . . . . . .38, 39, 48Estradiol/Norethindrone Acetate . . . . 39Estradiol/Norgestimate . . . . . . . . . . . . 39Estradiol Patch, Transdermal
Weekly . . . . . . . . . . . . . . . . . . . . . . . . 39Estrasorb . . . . . . . . . . . . . . . . . . . . . . . 39Estring . . . . . . . . . . . . . . . . . . . . . . . . . . 39Estrogel . . . . . . . . . . . . . . . . . . . . . . . . 39Estropipate Tablet . . . . . . . . . . . . . . . . 39Estrostep Fe . . . . . . . . . . . . . . . . . . . . . 38Eszopiclone . . . . . . . . . . . . . . . . . . 17, 48Ethambutol HCl . . . . . . . . . . . . . . . . . . 10Ethinyl Estradiol/Desogestrel . . . . . . . 38Ethinyl Estradiol/Drospirenone . . . . . . 38Ethosuximide . . . . . . . . . . . . . . . . . . . . 15Ethynodiol D-Ethinyl Estradiol . . . . . . 38Etidronate Disodium . . . . . . . . . . . . . . 47Etodolac . . . . . . . . . . . . . . . . . . . . . . . . 36Etodolac Tablet, Sustained-Release
24 Hour . . . . . . . . . . . . . . . . . . . . . . . 36Etoposide . . . . . . . . . . . . . . . . . . . . . . . 11Eulexin . . . . . . . . . . . . . . . . . . . . . . . . . . 11Eurax . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Evamist . . . . . . . . . . . . . . . . . . . . . . . . . 39Evista . . . . . . . . . . . . . . . . . . . . . . . 37, 48Evoclin . . . . . . . . . . . . . . . . . . . . . . . . . 26Evoxac . . . . . . . . . . . . . . . . . . . . . . . . . 29Exalgo . . . . . . . . . . . . . . . . . . . . . . . . . . 13Exelderm . . . . . . . . . . . . . . . . . . . . . . . . 27Exelon . . . . . . . . . . . . . . . . . . . . . . . . . . 16Exelon Solution . . . . . . . . . . . . . . . . . . 16Exemestane . . . . . . . . . . . . . . . . . . . . . 11Exforge . . . . . . . . . . . . . . . . . . . . . . . . . 23Exforge HCT . . . . . . . . . . . . . . . . . . . . 23Exjade . . . . . . . . . . . . . . . . . . . . . . . . . . 47Extavia . . . . . . . . . . . . . . . . . . . . . . . . . . 16Extina . . . . . . . . . . . . . . . . . . . . . . . . . . 27
FFabior . . . . . . . . . . . . . . . . . . . . . . . . . . 26Factive . . . . . . . . . . . . . . . . . . . . . . . . . . 8Famciclovir . . . . . . . . . . . . . . . . . . . . . . . 8Famotidine Suspension, Oral . . . . . . . 33Famvir . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Fanapt . . . . . . . . . . . . . . . . . . . . . . . . . . 18Fareston . . . . . . . . . . . . . . . . . . . . . . . . 11Farxiga . . . . . . . . . . . . . . . . . . . . . . . . . 31FazaClo . . . . . . . . . . . . . . . . . . . . . . . . . 18Feiba . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Felbamate . . . . . . . . . . . . . . . . . . . . . . . 15Felbatol . . . . . . . . . . . . . . . . . . . . . . . . . 15Feldene . . . . . . . . . . . . . . . . . . . . . . . . . 36Felodipine . . . . . . . . . . . . . . . . . . . . . . . 22Femara . . . . . . . . . . . . . . . . . . . . . . 11, 48Femcon Fe . . . . . . . . . . . . . . . . . . . . . . 38Femhrt . . . . . . . . . . . . . . . . . . . . . . . . . . 39Femring . . . . . . . . . . . . . . . . . . . . . . . . . 39Fenofibrate 50, 150 mg . . . . . . . . . . . 24Fenofibrate 54, 160 mg . . . . . . . . 24, 48Fenofibrate 67, 134, 200 mg . . . . . . . 24Fenofibrate Micronized 43, 130 mg . 24Fenofibrate Nanocrystallized
48, 145 mg . . . . . . . . . . . . . . . . . . . . 24Fenofibric Acid . . . . . . . . . . . . . . . . . . . 24Fenoglide . . . . . . . . . . . . . . . . . . . . . . . 24Fentanyl Citrate Lollipop . . . . . . . . . . . 13Fentanyl Lozenge . . . . . . . . . . . . . . . . . 48Fentanyl Transdermal . . . . . . . . . . . 13, 48Fentanyl Transdermal Patch . . . . . . . . 48Fentora . . . . . . . . . . . . . . . . . . . . . . . . . 13Ferriprox . . . . . . . . . . . . . . . . . . . . . . . . 47Fibricor . . . . . . . . . . . . . . . . . . . . . . . . . 24Finacea . . . . . . . . . . . . . . . . . . . . . . . . . 26Finasteride . . . . . . . . . . . . . . . . . . . . . . 45Fioricet . . . . . . . . . . . . . . . . . . . . . . 13, 48Fioricet w/Codeine . . . . . . . . . . . . . . . 13Fioricet with Codeine . . . . . . . . . . . . . 48Fioricet with Codeine
50-325-40-30 mg . . . . . . . . . . . . . . 48Fiorinal . . . . . . . . . . . . . . . . . . . . . . . . . 13Fiorinal w/Codeine 30 mg . . . . . . . . . 13Firazyr . . . . . . . . . . . . . . . . . . . . . . . . . . 43Flagyl . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Flagyl ER Tablet . . . . . . . . . . . . . . . . . . 10Flecainide Acetate . . . . . . . . . . . . . . . . 20Flector . . . . . . . . . . . . . . . . . . . . . . . . . . 36Flexeril . . . . . . . . . . . . . . . . . . . . . . . . . . 37Flo-Pred . . . . . . . . . . . . . . . . . . . . . . . . 30Flomax . . . . . . . . . . . . . . . . . . . . . . . 45, 48Flonase . . . . . . . . . . . . . . . . . . . . . . . . . 44Florinef Acetate . . . . . . . . . . . . . . . . . . 30Florone . . . . . . . . . . . . . . . . . . . . . . . . . 25
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2015 Prescription Drug List Medication Index
Flovent Diskus . . . . . . . . . . . . . . . . . . . 44Flovent HFA . . . . . . . . . . . . . . . . . . . . . 44Floxin . . . . . . . . . . . . . . . . . . . . . . . . . 8, 29Floxin Otic . . . . . . . . . . . . . . . . . . . . . . 29Flucinolone Acetonide Ointment . . . . 25Flucinonide 0 .1% Cream . . . . . . . . . . 25Fluconazole . . . . . . . . . . . . . . . . . . . 9, 39Flucytosine . . . . . . . . . . . . . . . . . . . . . . . 9Fludrocortisone Acetate . . . . . . . . . . . 30Flumadine . . . . . . . . . . . . . . . . . . . . . . . . 8Flunisolide . . . . . . . . . . . . . . . . . . . . . . 44Fluocinolone Acetonide Body Oil . . . 25Fluocinolone Acetonide Cream . . . . . 25Fluocinolone Acetonide Scalp Oil . . . 25Fluocinolone Acetonide Solution
Non-Oral . . . . . . . . . . . . . . . . . . . . . . 25Fluocinonide Cream, Gel, Ointment,
Solution, Non-Oral . . . . . . . . . . . . . . 25Fluoride Ion/Iron/Multivitamins . . . . . . 46Fluoride Ion/Iron/Vitamins
A,C, and D . . . . . . . . . . . . . . . . . . . . 46Fluoride Ion/Multivitamins . . . . . . . . . . 46Fluoride Ion/Vitamins A,C, and D . . . . 46Fluorometholone . . . . . . . . . . . . . . . . . 41Fluorouracil . . . . . . . . . . . . . . . . . . . . . . 28Fluoxetine . . . . . . . . . . . . . . . . . . . . 18, 49Fluoxetine Capsule, Delayed-Release 18Fluoxetine HCl Capsule . . . . . . . . . . . 18Fluoxetine HCl Tablet . . . . . . . . . . . . . 18Fluphenazine HCl . . . . . . . . . . . . . . . . 18Flurazepam HCl . . . . . . . . . . . . . . . . . . 17Flurbiprofen . . . . . . . . . . . . . . . . . . 36, 40Flurbiprofen Sodium . . . . . . . . . . . . . . 40Flutamide . . . . . . . . . . . . . . . . . . . . . . . 11Fluticasone Propionate . . . . . . . . . 25, 44Fluticasone Propionate Cream,
Ointment . . . . . . . . . . . . . . . . . . . . . . 25Fluvastatin Sodium . . . . . . . . . . . . . . . 24Fluvoxamine Maleate . . . . . . . . . . . . . . 18Fluvoxamine Maleate Capsule,
Extended-Release 24 Hour . . . . . . . 18FML . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41FML Forte . . . . . . . . . . . . . . . . . . . . . . . 41Focalin XR . . . . . . . . . . . . . . . . . . . . . . 19Follistim AQ . . . . . . . . . . . . . . . . . . . . . 39Fondaparinux Sodium . . . . . . . . . . . . . 20Foradil . . . . . . . . . . . . . . . . . . . . . . . . . . 44Forfivo XL . . . . . . . . . . . . . . . . . . . . . . . 17Fortamet . . . . . . . . . . . . . . . . . . . . . . . . 31Forteo . . . . . . . . . . . . . . . . . . . . . . . . . . 37Fortesta . . . . . . . . . . . . . . . . . . . . . . . . . 30Fortical . . . . . . . . . . . . . . . . . . . . . . 30, 37Fosamax . . . . . . . . . . . . . . . . . . . . . . . . 37Fosamax Plus D . . . . . . . . . . . . . . . . . . 37
Fosrenol . . . . . . . . . . . . . . . . . . . . . . . . 47Fragmin . . . . . . . . . . . . . . . . . . . . . . . . . 20Freestyle Insulinx . . . . . . . . . . . . . . . . . 32Freestyle Lite Test Strips . . . . . . . . . . . 32Freestyle Test Strips . . . . . . . . . . . . . . 32Frova . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Fulyzaq . . . . . . . . . . . . . . . . . . . . . . . . . 33Furadantin . . . . . . . . . . . . . . . . . . . . . . . . 8Furosemide . . . . . . . . . . . . . . . . . . . . . . 21Fuzeon . . . . . . . . . . . . . . . . . . . . . . . . . . 9Fycompa . . . . . . . . . . . . . . . . . . . . . . . . 16GGabapentin . . . . . . . . . . . . . . . . . . . . . 15Gabitril . . . . . . . . . . . . . . . . . . . . . . . . . 15Galantamine Capsule 24 Hour
Sustained-Release Pellets . . . . . . . 16Galantamine Tablet, Solution . . . . . . . 16Ganciclovir . . . . . . . . . . . . . . . . . . . . . . . 8Ganirelix Acetate . . . . . . . . . . . . . . . . . 31Garamycin . . . . . . . . . . . . . . . . . . . 26, 41Gastrocrom . . . . . . . . . . . . . . . . . . . . . 34Gatifloxacin . . . . . . . . . . . . . . . . . . . . . . 41Gelnique . . . . . . . . . . . . . . . . . . . . . . . . 45Gemfibrozil . . . . . . . . . . . . . . . . . . . . . . 24Generess Fe . . . . . . . . . . . . . . . . . . . . . 38generic Actonel . . . . . . . . . . . . . . . . . . 37generic Zymaxid . . . . . . . . . . . . . . . . . . 41Gengraf . . . . . . . . . . . . . . . . . . . . . . . . 11Genotropin . . . . . . . . . . . . . . . . . . . . . . 35Gentamicin Sulfate . . . . . . . . . . . . 26, 41Geodon . . . . . . . . . . . . . . . . . . . . . 18, 48Gilenya . . . . . . . . . . . . . . . . . . . . . . . . . 16Gleevec . . . . . . . . . . . . . . . . . . . . . . . . 11Glimepiride . . . . . . . . . . . . . . . . . . . . . . 31Glipizide . . . . . . . . . . . . . . . . . . . . . . . . 31Glipizide/Metformin HCl . . . . . . . . . . . 31Glipizide Tablet, Osmotic
Laser-Drilled Formulation . . . . . . . . 31Glucagen . . . . . . . . . . . . . . . . . . . . . . . 32Glucagon . . . . . . . . . . . . . . . . . . . . . . . 32Glucagon, Human Recombinant . . . . 32Glucagon Emergency Kit . . . . . . . . . . 32Glucagon Kit . . . . . . . . . . . . . . . . . . . . 32Glucophage . . . . . . . . . . . . . . . . . . . . . 31Glucophage XR . . . . . . . . . . . . . . . . . . 31Glucotrol . . . . . . . . . . . . . . . . . . . . . . . . 31Glucotrol XL . . . . . . . . . . . . . . . . . . . . . 31Glucovance . . . . . . . . . . . . . . . . . . . . . 31Glumetza . . . . . . . . . . . . . . . . . . . . . . . 31Glyburide . . . . . . . . . . . . . . . . . . . . . . . 31Glyburide/Metformin HCl . . . . . . . . . . 31Glyburide, Micronized . . . . . . . . . . . . . 31Glycate . . . . . . . . . . . . . . . . . . . . . . . . . 29Glycolax . . . . . . . . . . . . . . . . . . . . . . . . 34
Glycopyrrolate . . . . . . . . . . . . . . . . . . . 33Glynase . . . . . . . . . . . . . . . . . . . . . . . . . 31Glyset . . . . . . . . . . . . . . . . . . . . . . . . . . 31GoLYTELY . . . . . . . . . . . . . . . . . . . . . . 34Gonal-F . . . . . . . . . . . . . . . . . . . . . . . . . 39Gonal-F RFF . . . . . . . . . . . . . . . . . . . . 39Gralise . . . . . . . . . . . . . . . . . . . . . . . . . 16Granisetron HCl Tablet . . . . . . . . . . . . 34Grastek . . . . . . . . . . . . . . . . . . . . . . . . . 43Grifulvin V . . . . . . . . . . . . . . . . . . . . . . . . 9Gris-Peg . . . . . . . . . . . . . . . . . . . . . . . . . 9Griseofulvin Microsize . . . . . . . . . . . . . . 9Griseofulvin Ultramicrosize . . . . . . . . . . 9Guaifenesin/Codeine Phosphate . . . . 43Guaifenesin/Pseudoephedrine
HCl/Codeine . . . . . . . . . . . . . . . . . . 43Guanfacine HCl . . . . . . . . . . . . . . . . . . 22Gynazole-1 . . . . . . . . . . . . . . . . . . . . . . 39HHabitrol . . . . . . . . . . . . . . . . . . . . . . . . . 47Halcion . . . . . . . . . . . . . . . . . . . . . . . . . 17Haldol . . . . . . . . . . . . . . . . . . . . . . . . . . 18Halflytely . . . . . . . . . . . . . . . . . . . . . . . . 34Halobetasol Propionate Cream,
