MEDICAID DRUG FORMULARY EFFECTIVE SEPTEMBER 1, 2013 LAST UPDATED July 25, 2014 INTRODUCTION The Health Alliance Medicaid Drug Formulary is the list of drugs we cover at retail pharmacies. Members should show this list to their doctors and pharmacists. We encourage doctors to use this list when considering treatment options, but final treatment decisions are between the doctor and patient. The formulary could change at any time. Members can see the most up-to-date list on the “For Members” section of HealthAllianceConnect.org. Also, log in to CatamaranRx.com to learn more about drug coverage and prices. This formulary is not for members who have both Medicare and Medicaid. HOW TO USE THIS LIST This drug list is broken into groups of similar drugs used to treat the same condition or sickness. Each group has subsections in it to help locate drugs. All the drugs listed, whether generic or brand-name, are covered. To find a drug in this PDF, choose the search function, type in a drug name and click “Search” or “Find.” You can also use the index, which lists drugs in alphabetical order. Generics Like brand-name drugs, generic drugs go through an approval process by the Food and Drug Administration (FDA). Generics are safe and have about the same results as brand-name drugs. They also cost a lot less. As a patient, you can tell your pharmacist you want a generic. In most cases, your pharmacist can give you a generic without a new prescription from your doctor. To learn more about generics, go to AskForGenerics.org. Drugs to Treat Multiple Conditions Some drugs can treat more than one medical condition. In this document, each drug is listed by its first FDAapproved use. Check the index if you do not find your drug listed under your condition. COVERAGE AND LIMITATIONS Drug Costs Drugs on this formulary do not cost you anything. A generic must be used when available. Utilization Management Some drugs on this list require utilization management (UM), like preauthorization, quantity limits and/or steptherapy. If a drug needs UM, it has one of these symbols after its name: • • QL–Quantity Limits PA–Preauthorization • ST–Step-Therapy Preauthorization request forms are on the “For Providers” section of HealthAllianceConnect.org. Quantity Limits (QL) For safety reasons, some drugs have a limit on the amount we will cover. For example, we cover 60 pills in 30 days for some drugs. Preauthorization (PA) Some drugs need preauthorization (approval) from Health Alliance, which means certain criteria have to be met before a member can get the drug. If it is not approved, we will not cover the drug. Step-Therapy (ST) Sometimes, one or more (pre-requisite) drugs have to be tried before others (called step-therapy drugs) will be covered. These first drugs and their step-therapy counterparts treat the same conditions. Specialty Drugs Specialty drugs need special handling and/or administration (how it is given). These drugs are available from Health Alliance’s preferred specialty pharmacy vendor, CVS Caremark. Preauthorization might be needed before getting these drugs. Sign-up forms for CVS Caremark and a list of covered specialty drugs are on the “For Members” section of HealthAllianceConnect.org. Dispensing Limits Up to a 30-day supply for each new prescription or refill can be given at once. Members can’t get refills before 75 percent of the last amount has been taken as directed. Some drugs have limits set by the FDA. These limits are to make sure drugs are taken safely. Dosage Forms Some medications come in more than one dosage form, such as tablets, liquid, or patches. Health Alliance may not cover every dosage form that is available. Medical Exception A Medical Exception is a process for reviewing coverage for drugs not on our formulary. Members may get a Medical Exception if they meet one of these requirements. A. Documented failure of all formulary drugs in the same group/class. B. Documented allergy to a formulary drug, with no other formulary choices. C. A certain drug is working for his or her condition, and switching may cause a health risk. o Immunosuppressants o HIV/AIDS medications o Oncology medications o Antiarrhythmics o Seizure medications o Antipsychotics o Antidepressants Physicians—Requesting a Medical Exception For more information or to request a Medical Exception for a member, call the Health Alliance Pharmacy Department at 1-800-851-3379, option 4, or fax the Preauthorization/Medical Exception form to 217-255-4598. Please give the following information when requesting a Medical Exception: • • • • • Patient name and Health Alliance ID number Doctor name, address and phone number Drug name and strength Patient diagnosis Chart documentation/documentation of previous medical history related to the requested drug General Exclusions A. B. C. D. E. F. G. H. I. Over-the-counter (OTC) drugs and their equivalents (unless they are on the Covered OTC Drug List). Drugs for erectile dysfunction. Drugs for anorexia, weight loss or weight gain. Drugs for cosmetic (not medical) purposes. Fertility-enhancing drugs. Immunizations and vaccines (except flu vaccine). Experimental drugs, or any drug used in an experimental way. Replacement of lost or stolen drugs. Non-self-administered injectable drugs, unless otherwise noted, are not covered through the pharmacy benefit. Review your description of coverage materials to learn more. J. Foreign drugs and drugs not approved by the FDA. Over-the-Counter Drugs Health Alliance covers some over-the-counter (OTC) drugs at no cost to you with a prescription from your doctor. A list of covered OTC drugs is on the “For Members” section of HealthAllianceConnect.org. Mail-Order Program Health Alliance offers a 90-day supply of some maintenance drugs through our mail-order pharmacy program. These drugs are for long-term conditions or sicknesses. A list of covered maintenance drugs are on the “For Members” section of HealthAllianceConnect.org. To sign up for our mail order program, please call Catamaran, our pharmacy benefits manager, at 1-866-8147105. Or sign up at YourHealthAlliance.org. CONTACT US Health Alliance Pharmacy Department 301 S. Vine St. Urbana, IL 61801-3347 1-800-851-3379, option 4 HealthAllianceConnect.org Table of Contents ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 August 2014 HEALTH ALLIANCE CONNECT MEDICAID PREFERRED DRUG LIST ANTI-INFECTIVES PENICILLINS COVERED amoxicillin amoxicillin/clavulanate potassium amoxicillin/clavulanate potassium ER ampicillin dicloxacillin sodium penicillin v potassium Augmentin Moxatag CEPHALOSPORIN FIRST GENERATION COVERED cefadroxil cephalexin SECOND GENERATION COVERED cefaclor cefprozil cefuroxime axetil Cefaclor ER Ceftin THIRD GENERATION COVERED cefdinir cefpodoxime proxetil Cedax Cefditoren Pivoxil Ceftibuten Spectracef Suprax MACROLIDES COVERED azithromycin clarithromycin clarithromycin ER erythromycin ST Dificid E.e.s. Granules E.e.s. 400 Ery-TAB Eryped 200 Eryped 400 Erythrocin Stearate Erythromycin Base Erythromycin Ethylsuccinate PCE Zmax TETRACYCLINES COVERED avidoxy demeclocycline HCL doxycycline doxycycline hyclate doxycycline hyclate DR doxycycline monohydrate minocycline HCL minocycline HCL ER morgidox 1X100MG morgidox 2X100MG Tetracycline HCL Vibramycin QUINOLONES COVERED ciprofloxacin ciprofloxacin ER ciprofloxacin HCL levofloxacin ofloxacin Factive Noroxin AMINOGLYCOSIDES COVERED neomycin sulfate paromomycin sulfate PA tobramycin Kanamycin Sulfate Neo-fradin PA Tobi Podhaler SULFONAMIDES COVERED Sulfadiazine ANTIMYCOBACTERIAL AGENTS COVERED ethambutol HCL isoniazid pyrazinamide rifabutin rifampin Cycloserine Isoniazid Paser Priftin Rifamate Rifater Seromycin Trecator ANTIFUNGALS COVERED fluconazole flucytosine griseofulvin microsize griseofulvin ultramicrosize itraconazole ketoconazole nystatin terbinafine HCL PA voriconazole Lamisil PA Noxafil PA Onmel Sporanox ANTIVIRALS COVERED abacavir abacavir sulfate/lamivudine/zidovudine acyclovir PA adefovir dipivoxil didanosine famciclovir lamivudine lamivudine/zidovudine PA moderiba nevirapine nevirapine ER PA ribasphere PA ribavirin rimantadine HCL stavudine valacyclovir HCL zidovudine Aptivus Atripla PA Baraclude Complera Crixivan Edurant Emtriva Epivir Epivir HBV Epzicom PA,QL Incivek PA Infergen Intelence