1. No category

Marketplace Exchange Standard Formulary
L.A. Care Covered
Administered by MedImpact
Effective October 2014
Foreword
This document represents the efforts of L.A. Care Health
Plan and the MedImpact Healthcare Systems Pharmacy
and Therapeutics (P & T) and Formulary Committees to
provide physicians and pharmacists with a method to
evaluate the safety, efficacy and cost-effectiveness of
commercially available drug products. A structured
approach to the drug selection process is essential in
ensuring continuing patient access to rational drug
therapies.
This is accomplished through the auspices of the
MedImpact P & T and Formulary Committees. These
committees meet quarterly and more often as warranted
to ensure clinical relevancy of the Formulary. To
accommodate changes to this document, updates are
made accessible as necessary.
Access to the most current version of the L.A. Care
Covered Formulary can be obtained by visiting
http://www.lacarecovered.org/for-members/pharmacycenter.
The MedImpact P & T and Formulary Committees use the
following criteria in the evaluation of drug selection for the
Marketplace Exchange Standard Formulary:
• Drug safety profile
• Drug efficacy
• Comparison of relevant therapeutic benefits to current
formulary agents of similar use, and to minimize
therapeutic duplication where possible
• Cost-effectiveness relative to comparable therapies
How to Use the Formulary
The Formulary is a list of medications available to L.A.
Care Covered members under their pharmacy benefit. All
drugs are listed by their generic names and most common
proprietary (branded) name. The Formulary may be
accessed by using the index, either by generic or
proprietary name and by therapeutic drug category. In
situations where an FDA approved generic equivalent is
L.A. Care
available, brand names are listed for reference purposes
only, and do not denote coverage for the brand, unless
specifically noted.
All drugs are listed in each category in alphabetical order
by generic name. Where an FDA approved generic is
available for the listed generic name, the generic name is
bolded.
For certain agents within the Formulary, a recommended
prescribing guideline may apply. These are denoted
throughout the document using the following symbols:
Symbol
Guideline
Description
AGE
Age Edit
Coverage may depend on
patient age
G
Gender Edit
Coverage may depend on
patient gender
PA
Prior
Requires specific physician
Authorization request process
QL
Quantity
Limit
Coverage may be limited to
specific quantities per
prescription and/or time period
ST
Step
Therapy
Coverage may depend on
previous use of another drug
Please refer to the prescribing guideline appendix within
this document for details regarding specific agents.
Benefit Coverage and Limitations
This printed Formulary does not provide information
regarding the specific coverage and limitations an
individual member may be subject to. Many members
have specific benefit inclusions, exclusions, copays, or a
lack of coverage, which are not reflected in the Formulary.
The Formulary applies only to outpatient drugs provided
to members, and does not apply to medications used in
inpatient settings. If a member has any specific questions
regarding their coverage, they should contact L.A. Care
Page 1 of 90
Health Plan at (855) 270-2327 or MedImpact at (800)
788-2949.
Depending upon a member’s specific
benefit parameters, the following
topics may apply:
1.Generic Substitution
When available, FDA approved generic drugs are to
be used in all situations, regardless of the brand name
indicated. The generic names are bolded in the
formulary listing wherever an FDA approved generic
drug product is available. Greater economy is realized
through the use of generic equivalents. This policy is
not meant to preclude or supplant any state statutes
that may exist. All drugs that are or become available
generically are subject to review by MedImpact’s
Pharmacy and Therapeutics Committee. MedImpact
approves such multi-source drugs for addition to the
MAC list based on the following criteria:
• A multi-source drug product manufactured by at
least one (1) nationally marketed company.
• At least one (1) of the generic manufacturer’s
products must have an “A” rating or the generic
product has been determined to be unassociated
with efficacy, safety or bioequivalency concerns by
the MedImpact P & T Committee.
• Drug product will be approved for generic
substitution by the MedImpact P & T Committee.
This list is reviewed and updated periodically based
on the clinical literature and pharmacokinetic
characteristics of currently available versions of these
drug products.
If a member or physician requests a brand name
product in lieu of an approved generic, the member,
based upon their coverage, will typically be required
to pay the difference in cost between the brand and
the generic. If a physician determines that there is a
documented medical need for the brand equivalent, a
request for coverage may be made using the
medication request process.
2.Tier Benefit Design
The Formulary may be applied to a tier benefit design,
where the member shares the cost of prescription
drug therapy based on the drug’s tier and copayment
or coinsurance. In most instances, generically
L.A. Care
available drugs will be covered in a separate lower tier
(low copay), preferred branded drugs listed on the
Formulary will be covered under a higher tier, and
branded drugs not on the Formulary will be covered
under a separate non-preferred branded drug copay
tier. Specialty drugs will be covered under the highest
tier (highest copay). Essential health
benefit/preventative medications, if available on the
formulary (applies to new and non-grandfathered
plans), will be covered without cost sharing (zero
copay).
Tier Definitions
Tier 1:
Preferred generic medications
(formulary agents)
Tier 2:
Preferred brand medications (formulary
agents)
Tier 3:
Non-preferred medications (nonformulary agents)
Tier 4:
Specialty medications
Tier 5:
EHB Zero Copay/Preventative
medications
3.Medication Request Process
Depending upon plan benefit design, a medication
request process may apply as follows:
Drugs that are listed in the Formulary with
associated Prior Authorization (PA) require
evaluation, per MedImpact P & T Committee
Prior Authorization guidelines prior to dispensing
at a pharmacy. Each request will be reviewed on
an individual patient need basis. If the request
does not meet the guidelines established by the
P & T Committee, the request will not be
approved and alternative therapy may be
recommended.
If the request does not meet the guidelines
established by the P & T Committee, the request
will not be approved and alternative therapy may
be recommended.
Obtaining Coverage
Coverage, questions or information regarding the
medication request or formulary process may be
obtained by:
1. Faxing a completed Medication Request
Form to MedImpact at (800) 681-7651.
Page 2 of 90
2. Contacting MedImpact at (855) 270-2327 and
providing all necessary information requested.
MedImpact will provide an authorization number,
specific for the medical need, for all approved
requests. Non-approved requests may be
appealed. The prescriber must provide
information to support the appeal on the basis of
medical necessity. Prior Authorization is generally
not available for drugs that are specifically
excluded by benefit design.
San Diego, CA 92131
4.General Exclusions
A. Over the Counter (OTC) medications or their
equivalents, unless the individual’s pharmacy
benefit offers coverage of OTC medications.
B. Drugs specifically listed as not covered.
C. Any drug products used for cosmetic purposes.
D. Experimental drug products or any drug product
used in an experimental manner.
E. Replacement of lost or stolen medication.
F. Non self-administered injectable drug products
unless otherwise specified in the Formulary
listing.
G.Foreign sourced drugs or drugs not approved by
the United States Food & Drug Administration,
except in certain cases of drug shortage, when
allowed under the individual's pharmacy benefit.
The P & T and Formulary Committees recognize
that not all medical needs can be met with this
document and encourage inquiries about alternative
therapies.
5.Pharmacist and Physician Communication
The Formulary is a tool to promote cost-effective
prescription drug use. The P & T and Formulary
Committees have made every attempt to create a
document that meets all therapeutic needs; however,
the art of medicine makes this a formidable task.
MedImpact welcomes the participation of physicians,
pharmacists, and ancillary medical providers, in this
dynamic process. Physicians and pharmacists are
highly encouraged to direct any suggestions,
comments or formulary additions to MedImpact at the
following address:
Chairperson, Pharmacy & Therapeutics Committee
MedImpact Healthcare Systems, Inc.
10181 Scripps Gateway Court
L.A. Care
Page 3 of 90
This page is blank intentionally Commercial Formulary
ALLERGY
Nasal Antihistamine & Anti-inflam. Steroid
2nd Gen Antihistamine & Decongestant
Comb.
T3 azelastine/fluticasone DYMISTA
Combinations
T3 desloratadine/pseudoe CLARINEX-D 12
QL, ST
phedrine
HOUR
T1 fexofenadine/pseudo FEXOFENADINE/PSE
ephedrine
UDOEPHEDRINE
T3 pseudoephedrine
SEMPREX-D
hcl/acrivas
Allergenic Extracts, Therapeutics
T3 gr pol-orc/sw
ver/rye/kent/tim
T3 grass pollen-timothy,
std
T3 weed pollen-short
ragweed
ORALAIR
PA
GRASTEK
PA
RAGWITEK
PA
Antihistamines
T1 tripelennamine hcl
T1
T1
T3
T1
T1
T1
T1
T1
T1
CARBINOXAMINE
MALEATE
KARBINAL ER
AGE
AGE
L.A. Care
T2
T2
T3
T3
T1
T3
T1
T1
T3
T1
T3
T3
CETIRIZINE HCL
CLARINEX(SYRUP) QL, ST
CLARINEX(TAB)
QL
DESLORATADINE
QL, ST
FEXOFENADINE HCL
XYZAL(SOLUTION) QL, ST
T1
T1
T1
T2
T1
T1
T3
T1
XYZAL(TAB)
Nasal Antihistamine
T1 azelastine hcl
T1 azelastine hcl
T3 olopatadine hcl
T1
ASTEPRO
AZELASTINE HCL
PATANASE
BECONASE AQ
QL, ST
QNASL
QL, ST
RHINOCORT AQUA
OMNARIS
ZETONNA
FLUNISOLIDE
VERAMYST
FLONASE
QL, ST
QL, ST
QL, ST
QL
QL, ST
QL
NASONEX
TRIAMCINOLONE
ACETONIDE
QL
QL
T2 aprepitant
T2 aprepitant
T3
Antihistamines - 2nd Generation
cetirizine hcl
desloratadine
desloratadine
desloratadine
fexofenadine hcl
levocetirizine
dihydrochloride
T1 levocetirizine
dihydrochloride
T3 beclomethasone
dipropionate
T2 beclomethasone
dipropionate
T1 budesonide
T3 ciclesonide
T3 ciclesonide
T1 flunisolide
T3 fluticasone furoate
T1 fluticasone
propionate
T2 mometasone furoate
T1 triamcinolone
acetonide
Antiemetic/antivertigo Agents
CLEMASTINE
FUMARATE
cyproheptadine hcl CYPROHEPTADINE
HCL
dexchlorpheniramine DEXCHLORPHENIRA
maleate
MINE MALEATE
diphenhydramine hcl DICOPANOL
diphenhydramine hcl DIPHENHYDRAMINE
HCL
hydroxyzine hcl
HYDROXYZINE HCL
hydroxyzine pamoateHYDROXYZINE
PAMOATE
hydroxyzine pamoateVISTARIL
promethazine hcl
PHENERGAN
promethazine hcl
PROMETHAZINE HCL
T1
T3
T1
T1
T1
T1
Nasal Anti-inflammatory Steroids
ANTIEMESIS/ANTIVERTIGO
TRIPELENNAMINE
HCL
Antihistamines - 1st Generation
T1 carbinoxamine
maleate
T3 carbinoxamine
maleate
T1 clemastine fumarate
QL, ST
QL, ST
QL
QL, ST
EMEND(CAP DS PK) QL
EMEND(CAP)(125
QL
MG)
aprepitant
EMEND(CAP)(40 MG) QL
aprepitant
EMEND(CAP)(80 MG) QL
dolasetron mesylate ANZEMET(TAB)(100 QL, ST
MG)
dolasetron mesylate ANZEMET(TAB)(50
QL, ST
MG)
doxylamine/pyridoxine DICLEGIS
QL
hcl
dronabinol
MARINOL
QL, ST
granisetron
SANCUSO
QL, ST
granisetron hcl
GRANISETRON HCL QL, ST
meclizine hcl
ANTIVERT
nabilone
CESAMET
QL, ST
ondansetron
ZOFRAN ODT
ondansetron
ZUPLENZ(FILM)(4
QL, ST
MG)
ondansetron
ZUPLENZ(FILM)(8
QL, ST
MG)
ondansetron hcl
ONDANSETRON HCL
ondansetron hcl
ZOFRAN(SOLUTION) QL
ondansetron hcl
ZOFRAN(TAB)
prochlorperazine
COMPAZINE
edisylate
prochlorperazine
PROCHLORPERAZIN
maleate
E MALEATE
promethazine hcl
PROMETHEGAN
scopolamine
TRANSDERM-SCOP
trimethobenzamide TIGAN
hcl
trimethobenzamide TRIMETHOBENZAMI
hcl/b-caine
DE HCL
Page 5 of 90
Commercial Formulary
T3 guaifenesin/theophyllin QUIBRON
e
T2 ipratropium bromide ATROVENT HFA
T1 ipratropium bromide IPRATROPIUM
BROMIDE
T2 tiotropium bromide
SPIRIVA
ASTHMA
5-lipoxygenase Inhibitors
T3 zileuton
T3 zileuton
ZYFLO
ZYFLO CR
Adrenergic Agents,catecholamines
Glucocorticoids, Orally Inhaled
T1 epinephrine
T1 isoetharine hcl
T2 beclomethasone
dipropionate
T3 budesonide
EPINEPHRINE
ISOETHARINE HCL
Beta-adrenergic Agents
T1 albuterol sulfate
T2
T3
T2
T1
T3
T3
T2
T3
albuterol sulfate
albuterol sulfate
albuterol sulfate
albuterol sulfate
arformoterol tartrate
formoterol fumarate
formoterol fumarate
indacaterol maleate
T1 levalbuterol hcl
T3 levalbuterol tartrate
T1 metaproterenol
sulfate
T3 olodaterol hcl
T2 salmeterol xinafoate
T1 terbutaline sulfate
ALBUTEROL
SULFATE
PROAIR HFA
PROVENTIL HFA
VENTOLIN HFA
VOSPIRE ER
BROVANA
FORADIL
PERFOROMIST
ARCAPTA
NEOHALER
XOPENEX
XOPENEX HFA
METAPROTERENOL
SULFATE
STRIVERDI
RESPIMAT
SEREVENT DISKUS
TERBUTALINE
SULFATE
T1 budesonide
T1 budesonide
T2 budesonide
QL
QL, ST
QL
QL, ST
T3 ciclesonide
T3 flunisolide
T2 fluticasone propionate
T2 fluticasone propionate
T2 fluticasone propionate
QL
T2 fluticasone propionate
T2 fluticasone propionate
QL
PULMICORT
FLEXHALER
PULMICORT(AMPULNEB)(0.25MG/2ML)
PULMICORT(AMPULNEB)(0.5 MG/2ML)
PULMICORT(AMPULNEB)(1 MG/2 ML)
ALVESCO
AEROSPAN
FLOVENT
DISKUS(BLST
W/DEV)(100 MCG)
FLOVENT
DISKUS(BLST
W/DEV)(250 MCG)
FLOVENT
DISKUS(BLST
W/DEV)(50 MCG)
FLOVENT HFA(AER
W/ADAP)(110 MCG)
FLOVENT HFA(AER
W/ADAP)(220 MCG)
FLOVENT HFA(AER
W/ADAP)(44 MCG)
ASMANEX
QL, ST
T2 fluticasone propionate
Combinations
T3 mometasone furoate
T2 ipratropium/albuterol COMBIVENT
sulfate
RESPIMAT
T1 ipratropium/albuterol IPRATROPIUMsulfate
ALBUTEROL
T2 umeclidinium
ANORO ELLIPTA
brm/vilanterol tr
Leukotriene Receptor Antagonists
QL
QL
QL
QL, ST
QL, ST
QL
QL
QL
QL
QL
QL
QL, ST
T1 montelukast sodium SINGULAIR
T1 zafirlukast
ACCOLATE
QL
Mast Cell Stabilizers
Beta-adrenergic And Glucocorticoid
T1 cromolyn sodium
T1 cromolyn sodium
Combinations
Phosphodiesterase-4 (pde4) Inhibitors
SYMBICORT
QL, ST
ADVAIR DISKUS
ADVAIR HFA
BREO ELLIPTA
DULERA
QL
QL
QL
QL
General Bronchodilator Agents
T2 aclidinium bromide
TUDORZA PRESSAIR QL
T1 guaifenesin/dyphyllin LUFYLLIN-GG
e
T1 guaifenesin/theophyll BRONCOMAR GG
ine
L.A. Care
QL
QVAR
Beta-adrenergic And Anticholinergic
T3 budesonide/formoterol
fumarate
T2 fluticasone/salmeterol
T2 fluticasone/salmeterol
T2 fluticasone/vilanterol
T2 mometasone/formoter
ol
QL
T2 roflumilast
CROMOLYN SODIUM
GASTROCROM
DALIRESP
QL, ST
Respiratory Aids,devices,equipment
T3 compressor, for
DEVILBISS PULMOnebulizer
AIDE
T3 inhaler, assist devices ACE AEROSOL
CLOUD ENHANCER
T3 inhaler, assist devices AEROCHAMBER MINI
T3 inhaler, assist devices AEROCHAMBER MV
T3 inhaler, assist devices AEROCHAMBER
PLUS
T3 inhaler, assist devices AEROCHAMBER
PLUS FLOW-VU
T3 inhaler, assist devices AEROCHAMBER
PLUS Z STAT
Page 6 of 90
Commercial Formulary
T3 inhaler, assist devices AEROCHAMBER
WITH FLOWSIGNAL
T3 inhaler, assist devices AEROCHAMBER ZSTAT PLUS
T3 inhaler, assist devices AEROTRACH PLUS
T3 inhaler, assist devices AEROVENT II
T3 inhaler, assist devices BREATHERITE
T3 inhaler, assist devices BREATHRITE
T3 inhaler, assist devices COMPACT SPACE
CHAMBER PLUS
T3 inhaler, assist devices EASIVENT
T3 inhaler, assist devices E-Z SPACER
T3 inhaler, assist devices LITEAIRE
T3 inhaler, assist devices MICROCHAMBER
T3 inhaler, assist devices MICROSPACER
T3 inhaler, assist devices MONAGHAN Z STAT
T3 inhaler, assist devices POCKET CHAMBER
T3 inhaler, assist devices PRIMEAIRE
T3 inhaler, assist devices PROCHAMBER
T3 inhaler, assist devices RITEFLO
T3 inhaler, assist devices SPACE CHAMBER
PLUS
T3 inhaler, assist devices VORTEX
T3 inhaler, assist devices VORTEX VHC FROG
MASK
T3 inhaler, assist devices VORTEX VHC
LADYBUG MASK
T3 inhaler, assist devices WATCHHALER
T3 inhaler,assist
EASIVENT
device,accesory
T3 inhaler,assist
LITETOUCH
device,accesory
T3 inhaler,assist
OPTICHAMBER
device,accesory
T3 inhaler,assist
OPTICHAMBER
device,accesory
DIAMOND
T3 inhaler,assist
SILICONE MASK
device,accesory
T3 nebulizer
AEROECLIPSE
T3 nebulizer
AEROECLIPSE II
T3 nebulizer
ALTERA NEBULIZER
T3 nebulizer
BABY NEBULIZER
T3 nebulizer
ERAPID NEBULIZER
T3 nebulizer
INSPIRATION
T3 nebulizer
LC D NEBULIZER
SET
T3 nebulizer
LC PLUS
T3 nebulizer
LC SPRINT
NEBULIZER
T3 nebulizer
LC STAR
T3 nebulizer
MICRO PLUS
T3 nebulizer
MINI PLUS
NEBULIZER
T3 nebulizer
MISTERNEB
NEBULIZER
T3 nebulizer
NASONEB NASAL
NEBULIZER
T3 nebulizer
PARI LC SPRINT
SINUS
T3 nebulizer
PRODIGY MINI-MIST
T3 nebulizer
SIDESTREAM
L.A. Care
T3 nebulizer
T3 nebulizer
T3 nebulizer
T3 nebulizer/compressor
T3 nebulizer/compressor
T3 nebulizer/compressor
T3 nebulizer/compressor
T3 nebulizer/compressor
T3
T3
T3
T3
nebulizer/compressor
nebulizer/compressor
nebulizer/compressor
nebulizer/compressor
T3 nebulizer/compressor
T3
T3
T3
T3
T3
nebulizer/compressor
nebulizer/compressor
nebulizer/compressor
nebulizer/compressor
nebulizer/compressor
T3 nebulizer/compressor
T3 nebulizer/compressor
T3 peak flow meter
T3 peak flow meter
T3 peak flow meter/inh
asst dev
T3 peak flow meter/inh
asst dev
T3 spirometers and
accessories
T3 spirometers and
accessories
T3 spirometers and
accessories
SIDESTREAM
NEBULIZER
SIDESTREAM PLUS
SINUSTAR
COMP-AIR ELITE
COMPRESSOR SYST
COMP-AIR
NEBULIZER
COMPRESSOR
DEVILBISS
TRAVELER
INNOSPIRE
ELEGANCE
INNOSPIRE
ESSENCE
INSPIRATION ELITE
MICRO ELITE
MINIELITE
NASONEB NASAL
NEBULIZER
PARI SINUS
AEROSOL SYSTEM
PRONEB ULTRA
PRONEB ULTRA II
SAMI THE SEAL
SINUSTAR
TREK S COMBO
PACK
TREK S COMPACT
COMPRESSOR
VIOS AEROSOL
DELIVERY SYSTEM
MINI-WRIGHT PEAK
FLOW METER
TRUZONE PEAK
FLOW METER
AEROGEAR ASTHMA
ACTION KIT
ASTHMAPACK
CHILDREN'S
PFLEX TRAINER
THRESHOLD IMT
THRESHOLD PEP
Xanthines
T1
T1
T3
T3
T1
aminophylline
AMINOPHYLLINE
caffeine citrated
CAFCIT
dyphylline
LUFYLLIN
dyphylline
LUFYLLIN-400
theophyll/ephed
THEOTAL
hcl/phenobarb
T2 theophylline anhydrousTHEO-24
T1 theophylline
THEOPHYLLINE
anhydrous
ANHYDROUS
Page 7 of 90
Commercial Formulary
T1
T1
T3
T1
AUTONOMIC NERVOUS SYSTEM
DISORDERS
Alzheimer's Therapy, Nmda Receptor
Antagonists
T2 memantine hcl
T2 memantine hcl
T2 memantine hcl
T2 memantine hcl
T2 memantine hcl
NAMENDA XR(CAP
24 DSPK)
NAMENDA XR(CAP
SPR 24)
NAMENDA(SOLUTIO
N)
NAMENDA(TAB DS
PK)
NAMENDA(TAB)
QL
QL
QL
QL
QL
T1
T1
T1
T2
T1
T3
T3
T1
fluoxetine hcl
fluoxetine hcl
fluoxetine hcl
fluvoxamine maleate
FLUOXETINE HCL
PROZAC
SARAFEM
FLUVOXAMINE
MALEATE
fluvoxamine maleate LUVOX CR
paroxetine hcl
PAROXETINE HCL
paroxetine hcl
PAXIL CR
paroxetine hcl
PAXIL(ORAL SUSP)
paroxetine hcl
PAXIL(TAB)
paroxetine mesylate BRISDELLE
paroxetine mesylate PEXEVA
sertraline hcl
ZOLOFT
QL, ST
QL, ST
QL, ST
Serotonin-2 Antagonist/reuptake Inhibitors
T1 nefazodone hcl
T3 trazodone hcl
T1 trazodone hcl
NEFAZODONE HCL
OLEPTRO ER
TRAZODONE HCL
QL, ST
Cholinesterase Inhibitors
Serotonin-norepinephrine Reuptake-inhib
T1
T1
T1
T2
T1 desvenlafaxine
T3 desvenlafaxine
fumarate
T2 desvenlafaxine
succinate
T1 duloxetine hcl
T3 levomilnacipran
hydrochloride
T3 venlafaxine hcl
T2
T1
T2
T1
donepezil hcl
galantamine hbr
galantamine hbr
pyridostigmine
bromide
pyridostigmine
bromide
pyridostigmine
bromide
rivastigmine
rivastigmine tartrate
ARICEPT
RAZADYNE
QL
RAZADYNE ER
QL
MESTINON(SYRUP)
MESTINON(TAB ER)
MESTINON(TAB)
EXELON
EXELON
QL
T3 vilazodone
hydrochloride
T3 vilazodone
hydrochloride
ANTIDEPRESSANTS
Alpha-2 Receptor Antagonist
T3 vortioxetine
hydrobromide
VENLAFAXINE HCL
ER
VIIBRYD(TAB DS PK) ST
VIIBRYD(TAB)
QL, ST
BRINTELLIX
QL, ST
Tricyclic Antidepressant/benzodiazepine
MARPLAN
NARDIL
PARNATE
Combinatns
Norepinephrine And Dopamine Reuptake
Inhib
APLENZIN
FORFIVO XL
WELLBUTRIN XL
QL
QL, ST
Antidepressant
MIRTAZAPINE
REMERON
Maois - Non-selective & Irreversible
T3 bupropion hbr
T3 bupropion hcl
T1 bupropion hcl
DULOXETINE HCL
FETZIMA
QL, ST
Ssri & Serotonin Receptor Modulator
Antidepressants
T3 isocarboxazid
T1 phenelzine sulfate
T1 tranylcypromine
sulfate
QL, ST
QL, ST
Ssri & 5ht1a Partial Agonist Antidepressant
BEHAVIORAL HEALTH -
T1 mirtazapine
T1 mirtazapine
KHEDEZLA
DESVENLAFAXINE
FUMARATE ER
PRISTIQ ER
QL, ST
QL, ST
T1 amitrip
CHLORDIAZEPOXIDE
hcl/chlordiazepoxide -AMITRIPTYLINE
Tricyclic Antidepressant/phenothiazine
Combinatns
T1 perphenazine/amitrip PERPHENAZINEtyline hcl
AMITRIPTYLINE
Selective Serotonin Reuptake Inhibitor
Tricyclic Antidepressants & Rel. Non-sel. Ru-
T1 citalopram
CELEXA
hydrobromide
T1 citalopram
CITALOPRAM HBR
hydrobromide
T1 escitalopram oxalate LEXAPRO
inhib
L.A. Care
T1
T1
T1
T1
amitriptyline hcl
amoxapine
clomipramine hcl
desipramine hcl
AMITRIPTYLINE HCL
AMOXAPINE
ANAFRANIL
NORPRAMIN
Page 8 of 90
Commercial Formulary
T1
T1
T1
T1
T1
T1
T1
T3
doxepin hcl
imipramine hcl
imipramine pamoate
maprotiline hcl
nortriptyline hcl
nortriptyline hcl
protriptyline hcl
trimipramine maleate
DOXEPIN HCL
TOFRANIL
TOFRANIL-PM
MAPROTILINE HCL
NORTRIPTYLINE HCL
PAMELOR
VIVACTIL
SURMONTIL
BEHAVIORAL HEALTH - OTHER
Anti-narcolepsy & Anti-cataplexy,sedativetype Agt
T3 sodium oxybate
XYREM
PA
Antipsych,dopamine
Antag.,diphenylbutylpiperidines
T3 pimozide
ORAP
Adrenergics, Aromatic, Non-catecholamine
Antipsychotics, Atyp, D2 Partial Agonist/5ht
T1 dextroamphetamine DEXTROAMPHETAMI QL
sulfate
NE SULFATE(TAB)(10
MG)
T1 dextroamphetamine DEXTROAMPHETAMI QL
sulfate
NE SULFATE(TAB)(5
MG)
T1 dextroamphetamine PROCENTRA
QL
sulfate
T2 dextroamphetamine ZENZEDI
QL, ST
sulfate
T1 dextroamphetamine/ ADDERALL
QL
amphetamine
T2 lisdexamfetamine
VYVANSE
QL, ST
dimesylate
QL
T1 methamphetamine DESOXYN
hcl
Mixed
Anti-alcoholic Preparations
T1 disulfiram
ANTABUSE
T2 aripiprazole
T2 aripiprazole
T2 aripiprazole
T2 aripiprazole
T4 loxapine
T1 loxapine succinate
T1 loxapine succinate
T3
T4
T4
T4
T4
T3
T3
T3
T1
T1
T1
T1
T1
T1
T1
Anti-mania Drugs
T3 carbamazepine
T1 lithium carbonate
T1 lithium carbonate
T1 lithium carbonate
T1 lithium citrate
L.A. Care
EQUETRO
ESKALITH
LITHIUM
CARBONATE
LITHOBID
LITHIUM
QL, ST
QL, ST
ADASUVE
LOXAPINE
LOXITANE
Antipsychotics,atypical,dopamine,&
T1 alprazolam
T2 alprazolam
T1
QL, ST
Antagonists
Serotonin Antag
T1
T1
T3
T1
QL, ST
Antipsychotics, Dopamine & Serotonin
Anti-anxiety Drugs
ALPRAZOLAM
ALPRAZOLAM
INTENSOL
alprazolam
XANAX
buspirone hcl
BUSPIRONE HCL
chlordiazepoxide
LIBRITABS
chlordiazepoxide hcl CHLORDIAZEPOXIDE
HCL
clorazepate
TRANXENE T-TAB
dipotassium
diazepam
DIAZEPAM
diazepam
VALIUM
lorazepam
ATIVAN
lorazepam
LORAZEPAM
meprobamate
MEPROBAMATE
meprobamate
MILTOWN
oxazepam
OXAZEPAM
ABILIFY
DISCMELT(TAB RDP
DIS)(10 MG)
ABILIFY
DISCMELT(TAB RDP
DIS)(15 MG)
ABILIFY(SOLUTION)
ABILIFY(TAB)
asenapine maleate
clozapine
clozapine
clozapine
clozapine
iloperidone
iloperidone
lurasidone hcl
SAPHRIS
QL, ST
CLOZAPINE
QL
CLOZARIL
QL
FAZACLO
QL, ST
VERSACLOZ
QL, ST
FANAPT(TAB DS PK) QL, ST
FANAPT(TAB)
QL, ST
LATUDA(TAB)(120
QL, ST
MG)
T3 lurasidone hcl
LATUDA(TAB)(20 MG) QL, ST
T3 lurasidone hcl
LATUDA(TAB)(40 MG) QL, ST
T3 lurasidone hcl
LATUDA(TAB)(60 MG) QL, ST
T3 lurasidone hcl
LATUDA(TAB)(80 MG) QL, ST
T1 olanzapine
ZYPREXA
QL
T3 paliperidone
INVEGA(TAB ER
QL, ST
24H)(1.5 MG)
T3 paliperidone
INVEGA(TAB ER
QL, ST
24H)(3 MG)
T3 paliperidone
INVEGA(TAB ER
QL, ST
24H)(6 MG)
T3 paliperidone
INVEGA(TAB ER
QL, ST
24H)(9 MG)
T1 quetiapine fumarate SEROQUEL
QL
T2 quetiapine fumarate SEROQUEL XR
QL, ST
T1 risperidone
RISPERDAL(SOLUTI QL
ON)
T1 risperidone
RISPERDAL(TAB)
QL
T1 risperidone
RISPERIDONE
QL
T1 ziprasidone hcl
GEODON
QL
Page 9 of 90
Commercial Formulary
Antipsychotics,dopamine Antagonists,
T3 zolpidem tartrate
T1 zolpidem tartrate
Thioxanthenes
T3 zolpidem tartrate
T1 thiothixene
THIOTHIXENE
T1 olanzapine/fluoxetine SYMBYAX
hcl
HALOPERIDOL
HALOPERIDOL
LACTATE
Agonist
T1 chlorpromazine hcl
T1 clonidine hcl
T3 guanfacine hcl
CHLORPROMAZINE
HCL
FLUPHENAZINE HCL
PERPHENAZINE
THIORIDAZINE HCL
TRIFLUOPERAZINE
HCL
T1 dexmethylphenidate
hcl
T2 dexmethylphenidate
hcl
T3 methylphenidate
T1 methylphenidate hcl
BUTISOL SODIUM
PHENOBARBITAL
SECONAL SODIUM
T1 methylphenidate hcl
Agonists
T1 methylphenidate hcl
ROZEREM
HETLIOZ
QL, ST
PA
T1 methylphenidate hcl
QL
T2 methylphenidate hcl
T1 methylphenidate hcl
Monoamine Oxidase(mao) Inhibitors
T3 selegiline
EMSAM
Narcolepsy And Sleep Disorder Therapy
T1 methylphenidate hcl
Agents
T2 armodafinil
T1 modafinil
NUVIGIL
PROVIGIL
PA
PA
T1 methylphenidate hcl
Narcotic Antagonists
T3 naloxone hcl
T1 naltrexone hcl
T1 methylphenidate hcl
EVZIO
REVIA
T1 methylphenidate hcl
Sedative-hypnotics,non-barbiturate
T3
T1
T1
T3
T1
T1
T1
T1
T1
T1
T1
T1
T1
T1
T3
doxepin hcl
estazolam
eszopiclone
ethchlorvynol
flurazepam hcl
glutethimide
midazolam hcl
quazepam
temazepam
temazepam
triazolam
triazolam
zaleplon
zolpidem tartrate
zolpidem tartrate
L.A. Care
SILENOR
ESTAZOLAM
LUNESTA
PLACIDYL
FLURAZEPAM HCL
GLUTETHIMIDE
MIDAZOLAM HCL
DORAL
RESTORIL
TEMAZEPAM
HALCION
TRIAZOLAM
SONATA
AMBIEN
EDLUAR
QL
QL
hyperact(adhd)/narcolepsy
Hypnotics, Melatonin Mt1/mt2 Receptor
T3 ramelteon
T4 tasimelteon
KAPVAY
INTUNIV
Tx For Attention Deficit-
Barbiturates
T3 butabarbital sodium
T1 phenobarbital
T3 secobarbital sodium
QL
Tx For Adhd - Selective Alpha-2a Receptor
Anti-psychotics,phenothiazines
fluphenazine hcl
perphenazine
thioridazine hcl
trifluoperazine hcl
QL, ST
Antag Comb
Antagonists,butyrophenones
T1
T1
T1
T1
QL, ST
QL
Ssri &antipsych,atyp,dopamine&serotonin
Antipsychotics,dopamine
T1 haloperidol
T1 haloperidol lactate
INTERMEZZO
ZOLPIDEM
TARTRATE
ZOLPIMIST
FOCALIN
QL
FOCALIN XR
QL
DAYTRANA
CONCERTA(TAB ER
24H)(18 MG)
CONCERTA(TAB ER
24H)(27 MG)
CONCERTA(TAB ER
24H)(36 MG)
CONCERTA(TAB ER
24H)(54 MG)
METHYLIN
METHYLPHENIDATE
ER(CPBP 50-50)(20
MG)
METHYLPHENIDATE
ER(CPBP 50-50)(30
MG)
METHYLPHENIDATE
ER(CPBP 50-50)(40
MG)
METHYLPHENIDATE
ER(TAB ER)(10 MG)
METHYLPHENIDATE
ER(TAB ER)(20 MG)
QUILLIVANT XR
RITALIN LA
QL, ST
QL
QL
QL
QL
QL
QL
QL
QL
QL, ST
T3 methylphenidate hcl
T2 methylphenidate hcl
QL, ST
QL
QL, ST
Tx For Attention Deficit-hyperact.(adhd), Nritype
T2 atomoxetine hcl
T2 atomoxetine hcl
T2 atomoxetine hcl
QL
QL
QL, ST
T2 atomoxetine hcl
STRATTERA(CAP)(10 QL
MG)
STRATTERA(CAP)
QL
(100 MG)
STRATTERA(CAP)(18 QL
MG)
STRATTERA(CAP)(25 QL
MG)
Page 10 of 90
Commercial Formulary
T2 atomoxetine hcl
T2 atomoxetine hcl
T2 atomoxetine hcl
STRATTERA(CAP)(40 QL
MG)
STRATTERA(CAP)(60 QL
MG)
STRATTERA(CAP)(80 QL
MG)
CARDIOVASCULAR DISEASE ARRHYTHMIA
Antiarrhythmics
T1 amiodarone hcl
T1 disopyramide
phosphate
T2 disopyramide
phosphate
T2 dofetilide
T2 dronedarone hcl
T1 flecainide acetate
T1
T1
T2
T1
T1
T1
T1
T1
AMIODARONE HCL
NORPACE
NORPACE CR
TIKOSYN
MULTAQ
FLECAINIDE
ACETATE
mexiletine hcl
MEXILETINE HCL
procainamide hcl
PROCAINAMIDE HCL
procainamide hcl
PRONESTYL
propafenone hcl
PROPAFENONE HCL
propafenone hcl
RYTHMOL
propafenone hcl
RYTHMOL SR
quinidine gluconate QUINIDINE
GLUCONATE
quinidine sulfate
QUINIDINE SULFATE
CARDIOVASCULAR DISEASE -
T1 captopril/hydrochlor CAPTOPRILothiazide
HYDROCHLOROTHIA
ZIDE
T1 enalapril/hydrochloro ENALAPRILthiazide
HYDROCHLOROTHIA
ZIDE
T1 enalapril/hydrochloro VASERETIC
thiazide
T1 fosinopril/hydrochlor FOSINOPRILothiazide
HYDROCHLOROTHIA
ZIDE
T1 lisinopril/hydrochloro ZESTORETIC
thiazide
T1 moexipril/hydrochlor MOEXIPRILothiazide
HYDROCHLOROTHIA
ZIDE
T1 moexipril/hydrochlor UNIRETIC
othiazide
T1 quinapril/hydrochlor ACCURETIC
othiazide
Alpha/beta-adrenergic Blocking Agents
T1
T2
T1
T1
carvedilol
carvedilol phosphate
labetalol hcl
labetalol hcl
COREG
COREG CR
LABETALOL HCL
TRANDATE
Alpha-adrenergic Blocking Agents
T1
T3
T2
T1
T1
doxazosin mesylate CARDURA
doxazosin mesylate
CARDURA XL
phenoxybenzamine hclDIBENZYLINE
prazosin hcl
MINIPRESS
terazosin hcl
TERAZOSIN HCL
CARDIAC STIMULANT
Angioten.receptr Antag./cal.chanl
Digitalis Glycosides
Blkr/thiazide Cb
T1 digoxin
T2 digoxin
T3 digoxin
DIGOX
DIGOXIN
LANOXIN
CARDIOVASCULAR DISEASE -
T2 amlodipine/valsartan/h EXFORGE HCT
cthiazid
T3 olmesartan/amlodipin/ TRIBENZOR
hcthiazid
ST
ST
Angiotensin Receptor Antag./thiazide
HYPERTENSION
Diuretic Comb
Ace Inhibitor/calcium Channel Blocker
T3 azilsartan
EDARBYCLOR
ST
med/chlorthalidone
T1 candesartan/hydroch ATACAND HCT
lorothiazid
T3 eprosartan/hydrochloroTEVETEN HCT
ST
thiazide
T1 irbesartan/hydrochlo AVALIDE
rothiazide
T1 losartan/hydrochloro HYZAAR
thiazide
T2 olmesartan/hydrochlor BENICAR HCT
ST
othiazide
T1 telmisartan/hydrochl TELMISARTANorothiazid
HYDROCHLOROTHIA
ZID
T1 valsartan/hydrochlor DIOVAN HCT
othiazide
Combination
T1 amlodipine
LOTREL
besylate/benazepril
T3 trandolapril/verapamil TARKA
hcl
Ace Inhibitor/thiazide & Thiazide-like Diuretic
T1 benazepril/hydrochlo BENAZEPRILrothiazide
HYDROCHLOROTHIA
ZIDE
T1 benazepril/hydrochlo LOTENSIN HCT
rothiazide
L.A. Care
Page 11 of 90
Commercial Formulary
T1 reserpine
RESERPINE
T1 reserpine/hydrochlor HYDROCHLOROTHIA
othiazide
ZIDE/RESERPINE
Angiotensin Receptor Antgnst &
Calc.channel Blockr
T3 amlodipine
bes/olmesartan med
T2 amlodipine/valsartan
T1 telmisartan/amlodipi
ne
AZOR
ST
EXFORGE
TELMISARTANAMLODIPINE
ST
Antihypertensives, Ace Inhibitors
T1
T1
T1
T1
benazepril hcl
benazepril hcl
captopril
enalapril maleate
BENAZEPRIL HCL
LOTENSIN
CAPTOPRIL
ENALAPRIL
MALEATE
T3 enalapril maleate
EPANED
T1 enalapril maleate
VASOTEC
T1 fosinopril sodium
FOSINOPRIL
SODIUM
T1 lisinopril
ZESTRIL
T1 moexipril hcl
UNIVASC
T1 perindopril erbumine ACEON
T1 perindopril erbumine PERINDOPRIL
ERBUMINE
T1 quinapril hcl
ACCUPRIL
T1 ramipril
ALTACE
T1 trandolapril
MAVIK
QL, ST
Antagonist
azilsartan medoxomil EDARBI
candesartan cilexetil ATACAND
eprosartan mesylate TEVETEN
irbesartan
AVAPRO
losartan potassium COZAAR
olmesartan medoxomil BENICAR
telmisartan
TELMISARTAN
valsartan
DIOVAN
VECAMYL
Antihypertensives, Miscellaneous
T3 metyrosine
DEMSER
Antihypertensives, Sympatholytic
T1
T1
T1
T1
T1
T1
T2
T1
T3
T1
clonidine
CATAPRES-TTS 1
clonidine
CATAPRES-TTS 2
clonidine
CATAPRES-TTS 3
clonidine hcl
CATAPRES
clonidine
CLORPRES
hcl/chlorthalidone
guanfacine hcl
TENEX
methyldopa
ALDOMET
methyldopa
METHYLDOPA
methyldopa/hydrochlor ALDORIL-D50
othiazide
methyldopa/hydrochl METHYLDOPAorothiazide
HYDROCHLOROTHIA
ZIDE
L.A. Care
HYDRALAZINE HCL
HYDRALAZINE
W/HCTZ
HCTZ/RESERPINE/H
YDRALAZINE
MINOXIDIL
T1
T1
T1
T1
T1
T1
T1
T1
T2
T3
T1
T3
T3
T3
T1
T1
T1
T1
acebutolol hcl
SECTRAL
atenolol
TENORMIN
betaxolol hcl
BETAXOLOL HCL
bisoprolol fumarate ZEBETA
metoprolol succinate TOPROL XL
metoprolol tartrate LOPRESSOR
metoprolol tartrate METOPROLOL
TARTRATE
nadolol
CORGARD
nebivolol hcl
BYSTOLIC
penbutolol sulfate
LEVATOL
pindolol
PINDOLOL
propranolol hcl
HEMANGEOL
propranolol hcl
INDERAL XL
ST
propranolol hcl
INNOPRAN XL
ST
propranolol hcl
PROPRANOLOL HCL
sotalol hcl
BETAPACE
sotalol hcl
SOTALOL
timolol maleate
TIMOLOL MALEATE
ST
Beta-adrenergic Blocking Agents/thiazide &
ST
Related
ST
Antihypertensives, Ganglionic Blockers
T3 mecamylamine hcl
T1 hydralazine hcl
T1 hydralazine/hydrochl
orothiazid
T1 hydralazine/reserpin/
hctz
T1 minoxidil
Beta-adrenergic Blocking Agents
Antihypertensives, Angiotensin Receptor
T3
T1
T1
T1
T1
T2
T1
T1
Antihypertensives, Vasodilators
PA
T1 atenolol/chlorthalido TENORETIC 100
ne
T1 atenolol/chlorthalido TENORETIC 50
ne
T1 bisoprolol
ZIAC
fumarate/hctz
T3 metoprolol
DUTOPROL
succinate/hctz
T1 metoprolol/hydrochlo LOPRESSOR HCT
rothiazide
T1 metoprolol/hydrochlo METOPROLOLrothiazide
HYDROCHLOROTHIA
ZIDE
T1 nadolol/bendroflumet CORZIDE
hiazide
T1 propranolol/hydrochl PROPRANOLOLorothiazid
HYDROCHLOROTHIA
ZID
Calcium Channel Blocking Agents
T1
T1
T3
T1
T1
T1
amlodipine besylate
diltiazem hcl
diltiazem hcl
diltiazem hcl
felodipine
isradipine
NORVASC
CARDIZEM CD
CARDIZEM LA
DILTIAZEM 24HR ER
FELODIPINE ER
ISRADIPINE
Page 12 of 90
Commercial Formulary
T3
T1
T1
T1
T1
T4
T1
T1
T1
T1
nicardipine hcl
nicardipine hcl
nifedipine
nifedipine
nimodipine
nimodipine
nisoldipine
nisoldipine
verapamil hcl
verapamil hcl
CARDENE SR
NICARDIPINE HCL
ADALAT CC
PROCARDIA XL
NIMOTOP
NYMALIZE
NISOLDIPINE
SULAR
CALAN SR
VERAPAMIL ER
Pulmonary Antihypertensives, Prostacyclintype
PA
Loop Diuretics
T1
T3
T1
T1
T1
bumetanide
ethacrynic acid
furosemide
furosemide
torsemide
BUMETANIDE
EDECRIN
FUROSEMIDE
LASIX
DEMADEX
amiloride hcl
eplerenone
eplerenone
spironolactone
triamterene
T3 aliskiren/amlodipin/hct AMTURNIDE
hiazide
T3 aliskiren hemifumarate TEKTURNA
T3 aliskiren/amlodipine
besylate
TEKAMLO
PA
T1 amiloride/hydrochlor AMILORIDEothiazide
HYDROCHLOROTHIA
ZIDE
T1 spironolact/hydrochl ALDACTAZIDE(TAB)
orothiazid
(25 MG-25MG)
T3 spironolact/hydrochlor ALDACTAZIDE(TAB)
othiazid
(50 MG-50MG)
T1 triamterene/hydrochl DYAZIDE
orothiazid
T1 triamterene/hydrochl MAXZIDE-25 MG
orothiazid
T1 triamterene/hydrochl TRIAMTERENE-HCTZ
orothiazid
Comb
T3 aliskiren/hydrochlorothi TEKTURNA HCT
azide
T3
T1
T3
T1
T1
Stimulator
PA
bendroflumethiazide
chlorothiazide
chlorothiazide
chlorthalidone
hydrochlorothiazide
NATURETIN-5
CHLOROTHIAZIDE
DIURIL
CHLORTHALIDONE
HYDROCHLOROTHIA
ZIDE
T1 hydrochlorothiazide MICROZIDE
T3 hydroflumethiazide
SALURON
T1 indapamide
INDAPAMIDE
T1 methyclothiazide
METHYCLOTHIAZIDE
T1 metolazone
METOLAZONE
T1 metolazone
ZAROXOLYN
Pulm.anti-htn,sel.c-gmp Phosphodiesterase
Vasodilators, Combination
T5 Inhib
T3 isosorb
dinit/hydralazine hcl
T1 sildenafil citrate
T4 tadalafil
QL
QL
PA, ST
Pulmonary Anti-htn, Endothelin Receptor
Antagonist
T4 ambrisentan
T4 bosentan
T4 macitentan
L.A. Care
LETAIRIS
TRACLEER
OPSUMIT
PA
Thiazide And Related Diuretics
Pulm Anti-htn,soluble Guanylate Cyclase
REVATIO(SUSP
RECON)
REVATIO(TAB)
ADCIRCA
PA
Blocker
Renin Inhibitor, Direct/thiazide Diuretic
T4 sildenafil citrate
PA
Renin Inhibitor, Direct & Calcium Channel
AMILORIDE HCL
EPLERENONE
INSPRA
ALDACTONE
DYRENIUM
ADEMPAS
PA
Renin Inhibitor, Direct
RESECTISOL
Potassium Sparing Diuretics In Combination
T4 riociguat
PA
PA
PA
PA
PA
Blkr/thiazide Cb
Potassium Sparing Diuretics
T1
T1
T1
T1
T3
iloprost tromethamine VENTAVIS
treprostinil
TYVASO
treprostinil diolamine ORENITRAM ER
treprostinil sodium
REMODULIN
treprostinil/neb
TYVASO
accessories
T4 treprostinil/nebulizer/acTYVASO
cesor
Renin Inhib, Direct/calc. Channel
Osmotic Diuretics
T3 mannitol
T4
T4
T4
T4
T4
PA
PA
PA
BIDIL
CARDIOVASCULAR DISEASE - LIPID
IRREGULARITY
Antihyperlip.hmg Coa Reduct
Inhib&cholest.ab.inhib
T3 ezetimibe/atorvastatin LIPTRUZET(TAB)(10 QL, ST
calcium
MG-10MG)
Page 13 of 90
Commercial Formulary
T3 ezetimibe/atorvastatin
calcium
T3 ezetimibe/atorvastatin
calcium
T3 ezetimibe/atorvastatin
calcium
T3 ezetimibe/simvastatin
LIPTRUZET(TAB)(10
MG-20MG)
LIPTRUZET(TAB)(10
MG-40MG)
LIPTRUZET(TAB)(10
MG-80MG)
VYTORIN(TAB)(10
MG-10MG)
T3 ezetimibe/simvastatin VYTORIN(TAB)(10
MG-20MG)
T3 ezetimibe/simvastatin VYTORIN(TAB)(10
MG-40MG)
T3 ezetimibe/simvastatin VYTORIN(TAB)(10
MG-80MG)
QL, ST
T2 niacin/simvastatin
QL, ST
T2 niacin/simvastatin
QL, ST
T2 niacin/simvastatin
QL, ST
T2 niacin/simvastatin
QL, ST
T2 niacin/simvastatin
QL, ST
Bile Salt Sequestrants
QL, ST
T1 cholestyramine (with QUESTRAN
sugar)
T1 cholestyramine/asparCHOLESTYRAMINE
tame
LIGHT
T2 colesevelam hcl
WELCHOL
T1 colestipol hcl
COLESTID(GRANULE
S)
T1 colestipol hcl
COLESTID(PACKET)
(5 G)
T3 colestipol hcl
COLESTID(PACKET)
(7.5G)
T1 colestipol hcl
COLESTID(TAB)
Antihyperlipidemic - Apo B-100 Synthesis
Inhibitor
T4 mipomersen sodium
KYNAMRO
PA
Antihyperlipidemic - Hmg Coa Reductase
Inhibitors
T1
T1
T3
T3
T1
T1
T3
T1
T1
atorvastatin calcium
fluvastatin sodium
fluvastatin sodium
lovastatin
lovastatin
lovastatin
pitavastatin calcium
pravastatin sodium
pravastatin sodium
T2 rosuvastatin calcium
T2 rosuvastatin calcium
T2 rosuvastatin calcium
T2 rosuvastatin calcium
T1
T1
T1
T1
T1
simvastatin
simvastatin
simvastatin
simvastatin
simvastatin
LIPITOR
LESCOL
LESCOL XL
ALTOPREV
LOVASTATIN
MEVACOR
LIVALO
PRAVACHOL
PRAVASTATIN
SODIUM
CRESTOR(TAB)(10
MG)
CRESTOR(TAB)(20
MG)
CRESTOR(TAB)(40
MG)
CRESTOR(TAB)(5
MG)
ZOCOR(TAB)(10 MG)
ZOCOR(TAB)(20 MG)
ZOCOR(TAB)(40 MG)
ZOCOR(TAB)(5 MG)
ZOCOR(TAB)(80 MG)
QL, ST
QL, ST
QL, ST
QL, ST
T1
QL, ST
JUXTAPID
T1
T1
T1
T2
T3
T1
T1
ST
Antihyperlipidemic - Mtp Inhibitor
T4 lomitapide mesylate
T2
T2
T1
T1
QL, ST
QL, ST
ezetimibe
ZETIA
fenofibrate
FENOGLIDE
fenofibrate
LOFIBRA
fenofibrate
TRICOR
nanocrystallized
fenofibrate,micronized ANTARA
fenofibrate,micronize FENOFIBRATE
d
fenofibrate,micronize LOFIBRA
d
fenofibric acid
FIBRICOR
fenofibric acid
TRILIPIX
(choline)
gemfibrozil
LOPID
icosapent ethyl
VASCEPA
methionine/inositol/cho LIPOCHOL PLUS
line/fa
niacin
NIASPAN
omega-3 acid ethyl LOVAZA
esters
PA
T1 niacin
Inhib.&niacin
MISCELLANEOUS AGENTS
T3 niacin/lovastatin
T3 niacin/lovastatin
T3 niacin/lovastatin
L.A. Care
QL, ST
QL, ST
QL, ST
QL
ST
ST
QL
ST
QL
NIACIN SR 250MG
CARDIOVASCULAR DISEASE -
ADVICOR(TBMP
24HR)(1000-20MG)
ADVICOR(TBMP
24HR)(1000-40 MG)
ADVICOR(TBMP
24HR)(500MG-20MG)
ADVICOR(TBMP
24HR)(750MG-20MG)
QL, ST
Niacin Preparations
Antihyperlipidemic-hmg Coa Reductase
T3 niacin/lovastatin
QL, ST
Lipotropics
T3
T1
QL, ST
SIMCOR(TBMP
24HR)(1000-20MG)
SIMCOR(TBMP
24HR)(1000-40 MG)
SIMCOR(TBMP
24HR)(500MG-20MG)
SIMCOR(TBMP
24HR)(500MG-40MG)
SIMCOR(TBMP
24HR)(750MG-20MG)
QL, ST
QL, ST
QL, ST
Adrenergic Vasopressor Agents
T4 droxidopa
T1 midodrine hcl
NORTHERA
MIDODRINE HCL
PA
QL, ST
Page 14 of 90
Commercial Formulary
Antianginal & Anti-ischemic Agents,non-
T3 medroxyprogesterone DEPO-SUBQ
acetate
PROVERA 104
hemodynamic
Contraceptives,intravaginal
T2 ranolazine
T2 ranolazine
RANEXA(TAB ER
12H)(1000 MG)
RANEXA(TAB ER
12H)(500 MG)
QL
QL
T5 nonoxynol 9
T5 nonoxynol 9
T5 nonoxynol 9
Antihyperlip - Hmg-coa&calcium Channel
T5 nonoxynol 9
Blocker Cb
Contraceptives,oral
T1 amlodipine/atorvasta CADUET
tin
QL
CARDIOVASCULAR DISEASE VASODILATION
Vasodilators,coronary
T3
T1
T2
T1
T1
isosorbide dinitrate
isosorbide dinitrate
isosorbide dinitrate
isosorbide dinitrate
isosorbide dinitrate
T1 isosorbide
mononitrate
T2 nitroglycerin
T1 nitroglycerin
T1 nitroglycerin
T2 nitroglycerin
T1 nitroglycerin
T1 nitroglycerin
T2 nitroglycerin
T2 nitroglycerin
DILATRATE-SR
ISOCHRON
ISORDIL
ISORDIL TITRADOSE
ISOSORBIDE
DINITRATE
IMDUR
NITRO-BID
NITRO-DUR(PATCH
TD24)(0.1MG/HR)
NITRO-DUR(PATCH
TD24)(0.2MG/HR)
NITRO-DUR(PATCH
TD24)(0.3 MG/HR)
NITRO-DUR(PATCH
TD24)(0.4MG/HR)
NITRO-DUR(PATCH
TD24)(0.6MG/HR)
NITRO-DUR(PATCH
TD24)(0.8MG/HR)
NITROSTAT
Vasodilators,peripheral
T1 ergoloid mesylates
T3
T1
T1
T1
ethaverine hcl
isoxsuprine hcl
nylidrin hcl
papaverine hcl
ERGOLOID
MESYLATES
ISOVEX
ISOXSUPRINE HCL
NYLIDRIN HCL
PAPAVERINE HCL
CONTRACEPTION/OXYTOCICS
Contraceptives, Intravaginal, Systemic
T3 etonogestrel/ethinyl
estradiol
NUVARING
QL, ST
Contraceptives,injectable
T1 medroxyprogesteron DEPO-PROVERA
e acetate
L.A. Care
QL
CONCEPTROL(OTC)
GYNOL II(OTC)
TODAY
CONTRACEPTIVE
SPONGE(OTC)
VCF(OTC)
T5 desogVIORELE
e.estradiol/e.estradiol
T5 desogestrel-ethinyl APRI
estradiol
T3 drospir/eth
BEYAZ
estra/levomefol ca
T3 drospir/eth
SAFYRAL
estra/levomefol ca
T3 estradiol
NATAZIA
valerate/dienogest
T5 ethinyl
OCELLA
estradiol/drospirenon
e
T5 ethynodiol d-ethinyl ZOVIA 1-35E
estradiol
T5 levonorgestrel
NEXT CHOICE ONE
DOSE
T5 levonorgestrel
PLAN B ONESTEP(OTC)
T3 levonorgestrel-ethin
AMETHYST
estradiol
T5 levonorgestrel-ethin LEVORA-28
estradiol
T5 l-norgest-eth
CAMRESE
estr/ethin estra
T3 l-norgest-eth estr/ethin QUARTETTE
estra
T3 noreth-ethinyl
GENERESS FE
estradiol/iron
T5 noreth-ethinyl
WYMZYA FE
estradiol/iron
T5 norethindrone
NORA-BE
T5 norethindrone ac-eth LOESTRIN
estradiol
T5 norethindrone ac-eth MICROGESTIN
estradiol
T2 norethindroneLO LOESTRIN FE
e.estradiol-iron
T5 norethindroneLOESTRIN FE
e.estradiol-iron
T5 norethindroneMICROGESTIN FE
e.estradiol-iron
T3 norethindroneMINASTRIN 24 FE
e.estradiol-iron
T5 norethindroneNECON
ethinyl estrad
T5 norethindroneORTHO-NOVUM
ethinyl estrad
T5 norethindroneNORINYL 1+50
mestranol
QL
G
G
G
G
G
G
ST
ST
ST
G, ST
G
AGE,
G
AGE,
G
ST
G
G, QL
G
G
G
G
ST
G
G
G
G
G
Page 15 of 90
Commercial Formulary
T2 norgestimate-ethinyl
estradiol
T5 norgestimate-ethinyl
estradiol
T5 norgestrel-ethinyl
estradiol
T3 ulipristal acetate
ORTHO TRI-CYCLEN ST
LO
SPRINTEC
G
T3 hydrocodone/chlorphe VITUZ
niramine
T1 promethazine
PROMETHAZINEhcl/codeine
CODEINE
CRYSELLE
Narcotic Antitussive-anticholinergic Comb.
G
T1 hydrocodone
bit/homatrop me-br
ELLA
Diaphragms/cervical Cap
T5 cervical cap
FEMCAP
T5 diaphragms, wide seal WIDE SEAL
DIAPHRAGM
G
G
Oxytocics
T3 dinoprostone
T3 dinoprostone
T3 dinoprostone
T1 methylergonovine
maleate
CERVIDIL
PREPIDIL
PROSTIN E2
VAGINAL
SUPPOSITORY
METHYLERGONOVIN
E MALEATE
COUGH AND COLD
1st Gen Antihistamine & Decongestant
Combinations
T1 phenylephrine
PROMETHAZINE VC
hcl/prometh hcl
T1 pseudoephedrine
HISTAFED-LA
hcl/chlor-mal
T1 pseudoephedrine/bro BROFED
mpheniramin
1st Gen Antihist-decongest-anticholinergic
T1 p-ephed hcl/chlormal/bell alk
RESPA A.R.
Combination
T3 guaifenesin/codeine ALLFEN CDX
phosphate
T1 guaifenesin/codeine GUAIFENESINphosphate
CODEINE
Non-narc Antituss-1st Gen. Antihistaminedecongest
T1 brompheniram/pheny LOHIST-DM
lephrine/dm
T1 dm/phenyleph/chlorp CENTERGY DM
heniramine
T1 d-methorphan hb/p- BROMFED DM
epd hcl/bpm
Non-narc Antitussive-1st Gen Antihistamine
Comb.