Ointment . . . . . . . . . . . . . . . . . . . . . . 25Halog Cream, Ointment . . . . . . . . . . . 25Haloperidol . . . . . . . . . . . . . . . . . . . . . . 18Haloperidol Lactate Concentrate,
Oral . . . . . . . . . . . . . . . . . . . . . . . . . . 18Hectorol . . . . . . . . . . . . . . . . . . . . . . . . 30Helidac . . . . . . . . . . . . . . . . . . . . . . . . . 33Helixate FS . . . . . . . . . . . . . . . . . . . . . . 21Hemofil-M . . . . . . . . . . . . . . . . . . . . . . . 21Heparin . . . . . . . . . . . . . . . . . . . . . . . . . 20Heparin Sodium . . . . . . . . . . . . . . . . . . 20Hepsera . . . . . . . . . . . . . . . . . . . . . . . . . 8Hexalen . . . . . . . . . . . . . . . . . . . . . . . . . 11Homatropine HBr . . . . . . . . . . . . . . . . 40Horizant . . . . . . . . . . . . . . . . . . . . . . . . 16Humalog KwikPen . . . . . . . . . . . . . . . . 31Humalog Mix 50-50 Vial . . . . . . . . . . . 31Humalog Mix 50/50 KwikPen . . . . . . . 31Humalog Mix 75-25 Vial . . . . . . . . . . . 31Humalog Mix 75/25 KwikPen . . . . . . . 31Humalog Vial . . . . . . . . . . . . . . . . . . . . 31Humate-P . . . . . . . . . . . . . . . . . . . . . . . 21Humatin . . . . . . . . . . . . . . . . . . . . . . . . 10Humatrope . . . . . . . . . . . . . . . . . . . . . . 35Humira . . . . . . . . . . . . . . . . . . . . . . . . . 36Humulin 70-30 KwikPen . . . . . . . . . . . 31Humulin 70-30 Vial . . . . . . . . . . . . . . . 31Humulin N KwikPen . . . . . . . . . . . . . . . 31Humulin N Vial . . . . . . . . . . . . . . . . . . . 31Humulin R Vial . . . . . . . . . . . . . . . . . . . 31
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2015 Prescription Drug List Medication Index
Hycamtin . . . . . . . . . . . . . . . . . . . . . . . . 11Hycet . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Hydralazine HCl . . . . . . . . . . . . . . . . . . 22Hydrea . . . . . . . . . . . . . . . . . . . . . . . . . 11Hydrochlorothiazide . . . . . . . . .21, 23, 48Hydrocodone/Acetaminophen . . . . . . 13Hydrocodone/Chlorpheniramine
Suspension, Sustained-Release 12 Hour . . . . . . . . . . . . . . . . . . . . . . . 43
Hydrocodone Bit/Acetaminophen . . . 13Hydrocodone Bit/Acetaminophen
Solution, Oral . . . . . . . . . . . . . . . . . . 13Hydrocortisone . .25, 27, 29, 30, 34, 41Hydrocortisone 2 .5% Cream,
Ointment, Lotion . . . . . . . . . . . . . . . . 25Hydrocortisone Acetate/
Pramoxine Cream . . . . . . . . . . . . . . . 27Hydrocortisone Acetate/
Pramoxine HCl . . . . . . . . . . . . . . . . . 34Hydrocortisone Acetate Suppository,
Rectal . . . . . . . . . . . . . . . . . . . . . . . . 34Hydrocortisone Butyrate Cream . . . . 25Hydrocortisone Butyrate Ointment,
Solution, Non-Oral . . . . . . . . . . . . . . 25Hydrocortisone Cream . . . . . . . . . . . . 34Hydrocortisone Tablet . . . . . . . . . . . . . 30Hydrocortisone Valerate Cream,
Ointment . . . . . . . . . . . . . . . . . . . . . . 25HydroDIURIL . . . . . . . . . . . . . . . . . . . . 21Hydromorphone Extended-Release
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 13Hydromorphone HCl . . . . . . . . . . . . . . 13Hydroxychloroquine Sulfate . . . . . 10, 36Hydroxyurea . . . . . . . . . . . . . . . . . . . . . 11Hydroxyzine HCl . . . . . . . . . . . . . . . . . 43Hydroxyzine Pamoate . . . . . . . . . . . . . 43Hyoscyamine Sulfate . . . . . . . . . . . . . . 33Hyoscyamine Sulfate Capsule,
Sustained-Release 12 Hour . . . . . . 33Hyoscyamine Sulfate Drops . . . . . . . . 33Hyoscyamine Sulfate Tablet,
Rapid Dissolve . . . . . . . . . . . . . . . . . 33Hyoscyamine Sulfate Tablet,
Sustained-Release 12 Hour . . . . . . 33Hytone . . . . . . . . . . . . . . . . . . . . . . . . . 25Hytrin . . . . . . . . . . . . . . . . . . . . . . . . 22, 45Hyzaar . . . . . . . . . . . . . . . . . . . . . . . 23, 48IIbandronate Sodium . . . . . . . . . . . . . . 37Ibuprofen . . . . . . . . . . . . . . . . . . . . 13, 36Ibuprofen/Hydrocodone . . . . . . . . . . . 13Ilevro . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Ilotycin . . . . . . . . . . . . . . . . . . . . . . . . . . 41Imdur . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Imipramine Pamoate . . . . . . . . . . . . . . 17Imiquimod . . . . . . . . . . . . . . . . . . . . . . . 28Imitrex . . . . . . . . . . . . . . . . . . . . . . . 14, 48Imitrex Injection . . . . . . . . . . . . . . . 14, 48Imitrex Injection & Tablets . . . . . . . . . . 48Imitrex Nasal Spray . . . . . . . . . . . . . . . 14Imitrex Tablet . . . . . . . . . . . . . . . . . . . . 14Imuran . . . . . . . . . . . . . . . . . . . . . . . 11, 36Increlex . . . . . . . . . . . . . . . . . . . . . . . . . 35Inderal . . . . . . . . . . . . . . . . . . . . . . . . . . 21Inderal LA . . . . . . . . . . . . . . . . . . . . . . . 21Inderide . . . . . . . . . . . . . . . . . . . . . . . . . 23Indocin . . . . . . . . . . . . . . . . . . . . . . . . . 36Indocin SR . . . . . . . . . . . . . . . . . . . . . . 36Indomethacin . . . . . . . . . . . . . . . . . . . . 36Indomethacin Capsule,
Sustained-Action . . . . . . . . . . . . . . . 36Infergen . . . . . . . . . . . . . . . . . . . . . . . . . 35Inflamase Forte . . . . . . . . . . . . . . . . . . . 41Innopran XL . . . . . . . . . . . . . . . . . . . . . 21Inspra . . . . . . . . . . . . . . . . . . . . . . . . . . 21Intal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Intelence . . . . . . . . . . . . . . . . . . . . . . . . . 9Intermezzo . . . . . . . . . . . . . . . . . . . . . . 17Intron A . . . . . . . . . . . . . . . . . . . . . . . . . 35Intuniv . . . . . . . . . . . . . . . . . . . . . . . . . . 19Invega . . . . . . . . . . . . . . . . . . . . . . . . . . 18Invirase . . . . . . . . . . . . . . . . . . . . . . . . . . 9Invokamet . . . . . . . . . . . . . . . . . . . . . . . 31Invokana . . . . . . . . . . . . . . . . . . . . . . . . 31Iopidine 0 .5% . . . . . . . . . . . . . . . . . . . . 41Iopidine 1% . . . . . . . . . . . . . . . . . . . . . 41Ipratropium Bromide Solution,
Non-Oral . . . . . . . . . . . . . . . . . . . . . . 44Irbesartan . . . . . . . . . . . . . . . . . . . . . . . 23Irbesartan/Hydrochlorothiazide . . . . . 23Isentress . . . . . . . . . . . . . . . . . . . . . . . . . 9ISMO . . . . . . . . . . . . . . . . . . . . . . . . . . 20Isometheptene Mucate/
Acetaminophen/Dichloralphenazone 14Isoniazid . . . . . . . . . . . . . . . . . . . . . . . . 10Isopto Atropine . . . . . . . . . . . . . . . . . . 40Isopto Carpine
0 .5%, 1%, 2%, 4%, 6% . . . . . . . . . 40Isopto Homatropine . . . . . . . . . . . . . . . 40Isordil 2 .5, 5 mg . . . . . . . . . . . . . . . . . . 20Isordil 40 mg . . . . . . . . . . . . . . . . . . . . 20Isordil 5, 10, 20, 30 mg . . . . . . . . . . . 20Isosorbide Dinitrate Tablet . . . . . . . . . 20Isosorbide Dinitrate Tablet,
Sublingual . . . . . . . . . . . . . . . . . . . . . 20Isosorbide Mononitrate . . . . . . . . . . . . 20Isosorbide Mononitrate Tablet,
Sustained-Release 24 Hour . . . . . . 20
Istalol . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Itraconazole Capsule . . . . . . . . . . . . . . . 9JJakafi . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Jalyn . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Janumet . . . . . . . . . . . . . . . . . . . . . . . . 31Janumet XR . . . . . . . . . . . . . . . . . . . . . 31Januvia . . . . . . . . . . . . . . . . . . . . . . . . . 31Jentadueto . . . . . . . . . . . . . . . . . . . . . . 31Juxtapid . . . . . . . . . . . . . . . . . . . . . . . . . 24KK-Dur . . . . . . . . . . . . . . . . . . . . . . . . . . . 46K-Phos M .F . . . . . . . . . . . . . . . . . . . . . . 45K-Phos Original . . . . . . . . . . . . . . . . . . 45K-Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 46K-Tab, Slow-K . . . . . . . . . . . . . . . . . . . 46Kadian . . . . . . . . . . . . . . . . . . . . . . . . . . 13Kaletra . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Kapvay . . . . . . . . . . . . . . . . . . . . . . . . . 19Kayexalate . . . . . . . . . . . . . . . . . . . . . . 47Kazano . . . . . . . . . . . . . . . . . . . . . . . . . 31Keflex . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Kenalog . . . . . . . . . . . . . . . . . . . . . . 25, 29Kenalog in Orabase . . . . . . . . . . . . . . . 29Keppra . . . . . . . . . . . . . . . . . . . . . . 15, 16Keppra XR . . . . . . . . . . . . . . . . . . . 15, 16Keralyt Scalp . . . . . . . . . . . . . . . . . . . . 27Kerlone . . . . . . . . . . . . . . . . . . . . . . . . . 21Ketek . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Ketoconazole . . . . . . . . . . . . . . . . . . 9, 27Ketoconazole Cream, Shampoo . . . . 27Ketoconazole Foam . . . . . . . . . . . . . . . 27Ketoprofen . . . . . . . . . . . . . . . . . . . . . . 36Ketoprofen Capsule, 24 Hour
Sustained-Release . . . . . . . . . . . . . . 36Ketorolac Tromethamine . . . . . . . . 36, 40Khedezla . . . . . . . . . . . . . . . . . . . . . . . . 17Kineret . . . . . . . . . . . . . . . . . . . . . . . . . 36Klaron . . . . . . . . . . . . . . . . . . . . . . . . . . 26Klonopin . . . . . . . . . . . . . . . . . . . . . . . . 15Klor-Con 25mEq . . . . . . . . . . . . . . . . . 46Koate-DVI . . . . . . . . . . . . . . . . . . . . . . . 21Kogenate FS . . . . . . . . . . . . . . . . . . . . 21Kombiglyze XR . . . . . . . . . . . . . . . . . . . 31Kristalose . . . . . . . . . . . . . . . . . . . . . . . 34Kuvan . . . . . . . . . . . . . . . . . . . . . . . . . . 30Kynamro . . . . . . . . . . . . . . . . . . . . . . . . 24Kytril . . . . . . . . . . . . . . . . . . . . . . . . . . . 34LLabetalol HCl . . . . . . . . . . . . . . . . . . . . 21Lacrisert . . . . . . . . . . . . . . . . . . . . . . . . 42Lactulose . . . . . . . . . . . . . . . . . . . . . . . 34Lamictal . . . . . . . . . . . . . . . . . . . . . 15, 16Lamictal Chewable . . . . . . . . . . . . . . . 15
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Lamictal Dose Pack . . . . . . . . . . . . . . . 16Lamictal ODT . . . . . . . . . . . . . . . . . . . . 16Lamictal XR . . . . . . . . . . . . . . . . . . . . . 16Lamisil . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Lamisil Granules . . . . . . . . . . . . . . . . . . 9Lamivudine . . . . . . . . . . . . . . . . . . . . . 8, 9Lamivudine Tablet . . . . . . . . . . . . . . . . . 9Lamotrigine 5, 25 mg
Chewable Tablet . . . . . . . . . . . . . . . . 15Lamotrigine Orally Disintegrating
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 16Lamotrigine Tablet . . . . . . . . . . . . . 15, 16Lamotrigine Tablet,
Extended-Release 24 Hour . . . . . . . 16Lanoxin . . . . . . . . . . . . . . . . . . . . . . . . . 20Lansoprazole/Amoxicillin/
Clarithromycin . . . . . . . . . . . . . . . . . . 33Lansoprazole Capsule,
Delayed-Release . . . . . . . . . . . . . . . 33Lantus Solostar Pen/Cartridge . . . . . . 31Lantus Vial . . . . . . . . . . . . . . . . . . . . . . 31Lariam . . . . . . . . . . . . . . . . . . . . . . . . . . 10Lasix . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Lastacaft . . . . . . . . . . . . . . . . . . . . . 42, 48Latanoprost . . . . . . . . . . . . . . . . . . . . . 40Latuda . . . . . . . . . . . . . . . . . . . . . . . . . . 18Lazanda . . . . . . . . . . . . . . . . . . . . . . . . 13Leflunomide . . . . . . . . . . . . . . . . . . . . . 36Lescol . . . . . . . . . . . . . . . . . . . . . . . . . . 24Lescol XL . . . . . . . . . . . . . . . . . . . . . . . 24Letairis . . . . . . . . . . . . . . . . . . . . . . . . . 44Letrozole . . . . . . . . . . . . . . . . . . . . . 11, 48Leucovorin Calcium . . . . . . . . . . . . . . . 12Leucovorin Calcium 10, 15 mg . . . . . 12Leucovorin Calcium 5, 25 mg . . . . . . 12Leukeran . . . . . . . . . . . . . . . . . . . . . . . . 11Leukine . . . . . . . . . . . . . . . . . . . . . . 12, 35Leuprolide Acetate . . . . . . . . . . . . 11, 39Levalbuterol HCl . . . . . . . . . . . . . . . . . 44Levaquin Tablet, Solution . . . . . . . . . . . 8Levatol . . . . . . . . . . . . . . . . . . . . . . . . . 21Levbid . . . . . . . . . . . . . . . . . . . . . . . . . . 33Levemir Flexpen . . . . . . . . . . . . . . . . . . 31Levemir Vial . . . . . . . . . . . . . . . . . . . . . 31Levetiracetam . . . . . . . . . . . . . . . . . . . . 15Levetiracetam Tablet,