Invirase Isentress Kaletra Lexiva PA Moderiba Nevirapine Norvir PA Olysio PA Peg-intron PA Peg-intron Redipen PA Peg-intron Redipen PAK 4 PA Pegasys PA Pegasys Proclick Prezista PA Rebetol Relenza Diskhaler Rescriptor Reyataz PA Ribasphere PA Ribasphere Ribapak PA Ribatab Selzentry PA Sovaldi Stribild Sustiva Tamiflu Tivicay Truvada PA Tyzeka Valcyte PA,QL Victrelis Videx Pediatric Viracept Viramune Viramune XR Virazole Viread Ziagen ANTIMALARIALS COVERED atovaquone/proguanil HCL chloroquine phosphate hydroxychloroquine sulfate Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 1 mefloquine HCL PA quinine sulfate Coartem Daraprim Primaquine Phosphate Nilandron PA Xtandi Zoladex PA Zytiga CHEMOTHERAPY ADJUNCTS IMMUNOMODULATORS AMEBICIDES COVERED Yodoxin ANTHELMINTICS COVERED Albenza Biltricide Stromectol MISC. ANTI-INFECTIVES COVERED atovaquone clindamycin palmitate HCL clindamycin HCL e.s.p. erythromycin/sulfisoxazole metronidazole sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS sulfatrim pediatric tinidazole trimethoprim vancomycin HCL Alinia PA Cayston Dapsone First-vancomycin 25 First-vancomycin 50 Flagyl ER Ketek Nebupent Primsol PA Xifaxan PA Zyvox ANTINEOPLASTICS, ETC ALKYLATING AGENTS COVERED Cyclophosphamide Hexalen Leukeran ANTIMETABOLITES COVERED mercaptopurine methotrexate Tabloid Trexall HORMONAL AGENTS COVERED anastrozole bicalutamide exemestane flutamide letrozole PA leuprolide acetate megestrol acetate tamoxifen citrate Emcyt Fareston Lysodren COVERED leucovorin calcium Mesnex COVERED azathioprine cyclosporine cyclosporine modified gengraf hecoria mycophenolate mofetil mycophenolic acid DR sirolimus tacrolimus Astagraf XL Azasan Cellcept Cyclosporine Modified Neoral PA Pomalyst Rapamune PA Revlimid Sandimmune PA Thalomid Zortress ENZYME INHIBITORS COVERED PA Afinitor PA Afinitor Disperz PA Bosulif Caprelsa PA Cometriq PA Gilotrif PA Gleevec PA Iclusig PA Imbruvica PA Inlyta PA Jakafi PA Mekinist PA Nexavar PA Sprycel PA Stivarga PA Sutent PA Tafinlar PA Tarceva PA Tasigna PA Tykerb PA Votrient PA Xalkori PA Zelboraf PA Zolinza PA Zykadia ANTINEOPLASTICS MISC. COVERED hydroxyurea tretinoin PA Actimmune Intron-a W/Diluent Matulane PA Sylatron Synribo Targretin CHEMOTHERAPY RESCUE COVERED Kepivance CARDIOVASCULAR DRUGS CARDIAC GLYCOSIDES COVERED digox digoxin Lanoxin ANTIANGINAL AGENTS COVERED isoditrate ER isosorbide dinitrate isosorbide dinitrate ER isosorbide mononitrate isosorbide mononitrate ER minitran nitroglycerin nitroglycerin lingual nitroglycerin transdermal Dilatrate SR Isordil Titradose Isosorbide Dinitrate Nitro-bid Nitro-dur Nitrostat Ranexa BETA BLOCKERS COVERED acebutolol HCL atenolol betaxolol HCL bisoprolol fumarate carvedilol labetalol HCL metoprolol succinate ER metoprolol tartrate nadolol pindolol propranolol HCL propranolol HCL ER sorine sotalol HCL Bystolic Hemangeol Inderal XL Innopran XL Levatol Timolol Maleate CALCIUM CHANNEL BLOCKERS COVERED afeditab CR amlodipine besylate cartia XT dilt-CD dilt-XR diltiazem CD diltiazem HCL diltiazem HCL ER diltzac matzim LA Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 2 nicardipine HCL nifediac CC nifedical XL PA nifedipine nifedipine ER nimodipine taztia XT verapamil HCL verapamil HCL ER verapamil HCL SR Cardene SR Isradipine Nymalize ANTIARRHYTHMICS COVERED amiodarone HCL PA disopyramide phosphate flecainide acetate mexiletine HCL pacerone propafenone HCL propafenone HCL ER quinidine gluconate CR quinidine gluconate ER quinidine sulfate Multaq Nexterone Quinidine Sulfate ER Tikosyn ACE INHIBITORS COVERED benazepril HCL captopril enalapril maleate fosinopril sodium lisinopril moexipril HCL perindopril erbumine quinapril HCL ramipril trandolapril Epaned ANGIOTENSIN RCPTR BLOCKER COVERED candesartan cilexetil eprosartan mesylate irbesartan losartan potassium Diovan Edarbi Teveten ANTIHYPERTENSIVES MISC. COVERED clonidine HCL doxazosin mesylate eplerenone PA guanfacine HCL hydralazine HCL PA methyldopa minoxidil prazosin HCL terazosin HCL Demser Dibenzyline ANTIHYPERTENSIVE COMBO COVERED amlodipine besylate/benazepril hydrochloride amlodipine besylate/benazepril HCL atenolol/chlorthalidone benazepril HCL/hydrochlorothiazide bisoprolol fumarate/hydrochlorothiazide candesartan cilexetil/hydrochlorothiazide enalapril maleate/hydrochlorothiazide fosinopril sodium/hydrochlorothiazide irbesartan/hydrochlorothiazide lisinopril/hydrochlorothiazide losartan potassium/hydrochlorothiazide metoprolol/hydrochlorothiazide moexipril/hydrochlorothiazide nadolol/bendroflumethiazide quinapril/hydrochlorothiazide valsartan/hydrochlorothiazide Azor Captopril/Hydrochlorothiazide Clorpres Dutoprol Edarbyclor Propranolol/Hydrochlorothiazide Tarka Teveten HCT DIURETICS COVERED acetazolamide acetazolamide ER amiloride HCL amiloride/hydrochlorothiazide bumetanide chlorothiazide furosemide hydrochlorothiazide indapamide methazolamide metolazone spironolactone spironolactone/hydrochlorothiazide torsemide triamterene/hydrochlorothiazide Acetazolamide Chlorthalidone Diuril Dyrenium Edecrin Methyclothiazide VASOPRESSORS COVERED midodrine HCL Adrenaclick Auvi-q Epinephrine Epipen 2-PAK Epipen-JR 2-PAK ANTIHYPERLIPIDEMICS COVERED atorvastatin calcium cholestyramine cholestyramine light colestipol HCL colestipol HCL for oral suspension fenofibrate fenofibrate micronized fluvastatin gemfibrozil lovastatin micronized colestipol HCL pravastatin sodium prevalite simvastatin Fenofibrate Lipofen Niacor Triglide PA Zetia CARDIOVASCULAR - MISC. COVERED amlodipine besylate/atorvastatin calcium PA sildenafil PA sildenafil citrate PA Adcirca Adempas Bidil PA Letairis Opsumit PA Tracleer Veletri PA Ventavis DERMATOLOGICALS ACNE PRODUCTS COVERED adapalene avita clindacin etz pledgets clindacin-p clindamax clindamycin phosphate erythromycin sodium sulfacetamide sulfacetamide sodium tretinoin Azelex Clindagel ROSACEA AGENTS COVERED metronidazole rosadan PA Finacea ANTIBIOTICS - TOPICAL COVERED mupirocin mupirocin calcium Gentamicin Sulfate ANTIFUNGALS - TOPICAL COVERED ciclodan ciclopirox ciclopirox nail lacquer ciclopirox olamine clotrimazole clotrimazole/betamethasone dipropionate econazole nitrate ketoconazole ketodan nyamyc nystatin nystatin/triamcinolone Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 3 nystop pedi-dri ST Mentax ST Naftin ST Oxistat Vusion Xolegel triamcinolone acetonide triderm Amcinonide Cordran Tape Texacort Triamcinolone Acetonide IMMUNOMODULATING AGENTS ANTIVIRALS - TOPICAL COVERED acyclovir ST Denavir Zovirax COVERED imiquimod Elidel Protopic DERMATOLOGICALS - MISC. ANTI-INFLAMMATORY AGENTS COVERED Voltaren ANTIPRURITICS COVERED Prudoxin Zonalon ANTIPSORIATICS COVERED acitretin calcipotriene calcitrene methoxsalen ST Calcitriol Dritho-creme HP PA Tazorac ST Vectical 8-mop ANTISEBORRHEIC AGENTS COVERED selenium sulfide Tersi Foam CORTICOSTEROIDS - TOPICAL COVERED ala cort alclometasone dipropionate alphatrex augmented betamethasone dipropionate betamethasone dipropionate betamethasone valerate clobetasol propionate clobetasol propionate e clobetasol propionate emollient cormax scalp application cortalo desonide desoximetasone fluocinolone acetonide fluocinolone acetonide body fluocinolone acetonide scalp fluocinonide fluticasone propionate halobetasol propionate hydrocortisone hydrocortisone acetate/aloe hydrocortisone butyrate hydrocortisone valerate hydrocortisone IN absorbase lokara mometasone furoate prednicarbate COVERED acticin ammonium lactate hypercare laclotion lidocaine lidocaine HCL lidocaine HCL jelly lidocaine/prilocaine lindane malathion permethrin podofilox Anacaine Cocaine HCL Eurax Hylira Natroba Oxsoralen Pliaglis Podocon 25 IN Benzoin Tincture Pyrogallic Acid PA Sklice Spinosad Synera Ulesfia Veregen Xerac Ac ENDOCRINE AND METABOLIC CORTICOSTEROIDS COVERED baycadron budesonide dexamethasone fludrocortisone acetate hydrocortisone methylprednisolone methylprednisolone dose pack prednisolone prednisolone sodium phosphate prednisone Celestone Cortisone Acetate Dexamethasone Dexamethasone Intensol Dexpak 10 Day Dexpak 13 Day Dexpak 6 Day FLO-pred Medrol Millipred Millipred DP Orapred Odt Rayos PA Uceris Veripred 20 ANDROGENS-ANABOLIC COVERED PA danazol oxandrolone testosterone cypionate testosterone enanthate PA Androxy ESTROGENS COVERED PA estradiol PA