T1 car-b-pen ta/chlor-tanTRIONATE
T1 d-methorphan
PROMETHAZINE-DM
hb/prometh hcl
Nose Preparations, Vasoconstrictors
T3 tetrahydrozoline hcl
ADRENALIN
CHLORIDE
TYZINE
Sympathomimetic Agents
Antitussives,non-narcotic
T1 benzonatate
T1 benzonatate
T3 benzonatate
Narcotic Antitussive-expectorant
T3 epinephrine hcl
Comb
HYDROCODONEHOMATROPINE MBR
BENZONATATE
TESSALON PERLE
ZONATUSS
T1 pseudoephedrine hcl PSEUDOEPHEDRINE
HCL
DERMATOLOGY - ACNE
Narcotic Antituss-1st Gen. Antihistamine-
Acne Agents,systemic
decongest
T2 isotretinoin
T1 isotretinoin
T1 promethazine/phenyl PROMETHAZINE VCeph/codeine
CODEINE
T3 pyril ma/pe/codeine
ZOTEX-C
phos
Acne Agents,topical
Narcotic Antitussive-1st Generation
Antihistamine
T3 hydrocodone/chlorphe TUSSICAPS
n p-stirex
T1 hydrocodone/chlorph TUSSIONEX
en p-stirex
L.A. Care
T3 adapalene/benzoyl
peroxide
T3 azelaic acid
T3 clindamycin
phos/benzoyl perox
T3 clindamycin
phos/benzoyl perox
T1 clindamycin
phos/benzoyl perox
T3 clindamycin/benzoyl/e
mol cmb94
ABSORICA
CLARAVIS
EPIDUO
AZELEX
ACANYA
BENZACLIN(GEL
W/PUMP)
BENZACLIN(GEL)
NEUAC
Page 16 of 90
Commercial Formulary
T3
T3
T3
T1
clindamycin/tretinoin
clindamycin/tretinoin
dapsone
sulfacetamide
sodium
T3 sulfacetamide
sodium/bakuchiol
T1 tretinoin
microspheres
T1 tretinoin
microspheres
VELTIN
ZIANA
ACZONE
KLARON
APOP
Anticorrosive Agents
T3 butylated
hydroxytoluene
BUTYLATED
HYDROXYTOLUENE
(BHT)
Keratolytic-glucocorticoid Combinations
T2 benzoyl
VANOXIDE-HC
peroxide/hydrocortison
T3
T3
T1
T1
T1
T3
T1
T3
azelaic acid
brimonidine tartrate
metronidazole
metronidazole
metronidazole
metronidazole
metronidazole
metronidazole/skin
cleansr #23
FINACEA
MIRVASO
METROGEL
METROLOTION
METRONIDAZOLE
NORITATE
ROSADAN
ROSADAN
RETIN-A MICRO
PUMP(GEL
W/PUMP)(0.04 %)
T3 tretinoin microspheres RETIN-A MICRO
PUMP(GEL
W/PUMP)(0.08 %)
T1 tretinoin
RETIN-A MICRO
microspheres
PUMP(GEL
W/PUMP)(0.1 %)
T3 tretinoin/emol
TRETIN-X
cmb9/skin cln1
AGE
AGE
AGE
AGE
AGE
Vitamin A Derivatives, Topical Acne Agents
T2 tazarotene
Rosacea Agents, Topical
RETIN-A MICRO
FABIOR
AGE
DERMATOLOGY - ANTIINFECTIVE
QL
Antiparasitics
T3 nitazoxanide
T3 sulfur
ALINIA
SULFUR
Topical Antibiotics
T3 cadexomer iodine
IODOFLEX
T3 cadexomer iodine
IODOSORB
T3 clioquinol/hc/emollient DERMASORB AF
cmb#88
T3 clioquinol/hydrocortiso ALA-QUIN
ne
T1 clioquinol/hydrocorti 1 + 1-F
sone/pram
T3 hydrocortisone/iodoqui ALCORTIN A
n/aloe#2
T1 hydrocortisone/iodoq HYDROCORTISONEuinol
IODOQUINOL
T1 iodine/potassium
LUGOL'S
iodide
ALOQUIN
T3 iodoquinol/aloe
polysacchar #1
T3 nitrofurazone
FURACIN
T3 silver
SILVRSTAT
T3 silver carbonate
NORMLGEL AG
T1 silver nitrate
SILVER NITRATE
T3 clindamycin phos/skin CLINDACIN ETZ
clnsr 19
T3 clindamycin phos/skin CLINDACIN PAC
clnsr 19
T1 clindamycin
CLEOCIN T
phosphate
T1 clindamycin
CLINDACIN P
phosphate
T3 clindamycin phosphate CLINDAGEL
T1 clindamycin
EVOCLIN
phosphate
T3 erythromycin base
AKNE-MYCIN
T1 erythromycin
ERYGEL
base/ethanol
T1 erythromycin
ERYTHROMYCIN
base/ethanol
T1 erythromycin/benzoy BENZAMYCIN
l peroxide
T2 erythromycin/benzoyl BENZAMYCINPAK
peroxide
T1 gentamicin sulfate
GENTAMICIN
SULFATE
T1 mupirocin
BACTROBAN
T3 mupirocin
CENTANY AT
T1 mupirocin calcium BACTROBAN
Vitamin A Derivatives
Topical Antifungal/antiinflammatory,steriod
Topical Preparations,antibacterials
T1 adapalene
T1 adapalene
T1 adapalene
T2 adapalene
T2 adapalene
T3 tretinoin
T1 tretinoin
T3 tretinoin
L.A. Care
DIFFERIN(CREAM)
DIFFERIN(GEL
W/PUMP)
DIFFERIN(GEL)
DIFFERIN(LOTION)
DIFFERIN(MED
SWAB)
ATRALIN
RETIN-A
TRETIN-X
AGE
AGE
Agent
AGE
AGE
AGE
T1 clotrimazole/betamet CLOTRIMAZOLEhasone dip
BETAMETHASONE
T1 clotrimazole/betamet LOTRISONE
hasone dip
AGE
AGE
AGE
Topical Antifungals
T3 butenafine hcl
T1 ciclopirox
MENTAX
LOPROX
Page 17 of 90
Commercial Formulary
T1
T1
T1
T3
T3
T1
T1
T1
T3
T3
T1
T1
T1
T3
T3
T3
T3
T3
T2
T2
T3
T1
T3
T1
T3
T3
T1
T2
T3
ciclopirox
PENLAC
ciclopirox olamine
CICLODAN
ciclopirox olamine
CICLOPIROX
ciclopirox/nail lacq/ft PEDIPIROX-4
deod#4
ciclopirox/skin cleanserCICLODAN
no.28
ciclopirox/ure/camph CICLODAN
/menth/euc
clotrimazole
CLOTRIMAZOLE
econazole nitrate
ECONAZOLE
NITRATE
econazole nitrate
ECOZA
efinaconazole
JUBLIA
gentian viol/brlnt
TRIPLE DYE
grn/proflav
ketoconazole
KETOCONAZOLE
ketoconazole
NIZORAL
ketoconazole
XOLEGEL
ketoconazole/skin
KETODAN
cleanser #28
luliconazole
LUZU
miconazole nitrate/hc FUNGOID & HC
miconazole nitrate/zinc VUSION
ox/pet
naftifine hcl
NAFTIN(CREAM)
naftifine hcl
NAFTIN(GEL)(1 %)
naftifine hcl
NAFTIN(GEL)(2 %)
nystatin
NYSTATIN
nystatin/emollient
PEDIADERM AF
combo no.54
nystatin/triamcin
NYSTATINTRIAMCINOLONE
oxiconazole nitrate
OXISTAT
sertaconazole nitrate ERTACZO
sodium
EXODERM
thiosulfate/sal acid
sulconazole nitrate
EXELDERM
tavaborole
KERYDIN
Topical Antiparasitics
T3 benzyl alcohol
ULESFIA
T3 citric/citronellyl/hydrox/ LYCELLE
meth
T2 crotamiton
EURAX
T3 ivermectin
SKLICE
T1 lindane
LINDANE
T1 malathion
OVIDE
T1 permethrin
ELIMITE
T1 spinosad
NATROBA
Topical Antiviral & Local Anesthetic
Combinations
T3 acyclovir/lidocaine hcl LIDOVIR
Topical Antivirals
T2 acyclovir
T1 acyclovir
T3 penciclovir
L.A. Care
ZOVIRAX(CREAM)
ZOVIRAX(OINT)
DENAVIR
Topical Antivirals/antiinflammatory, Steroid
Agent
T3 acyclovir/hydrocortison XERESE
e
Topical Genital Wart-hpv Treatment Agents
T3 sinecatechins
VEREGEN
Topical Pleuromutilin Derivatives
T3 retapamulin
PA
Topical Sulfonamides
T3 mafenide acetate
T1 mafenide acetate
T1 silver sulfadiazine
QL, ST
PA
ALTABAX
SULFAMYLON(CREA
M)
SULFAMYLON(PACK
ET)
SILVER
SULFADIAZINE
SE 10-5 SS
T1 sulfacet
sod/sulfur/witch haz
T1 sulfacetamide
SODIUM
sod/sulfur/urea
SULFACETAMIDESULFUR
T3 sulfacetamide
AVAR LS
sodium/sulfur
T1 sulfacetamide
AVAR(CLEANSER)
sodium/sulfur
T3 sulfacetamide
AVAR(MED PAD)
sodium/sulfur
T3 sulfacetamide
PLEXION
sodium/sulfur
T3 sulfacetamide
ROSANIL
sodium/sulfur
T1 sulfacetamide
SODIUM
sodium/sulfur
SULFACETAMIDESULFUR
T1 sulfacetamide
SUMADAN
sodium/sulfur
T1 sulfacetamide
SUMAXIN
sodium/sulfur
ZENCIA
T1 sulfacetamide
sodium/sulfur
T1 sulfacetamide/sulfur/ SODIUM
cleansr23
SULFACETAMIDESULFUR
T3 sulfacetamide/sulfur/cl SUMADAN
eansr23
T3 sulfacetamide/sulfur/cl SUMAXIN CP
eansr23
DERMATOLOGY ANTIINFLAMMATORY
Topical
Antibiotics/antiinflammatory,steroidal
T3 neomycin
sulfate/fluocinolone
NEO-SYNALAR
Page 18 of 90
Commercial Formulary
T2 neomycin/bacitra/poly CORTISPORIN
myxin/hc
T3 neomycin/fluocinolone/ NEO-SYNALAR
emol #65
T2 neomycin/polymyxin b CORTISPORIN
sulf/hc
Topical Anti-inflammatory Steroidal
T1 alclometasone
ACLOVATE
dipropionate
T1 alclometasone
ALCLOMETASONE
dipropionate
DIPROPIONATE
T1 amcinonide
AMCINONIDE
T1 betamethasone
BETAMETHASONE
dipropionate
DIPROPIONATE
T1 betamethasone
DEL-BETA
dipropionate
T1 betamethasone
BETAMETHASONE
valerate
VALERATE
T1 betamethasone
LUXIQ
valerate
T1 betamethasone/prop DIPROLENE
ylene glyc
T1 betamethasone/prop DIPROLENE AF
ylene glyc
T1 clobetasol
CLOBETASOL
propionate
PROPIONATE
T1 clobetasol
CLOBEX(LOTION)
propionate
T2 clobetasol propionate CLOBEX(SPRAY)
T1 clobetasol
CLODAN
propionate
T1 clobetasol
OLUX
propionate
T1 clobetasol
TEMOVATE
propionate
CLOBETASOL
T1 clobetasol
propionate/emoll
EMOLLIENT
T1 clobetasol
TEMOVATE
propionate/emoll
EMOLLIENT
T3 clobetasol/skin
CLODAN
cleanser #28
T1 clocortolone pivalate CLODERM
T3 desonide
DESONATE
T1 desonide
DESONIDE
T1 desonide
TRIDESILON
T3 desonide
VERDESO
T1 desoximetasone
TOPICORT(CREAM)
T1 desoximetasone
TOPICORT(GEL)
T1 desoximetasone
TOPICORT(OINT)
T3 desoximetasone
TOPICORT(SPRAY) ST
T1 diflorasone diacetate DIFLORASONE
DIACETATE
T2 diflorasone
APEXICON E
diacetate/emoll
T3 fluocinolone acetonide CAPEX SHAMPOO
T1 fluocinolone
DERMA-SMOOTHEacetonide
FS
T1 fluocinolone
FLUOCINOLONE
acetonide
ACETONIDE
T1 fluocinolone
SYNALAR
acetonide
L.A. Care
T3 fluocinolone/emol
SYNALAR
cmb#65
T1 fluocinolone/shower DERMA-SMOOTHEcap
FS
T3 fluocinolone/skin
SYNALAR TS
clnsr28
T1 fluocinonide
FLUOCINONIDE
T1 fluocinonide/emollien FLUOCINONIDE-E
t base
T2 flurandrenolide
CORDRAN
T1 fluticasone
CUTIVATE
propionate
T1 fluticasone
FLUTICASONE
propionate
PROPIONATE
T3 halcinonide
HALOG
T1 halobetasol
ULTRAVATE
propionate
T3 halobetasol/ammoniu HALONATE
m lactate
T3 halobetasol/lactic acid ULTRAVATE X
T1 hc/mineral
HYDROCORTISONE
oil/petrolat,wht
T2 hydrocort/sal
SCALACORT DK
acid/sulf/shmp#1
T2 hydrocortisone
FIRSTHYDROCORTISONE
T1 hydrocortisone
HYDROCORTISONE
T1 hydrocortisone
LACTICARE-HC
T2 hydrocortisone
TEXACORT
T1 hydrocortisone
HYDROCORTISONE
acetate/aloe v
ACETATE
T3 hydrocortisone
NUCORT
acetate/aloe v
T1 hydrocortisone
U-CORT
acetate/urea
T1 hydrocortisone
HYDROCORTISONE
butyrate
BUTYRATE
T2 hydrocortisone
LOCOID(CREAM)
butyrate
T3 hydrocortisone
LOCOID(LOTION)
butyrate
T1 hydrocortisone
LOCOID(OINT)
butyrate
T1 hydrocortisone
LOCOID(SOLUTION)
butyrate
T1 hydrocortisone
HYDROCORTISONE
butyrate/emoll
BUTYRATE
T2 hydrocortisone
LOCOID LIPOCREAM
butyrate/emoll
T2 hydrocortisone
PANDEL
probutate
T1 hydrocortisone
HYDROCORTISONE
valerate
VALERATE
T3 hydrocortisone/emol PEDIADERM HC
no.45
T3 hydrocortisone/skin
AQUA GLYCOLIC HC
clnsr #25
T3 hydrocortisone/skin
DERMASORB HC
clnsr #35
T3 mometasone
MOMEXIN
furoat/ammonium lac
T1 mometasone furoate ELOCON
Page 19 of 90
Commercial Formulary
T1 prednicarbate
DERMATOP
T3 triamcin/hydrophilic
AQUAPHILIC
ointment
W/TRIAMCINOLONE
T3 triamcin/urea/hydro
AQUAPHILIC W/TAC
oint
+ CARBAMIDE
T2 triamcinolone
KENALOG(AEROSO
acetonide
L)
T1 triamcinolone
KENALOG(LOTION)
acetonide
T1 triamcinolone
TRIAMCINOLONE
acetonide
ACETONIDE
T1 triamcinolone
TRIDERM
acetonide
T3 triamcinolone/emollient PEDIADERM TA
cmb#45
T3 triamcinolone/emollient DERMASORB TA
cmb#86
Antiseptics,miscellaneous
T3 guaiacol
T1 phenol
Emollients
Topical Anti-inflammatory, Nsaids
T3 diclofenac epolamine FLECTOR
T3 diclofenac sodium
PENNSAID
T2 diclofenac sodium
VOLTAREN
ST
DERMATOLOGY - ANTIPRURITIC
DRUGS
Antipruritics,topical
T3 doxepin hcl
T3 doxepin hcl
PRUDOXIN
ZONALON
DERMATOLOGY - MISCELLANEOUS
Antiperspirants
T1 aluminum chloride
T3 aluminum chloride
DRYSOL
XERAC AC
Antiseborrheic Agents
T3 emollient #43/skin
cleanser#27
T3 emollient combination
no.43
T1 emollient
combination no.43
T1 emollient
combination no.85
T1 selenium sulfide
T3 selenium sulfide
T1 sulfacetamide
sodium
T3 sulfacetamide sodium
PROMISEB
COMPLETE
PROMISEB
TL TRISEB
LOUTREX
SELENIUM SULFIDE
TERSI FOAM
OVACE
OVACE
PLUS(CLEANSR ER)
T3 sulfacetamide sodium OVACE
PLUS(CREAM)
T3 sulfacetamide sodium OVACE
PLUS(LOTION)
T2 sulfacetamide sodium OVACE
PLUS(SHAMPOO)
T1 sulfacetamide
SODIUM
sodium/urea
SULFACETAMIDE
L.A. Care
GUAIACOL
PHENOL
T3 alc/isopropanol/prop VEHICLE-N
gly/water
T3 alc/isopropanol/prop VEHICLE-N MILD
gly/water
T1 ammonium lactate
LAC-HYDRIN
T3 em#53/namgf/cyc/pho AURSTAT
s/nahc/nacl
T1 emol53/namgfs/ha/na MB HYDROGEL
hypochlorit
T1 emollient
PRUTECT
combination no.10
T3 emollient combination SONAFINE
no.10
T1 emollient
EMULSION SB
combination no.32
T1 emollient
PRUMYX
combination no.35
T3 emollient combination NEOSALUS
no.38
T3 emollient combination HPR
no.44
T3 emollient combination HYLATOPIC
no.44
T3 emollient combination NEOSALUS
no.47
T3 emollient combination NEOSALUS CP
no.47
T3 emollient combination TROPAZONE
no.48
T3 emollient combination HPR PLUS
no.53
T3 emollient combination HYLATOPIC PLUS
no.53
T3 emollient combination TROPAZONE
no.57
T3 emollient combination ATRAPRO
no.60
HYDROGEL
T3 emollient combination PRESERA
no.80
T3 emollient combo no.47 ATRAPRO CP
& no.60
T3 hyaluro/dl-e
XCLAIR
ac/e12/allan/shea
T1 lactic acid
LACTIC ACID
T3 namgflu/cyclo/phos/na AURSTAT
hco3/nacl
T3 petrolatum,white
VASELINE WHITE
PETROLEUM
PRUCLAIR
T1 vite
ac/grape/hyaluronic
acid
Irrigants
T1 acetic acid
T1 mannitol/sorbitol
solution
ACETIC ACID
SORBITOLMANNITOL
Page 20 of 90
Commercial Formulary
T1 neomy
sulf/polymyxin b
sulfate
T1 ringers solution
T3 ringers
solution,lactated
T3 sodium
chlor/hypochlorous
acid
T1 sodium chloride irrig
solution
T1 sorbitol solution
T1 water for
irrigation,sterile
T3
T3
T3
T3
T3
T3
T3
T3
NEOSPORIN G.U.
IRRIGANT
RINGERS
IRRIGATION
LACTATED RINGERS
VASHE WOUND
THERAPY
T3
SODIUM CHLORIDE
T1
SORBITOL
WATER
T1
T1
Irritants/counter-irritants
T3 capsaicin/skin cleanserQUTENZA
T3 menthol/bandages,
ICY HOT(OTC)
tubular
T3 oxalic acid
OXALIS
PA
urea
urea
urea
urea
urea
urea
urea
urea/emollient cmb
no.18
urea/emollient
combination #65
urea/hyaluronate
sodium
urea/lactic ac/zn
undecylenate
urea/lactic
acid/salicyl acid
GORDO-UREA
HYDRO 35
KERAFOAM
KERALAC
UMECTA
UMECTA PD
URAMAXIN
DERMASORB XM
URAMAXIN GT
UREA
BP-50% UREA
UREA
Oxidizing Agents
T3 elect wtr/sod ch/sod
hy/hyp ac
ATRAPRO DERMAL
SPRAY
Keratolytics
Protectives
T1
T3
T3
T3
T1
T3 carbit/equis
GENADUR
xt/ethan/chit/msm
T3 hyaluron
RADIAPLEXRX
sod/allantoin/aloe xt
T3 hyaluronate sodium
BIONECT
T3 poly-ureaurethane
NUVAIL
T1 protect
PR CREAM
cmb2/ceramide 1,3,611
T3
T3
T3
T2
T1
T1
T1
T3
T3
T1
T3
T1
T1
T1
T3
T1
T1
T3
T1
T3
T1
T1
benzoyl peroxide
BPO
benzoyl peroxide
PACNEX HP
benzoyl peroxide
PACNEX LP
benzoyl peroxide
RIAX
benzoyl peroxide
SE BPO
microspheres
benzoyl peroxide/sulfurNUOX
benzoyl peroxide/vit e INOVA
mix
dichloroacetic acid
BICHLORACETIC
ACID
podofilox
CONDYLOX(GEL)
podofilox
CONDYLOX(SOLUTI
ON)
podophyllum resin PODOCON-25
potassium hydroxide POTASSIUM
HYDROXIDE
salicylic ac/benzoyl
INOVA 4-1
per/vit e
salicylic ac/benzoyl
INOVA 8-2
per/vit e
salicylic acid
KERALYT
salicylic acid
KERALYT SCALP
salicylic acid
SALACYN
salicylic acid
SALEX
salicylic acid
SALICYLIC ACID
salicylic acid
ULTRASAL-ER
salicylic acid
VIRASAL
salicylic acid/ammon SALICYLIC ACID
lact/aloe
salicylic
EMERSAL
acid/ammoniated hg
SALEX
salicylic
acid/ceramide cmb
#1
salicylic acid/urea
SALVAX DUO PLUS
silver nitrate
SILVER NITRATE
silver nitrate
SILVER NITRATE
applicator
APPLICATOR
L.A. Care
Topical Antifungals
T3 salicylic acid
BENSAL HP
Topical Anti-inflammatory Steroid-local
Anesthetic
T1 hydrocortisone
LIDOCAINEac/lidocaine
HYDROCORTISONE
T3 hydrocortisone/pramox EPIFOAM
ine
T1 hydrocortisone/pram PRAMOSONE(CREA
oxine
M)
T2 hydrocortisone/pramox PRAMOSONE(LOTIO
ine
N)
T2 hydrocortisone/pramox PRAMOSONE(OINT)
ine
T3 hydrocortisone/pramox NOVACORT
ine/aloe
T2 hydrocortisone/pramox PRAMOSONE E
ine/emoll
Topical Antineoplastic & Premalignant
Lesion Agnts
T4 bexarotene
T1 diclofenac sodium
T3 fluorouracil
T1 fluorouracil
TARGRETIN
DICLOFENAC
SODIUM
CARAC
EFUDEX
PA
PA, QL
Page 21 of 90
Commercial Formulary
T3 fluorouracil
T1 fluorouracil
T2 ingenol mebutate
T2 ingenol mebutate
T4 mechlorethamine hcl
FLUOROPLEX
FLUOROURACIL
PICATO(GEL)(0.015 QL
%)
PICATO(GEL)(0.05 %) QL
VALCHLOR
PA
Topical Local Anesthetics
T3 benzocaine
T1 cocaine hcl
T3 dichlorotetrafluoroetha
ne
T1 ethyl chloride
T1 lidocaine
T1 lidocaine
T1 lidocaine hcl
T3 lidocaine hcl
T3 lidocaine hcl/collagen
T3 lidocaine/allantoin/petr
olatum
T1 lidocaine/prilocaine
T1 lidocaine/prilocaine
T3
T3
T3
T3
T3
T3
T3
T3
ANACAINE
COCAINE HCL
GEBAUER'S 114
ETHYL CHLORIDE
LIDOCAINE
LIDODERM
LIDOCAINE HCL
LIDORX
REGENECARE
VEXA
EMLA
LIDOCAINEPRILOCAINE
lidocaine/tetracaine
PLIAGLIS
lidocaine/tetracaine
SYNERA
norflurane/hfc 245fa PAIN EASE
norflurane/hfc 245fa SPRAY AND
STRETCH
tetracaine hcl
PONTOCAINE
tetracaine/benzocaine/ CETACAINE
butamben
tetracaine/benzocaine/ CETACAINE
butamben
ANESTHETIC
vit e/lidocain/alo
REGENECARE
ver/colagn
Topical Preparations,miscellaneous
T3 honey
MEDIHONEY
Topical/mucous Membr./subcut. Enzymes
T3 collagenase
clostridium hist.
T1 trypsin/balsam
peru/castor oil
SANTYL
VASOLEX
DERMATOLOGY - PIGMENTATION
DISORDERS
Topical Hyperpigmentation Agents
T2 methoxsalen
OXSORALEN
DERMATOLOGY PSORIASIS/ECZEMA
Antipsoriatic Agents,systemic
T4 acitretin
T2 methoxsalen
T1 methoxsalen, rapid
L.A. Care
SORIATANE
8-MOP
OXSORALEN-ULTRA
Antipsoriatics Agents
T2
T3
T3
T1
T1
T3
T1
T2
anthralin
anthralin
anthralin micronized
calcipotriene
calcipotriene
calcipotriene
calcitriol
tazarotene
DRITHOCREME HP
ZITHRANOL-RR
ZITHRANOL
CALCIPOTRIENE
DOVONEX
SORILUX
VECTICAL
TAZORAC
ST
ST
ST
ST
ST
ST
ST
Topical Agents,miscellaneous
T3 pyrogallol
T3 urea
PYROGALLIC ACID
GORDO-UREA
Topical Immunosuppressive Agents
T3 pimecrolimus
ELIDEL
T2 tacrolimus
PROTOPIC
AGE,
ST
AGE,
ST
Topical Vit D Analog/antiinflammatory,
Steroidal
T1 calcipotriene/betametTACLONEX(OINT)
ST
hasone
T3 calcipotriene/betameth TACLONEX(SUSPEN ST
asone
SION)
DIABETES
Antihypergly, (dpp-4) Inhibitor & Biguanide
Comb.
T3 alogliptin
benz/metformin hcl
T2 linagliptin/metformin
hcl
T3 saxagliptin
hcl/metformin hcl
T3 saxagliptin
hcl/metformin hcl
T3 saxagliptin
hcl/metformin hcl
T2 sitagliptin
phos/metformin hcl
T2 sitagliptin
phos/metformin hcl
T2 sitagliptin
phos/metformin hcl
T2 sitagliptin
phos/metformin hcl
KAZANO
QL, ST
JENTADUETO
QL
KOMBIGLYZE
XR(TBMP 24HR)(2.51000MG)
KOMBIGLYZE
XR(TBMP 24HR)(5
MG-500MG)
KOMBIGLYZE
XR(TBMP
24HR)(5MG-1000MG)
JANUMET
QL, ST
QL, ST
QL, ST
QL
JANUMET XR(TBMP QL
24HR)(100-1000MG)
JANUMET XR(TBMP QL
24HR)(50-1000 MG)
JANUMET XR(TBMP QL
24HR)(50MG-500MG)
Antihypergly,dpp-4 Enzyme Inhib
&thiazolidinedione
T3 alogliptin
benz/pioglitazone
OSENI
QL, ST
Page 22 of 90
Commercial Formulary
Antihypergly,incretin Mimetic
Antihyperglycemic,biguanide Type
T3 albiglutide
T2 exenatide
TANZEUM
QL, ST
BYETTA(PEN
QL, ST
INJCTR)(10MCG/0.04)
BYETTA(PEN
QL, ST
INJCTR)(5MCG/0.02)
BYDUREON
QL, ST
T1 metformin hcl
T3 metformin hcl
T2 metformin hcl
BYDUREON PEN
QL, ST
VICTOZA 2-PAK
VICTOZA 3-PAK
QL, ST
QL, ST
T1 glipizide/metformin
hcl
T1 glyburide/metformin
hcl
T1 glyburide/metformin
hcl
T2 repaglinide/metformin
hcl
T2 exenatide
T2 exenatide
microspheres
T2 exenatide
microspheres
T2 liraglutide
T2 liraglutide
Antihyperglycemc-sod/gluc
Cotransport2(sglt2)inhib
T2 canagliflozin
T3 dapagliflozin
propanediol
T3 empagliflozin
INVOKANA
FARXIGA
QL, ST
QL, ST
Agonists
CYCLOSET
Antihyperglycemic,insulin-rel Stim.&
Biguanide Cmb
ST
T4 mifepristone
PRECOSE
GLYSET
Antihyperglycemic, Amylin Analog-type
SYMLINPEN 120
SYMLINPEN 60
QL, ST
QL
QL, ST
QL
Antihyperglycemic, Insulin-release Stimulant
Type
T1
T1
T1
T2
T1
T1
T1
T1
T1
T1
chlorpropamide
CHLORPROPAMIDE
glimepiride
AMARYL
glipizide
GLUCOTROL
glyburide
DIABETA
glyburide
GLYBURIDE
glyburide,micronized GLYNASE
nateglinide
STARLIX
repaglinide
PRANDIN
tolazamide
TOLAZAMIDE
tolbutamide
TOLBUTAMIDE
Antihyperglycemic, Insulin-response
Enhancer
T1 pioglitazone hcl
ACTOS
T3 rosiglitazone maleate AVANDIA
L.A. Care
KORLYM
PA
Antihyperglycemic-sglt2 Inhibitor &
Biguanide Comb
T3 canagliflozin/metformin INVOKAMET
hcl
Antihyperglycemic, Dpp-4 Inhibitors
NESINA
TRADJENTA
ONGLYZA
JANUVIA
ST
Antihyperglycemic-glucocorticoid Receptor
T1 acarbose
T3 miglitol
alogliptin benzoate
linagliptin
saxagliptin hcl
sitagliptin phosphate
GLYBURIDEMETFORMIN HCL
PRANDIMET
T1 pioglitazone
DUETACT
hcl/glimepiride
T3 rosiglitazone/glimepirid AVANDARYL
e
Blocker
T3
T2
T3
T2
GLIPIZIDEMETFORMIN
GLUCOVANCE
Antihyperglycemic,insulin-response &
Antihyperglycemic, Alpha-glucosidase Inhib
T2 pramlintide acetate
T2 pramlintide acetate
ST
Release Comb.
JARDIANCE
Antihyperglycemic - Dopamine Receptor
T3 bromocriptine
mesylate
GLUCOPHAGE
GLUMETZA
RIOMET
Antihyperglycm,insul-resp.enhancer &
Biguanide Cmb
T1 pioglitazone
ACTOPLUS MET
ST
hcl/metformin hcl
T2 pioglitazone
ACTOPLUS MET XR ST
hcl/metformin hcl
T3 rosiglitazone/metformi AVANDAMET
n hcl
Blood Sugar Diagnostics
T3 blood sugar diagnostic CONTOUR TS(OTC)
T3 blood sugar diagnostic GLUCOFILM(OTC)
T3 blood sugar diagnostic GLUCOSTIX
REAGENT(OTC)
Diabetic Supplies
T2 blood glucose ctl
high,nml&low
T3 blood glucose stripsdispmeter
T3 blood-gl & bp
meter,adult cuff
MYGLUCOHEALTH
CONTROL
SOLUTION(OTC)
SIDEKICK(OTC)
FORA D15(OTC)
Page 23 of 90
Commercial Formulary
T3 blood-glu
meter,cont/transmit
T3 blood-gluc.meter&
wrist bp mon
T3 blood-gluc.meter&
wrist bp mon
T3 blood-gluc.meter&
wrist bp mon
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3
T3
T3
T3
T3
T3
T3
T3
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
L.A. Care
GUARDIAN REALTIME
2TEK(OTC)
ADVOCATE
DUO(OTC)
FORA D10(OTC)
ADVOCATE BLOOD
GLUCOSE
MONITOR(OTC)
ADVOCATE REDICODE(OTC)
ADVOCATE REDICODE+(OTC)
AGAMATRIX
AMP(OTC)
ASSURE 4(OTC)
ASSURE
PLATINUM(OTC)
ASSURE PRO(OTC)
AT-LAST(OTC)
BLOOD GLUCOSE
METER(OTC)
BLOOD GLUCOSE
MONITOR(OTC)
BLOOD GLUCOSE
MONITORING(OTC)
BLOOD-GLUCOSE
METER(OTC)
CARESENS N
VOICE(OTC)
CARESENS N(OTC)
CHOICEDM
CLARUS(OTC)
CLEVER CHEK
BLOOD GLUCOSE
SYST(OTC)
CLEVER CHOICE
BLOOD GLUC
SYS(OTC)
CLEVER CHOICE HD
GLUCOSE
SYST(OTC)
CLEVER CHOICE
MICRO(OTC)
CLEVER CHOICE
PRO(OTC)
CLEVER CHOICE
TALK(OTC)
CLEVER
CHOICE(OTC)
CONTROL(OTC)
DIATRUE PLUS(OTC)
EASY CHECK(OTC)
EASY PLUS II(OTC)
EASY PLUS(OTC)
EASY STEP(OTC)
EASY TALK(OTC)
EASY TOUCH
GLUCOSE
MONITOR(OTC)
T3 blood-glucose meter
T3 blood-glucose meter
T3
T3
T3
T3
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3
T3
T3
T3
T3
T3
T3
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
T3 blood-glucose meter
T3
T3
T3
T3
T3
T3
T3
T3
T3
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
EASY TRAK(OTC)
EASYGLUCO
PLUS(OTC)
EASYGLUCO(OTC)
EASYMAX L(OTC)
EASYMAX NG(OTC)
EASYMAX V
SPEAKING(OTC)
EASYMAX V2(OTC)
ELEMENT BLOOD
GLUCOSE
METER(OTC)
ELEMENT
COMPACT(OTC)
ELEMENT
PLUS(OTC)
EMBRACE EVO(OTC)
EMBRACE PRO(OTC)
EMBRACE(OTC)
EVENCARE G2(OTC)
EVENCARE G3(OTC)
EVENCARE(OTC)
EVOLUTION BLOOD
GLUCOSE
METER(OTC)
EZ SMART
PLUS(OTC)
EZ SMART(OTC)
FORA D20(OTC)
FORA G20(OTC)
FORA G30A(OTC)
FORA V10(OTC)
FORA V12(OTC)
FORA V20(OTC)
FORA V30A(OTC)
FORACARE
GD20(OTC)
FORACARE
GD40A(OTC)
FORACARE
GD40B(OTC)
GDRIVE(OTC)
GE100 BLOOD
GLUCOSE
SYSTEM(OTC)
GLUCO NAVII(OTC)
GLUCOCARD
01(OTC)
GLUCOCARD 01MINI(OTC)
GLUCOCARD
EXPRESSION(OTC)
GLUCOCARD
VITAL(OTC)
GLUCOCOM BLOOD
GLUCOSE(OTC)
GMATE VOICE
METER(OTC)
GMATE VOICE
STARTER(OTC)
Page 24 of 90
Commercial Formulary
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3
T3
T3
T3
T3
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
L.A. Care
HEALTHPRO
GLUCOSE
MONITOR(OTC)
IBG-STAR(OTC)
INFINITY(OTC)
LIBERTY
MONITOR(OTC)
MICRO(OTC)
MICRODOT(OTC)
MYGLUCOHEALTH(O
TC)
NEWTEK(OTC)
NOVA MAX BLOOD
GLUCOSE
METER(OTC)
ON CALL EXPRESS
METER(OTC)
ON CALL PLUS
METER(OTC)
ON CALL VIVID
METER(OTC)
ON CALL VIVID
PAL(OTC)
OPTUMRX(OTC)
PHARMACIST
CHOICE(OTC)
PREMIUM BLOOD
GLUCOSE(OTC)
PREMIUM V10(OTC)
PRESTO PRO(OTC)
PRODIGY
POCKET(OTC)
PRODIGY
VOICE(OTC)
PRODIGY(OTC)
QUINTET AC(OTC)
QUINTET(OTC)
REFUAH PLUS(OTC)
RELION
CONFIRM(OTC)
RELION MICRO(OTC)
RELION PRIME(OTC)
REVEAL BLOOD
GLUCOSE
METER(OTC)
RIGHTEST GM100
SYSTEM(OTC)
RIGHTEST GM250S
METER(OTC)
RIGHTEST GM260
METER(OTC)
RIGHTEST GM300
SYSTEM(OTC)
RIGHTEST GM550
SYSTEM(OTC)
RIGHTSOURCE(OTC)
SMART CARESENS
N(OTC)
SMART SENSE
MONITORING
SYSTEM(OTC)
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose meter
T3 blood-glucose
meter,continuous
T2 lancing device
SMARTDIABETES
XPRES(OTC)
SMARTEST
EJECT(OTC)
SMARTEST
PERSONA(OTC)
SMARTEST
PRONTO(OTC)
SMARTEST
PROTEGE(OTC)
SMARTEST SMART
CODE(OTC)
SMARTEST
TALKING(OTC)
SOLUS V2(OTC)
STARTER KIT(OTC)
SURE EDGE BLOOD
GLUCOSE
METER(OTC)
SURE-TEST
EASYPLUS
MINI(OTC)
TD GOLD BLOOD
GLUCOSE
MONITOR(OTC)
TD GOLD VOICE
GLUCOSE
MONITOR(OTC)
TELCARE(OTC)
TEST N'GO(OTC)
TRUE2GO BLOOD
GLUCOSE
SYSTEM(OTC)
TRUERESULT
BLOOD GLUCOSE
SYSTM(OTC)
TRUETRACK BLOOD
GLUCOSE
SYSTEM(OTC)
TRUETRACK
METER(OTC)
TRUETRACK SMART
SYSTEM(OTC)
ULTIMA(OTC)
ULTRATRAK
PRO(OTC)
ULTRATRAK
ULTIMATE(OTC)
ULTRATRAK(OTC)
VICTORY(OTC)
WAVESENSE
AMP(OTC)
WAVESENSE
JAZZ(OTC)
WAVESENSE
PRESTO(OTC)
DEXCOM G4
ADJUSTABLE
LANCING
DEVICE(OTC)
Page 25 of 90
Commercial Formulary
T3 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
T2 lancing device
L.A. Care
ADVOCATE RAPIDSAFE(OTC)
ALTERNATE SITE
LANCING
DEVICE(OTC)
AQUA LANCE
LANCING
DEVICE(OTC)
AUTO-LANCET
MINI(OTC)
AUTOLET LANCING
DEVICE(OTC)
CAREONE(OTC)
DROPLET LANCING
DEVICE(OTC)
EASY CLICK(OTC)
EASY TOUCH
LANCING
DEVICE(OTC)
FORA LANCING
DEVICE(OTC)
GENTLE DRAW(OTC)
GLUCOLET 2(OTC)
GLUCOSOURCE(OT
C)
HEALTHY ACCENTS
AUTOLET(OTC)
INCONTROL
LANCING
DEVICE(OTC)
LANCET
DEVICE(OTC)
LANCING
DEVICE(OTC)
LANCING
SYSTEM(OTC)
LITE TOUCH(OTC)
MINI LANCING
DEVICE(OTC)
MULTI-LANCET
DEVICE(OTC)
ON CALL LANCING
DEVICE(OTC)
ON CALL PLUS
LANCING
DEVICE(OTC)
PRODIGY LANCING
DEVICE(OTC)
RELIAMED MINI
LANCING
DEVICE(OTC)
RIGHTEST
GD500(OTC)
SELECT-LITE(OTC)
SMARTDIABETES
VANTAGE(OTC)
SOFT TOUCH(OTC)
SOFTCLIX(OTC)
SURE COMFORT
LANCING PEN(OTC)
SUREFLEX(OTC)
SURE-PEN(OTC)
T2 lancing device
ULTI-LANCE(OTC)
T2 lancing device/lancets ACCU-CHEK
FASTCLIX(OTC)
T2 lancing device/lancets ACCU-CHEK
SOFTCLIX(OTC)
T2 lancing device/lancets ACCU-CHEK(OTC)
T2 lancing device/lancets ADVANCED LANCING
DEVICE(OTC)
T2 lancing device/lancets AUTOLET
IMPRESSION(OTC)
T2 lancing device/lancets GLUCOLET 2(OTC)
T2 lancing device/lancets HYPOLANCE(OTC)
T2 lancing device/lancets LANCING
DEVICE(OTC)
T2 lancing device/lancets MICROLET 2(OTC)
T2 lancing device/lancets ONE TOUCH
DELICA(OTC)
T2 lancing device/lancets ONE TOUCH
SURESOFT(OTC)
T2 lancing device/lancets PENLET PLUS
BLOOD
SAMPLER(OTC)
T2 lancing device/lancets SOLUS V2 LANCING
DEVICE(OTC)
T2 lancing device/lancets SUREFLEX(OTC)
T2 lancing device/lancets ULTI-LANCE(OTC)
T2 lancing device/lancets UNISTIK 2
EXTRA(OTC)
T2 lancing device/lancets UNISTIK 2 NORMAL
T2 lancing device/lancets UNISTIK 2
NORMAL(OTC)
T2 lancing device/lancets UNISTIK 2(OTC)
T2 lancing device/lancets UNISTIK 3
COMFORT(OTC)
T2 lancing device/lancets UNISTIK 3
NEONATAL(OTC)
T2 lancing device/lancets UNISTIK 3(OTC)
Diabetic Ulcer Preparations,topical
T2 becaplermin
REGRANEX
Hyperglycemics
T3 diazoxide
T2 glucagon,human
recombinant
T2 glucagon,human
recombinant
PROGLYCEM
GLUCAGEN
GLUCAGON
EMERGENCY KIT
Insulins
T2 hum insulin nph/reg
insulin hm
T2 hum insulin nph/reg
insulin hm
T2 hum insulin nph/reg
insulin hm
T2 insulin aspart
T2 insulin aspart
T3 insulin detemir
T3 insulin detemir
T3 insulin detemir
HUMULIN 70/30
KWIKPEN(OTC)
HUMULIN 70-30(OTC)
NOVOLIN 70-30(OTC)
NOVOLOG
NOVOLOG FLEXPEN
LEVEMIR
ST
LEVEMIR FLEXPEN ST
LEVEMIR
ST
FLEXTOUCH
Page 26 of 90
Commercial Formulary
T2 insulin
LANTUS
glargine,hum.rec.anlog
T2 insulin
LANTUS SOLOSTAR
glargine,hum.rec.anlog
T3 insulin glulisine
APIDRA
T3 insulin glulisine
APIDRA SOLOSTAR
T2 insulin lispro
HUMALOG
T2 insulin npl/insulin lisproHUMALOG MIX 50-50
T2 insulin npl/insulin lisproHUMALOG MIX 75-25
T2 insulin regular, human HUMULIN R
T2 insulin regular, human HUMULIN R(OTC)
T2 insulin regular, human NOVOLIN R(OTC)
T2 insuln asp prt/insulin NOVOLOG MIX 70-30
aspart
T2 insuln asp prt/insulin NOVOLOG MIX 70-30
aspart
FLEXPEN
T2 nph, human insulin
HUMULIN N(OTC)
isophane
T2 nph, human insulin
NOVOLIN N
isophane
INNOLET(OTC)
T2 nph, human insulin
NOVOLIN N(OTC)
isophane
EAR - GENERAL DISORDERS
Ear Preparations Anti-inflammatory
T1 fluocinolone
acetonide oil
DERMOTIC
Ear Preparations, Misc. Anti-infectives
T1 acetic acid
ACETIC ACID
T1 acetic acid/aluminum DOMEBORO
acetate
T1 acetic
HYDROCORTISONEacid/hydrocortisone ACETIC ACID
T1 cresyl acetate
CRESYLATE
T1 hc/pramox hcl/clCORTANE-B
xylenol/water
T3 hc/pramoxine
CORTANE-B
hcl/chloroxylenol
T1 hc/pramoxine
OTICIN HC
hcl/chloroxylenol
T1 benzocaine
PINNACAINE
Otic Preparations,anti-inflammatoryantibiotics
T2 ciprofloxacin
CIPRODEX
hcl/dexameth
T3 ciprofloxacin/hydrocorti CIPRO HC
sone
Otic,antiinfective-local Anesthetic
Combinations
T3 chloroxylenol/pramoxin OTICIN
e hcl
ELECTROLYTE REGULATION
Arginine Vasopressin (avp) Receptor
Antagonists
T3 tolvaptan
T3 tolvaptan
SAMSCA(TAB)(15
MG)
SAMSCA(TAB)(30
MG)
T1
T1
T3
T1
calcium acetate
calcium acetate
calcium acetate
calcium
carbonate/mag
carb/fa
T3 lanthanum carbonate
T2 sevelamer carbonate
CALCIUM ACETATE
PHOSLO
PHOSLYRA
MAGNEBIND 400 RX
FOSRENOL
RENVELA(POWD
PACK)
T1 sevelamer carbonate RENVELA(TAB)
T2 sevelamer hcl
RENAGEL
T1 sodium polystyrene SPS
sulfonate
T3 sucroferric
VELPHORO
oxyhydroxide
Potassium Replacement
T1 ciprofloxacin hcl
T3 neomy sulf/colist
sul/hc/thonz
T3 neomy sulf/colist
sul/hc/thonz
T1 neomycin/polymyxin
b sulf/hc
T3 ofloxacin
T1 pot chloride/pot
POTASSIUM
bicarb/cit ac
CHLORIDE
T3 potassium bicarbonate QUIC-K
T3 potassium
EFFER-K
bicarbonate/cit ac
T1 potassium
KLOR-CON-EF
bicarbonate/cit ac
T1 potassium chloride KAOCHLOR
T1 potassium chloride K-TAB ER
T1 potassium chloride POTASSIUM
CHLORIDE
T1 potassium gluconate POTASSIUM
GLUCONATE
CORTISPORIN-TC
NEOMYCINPOLYMYXIN-HC
FLOXIN
Ear Preparations,local Anesthetics
T1 aa/antipyrn/bcaine/poTREAGAN OTIC
lico#1/al
T3 antipyrine/benzocain/gl OTOZIN
y/zinc
T1 antipyrine/benzocain ANTIPYRINEe
BENZOCAINE
T3 antipyrine/benzocaine OTIC CARE
L.A. Care
QL
Electrolyte Depleters
Ear Preparations,antibiotics
CETRAXAL
COLY-MYCIN S
QL
Sodium/saline Preparations
T1 0.5 normal saline
SODIUM CHLORIDE
Page 27 of 90
Commercial Formulary
T1 0.9 % sodium
chloride
T1 normal saline
T1 sodium chloride 0.45
%
T3 risedronate sodium
NORMAL SALINE
FLUSH
SODIUM CHLORIDE
SODIUM CHLORIDE
T3 risedronate sodium
T3 risedronate sodium
ACTONEL(TAB)(30
MG)
ACTONEL(TAB)(35
MG)
ACTONEL(TAB)(5
MG)
ATELVIA
QL, ST
QL, ST
QL, ST
ENDOCRINE DISORDER - OTHER
T3 risedronate sodium
Antidiuretic And Vasopressor Hormones
Calcimimetic,parathyroid Calcium Enhancer
T1 desmopressin
DDAVP
(nonrefrigerated)
T3 desmopressin acetate DDAVP(AMPUL)(15
MCG/ML)
T1 desmopressin
DDAVP(AMPUL)
acetate
(4MCG/ML)
T2 desmopressin acetate DDAVP(SOLUTION)
T1 desmopressin
DDAVP(TAB)
acetate
T1 desmopressin
DDAVP(VIAL)
acetate
T1 desmopressin
DESMOPRESSIN
acetate
ACETATE
T3 desmopressin acetate STIMATE
T4 cinacalcet hcl
Antineoplastic Lhrh(gnrh) Agonist,pituitary
T4
T4
T4
T4
T4
ELIGARD
LEUPROLIDE
ACETATE
T4 pegvisomant
T4 somatropin
T4 somatropin
T4 somatropin
T4 somatropin
T4 somatropin
T4 somatropin
PA
somatropin
somatropin
somatropin
somatropin
somatropin
GENOTROPIN
HUMATROPE
NORDITROPIN
FLEXPRO
NORDITROPIN
NORDIFLEX
NUTROPIN AQ
NUTROPIN AQ
NUSPIN
OMNITROPE
SAIZEN
SEROSTIM
TEV-TROPIN
ZORBTIVE
QL
T1 doxercalciferol
T1 paricalcitol
PA
PA
PA
PA
PA
PA
PA
HECTOROL
ZEMPLAR
Insulin-like Growth Factor-1 (igf-1)
Combinations
Hormones
FOSAMAX PLUS D
T4 mecasermin
INCRELEX
PA
Leptin Hormone Analogs
Bone Resorption Inhibitors
T4 metreleptin
T1 alendronate sodium ALENDRONATE
QL
SODIUM(SOLUTION)
T1 alendronate sodium ALENDRONATE
SODIUM(TAB)
T3 alendronate sodium
BINOSTO
QL, ST
T1 alendronate sodium FOSAMAX
T3 calcitonin,salmon,synt FORTICAL
hetic
T1 calcitonin,salmon,sy MIACALCIN(SPRAY/P
nthetic
UMP)
T3 calcitonin,salmon,synt MIACALCIN(VIAL)
hetic
T1 etidronate disodium ETIDRONATE
DISODIUM
T1 ibandronate sodium BONIVA
T1 raloxifene hcl
EVISTA
PA, QL
T1 risedronate sodium ACTONEL(TAB)(150 QL, ST
MG)
Lhrh(gnrh) Agonist Analog Pituitary
L.A. Care
PA
Analog-type
Bone Resorption Inhibitor & Vitamin D
T2 alendronate
sodium/vitamin d3
PA
PA
PA
Hyperparathyroid Tx Agents - Vitamin D
Hormone
FORTEO
SOMAVERT
Growth Hormones
Bone Formation Stim. Agents - Parathyroid
T4 teriparatide
SENSIPAR
Growth Hormone Receptor Antagonists
Suppr.
T4 leuprolide acetate
T4 leuprolide acetate
QL, ST
MYALEPT
Suppressants
T3 histrelin acetate
T4 histrelin acetate
T4 nafarelin acetate
SUPPRELIN
VANTAS
SYNAREL
Lhrh(gnrh)agnst Pit.sup-central Precocious
Puberty
T4 histrelin acetate
SUPPRELIN LA
Luteinizing Hormone Releasing Hormone
-lhrh
T2 gonadorelin acetate
LUTREPULSE
Page 28 of 90
Commercial Formulary
Menopausal Sympt Supp-sel Estrogen
Recep Modulator
T3 ospemifene
OSPHENA
QL
T3
T3
T1
T2
T2
bepotastine besilate BEPREVE
emedastine difumarate EMADINE
epinastine hcl
ELESTAT
olopatadine hcl
PATADAY
olopatadine hcl
PATANOL
Pituitary Suppressive Agents
Eye Anti-infectives
T1 cabergoline
T1 danazol
T3 povidone-iodine
CABERGOLINE
DANAZOL
ENDOCRINE DISORDER - THYROID
Antithyroid Preparations
T1 methimazole
T1 methimazole
T1 propylthiouracil
METHIMAZOLE
TAPAZOLE
PROPYLTHIOURACIL
Iodine Containing Agents
T1 potassium iodide
T1 potassium
iodide/iodine
SSKI
STRONG IODINE
Thyroid Hormones
T1 levothyroxine
sodium
T3 levothyroxine sodium
T1 levothyroxine
sodium
T1 liothyronine sodium
T3 liotrix
T3 liotrix
T3 liotrix
T3 liotrix
T3 liotrix
T2 thyroid,pork
T1 thyroid,pork
SYNTHROID
TIROSINT
UNITHROID
CYTOMEL
THYROLAR-1
THYROLAR-1/2
THYROLAR-1/4
THYROLAR-2
THYROLAR-3
ARMOUR THYROID
NATURE-THROID
EYE - GENERAL DISORDERS
Eye Antibiotic-corticoid Combinations
T3 gentamicin/prednisol
ac
T1 neo/polymyx b
sulf/dexameth
T1 neomy sulf/bacitrac
zn/poly/hc
T1
T3
T1
T2
T2
PRED-G
MAXITROL
NEOMYCINBACITRACIN-POLYHC
neomycin sulfate/dex NEOMYCIN
na ph
W/DEXAMETHASONE
tobramycin/dexametha TOBRADEX ST
sone
tobramycin/dexamet TOBRADEX(DROPS
hasone
SUSP)
tobramycin/dexametha TOBRADEX(OINT)
sone
tobramycin/lotepred
ZYLET
etab
Eye Antihistamines
T3 alcaftadine
T1 azelastine hcl
L.A. Care
LASTACAFT
OPTIVAR
BETADINE
Eye Antiinflammatory Agents
T1 bromfenac sodium
BROMFENAC
SODIUM
PROLENSA
MAXIDEX
DECADRON
T3 bromfenac sodium
T3 dexamethasone
T3 dexamethasone sod
phosphate
T1 dexamethasone sod DEXAMETHASONE
phosphate
SODIUM
PHOSPHATE
T1 diclofenac sodium
DICLOFENAC
SODIUM
T2 difluprednate
DUREZOL
T1 fluorometholone
FLUOROMETHOLON
E
T2 fluorometholone
FML FORTE
T2 fluorometholone
FML S.O.P.
T2 fluorometholone
FLAREX
acetate
T1 flurbiprofen sodium OCUFEN
T1 ketorolac
ACULAR
tromethamine
T1 ketorolac
ACULAR LS
tromethamine
T3 ketorolac
ACUVAIL
tromethamine/pf
T2 loteprednol etabonate ALREX
T2 loteprednol etabonate LOTEMAX
T2 nepafenac
ILEVRO
T2 nepafenac
NEVANAC
T1 prednisolone acetate OMNIPRED
T2 prednisolone acetate PRED MILD
T1 prednisolone sod
PREDNISOLONE
phosphate
SODIUM
PHOSPHATE
T3 rimexolone
VEXOL
Eye Antivirals
T2 ganciclovir
T1 trifluridine
ZIRGAN
VIROPTIC
Eye Local Anesthetics
T1 benoxinate
hcl/fluorescein na
T3 lidocaine hcl/pf
T1 proparacaine hcl
T1 proparacaine/fluores
cein sod
T1 tetracaine hcl
T3 tetracaine hcl
T3 tetracaine hcl
T1 tetracaine hcl/pf
FLUROX
AKTEN
PROPARACAINE HCL
FLUCAINE
TETCAINE
TETRAVISC
TETRAVISC FORTE
TETRACAINE HCL
Page 29 of 90
Commercial Formulary
Eye Sulfonamides
T3 na sulfacetm/prednis
sp
T1 na sulfacetm/prednis
sp
T1 sulfacetamide
sodium
T1 sulfacetamide/predni
solone sp
T2 sulfacetm na/prednisol
ac
T2 sulfacetm na/prednisol
ac
EYE - GLAUCOMA
OPTIMYD
Carbonic Anhydrase Inhibitors
SULFALONE
T1 acetazolamide
T1 acetazolamide
T1 methazolamide
SULFACETAMIDE
SODIUM
SULFACETAMIDEPREDNISOLONE
BLEPHAMIDE
Miotics/other Intraoc. Pressure Reducers
T3 apraclonidine hcl
BLEPHAMIDE S.O.P.
Eye Vasoconstrictors
T1 naphazoline hcl
T1 naphazoline
hcl/antazoline
T1 phenylephrine hcl
NAPHAZOLINE HCL
NAPHAZOLINE HCL
W/ANTAZOLINE
PHENYLEPHRINE
HCL
Ophthalmic Antibiotics
T3 azithromycin
AZASITE
T1 bacitracin
BACITRACIN
T1 bacitracin/polymyxin BACITRACINb sulfate
POLYMYXIN
T2 besifloxacin hcl
BESIVANCE
T1 ciprofloxacin hcl
CILOXAN(DROPS)
T2 ciprofloxacin hcl
CILOXAN(OINT)
T1 erythromycin base ILOTYCIN
T1 gatifloxacin
ZYMAXID
T1 gentamicin sulfate
GARAMYCIN
T1 levofloxacin
LEVOFLOXACIN
T2 moxifloxacin hcl
MOXEZA
T2 moxifloxacin hcl
VIGAMOX
T3 natamycin
NATACYN
NEO-POLYCIN
T1 neomy
sulf/bacitra/polymyxi
nb
T1 neomycin/polymyxn NEOSPORIN
b/gramicidin
T1 ofloxacin
OCUFLOX
T3 oxy-tcn hcl/polymyx b TERAK
sulf
T3 oxytetracycline/polymy TERRAMYCIN WITH
x b sulf
POLYMYXIN
T1 polymyxin b
POLYTRIM
sulf/trimethoprim
T1 tobramycin
TOBREX(DROPS)
T2 tobramycin
TOBREX(OINT)
Ophthalmic Anti-inflammatory
Immunomodulator-type
T2 cyclosporine
RESTASIS
Ophthalmic Mast Cell Stabilizers
T1 cromolyn sodium
T2 lodoxamide
tromethamine
T2 nedocromil sodium
L.A. Care
CROMOLYN SODIUM
ALOMIDE
ALOCRIL
ACETAZOLAMIDE
DIAMOX SEQUELS
NEPTAZANE
QL
IOPIDINE(DROPERET
TE)
T1 apraclonidine hcl
IOPIDINE(DROPS)
T1 betaxolol hcl
BETAXOLOL HCL
T2 betaxolol hcl
BETOPTIC S
T2 bimatoprost
LUMIGAN
QL
T2 brimonidine tartrate
ALPHAGAN
P(DROPS)(0.1 %)
T1 brimonidine tartrate ALPHAGAN
P(DROPS)(0.15 %)
T1 brimonidine tartrate BRIMONIDINE
TARTRATE
T2 brimonidine
COMBIGAN
tartrate/timolol
T2 brinzolamide
AZOPT
T2 brinzolamide/brimonid SIMBRINZA
tart
T2 carbachol
ISOPTO CARBACHOL
T1 carteolol hcl
CARTEOLOL HCL
T3 demecarium bromide HUMORSOL
T1 dorzolamide hcl
TRUSOPT
T1 dorzolamide
COSOPT
hcl/timolol maleat
T3 dorzolamide/timolol/pf COSOPT PF
QL, ST
T3 echothiophate iodide PHOSPHOLINE
IODIDE
T1 latanoprost
XALATAN
T1 levobunolol hcl
BETAGAN
T1 metipranolol
METIPRANOLOL
T1 pilocarpine hcl
ISOPTO
CARPINE(DROPS)(1
%)
T1 pilocarpine hcl
ISOPTO
CARPINE(DROPS)(2
%)
T1 pilocarpine hcl
ISOPTO
CARPINE(DROPS)(4
%)
T3 pilocarpine hcl
ISOPTO
CARPINE(DROPS)(8
%)
T1 pilocarpine hcl
PILOCARPINE HCL
T3 tafluprost/pf
ZIOPTAN
QL, ST
T2 timolol
BETIMOL
T3 timolol maleate
ISTALOL
T1 timolol maleate
TIMOPTIC
T1 timolol maleate
TIMOPTIC-XE
T3 timolol maleate/pf
TIMOPTIC OCUDOSE QL, ST
T2 travoprost
TRAVATAN Z
QL
T1 travoprost
TRAVOPROST
QL
(benzalkonium)
T3 unoprostone isopropyl RESCULA
QL, ST
Page 30 of 90
Commercial Formulary
Mydriatics
Antihemophilic Factors
T1 atropine sulfate
T1 atropine sulfate
T2 cyclopentolate hcl
T4 antihemoph.fviii
ADVATE
plas/alb free
T4 antihemoph.fviii
ADVATE H
plas/alb free
T4 antihemoph.fviii
ADVATE L
plas/alb free
T4 antihemoph.fviii
ADVATE M
plas/alb free
T4 antihemoph.fviii
ADVATE SH
plas/alb free
T4 antihemoph.fviii
ADVATE UH
plas/alb free
T4 antihemoph.fviii
XYNTHA
plas/alb free
T4 antihemoph.fviii
XYNTHA SOLOFUSE
plas/alb free
T4 antihemophilic factor, BIOCLATE
hum rec
T4 antihemophilic factor, HELIXATE FS
hum rec
T4 antihemophilic factor, KOGENATE FS
hum rec
T4 antihemophilic factor, RECOMBINATE
hum rec
T4 antihemophilic factor, HEMOFIL M
human
T4 antihemophilic factor, KOATE-DVI
human
T4 antihemophilic factor, MONOCLATE-P
human
T4 antihemophilic
ALPHANATE
factor/vwf
T4 antihemophilic
HUMATE-P
factor/vwf
T4 antihemophilic
WILATE
factor/vwf
T4 anti-inhibitor coagulant FEIBA NF
comp.
T4 anti-inhibitor coagulant FEIBA VH IMMUNO
comp.
T4 coagulation factor
NOVOSEVEN
viia,recomb
T4 coagulation factor
NOVOSEVEN RT
viia,recomb
T4 factor viii rec,fc fusion ELOCTATE
prot
T1
T1
T3
T1
T3
T3
T1
T1
ATROPINE SULFATE
ISOPTO ATROPINE
CYCLOGYL(DROPS)
(0.5 %)
cyclopentolate hcl
CYCLOGYL(DROPS)
(1 %)
cyclopentolate hcl
CYCLOGYL(DROPS)
(2 %)
cyclopentolate/phenyle CYCLOMYDRIL
phrine
homatropine hbr
HOMATROPAIRE
hydroxyamphetamine/t PAREMYD
ropicamide
ISOPTO HYOSCINE
scopolamine
hydrobromide
tropicamide
MYDRIACYL
tropicamide
TROPICAMIDE
Ophthalmic Antifibrotic Agents
T3 mitomycin
MITOSOL
EYE - MISCELLANEOUS
Artificial Tears
T3 hydroxypropyl
cellulose
LACRISERT
Eye Preparations, Miscellaneous
T3 gelatin
GELFILM
Ophthalmic Cystine Depleting Agents
T4 cysteamine hcl
CYSTARAN
PA
GOUT AND RELATED DISEASES
Colchicine
T2 colchicine
COLCRYS
T1 colchicine/probeneci PROBENECIDd
COLCHICINE
Hyperuricemia Tx - Purine Inhibitors
T1 allopurinol
T2 febuxostat
ZYLOPRIM
ULORIC
Uricosuric Agents
T1 probenecid
PROBENECID
HEMATOLOGICAL DISORDERS
QL, ST
Blood Factors,miscellaneous
T4 factor xiii
CORIFACT
Anticoagulants,coumarin Type
Citrates As Anticoagulants
T1 warfarin sodium
T1 citrate phosphate
dextros soln
COUMADIN
Antifibrinolytic Agents
T1 aminocaproic acid
T1 tranexamic acid
AMINOCAPROIC
ACID
LYSTEDA
T3 dextrose/sod
citrate/citric ac
T1 sodium citrate
CITRATE
PHOSPHATE
DEXTROSE
ACD
SODIUM CITRATE
Direct Factor Xa Inhibitors
T2 apixaban
L.A. Care
ELIQUIS
QL
Page 31 of 90
Commercial Formulary
T2 rivaroxaban
T2 rivaroxaban
T2 rivaroxaban
XARELTO(TAB)(10
MG)
XARELTO(TAB)(15
MG)
XARELTO(TAB)(20
MG)
QL
T4 enoxaparin sodium
QL
QL
T4
QL
QL
T4
T4
Factor Ix Preparations
T4 factor ix
T4 factor ix
T4 factor ix complex
human
T4 factor ix complex
human
T4 factor ix human
recombinant
T4 factor ix human
recombinant
T4 factor ix rec, fc fusion
protn
T4
ALPHANINE SD
MONONINE
BEBULIN
T4
T4
PROFILNINE
T1
BENEFIX
T1
RIXUBIS
T1
ALPROLIX
T1
Factor Xiii Preparations
T1
T4 factor xiii asubunit,recomb
T1
TRETTEN
Hematinics,other
T4 darbepoetin alfa in
polysorbat
T4 epoetin alfa
T4 epoetin alfa
T1
ARANESP
PA
EPOGEN
PROCRIT
PA
PA
T1
Hemorrheologic Agents
T1 pentoxifylline
T4 enoxaparin sodium
T4 enoxaparin sodium
T4 enoxaparin sodium
T4 enoxaparin sodium
L.A. Care
FRAGMIN(SYRINGE)
(10000/ML)
FRAGMIN(SYRINGE)
(12500/0.5)
FRAGMIN(SYRINGE)
(15000/0.6)
FRAGMIN(SYRINGE)
(18000/0.72)
FRAGMIN(SYRINGE)
(2500/0.2ML)
FRAGMIN(SYRINGE)
(5000/0.2ML)
FRAGMIN(SYRINGE)
(7500/0.3ML)
FRAGMIN(VIAL)
QL
LOVENOX(SYRINGE)
(100 MG/ML)
LOVENOX(SYRINGE)
(120MG/.8ML)
LOVENOX(SYRINGE)
(150 MG/ML)
LOVENOX(SYRINGE)
(30MG/0.3ML)
LOVENOX(SYRINGE)
(40MG/0.4ML)
QL
QL
QL
QL
QL
QL
QL
QL
QL
Leukocyte (wbc) Stimulants
T4 filgrastim
T4 pegfilgrastim
T4 sargramostim
PENTOXIFYLLINE
Heparin And Related Preparations
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 dalteparin
sodium,porcine
T4 enoxaparin sodium
LOVENOX(SYRINGE)
(60MG/0.6ML)
enoxaparin sodium LOVENOX(SYRINGE)
(80MG/0.8ML)
enoxaparin sodium LOVENOX(VIAL)
fondaparinux sodium ARIXTRA(SYRINGE)
(10MG/0.8ML)
fondaparinux sodium ARIXTRA(SYRINGE)
(2.5 MG/0.5)
fondaparinux sodium ARIXTRA(SYRINGE)
(5MG/0.4ML)
fondaparinux sodium ARIXTRA(SYRINGE)
(7.5MG/0.6)
heparin sod,porcine- HEPARIN FLUSH
0.9 % nacl
heparin sod,pork in HEPARIN SODIUM IN
0.45% nacl
0.45% NACL
heparin
HEPARIN SODIUM
sodium,porcine
heparin
HEPARIN SODIUMsodium,porcine/d5w D5W
heparin
HEP-PAK CVC
sodium,porcine/ns
heparin
HEPARIN SODIUMsodium,porcine/ns/pf NS
heparin
HEPARIN FLUSH
sodium,porcine/pf
heparin
MONOJECT PREFILL
sodium,porcine/pf
ADVANCED
NEUPOGEN
NEULASTA
LEUKINE
PA
PA
PA
Platelet Aggregation Inhibitors
T3
T1
T1
T1
T1
T2
T2
T1
T3
aspirin/dipyridamole
cilostazol
clopidogrel bisulfate
dipyridamole
dipyridamole
prasugrel hcl
ticagrelor
ticlopidine hcl
vorapaxar sulfate
AGGRENOX
PLETAL
PLAVIX
DIPYRIDAMOLE
PERSANTINE
EFFIENT
BRILINTA
TICLOPIDINE HCL
ZONTIVITY
QL
Platelet Proliferation Stimulants
QL
T4 oprelvekin
QL
Platelet Reducing Agents
QL
T1 anagrelide hcl
T1 anagrelide hcl
QL
Sickle Cell Anemia Agents
T3 hydroxyurea
QL
QL
NEUMEGA
AGRYLIN
ANAGRELIDE HCL
DROXIA
QL
Thrombin Inhibitors,sel.,direct,&rev.-hirudin
QL
Type
QL
T4 desirudin
IPRIVASK
PA, QL
Page 32 of 90
Commercial Formulary
Thrombin Inhibitors,selective,direct, &
Reversible
T3 dabigatran etexilate
mesylate
PRADAXA
PA, QL
Thrombopoietin Receptor Agonists
T4 eltrombopag olamine PROMACTA
PA
Topical Hemostatics
T3 cellulose,oxidized
OXYCEL
T3 ferric subsulfate
ASTRINGYN
T3 fibrinogen/thrombin
TACHOSIL
(hum plas)
T3 gelatin
GELFOAM
sponge,absorbable
T3 gelatin
GELFOAM PACKS
sponge,absorbable
T3 microfibrillar collagen AVITENE
T3 microfibrillar collagen ENDO-AVITENE
T3 microfibrillar collagen SYRINGE AVITENE
T3 microfibrillar collagen ULTRAFOAM
T1 thrombin (bovine)
THROMBIN-JMI
T3 thrombin
RECOTHROM
(recombinant)
T3 thrombin(hum
TISSEEL VHSD
plas)/fib/apro/ca
T1 thrombin/fibrinogen/ HEMASEEL
apro/cal
APR(KIT)(1 ML)
T3 thrombin/fibrinogen/aprHEMASEEL
o/cal
APR(KIT)(2 ML)
T1 thrombin/fibrinogen/ HEMASEEL
apro/cal
APR(KIT)(5ML)
Estrogen & Progestin With
Antimineralocorticoid Cb
T3 drospirenone/estradiol ANGELIQ
Estrogen & Selective Estrogen Recept
Mod(serm)comb
T2 estrogens,conj/bazedo DUAVEE
xifene
Estrogen/androgen Combinations
T1 estrogen,ester/metestosterone
AQUA-MEPHYTON
MEPHYTON
HORMONAL DEFICIENCY
Androgenic Agents
T1
T2
T2
T2
T1
T3
T3
T2
T2
T1
T3
T1
T1
T1
fluoxymesterone
methyltestosterone
methyltestosterone
methyltestosterone
oxandrolone
oxymetholone
testosterone
testosterone
testosterone
testosterone
testosterone
testosterone
testosterone
testosterone
T3 testosterone
ANDROXY
ANDROID
METHITEST
TESTRED
OXANDRIN
ANADROL-50
ANDRODERM
ANDROGEL
AXIRON
FORTESTA
STRIANT
TESTIM
TESTOSTERONE
VOGELXO(GEL MD
PMP)
VOGELXO(GEL
PACKET)
QL
T2
T1
T3
T3
T1
T3
T3
T3
T3
T2
T2
T3
T2
PA
PA
PA
PA
PA
PA
PA
PA
PA
T1
T3
T2
T2
T2
T3
T3
L.A. Care
ESTROGEN &
METHYLTESTOSTER
ONE
Estrogenic Agents
Vitamin K Preparations
T1 phytonadione
T2 phytonadione
PA
T2 testosterone cypionate DEPOTESTOSTERONE(VIA
L)(100 MG/ML)
T1 testosterone
DEPOPA
cypionate
TESTOSTERONE(VIA
L)(200 MG/ML)
T1 testosterone
TESTOSTERONE
PA
cypionate
CYPIONATE
T2 testosterone enanthateDELATESTRYL(SYRI PA
NGE)
T1 testosterone
DELATESTRYL(VIAL) PA
enanthate
T3 testosterone
FIRSTpropionate
TESTOSTERONE
T3 testosterone
FIRSTpropionate
TESTOSTERONE MC
estradiol
ALORA
estradiol
CLIMARA
estradiol
DIVIGEL
estradiol
ELESTRIN
estradiol
ESTRACE
estradiol
ESTRASORB
estradiol
ESTROGEL
estradiol
EVAMIST
estradiol
MENOSTAR
estradiol
MINIVELLE
estradiol
VIVELLE-DOT
estradiol/levonorgestre CLIMARA PRO
l
estradiol/norethindrone COMBIPATCH
acet
estradiol/norethindro ESTRADIOLne acet
NORETHINDRONE
ACETAT
estradiol/norgestimate PREFEST
estrogen,con/mPREMPHASE
progest acet
estrogen,con/mPREMPRO
progest acet
estrogens, conjugated PREMARIN
estrogens,conj.,synthetCENESTIN
ic a
estrogens,conj.,synthetENJUVIA
ic b
QL
QL
QL
QL
QL
QL
QL
Page 33 of 90
Commercial Formulary
T2 estrogens,esterified
T1 estropipate
T2 norethindrone ac-eth
estradiol
T1 norethindrone ac-eth
estradiol
T4 cyclosporine,
CYCLOSPORINE
modified
MODIFIED
T4 everolimus
ZORTRESS
T1 mycophenolate
CELLCEPT(CAP)
mofetil
T2 mycophenolate mofetil CELLCEPT(SUSP
RECON)
T1 mycophenolate
CELLCEPT(TAB)
mofetil
T1 mycophenolate
MYCOPHENOLIC
sodium
ACID
T4 sirolimus
RAPAMUNE
T4 tacrolimus
ASTAGRAF XL
T4 tacrolimus
HECORIA
MENEST
OGEN
FEMHRT
JINTELI
Progestational Agents
T1 medroxyprogesteron MEDROXYPROGEST
e acet
ERONE ACETATE
T1 medroxyprogesteron PROVERA
e acetate
T1 norethindrone
AYGESTIN
acetate
T1 progesterone
PROGESTERONE
T3 progesterone,microniz CRINONE
ed
T1 progesterone,microniPROMETRIUM
zed
INFECTIOUS DISEASE - BACTERIAL
Absorbable Sulfonamides
T1 sulfamethoxazole/tri BACTRIM
methoprim
T1 sulfamethoxazole/tri SULFAMETHOXAZOL
methoprim
E-TRIMETHOPRIM
IMMUNIZATION
Influenza Virus Vaccines
T2 flu vac tv 2013(18FLUBLOK 2013-2014
49yr)rcm/pf
T2 flu vacc qs 2013FLUARIX QUAD 201314(36mos+)/pf
2014
T2 flu vacc qs 2013SINGLE USE EZ FLU
14(36mos+)/pf
2013-2014
T2 flu vacc qv live 2014(2- FLUMIST QUAD 2014-QL
49yrs)
2015
T2 flu vacc ts 2013FLULAVAL 2013-2014
14(36mos+)
T2 flu vacc ts 2013FLUARIX 2013-2014
14(36mos+)/pf
T2 flu vaccine qs 2013- FLULAVAL QUAD
14(36mos+)
2013-2014
T2 flu vaccine ts2013SINGLE USE EZ FLU
14(4yr+)/pf
2013-2014
IMMUNOSUPPRESSION/MODULATION
Immunomodulators
T1 imiquimod
T3 imiquimod
T3 imiquimod
T3 imiquimod
T4 interferon alfa2b,recomb.