Extended-Release 24 Hour . . . . . . . 15Levitra . . . . . . . . . . . . . . . . . . . . . . . . . . 45Levo-Dromoran . . . . . . . . . . . . . . . . . . 13Levobunolol HCl . . . . . . . . . . . . . . . . . 40Levocarnitine . . . . . . . . . . . . . . . . . . . . 47Levocetirizine Dihydrochloride
Solution, Oral . . . . . . . . . . . . . . . . . . 43
Levocetirizine Dihydrochloride Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 43
Levofloxacin . . . . . . . . . . . . . . . . . . . 8, 41Levonorgestrel-Eth Estr/
Ethinyl Estradiol . . . . . . . . . . . . . . . . 38Levonorgestrel-Ethinyl Estradiol . . . . . 38Levonorgestrel-Ethinyl Estradiol
Tablet, Dosepak, 3 month . . . . . . . . 38Levorphanol Tartrate . . . . . . . . . . . . . . 13Levothroid . . . . . . . . . . . . . . . . . . . . . . . 30Levothyroxine . . . . . . . . . . . . . . . . . . . . 30Levothyroxine Sodium . . . . . . . . . . . . . 30Levoxyl . . . . . . . . . . . . . . . . . . . . . . . . . 30Levsin . . . . . . . . . . . . . . . . . . . . . . . . . . 33Levsin/SL . . . . . . . . . . . . . . . . . . . . . . . 33Levsinex . . . . . . . . . . . . . . . . . . . . . . . . 33Lexapro . . . . . . . . . . . . . . . . . . . . . . 18, 48Lexiva . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Lialda . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Librium . . . . . . . . . . . . . . . . . . . . . . . . . 19Lidex . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Lidocaine/Prilocaine Cream . . . . . . . . 26Lidocaine Adhesive Patch . . . . . . . . . 26Lidocaine HCL Gel, Solution . . . . . . . 26Lidocaine HCL Ointment . . . . . . . . . . 26Lidocaine Transdermal Patch . . . . . . . 48Lidoderm . . . . . . . . . . . . . . . . . . . . 26, 48Lindane . . . . . . . . . . . . . . . . . . . . . . . . . 27Lindane Lotion, Shampoo . . . . . . . . . . 27Linzess . . . . . . . . . . . . . . . . . . . . . . . . . 34Lioresal . . . . . . . . . . . . . . . . . . . . . . . . . 37Liothyronine Sodium . . . . . . . . . . . . . . 30Lipitor . . . . . . . . . . . . . . . . . . . . . . . 24, 48Lipofen . . . . . . . . . . . . . . . . . . . . . . . . . 24Liptruzet . . . . . . . . . . . . . . . . . . . . . . . . 24Lisinopril . . . . . . . . . . . . . . . . . . . . . 22, 23Lisinopril/Hydrochlorothiazide . . . . . . 23Lithium Carbonate . . . . . . . . . . . . . . . . 19Lithium Carbonate,
Sustained-Action . . . . . . . . . . . . . . . 19Lithium Carbonate Tablet,
Sustained-Action . . . . . . . . . . . . . . . 19Lithobid . . . . . . . . . . . . . . . . . . . . . . . . . 19Livalo . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Lo/Ovral . . . . . . . . . . . . . . . . . . . . . . . . 38Lo Loestrin Fe . . . . . . . . . . . . . . . . . . . 38Lo Minastrin Fe . . . . . . . . . . . . . . . . . . 38Locoid . . . . . . . . . . . . . . . . . . . . . . . . . . 25Locoid Lipocream . . . . . . . . . . . . . . . . 25Locoid Lotion . . . . . . . . . . . . . . . . . . . . 25Lodine . . . . . . . . . . . . . . . . . . . . . . . . . . 36Lodine XL . . . . . . . . . . . . . . . . . . . . . . . 36Loestrin . . . . . . . . . . . . . . . . . . . . . . . . . 38Loestrin 24 FE . . . . . . . . . . . . . . . . . . . 38
Loestrin Fe . . . . . . . . . . . . . . . . . . . . . . 38Lofibra . . . . . . . . . . . . . . . . . . . . . . . 24, 48Lofibra 54, 160 mg . . . . . . . . . . . . . . . 48LoMedia 24 FE . . . . . . . . . . . . . . . . . . 38Lomotil . . . . . . . . . . . . . . . . . . . . . . . . . 33Lopid . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Lopressor . . . . . . . . . . . . . . . . . . . . 21, 23Lopressor HCT . . . . . . . . . . . . . . . . . . 23Loprox 0 .77% . . . . . . . . . . . . . . . . . . . 27Loprox 1% . . . . . . . . . . . . . . . . . . . . . . 27Loprox Shampoo . . . . . . . . . . . . . . . . . 27Loratadine Tablet, Syrup . . . . . . . . . . . 43Lorazepam . . . . . . . . . . . . . . . . . . . 19, 48Lorzone . . . . . . . . . . . . . . . . . . . . . . . . . 37Losartan . . . . . . . . . . . . . . . . . . . . . 23, 48Losartan/Hydrochlorothiazide . . . . . . 48Losartan Potassium . . . . . . . . . . . . . . . 23Losartan Potassium/
Hydrochlorothiazide . . . . . . . . . . . . . 23LoSeasonique . . . . . . . . . . . . . . . . . . . 38Lotemax Gel . . . . . . . . . . . . . . . . . . . . . 41Lotemax Ointment, Suspension . . . . . 41Lotensin . . . . . . . . . . . . . . . . . . . . . 22, 23Lotensin HCT . . . . . . . . . . . . . . . . . . . . 23Lotrel . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Lotrisone . . . . . . . . . . . . . . . . . . . . . . . . 27Lotronex . . . . . . . . . . . . . . . . . . . . . . . . 34Lovastatin . . . . . . . . . . . . . . . . . . . . . . . 24Lovaza . . . . . . . . . . . . . . . . . . . . . . . 24, 48Lovenox . . . . . . . . . . . . . . . . . . . . . . . . . 20Ludiomil . . . . . . . . . . . . . . . . . . . . . . . . 17Lufyllin Tablet . . . . . . . . . . . . . . . . . . . . 44Lumigan . . . . . . . . . . . . . . . . . . . . . . . . 40Lunesta . . . . . . . . . . . . . . . . . . . . . . 17, 48Lupron 1 mg/0 .2 ml . . . . . . . . . . . . 11, 39Luride . . . . . . . . . . . . . . . . . . . . . . . . . . 46Luvox . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Luvox CR . . . . . . . . . . . . . . . . . . . . . . . 18Luxiq . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Luzu . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Lybrel . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Lyrica . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Lysodren . . . . . . . . . . . . . . . . . . . . . . . . 11Lysteda . . . . . . . . . . . . . . . . . . . . . . . . . 39MMacrobid . . . . . . . . . . . . . . . . . . . . . . . . 8Macrodantin 25 mg . . . . . . . . . . . . . . . . 8Macrodantin 50, 100 mg . . . . . . . . . . . 8Malarone . . . . . . . . . . . . . . . . . . . . . . . . 10Malathion . . . . . . . . . . . . . . . . . . . . 27, 48Maprotiline HCl . . . . . . . . . . . . . . . . . . 17Marinol . . . . . . . . . . . . . . . . . . . . . . . . . 34Marplan . . . . . . . . . . . . . . . . . . . . . . . . . 17Matulane . . . . . . . . . . . . . . . . . . . . . . . . 11
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Mavik . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Maxalt . . . . . . . . . . . . . . . . . . . . . . . 14, 48Maxalt-MLT . . . . . . . . . . . . . . . . . . . . . . 48Maxalt MLT . . . . . . . . . . . . . . . . . . . 14, 48Maxidex . . . . . . . . . . . . . . . . . . . . . . . . . 41Maxitrol . . . . . . . . . . . . . . . . . . . . . . . . . 41Maxivate . . . . . . . . . . . . . . . . . . . . . . . . 25Maxzide . . . . . . . . . . . . . . . . . . . . . . . . . 21Meclofenamate Sodium . . . . . . . . . . . 36Meclomen . . . . . . . . . . . . . . . . . . . . . . . 36Medrol 2, 8, 24 mg . . . . . . . . . . . . . . . 30Medrol 4, 16, 32 mg . . . . . . . . . . . . . . 30Medroxyprogesterone Acet . . . . . . . . 38Mefenamic Acid . . . . . . . . . . . . . . . . . . 36Mefloquine HCl . . . . . . . . . . . . . . . . . . 10Megace . . . . . . . . . . . . . . . . . . . . . . . . . 11Megace ES . . . . . . . . . . . . . . . . . . . . . 11Megestrol Acetate . . . . . . . . . . . . . . . . 11Megestrol Acetate Suspension . . . . . 11Mekinist . . . . . . . . . . . . . . . . . . . . . . . . 11Mellaril . . . . . . . . . . . . . . . . . . . . . . . . . . 18Meloxicam . . . . . . . . . . . . . . . . . . . . . . . 36Menest . . . . . . . . . . . . . . . . . . . . . . . . . 39Menopur . . . . . . . . . . . . . . . . . . . . . . . . 39Menostar Patch, Transdermal
Weekly . . . . . . . . . . . . . . . . . . . . . . . . 39Mentax . . . . . . . . . . . . . . . . . . . . . . . . . 27Meperidine HCl . . . . . . . . . . . . . . . . . . 13Mephyton . . . . . . . . . . . . . . . . . . . . . . . 21Mepron . . . . . . . . . . . . . . . . . . . . . . 10, 48Mercaptopurine . . . . . . . . . . . . . . . . . . 11Mesalamine Enema . . . . . . . . . . . . . . . 34Mestinon . . . . . . . . . . . . . . . . . . . . . . . . 16Mestinon 60 mg . . . . . . . . . . . . . . . . . . 16Metadate CD . . . . . . . . . . . . . . . . . . . . 19Metadate ER . . . . . . . . . . . . . . . . . . . . 19Metaglip . . . . . . . . . . . . . . . . . . . . . . . . 31Metaproterenol Sulfate Solution,
Non-Oral . . . . . . . . . . . . . . . . . . . . . . 44Metaxalone . . . . . . . . . . . . . . . . . . . 37, 49Metformin HCl . . . . . . . . . . . . . . . . . . . 31Metformin HCl Sustained-Release . . 31Metformin HCl Tablet,
Extended-Release 24 Hour . . . . . . . 31Methadone HCl . . . . . . . . . . . . . . . . . . 13Methamphetamine HCl . . . . . . . . . . . . 19Methazolamide . . . . . . . . . . . . . . . . . . . 40Methenamine Mandelate . . . . . . . . . . . . 8Methergine . . . . . . . . . . . . . . . . . . . . . . 38Methimazole . . . . . . . . . . . . . . . . . . . . . 30Methocarbamol . . . . . . . . . . . . . . . . . . 37Methotrexate . . . . . . . . . . . . . . . . . 11, 36Methotrexate Sodium . . . . . . . . . . 11, 36Methylergonovine Maleate . . . . . . . . . 38
Methylin Solution, Oral . . . . . . . . . . . . 19Methylin Tablet, Chewable . . . . . . . . . 19Methylphenidate HCl . . . . . . . . . . . . . 19Methylphenidate HCl Capsule,
Extended-Release Multiphase . . . . 19Methylphenidate HCl Capsule,
Extended-Release Multiphase 30-70 . . . . . . . . . . . . . . . . . . . . . . . . 19
Methylphenidate HCl Tablet, Extended-Release 24 Hour . . . . . . . 19
Methylphenidate HCl Tablet, Sustained-Action . . . . . . . . . . . . . . . 19
Methylprednisolone Tablet, Dose Pack . . . . . . . . . . . . . . . . . . . . . 30
Meticorten . . . . . . . . . . . . . . . . . . . . . . 30Metipranolol . . . . . . . . . . . . . . . . . . . . . 40Metoclopramide HCl . . . . . . . . . . . . . . 34Metoclopramide Orally
Disintegrating Tablet . . . . . . . . . . . . 34Metolazone . . . . . . . . . . . . . . . . . . . . . . 21Metoprolol/Hydrochlorothiazide . . . . . 23Metoprolol Succinate Tablet,
Sustained-Release 24 Hour . . . . . . 21Metoprolol Tartrate . . . . . . . . . . . . . . . . 21Metozolv ODT . . . . . . . . . . . . . . . . . . . 34Metrocream . . . . . . . . . . . . . . . . . . . . . 26Metrogel 0 .75% . . . . . . . . . . . . . . . . . . 26Metrogel 1% . . . . . . . . . . . . . . . . . . . . 26Metrogel Vaginal . . . . . . . . . . . . . . . . . 39Metrolotion . . . . . . . . . . . . . . . . . . . . . . 26Metronidazole . . . . . . . . . . . . . .10, 26, 39Metronidazole Cream . . . . . . . . . . . . . 26Metronidazole Gel . . . . . . . . . . . . . . . . 26Metronidazole Gel 1% . . . . . . . . . . . . 26Metronidazole Vaginal Gel . . . . . . . . . 39Mevacor . . . . . . . . . . . . . . . . . . . . . . . . 24Mexiletine HCl . . . . . . . . . . . . . . . . . . . 20Mexitil . . . . . . . . . . . . . . . . . . . . . . . . . . 20Miacalcin . . . . . . . . . . . . . . . . . . . . 30, 37Micardis . . . . . . . . . . . . . . . . . . . . . 23, 48Micardis HCT . . . . . . . . . . . . . . . . . 23, 48Micro-K . . . . . . . . . . . . . . . . . . . . . . . . . 46Microzide . . . . . . . . . . . . . . . . . . . . . . . 21Midamor . . . . . . . . . . . . . . . . . . . . . . . . 21Midodrine HCl . . . . . . . . . . . . . . . . . . . 47Midrin . . . . . . . . . . . . . . . . . . . . . . . . . . 14Migranal . . . . . . . . . . . . . . . . . . . . . . . . 14Minipress . . . . . . . . . . . . . . . . . . . . . . . 22Minivelle . . . . . . . . . . . . . . . . . . . . . . . . 39Minocin . . . . . . . . . . . . . . . . . . . . . . . . . . 7Minocycline HCl Capsule . . . . . . . . . . . 7Minocycline HCl Tablet . . . . . . . . . . . . . 7Minocycline HCl Tablet,