estradiol valerate PA estropipate PA ortho-est Depo-estradiol Estrasorb Estrogel Jinteli CONTRACEPTIVES COVERED altavera alyacen 1/35 alyacen 7/7/7 amethia amethia LO apri aranelle aubra aviane azurette balziva briellyn camila camrese camrese LO caziant cesia chateal cryselle-28 cyclafem 1/35 cyclafem 7/7/7 dasetta 1/35 dasetta 7/7/7 daysee delyla desogestrel/ethinyl estradiol drospirenone/ethinyl estradiol elinest emoquette enpresse-28 enskyce errin estarylla falmina gianvi gildagia gildess FE 1.5/30 gildess FE 1/20 gildess 1.5/30 gildess 1/20 heather introvale jencycla jolessa jolivette Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 4 junel FE 1.5/30 junel FE 1/20 junel 1.5/30 junel 1/20 kariva kelnor 1/35 kurvelo larin FE 1.5/30 larin FE 1/20 larin 1.5/30 larin 1/20 leena lessina levonest levonorgestrel levonorgestrel and ethinyl estradiol levonorgestrel/ethinyl estradiol levora 0.15/30-28 loryna low-ogestrel lutera lyza marlissa medroxyprogesterone acetate microgestin FE microgestin FE 1.5/30 microgestin 1.5/30 microgestin 1/20 mono-linyah mononessa my way myzilra necon 0.5/35-28 necon 1/35 necon 7/7/7 next choice next choice one dose nora-be norethindrone norethindrone acetate/ethinyl estradiol norethindrone acetate/ethinyl estradiol/ferrous fumarate norgestimate/ethinyl estradiol norlyroc nortrel 0.5/35 (28) nortrel 1/35 nortrel 7/7/7 ocella orsythia philith pimtrea pirmella 1/35 pirmella 7/7/7 portia-28 previfem quasense reclipsen solia sprintec 28 sronyx syeda take action tilia FE tri-estarylla tri-legest FE tri-linyah tri-previfem tri-sprintec trinessa trivora-28 velivet vestura viorele vyfemla wera wymzya FE xulane zarah zenchent zenchent FE zovia 1/35e Depo-subq Provera 104 Ella Falessa LO Minastrin FE Necon 1/50-28 Necon 10/11-28 Norinyl 1+50 Nuvaring Ogestrel Quartette Zovia 1/50e PROGESTINS COVERED medroxyprogesterone acetate norethindrone acetate progesterone Megace ES ANTIDIABETIC AGENTS INSULIN metformin HCL ER Glumetza Riomet MEGLITINIDE ANALOGUES COVERED nateglinide repaglinide DIABETIC OTHER COVERED Glucagon Emergency Kit PA Korlym Proglycem ALPHA-GLUCOSIDASE INHIBIT COVERED acarbose Glyset DPP-4 INHIBITORS COVERED PA Tradjenta INSULIN SENSITIZING AGENT COVERED ST pioglitazone HCL Avandia ANTIDIABETIC COMBINATIONS COVERED glipizide/metformin HCL ST pioglitazone HCL-glimepiride ST pioglitazone HCL/metformin HCL PA,QL Jentadueto Prandimet COVERED Apidra Apidra Solostar Humalog Humalog Kwikpen Humalog Mix 50/50 Humalog Mix 50/50 Kwikpen Humalog Mix 75/25 Humalog Mix 75/25 Kwikpen Humulin N Humulin N U-100 Pen Humulin R Humulin R U-500 (concentrated) Humulin 70/30 Humulin 70/30 Pen Lantus Lantus Solostar Levemir BISPHOSPHONATES AMYLIN ANALOGS COVERED raloxifene hydrochloride COVERED ST Symlinpen 120 ST Symlinpen 60 INCRETIN MIMETIC AGENTS COVERED Victoza SULFONYLUREAS COVERED glimepiride glipizide glipizide ER glipizide XL glyburide tolazamide Glyburide Tolazamide Tolbutamide BIGUANIDES COVERED metformin HCL COVERED alendronate sodium ibandronate sodium Etidronate Disodium Skelid CALCITONINS COVERED calcitonin salmon calcitonin-salmon Fortical PARATHYROID HORMONE COVERED PA Forteo HORMONE RECEPTOR MDLTR FERTILITY REGULATORS COVERED PA chorionic gonadotropin PA novarel PA pregnyl w/diluent benzyl alcohol/NACL LHRH/GNRH AGONIST COVERED Synarel GROWTH HORMONES COVERED PA Genotropin PA Genotropin Miniquick PA Humatrope PA Humatrope Combo Pack PA Norditropin Cartridge Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 5 PA Norditropin Flexpro PA Norditropin Nordiflex Pen PA Nutropin PA Nutropin AQ Nuspin 10 PA Nutropin AQ Nuspin 20 PA Nutropin AQ Nuspin 5 PA Nutropin AQ Pen PA Omnitrope Saizen Saizen Click.easy Serostim PA Tev-tropin Zorbtive SOMATOMEDINS COVERED PA Increlex SOMATOSTATIC AGENTS COVERED PA octreotide acetate GH RECEPTOR ANTAGONISTS COVERED PA Somavert POSTERIOR PITUITARY COVERED desmopressin acetate Stimate PROLACTIN INHIBITORS COVERED cabergoline unithroid unithroid direct Armour Thyroid Synthroid Thyrolar-1 Thyrolar-1/2 Thyrolar-1/4 Thyrolar-2 Thyrolar-3 Tirosint GASTROINTESTINAL LAXATIVES COVERED constulose gavilyte-c gavilyte-n/flavor pack gavilyte-G lactulose peg 3350/electrolytes peg-3350/electrolytes peg-3350/NACL/NA bicarbonate/KCL pegylax polyethylene glycol 3350 trilyte Golytely Halflytely Bowel Prep/Flavor Packs Kristalose Moviprep Osmoprep Prepopik Suclear Suprep Bowel Prep ANTIDIARRHEALS VASOPRESSIN ANTAGONISTS COVERED PA Samsca PROGESTERONE ANTAGONISTS COVERED Mifeprex METABOLIC MODIFIERS COVERED calcitriol doxercalciferol levocarnitine paricalcitol sodium phenylbutyrate Buphenyl Carbaglu Cystadane PA Kuvan Lumizyme Myozyme PA Orfadin PA Sensipar PA Vimizim THYROID AGENTS COVERED levothroid levothyroxine sodium levoxyl liothyronine sodium methimazole propylthiouracil COVERED diphenoxylate/atropine lofene lonox loperamide HCL Diphenoxylate/Atropine Motofen Opium Tincture (paregoric) ULCER DRUGS COVERED cimetidine cimetidine HCL dicyclomine HCL ed-spaz ST eq lansoprazole famotidine glycopyrrolate ST gnp lansoprazole ST heartburn relief 24 HOUR ST heartburn treatment 24 HOUR hyomax-SL hyoscyamine sulfate hyoscyamine sulfate odt PA hyoscyamine sulfate ER PA hyoscyamine sulfate SR hyosyne ST kls lansoprazole ST lansoprazole methscopolamine bromide misoprostol nizatidine nulev omeprazole omeprazole/sodium bicarbonate oscimin PA oscimin SR pantoprazole sodium ST ra lansoprazole ranitidine HCL ST sm lansoprazole sucralfate symax fastabs symax-SL PA symax-SR Cantil Carafate Cuvposa ST CVS lansoprazole Helidac ST HM lansoprazole Propantheline Bromide Pylera Zantac ANTIEMETICS COVERED dronabinol granisetron HCL meclizine HCL ondansetron odt ondansetron HCL PA trimethobenzamide HCL Cesamet Granisol Sancuso Transderm-scop DIGESTIVE AIDS COVERED Creon Pancrelipase Sucraid Zenpep GASTROINTESTINAL - MISC. COVERED balsalazide disodium calcium acetate colocort cromolyn sodium enulose generlac hydrocort ene 100MG hydrocortisone lactulose mesalamine metoclopramide HCL procto-PAK proctocream HC proctosol HC proctozone-HC sulfasalazine sulfazine sulfazine EC ursodiol PA,QL Amitiza Apriso Asacol Asacol HD Chenodal PA Cimzia PA Cimzia Starter Kit Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 6 Cortifoam Delzicol Dipentum Fosrenol PA Lotronex Metozolv Odt Phoslyra Rectiv PA Relistor Renagel Renvela Sevelamer Carbonate GENITOURINARY URINARY ANTI-INFECTIVES COVERED methenamine mandelate PA nitrofurantoin PA nitrofurantoin macrocrystals PA nitrofurantoin monohydrate PA nitrofurantoin monohydrate/macrocrystals Monurol URINARY ANTISPASMODICS COVERED bethanechol chloride flavoxate HCL oxybutynin chloride oxybutynin chloride ER tolterodine tartrate trospium chloride trospium chloride ER Gelnique Toviaz VAGINAL PRODUCTS COVERED clindamycin phosphate metronidazole vaginal terconazole vandazole zazole Avc Cleocin Crinone Estrace Estring Femring Miconazole 3 Premarin Vagifem GENITOURINARY - MISC. COVERED alfuzosin HCL ER argyle sterile saline 100ML citric acid/sodium citrate curity sterile saline cytra k crystals cytra-2 finasteride phenazo phenazopyridine HCL potassium citrate-citric acid crystals sodium chloride sodium chloride 0.9% tamsulosin HCL taron-crystals Cystagon Cytra-k Cytra-3 Elmiron K-phos NO 2 Lithostat Oracit Potassium Citrate Potassium Citrate ER PA Procysbi Thiola Tricitrates Urocit-k 10 Urocit-k 15 Urocit-k 5 HEMATOLOGICAL HEMATOPOIETIC AGENTS COVERED cyanocobalamin folic acid PA Aranesp Albumin Free Droxia PA Epogen Granix Leukine Neulasta PA Neumega Neupogen PA Procrit PA Promacta Vpriv PA Zavesca ANTICOAGULANTS COVERED enoxaparin sodium fondaparinux sodium jantoven warfarin sodium Coumadin Fragmin ST Pradaxa ST Xarelto HEMOSTATICS COVERED aminocaproic acid tranexamic acid HEMATOLOGICAL - MISC. COVERED anagrelide hydrochloride cilostazol clopidogrel PA dipyridamole pentoxifylline ER PA ticlopidine HCL Aggrenox PA Firazyr PA Thrombate Iii W/20 ML Sterile Water MOUTH/THROAT/DENTAL AGENT COVERED cavarest cavirinse cevimeline HCL chlorhexidine gluconate chlorhexidine gluconate oral rinse clotrimazole controlrx denta 5000 plus dentagel fluoridex daily defense fluoridex daily defense enhanced whitening karigel karigel-n lidocaine viscous lidocaine HCL neutragard advanced neutral sodium fluoride nystatin oralone