T4 interferon alfa-n3
T4 interferon gamma1b,recomb.
ALDARA
ZYCLARA(CREAM
PACK)
ZYCLARA(CRM MD
PMP)(2.5 %)
ZYCLARA(CRM MD
PMP)(3.75 %)
INTRON A
ALFERON N
ACTIMMUNE
Immunosuppressives
T3 azathioprine
T1 azathioprine
T4 cyclosporine
L.A. Care
AZASAN
IMURAN
SANDIMMUNE
PA, QL
PA, QL
PA, QL
PA, QL
PA
Betalactams
T4 aztreonam lysine
CAYSTON
PA
Cephalosporins - 1st Generation
T1 cefadroxil
T1 cephalexin
T1 cephalexin
CEFADROXIL
CEPHALEXIN
KEFLEX
Cephalosporins - 2nd Generation
T1 cefaclor
T1 cefprozil
T2 cefuroxime axetil
T1 cefuroxime axetil
CEFACLOR
CEFPROZIL
CEFTIN(SUSP
RECON)
CEFTIN(TAB)
Cephalosporins - 3rd Generation
T1
T1
T2
T1
cefdinir
CEFDINIR
cefditoren pivoxil
SPECTRACEF
cefixime
SUPRAX
cefpodoxime proxetil CEFPODOXIME
PROXETIL
T1 ceftibuten dihydrate CEDAX(CAP)
T1 ceftibuten dihydrate CEDAX(SUSP
RECON)(180
MG/5ML)
T3 ceftibuten dihydrate
CEDAX(SUSP
RECON)(90 MG/5 ML)
Chemotherapeutics, Antibacterial, Misc.
T3 fosfomycin
MONUROL
tromethamine
T3 methen/m-blue/sal/na URELLE
phos/hyos
T1 methen/m-blue/sal/na UTA
phos/hyos
T1 methen/sod
URYL
phos/meth blue/hyos
Page 34 of 90
Commercial Formulary
T1 methenam/me
blue/ba/salicy/hyo
T2 methenam/me
blue/ba/salicy/hyo
T1 methenamine
hippurate
T1 methenamine
mandelate
T2 mth/me blue/sod
phos/phen/hyos
T2 mth/me blue/sod
phos/phen/hyos
T3 mth/me blue/sod
phos/phen/hyos
T2 mth/me blue/sod
phos/phen/hyos
T1 mth/me blue/sod
phos/phen/hyos
T2 trimethoprim
T1 trimethoprim
T1 amoxicillin
AMOXIL
T1 amoxicillin trihydrate AMOXICILLIN
T1 amoxicillin/potassiu AMOX TRm clav
POTASSIUM
CLAVULANATE
T1 amoxicillin/potassiu AUGMENTIN ES-600
m clav
T2 amoxicillin/potassium AUGMENTIN(SUSP
clav
RECON)(125-31.25/)
T1 amoxicillin/potassiu AUGMENTIN(SUSP
m clav
RECON)(250-62.5/5)
T1 amoxicillin/potassiu AUGMENTIN(TAB)
m clav
T1 ampicillin trihydrate AMPICILLIN
TRIHYDRATE
T1 dicloxacillin sodium DICLOXACILLIN
SODIUM
T3 oxacillin sodium
BACTOCILL
T1 penicillin v
PENICILLIN V
potassium
POTASSIUM
HYOPHEN
PROSED-DS
HIPREX
METHENAMINE
MANDELATE
PHOSPHASAL
URETRON D-S
URIBEL
URIN D.S.
UTIRA-C
PRIMSOL
TRIMETHOPRIM
Quinolones
Ketolides
T2 telithromycin
KETEK
T1 ciprofloxacin
T1 ciprofloxacin hcl
T1 ciprofloxacin hcl
Macrolides
T1
T1
T2
T1
T1
T2
T1
T2
T2
T2
T2
T1
T1
T2
azithromycin
azithromycin
azithromycin
clarithromycin
clarithromycin
erythromycin base
erythromycin base
erythromycin base
erythromycin
ethylsuccinate
erythromycin
ethylsuccinate
erythromycin
ethylsuccinate
erythromycin
ethylsuccinate
erythromycin
stearate
fidaxomicin
ZITHROMAX
ZITHROMAX TRI-PAK
ZMAX
BIAXIN
CLARITHROMYCIN
ERY-TAB
ERYTHROMYCIN
PCE
E.E.S. 200
T1
T3
T1
T1
T3
T1
T1
T3
T3
T1
ERYPED 200
ERYPED 400
Tetracyclines
ERYTHROMYCIN
ETHYLSUCCINATE
ERYTHROCIN
STEARATE
DIFICID
T1 demeclocycline hcl
QL, ST
Nitrofuran Derivatives
T1 nitrofurantoin
T1 nitrofurantoin
macrocrystal
T2 nitrofurantoin
macrocrystal
T1 nitrofurantoin
macrocrystal
T1 nitrofurantoin
monohyd/m-cryst
ZYVOX
SIVEXTRO
Penicillins
T1 amoxicillin
L.A. Care
T2 doxycycline calcium
T3 doxycycline hyclate
T1 doxycycline hyclate
T3 doxycycline hyclate
FURADANTIN
MACRODANTIN(CAP)
(100 MG)
MACRODANTIN(CAP)
(25 MG)
MACRODANTIN(CAP)
(50 MG)
MACROBID
T1 doxycycline hyclate
Oxazolidinones
T2 linezolid
T2 tedizolid phosphate
CIPROFLOXACIN
CIPRO
CIPROFLOXACIN
HCL
ciprofloxacin/ciproflo CIPRO XR
xa hcl
gemifloxacin mesylate FACTIVE
levofloxacin
LEVAQUIN
levofloxacin
LEVOFLOXACIN
lomefloxacin hcl
MAXAQUIN
moxifloxacin hcl
AVELOX
nalidixic acid
NALIDIXIC ACID
nalidixic acid
NEGGRAM
norfloxacin
NOROXIN
ofloxacin
OFLOXACIN
PA
T1 doxycycline hyclate
T1 doxycycline hyclate
T3 doxycycline
monohy/skin clnsr9
T3 doxycycline
monohy/skin clnsr9
T1 doxycycline
monohydrate
T1 doxycycline
monohydrate
T1 doxycycline
monohydrate
DEMECLOCYCLINE
HCL
VIBRAMYCIN
ACTICLATE
QL, ST
DORYX(TAB DR)(150
MG)
DORYX(TAB DR)(200 QL, ST
MG)
DOXYCYCLINE
HYCLATE
MORGIDOX
VIBRAMYCIN
ADOXA CK
ADOXA TT
ADOXA
ADOXA PAK
QL, ST
AVIDOXY
AMOXICILLIN
Page 35 of 90
Commercial Formulary
T1 doxycycline
monohydrate
T3 doxycycline
monohydrate
T1 doxycycline
monohydrate
T3 doxycycline/benzoyl
peroxide
T3 doxycycline/benzoyl
peroxide
T3 doxycycline/salicy/oct/
zinc ox
T3 doxycycline/skin
cleanser #19
T1 minocycline hcl
T1 minocycline hcl
T1 minocycline hcl
T1 minocycline hcl
T3 minocycline hcl
MONODOX
ORACEA
Antifungal-antibiotic-steroid-antihistamine
AGE,
QL, ST
Comb
VIBRAMYCIN
T3 nystatin/tcn/hc/diphenh FIRST-MARY'S
ydramin
BENOXYLDOXY 30
Antifungal-anti-inflammatory Steroid-
BENOXYLDOXY 60
antihistamine
AVIDOXY DK
T3 nystatin/hydrocortisoneFIRST-DUKE'S
/diphen
MORGIDOX
Antifungal-local Anesthetic-antihistamine
DYNACIN
MINOCIN
MINOCYCLINE
HCL(TAB ER 24H)
MINOCYCLINE
HCL(TAB)
SOLODYN
Comb
T3 minocycline hcl/skin cl MINOCIN
no.4
T1 tetracycline hcl
ALA-TET
T1 tetracycline hcl
TETRACYCLINE HCL
INFECTIOUS DISEASE - FUNGAL
AGE,
QL
T3 nystatin/lidocaine/diph FIRST-BXN
enhyd
INFECTIOUS DISEASE AGE,
QL, ST
MISCELLANEOUS
Aminoglycosides
T1
T4
T4
T4
Antifungal Agents
T1
T1
T1
T3
T1
T2
clotrimazole
fluconazole
flucytosine
itraconazole
itraconazole
itraconazole
T1
T3
T3
T2
ketoconazole
miconazole
posaconazole
terbinafine hcl
T1 terbinafine hcl
T3 terbinafine/hydroxy
chitosan
T1 triacetin
T1 voriconazole
CLOTRIMAZOLE
DIFLUCAN
ANCOBON
ONMEL
SPORANOX(CAP)
SPORANOX(SOLUTI
ON)
KETOCONAZOLE
ORAVIG
NOXAFIL
LAMISIL(GRAN
PACK)
LAMISIL(TAB)
TERBINEX
TRIACETIN
VFEND
Antifungal Antibiotics
T1 griseofulvin
ultramicrosize
T3 griseofulvin, microsize
T1 griseofulvin,
microsize
T1 griseofulvin,
microsize
T1 nystatin
L.A. Care
GRIS-PEG
FULVICIN U/F
GRIFULVIN V
GRISEOFULVIN
NYSTATIN
neomycin sulfate
NEOMYCIN SULFATE
tobramycin
BETHKIS
PA
tobramycin
TOBI PODHALER
PA
tobramycin in 0.225% TOBI
PA
nacl
Antibacterial Agents,miscellaneous
T1 glycine urologic
solution
T3 urologic solution-g
T1 urologic solution-g
T3 urologic solution-g
GLYCINE
IRRIGATING
SOLUTION G
UROLOGIC
SOLUTION G(IRRIG
SOLN)(3.24G-380)
UROLOGIC
SOLUTION G(IRRIG
SOLN)(3.24G-380)
Antileprotics
T1 dapsone
T4 thalidomide
DAPSONE
THALOMID
PA, QL
Anti-mycobacterium Agents
T3
T1
T1
T3
T1
T1
T1
aminosalicylic acid
ethambutol hcl
ethambutol hcl
ethionamide
isoniazid
pyrazinamide
rifabutin
PASER
ETHAMBUTOL HCL
MYAMBUTOL
TRECATOR
ISONIAZID
PYRAZINAMIDE
MYCOBUTIN
Antitubercular Antibiotics
T4 bedaquiline fumarate
T1 cycloserine
T3 rifamp/isoniazid/pyrazi
namide
T1 rifampin
SIRTURO
CYCLOSERINE
RIFATER
PA
RIFADIN
Page 36 of 90
Commercial Formulary
T2 rifampin/isoniazid
T3 rifapentine
RIFAMATE
PRIFTIN
Antiprotozoal Drugs,miscellaneous
T1 atovaquone
T2 pentamidine
isethionate
Lincosamides
T1 clindamycin hcl
T1 clindamycin
palmitate hcl
CLEOCIN HCL
CLINDAMYCIN
PALMITATE HCL
INFECTIOUS DISEASE - VIRAL
Rifamycins And Related Derivative
Antivirals, General
Antibiotics
T3
T1
T1
T2
T3 rifaximin
T2 rifaximin
XIFAXAN(TAB)(200
MG)
XIFAXAN(TAB)(550
MG)
QL, ST
Vancomycin And Derivatives
T1 vancomycin hcl
VANCOCIN HCL
QL
INFECTIOUS DISEASE - PARASITIC
2nd Gen. Anaerobic Antiprotozoalantibacterial
T1 tinidazole
TINDAMAX
ATOVAQUONE
NEBUPENT
acyclovir
acyclovir
famciclovir
oseltamivir phosphate
SITAVIG
ZOVIRAX
FAMVIR
TAMIFLU(CAP)(30
MG)
T2 oseltamivir phosphate TAMIFLU(CAP)(45
MG)
T2 oseltamivir phosphate TAMIFLU(CAP)(75
MG)
T2 oseltamivir phosphate TAMIFLU(SUSP
RECON)
T2 ribavirin
VIRAZOLE
T1 rimantadine hcl
FLUMADINE
T1 valacyclovir hcl
VALTREX
T3 valganciclovir hcl
VALCYTE
T3 zanamivir
RELENZA
QL
QL
QL
QL
QL
Amebacides
Antivirals, Hiv-spec, Non-peptidic Protease
T2 iodoquinol
YODOXIN
T1 paromomycin sulfate PAROMOMYCIN
SULFATE
Inhib
T4 darunavir ethanolate
Anaerobic Antiprotozoal-antibacterial
T4 darunavir ethanolate
Agents
T4 darunavir ethanolate
T2 metronidazole
T1 metronidazole
FLAGYL ER
METRONIDAZOLE
Anthelmintics
T3 albendazole
T3 ivermectin
T2 praziquantel
T4 darunavir ethanolate
ALBENZA
STROMECTOL
BILTRICIDE
Antimalarial Drugs
T3 artemether/lumefantrin COARTEM
e
T1 atovaquone/proguani MALARONE
l hcl
T1 chloroquine
ARALEN
phosphate
PHOSPHATE
T1 chloroquine
CHLOROQUINE
phosphate
PHOSPHATE
T3 halofantrine hcl
HALFAN
T1 hydroxychloroquine PLAQUENIL
sulfate
T1 mefloquine hcl
MEFLOQUINE HCL
T2 primaquine phosphate PRIMAQUINE
T2 pyrimethamine
DARAPRIM
T1 quinine sulfate
QUALAQUIN
T1 quinine sulfate
QUININE SULFATE
L.A. Care
T4 darunavir ethanolate
T4 darunavir ethanolate
T4 tipranavir
T4 tipranavir/vitamin e
tpgs
PREZISTA(ORAL
SUSP)
PREZISTA(TAB)(150
MG)
PREZISTA(TAB)(400
MG)
PREZISTA(TAB)(600
MG)
PREZISTA(TAB)(75
MG)
PREZISTA(TAB)(800
MG)
APTIVUS
APTIVUS
QL
QL
QL
QL
QL
QL
PA
PA
Antivirals, Hiv-spec, Nucleoside-nucleotide
Analog
T4 emtricitabine/tenofovir TRUVADA
QL
Antivirals, Hiv-spec., Nucleoside Analog, Rti
Comb
T4 abacavir
EPZICOM
sulfate/lamivudine
T4 abacavir/lamivudine/ TRIZIVIR
zidovudine
T4 lamivudine/zidovudin COMBIVIR
e
QL
PA
QL
Page 37 of 90
Commercial Formulary
Antivirals, Hiv-specific, Ccr5 Co-receptor
Antivirals, Hiv-specific, Protease Inhibitors
Antag.
T4
T4
T2
T4
T4
T4
T4
T4 maraviroc
SELZENTRY
PA
Antivirals, Hiv-specific, Fusion Inhibitors
T4 enfuvirtide
FUZEON
QL, ST
Antivirals, Hiv-specific, Non-nucleoside, Rti
T2
T4
T4
T2
T1
delavirdine mesylate
efavirenz
etravirine
nevirapine
nevirapine
T1 nevirapine
T4 rilpivirine hcl
RESCRIPTOR
SUSTIVA
INTELENCE
VIRAMUNE XR
VIRAMUNE(ORAL
SUSP)
VIRAMUNE(TAB)
EDURANT
Inhibtr
QL
T4 dolutegravir sodium
T4 raltegravir potassium
QL
PA
Rti
abacavir sulfate
abacavir sulfate
didanosine
didanosine
T1 didanosine
T1 didanosine
T1 didanosine
T2
T2
T2
T1
T1
T1
T1
T1
T1
T1
emtricitabine
emtricitabine
lamivudine
lamivudine
lamivudine
stavudine
stavudine
zidovudine
zidovudine
zidovudine
ZIAGEN(SOLUTION) QL
ZIAGEN(TAB)
QL
VIDEX
QL
VIDEX EC(CAP
QL
DR)(125 MG)
VIDEX EC(CAP
QL
DR)(200 MG)
VIDEX EC(CAP
DR)(250 MG)
VIDEX EC(CAP
DR)(400 MG)
EMTRIVA(CAP)
QL
EMTRIVA(SOLUTION) QL
EPIVIR(SOLUTION) QL
EPIVIR(TAB)(150 MG) QL
EPIVIR(TAB)(300 MG) QL
ZERIT(CAP)
QL
ZERIT(SOLN RECON) QL
RETROVIR(CAP)
QL
RETROVIR(SYRUP) QL
ZIDOVUDINE
QL
TIVICAY
ISENTRESS
T4 efavirenz/emtricitab/te ATRIPLA
nofovir
T4 emtricitab/rilpivirine/ten COMPLERA
ofov
T4 elvitegr/cobicist/emtric/ STRIBILD
tenof
QL
Antivirals, Hiv-specific, Protease Inhibitor
Comb
T4 lopinavir/ritonavir
T4 lopinavir/ritonavir
T4 lopinavir/ritonavir
L.A. Care
KALETRA(SOLUTIO
N)
KALETRA(TAB)
(100MG-25MG)
KALETRA(TAB)
(200MG-50MG)
PA
QL
Arv Comb-nrtis & Integrase Inhibitor
T4 abacavir/dolutegravir/l TRIUMEQ
amivudi
Hep C Virus,nucleotide Analog Ns5b
Polymerase Inh
T4 sofosbuvir
SOVALDI
PA
Hepatitis B Treatment Agents
T4
T4
T2
T1
T4
adefovir dipivoxil
entecavir
lamivudine
lamivudine
telbivudine
HEPSERA
BARACLUDE
EPIVIR HBV
LAMIVUDINE HBV
TYZEKA
T4
T4
T4
T4
VIREAD(TAB)
QL
Arv Cmb-nrti,n(t)rti, Integrase Inhibitor
Rti
QL
PA
nucleoside Rti
Hepatitis C Treatment Agents
VIREAD(POWDER)
QL
QL, ST
QL, ST
Artv Cmb Nucleoside,nucleotide,&non-
Antivirals, Hiv-specific, Nucleotide Analog,
T4 tenofovir disoproxil
fumarate
T4 tenofovir disoproxil
fumarate
PA
Antivirals,hiv-1 Integrase Strand Transfer
PA
Antivirals, Hiv-specific, Nucleoside Analog,
T4
T4
T2
T1
atazanavir sulfate
REYATAZ
fosamprenavir calcium LEXIVA
indinavir sulfate
CRIXIVAN
nelfinavir mesylate
VIRACEPT
ritonavir
NORVIR
saquinavir mesylate INVIRASE(CAP)
saquinavir mesylate INVIRASE(TAB)
peginterferon alfa-2a
peginterferon alfa-2a
peginterferon alfa-2b
peginterferon alfa-2b
T1 ribavirin
T1 ribavirin
T2 ribavirin
PEGASYS
PA
PEGASYS PROCLICK PA
PEGINTRON
PA
PEGINTRON
PA
REDIPEN
COPEGUS
REBETOL(CAP)
REBETOL(SOLUTIO
N)
QL
Hepatitis C Virus Ns3/4a Serine Protease
QL
Inhib.
QL
T4 boceprevir
T4 simeprevir sodium
T4 telaprevir
VICTRELIS
OLYSIO
INCIVEK
PA
PA
PA
Page 38 of 90
Commercial Formulary
INFLAMMATORY DISEASE
T4 c1 esterase inhibitor,
recomb
Anti-arthritic And Chelating Agents
Glucocorticoids
T2 penicillamine
T2 penicillamine
T1 budesonide
T3 budesonide
T1 cortisone acetate
CUPRIMINE
DEPEN
Anti-arthritic, Folate Antagonist Agents
T1 methotrexate sodium METHOTREXATE
T4 methotrexate/pf
OTREXUP
QL, ST
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(10MG/0.2ML)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(12.5/0.25)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(15MG/0.3ML)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(17.5/0.35)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(22.5/0.45)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(25MG/0.5ML)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(27.5/0.55)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(30MG/0.6ML)
T4 methotrexate/pf
RASUVO(AUTO
QL, ST
INJECT)(7.5MG/0.15)
Anti-flam. Interleukin-1 Receptor Antagonist
T4 anakinra
T4 rilonacept
KINERET
ARCALYST
PA
Anti-inflammatory Tumor Necrosis Factor
Inhibitor
T4 adalimumab
T4 etanercept
T4 golimumab
HUMIRA
ENBREL
SIMPONI
PA
PA
PA
Anti-inflammatory, Pyrimidine Synthesis
Inhibitor
T1 leflunomide
ARAVA
T1 dexamethasone
T3 dexamethasone
T3
T1
T1
T1
dexamethasone
hydrocortisone
methylprednisolone
methylprednisolone
T2 methylprednisolone
T1 methylprednisolone
T1 methylprednisolone
T1 methylprednisolone
T1 methylprednisolone
T2
T2
T1
T3
T3
prednisolone
prednisolone
prednisolone
prednisolone acetate
prednisolone sod
phosphate
T3 prednisolone sod
phosphate
T1 prednisolone sod
phosphate
T1 prednisolone sod
phosphate
T3 prednisolone sod
phosphate
T1 prednisone
T2 prednisone
RUCONEST
ENTOCORT EC
UCERIS
ST
CORTISONE
ACETATE
DEXAMETHASONE
DEXAMETHASONE
INTENSOL
DEXPAK
CORTEF
MEDROL(TAB DS PK)
MEDROL(TAB)(16
MG)
MEDROL(TAB)(2 MG)
MEDROL(TAB)(32
MG)
MEDROL(TAB)(4 MG)
MEDROL(TAB)(8 MG)
METHYLPREDNISOL
ONE
MILLIPRED
MILLIPRED DP
PREDNISOLONE
FLO-PRED
MILLIPRED
ORAPRED ODT
PEDIAPRED
PREDNISOLONE
SODIUM
PHOSPHATE
VERIPRED 20
PREDNISONE
PREDNISONE
INTENSOL
T3 prednisone
RAYOS
T3 triamcinolone diacetateARISTOCORT
T3 auranofin
4(pde4) Inhib.
Interleukin-6 (il-6) Receptor Inhibitors
OTEZLA
PA
Antinflammatory, Sel.costim.mod.,t-cell
ORENCIA
PA
Bradykinin B2 Receptor Antagonists
T4 icatibant acetate
FIRAZYR
PA
C1 Esterase Inhibitors
T4 c1 esterase inhibitor
T4 c1 esterase inhibitor
L.A. Care
T4 tocilizumab
BERINERT
CINRYZE
PA
PA
RIDAURA
ACTEMRA
PA
Janus Kinase (jak) Inhibitors
T4 tofacitinib citrate
Inhibitor
T4 abatacept
ST
Gold Salts
Anti-inflammatory,phosphodiesteraseT4 apremilast
PA
XELJANZ
PA
Mineralocorticoids
T1 fludrocortisone
acetate
FLUDROCORTISONE
ACETATE
Monoclonal Antibody-human Interleukin
12/23 Inhib
T4 ustekinumab
STELARA
PA
Page 39 of 90
Commercial Formulary
Nasal Nsaids, Cox Non-selective,systemic
Analgesic
T3 ketorolac
tromethamine
SPRIX
QL
Nsaid & Histamine H2 Receptor Antagonist
Comb.
T3 ibuprofen/famotidine
DUEXIS
QL, ST
T1
T1
T1
T1
T3
T1
T1
T1
T1
T1
T1
naproxen
naproxen
naproxen sodium
naproxen sodium
naproxen sodium
oxaprozin
phenylbutazone
piroxicam
piroxicam
sulindac
tolmetin sodium
NAPROSYN
NAPROXEN
ANAPROX
ANAPROX DS
NAPRELAN
DAYPRO
PHENYLBUTAZONE
FELDENE
PIROXICAM
SULINDAC
TOLMETIN SODIUM
Nsaid, Cox Inhibitor-type & Proton Pump
Unknown
Inhib Comb
Nsaids (cox Non-specific Inhib)&
T3 ibuprofen/irr cnt-irrit
cmb #2
T3 meloxicam/irr cntr-irr
cmb #2
T3 naproxen/irr cntr-irrit
cmb #2
Prostaglandin Cmb
LOCAL ANESTHESIA
T2 naproxen/esomeprazol VIMOVO
e mag
ST
T1 diclofenac
ARTHROTEC 50
sodium/misoprostol
T1 diclofenac
ARTHROTEC 75
sodium/misoprostol
Local Anesthetics
Nsaids, Cyclooxygenase 2 Inhibitor - Type
T2 celecoxib
CELEBREX
AGE,
ST
Nsaids, Cyclooxygenase Inhibitor-type
T1 diclofenac potassiumCATAFLAM
T3 diclofenac potassium ZIPSOR
QL, ST
T1 diclofenac sodium
DICLOFENAC
SODIUM
T3 diclofenac
ZORVOLEX
QL, ST
submicronized
T1 etodolac
ETODOLAC
T2 fenoprofen calcium
FENOPROFEN
CALCIUM(CAP)
T1 fenoprofen calcium FENOPROFEN
CALCIUM(TAB)
T1 flurbiprofen
ANSAID
T1 flurbiprofen
FLURBIPROFEN
T1 ibuprofen
IBUPROFEN
T2 indomethacin
INDOCIN
T1 indomethacin
INDOMETHACIN
T1 ketoprofen
KETOPROFEN
T1 ketorolac
KETOROLAC
tromethamine
TROMETHAMINE
T1 ketorolac
TORADOL(CARTRID
tromethamine
GE)(15 MG/ML)
T3 ketorolac
TORADOL(CARTRID
tromethamine
GE)(15 MG/ML)
T3 ketorolac
TORADOL(CARTRID
tromethamine
GE)(30 MG/ML)
T1 meclofenamate
MECLOFENAMATE
sodium
SODIUM
T1 mefenamic acid
PONSTEL
T1 meloxicam
MOBIC
T1 nabumetone
NABUMETONE
T1 naproxen
EC-NAPROSYN
L.A. Care
COMFORT PACIBUPROFEN
COMFORT PACMELOXICAM
COMFORT PACNAPROXEN
T3 b-caine/zinc
cl/pine/cpyrd
T1 lidocaine hcl
BUCALSEP
LIDOCAINE HCL
VISCOUS
LOWER GASTROINTESTINAL
DISORDERS - BOWEL INFLAMMAT
Bowel Antiinflamatory Agents
T1 sulfadiazine
SULFADIAZINE
T1 sulfamethoxazole/tri SULFATRIM
methoprim
T1 sulfasalazine
SULFASALAZINE
Chronic Inflam. Colon Dx, 5-a-salicylat,rectal
Tx
T2 mesalamine
T1 mesalamine
T1 mesalamine
w/cleansing wipes
CANASA
SFROWASA
ROWASA
Drug Tx-chronic Inflam. Colon Dx,5aminosalicylat
T1
T3
T2
T3
T3
T3
T3
T3
balsalazide disodium COLAZAL
balsalazide disodium GIAZO
mesalamine
APRISO
mesalamine
ASACOL HD
mesalamine
DELZICOL
mesalamine
LIALDA
mesalamine
PENTASA
olsalazine sodium
DIPENTUM
ST
ST
ST
ST
ST
ST
Page 40 of 90
Commercial Formulary
Drugs To Tx Chronic Inflamm. Disease Of
Antidiarrheal - G.i. Chloride Channel
Colon
Inhibitors
T4 certolizumab pegol
CIMZIA
PA
T3 crofelemer
Hemorrhoidal Prep, Anti-infam Steroid/local
Antidiarrheals
Anesth
T3 difenoxin hcl/atropine
sulfate
T1 diphenoxylate
hcl/atropine
T1 diphenoxylate
hcl/atropine
T1 loperamide hcl
T1 opium tincture
T1 paregoric
T1 hydrocort/lidocaine HYDROCORTISONEin coleus
LIDOCAINE
T1 hydrocort/pramoxin/eANALPRAM E
mol/pram#1
T1 hydrocortisone
LIDOCAINEac/lidocaine
HYDROCORTISONE
T1 hydrocortisone/lidoc LIDOCAINEaine/aloe
HYDROCORTISONE
T2 hydrocortisone/pramox ANALPRAM HC
ine
T1 hydrocortisone/pram HYDROCORTISONEoxine
PRAMOXINE
T1 hydrocortisone/pram PRAMCORT
oxine
T3 hydrocortisone/pramox PROCORT
ine
T2 hydrocortisone/pramox PROCTOFOAM-HC
ine
FULYZAQ
MOTOFEN
DIPHENOXYLATEATROPINE
LOMOTIL
LOPERAMIDE
OPIUM TINCTURE
PAREGORIC
Bile Salts
T3
T1
T1
T1
chenodiol
ursodiol
ursodiol
ursodiol
CHENODAL
ACTIGALL
URSO
URSO FORTE
Irritable Bowel Synd. Agent,5ht-3
Antagonist-type
T3 alosetron hcl
LOTRONEX
Irritable Bowel Agents,guanylate Cylase-c
Laxatives And Cathartics
Agonist
T2
T1
T2
T3
T2 linaclotide
LINZESS
QL
Local Anorectal Nitrate Preparations
T3 nitroglycerin
T3
RECTIV
Rectal Preparations
T1 hydrocortisone
T1 hydrocortisone
acetate
T1 hydrocortisone
acetate
T1
PROCTOZONE-HC
HYDROCORTISONE
ACETATE
PROCTOCORT
T2
T3
Rectal/lower Bowel Prep.,glucocort.
T3
T1 hydrocortisone
CORTENEMA
T3 hydrocortisone acetate CORTIFOAM
T1
LOWER GASTROINTESTINAL
T3
T1
DISORDERS - OTHER
T3
Ammonia Inhibitors
T3
T4
T4
T1
T3
acetohydroxamic acid LITHOSTAT
carglumic acid
CARBAGLU
glycerol phenylbutyrateRAVICTI
lactulose
GENERLAC
sodium benzoate/na UCEPHAN
ph-acetate
T4 sodium phenylbutyrate BUPHENYL
L.A. Care
QL, ST
lactulose
KRISTALOSE
lactulose
LACTULOSE
lubiprostone
AMITIZA
naphos m-b m-h/na
OSMOPREP
phos,di-ba
peg 3350/na
COLYTE WITH
sulf,bicarb,cl/kcl
FLAVOR PACKS
peg 3350/na
GAVILYTE-C
sulf,bicarb,cl/kcl
peg 3350/na
GOLYTELY
sulf,bicarb,cl/kcl
peg 3350-bowel 2,two SUCLEAR
part prep
peg3350/sod
MOVIPREP
sul/nacl/asb/c/kcl
polyethylene glycol POLYETHYLENE
3350
GLYCOL 3350
sod picosulf/mag
PREPOPIK
ox/citric ac
GAVILYTE-N
sodium
chloride/nahco3/kcl/p
eg
sodium,potassium,&m SUPREP
ag sulfates
QL
Narcotic Antagonists, Peripherally-acting
PA
T3 alvimopan
T2 methylnaltrexone
bromide
ENTEREG
RELISTOR
PA
Page 41 of 90
Commercial Formulary
Sbs - Glucagon-like Peptide-2 (glp-2)
T1 exemestane
T1 letrozole
Analogs
Antineoplastic - Hedgehog Pathway Inhibitor
T4 teduglutide
GATTEX
PA
T4 ruxolitinib phosphate
Anaphylaxis Therapy Agents
epinephrine
epinephrine
epinephrine
epinephrine
ADRENACLICK
AUVI-Q
EPIPEN 2-PAK
EPIPEN JR 2-PAK
ST
T4 everolimus
T4 everolimus
Parasympathetic Agents
bethanechol chloride URECHOLINE
cevimeline hcl
EVOXAC
guanidine hcl
GUANIDINE HCL
pilocarpine hcl
SALAGEN
T4 topotecan hcl
T4
T4
T4
T4
HEXALEN
MYLERAN
GLIADEL
abiraterone acetate
bicalutamide
bicalutamide
enzalutamide
flutamide
nilutamide
PA, QL
PA, QL
T4 degarelix acetate
T4
T4
T4
T4
T4
PA, QL
T4
PA, QL
T4
T4
Antineoplastic Aromatase Inhibitors
T1 anastrozole
L.A. Care
ARIMIDEX
REVLIMID
SYLATRON
SYLATRON 4-PACK
POMALYST
PA, QL
PA, QL
PA, QL
PA
FIRMAGON(VIAL)(120 QL
MG)
FIRMAGON(VIAL)(80 QL
MG)
Antineoplastic Systemic Enzyme Inhibitors
T4 capecitabine
QL
Antimetabolites
T1
T4
T1
T2
T1
lenalidomide
peginterferon alfa-2b
peginterferon alfa-2b
pomalidomide
T4 degarelix acetate
T4
T4
T4
T4
T4
XELODA(TAB)(150
MG)
capecitabine
XELODA(TAB)(500
MG)
mercaptopurine
PURINETHOL
mercaptopurine
PURIXAN
methotrexate sodium METHOTREXATE
methotrexate sodium TREXALL
methotrexate
METHOTREXATE
sodium/pf
SODIUM
thioguanine
TABLOID
HYCAMTIN
Antagonist,pituit.supprs
LEUKERAN
CYCLOPHOSPHAMID
E
HYDREA
LOMUSTINE
ALKERAN
TEMODAR
PA
ZYTIGA
BICALUTAMIDE
CASODEX
XTANDI
FLUTAMIDE
NILANDRON
AFINITOR DISPERZ PA
AFINITOR(TAB)(10
PA, QL
MG)
AFINITOR(TAB)(2.5 PA, QL
MG)
AFINITOR(TAB)(5 MG)PA, QL
AFINITOR(TAB)(7.5 PA
MG)
Antineoplastic Lhrh(gnrh)
Antiandrogenic Agents
T4
T1
T1
T4
T1
T4
PA, QL
Antineoplastic Immunomodulator Agents
Alkylating Agents
hydroxyurea
lomustine
melphalan
temozolomide
JAKAFI
Antineoplastic - Topoisomerase I Inhibitors
NEOPLASTIC DISEASE
T1
T4
T2
T4
T4 everolimus
T4 everolimus
T4 everolimus
T3 liver extract (beef-pork)NEXAVIR
T4 altretamine
T4 busulfan
T4 carmustine in
polifeprosan 20
T4 chlorambucil
T4 cyclophosphamide
PA, QL
Antineoplastic - Mtor Kinase Inhibitors
Miscellaneous Agents
T1
T1
T1
T1
ERIVEDGE
PA
Antineoplastic - Janus Kinase (jak) Inhibitors
MISCELLANEOUS AGENTS
T1
T3
T2
T2
T4 vismodegib
AROMASIN
FEMARA
T4
T4
T4
T4
T4
T4
afatinib dimaleate
axitinib
axitinib
bosutinib
GILOTRIF
INLYTA(TAB)(1 MG)
INLYTA(TAB)(5 MG)
BOSULIF(TAB)(100
MG)
bosutinib
BOSULIF(TAB)(500
MG)
cabozantinib s-malate COMETRIQ
ceritinib
ZYKADIA
crizotinib
XALKORI
dabrafenib mesylate TAFINLAR
dasatinib
SPRYCEL(TAB)(100
MG)
dasatinib
SPRYCEL(TAB)(140
MG)
dasatinib
SPRYCEL(TAB)(20
MG)
dasatinib
SPRYCEL(TAB)(50
MG)
dasatinib
SPRYCEL(TAB)(70
MG)
dasatinib
SPRYCEL(TAB)(80
MG)
erlotinib hcl
TARCEVA
ibrutinib
IMBRUVICA
PA
PA, QL
PA, QL
PA, QL
PA, QL
PA, QL
PA
PA, QL
PA
PA, QL
PA, QL
PA, QL
PA, QL
PA, QL
PA, QL
PA, QL
PA
Page 42 of 90
Commercial Formulary
T4
T4
T4
T4
T4
T4
T4
T4
T4
T4
T4
idelalisib
imatinib mesylate
lapatinib ditosylate
nilotinib hcl
pazopanib hcl
ponatinib hcl
ponatinib hcl
regorafenib
sorafenib tosylate
sunitinib malate
trametinib dimethyl
sulfoxide
T4 vandetanib
ZYDELIG
PA
GLEEVEC
PA, QL
TYKERB
PA
TASIGNA
PA, QL
VOTRIENT
PA, QL
ICLUSIG(TAB)(15 MG) PA, QL
ICLUSIG(TAB)(45 MG) PA, QL
STIVARGA
PA, QL
NEXAVAR
PA, QL
SUTENT
PA, QL
MEKINIST
PA
T4 vandetanib
CAPRELSA(TAB)(100 PA, QL
MG)
CAPRELSA(TAB)(300 PA, QL
MG)
ZELBORAF
PA, QL
T4 vemurafenib
Antineoplastic,histone Deacetylase
Inhibitors,hdis
T4 vorinostat
ZOLINZA
NEUROLOGICAL DISEASE MISCELLANEOUS
Agents To Treat Multiple Sclerosis
T4
T4
T4
T4
T4
T4
dimethyl fumarate
fingolimod hcl
glatiramer acetate
interferon beta-1a
interferon beta-1a
interferon beta1a/albumin
T4 interferon beta1a/albumin
T4 interferon beta1a/albumin
T4 interferon beta-1b
T4 interferon beta-1b
T4 teriflunomide
TECFIDERA
GILENYA
COPAXONE
AVONEX
AVONEX PEN
AVONEX
ADMINISTRATION
PACK
REBIF
PA
PA
PA
PA
PA
PA
REBIF REBIDOSE
PA
BETASERON
EXTAVIA
AUBAGIO
PA
PA
PA
PA
Antineoplastics,miscellaneous
Agts Tx Neuromusc Transmission Dis,pot-
T1 etoposide
T4 mitotane
T4 omacetaxine
mepesuccinate
T4 procarbazine hcl
T4 tretinoin
chan Blkr
ETOPOSIDE
LYSODREN
SYNRIBO
PA
T4 dalfampridine
AMPYRA
PA
Amyotrophic Lateral Sclerosis Agents
MATULANE
TRETINOIN
T4 riluzole
RILUTEK
Chemotherapy Rescue/antidote Agents
Fibromyalgia Agents,serotonin-norepineph
T1 leucovorin calcium
Ru Inhib
T3 mesna
LEUCOVORIN
CALCIUM
MESNEX
T2 milnacipran hcl
Intrapleural Sclerosing Agents, Antineoplast.
T3 talc
T1 talc
T3 gabapentin enacarbil
SCLEROSOL
STERILE TALC
Photoactivated, Antineopls. & Premalignant
Lesions
Selective Estrogen Receptor Modulators
SOLTAMOX
PA
TAMOXIFEN CITRATEPA
FARESTON
PA
Selective Retinoid X Receptor Agonists
T4 bexarotene
TARGRETIN
Steroid Antineoplastics
T4 estramustine
phosphate sodium
T1 megestrol acetate
T4 tetrabenazine
PA
T3 gabapentin
T3 gabapentin
QL, ST
QL, ST
GRALISE(TAB ER
24H)(300 MG)
GRALISE(TAB ER
24H)(300-600 MG)
GRALISE(TAB ER
24H)(600 MG)
QL, ST
QL, ST
QL, ST
Pseudobulbar Affect (pba) Agents, Nmda
Antagonists
T3 dextromethorphan
hbr/quinidine
NUEDEXTA
PA
EMCYT
ORAL/PHARYNGEAL DISORDERS
MEGESTROL
ACETATE
Dental Aids And Preparations
T1 chlorhexidine
gluconate
L.A. Care
HORIZANT(TAB
ER)(300 MG)
HORIZANT(TAB
ER)(600 MG)
XENAZINE
Postherpetic Neuralgia Agents
T3 gabapentin
T3 aminolevulinic acid hcl LEVULAN
T2 tamoxifen citrate
T1 tamoxifen citrate
T4 toremifene citrate
Movement Disorders
T3 gabapentin enacarbil
Adj.
SAVELLA
CHLORHEXIDINE
GLUCONATE
Page 43 of 90
Commercial Formulary
T1 triamcinolone
acetonide
T3 zinc cl/bcaine/cetylpyrd cl
TRIAMCINOLONE
ACETONIDE
BUCALCIDE
Analgesic/antipyretics, Salicylates
Nose Preparations Antibiotics
T2 mupirocin calcium
BACTROBAN NASAL
Nose Preparations, Miscellaneous
T1 ipratropium bromide ATROVENT
Periodontal Tetracycline Antiinfective, Local
T3 minocycline hcl
microspheres
ARESTIN
OTHER RESPIRATORY DISORDERS
Cystic Fib.transmemb
KALYDECO
PA
Lung Surfactants
T3
T3
T3
T3
beractant
calfactant
lucinactant
poractant alfa
SURVANTA
INFASURF
SURFAXIN
CUROSURF
ACETYLCYSTEINE
PULMOZYME
PA
PAIN MANAGEMENT - ANALGESICS
Analgesic, Non-salicylate & Barbiturate
Comb.
T1 butalbital/acetaminopACETAMINOPHENhen
BUTALBITAL
T3 butalbital/acetaminoph BUPAP
en
Analgesic, Salicylate, Barbiturate,& Xanthine
Cmb
T1 butalbital/aspirin/caff FIORINAL
eine
Analgesic,nonsalicylate,barbiturate,&xanthine Cmb
T1 acetaminophen/caffei AMERICET
ne/butalb
T1 butalb/acetaminophe BUTALBITALn/caffeine
ACETAMINOPHENCAFFE
T1 butalb/acetaminophe ESGIC
n/caffeine
T1 butalb/acetaminophe FIORICET
n/caffeine
L.A. Care
Combination
T1 hydrocodone/ibuprof VICOPROFEN
en
T1 ibuprofen/oxycodone OXYCODONE HCLhcl
IBUPROFEN
Analgesics,narcotics
Mucolytics
T1 acetylcysteine
T4 dornase alfa
AGE
Analgesics, Narcotic Agonist And Nsaid
Conduct.reg.(cftr)potentiator
T4 ivacaftor
T3 asa/salicylam/acetami LEVACET
noph/caff
T1 aspirin
ASPIRIN EC
T5 aspirin
ASPIRIN EC(OTC)
T1 choline sal/mag
CHOLINE MAG
salicylate
TRISALICYLATE
T1 diflunisal
DIFLUNISAL
T3 magnesium salicylate MAGAN
ASP
T1 salamide/acetaminophn/
p-tlox
DOLOREX
T1 salamide/acetaminophn/
p-tlox
T1 salsalate
SALSALATE
T2 buprenorphine
BUTRANS
QL
T1 butorphanol tartrate BUTORPHANOL
TARTRATE
T1 codeine sulfate
CODEINE SULFATE
T1 codeine/carisoprodol CARISOPRODOL/aspirin
ASPIRIN-CODEINE
T1 dihydrocodeine/aspir SYNALGOS-DC
in/caffein
T1 fentanyl
DURAGESIC
QL
T3 fentanyl
SUBSYS
PA
T3 fentanyl citrate
ABSTRAL
PA
T1 fentanyl citrate
ACTIQ
PA
T3 fentanyl citrate
FENTORA
PA
T3 fentanyl citrate
LAZANDA
PA
T3 hydrocodone bitartrate ZOHYDRO ER
QL
T1 hydrocodone/acetam HYCET
QL
inophen
QL
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(S
OLUTION)(10-325/15)
QL
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(S
OLUTION)(2.5-167/5)
QL
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(S
OLUTION)(5-163/7.5)
QL
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(TA
B)(10MG-300MG)
T1 hydrocodone/acetam HYDROCODONEQL
inophen
ACETAMINOPHEN(TA
B)(10MG-325MG)
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(TA
B)(2.5-325MG)
Page 44 of 90
Commercial Formulary
T1 hydrocodone/acetam HYDROCODONEQL
inophen
ACETAMINOPHEN(TA
B)(5MG-300MG)
T1 hydrocodone/acetam HYDROCODONEQL
inophen
ACETAMINOPHEN(TA
B)(5MG-325MG)
QL
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(TA
B)(7.5-300MG)
QL
T1 hydrocodone/acetam HYDROCODONEinophen
ACETAMINOPHEN(TA
B)(7.5-325MG)
T2 hydrocodone/acetamin STAGESIC-10
QL
ophen
T3 hydrocodone/acetamin ZAMICET
QL
ophen
T1 hydromorphone hcl DILAUDID
T1 hydromorphone hcl HYDROMORPHONE
HCL
T1 hydromorphone
DILAUDID
hcl/pf
T1 hydromorphone
DILAUDIDhcl/pf
HP(AMPUL)
T3 hydromorphone hcl/pf DILAUDID-HP(VIAL)
T1 hydromorphone
HYDROMORPHONE
hcl/pf
HCL
T1 levorphanol tartrate LEVORPHANOL
TARTRATE
T1 meperidine hcl
MEPERIDINE HCL
T3 meperidine hcl/pf
DEMEROL
T1 methadone hcl
DOLOPHINE HCL
T1 methadone hcl
METHADONE HCL
T1 morphine sulfate
AVINZA
T1 morphine sulfate
KADIAN(CAP ER
PEL)(20 MG)
T3 morphine sulfate
KADIAN(CAP ER
PEL)(200 MG)
T3 morphine sulfate
KADIAN(CAP ER
PEL)(40 MG)
T1 morphine sulfate
KADIAN(CAP ER
PEL)(50 MG)
T1 morphine sulfate
KADIAN(CAP ER
PEL)(60 MG)
T1 morphine sulfate
KADIAN(CAP ER
PEL)(80 MG)
T3 morphine sulfate
MORPHINE SULFATE
T1 morphine sulfate
MORPHINE SULFATE
ER
T1 morphine sulfate
MS CONTIN
T1 morphine sulfate/pf MORPHINE SULFATE
T1 nalbuphine hcl
NALBUPHINE HCL
T1 opium/belladonna
BELLADONNAalkaloids
OPIUM
T3 oxycodone hcl
OXECTA
T1 oxycodone hcl
OXYCODONE HCL
T2 oxycodone hcl
OXYCONTIN
T1 oxycodone hcl
ROXICODONE
PERCOCET
QL
T1 oxycodone
hcl/acetaminophen
T3 oxycodone
PRIMLEV
QL
hcl/acetaminophen
L.A. Care
T3 oxycodone
hcl/acetaminophen
T1 oxycodone
hcl/aspirin
T3 oxymorphone hcl
T3 oxymorphone hcl
T1 oxymorphone hcl
T1 pentazocine
hcl/naloxone hcl
T3 pentazocine lactate
T2 tapentadol hcl
T2 tapentadol hcl
T3 tramadol hcl
T1 tramadol hcl
T1 tramadol
hcl/acetaminophen
XARTEMIS XR
QL
PERCODAN
NUMORPHAN
OPANA(AMPUL)
OPANA(TAB)
PENTAZOCINENALOXONE HCL
TALWIN
NUCYNTA
NUCYNTA ER
CONZIP
ULTRAM
ULTRACET
QL
QL
QL, ST
Antimigraine Preparations
T3 almotriptan malate
AXERT
T3 diclofenac potassium CAMBIA
T1 dihydroergotamine D.H.E.45
mesylate
T1 dihydroergotamine DIHYDROERGOTAMI
mesylate
NE MESYLATE
T1 dihydroergotamine MIGRANAL
mesylate
T3 eletriptan hbr
RELPAX
T3 ergotamine tartrate
ERGOMAR
T2 ergotamine
CAFERGOT
tartrate/caffeine
T1 ergotamine
MIGERGOT
tartrate/caffeine
T3 frovatriptan succinate FROVA
T1 isomethept/dichlphn/ ISOMETHEPTacetaminop
DICHLORALPACETAMIN
T1 naratriptan hcl
AMERGE
T1 rizatriptan benzoate MAXALT
T1 rizatriptan benzoate MAXALT MLT
T1 sumatriptan
IMITREX
T3 sumatriptan
TREXIMET
succ/naproxen sod
T3 sumatriptan succinate ALSUMA
T1 sumatriptan
IMITREX(CARTRIDG
succinate
E)
T1 sumatriptan
IMITREX(PEN
succinate
INJCTR)
T1 sumatriptan
IMITREX(TAB)
succinate
T1 sumatriptan
IMITREX(VIAL)
succinate
T3 sumatriptan succinate SUMAVEL DOSEPRO
T2 zolmitriptan
ZOMIG(SPRAY)(2.5
MG)
T2 zolmitriptan
ZOMIG(SPRAY)(5
MG)
T1 zolmitriptan
ZOMIG(TAB)
QL, ST
QL
QL
QL
QL, ST
QL
QL
QL
QL, ST
QL
QL
QL
QL
QL, ST
QL
QL
QL
QL
QL
QL, ST
QL, ST
QL, ST
QL, ST
Page 45 of 90
Commercial Formulary
Narc.& Non-sal.analgesic,barbiturate
&xanthine Cmb
T1 butalbit/acetamin/caffBUTALB-CAFF/codeine
ACETAMINOPHCODEIN
Narcotic & Salicylate Analgesics, Barb.&
Xanthine
T1 codeine/butalbital/as FIORINAL WITH
a/caffein
CODEINE #3
Narcotic Analgesic & Non-salicylate
Analgesic Comb
T1 acetaminophen with
codeine
T2 acetaminophen with
codeine
T1 acetaminophen with
codeine
T1 acetaminophen with
codeine
T1 codeine
phos/acetaminophen
ACETAMINOPHENCODEINE
CAPITAL W-CODEINE
TYLENOL-CODEINE
NO.3
TYLENOL-CODEINE
NO.4
ACETAMINOPHEN
W/CODEINE
T3 buprenorphine
hcl/naloxone hcl
T1 buprenorphine
hcl/naloxone hcl
T2 buprenorphine
hcl/naloxone hcl
T3 buprenorphine
hcl/naloxone hcl
BUPRENEX
BUPRENORPHINE
HCL
BUNAVAIL
T1 carbidopa
PA
PA
ZUBSOLV
PA
PA
T1 benztropine mesylateBENZTROPINE
MESYLATE
T1 trihexyphenidyl hcl TRIHEXYPHENIDYL
HCL
L.A. Care
T3
T3
T1
T3
T3
Antiparkinsonism Drugs,other
T1
T1
T1
T1
T1
T1
T1
T2
T3
T3
T1
T1
T1
T1
T1
T3
T3
Antiparkinsonism Drugs,anticholinergic
CARBIDOPALEVODOPA
carbidopa/levodopa SINEMET 10-100
carbidopa/levodopa SINEMET 25-100
carbidopa/levodopa SINEMET 25-250
carbidopa/levodopa/eSTALEVO 100
ntacapone
QL
QL, ST
CARBIDOPA
Anticonvulsants
BUPRENORPHINENALOXONE
SUBOXONE
AMANTADINE
APOKYN
PARLODEL
QL, ST
QL, ST
SEIZURE DISORDER
PARKINSONS DISEASE
T1 amantadine hcl
T4 apomorphine hcl
T1 bromocriptine
mesylate
T1 carbidopa/levodopa
QL, ST
QL
Decarboxylase Inhibitors
Narcotic Withdrawal Therapy Agents
T3 buprenorphine hcl
T1 buprenorphine hcl
T1 carbidopa/levodopa/eSTALEVO 125
ntacapone
T1 carbidopa/levodopa/eSTALEVO 150
ntacapone
T1 carbidopa/levodopa/eSTALEVO 200
ntacapone
T1 carbidopa/levodopa/eSTALEVO 50
ntacapone
T1 carbidopa/levodopa/eSTALEVO 75
ntacapone
T1 entacapone
COMTAN
T1 pramipexole di-hcl MIRAPEX
T3 pramipexole di-hcl
MIRAPEX ER
T2 rasagiline mesylate
AZILECT
T1 ropinirole hcl
REQUIP
T1 ropinirole hcl
REQUIP XL
T2 rotigotine
NEUPRO
T1 selegiline hcl
ELDEPRYL
T1 selegiline hcl
SELEGILINE HCL
T3 selegiline hcl
ZELAPAR
T3 tolcapone
TASMAR
PA, QL
carbamazepine
carbamazepine
carbamazepine
carbamazepine
clobazam
clobazam
clonazepam
clonazepam
diazepam
diazepam
divalproex sodium
eslicarbazepine
acetate
eslicarbazepine
acetate
eslicarbazepine
acetate
eslicarbazepine
acetate
ethosuximide
ethotoin
ezogabine
T3 ezogabine
T3 ezogabine
T3 ezogabine
T1 felbamate
T1 felbamate
CARBAMAZEPINE
CARBATROL
TEGRETOL
TEGRETOL XR
ONFI(ORAL SUSP)
ONFI(TAB)
CLONAZEPAM
KLONOPIN
DIASTAT
DIASTAT ACUDIAL
DEPAKOTE ER
APTIOM(TAB)(200
MG)
APTIOM(TAB)(400
MG)
APTIOM(TAB)(600
MG)
APTIOM(TAB)(800
MG)
ZARONTIN
PEGANONE
POTIGA(TAB)(200
MG)
POTIGA(TAB)(300
MG)
POTIGA(TAB)(400
MG)
POTIGA(TAB)(50 MG)
FELBATOL(ORAL
SUSP)
FELBATOL(TAB)(400
MG)
QL, ST
QL, ST
QL
QL
QL, ST
QL, ST
QL, ST
QL, ST
QL, ST
QL, ST
QL, ST
QL, ST
QL, ST
QL, ST
Page 46 of 90
Commercial Formulary
T1 felbamate
T3
T1
T1
T3
T3
T1
T1
T2
T2
T3
gabapentin
gabapentin
gabapentin
lacosamide
lacosamide
lamotrigine
lamotrigine
lamotrigine
lamotrigine
lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T3 lamotrigine
T1
T1
T3
T1
T3
levetiracetam
levetiracetam
methsuximide
oxcarbazepine
oxcarbazepine
T3 oxcarbazepine
T3 oxcarbazepine
T2 oxcarbazepine
T1 oxcarbazepine
T3 perampanel
T3 perampanel
T3 perampanel
T3 perampanel
T3 perampanel
T3 perampanel
T1
T1
T1
T1
phenytoin
phenytoin
phenytoin
phenytoin sodium
extended
T2 phenytoin sodium
extended
L.A. Care
FELBATOL(TAB)(600 QL, ST
MG)
FANATREX
GABAPENTIN
NEURONTIN
VIMPAT(SOLUTION)
VIMPAT(TAB)
QL, ST
LAMICTAL
LAMICTAL (BLUE)
LAMICTAL (GREEN)
LAMICTAL (ORANGE)
LAMICTAL ODT
ST
(BLUE)
LAMICTAL ODT
ST
(GREEN)
LAMICTAL ODT
ST
(ORANGE)
LAMICTAL ODT(TAB QL, ST
RDP DIS)(100 MG)
LAMICTAL ODT(TAB QL, ST
RDP DIS)(200 MG)
LAMICTAL ODT(TAB QL, ST
RDP DIS)(25 MG)
LAMICTAL ODT(TAB QL, ST
RDP DIS)(50 MG)
LAMICTAL XR (BLUE) ST
LAMICTAL XR
ST
(GREEN)
LAMICTAL XR
ST
(ORANGE)
KEPPRA
LEVETIRACETAM
CELONTIN
OXCARBAZEPINE
OXTELLAR XR(TAB QL, ST
ER 24H)(150 MG)
OXTELLAR XR(TAB QL, ST
ER 24H)(300 MG)
OXTELLAR XR(TAB QL, ST
ER 24H)(600 MG)
TRILEPTAL(ORAL
SUSP)
TRILEPTAL(TAB)
FYCOMPA(TAB)(10 QL, ST
MG)
FYCOMPA(TAB)(12 QL, ST
MG)
FYCOMPA(TAB)(2
QL, ST
MG)
FYCOMPA(TAB)(4
QL, ST
MG)
FYCOMPA(TAB)(6
QL, ST
MG)
FYCOMPA(TAB)(8
QL, ST
MG)
DILANTIN
DILANTIN-125
PHENYTOIN
DILANTIN(CAP)(100
MG)
DILANTIN(CAP)(30
MG)
T2 phenytoin sodium
extended
T1 phenytoin sodium
extended
T2 pregabalin
T1 primidone
T3 rufinamide
T3 rufinamide
T3 rufinamide
T3 tiagabine hcl
T3 tiagabine hcl
T1 tiagabine hcl
T1 tiagabine hcl
T3 topiramate
T3 topiramate
T3 topiramate
T3 topiramate
T3 topiramate
T1 topiramate
T3 topiramate
T3 topiramate
T3 topiramate
T3 topiramate
T1
T3
T1
T1
valproic acid
valproic acid
valproic acid
valproic acid (as
sodium salt)
T3 vigabatrin
T1 zonisamide
T1 zonisamide
PHENYTEK
PHENYTOIN SODIUM
EXTENDED
LYRICA
MYSOLINE
BANZEL(ORAL SUSP)QL, ST
BANZEL(TAB)(200
QL, ST
MG)
BANZEL(TAB)(400
QL, ST
MG)
GABITRIL(TAB)(12
QL, ST
MG)
GABITRIL(TAB)(16
QL, ST
MG)
GABITRIL(TAB)(2 MG) QL, ST
GABITRIL(TAB)(4 MG) QL, ST
QUDEXY XR(CAP
QL, ST
SPR 24)(100 MG)
QUDEXY XR(CAP
QL, ST
SPR 24)(150 MG)
QUDEXY XR(CAP
QL, ST
SPR 24)(200 MG)
QUDEXY XR(CAP
QL, ST
SPR 24)(25 MG)
QUDEXY XR(CAP
QL, ST
SPR 24)(50 MG)
TOPAMAX
TROKENDI XR(CAP QL, ST
ER 24H)(100 MG)
TROKENDI XR(CAP QL, ST
ER 24H)(200 MG)
TROKENDI XR(CAP QL, ST
ER 24H)(25 MG)
TROKENDI XR(CAP QL, ST
ER 24H)(50 MG)
DEPAKENE
STAVZOR
ST
VALPROIC ACID
DEPAKENE
SABRIL
ZONEGRAN
ZONISAMIDE
QL
SKELETAL MUSCLE DISORDER
Skeletal Muscle Relaxants
T1 baclofen
BACLOFEN
T1 carisoprodol
SOMA
T1 carisoprodol/aspirin CARISOPRODOLASPIRIN
T3 chlorzoxazone
LORZONE
T1 chlorzoxazone
PARAFON FORTE
DSC
T1 chlorzoxazone/aceta CHLORZOXAZONE
minophen
W/ACETAMINOPHEN
T3 cyclobenzaprine hcl
AMRIX
T1 cyclobenzaprine hcl CYCLOBENZAPRINE
HCL
T1 cyclobenzaprine hcl FEXMID
Page 47 of 90
Commercial Formulary
T1
T1
T1
T1
T1
dantrolene sodium
metaxalone
methocarbamol
methocarbamol
orphenadrine citrate
DANTRIUM
SKELAXIN
ROBAXIN
ROBAXIN-750
ORPHENADRINE
CITRATE
T1 orphenadrine/aspirin/ ORPHENADRINE
caffeine
COMPOUND FORTE
T1 tizanidine hcl
TIZANIDINE HCL
T1 tizanidine hcl
ZANAFLEX
T2 lipase/protease/amylas ZENPEP(CAP DR)(20e
68-109K)
T2 lipase/protease/amylas ZENPEP(CAP DR)(25e
85-136K)
T2 lipase/protease/amylas ZENPEP(CAP
e
DR)(3K-10K-16K)
T1 lipase/protease/amyl ZENPEP(CAP
ase
DR)(5K-17K-27K)
UPPER GASTROINTESTINAL
Unknown
T3 cyclobenz hcl/irr cntrirr cb2
T3 tizanidine/irr cntr-irr
cmb #2
DISORDERS - SPASTIC DISEASE
COMFORT PACCYCLOBENZAPRINE
COMFORT PACTIZANIDINE
Anticholinergics/antispasmodics
T1 dicyclomine hcl
T1 dicyclomine hcl
SMOKING CESSATION
Belladonna Alkaloids
Smoking Deterrent Agents
T3 nicotine
T3 nicotine
NICOTROL
NICOTROL NS
QL
QL
Smoking Deterrent-nicotinic Recept.partial
Agonist
T3 varenicline tartrate
CHANTIX
QL
Smoking Deterrents, Other
T1 bupropion hcl
BUPROBAN
T3 belladonna
alkaloids/phenobarb
T1 belladonna
alkaloids/phenobarb
T1 hyoscyamine
T2 hyoscyamine sulfate
T1 hyoscyamine sulfate
T3
T1
T1
UPPER GASTROINTESTINAL
T1
DISORDERS - DIGESTIVE
T1
T2
Gastric Enzymes
T4 sacrosidase
SUCRAID
Pancreatic Enzymes
T2 lipase/protease/amylas CREON
e
T3 lipase/protease/amylas PANCREAZE
e
T3 lipase/protease/amylas PERTZYE
e
T2 lipase/protease/amylas ULTRASE
e
T2 lipase/protease/amylas ULTRASE MT 12
e
T2 lipase/protease/amylas ULTRASE MT 18
e
T2 lipase/protease/amylas ULTRASE MT 20
e
T3 lipase/protease/amylas ULTRESA
e
T3 lipase/protease/amylas VIOKACE
e
T2 lipase/protease/amylas ZENPEP(CAP DR)(10e
34-55K)
T2 lipase/protease/amylas ZENPEP(CAP DR)(15e
51-82K)
L.A. Care
BENTYL
DICYCLOMINE HCL
PA
BARBIDONNA
SPASMOLIN
HYOSCYAMINE
CYSTOSPAZ-M
HYOSCYAMINE
SULFATE
hyoscyamine sulfate SYMAX DUOTAB
hyoscyamine sulfate SYMAX-SL
methscopolamine
PAMINE
bromide
methscopolamine
PAMINE FORTE
bromide
phenobarb/hyoscy/at ANTISPASMODIC
ropine/scop
phenobarb/hyoscy/atro DONNATAL
pine/scop
UPPER GASTROINTESTINAL
DISORDERS - ULCER DISEASE
Anticholinergics,quaternary Ammonium
T1 chlordiazepoxide/clid LIBRAX
inium br
T3 glycopyrrolate
CUVPOSA
T1 glycopyrrolate
ROBINUL
T1 glycopyrrolate
ROBINUL FORTE
T1 isopropamide/prochl PROCHLORPERAZIN
orperazine
E/ISOPROPAMIDE
T3 mepenzolate bromide CANTIL
T3 propantheline bromide PRO-BANTHINE
T1 propantheline
PROPANTHELINE
bromide
BROMIDE
T1 propantheline/pheno PROBANTHELINE
barbital
W/PHENOBARBITAL
Anti-ulcer Preparations
T1 misoprostol
T2 sucralfate
CYTOTEC
CARAFATE(ORAL
SUSP)
Page 48 of 90
Commercial Formulary
T1 sucralfate
T1 sucralfate
CARAFATE(TAB)
SUCRALFATE
URINARY TRACT - FUNCTIONAL
Anti-ulcer-h.pylori Agents
T3 bismuth/metronid/tetra PYLERA
cycline
T1 lansoprazole/amoxici PREVPAC
ln/clarith
T3 omeprazole/clarith/am OMECLAMOX-PAK
oxicillin
DISORDERS
QL
Agents
T1
T2
T1
T3
T1
Histamine H2-receptor Inhibitors
T1
T1
T1
T1
T1
T1
T1
T3
T1
T1
cimetidine
cimetidine
cimetidine hcl
famotidine
nizatidine
nizatidine
ranitidine
ranitidine hcl
ranitidine hcl
ranitidine hcl
CIMETIDINE
TAGAMET
CIMETIDINE
PEPCID
AXID
NIZATIDINE
RANITIDINE 150MG
DEPRIZINE
RANITIDINE HCL
ZANTAC
T2 dutasteride/tamsulosin JALYN
hcl
T3
T1
T1
T3
T3 cysteamine bitartrate
T4 cysteamine bitartrate
T3 tiopronin
G, ST
CYSTAGON
PROCYSBI
THIOLA
PA
Overactive Bladder Agents, Beta-3
Adrenergic Recep
T3 mirabegron
QL, ST
QL
FIRSTLANSOPRAZOLE
PREVACID(CAP DR)
PREVACID(TAB RAP ST
DR)
FIRST-OMEPRAZOLE
OMEPRAZOLE
PRILOSEC
PRILOSEC
omeprazole
omeprazole
omeprazole
omeprazole
magnesium
T1 omeprazole/sodium ZEGERID(CAP)
bicarbonate
T3 omeprazole/sodium
ZEGERID(PACKET)
bicarbonate
T3 pantoprazole sodium PROTONIX(GRANPK
T DR)
T1 pantoprazole sodium PROTONIX(TAB DR)
T3 rabeprazole sodium
ACIPHEX SPRINKLE
T1 rabeprazole sodium RABEPRAZOLE
SODIUM
G, ST
G
G, ST
Kidney Stone Agents
Proton-pump Inhibitors
T1 lansoprazole
T2 lansoprazole
UROXATRAL
AVODART
PROSCAR
RAPAFLO
FLOMAX
Antg Cmb
T1 metoclopramide hcl METOCLOPRAMIDE
HCL
T3 metoclopramide hcl
METOZOLV ODT
T1 metoclopramide hcl REGLAN
DEXILANT
NEXIUM
alfuzosin hcl
dutasteride
finasteride
silodosin
tamsulosin hcl
Bph Agents,5-alpha-red Inh & Alpha-1-adr
Intestinal Motility Stimulants
T3 dexlansoprazole
T2 esomeprazole
magnesium
T3 lansoprazole
Benign Prostatic Hypertrophy/micturition
QL, ST
QL, ST
ST
QL, ST
QL
MYRBETRIQ
QL, ST
Urinary Ph Modifiers
T3 citric acid/glactone/mag carb
T1 citric acid/sodium
citrate
T3 citric acid/sodium
citrate
T3 citric acid/sodium
citrate
T3 methen mand/naphos
m-b m-h
T3 na phos,m-b/k
phos,monob
T1 phosphorus #1
T1 potassium citrate
RENACIDIN
CYTRA-2
ORACIT
SHOHL'S MODIFIED
UROQID-ACID NO.2
K-PHOS NO.2
PHOSPHA 250
NEUTRAL
POTASSIUM CITRATE
ER
UROCIT-K
CYTRA-K
T1 potassium citrate
T1 potassium
citrate/citric acid
T3 potassium
K-PHOS ORIGINAL
phosphate,monobasic
T1 sod/pot/k cit/sod
CYTRA-3
cit/cit acid
Urinary Tract Analgesic Agents
T2 pentosan polysulfate
sodium
L.A. Care
ELMIRON
Page 49 of 90
Commercial Formulary
Urinary Tract Anesthetic/analgesic Agnt
VITAMIN AND/OR MINERAL
T1 phenazopyridine hcl PHENAZOPYRIDINE
HCL
T1 phenazopyridine hcl PYRIDIUM
DEFICIENCY
Urinary Tract Antispasmodic, M(3) Selective
Calcium Replacement
Antag.