Extended-Release 24 Hour . . . . . . . . 7
Mirapex . . . . . . . . . . . . . . . . . . . . . . . . . 15Mirapex ER . . . . . . . . . . . . . . . . . . . . . . 15Mircette . . . . . . . . . . . . . . . . . . . . . . . . . 38Mirtazapine . . . . . . . . . . . . . . . . . . . . . . 17Mirtazapine Dispersible Tablet . . . . . . 17Mirvaso . . . . . . . . . . . . . . . . . . . . . . . . . 26Misoprostol . . . . . . . . . . . . . . . . . . . 33, 36Mobic . . . . . . . . . . . . . . . . . . . . . . . . . . 36Modafinil . . . . . . . . . . . . . . . . . . . . . . . . 19Modicon . . . . . . . . . . . . . . . . . . . . . . . . 38Moduretic . . . . . . . . . . . . . . . . . . . . . . . 21Moexipril HCl . . . . . . . . . . . . . . . . . . . . 22Mometasone Furoate 0 .1% Cream . . 48Mometasone Furoate Cream,
Ointment, Solution . . . . . . . . . . . . . . 25Monoclate-P . . . . . . . . . . . . . . . . . . . . . 21Monodox . . . . . . . . . . . . . . . . . . . . . . 7, 48Mononine . . . . . . . . . . . . . . . . . . . . . . . 21Montelukast . . . . . . . . . . . . . . . . . . 44, 49Montelukast Chewable Tablet . . . . . . 49Montelukast Sodium . . . . . . . . . . . . . . 44Monurol . . . . . . . . . . . . . . . . . . . . . . . . . . 8Morgidox . . . . . . . . . . . . . . . . . . . . . . . . . 7Morphine Sulfate Capsule,
Extended-Release . . . . . . . . . . . . . . 13Morphine Sulfate Capsule,
Extended-Release Pellets . . . . . . . . 13Morphine Sulfate Extended-Release
Capsule . . . . . . . . . . . . . . . . . . . . . . . 48Morphine Sulfate Extended-Release
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 48Morphine Sulfate Solution, Oral . . . . . 13Morphine Sulfate Tablet,
Sustained-Action . . . . . . . . . . . . . . . 13Motofen . . . . . . . . . . . . . . . . . . . . . . . . 33Motrin . . . . . . . . . . . . . . . . . . . . . . . . . . 36Moviprep . . . . . . . . . . . . . . . . . . . . . . . . 34Moxeza . . . . . . . . . . . . . . . . . . . . . . . . . 41Moxifloxacin . . . . . . . . . . . . . . . . 8, 41, 48Moxifloxacin Tablet . . . . . . . . . . . . . . . . . 8Moxifloxacin Tablets . . . . . . . . . . . . . . . 48Mozobil . . . . . . . . . . . . . . . . . . . . . . . . . 35MS Contin . . . . . . . . . . . . . . . . . . . 13, 48MSIR 20 mg/ml, Roxanol . . . . . . . . . . 13Mucomyst . . . . . . . . . . . . . . . . . . . . . . . 44Multaq . . . . . . . . . . . . . . . . . . . . . . . . . . 20Mupirocin Calcium Cream . . . . . . . . . 26Mupirocin Ointment . . . . . . . . . . . . . . . 26Muse . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Myambutol . . . . . . . . . . . . . . . . . . . . . . 10Mycelex . . . . . . . . . . . . . . . . . . . . . . . . . . 9Mycolog II . . . . . . . . . . . . . . . . . . . . . . . 27Mycophenolate Mofetil Capsule,
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 11
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Mycophenolic Acid . . . . . . . . . . . . . . . 11Mycostatin . . . . . . . . . . . . . . . . . . . . 9, 27Mydriacyl . . . . . . . . . . . . . . . . . . . . . . . 40Myfortic . . . . . . . . . . . . . . . . . . . . . . . . . 11Myleran . . . . . . . . . . . . . . . . . . . . . . . . . 11Myorisan . . . . . . . . . . . . . . . . . . . . . . . . 26Myrbetriq . . . . . . . . . . . . . . . . . . . . . . . 45Mysoline . . . . . . . . . . . . . . . . . . . . . . . . 15Mytelase . . . . . . . . . . . . . . . . . . . . . . . . 16NNabumetone . . . . . . . . . . . . . . . . . . . . . 36Nadolol . . . . . . . . . . . . . . . . . . . . . . 21, 23Nadolol/Bendroflumethiazide . . . . . . . 23Naftin . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Naltrexone HCl . . . . . . . . . . . . . . . . . . 14Namenda XR . . . . . . . . . . . . . . . . . . . . 16Naphazoline HCl . . . . . . . . . . . . . . . . . 40Naprelan . . . . . . . . . . . . . . . . . . . . . . . . 36Naprosyn . . . . . . . . . . . . . . . . . . . . . . . 36Naproxen . . . . . . . . . . . . . . . . . . . . . . . 36Naproxen Sodium . . . . . . . . . . . . . . . . 36Naratriptan HCl . . . . . . . . . . . . . . . . . . 14Nardil . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Nasacort AQ . . . . . . . . . . . . . . . . . . . . 44Nascobal . . . . . . . . . . . . . . . . . . . . . . . 46Nasonex . . . . . . . . . . . . . . . . . . . . . . . . 44Natacyn . . . . . . . . . . . . . . . . . . . . . . . . 41Natazia . . . . . . . . . . . . . . . . . . . . . . . . . 38Nateglinide . . . . . . . . . . . . . . . . . . . . . . 31Natroba . . . . . . . . . . . . . . . . . . . . . . 27, 48Navane . . . . . . . . . . . . . . . . . . . . . . . . . 18NebuPent . . . . . . . . . . . . . . . . . . . . . . . 10Nefazodone HCl . . . . . . . . . . . . . . . . . 17Neo-Synephrine . . . . . . . . . . . . . . . . . . 40Neomycin/Polymyxin B Sulfate/
Dexamethasone . . . . . . . . . . . . . . . . 41Neomycin Sulfate . . . . . . . . . . . . 9, 29, 41Neomycin Sulfate/Bacitracin/
Polymyxin B Ointment . . . . . . . . . . . 41Neomycin Sulfate/Bacitracin Zinc/
Polymyxin B/Hydrocortisone Ointment . . . . . . . . . . . . . . . . . . . . . . 41
Neomycin Sulfate/Gramicidin D/Polymyxin B Drops . . . . . . . . . . . . . . 41
Neomycin Sulfate/Polymyxin B Sulfate/Hydrocortisone . . . . . . . 29, 41
Neomycin Sulfate/Polymyxin B Sulfate/Hydrocortisone Suspension, Drops . . . . . . . . . . . . . . . . . . . . . . . . . 41
Neoral . . . . . . . . . . . . . . . . . . . . . . . . . . 11Neosporin . . . . . . . . . . . . . . . . . . . . . . . 41Neptazane . . . . . . . . . . . . . . . . . . . . . . 40Nesina . . . . . . . . . . . . . . . . . . . . . . . . . . 31Neulasta . . . . . . . . . . . . . . . . . . . . . . . . 35
Neumega . . . . . . . . . . . . . . . . . . . . . . . 35Neupogen . . . . . . . . . . . . . . . . . . . . 12, 35Neurontin . . . . . . . . . . . . . . . . . . . . 15, 16Nevanac . . . . . . . . . . . . . . . . . . . . . . . . 40Nevirapine . . . . . . . . . . . . . . . . . . . . 9, 49Nevirapine Extended-Release . . . . 9, 49Nexavar . . . . . . . . . . . . . . . . . . . . . . . . . 11Nexiclon XR . . . . . . . . . . . . . . . . . . . . . 22Nexium Capsule . . . . . . . . . . . . . . . . . . 33Nexium Suspension . . . . . . . . . . . . . . . 33Niacin Extended-Release . . . . . . . . . . 24Niaspan . . . . . . . . . . . . . . . . . . . . . . . . . 24Nicardipine HCl . . . . . . . . . . . . . . . . . . 22Nicotine Patch, Transdermal
24 Hour . . . . . . . . . . . . . . . . . . . . . . . 47Nicotrol Inhaler . . . . . . . . . . . . . . . . . . . 47Nicotrol NS . . . . . . . . . . . . . . . . . . . . . 47Nifedipine . . . . . . . . . . . . . . . . . . . . . . . 22Nifedipine Tablet, Osmotic
Laser-Drilled Formulation . . . . . . . . 22Nilandron . . . . . . . . . . . . . . . . . . . . . . . 11Nimodipine . . . . . . . . . . . . . . . . . . . . . . 16Nimotop . . . . . . . . . . . . . . . . . . . . . . . . 16Niravam . . . . . . . . . . . . . . . . . . . . . . . . . 19Nisoldipine . . . . . . . . . . . . . . . . . . . . . . 22Nitro-Bid . . . . . . . . . . . . . . . . . . . . . . . . 20Nitro-Dur . . . . . . . . . . . . . . . . . . . . . . . . 20Nitrofurantoin/Nitrofurantoin
Macrocrystal . . . . . . . . . . . . . . . . . . . . 8Nitrofurantoin Macrocrystal . . . . . . . . . 8Nitrofurantoin Suspension, Oral . . . . . . 8Nitroglycerin . . . . . . . . . . . . . . . . . . 20, 45Nitroglycerin Capsule,
Sustained-Action . . . . . . . . . . . . . . . 20Nitroglycerin Patch, Transdermal
24 Hour . . . . . . . . . . . . . . . . . . . . . . . 20Nitroglycerin Spray . . . . . . . . . . . . . . . 20Nitroglycerin Spray, Non-Aerosol . . . . 20Nitrolingual . . . . . . . . . . . . . . . . . . . . . . 20Nitromist . . . . . . . . . . . . . . . . . . . . . . . . 20Nitrostat . . . . . . . . . . . . . . . . . . . . . . . . 20Nizatidine Solution, Oral . . . . . . . . . . . 33Nizoral . . . . . . . . . . . . . . . . . . . . . . . . 9, 27Nizoral 2% . . . . . . . . . . . . . . . . . . . . . . 27Nolvadex . . . . . . . . . . . . . . . . . . . . . . . . 11Nor-Q-D . . . . . . . . . . . . . . . . . . . . . . . . 38Norco . . . . . . . . . . . . . . . . . . . . . . . . . . 13Nordette . . . . . . . . . . . . . . . . . . . . . . . . 38Norditropin . . . . . . . . . . . . . . . . . . . . . . 35Norelgestromin/Ethinyl Estradiol
Patch . . . . . . . . . . . . . . . . . . . . . . . . . 38Norelgestromin/Ethinyl Estradiol
Topical Patch . . . . . . . . . . . . . . . . . . 48Norethindrone . . . . . . . . . . . . . . . . 38, 39
Norethindrone-Ethinyl Estradiol . . . . . 38Norethindrone-Ethinyl Estradiol /
Iron Tablet, Chewable . . . . . . . . . . . 38Norethindrone-Mestranol . . . . . . . . . . 38Norethindrone A-E Estradiol . . . . . . . . 38Norethindrone A-E Estradiol/
Ferrous Fumarate . . . . . . . . . . . . . . . 38Norethindrone Acetate . . . . . . . . . 38, 39Norethindrone Acetate/Ethinyl
Estradiol . . . . . . . . . . . . . . . . . . . . . . 39Norflex . . . . . . . . . . . . . . . . . . . . . . . . . . 37Norgesic, Norgesic Forte . . . . . . . . . . 37Norgestimate-Ethinyl Estradiol . . . . . . 38Norgestrel-Ethinyl Estradiol . . . . . . . . 38Noritate . . . . . . . . . . . . . . . . . . . . . . . . . 26Normodyne . . . . . . . . . . . . . . . . . . . . . . 21Noroxin . . . . . . . . . . . . . . . . . . . . . . . . . . 8Norpace . . . . . . . . . . . . . . . . . . . . . . . . 20Norpace CR . . . . . . . . . . . . . . . . . . . . . 20Norpramin . . . . . . . . . . . . . . . . . . . . . . . 17Nortriptyline HCl . . . . . . . . . . . . . . . . . 17Norvasc . . . . . . . . . . . . . . . . . . . . . . . . 22Norvir . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Novolin Vial . . . . . . . . . . . . . . . . . . . . . . 31NovoLog 70-30 Flexpen . . . . . . . . . . . 31NovoLog 70-30 Vial . . . . . . . . . . . . . . 31NovoLog Flexpen . . . . . . . . . . . . . . . . . 31NovoLog Vial . . . . . . . . . . . . . . . . . . . . 31Novoseven . . . . . . . . . . . . . . . . . . . . . . 21Noxafil Suspension . . . . . . . . . . . . . . . . 9Nucynta . . . . . . . . . . . . . . . . . . . . . . . . 14Nucynta ER . . . . . . . . . . . . . . . . . . . . . 14Nuedexta . . . . . . . . . . . . . . . . . . . . . . . 16Nulev . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Nulytely w/Flavor Packs . . . . . . . . . . . 34Nutropin . . . . . . . . . . . . . . . . . . . . . . . . 35Nutropin AQ . . . . . . . . . . . . . . . . . . . . . 35Nutropin AQ NuSpin . . . . . . . . . . . . . . 35Nuvaring . . . . . . . . . . . . . . . . . . . . . . . . 38Nuvigil . . . . . . . . . . . . . . . . . . . . . . . . . . 19Nystatin . . . . . . . . . . . . . . . . . . . . . . . 9, 27Nystatin/Triamcinolone Acetonide . . . 27OOctreotide Acetate . . . . . . . . . . . . 11, 30Ocufen . . . . . . . . . . . . . . . . . . . . . . . . . 40Ocuflox . . . . . . . . . . . . . . . . . . . . . . . . . 41Ocupress . . . . . . . . . . . . . . . . . . . . . . . 40Ofloxacin . . . . . . . . . . . . . . . . . . . 8, 29, 41Ogen . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Olanzapine . . . . . . . . . . . . . . . . . . . 18, 49Olanzapine/Fluoxetine . . . . . . . . . . . . . 18Olanzapine Orally Disintegrating
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 49Olanzapine Tablet . . . . . . . . . . . . . . . . 18
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Olanzapine Tablet, Rapid Dissolve . . . 18Oleptro ER . . . . . . . . . . . . . . . . . . . . . . 17Olpatadine . . . . . . . . . . . . . . . . . . . . . . 43Olux . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Olux-E . . . . . . . . . . . . . . . . . . . . . . . . . . 25Olysio . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Omeclamox Pak . . . . . . . . . . . . . . . . . . 33Omega-3-Acid Ethyl Esters . . . . . 24, 48Omeprazole . . . . . . . . . . . . . . . . . . 33, 48Omeprazole/Sodium Bicarbonate