paroex perio MED periogard phos-flur pilocarpine hydrochloride pilocarpine HCL stannous fluoride oral rinse triamcinolone acetonide triamcinolone IN orabase Arestin Oravig SF SF 5000 plus NEUROLOGY, CNS, PSYCH ANTIANXIETY AGENTS COVERED alprazolam ST alprazolam odt alprazolam ER alprazolam XR buspirone HCL chlordiazepoxide HCL clorazepate dipotassium diazepam gene-xene TAB 15MG gene-xene TAB 3.75MG gene-xene TAB 7.5MG PA hydroxyzine pamoate PA hydroxyzine HCL lorazepam oxazepam ANTIDEPRESSANTS COVERED amitriptyline HCL budeprion SR bupropion HCL bupropion HCL ER bupropion HCL SR bupropion HCL XL citalopram hydrobromide clomipramine HCL desipramine HCL doxepin HCL duloxetine HCL escitalopram oxalate fluoxetine DR fluoxetine HCL fluvoxamine maleate fluvoxamine maleate ER imipramine pamoate imipramine HCL mirtazapine mirtazapine odt Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 7 nefazodone HCL nortriptyline HCL paroxetine HCL paroxetine HCL ER phenelzine sulfate protriptyline HCL sertraline HCL tranylcypromine sulfate trazodone HCL trimipramine maleate venlafaxine HCL venlafaxine HCL ER Amoxapine PA,QL Aplenzin Desvenlafaxine ER Emsam Forfivo XL Khedezla Maprotiline HCL Marplan Paxil ST Pexeva PA Pristiq Surmontil PA Viibryd ANTIPSYCHOTICS COVERED chlorpromazine HCL clozapine compazine compro fluphenazine decanoate fluphenazine HCL haloperidol haloperidol decanoate haloperidol lactate lithium carbonate lithium carbonate ER loxapine loxapine succinate olanzapine olanzapine odt perphenazine prochlorperazine prochlorperazine edisylate prochlorperazine maleate quetiapine fumarate risperidone risperidone odt risperidone M-TAB thioridazine HCL thiothixene trifluoperazine HCL ziprasidone HCL ST Abilify Abilify Discmelt Abilify Maintena Chlorpromazine HCL Clozapine Odt Equetro ST Fanapt ST Fanapt Titration Pack Fazaclo Fluphenazine HCL Geodon ST Invega Invega Sustenna ST Latuda Lithium Citrate Lithobid Risperdal Consta ST Saphris ST Seroquel XR Zyprexa Relprevv HYPNOTICS COVERED estazolam flurazepam HCL midazolam HCL phenobarbital temazepam triazolam PA zaleplon zolpidem tartrate Rozerem ADHD, NARCOLEPSY, ETC. COVERED PA amphetamine/dextroamphetamine caffeine citrate clonidine HCL ER PA dexmethylphenidate HCL PA dexmethylphenidate HCL ER PA dextroamphetamine sulfate PA dextroamphetamine sulfate ER PA metadate ER PA methamphetamine HCL PA methylphenidate hydrochloride PA methylphenidate HCL PA methylphenidate HCL CD PA methylphenidate HCL ER PA methylphenidate HCL SR PA zenzedi PA Daytrana PA Focalin XR Kapvay Dose Pack PA Methylin PA Nuvigil PA Ritalin LA ANTICONVULSANTS COVERED carbamazepine carbamazepine ER clonazepam clonazepam odt divalproex sodium divalproex sodium DR divalproex sodium ER epitol ethosuximide felbamate gabapentin lamotrigine lamotrigine ER levetiracetam levetiracetam ER oxcarbazepine phenytoin phenytoin infatabs phenytoin sodium extended primidone tiagabine hydrochloride topiragen topiramate valproic acid zonisamide ST Aptiom Banzel Celontin Dilantin Dilantin Infatabs Fycompa Gabitril Lamictal Starter/Taking Valproate ST Lyrica Onfi Oxtellar XR Peganone Phenytek PA Potiga PA Sabril Stavzor Trokendi XR Vimpat ANTIPARKINSON AGENTS COVERED amantadine HCL benztropine mesylate bromocriptine mesylate carbidopa carbidopa/levodopa carbidopa/levodopa odt carbidopa/levodopa ER entacapone pramipexole dihydrochloride ropinirole ER ropinirole HCL selegiline HCL PA trihexyphenidyl HCL Azilect Carbidopa/Levodopa/Entacapone Mirapex ER Neupro Stalevo 100 Stalevo 125 Stalevo 150 Stalevo 200 Stalevo 50 Stalevo 75 Tasmar Zelapar NEUROLOGY, PSYCH - MISC. COVERED acamprosate calcium DR buproban bupropion HCL SR disulfiram donepezil HCL galantamine galantamine hydrobromide ST olanzapine/fluoxetine rivastigmine tartrate PA Ampyra Aubagio PA Avonex PA Avonex Pen PA Betaseron Chantix Chantix Continuing Month PAK Chantix Starting Month PAK PA Copaxone PA Extavia Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 8 ST Gralise ST Gralise Starter Namenda Namenda Titration PAK Nicotrol Inhaler Nicotrol Ns Nuedexta Orap PA Savella PA Savella Titration Pack PA Xenazine PA Xyrem NEUROMUSCULAR AGENTS COVERED PA riluzole PA Myobloc MUSCULOSKELETAL AGENTS COVERED baclofen PA chlorzoxazone PA cyclobenzaprine HCL dantrolene sodium PA metaxalone PA methocarbamol PA orphenadrine citrate ER tizanidine HCL ANTIMYASTHENIC AGENTS COVERED pyridostigmine bromide Guanidine HCL Mestinon Mestinon Timespan Prostigmin dorzolamide HCL/timolol maleate levobunolol HCL timolol maleate timolol maleate ophthalmic gel forming OPHTHALMIC STEROIDS COVERED dexamethasone sodium phosphate fluorometholone neo-polycin HC neomycin/polymyxin/bacitracin/hydrocortisone neomycin/polymyxin/dexamethasone poly-dex prednisolone acetate sulfacetamide sodium/prednisolone sodium phosphate tobramycin/dexamethasone Neomycin/Polymyxin/Hydrocortisone Prednisolone Sodium Phosphate PROSTAGLANDINS COVERED latanoprost Travatan Z Travoprost OPHTHALMOLOGY AND OTIC COVERED ak-poly-bac bacitracin/polymyxin b ciprofloxacin HCL erythromycin garamycin gentak gentamicin sulfate ilotycin levofloxacin neo-polycin neomycin/bacitracin/polymyxin neomycin/polymyxin/bacitracin zinc neomycin/polymyxin/gramicidin ofloxacin polycin polycin b polymyxin b sulfate/trimethoprim sulfate romycin sodium sulfacetamide sulfacetamide sodium tobramycin sulfate trifluridine trimethoprim sulfate/polymyxin b sulfate Bacitracin OTIC AGENTS COVERED acetasol HC acetic acid antipyrine/benzocaine aurodex fluocinolone acetonide fluocinolone acetonide ear drops hydrocortisone/acetic acid neomycin/polymyxin/hydrocortisone neomycin/polymyxin/HC ofloxacin otic care Cetraxal Ciprofloxacin Cresylate CYCLOPLEGIC MYDRIATICS COVERED atropine sulfate atropine-care cyclopentolate HCL homatropaire homatropine HBR mydral tropicamide DECONGESTANTS ANTI-INFECTIVES diclofenac sodium dorzolamide HCL epinastine HCL flucaine fluorescein/proparacaine flurbiprofen sodium ketorolac tromethamine Alocril Bromfenac COVERED altafrin neofrin phenylephrine HCL Naphazoline HCL MIOTICS COVERED pilocarpine HCL Phospholine Iodide Pilopine HS ADRENERGIC AGENTS COVERED apraclonidine brimonidine tartrate LOCAL ANESTHETICS COVERED altacaine parcaine proparacaine HCL tetcaine tetracaine HCL tetravisc tetravisc forte Akten BETA-BLOCKERS OPHTHALMICS - MISC. COVERED betaxolol HCL carteolol HCL COVERED azelastine HCL cromolyn sodium OXYTOCICS COVERED methylergonovine maleate Prostin E2 PAIN MANAGEMENT ANALGESICS - NONNARCOTIC COVERED adult aspirin EC low strength ali-flex aspir-low aspir-81 aspirin aspirin adult low strength aspirin childrens aspirin enteric coated adult low strength aspirin low dose aspirin low strength aspirin EC aspirin EC low dose aspirin EC LO-dose aspirin 81 aspirin/enteric aspirtab aspirtab maximum strength bayer advanced aspirin extra strength bayer advanced aspirin regular strength bayer aspirin bayer aspirin regimen bayer aspirin EC low dose bayer chewable low dose bayer low dose butal/asa/caff butalbital compound butalbital/acetaminophen/caffeine butalbital/apap/caffeine butalbital/asa/caffeine capacet childrens aspirin childrens aspirin low strength choline magnesium trisalicylate Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 9 diflunisal dolorex duraxin ecotrin low strength ecpirin ed-flex enteric coated aspirin eq adult aspirin low strength eq aspirin eq aspirin adult low dose eq aspirin low dose eq aspirin EC eq childrens aspirin eql adult aspirin low strength eql aspirin eql aspirin low dose eql aspirin EC eql childrens aspirin esgic gnp adult aspirin low strength gnp aspirin gnp aspirin low dose goodsense aspirin low dose halfprin kls aspirin low dose kls aspirin EC kp aspirin margesic meijer aspirin EC miniprin low dose norwich aspirin px aspirin px enteric aspirin qc aspirin qc aspirin low dose qc childrens aspirin ra aspirin ra aspirin adult low dose ra aspirin adult low strength ra aspirin childrens ra aspirin EC ra aspirin EC adult low strength ra childrens aspirin repan salsalate sm aspirin sm aspirin adult low strength sm aspirin enteric coated sm aspirin low dose sm aspirin EC low strength sm childrens aspirin st joseph aspirin tgt aspirin tgt aspirin low dose tgt childrens aspirin tgt enteric-coated aspirin th aspirin th aspirin low