T1 cal
FOLGARD OS
carb/mgox/d3/b12/fa/
b6/bor
T3 darifenacin
hydrobromide
T2 solifenacin succinate
ENABLEX
ST
VESICARE
ST
Urinary Tract
Antispasmodic/antiincontinence Agent
T2
T1
T3
T3
T3
T1
fesoterodine fumarate
flavoxate hcl
oxybutynin
oxybutynin
oxybutynin chloride
oxybutynin chloride
T1 tolterodine tartrate
T1 trospium chloride
TOVIAZ
FLAVOXATE HCL
GELNIQUE
OXYTROL
GELNIQUE
OXYBUTYNIN
CHLORIDE
DETROL
SANCTURA
ST
ST
ST
ST
ST
ST
VAGINAL DISORDERS
T1 clindamycin
CLEOCIN(CREAM/AP
phosphate
PL)
T3 clindamycin phosphate CLEOCIN(SUPP VAG)
T3 clindamycin phosphate CLINDESSE
T1 metronidazole
METROGEL-VAGINAL
T2 metronidazole
VANDAZOLE
T5 ferrous sulfate
QL
QL
Vaginal/cervical Care And Treatment Agents
L.A. Care
FOLIC ACID
FOLIC ACID(OTC)
G
Iron Replacement
AVC
AMINO ACID
T1 sod
propion/inositol/aa14 CERVICAL
/urea
PREVIDENT 5000
ENAMEL PROTECT
PREVIDENT 5000
SENSITIVE
FLUOR-A-DAY
STANNOUS
FLUORIDE
T3 mv, min
REQ49+
cmb#16/fa/lutein/lycop
Vaginal Sulfonamides
T2 sulfanilamide
CLINPRO 5000
FLUORABON
FLUOR-A-DAY
FLUORIDE
FLUORITAB
FLURA-DROPS
PREVIDENT
PREVIDENT 5000
FLUORIDEX
SENSITIVITY RELIEF
Geriatric Vitamin Preparations
MICONAZOLE 3
TERCONAZOLE
ESTRACE
ESTRING
VAGIFEM
FEMRING
PREMARIN
T3
T1 folic acid
T5 folic acid
Vaginal Estrogen Preparations
estradiol
estradiol
estradiol
estradiol acetate
estrogens, conjugated
T3
sodium fluoride
sodium fluoride
sodium fluoride
sodium fluoride
sodium fluoride
sodium fluoride
sodium fluoride
sodium fluoride
sodium
fluoride/potassium
nit
sodium
fluoride/potassium nit
sodium
fluoride/potassium nit
sodium fluoride/xylitol
stannous fluoride
Folic Acid Preparations
Vaginal Antifungals
T2
T3
T2
T3
T2
T3
T3
T3
T5
T2
T2
T3
T3
T1
T3
T1
Vaginal Antibiotics
T1 miconazole nitrate
T1 terconazole
Fluoride Preparations
CHILDREN'S
FERROUS
SULFATE(OTC)
Multivitamin Preparations
T1 b complex with
SUPPORT-500
vitamin c
T3 b complex with vitamin VI-CERT C1000 WITH
c
B12
T3 fa/mu-vits-min
CORVITA
th/lycopene/lut
T3 fa/mu-vits-min
CORVITE
th/lycopene/lut
T1 fe fumarate/fa/vit
DIALYVITE 800 WITH
bcomp&c
IRON
T1 folic acid/mu-vits-min VITE CON FORTE
th
T3 folic acid/mv,fe,other NUTRICAP
min
NICOMIDE
T3 mtetrahyrofolate/niacin/c
u/zn
Page 50 of 90
Commercial Formulary
T3 multivit, iron, min #4, faMULTICHEW
T1 multivit, iron, min #5, STROVITE FORTE
fa
T1 multivit, min
BACMIN
cmb#20/iron/fa
T3 multivit, min no.21/folic SUPERVITE EC
acid
T1 multivitamin no.44/vit MULTIVITAMINSd3/k
A,B,D,E,K,ZN
T3 multivitamin w/iron,
HEMOCYTE
minerals
T1 multivitamins with
V-C FORTE
min no.7/fa
T3 mv, min cmb
CORVITE FREE
#6/fa/lut/lyco/q10
T3 mv, min cmb#24/iron PROTECT IRON
ps cmp/fa
T3 mv, min cmb#9/fa/saw UDAMIN SP
palmet xt
T3 mv/dietary 4/dna/rna FORTAVIT
T1 om-3/ca
ADVANCED AM/PM
carb/d3/fa/mv cmb 13
T3 omANIMI-3
3/dha/epa/d3/b12/fa/b6/phy
Pediatric Vitamin Preparations
T1 fluoride
MULTIVITAMINS
ion/multivitamins
W/FLUORIDE
T1 fluoride/iron/vit a,c&dTRI-VIT WITH
FLUORIDE-IRON
T3 iron/fluoride/vits a, c, & MYKIDZ IRON FL
d3
T1 ped mv a,c,d3 #21 w- TRI-VITAMIN WITH
fluoride
FLUORIDE
T1 ped mv a,c,d3 #38 w- TRI-VI-FLOR
fluoride
T1 pedi m.vit no.17 with MULTIVITAMIN WITH
fluoride
FLUORIDE
T3 pedi multivit #37 wPOLY-VI-FLOR
fluoride
T3 pedi multivit
ESCAVITE
#47/iron/fluorid
T1 pedi multivit
TL-FLUORIVITE
#47/iron/fluorid
T3 pedi multivit #61/vit
COMPLETE
d3/vit k
FORMULATION
D3000
T1 pedi multivit #65/vit MULTIVITAMINSd3/vit k
A,B,D,E,K,ZN
T3 pedi multivit #77/vit
COMPLETE
d3/vit k
FORMULATION
PEDIATRIC
T3 pedi multivit
ESCAVITE D
#78/iron/fluorid
T1 pedi multivit no.2 w- MULTI-VITAMIN Wfluoride
FLUORIDE
T3 pedi mv #37 w-fluoride POLY-VI-FLOR WITH
& iron
IRON
T1 pedi mv
MULTIVITAMINS W#45/fluoride/iron
FLUORIDE-IRON
L.A. Care
T1 pedi mv
#75/fluoride/iron
T1 pedi mv no.83 with
fluoride
T1 pedi mv no.84 with
fluoride
T1 pedi mvi
no.12/sodium
fluoride
T1 pedi mvi no.16 with
fluoride
T3 pedi mvi no.33 with
fluoride
T1 pedi mvi no.82 with
fluoride
T3 pediatric mv #33 wfluoride&fe
MULTIVITAMINS WFLUORIDE-IRON
QUFLORA
QUFLORA
MVC-FLUORIDE
MULTIVITAMINS
WITH FLUORIDE
POLY-VI-FLOR
MULTIVITAMINS
WITH FLUORIDE
POLY-VI-FLOR WITH
IRON
Prenatal Vitamin Preparations
T3 pn vit.w-o ca #7,
iron,fa,dha
T3 pn vits.w-o ca #8,
iron,fa
T1 pn w-ca64/iron
cb&gl/fa/dss/dh
T3 pn85/iron cb&asp
g/fa/dha/fish
T1 pnv #14/ferrous
fum/folic acid
T3 pnv #30/iron
carb&aspg/fa/om3
T3 pnv #35/iron/fa #6/dha
ELITE OB DHA
VP-ERA OB PLUS
NATALVIRT 90 DHA
OB COMPLETE ONE
COMPLETENATE
OB COMPLETE WITH
DHA
PRENATE
ESSENTIAL
OB COMPLETE
PETITE
PRENATE DHA
T3 pnv #56/iron
carb&aspg/fa/dha
T3 pnv #78/iron asp
gly/fa#1/dha
T1 pnv #8/iron ps
PAIRE OB PLUS DHA
cmp&aspg/fa/dha
T3 pnv #86/iron
NESTABS ABC
poly/fa/dha/epa
T1 pnv #87/iron
NESTABS DHA
bisgly/fa/dha
T1 pnv 11-iron fum-folic RELNATE DHA
acid-om3
PREQUE 10
T3 pnv
18/fe,carb/fa/dss/ubi/d
ha
T3 pnv comb no.3/iron
MAXINATE
fum&gluc/fa
VITASPIRE
T1 pnv
comb.no.44/iron/folic
acid
ATABEX EC
T3 pnv
comb.no43/iron,carb/fa
/dss
T3 pnv combo #19/iron/fol PREFERA-OB ONE
ac/dha
T1 pnv combo
VP-HEME ONE
#19/iron/fol ac/dha
T1 pnv combo
HEMENATAL OB +
#22/iron/fa/om3/dha DHA
Page 51 of 90
Commercial Formulary
T1 pnv
ZATEAN-PN DHA
combo#47/iron/fa
#1/dha
T1 pnv no.115/iron
PRENATAL 19
fumarate/fa
T1 pnv no.118/iron
SE-NATAL 19
fumarate/fa
T1 pnv no.15/iron fum & CONCEPT OB
ps cmp/fa
T1 pnv no.22/iron
CITRANATAL RX
cbn&gluc/fa/dss
T1 pnv
R-NATAL OB
no.66/iron,carbonyl/f
a/dha
FOLET ONE
T3 pnv
no.80/iron/mfolate/dss/
dha
T3 pnv no.81/iron
CITRANATAL RX
cbn&gluc/fa/dss
T1 pnv no10/iron
SE-TAN DHA
fum&p/fa/omega-3
OBTREX DHA
T1 pnv
no12/iron,carb/fa/dss
/om-3
T1 pnv w-ca #40/iron
PNV-SELECT
fum/fa cmb#1
ULTIMATECARE ONE
T1 pnv w-ca
no.37/iron/fa/omega3
T1 pnv wPNV-IRON
ca8/iron/fa/lmefolate
ca
T1 pnv with ca
ZATEAN-PN PLUS
#68/iron/fa#1/dha
T1 pnv with ca
MARNATAL-F
no.65/iron poly/fa
T3 pnv with
GESTICARE DHA
ca,no.60/iron/fa/dha
T1 pnv with
TRIVEEN-ONE
ca,no.62/iron/fa/dha
T1 pnv with
NATELLE ONE
ca,no.70/iron/fa/dha
T1 pnv with
PRENAPLUS
ca,no.71/iron/fa
T1 pnv with
PRENATAL PLUS
ca,no.72/iron,carb/fa
T1 pnv with
PRENATAL PLUS
ca,no.72/iron/fa
T1 pnv with
PRENATAL LOW
ca,no.74/iron/fa
IRON
T1 pnv with
TARON-BC
ca,no63/iron/fa/b6
T1 pnv w-o ca no5/fe
PRENATAL-U
fumarate/fa
T1 pnv#16/iron fum &
CONCEPT DHA
ps/fa/om-3
T1 pnv#20/iron/fa/ds/fishTRICARE PRENATAL
/dha/epa
DHA ONE
T1 pnv#64/iron/lmfolate/ VINATE DHA RF
algal/soy
T3 pnv#67/iron ps/fa
VITAFOL ULTRA
cmb#1/dha
L.A. Care
T1 pnv#79/iron/fa/lmfola VINATE DHA
te ca/dha
T1 pnv,ca,no.35/iron/fa/d ULTIMATECARE ONE
s/omeg-3
NF
T1 pnv,ca42/iron/fa/lmef PNV-DHA PLUS
ol ca/dha
T1 pnv/ferrous
MYNATE 90 PLUS
fumarate/doss/fa
T1 pnv/ferrous
VINATE-M
fumarate/fa/se
T1 pnv/iron,carbonyl/do MYNATAL
cusate/fa
T1 pnv100/iron
BAL-CARE DHA
edta&ps/fa/omega3 ESSENTIAL
T3 pnv103/fe/fa/dha/epa/o TRICARE PRENATAL
ther om3
COMPLEAT
T3 pnv106/iron/fa/om3/dh DUET DHA
a/epa
T3 pnv106/iron/fa/om3/dh DUET DHA 400
a/epa
T3 pnv107/iron/fa/om3/dh DUET DHA EC
a/epa
T1 pnv115/iron
PRENATAL 19
fumarate/fa/dss
T1 pnv119/iron
SE-NATAL 19
fumarate/fa/dss
T1 pnv17/iron/fa/fish
ELITE-OB 400
oil/dha/om
T1 pnv19/iron bg
PR NATAL 400 EC
hc&succ-p/fa/om3
T3 pnv2/iron b-g sucCOMPLETE NATAL
p/fa/omega-3
DHA
T3 pnv2/iron b-g sucTRUST NATAL DHA
p/fa/omega-3
T3 pnv22/iron
CITRANATAL DHA
cbn&gluc/fa/dss/dha
T1 pnv22/iron
PNV OB+DHA
cbn&gluc/fa/dss/dha
T3 pnv29/iron
OB COMPLETE 400
cb&aspg/fa/dha/fish
T1 pnv34/iron,carb&fum/VP CH ULTRA
fa/dss/dha
T1 pnv34/iron,carbonyl/f VP-CH-PNV
a/dss/dha
T1 pnv38/iron
NATALVIRT CA
cbn&gluc/fa/dss/dha
TARON-PREX
T1 pnv39/iron
fumarate/fa/dss/dha PRENATAL
T1 pnv48/iron na
CAVAN-EC SOD DHA
feredetat/fa/om3
T1 pnv53/iron b-g hcl- PR NATAL 400
p/fa/omega3
T3 pnv53/iron
NEXA PLUS
fum/fa/docusate/dha
T1 pnv54/iron b-g hcl- PR NATAL 430
p/fa/omega3
T1 pnv55/iron bg
SETONET-EC
hc&succ#2/fa/om3
T1 pnv55/iron bg
PR NATAL 430 EC
hc&succ-p/fa/om3
T3 pnv55/iron fum &
NATACHEW
bisgly/fa
Page 52 of 90
Commercial Formulary
T3 pnv59/iron,carb&fum/f CITRANATAL
a/dss/dha
HARMONY
T1 pnv59/iron,carbonyl/f VP-CH PLUS
a/dss/dha
T1 pnv66/iron
TRIVEEN-PRX RNF
fumarate/fa/dss/dha
T1 pnv69/iron,carbonyl/f PRENAISSANCE
a/dss/dha
PLUS
T1 pnv7/fe asp
VINATE PN CARE
gly/docusate/fa
T3 pnv72/iron,carb&glu/fa/CITRANATAL 90 DHA
dss/dha
T3 pnv76/iron,carb&glu/fa/CITRANATAL DHA
dss/dha
T1 pnv77/sod iron edta& VENATAL COMPLETE
ps/fa/om3
DHA
T1 pnv80/iron
PRENAISSANCE
fumarate/fa/dss/dha
T1 pnv81/sod iron edta& VENA-BAL DHA
ps/fa/om3
T3 pnv83/iron,carb/iron OB COMPLETE
asp gl/fa
PREMIER
T3 pnv84/iron,carbonyl/fa/ OB COMPLETE
dha
T1 pnv94/sod iron edta& VIRT-BAL DHA PLUS
ps/fa/om3
T1 prenat vit
VITAFOL-OB+DHA
comb.10/iron/fa/dha
T3 prenatal #103/iron
TRICARE
fumarate/fa
T1 prenatal
TL-SELECT DHA
#57/iron/fa/dss/dha
T3 prenatal #79/iron asp PRENATE ELITE
gly/fa#1
T1 prenatal comb
VITAMEDMD
no.42/folic acid
REDICHEW RX
T1 prenatal no.13/iron SELECT-OB
ps/fa cb#1
T1 prenatal no.25/iron/fa VITAMEDMD ONE RX
#6/dha
T1 prenatal no.39/iron/fa VITAMEDMD PLUS
#6/dha
RX
T1 prenatal
VP-PNV-DHA
no.52/iron/fa/dha
T1 prenatal
VITAFOL NANO
no.75/iron/folate #1
T3 prenatal no.77/iron asp PRENATE STAR
gly/fa
T1 prenatal vit #60/iron PNV FOLIC ACID +
fum/fa
IRON
PRENATE ENHANCE
T3 prenatal vit
#68/iron/fa#6/dha
T3 prenatal vit
PRENATE RESTORE
#69/iron/fa#6/dha
T1 prenatal vit
VOL-TAB RX
#76/iron,carb/fa
T1 prenatal vit 15/iron PRENATAL AD
cb/fa/dss
T1 prenatal vit 16/iron VINATE GT
cb/fa/dss
T1 prenatal vit 18/iron VINATE ULTRA
cb/fa/dss
L.A. Care
T3 prenatal vit
VITAFOL-OB
comb.10/iron/fa
T1 prenatal vit
VINATE CARE
no.109/iron/fa
T3 prenatal vit no.112/folic PRENATE
acid
CHEWABLE
T3 prenatal vit
PRENATE AM
no.114/fa/ginger
T3 prenatal vit
PRENATE MINI
no.44/iron/fa/dha
T1 prenatal vit
TRINATE
no.73/iron/fa
T1 prenatal vit
PRENATABS FA
no.78/iron/fa
T3 prenatal vit#36/iron/fa PRENATE ELITE
cmb#6
T1 prenatal vit#4/iron
PUREFE OB PLUS
fum &ps/fa
T3 prenatal vit#65/iron
PROVIDA OB
fum&ps/fa
T1 prenatal vit#86/iron NESTABS
bisgly/fa
T1 prenatal vit/fe carb- PRENAFORT
feso4/fa
T1 prenatal vit/iron
VINATE II
bisglycin/fa
T3 prenatal vit/iron
NATALVIT
fumarate/fa
T1 prenatal vit/iron
O-CAL FA
fumarate/fa
T1 prenatal
TRINATAL RX 1
vit27&calcium/iron/fa
T3 prenatal vit37/iron/folic PRENATA
acid
T1 prenatal vitamins#21, HEMENATAL OB
iron, fa
T3 prenatal vits
SELECT-OB + DHA
#33/iron/fa/dha
T1 prenatal vits wPRENATAL Z
ca,fe,fa(1mg)
T1 prenatal vits#4/iron PUREFE PLUS
fum/fa
T3 pv w-o
OBSTETRIX EC
cal/fe,carbonyl/doss/fa
OBTREX
T3 pv w-o
cal/fe,carbonyl/doss/fa
T3 pv w-o cal/ferrous
M-VIT
fumarate/fa
T1 pv w-o cal/iron ps
SELECT-OB
cplx/fa
Prenatal Vitamins Without Iron
T1 pnv w-o
iron/fa/calcium/b6/b1
2
T1 pnv/fa/b6/calcium
carb/ginger
T1 pnv/fa/b6/calcium
phos/ginger
FOLBECAL
PRENAISSANCE
NEXT-B
PRENAISSANCE
NEXT
Page 53 of 90
Commercial Formulary
Vitamin B Preparations
Vitamin B6 Preparations
T1 b cmplx 4/vit
VITAL-D RX
d3/c/fa/zinc ox
T1 b complex & c
RENAL CAPS
no.20/folic acid
T1 cyanocobalamin/fa/p FOLBEE
yridoxine
T3 cyanocobalamin/fa/pyri MYO VYT
doxine
T3 cyanocobalamin/fa/pyri VITA-RESPA
doxine
DIALYVITE 3000
T1 fa/vit
bcomp&c/se/min
aa/zn
T1 folic acid/b complex VIRT-VITE PLUS
& c no.17
T1 folic acid/vit
FOLBEE PLUS CZ
bcomp&c/cu/znox
T1 folic acid/vitamin b DIALYVITE
comp w-c
T3 lysine hcl/vit b
SUPERVITE
comp/fa/zinc
T3 lysine/vitamin b
LYSIPLEX
complex/fa/zn
T3 multivit,
DIALYVITE 5000
mincmb#11/folic acid
T3 multivitamin, min
DIALYVITE SUPREME
cmb#25/fa/d3
D
T1 potassium
AMINOBENZOATE
aminobenzoate
POTASSIUM
T3 potassium
POTABA
aminobenzoate
T1 vit b cmplx 3/fa/vit
RENA-VITE RX
c/biotin
T1 vit b cmplx
NEPHPLEX RX
no3/fa/c/biot/zinc
T3 vit b complex & c
NEPHROCAPS QT
no.13/fa/d3
T1 vit b cplx
DIALYVITE ZINC
#11/fa/c/biot/zn ox
T1 vitamin b complex
B COMPLEX 100
T1 vitamins
B-COMPLEX
b1,b2,b3,b5,& b6
T1 pyridoxine hcl
PYRIDOXINE HCL
Vitamin C Preparations
T1 ascorbic acid
T1 ascorbic acid
ASCORBIC ACID
VI-CERT C500
Vitamin D Preparations
T1 calcitriol
T5 cholecalciferol
(vitamin d3)
T2 dihydrotachysterol
T1 ergocalciferol
(vitamin d2)
ROCALTROL
VITAMIN D3(OTC)
AGE
DHT
DRISDOL
Zinc Replacement
T1 zinc sulfate
MAR-ZINC
Vitamin B1 Preparations
T1 thiamine hcl
THIAMINE HCL
Vitamin B12 Preparations
T1 cyanocobalamin
VITMAIN B-12
T1 cyanocobalamin
CYANOCOBALAMIN
(vitamin b-12)
INJECTION
T3 cyanocobalamin
NASCOBAL
(vitamin b-12)
T1 cyanocobalamin/mec NEURIN-SL
obalamin
T3 cyanocobalamin/vit
VITAJECT
bcomp&c
T1 hydroxocobalamin HYDROXOCOBALAMI
N
L.A. Care
Page 54 of 90
Preferred Drug List Medication Prescribing Limitations
AGE RESTRICTIONS - FORMULARY
• ASPIRIN EC(OTC)
• ATRALIN
• CARBINOXAMINE MALEATE
• CELEBREX
• DIFFERIN(CREAM)
• DIFFERIN(GEL W/PUMP)
• DIFFERIN(GEL)
• DIFFERIN(LOTION)
• DIFFERIN(MED SWAB)
• ELIDEL
• FABIOR
• KARBINAL ER
• MINOCYCLINE HCL(TAB ER
24H)
• NEXT CHOICE ONE DOSE
• ORACEA
• PLAN B ONE-STEP(OTC)
• PROTOPIC
• RETIN-A
• RETIN-A MICRO
• RETIN-A MICRO PUMP(GEL
W/PUMP)(0.04 %)
• RETIN-A MICRO PUMP(GEL
W/PUMP)(0.08 %)
• RETIN-A MICRO PUMP(GEL
W/PUMP)(0.1 %)
• SOLODYN
• TRETIN-X
• VITAMIN D3(OTC)
L.A. Care
>= 45 years
<= 25 years
>= 2 years
>= 60 years
<= 25 years
<= 25 years
<= 25 years
<= 25 years
<= 25 years
>= 2 years
>= 12 years
>= 2 years
>= 12 years
< 15 years
>= 18 years
< 15 years
>= 2 years
<= 25 years
<= 25 years
<= 25 years
<= 25 years
<= 25 years
>= 12 years
<= 25 years
>= 65 years
Page 55 of 90
Preferred Drug List Medication Prescribing Limitations
QUANTITY RESTRICTIONS - FORMULARY
• ABILIFY DISCMELT(TAB RDP
DIS)(10 MG)
• ABILIFY DISCMELT(TAB RDP
DIS)(15 MG)
• ABILIFY(SOLUTION)
• ABILIFY(TAB)
• ACIPHEX SPRINKLE
• ACTICLATE
• ACTONEL(TAB)(150 MG)
• ACTONEL(TAB)(30 MG)
• ACTONEL(TAB)(35 MG)
• ACTONEL(TAB)(5 MG)
• ADDERALL
• ADOXA PAK
• ADVAIR DISKUS
3 units per 1 days
2 units per 1 days
30 ml per 1 days
1 units per 1 days
1 units per 1 days
2 units per 1 days
1 units per 30 days
1 units per 1 days
1 units per 7 days
1 units per 1 days
2 units per 1 days
2 units per 1 days
2 units per 1 days;60
units per 30 days
12 gm per 30 days
• ADVAIR HFA
• ADVICOR(TBMP 24HR)(100020MG)
2 units per 1 days
• ADVICOR(TBMP 24HR)(1000-40
MG)
1 units per 1 days
• ADVICOR(TBMP 24HR)(500MG20MG)
1 units per 1 days
• ADVICOR(TBMP 24HR)(750MG20MG)
2 units per 1 days
• AEROSPAN
17.8 gm per 30 days
• AFINITOR(TAB)(10 MG)
1 units per 1 days
• AFINITOR(TAB)(2.5 MG)
1 units per 1 days
• AFINITOR(TAB)(5 MG)
1 units per 1 days
• ALDARA
24 units per 30 days
• ALENDRONATE
SODIUM(SOLUTION)
75 ml per 7 days
• ALORA
2 units per 7 days
• ALSUMA
1 ml per 14 days
• ALTOPREV
1 units per 1 days
• ALVESCO
12.2 gm per 25 days
• AMBIEN
1 units per 1 days
• AMERGE
3 units per 5 days
• AMITIZA
2 units per 1 days
• ANDROXY
120 units per 30 days
• ANORO ELLIPTA
60 units per 30 days
• ANZEMET(TAB)(100 MG)
4 units per fill
• ANZEMET(TAB)(50 MG)
8 units per fill
• APLENZIN
1 units per 1 days
• APOKYN
2 ml per 1 days
• APTIOM(TAB)(200 MG)
1 units per 1 days
• APTIOM(TAB)(400 MG)
1 units per 1 days
• APTIOM(TAB)(600 MG)
2 units per 1 days
• APTIOM(TAB)(800 MG)
1 units per 1 days
• ARCAPTA NEOHALER
1 units per 1 days
•
ARIXTRA(SYRINGE)
(10MG/0.8ML)
8 ml per 30 days
• ARIXTRA(SYRINGE)(2.5 MG/0.5) 5 ml per 30 days
•
ARIXTRA(SYRINGE)(5MG/0.4ML) 4 ml per 30 days
• ARIXTRA(SYRINGE)(7.5MG/0.6) 6 ml per 30 days
• ASMANEX
1 units per 30 days
• ASTEPRO
60 ml per 30 days
• ATELVIA
1 units per 7 days
• ATRIPLA
30 units per 30 days
• ATROVENT HFA
25.8 gm per 28 days
L.A. Care
• AXERT
• AZELASTINE HCL
• AZILECT
• BANZEL(ORAL SUSP)
• BANZEL(TAB)(200 MG)
• BANZEL(TAB)(400 MG)
• BECONASE AQ
• BINOSTO
• BOSULIF(TAB)(100 MG)
• BOSULIF(TAB)(500 MG)
• BREO ELLIPTA
• BRILINTA
• BRINTELLIX
• BRISDELLE
• BROVANA
• BUTRANS
• BYDUREON
• BYDUREON PEN
• BYETTA(PEN
INJCTR)(10MCG/0.04)
• BYETTA(PEN
INJCTR)(5MCG/0.02)
• CADUET
• CAFERGOT
• CAMBIA
• CAMRESE
2 units per 5 days
60 ml per 30 days
1 units per 1 days
80 ml per 1 days
16 units per 1 days
8 units per 1 days
25 gm per 30 days
1 units per 7 days
4 units per 1 days
1 units per 1 days
60 units per 30 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
60 ml per 15 days
1 units per 7 days
1 units per 7 days
1 units per 7 days
2.4 ml per 30 days
1.2 ml per 30 days
1 units per 1 days
10 units per 7 days
3 units per 10 days
91 days;91 units per 84
days
• CAPRELSA(TAB)(100 MG)
2 units per 1 days
• CAPRELSA(TAB)(300 MG)
1 units per 1 days
• CESAMET
6 units per 1 days
• CHANTIX
2 units per 1 days
• CLARINEX(SYRUP)
10 ml per 1 days
• CLARINEX(TAB)
1 units per 1 days
• CLARINEX-D 12 HOUR
2 units per 1 days
• CLIMARA
1 units per 7 days
• CLIMARA PRO
1 units per 7 days
• CLOZAPINE
3 units per 1 days
• CLOZARIL
3 units per 1 days
• COMBIPATCH
2 units per 7 days
• COMBIVIR
60 units per 30 days
• COMETRIQ
4 units per 1 days
• CONCERTA(TAB ER 24H)(18 MG)1 units per 1 days
• CONCERTA(TAB ER 24H)(27 MG)1 units per 1 days
• CONCERTA(TAB ER 24H)(36 MG)2 units per 1 days
• CONCERTA(TAB ER 24H)(54 MG)1 units per 1 days
• CONZIP
1 units per 1 days
• COSOPT PF
2 units per 1 days
• CRESTOR(TAB)(10 MG)
1 units per 1 days
• CRESTOR(TAB)(20 MG)
1 units per 1 days
• CRESTOR(TAB)(40 MG)
1 units per 1 days
• CRESTOR(TAB)(5 MG)
1 units per 1 days
• D.H.E.45
15 ml per 14 days
• DALIRESP
1 units per 1 days
• DAYTRANA
1 units per 1 days;30
units per 30 days
• DEPO-PROVERA
1 ml per 84 days;90 days
• DEPO-SUBQ PROVERA 104
.65 ml per 84 days;90
days
• DESLORATADINE
1 units per 1 days
• DESOXYN
150 units per 30 days
• DESVENLAFAXINE FUMARATE
ER
1 units per 1 days
Page 56 of 90
Preferred Drug List Medication Prescribing Limitations
• DEXILANT
• DEXTROAMPHETAMINE
SULFATE(TAB)(10 MG)
• DEXTROAMPHETAMINE
SULFATE(TAB)(5 MG)
• DIASTAT
• DIASTAT ACUDIAL
• DICLEGIS
• DICLOFENAC SODIUM
• DIFICID
• DORYX(TAB DR)(200 MG)
• DUEXIS
• DULERA
• DULOXETINE HCL
• DURAGESIC
• DYMISTA
• EDLUAR
• EFFIENT
• ELIQUIS
• EMEND(CAP DS PK)
• EMEND(CAP)(125 MG)
• EMEND(CAP)(40 MG)
• EMEND(CAP)(80 MG)
• EMSAM
• EMTRIVA(CAP)
• EMTRIVA(SOLUTION)
• EPANED
• EPIVIR(SOLUTION)
• EPIVIR(TAB)(150 MG)
• EPIVIR(TAB)(300 MG)
• EPZICOM
• ERGOMAR
• ERIVEDGE
• ESTRING
• EVISTA
• EXELON
• FANAPT(TAB DS PK)
• FANAPT(TAB)
• FARXIGA
• FAZACLO
• FELBATOL(ORAL SUSP)
• FELBATOL(TAB)(400 MG)
• FELBATOL(TAB)(600 MG)
• FEMRING
1 units per 1 days
180 units per 30 days
90 units per 30 days
1 units per fill
1 units per fill
4 units per 1 days
100 gm per fill
20 units per 30 days
1 units per 1 days
3 units per 1 days
13 gm per 30 days
2 units per 1 days
1 units per 3 days
23 gm per 30 days
1 units per 1 days
1 units per 1 days
2 units per 1 days
3 units per fill
1 units per fill
4 units per fill
2 units per fill
1 units per 1 days
30 units per 30 days
720 ml per 30 days
1200 ml per 30 days
900 ml per 30 days
60 units per 30 days
30 units per 30 days
30 units per 30 days
10 units per 7 days
1 units per 1 days
1 units per 90 days;90
days
1 units per 1 days
30 units per 30 days
2 units per 1 days;8 units
per 28 days
2 units per 1 days
1 units per 1 days
3 units per 1 days
30 ml per 1 days
9 units per 1 days
6 units per 1 days
1 units per 84 days;90
days
1 units per 1 days
2 units per 365 days
1 units per 30 days
16 gm per 30 days
• FETZIMA
• FIRMAGON(VIAL)(120 MG)
• FIRMAGON(VIAL)(80 MG)
• FLONASE
• FLOVENT DISKUS(BLST
W/DEV)(100 MCG)
2 units per 1 days
• FLOVENT DISKUS(BLST
W/DEV)(250 MCG)
4 units per 1 days
• FLOVENT DISKUS(BLST
W/DEV)(50 MCG)
2 units per 1 days
• FLOVENT HFA(AER
W/ADAP)(110 MCG)
12 gm per 30 days
• FLOVENT HFA(AER
W/ADAP)(220 MCG)
24 gm per 30 days
• FLOVENT HFA(AER W/ADAP)(44
MCG)
21.2 gm per 30 days
• FLUMIST QUAD 2014-2015
1 units per 365 days
L.A. Care
• FLUNISOLIDE
25 ml per 30 days
• FOCALIN
2 units per 1 days
• FOCALIN XR
1 units per 1 days
• FORADIL
60 units per 30 days
• FORFIVO XL
1 units per 1 days
• FORTEO
2.4 ml per 28 days
• FRAGMIN(SYRINGE)(10000/ML) 10 ml per 30 days
• FRAGMIN(SYRINGE)(12500/0.5) 5 ml per 30 days
• FRAGMIN(SYRINGE)(15000/0.6) 6 ml per 30 days
• FRAGMIN(SYRINGE)(18000/0.72)7.2 ml per 30 days
•
FRAGMIN(SYRINGE)(2500/0.2ML) 2 ml per 30 days
•
FRAGMIN(SYRINGE)(5000/0.2ML) 2 ml per 30 days
•
FRAGMIN(SYRINGE)(7500/0.3ML) 3 ml per 30 days
• FRAGMIN(VIAL)
38 ml per 30 days
• FROVA
3 units per 5 days
• FULYZAQ
2 units per 1 days
• FUZEON
60 units per 30 days
• FYCOMPA(TAB)(10 MG)
30 units per 30 days
• FYCOMPA(TAB)(12 MG)
30 units per 30 days
• FYCOMPA(TAB)(2 MG)
120 units per 30 days
• FYCOMPA(TAB)(4 MG)
60 units per 30 days
• FYCOMPA(TAB)(6 MG)
60 units per 30 days
• FYCOMPA(TAB)(8 MG)
30 units per 30 days
• GABITRIL(TAB)(12 MG)
4 units per 1 days
• GABITRIL(TAB)(16 MG)
3 units per 1 days
• GABITRIL(TAB)(2 MG)
4 units per 1 days
• GABITRIL(TAB)(4 MG)
4 units per 1 days
• GEODON
2 units per 1 days
• GLEEVEC
2 units per 1 days
• GRALISE(TAB ER 24H)(300 MG) 3 units per 1 days
• GRALISE(TAB ER 24H)(300-600
MG)
39 units per 15 days
• GRALISE(TAB ER 24H)(600 MG) 3 units per 1 days
• GRANISETRON HCL
8 units per 30 days
• HORIZANT(TAB ER)(300 MG)
30 units per 30 days
• HORIZANT(TAB ER)(600 MG)
2 units per 1 days
• HYCET
184 ml per 1 days
• HYDROCODONEACETAMINOPHEN(SOLUTION)
(10-325/15)
184 ml per 1 days
• HYDROCODONEACETAMINOPHEN(SOLUTION)
(2.5-167/5)
120 ml per 1 days
• HYDROCODONEACETAMINOPHEN(SOLUTION)(5163/7.5)
184 ml per 1 days
• HYDROCODONEACETAMINOPHEN(TAB)(10MG300MG)
13 units per 1 days
• HYDROCODONEACETAMINOPHEN(TAB)(10MG325MG)
12 units per 1 days
• HYDROCODONEACETAMINOPHEN(TAB)(5MG300MG)
13 units per 1 days
• HYDROCODONEACETAMINOPHEN(TAB)(5MG325MG)
12 units per 1 days
• HYDROCODONEACETAMINOPHEN(TAB)(7.5300MG)
13 units per 1 days
Page 57 of 90
Preferred Drug List Medication Prescribing Limitations
• HYDROCODONEACETAMINOPHEN(TAB)(7.5325MG)
• ICLUSIG(TAB)(15 MG)
• ICLUSIG(TAB)(45 MG)
• IMITREX
• IMITREX(CARTRIDGE)
• IMITREX(PEN INJCTR)
• IMITREX(TAB)
• IMITREX(VIAL)
• INLYTA(TAB)(1 MG)
• INLYTA(TAB)(5 MG)
• INTERMEZZO
• INTUNIV
• INVEGA(TAB ER 24H)(1.5 MG)
• INVEGA(TAB ER 24H)(3 MG)
• INVEGA(TAB ER 24H)(6 MG)
• INVEGA(TAB ER 24H)(9 MG)
• INVIRASE(CAP)
• INVIRASE(TAB)
• INVOKANA
• IPRIVASK
• JAKAFI
• JANUMET
• JANUMET XR(TBMP 24HR)(1001000MG)
• JANUMET XR(TBMP 24HR)(501000 MG)
• JANUMET XR(TBMP
24HR)(50MG-500MG)
• JANUVIA
• JENTADUETO
• KALETRA(SOLUTION)
• KALETRA(TAB)(100MG-25MG)
• KALETRA(TAB)(200MG-50MG)
• KAPVAY
• KAZANO
• KHEDEZLA
• KOMBIGLYZE XR(TBMP
24HR)(2.5-1000MG)
• KOMBIGLYZE XR(TBMP
24HR)(5 MG-500MG)
• KOMBIGLYZE XR(TBMP
24HR)(5MG-1000MG)
• LAMICTAL ODT(TAB RDP
DIS)(100 MG)
• LAMICTAL ODT(TAB RDP
DIS)(200 MG)
• LAMICTAL ODT(TAB RDP
DIS)(25 MG)
• LAMICTAL ODT(TAB RDP
DIS)(50 MG)
• LATUDA(TAB)(120 MG)
• LATUDA(TAB)(20 MG)
• LATUDA(TAB)(40 MG)
• LATUDA(TAB)(60 MG)
• LATUDA(TAB)(80 MG)
• LESCOL
• LESCOL XL
• LINZESS
• LIPTRUZET(TAB)(10 MG-10MG)
• LIPTRUZET(TAB)(10 MG-20MG)
• LIPTRUZET(TAB)(10 MG-40MG)
L.A. Care
12 units per 1 days
2 units per 1 days
1 units per 1 days
6 units per 15 days
1 ml per 14 days
1 ml per 14 days
3 units per 5 days
1 ml per 14 days
6 units per 1 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 1 days;2 units
per 1 days
1 units per 1 days
300 units per 30 days
120 units per 30 days
30 units per 30 days
6 units per 30 days
2 units per 1 days
2 units per 1 days
1 units per 1 days
2 units per 1 days
2 units per 1 days
1 units per 1 days
2 units per 1 days
390 ml per 30 days
300 units per 30 days
120 units per 30 days
120 units per 30 days
2 units per 1 days
1 units per 1 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
3 units per 1 days
2 units per 1 days
6 units per 1 days
6 units per 1 days
30 units per 30 days
30 units per 30 days
30 units per 30 days
30 units per 30 days
60 units per 30 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
30 units per 30 days
30 units per 30 days
30 units per 30 days
• LIPTRUZET(TAB)(10 MG-80MG)
• LIVALO
• LOVAZA
• LOVENOX(SYRINGE)(100
MG/ML)
•
LOVENOX(SYRINGE)
(120MG/.8ML)
• LOVENOX(SYRINGE)(150
MG/ML)
•
LOVENOX(SYRINGE)
(30MG/0.3ML)
•
LOVENOX(SYRINGE)
(40MG/0.4ML)
•
LOVENOX(SYRINGE)
(60MG/0.6ML)
•
LOVENOX(SYRINGE)
(80MG/0.8ML)
• LOVENOX(VIAL)
• LUMIGAN
• LUNESTA
• LUVOX CR
• LUZU
• MARINOL
• MAXALT
• MAXALT MLT
• MENOSTAR
• METHYLIN
• METHYLPHENIDATE ER(CPBP
50-50)(20 MG)
• METHYLPHENIDATE ER(CPBP
50-50)(30 MG)
• METHYLPHENIDATE ER(TAB
ER)(20 MG)
• MIGERGOT
• MIGRANAL
• MINIVELLE
• MINOCYCLINE HCL(TAB ER
24H)
• MIRAPEX ER
• MIRVASO
• MYRBETRIQ
• NAMENDA XR(CAP 24 DSPK)
• NAMENDA XR(CAP SPR 24)
• NAMENDA(SOLUTION)
• NAMENDA(TAB DS PK)
• NAMENDA(TAB)
• NASONEX
• NESINA
• NEUPRO
• NEXAVAR
• NEXIUM
• NICOTROL
• NICOTROL NS
• NILANDRON
• NORVIR
• NUCYNTA
• NUCYNTA ER
• NUVARING
• OLEPTRO ER
30 units per 30 days
1 units per 1 days
4 units per 1 days
20 ml per 30 days
16 ml per 30 days
20 ml per 30 days
6 ml per 30 days
8 ml per 30 days
12 ml per 30 days
16 ml per 30 days
60 ml per 30 days
1 ml per 12 days
1 units per 1 days
2 units per 1 days
60 gm per 28 days
2 units per 1 days
3 units per 5 days
3 units per 5 days
1 units per 7 days
90 units per 30 days
1 units per 1 days
2 units per 1 days
90 units per 30 days
5 units per 7 days
8 ml per 7 days
2 units per 7 days
1 units per 1 days
1 units per 1 days
30 gm per 30 days
30 units per 30 days
28 units per 28 days
30 units per 30 days
300 ml per 30 days
49 units per 28 days
60 units per 30 days
17 gm per 30 days
1 units per 1 days
1 units per 1 days
4 units per 1 days
1 units per 1 days
2016 units per 365 days
480 ml per 365 days
150 units after 30 days
360 units per 30 days
6 units per 1 days
2 units per 1 days
1 units per 28 days
3 units per 2 days
Page 58 of 90
Preferred Drug List Medication Prescribing Limitations
• OMNARIS
5 gm per 12 days
• ONFI(ORAL SUSP)
480 ml per 30 days
• ONFI(TAB)
2 units per 1 days
• ONGLYZA
1 units per 1 days
• ORACEA
1 units per 1 days
• OSENI
1 units per 1 days
• OSPHENA
1 units per 1 days
• OTREXUP
1.6 ml per 28 days
• OXTELLAR XR(TAB ER 24H)(150
MG)
1 units per 1 days
• OXTELLAR XR(TAB ER 24H)(300
MG)
1 units per 1 days
• OXTELLAR XR(TAB ER 24H)(600
MG)
4 units per 1 days
• PATANASE
30.5 gm per 30 days
• PERCOCET
12 units per 1 days
• PERFOROMIST
120 ml per 30 days
• PEXEVA
1 units per 1 days
• PICATO(GEL)(0.015 %)
3 units per 28 days
• PICATO(GEL)(0.05 %)
2 units per 28 days
• POTIGA(TAB)(200 MG)
3 units per 1 days
• POTIGA(TAB)(300 MG)
3 units per 1 days
• POTIGA(TAB)(400 MG)
3 units per 1 days
• POTIGA(TAB)(50 MG)
9 units per 1 days
• PRADAXA
2 units per 1 days
• PREVPAC
112 units per 10 days
• PREZISTA(ORAL SUSP)
240 ml per 30 days
• PREZISTA(TAB)(150 MG)
240 units per 30 days
• PREZISTA(TAB)(400 MG)
60 units per 30 days
• PREZISTA(TAB)(600 MG)
60 units per 30 days
• PREZISTA(TAB)(75 MG)
480 units per 30 days
• PREZISTA(TAB)(800 MG)
30 units per 30 days
• PRIMLEV
13 units per 1 days
• PRISTIQ ER
1 units per 1 days
• PROCENTRA
1800 ml per 30 days
• PULMICORT FLEXHALER
1 units per 30 days
• PULMICORT(AMPULNEB)(0.25MG/2ML)
60 ml per 15 days
• PULMICORT(AMPUL-NEB)(0.5
MG/2ML)
60 ml per 15 days
• PULMICORT(AMPUL-NEB)(1
MG/2 ML)
60 ml per 15 days
• QNASL
8.7 gm per 30 days
• QUDEXY XR(CAP SPR 24)(100
MG)
1 units per 1 days
• QUDEXY XR(CAP SPR 24)(150
MG)
2 units per 1 days
• QUDEXY XR(CAP SPR 24)(200
MG)
2 units per 1 days
• QUDEXY XR(CAP SPR 24)(25
MG)
1 units per 1 days
• QUDEXY XR(CAP SPR 24)(50
MG)
1 units per 1 days
• QUILLIVANT XR
2 ml per 1 days
• QVAR
174 gm per 300 days
• RABEPRAZOLE SODIUM
1 units per 1 days
• RANEXA(TAB ER 12H)(1000 MG)60 units per 30 days
• RANEXA(TAB ER 12H)(500 MG) 120 units per 30 days
• RASUVO(AUTO
INJECT)(10MG/0.2ML)
.8 ml per 28 days
• RASUVO(AUTO
INJECT)(12.5/0.25)
1 ml per 28 days
• RASUVO(AUTO
INJECT)(15MG/0.3ML)
1.2 ml per 28 days
L.A. Care
• RASUVO(AUTO
INJECT)(17.5/0.35)
• RASUVO(AUTO
INJECT)(22.5/0.45)
• RASUVO(AUTO
INJECT)(25MG/0.5ML)
• RASUVO(AUTO
INJECT)(27.5/0.55)
• RASUVO(AUTO
INJECT)(30MG/0.6ML)
• RASUVO(AUTO
INJECT)(7.5MG/0.15)
• RAZADYNE
• RAZADYNE ER
• RELENZA
• RELPAX
• REQUIP XL
• RESCULA
• RESTASIS
• RETROVIR(CAP)
• RETROVIR(SYRUP)
• REVATIO(SUSP RECON)
• REVATIO(TAB)
• REVLIMID
• RHINOCORT AQUA
• RISPERDAL(SOLUTION)
• RISPERDAL(TAB)
• RISPERIDONE
• RITALIN LA
• ROZEREM
• SABRIL
• SAMSCA(TAB)(15 MG)
• SAMSCA(TAB)(30 MG)
• SANCUSO
• SAPHRIS
• SEREVENT DISKUS
• SEROQUEL
• SEROQUEL XR
• SILENOR
• SIMCOR(TBMP 24HR)(100020MG)
• SIMCOR(TBMP 24HR)(1000-40
MG)
• SIMCOR(TBMP 24HR)(500MG20MG)
• SIMCOR(TBMP 24HR)(500MG40MG)
• SIMCOR(TBMP 24HR)(750MG20MG)
• SOLODYN
• SONATA
• SPIRIVA
• SPRIX
• SPRYCEL(TAB)(100 MG)
• SPRYCEL(TAB)(140 MG)
• SPRYCEL(TAB)(20 MG)
• SPRYCEL(TAB)(50 MG)
• SPRYCEL(TAB)(70 MG)
• SPRYCEL(TAB)(80 MG)
• STAGESIC-10
• STIVARGA
• STRATTERA(CAP)(10 MG)
• STRATTERA(CAP)(100 MG)
1.4 ml per 28 days
1.8 ml per 28 days
2 ml per 28 days
2.2 ml per 28 days
2.4 ml per 28 days
.6 ml per 28 days
60 units per 30 days
30 units per 30 days
40 units per 183 days
2 units per 5 days
1 units per 1 days
1 ml per 3 days
64 units per 30 days
180 units per 30 days
1800 ml per 30 days
224 ml per 30 days
3 units per 1 days
1 units per 1 days
43 gm per 75 days
2 ml per 1 days;8 ml per
1 days
2 units per 1 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
6 units per 1 days
30 units per 365 days
60 units per 365 days
1 units per 7 days
2 units per 1 days
60 units per 30 days
3 units per 1 days
1 units per 1 days
1 units per 1 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 1 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 6 days
1 units per 1 days
1 units per 1 days
2 units per 1 days
1 units per 1 days
1 units per 1 days
1 units per 1 days
16 units per 1 days
3 units per 1 days
60 units per 30 days
30 units per 30 days
Page 59 of 90
Preferred Drug List Medication Prescribing Limitations
• STRATTERA(CAP)(18 MG)
• STRATTERA(CAP)(25 MG)
• STRATTERA(CAP)(40 MG)
• STRATTERA(CAP)(60 MG)
• STRATTERA(CAP)(80 MG)
• STRIBILD
• SUMAVEL DOSEPRO
• SUTENT
• SYLATRON
60 units per 30 days
60 units per 30 days
60 units per 30 days
30 units per 30 days
30 units per 30 days
30 units per 30 days
1 ml per 14 days
1 units per 1 days
1 units per 28 days;1
units per 7 days
• SYLATRON 4-PACK
1 units per 28 days
• SYMBICORT
10.2 gm per 30 days
• SYMBYAX
1 units per 1 days
• TAMIFLU(CAP)(30 MG)
40 units per 183 days
• TAMIFLU(CAP)(45 MG)
20 units per 183 days
• TAMIFLU(CAP)(75 MG)
20 units per 183 days
• TAMIFLU(SUSP RECON)
360 ml per 183 days
• TANZEUM
4 units per 28 days
• TARCEVA
1 units per 1 days
• TASIGNA
4 units per 1 days
• TASMAR
3 units per 1 days
• THALOMID
2 units per 1 days
• TIMOPTIC OCUDOSE
2 units per 1 days
• TRADJENTA
1 units per 1 days
• TRAVATAN Z
1 ml per 12 days
• TRAVOPROST
1 ml per 12 days
• TREXIMET
1 units per 3 days
• TRIAMCINOLONE ACETONIDE 11 gm per 20 days
• TROKENDI XR(CAP ER 24H)(100
MG)
1 units per 1 days
• TROKENDI XR(CAP ER 24H)(200
MG)
2 units per 1 days
• TROKENDI XR(CAP ER 24H)(25
MG)
1 units per 1 days
• TROKENDI XR(CAP ER 24H)(50
MG)
1 units per 1 days
• TRUVADA
30 units per 30 days
• TUDORZA PRESSAIR
1 units per 30 days
• ULORIC
30 units per 30 days
• VANCOCIN HCL
40 units per 30 days
• VASCEPA
4 units per 1 days
• VERAMYST
10 gm per 30 days
• VERSACLOZ
18 ml per 1 days;3 ml per
1 days
• VICTOZA 2-PAK
9 ml per 30 days
• VICTOZA 3-PAK
9 ml per 30 days
• VIDEX
1200 ml per 30 days
• VIDEX EC(CAP DR)(125 MG)
60 units per 30 days
• VIDEX EC(CAP DR)(200 MG)
60 units per 30 days
• VIIBRYD(TAB)
1 units per 1 days
• VIMPAT(TAB)
2 units per 1 days
• VIRAMUNE(ORAL SUSP)
1200 ml per 30 days
• VIRAMUNE(TAB)
60 units per 30 days
• VIREAD(POWDER)
225 gm per 30 days
• VIREAD(TAB)
30 units per 30 days
• VIVELLE-DOT
2 units per 7 days
• VOTRIENT
4 units per 1 days
• VYTORIN(TAB)(10 MG-10MG) 1 units per 1 days
• VYTORIN(TAB)(10 MG-20MG) 1 units per 1 days
• VYTORIN(TAB)(10 MG-40MG) 1 units per 1 days
• VYTORIN(TAB)(10 MG-80MG) 1 units per 1 days
• VYVANSE
1 units per 1 days
• XALKORI
2 units per 1 days
• XARELTO(TAB)(10 MG)
1 units per 1 days
L.A. Care
• XARELTO(TAB)(15 MG)
15 units after 21 days;2
units per 1 days
• XARELTO(TAB)(20 MG)
1 units per 1 days
• XARTEMIS XR
12 units per 1 days
• XELODA(TAB)(150 MG)
28 units per 21 days
• XELODA(TAB)(500 MG)
112 units per 21 days
• XIFAXAN(TAB)(550 MG)
2 units per 1 days
• XTANDI
4 units per 1 days
• XYZAL(SOLUTION)
10 ml per 1 days
• ZAMICET
184 ml per 1 days
• ZEGERID(CAP)
1 units per 1 days
• ZEGERID(PACKET)
1 units per 1 days
• ZELAPAR
2 units per 1 days
• ZELBORAF
8 units per 1 days
• ZENZEDI
90 units per 30 days
• ZERIT(CAP)
60 units per 30 days
• ZERIT(SOLN RECON)
2400 ml per 30 days
• ZETIA
1 units per 1 days
• ZETONNA
6.1 gm per 30 days
• ZIAGEN(SOLUTION)
900 ml per 30 days
• ZIAGEN(TAB)
60 units per 30 days
• ZIDOVUDINE
60 units per 30 days
• ZIOPTAN
1 units per 1 days
• ZIPSOR
4 units per 1 days
• ZOFRAN(SOLUTION)
50 ml per 15 days
• ZOHYDRO ER
2 units per 1 days
• ZOLPIDEM TARTRATE
1 units per 1 days
• ZOLPIMIST
77 ml per 300 days
• ZOMIG(SPRAY)(2.5 MG)
12 units per 30 days
• ZOMIG(SPRAY)(5 MG)
6 units per 15 days
• ZOMIG(TAB)
2 units per 5 days
• ZORVOLEX
3 units per 1 days
• ZUPLENZ(FILM)(4 MG)
2 units per 3 days
• ZUPLENZ(FILM)(8 MG)
1 units per 3 days
• ZYCLARA(CREAM PACK)
1 units per 1 days
• ZYCLARA(CRM MD PMP)(2.5 %) 7.5 gm per 1 days
• ZYCLARA(CRM MD PMP)(3.75
%)
7.5 gm per 28 days
• ZYPREXA
1 units per 1 days
• ZYTIGA
4 units per 1 days
Page 60 of 90
Preferred Drug List Medication Prescribing Limitations
STEP THERAPY EDITS - FORMULARY
• ABILIFY DISCMELT(TAB RDP DIS)(10 Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
MG)
days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365
days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365
days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ABILIFY DISCMELT(TAB RDP DIS)(15 Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
MG)
days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365
days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365
days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ABILIFY(SOLUTION)
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365
days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365
days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ABILIFY(TAB)
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365
days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365
days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ACIPHEX SPRINKLE
Atleast 2 of Prior prescription for Prevacid 24hr in 365 days or Prilosec in 365 days
or Protonix Iv in 365 days
• ACTICLATE
Prior prescription for Vibramycin in 120 days
• ACTONEL(TAB)(150 MG)
Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days
• ACTONEL(TAB)(30 MG)
Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days
• ACTONEL(TAB)(35 MG)
Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days
• ACTONEL(TAB)(5 MG)
Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days
• ACTOPLUS MET
Prior prescription for Avandamet in 120 days or Avandaryl in 120 days or Avandia in
120 days or Chlorpropamide in 120 days or Glimepiride in 120 days or Glucotrol Xl
in 120 days or Glyburide-metformin Hcl in 120 days or Metaglip in 120 days or
Micronase in 120 days or Riomet in 120 days or Tolazamide in 120 days or
Tolbutamide in 120 days
• ACTOPLUS MET XR
Prior prescription for Avandamet in 120 days or Avandaryl in 120 days or Avandia in
120 days or Chlorpropamide in 120 days or Glimepiride in 120 days or Glucotrol Xl
in 120 days or Glyburide-metformin Hcl in 120 days or Metaglip in 120 days or
Micronase in 120 days or Riomet in 120 days or Tolazamide in 120 days or
Tolbutamide in 120 days
• ADCIRCA
Prior prescription for Revatio in 120 days or Sildenafil in 120 days
• ADOXA PAK
Prior prescription for Vibramycin in 120 days
• ADVICOR(TBMP 24HR)(1000-20MG)
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• ADVICOR(TBMP 24HR)(1000-40 MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• ADVICOR(TBMP 24HR)(500MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• ADVICOR(TBMP 24HR)(750MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• AEROSPAN
Atleast 2 of Prior prescription for Fluticasone Propionate in 365 days or Qvar in 365
days
• ALTOPREV
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• ALVESCO
Atleast 2 of Prior prescription for Flovent Diskus in 365 days or Qvar in 365 days
• AMETHYST
Prior prescription for Norgestimate-ethinyl Estradiol in 120 days
• ANTARA
Prior prescription for Fenofibrate in 120 days or Lofibra in 120 days or Lopid in 120
days or Tricor in 120 days or Triglide in 120 days
• ANZEMET(TAB)(100 MG)
Prior prescription for Anzemet in 120 days or Ondansetron Hcl in 120 days or Zofran
Odt in 120 days or Zofran in 120 days
• ANZEMET(TAB)(50 MG)
Prior prescription for Anzemet in 120 days or Ondansetron Hcl in 120 days or Zofran
Odt in 120 days or Zofran in 120 days
• APLENZIN
Prior prescription for Zyban in 120 days
• APTIOM(TAB)(200 MG)
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
L.A. Care
Page 61 of 90
Preferred Drug List Medication Prescribing Limitations
• APTIOM(TAB)(400 MG)
• APTIOM(TAB)(600 MG)
• APTIOM(TAB)(800 MG)
• ARCAPTA NEOHALER
• ASACOL HD
• ASMANEX
• ASTEPRO
• ATELVIA
• AUVI-Q
• AVODART
• AXERT
• AZOR
• BANZEL(ORAL SUSP)
• BANZEL(TAB)(200 MG)
• BANZEL(TAB)(400 MG)
• BECONASE AQ
• BENICAR
• BENICAR HCT
• BEYAZ
• BINOSTO
• BRINTELLIX
• BRISDELLE
• BYDUREON
• BYDUREON PEN
• BYETTA(PEN INJCTR)(10MCG/0.04)
L.A. Care
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
Prior prescription for Serevent Diskus in 120 days
Prior prescription for Apriso in 120 days or Colazal in 120 days
Atleast 2 of Prior prescription for Flovent Diskus in 365 days or Qvar in 365 days
Prior prescription for Azelastine Hcl in 120 days
Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days
Prior prescription for Auvi-q in 120 days or Twinject in 120 days
Prior prescription for Doxazosin Mesylate in 120 days or Prazosin Hcl in 120 days or
Proscar in 120 days or Rapaflo in 120 days or Tamsulosin Hcl in 120 days or
Terazosin Hcl in 120 days or Uroxatral in 120 days
Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Prior prescription for Divalproex Sodium Er in 120 days or Lamotrigine Er in 120
days or Trokendi Xr in 120 days or Valproic Acid in 120 days
Prior prescription for Divalproex Sodium Er in 120 days or Lamotrigine Er in 120
days or Trokendi Xr in 120 days or Valproic Acid in 120 days
Prior prescription for Divalproex Sodium Er in 120 days or Lamotrigine Er in 120
days or Trokendi Xr in 120 days or Valproic Acid in 120 days
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Atleast 2 of Prior prescription for in 365 days or Generess Fe in 365 days or Lo
Loestrin Fe in 365 days or Lomedia 24 Fe in 365 days or Loseasonique in 365 days
or Microgestin Fe in 365 days or Microgestin in 365 days or Necon in 365 days or
Norethin-eth Estra Ferrous Fum in 365 days or Norethindron-ethinyl Estradiol in 365
days or Norinyl 1+50 in 365 days or Ortho Tri-cyclen Lo in 365 days or Ovcon-50 in
365 days or Ovral-28 in 365 days or Pirmella in 365 days or Portia in 365 days or
Seasonale in 365 days or Seasonique in 365 days or Sharobel in 365 days or Sprintec
in 365 days or Sronyx in 365 days or Tri-legest Fe in 365 days or Tri-norinyl in 365
days or Trinessa in 365 days or Trivora-28 in 365 days or Viorele in 365 days or
Wera in 365 days or Zenchent in 365 days or Zeosa in 365 days or Zovia 1-50e in
365 days
Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days or
Venlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
Prior prescription for Paxil Cr in 120 days or Paxil in 120 days or Venlafaxine Hcl Er
in 120 days
Prior prescription for Tolbutamide in 120 days
Prior prescription for Tolbutamide in 120 days
Prior prescription for Chlorpropamide in 120 days or Glimepiride in 120 days or
Glucotrol Xl in 120 days or Glyburide-metformin Hcl in 120 days or Glynase in 120
days or Metaglip in 120 days or Micronase in 120 days or Pioglitazone Hcl in 120
days or Pioglitazone-glimepiride in 120 days or Pioglitazone-metformin in 120 days
or Riomet in 120 days or Tolazamide in 120 days or Tolbutamide in 120 days
Page 62 of 90
Preferred Drug List Medication Prescribing Limitations
• BYETTA(PEN INJCTR)(5MCG/0.02)
• CALCIPOTRIENE
• CELEBREX
• CESAMET
• CLARINEX(SYRUP)
• CLARINEX-D 12 HOUR
• CONZIP
• COSOPT PF
• CRESTOR(TAB)(10 MG)
• CRESTOR(TAB)(20 MG)
• CRESTOR(TAB)(40 MG)
• CRESTOR(TAB)(5 MG)
• CYCLOSET
• DALIRESP
• DAYTRANA
• DELZICOL
• DESLORATADINE
• DESVENLAFAXINE FUMARATE ER
• DETROL
• DEXILANT
• DIFICID
• DIPENTUM
• DORYX(TAB DR)(200 MG)
• DOVONEX
• DRITHOCREME HP
• DUETACT
Prior prescription for Chlorpropamide in 120 days or Glimepiride in 120 days or
Glucotrol Xl in 120 days or Glyburide-metformin Hcl in 120 days or Glynase in 120
days or Metaglip in 120 days or Micronase in 120 days or Pioglitazone Hcl in 120
days or Pioglitazone-glimepiride in 120 days or Pioglitazone-metformin in 120 days
or Riomet in 120 days or Tolazamide in 120 days or Tolbutamide in 120 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Atleast 2 of Prior prescription for in 120 days or Actron in 120 days or Diclofenac
Sodium in 120 days or Diclofenac Sodium-misoprostol in 120 days or Etodolac Er in
120 days or Fenoprofen Calcium in 120 days or Flurbiprofen in 120 days or
Ibuprofen in 120 days or Ibuprohm in 120 days or Indocin in 120 days or
Indomethacin in 120 days or Infants' Motrin in 120 days or Ketoprofen in 120 days
or Ketorolac Tromethamine in 120 days or Meclofenamate Sodium in 120 days or
Mobic in 120 days or Motrin in 120 days or Nalfon in 120 days or Naprelan in 120
days or Naproxen Sodium in 120 days or Naproxen in 120 days or Oxaprozin in 120
days or Phenylbutazone in 120 days or Piroxicam in 120 days or Ponstel in 120 days
or Relafen in 120 days or Sulindac in 120 days or Tolmetin Sodium in 120 days or
Toradol in 120 days or Voltaren in 120 days or Voltaren-xr in 120 days or Wal-profen
in 120 days or Wal-proxen in 120 days or Zipsor in 120 days
Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days
Prior prescription for Desloratadine in 120 days or Xyzal in 120 days
Prior prescription for Wal-itin D 12 Hour in 180 days or Wal-vert in 180 days or
Xyzal in 180 days or Zyrtec in 180 days or Zyrtec-d in 180 days
Prior prescription for Conzip in 120 days or Tramadol Hcl Er in 120 days or Ultram
Er in 120 days
Prior prescription for Dorzolamide-timolol in 120 days
Prior prescription for Lipitor in 120 days
Prior prescription for Lipitor in 120 days
Prior prescription for Lipitor in 120 days
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
Prior prescription for Glyburide-metformin Hcl in 180 days or Metaglip in 180 days
or Riomet in 180 days
Prior prescription for Arcapta Neohaler in 120 days or Atrovent Hfa in 120 days or
Combivent Respimat in 120 days or Combivent in 120 days or Foradil in 120 days or
Serevent Diskus in 120 days or Spiriva in 120 days
Prior prescription for in 120 days or Methylphenidate Hcl Cd in 120 days or
Methylphenidate Hcl in 120 days or Quillivant Xr in 120 days or Ritalin La in 120
days or Ritalin-sr in 120 days
Prior prescription for Apriso in 120 days or Colazal in 120 days
Prior prescription for Desloratadine in 120 days or Xyzal in 120 days
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days or
Venlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days or
Prevacid in 120 days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonix
in 120 days
Prior prescription for Vancomycin Hcl in 120 days
Prior prescription for Apriso in 120 days or Colazal in 120 days
Prior prescription for Vibramycin in 120 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Prior prescription for Avandamet in 120 days or Avandaryl in 120 days or Avandia in
120 days or Chlorpropamide in 120 days or Glimepiride in 120 days or Glucotrol Xl
in 120 days or Glyburide-metformin Hcl in 120 days or Metaglip in 120 days or
Micronase in 120 days or Riomet in 120 days or Tolazamide in 120 days or
Tolbutamide in 120 days
• DUEXIS
Prior prescription for Etodolac Er in 120 days or Flurbiprofen in 120 days or
Indomethacin in 120 days or Ketoprofen in 120 days or Meclofenamate Sodium in
120 days or Mobic in 120 days or Nalfon in 120 days or Oxaprozin in 120 days or
Piroxicam in 120 days or Relafen in 120 days or Sulindac in 120 days or Tolmetin
L.A. Care
Page 63 of 90
Preferred Drug List Medication Prescribing Limitations
• DYMISTA
• EDARBI
• EDARBYCLOR
• EDLUAR
• ELIDEL
• ENABLEX
• EPANED
• EXFORGE
• EXFORGE HCT
• FANAPT(TAB DS PK)
• FANAPT(TAB)
• FARXIGA
• FAZACLO
• FELBATOL(ORAL SUSP)
• FELBATOL(TAB)(400 MG)
• FELBATOL(TAB)(600 MG)
• FENOGLIDE
• FETZIMA
• FORADIL
• FORFIVO XL
• FROVA
• FULYZAQ
• FUZEON
• FYCOMPA(TAB)(10 MG)
• FYCOMPA(TAB)(12 MG)
• FYCOMPA(TAB)(2 MG)
• FYCOMPA(TAB)(4 MG)
• FYCOMPA(TAB)(6 MG)
L.A. Care
Sodium in 120 days or Toradol in 120 days or Voltaren-xr in 120 days or Wal-profen
in 120 days or Wal-proxen in 120 days
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Prior prescription for Edluar in 180 days or Zolpidem Tartrate Er in 180 days or
Zolpidem Tartrate in 180 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
Prior prescription for Vasotec in 120 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Exforge in 120
days or Losartan Potassium in 120 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Prior prescription for Chlorpropamide in 365 days or Glimepiride in 365 days or
Glucotrol Xl in 365 days or Glyburide-metformin Hcl in 365 days or Glynase in 365
days or Invokana in 365 days or Metaglip in 365 days or Micronase in 365 days or
Pioglitazone Hcl in 365 days or Pioglitazone-glimepiride in 365 days or
Pioglitazone-metformin in 365 days or Riomet in 365 days or Tolazamide in 365
days or Tolbutamide in 365 days
Atleast 2 of Prior prescription for Fazaclo in 365 days or Risperidone Odt in 365
days or Seroquel Xr in 365 days or Ziprasidone Hcl in 365 days or Zyprexa Zydis in
365 days
Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days
Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days
Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days
Prior prescription for Lofibra in 120 days or Lopid in 120 days or Tricor in 120 days
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days or
Venlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
Prior prescription for Serevent Diskus in 120 days
Prior prescription for Wellbutrin Sr in 120 days or Wellbutrin Xl in 120 days or
Wellbutrin in 120 days or Zyban in 120 days
Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days
Prior prescription for Antiretrovirals in 120 days
Prior prescription for Antiretrovirals in 120 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or
Neurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days or
Trokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or
Neurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days or
Trokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or
Neurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days or
Trokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or
Neurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days or
Trokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or
Neurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days or
Trokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
Page 64 of 90
Preferred Drug List Medication Prescribing Limitations
• FYCOMPA(TAB)(8 MG)
• GABITRIL(TAB)(12 MG)
• GABITRIL(TAB)(16 MG)
• GABITRIL(TAB)(2 MG)
• GABITRIL(TAB)(4 MG)
• GELNIQUE
• GIAZO
• GLUMETZA
• GRALISE(TAB ER 24H)(300 MG)
• GRALISE(TAB ER 24H)(300-600 MG)
• GRALISE(TAB ER 24H)(600 MG)
• GRANISETRON HCL
• HORIZANT(TAB ER)(300 MG)
• HORIZANT(TAB ER)(600 MG)
• INDERAL XL
• INNOPRAN XL
• INTERMEZZO
• INVEGA(TAB ER 24H)(1.5 MG)
• INVEGA(TAB ER 24H)(3 MG)
• INVEGA(TAB ER 24H)(6 MG)
• INVEGA(TAB ER 24H)(9 MG)
• INVIRASE(CAP)
• INVIRASE(TAB)
• INVOKANA
• JALYN
• KAZANO
• KHEDEZLA
• KOMBIGLYZE XR(TBMP 24HR)(2.51000MG)
L.A. Care
Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or
Neurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days or
Trokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
Prior prescription for Apriso in 120 days or Colazal in 120 days
Prior prescription for Metformin Hcl Er in 120 days
Prior prescription for in 120 days or Gralise in 120 days or Neurontin in 120 days
Prior prescription for in 120 days or Gralise in 120 days or Neurontin in 120 days
Prior prescription for in 120 days or Gralise in 120 days or Neurontin in 120 days
Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days
Prior prescription for Neurontin in 120 days or Pramipexole Dihydrochloride in 120
days or Ropinirole Hcl in 120 days
Prior prescription for Neurontin in 120 days or Pramipexole Dihydrochloride in 120
days or Ropinirole Hcl in 120 days
Prior prescription for Propranolol Hcl Er in 120 days
Prior prescription for Propranolol Hcl Er in 120 days
Prior prescription for Intermezzo in 120 days or Zolpidem Tartrate in 120 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Prior prescription for Atripla in 120 days or Isentress in 120 days or Prezista in 120
days or Reyataz in 120 days or Sustiva in 120 days
Prior prescription for Atripla in 120 days or Isentress in 120 days or Prezista in 120
days or Reyataz in 120 days or Sustiva in 120 days
Prior prescription for Chlorpropamide in 120 days or Glimepiride in 120 days or
Glucotrol Xl in 120 days or Glyburide-metformin Hcl in 120 days or Glynase in 120
days or Metaglip in 120 days or Micronase in 120 days or Pioglitazone Hcl in 120
days or Pioglitazone-glimepiride in 120 days or Pioglitazone-metformin in 120 days
or Riomet in 120 days or Tolazamide in 120 days or Tolbutamide in 120 days
Prior prescription for in 120 days or Doxazosin Mesylate in 120 days or Prazosin Hcl
in 120 days or Proscar in 120 days or Rapaflo in 120 days or Tamsulosin Hcl in 120
days or Terazosin Hcl in 120 days or Uroxatral in 120 days
Prior prescription for Janumet Xr in 120 days or Jentadueto in 120 days or Juvisync
in 120 days or Tradjenta in 120 days
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Desvenlafaxine Er
in 365 days or Khedezla in 365 days or Lexapro in 365 days or Paxil Cr in 365 days
or Remeron in 365 days or Selfemra in 365 days or Venlafaxine Hcl Er in 365 days
or Zoloft in 365 days or Zyban in 365 days
Prior prescription for Januvia in 120 days or Jentadueto in 120 days
Page 65 of 90
Preferred Drug List Medication Prescribing Limitations
• KOMBIGLYZE XR(TBMP 24HR)(5 MG500MG)
• KOMBIGLYZE XR(TBMP 24HR)(5MG1000MG)
• LAMICTAL ODT (BLUE)
• LAMICTAL ODT (GREEN)
• LAMICTAL ODT (ORANGE)
• LAMICTAL ODT(TAB RDP DIS)(100
MG)
• LAMICTAL ODT(TAB RDP DIS)(200
MG)
• LAMICTAL ODT(TAB RDP DIS)(25 MG)
• LAMICTAL ODT(TAB RDP DIS)(50 MG)
• LAMICTAL XR (BLUE)
• LAMICTAL XR (GREEN)
• LAMICTAL XR (ORANGE)
• LATUDA(TAB)(120 MG)
• LATUDA(TAB)(20 MG)
• LATUDA(TAB)(40 MG)
• LATUDA(TAB)(60 MG)
• LATUDA(TAB)(80 MG)
• LESCOL
• LESCOL XL
• LEVEMIR
• LEVEMIR FLEXPEN
• LEVEMIR FLEXTOUCH
• LIALDA
• LIPTRUZET(TAB)(10 MG-10MG)
• LIPTRUZET(TAB)(10 MG-20MG)
• LIPTRUZET(TAB)(10 MG-40MG)
• LIPTRUZET(TAB)(10 MG-80MG)
• LIVALO
• LO LOESTRIN FE
• LUNESTA
• LUVOX CR
• LUZU
• MARINOL
• MIRAPEX ER
• MYRBETRIQ
L.A. Care
Prior prescription for Januvia in 120 days or Jentadueto in 120 days
Prior prescription for Januvia in 120 days or Jentadueto in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Prior prescription for Lamotrigine in 120 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
Prior prescription for Lantus Solostar in 120 days
Prior prescription for Lantus Solostar in 120 days
Prior prescription for Lantus Solostar in 120 days
Prior prescription for Apriso in 120 days or Colazal in 120 days
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
Prior prescription for Lipitor in 365 days
Prior prescription for Lipitor in 365 days
Prior prescription for Lipitor in 365 days
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
Atleast 2 of Prior prescription for Desog-e.estradiol/e.estradiol in 365 days or
Desogestrel-ethinyl Estradiol in 365 days or Ethinyl Estradiol/drospirenone in 365
days or Ethynodiol D-ethinyl Estradiol in 365 days or Etonogestrel/ethinyl Estradiol
in 365 days or L-norgest-eth Estr/ethin Estra in 365 days or Levonorgestrel in 365
days or Levonorgestrel-ethin Estradiol in 365 days or Norelgestromin/ethin.estradiol
in 365 days or Noreth-ethinyl Estradiol/iron in 365 days or Norethindrone Ac-eth
Estradiol in 365 days or Norethindrone in 365 days or Norethindrone-e.estradiol-iron
in 365 days or Norethindrone-ethinyl Estrad in 365 days or Norethindrone-mestranol
in 365 days or Norgestimate-ethinyl Estradiol in 365 days or Norgestrel-ethinyl
Estradiol in 365 days
Prior prescription for Zolpidem Tartrate in 180 days
Prior prescription for Citalopram Hbr in 120 days or Fluvoxamine Maleate in 120
days or Lexapro in 120 days or Paxil Cr in 120 days or Selfemra in 120 days or
Zoloft in 120 days
Atleast 2 of Prior prescription for Nizoral in 365 days or Ringworm in 365 days
Atleast 3 of Prior prescription for Emend in 365 days or Methylprednisolone in 365
days or Zofran in 365 days
Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in
120 days
Atleast 2 of Prior prescription for Enablex in 365 days or Gelnique in 365 days or
Oxybutynin Chloride in 365 days or Oxytrol in 365 days or Tolterodine Tartrate Er in
365 days or Toviaz in 365 days or Trospium Chloride Er in 365 days or Vesicare in
365 days
Page 66 of 90
Preferred Drug List Medication Prescribing Limitations
• NATAZIA
Atleast 2 of Prior prescription for in 120 days or Desog-e.estradiol/e.estradiol in 365
days or Desogestrel-ethinyl Estradiol in 365 days or Ethinyl Estradiol/drospirenone
in 365 days or Ethynodiol D-ethinyl Estradiol in 365 days or Etonogestrel/ethinyl
Estradiol in 365 days or L-norgest-eth Estr/ethin Estra in 365 days or Levonorgestrel
in 365 days or Levonorgestrel-ethin Estradiol in 365 days or
Norelgestromin/ethin.estradiol in 365 days or Noreth-ethinyl Estradiol/iron in 365
days or Norethindron-ethinyl Estradiol in 120 days or Norethindrone Ac-eth
Estradiol in 365 days or Norethindrone in 365 days or Norethindrone-e.estradiol-iron
in 365 days or Norethindrone-ethinyl Estrad in 365 days or Norethindrone-mestranol
in 365 days or Norgestimate-ethinyl Estradiol in 365 days or Norgestrel-ethinyl
Estradiol in 365 days or Norinyl 1+50 in 120 days or Ovral-28 in 120 days or
Seasonique in 120 days or Sharobel in 120 days or Take Action in 120 days or Trilegest Fe in 120 days or Trinessa in 120 days or Trivora-28 in 120 days or Velivet in
120 days or Viorele in 120 days or Zarah in 120 days or Zenchent in 120 days or
Zeosa in 120 days or Zovia 1-50e in 120 days
• NESINA
Prior prescription for Janumet Xr in 120 days or Jentadueto in 120 days or Juvisync
in 120 days or Tradjenta in 120 days
• NEUPRO
Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in
120 days
• NIASPAN
Prior prescription for Lipitor in 365 days or Lofibra in 365 days or Lopid in 365 days
or Mevacor in 365 days or Pravastatin Sodium in 365 days or Tricor in 365 days or
Triglide in 365 days or Zocor in 365 days
• NUVARING
Prior prescription for Norgestimate-ethinyl Estradiol in 120 days
• OCELLA
Atleast 2 of Prior prescription for Generess Fe in 365 days or Lo Loestrin Fe in 365
days or Lomedia 24 Fe in 365 days or Loseasonique in 365 days or Lybrel in 365
days or Microgestin Fe in 365 days or Microgestin in 365 days or Necon in 365 days
or Norethin-eth Estra Ferrous Fum in 365 days or Norethindron-ethinyl Estradiol in
365 days or Norinyl 1+50 in 365 days or Ortho Tri-cyclen Lo in 365 days or Ovcon50 in 365 days or Ovral-28 in 365 days or Pirmella in 365 days or Portia in 365 days
or Seasonale in 365 days or Seasonique in 365 days or Sharobel in 365 days or
Sprintec in 365 days or Sronyx in 365 days or Tri-legest Fe in 365 days or Trinorinyl in 365 days or Trinessa in 365 days or Trivora-28 in 365 days or Velivet in
365 days or Viorele in 365 days or Wera in 365 days or Zenchent in 365 days or
Zeosa in 365 days or Zovia 1-50e in 365 days
• OLEPTRO ER
Prior prescription for Oleptro Er in 120 days or Trazodone Hcl in 120 days
• OMNARIS
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
• ONFI(ORAL SUSP)
Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days
• ONFI(TAB)
Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days
• ONGLYZA
Prior prescription for Januvia in 120 days or Jentadueto in 120 days
• ORACEA
Prior prescription for Vibramycin in 120 days
• ORTHO TRI-CYCLEN LO
Atleast 2 of Prior prescription for Desog-e.estradiol/e.estradiol in 365 days or
Desogestrel-ethinyl Estradiol in 365 days or Ethinyl Estradiol/drospirenone in 365
days or Ethynodiol D-ethinyl Estradiol in 365 days or Etonogestrel/ethinyl Estradiol
in 365 days or L-norgest-eth Estr/ethin Estra in 365 days or Levonorgestrel in 365
days or Levonorgestrel-ethin Estradiol in 365 days or Norelgestromin/ethin.estradiol
in 365 days or Noreth-ethinyl Estradiol/iron in 365 days or Norethindrone Ac-eth
Estradiol in 365 days or Norethindrone in 365 days or Norethindrone-e.estradiol-iron
in 365 days or Norethindrone-ethinyl Estrad in 365 days or Norethindrone-mestranol
in 365 days or Norgestimate-ethinyl Estradiol in 365 days or Norgestrel-ethinyl
Estradiol in 365 days
• OSENI
Prior prescription for Janumet Xr in 120 days or Jentadueto in 120 days or Juvisync
in 120 days or Tradjenta in 120 days
• OTREXUP
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
• OXTELLAR XR(TAB ER 24H)(150 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
• OXTELLAR XR(TAB ER 24H)(300 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
• OXTELLAR XR(TAB ER 24H)(600 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Lamotrigine
Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or Tegretol
L.A. Care
Page 67 of 90
Preferred Drug List Medication Prescribing Limitations
• OXYTROL
• PATANASE
• PENNSAID
• PENTASA
• PEXEVA
• POTIGA(TAB)(200 MG)
• POTIGA(TAB)(300 MG)
• POTIGA(TAB)(400 MG)
• POTIGA(TAB)(50 MG)
• PREVACID(TAB RAP DR)
• PRISTIQ ER
• PROTONIX(GRANPKT DR)
• PROTOPIC
• PULMICORT FLEXHALER
• QNASL
• QUDEXY XR(CAP SPR 24)(100 MG)
• QUDEXY XR(CAP SPR 24)(150 MG)
• QUDEXY XR(CAP SPR 24)(200 MG)
• QUDEXY XR(CAP SPR 24)(25 MG)
• QUDEXY XR(CAP SPR 24)(50 MG)
• QUILLIVANT XR
• RAPAFLO
• RASUVO(AUTO INJECT)(10MG/0.2ML)
• RASUVO(AUTO INJECT)(12.5/0.25)
• RASUVO(AUTO INJECT)(15MG/0.3ML)
• RASUVO(AUTO INJECT)(17.5/0.35)
• RASUVO(AUTO INJECT)(22.5/0.45)
• RASUVO(AUTO INJECT)(25MG/0.5ML)
• RASUVO(AUTO INJECT)(27.5/0.55)
• RASUVO(AUTO INJECT)(30MG/0.6ML)
• RASUVO(AUTO INJECT)(7.5MG/0.15)
• RAYOS
L.A. Care
Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acid
in 365 days or Zonisamide in 365 days
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
Prior prescription for Azelastine Hcl in 120 days
Prior prescription for Voltaren in 120 days
Prior prescription for Apriso in 120 days or Colazal in 120 days or Pentasa in 120
days
Prior prescription for Paxil in 120 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days or
Prevacid in 120 days or Prilosec in 120 days or Protonix in 120 days
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days or
Venlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
Prior prescription for Omeprazole Magnesium in 120 days or Omeprazole in 120
days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonix in 120 days
Prior prescription for Protopic in 120 days or Topical Anti-inflammatory Steroidal in
120 days
Atleast 2 of Prior prescription for Flovent Diskus in 365 days or Qvar in 365 days
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
Prior prescription for Topiramate in 120 days
Prior prescription for Topiramate in 120 days
Prior prescription for Topiramate in 120 days