Capsule . . . . . . . . . . . . . . . . . . . . . . . 33Omnaris . . . . . . . . . . . . . . . . . . . . . . . . 44Omnicef . . . . . . . . . . . . . . . . . . . . . . . . . 7Omnitrope . . . . . . . . . . . . . . . . . . . . . . 35Ondansetron HCl . . . . . . . . . . . . . . . . 34Ondansetron HCl Tablet,
Rapid Dissolve . . . . . . . . . . . . . . . . . 34One Touch Ultra 2 System . . . . . . . . . 32One Touch Ultra Blue Test Strips . . . . 32One Touch Ultra Mini System . . . . . . . 32One Touch Verio IQ System . . . . . . . . 32One Touch Verio IQ Test Strips . . . . . 32One Touch Verio Sync . . . . . . . . . . . . . 32Onfi . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Onglyza . . . . . . . . . . . . . . . . . . . . . . . . . 31Onmel . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Opana . . . . . . . . . . . . . . . . . . . . . . . . . . 13Opana ER . . . . . . . . . . . . . . . . . . . . . . . 13Optase . . . . . . . . . . . . . . . . . . . . . . . . . 27OptiPranolol . . . . . . . . . . . . . . . . . . . . . 40Optivar . . . . . . . . . . . . . . . . . . . . . . 42, 48Oracea . . . . . . . . . . . . . . . . . . . . . . . . . . 7Oracit . . . . . . . . . . . . . . . . . . . . . . . . . . 45Oralair . . . . . . . . . . . . . . . . . . . . . . . . . . 43Orapred . . . . . . . . . . . . . . . . . . . . . . . . 30Orapred ODT . . . . . . . . . . . . . . . . . . . . 30Orencia . . . . . . . . . . . . . . . . . . . . . . . . . 36Orphenadrine . . . . . . . . . . . . . . . . . . . . 37Orphenadrine/Aspirin/Caffeine . . . . . 37Ortho-Cyclen . . . . . . . . . . . . . . . . . . . . 38Ortho-Novum 1-0 .035 mg . . . . . . . . . 38Ortho-Novum 1-0 .05 mg . . . . . . . . . . 38Ortho-Novum 10-11 . . . . . . . . . . . . . . 38Ortho-Novum 2-0 .1 mg . . . . . . . . . . . 38Ortho-Novum 7/7/7 . . . . . . . . . . . . . . 38Ortho Evra . . . . . . . . . . . . . . . . . . . 38, 48Ortho Micronor . . . . . . . . . . . . . . . . . . 38Ortho Tri-Cyclen . . . . . . . . . . . . . . . . . 38Ortho Tri-Cyclen Lo . . . . . . . . . . . . . . . 38Orudis . . . . . . . . . . . . . . . . . . . . . . . . . . 36Oruvail 200 mg . . . . . . . . . . . . . . . . . . 36Oseni . . . . . . . . . . . . . . . . . . . . . . . . . . 31Osmoprep . . . . . . . . . . . . . . . . . . . . . . 34Otezla . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Ovcon . . . . . . . . . . . . . . . . . . . . . . . . . . 38Ovcon 35 . . . . . . . . . . . . . . . . . . . . . . . 38Ovide . . . . . . . . . . . . . . . . . . . . . . . 27, 48Ovidrel . . . . . . . . . . . . . . . . . . . . . . . . . 39Ovral . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Oxandrin . . . . . . . . . . . . . . . . . . . . . 11, 30Oxandrolone . . . . . . . . . . . . . . . . . . 11, 30Oxaprozin . . . . . . . . . . . . . . . . . . . . . . . 36Oxazepam . . . . . . . . . . . . . . . . . . . . . . 19Oxcarbazepine . . . . . . . . . . . . . . . . . . . 15Oxistat Cream . . . . . . . . . . . . . . . . . . . 27Oxistat Lotion . . . . . . . . . . . . . . . . . . . . 27Oxsoralen-Ultra . . . . . . . . . . . . . . . . . . 28Oxtellar XR . . . . . . . . . . . . . . . . . . . . . . 16Oxybutynin Chloride . . . . . . . . . . . . . . 45Oxybutynin Chloride Tablet,
Sustained-Release . . . . . . . . . . . . . . 45Oxycodone/Aspirin . . . . . . . . . . . . . . . 13Oxycodone HCl . . . . . . . . . . . . . . . . . . 13Oxycodone HCl/Acetaminophen
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 13Oxycodone HCl/Ibuprofen . . . . . . . . . 13Oxycodone HCl Concentrate, Oral . . 13OxyContin . . . . . . . . . . . . . . . . . . . . . . 13OxyFAST . . . . . . . . . . . . . . . . . . . . . . . . 13OxyIR . . . . . . . . . . . . . . . . . . . . . . . . . . 13Oxymorphone HCl Tablet,
Sustained-Release 12 Hour . . . . . . 13Oxymorphone Tablet . . . . . . . . . . . . . . 13Oxytrol . . . . . . . . . . . . . . . . . . . . . . . . . . 45PPamelor . . . . . . . . . . . . . . . . . . . . . . . . . 17Pancreaze . . . . . . . . . . . . . . . . . . . . . . . 34Pandel Cream . . . . . . . . . . . . . . . . . . . 25Panretin Gel . . . . . . . . . . . . . . . . . . . . . 28Pantoprazole . . . . . . . . . . . . . . . . . 33, 48Parafon Forte DSC . . . . . . . . . . . . . . . 37Parcopa . . . . . . . . . . . . . . . . . . . . . . . . 15Paremyd . . . . . . . . . . . . . . . . . . . . . . . . 40Paricalcitol . . . . . . . . . . . . . . . . . . . . . . 30Parlodel . . . . . . . . . . . . . . . . . . . . . . . . . 15Parnate . . . . . . . . . . . . . . . . . . . . . . . . . 17Paromomycin Sulfate . . . . . . . . . . . . . 10Paroxetine HCl Sustained-Release,
24 Hour . . . . . . . . . . . . . . . . . . . . . . . 18Paroxetine HCl Tablet . . . . . . . . . . . . . 18Pataday . . . . . . . . . . . . . . . . . . . . . . . . . 42Patanase . . . . . . . . . . . . . . . . . . . . . . . . 43Patanol . . . . . . . . . . . . . . . . . . . . . . . . . 42Paxil . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Paxil CR . . . . . . . . . . . . . . . . . . . . . . . . 18PCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Pediapred . . . . . . . . . . . . . . . . . . . . . . . 30Pediazole . . . . . . . . . . . . . . . . . . . . . . . . 7
Peg-Intron . . . . . . . . . . . . . . . . . . . . . . . 35Peganone . . . . . . . . . . . . . . . . . . . . . . . 15Pegasys . . . . . . . . . . . . . . . . . . . . . . . . 35Pen-V K . . . . . . . . . . . . . . . . . . . . . . . . . 7Penicillin V Potassium . . . . . . . . . . . . . . 7Penlac . . . . . . . . . . . . . . . . . . . . . . . . . . 27Pennsaid 1 .5% . . . . . . . . . . . . . . . . . . 36Pentasa . . . . . . . . . . . . . . . . . . . . . . . . . 34Pentazocine HCl/Naloxone HCl . . . . 14Pepcid . . . . . . . . . . . . . . . . . . . . . . . . . . 33Percocet . . . . . . . . . . . . . . . . . . . . . 13, 48Percodan . . . . . . . . . . . . . . . . . . . . . . . 13Perforomist . . . . . . . . . . . . . . . . . . . . . . 44Periactin . . . . . . . . . . . . . . . . . . . . . . . . 43Peridex . . . . . . . . . . . . . . . . . . . . . . . . . 29Perindopril . . . . . . . . . . . . . . . . . . . . . . 22Periostat . . . . . . . . . . . . . . . . . . . . . . . . . 7Permethrin . . . . . . . . . . . . . . . . . . . 27, 48Perphenazine . . . . . . . . . . . . . . . . . . . . 18Persantine . . . . . . . . . . . . . . . . . . . . . . 20Pertzye . . . . . . . . . . . . . . . . . . . . . . . . . 34Pexeva . . . . . . . . . . . . . . . . . . . . . . . . . . 18Phenazopyridine HCl . . . . . . . . . . . . . . 45Phenelzine Sulfate . . . . . . . . . . . . . . . . 17Phenergan . . . . . . . . . . . . . . . . . . . 34, 43Phenergan VC . . . . . . . . . . . . . . . . . . . 43Phenergan VC w/Codeine . . . . . . . . . 43Phenergan w/Codeine . . . . . . . . . . . . 43Phenobarbital . . . . . . . . . . . . . . . . . 15, 33Phenylephrine HCl . . . . . . . . . . . . 40, 43Phenylephrine HCl/Codeine/
Promethazine . . . . . . . . . . . . . . . . . . 43Phenylephrine HCl/Promethazine
HCl . . . . . . . . . . . . . . . . . . . . . . . . . . 43Phenytek . . . . . . . . . . . . . . . . . . . . . . . . 15Phenytoin . . . . . . . . . . . . . . . . . . . . . . . 15Phenytoin Sodium
Extended-Release . . . . . . . . . . . . . . 15PhosLo . . . . . . . . . . . . . . . . . . . . . . . . . 47Phytonadione . . . . . . . . . . . . . . . . . . . . 21Picato . . . . . . . . . . . . . . . . . . . . . . . . . . 28Pilocarpine HCl . . . . . . . . . . . .29, 40, 47Pilopine HS . . . . . . . . . . . . . . . . . . . . . 40Pindolol . . . . . . . . . . . . . . . . . . . . . . . . . 21Pioglitazone . . . . . . . . . . . . . . . . . . 31, 48Pioglitazone HCl . . . . . . . . . . . . . . . . . 31Pioglitazone HCl/Glimepiride . . . . . . . 31Pioglitazone HCl/Metformin HCl . . . . 31Piroxicam . . . . . . . . . . . . . . . . . . . . . . . 36Plan B . . . . . . . . . . . . . . . . . . . . . . . . . . 38Plaquenil . . . . . . . . . . . . . . . . . . . . . 10, 36Plavix . . . . . . . . . . . . . . . . . . . . . . . . 20, 48Plendil . . . . . . . . . . . . . . . . . . . . . . . . . . 22Pletal . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
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Podofilox Liquid . . . . . . . . . . . . . . . . . . 28Poly-Vi-Flor . . . . . . . . . . . . . . . . . . . . . . 46Poly-Vi-Flor w/Iron . . . . . . . . . . . . . . . . 46Polyethylene Glycol 3350 Powder . . 34Polymyxin B Sulfate/Trimethoprim . . . 41Polysporin . . . . . . . . . . . . . . . . . . . . . . . 41Polytrim . . . . . . . . . . . . . . . . . . . . . . . . . 41Pomalyst . . . . . . . . . . . . . . . . . . . . . . . . 12Ponstel . . . . . . . . . . . . . . . . . . . . . . . . . 36Potassium Chloride . . . . . . . . . . . . 34, 46Potassium Chloride Capsule,
Sustained-Action . . . . . . . . . . . . . . . 46Potassium Chloride Packet . . . . . . . . 46Potassium Chloride Tablet,
Sustained-Action . . . . . . . . . . . . . . . 46Potiga . . . . . . . . . . . . . . . . . . . . . . . . . . 16Pradaxa . . . . . . . . . . . . . . . . . . . . . . . . . 20Pramipexole Di-HCl . . . . . . . . . . . . . . . 15Pramosone 2 .5%-1% . . . . . . . . . . . . . 27Prandin . . . . . . . . . . . . . . . . . . . . . . . . . 31Pravachol . . . . . . . . . . . . . . . . . . . . . . . 24Pravastatin . . . . . . . . . . . . . . . . . . . . . . 24Prazosin HCl . . . . . . . . . . . . . . . . . . . . 22Precision Xtra Test Strips . . . . . . . . . . 32Precose . . . . . . . . . . . . . . . . . . . . . . . . 31Pred-G . . . . . . . . . . . . . . . . . . . . . . . . . 41Pred Forte . . . . . . . . . . . . . . . . . . . . . . . 41Pred Mild . . . . . . . . . . . . . . . . . . . . . . . 41Prednicarbate Cream . . . . . . . . . . . . . 25Prednisolone Acetate . . . . . . . . . . . . . 41Prednisolone Sodium
Phosphate . . . . . . . . . . . . . . . . . . 30, 41Prednisolone Sodium Phosphate
Solution, Oral . . . . . . . . . . . . . . . . . . 30Prednisolone Syrup . . . . . . . . . . . . . . . 30Prednisone . . . . . . . . . . . . . . . . . . . . . . 30Prefest . . . . . . . . . . . . . . . . . . . . . . . . . 39Prelone . . . . . . . . . . . . . . . . . . . . . . . . . 30Premarin . . . . . . . . . . . . . . . . . . . . . . . . 39Premphase . . . . . . . . . . . . . . . . . . . . . . 39Prempro . . . . . . . . . . . . . . . . . . . . . . . . 39Prenatal . . . . . . . . . . . . . . . . . . . . . . . . 46Prenatal Vit/Fe Fumarate/FA . . . . . . . 46Prepopik . . . . . . . . . . . . . . . . . . . . . . . . 34Prevacid . . . . . . . . . . . . . . . . . . . . . . . . 33Prevacid Solutab . . . . . . . . . . . . . . . . . 33Prevident 1 .1% . . . . . . . . . . . . . . . . . . 29Prevpac . . . . . . . . . . . . . . . . . . . . . . . . . 33Prezista . . . . . . . . . . . . . . . . . . . . . . . . . . 9Priftin . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Prilosec . . . . . . . . . . . . . . . . . . . . . . 33, 48Prilosec Suspension . . . . . . . . . . . . . . 33Primaquine . . . . . . . . . . . . . . . . . . . . . . 10Primidone . . . . . . . . . . . . . . . . . . . . . . . 15
Primsol . . . . . . . . . . . . . . . . . . . . . . . . . . 8Prinivil . . . . . . . . . . . . . . . . . . . . . . . . . . 22Prinzide . . . . . . . . . . . . . . . . . . . . . . . . . 23Pristiq . . . . . . . . . . . . . . . . . . . . . . . . . . 17Proair HFA . . . . . . . . . . . . . . . . . . . . . . 44ProAmatine . . . . . . . . . . . . . . . . . . . . . . 47Probenecid . . . . . . . . . . . . . . . . . . . . . . 36Procardia . . . . . . . . . . . . . . . . . . . . . . . 22Procardia XL . . . . . . . . . . . . . . . . . . . . 22Prochlorperazine Maleate Tablet . . . . 34Procrit . . . . . . . . . . . . . . . . . . . . . . . . . . 35ProctoCream-HC 2 .5% . . . . . . . . . . . 34Procysbi . . . . . . . . . . . . . . . . . . . . . . . . 45Profilnine SD . . . . . . . . . . . . . . . . . . . . 21Progesterone, Micronized . . . . . . . . . . 38Prograf . . . . . . . . . . . . . . . . . . . . . . . . . 11Prolensa . . . . . . . . . . . . . . . . . . . . . . . . 40Prolixin . . . . . . . . . . . . . . . . . . . . . . . . . 18Proloprim . . . . . . . . . . . . . . . . . . . . . . . . 8Promacta . . . . . . . . . . . . . . . . . . . . . . . 21Promethazine HCl . . . . . . . . . . . . . 34, 43Prometrium . . . . . . . . . . . . . . . . . . . . . . 38Propafenone Capsule,