dose th enteric aspirin zebutal Bioregesic Butalbital/Aspirin/Caffeine CVS aspirin CVS aspirin adult low dose CVS aspirin adult low strength CVS aspirin child CVS aspirin low dose CVS aspirin low strength CVS aspirin EC CVS childrens aspirin CVS enteric aspirin Dolgic Plus EC-81 aspirin HM aspirin HM aspirin EC HM aspirin EC low dose Mst 600 MM aspirin Orbivan Relagesic Rhinoflex-650 SB aspirin SB aspirin EC SB childrens aspirin SB low dose asa EC Zgesic 1/2halfprin ANALGESICS - OPIOID COVERED acetaminophen/codeine acetaminophen/codeine #2 acetaminophen/codeine #3 acetaminophen/codeine #4 acetaminophen/codeine phosphate buprenorphine HCL buprenorphine HCL/naloxone HCL butorphanol tartrate endocet endodan fentanyl PA fentanyl citrate oral transmucosal hydrocodone bitartrate/acetaminophen hydrocodone/acetaminophen hydrocodone/ibuprofen hydrogesic hydromorphone HCL ibudone lorcet lorcet plus lorcet HD lortab methadone HCL methadone HCL intensol methadose morphine sulfate ST morphine sulfate ER oxycodone HCL oxycodone/acetaminophen oxycodone/aspirin oxycodone/ibuprofen oxymorphone hydrochloride oxymorphone hydrochloride ER reprexain roxicet stagesic tramadol hydrochloride/acetaminophen tramadol HCL tramadol HCL ER verdrocet vicodin vicodin ES vicodin HP xylon Acetaminophen/Caffeine/Dihydrocodeine Bitartrate Aspirin-caffeine-dihydrocodeine Capital/Codeine Codeine Sulfate CO-gesic Levorphanol Tartrate Lortab Morphine Sulfate Roxicet Synalgos-dc Trezix Zolvit ANTI-INFLAMMATORY COVERED diclofenac potassium diclofenac sodium DR diclofenac sodium ER diclofenac sodium/misoprostol etodolac etodolac ER flurbiprofen ibuprofen PA indomethacin PA indomethacin ER ketoprofen leflunomide mefenamic acid meloxicam nabumetone naproxen naproxen sodium naproxen DR oxaprozin piroxicam sulindac tolmetin sodium PA Enbrel PA Enbrel Sureclick Fenoprofen Calcium PA Humira PA Humira Pen PA Humira Pen-crohns Diseasestarter PA Humira Pen-psoriasis Starter Ketoprofen ER Meclofenamate Sodium Ridaura MIGRAINE PRODUCTS COVERED naratriptan HCL rizatriptan benzoate rizatriptan benzoate odt sumatriptan succinate sumatriptan succinate refill Alsuma Cafergot Dihydroergotamine Mesylate Ergomar Migergot Migranal Sumatriptan Succinate GOUT AGENTS COVERED allopurinol probenecid probenecid/colchicine Colcrys Uloric RESPIRATORY, ALLERGY, ETC ANTIHISTAMINES Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 10 COVERED cetirizine HCL cyproheptadine HCL PA phenadoz PA promethazine HCL PA promethazine HCL plain PA promethegan NASAL AGENTS COVERED azelastine HCL flunisolide fluticasone propionate ipratropium bromide triamcinolone acetonide Bactroban Nasal Flunisolide Tyzine Tyzine Pediatric Nasal Drops COUGH/COLD/ALLERGY COVERED acetylcysteine nebusal pulmosal sodium chloride ANTIASTHMATIC/COPD AGENTS COVERED albuterol sulfate albuterol sulfate ER albuterol TAB 4MG PA budesonide cromolyn sodium ipratropium bromide ipratropium bromide/albuterol sulfate PA levalbuterol PA levalbuterol HCL montelukast sodium terbutaline sulfate theochron theophylline CR theophylline ER zafirlukast Aerospan ST Anoro Ellipta Atrovent HFA Broncomar-1 Brovana Combivent Combivent Respimat ST Daliresp Dulera Elixophyllin Lufyllin Maxair Autohaler Metaproterenol Sulfate PA Pulmicort Pulmicort Flexhaler Qvar Serevent Diskus Symbicort Theo-24 Tudorza Pressair Ventolin HFA Zyflo Zyflo CR RESPIRATORY AGENTS - MISC COVERED PA Kalydeco PA Pulmozyme TOXOIDS COVERED Adacel Boostrix Tetanus/Diphtheria Toxoids-adsorbed Adult VITAMINS VITAMINS COVERED aqueous vitamin d infants bio-d-mulsion bio-d-mulsion forte bprotected pedia d-vite calcidol calciferol d 1000 d 10000 d 2000 d 400 d 5000 d-vita d-1000 d-1000 extra strength d-2000 maximum strength d-3-5 d-400 d-5000 d-5000 maximum strength decara delta d3 dialyvite vitamin d 5000 d2000 ultra strength d3 d3 adult d3 high potency d3 kids d3 maximum strength d3 super strength d3 ultra strength d3-1000 d3-50 eql childrens vitamin d gummies eql vitamin d-3 eql vitamin d3 ergocalciferol gnp vitamin d gnp vitamin d maximum strength gnp vitamin d super strength gnp vitamin d3 extra strength healthy kids vitamin d3 just d kp vitamin d maximum d3 optimal-d optimal-d pack opurity vitamin d pronutrients vitamin d3 ra vitamin d-3 sm vitamin d sm vitamin d3 th vitamin d3 thera-d rapid repletion thera-d 2000 vitamin d vitamin d high potency vitamin d 400 vitamin d-1000 vitamin d-1000 maximum strength vitamin d-3 vitamin d-400 vitamin d3 vitamin d3 high potency vitamin d3 maximum strength vitamin d3 super strength CVS childrens vitamin d for bone health CVS vitamin d CVS vitamin d infants CVS vitamin d 5000 high-potency CVS vitamin d3 HM vitamin d HM vitamin d3 PA vitamin d-3 PA vitamin d-3 gummy MULTIVITAMINS COVERED multi-vit/fluoride multi-vitamin/fluoride M-vit O-CAL Fa Prenaplus Prenatal Prenatal Low Iron Prenatal Plus Prenatal Vitamins Plus Preplus PNV Folic Acid + Iron Multivitamin PNV Prenatal Plus Multivitamin Tri-vit/Fluoride/Iron Tricare Vol-plus MEDICAL DEVICES DIABETIC SUPPLIES COVERED Freestyle Insulinx Blood Glucose Test Freestyle Insulinx Blood Glucose Test Strips Freestyle Lite Test Strips Freestyle Test Strips Precision XTRA Blood Glucose Test Strips MEDICAL DEVICES - MISC COVERED Aerochamber Mini Aerosol Chamber Aerochamber MV Aerochamber Plus Flow VU Aerochamber Plus Flow-VU Aerochamber Plus Flow-VU/Large Mask Aerochamber Plus Flow-VU/Mask Aerochamber Plus Flow-VU/Medium Mask Aerochamber Plus Flow-VU/Small Mask Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU Aerochamber Z-stat Plus/Flowsignal Aerochamber Z-stat Plus/Large Mask Aerochamber Z-stat Plus/Medium Mask Aerochamber Z-stat Plus/Small Mask Aerochamber/Flowsignal Breatherite Breatherite Collapsible Adult Spacer W/Mask Breatherite Collapsible Child Spacer W/Mask Breatherite Collapsible Infant Spacer W/Mask Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 11 Breatherite Collapsible Small Child Spacer W/Mask Breatherite Collapsible Spacer W/ Neonate Mask Breatherite Rigid Spacer W/Mask Breatherite W/Large Mask Breatherite W/Medium Mask Breatherite W/Small Mask E-z Spacer E-z Spacer The Body Guards Pack Easivent Easivent/Mask-large Easivent/Mask-medium Easivent/Mask-small Inspirease Bags Inspirease Drug Delivery System Inspirease Mouthpiece Inspirease Reservoir Bags Liteaire Microchamber Microspacer Optichamber Advantage Optichamber Diamond Optichamber Diamond/Largeface Mask Optichamber Diamond/Medium Face Mask Optichamber Diamond/Smallface Mask Optihaler Optihaler MDI Drug Delivery System Pocket Chamber Pocket Spacer Riteflo Valved Holding Chamber Vortex Valved Holding Chamber Watchhaler MISCELLANEOUS COVERED PA Exjade PA Ferriprox Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of Catamaran. The presence of a medication on this formulary list does not guarantee coverage. Effective August 1, 2014 PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 12 Index alendronate sodium, 5 alfuzosin HCL ER, 7 abacavir, 1 ali-flex, 9 abacavir sulfate/lamivudine/zidovudine, 1 Alinia, 2 Abilify, 8 allopurinol, 10 Abilify Discmelt, 8 Alocril, 9 Abilify Maintena, 8 alphatrex, 4 acamprosate calcium DR, 8 alprazolam, 7 acarbose, 5 alprazolam ER, 7 acebutolol HCL, 2 alprazolam odt, 7 Acetaminophen/Caffeine/Dihydrocodeine alprazolam XR, 7 Bitartrate, 10 Alsuma, 10 acetaminophen/codeine, 10 altacaine, 9 acetaminophen/codeine #2, 10 altafrin, 9 acetaminophen/codeine #3, 10 altavera, 4 acetaminophen/codeine #4, 10 alyacen 1/35, 4 acetaminophen/codeine phosphate, 10 alyacen 7/7/7, 4 acetasol HC, 9 amantadine HCL, 8 acetazolamide, 3 Amcinonide, 4 Acetazolamide, 3 amethia, 4 acetazolamide ER, 3 amethia LO, 4 acetic acid, 9 amiloride HCL, 3 acetylcysteine, 11 amiloride/hydrochlorothiazide, 3 acitretin, 4 aminocaproic acid, 7 acticin, 4 amiodarone HCL, 3 Actimmune, 2 Amitiza, 6 acyclovir, 1, 4 amitriptyline HCL, 7 Adacel, 11 amlodipine besylate, 2 adapalene, 3 amlodipine besylate/atorvastatin calcium, Adcirca, 3 3 adefovir dipivoxil, 1 amlodipine besylate/benazepril HCL, 3 Adempas, 3 amlodipine besylate/benazepril Adrenaclick, 3 hydrochloride, 3 adult aspirin EC low strength, 9 ammonium lactate, 4 Aerochamber Mini Aerosol Chamber, 11 Amoxapine, 8 Aerochamber MV, 11 amoxicillin, 1 Aerochamber Plus Flow VU, 11 amoxicillin/clavulanate potassium, 