Prior prescription for Topiramate in 120 days
Prior prescription for Topiramate in 120 days
Prior prescription for Methylphenidate Hcl Cd in 120 days or Ritalin La in 120 days
Prior prescription for Doxazosin Mesylate in 120 days or Prazosin Hcl in 120 days or
Proscar in 120 days or Rapaflo in 120 days or Tamsulosin Hcl in 120 days or
Terazosin Hcl in 120 days or Uroxatral in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 days
or Rheumatrex in 120 days or Trexall in 120 days
Prior prescription for Prednisone in 120 days or Rayos in 120 days
Page 68 of 90
Preferred Drug List Medication Prescribing Limitations
• RELPAX
• REQUIP XL
Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days
Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in
120 days
• RESCULA
Atleast 2 of Prior prescription for Travatan Z in 365 days or Xalatan in 365 days
• RHINOCORT AQUA
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
• ROZEREM
Prior prescription for Zaleplon in 120 days or Zolpidem Tartrate in 120 days
• SAFYRAL
Atleast 2 of Prior prescription for in 365 days or Beyaz in 365 days or Generess Fe in
365 days or Lo Loestrin Fe in 365 days or Lomedia 24 Fe in 365 days or
Loseasonique in 365 days or Microgestin Fe in 365 days or Microgestin in 365 days
or Necon in 365 days or Norethin-eth Estra Ferrous Fum in 365 days or
Norethindron-ethinyl Estradiol in 365 days or Norinyl 1+50 in 365 days or Ortho Tricyclen Lo in 365 days or Ovcon-50 in 365 days or Ovral-28 in 365 days or Pirmella
in 365 days or Portia in 365 days or Seasonale in 365 days or Seasonique in 365 days
or Sharobel in 365 days or Sprintec in 365 days or Sronyx in 365 days or Tri-legest
Fe in 365 days or Tri-norinyl in 365 days or Trinessa in 365 days or Trivora-28 in
365 days or Viorele in 365 days or Wera in 365 days or Zenchent in 365 days or
Zeosa in 365 days or Zovia 1-50e in 365 days
• SANCTURA
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
• SANCUSO
Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days
• SAPHRIS
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
• SEROQUEL XR
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365
days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365
days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• SILENOR
Prior prescription for Silenor in 120 days or Zaleplon in 120 days or Zolpimist in 120
days
• SIMCOR(TBMP 24HR)(1000-20MG)
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(1000-40 MG)
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(500MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(500MG-40MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(750MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
• SOLODYN
Prior prescription for Minocycline Hcl in 120 days
• SORILUX
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
• STAVZOR
Prior prescription for in 120 days or Valproic Acid in 120 days
• SUMAVEL DOSEPRO
Prior prescription for Sumatriptan Succinate in 180 days or Sumatriptan in 180 days
• SYMBICORT
Prior prescription for Advair Hfa in 120 days or Breo Ellipta in 120 days or Dulera in
120 days
• TACLONEX(OINT)
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
• TACLONEX(SUSPENSION)
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
• TANZEUM
Atleast 2 of Prior prescription for Byetta in 365 days or Tolbutamide in 365 days
• TASMAR
Prior prescription for Entacapone in 120 days
• TEVETEN
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
• TEVETEN HCT
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
• TIMOPTIC OCUDOSE
Prior prescription for Timoptic Ocudose in 120 days or Timoptic in 120 days
• TOPICORT(SPRAY)
Prior prescription for Diprosone in 120 days or Fluocinonide in 120 days or
Mometasone Furoate in 120 days or Topicort in 120 days
• TOVIAZ
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
• TREXIMET
Prior prescription for Sumatriptan in 180 days or Sumavel Dosepro in 180 days or
Zomig Zmt in 180 days
• TRIBENZOR
Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
• TROKENDI XR(CAP ER 24H)(100 MG) Prior prescription for Topiramate in 120 days
• TROKENDI XR(CAP ER 24H)(200 MG) Prior prescription for Topiramate in 120 days
L.A. Care
Page 69 of 90
Preferred Drug List Medication Prescribing Limitations
• TROKENDI XR(CAP ER 24H)(25 MG)
• TROKENDI XR(CAP ER 24H)(50 MG)
• UCERIS
• ULORIC
• VECTICAL
• VERAMYST
• VERSACLOZ
• VESICARE
• VICTOZA 2-PAK
• VICTOZA 3-PAK
• VIIBRYD(TAB DS PK)
• VIIBRYD(TAB)
• VIMOVO
• VIMPAT(TAB)
• VYTORIN(TAB)(10 MG-10MG)
• VYTORIN(TAB)(10 MG-20MG)
• VYTORIN(TAB)(10 MG-40MG)
• VYTORIN(TAB)(10 MG-80MG)
• VYVANSE
• XIFAXAN(TAB)(550 MG)
• XYZAL(SOLUTION)
• ZEGERID(CAP)
• ZEGERID(PACKET)
• ZENZEDI
• ZETONNA
• ZIOPTAN
• ZIPSOR
• ZITHRANOL
• ZITHRANOL-RR
• ZOCOR(TAB)(80 MG)
• ZOLPIMIST
• ZOMIG(SPRAY)(2.5 MG)
• ZOMIG(SPRAY)(5 MG)
• ZOMIG(TAB)
• ZORVOLEX
• ZUPLENZ(FILM)(4 MG)
• ZUPLENZ(FILM)(8 MG)
L.A. Care
Prior prescription for Topiramate in 120 days
Prior prescription for Topiramate in 120 days
Prior prescription for Colazal in 120 days
Prior prescription for Uloric in 120 days or Zyloprim in 120 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Seroquel Xr in 365
days or Ziprasidone Hcl in 365 days or Zyprexa Zydis in 365 days
Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days
Prior prescription for Tolbutamide in 120 days
Prior prescription for Tolbutamide in 120 days
Atleast 2 of Prior prescription for Citalopram Hbr in 120 days or Lexapro in 120
days or Paxil Cr in 365 days or Remeron in 120 days or Selfemra in 120 days or
Venlafaxine Hcl Er in 120 days or Zoloft in 120 days or Zyban in 120 days
Atleast 2 of Prior prescription for Citalopram Hbr in 120 days or Lexapro in 120
days or Paxil Cr in 365 days or Remeron in 120 days or Selfemra in 120 days or
Venlafaxine Hcl Er in 120 days or Zoloft in 120 days or Zyban in 120 days
Prior prescription for Naproxen in 120 days or Wal-proxen in 120 days
Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365
days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days
or Valproic Acid in 365 days
Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days
Prior prescription for Lipitor in 120 days
Prior prescription for Lipitor in 120 days
Prior prescription for Zocor in 365 days
Prior prescription for Amphetamine Salt Combo in 120 days or Ritalin in 120 days
Prior prescription for Lactulose in 120 days
Prior prescription for Desloratadine in 120 days or Xyzal in 120 days
Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days or
Prevacid in 120 days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonix
in 120 days
Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days or
Prevacid in 120 days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonix
in 120 days
Prior prescription for Procentra in 120 days or Zenzedi in 120 days
Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days
Atleast 2 of Prior prescription for Travatan Z in 365 days or Xalatan in 365 days
Prior prescription for Diclofenac Sodium-misoprostol in 120 days or Voltaren-xr in
120 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Prior prescription for Topical Anti-inflammatory Steroidal in 120 days
Prior prescription for Vytorin in 365 days
Prior prescription for Zolpidem Tartrate in 120 days
Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days
Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days
Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days
Prior prescription for Voltaren-xr in 120 days
Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days or Zuplenz in 120 days
Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days or Zuplenz in 120 days
Page 70 of 90
Preferred Drug List Medication Prescribing Limitations
PRIOR AUTHORIZATION RESRICTION - FORMULARY
• ABSTRAL
• ACTEMRA
• ACTIQ
• ADCIRCA
• ADEMPAS
• AFINITOR DISPERZ
• AFINITOR(TAB)(10 MG)
• AFINITOR(TAB)(2.5 MG)
• AFINITOR(TAB)(5 MG)
• AFINITOR(TAB)(7.5 MG)
• ALDARA
• AMPYRA
• AMTURNIDE
• ANDRODERM
• ANDROGEL
• APOKYN
• APTIVUS
• ARANESP
• AROMASIN
• AUBAGIO
• AVONEX
• AVONEX ADMINISTRATION PACK
• AVONEX PEN
• AXIRON
• BERINERT
• BETASERON
• BETHKIS
• BOSULIF(TAB)(100 MG)
• BOSULIF(TAB)(500 MG)
• BUNAVAIL
• BUPRENORPHINE-NALOXONE
• CAPRELSA(TAB)(100 MG)
• CAPRELSA(TAB)(300 MG)
• CAYSTON
• CIMZIA
• CINRYZE
• COMETRIQ
• COMPLERA
• COPAXONE
• CYSTARAN
• DELATESTRYL(SYRINGE)
• DELATESTRYL(VIAL)
• DEPO-TESTOSTERONE(VIAL)(100 MG/ML)
• DEPO-TESTOSTERONE(VIAL)(200 MG/ML)
• DICLOFENAC SODIUM
• EDURANT
• ELIGARD
• ENBREL
• EPOGEN
• ERIVEDGE
• EVISTA
• EXTAVIA
• FARESTON
• FENTORA
• FIRAZYR
• FORTESTA
• GATTEX
• GENOTROPIN
• GILENYA
• GILOTRIF
• GLEEVEC
• GRASTEK
L.A. Care
• HETLIOZ
• HUMATROPE
• HUMIRA
• ICLUSIG(TAB)(15 MG)
• ICLUSIG(TAB)(45 MG)
• IMBRUVICA
• INCIVEK
• INCRELEX
• INLYTA(TAB)(1 MG)
• INLYTA(TAB)(5 MG)
• INTELENCE
• INTRON A
• IPRIVASK
• JAKAFI
• JUBLIA
• JUXTAPID
• KALYDECO
• KERYDIN
• KINERET
• KORLYM
• KYNAMRO
• LAZANDA
• LETAIRIS
• LEUKINE
• LEXIVA
• MEKINIST
• NEULASTA
• NEUPOGEN
• NEXAVAR
• NORDITROPIN FLEXPRO
• NORDITROPIN NORDIFLEX
• NORTHERA
• NUEDEXTA
• NUTROPIN AQ
• NUTROPIN AQ NUSPIN
• NUVIGIL
• NYMALIZE
• OLYSIO
• OMNITROPE
• OPSUMIT
• ORALAIR
• ORENCIA
• ORENITRAM ER
• OTEZLA
• PEGASYS
• PEGASYS PROCLICK
• PEGINTRON
• PEGINTRON REDIPEN
• POMALYST
• PRADAXA
• PROCRIT
• PROCYSBI
• PROMACTA
• PROVIGIL
• PULMOZYME
• QUTENZA
• RAGWITEK
• RAVICTI
• REBIF
• REBIF REBIDOSE
• RELISTOR
• REMODULIN
Page 71 of 90
Preferred Drug List Medication Prescribing Limitations
• REVLIMID
• RUCONEST
• SAIZEN
• SELZENTRY
• SEROSTIM
• SIMPONI
• SIRTURO
• SOLTAMOX
• SOVALDI
• SPRYCEL(TAB)(100 MG)
• SPRYCEL(TAB)(140 MG)
• SPRYCEL(TAB)(20 MG)
• SPRYCEL(TAB)(50 MG)
• SPRYCEL(TAB)(70 MG)
• SPRYCEL(TAB)(80 MG)
• STELARA
• STIVARGA
• STRIANT
• SUBOXONE
• SUBSYS
• SUCRAID
• SUTENT
• SYLATRON
• SYLATRON 4-PACK
• SYNRIBO
• TAFINLAR
• TAMOXIFEN CITRATE
• TARCEVA
• TARGRETIN
• TASIGNA
• TECFIDERA
• TEKAMLO
• TEKTURNA
• TEKTURNA HCT
• TEMODAR
• TESTIM
• TESTOSTERONE
• TESTOSTERONE CYPIONATE
• TEV-TROPIN
• THALOMID
• TIVICAY
• TOBI
• TOBI PODHALER
• TRACLEER
• TRIZIVIR
• TYKERB
• TYVASO
• VALCHLOR
• VECAMYL
• VENTAVIS
• VICTRELIS
• VOGELXO(GEL MD PMP)
• VOGELXO(GEL PACKET)
• VOTRIENT
• XALKORI
• XELJANZ
• XELODA(TAB)(150 MG)
• XELODA(TAB)(500 MG)
• XTANDI
• XYREM
• ZELBORAF
• ZORBTIVE
• ZUBSOLV
• ZYCLARA(CREAM PACK)
L.A. Care
• ZYCLARA(CRM MD PMP)(2.5 %)
• ZYCLARA(CRM MD PMP)(3.75 %)
• ZYDELIG
• ZYKADIA
• ZYTIGA
• ZYVOX
Page 72 of 90
Preferred Drug List Medication Prescribing Limitations
GENDER LIMITS - FORMULARY
• APRI
• AVODART
• CAMRESE
• CONCEPTROL(OTC)
• CRYSELLE
• FEMCAP
• FOLIC ACID(OTC)
• GYNOL II(OTC)
• JALYN
• LEVORA-28
• LOESTRIN
• LOESTRIN FE
• MICROGESTIN
• MICROGESTIN FE
• NECON
• NEXT CHOICE ONE DOSE
• NORA-BE
• NORINYL 1+50
• OCELLA
• ORTHO-NOVUM
• PLAN B ONE-STEP(OTC)
• PROSCAR
• RAPAFLO
• SPRINTEC
• TODAY CONTRACEPTIVE
SPONGE(OTC)
• VCF(OTC)
• VIORELE
• WIDE SEAL DIAPHRAGM
• WYMZYA FE
• ZOVIA 1-35E
L.A. Care
Female Only
Male Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Male Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Male Only
Male Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Female Only
Page 73 of 90
Index
-#0.5 NORMAL SALINE.............................................. 27
0.9 % SODIUM CHLORIDE......................................28
1 + 1-F...................................................................... 17
2TEK(OTC)...............................................................24
8-MOP...................................................................... 22
-AAA/ANTIPYRN/BCAINE/POLICO#1/AL................... 27
ABACAVIR SULFATE............................................... 38
ABACAVIR SULFATE/LAMIVUDINE........................ 37
ABACAVIR/DOLUTEGRAVIR/LAMIVUDI.................38
ABACAVIR/LAMIVUDINE/ZIDOVUDINE..................37
ABATACEPT.............................................................39
ABILIFY DISCMELT(TAB RDP DIS)(10 MG)......9, 56,
6
1
ABILIFY DISCMELT(TAB RDP DIS)(15 MG)......9, 56,
6
1
ABILIFY(SOLUTION)..................................... 9, 56, 61
ABILIFY(TAB)................................................. 9, 56, 61
ABIRATERONE ACETATE....................................... 42
ABSORICA............................................................... 16
ABSTRAL........................................................... 44, 71
ACANYA................................................................... 16
ACARBOSE..............................................................23
ACCOLATE.................................................................6
ACCU-CHEK FASTCLIX(OTC)................................ 26
ACCU-CHEK SOFTCLIX(OTC)................................26
ACCU-CHEK(OTC).................................................. 26
ACCUPRIL................................................................12
ACCURETIC............................................................. 11
ACD.......................................................................... 31
ACE AEROSOL CLOUD ENHANCER....................... 6
ACEBUTOLOL HCL................................................. 12
ACEON..................................................................... 12
ACETAMINOPHEN W/CODEINE.............................46
ACETAMINOPHEN WITH CODEINE....................... 46
ACETAMINOPHEN/CAFFEINE/BUTALB................. 44
ACETAMINOPHEN-BUTALBITAL............................ 44
ACETAMINOPHEN-CODEINE................................. 46
ACETAZOLAMIDE....................................................30
ACETIC ACID..................................................... 20, 27
ACETIC ACID/ALUMINUM ACETATE......................27
ACETIC ACID/HYDROCORTISONE........................27
ACETOHYDROXAMIC ACID................................... 41
ACETYLCYSTEINE..................................................44
ACIPHEX SPRINKLE................................... 49, 56, 61
ACITRETIN...............................................................22
ACLIDINIUM BROMIDE............................................. 6
ACLOVATE............................................................... 19
ACTEMRA.......................................................... 39, 71
ACTICLATE.................................................. 35, 56, 61
ACTIGALL................................................................ 41
ACTIMMUNE............................................................ 34
ACTIQ.................................................................44, 71
ACTONEL(TAB)(150 MG)............................ 28, 56, 61
ACTONEL(TAB)(30 MG).............................. 28, 56, 61
ACTONEL(TAB)(35 MG).............................. 28, 56, 61
ACTONEL(TAB)(5 MG)................................ 28, 56, 61
ACTOPLUS MET................................................23, 61
ACTOPLUS MET XR..........................................23, 61
ACTOS..................................................................... 23
ACULAR................................................................... 29
ACULAR LS..............................................................29
ACUVAIL...................................................................29
ACYCLOVIR....................................................... 18, 37
ACYCLOVIR/HYDROCORTISONE..........................18
ACYCLOVIR/LIDOCAINE HCL................................ 18
ACZONE...................................................................17
ADALAT CC..............................................................13
ADALIMUMAB.......................................................... 39
ADAPALENE............................................................ 17
ADAPALENE/BENZOYL PEROXIDE....................... 16
ADASUVE...................................................................9
ADCIRCA..................................................... 13, 61, 71
ADDERALL...........................................................9, 56
ADEFOVIR DIPIVOXIL.............................................38
ADEMPAS.......................................................... 13, 71
ADJUSTABLE LANCING DEVICE(OTC)................. 25
ADOXA..................................................................... 35
ADOXA CK............................................................... 35
ADOXA PAK................................................. 35, 56, 61
ADOXA TT................................................................35
ADRENACLICK........................................................ 42
ADRENALIN CHLORIDE..........................................16
ADVAIR DISKUS.................................................. 6, 56
ADVAIR HFA.........................................................6, 56
ADVANCED AM/PM................................................. 51
ADVANCED LANCING DEVICE(OTC).....................26
L.A. Care
ADVATE....................................................................31
ADVATE H................................................................ 31
ADVATE L.................................................................31
ADVATE M................................................................31
ADVATE SH..............................................................31
ADVATE UH..............................................................31
ADVICOR(TBMP 24HR)(1000-20MG)......... 14, 56, 61
ADVICOR(TBMP 24HR)(1000-40 MG)........ 14, 56, 61
ADVICOR(TBMP 24HR)(500MG-20MG)......14, 56,
6
1
ADVICOR(TBMP 24HR)(750MG-20MG)......14, 56,
6
1
ADVOCATE BLOOD GLUCOSE MONITOR(OTC)......
2
4
ADVOCATE DUO(OTC)........................................... 24
ADVOCATE RAPID-SAFE(OTC)..............................26
ADVOCATE REDI-CODE(OTC)............................... 24
ADVOCATE REDI-CODE+(OTC)............................. 24
AEROCHAMBER MINI............................................... 6
AEROCHAMBER MV................................................. 6
AEROCHAMBER PLUS............................................. 6
AEROCHAMBER PLUS FLOW-VU............................6
AEROCHAMBER PLUS Z STAT................................ 6
AEROCHAMBER WITH FLOWSIGNAL.....................7
AEROCHAMBER Z-STAT PLUS................................ 7
AEROECLIPSE.......................................................... 7
AEROECLIPSE II....................................................... 7
AEROGEAR ASTHMA ACTION KIT.......................... 7
AEROSPAN.................................................... 6, 56, 61
AEROTRACH PLUS...................................................7
AEROVENT II............................................................. 7
AFATINIB DIMALEATE.............................................42
AFINITOR DISPERZ.......................................... 42, 71
AFINITOR(TAB)(10 MG)...............................42, 56, 71
AFINITOR(TAB)(2.5 MG)..............................42, 56, 71
AFINITOR(TAB)(5 MG).................................42, 56, 71
AFINITOR(TAB)(7.5 MG)....................................42, 71
AGAMATRIX AMP(OTC).......................................... 24
AGGRENOX............................................................. 32
AGRYLIN.................................................................. 32
AKNE-MYCIN........................................................... 17
AKTEN......................................................................29
ALA-QUIN.................................................................17
ALA-TET................................................................... 36
ALBENDAZOLE....................................................... 37
ALBENZA................................................................. 37
ALBIGLUTIDE.......................................................... 23
ALBUTEROL SULFATE..............................................6
ALC/ISOPROPANOL/PROP GLY/WATER............... 20
ALCAFTADINE......................................................... 29
ALCLOMETASONE DIPROPIONATE...................... 19
ALCORTIN A............................................................ 17
ALDACTAZIDE(TAB)(25 MG-25MG)........................13
ALDACTAZIDE(TAB)(50 MG-50MG)........................13
ALDACTONE............................................................13
ALDARA....................................................... 34, 56, 71
ALDOMET................................................................ 12
ALDORIL-D50.......................................................... 12
ALENDRONATE SODIUM........................................28
ALENDRONATE SODIUM(SOLUTION).............28, 56
ALENDRONATE SODIUM(TAB).............................. 28
ALENDRONATE SODIUM/VITAMIN D3...................28
ALFERON N............................................................. 34
ALFUZOSIN HCL..................................................... 49
ALINIA...................................................................... 17
ALISKIREN HEMIFUMARATE................................. 13
ALISKIREN/AMLODIPIN/HCTHIAZIDE....................13
ALISKIREN/AMLODIPINE BESYLATE.................... 13
ALISKIREN/HYDROCHLOROTHIAZIDE................. 13
ALKERAN................................................................. 42
ALLFEN CDX........................................................... 16
ALLOPURINOL........................................................ 31
ALMOTRIPTAN MALATE......................................... 45
ALOCRIL.................................................................. 30
ALOGLIPTIN BENZ/METFORMIN HCL................... 22
ALOGLIPTIN BENZ/PIOGLITAZONE.......................22
ALOGLIPTIN BENZOATE........................................ 23
ALOMIDE..................................................................30
ALOQUIN..................................................................17
ALORA............................................................... 33, 56
ALOSETRON HCL................................................... 41
ALPHAGAN P(DROPS)(0.1 %)................................ 30
ALPHAGAN P(DROPS)(0.15 %).............................. 30
ALPHANATE.............................................................31
ALPHANINE SD....................................................... 32
ALPRAZOLAM............................................................9
ALPRAZOLAM INTENSOL.........................................9
ALPROLIX................................................................ 32
ALREX...................................................................... 29
ALSUMA............................................................. 45, 56
ALTABAX.................................................................. 18
ALTACE.................................................................... 12
ALTERA NEBULIZER.................................................7
ALTERNATE SITE LANCING DEVICE(OTC)...........26
ALTOPREV...................................................14, 56, 61
ALTRETAMINE......................................................... 42
ALUMINUM CHLORIDE........................................... 20
ALVESCO....................................................... 6, 56, 61
ALVIMOPAN............................................................. 41
AMANTADINE.......................................................... 46
AMANTADINE HCL.................................................. 46
AMARYL................................................................... 23
AMBIEN.............................................................. 10, 56
AMBRISENTAN........................................................ 13
AMCINONIDE...........................................................19
AMERGE............................................................ 45, 56
AMERICET............................................................... 44
AMETHYST........................................................ 15, 61
AMILORIDE HCL......................................................13
AMILORIDE/HYDROCHLOROTHIAZIDE................ 13
AMILORIDE-HYDROCHLOROTHIAZIDE................ 13
AMINO ACID CERVICAL......................................... 50
AMINOBENZOATE POTASSIUM.............................54
AMINOCAPROIC ACID............................................ 31
AMINOLEVULINIC ACID HCL..................................43
AMINOPHYLLINE.......................................................7
AMINOSALICYLIC ACID.......................................... 36
AMIODARONE HCL................................................. 11
AMITIZA..............................................................41, 56
AMITRIP HCL/CHLORDIAZEPOXIDE....................... 8
AMITRIPTYLINE HCL................................................ 8
AMLODIPINE BES/OLMESARTAN MED.................12
AMLODIPINE BESYLATE........................................ 12
AMLODIPINE BESYLATE/BENAZEPRIL................. 11
AMLODIPINE/ATORVASTATIN................................ 15
AMLODIPINE/VALSARTAN......................................12
AMLODIPINE/VALSARTAN/HCTHIAZID..................11
AMMONIUM LACTATE.............................................20
AMOX TR-POTASSIUM CLAVULANATE.................35
AMOXAPINE.............................................................. 8
AMOXICILLIN........................................................... 35
AMOXICILLIN TRIHYDRATE................................... 35
AMOXICILLIN/POTASSIUM CLAV...........................35
AMOXIL.................................................................... 35
AMPICILLIN TRIHYDRATE...................................... 35
AMPYRA............................................................ 43, 71
AMRIX...................................................................... 47
AMTURNIDE...................................................... 13, 71
ANACAINE............................................................... 22
ANADROL-50........................................................... 33
ANAFRANIL................................................................8
ANAGRELIDE HCL.................................................. 32
ANAKINRA............................................................... 39
ANALPRAM E.......................................................... 41
ANALPRAM HC........................................................41
ANAPROX................................................................ 40
ANAPROX DS.......................................................... 40
ANASTROZOLE....................................................... 42
ANCOBON................................................................36
ANDRODERM.................................................... 33, 71
ANDROGEL....................................................... 33, 71
ANDROID................................................................. 33
ANDROXY.......................................................... 33, 56
ANGELIQ..................................................................33
ANIMI-3.....................................................................51
ANORO ELLIPTA................................................. 6, 56
ANSAID.................................................................... 40
ANTABUSE.................................................................9
ANTARA............................................................. 14, 61
ANTHRALIN............................................................. 22
ANTHRALIN MICRONIZED......................................22
ANTIHEMOPH.FVIII PLAS/ALB FREE.................... 31
ANTIHEMOPHILIC FACTOR, HUM REC.................31
ANTIHEMOPHILIC FACTOR, HUMAN.................... 31
ANTIHEMOPHILIC FACTOR/VWF...........................31
ANTI-INHIBITOR COAGULANT COMP................... 31
ANTIPYRINE/BENZOCAIN/GLY/ZINC.....................27
ANTIPYRINE/BENZOCAINE....................................27
ANTIPYRINE-BENZOCAINE....................................27
ANTISPASMODIC.................................................... 48
ANTIVERT.................................................................. 5
ANZEMET(TAB)(100 MG).............................. 5, 56, 61
ANZEMET(TAB)(50 MG)................................ 5, 56, 61
APEXICON E............................................................19
APIDRA.................................................................... 27
APIDRA SOLOSTAR................................................ 27
Page 74 of 90
Index
APIXABAN................................................................31
APLENZIN...................................................... 8, 56, 61
APOKYN.......................................................46, 56, 71
APOMORPHINE HCL...............................................46
APOP........................................................................17
APRACLONIDINE HCL............................................ 30
APREMILAST........................................................... 39
APREPITANT............................................................. 5
APRI................................................................... 15, 73
APRISO.................................................................... 40
APTIOM(TAB)(200 MG)................................46, 56, 61
APTIOM(TAB)(400 MG)................................46, 56, 62
APTIOM(TAB)(600 MG)................................46, 56, 62
APTIOM(TAB)(800 MG)................................46, 56, 62
APTIVUS............................................................ 37, 71
AQUA GLYCOLIC HC.............................................. 19
AQUA LANCE LANCING DEVICE(OTC)................. 26
AQUA-MEPHYTON.................................................. 33
AQUAPHILIC W/TAC + CARBAMIDE...................... 20
AQUAPHILIC W/TRIAMCINOLONE.........................20
ARALEN PHOSPHATE............................................ 37
ARANESP.......................................................... 32, 71
ARAVA...................................................................... 39
ARCALYST............................................................... 39
ARCAPTA NEOHALER.................................. 6, 56, 62
ARESTIN.................................................................. 44
ARFORMOTEROL TARTRATE.................................. 6
ARICEPT.................................................................... 8
ARIMIDEX................................................................ 42
ARIPIPRAZOLE..........................................................9
ARISTOCORT.......................................................... 39
ARIXTRA(SYRINGE)(10MG/0.8ML).................. 32, 56
ARIXTRA(SYRINGE)(2.5 MG/0.5)..................... 32, 56
ARIXTRA(SYRINGE)(5MG/0.4ML).................... 32, 56
ARIXTRA(SYRINGE)(7.5MG/0.6)...................... 32, 56
ARMODAFINIL......................................................... 10
ARMOUR THYROID.................................................29
AROMASIN........................................................ 42, 71
ARTEMETHER/LUMEFANTRINE............................ 37
ARTHROTEC 50...................................................... 40
ARTHROTEC 75...................................................... 40
ASA/SALICYLAM/ACETAMINOPH/CAFF................44
ASACOL HD....................................................... 40, 62
ASCORBIC ACID..................................................... 54
ASENAPINE MALEATE..............................................9
ASMANEX...................................................... 6, 56, 62
ASP.......................................................................... 44
ASPIRIN................................................................... 44
ASPIRIN EC............................................................. 44
ASPIRIN EC(OTC)............................................. 44, 55
ASPIRIN/DIPYRIDAMOLE....................................... 32
ASSURE 4(OTC)...................................................... 24
ASSURE PLATINUM(OTC)...................................... 24
ASSURE PRO(OTC)................................................ 24
ASTAGRAF XL......................................................... 34
ASTEPRO...................................................... 5, 56, 62
ASTHMAPACK CHILDREN'S.....................................7
ASTRINGYN.............................................................33
ATABEX EC.............................................................. 51
ATACAND................................................................. 12
ATACAND HCT......................................................... 11
ATAZANAVIR SULFATE........................................... 38
ATELVIA....................................................... 28, 56, 62
ATENOLOL...............................................................12
ATENOLOL/CHLORTHALIDONE.............................12
ATIVAN....................................................................... 9
AT-LAST(OTC)......................................................... 24
ATOMOXETINE HCL.......................................... 10, 11
ATORVASTATIN CALCIUM...................................... 14
ATOVAQUONE......................................................... 37
ATOVAQUONE/PROGUANIL HCL...........................37
ATRALIN.............................................................17, 55
ATRAPRO CP...........................................................20
ATRAPRO DERMAL SPRAY....................................21
ATRAPRO HYDROGEL........................................... 20
ATRIPLA............................................................. 38, 56
ATROPINE SULFATE...............................................31
ATROVENT.............................................................. 44
ATROVENT HFA.................................................. 6, 56
AUBAGIO........................................................... 43, 71
AUGMENTIN ES-600............................................... 35
AUGMENTIN(SUSP RECON)(125-31.25/).............. 35
AUGMENTIN(SUSP RECON)(250-62.5/5).............. 35
AUGMENTIN(TAB)................................................... 35
AURANOFIN.............................................................39
AURSTAT................................................................. 20
AUTO-LANCET MINI(OTC)......................................26
AUTOLET IMPRESSION(OTC)................................26
L.A. Care
AUTOLET LANCING DEVICE(OTC)........................26
AUVI-Q............................................................... 42, 62
AVALIDE................................................................... 11
AVANDAMET............................................................23
AVANDARYL............................................................ 23
AVANDIA.................................................................. 23
AVAPRO................................................................... 12
AVAR LS................................................................... 18
AVAR(CLEANSER)...................................................18
AVAR(MED PAD)...................................................... 18
AVC...........................................................................50
AVELOX....................................................................35
AVIDOXY.................................................................. 35
AVIDOXY DK............................................................ 36
AVINZA..................................................................... 45
AVITENE...................................................................33
AVODART.....................................................49, 62, 73
AVONEX............................................................. 43, 71
AVONEX ADMINISTRATION PACK................... 43, 71
AVONEX PEN.....................................................43, 71
AXERT..........................................................45, 56, 62
AXID......................................................................... 49
AXIRON.............................................................. 33, 71
AXITINIB...................................................................42
AYGESTIN................................................................34
AZASAN................................................................... 34
AZASITE...................................................................30
AZATHIOPRINE....................................................... 34
AZELAIC ACID................................................... 16, 17
AZELASTINE HCL......................................... 5, 29, 56
AZELASTINE/FLUTICASONE....................................5
AZELEX.................................................................... 16
AZILECT............................................................. 46, 56
AZILSARTAN MED/CHLORTHALIDONE................. 11
AZILSARTAN MEDOXOMIL.....................................12
AZITHROMYCIN................................................ 30, 35
AZOPT......................................................................30
AZOR..................................................................12, 62
AZTREONAM LYSINE..............................................34
-BB CMPLX 4/VIT D3/C/FA/ZINC OX.......................... 54
B COMPLEX & C NO.20/FOLIC ACID..................... 54
B COMPLEX 100......................................................54
B COMPLEX WITH VITAMIN C................................50
BABY NEBULIZER..................................................... 7
BACITRACIN............................................................ 30
BACITRACIN/POLYMYXIN B SULFATE.................. 30
BACITRACIN-POLYMYXIN...................................... 30
BACLOFEN.............................................................. 47
BACMIN....................................................................51
BACTOCILL..............................................................35
BACTRIM..................................................................34
BACTROBAN........................................................... 17
BACTROBAN NASAL.............................................. 44
BAL-CARE DHA ESSENTIAL.................................. 52
BALSALAZIDE DISODIUM...................................... 40
BANZEL(ORAL SUSP).................................47, 56, 62
BANZEL(TAB)(200 MG)............................... 47, 56, 62
BANZEL(TAB)(400 MG)............................... 47, 56, 62
BARACLUDE............................................................38
BARBIDONNA.......................................................... 48
B-CAINE/ZINC CL/PINE/CPYRD............................. 40
B-COMPLEX.............................................................54
BEBULIN.................................................................. 32
BECAPLERMIN........................................................ 26
BECLOMETHASONE DIPROPIONATE.................5, 6
BECONASE AQ............................................. 5, 56, 62
BEDAQUILINE FUMARATE..................................... 36
BELLADONNA ALKALOIDS/PHENOBARB............. 48
BELLADONNA-OPIUM.............................................45
BENAZEPRIL HCL................................................... 12
BENAZEPRIL/HYDROCHLOROTHIAZIDE..............11
BENAZEPRIL-HYDROCHLOROTHIAZIDE..............11
BENDROFLUMETHIAZIDE......................................13
BENEFIX.................................................................. 32
BENICAR............................................................12, 62
BENICAR HCT....................................................11, 62
BENOXINATE HCL/FLUORESCEIN NA.................. 29
BENOXYLDOXY 30................................................. 36
BENOXYLDOXY 60................................................. 36
BENSAL HP............................................................. 21
BENTYL....................................................................48
BENZACLIN(GEL W/PUMP).................................... 16
BENZACLIN(GEL).................................................... 16
BENZAMYCIN.......................................................... 17
BENZAMYCINPAK................................................... 17
BENZOCAINE.................................................... 22, 27
BENZONATATE........................................................ 16
BENZOYL PEROXIDE............................................. 21
BENZOYL PEROXIDE MICROSPHERES............... 21
BENZOYL PEROXIDE/HYDROCORTISON............ 17
BENZOYL PEROXIDE/SULFUR.............................. 21
BENZOYL PEROXIDE/VIT E MIX............................ 21
BENZTROPINE MESYLATE.................................... 46
BENZYL ALCOHOL................................................. 18
BEPOTASTINE BESILATE.......................................29
BEPREVE.................................................................29
BERACTANT............................................................ 44
BERINERT..........................................................39, 71
BESIFLOXACIN HCL............................................... 30
BESIVANCE............................................................. 30
BETADINE................................................................ 29
BETAGAN.................................................................30
BETAMETHASONE DIPROPIONATE......................19
BETAMETHASONE VALERATE...............................19
BETAMETHASONE/PROPYLENE GLYC................ 19
BETAPACE............................................................... 12
BETASERON......................................................43, 71
BETAXOLOL HCL.............................................. 12, 30
BETHANECHOL CHLORIDE................................... 42
BETHKIS............................................................ 36, 71
BETIMOL.................................................................. 30
BETOPTIC S............................................................ 30
BEXAROTENE................................................... 21, 43
BEYAZ................................................................ 15, 62
BIAXIN...................................................................... 35
BICALUTAMIDE....................................................... 42
BICHLORACETIC ACID........................................... 21
BIDIL.........................................................................13
BILTRICIDE.............................................................. 37
BIMATOPROST........................................................30
BINOSTO......................................................28, 56, 62
BIOCLATE................................................................ 31
BIONECT..................................................................21
BISMUTH/METRONID/TETRACYCLINE................. 49
BISOPROLOL FUMARATE...................................... 12
BISOPROLOL FUMARATE/HCTZ........................... 12
BLEPHAMIDE.......................................................... 30
BLEPHAMIDE S.O.P................................................ 30
BLOOD GLUCOSE CTL HIGH,NML&LOW..............23
BLOOD GLUCOSE METER(OTC)........................... 24
BLOOD GLUCOSE MONITOR(OTC).......................24
BLOOD GLUCOSE MONITORING(OTC)................ 24
BLOOD GLUCOSE STRIPS-DISPMETER.............. 23
BLOOD SUGAR DIAGNOSTIC................................ 23
BLOOD-GL & BP METER,ADULT CUFF................. 23
BLOOD-GLU METER,CONT/TRANSMIT................ 24
BLOOD-GLUC.METER& WRIST BP MON.............. 24
BLOOD-GLUCOSE METER...............................24, 25
BLOOD-GLUCOSE METER(OTC)...........................24
BLOOD-GLUCOSE METER,CONTINUOUS............25
BOCEPREVIR.......................................................... 38
BONIVA.................................................................... 28
BOSENTAN.............................................................. 13
BOSULIF(TAB)(100 MG).............................. 42, 56, 71
BOSULIF(TAB)(500 MG).............................. 42, 56, 71
BOSUTINIB.............................................................. 42
BP-50% UREA......................................................... 21
BPO.......................................................................... 21
BREATHERITE...........................................................7
BREATHRITE............................................................. 7
BREO ELLIPTA.................................................... 6, 56
BRILINTA............................................................32, 56
BRIMONIDINE TARTRATE................................ 17, 30
BRIMONIDINE TARTRATE/TIMOLOL......................30
BRINTELLIX................................................... 8, 56, 62
BRINZOLAMIDE.......................................................30
BRINZOLAMIDE/BRIMONID TART..........................30
BRISDELLE.................................................... 8, 56, 62
BROFED...................................................................16
BROMFED DM......................................................... 16
BROMFENAC SODIUM........................................... 29
BROMOCRIPTINE MESYLATE......................... 23, 46
BROMPHENIRAM/PHENYLEPHRINE/DM.............. 16
BRONCOMAR GG..................................................... 6
BROVANA............................................................ 6, 56
BUCALCIDE............................................................. 44
BUCALSEP.............................................................. 40
BUDESONIDE.................................................. 5, 6, 39
BUDESONIDE/FORMOTEROL FUMARATE............. 6
BUMETANIDE.......................................................... 13
BUNAVAIL.......................................................... 46, 71
BUPAP......................................................................44
BUPHENYL.............................................................. 41
BUPRENEX.............................................................. 46
BUPRENORPHINE.................................................. 44
Page 75 of 90
Index
BUPRENORPHINE HCL.......................................... 46
BUPRENORPHINE HCL/NALOXONE HCL............. 46
BUPRENORPHINE-NALOXONE....................... 46, 71
BUPROBAN..............................................................48
BUPROPION HBR......................................................8
BUPROPION HCL................................................ 8, 48
BUSPIRONE HCL...................................................... 9
BUSULFAN...............................................................42
BUTABARBITAL SODIUM........................................10
BUTALB/ACETAMINOPHEN/CAFFEINE................. 44
BUTALB-CAFF-ACETAMINOPH-CODEIN...............46
BUTALBIT/ACETAMIN/CAFF/CODEINE..................46
BUTALBITAL/ACETAMINOPHEN.............................44
BUTALBITAL/ASPIRIN/CAFFEINE.......................... 44
BUTALBITAL-ACETAMINOPHEN-CAFFE............... 44
BUTENAFINE HCL...................................................17
BUTISOL SODIUM................................................... 10
BUTORPHANOL TARTRATE................................... 44
BUTRANS.......................................................... 44, 56
BUTYLATED HYDROXYTOLUENE......................... 17
BUTYLATED HYDROXYTOLUENE(BHT)............... 17
BYDUREON................................................. 23, 56, 62
BYDUREON PEN......................................... 23, 56, 62
BYETTA(PEN INJCTR)(10MCG/0.04)..........23, 56, 62
BYETTA(PEN INJCTR)(5MCG/0.02)............23, 56, 63
BYSTOLIC................................................................ 12
-CC1 ESTERASE INHIBITOR......................................39
C1 ESTERASE INHIBITOR, RECOMB.................... 39
CABERGOLINE........................................................29
CABOZANTINIB S-MALATE.................................... 42
CADEXOMER IODINE............................................. 17
CADUET............................................................. 15, 56
CAFCIT.......................................................................7
CAFERGOT........................................................45, 56
CAFFEINE CITRATED............................................... 7
CAL CARB/MGOX/D3/B12/FA/B6/BOR................... 50
CALAN SR................................................................13
CALCIPOTRIENE...............................................22, 63
CALCIPOTRIENE/BETAMETHASONE....................22
CALCITONIN,SALMON,SYNTHETIC...................... 28
CALCITRIOL...................................................... 22, 54
CALCIUM ACETATE................................................ 27
CALCIUM CARBONATE/MAG CARB/FA.................27
CALFACTANT...........................................................44
CAMBIA.............................................................. 45, 56
CAMRESE.................................................... 15, 56, 73
CANAGLIFLOZIN..................................................... 23
CANAGLIFLOZIN/METFORMIN HCL...................... 23
CANASA................................................................... 40
CANDESARTAN CILEXETIL....................................12
CANDESARTAN/HYDROCHLOROTHIAZID............11
CANTIL..................................................................... 48
CAPECITABINE........................................................42
CAPEX SHAMPOO.................................................. 19
CAPITAL W-CODEINE............................................. 46
CAPRELSA(TAB)(100 MG).......................... 43, 56, 71
CAPRELSA(TAB)(300 MG).......................... 43, 56, 71
CAPSAICIN/SKIN CLEANSER................................ 21
CAPTOPRIL............................................................. 12
CAPTOPRIL/HYDROCHLOROTHIAZIDE................11
CAPTOPRIL-HYDROCHLOROTHIAZIDE................11
CARAC..................................................................... 21
CARAFATE(ORAL SUSP)........................................ 48
CARAFATE(TAB)......................................................49
CARBACHOL........................................................... 30
CARBAGLU.............................................................. 41
CARBAMAZEPINE............................................... 9, 46
CARBATROL............................................................ 46
CARBIDOPA.............................................................46
CARBIDOPA/LEVODOPA........................................ 46
CARBIDOPA/LEVODOPA/ENTACAPONE...............46
CARBIDOPA-LEVODOPA........................................ 46
CARBINOXAMINE MALEATE.............................. 5, 55
CARBIT/EQUIS XT/ETHAN/CHIT/MSM...................21
CAR-B-PEN TA/CHLOR-TAN...................................16
CARDENE SR.......................................................... 13
CARDIZEM CD.........................................................12
CARDIZEM LA..........................................................12
CARDURA................................................................ 11
CARDURA XL...........................................................11
CAREONE(OTC)...................................................... 26
CARESENS N VOICE(OTC).................................... 24
CARESENS N(OTC)................................................ 24
CARGLUMIC ACID...................................................41
CARISOPRODOL.....................................................47
CARISOPRODOL/ASPIRIN..................................... 47
CARISOPRODOL-ASPIRIN..................................... 47
L.A. Care
CARISOPRODOL-ASPIRIN-CODEINE....................44
CARMUSTINE IN POLIFEPROSAN 20................... 42
CARTEOLOL HCL....................................................30
CARVEDILOL........................................................... 11
CARVEDILOL PHOSPHATE.................................... 11
CASODEX................................................................ 42
CATAFLAM............................................................... 40
CATAPRES...............................................................12
CATAPRES-TTS 1....................................................12
CATAPRES-TTS 2....................................................12
CATAPRES-TTS 3....................................................12
CAVAN-EC SOD DHA.............................................. 52
CAYSTON...........................................................34, 71
CEDAX(CAP)............................................................34
CEDAX(SUSP RECON)(180 MG/5ML).................... 34
CEDAX(SUSP RECON)(90 MG/5 ML)..................... 34
CEFACLOR.............................................................. 34
CEFADROXIL........................................................... 34
CEFDINIR.................................................................34
CEFDITOREN PIVOXIL........................................... 34
CEFIXIME.................................................................34
CEFPODOXIME PROXETIL.................................... 34
CEFPROZIL..............................................................34
CEFTIBUTEN DIHYDRATE......................................34
CEFTIN(SUSP RECON)...........................................34
CEFTIN(TAB)............................................................34
CEFUROXIME AXETIL............................................ 34
CELEBREX.................................................. 40, 55, 63
CELECOXIB............................................................. 40
CELEXA..................................................................... 8
CELLCEPT(CAP)..................................................... 34
CELLCEPT(SUSP RECON)..................................... 34
CELLCEPT(TAB)...................................................... 34
CELLULOSE,OXIDIZED.......................................... 33
CELONTIN................................................................47
CENESTIN................................................................33
CENTANY AT........................................................... 17
CENTERGY DM....................................................... 16
CEPHALEXIN........................................................... 34
CERITINIB................................................................ 42
CERTOLIZUMAB PEGOL........................................ 41
CERVICAL CAP....................................................... 16
CERVIDIL................................................................. 16
CESAMET...................................................... 5, 56, 63
CETACAINE............................................................. 22
CETACAINE ANESTHETIC......................................22
CETIRIZINE HCL........................................................5
CETRAXAL...............................................................27
CEVIMELINE HCL....................................................42
CHANTIX............................................................ 48, 56
CHENODAL..............................................................41
CHENODIOL............................................................ 41
CHILDREN'S FERROUS SULFATE(OTC)............... 50
CHLORAMBUCIL..................................................... 42
CHLORDIAZEPOXIDE............................................... 9
CHLORDIAZEPOXIDE HCL.......................................9
CHLORDIAZEPOXIDE/CLIDINIUM BR....................48
CHLORDIAZEPOXIDE-AMITRIPTYLINE...................8
CHLORHEXIDINE GLUCONATE............................. 43
CHLOROQUINE PHOSPHATE................................ 37
CHLOROTHIAZIDE.................................................. 13
CHLOROXYLENOL/PRAMOXINE HCL................... 27
CHLORPROMAZINE HCL........................................10
CHLORPROPAMIDE................................................23
CHLORTHALIDONE.................................................13
CHLORZOXAZONE................................................. 47
CHLORZOXAZONE W/ACETAMINOPHEN.............47
CHLORZOXAZONE/ACETAMINOPHEN................. 47
CHOICEDM CLARUS(OTC).....................................24
CHOLECALCIFEROL (VITAMIN D3)....................... 54
CHOLESTYRAMINE (WITH SUGAR)...................... 14
CHOLESTYRAMINE LIGHT.....................................14
CHOLESTYRAMINE/ASPARTAME..........................14
CHOLINE MAG TRISALICYLATE............................ 44
CHOLINE SAL/MAG SALICYLATE.......................... 44
CICLESONIDE....................................................... 5, 6
CICLODAN............................................................... 18
CICLOPIROX..................................................... 17, 18
CICLOPIROX OLAMINE.......................................... 18
CICLOPIROX/NAIL LACQ/FT DEOD#4................... 18
CICLOPIROX/SKIN CLEANSER NO.28.................. 18
CICLOPIROX/URE/CAMPH/MENTH/EUC...............18
CILOSTAZOL............................................................32
CILOXAN(DROPS)...................................................30
CILOXAN(OINT)....................................................... 30
CIMETIDINE............................................................. 49
CIMETIDINE HCL.....................................................49
CIMZIA................................................................41, 71
CINACALCET HCL...................................................28
CINRYZE............................................................ 39, 71
CIPRO...................................................................... 35
CIPRO HC................................................................ 27
CIPRO XR................................................................ 35
CIPRODEX............................................................... 27
CIPROFLOXACIN.................................................... 35
CIPROFLOXACIN HCL................................ 27, 30, 35
CIPROFLOXACIN HCL/DEXAMETH....................... 27
CIPROFLOXACIN/CIPROFLOXA HCL.................... 35
CIPROFLOXACIN/HYDROCORTISONE................. 27
CITALOPRAM HBR.................................................... 8
CITALOPRAM HYDROBROMIDE..............................8
CITRANATAL 90 DHA.............................................. 53
CITRANATAL DHA............................................. 52, 53
CITRANATAL HARMONY........................................ 53
CITRANATAL RX......................................................52
CITRATE PHOSPHATE DEXTROS SOLN.............. 31
CITRATE PHOSPHATE DEXTROSE.......................31
CITRIC ACID/G-LACTONE/MAG CARB.................. 49
CITRIC ACID/SODIUM CITRATE.............................49
CITRIC/CITRONELLYL/HYDROX/METH.................18
CLARAVIS................................................................ 16
CLARINEX(SYRUP)....................................... 5, 56, 63
CLARINEX(TAB)...................................................5, 56
CLARINEX-D 12 HOUR................................. 5, 56, 63
CLARITHROMYCIN................................................. 35
CLEMASTINE FUMARATE........................................ 5
CLEOCIN HCL..........................................................37
CLEOCIN T...............................................................17
CLEOCIN(CREAM/APPL)........................................ 50
CLEOCIN(SUPP VAG)............................................. 50
CLEVER CHEK BLOOD GLUCOSE SYST(OTC)......