Sustained-Release 12 Hour . . . . . . 20Propafenone HCl . . . . . . . . . . . . . . . . . 20Propranolol HCl/
Hydrochlorothiazide . . . . . . . . . . . . . 23Propranolol HCl Sustained-Action
Capsule . . . . . . . . . . . . . . . . . . . . . . . 21Propranolol HCl Tablet . . . . . . . . . . . . 21Propylthiouracil . . . . . . . . . . . . . . . . . . 30Proscar . . . . . . . . . . . . . . . . . . . . . . . . . 45Prostigmin . . . . . . . . . . . . . . . . . . . . . . 16Protonix . . . . . . . . . . . . . . . . . . . . . . 33, 48Protonix Suspension . . . . . . . . . . . . . . 33Protopic . . . . . . . . . . . . . . . . . . . . . . . . 28Protriptyline HCl . . . . . . . . . . . . . . . . . 17Proventil . . . . . . . . . . . . . . . . . . . . . . . . 44Proventil HFA . . . . . . . . . . . . . . . . . . . . 44Provera . . . . . . . . . . . . . . . . . . . . . . . . . 38Provigil . . . . . . . . . . . . . . . . . . . . . . . . . 19Prozac . . . . . . . . . . . . . . . . . . . . . . . 18, 49Prozac Weekly . . . . . . . . . . . . . . . . . . . 18Pseudoephedrine Sulfate/
Loratadine . . . . . . . . . . . . . . . . . . . . . 43Psorcon . . . . . . . . . . . . . . . . . . . . . . . . 25Pulmicort Flexhaler . . . . . . . . . . . . . . . 44Pulmicort Respules
0 .25 mg/2 ml, 0 .5 mg/2 ml . . . . . . . 44Pulmicort Respules 1 mg/2 ml . . . . . . 44Pulmozyme . . . . . . . . . . . . . . . . . . . . . . 44Purinethol . . . . . . . . . . . . . . . . . . . . . . . 11Pylera . . . . . . . . . . . . . . . . . . . . . . . . . . 33Pyrazinamide . . . . . . . . . . . . . . . . . . . . 10
Pyridium . . . . . . . . . . . . . . . . . . . . . . . . 45Pyridostigmine Bromide Tablet . . . . . . 16QQnasl . . . . . . . . . . . . . . . . . . . . . . . . . . 44Qualaquin . . . . . . . . . . . . . . . . . . . . . . . 10Quartette . . . . . . . . . . . . . . . . . . . . . . . 38Questran . . . . . . . . . . . . . . . . . . . . . . . . 24Questran Light . . . . . . . . . . . . . . . . . . . 24Quetiapine . . . . . . . . . . . . . . . . . . . 18, 49Quetiapine Fumarate . . . . . . . . . . . . . . 18Quillivant XR . . . . . . . . . . . . . . . . . . . . 19Quinapril HCl/Hydrochlorothiazide . . 23Quinidex . . . . . . . . . . . . . . . . . . . . . . . . 20Quinidine Gluconate . . . . . . . . . . . . . . 20Quinidine Sulfate . . . . . . . . . . . . . . . . . 20Quinidine Sulfate Tablet,
Sustained-Action . . . . . . . . . . . . . . . 20Quinine Sulfate . . . . . . . . . . . . . . . . . . 10Quixin . . . . . . . . . . . . . . . . . . . . . . . . . . 41QVAR . . . . . . . . . . . . . . . . . . . . . . . . . . 44RRabeprazole . . . . . . . . . . . . . . . . . . 33, 48Ragwitek . . . . . . . . . . . . . . . . . . . . . . . . 43Raloxifene . . . . . . . . . . . . . . . . . . . . 37, 48Ramipril . . . . . . . . . . . . . . . . . . . . . . . . . 22Ranexa . . . . . . . . . . . . . . . . . . . . . . . . . 24Ranitidine HCl Syrup . . . . . . . . . . . . . . 33Rapaflo . . . . . . . . . . . . . . . . . . . . . . . . . 45Rapamune . . . . . . . . . . . . . . . . . . . . . . 11Ravicti . . . . . . . . . . . . . . . . . . . . . . . . . . 30Rayos . . . . . . . . . . . . . . . . . . . . . . . . . . 30Razadyne . . . . . . . . . . . . . . . . . . . . . . . 16Razadyne ER . . . . . . . . . . . . . . . . . . . . 16Rebetol Capsules . . . . . . . . . . . . . . . . . 8Rebetol Solution . . . . . . . . . . . . . . . . . . 8Rebif . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Recombinate . . . . . . . . . . . . . . . . . . . . 21Rectiv . . . . . . . . . . . . . . . . . . . . . . . . . . 34Reglan . . . . . . . . . . . . . . . . . . . . . . . . . . 34Regranex . . . . . . . . . . . . . . . . . . . . . . . 28Relafen . . . . . . . . . . . . . . . . . . . . . . . . . 36Relenza . . . . . . . . . . . . . . . . . . . . . . . . . . 8Relistor . . . . . . . . . . . . . . . . . . . . . . . . . 34Relpax . . . . . . . . . . . . . . . . . . . . . . . . . . 14Remeron . . . . . . . . . . . . . . . . . . . . . . . . 17Remeron SolTab . . . . . . . . . . . . . . . . . 17Renacidin . . . . . . . . . . . . . . . . . . . . . . . 45Renagel . . . . . . . . . . . . . . . . . . . . . . . . 47Renvela . . . . . . . . . . . . . . . . . . . . . . . . . 47Repaglinide . . . . . . . . . . . . . . . . . . . . . 31Repronex . . . . . . . . . . . . . . . . . . . . . . . 39Requip . . . . . . . . . . . . . . . . . . . . . . . . . 15Requip XL . . . . . . . . . . . . . . . . . . . . . . . 15Rescriptor . . . . . . . . . . . . . . . . . . . . . . . . 9
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Rescula . . . . . . . . . . . . . . . . . . . . . . . . . 40Restasis . . . . . . . . . . . . . . . . . . . . . . . . 42Restoril . . . . . . . . . . . . . . . . . . . . . . . . . 17Retin-A . . . . . . . . . . . . . . . . . . . . . . . . . 26Retin-A Micro . . . . . . . . . . . . . . . . . . . . 26Retrovir . . . . . . . . . . . . . . . . . . . . . . . . . . 9Revatio . . . . . . . . . . . . . . . . . . . . . . 44, 49ReVia . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Revlimid . . . . . . . . . . . . . . . . . . . . . . . . 11Reyataz . . . . . . . . . . . . . . . . . . . . . . . . . . 9Rheumatrex . . . . . . . . . . . . . . . . . . . . . 11Rhinocort Aqua . . . . . . . . . . . . . . . . . . 44Ribapak . . . . . . . . . . . . . . . . . . . . . . . . . . 8Ribavirin . . . . . . . . . . . . . . . . . . . . . . . . . 8Rifadin . . . . . . . . . . . . . . . . . . . . . . . . . . 10Rifamate . . . . . . . . . . . . . . . . . . . . . . . . 10Rifampin . . . . . . . . . . . . . . . . . . . . . . . . 10Rifampin/Isoniazid . . . . . . . . . . . . . . . . 10Rifater . . . . . . . . . . . . . . . . . . . . . . . . . . 10Rilutek . . . . . . . . . . . . . . . . . . . . . . . . . . 47Riluzole . . . . . . . . . . . . . . . . . . . . . . . . . 47Rimantadine HCl Tablet . . . . . . . . . . . . 8Riomet Solution, Oral . . . . . . . . . . . . . 31Risedronate 150 mg . . . . . . . . . . . . . . 37Risperdal . . . . . . . . . . . . . . . . . . . . 18, 49Risperdal M-Tab . . . . . . . . . . . . . . . . . . 18Risperidone . . . . . . . . . . . . . . . . . . 18, 49Risperidone Solution . . . . . . . . . . . . . . 18Risperidone Tablet . . . . . . . . . . . . . . . . 18Risperidone Tablet, Rapid Dissolve . . 18Ritalin, Ritalin SR . . . . . . . . . . . . . . . . . 19Ritalin LA . . . . . . . . . . . . . . . . . . . . . . . 19Rivastigmine Tartrate Capsule . . . . . . 16Rizatriptan . . . . . . . . . . . . . . . . . . . 14, 48Rizatriptan Benzoate Tablet . . . . . . . . 14Rizatriptan Benzoate Tablet,
Disintegrating . . . . . . . . . . . . . . . . . . 14Rizatriptan Orally Disintegrating
Tablet . . . . . . . . . . . . . . . . . . . . . . . . . 48Robaxin . . . . . . . . . . . . . . . . . . . . . . . . . 37Robinul . . . . . . . . . . . . . . . . . . . . . . . . . 33Robinul Forte . . . . . . . . . . . . . . . . . . . . 33Robitussin-DAC . . . . . . . . . . . . . . . . . . 43Robitussin A-C . . . . . . . . . . . . . . . . . . 43Rocaltrol . . . . . . . . . . . . . . . . . . . . . . . . 30Ropinirole HCl . . . . . . . . . . . . . . . . . . . 15Ropinirole HCl Tablet,
Extended-Release 24 Hour . . . . . . . 15Rowasa . . . . . . . . . . . . . . . . . . . . . . . . . 34Roxicodone . . . . . . . . . . . . . . . . . . . . . 13Rozerem . . . . . . . . . . . . . . . . . . . . . . . . 17Rythmol . . . . . . . . . . . . . . . . . . . . . . . . . 20Rythmol SR . . . . . . . . . . . . . . . . . . . . . 20Ryzolt . . . . . . . . . . . . . . . . . . . . . . . . . . 14
SSabril . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Safyral . . . . . . . . . . . . . . . . . . . . . . . . . . 38Saizen . . . . . . . . . . . . . . . . . . . . . . . . . . 35Salagen . . . . . . . . . . . . . . . . . . . . . 29, 47Salagen 5 mg . . . . . . . . . . . . . . . . . . . . 29Salflex . . . . . . . . . . . . . . . . . . . . . . . . . . 36Salsalate . . . . . . . . . . . . . . . . . . . . . . . . 36Samsca . . . . . . . . . . . . . . . . . . . . . . . . . 30Sanctura . . . . . . . . . . . . . . . . . . . . . . . . 45Sanctura XR . . . . . . . . . . . . . . . . . . . . . 45Sancuso . . . . . . . . . . . . . . . . . . . . . . . . 34Sandimmune . . . . . . . . . . . . . . . . . . . . 11Sandostatin . . . . . . . . . . . . . . . . . . . . . 11Santyl . . . . . . . . . . . . . . . . . . . . . . . . . . 27Saphris . . . . . . . . . . . . . . . . . . . . . . . . . 18Sarafem . . . . . . . . . . . . . . . . . . . . . . . . 18Savella . . . . . . . . . . . . . . . . . . . . . . . . . 16Seasonale . . . . . . . . . . . . . . . . . . . . . . . 38Seasonique . . . . . . . . . . . . . . . . . . . . . 38Sectral . . . . . . . . . . . . . . . . . . . . . . . . . 21Selegiline HCl . . . . . . . . . . . . . . . . . . . 15Selzentry . . . . . . . . . . . . . . . . . . . . . . . . . 9Sensipar . . . . . . . . . . . . . . . . . . . . . . . . 30Septra . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Septra DS . . . . . . . . . . . . . . . . . . . . . . . 8Serax . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Serevent Diskus . . . . . . . . . . . . . . . . . . 44Serophene . . . . . . . . . . . . . . . . . . . . . . 39Seroquel . . . . . . . . . . . . . . . . . . . . . 18, 49Seroquel XR . . . . . . . . . . . . . . . . . . . . . 18Serostim . . . . . . . . . . . . . . . . . . . . . . . . 35Sertraline . . . . . . . . . . . . . . . . . . . . 18, 49Sertraline HCl . . . . . . . . . . . . . . . . . . . 18Serzone . . . . . . . . . . . . . . . . . . . . . . . . 17Sevelamer . . . . . . . . . . . . . . . . . . . . . . . 47Sildenafil . . . . . . . . . . . . . . . . . . . . . 44, 49Sildenafil Citrate . . . . . . . . . . . . . . . . . 44Silenor . . . . . . . . . . . . . . . . . . . . . . . . . . 17Silvadene . . . . . . . . . . . . . . . . . . . . . . . 27Silver Sulfadiazine . . . . . . . . . . . . . . . . 27Simbrinza . . . . . . . . . . . . . . . . . . . . . . . 40Simcor . . . . . . . . . . . . . . . . . . . . . . . . . 24Simponi . . . . . . . . . . . . . . . . . . . . . . . . . 36Simvastatin . . . . . . . . . . . . . . . . . . . . . . 24Sinemet . . . . . . . . . . . . . . . . . . . . . . . . 15Sinemet CR . . . . . . . . . . . . . . . . . . . . . 15Sinequan . . . . . . . . . . . . . . . . . . . . . . . 17Singulair . . . . . . . . . . . . . . . . . . . . . 44, 49Singulair Chewable Tablet . . . . . . . . . 49Singulair Tablet . . . . . . . . . . . . . . . . . . 49Sirolimus . . . . . . . . . . . . . . . . . . . . . . . . 11Situro . . . . . . . . . . . . . . . . . . . . . . . . . . 10Skelaxin . . . . . . . . . . . . . . . . . . . . . . 37, 49
Skelaxin 800 mg . . . . . . . . . . . . . . . . . 37Sklice . . . . . . . . . . . . . . . . . . . . . . . . . . 27Sod Chloride/NaHCO3/
KCl/PEGs . . . . . . . . . . . . . . . . . . . . . 34Sodium Fluoride . . . . . . . . . . . . . . . 29, 46Sodium Fluoride Gel . . . . . . . . . . . . . . 29Sodium Polystyrene Sulfonate . . . . . . 47Sodium Sulfate/Sodium/Sodium
Bicarbonate/Potassium Chloride/Polyethylene Glycols . . . . . . . . . . . . 34
Sodium Sulfate/Sodium/Sodium Bicarbonate/Potassium Chloride/Polyethylene Glycols Solution, Reconstituted, Oral . . . . . . . . . . . . . 34