1 Aerochamber Plus Flow-VU, 11 amoxicillin/clavulanate potassium ER, 1 Aerochamber Plus Flow-VU/Large Mask, amphetamine/dextroamphetamine, 8 11 ampicillin, 1 Aerochamber Plus Flow-VU/Mask, 11 Ampyra, 8 Aerochamber Plus Flow-VU/Medium Anacaine, 4 Mask, 11 anagrelide hydrochloride, 7 Aerochamber Plus Flow-VU/Small Mask, anastrozole, 2 11 Androxy, 4 Aerochamber Z-stat Plus Valved Holding Anoro Ellipta, 11 Chamber W/Flow VU, 11 antipyrine/benzocaine, 9 Aerochamber Z-stat Plus/Flowsignal, 11 Apidra, 5 Aerochamber Z-stat Plus/Large Mask, 11 Apidra Solostar, 5 Aerochamber Z-stat Plus/Medium Mask, Aplenzin, 8 11 apraclonidine, 9 Aerochamber Z-stat Plus/Small Mask, 11 apri, 4 Aerochamber/Flowsignal, 11 Apriso, 6 Aerospan, 11 Aptiom, 8 afeditab CR, 2 Aptivus, 1 Afinitor, 2 aqueous vitamin d infants, 11 Afinitor Disperz, 2 aranelle, 4 Aggrenox, 7 Aranesp Albumin Free, 7 ak-poly-bac, 9 Arestin, 7 Akten, 9 argyle sterile saline 100ML, 7 ala cort, 4 Armour Thyroid, 6 Albenza, 2 Asacol, 6 albuterol sulfate, 11 Asacol HD, 6 albuterol sulfate ER, 11 aspir-81, 9 albuterol TAB 4MG, 11 aspir-low, 9 alclometasone dipropionate, 4 A aspirin, 9 aspirin 81, 9 aspirin adult low strength, 9 aspirin childrens, 9 aspirin EC, 9 aspirin EC LO-dose, 9 aspirin EC low dose, 9 aspirin enteric coated adult low strength, 9 aspirin low dose, 9 aspirin low strength, 9 Aspirin-caffeine-dihydrocodeine, 10 aspirin/enteric, 9 aspirtab, 9 aspirtab maximum strength, 9 Astagraf XL, 2 atenolol, 2 atenolol/chlorthalidone, 3 atorvastatin calcium, 3 atovaquone, 2 atovaquone/proguanil HCL, 1 Atripla, 1 atropine sulfate, 9 atropine-care, 9 Atrovent HFA, 11 Aubagio, 8 aubra, 4 augmented betamethasone dipropionate, 4 Augmentin, 1 aurodex, 9 Auvi-q, 3 Avandia, 5 Avc, 7 aviane, 4 avidoxy, 1 avita, 3 Avonex, 8 Avonex Pen, 8 Azasan, 2 azathioprine, 2 azelastine HCL, 9, 11 Azelex, 3 Azilect, 8 azithromycin, 1 Azor, 3 azurette, 4 B Bacitracin, 9 bacitracin/polymyxin b, 9 baclofen, 9 Bactroban Nasal, 11 balsalazide disodium, 6 balziva, 4 Banzel, 8 Baraclude, 1 baycadron, 4 bayer advanced aspirin extra strength, 9 bayer advanced aspirin regular strength, 9 bayer aspirin, 9 bayer aspirin EC low dose, 9 bayer aspirin regimen, 9 bayer chewable low dose, 9 bayer low dose, 9 benazepril HCL, 3 benazepril HCL/hydrochlorothiazide, 3 benztropine mesylate, 8 betamethasone dipropionate, 4 betamethasone valerate, 4 Betaseron, 8 betaxolol HCL, 2, 9 bethanechol chloride, 7 bicalutamide, 2 Bidil, 3 Biltricide, 2 bio-d-mulsion, 11 bio-d-mulsion forte, 11 Bioregesic, 10 bisoprolol fumarate, 2 bisoprolol fumarate/hydrochlorothiazide, 3 Boostrix, 11 Bosulif, 2 bprotected pedia d-vite, 11 Breatherite, 11 Breatherite Collapsible Adult Spacer W/Mask, 11 Breatherite Collapsible Child Spacer W/Mask, 11 Breatherite Collapsible Infant Spacer W/Mask, 11 Breatherite Collapsible Small Child Spacer W/Mask, 12 Breatherite Collapsible Spacer W/ Neonate Mask, 12 Breatherite Rigid Spacer W/Mask, 12 Breatherite W/Large Mask, 12 Breatherite W/Medium Mask, 12 Breatherite W/Small Mask, 12 briellyn, 4 brimonidine tartrate, 9 Bromfenac, 9 bromocriptine mesylate, 8 Broncomar-1, 11 Brovana, 11 budeprion SR, 7 budesonide, 4, 11 bumetanide, 3 Buphenyl, 6 buprenorphine HCL, 10 buprenorphine HCL/naloxone HCL, 10 buproban, 8 bupropion HCL, 7 bupropion HCL ER, 7 bupropion HCL SR, 7, 8 bupropion HCL XL, 7 buspirone HCL, 7 butal/asa/caff, 9 butalbital compound, 9 butalbital/acetaminophen/caffeine, 9 butalbital/apap/caffeine, 9 butalbital/asa/caffeine, 9 Butalbital/Aspirin/Caffeine, 10 butorphanol tartrate, 10 Bystolic, 2 C cabergoline, 6 Cafergot, 10 caffeine citrate, 8 calcidol, 11 calciferol, 11 calcipotriene, 4 calcitonin salmon, 5 calcitonin-salmon, 5 calcitrene, 4 Calcitriol, 4 calcitriol, 6 calcium acetate, 6 camila, 4 camrese, 4 camrese LO, 4 candesartan cilexetil, 3 candesartan cilexetil/hydrochlorothiazide, 3 Cantil, 6 capacet, 9 Capital/Codeine, 10 Caprelsa, 2 captopril, 3 Captopril/Hydrochlorothiazide, 3 Carafate, 6 Carbaglu, 6 carbamazepine, 8 carbamazepine ER, 8 carbidopa, 8 carbidopa/levodopa, 8 carbidopa/levodopa ER, 8 carbidopa/levodopa odt, 8 Carbidopa/Levodopa/Entacapone, 8 Cardene SR, 3 carteolol HCL, 9 cartia XT, 2 carvedilol, 2 cavarest, 7 cavirinse, 7 Cayston, 2 caziant, 4 Cedax, 1 cefaclor, 1 Cefaclor ER, 1 cefadroxil, 1 cefdinir, 1 Cefditoren Pivoxil, 1 cefpodoxime proxetil, 1 cefprozil, 1 Ceftibuten, 1 Ceftin, 1 cefuroxime axetil, 1 Celestone, 4 Cellcept, 2 Celontin, 8 cephalexin, 1 Cesamet, 6 cesia, 4 cetirizine HCL, 11 Cetraxal, 9 cevimeline HCL, 7 Chantix, 8 Chantix Continuing Month PAK, 8 Chantix Starting Month PAK, 8 chateal, 4 Chenodal, 6 childrens aspirin, 9 childrens aspirin low strength, 9 chlordiazepoxide HCL, 7 chlorhexidine gluconate, 7 chlorhexidine gluconate oral rinse, 7 chloroquine phosphate, 1 chlorothiazide, 3 chlorpromazine HCL, 8 Chlorpromazine HCL, 8 Chlorthalidone, 3 chlorzoxazone, 9 cholestyramine, 3 cholestyramine light, 3 choline magnesium trisalicylate, 9 chorionic gonadotropin, 5 ciclodan, 3 ciclopirox, 3 ciclopirox nail lacquer, 3 ciclopirox olamine, 3 cilostazol, 7 cimetidine, 6 cimetidine HCL, 6 Cimzia, 6 Cimzia Starter Kit, 6 ciprofloxacin, 1 Ciprofloxacin, 9 ciprofloxacin ER, 1 ciprofloxacin HCL, 1, 9 citalopram hydrobromide, 7 citric acid/sodium citrate, 7 clarithromycin, 1 clarithromycin ER, 1 Cleocin, 7 clindacin etz pledgets, 3 clindacin-p, 3 Clindagel, 3 clindamax, 3 clindamycin HCL, 2 clindamycin palmitate HCL, 2 clindamycin phosphate, 3, 7 clobetasol propionate, 4 clobetasol propionate e, 4 clobetasol propionate emollient, 4 clomipramine HCL, 7 clonazepam, 8 clonazepam odt, 8 clonidine HCL, 3 clonidine HCL ER, 8 clopidogrel, 7 clorazepate dipotassium, 7 Clorpres, 3 clotrimazole, 3, 7 clotrimazole/betamethasone dipropionate, 3 clozapine, 8 Clozapine Odt, 8 CO-gesic, 10 Coartem, 2 Cocaine HCL, 4 Codeine Sulfate, 10 Colcrys, 10 colestipol HCL, 3 colestipol HCL for oral suspension, 3 colocort, 6 Combivent, 11 Combivent Respimat, 11 Cometriq, 2 compazine, 8 Complera, 1 compro, 8 constulose, 6 controlrx, 7 Copaxone, 8 Cordran Tape, 4 cormax scalp application, 4 cortalo, 4 Cortifoam, 7 Cortisone Acetate, 4 Coumadin, 7 Creon, 6 Cresylate, 9 Crinone, 7 Crixivan, 1 cromolyn sodium, 6, 9, 11 cryselle-28, 4 curity sterile saline, 7 Cuvposa, 6 CVS aspirin, 10 CVS aspirin adult low dose, 10 CVS aspirin adult low strength, 10 CVS aspirin child, 10 CVS aspirin EC, 10 CVS aspirin low dose, 10 CVS aspirin low strength, 10 CVS childrens aspirin, 10 CVS childrens vitamin d for bone health, 11 CVS enteric aspirin, 10 CVS lansoprazole, 6 CVS vitamin d, 11 CVS vitamin d 5000 high-potency, 11 CVS vitamin d infants, 11 CVS vitamin d3, 11 cyanocobalamin, 7 cyclafem 1/35, 4 cyclafem 7/7/7, 4 cyclobenzaprine HCL, 9 cyclopentolate HCL, 9 Cyclophosphamide, 2 Cycloserine, 1 cyclosporine, 2 cyclosporine modified, 2 Cyclosporine Modified, 2 cyproheptadine HCL, 11 Cystadane, 6 Cystagon, 7 cytra k crystals, 7 cytra-2, 7 Cytra-3, 7 Cytra-k, 7 D d 1000, 11 d 10000, 11 d 2000, 11 d 400, 11 d 5000, 11 d-1000, 11 d-1000 extra strength, 11 d-2000 maximum strength, 11 d-3-5, 11 d-400, 11 d-5000, 11 d-5000 maximum strength, 11 d-vita, 11 d2000 ultra strength, 11 d3, 11 d3 adult, 11 d3 high potency, 11 d3 kids, 11 d3 maximum strength, 11 d3 super strength, 11 d3 ultra strength, 11 d3-1000, 11 d3-50, 11 Daliresp, 11 danazol, 4 dantrolene sodium, 9 Dapsone, 2 Daraprim, 2 dasetta 1/35, 4 dasetta 7/7/7, 4 daysee, 4 Daytrana, 8 decara, 11 delta d3, 11 delyla, 4 Delzicol, 7 demeclocycline HCL, 1 Demser, 3 Denavir, 4 denta 5000 plus, 7 dentagel, 7 Depo-estradiol, 4 Depo-subq Provera 104, 5 desipramine HCL, 7 desmopressin acetate, 6 desogestrel/ethinyl estradiol, 4 desonide, 4 desoximetasone, 4 Desvenlafaxine ER, 8 dexamethasone, 4 Dexamethasone, 4 Dexamethasone Intensol, 4 dexamethasone sodium phosphate, 9 dexmethylphenidate HCL, 8 dexmethylphenidate HCL ER, 8 Dexpak 10 Day, 4 Dexpak 13 Day, 4 Dexpak 6 Day, 4 dextroamphetamine sulfate, 8 dextroamphetamine sulfate ER, 8 dialyvite vitamin d 5000, 11 diazepam, 7 Dibenzyline, 3 diclofenac potassium, 10 diclofenac sodium, 9 diclofenac sodium DR, 10 diclofenac sodium ER, 10 diclofenac sodium/misoprostol, 10 dicloxacillin sodium, 1 dicyclomine HCL, 6 didanosine, 1 Dificid, 1 diflunisal, 10 