2
4
CLEVER CHOICE BLOOD GLUC SYS(OTC)..........24
CLEVER CHOICE HD GLUCOSE SYST(OTC)....... 24
CLEVER CHOICE MICRO(OTC)............................. 24
CLEVER CHOICE PRO(OTC)..................................24
CLEVER CHOICE TALK(OTC).................................24
CLEVER CHOICE(OTC).......................................... 24
CLIMARA............................................................33, 56
CLIMARA PRO................................................... 33, 56
CLINDACIN ETZ.......................................................17
CLINDACIN P........................................................... 17
CLINDACIN PAC...................................................... 17
CLINDAGEL............................................................. 17
CLINDAMYCIN HCL.................................................37
CLINDAMYCIN PALMITATE HCL.............................37
CLINDAMYCIN PHOS/BENZOYL PEROX.............. 16
CLINDAMYCIN PHOS/SKIN CLNSR 19.................. 17
CLINDAMYCIN PHOSPHATE............................ 17, 50
CLINDAMYCIN/BENZOYL/EMOL CMB94............... 16
CLINDAMYCIN/TRETINOIN.....................................17
CLINDESSE............................................................. 50
CLINPRO 5000.........................................................50
CLIOQUINOL/HC/EMOLLIENT CMB#88................. 17
CLIOQUINOL/HYDROCORTISONE........................ 17
CLIOQUINOL/HYDROCORTISONE/PRAM.............17
CLOBAZAM.............................................................. 46
CLOBETASOL EMOLLIENT.....................................19
CLOBETASOL PROPIONATE..................................19
CLOBETASOL PROPIONATE/EMOLL.................... 19
CLOBETASOL/SKIN CLEANSER #28..................... 19
CLOBEX(LOTION)................................................... 19
CLOBEX(SPRAY).....................................................19
CLOCORTOLONE PIVALATE.................................. 19
CLODAN...................................................................19
CLODERM................................................................19
CLOMIPRAMINE HCL................................................8
CLONAZEPAM......................................................... 46
CLONIDINE.............................................................. 12
CLONIDINE HCL................................................ 10, 12
CLONIDINE HCL/CHLORTHALIDONE....................12
CLOPIDOGREL BISULFATE....................................32
CLORAZEPATE DIPOTASSIUM................................ 9
CLORPRES.............................................................. 12
CLOTRIMAZOLE................................................18, 36
CLOTRIMAZOLE/BETAMETHASONE DIP..............17
CLOTRIMAZOLE-BETAMETHASONE.....................17
CLOZAPINE......................................................... 9, 56
CLOZARIL............................................................ 9, 56
COAGULATION FACTOR VIIA,RECOMB................31
COARTEM................................................................37
COCAINE HCL......................................................... 22
CODEINE PHOS/ACETAMINOPHEN...................... 46
CODEINE SULFATE.................................................44
CODEINE/BUTALBITAL/ASA/CAFFEIN...................46
CODEINE/CARISOPRODOL/ASPIRIN.................... 44
Page 76 of 90
Index
COLAZAL................................................................. 40
COLCHICINE............................................................31
COLCHICINE/PROBENECID...................................31
COLCRYS................................................................ 31
COLESEVELAM HCL...............................................14
COLESTID(GRANULES)..........................................14
COLESTID(PACKET)(5 G)....................................... 14
COLESTID(PACKET)(7.5G)..................................... 14
COLESTID(TAB).......................................................14
COLESTIPOL HCL................................................... 14
COLLAGENASE CLOSTRIDIUM HIST.................... 22
COLY-MYCIN S........................................................ 27
COLYTE WITH FLAVOR PACKS............................. 41
COMBIGAN.............................................................. 30
COMBIPATCH.................................................... 33, 56
COMBIVENT RESPIMAT........................................... 6
COMBIVIR.......................................................... 37, 56
COMETRIQ.................................................. 42, 56, 71
COMFORT PAC-CYCLOBENZAPRINE...................48
COMFORT PAC-IBUPROFEN................................. 40
COMFORT PAC-MELOXICAM.................................40
COMFORT PAC-NAPROXEN.................................. 40
COMFORT PAC-TIZANIDINE.................................. 48
COMPACT SPACE CHAMBER PLUS........................7
COMP-AIR ELITE COMPRESSOR SYST................. 7
COMP-AIR NEBULIZER COMPRESSOR..................7
COMPAZINE...............................................................5
COMPLERA....................................................... 38, 71
COMPLETE FORMULATION D3000....................... 51
COMPLETE FORMULATION PEDIATRIC............... 51
COMPLETE NATAL DHA......................................... 52
COMPLETENATE.....................................................51
COMPRESSOR, FOR NEBULIZER........................... 6
COMTAN.................................................................. 46
CONCEPT DHA........................................................52
CONCEPT OB.......................................................... 52
CONCEPTROL(OTC).........................................15, 73
CONCERTA(TAB ER 24H)(18 MG).................... 10, 56
CONCERTA(TAB ER 24H)(27 MG).................... 10, 56
CONCERTA(TAB ER 24H)(36 MG).................... 10, 56
CONCERTA(TAB ER 24H)(54 MG).................... 10, 56
CONDYLOX(GEL).................................................... 21
CONDYLOX(SOLUTION).........................................21
CONTOUR TS(OTC)................................................ 23
CONTROL(OTC)...................................................... 24
CONZIP........................................................ 45, 56, 63
COPAXONE........................................................43, 71
COPEGUS................................................................38
CORDRAN................................................................19
COREG.....................................................................11
COREG CR...............................................................11
CORGARD............................................................... 12
CORIFACT................................................................31
CORTANE-B.............................................................27
CORTEF................................................................... 39
CORTENEMA...........................................................41
CORTIFOAM............................................................ 41
CORTISONE ACETATE........................................... 39
CORTISPORIN.........................................................19
CORTISPORIN-TC...................................................27
CORVITA.................................................................. 50
CORVITE..................................................................50
CORVITE FREE....................................................... 51
CORZIDE..................................................................12
COSOPT...................................................................30
COSOPT PF................................................. 30, 56, 63
COUMADIN.............................................................. 31
COZAAR...................................................................12
CREON.....................................................................48
CRESTOR(TAB)(10 MG)..............................14, 56, 63
CRESTOR(TAB)(20 MG)..............................14, 56, 63
CRESTOR(TAB)(40 MG)..............................14, 56, 63
CRESTOR(TAB)(5 MG)................................14, 56, 63
CRESYL ACETATE.................................................. 27
CRESYLATE.............................................................27
CRINONE................................................................. 34
CRIXIVAN................................................................. 38
CRIZOTINIB............................................................. 42
CROFELEMER.........................................................41
CROMOLYN SODIUM..........................................6, 30
CROTAMITON..........................................................18
CRYSELLE......................................................... 16, 73
CUPRIMINE..............................................................39
CUROSURF............................................................. 44
CUTIVATE................................................................ 19
CUVPOSA................................................................ 48
CYANOCOBALAMIN................................................ 54
CYANOCOBALAMIN (VITAMIN B-12)......................54
L.A. Care
CYANOCOBALAMIN INJECTION............................ 54
CYANOCOBALAMIN/FA/PYRIDOXINE................... 54
CYANOCOBALAMIN/MECOBALAMIN.................... 54
CYANOCOBALAMIN/VIT BCOMP&C...................... 54
CYCLOBENZ HCL/IRR CNTR-IRR CB2.................. 48
CYCLOBENZAPRINE HCL...................................... 47
CYCLOGYL(DROPS)(0.5 %)................................... 31
CYCLOGYL(DROPS)(1 %)...................................... 31
CYCLOGYL(DROPS)(2 %)...................................... 31
CYCLOMYDRIL........................................................31
CYCLOPENTOLATE HCL........................................ 31
CYCLOPENTOLATE/PHENYLEPHRINE.................31
CYCLOPHOSPHAMIDE...........................................42
CYCLOSERINE........................................................ 36
CYCLOSET........................................................ 23, 63
CYCLOSPORINE............................................... 30, 34
CYCLOSPORINE MODIFIED...................................34
CYCLOSPORINE, MODIFIED..................................34
CYPROHEPTADINE HCL.......................................... 5
CYSTAGON..............................................................49
CYSTARAN........................................................ 31, 71
CYSTEAMINE BITARTRATE....................................49
CYSTEAMINE HCL.................................................. 31
CYSTOSPAZ-M........................................................ 48
CYTOMEL................................................................ 29
CYTOTEC.................................................................48
CYTRA-2.................................................................. 49
CYTRA-3.................................................................. 49
CYTRA-K.................................................................. 49
-DD.H.E.45............................................................. 45, 56
DABIGATRAN ETEXILATE MESYLATE.................. 33
DABRAFENIB MESYLATE.......................................42
DALFAMPRIDINE.....................................................43
DALIRESP...................................................... 6, 56, 63
DALTEPARIN SODIUM,PORCINE...........................32
DANAZOL.................................................................29
DANTRIUM...............................................................48
DANTROLENE SODIUM..........................................48
DAPAGLIFLOZIN PROPANEDIOL...........................23
DAPSONE.......................................................... 17, 36
DARAPRIM...............................................................37
DARBEPOETIN ALFA IN POLYSORBAT.................32
DARIFENACIN HYDROBROMIDE...........................50
DARUNAVIR ETHANOLATE.................................... 37
DASATINIB............................................................... 42
DAYPRO...................................................................40
DAYTRANA.................................................. 10, 56, 63
DDAVP......................................................................28
DDAVP(AMPUL)(15 MCG/ML)................................. 28
DDAVP(AMPUL)(4MCG/ML).................................... 28
DDAVP(SOLUTION).................................................28
DDAVP(TAB)............................................................ 28
DDAVP(VIAL)........................................................... 28
DECADRON............................................................. 29
DEGARELIX ACETATE............................................ 42
DELATESTRYL(SYRINGE)................................33, 71
DELATESTRYL(VIAL)........................................ 33, 71
DELAVIRDINE MESYLATE...................................... 38
DEL-BETA................................................................ 19
DELZICOL.......................................................... 40, 63
DEMADEX................................................................ 13
DEMECARIUM BROMIDE....................................... 30
DEMECLOCYCLINE HCL........................................ 35
DEMEROL................................................................ 45
DEMSER.................................................................. 12
DENAVIR.................................................................. 18
DEPAKENE.............................................................. 47
DEPAKOTE ER........................................................ 46
DEPEN..................................................................... 39
DEPO-PROVERA...............................................15, 56
DEPO-SUBQ PROVERA 104............................ 15, 56
DEPO-TESTOSTERONE(VIAL)(100 MG/ML)......33,
7
1
DEPO-TESTOSTERONE(VIAL)(200 MG/ML)......33,
7
1
DEPRIZINE...............................................................49
DERMA-SMOOTHE-FS............................................19
DERMASORB AF..................................................... 17
DERMASORB HC.................................................... 19
DERMASORB TA..................................................... 20
DERMASORB XM.................................................... 21
DERMATOP..............................................................20
DERMOTIC...............................................................27
DESIPRAMINE HCL...................................................8
DESIRUDIN.............................................................. 32
DESLORATADINE..........................................5, 56, 63
DESLORATADINE/PSEUDOEPHEDRINE.................5
DESMOPRESSIN (NONREFRIGERATED)............. 28
DESMOPRESSIN ACETATE....................................28
DESOG-E.ESTRADIOL/E.ESTRADIOL................... 15
DESOGESTREL-ETHINYL ESTRADIOL................. 15
DESONATE.............................................................. 19
DESONIDE............................................................... 19
DESOXIMETASONE................................................ 19
DESOXYN............................................................ 9, 56
DESVENLAFAXINE....................................................8
DESVENLAFAXINE FUMARATE............................... 8
DESVENLAFAXINE FUMARATE ER............. 8, 56, 63
DESVENLAFAXINE SUCCINATE.............................. 8
DETROL............................................................. 50, 63
DEVILBISS PULMO-AIDE..........................................6
DEVILBISS TRAVELER............................................. 7
DEXAMETHASONE........................................... 29, 39
DEXAMETHASONE INTENSOL.............................. 39
DEXAMETHASONE SOD PHOSPHATE................. 29
DEXAMETHASONE SODIUM PHOSPHATE...........29
DEXCHLORPHENIRAMINE MALEATE..................... 5
DEXCOM G4............................................................ 25
DEXILANT.................................................... 49, 57, 63
DEXLANSOPRAZOLE............................................. 49
DEXMETHYLPHENIDATE HCL............................... 10
DEXPAK................................................................... 39
DEXTROAMPHETAMINE SULFATE..........................9
DEXTROAMPHETAMINE SULFATE(TAB)(10 MG)
..............................................................................9, 57
DEXTROAMPHETAMINE SULFATE(TAB)(5 MG)......
9,
57
DEXTROAMPHETAMINE/AMPHETAMINE............... 9
DEXTROMETHORPHAN HBR/QUINIDINE............. 43
DEXTROSE/SOD CITRATE/CITRIC AC.................. 31
DHT.......................................................................... 54
DIABETA...................................................................23
DIALYVITE................................................................54
DIALYVITE 3000.......................................................54
DIALYVITE 5000.......................................................54
DIALYVITE 800 WITH IRON.................................... 50
DIALYVITE SUPREME D......................................... 54
DIALYVITE ZINC...................................................... 54
DIAMOX SEQUELS................................................. 30
DIAPHRAGMS, WIDE SEAL.................................... 16
DIASTAT............................................................. 46, 57
DIASTAT ACUDIAL............................................ 46, 57
DIATRUE PLUS(OTC)..............................................24
DIAZEPAM............................................................9, 46
DIAZOXIDE.............................................................. 26
DIBENZYLINE.......................................................... 11
DICHLOROACETIC ACID........................................ 21
DICHLOROTETRAFLUOROETHANE..................... 22
DICLEGIS............................................................. 5, 57
DICLOFENAC EPOLAMINE.....................................20
DICLOFENAC POTASSIUM...............................40, 45
DICLOFENAC SODIUM............. 20, 21, 29, 40, 57, 71
DICLOFENAC SODIUM/MISOPROSTOL................40
DICLOFENAC SUBMICRONIZED........................... 40
DICLOXACILLIN SODIUM....................................... 35
DICOPANOL...............................................................5
DICYCLOMINE HCL.................................................48
DIDANOSINE........................................................... 38
DIFENOXIN HCL/ATROPINE SULFATE.................. 41
DIFFERIN(CREAM)............................................17, 55
DIFFERIN(GEL W/PUMP)..................................17, 55
DIFFERIN(GEL)..................................................17, 55
DIFFERIN(LOTION)........................................... 17, 55
DIFFERIN(MED SWAB)..................................... 17, 55
DIFICID.........................................................35, 57, 63
DIFLORASONE DIACETATE................................... 19
DIFLORASONE DIACETATE/EMOLL...................... 19
DIFLUCAN................................................................36
DIFLUNISAL............................................................. 44
DIFLUPREDNATE.................................................... 29
DIGOX...................................................................... 11
DIGOXIN...................................................................11
DIHYDROCODEINE/ASPIRIN/CAFFEIN................. 44
DIHYDROERGOTAMINE MESYLATE..................... 45
DIHYDROTACHYSTEROL.......................................54
DILANTIN................................................................. 47
DILANTIN(CAP)(100 MG)........................................ 47
DILANTIN(CAP)(30 MG).......................................... 47
DILANTIN-125.......................................................... 47
DILATRATE-SR........................................................ 15
DILAUDID................................................................. 45
DILAUDID-HP(AMPUL)............................................ 45
DILAUDID-HP(VIAL).................................................45
DILTIAZEM 24HR ER............................................... 12
DILTIAZEM HCL....................................................... 12
Page 77 of 90
Index
DIMETHYL FUMARATE........................................... 43
DINOPROSTONE.....................................................16
DIOVAN.................................................................... 12
DIOVAN HCT............................................................ 11
DIPENTUM......................................................... 40, 63
DIPHENHYDRAMINE HCL........................................ 5
DIPHENOXYLATE HCL/ATROPINE........................ 41
DIPHENOXYLATE-ATROPINE................................ 41
DIPROLENE............................................................. 19
DIPROLENE AF....................................................... 19
DIPYRIDAMOLE.......................................................32
DISOPYRAMIDE PHOSPHATE............................... 11
DISULFIRAM.............................................................. 9
DIURIL...................................................................... 13
DIVALPROEX SODIUM............................................46
DIVIGEL................................................................... 33
DM/PHENYLEPH/CHLORPHENIRAMINE...............16
D-METHORPHAN HB/P-EPD HCL/BPM................. 16
D-METHORPHAN HB/PROMETH HCL................... 16
DOFETILIDE.............................................................11
DOLASETRON MESYLATE....................................... 5
DOLOPHINE HCL.................................................... 45
DOLOREX................................................................ 44
DOLUTEGRAVIR SODIUM...................................... 38
DOMEBORO............................................................ 27
DONEPEZIL HCL....................................................... 8
DONNATAL...............................................................48
DORAL..................................................................... 10
DORNASE ALFA...................................................... 44
DORYX(TAB DR)(150 MG)...................................... 35
DORYX(TAB DR)(200 MG).......................... 35, 57, 63
DORZOLAMIDE HCL............................................... 30
DORZOLAMIDE HCL/TIMOLOL MALEAT............... 30
DORZOLAMIDE/TIMOLOL/PF................................. 30
DOVONEX..........................................................22, 63
DOXAZOSIN MESYLATE.........................................11
DOXEPIN HCL............................................... 9, 10, 20
DOXERCALCIFEROL.............................................. 28
DOXYCYCLINE CALCIUM.......................................35
DOXYCYCLINE HYCLATE.......................................35
DOXYCYCLINE MONOHY/SKIN CLNSR9.............. 35
DOXYCYCLINE MONOHYDRATE.....................35, 36
DOXYCYCLINE/BENZOYL PEROXIDE.................. 36
DOXYCYCLINE/SALICY/OCT/ZINC OX.................. 36
DOXYCYCLINE/SKIN CLEANSER #19................... 36
DOXYLAMINE/PYRIDOXINE HCL.............................5
DRISDOL..................................................................54
DRITHOCREME HP........................................... 22, 63
DRONABINOL............................................................ 5
DRONEDARONE HCL............................................. 11
DROPLET LANCING DEVICE(OTC)....................... 26
DROSPIR/ETH ESTRA/LEVOMEFOL CA............... 15
DROSPIRENONE/ESTRADIOL............................... 33
DROXIA.................................................................... 32
DROXIDOPA............................................................ 14
DRYSOL................................................................... 20
DUAVEE................................................................... 33
DUET DHA............................................................... 52
DUET DHA 400........................................................ 52
DUET DHA EC......................................................... 52
DUETACT........................................................... 23, 63
DUEXIS........................................................ 40, 57, 63
DULERA............................................................... 6, 57
DULOXETINE HCL.............................................. 8, 57
DURAGESIC...................................................... 44, 57
DUREZOL.................................................................29
DUTASTERIDE.........................................................49
DUTASTERIDE/TAMSULOSIN HCL........................ 49
DUTOPROL..............................................................12
DYAZIDE.................................................................. 13
DYMISTA........................................................ 5, 57, 64
DYNACIN..................................................................36
DYPHYLLINE............................................................. 7
DYRENIUM...............................................................13
-EE.E.S. 200................................................................ 35
EASIVENT.................................................................. 7
EASY CHECK(OTC).................................................24
EASY CLICK(OTC)...................................................26
EASY PLUS II(OTC).................................................24
EASY PLUS(OTC)....................................................24
EASY STEP(OTC)....................................................24
EASY TALK(OTC).................................................... 24
EASY TOUCH GLUCOSE MONITOR(OTC)............24
EASY TOUCH LANCING DEVICE(OTC)................. 26
EASY TRAK(OTC)....................................................24
EASYGLUCO PLUS(OTC)....................................... 24
EASYGLUCO(OTC)................................................. 24
L.A. Care
EASYMAX L(OTC)................................................... 24
EASYMAX NG(OTC)................................................ 24
EASYMAX V SPEAKING(OTC)................................24
EASYMAX V2(OTC)................................................. 24
ECHOTHIOPHATE IODIDE......................................30
EC-NAPROSYN....................................................... 40
ECONAZOLE NITRATE........................................... 18
ECOZA..................................................................... 18
EDARBI.............................................................. 12, 64
EDARBYCLOR................................................... 11, 64
EDECRIN..................................................................13
EDLUAR....................................................... 10, 57, 64
EDURANT.......................................................... 38, 71
EFAVIRENZ.............................................................. 38
EFAVIRENZ/EMTRICITAB/TENOFOVIR................. 38
EFFER-K.................................................................. 27
EFFIENT.............................................................32, 57
EFINACONAZOLE................................................... 18
EFUDEX................................................................... 21
ELDEPRYL............................................................... 46
ELECT WTR/SOD CH/SOD HY/HYP AC.................21
ELEMENT BLOOD GLUCOSE METER(OTC)......... 24
ELEMENT COMPACT(OTC).................................... 24
ELEMENT PLUS(OTC)............................................ 24
ELESTAT.................................................................. 29
ELESTRIN................................................................ 33
ELETRIPTAN HBR................................................... 45
ELIDEL......................................................... 22, 55, 64
ELIGARD............................................................ 28, 71
ELIMITE....................................................................18
ELIQUIS............................................................. 31, 57
ELITE OB DHA......................................................... 51
ELITE-OB 400.......................................................... 52
ELLA......................................................................... 16
ELMIRON................................................................. 49
ELOCON...................................................................19
ELOCTATE............................................................... 31
ELTROMBOPAG OLAMINE..................................... 33
ELVITEGR/COBICIST/EMTRIC/TENOF.................. 38
EM#53/NAMGF/CYC/PHOS/NAHC/NACL...............20
EMADINE................................................................. 29
EMBRACE EVO(OTC)............................................. 24
EMBRACE PRO(OTC)............................................. 24
EMBRACE(OTC)...................................................... 24
EMCYT..................................................................... 43
EMEDASTINE DIFUMARATE.................................. 29
EMEND(CAP DS PK)........................................... 5, 57
EMEND(CAP)(125 MG)........................................5, 57
EMEND(CAP)(40 MG)..........................................5, 57
EMEND(CAP)(80 MG)..........................................5, 57
EMERSAL................................................................ 21
EMLA........................................................................ 22
EMOL53/NAMGFS/HA/NAHYPOCHLORIT............. 20
EMOLLIENT #43/SKIN CLEANSER#27.................. 20
EMOLLIENT COMBINATION NO.10........................20
EMOLLIENT COMBINATION NO.32........................20
EMOLLIENT COMBINATION NO.35........................20
EMOLLIENT COMBINATION NO.38........................20
EMOLLIENT COMBINATION NO.43........................20
EMOLLIENT COMBINATION NO.44........................20
EMOLLIENT COMBINATION NO.47........................20
EMOLLIENT COMBINATION NO.48........................20
EMOLLIENT COMBINATION NO.53........................20
EMOLLIENT COMBINATION NO.57........................20
EMOLLIENT COMBINATION NO.60........................20
EMOLLIENT COMBINATION NO.80........................20
EMOLLIENT COMBINATION NO.85........................20
EMOLLIENT COMBO NO.47 & NO.60.................... 20
EMPAGLIFLOZIN..................................................... 23
EMSAM.............................................................. 10, 57
EMTRICITAB/RILPIVIRINE/TENOFOV....................38
EMTRICITABINE...................................................... 38
EMTRICITABINE/TENOFOVIR................................ 37
EMTRIVA(CAP).................................................. 38, 57
EMTRIVA(SOLUTION)....................................... 38, 57
EMULSION SB......................................................... 20
ENABLEX........................................................... 50, 64
ENALAPRIL MALEATE............................................ 12
ENALAPRIL/HYDROCHLOROTHIAZIDE................ 11
ENALAPRIL-HYDROCHLOROTHIAZIDE................ 11
ENBREL............................................................. 39, 71
ENDO-AVITENE....................................................... 33
ENFUVIRTIDE..........................................................38
ENJUVIA...................................................................33
ENOXAPARIN SODIUM........................................... 32
ENTACAPONE......................................................... 46
ENTECAVIR............................................................. 38
ENTEREG................................................................ 41
ENTOCORT EC........................................................39
ENZALUTAMIDE...................................................... 42
EPANED....................................................... 12, 57, 64
EPIDUO.................................................................... 16
EPIFOAM..................................................................21
EPINASTINE HCL.................................................... 29
EPINEPHRINE..................................................... 6, 42
EPINEPHRINE HCL................................................. 16
EPIPEN 2-PAK......................................................... 42
EPIPEN JR 2-PAK.................................................... 42
EPIVIR HBV............................................................. 38
EPIVIR(SOLUTION)........................................... 38, 57
EPIVIR(TAB)(150 MG)........................................38, 57
EPIVIR(TAB)(300 MG)........................................38, 57
EPLERENONE......................................................... 13
EPOETIN ALFA........................................................ 32
EPOGEN............................................................ 32, 71
EPROSARTAN MESYLATE..................................... 12
EPROSARTAN/HYDROCHLOROTHIAZIDE............11
EPZICOM........................................................... 37, 57
EQUETRO.................................................................. 9
ERAPID NEBULIZER................................................. 7
ERGOCALCIFEROL (VITAMIN D2)......................... 54
ERGOLOID MESYLATES........................................ 15
ERGOMAR......................................................... 45, 57
ERGOTAMINE TARTRATE...................................... 45
ERGOTAMINE TARTRATE/CAFFEINE....................45
ERIVEDGE................................................... 42, 57, 71
ERLOTINIB HCL.......................................................42
ERTACZO.................................................................18
ERYGEL................................................................... 17
ERYPED 200............................................................ 35
ERYPED 400............................................................ 35
ERY-TAB...................................................................35
ERYTHROCIN STEARATE...................................... 35
ERYTHROMYCIN...............................................17, 35
ERYTHROMYCIN BASE.............................. 17, 30, 35
ERYTHROMYCIN BASE/ETHANOL........................ 17
ERYTHROMYCIN ETHYLSUCCINATE................... 35
ERYTHROMYCIN STEARATE.................................35
ERYTHROMYCIN/BENZOYL PEROXIDE............... 17
ESCAVITE................................................................ 51
ESCAVITE D.............................................................51
ESCITALOPRAM OXALATE...................................... 8
ESGIC.......................................................................44
ESKALITH.................................................................. 9
ESLICARBAZEPINE ACETATE............................... 46
ESOMEPRAZOLE MAGNESIUM.............................49
ESTAZOLAM............................................................ 10
ESTRACE...........................................................33, 50
ESTRADIOL....................................................... 33, 50
ESTRADIOL ACETATE............................................ 50
ESTRADIOL VALERATE/DIENOGEST....................15
ESTRADIOL/LEVONORGESTREL.......................... 33
ESTRADIOL/NORETHINDRONE ACET.................. 33
ESTRADIOL/NORGESTIMATE................................33
ESTRADIOL-NORETHINDRONE ACETAT..............33
ESTRAMUSTINE PHOSPHATE SODIUM............... 43
ESTRASORB............................................................33
ESTRING............................................................50, 57
ESTROGEL.............................................................. 33
ESTROGEN & METHYLTESTOSTERONE............. 33
ESTROGEN,CON/M-PROGEST ACET................... 33
ESTROGEN,ESTER/ME-TESTOSTERONE............33
ESTROGENS, CONJUGATED...........................33, 50
ESTROGENS,CONJ.,SYNTHETIC A.......................33
ESTROGENS,CONJ.,SYNTHETIC B.......................33
ESTROGENS,CONJ/BAZEDOXIFENE....................33
ESTROGENS,ESTERIFIED..................................... 34
ESTROPIPATE......................................................... 34
ESZOPICLONE........................................................ 10
ETANERCEPT..........................................................39
ETHACRYNIC ACID.................................................13
ETHAMBUTOL HCL................................................. 36
ETHAVERINE HCL...................................................15
ETHCHLORVYNOL..................................................10
ETHINYL ESTRADIOL/DROSPIRENONE............... 15
ETHIONAMIDE.........................................................36
ETHOSUXIMIDE...................................................... 46
ETHOTOIN............................................................... 46
ETHYL CHLORIDE...................................................22
ETHYNODIOL D-ETHINYL ESTRADIOL................. 15
ETIDRONATE DISODIUM........................................28
ETODOLAC.............................................................. 40
ETONOGESTREL/ETHINYL ESTRADIOL...............15
ETOPOSIDE.............................................................43
ETRAVIRINE............................................................ 38
EURAX..................................................................... 18
Page 78 of 90
Index
EVAMIST.................................................................. 33
EVENCARE G2(OTC).............................................. 24
EVENCARE G3(OTC).............................................. 24
EVENCARE(OTC).................................................... 24
EVEROLIMUS.................................................... 34, 42
EVISTA......................................................... 28, 57, 71
EVOCLIN.................................................................. 17
EVOLUTION BLOOD GLUCOSE METER(OTC)......
2
4
EVOXAC...................................................................42
EVZIO....................................................................... 10
EXELDERM.............................................................. 18
EXELON............................................................... 8, 57
EXEMESTANE......................................................... 42
EXENATIDE..............................................................23
EXENATIDE MICROSPHERES............................... 23
EXFORGE.......................................................... 12, 64
EXFORGE HCT.................................................. 11, 64
EXODERM................................................................18
EXTAVIA............................................................. 43, 71
EZ SMART PLUS(OTC)........................................... 24
EZ SMART(OTC)......................................................24
E-Z SPACER.............................................................. 7
EZETIMIBE...............................................................14
EZETIMIBE/ATORVASTATIN CALCIUM............ 13, 14
EZETIMIBE/SIMVASTATIN.......................................14
EZOGABINE.............................................................46
-FFA/MU-VITS-MIN TH/LYCOPENE/LUT....................50
FA/VIT BCOMP&C/SE/MIN AA/ZN...........................54
FABIOR.............................................................. 17, 55
FACTIVE...................................................................35
FACTOR IX...............................................................32
FACTOR IX COMPLEX HUMAN.............................. 32
FACTOR IX HUMAN RECOMBINANT..................... 32
FACTOR IX REC, FC FUSION PROTN................... 32
FACTOR VIII REC,FC FUSION PROT.....................31
FACTOR XIII.............................................................31
FACTOR XIII A-SUBUNIT,RECOMB........................ 32
FAMCICLOVIR......................................................... 37
FAMOTIDINE............................................................49
FAMVIR.................................................................... 37
FANAPT(TAB DS PK).....................................9, 57, 64
FANAPT(TAB).................................................9, 57, 64
FANATREX............................................................... 47
FARESTON........................................................ 43, 71
FARXIGA...................................................... 23, 57, 64
FAZACLO....................................................... 9, 57, 64
FE FUMARATE/FA/VIT BCOMP&C......................... 50
FEBUXOSTAT.......................................................... 31
FEIBA NF..................................................................31
FEIBA VH IMMUNO................................................. 31
FELBAMATE.......................................................46, 47
FELBATOL(ORAL SUSP).............................46, 57, 64
FELBATOL(TAB)(400 MG)........................... 46, 57, 64
FELBATOL(TAB)(600 MG)........................... 47, 57, 64
FELDENE................................................................. 40
FELODIPINE............................................................ 12
FELODIPINE ER...................................................... 12
FEMARA...................................................................42
FEMCAP.............................................................16, 73
FEMHRT...................................................................34
FEMRING........................................................... 50, 57
FENOFIBRATE.........................................................14
FENOFIBRATE NANOCRYSTALLIZED................... 14
FENOFIBRATE,MICRONIZED................................. 14
FENOFIBRIC ACID.................................................. 14
FENOFIBRIC ACID (CHOLINE)............................... 14
FENOGLIDE....................................................... 14, 64
FENOPROFEN CALCIUM........................................40
FENOPROFEN CALCIUM(CAP)..............................40
FENOPROFEN CALCIUM(TAB).............................. 40
FENTANYL............................................................... 44
FENTANYL CITRATE............................................... 44
FENTORA...........................................................44, 71
FERRIC SUBSULFATE............................................ 33
FERROUS SULFATE............................................... 50
FESOTERODINE FUMARATE.................................50
FETZIMA........................................................ 8, 57, 64
FEXMID.................................................................... 47
FEXOFENADINE HCL................................................5
FEXOFENADINE/PSEUDOEPHEDRINE...................5
FIBRICOR.................................................................14
FIBRINOGEN/THROMBIN (HUM PLAS)................. 33
FIDAXOMICIN.......................................................... 35
FILGRASTIM............................................................ 32
FINACEA.................................................................. 17
FINASTERIDE.......................................................... 49
L.A. Care
FINGOLIMOD HCL...................................................43
FIORICET................................................................. 44
FIORINAL................................................................. 44
FIORINAL WITH CODEINE #3.................................46
FIRAZYR............................................................ 39, 71
FIRMAGON(VIAL)(120 MG)............................... 42, 57
FIRMAGON(VIAL)(80 MG)................................. 42, 57
FIRST-BXN............................................................... 36
FIRST-DUKE'S......................................................... 36
FIRST-HYDROCORTISONE.................................... 19
FIRST-LANSOPRAZOLE......................................... 49
FIRST-MARY'S......................................................... 36
FIRST-OMEPRAZOLE............................................. 49
FIRST-TESTOSTERONE......................................... 33
FIRST-TESTOSTERONE MC.................................. 33
FLAGYL ER.............................................................. 37
FLAREX....................................................................29
FLAVOXATE HCL.....................................................50
FLECAINIDE ACETATE............................................11
FLECTOR................................................................. 20
FLOMAX................................................................... 49
FLONASE............................................................. 5, 57
FLO-PRED................................................................39
FLOVENT DISKUS(BLST W/DEV)(100 MCG)......6,
5
7
FLOVENT DISKUS(BLST W/DEV)(250 MCG)......6,
5
7
FLOVENT DISKUS(BLST W/DEV)(50 MCG).......6, 57
FLOVENT HFA(AER W/ADAP)(110 MCG)...........6, 57
FLOVENT HFA(AER W/ADAP)(220 MCG).......... 6, 57
FLOVENT HFA(AER W/ADAP)(44 MCG)............ 6, 57
FLOXIN.....................................................................27
FLU VAC TV 2013(18-49YR)RCM/PF......................34
FLU VACC QS 2013-14(36MOS+)/PF..................... 34
FLU VACC QV LIVE 2014(2-49YRS)....................... 34
FLU VACC TS 2013-14(36MOS+)............................34
FLU VACC TS 2013-14(36MOS+)/PF...................... 34
FLU VACCINE QS 2013-14(36MOS+)..................... 34
FLU VACCINE TS2013-14(4YR+)/PF...................... 34
FLUARIX 2013-2014................................................ 34
FLUARIX QUAD 2013-2014..................................... 34
FLUBLOK 2013-2014............................................... 34
FLUCAINE................................................................ 29
FLUCONAZOLE....................................................... 36
FLUCYTOSINE.........................................................36
FLUDROCORTISONE ACETATE.............................39
FLULAVAL 2013-2014.............................................. 34
FLULAVAL QUAD 2013-2014...................................34
FLUMADINE............................................................. 37
FLUMIST QUAD 2014-2015...............................34, 57
FLUNISOLIDE.................................................. 5, 6, 57
FLUOCINOLONE ACETONIDE............................... 19
FLUOCINOLONE ACETONIDE OIL.........................27
FLUOCINOLONE/EMOL CMB#65........................... 19
FLUOCINOLONE/SHOWER CAP............................19
FLUOCINOLONE/SKIN CLNSR28...........................19
FLUOCINONIDE.......................................................19
FLUOCINONIDE/EMOLLIENT BASE.......................19
FLUOCINONIDE-E................................................... 19
FLUORABON........................................................... 50
FLUOR-A-DAY..........................................................50
FLUORIDE................................................................50
FLUORIDE ION/MULTIVITAMINS............................51
FLUORIDE/IRON/VIT A,C&D................................... 51
FLUORIDEX SENSITIVITY RELIEF.........................50
FLUORITAB..............................................................50
FLUOROMETHOLONE............................................ 29
FLUOROMETHOLONE ACETATE...........................29
FLUOROPLEX......................................................... 22
FLUOROURACIL............................................... 21, 22
FLUOXETINE HCL..................................................... 8
FLUOXYMESTERONE.............................................33
FLUPHENAZINE HCL.............................................. 10
FLURA-DROPS........................................................ 50
FLURANDRENOLIDE.............................................. 19
FLURAZEPAM HCL..................................................10
FLURBIPROFEN...................................................... 40
FLURBIPROFEN SODIUM.......................................29
FLUROX................................................................... 29
FLUTAMIDE..............................................................42
FLUTICASONE FUROATE.........................................5
FLUTICASONE PROPIONATE........................ 5, 6, 19
FLUTICASONE/SALMETEROL................................. 6
FLUTICASONE/VILANTEROL................................... 6
FLUVASTATIN SODIUM...........................................14
FLUVOXAMINE MALEATE........................................ 8
FML FORTE............................................................. 29
FML S.O.P................................................................ 29
FOCALIN............................................................ 10, 57
FOCALIN XR...................................................... 10, 57
FOLBECAL............................................................... 53
FOLBEE................................................................... 54
FOLBEE PLUS CZ................................................... 54
FOLET ONE............................................................. 52
FOLGARD OS.......................................................... 50
FOLIC ACID..............................................................50
FOLIC ACID(OTC)..............................................50, 73
FOLIC ACID/B COMPLEX & C NO.17..................... 54
FOLIC ACID/MU-VITS-MIN TH................................ 50
FOLIC ACID/MV,FE,OTHER MIN.............................50
FOLIC ACID/VIT BCOMP&C/CU/ZNOX...................54
FOLIC ACID/VITAMIN B COMP W-C.......................54
FONDAPARINUX SODIUM...................................... 32
FORA D10(OTC)...................................................... 24
FORA D15(OTC)...................................................... 23
FORA D20(OTC)...................................................... 24
FORA G20(OTC)...................................................... 24
FORA G30A(OTC)....................................................24
FORA LANCING DEVICE(OTC).............................. 26
FORA V10(OTC)...................................................... 24
FORA V12(OTC)...................................................... 24
FORA V20(OTC)...................................................... 24
FORA V30A(OTC).................................................... 24
FORACARE GD20(OTC)......................................... 24
FORACARE GD40A(OTC)....................................... 24
FORACARE GD40B(OTC)....................................... 24
FORADIL........................................................ 6, 57, 64
FORFIVO XL.................................................. 8, 57, 64
FORMOTEROL FUMARATE......................................6
FORTAVIT.................................................................51
FORTEO.............................................................28, 57
FORTESTA.........................................................33, 71
FORTICAL................................................................ 28
FOSAMAX................................................................ 28
FOSAMAX PLUS D.................................................. 28
FOSAMPRENAVIR CALCIUM..................................38
FOSFOMYCIN TROMETHAMINE............................34
FOSINOPRIL SODIUM.............................................12
FOSINOPRIL/HYDROCHLOROTHIAZIDE.............. 11
FOSINOPRIL-HYDROCHLOROTHIAZIDE.............. 11
FOSRENOL.............................................................. 27
FRAGMIN(SYRINGE)(10000/ML)...................... 32, 57
FRAGMIN(SYRINGE)(12500/0.5)...................... 32, 57
FRAGMIN(SYRINGE)(15000/0.6)...................... 32, 57
FRAGMIN(SYRINGE)(18000/0.72).................... 32, 57
FRAGMIN(SYRINGE)(2500/0.2ML)................... 32, 57
FRAGMIN(SYRINGE)(5000/0.2ML)................... 32, 57
FRAGMIN(SYRINGE)(7500/0.3ML)................... 32, 57
FRAGMIN(VIAL)................................................. 32, 57
FROVA..........................................................45, 57, 64
FROVATRIPTAN SUCCINATE................................. 45
FULVICIN U/F...........................................................36
FULYZAQ..................................................... 41, 57, 64
FUNGOID & HC........................................................18
FURACIN..................................................................17
FURADANTIN...........................................................35
FUROSEMIDE..........................................................13
FUZEON....................................................... 38, 57, 64
FYCOMPA(TAB)(10 MG)..............................47, 57, 64
FYCOMPA(TAB)(12 MG)..............................47, 57, 64
FYCOMPA(TAB)(2 MG)................................47, 57, 64
FYCOMPA(TAB)(4 MG)................................47, 57, 64
FYCOMPA(TAB)(6 MG)................................47, 57, 64
FYCOMPA(TAB)(8 MG)................................47, 57, 65
-GGABAPENTIN.................................................... 43, 47
GABAPENTIN ENACARBIL..................................... 43
GABITRIL(TAB)(12 MG)............................... 47, 57, 65
GABITRIL(TAB)(16 MG)............................... 47, 57, 65
GABITRIL(TAB)(2 MG)................................. 47, 57, 65
GABITRIL(TAB)(4 MG)................................. 47, 57, 65
GALANTAMINE HBR..................................................8
GANCICLOVIR......................................................... 29
GARAMYCIN............................................................ 30
GASTROCROM..........................................................6
GATIFLOXACIN........................................................30
GATTEX..............................................................42, 71
GAVILYTE-C.............................................................41
GAVILYTE-N.............................................................41
GDRIVE(OTC).......................................................... 24
GE100 BLOOD GLUCOSE SYSTEM(OTC)............ 24
GEBAUER'S 114...................................................... 22
GELATIN...................................................................31
GELATIN SPONGE,ABSORBABLE......................... 33
GELFILM.................................................................. 31
GELFOAM................................................................ 33
Page 79 of 90
Index
GELFOAM PACKS................................................... 33
GELNIQUE......................................................... 50, 65
GEMFIBROZIL......................................................... 14
GEMIFLOXACIN MESYLATE...................................35
GENADUR................................................................21
GENERESS FE........................................................ 15
GENERLAC.............................................................. 41
GENOTROPIN....................................................28, 71
GENTAMICIN SULFATE.....................................17, 30
GENTAMICIN/PREDNISOL AC................................29
GENTIAN VIOL/BRLNT GRN/PROFLAV................. 18
GENTLE DRAW(OTC)............................................. 26
GEODON..............................................................9, 57
GESTICARE DHA.................................................... 52
GIAZO................................................................ 40, 65
GILENYA............................................................ 43, 71
GILOTRIF........................................................... 42, 71
GLATIRAMER ACETATE..........................................43
GLEEVEC.....................................................43, 57, 71
GLIADEL.................................................................. 42
GLIMEPIRIDE...........................................................23
GLIPIZIDE................................................................ 23
GLIPIZIDE/METFORMIN HCL................................. 23
GLIPIZIDE-METFORMIN......................................... 23
GLUCAGEN..............................................................26
GLUCAGON EMERGENCY KIT.............................. 26
GLUCAGON,HUMAN RECOMBINANT................... 26
GLUCO NAVII(OTC).................................................24
GLUCOCARD 01(OTC)............................................24
GLUCOCARD 01-MINI(OTC)................................... 24
GLUCOCARD EXPRESSION(OTC)........................ 24
GLUCOCARD VITAL(OTC)...................................... 24
GLUCOCOM BLOOD GLUCOSE(OTC).................. 24
GLUCOFILM(OTC)...................................................23
GLUCOLET 2(OTC)................................................. 26
GLUCOPHAGE........................................................ 23
GLUCOSOURCE(OTC)............................................26
GLUCOSTIX REAGENT(OTC).................................23
GLUCOTROL........................................................... 23
GLUCOVANCE.........................................................23
GLUMETZA........................................................ 23, 65
GLUTETHIMIDE....................................................... 10
GLYBURIDE............................................................. 23
GLYBURIDE,MICRONIZED..................................... 23
GLYBURIDE/METFORMIN HCL.............................. 23
GLYBURIDE-METFORMIN HCL.............................. 23
GLYCEROL PHENYLBUTYRATE............................ 41
GLYCINE.................................................................. 36
GLYCINE UROLOGIC SOLUTION...........................36
GLYCOPYRROLATE................................................48
GLYNASE................................................................. 23
GLYSET....................................................................23
GMATE VOICE METER(OTC)................................. 24
GMATE VOICE STARTER(OTC)..............................24
GOLIMUMAB............................................................39
GOLYTELY............................................................... 41
GONADORELIN ACETATE...................................... 28
GORDO-UREA................................................... 21, 22
GR POL-ORC/SW VER/RYE/KENT/TIM....................5
GRALISE(TAB ER 24H)(300 MG)................ 43, 57, 65
GRALISE(TAB ER 24H)(300-600 MG)......... 43, 57, 65
GRALISE(TAB ER 24H)(600 MG)................ 43, 57, 65
GRANISETRON......................................................... 5
GRANISETRON HCL..................................... 5, 57, 65
GRASS POLLEN-TIMOTHY, STD..............................5
GRASTEK............................................................ 5, 71
GRIFULVIN V........................................................... 36
GRISEOFULVIN....................................................... 36
GRISEOFULVIN ULTRAMICROSIZE.......................36
GRISEOFULVIN, MICROSIZE................................. 36
GRIS-PEG................................................................ 36
GUAIACOL............................................................... 20
GUAIFENESIN/CODEINE PHOSPHATE................. 16
GUAIFENESIN/DYPHYLLINE.................................... 6
GUAIFENESIN/THEOPHYLLINE............................... 6
GUAIFENESIN-CODEINE........................................16
GUANFACINE HCL............................................ 10, 12
GUANIDINE HCL......................................................42
GUARDIAN REAL-TIME...........................................24
GYNOL II(OTC).................................................. 15, 73
-HHALCINONIDE......................................................... 19
HALCION..................................................................10
HALFAN....................................................................37
HALOBETASOL PROPIONATE............................... 19
HALOBETASOL/AMMONIUM LACTATE..................19
HALOBETASOL/LACTIC ACID................................ 19
HALOFANTRINE HCL.............................................. 37
L.A. Care
HALOG..................................................................... 19
HALONATE...............................................................19
HALOPERIDOL........................................................ 10
HALOPERIDOL LACTATE....................................... 10
HC/MINERAL OIL/PETROLAT,WHT........................ 19
HC/PRAMOX HCL/CL-XYLENOL/WATER...............27
HC/PRAMOXINE HCL/CHLOROXYLENOL.............27
HCTZ/RESERPINE/HYDRALAZINE........................ 12
HEALTHPRO GLUCOSE MONITOR(OTC)............. 25
HEALTHY ACCENTS AUTOLET(OTC)....................26
HECORIA................................................................. 34
HECTOROL..............................................................28
HELIXATE FS........................................................... 31
HEMANGEOL...........................................................12
HEMASEEL APR(KIT)(1 ML)................................... 33
HEMASEEL APR(KIT)(2 ML)................................... 33
HEMASEEL APR(KIT)(5ML).................................... 33
HEMENATAL OB...................................................... 53
HEMENATAL OB + DHA.......................................... 51
HEMOCYTE............................................................. 51
HEMOFIL M..............................................................31
HEPARIN FLUSH..................................................... 32
HEPARIN SOD,PORCINE-0.9 % NACL...................32
HEPARIN SOD,PORK IN 0.45% NACL....................32
HEPARIN SODIUM...................................................32
HEPARIN SODIUM IN 0.45% NACL........................ 32
HEPARIN SODIUM,PORCINE................................. 32
HEPARIN SODIUM,PORCINE/D5W........................ 32
HEPARIN SODIUM,PORCINE/NS........................... 32
HEPARIN SODIUM,PORCINE/NS/PF......................32
HEPARIN SODIUM,PORCINE/PF............................32
HEPARIN SODIUM-D5W......................................... 32
HEPARIN SODIUM-NS............................................ 32
HEP-PAK CVC..........................................................32
HEPSERA................................................................ 38
HETLIOZ............................................................ 10, 71
HEXALEN................................................................. 42
HIPREX.................................................................... 35
HISTAFED-LA...........................................................16
HISTRELIN ACETATE..............................................28
HOMATROPAIRE..................................................... 31
HOMATROPINE HBR...............................................31
HONEY..................................................................... 22
HORIZANT(TAB ER)(300 MG)..................... 43, 57, 65
HORIZANT(TAB ER)(600 MG)..................... 43, 57, 65
HPR.......................................................................... 20
HPR PLUS................................................................20
HUM INSULIN NPH/REG INSULIN HM................... 26
HUMALOG................................................................27
HUMALOG MIX 50-50.............................................. 27
HUMALOG MIX 75-25.............................................. 27
HUMATE-P............................................................... 31
HUMATROPE..................................................... 28, 71
HUMIRA..............................................................39, 71
HUMORSOL............................................................. 30
HUMULIN 70/30 KWIKPEN(OTC)............................26
HUMULIN 70-30(OTC)............................................. 26
HUMULIN N(OTC)....................................................27
HUMULIN R..............................................................27
HUMULIN R(OTC)....................................................27
HYALURO/DL-E AC/E12/ALLAN/SHEA...................20
HYALURON SOD/ALLANTOIN/ALOE XT................ 21
HYALURONATE SODIUM........................................21
HYCAMTIN............................................................... 42
HYCET............................................................... 44, 57
HYDRALAZINE HCL................................................ 12
HYDRALAZINE W/HCTZ..........................................12
HYDRALAZINE/HYDROCHLOROTHIAZID............. 12
HYDRALAZINE/RESERPIN/HCTZ...........................12
HYDREA...................................................................42
HYDRO 35................................................................21
HYDROCHLOROTHIAZIDE..................................... 13
HYDROCHLOROTHIAZIDE/RESERPINE............... 12
HYDROCODONE BIT/HOMATROP ME-BR............ 16
HYDROCODONE BITARTRATE.............................. 44
HYDROCODONE/ACETAMINOPHEN...............44, 45
HYDROCODONE/CHLORPHEN P-STIREX............16
HYDROCODONE/CHLORPHENIRAMINE.............. 16
HYDROCODONE/IBUPROFEN............................... 44
HYDROCODONEACETAMINOPHEN(SOLUTION)(10-325/15)......44,
5
7
HYDROCODONEACETAMINOPHEN(SOLUTION)(2.5-167/5)...... 44, 57
HYDROCODONEACETAMINOPHEN(SOLUTION)(5-163/7.5)...... 44, 57
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG300MG)...............................................................44, 57
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG325MG)...............................................................44, 57
HYDROCODONE-ACETAMINOPHEN(TAB)(2.5325MG).....................................................................44
HYDROCODONE-ACETAMINOPHEN(TAB)(5MG300MG)...............................................................45, 57
HYDROCODONE-ACETAMINOPHEN(TAB)(5MG325MG)...............................................................45, 57
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5300MG)...............................................................45, 57
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5325MG)...............................................................45, 58
HYDROCODONE-HOMATROPINE MBR................ 16
HYDROCORT/LIDOCAINE IN COLEUS..................41
HYDROCORT/PRAMOXIN/EMOL/PRAM#1............41
HYDROCORT/SAL ACID/SULF/SHMP#1................19
HYDROCORTISONE................................... 19, 39, 41
HYDROCORTISONE AC/LIDOCAINE............... 21, 41
HYDROCORTISONE ACETATE........................ 19, 41
HYDROCORTISONE ACETATE/ALOE V................ 19
HYDROCORTISONE ACETATE/UREA................... 19
HYDROCORTISONE BUTYRATE........................... 19
HYDROCORTISONE BUTYRATE/EMOLL.............. 19
HYDROCORTISONE PROBUTATE......................... 19
HYDROCORTISONE VALERATE............................ 19
HYDROCORTISONE/EMOL NO.45.........................19
HYDROCORTISONE/IODOQUIN/ALOE#2..............17
HYDROCORTISONE/IODOQUINOL....................... 17
HYDROCORTISONE/LIDOCAINE/ALOE................ 41
HYDROCORTISONE/PRAMOXINE...................21, 41
HYDROCORTISONE/PRAMOXINE/ALOE.............. 21
HYDROCORTISONE/PRAMOXINE/EMOLL............21
HYDROCORTISONE/SKIN CLNSR #25..................19
HYDROCORTISONE/SKIN CLNSR #35..................19
HYDROCORTISONE-ACETIC ACID....................... 27
HYDROCORTISONE-IODOQUINOL....................... 17
HYDROCORTISONE-LIDOCAINE...........................41
HYDROCORTISONE-PRAMOXINE.........................41
HYDROFLUMETHIAZIDE........................................ 13
HYDROMORPHONE HCL....................................... 45
HYDROMORPHONE HCL/PF..................................45
HYDROXOCOBALAMIN.......................................... 54
HYDROXYAMPHETAMINE/TROPICAMIDE............ 31
HYDROXYCHLOROQUINE SULFATE.................... 37
HYDROXYPROPYL CELLULOSE........................... 31
HYDROXYUREA................................................ 32, 42
HYDROXYZINE HCL..................................................5
HYDROXYZINE PAMOATE........................................5
HYLATOPIC..............................................................20
HYLATOPIC PLUS................................................... 20
HYOPHEN................................................................ 35
HYOSCYAMINE....................................................... 48
HYOSCYAMINE SULFATE.......................................48
HYPOLANCE(OTC)..................................................26
HYZAAR................................................................... 11
-IIBANDRONATE SODIUM.........................................28
IBG-STAR(OTC)....................................................... 25
IBRUTINIB................................................................ 42
IBUPROFEN.............................................................40
IBUPROFEN/FAMOTIDINE......................................40
IBUPROFEN/IRR CNT-IRRIT CMB #2.....................40
IBUPROFEN/OXYCODONE HCL............................ 44
ICATIBANT ACETATE.............................................. 39
ICLUSIG(TAB)(15 MG)................................. 43, 58, 71
ICLUSIG(TAB)(45 MG)................................. 43, 58, 71
ICOSAPENT ETHYL................................................ 14
ICY HOT(OTC)......................................................... 21
IDELALISIB.............................................................. 43
ILEVRO.................................................................... 29
ILOPERIDONE........................................................... 9
ILOPROST TROMETHAMINE................................. 13
ILOTYCIN................................................................. 30
IMATINIB MESYLATE.............................................. 43
IMBRUVICA........................................................42, 71
IMDUR...................................................................... 15
IMIPRAMINE HCL...................................................... 9
IMIPRAMINE PAMOATE............................................ 9
IMIQUIMOD.............................................................. 34
IMITREX............................................................. 45, 58
IMITREX(CARTRIDGE)......................................45, 58
IMITREX(PEN INJCTR)......................................45, 58
IMITREX(TAB).................................................... 45, 58
IMITREX(VIAL)................................................... 45, 58
IMURAN....................................................................34
INCIVEK............................................................. 38, 71
INCONTROL LANCING DEVICE(OTC)................... 26
INCRELEX..........................................................28, 71
Page 80 of 90
Index
INDACATEROL MALEATE.........................................6
INDAPAMIDE............................................................13
INDERAL XL.......................................................12, 65
INDINAVIR SULFATE............................................... 38
INDOCIN...................................................................40
INDOMETHACIN...................................................... 40
INFASURF................................................................ 44
INFINITY(OTC).........................................................25
INGENOL MEBUTATE............................................. 22
INHALER, ASSIST DEVICES................................ 6, 7
INHALER,ASSIST DEVICE,ACCESORY...................7
INLYTA(TAB)(1 MG)..................................... 42, 58, 71
INLYTA(TAB)(5 MG)..................................... 42, 58, 71
INNOPRAN XL................................................... 12, 65
INNOSPIRE ELEGANCE........................................... 7
INNOSPIRE ESSENCE..............................................7
INOVA.......................................................................21
INOVA 4-1.................................................................21
INOVA 8-2.................................................................21
INSPIRATION............................................................. 7
INSPIRATION ELITE.................................................. 7
INSPRA.................................................................... 13
INSULIN ASPART.................................................... 26
INSULIN DETEMIR.................................................. 26
INSULIN GLARGINE,HUM.REC.ANLOG.................27
INSULIN GLULISINE................................................27
INSULIN LISPRO..................................................... 27
INSULIN NPL/INSULIN LISPRO.............................. 27
INSULIN REGULAR, HUMAN.................................. 27
INSULN ASP PRT/INSULIN ASPART...................... 27
INTELENCE....................................................... 38, 71
INTERFERON ALFA-2B,RECOMB.......................... 34
INTERFERON ALFA-N3...........................................34
INTERFERON BETA-1A...........................................43
INTERFERON BETA-1A/ALBUMIN..........................43
INTERFERON BETA-1B...........................................43
INTERFERON GAMMA-1B,RECOMB..................... 34
INTERMEZZO.............................................. 10, 58, 65
INTRON A...........................................................34, 71
INTUNIV............................................................. 10, 58
INVEGA(TAB ER 24H)(1.5 MG)..................... 9, 58, 65
INVEGA(TAB ER 24H)(3 MG)........................ 9, 58, 65
INVEGA(TAB ER 24H)(6 MG)........................ 9, 58, 65
INVEGA(TAB ER 24H)(9 MG)........................ 9, 58, 65
INVIRASE(CAP)........................................... 38, 58, 65
INVIRASE(TAB)............................................38, 58, 65
INVOKAMET.............................................................23
INVOKANA................................................... 23, 58, 65
IODINE/POTASSIUM IODIDE.................................. 17
IODOFLEX................................................................17
IODOQUINOL...........................................................37
IODOQUINOL/ALOE POLYSACCHAR #1............... 17
IODOSORB.............................................................. 17
IOPIDINE(DROPERETTE)....................................... 30
IOPIDINE(DROPS)...................................................30
IPRATROPIUM BROMIDE................................... 6, 44
IPRATROPIUM/ALBUTEROL SULFATE....................6
IPRATROPIUM-ALBUTEROL.................................... 6
IPRIVASK..................................................... 32, 58, 71
IRBESARTAN........................................................... 12
IRBESARTAN/HYDROCHLOROTHIAZIDE..............11
IRON/FLUORIDE/VITS A, C, & D3...........................51
IRRIGATING SOLUTION G......................................36
ISENTRESS............................................................. 38
ISOCARBOXAZID...................................................... 8
ISOCHRON.............................................................. 15
ISOETHARINE HCL................................................... 6
ISOMETHEPT/DICHLPHN/ACETAMINOP.............. 45
ISOMETHEPT-DICHLORALP-ACETAMIN...............45
ISONIAZID................................................................36
ISOPROPAMIDE/PROCHLORPERAZINE...............48
ISOPTO ATROPINE................................................. 31
ISOPTO CARBACHOL.............................................30
ISOPTO CARPINE(DROPS)(1 %)........................... 30
ISOPTO CARPINE(DROPS)(2 %)........................... 30
ISOPTO CARPINE(DROPS)(4 %)........................... 30
ISOPTO CARPINE(DROPS)(8 %)........................... 30
ISOPTO HYOSCINE................................................ 31
ISORDIL................................................................... 15
ISORDIL TITRADOSE..............................................15
ISOSORB DINIT/HYDRALAZINE HCL.....................13
ISOSORBIDE DINITRATE........................................15
ISOSORBIDE MONONITRATE................................ 15
ISOTRETINOIN........................................................ 16
ISOVEX.................................................................... 15
ISOXSUPRINE HCL................................................. 15
ISRADIPINE............................................................. 12
ISTALOL................................................................... 30
L.A. Care
ITRACONAZOLE......................................................36
IVACAFTOR............................................................. 44
IVERMECTIN......................................................18, 37
-JJAKAFI......................................................... 42, 58, 71
JALYN...........................................................49, 65, 73
JANUMET...........................................................22, 58
JANUMET XR(TBMP 24HR)(100-1000MG).......22, 58
JANUMET XR(TBMP 24HR)(50-1000 MG)........22, 58
JANUMET XR(TBMP 24HR)(50MG-500MG)......22,
5
8
JANUVIA............................................................ 23, 58
JARDIANCE............................................................. 23
JENTADUETO.................................................... 22, 58
JINTELI.....................................................................34
JUBLIA............................................................... 18, 71
JUXTAPID...........................................................14, 71
-KKADIAN(CAP ER PEL)(20 MG)................................45
KADIAN(CAP ER PEL)(200 MG)............................. 45
KADIAN(CAP ER PEL)(40 MG)................................45
KADIAN(CAP ER PEL)(50 MG)................................45
KADIAN(CAP ER PEL)(60 MG)................................45
KADIAN(CAP ER PEL)(80 MG)................................45
KALETRA(SOLUTION)...................................... 38, 58
KALETRA(TAB)(100MG-25MG)......................... 38, 58
KALETRA(TAB)(200MG-50MG)......................... 38, 58
KALYDECO........................................................ 44, 71
KAOCHLOR..............................................................27
KAPVAY..............................................................10, 58
KARBINAL ER...................................................... 5, 55
KAZANO....................................................... 22, 58, 65
KEFLEX.................................................................... 34
KENALOG(AEROSOL)............................................ 20
KENALOG(LOTION).................................................20
KEPPRA................................................................... 47
KERAFOAM..............................................................21
KERALAC................................................................. 21
KERALYT..................................................................21
KERALYT SCALP.....................................................21
KERYDIN............................................................18, 71
KETEK...................................................................... 35
KETOCONAZOLE.............................................. 18, 36
KETOCONAZOLE/SKIN CLEANSER #28............... 18
KETODAN................................................................ 18
KETOPROFEN......................................................... 40
KETOROLAC TROMETHAMINE....................... 29, 40
KETOROLAC TROMETHAMINE/PF........................29
KHEDEZLA.....................................................8, 58, 65
KINERET............................................................ 39, 71
KLARON................................................................... 17
KLONOPIN............................................................... 46
KLOR-CON-EF......................................................... 27
KOATE-DVI...............................................................31
KOGENATE FS........................................................ 31
KOMBIGLYZE XR(TBMP 24HR)(2.5-1000MG)......22,
58,
65
KOMBIGLYZE XR(TBMP 24HR)(5 MG-500MG)......