Solaraze . . . . . . . . . . . . . . . . . . . . . . . . 28Solodyn . . . . . . . . . . . . . . . . . . . . . . . . . . 7Solodyn 45, 90, 135 mg . . . . . . . . . . . . 7Soma 250 mg . . . . . . . . . . . . . . . . . . . 37Soma 350 mg . . . . . . . . . . . . . . . . . . . 37Somatuline Depot . . . . . . . . . . . . . . . . 12Sonata . . . . . . . . . . . . . . . . . . . . . . 17, 48Soriatane . . . . . . . . . . . . . . . . . . . . . . . 27Sorilux . . . . . . . . . . . . . . . . . . . . . . . . . . 27Sotalol HCl . . . . . . . . . . . . . . . . . . . . . . 20Sotret . . . . . . . . . . . . . . . . . . . . . . . . . . 26Spasdel . . . . . . . . . . . . . . . . . . . . . . . . 33Spectazole 1% . . . . . . . . . . . . . . . . . . 27Spectracef . . . . . . . . . . . . . . . . . . . . . . . 7Spinosad . . . . . . . . . . . . . . . . . . . . 27, 48Spiriva . . . . . . . . . . . . . . . . . . . . . . . . . . 44Spironolactone . . . . . . . . . . . . . . . . . . . 21Spironolactone/Hydrochlorothiazide . 21Sporanox Capsule . . . . . . . . . . . . . . . . . 9Sporanox Solution, Oral . . . . . . . . . . . . 9Sprix . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Sprycel . . . . . . . . . . . . . . . . . . . . . . . . . 12Stadol . . . . . . . . . . . . . . . . . . . . . . . . . . 14Stalevo . . . . . . . . . . . . . . . . . . . . . . . . . 15Starlix . . . . . . . . . . . . . . . . . . . . . . . . . . 31Stavudine . . . . . . . . . . . . . . . . . . . . . . . . 9Stavzor . . . . . . . . . . . . . . . . . . . . . . . . . 16Staxyn 45Stelara . . . . . . . . . . . . . . . . . . . . . . . . . 36Stelazine . . . . . . . . . . . . . . . . . . . . . . . . 18Stivarga . . . . . . . . . . . . . . . . . . . . . . . . . 11Strattera . . . . . . . . . . . . . . . . . . . . . . . . 19Striant . . . . . . . . . . . . . . . . . . . . . . . . . . 30Stribild . . . . . . . . . . . . . . . . . . . . . . . . . . 9Stromectol . . . . . . . . . . . . . . . . . . . . . . 10Suboxone . . . . . . . . . . . . . . . . . . . . . . . 14Suboxone Film . . . . . . . . . . . . . . . . . . . 14Subsys . . . . . . . . . . . . . . . . . . . . . . . . . 13Subutex . . . . . . . . . . . . . . . . . . . . . . . . . 14Suclear . . . . . . . . . . . . . . . . . . . . . . . . . 34
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Sucraid . . . . . . . . . . . . . . . . . . . . . . . . . 34Sucralfate Tablet . . . . . . . . . . . . . . . . . 33Sular . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Sulfacetamide Sodium . . . . . . . . . 26, 41Sulfacetamide Sodium/Prednisolone
Sodium Phosphate . . . . . . . . . . . . . . 41Sulfacetamide Sodium Suspension,
Topical . . . . . . . . . . . . . . . . . . . . . . . . 26Sulfadiazine . . . . . . . . . . . . . . . . . . . 8, 27Sulfamethoxazole/Trimethoprim . . . . . . 8Sulfasalazine Tablet . . . . . . . . . . . . 34, 36Sulfasalazine Tablet,
Enteric-Coated . . . . . . . . . . . . . . 34, 36Sulindac . . . . . . . . . . . . . . . . . . . . . . . . 36Sumatriptan Injection, Tablet . . . . . . . 48Sumatriptan Succinate Injection . . . . 14Sumatriptan Succinate Nasal Spray . 14Sumatriptan Succinate Tablet . . . . . . 14Sumavel Dosepro . . . . . . . . . . . . . . . . 14Suprax Tablet, Capsule, Suspension . . 7Suprep . . . . . . . . . . . . . . . . . . . . . . . . . 34Sustiva . . . . . . . . . . . . . . . . . . . . . . . . . . 9Sutent . . . . . . . . . . . . . . . . . . . . . . . . . . 11Sylatron . . . . . . . . . . . . . . . . . . . . . . . . . 11Symax Duotab . . . . . . . . . . . . . . . . . . . 33Symbicort . . . . . . . . . . . . . . . . . . . . . . . 44Symbyax . . . . . . . . . . . . . . . . . . . . . . . . 18SymlinPen . . . . . . . . . . . . . . . . . . . . . . . 31Symmetrel . . . . . . . . . . . . . . . . . . . . 8, 15Synalar . . . . . . . . . . . . . . . . . . . . . . . . . 25Synalgos-DC . . . . . . . . . . . . . . . . . . . . 13Synarel . . . . . . . . . . . . . . . . . . . . . . 30, 39Synthroid . . . . . . . . . . . . . . . . . . . . . . . 30Syprine . . . . . . . . . . . . . . . . . . . . . . . . . 30TTaclonex . . . . . . . . . . . . . . . . . . . . . 27, 49Taclonex Ointment . . . . . . . . . . . . . . . . 49Taclonex Suspension . . . . . . . . . . . . . . 27Tacrolimus Anhydrous . . . . . . . . . . . . . 11Tafinlar . . . . . . . . . . . . . . . . . . . . . . . . . . 11Tagamet . . . . . . . . . . . . . . . . . . . . . . . . 33Talwin NX . . . . . . . . . . . . . . . . . . . . . . . 14Tambocor . . . . . . . . . . . . . . . . . . . . . . . 20Tamiflu . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Tamoxifen . . . . . . . . . . . . . . . . . . . . . . . 11Tamsulosin . . . . . . . . . . . . . . . . . . . 45, 48Tamsulosin HCl . . . . . . . . . . . . . . . . . . 45Tanzeum . . . . . . . . . . . . . . . . . . . . . . . . 31Tapazole . . . . . . . . . . . . . . . . . . . . . . . . 30Tarceva . . . . . . . . . . . . . . . . . . . . . . . . . 11Tarka . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Tasigna . . . . . . . . . . . . . . . . . . . . . . . . . 11Tasmar . . . . . . . . . . . . . . . . . . . . . . . . . 15Tazorac . . . . . . . . . . . . . . . . . . . . . . . . . 26
Tecfidera . . . . . . . . . . . . . . . . . . . . . . . . 16Tegretol . . . . . . . . . . . . . . . . . . . . . . . . . 15Tegretol XR . . . . . . . . . . . . . . . . . . . . . . 15Tekamlo . . . . . . . . . . . . . . . . . . . . . . . . . 23Tekturna . . . . . . . . . . . . . . . . . . . . . . . . 23Tekturna HCT . . . . . . . . . . . . . . . . . . . . 23Telmisartan . . . . . . . . . . . . . . . . . . . 23, 48Telmisartan/Hydrochlorothiazide . 23, 48Temazepam . . . . . . . . . . . . . . . . . . . . . 17Temodar . . . . . . . . . . . . . . . . . . . . . . . . 11Temovate . . . . . . . . . . . . . . . . . . . . . . . 25Temovate E . . . . . . . . . . . . . . . . . . . . . . 25Temozolamide . . . . . . . . . . . . . . . . . . . 11Tenex . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Tenormin . . . . . . . . . . . . . . . . . . . . . . . . 21Terazol . . . . . . . . . . . . . . . . . . . . . . . . . . 39Terazosin HCl . . . . . . . . . . . . . . . . . 22, 45Terbinafine HCl Tablet . . . . . . . . . . . . . . 9Terbutaline Sulfate . . . . . . . . . . . . . 39, 44Terconazole Cream w/Applicator . . . . 39Terconazole Suppository, Vaginal . . . . 39Testim . . . . . . . . . . . . . . . . . . . . . . . . . . 30Testosterone Topical Gel . . . . . . . . . . 30Tetracycline HCl . . . . . . . . . . . . . . . . . . 7Tev-Tropin . . . . . . . . . . . . . . . . . . . . . . . 35Teveten . . . . . . . . . . . . . . . . . . . . . . . . . 23Teveten HCT . . . . . . . . . . . . . . . . . . . . 23Thalomid . . . . . . . . . . . . . . . . . . . . . . . . 11Theo-24 . . . . . . . . . . . . . . . . . . . . . . . . 44Theochron . . . . . . . . . . . . . . . . . . . . . . 44Theophylline Anhydrous Tablet,
Extended-Release 12 Hour . . . . . . . 44Thioridazine HCl . . . . . . . . . . . . . . . . . 18Thiothixene . . . . . . . . . . . . . . . . . . . . . . 18Thorazine 200 mg . . . . . . . . . . . . . . . . 18Thyrolar . . . . . . . . . . . . . . . . . . . . . . . . . 30Tiagabine HCl . . . . . . . . . . . . . . . . . . . 15Tiazac . . . . . . . . . . . . . . . . . . . . . . . . . . 22Ticlid . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Ticlopidine HCl . . . . . . . . . . . . . . . . . . 20Tigan 250, 300 mg . . . . . . . . . . . . . . . 34Tikosyn . . . . . . . . . . . . . . . . . . . . . . . . . 20Timolol Maleate . . . . . . . . . . . . . . . . . . 40Timolol Maleate Drops . . . . . . . . . . . . 40Timoptic . . . . . . . . . . . . . . . . . . . . . . . . 40Timoptic-XE . . . . . . . . . . . . . . . . . . . . . 40Tindamax . . . . . . . . . . . . . . . . . . . . . . . . 10Tinidazole . . . . . . . . . . . . . . . . . . . . . . . 10Tirosint . . . . . . . . . . . . . . . . . . . . . . . . . 30Tizanidine HCl Capsule . . . . . . . . . . . 37Tizanidine HCl Tablet . . . . . . . . . . . . . . 37Tobi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Tobi Podhaler . . . . . . . . . . . . . . . . . . . . . 9Tobradex . . . . . . . . . . . . . . . . . . . . . . . . 41
Tobradex ST . . . . . . . . . . . . . . . . . . . . . 41Tobramycin/Dexamethasone
Suspension . . . . . . . . . . . . . . . . . . . . 41Tobramycin Nebulized Solution . . . . . . 9Tobramycin Sulfate Drops . . . . . . . . . . 41Tobrex . . . . . . . . . . . . . . . . . . . . . . . . . . 41Tobrex Ointment . . . . . . . . . . . . . . . . . . 41Tofranil-PM . . . . . . . . . . . . . . . . . . . . . . 17Tolectin . . . . . . . . . . . . . . . . . . . . . . . . . 36Tolectin DS . . . . . . . . . . . . . . . . . . . . . . 36Tolmetin Sodium . . . . . . . . . . . . . . . . . 36Tolterodine Extended-Release . . . . . . 45Tolterodine Tartrate . . . . . . . . . . . . . . . 45Topamax . . . . . . . . . . . . . . . . . . . . . 15, 16Topicort . . . . . . . . . . . . . . . . . . . . . . . . . 25Topicort Spray . . . . . . . . . . . . . . . . . . . 25Topiramate Capsule, Sprinkle . . . . . . . 15Topiramate Tablet . . . . . . . . . . . . . . . . . 15Toprol XL 25 mg . . . . . . . . . . . . . . . . . 21Toprol XL 50, 100, 200 mg . . . . . . . . 21Toradol . . . . . . . . . . . . . . . . . . . . . . . . . 36Toviaz . . . . . . . . . . . . . . . . . . . . . . . . . . 45Tracleer . . . . . . . . . . . . . . . . . . . . . . . . . 44Tradjenta . . . . . . . . . . . . . . . . . . . . . . . . 31Tramadol HCl . . . . . . . . . . . . . . . . . . . . 14Tramadol HCl/Acetaminophen . . . . . . 14Tramadol HCl Tablet,
Extended-Release Multiphase 24 Hour . . . . . . . . . . . . . . . . . . . . . . . 14
Tramadol HCl Tablet, Sustained-Release 24 Hour . . . . . . 14
Trandolapril . . . . . . . . . . . . . . . . . . . 22, 23Trandolapril/Verapamil . . . . . . . . . . . . . 23Tranexamic Acid . . . . . . . . . . . . . . . . . . 39Transderm-Nitro . . . . . . . . . . . . . . . . . . 20Transderm-Scop . . . . . . . . . . . . . . . . . 34Tranylcypromine Sulfate . . . . . . . . . . . 17Travatan . . . . . . . . . . . . . . . . . . . . . . . . 40Travatan Z . . . . . . . . . . . . . . . . . . . . . . . 40Travoprost . . . . . . . . . . . . . . . . . . . . . . . 40Trazodone HCl . . . . . . . . . . . . . . . . . . . 17Tretin-X . . . . . . . . . . . . . . . . . . . . . . . . . 26Tretinoin . . . . . . . . . . . . . . . . . . . . . 11, 26Tretinoin Cream . . . . . . . . . . . . . . . . . . 26Tretinoin Cream, Gel . . . . . . . . . . . . . . 26Tretinoin Microspheres . . . . . . . . . . . . 26Trexall . . . . . . . . . . . . . . . . . . . . . . . . . . 11Treximet . . . . . . . . . . . . . . . . . . . . . . . . . 14Tri-Vi-Flor . . . . . . . . . . . . . . . . . . . . . . . 46Tri-Vi-Flor w/Iron . . . . . . . . . . . . . . . . . 46Triamcinolone Acetonide . 25, 27, 29, 44Triamcinolone Acetonide Cream . . . . 25Triamcinolone Acetonide Cream,
Ointment, Lotion . . . . . . . . . . . . . . . . 25
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Triamcinolone Acetonide Ointment . . 25Triamterene/Hydrochlorothiazide . . . . 21Trianex . . . . . . . . . . . . . . . . . . . . . . . . . . 25Triazolam . . . . . . . . . . . . . . . . . . . . . . . . 17Tribenzor . . . . . . . . . . . . . . . . . . . . . . . . 23Tricor . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Tridesilon . . . . . . . . . . . . . . . . . . . . . . . 25Trifluoperazine HCl . . . . . . . . . . . . . . . 18Trifluridine . . . . . . . . . . . . . . . . . . . . . . . 42Triglide . . . . . . . . . . . . . . . . . . . . . . . . . 24Trihexyphenidyl HCl . . . . . . . . . . . . . . . 15Trilafon . . . . . . . . . . . . . . . . . . . . . . . . . 18Trileptal . . . . . . . . . . . . . . . . . . . . . . 15, 16Trilipix . . . . . . . . . . . . . . . . . . . . . . . . . . 24Trimethobenzamide HCl Capsule . . . 34Trimethoprim . . . . . . . . . . . . . . . . . . . 8, 41TriNorinyl . . . . . . . . . . . . . . . . . . . . . . . . 38Triphasil . . . . . . . . . . . . . . . . . . . . . . . . . 38Trizivir . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Trokendi XR . . . . . . . . . . . . . . . . . . . . . 16Tropicamide . . . . . . . . . . . . . . . . . . . . . 40Trospium Chloride . . . . . . . . . . . . . . . . 45Trospium Chloride Capsule,