digox, 2 digoxin, 2 Dihydroergotamine Mesylate, 10 Dilantin, 8 Dilantin Infatabs, 8 Dilatrate SR, 2 dilt-CD, 2 dilt-XR, 2 diltiazem CD, 2 diltiazem HCL, 2 diltiazem HCL ER, 2 diltzac, 2 Diovan, 3 Dipentum, 7 diphenoxylate/atropine, 6 Diphenoxylate/Atropine, 6 dipyridamole, 7 disopyramide phosphate, 3 disulfiram, 8 Diuril, 3 divalproex sodium, 8 divalproex sodium DR, 8 divalproex sodium ER, 8 Dolgic Plus, 10 dolorex, 10 donepezil HCL, 8 dorzolamide HCL, 9 dorzolamide HCL/timolol maleate, 9 doxazosin mesylate, 3 doxepin HCL, 7 doxercalciferol, 6 doxycycline, 1 doxycycline hyclate, 1 doxycycline hyclate DR, 1 doxycycline monohydrate, 1 Dritho-creme HP, 4 dronabinol, 6 drospirenone/ethinyl estradiol, 4 Droxia, 7 Dulera, 11 duloxetine HCL, 7 duraxin, 10 Dutoprol, 3 Dyrenium, 3 E E-z Spacer, 12 E-z Spacer The Body Guards Pack, 12 E.e.s. 400, 1 E.e.s. Granules, 1 e.s.p., 2 Easivent, 12 Easivent/Mask-large, 12 Easivent/Mask-medium, 12 Easivent/Mask-small, 12 EC-81 aspirin, 10 econazole nitrate, 3 ecotrin low strength, 10 ecpirin, 10 ed-flex, 10 ed-spaz, 6 Edarbi, 3 Edarbyclor, 3 Edecrin, 3 Edurant, 1 Elidel, 4 elinest, 4 Elixophyllin, 11 Ella, 5 Elmiron, 7 Emcyt, 2 emoquette, 4 Emsam, 8 Emtriva, 1 enalapril maleate, 3 enalapril maleate/hydrochlorothiazide, 3 Enbrel, 10 Enbrel Sureclick, 10 endocet, 10 endodan, 10 enoxaparin sodium, 7 enpresse-28, 4 enskyce, 4 entacapone, 8 enteric coated aspirin, 10 enulose, 6 Epaned, 3 epinastine HCL, 9 Epinephrine, 3 Epipen 2-PAK, 3 Epipen-JR 2-PAK, 3 epitol, 8 Epivir, 1 Epivir HBV, 1 eplerenone, 3 Epogen, 7 eprosartan mesylate, 3 Epzicom, 1 eq adult aspirin low strength, 10 eq aspirin, 10 eq aspirin adult low dose, 10 eq aspirin EC, 10 eq aspirin low dose, 10 eq childrens aspirin, 10 eq lansoprazole, 6 eql adult aspirin low strength, 10 eql aspirin, 10 eql aspirin EC, 10 eql aspirin low dose, 10 eql childrens aspirin, 10 eql childrens vitamin d gummies, 11 eql vitamin d-3, 11 eql vitamin d3, 11 Equetro, 8 ergocalciferol, 11 Ergomar, 10 errin, 4 Ery-TAB, 1 Eryped 200, 1 Eryped 400, 1 Erythrocin Stearate, 1 erythromycin, 1, 3, 9 Erythromycin Base, 1 Erythromycin Ethylsuccinate, 1 erythromycin/sulfisoxazole, 2 escitalopram oxalate, 7 esgic, 10 estarylla, 4 estazolam, 8 Estrace, 7 estradiol, 4 estradiol valerate, 4 Estrasorb, 4 Estring, 7 Estrogel, 4 estropipate, 4 ethambutol HCL, 1 ethosuximide, 8 Etidronate Disodium, 5 etodolac, 10 etodolac ER, 10 Eurax, 4 exemestane, 2 Exjade, 12 Extavia, 8 F Factive, 1 Falessa, 5 falmina, 4 famciclovir, 1 famotidine, 6 Fanapt, 8 Fanapt Titration Pack, 8 Fareston, 2 Fazaclo, 8 felbamate, 8 Femring, 7 fenofibrate, 3 Fenofibrate, 3 fenofibrate micronized, 3 Fenoprofen Calcium, 10 fentanyl, 10 fentanyl citrate oral transmucosal, 10 Ferriprox, 12 Finacea, 3 finasteride, 7 Firazyr, 7 First-vancomycin 25, 2 First-vancomycin 50, 2 Flagyl ER, 2 flavoxate HCL, 7 flecainide acetate, 3 FLO-pred, 4 flucaine, 9 fluconazole, 1 flucytosine, 1 fludrocortisone acetate, 4 flunisolide, 11 Flunisolide, 11 fluocinolone acetonide, 4, 9 fluocinolone acetonide body, 4 fluocinolone acetonide ear drops, 9 fluocinolone acetonide scalp, 4 fluocinonide, 4 fluorescein/proparacaine, 9 fluoridex daily defense, 7 fluoridex daily defense enhanced whitening, 7 fluorometholone, 9 fluoxetine DR, 7 fluoxetine HCL, 7 fluphenazine decanoate, 8 fluphenazine HCL, 8 Fluphenazine HCL, 8 flurazepam HCL, 8 flurbiprofen, 10 flurbiprofen sodium, 9 flutamide, 2 fluticasone propionate, 4, 11 fluvastatin, 3 fluvoxamine maleate, 7 fluvoxamine maleate ER, 7 Focalin XR, 8 folic acid, 7 fondaparinux sodium, 7 Forfivo XL, 8 Forteo, 5 Fortical, 5 fosinopril sodium, 3 fosinopril sodium/hydrochlorothiazide, 3 Fosrenol, 7 Fragmin, 7 Freestyle Insulinx Blood Glucose Test, 11 Freestyle Insulinx Blood Glucose Test Strips, 11 Freestyle Lite Test Strips, 11 Freestyle Test Strips, 11 furosemide, 3 Fycompa, 8 G gabapentin, 8 Gabitril, 8 galantamine, 8 galantamine hydrobromide, 8 garamycin, 9 gavilyte-c, 6 gavilyte-G, 6 gavilyte-n/flavor pack, 6 Gelnique, 7 gemfibrozil, 3 gene-xene TAB 15MG, 7 gene-xene TAB 3.75MG, 7 gene-xene TAB 7.5MG, 7 generlac, 6 gengraf, 2 Genotropin, 5 Genotropin Miniquick, 5 gentak, 9 Gentamicin Sulfate, 3 gentamicin sulfate, 9 Geodon, 8 gianvi, 4 gildagia, 4 gildess 1.5/30, 4 gildess 1/20, 4 gildess FE 1.5/30, 4 gildess FE 1/20, 4 Gilotrif, 2 Gleevec, 2 glimepiride, 5 glipizide, 5 glipizide ER, 5 glipizide XL, 5 glipizide/metformin HCL, 5 Glucagon Emergency Kit, 5 Glumetza, 5 glyburide, 5 Glyburide, 5 glycopyrrolate, 6 Glyset, 5 gnp adult aspirin low strength, 10 gnp aspirin, 10 gnp aspirin low dose, 10 gnp lansoprazole, 6 gnp vitamin d, 11 gnp vitamin d maximum strength, 11 gnp vitamin d super strength, 11 gnp vitamin d3 extra strength, 11 Golytely, 6 goodsense aspirin low dose, 10 Gralise, 9 Gralise Starter, 9 granisetron HCL, 6 Granisol, 6 Granix, 7 griseofulvin microsize, 1 griseofulvin ultramicrosize, 1 guanfacine HCL, 3 Guanidine HCL, 9 H Halflytely Bowel Prep/Flavor Packs, 6 halfprin, 10 halobetasol propionate, 4 haloperidol, 8 haloperidol decanoate, 8 haloperidol lactate, 8 healthy kids vitamin d3, 11 heartburn relief 24 HOUR, 6 heartburn treatment 24 HOUR, 6 heather, 4 hecoria, 2 Helidac, 6 Hemangeol, 2 Hexalen, 2 HM aspirin, 10 HM aspirin EC, 10 HM aspirin EC low dose, 10 HM lansoprazole, 6 HM vitamin d, 11 HM vitamin d3, 11 homatropaire, 9 homatropine HBR, 9 Humalog, 5 Humalog Kwikpen, 5 Humalog Mix 50/50, 5 Humalog Mix 50/50 Kwikpen, 5 Humalog Mix 75/25, 5 Humalog Mix 75/25 Kwikpen, 5 Humatrope, 5 Humatrope Combo Pack, 5 Humira, 10 Humira Pen, 10 Humira Pen-crohns Diseasestarter, 10 Humira Pen-psoriasis Starter, 10 Humulin 70/30, 5 Humulin 70/30 Pen, 5 Humulin N, 5 Humulin N U-100 Pen, 5 Humulin R, 5 Humulin R U-500 (concentrated), 5 hydralazine HCL, 3 hydrochlorothiazide, 3 hydrocodone bitartrate/acetaminophen, 10 hydrocodone/acetaminophen, 10 hydrocodone/ibuprofen, 10 hydrocort ene 100MG, 6 hydrocortisone, 4(2), 6 hydrocortisone acetate/aloe, 4 hydrocortisone butyrate, 4 hydrocortisone IN absorbase, 4 hydrocortisone valerate, 4 hydrocortisone/acetic acid, 9 hydrogesic, 10 hydromorphone HCL, 10 hydroxychloroquine sulfate, 1 hydroxyurea, 2 hydroxyzine HCL, 7 hydroxyzine pamoate, 7 Hylira, 4 hyomax-SL, 6 hyoscyamine sulfate, 6 hyoscyamine sulfate ER, 6 hyoscyamine sulfate odt, 6 hyoscyamine sulfate SR, 6 hyosyne, 6 hypercare, 4 I ibandronate sodium, 5 ibudone, 10 ibuprofen, 10 Iclusig, 2 ilotycin, 9 Imbruvica, 2 imipramine HCL, 7 imipramine pamoate, 7 imiquimod, 4 Incivek, 1 Increlex, 6 indapamide, 3 Inderal XL, 2 indomethacin, 10 indomethacin ER, 10 Infergen, 1 Inlyta, 2 Innopran XL, 2 Inspirease Bags, 12 Inspirease Drug Delivery System, 12 Inspirease Mouthpiece, 12 Inspirease Reservoir Bags, 12 Intelence, 1 Intron-a W/Diluent, 2 introvale, 4 Invega, 8 Invega Sustenna, 8 Invirase, 1 ipratropium bromide, 11(2) ipratropium bromide/albuterol sulfate, 11 irbesartan, 3 irbesartan/hydrochlorothiazide, 3 Isentress, 1 isoditrate ER, 2 isoniazid, 1 Isoniazid, 1 Isordil Titradose, 2 isosorbide dinitrate, 2 Isosorbide Dinitrate, 2 isosorbide dinitrate ER, 2 isosorbide mononitrate, 2 isosorbide mononitrate ER, 2 Isradipine, 3 itraconazole, 1 J Jakafi, 2 jantoven, 7 jencycla, 4 Jentadueto, 5 Jinteli, 4 jolessa, 4 jolivette, 4 junel 1.5/30, 5 junel 1/20, 5 junel FE 1.5/30, 5 junel FE 1/20, 5 just d, 11 K K-phos NO 2, 7 Kaletra, 1 Kalydeco, 11 Kanamycin Sulfate, 1 Kapvay Dose Pack, 8 karigel, 7 karigel-n, 7 kariva, 5 kelnor 1/35, 5 Kepivance, 2 Ketek, 2 ketoconazole, 1, 3 ketodan, 3 ketoprofen, 10 Ketoprofen ER, 10 ketorolac tromethamine, 9 Khedezla, 8 kls aspirin EC, 10 kls aspirin low dose, 10 kls lansoprazole, 6 Korlym, 5 kp aspirin, 10 kp vitamin d, 11 Kristalose, 6 kurvelo, 5 Kuvan, 6 L labetalol HCL, 2 laclotion, 4 lactulose, 6(2) Lamictal Starter/Taking Valproate, 8 Lamisil, 1 lamivudine, 1 lamivudine/zidovudine, 1 lamotrigine, 8 lamotrigine ER, 8 Lanoxin, 2 lansoprazole, 6 Lantus, 5 Lantus Solostar, 5 larin 1.5/30, 5 larin 1/20, 5 larin FE 1.5/30, 5 larin FE 1/20, 5 latanoprost, 9 Latuda, 8 leena, 5 leflunomide, 10 lessina, 5 Letairis, 3 letrozole, 2 leucovorin calcium, 2 Leukeran, 2 Leukine, 7 leuprolide acetate, 2 levalbuterol, 11 levalbuterol HCL, 11 Levatol, 2 Levemir, 5 levetiracetam, 8 levetiracetam ER, 8 levobunolol