22,
58,
66
KOMBIGLYZE XR(TBMP 24HR)(5MG-1000MG)......
22,
58,
66
KORLYM.............................................................23, 71
K-PHOS NO.2...........................................................49
K-PHOS ORIGINAL..................................................49
KRISTALOSE........................................................... 41
K-TAB ER................................................................. 27
KYNAMRO......................................................... 14, 71
-LLABETALOL HCL..................................................... 11
LAC-HYDRIN............................................................20
LACOSAMIDE.......................................................... 47
LACRISERT..............................................................31
LACTATED RINGERS.............................................. 21
LACTIC ACID........................................................... 20
LACTICARE-HC....................................................... 19
LACTULOSE............................................................ 41
LAMICTAL................................................................ 47
LAMICTAL (BLUE)....................................................47
LAMICTAL (GREEN)................................................ 47
LAMICTAL (ORANGE)............................................. 47
LAMICTAL ODT (BLUE)..................................... 47, 66
LAMICTAL ODT (GREEN)..................................47, 66
LAMICTAL ODT (ORANGE)...............................47, 66
LAMICTAL ODT(TAB RDP DIS)(100 MG)......47, 58,
6
6
LAMICTAL ODT(TAB RDP DIS)(200 MG)......47, 58,
6
6
LAMICTAL ODT(TAB RDP DIS)(25 MG)......47, 58, 66
LAMICTAL ODT(TAB RDP DIS)(50 MG)......47, 58, 66
LAMICTAL XR (BLUE)........................................47, 66
LAMICTAL XR (GREEN).................................... 47, 66
LAMICTAL XR (ORANGE)................................. 47, 66
LAMISIL(GRAN PACK).............................................36
LAMISIL(TAB)...........................................................36
LAMIVUDINE............................................................38
LAMIVUDINE HBV................................................... 38
LAMIVUDINE/ZIDOVUDINE.....................................37
LAMOTRIGINE......................................................... 47
LANCET DEVICE(OTC)........................................... 26
LANCING DEVICE............................................. 25, 26
LANCING DEVICE(OTC)......................................... 26
LANCING DEVICE/LANCETS..................................26
LANCING SYSTEM(OTC)........................................ 26
LANOXIN.................................................................. 11
LANSOPRAZOLE.....................................................49
LANSOPRAZOLE/AMOXICILN/CLARITH............... 49
LANTHANUM CARBONATE.................................... 27
LANTUS....................................................................27
LANTUS SOLOSTAR............................................... 27
LAPATINIB DITOSYLATE.........................................43
LASIX....................................................................... 13
LASTACAFT............................................................. 29
LATANOPROST....................................................... 30
LATUDA(TAB)(120 MG)................................. 9, 58, 66
LATUDA(TAB)(20 MG)................................... 9, 58, 66
LATUDA(TAB)(40 MG)................................... 9, 58, 66
LATUDA(TAB)(60 MG)................................... 9, 58, 66
LATUDA(TAB)(80 MG)................................... 9, 58, 66
LAZANDA........................................................... 44, 71
LC D NEBULIZER SET.............................................. 7
LC PLUS.....................................................................7
LC SPRINT NEBULIZER............................................7
LC STAR.....................................................................7
LEFLUNOMIDE........................................................ 39
LENALIDOMIDE....................................................... 42
LESCOL....................................................... 14, 58, 66
LESCOL XL.................................................. 14, 58, 66
LETAIRIS............................................................ 13, 71
LETROZOLE............................................................ 42
LEUCOVORIN CALCIUM.........................................43
LEUKERAN.............................................................. 42
LEUKINE............................................................ 32, 71
LEUPROLIDE ACETATE..........................................28
LEVACET..................................................................44
LEVALBUTEROL HCL................................................6
LEVALBUTEROL TARTRATE.................................... 6
LEVAQUIN................................................................35
LEVATOL.................................................................. 12
LEVEMIR............................................................ 26, 66
LEVEMIR FLEXPEN.......................................... 26, 66
LEVEMIR FLEXTOUCH..................................... 26, 66
LEVETIRACETAM.................................................... 47
LEVOBUNOLOL HCL...............................................30
LEVOCETIRIZINE DIHYDROCHLORIDE.................. 5
LEVOFLOXACIN................................................ 30, 35
LEVOMILNACIPRAN HYDROCHLORIDE................. 8
LEVONORGESTREL............................................... 15
LEVONORGESTREL-ETHIN ESTRADIOL.............. 15
LEVORA-28........................................................ 15, 73
LEVORPHANOL TARTRATE................................... 45
LEVOTHYROXINE SODIUM....................................29
LEVULAN................................................................. 43
LEXAPRO...................................................................8
LEXIVA............................................................... 38, 71
LIALDA............................................................... 40, 66
LIBERTY MONITOR(OTC).......................................25
LIBRAX..................................................................... 48
LIBRITABS..................................................................9
LIDOCAINE.............................................................. 22
LIDOCAINE HCL................................................ 22, 40
LIDOCAINE HCL VISCOUS..................................... 40
LIDOCAINE HCL/COLLAGEN................................. 22
LIDOCAINE HCL/PF.................................................29
LIDOCAINE/ALLANTOIN/PETROLATUM................ 22
LIDOCAINE/PRILOCAINE....................................... 22
LIDOCAINE/TETRACAINE.......................................22
LIDOCAINE-HYDROCORTISONE.....................21, 41
LIDOCAINE-PRILOCAINE....................................... 22
LIDODERM...............................................................22
LIDORX.................................................................... 22
LIDOVIR................................................................... 18
LINACLOTIDE.......................................................... 41
LINAGLIPTIN............................................................23
LINAGLIPTIN/METFORMIN HCL.............................22
LINDANE.................................................................. 18
LINEZOLID............................................................... 35
Page 81 of 90
Index
LINZESS.............................................................41, 58
LIOTHYRONINE SODIUM....................................... 29
LIOTRIX....................................................................29
LIPASE/PROTEASE/AMYLASE...............................48
LIPITOR....................................................................14
LIPOCHOL PLUS..................................................... 14
LIPTRUZET(TAB)(10 MG-10MG).................13, 58, 66
LIPTRUZET(TAB)(10 MG-20MG).................14, 58, 66
LIPTRUZET(TAB)(10 MG-40MG).................14, 58, 66
LIPTRUZET(TAB)(10 MG-80MG).................14, 58, 66
LIRAGLUTIDE.......................................................... 23
LISDEXAMFETAMINE DIMESYLATE........................ 9
LISINOPRIL.............................................................. 12
LISINOPRIL/HYDROCHLOROTHIAZIDE................ 11
LITE TOUCH(OTC).................................................. 26
LITEAIRE....................................................................7
LITETOUCH............................................................... 7
LITHIUM..................................................................... 9
LITHIUM CARBONATE.............................................. 9
LITHIUM CITRATE..................................................... 9
LITHOBID................................................................... 9
LITHOSTAT.............................................................. 41
LIVALO......................................................... 14, 58, 66
LIVER EXTRACT (BEEF-PORK)............................. 42
L-NORGEST-ETH ESTR/ETHIN ESTRA................. 15
LO LOESTRIN FE.............................................. 15, 66
LOCOID LIPOCREAM..............................................19
LOCOID(CREAM).....................................................19
LOCOID(LOTION).................................................... 19
LOCOID(OINT)......................................................... 19
LOCOID(SOLUTION)............................................... 19
LODOXAMIDE TROMETHAMINE............................30
LOESTRIN..........................................................15, 73
LOESTRIN FE.................................................... 15, 73
LOFIBRA.................................................................. 14
LOHIST-DM.............................................................. 16
LOMEFLOXACIN HCL............................................. 35
LOMITAPIDE MESYLATE........................................ 14
LOMOTIL.................................................................. 41
LOMUSTINE.............................................................42
LOPERAMIDE.......................................................... 41
LOPERAMIDE HCL.................................................. 41
LOPID....................................................................... 14
LOPINAVIR/RITONAVIR...........................................38
LOPRESSOR........................................................... 12
LOPRESSOR HCT................................................... 12
LOPROX...................................................................17
LORAZEPAM..............................................................9
LORZONE................................................................ 47
LOSARTAN POTASSIUM.........................................12
LOSARTAN/HYDROCHLOROTHIAZIDE................. 11
LOTEMAX.................................................................29
LOTENSIN................................................................12
LOTENSIN HCT........................................................11
LOTEPREDNOL ETABONATE.................................29
LOTREL.................................................................... 11
LOTRISONE............................................................. 17
LOTRONEX.............................................................. 41
LOUTREX.................................................................20
LOVASTATIN............................................................ 14
LOVAZA..............................................................14, 58
LOVENOX(SYRINGE)(100 MG/ML).................. 32, 58
LOVENOX(SYRINGE)(120MG/.8ML)................ 32, 58
LOVENOX(SYRINGE)(150 MG/ML).................. 32, 58
LOVENOX(SYRINGE)(30MG/0.3ML)................ 32, 58
LOVENOX(SYRINGE)(40MG/0.4ML)................ 32, 58
LOVENOX(SYRINGE)(60MG/0.6ML)................ 32, 58
LOVENOX(SYRINGE)(80MG/0.8ML)................ 32, 58
LOVENOX(VIAL)................................................ 32, 58
LOXAPINE..................................................................9
LOXAPINE SUCCINATE............................................ 9
LOXITANE.................................................................. 9
LUBIPROSTONE......................................................41
LUCINACTANT.........................................................44
LUFYLLIN................................................................... 7
LUFYLLIN-400............................................................7
LUFYLLIN-GG............................................................ 6
LUGOL'S.................................................................. 17
LULICONAZOLE...................................................... 18
LUMIGAN........................................................... 30, 58
LUNESTA..................................................... 10, 58, 66
LURASIDONE HCL.................................................... 9
LUTREPULSE.......................................................... 28
LUVOX CR..................................................... 8, 58, 66
LUXIQ....................................................................... 19
LUZU............................................................ 18, 58, 66
LYCELLE.................................................................. 18
LYRICA..................................................................... 47
L.A. Care
LYSINE HCL/VIT B COMP/FA/ZINC........................ 54
LYSINE/VITAMIN B COMPLEX/FA/ZN.....................54
LYSIPLEX................................................................. 54
LYSODREN.............................................................. 43
LYSTEDA..................................................................31
-MMACITENTAN...........................................................13
MACROBID.............................................................. 35
MACRODANTIN(CAP)(100 MG).............................. 35
MACRODANTIN(CAP)(25 MG)................................ 35
MACRODANTIN(CAP)(50 MG)................................ 35
MAFENIDE ACETATE.............................................. 18
MAGAN.....................................................................44
MAGNEBIND 400 RX............................................... 27
MAGNESIUM SALICYLATE..................................... 44
MALARONE..............................................................37
MALATHION............................................................. 18
MANNITOL............................................................... 13
MANNITOL/SORBITOL SOLUTION.........................20
MAPROTILINE HCL................................................... 9
MARAVIROC............................................................ 38
MARINOL....................................................... 5, 58, 66
MARNATAL-F........................................................... 52
MARPLAN.................................................................. 8
MAR-ZINC................................................................ 54
MATULANE.............................................................. 43
MAVIK.......................................................................12
MAXALT..............................................................45, 58
MAXALT MLT......................................................45, 58
MAXAQUIN...............................................................35
MAXIDEX..................................................................29
MAXINATE................................................................51
MAXITROL............................................................... 29
MAXZIDE-25 MG......................................................13
MB HYDROGEL....................................................... 20
MECAMYLAMINE HCL............................................ 12
MECASERMIN......................................................... 28
MECHLORETHAMINE HCL..................................... 22
MECLIZINE HCL........................................................ 5
MECLOFENAMATE SODIUM.................................. 40
MEDIHONEY............................................................ 22
MEDROL(TAB DS PK)............................................. 39
MEDROL(TAB)(16 MG)............................................ 39
MEDROL(TAB)(2 MG).............................................. 39
MEDROL(TAB)(32 MG)............................................ 39
MEDROL(TAB)(4 MG).............................................. 39
MEDROL(TAB)(8 MG).............................................. 39
MEDROXYPROGESTERONE ACET.......................34
MEDROXYPROGESTERONE ACETATE.......... 15, 34
MEFENAMIC ACID...................................................40
MEFLOQUINE HCL..................................................37
MEGESTROL ACETATE.......................................... 43
MEKINIST...........................................................43, 71
MELOXICAM............................................................ 40
MELOXICAM/IRR CNTR-IRR CMB #2.....................40
MELPHALAN............................................................ 42
MEMANTINE HCL...................................................... 8
MENEST...................................................................34
MENOSTAR........................................................33, 58
MENTAX................................................................... 17
MENTHOL/BANDAGES, TUBULAR........................ 21
MEPENZOLATE BROMIDE..................................... 48
MEPERIDINE HCL................................................... 45
MEPERIDINE HCL/PF..............................................45
MEPHYTON............................................................. 33
MEPROBAMATE........................................................ 9
MERCAPTOPURINE................................................42
MESALAMINE.......................................................... 40
MESALAMINE W/CLEANSING WIPES................... 40
MESNA..................................................................... 43
MESNEX...................................................................43
MESTINON(SYRUP).................................................. 8
MESTINON(TAB ER)..................................................8
MESTINON(TAB)........................................................8
METAPROTERENOL SULFATE................................ 6
METAXALONE......................................................... 48
METFORMIN HCL....................................................23
METHADONE HCL...................................................45
METHAMPHETAMINE HCL....................................... 9
METHAZOLAMIDE...................................................30
METHEN MAND/NAPHOS M-B M-H....................... 49
METHEN/M-BLUE/SAL/NA PHOS/HYOS................34
METHEN/SOD PHOS/METH BLUE/HYOS..............34
METHENAM/ME BLUE/BA/SALICY/HYO................ 35
METHENAMINE HIPPURATE..................................35
METHENAMINE MANDELATE................................ 35
METHIMAZOLE........................................................29
METHIONINE/INOSITOL/CHOLINE/FA................... 14
METHITEST............................................................. 33
METHOCARBAMOL.................................................48
METHOTREXATE.............................................. 39, 42
METHOTREXATE SODIUM............................... 39, 42
METHOTREXATE SODIUM/PF............................... 42
METHOTREXATE/PF...............................................39
METHOXSALEN.......................................................22
METHOXSALEN, RAPID..........................................22
METHSCOPOLAMINE BROMIDE........................... 48
METHSUXIMIDE...................................................... 47
METHYCLOTHIAZIDE............................................. 13
METHYLDOPA......................................................... 12
METHYLDOPA/HYDROCHLOROTHIAZIDE........... 12
METHYLDOPA-HYDROCHLOROTHIAZIDE........... 12
METHYLERGONOVINE MALEATE......................... 16
METHYLIN......................................................... 10, 58
METHYLNALTREXONE BROMIDE......................... 41
METHYLPHENIDATE...............................................10
METHYLPHENIDATE ER(CPBP 50-50)(20 MG)......
10,
58
METHYLPHENIDATE ER(CPBP 50-50)(30 MG)......
10,
58
METHYLPHENIDATE ER(CPBP 50-50)(40 MG)......
1
0
METHYLPHENIDATE ER(TAB ER)(10 MG)............ 10
METHYLPHENIDATE ER(TAB ER)(20 MG)...... 10, 58
METHYLPHENIDATE HCL.......................................10
METHYLPREDNISOLONE.......................................39
METHYLTESTOSTERONE...................................... 33
METIPRANOLOL......................................................30
METOCLOPRAMIDE HCL....................................... 49
METOLAZONE......................................................... 13
METOPROLOL SUCCINATE................................... 12
METOPROLOL SUCCINATE/HCTZ.........................12
METOPROLOL TARTRATE..................................... 12
METOPROLOL/HYDROCHLOROTHIAZIDE........... 12
METOPROLOL-HYDROCHLOROTHIAZIDE...........12
METOZOLV ODT......................................................49
METRELEPTIN.........................................................28
METROGEL..............................................................17
METROGEL-VAGINAL............................................. 50
METROLOTION....................................................... 17
METRONIDAZOLE.......................................17, 37, 50
METRONIDAZOLE/SKIN CLEANSR #23................ 17
METYROSINE.......................................................... 12
MEVACOR................................................................14
MEXILETINE HCL.................................................... 11
MIACALCIN(SPRAY/PUMP).................................... 28
MIACALCIN(VIAL).................................................... 28
MICONAZOLE.......................................................... 36
MICONAZOLE 3....................................................... 50
MICONAZOLE NITRATE..........................................50
MICONAZOLE NITRATE/HC....................................18
MICONAZOLE NITRATE/ZINC OX/PET.................. 18
MICRO ELITE.............................................................7
MICRO PLUS............................................................. 7
MICRO(OTC)............................................................25
MICROCHAMBER......................................................7
MICRODOT(OTC).................................................... 25
MICROFIBRILLAR COLLAGEN............................... 33
MICROGESTIN.................................................. 15, 73
MICROGESTIN FE.............................................15, 73
MICROLET 2(OTC).................................................. 26
MICROSPACER......................................................... 7
MICROZIDE..............................................................13
MIDAZOLAM HCL.................................................... 10
MIDODRINE HCL..................................................... 14
MIFEPRISTONE.......................................................23
MIGERGOT........................................................ 45, 58
MIGLITOL................................................................. 23
MIGRANAL......................................................... 45, 58
MILLIPRED...............................................................39
MILLIPRED DP.........................................................39
MILNACIPRAN HCL................................................. 43
MILTOWN................................................................... 9
MINASTRIN 24 FE................................................... 15
MINI LANCING DEVICE(OTC).................................26
MINI PLUS NEBULIZER.............................................7
MINIELITE.................................................................. 7
MINIPRESS.............................................................. 11
MINIVELLE......................................................... 33, 58
MINI-WRIGHT PEAK FLOW METER.........................7
MINOCIN.................................................................. 36
MINOCYCLINE HCL.................................................36
MINOCYCLINE HCL MICROSPHERES.................. 44
MINOCYCLINE HCL(TAB ER 24H)..............36, 55, 58
MINOCYCLINE HCL(TAB)....................................... 36
MINOCYCLINE HCL/SKIN CL NO.4........................ 36
Page 82 of 90
Index
MINOXIDIL............................................................... 12
MIPOMERSEN SODIUM..........................................14
MIRABEGRON......................................................... 49
MIRAPEX..................................................................46
MIRAPEX ER............................................... 46, 58, 66
MIRTAZAPINE............................................................8
MIRVASO........................................................... 17, 58
MISOPROSTOL....................................................... 48
MISTERNEB NEBULIZER..........................................7
MITOMYCIN............................................................. 31
MITOSOL..................................................................31
MITOTANE............................................................... 43
MOBIC...................................................................... 40
MODAFINIL.............................................................. 10
MOEXIPRIL HCL...................................................... 12
MOEXIPRIL/HYDROCHLOROTHIAZIDE.................11
MOEXIPRIL-HYDROCHLOROTHIAZIDE................ 11
MOMETASONE FUROAT/AMMONIUM LAC........... 19
MOMETASONE FUROATE.............................. 5, 6, 19
MOMETASONE/FORMOTEROL................................6
MOMEXIN.................................................................19
MONAGHAN Z STAT..................................................7
MONOCLATE-P........................................................31
MONODOX...............................................................36
MONOJECT PREFILL ADVANCED......................... 32
MONONINE.............................................................. 32
MONTELUKAST SODIUM......................................... 6
MONUROL............................................................... 34
MORGIDOX........................................................35, 36
MORPHINE SULFATE..............................................45
MORPHINE SULFATE ER........................................45
MORPHINE SULFATE/PF........................................ 45
MOTOFEN................................................................41
MOVIPREP...............................................................41
MOXEZA...................................................................30
MOXIFLOXACIN HCL........................................ 30, 35
MS CONTIN..............................................................45
M-TETRAHYROFOLATE/NIACIN/CU/ZN................ 50
MTH/ME BLUE/SOD PHOS/PHEN/HYOS............... 35
MULTAQ....................................................................11
MULTICHEW............................................................ 51
MULTI-LANCET DEVICE(OTC)............................... 26
MULTIVIT, IRON, MIN #4, FA................................... 51
MULTIVIT, IRON, MIN #5, FA................................... 51
MULTIVIT, MIN CMB#20/IRON/FA........................... 51
MULTIVIT, MIN NO.21/FOLIC ACID.........................51
MULTIVIT, MINCMB#11/FOLIC ACID...................... 54
MULTIVITAMIN NO.44/VIT D3/K..............................51
MULTIVITAMIN W/IRON, MINERALS...................... 51
MULTI-VITAMIN W-FLUORIDE................................ 51
MULTIVITAMIN WITH FLUORIDE........................... 51
MULTIVITAMIN, MIN CMB#25/FA/D3...................... 54
MULTIVITAMINS W/FLUORIDE...............................51
MULTIVITAMINS W-FLUORIDE-IRON.....................51
MULTIVITAMINS WITH FLUORIDE......................... 51
MULTIVITAMINS WITH MIN NO.7/FA......................51
MULTIVITAMINS-A,B,D,E,K,ZN............................... 51
MUPIROCIN............................................................. 17
MUPIROCIN CALCIUM...................................... 17, 44
MV, MIN CMB #6/FA/LUT/LYCO/Q10...................... 51
MV, MIN CMB#16/FA/LUTEIN/LYCOP..................... 50
MV, MIN CMB#24/IRON PS CMP/FA.......................51
MV, MIN CMB#9/FA/SAW PALMET XT....................51
MV/DIETARY 4/DNA/RNA........................................51
MVC-FLUORIDE...................................................... 51
M-VIT........................................................................ 53
MYALEPT................................................................. 28
MYAMBUTOL........................................................... 36
MYCOBUTIN............................................................ 36
MYCOPHENOLATE MOFETIL.................................34
MYCOPHENOLATE SODIUM.................................. 34
MYCOPHENOLIC ACID........................................... 34
MYDRIACYL.............................................................31
MYGLUCOHEALTH CONTROL SOLUTION(OTC)
..................................................................................23
MYGLUCOHEALTH(OTC)........................................25
MYKIDZ IRON FL..................................................... 51
MYLERAN................................................................ 42
MYNATAL................................................................. 52
MYNATE 90 PLUS....................................................52
MYO VYT..................................................................54
MYRBETRIQ................................................ 49, 58, 66
MYSOLINE............................................................... 47
-NNA PHOS,M-B/K PHOS,MONOB.............................49
NA SULFACETM/PREDNIS SP............................... 30
NABILONE..................................................................5
NABUMETONE........................................................ 40
L.A. Care
NADOLOL................................................................ 12
NADOLOL/BENDROFLUMETHIAZIDE....................12
NAFARELIN ACETATE.............................................28
NAFTIFINE HCL....................................................... 18
NAFTIN(CREAM)..................................................... 18
NAFTIN(GEL)(1 %)...................................................18
NAFTIN(GEL)(2 %)...................................................18
NALBUPHINE HCL.................................................. 45
NALIDIXIC ACID.......................................................35
NALOXONE HCL..................................................... 10
NALTREXONE HCL................................................. 10
NAMENDA XR(CAP 24 DSPK)............................ 8, 58
NAMENDA XR(CAP SPR 24).............................. 8, 58
NAMENDA(SOLUTION)....................................... 8, 58
NAMENDA(TAB DS PK).......................................8, 58
NAMENDA(TAB)...................................................8, 58
NAMGFLU/CYCLO/PHOS/NAHCO3/NACL............. 20
NAPHAZOLINE HCL................................................ 30
NAPHAZOLINE HCL W/ANTAZOLINE.................... 30
NAPHAZOLINE HCL/ANTAZOLINE.........................30
NAPHOS M-B M-H/NA PHOS,DI-BA....................... 41
NAPRELAN.............................................................. 40
NAPROSYN..............................................................40
NAPROXEN..............................................................40
NAPROXEN SODIUM.............................................. 40
NAPROXEN/ESOMEPRAZOLE MAG......................40
NAPROXEN/IRR CNTR-IRRIT CMB #2...................40
NARATRIPTAN HCL.................................................45
NARDIL.......................................................................8
NASCOBAL.............................................................. 54
NASONEB NASAL NEBULIZER................................ 7
NASONEX............................................................ 5, 58
NATACHEW..............................................................52
NATACYN................................................................. 30
NATALVIRT 90 DHA................................................. 51
NATALVIRT CA.........................................................52
NATALVIT................................................................. 53
NATAMYCIN............................................................. 30
NATAZIA............................................................. 15, 67
NATEGLINIDE.......................................................... 23
NATELLE ONE......................................................... 52
NATROBA.................................................................18
NATURE-THROID.................................................... 29
NATURETIN-5.......................................................... 13
NEBIVOLOL HCL..................................................... 12
NEBULIZER................................................................7
NEBULIZER/COMPRESSOR.....................................7
NEBUPENT.............................................................. 37
NECON...............................................................15, 73
NEDOCROMIL SODIUM.......................................... 30
NEFAZODONE HCL...................................................8
NEGGRAM............................................................... 35
NELFINAVIR MESYLATE.........................................38
NEO/POLYMYX B SULF/DEXAMETH..................... 29
NEOMY SULF/BACITRA/POLYMYXIN B.................30
NEOMY SULF/BACITRAC ZN/POLY/HC.................29
NEOMY SULF/COLIST SUL/HC/THONZ.................27
NEOMY SULF/POLYMYXIN B SULFATE................ 21
NEOMYCIN SULFATE..............................................36
NEOMYCIN SULFATE/DEX NA PH......................... 29
NEOMYCIN SULFATE/FLUOCINOLONE................ 18
NEOMYCIN W/DEXAMETHASONE........................ 29
NEOMYCIN/BACITRA/POLYMYXIN/HC..................19
NEOMYCIN/FLUOCINOLONE/EMOL #65...............19
NEOMYCIN/POLYMYXIN B SULF/HC...............19, 27
NEOMYCIN/POLYMYXN B/GRAMICIDIN................30
NEOMYCIN-BACITRACIN-POLY-HC.......................29
NEOMYCIN-POLYMYXIN-HC.................................. 27
NEO-POLYCIN......................................................... 30
NEOSALUS.............................................................. 20
NEOSALUS CP........................................................ 20
NEOSPORIN............................................................ 30
NEOSPORIN G.U. IRRIGANT..................................21
NEO-SYNALAR.................................................. 18, 19
NEPAFENAC............................................................ 29
NEPHPLEX RX........................................................ 54
NEPHROCAPS QT...................................................54
NEPTAZANE............................................................ 30
NESINA........................................................ 23, 58, 67
NESTABS................................................................. 53
NESTABS ABC.........................................................51
NESTABS DHA.........................................................51
NEUAC..................................................................... 16
NEULASTA......................................................... 32, 71
NEUMEGA................................................................32
NEUPOGEN....................................................... 32, 71
NEUPRO...................................................... 46, 58, 67
NEURIN-SL.............................................................. 54
NEURONTIN............................................................ 47
NEVANAC.................................................................29
NEVIRAPINE............................................................ 38
NEWTEK(OTC)........................................................ 25
NEXA PLUS............................................................. 52
NEXAVAR..................................................... 43, 58, 71
NEXAVIR.................................................................. 42
NEXIUM..............................................................49, 58
NEXT CHOICE ONE DOSE......................... 15, 55, 73
NIACIN......................................................................14
NIACIN SR 250MG...................................................14
NIACIN/LOVASTATIN............................................... 14
NIACIN/SIMVASTATIN............................................. 14
NIASPAN............................................................ 14, 67
NICARDIPINE HCL.................................................. 13
NICOMIDE................................................................50
NICOTINE.................................................................48
NICOTROL......................................................... 48, 58
NICOTROL NS................................................... 48, 58
NIFEDIPINE..............................................................13
NILANDRON...................................................... 42, 58
NILOTINIB HCL........................................................ 43
NILUTAMIDE............................................................ 42
NIMODIPINE............................................................ 13
NIMOTOP................................................................. 13
NISOLDIPINE........................................................... 13
NITAZOXANIDE....................................................... 17
NITRO-BID............................................................... 15
NITRO-DUR(PATCH TD24)(0.1MG/HR).................. 15
NITRO-DUR(PATCH TD24)(0.2MG/HR).................. 15
NITRO-DUR(PATCH TD24)(0.3 MG/HR)................. 15
NITRO-DUR(PATCH TD24)(0.4MG/HR).................. 15
NITRO-DUR(PATCH TD24)(0.6MG/HR).................. 15
NITRO-DUR(PATCH TD24)(0.8MG/HR).................. 15
NITROFURANTOIN..................................................35
NITROFURANTOIN MACROCRYSTAL................... 35
NITROFURANTOIN MONOHYD/M-CRYST............ 35
NITROFURAZONE...................................................17
NITROGLYCERIN.............................................. 15, 41
NITROSTAT..............................................................15
NIZATIDINE.............................................................. 49
NIZORAL.................................................................. 18
NONOXYNOL 9........................................................15
NORA-BE........................................................... 15, 73
NORDITROPIN FLEXPRO.................................28, 71
NORDITROPIN NORDIFLEX............................. 28, 71
NORETH-ETHINYL ESTRADIOL/IRON...................15
NORETHINDRONE.................................................. 15
NORETHINDRONE ACETATE.................................34
NORETHINDRONE AC-ETH ESTRADIOL........ 15, 34
NORETHINDRONE-E.ESTRADIOL-IRON...............15
NORETHINDRONE-ETHINYL ESTRAD.................. 15
NORETHINDRONE-MESTRANOL.......................... 15
NORFLOXACIN........................................................35
NORFLURANE/HFC 245FA..................................... 22
NORGESTIMATE-ETHINYL ESTRADIOL............... 16
NORGESTREL-ETHINYL ESTRADIOL................... 16
NORINYL 1+50...................................................15, 73
NORITATE................................................................ 17
NORMAL SALINE.................................................... 28
NORMAL SALINE FLUSH........................................28
NORMLGEL AG....................................................... 17
NOROXIN................................................................. 35
NORPACE................................................................ 11
NORPACE CR.......................................................... 11
NORPRAMIN..............................................................8
NORTHERA........................................................14, 71
NORTRIPTYLINE HCL...............................................9
NORVASC................................................................ 12
NORVIR..............................................................38, 58
NOVA MAX BLOOD GLUCOSE METER(OTC)....... 25
NOVACORT..............................................................21
NOVOLIN 70-30(OTC)............................................. 26
NOVOLIN N INNOLET(OTC)................................... 27
NOVOLIN N(OTC).................................................... 27
NOVOLIN R(OTC).................................................... 27
NOVOLOG................................................................26
NOVOLOG FLEXPEN.............................................. 26
NOVOLOG MIX 70-30.............................................. 27
NOVOLOG MIX 70-30 FLEXPEN............................ 27
NOVOSEVEN........................................................... 31
NOVOSEVEN RT..................................................... 31
NOXAFIL.................................................................. 36
NPH, HUMAN INSULIN ISOPHANE........................ 27
NUCORT.................................................................. 19
NUCYNTA...........................................................45, 58
NUCYNTA ER.....................................................45, 58
NUEDEXTA........................................................ 43, 71
Page 83 of 90
Index
NUMORPHAN.......................................................... 45
NUOX....................................................................... 21
NUTRICAP............................................................... 50
NUTROPIN AQ...................................................28, 71
NUTROPIN AQ NUSPIN.................................... 28, 71
NUVAIL..................................................................... 21
NUVARING................................................... 15, 58, 67
NUVIGIL............................................................. 10, 71
NYLIDRIN HCL.........................................................15
NYMALIZE..........................................................13, 71
NYSTATIN.......................................................... 18, 36
NYSTATIN/EMOLLIENT COMBO NO.54................. 18
NYSTATIN/HYDROCORTISONE/DIPHEN...............36
NYSTATIN/LIDOCAINE/DIPHENHYD......................36
NYSTATIN/TCN/HC/DIPHENHYDRAMIN................ 36
NYSTATIN/TRIAMCIN.............................................. 18
NYSTATIN-TRIAMCINOLONE................................. 18
-OOB COMPLETE........................................................53
OB COMPLETE 400.................................................52
OB COMPLETE ONE............................................... 51
OB COMPLETE PETITE.......................................... 51
OB COMPLETE PREMIER...................................... 53
OB COMPLETE WITH DHA..................................... 51
OBSTETRIX EC....................................................... 53
OBTREX................................................................... 53
OBTREX DHA.......................................................... 52
O-CAL FA................................................................. 53
OCELLA....................................................... 15, 67, 73
OCUFEN...................................................................29
OCUFLOX................................................................ 30
OFLOXACIN................................................. 27, 30, 35
OGEN....................................................................... 34
OLANZAPINE............................................................. 9
OLANZAPINE/FLUOXETINE HCL........................... 10
OLEPTRO ER................................................ 8, 58, 67
OLMESARTAN MEDOXOMIL.................................. 12
OLMESARTAN/AMLODIPIN/HCTHIAZID.................11
OLMESARTAN/HYDROCHLOROTHIAZIDE............11
OLODATEROL HCL................................................... 6
OLOPATADINE HCL.............................................5, 29
OLSALAZINE SODIUM............................................ 40
OLUX........................................................................ 19
OLYSIO...............................................................38, 71
OM-3/CA CARB/D3/FA/MV CMB 13........................ 51
OM-3/DHA/EPA/D3/B12/FA/B-6/PHY.......................51
OMACETAXINE MEPESUCCINATE........................ 43
OMECLAMOX-PAK.................................................. 49
OMEGA-3 ACID ETHYL ESTERS............................14
OMEPRAZOLE.........................................................49
OMEPRAZOLE MAGNESIUM..................................49
OMEPRAZOLE/CLARITH/AMOXICILLIN.................49
OMEPRAZOLE/SODIUM BICARBONATE...............49
OMNARIS....................................................... 5, 59, 67
OMNIPRED.............................................................. 29
OMNITROPE...................................................... 28, 71
ON CALL EXPRESS METER(OTC).........................25
ON CALL LANCING DEVICE(OTC)......................... 26
ON CALL PLUS LANCING DEVICE(OTC)...............26
ON CALL PLUS METER(OTC)................................ 25
ON CALL VIVID METER(OTC)................................ 25
ON CALL VIVID PAL(OTC)...................................... 25
ONDANSETRON........................................................5
ONDANSETRON HCL................................................5
ONE TOUCH DELICA(OTC).................................... 26
ONE TOUCH SURESOFT(OTC)..............................26
ONFI(ORAL SUSP)...................................... 46, 59, 67
ONFI(TAB).................................................... 46, 59, 67
ONGLYZA.....................................................23, 59, 67
ONMEL..................................................................... 36
OPANA(AMPUL).......................................................45
OPANA(TAB)............................................................ 45
OPIUM TINCTURE...................................................41
OPIUM/BELLADONNA ALKALOIDS........................45
OPRELVEKIN........................................................... 32
OPSUMIT........................................................... 13, 71
OPTICHAMBER......................................................... 7
OPTICHAMBER DIAMOND....................................... 7
OPTIMYD................................................................. 30
OPTIVAR.................................................................. 29
OPTUMRX(OTC)......................................................25
ORACEA................................................ 36, 55, 59, 67
ORACIT.................................................................... 49
ORALAIR.............................................................. 5, 71
ORAP..........................................................................9
ORAPRED ODT....................................................... 39
ORAVIG.................................................................... 36
ORENCIA........................................................... 39, 71
L.A. Care
ORENITRAM ER................................................ 13, 71
ORPHENADRINE CITRATE.....................................48
ORPHENADRINE COMPOUND FORTE................. 48
ORPHENADRINE/ASPIRIN/CAFFEINE...................48
ORTHO TRI-CYCLEN LO.................................. 16, 67
ORTHO-NOVUM................................................ 15, 73
OSELTAMIVIR PHOSPHATE................................... 37
OSENI.......................................................... 22, 59, 67
OSMOPREP............................................................. 41
OSPEMIFENE.......................................................... 29
OSPHENA.......................................................... 29, 59
OTEZLA..............................................................39, 71
OTIC CARE.............................................................. 27
OTICIN......................................................................27
OTICIN HC............................................................... 27
OTOZIN.................................................................... 27
OTREXUP.................................................... 39, 59, 67
OVACE..................................................................... 20
OVACE PLUS(CLEANSR ER)..................................20
OVACE PLUS(CREAM)............................................20
OVACE PLUS(LOTION)........................................... 20
OVACE PLUS(SHAMPOO)...................................... 20
OVIDE.......................................................................18
OXACILLIN SODIUM................................................35
OXALIC ACID........................................................... 21
OXALIS.....................................................................21
OXANDRIN...............................................................33
OXANDROLONE......................................................33
OXAPROZIN.............................................................40
OXAZEPAM................................................................ 9
OXCARBAZEPINE................................................... 47
OXECTA................................................................... 45
OXICONAZOLE NITRATE........................................18
OXISTAT...................................................................18
OXSORALEN........................................................... 22
OXSORALEN-ULTRA...............................................22
OXTELLAR XR(TAB ER 24H)(150 MG)....... 47, 59, 67
OXTELLAR XR(TAB ER 24H)(300 MG)....... 47, 59, 67
OXTELLAR XR(TAB ER 24H)(600 MG)....... 47, 59, 67
OXYBUTYNIN.......................................................... 50
OXYBUTYNIN CHLORIDE.......................................50
OXYCEL................................................................... 33
OXYCODONE HCL.................................................. 45
OXYCODONE HCL/ACETAMINOPHEN.................. 45
OXYCODONE HCL/ASPIRIN...................................45
OXYCODONE HCL-IBUPROFEN............................ 44
OXYCONTIN............................................................ 45
OXYMETHOLONE................................................... 33
OXYMORPHONE HCL.............................................45
OXY-TCN HCL/POLYMYX B SULF.......................... 30
OXYTETRACYCLINE/POLYMYX B SULF............... 30
OXYTROL.......................................................... 50, 68
-PPACNEX HP............................................................. 21
PACNEX LP..............................................................21
PAIN EASE............................................................... 22
PAIRE OB PLUS DHA.............................................. 51
PALIPERIDONE......................................................... 9
PAMELOR.................................................................. 9
PAMINE.................................................................... 48
PAMINE FORTE....................................................... 48
PANCREAZE............................................................ 48
PANDEL....................................................................19
PANTOPRAZOLE SODIUM..................................... 49
PAPAVERINE HCL................................................... 15
PARAFON FORTE DSC...........................................47
PAREGORIC............................................................ 41
PAREMYD................................................................ 31
PARI LC SPRINT SINUS............................................7
PARI SINUS AEROSOL SYSTEM............................. 7
PARICALCITOL........................................................ 28
PARLODEL...............................................................46
PARNATE................................................................... 8
PAROMOMYCIN SULFATE......................................37
PAROXETINE HCL.....................................................8
PAROXETINE MESYLATE.........................................8
PASER......................................................................36
PATADAY.................................................................. 29
PATANASE..................................................... 5, 59, 68
PATANOL..................................................................29
PAXIL CR....................................................................8
PAXIL(ORAL SUSP)...................................................8
PAXIL(TAB).................................................................8
PAZOPANIB HCL..................................................... 43
PCE.......................................................................... 35
PEAK FLOW METER................................................. 7
PEAK FLOW METER/INH ASST DEV....................... 7
PED MV A,C,D3 #21 W-FLUORIDE.........................51
PED MV A,C,D3 #38 W-FLUORIDE.........................51
PEDI M.VIT NO.17 WITH FLUORIDE...................... 51
PEDI MULTIVIT #37 W-FLUORIDE......................... 51
PEDI MULTIVIT #47/IRON/FLUORID...................... 51
PEDI MULTIVIT #61/VIT D3/VIT K........................... 51
PEDI MULTIVIT #65/VIT D3/VIT K........................... 51
PEDI MULTIVIT #77/VIT D3/VIT K........................... 51
PEDI MULTIVIT #78/IRON/FLUORID...................... 51
PEDI MULTIVIT NO.2 W-FLUORIDE....................... 51
PEDI MV #37 W-FLUORIDE & IRON.......................51
PEDI MV #45/FLUORIDE/IRON...............................51
PEDI MV #75/FLUORIDE/IRON...............................51
PEDI MV NO.83 WITH FLUORIDE.......................... 51
PEDI MV NO.84 WITH FLUORIDE.......................... 51
PEDI MVI NO.12/SODIUM FLUORIDE.................... 51
PEDI MVI NO.16 WITH FLUORIDE......................... 51
PEDI MVI NO.33 WITH FLUORIDE......................... 51
PEDI MVI NO.82 WITH FLUORIDE......................... 51
PEDIADERM AF.......................................................18
PEDIADERM HC...................................................... 19
PEDIADERM TA....................................................... 20
PEDIAPRED............................................................. 39
PEDIATRIC MV #33 W-FLUORIDE&FE...................51
PEDIPIROX-4........................................................... 18
PEG 3350/NA SULF,BICARB,CL/KCL..................... 41
PEG 3350-BOWEL 2,TWO PART PREP................. 41
PEG3350/SOD SUL/NACL/ASB/C/KCL................... 41
PEGANONE............................................................. 46
PEGASYS.......................................................... 38, 71
PEGASYS PROCLICK....................................... 38, 71
PEGFILGRASTIM.....................................................32
PEGINTERFERON ALFA-2A................................... 38
PEGINTERFERON ALFA-2B............................. 38, 42
PEGINTRON...................................................... 38, 71
PEGINTRON REDIPEN..................................... 38, 71
PEGVISOMANT....................................................... 28
PENBUTOLOL SULFATE.........................................12
PENCICLOVIR......................................................... 18
PENICILLAMINE...................................................... 39
PENICILLIN V POTASSIUM.....................................35
PENLAC................................................................... 18
PENLET PLUS BLOOD SAMPLER(OTC)............... 26
PENNSAID......................................................... 20, 68
PENTAMIDINE ISETHIONATE.................................37
PENTASA........................................................... 40, 68
PENTAZOCINE HCL/NALOXONE HCL................... 45
PENTAZOCINE LACTATE........................................45
PENTAZOCINE-NALOXONE HCL........................... 45
PENTOSAN POLYSULFATE SODIUM.................... 49
PENTOXIFYLLINE................................................... 32
PEPCID.................................................................... 49
P-EPHED HCL/CHLOR-MAL/BELL ALK..................16
PERAMPANEL......................................................... 47
PERCOCET........................................................45, 59
PERCODAN............................................................. 45
PERFOROMIST................................................... 6, 59
PERINDOPRIL ERBUMINE..................................... 12
PERMETHRIN.......................................................... 18
PERPHENAZINE......................................................10
PERPHENAZINE/AMITRIPTYLINE HCL................... 8
PERPHENAZINE-AMITRIPTYLINE........................... 8
PERSANTINE...........................................................32
PERTZYE................................................................. 48
PETROLATUM,WHITE.............................................20
PEXEVA..........................................................8, 59, 68
PFLEX TRAINER........................................................7
PHARMACIST CHOICE(OTC)................................. 25
PHENAZOPYRIDINE HCL....................................... 50
PHENELZINE SULFATE............................................ 8
PHENERGAN............................................................. 5
PHENOBARB/HYOSCY/ATROPINE/SCOP.............48
PHENOBARBITAL....................................................10
PHENOL................................................................... 20
PHENOXYBENZAMINE HCL................................... 11
PHENYLBUTAZONE................................................ 40
PHENYLEPHRINE HCL........................................... 30
PHENYLEPHRINE HCL/PROMETH HCL................ 16
PHENYTEK.............................................................. 47
PHENYTOIN.............................................................47
PHENYTOIN SODIUM EXTENDED.........................47
PHOSLO...................................................................27
PHOSLYRA.............................................................. 27
PHOSPHA 250 NEUTRAL....................................... 49
PHOSPHASAL......................................................... 35
PHOSPHOLINE IODIDE.......................................... 30
PHOSPHORUS #1................................................... 49
PHYTONADIONE..................................................... 33
PICATO(GEL)(0.015 %)..................................... 22, 59
Page 84 of 90
Index
PICATO(GEL)(0.05 %)....................................... 22, 59
PILOCARPINE HCL........................................... 30, 42
PIMECROLIMUS...................................................... 22
PIMOZIDE.................................................................. 9
PINDOLOL............................................................... 12
PINNACAINE............................................................27
PIOGLITAZONE HCL............................................... 23
PIOGLITAZONE HCL/GLIMEPIRIDE....................... 23
PIOGLITAZONE HCL/METFORMIN HCL................ 23
PIROXICAM..............................................................40
PITAVASTATIN CALCIUM........................................ 14
PLACIDYL................................................................ 10
PLAN B ONE-STEP(OTC)........................... 15, 55, 73
PLAQUENIL............................................................. 37
PLAVIX..................................................................... 32
PLETAL.....................................................................32
PLEXION.................................................................. 18
PLIAGLIS..................................................................22
PN VIT.W-O CA #7, IRON,FA,DHA.......................... 51
PN VITS.W-O CA #8, IRON,FA................................ 51
PN W-CA64/IRON CB&GL/FA/DSS/DH................... 51
PN85/IRON CB&ASP G/FA/DHA/FISH.................... 51
PNV #14/FERROUS FUM/FOLIC ACID...................51
PNV #30/IRON CARB&ASPG/FA/OM3....................51
PNV #35/IRON/FA #6/DHA...................................... 51
PNV #56/IRON CARB&ASPG/FA/DHA.................... 51
PNV #78/IRON ASP GLY/FA#1/DHA....................... 51
PNV #8/IRON PS CMP&ASPG/FA/DHA.................. 51
PNV #86/IRON POLY/FA/DHA/EPA......................... 51
PNV #87/IRON BISGLY/FA/DHA..............................51
PNV 11-IRON FUM-FOLIC ACID-OM3.................... 51
PNV 18/FE,CARB/FA/DSS/UBI/DHA....................... 51
PNV COMB NO.3/IRON FUM&GLUC/FA.................51
PNV COMB.NO.44/IRON/FOLIC ACID.................... 51
PNV COMB.NO43/IRON,CARB/FA/DSS................. 51
PNV COMBO #19/IRON/FOL AC/DHA.................... 51
PNV COMBO #22/IRON/FA/OM3/DHA.................... 51
PNV COMBO#47/IRON/FA #1/DHA.........................52
PNV FOLIC ACID + IRON........................................ 53
PNV NO.115/IRON FUMARATE/FA......................... 52
PNV NO.118/IRON FUMARATE/FA......................... 52
PNV NO.15/IRON FUM & PS CMP/FA.....................52
PNV NO.22/IRON CBN&GLUC/FA/DSS.................. 52
PNV NO.66/IRON,CARBONYL/FA/DHA.................. 52
PNV NO.80/IRON/MFOLATE/DSS/DHA.................. 52
PNV NO.81/IRON CBN&GLUC/FA/DSS.................. 52
PNV NO10/IRON FUM&P/FA/OMEGA-3................. 52
PNV NO12/IRON,CARB/FA/DSS/OM-3................... 52
PNV OB+DHA.......................................................... 52
PNV W-CA #40/IRON FUM/FA CMB#1....................52
PNV W-CA NO.37/IRON/FA/OMEGA-3................... 52
PNV W-CA8/IRON/FA/LMEFOLATE CA.................. 52
PNV WITH CA #68/IRON/FA#1/DHA....................... 52
PNV WITH CA NO.65/IRON POLY/FA..................... 52
PNV WITH CA,NO.60/IRON/FA/DHA.......................52
PNV WITH CA,NO.62/IRON/FA/DHA.......................52
PNV WITH CA,NO.70/IRON/FA/DHA.......................52
PNV WITH CA,NO.71/IRON/FA............................... 52
PNV WITH CA,NO.72/IRON,CARB/FA.................... 52
PNV WITH CA,NO.72/IRON/FA............................... 52
PNV WITH CA,NO.74/IRON/FA............................... 52
PNV WITH CA,NO63/IRON/FA/B6........................... 52
PNV W-O CA NO5/FE FUMARATE/FA.................... 52
PNV W-O IRON/FA/CALCIUM/B6/B12.....................53
PNV#16/IRON FUM & PS/FA/OM-3......................... 52
PNV#20/IRON/FA/DS/FISH/DHA/EPA..................... 52
PNV#64/IRON/LMFOLATE/ALGAL/SOY................. 52
PNV#67/IRON PS/FA CMB#1/DHA......................... 52
PNV#79/IRON/FA/LMFOLATE CA/DHA...................52
PNV,CA,NO.35/IRON/FA/DS/OMEG-3.....................52
PNV,CA42/IRON/FA/LMEFOL CA/DHA................... 52
PNV/FA/B6/CALCIUM CARB/GINGER.................... 53
PNV/FA/B6/CALCIUM PHOS/GINGER.................... 53
PNV/FERROUS FUMARATE/DOSS/FA...................52
PNV/FERROUS FUMARATE/FA/SE........................ 52
PNV/IRON,CARBONYL/DOCUSATE/FA................. 52
PNV100/IRON EDTA&PS/FA/OMEGA3................... 52
PNV103/FE/FA/DHA/EPA/OTHER OM3.................. 52
PNV106/IRON/FA/OM3/DHA/EPA............................52
PNV107/IRON/FA/OM3/DHA/EPA............................52
PNV115/IRON FUMARATE/FA/DSS........................ 52
PNV119/IRON FUMARATE/FA/DSS........................ 52
PNV17/IRON/FA/FISH OIL/DHA/OM........................52
PNV19/IRON BG HC&SUCC-P/FA/OM3..................52
PNV2/IRON B-G SUC-P/FA/OMEGA-3....................52
PNV22/IRON CBN&GLUC/FA/DSS/DHA................. 52
PNV29/IRON CB&ASPG/FA/DHA/FISH...................52
PNV34/IRON,CARB&FUM/FA/DSS/DHA.................52
L.A. Care
PNV34/IRON,CARBONYL/FA/DSS/DHA................. 52
PNV38/IRON CBN&GLUC/FA/DSS/DHA................. 52
PNV39/IRON FUMARATE/FA/DSS/DHA................. 52
PNV48/IRON NA FEREDETAT/FA/OM3.................. 52
PNV53/IRON B-G HCL-P/FA/OMEGA3................... 52
PNV53/IRON FUM/FA/DOCUSATE/DHA.................52
PNV54/IRON B-G HCL-P/FA/OMEGA3................... 52
PNV55/IRON BG HC&SUCC#2/FA/OM3................. 52
PNV55/IRON BG HC&SUCC-P/FA/OM3..................52
PNV55/IRON FUM & BISGLY/FA............................. 52
PNV59/IRON,CARB&FUM/FA/DSS/DHA.................53
PNV59/IRON,CARBONYL/FA/DSS/DHA................. 53
PNV66/IRON FUMARATE/FA/DSS/DHA................. 53
PNV69/IRON,CARBONYL/FA/DSS/DHA................. 53
PNV7/FE ASP GLY/DOCUSATE/FA........................ 53
PNV72/IRON,CARB&GLU/FA/DSS/DHA................. 53
PNV76/IRON,CARB&GLU/FA/DSS/DHA................. 53
PNV77/SOD IRON EDTA& PS/FA/OM3...................53
PNV80/IRON FUMARATE/FA/DSS/DHA................. 53
PNV81/SOD IRON EDTA& PS/FA/OM3...................53
PNV83/IRON,CARB/IRON ASP GL/FA.................... 53
PNV84/IRON,CARBONYL/FA/DHA......................... 53
PNV94/SOD IRON EDTA& PS/FA/OM3...................53
PNV-DHA PLUS....................................................... 52
PNV-IRON................................................................ 52
PNV-SELECT........................................................... 52
POCKET CHAMBER.................................................. 7
PODOCON-25.......................................................... 21
PODOFILOX.............................................................21
PODOPHYLLUM RESIN.......................................... 21
POLYETHYLENE GLYCOL 3350............................. 41
POLYMYXIN B SULF/TRIMETHOPRIM...................30
POLYTRIM................................................................30
POLY-UREAURETHANE..........................................21
POLY-VI-FLOR......................................................... 51
POLY-VI-FLOR WITH IRON..................................... 51
POMALIDOMIDE......................................................42
POMALYST........................................................ 42, 71
PONATINIB HCL...................................................... 43
PONSTEL................................................................. 40
PONTOCAINE.......................................................... 22
PORACTANT ALFA.................................................. 44
POSACONAZOLE.................................................... 36
POT CHLORIDE/POT BICARB/CIT AC................... 27
POTABA................................................................... 54
POTASSIUM AMINOBENZOATE.............................54
POTASSIUM BICARBONATE.................................. 27
POTASSIUM BICARBONATE/CIT AC..................... 27
POTASSIUM CHLORIDE......................................... 27
POTASSIUM CITRATE.............................................49
POTASSIUM CITRATE ER.......................................49
POTASSIUM CITRATE/CITRIC ACID...................... 49
POTASSIUM GLUCONATE......................................27
POTASSIUM HYDROXIDE...................................... 21
POTASSIUM IODIDE............................................... 29
POTASSIUM IODIDE/IODINE.................................. 29
POTASSIUM PHOSPHATE,MONOBASIC...............49
POTIGA(TAB)(200 MG)................................46, 59, 68
POTIGA(TAB)(300 MG)................................46, 59, 68
POTIGA(TAB)(400 MG)................................46, 59, 68
POTIGA(TAB)(50 MG)..................................46, 59, 68
POVIDONE-IODINE................................................. 29
PR CREAM...............................................................21
PR NATAL 400..........................................................52
PR NATAL 400 EC....................................................52
PR NATAL 430..........................................................52
PR NATAL 430 EC....................................................52
PRADAXA.................................................... 33, 59, 71
PRAMCORT............................................................. 41
PRAMIPEXOLE DI-HCL........................................... 46
PRAMLINTIDE ACETATE........................................ 23
PRAMOSONE E....................................................... 21
PRAMOSONE(CREAM)........................................... 21
PRAMOSONE(LOTION)...........................................21
PRAMOSONE(OINT)............................................... 21
PRANDIMET.............................................................23
PRANDIN..................................................................23
PRASUGREL HCL................................................... 32
PRAVACHOL............................................................ 14
PRAVASTATIN SODIUM.......................................... 14
PRAZIQUANTEL...................................................... 37
PRAZOSIN HCL....................................................... 11
PRECOSE................................................................ 23
PRED MILD.............................................................. 29
PRED-G....................................................................29
PREDNICARBATE................................................... 20
PREDNISOLONE..................................................... 39
PREDNISOLONE ACETATE.............................. 29, 39
PREDNISOLONE SOD PHOSPHATE............... 29, 39
PREDNISOLONE SODIUM PHOSPHATE.........29, 39
PREDNISONE.......................................................... 39
PREDNISONE INTENSOL....................................... 39
PREFERA-OB ONE..................................................51
PREFEST................................................................. 33
PREGABALIN...........................................................47
PREMARIN.........................................................33, 50
PREMIUM BLOOD GLUCOSE(OTC).......................25
PREMIUM V10(OTC)............................................... 25
PREMPHASE........................................................... 33
PREMPRO................................................................33
PRENAFORT............................................................53
PRENAISSANCE..................................................... 53
PRENAISSANCE NEXT........................................... 53
PRENAISSANCE NEXT-B....................................... 53
PRENAISSANCE PLUS........................................... 53
PRENAPLUS............................................................ 52
PRENAT VIT COMB.10/IRON/FA/DHA.................... 53
PRENATA................................................................. 53
PRENATABS FA....................................................... 53
PRENATAL #103/IRON FUMARATE/FA.................. 53
PRENATAL #57/IRON/FA/DSS/DHA........................53
PRENATAL #79/IRON ASP GLY/FA#1.....................53
PRENATAL 19.......................................................... 52
PRENATAL AD......................................................... 53
PRENATAL COMB NO.42/FOLIC ACID...................53
PRENATAL LOW IRON............................................ 52
PRENATAL NO.13/IRON PS/FA CB#1.....................53
PRENATAL NO.25/IRON/FA #6/DHA.......................53
PRENATAL NO.39/IRON/FA #6/DHA.......................53
PRENATAL NO.52/IRON/FA/DHA............................53
PRENATAL NO.75/IRON/FOLATE #1...................... 53
PRENATAL NO.77/IRON ASP GLY/FA.................... 53
PRENATAL PLUS.....................................................52
PRENATAL VIT #60/IRON FUM/FA......................... 53
PRENATAL VIT #68/IRON/FA#6/DHA......................53
PRENATAL VIT #69/IRON/FA#6/DHA......................53
PRENATAL VIT #76/IRON,CARB/FA....................... 53
PRENATAL VIT 15/IRON CB/FA/DSS......................53
PRENATAL VIT 16/IRON CB/FA/DSS......................53
PRENATAL VIT 18/IRON CB/FA/DSS......................53
PRENATAL VIT COMB.10/IRON/FA........................ 53
PRENATAL VIT NO.109/IRON/FA............................53
PRENATAL VIT NO.112/FOLIC ACID...................... 53
PRENATAL VIT NO.114/FA/GINGER....................... 53
PRENATAL VIT NO.44/IRON/FA/DHA..................... 53
PRENATAL VIT NO.73/IRON/FA..............................53
PRENATAL VIT NO.78/IRON/FA..............................53
PRENATAL VIT#36/IRON/FA CMB#6...................... 53
PRENATAL VIT#4/IRON FUM &PS/FA.................... 53
PRENATAL VIT#65/IRON FUM&PS/FA................... 53
PRENATAL VIT#86/IRON BISGLY/FA..................... 53
PRENATAL VIT/FE CARB-FESO4/FA......................53
PRENATAL VIT/IRON BISGLYCIN/FA..................... 53
PRENATAL VIT/IRON FUMARATE/FA.....................53
PRENATAL VIT27&CALCIUM/IRON/FA...................53
PRENATAL VIT37/IRON/FOLIC ACID..................... 53
PRENATAL VITAMINS#21, IRON, FA...................... 53
PRENATAL VITS #33/IRON/FA/DHA....................... 53
PRENATAL VITS W-CA,FE,FA(1MG).......................53
PRENATAL VITS#4/IRON FUM/FA.......................... 53
PRENATAL Z............................................................ 53
PRENATAL-U........................................................... 52
PRENATE AM...........................................................53
PRENATE CHEWABLE............................................ 53
PRENATE DHA........................................................ 51
PRENATE ELITE...................................................... 53
PRENATE ENHANCE.............................................. 53
PRENATE ESSENTIAL............................................ 51
PRENATE MINI........................................................ 53
PRENATE RESTORE...............................................53
PRENATE STAR.......................................................53
PREPIDIL................................................................. 16
PREPOPIK............................................................... 41
PREQUE 10............................................................. 51
PRESERA................................................................ 20
PRESTO PRO(OTC)................................................ 25
PREVACID(CAP DR)................................................49
PREVACID(TAB RAP DR)..................................49, 68
PREVIDENT............................................................. 50
PREVIDENT 5000.................................................... 50
PREVIDENT 5000 ENAMEL PROTECT.................. 50
PREVIDENT 5000 SENSITIVE................................ 50
PREVPAC...........................................................49, 59
PREZISTA(ORAL SUSP)................................... 37, 59
PREZISTA(TAB)(150 MG).................................. 37, 59
PREZISTA(TAB)(400 MG).................................. 37, 59
Page 85 of 90
Index
PREZISTA(TAB)(600 MG).................................. 37, 59
PREZISTA(TAB)(75 MG).................................... 37, 59
PREZISTA(TAB)(800 MG).................................. 37, 59
PRIFTIN....................................................................37
PRILOSEC............................................................... 49
PRIMAQUINE........................................................... 37
PRIMAQUINE PHOSPHATE.................................... 37
PRIMEAIRE................................................................ 7
PRIMIDONE............................................................. 47
PRIMLEV............................................................ 45, 59
PRIMSOL..................................................................35
PRISTIQ ER................................................... 8, 59, 68
PROAIR HFA.............................................................. 6
PROBANTHELINE W/PHENOBARBITAL................ 48
PRO-BANTHINE.......................................................48
PROBENECID.......................................................... 31
PROBENECID-COLCHICINE...................................31
PROCAINAMIDE HCL.............................................. 11
PROCARBAZINE HCL............................................. 43
PROCARDIA XL....................................................... 13
PROCENTRA....................................................... 9, 59
PROCHAMBER.......................................................... 7
PROCHLORPERAZINE EDISYLATE.........................5
PROCHLORPERAZINE MALEATE............................5
PROCHLORPERAZINE/ISOPROPAMIDE...............48
PROCORT................................................................41
PROCRIT............................................................32, 71
PROCTOCORT........................................................ 41
PROCTOFOAM-HC..................................................41
PROCTOZONE-HC.................................................. 41
PROCYSBI......................................................... 49, 71
PRODIGY LANCING DEVICE(OTC)........................26
PRODIGY MINI-MIST.................................................7
PRODIGY POCKET(OTC)....................................... 25
PRODIGY VOICE(OTC)........................................... 25
PRODIGY(OTC)....................................................... 25
PROFILNINE............................................................ 32
PROGESTERONE................................................... 34
PROGESTERONE,MICRONIZED............................34
PROGLYCEM........................................................... 26
PROLENSA.............................................................. 29
PROMACTA........................................................33, 71
PROMETHAZINE HCL............................................... 5
PROMETHAZINE HCL/CODEINE............................16
PROMETHAZINE VC............................................... 16
PROMETHAZINE VC-CODEINE..............................16
PROMETHAZINE/PHENYLEPH/CODEINE............. 16
PROMETHAZINE-CODEINE....................................16
PROMETHAZINE-DM.............................................. 16
PROMETHEGAN........................................................5
PROMETRIUM......................................................... 34
PROMISEB...............................................................20
PROMISEB COMPLETE.......................................... 20
PRONEB ULTRA........................................................ 7
PRONEB ULTRA II..................................................... 7
PRONESTYL............................................................ 11
PROPAFENONE HCL.............................................. 11
PROPANTHELINE BROMIDE..................................48
PROPANTHELINE/PHENOBARBITAL.....................48
PROPARACAINE HCL............................................. 29
PROPARACAINE/FLUORESCEIN SOD.................. 29
PROPRANOLOL HCL.............................................. 12
PROPRANOLOL/HYDROCHLOROTHIAZID........... 12
PROPRANOLOL-HYDROCHLOROTHIAZID...........12
PROPYLTHIOURACIL..............................................29
PROSCAR.......................................................... 49, 73
PROSED-DS............................................................ 35
PROSTIN E2 VAGINAL SUPPOSITORY................. 16
PROTECT CMB2/CERAMIDE 1,3,6-11....................21
PROTECT IRON.......................................................51
PROTONIX(GRANPKT DR)............................... 49, 68
PROTONIX(TAB DR)................................................49
PROTOPIC................................................... 22, 55, 68
PROTRIPTYLINE HCL............................................... 9
PROVENTIL HFA....................................................... 6
PROVERA................................................................ 34
PROVIDA OB........................................................... 53
PROVIGIL...........................................................10, 71
PROZAC.....................................................................8
PRUCLAIR................................................................20
PRUDOXIN...............................................................20
PRUMYX.................................................................. 20
PRUTECT.................................................................20
PSEUDOEPHEDRINE HCL..................................... 16
PSEUDOEPHEDRINE HCL/ACRIVAS.......................5
PSEUDOEPHEDRINE HCL/CHLOR-MAL............... 16
PSEUDOEPHEDRINE/BROMPHENIRAMIN........... 16
PULMICORT FLEXHALER.............................6, 59, 68
L.A. Care
PULMICORT(AMPUL-NEB)(0.25MG/2ML).......... 6, 59
PULMICORT(AMPUL-NEB)(0.5 MG/2ML)........... 6, 59
PULMICORT(AMPUL-NEB)(1 MG/2 ML)............. 6, 59
PULMOZYME..................................................... 44, 71
PUREFE OB PLUS.................................................. 53
PUREFE PLUS.........................................................53
PURINETHOL...........................................................42
PURIXAN..................................................................42
PV W-O CAL/FE,CARBONYL/DOSS/FA..................53
PV W-O CAL/FERROUS FUMARATE/FA................ 53
PV W-O CAL/IRON PS CPLX/FA............................. 53
PYLERA................................................................... 49
PYRAZINAMIDE.......................................................36
PYRIDIUM................................................................ 50
PYRIDOSTIGMINE BROMIDE...................................8
PYRIDOXINE HCL................................................... 54
PYRIL MA/PE/CODEINE PHOS.............................. 16
PYRIMETHAMINE....................................................37
PYROGALLIC ACID................................................. 22
PYROGALLOL......................................................... 22
-QQNASL........................................................... 5, 59, 68
QUALAQUIN.............................................................37
QUARTETTE............................................................ 15
QUAZEPAM..............................................................10
QUDEXY XR(CAP SPR 24)(100 MG).......... 47, 59, 68
QUDEXY XR(CAP SPR 24)(150 MG).......... 47, 59, 68
QUDEXY XR(CAP SPR 24)(200 MG).......... 47, 59, 68
QUDEXY XR(CAP SPR 24)(25 MG)............ 47, 59, 68
QUDEXY XR(CAP SPR 24)(50 MG)............ 47, 59, 68
QUESTRAN..............................................................14
QUETIAPINE FUMARATE......................................... 9
QUFLORA................................................................ 51
QUIBRON................................................................... 6
QUIC-K..................................................................... 27
QUILLIVANT XR........................................... 10, 59, 68
QUINAPRIL HCL...................................................... 12
QUINAPRIL/HYDROCHLOROTHIAZIDE.................11
QUINIDINE GLUCONATE........................................ 11
QUINIDINE SULFATE...............................................11
QUININE SULFATE.................................................. 37
QUINTET AC(OTC).................................................. 25
QUINTET(OTC)........................................................ 25
QUTENZA...........................................................21, 71
QVAR....................................................................6, 59
-RRABEPRAZOLE SODIUM..................................49, 59
RADIAPLEXRX........................................................ 21
RAGWITEK...........................................................5, 71
RALOXIFENE HCL...................................................28
RALTEGRAVIR POTASSIUM................................... 38
RAMELTEON............................................................10
RAMIPRIL.................................................................12
RANEXA(TAB ER 12H)(1000 MG)..................... 15, 59
RANEXA(TAB ER 12H)(500 MG)....................... 15, 59
RANITIDINE............................................................. 49
RANITIDINE 150MG.................................................49
RANITIDINE HCL..................................................... 49
RANOLAZINE...........................................................15
RAPAFLO..................................................... 49, 68, 73
RAPAMUNE..............................................................34
RASAGILINE MESYLATE........................................ 46
RASUVO(AUTO INJECT)(10MG/0.2ML)......39, 59,
6
8
RASUVO(AUTO INJECT)(12.5/0.25)........... 39, 59, 68
RASUVO(AUTO INJECT)(15MG/0.3ML)......39, 59,
6
8
RASUVO(AUTO INJECT)(17.5/0.35)........... 39, 59, 68
RASUVO(AUTO INJECT)(22.5/0.45)........... 39, 59, 68
RASUVO(AUTO INJECT)(25MG/0.5ML)......39, 59,
6
8
RASUVO(AUTO INJECT)(27.5/0.55)........... 39, 59, 68
RASUVO(AUTO INJECT)(30MG/0.6ML)......39, 59,
6
8
RASUVO(AUTO INJECT)(7.5MG/0.15)....... 39, 59, 68
RAVICTI..............................................................41, 71
RAYOS............................................................... 39, 68
RAZADYNE.......................................................... 8, 59
RAZADYNE ER.................................................... 8, 59
REBETOL(CAP)....................................................... 38
REBETOL(SOLUTION)............................................ 38
REBIF................................................................. 43, 71
REBIF REBIDOSE............................................. 43, 71
RECOMBINATE........................................................31
RECOTHROM.......................................................... 33
RECTIV.....................................................................41
REFUAH PLUS(OTC)...............................................25
REGENECARE.........................................................22
REGLAN................................................................... 49
REGORAFENIB........................................................43
REGRANEX..............................................................26
RELENZA........................................................... 37, 59
RELIAMED MINI LANCING DEVICE(OTC)............. 26
RELION CONFIRM(OTC).........................................25
RELION MICRO(OTC)............................................. 25
RELION PRIME(OTC).............................................. 25
RELISTOR..........................................................41, 71
RELNATE DHA.........................................................51
RELPAX........................................................45, 59, 69
REMERON................................................................. 8
REMODULIN...................................................... 13, 71
RENACIDIN.............................................................. 49
RENAGEL................................................................ 27
RENAL CAPS........................................................... 54
RENA-VITE RX.........................................................54
RENVELA(POWD PACK).........................................27
RENVELA(TAB)........................................................27
REPAGLINIDE..........................................................23
REPAGLINIDE/METFORMIN HCL...........................23
REQ49+....................................................................50
REQUIP.................................................................... 46
REQUIP XL.................................................. 46, 59, 69
RESCRIPTOR.......................................................... 38
RESCULA.....................................................30, 59, 69
RESECTISOL........................................................... 13
RESERPINE............................................................. 12
RESERPINE/HYDROCHLOROTHIAZIDE............... 12
RESPA A.R...............................................................16
RESTASIS.......................................................... 30, 59
RESTORIL................................................................10
RETAPAMULIN.........................................................18
RETIN-A............................................................. 17, 55
RETIN-A MICRO................................................ 17, 55
RETIN-A MICRO PUMP(GEL W/PUMP)(0.04 %)......