Sustained-Release 24 Hour . . . . . . 45Trusopt . . . . . . . . . . . . . . . . . . . . . . . . . 40Truvada . . . . . . . . . . . . . . . . . . . . . . . . . . 9Tudorza Pressair . . . . . . . . . . . . . . . . . 44Tussionex . . . . . . . . . . . . . . . . . . . . . . . 43Twysta . . . . . . . . . . . . . . . . . . . . . . . . . . 23Tykerb . . . . . . . . . . . . . . . . . . . . . . . . . . 11Tylenol w/Codeine . . . . . . . . . . . . . . . . 13Tyvaso . . . . . . . . . . . . . . . . . . . . . . . . . . 44Tyzeka . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Tyzine . . . . . . . . . . . . . . . . . . . . . . . . . . 29UUceris . . . . . . . . . . . . . . . . . . . . . . . . . . 34Uloric . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Ultracet . . . . . . . . . . . . . . . . . . . . . . . . . 14Ultram . . . . . . . . . . . . . . . . . . . . . . . . . . 14Ultram ER . . . . . . . . . . . . . . . . . . . . . . . 14Ultravate . . . . . . . . . . . . . . . . . . . . . . . . 25Ultresa . . . . . . . . . . . . . . . . . . . . . . . . . 34Umecta . . . . . . . . . . . . . . . . . . . . . . . . . 28Univasc . . . . . . . . . . . . . . . . . . . . . . . . . 22Urea 40% Emulsion . . . . . . . . . . . . . . 28Urecholine . . . . . . . . . . . . . . . . . . . . . . 45Uroxatral . . . . . . . . . . . . . . . . . . . . . . . . 45URSO 250 . . . . . . . . . . . . . . . . . . . . . . 34URSO Forte . . . . . . . . . . . . . . . . . . . . . 34Ursodiol . . . . . . . . . . . . . . . . . . . . . . . . 34VVagifem . . . . . . . . . . . . . . . . . . . . . . . . . 39Valacyclovir . . . . . . . . . . . . . . . . . . . . 8, 49Valacyclovir HCl . . . . . . . . . . . . . . . . . . . 8
Valcyte . . . . . . . . . . . . . . . . . . . . . . . . . . 8Valisone . . . . . . . . . . . . . . . . . . . . . . . . 25Valium . . . . . . . . . . . . . . . . . . . .19, 37, 49Valproic Acid . . . . . . . . . . . . . . . . . . . . 15Valsartan . . . . . . . . . . . . . . . . . . . . . 23, 48Valsartan/Hydrochlorothiazide . . . 23, 48Valtrex . . . . . . . . . . . . . . . . . . . . . . . . 8, 49Vancocin HCl . . . . . . . . . . . . . . . . . . . . . 9Vancomycin HCl . . . . . . . . . . . . . . . . . . 9Vanos . . . . . . . . . . . . . . . . . . . . . . . . . . 25Vantin . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Vascepa . . . . . . . . . . . . . . . . . . . . . 24, 48Vaseretic . . . . . . . . . . . . . . . . . . . . . . . . 23Vasocidin . . . . . . . . . . . . . . . . . . . . . . . 41Vasotec . . . . . . . . . . . . . . . . . . . . . . . . . 22Vectical . . . . . . . . . . . . . . . . . . . . . . . . . 27Veltin . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Venlafaxine Extended-Release
Capsule . . . . . . . . . . . . . . . . . . . . . . . 48Venlafaxine HCl Capsule,
Sustained-Release 24 Hour . . . . . . 17Venlafaxine HCl ER . . . . . . . . . . . . . . . 17Venlafaxine HCl Tablet,
Extended-Release 24 Hour . . . . . . . 17Ventavis . . . . . . . . . . . . . . . . . . . . . . . . 44Ventolin . . . . . . . . . . . . . . . . . . . . . . . . . 44Ventolin HFA . . . . . . . . . . . . . . . . . . . . 44VePesid . . . . . . . . . . . . . . . . . . . . . . . . . 11Veramyst . . . . . . . . . . . . . . . . . . . . . . . . 44Verapamil HCl . . . . . . . . . . . . . . . . . . . 22Verapamil HCl Capsule, 24 Hour
Sustained-Release Pellets . . . . . . . 22Verapamil HCl Tablet,
Sustained-Action . . . . . . . . . . . . . . . 22Verdeso . . . . . . . . . . . . . . . . . . . . . . . . . 25Veregen . . . . . . . . . . . . . . . . . . . . . . . . 28Verelan . . . . . . . . . . . . . . . . . . . . . . . . . 22Verelan PM . . . . . . . . . . . . . . . . . . . . . . 22Vesanoid . . . . . . . . . . . . . . . . . . . . . . . . 11Vesicare . . . . . . . . . . . . . . . . . . . . . . . . 45Vexol . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Vfend . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Viagra 45Vibra-Tab . . . . . . . . . . . . . . . . . . . . . . . 48Vibra-Tabs . . . . . . . . . . . . . . . . . . . . . . . 7Vibramycin . . . . . . . . . . . . . . . . . . . . 7, 48Vibramycin Suspension . . . . . . . . . . . . . 7Vicodin, Vicodin ES, Vicodin HP . . . . 13Vicoprofen . . . . . . . . . . . . . . . . . . . . . . 13Victoza . . . . . . . . . . . . . . . . . . . . . . . . . 31Videx EC . . . . . . . . . . . . . . . . . . . . . . . . . 9Vigamox . . . . . . . . . . . . . . . . . . . . . . . . 41Viibryd . . . . . . . . . . . . . . . . . . . . . . . . . . 17Vimovo . . . . . . . . . . . . . . . . . . . . . . . . . 36
Vimpat . . . . . . . . . . . . . . . . . . . . . . . . . . 16Viokace . . . . . . . . . . . . . . . . . . . . . . . . . 34Viracept . . . . . . . . . . . . . . . . . . . . . . . . . . 9Viramune . . . . . . . . . . . . . . . . . . . . . . 9, 49Viramune XR . . . . . . . . . . . . . . . . . . 9, 49Viramune XR 400 mg . . . . . . . . . . . . . 49Viread . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Viroptic . . . . . . . . . . . . . . . . . . . . . . . . . 42Visicol . . . . . . . . . . . . . . . . . . . . . . . . . . 34Visken . . . . . . . . . . . . . . . . . . . . . . . . . . 21Vistaril . . . . . . . . . . . . . . . . . . . . . . . . . . 43Vivactil . . . . . . . . . . . . . . . . . . . . . . . . . . 17Vivelle-Dot . . . . . . . . . . . . . . . . . . . . . . 39Voltaren . . . . . . . . . . . . . . . . . . . . . . 36, 40Voltaren-XR . . . . . . . . . . . . . . . . . . . . . 36Voltaren Gel . . . . . . . . . . . . . . . . . . . . . 36Voriconazole . . . . . . . . . . . . . . . . . . . . . . 9VoSol . . . . . . . . . . . . . . . . . . . . . . . . . . 29VoSol HC . . . . . . . . . . . . . . . . . . . . . . . 29Votrient . . . . . . . . . . . . . . . . . . . . . . . . . 11Vusion . . . . . . . . . . . . . . . . . . . . . . . . . . 27Vytorin . . . . . . . . . . . . . . . . . . . . . . . . . . 24Vyvanse . . . . . . . . . . . . . . . . . . . . . . . . . 19WWarfarin Sodium . . . . . . . . . . . . . . . . . 20Welchol . . . . . . . . . . . . . . . . . . . . . . . . . 24Wellbutrin . . . . . . . . . . . . . . . . . . . . 17, 49Wellbutrin SR . . . . . . . . . . . . . . . . . 17, 49Wellbutrin XL . . . . . . . . . . . . . . . . . 17, 49Westcort . . . . . . . . . . . . . . . . . . . . . . . . 25XXalatan . . . . . . . . . . . . . . . . . . . . . . . . . 40Xalkori . . . . . . . . . . . . . . . . . . . . . . . . . . 11Xanax . . . . . . . . . . . . . . . . . . . . . . . 19, 49Xanax XR . . . . . . . . . . . . . . . . . . . . 19, 49Xarelto . . . . . . . . . . . . . . . . . . . . . . . . . 20Xeljanz . . . . . . . . . . . . . . . . . . . . . . . . . . 36Xeloda . . . . . . . . . . . . . . . . . . . . . . . . . . 11Xenaderm . . . . . . . . . . . . . . . . . . . . . . . 27Xerese . . . . . . . . . . . . . . . . . . . . . . . . . . 27Xibrom . . . . . . . . . . . . . . . . . . . . . . . . . 40Xifaxan . . . . . . . . . . . . . . . . . . . . . . . . . . 9Xodol . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Xolegel . . . . . . . . . . . . . . . . . . . . . . . . . 27Xopenex HFA . . . . . . . . . . . . . . . . . . . . 44Xopenex Vial, Nebulizer . . . . . . . . . . . . 44Xtandi . . . . . . . . . . . . . . . . . . . . . . . . . . 12Xulane . . . . . . . . . . . . . . . . . . . . . . . . . . 48Xylocaine . . . . . . . . . . . . . . . . . . . . . . . 26Xyntha . . . . . . . . . . . . . . . . . . . . . . . . . . 21Xyrem . . . . . . . . . . . . . . . . . . . . . . . . . . 19Xyzal . . . . . . . . . . . . . . . . . . . . . . . . . . . 43YYasmin . . . . . . . . . . . . . . . . . . . . . . . . . 38
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2015 Prescription Drug List Medication Index
Yaz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38ZZafirlukast . . . . . . . . . . . . . . . . . . . . . . . 44Zaleplon . . . . . . . . . . . . . . . . . . . . . 17, 48Zanaflex . . . . . . . . . . . . . . . . . . . . . . . . 37Zantac Syrup . . . . . . . . . . . . . . . . . . . . 33Zarontin . . . . . . . . . . . . . . . . . . . . . . . . 15Zaroxolyn . . . . . . . . . . . . . . . . . . . . . . . 21Zegerid . . . . . . . . . . . . . . . . . . . . . . . . . 33Zegerid Capsule . . . . . . . . . . . . . . . . . 33Zegerid Packet . . . . . . . . . . . . . . . . . . . 33Zelapar . . . . . . . . . . . . . . . . . . . . . . . . . 15Zelboraf . . . . . . . . . . . . . . . . . . . . . . . . 11Zemplar . . . . . . . . . . . . . . . . . . . . . . . . . 30Zenatane . . . . . . . . . . . . . . . . . . . . . . . 26Zenpep . . . . . . . . . . . . . . . . . . . . . . . . . 34Zenzedi . . . . . . . . . . . . . . . . . . . . . . . . . 19Zerit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Zestoretic . . . . . . . . . . . . . . . . . . . . . . . 23Zestril . . . . . . . . . . . . . . . . . . . . . . . . . . 22Zetia . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Zetonna . . . . . . . . . . . . . . . . . . . . . . . . 44Ziac . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Ziagen . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Ziana . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Zidovudine . . . . . . . . . . . . . . . . . . . . . . . 9
Zidovudine/Lamivudine . . . . . . . . . . . . . 9Zioptan . . . . . . . . . . . . . . . . . . . . . . . . . 40Ziprasidone . . . . . . . . . . . . . . . . . . 18, 48Zipsor . . . . . . . . . . . . . . . . . . . . . . . . . . 36Zirgan . . . . . . . . . . . . . . . . . . . . . . . . . . 42Zithromax . . . . . . . . . . . . . . . . . . . . . . . . 7Zmax . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Zocor . . . . . . . . . . . . . . . . . . . . . . . . . . 24Zofran . . . . . . . . . . . . . . . . . . . . . . . . . . 34Zofran ODT . . . . . . . . . . . . . . . . . . . . . 34Zohydro ER . . . . . . . . . . . . . . . . . . . . . 13Zolinza . . . . . . . . . . . . . . . . . . . . . . . . . . 11Zolmitriptan . . . . . . . . . . . . . . . . . . . . . 14Zolmitriptan Orally Disintegrating Tablet .
14Zoloft . . . . . . . . . . . . . . . . . . . . . . . . 18, 49Zolpidem . . . . . . . . . . . . . . . . . . . . . 17, 48Zolpidem Tartrate . . . . . . . . . . . . . . . . . 17Zolpidem Tartrate Tablet, Multiphasic-
Release . . . . . . . . . . . . . . . . . . . . . . . 17Zolpimist . . . . . . . . . . . . . . . . . . . . . . . . 17Zomig . . . . . . . . . . . . . . . . . . . . . . . . . . 14Zomig-ZMT . . . . . . . . . . . . . . . . . . . . . 14Zomig Nasal Spray . . . . . . . . . . . . . . . 14Zonalon . . . . . . . . . . . . . . . . . . . . . . . . . 28Zonegran . . . . . . . . . . . . . . . . . . . . 15, 16
Zonisamide . . . . . . . . . . . . . . . . . . . . . . 15Zorbtive . . . . . . . . . . . . . . . . . . . . . . . . . 35Zorvolex . . . . . . . . . . . . . . . . . . . . . . . . 36Zovirax . . . . . . . . . . . . . . . . . . . . . 8, 27, 49Zovirax Cream . . . . . . . . . . . . . . . . . . . 27Zovirax Ointment . . . . . . . . . . . . . . . . . 49Zubsolv . . . . . . . . . . . . . . . . . . . . . . . . . 14Zutripro . . . . . . . . . . . . . . . . . . . . . . 43, 49Zyban . . . . . . . . . . . . . . . . . . . . . . . . . . 47Zyclara . . . . . . . . . . . . . . . . . . . . . . . . . 28Zyflo . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Zyflo CR . . . . . . . . . . . . . . . . . . . . . . . . 44Zykadia . . . . . . . . . . . . . . . . . . . . . . . . . 12Zylet . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Zyloprim . . . . . . . . . . . . . . . . . . . . . . . . 36Zyprexa . . . . . . . . . . . . . . . . . . . . . . 18, 49Zyprexa Zydis . . . . . . . . . . . . . . . . . 18, 49Zytiga . . . . . . . . . . . . . . . . . . . . . . . . . . 11Zyvox . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
UnitedHealthcare Physician PDL Booklet 1/15 Created November, 2014© 2014 UnitedHealthCare Services, Inc . All rights reserved .