17,
55
RETIN-A MICRO PUMP(GEL W/PUMP)(0.08 %)......
17,
55
RETIN-A MICRO PUMP(GEL W/PUMP)(0.1 %)......
17,
55
RETROVIR(CAP)............................................... 38, 59
RETROVIR(SYRUP).......................................... 38, 59
REVATIO(SUSP RECON).................................. 13, 59
REVATIO(TAB)................................................... 13, 59
REVEAL BLOOD GLUCOSE METER(OTC)............25
REVIA....................................................................... 10
REVLIMID.....................................................42, 59, 72
REYATAZ.................................................................. 38
RHINOCORT AQUA.......................................5, 59, 69
RIAX......................................................................... 21
RIBAVIRIN.......................................................... 37, 38
RIDAURA..................................................................39
RIFABUTIN............................................................... 36
RIFADIN....................................................................36
RIFAMATE................................................................ 37
RIFAMP/ISONIAZID/PYRAZINAMIDE..................... 36
RIFAMPIN.................................................................36
RIFAMPIN/ISONIAZID..............................................37
RIFAPENTINE.......................................................... 37
RIFATER...................................................................36
RIFAXIMIN................................................................37
RIGHTEST GD500(OTC)......................................... 26
RIGHTEST GM100 SYSTEM(OTC)......................... 25
RIGHTEST GM250S METER(OTC).........................25
RIGHTEST GM260 METER(OTC)........................... 25
RIGHTEST GM300 SYSTEM(OTC)......................... 25
RIGHTEST GM550 SYSTEM(OTC)......................... 25
RIGHTSOURCE(OTC)............................................. 25
RILONACEPT...........................................................39
RILPIVIRINE HCL.................................................... 38
RILUTEK...................................................................43
RILUZOLE................................................................ 43
RIMANTADINE HCL................................................. 37
RIMEXOLONE..........................................................29
RINGERS IRRIGATION............................................21
RINGERS SOLUTION.............................................. 21
RINGERS SOLUTION,LACTATED...........................21
RIOCIGUAT.............................................................. 13
RIOMET....................................................................23
RISEDRONATE SODIUM.........................................28
RISPERDAL(SOLUTION).....................................9, 59
RISPERDAL(TAB)................................................ 9, 59
RISPERIDONE..................................................... 9, 59
RITALIN LA.........................................................10, 59
RITEFLO.....................................................................7
RITONAVIR.............................................................. 38
RIVAROXABAN........................................................ 32
Page 86 of 90
Index
RIVASTIGMINE.......................................................... 8
RIVASTIGMINE TARTRATE.......................................8
RIXUBIS................................................................... 32
RIZATRIPTAN BENZOATE.......................................45
R-NATAL OB.............................................................52
ROBAXIN..................................................................48
ROBAXIN-750.......................................................... 48
ROBINUL..................................................................48
ROBINUL FORTE.....................................................48
ROCALTROL............................................................ 54
ROFLUMILAST...........................................................6
ROPINIROLE HCL................................................... 46
ROSADAN................................................................ 17
ROSANIL.................................................................. 18
ROSIGLITAZONE MALEATE................................... 23
ROSIGLITAZONE/GLIMEPIRIDE.............................23
ROSIGLITAZONE/METFORMIN HCL......................23
ROSUVASTATIN CALCIUM..................................... 14
ROTIGOTINE........................................................... 46
ROWASA..................................................................40
ROXICODONE......................................................... 45
ROZEREM....................................................10, 59, 69
RUCONEST........................................................39, 72
RUFINAMIDE........................................................... 47
RUXOLITINIB PHOSPHATE.................................... 42
RYTHMOL................................................................ 11
RYTHMOL SR.......................................................... 11
-SSABRIL............................................................... 47, 59
SACROSIDASE........................................................48
SAFYRAL........................................................... 15, 69
SAIZEN...............................................................28, 72
SALACYN................................................................. 21
SALAGEN.................................................................42
SAL-AMIDE/ACETAMINOPHN/P-TLOX...................44
SALEX...................................................................... 21
SALICYLIC AC/BENZOYL PER/VIT E..................... 21
SALICYLIC ACID......................................................21
SALICYLIC ACID/AMMON LACT/ALOE.................. 21
SALICYLIC ACID/AMMONIATED HG...................... 21
SALICYLIC ACID/CERAMIDE CMB #1....................21
SALICYLIC ACID/UREA...........................................21
SALMETEROL XINAFOATE...................................... 6
SALSALATE............................................................. 44
SALURON................................................................ 13
SALVAX DUO PLUS.................................................21
SAMI THE SEAL.........................................................7
SAMSCA(TAB)(15 MG)...................................... 27, 59
SAMSCA(TAB)(30 MG)...................................... 27, 59
SANCTURA........................................................ 50, 69
SANCUSO...................................................... 5, 59, 69
SANDIMMUNE......................................................... 34
SANTYL....................................................................22
SAPHRIS........................................................ 9, 59, 69
SAQUINAVIR MESYLATE........................................38
SARAFEM.................................................................. 8
SARGRAMOSTIM.................................................... 32
SAVELLA.................................................................. 43
SAXAGLIPTIN HCL.................................................. 23
SAXAGLIPTIN HCL/METFORMIN HCL................... 22
SCALACORT DK......................................................19
SCLEROSOL............................................................43
SCOPOLAMINE......................................................... 5
SCOPOLAMINE HYDROBROMIDE.........................31
SE 10-5 SS............................................................... 18
SE BPO.................................................................... 21
SECOBARBITAL SODIUM....................................... 10
SECONAL SODIUM................................................. 10
SECTRAL................................................................. 12
SELECT-LITE(OTC)................................................. 26
SELECT-OB............................................................. 53
SELECT-OB + DHA..................................................53
SELEGILINE.............................................................10
SELEGILINE HCL.................................................... 46
SELENIUM SULFIDE............................................... 20
SELZENTRY.......................................................38, 72
SEMPREX-D.............................................................. 5
SE-NATAL 19............................................................52
SENSIPAR................................................................28
SEREVENT DISKUS............................................ 6, 59
SEROQUEL..........................................................9, 59
SEROQUEL XR..............................................9, 59, 69
SEROSTIM......................................................... 28, 72
SERTACONAZOLE NITRATE.................................. 18
SERTRALINE HCL..................................................... 8
SE-TAN DHA............................................................ 52
SETONET-EC...........................................................52
SEVELAMER CARBONATE.....................................27
L.A. Care
SEVELAMER HCL................................................... 27
SFROWASA............................................................. 40
SHOHL'S MODIFIED................................................49
SIDEKICK(OTC)....................................................... 23
SIDESTREAM............................................................ 7
SIDESTREAM NEBULIZER....................................... 7
SIDESTREAM PLUS.................................................. 7
SILDENAFIL CITRATE............................................. 13
SILENOR...................................................... 10, 59, 69
SILICONE MASK........................................................7
SILODOSIN.............................................................. 49
SILVER..................................................................... 17
SILVER CARBONATE.............................................. 17
SILVER NITRATE............................................... 17, 21
SILVER NITRATE APPLICATOR..............................21
SILVER SULFADIAZINE...........................................18
SILVRSTAT............................................................... 17
SIMBRINZA.............................................................. 30
SIMCOR(TBMP 24HR)(1000-20MG)........... 14, 59, 69
SIMCOR(TBMP 24HR)(1000-40 MG).......... 14, 59, 69
SIMCOR(TBMP 24HR)(500MG-20MG)....... 14, 59, 69
SIMCOR(TBMP 24HR)(500MG-40MG)....... 14, 59, 69
SIMCOR(TBMP 24HR)(750MG-20MG)....... 14, 59, 69
SIMEPREVIR SODIUM............................................ 38
SIMPONI............................................................ 39, 72
SIMVASTATIN...........................................................14
SINECATECHINS.....................................................18
SINEMET 10-100..................................................... 46
SINEMET 25-100..................................................... 46
SINEMET 25-250..................................................... 46
SINGLE USE EZ FLU 2013-2014............................ 34
SINGULAIR................................................................ 6
SINUSTAR..................................................................7
SIROLIMUS.............................................................. 34
SIRTURO............................................................36, 72
SITAGLIPTIN PHOS/METFORMIN HCL..................22
SITAGLIPTIN PHOSPHATE..................................... 23
SITAVIG.................................................................... 37
SIVEXTRO................................................................35
SKELAXIN................................................................ 48
SKLICE..................................................................... 18
SMART CARESENS N(OTC)...................................25
SMART SENSE MONITORING SYSTEM(OTC)......25
SMARTDIABETES VANTAGE(OTC)........................26
SMARTDIABETES XPRES(OTC)............................ 25
SMARTEST EJECT(OTC)........................................25
SMARTEST PERSONA(OTC)..................................25
SMARTEST PRONTO(OTC)....................................25
SMARTEST PROTEGE(OTC)..................................25
SMARTEST SMART CODE(OTC)........................... 25
SMARTEST TALKING(OTC).................................... 25
SOD PICOSULF/MAG OX/CITRIC AC.....................41
SOD PROPION/INOSITOL/AA14/UREA..................50
SOD/POT/K CIT/SOD CIT/CIT ACID....................... 49
SODIUM BENZOATE/NA PH-ACETATE.................. 41
SODIUM CHLOR/HYPOCHLOROUS ACID.............21
SODIUM CHLORIDE....................................21, 27, 28
SODIUM CHLORIDE 0.45 %................................... 28
SODIUM CHLORIDE IRRIG SOLUTION................. 21
SODIUM CHLORIDE/NAHCO3/KCL/PEG............... 41
SODIUM CITRATE................................................... 31
SODIUM FLUORIDE................................................ 50
SODIUM FLUORIDE/POTASSIUM NIT................... 50
SODIUM FLUORIDE/XYLITOL................................ 50
SODIUM OXYBATE....................................................9
SODIUM PHENYLBUTYRATE................................. 41
SODIUM POLYSTYRENE SULFONATE..................27
SODIUM SULFACETAMIDE.....................................20
SODIUM SULFACETAMIDE-SULFUR..................... 18
SODIUM THIOSULFATE/SAL ACID.........................18
SODIUM,POTASSIUM,&MAG SULFATES...............41
SOFOSBUVIR.......................................................... 38
SOFT TOUCH(OTC)................................................ 26
SOFTCLIX(OTC)...................................................... 26
SOLIFENACIN SUCCINATE.................................... 50
SOLODYN.............................................. 36, 55, 59, 69
SOLTAMOX........................................................ 43, 72
SOLUS V2 LANCING DEVICE(OTC).......................26
SOLUS V2(OTC)...................................................... 25
SOMA....................................................................... 47
SOMATROPIN..........................................................28
SOMAVERT..............................................................28
SONAFINE............................................................... 20
SONATA............................................................. 10, 59
SORAFENIB TOSYLATE......................................... 43
SORBITOL................................................................21
SORBITOL SOLUTION............................................ 21
SORBITOL-MANNITOL............................................20
SORIATANE............................................................. 22
SORILUX............................................................ 22, 69
SOTALOL................................................................. 12
SOTALOL HCL......................................................... 12
SOVALDI............................................................ 38, 72
SPACE CHAMBER PLUS.......................................... 7
SPASMOLIN............................................................. 48
SPECTRACEF..........................................................34
SPINOSAD............................................................... 18
SPIRIVA................................................................6, 59
SPIROMETERS AND ACCESSORIES...................... 7
SPIRONOLACT/HYDROCHLOROTHIAZID.............13
SPIRONOLACTONE................................................ 13
SPORANOX(CAP)....................................................36
SPORANOX(SOLUTION).........................................36
SPRAY AND STRETCH........................................... 22
SPRINTEC......................................................... 16, 73
SPRIX................................................................. 40, 59
SPRYCEL(TAB)(100 MG).............................42, 59, 72
SPRYCEL(TAB)(140 MG).............................42, 59, 72
SPRYCEL(TAB)(20 MG)...............................42, 59, 72
SPRYCEL(TAB)(50 MG)...............................42, 59, 72
SPRYCEL(TAB)(70 MG)...............................42, 59, 72
SPRYCEL(TAB)(80 MG)...............................42, 59, 72
SPS.......................................................................... 27
SSKI......................................................................... 29
STAGESIC-10.....................................................45, 59
STALEVO 100.......................................................... 46
STALEVO 125.......................................................... 46
STALEVO 150.......................................................... 46
STALEVO 200.......................................................... 46
STALEVO 50............................................................ 46
STALEVO 75............................................................ 46
STANNOUS FLUORIDE...........................................50
STARLIX................................................................... 23
STARTER KIT(OTC).................................................25
STAVUDINE..............................................................38
STAVZOR........................................................... 47, 69
STELARA........................................................... 39, 72
STERILE TALC.........................................................43
STIMATE.................................................................. 28
STIVARGA....................................................43, 59, 72
STRATTERA(CAP)(10 MG)................................10, 59
STRATTERA(CAP)(100 MG)..............................10, 59
STRATTERA(CAP)(18 MG)................................10, 60
STRATTERA(CAP)(25 MG)................................10, 60
STRATTERA(CAP)(40 MG)................................11, 60
STRATTERA(CAP)(60 MG)................................11, 60
STRATTERA(CAP)(80 MG)................................11, 60
STRIANT............................................................ 33, 72
STRIBILD........................................................... 38, 60
STRIVERDI RESPIMAT............................................. 6
STROMECTOL.........................................................37
STRONG IODINE..................................................... 29
STROVITE FORTE...................................................51
SUBOXONE....................................................... 46, 72
SUBSYS............................................................. 44, 72
SUCLEAR.................................................................41
SUCRAID........................................................... 48, 72
SUCRALFATE.................................................... 48, 49
SUCROFERRIC OXYHYDROXIDE......................... 27
SULAR......................................................................13
SULCONAZOLE NITRATE.......................................18
SULFACET SOD/SULFUR/WITCH HAZ.................. 18
SULFACETAMIDE SOD/SULFUR/UREA.................18
SULFACETAMIDE SODIUM.........................17, 20, 30
SULFACETAMIDE SODIUM/BAKUCHIOL...............17
SULFACETAMIDE SODIUM/SULFUR..................... 18
SULFACETAMIDE SODIUM/UREA..........................20
SULFACETAMIDE/PREDNISOLONE SP.................30
SULFACETAMIDE/SULFUR/CLEANSR23...............18
SULFACETAMIDE-PREDNISOLONE...................... 30
SULFACETM NA/PREDNISOL AC.......................... 30
SULFADIAZINE........................................................ 40
SULFALONE............................................................ 30
SULFAMETHOXAZOLE/TRIMETHOPRIM........ 34, 40
SULFAMETHOXAZOLE-TRIMETHOPRIM.............. 34
SULFAMYLON(CREAM).......................................... 18
SULFAMYLON(PACKET)......................................... 18
SULFANILAMIDE..................................................... 50
SULFASALAZINE..................................................... 40
SULFATRIM..............................................................40
SULFUR................................................................... 17
SULINDAC................................................................40
SUMADAN................................................................18
SUMATRIPTAN........................................................ 45
SUMATRIPTAN SUCC/NAPROXEN SOD............... 45
SUMATRIPTAN SUCCINATE................................... 45
Page 87 of 90
Index
SUMAVEL DOSEPRO..................................45, 60, 69
SUMAXIN................................................................. 18
SUMAXIN CP........................................................... 18
SUNITINIB MALATE.................................................43
SUPERVITE............................................................. 54
SUPERVITE EC....................................................... 51
SUPPORT-500......................................................... 50
SUPPRELIN............................................................. 28
SUPPRELIN LA........................................................ 28
SUPRAX................................................................... 34
SUPREP................................................................... 41
SURE COMFORT LANCING PEN(OTC)................. 26
SURE EDGE BLOOD GLUCOSE METER(OTC)......
2
5
SUREFLEX(OTC).....................................................26
SURE-PEN(OTC)..................................................... 26
SURE-TEST EASYPLUS MINI(OTC).......................25
SURFAXIN................................................................44
SURMONTIL...............................................................9
SURVANTA...............................................................44
SUSTIVA...................................................................38
SUTENT....................................................... 43, 60, 72
SYLATRON...................................................42, 60, 72
SYLATRON 4-PACK.....................................42, 60, 72
SYMAX DUOTAB..................................................... 48
SYMAX-SL............................................................... 48
SYMBICORT.................................................. 6, 60, 69
SYMBYAX...........................................................10, 60
SYMLINPEN 120...................................................... 23
SYMLINPEN 60........................................................ 23
SYNALAR................................................................. 19
SYNALAR TS........................................................... 19
SYNALGOS-DC........................................................44
SYNAREL................................................................. 28
SYNERA................................................................... 22
SYNRIBO........................................................... 43, 72
SYNTHROID.............................................................29
SYRINGE AVITENE................................................. 33
-TTABLOID...................................................................42
TACHOSIL................................................................ 33
TACLONEX(OINT)..............................................22, 69
TACLONEX(SUSPENSION)...............................22, 69
TACROLIMUS.................................................... 22, 34
TADALAFIL...............................................................13
TAFINLAR...........................................................42, 72
TAFLUPROST/PF.....................................................30
TAGAMET.................................................................49
TALC.........................................................................43
TALWIN.....................................................................45
TAMIFLU(CAP)(30 MG)......................................37, 60
TAMIFLU(CAP)(45 MG)......................................37, 60
TAMIFLU(CAP)(75 MG)......................................37, 60
TAMIFLU(SUSP RECON).................................. 37, 60
TAMOXIFEN CITRATE.......................................43, 72
TAMSULOSIN HCL.................................................. 49
TANZEUM.....................................................23, 60, 69
TAPAZOLE............................................................... 29
TAPENTADOL HCL.................................................. 45
TARCEVA..................................................... 42, 60, 72
TARGRETIN................................................. 21, 43, 72
TARKA...................................................................... 11
TARON-BC............................................................... 52
TARON-PREX PRENATAL....................................... 52
TASIGNA...................................................... 43, 60, 72
TASIMELTEON.........................................................10
TASMAR....................................................... 46, 60, 69
TAVABOROLE.......................................................... 18
TAZAROTENE....................................................17, 22
TAZORAC.................................................................22
TD GOLD BLOOD GLUCOSE MONITOR(OTC)......
2
5
TD GOLD VOICE GLUCOSE MONITOR(OTC)....... 25
TECFIDERA....................................................... 43, 72
TEDIZOLID PHOSPHATE........................................ 35
TEDUGLUTIDE........................................................ 42
TEGRETOL.............................................................. 46
TEGRETOL XR........................................................ 46
TEKAMLO.......................................................... 13, 72
TEKTURNA........................................................ 13, 72
TEKTURNA HCT................................................ 13, 72
TELAPREVIR........................................................... 38
TELBIVUDINE.......................................................... 38
TELCARE(OTC)....................................................... 25
TELITHROMYCIN.................................................... 35
TELMISARTAN.........................................................12
TELMISARTAN/AMLODIPINE..................................12
TELMISARTAN/HYDROCHLOROTHIAZID..............11
L.A. Care
TELMISARTAN-AMLODIPINE................................. 12
TELMISARTAN-HYDROCHLOROTHIAZID..............11
TEMAZEPAM............................................................10
TEMODAR..........................................................42, 72
TEMOVATE.............................................................. 19
TEMOVATE EMOLLIENT......................................... 19
TEMOZOLOMIDE.....................................................42
TENEX......................................................................12
TENOFOVIR DISOPROXIL FUMARATE................. 38
TENORETIC 100...................................................... 12
TENORETIC 50........................................................ 12
TENORMIN...............................................................12
TERAK......................................................................30
TERAZOSIN HCL..................................................... 11
TERBINAFINE HCL..................................................36
TERBINAFINE/HYDROXY CHITOSAN....................36
TERBINEX................................................................36
TERBUTALINE SULFATE.......................................... 6
TERCONAZOLE.......................................................50
TERIFLUNOMIDE.................................................... 43
TERIPARATIDE........................................................ 28
TERRAMYCIN WITH POLYMYXIN.......................... 30
TERSI FOAM............................................................20
TESSALON PERLE..................................................16
TEST N'GO(OTC).....................................................25
TESTIM...............................................................33, 72
TESTOSTERONE.............................................. 33, 72
TESTOSTERONE CYPIONATE.........................33, 72
TESTOSTERONE ENANTHATE..............................33
TESTOSTERONE PROPIONATE............................ 33
TESTRED................................................................. 33
TETCAINE................................................................ 29
TETRABENAZINE.................................................... 43
TETRACAINE HCL.............................................22, 29
TETRACAINE HCL/PF............................................. 29
TETRACAINE/BENZOCAINE/BUTAMBEN..............22
TETRACYCLINE HCL.............................................. 36
TETRAHYDROZOLINE HCL....................................16
TETRAVISC..............................................................29
TETRAVISC FORTE.................................................29
TEVETEN........................................................... 12, 69
TEVETEN HCT................................................... 11, 69
TEV-TROPIN...................................................... 28, 72
TEXACORT.............................................................. 19
THALIDOMIDE......................................................... 36
THALOMID................................................... 36, 60, 72
THEO-24.....................................................................7
THEOPHYLL/EPHED HCL/PHENOBARB................. 7
THEOPHYLLINE ANHYDROUS................................ 7
THEOTAL................................................................... 7
THIAMINE HCL........................................................ 54
THIOGUANINE.........................................................42
THIOLA.....................................................................49
THIORIDAZINE HCL................................................ 10
THIOTHIXENE..........................................................10
THRESHOLD IMT...................................................... 7
THRESHOLD PEP..................................................... 7
THROMBIN (BOVINE)..............................................33
THROMBIN (RECOMBINANT).................................33
THROMBIN(HUM PLAS)/FIB/APRO/CA.................. 33
THROMBIN/FIBRINOGEN/APRO/CAL.................... 33
THROMBIN-JMI........................................................33
THYROID,PORK...................................................... 29
THYROLAR-1........................................................... 29
THYROLAR-1/2........................................................ 29
THYROLAR-1/4........................................................ 29
THYROLAR-2........................................................... 29
THYROLAR-3........................................................... 29
TIAGABINE HCL...................................................... 47
TICAGRELOR.......................................................... 32
TICLOPIDINE HCL................................................... 32
TIGAN.........................................................................5
TIKOSYN.................................................................. 11
TIMOLOL.................................................................. 30
TIMOLOL MALEATE.......................................... 12, 30
TIMOLOL MALEATE/PF...........................................30
TIMOPTIC.................................................................30
TIMOPTIC OCUDOSE................................. 30, 60, 69
TIMOPTIC-XE...........................................................30
TINDAMAX............................................................... 37
TINIDAZOLE.............................................................37
TIOPRONIN..............................................................49
TIOTROPIUM BROMIDE........................................... 6
TIPRANAVIR............................................................ 37
TIPRANAVIR/VITAMIN E TPGS...............................37
TIROSINT................................................................. 29
TISSEEL VHSD........................................................ 33
TIVICAY.............................................................. 38, 72
TIZANIDINE HCL......................................................48
TIZANIDINE/IRR CNTR-IRR CMB #2...................... 48
TL TRISEB................................................................20
TL-FLUORIVITE....................................................... 51
TL-SELECT DHA......................................................53
TOBI................................................................... 36, 72
TOBI PODHALER...............................................36, 72
TOBRADEX ST........................................................ 29
TOBRADEX(DROPS SUSP).................................... 29
TOBRADEX(OINT)................................................... 29
TOBRAMYCIN....................................................30, 36
TOBRAMYCIN IN 0.225% NACL............................. 36
TOBRAMYCIN/DEXAMETHASONE........................ 29
TOBRAMYCIN/LOTEPRED ETAB........................... 29
TOBREX(DROPS)....................................................30
TOBREX(OINT)........................................................ 30
TOCILIZUMAB..........................................................39
TODAY CONTRACEPTIVE SPONGE(OTC)......15,
7
3
TOFACITINIB CITRATE........................................... 39
TOFRANIL.................................................................. 9
TOFRANIL-PM........................................................... 9
TOLAZAMIDE...........................................................23
TOLBUTAMIDE........................................................ 23
TOLCAPONE............................................................46
TOLMETIN SODIUM................................................ 40
TOLTERODINE TARTRATE..................................... 50
TOLVAPTAN............................................................. 27
TOPAMAX................................................................ 47
TOPICORT(CREAM)................................................19
TOPICORT(GEL)......................................................19
TOPICORT(OINT).................................................... 19
TOPICORT(SPRAY)........................................... 19, 69
TOPIRAMATE...........................................................47
TOPOTECAN HCL................................................... 42
TOPROL XL..............................................................12
TORADOL(CARTRIDGE)(15 MG/ML)......................40
TORADOL(CARTRIDGE)(30 MG/ML)......................40
TOREMIFENE CITRATE.......................................... 43
TORSEMIDE............................................................ 13
TOVIAZ...............................................................50, 69
TRACLEER........................................................ 13, 72
TRADJENTA.......................................................23, 60
TRAMADOL HCL......................................................45
TRAMADOL HCL/ACETAMINOPHEN..................... 45
TRAMETINIB DIMETHYL SULFOXIDE................... 43
TRANDATE...............................................................11
TRANDOLAPRIL...................................................... 12
TRANDOLAPRIL/VERAPAMIL HCL.........................11
TRANEXAMIC ACID.................................................31
TRANSDERM-SCOP..................................................5
TRANXENE T-TAB..................................................... 9
TRANYLCYPROMINE SULFATE............................... 8
TRAVATAN Z...................................................... 30, 60
TRAVOPROST................................................... 30, 60
TRAVOPROST (BENZALKONIUM)......................... 30
TRAZODONE HCL..................................................... 8
TREAGAN OTIC.......................................................27
TRECATOR.............................................................. 36
TREK S COMBO PACK..............................................7
TREK S COMPACT COMPRESSOR......................... 7
TREPROSTINIL........................................................13
TREPROSTINIL DIOLAMINE...................................13
TREPROSTINIL SODIUM........................................ 13
TREPROSTINIL/NEB ACCESSORIES.................... 13
TREPROSTINIL/NEBULIZER/ACCESOR................13
TRETINOIN........................................................ 17, 43
TRETINOIN MICROSPHERES................................ 17
TRETINOIN/EMOL CMB9/SKIN CLN1.....................17
TRETIN-X........................................................... 17, 55
TRETTEN................................................................. 32
TREXALL..................................................................42
TREXIMET................................................... 45, 60, 69
TRIACETIN...............................................................36
TRIAMCIN/HYDROPHILIC OINTMENT................... 20
TRIAMCIN/UREA/HYDRO OINT..............................20
TRIAMCINOLONE ACETONIDE..............5, 20, 44, 60
TRIAMCINOLONE DIACETATE............................... 39
TRIAMCINOLONE/EMOLLIENT CMB#45............... 20
TRIAMCINOLONE/EMOLLIENT CMB#86............... 20
TRIAMTERENE........................................................ 13
TRIAMTERENE/HYDROCHLOROTHIAZID.............13
TRIAMTERENE-HCTZ............................................. 13
TRIAZOLAM............................................................. 10
TRIBENZOR....................................................... 11, 69
TRICARE.................................................................. 53
TRICARE PRENATAL COMPLEAT.......................... 52
TRICARE PRENATAL DHA ONE............................. 52
Page 88 of 90
Index
TRICOR.................................................................... 14
TRIDERM................................................................. 20
TRIDESILON............................................................ 19
TRIFLUOPERAZINE HCL........................................ 10
TRIFLURIDINE......................................................... 29
TRIHEXYPHENIDYL HCL........................................ 46
TRILEPTAL(ORAL SUSP)........................................47
TRILEPTAL(TAB)......................................................47
TRILIPIX................................................................... 14
TRIMETHOBENZAMIDE HCL....................................5
TRIMETHOBENZAMIDE HCL/B-CAINE.................... 5
TRIMETHOPRIM...................................................... 35
TRIMIPRAMINE MALEATE........................................ 9
TRINATAL RX 1........................................................53
TRINATE...................................................................53
TRIONATE................................................................16
TRIPELENNAMINE HCL............................................ 5
TRIPLE DYE.............................................................18
TRIUMEQ................................................................. 38
TRIVEEN-ONE......................................................... 52
TRIVEEN-PRX RNF................................................. 53
TRI-VI-FLOR.............................................................51
TRI-VIT WITH FLUORIDE-IRON..............................51
TRI-VITAMIN WITH FLUORIDE............................... 51
TRIZIVIR.............................................................37, 72
TROKENDI XR(CAP ER 24H)(100 MG)...... 47, 60, 69
TROKENDI XR(CAP ER 24H)(200 MG)...... 47, 60, 69
TROKENDI XR(CAP ER 24H)(25 MG)........ 47, 60, 70
TROKENDI XR(CAP ER 24H)(50 MG)........ 47, 60, 70
TROPAZONE............................................................20
TROPICAMIDE.........................................................31
TROSPIUM CHLORIDE........................................... 50
TRUE2GO BLOOD GLUCOSE SYSTEM(OTC)...... 25
TRUERESULT BLOOD GLUCOSE SYSTM(OTC)......
2
5
TRUETRACK BLOOD GLUCOSE SYSTEM(OTC)......
2
5
TRUETRACK METER(OTC).................................... 25
TRUETRACK SMART SYSTEM(OTC).................... 25
TRUSOPT.................................................................30
TRUST NATAL DHA................................................. 52
TRUVADA...........................................................37, 60
TRUZONE PEAK FLOW METER...............................7
TRYPSIN/BALSAM PERU/CASTOR OIL.................22
TUDORZA PRESSAIR......................................... 6, 60
TUSSICAPS............................................................. 16
TUSSIONEX............................................................. 16
TYKERB............................................................. 43, 72
TYLENOL-CODEINE NO.3...................................... 46
TYLENOL-CODEINE NO.4...................................... 46
TYVASO............................................................. 13, 72
TYZEKA....................................................................38
TYZINE..................................................................... 16
-UUCEPHAN................................................................ 41
UCERIS.............................................................. 39, 70
U-CORT....................................................................19
UDAMIN SP..............................................................51
ULESFIA...................................................................18
ULIPRISTAL ACETATE............................................ 16
ULORIC........................................................ 31, 60, 70
ULTI-LANCE(OTC)................................................... 26
ULTIMA(OTC)...........................................................25
ULTIMATECARE ONE..............................................52
ULTIMATECARE ONE NF........................................52
ULTRACET............................................................... 45
ULTRAFOAM............................................................33
ULTRAM................................................................... 45
ULTRASAL-ER......................................................... 21
ULTRASE................................................................. 48
ULTRASE MT 12...................................................... 48
ULTRASE MT 18...................................................... 48
ULTRASE MT 20...................................................... 48
ULTRATRAK PRO(OTC).......................................... 25
ULTRATRAK ULTIMATE(OTC).................................25
ULTRATRAK(OTC)...................................................25
ULTRAVATE..............................................................19
ULTRAVATE X.......................................................... 19
ULTRESA................................................................. 48
UMECLIDINIUM BRM/VILANTEROL TR................... 6
UMECTA...................................................................21
UMECTA PD.............................................................21
UNIRETIC................................................................. 11
UNISTIK 2 EXTRA(OTC)..........................................26
UNISTIK 2 NORMAL................................................ 26
UNISTIK 2 NORMAL(OTC)...................................... 26
UNISTIK 2(OTC).......................................................26
UNISTIK 3 COMFORT(OTC)................................... 26
L.A. Care
UNISTIK 3 NEONATAL(OTC)...................................26
UNISTIK 3(OTC).......................................................26
UNITHROID..............................................................29
UNIVASC.................................................................. 12
UNOPROSTONE ISOPROPYL................................30
URAMAXIN...............................................................21
URAMAXIN GT.........................................................21
UREA..................................................................21, 22
UREA/EMOLLIENT CMB NO.18.............................. 21
UREA/EMOLLIENT COMBINATION #65................. 21
UREA/HYALURONATE SODIUM.............................21
UREA/LACTIC AC/ZN UNDECYLENATE................ 21
UREA/LACTIC ACID/SALICYL ACID....................... 21
URECHOLINE.......................................................... 42
URELLE....................................................................34
URETRON D-S.........................................................35
URIBEL.....................................................................35
URIN D.S.................................................................. 35
UROCIT-K.................................................................49
UROLOGIC SOLUTION G(IRRIG SOLN)(3.24G-380)
..................................................................................36
UROLOGIC SOLUTION-G....................................... 36
UROQID-ACID NO.2................................................ 49
UROXATRAL............................................................ 49
URSO....................................................................... 41
URSO FORTE.......................................................... 41
URSODIOL............................................................... 41
URYL........................................................................ 34
USTEKINUMAB........................................................39
UTA...........................................................................34
UTIRA-C................................................................... 35
-VVAGIFEM..................................................................50
VALACYCLOVIR HCL.............................................. 37
VALCHLOR.........................................................22, 72
VALCYTE..................................................................37
VALGANCICLOVIR HCL.......................................... 37
VALIUM.......................................................................9
VALPROIC ACID...................................................... 47
VALPROIC ACID (AS SODIUM SALT).....................47
VALSARTAN............................................................. 12
VALSARTAN/HYDROCHLOROTHIAZIDE............... 11
VALTREX..................................................................37
VANCOCIN HCL.................................................37, 60
VANCOMYCIN HCL................................................. 37
VANDAZOLE............................................................ 50
VANDETANIB........................................................... 43
VANOXIDE-HC......................................................... 17
VANTAS....................................................................28
VARENICLINE TARTRATE.......................................48
VASCEPA........................................................... 14, 60
VASELINE WHITE PETROLEUM............................ 20
VASERETIC..............................................................11
VASHE WOUND THERAPY.....................................21
VASOLEX................................................................. 22
VASOTEC.................................................................12
V-C FORTE...............................................................51
VCF(OTC)...........................................................15, 73
VECAMYL.......................................................... 12, 72
VECTICAL.......................................................... 22, 70
VEHICLE-N...............................................................20
VEHICLE-N MILD..................................................... 20
VELPHORO..............................................................27
VELTIN..................................................................... 17
VEMURAFENIB........................................................43
VENA-BAL DHA....................................................... 53
VENATAL COMPLETE DHA.................................... 53
VENLAFAXINE HCL................................................... 8
VENLAFAXINE HCL ER............................................. 8
VENTAVIS.......................................................... 13, 72
VENTOLIN HFA..........................................................6
VERAMYST.................................................... 5, 60, 70
VERAPAMIL ER....................................................... 13
VERAPAMIL HCL..................................................... 13
VERDESO................................................................ 19
VEREGEN................................................................ 18
VERIPRED 20.......................................................... 39
VERSACLOZ.................................................. 9, 60, 70
VESICARE......................................................... 50, 70
VEXA........................................................................ 22
VEXOL......................................................................29
VFEND......................................................................36
VIBRAMYCIN..................................................... 35, 36
VI-CERT C1000 WITH B12...................................... 50
VI-CERT C500..........................................................54
VICOPROFEN.......................................................... 44
VICTORY(OTC)........................................................25
VICTOZA 2-PAK........................................... 23, 60, 70
VICTOZA 3-PAK........................................... 23, 60, 70
VICTRELIS......................................................... 38, 72
VIDEX................................................................. 38, 60
VIDEX EC(CAP DR)(125 MG)............................38, 60
VIDEX EC(CAP DR)(200 MG)............................38, 60
VIDEX EC(CAP DR)(250 MG)..................................38
VIDEX EC(CAP DR)(400 MG)..................................38
VIGABATRIN............................................................ 47
VIGAMOX................................................................. 30
VIIBRYD(TAB DS PK).......................................... 8, 70
VIIBRYD(TAB)................................................ 8, 60, 70
VILAZODONE HYDROCHLORIDE............................ 8
VIMOVO............................................................. 40, 70
VIMPAT(SOLUTION)................................................ 47
VIMPAT(TAB)................................................47, 60, 70
VINATE CARE.......................................................... 53
VINATE DHA............................................................ 52
VINATE DHA RF.......................................................52
VINATE GT............................................................... 53
VINATE II.................................................................. 53
VINATE PN CARE.................................................... 53
VINATE ULTRA........................................................ 53
VINATE-M.................................................................52
VIOKACE..................................................................48
VIORELE............................................................ 15, 73
VIOS AEROSOL DELIVERY SYSTEM...................... 7
VIRACEPT................................................................38
VIRAMUNE XR.........................................................38
VIRAMUNE(ORAL SUSP)..................................38, 60
VIRAMUNE(TAB)................................................38, 60
VIRASAL.................................................................. 21
VIRAZOLE................................................................ 37
VIREAD(POWDER)............................................38, 60
VIREAD(TAB)..................................................... 38, 60
VIROPTIC.................................................................29
VIRT-BAL DHA PLUS...............................................53
VIRT-VITE PLUS...................................................... 54
VISMODEGIB........................................................... 42
VISTARIL.................................................................... 5
VIT B CMPLX 3/FA/VIT C/BIOTIN............................54
VIT B CMPLX NO3/FA/C/BIOT/ZINC....................... 54
VIT B COMPLEX & C NO.13/FA/D3.........................54
VIT B CPLX #11/FA/C/BIOT/ZN OX......................... 54
VIT E/LIDOCAIN/ALO VER/COLAGN...................... 22
VITAFOL NANO........................................................53
VITAFOL ULTRA...................................................... 52
VITAFOL-OB.............................................................53
VITAFOL-OB+DHA................................................... 53
VITAJECT................................................................. 54
VITAL-D RX.............................................................. 54
VITAMEDMD ONE RX..............................................53
VITAMEDMD PLUS RX............................................ 53
VITAMEDMD REDICHEW RX..................................53
VITAMIN B COMPLEX............................................. 54
VITAMIN D3(OTC)..............................................54, 55
VITAMINS B1,B2,B3,B5,& B6...................................54
VITA-RESPA.............................................................54
VITASPIRE............................................................... 51
VITE AC/GRAPE/HYALURONIC ACID.................... 20
VITE CON FORTE....................................................50
VITMAIN B-12...........................................................54
VITUZ....................................................................... 16
VIVACTIL.................................................................... 9
VIVELLE-DOT.................................................... 33, 60
VOGELXO(GEL MD PMP)................................. 33, 72
VOGELXO(GEL PACKET)................................. 33, 72
VOL-TAB RX.............................................................53
VOLTAREN...............................................................20
VORAPAXAR SULFATE...........................................32
VORICONAZOLE..................................................... 36
VORINOSTAT...........................................................43
VORTEX..................................................................... 7
VORTEX VHC FROG MASK......................................7
VORTEX VHC LADYBUG MASK............................... 7
VORTIOXETINE HYDROBROMIDE.......................... 8
VOSPIRE ER..............................................................6
VOTRIENT................................................... 43, 60, 72
VP CH ULTRA.......................................................... 52
VP-CH PLUS............................................................ 53
VP-CH-PNV.............................................................. 52
VP-ERA OB PLUS....................................................51
VP-HEME ONE.........................................................51
VP-PNV-DHA............................................................53
VUSION.................................................................... 18
VYTORIN(TAB)(10 MG-10MG).................... 14, 60, 70
VYTORIN(TAB)(10 MG-20MG).................... 14, 60, 70
VYTORIN(TAB)(10 MG-40MG).................... 14, 60, 70
VYTORIN(TAB)(10 MG-80MG).................... 14, 60, 70
Page 89 of 90
Index
VYVANSE....................................................... 9, 60, 70
-WWARFARIN SODIUM............................................... 31
WATCHHALER........................................................... 7
WATER..................................................................... 21
WATER FOR IRRIGATION,STERILE.......................21
WAVESENSE AMP(OTC).........................................25
WAVESENSE JAZZ(OTC)........................................25
WAVESENSE PRESTO(OTC)..................................25
WEED POLLEN-SHORT RAGWEED........................ 5
WELCHOL................................................................ 14
WELLBUTRIN XL....................................................... 8
WIDE SEAL DIAPHRAGM................................. 16, 73
WILATE.....................................................................31
WYMZYA FE.......................................................15, 73
-XXALATAN..................................................................30
XALKORI...................................................... 42, 60, 72
XANAX........................................................................9
XARELTO(TAB)(10 MG)..................................... 32, 60
XARELTO(TAB)(15 MG)..................................... 32, 60
XARELTO(TAB)(20 MG)..................................... 32, 60
XARTEMIS XR................................................... 45, 60
XCLAIR.....................................................................20
XELJANZ............................................................ 39, 72
XELODA(TAB)(150 MG)...............................42, 60, 72
XELODA(TAB)(500 MG)...............................42, 60, 72
XENAZINE................................................................43
XERAC AC............................................................... 20
XERESE................................................................... 18
XIFAXAN(TAB)(200 MG).......................................... 37
XIFAXAN(TAB)(550 MG).............................. 37, 60, 70
XOLEGEL................................................................. 18
XOPENEX.................................................................. 6
XOPENEX HFA.......................................................... 6
XTANDI.........................................................42, 60, 72
XYNTHA................................................................... 31
XYNTHA SOLOFUSE...............................................31
XYREM................................................................. 9, 72
XYZAL(SOLUTION)....................................... 5, 60, 70
XYZAL(TAB)............................................................... 5
-YYODOXIN................................................................. 37
-ZZAFIRLUKAST........................................................... 6
ZALEPLON............................................................... 10
ZAMICET............................................................ 45, 60
ZANAFLEX............................................................... 48
ZANAMIVIR.............................................................. 37
ZANTAC....................................................................49
ZARONTIN............................................................... 46
ZAROXOLYN............................................................13
ZATEAN-PN DHA..................................................... 52
ZATEAN-PN PLUS................................................... 52
ZEBETA.................................................................... 12
ZEGERID(CAP)............................................ 49, 60, 70
ZEGERID(PACKET)..................................... 49, 60, 70
ZELAPAR............................................................46, 60
ZELBORAF...................................................43, 60, 72
ZEMPLAR.................................................................28
ZENCIA.....................................................................18
ZENPEP(CAP DR)(10-34-55K)................................ 48
ZENPEP(CAP DR)(15-51-82K)................................ 48
ZENPEP(CAP DR)(20-68-109K).............................. 48
ZENPEP(CAP DR)(25-85-136K).............................. 48
ZENPEP(CAP DR)(3K-10K-16K)............................. 48
ZENPEP(CAP DR)(5K-17K-27K)............................. 48
ZENZEDI........................................................ 9, 60, 70
ZERIT(CAP)........................................................38, 60
ZERIT(SOLN RECON)....................................... 38, 60
ZESTORETIC........................................................... 11
ZESTRIL................................................................... 12
ZETIA................................................................. 14, 60
ZETONNA.......................................................5, 60, 70
ZIAC..........................................................................12
ZIAGEN(SOLUTION)..........................................38, 60
ZIAGEN(TAB)..................................................... 38, 60
ZIANA....................................................................... 17
ZIDOVUDINE......................................................38, 60
ZILEUTON.................................................................. 6
ZINC CL/B-CAINE/CETYLPYRD CL........................ 44
ZINC SULFATE.........................................................54
ZIOPTAN...................................................... 30, 60, 70
ZIPRASIDONE HCL................................................... 9
ZIPSOR........................................................ 40, 60, 70
ZIRGAN.................................................................... 29
ZITHRANOL....................................................... 22, 70
ZITHRANOL-RR................................................. 22, 70
L.A. Care
ZITHROMAX.............................................................35
ZITHROMAX TRI-PAK..............................................35
ZMAX........................................................................35
ZOCOR(TAB)(10 MG).............................................. 14
ZOCOR(TAB)(20 MG).............................................. 14
ZOCOR(TAB)(40 MG).............................................. 14
ZOCOR(TAB)(5 MG)................................................ 14
ZOCOR(TAB)(80 MG)........................................ 14, 70
ZOFRAN ODT............................................................ 5
ZOFRAN(SOLUTION).......................................... 5, 60
ZOFRAN(TAB)............................................................5
ZOHYDRO ER....................................................44, 60
ZOLINZA...................................................................43
ZOLMITRIPTAN........................................................45
ZOLOFT......................................................................8
ZOLPIDEM TARTRATE...................................... 10, 60
ZOLPIMIST...................................................10, 60, 70
ZOMIG(SPRAY)(2.5 MG)............................. 45, 60, 70
ZOMIG(SPRAY)(5 MG)................................ 45, 60, 70
ZOMIG(TAB).................................................45, 60, 70
ZONALON................................................................ 20
ZONATUSS.............................................................. 16
ZONEGRAN............................................................. 47
ZONISAMIDE........................................................... 47
ZONTIVITY............................................................... 32
ZORBTIVE..........................................................28, 72
ZORTRESS.............................................................. 34
ZORVOLEX.................................................. 40, 60, 70
ZOTEX-C.................................................................. 16
ZOVIA 1-35E...................................................... 15, 73
ZOVIRAX.................................................................. 37
ZOVIRAX(CREAM)...................................................18
ZOVIRAX(OINT)....................................................... 18
ZUBSOLV........................................................... 46, 72
ZUPLENZ(FILM)(4 MG)..................................5, 60, 70
ZUPLENZ(FILM)(8 MG)..................................5, 60, 70
ZYCLARA(CREAM PACK)........................... 34, 60, 72
ZYCLARA(CRM MD PMP)(2.5 %)................34, 60, 72
ZYCLARA(CRM MD PMP)(3.75 %)............. 34, 60, 72
ZYDELIG............................................................ 43, 72
ZYFLO........................................................................ 6
ZYFLO CR.................................................................. 6
ZYKADIA............................................................ 42, 72
ZYLET.......................................................................29
ZYLOPRIM............................................................... 31
ZYMAXID..................................................................30
ZYPREXA............................................................. 9, 60
ZYTIGA.........................................................42, 60, 72
ZYVOX............................................................... 35, 72
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