HCL, 9 levocarnitine, 6 levofloxacin, 1, 9 levonest, 5 levonorgestrel, 5 levonorgestrel and ethinyl estradiol, 5 levonorgestrel/ethinyl estradiol, 5 levora 0.15/30-28, 5 Levorphanol Tartrate, 10 levothroid, 6 levothyroxine sodium, 6 levoxyl, 6 Lexiva, 1 lidocaine, 4 lidocaine HCL, 4, 7 lidocaine HCL jelly, 4 lidocaine viscous, 7 lidocaine/prilocaine, 4 lindane, 4 liothyronine sodium, 6 Lipofen, 3 lisinopril, 3 lisinopril/hydrochlorothiazide, 3 Liteaire, 12 lithium carbonate, 8 lithium carbonate ER, 8 Lithium Citrate, 8 Lithobid, 8 Lithostat, 7 LO Minastrin FE, 5 lofene, 6 lokara, 4 lonox, 6 loperamide HCL, 6 lorazepam, 7 lorcet, 10 lorcet HD, 10 lorcet plus, 10 lortab, 10 Lortab, 10 loryna, 5 losartan potassium, 3 losartan potassium/hydrochlorothiazide, 3 Lotronex, 7 lovastatin, 3 low-ogestrel, 5 loxapine, 8 loxapine succinate, 8 Lufyllin, 11 Lumizyme, 6 lutera, 5 Lyrica, 8 Lysodren, 2 lyza, 5 M M-vit, 11 malathion, 4 Maprotiline HCL, 8 margesic, 10 marlissa, 5 Marplan, 8 Matulane, 2 matzim LA, 2 Maxair Autohaler, 11 maximum d3, 11 meclizine HCL, 6 Meclofenamate Sodium, 10 Medrol, 4 medroxyprogesterone acetate, 5(2) mefenamic acid, 10 mefloquine HCL, 2 Megace ES, 5 megestrol acetate, 2 meijer aspirin EC, 10 Mekinist, 2 meloxicam, 10 Mentax, 4 mercaptopurine, 2 mesalamine, 6 Mesnex, 2 Mestinon, 9 Mestinon Timespan, 9 metadate ER, 8 Metaproterenol Sulfate, 11 metaxalone, 9 metformin HCL, 5 metformin HCL ER, 5 methadone HCL, 10 methadone HCL intensol, 10 methadose, 10 methamphetamine HCL, 8 methazolamide, 3 methenamine mandelate, 7 methimazole, 6 methocarbamol, 9 methotrexate, 2 methoxsalen, 4 methscopolamine bromide, 6 Methyclothiazide, 3 methyldopa, 3 methylergonovine maleate, 9 Methylin, 8 methylphenidate HCL, 8 methylphenidate HCL CD, 8 methylphenidate HCL ER, 8 methylphenidate HCL SR, 8 methylphenidate hydrochloride, 8 methylprednisolone, 4 methylprednisolone dose pack, 4 metoclopramide HCL, 6 metolazone, 3 metoprolol succinate ER, 2 metoprolol tartrate, 2 metoprolol/hydrochlorothiazide, 3 Metozolv Odt, 7 metronidazole, 2, 3 metronidazole vaginal, 7 mexiletine HCL, 3 Miconazole 3, 7 Microchamber, 12 microgestin 1.5/30, 5 microgestin 1/20, 5 microgestin FE, 5 microgestin FE 1.5/30, 5 micronized colestipol HCL, 3 Microspacer, 12 midazolam HCL, 8 midodrine HCL, 3 Mifeprex, 6 Migergot, 10 Migranal, 10 Millipred, 4 Millipred DP, 4 miniprin low dose, 10 minitran, 2 minocycline HCL, 1 minocycline HCL ER, 1 minoxidil, 3 Mirapex ER, 8 mirtazapine, 7 mirtazapine odt, 7 misoprostol, 6 MM aspirin, 10 moderiba, 1 Moderiba, 1 moexipril HCL, 3 moexipril/hydrochlorothiazide, 3 mometasone furoate, 4 mono-linyah, 5 mononessa, 5 montelukast sodium, 11 Monurol, 7 morgidox 1X100MG, 1 morgidox 2X100MG, 1 morphine sulfate, 10 Morphine Sulfate, 10 morphine sulfate ER, 10 Motofen, 6 Moviprep, 6 Moxatag, 1 Mst 600, 10 Multaq, 3 multi-vit/fluoride, 11 multi-vitamin/fluoride, 11 mupirocin, 3 mupirocin calcium, 3 my way, 5 mycophenolate mofetil, 2 mycophenolic acid DR, 2 mydral, 9 Myobloc, 9 Myozyme, 6 myzilra, 5 N nabumetone, 10 nadolol, 2 nadolol/bendroflumethiazide, 3 Naftin, 4 Namenda, 9 Namenda Titration PAK, 9 Naphazoline HCL, 9 naproxen, 10 naproxen DR, 10 naproxen sodium, 10 naratriptan HCL, 10 nateglinide, 5 Natroba, 4 Nebupent, 2 nebusal, 11 necon 0.5/35-28, 5 necon 1/35, 5 Necon 1/50-28, 5 Necon 10/11-28, 5 necon 7/7/7, 5 nefazodone HCL, 8 Neo-fradin, 1 neo-polycin, 9 neo-polycin HC, 9 neofrin, 9 neomycin sulfate, 1 neomycin/bacitracin/polymyxin, 9 neomycin/polymyxin/bacitracin zinc, 9 neomycin/polymyxin/bacitracin/hydrocorti sone, 9 neomycin/polymyxin/dexamethasone, 9 neomycin/polymyxin/gramicidin, 9 neomycin/polymyxin/HC, 9 Neomycin/Polymyxin/Hydrocortisone, 9 neomycin/polymyxin/hydrocortisone, 9 Neoral, 2 Neulasta, 7 Neumega, 7 Neupogen, 7 Neupro, 8 neutragard advanced, 7 neutral sodium fluoride, 7 nevirapine, 1 Nevirapine, 1 nevirapine ER, 1 Nexavar, 2 next choice, 5 next choice one dose, 5 Nexterone, 3 Niacor, 3 nicardipine HCL, 3 Nicotrol Inhaler, 9 Nicotrol Ns, 9 nifediac CC, 3 nifedical XL, 3 nifedipine, 3 nifedipine ER, 3 Nilandron, 2 nimodipine, 3 Nitro-bid, 2 Nitro-dur, 2 nitrofurantoin, 7 nitrofurantoin macrocrystals, 7 nitrofurantoin monohydrate, 7 nitrofurantoin monohydrate/macrocrystals, 7 nitroglycerin, 2 nitroglycerin lingual, 2 nitroglycerin transdermal, 2 Nitrostat, 2 nizatidine, 6 nora-be, 5 Norditropin Cartridge, 5 Norditropin Flexpro, 6 Norditropin Nordiflex Pen, 6 norethindrone, 5 norethindrone acetate, 5 norethindrone acetate/ethinyl estradiol, 5 norethindrone acetate/ethinyl estradiol/ferrous fumarate, 5 norgestimate/ethinyl estradiol, 5 Norinyl 1+50, 5 norlyroc, 5 Noroxin, 1 nortrel 0.5/35 (28), 5 nortrel 1/35, 5 nortrel 7/7/7, 5 nortriptyline HCL, 8 Norvir, 1 norwich aspirin, 10 novarel, 5 Noxafil, 1 Nuedexta, 9 nulev, 6 Nutropin, 6 Nutropin AQ Nuspin 10, 6 Nutropin AQ Nuspin 20, 6 Nutropin AQ Nuspin 5, 6 Nutropin AQ Pen, 6 Nuvaring, 5 Nuvigil, 8 nyamyc, 3 Nymalize, 3 nystatin, 1, 3, 7 nystatin/triamcinolone, 3 nystop, 4 O O-CAL Fa, 11 ocella, 5 octreotide acetate, 6 ofloxacin, 1, 9(2) Ogestrel, 5 olanzapine, 8 olanzapine odt, 8 olanzapine/fluoxetine, 8 Olysio, 1 omeprazole, 6 omeprazole/sodium bicarbonate, 6 Omnitrope, 6 ondansetron HCL, 6 ondansetron odt, 6 Onfi, 8 Onmel, 1 Opium Tincture (paregoric), 6 Opsumit, 3 Optichamber Advantage, 12 Optichamber Diamond, 12 Optichamber Diamond/Largeface Mask, 12 Optichamber Diamond/Medium Face Mask, 12 Optichamber Diamond/Smallface Mask, 12 Optihaler, 12 Optihaler MDI Drug Delivery System, 12 optimal-d, 11 optimal-d pack, 11 opurity vitamin d, 11 Oracit, 7 oralone, 7 Orap, 9 Orapred Odt, 4 Oravig, 7 Orbivan, 10 Orfadin, 6 orphenadrine citrate ER, 9 orsythia, 5 ortho-est, 4 oscimin, 6 oscimin SR, 6 Osmoprep, 6 otic care, 9 oxandrolone, 4 oxaprozin, 10 oxazepam, 7 oxcarbazepine, 8 Oxistat, 4 Oxsoralen, 4 Oxtellar XR, 8 oxybutynin chloride, 7 oxybutynin chloride ER, 7 oxycodone HCL, 10 oxycodone/acetaminophen, 10 oxycodone/aspirin, 10 oxycodone/ibuprofen, 10 oxymorphone hydrochloride, 10 oxymorphone hydrochloride ER, 10 P PA vitamin d-3, 11 PA vitamin d-3 gummy, 11 pacerone, 3 Pancrelipase, 6 pantoprazole sodium, 6 parcaine, 9 paricalcitol, 6 paroex, 7 paromomycin sulfate, 1 paroxetine HCL, 8 paroxetine HCL ER, 8 Paser, 1 Paxil, 8 PCE, 1 pedi-dri, 4 peg 3350/electrolytes, 6 peg-3350/electrolytes, 6 peg-3350/NACL/NA bicarbonate/KCL, 6 Peg-intron, 1 Peg-intron Redipen, 1 Peg-intron Redipen PAK 4, 1 Peganone, 8 Pegasys, 1 Pegasys Proclick, 1 pegylax, 6 penicillin v potassium, 1 pentoxifylline ER, 7 perindopril erbumine, 3 perio MED, 7 periogard, 7 permethrin, 4 perphenazine, 8 Pexeva, 8 phenadoz, 11 phenazo, 7 phenazopyridine HCL, 7 phenelzine sulfate, 8 phenobarbital, 8 phenylephrine HCL, 9 Phenytek, 8 phenytoin, 8 phenytoin infatabs, 8 phenytoin sodium extended, 8 philith, 5 phos-flur, 7 Phoslyra, 7 Phospholine Iodide, 9 pilocarpine HCL, 7, 9 pilocarpine hydrochloride, 7 Pilopine HS, 9 pimtrea, 5 pindolol, 2 pioglitazone HCL, 5 pioglitazone HCL-glimepiride, 5 pioglitazone HCL/metformin HCL, 5 pirmella 1/35, 5 pirmella 7/7/7, 5 piroxicam, 10 Pliaglis, 4 PNV Folic Acid + Iron Multivitamin, 11 PNV Prenatal Plus Multivitamin, 11 Pocket Chamber, 12 Pocket Spacer, 12 Podocon 25 IN Benzoin Tincture, 4 podofilox, 4 poly-dex, 9 polycin, 9 polycin b, 9 polyethylene glycol 3350, 6 polymyxin b sulfate/trimethoprim sulfate, 9 Pomalyst, 2 portia-28, 5 Potassium Citrate, 7 Potassium Citrate ER, 7 potassium citrate-citric acid crystals, 7 Potiga, 8 Pradaxa, 7 pramipexole dihydrochloride, 8 Prandimet, 5 pravastatin sodium, 3 prazosin HCL, 3 Precision XTRA Blood Glucose Test Strips, 11 prednicarbate, 4 prednisolone, 4 prednisolone acetate, 9 prednisolone sodium phosphate, 4 Prednisolone Sodium Phosphate, 9 prednisone, 4 pregnyl w/diluent benzyl alcohol/NACL, 5 Premarin, 7 Prenaplus, 11 Prenatal, 11 Prenatal Low Iron, 11 Prenatal Plus, 11 Prenatal Vitamins Plus, 11 Preplus, 11 Prepopik, 6 prevalite, 3 previfem, 5 Prezista, 1 Priftin, 1 Primaquine Phosphate, 2 primidone, 8 Primsol, 2 Pristiq, 8 probenecid, 10 probenecid/colchicine, 10 prochlorperazine, 8 prochlorperazine edisylate, 8 prochlorperazine maleate, 8 Procrit, 7 procto-PAK, 6 proctocream HC, 6 proctosol HC, 6 proctozone-HC, 6 Procysbi, 7 progesterone, 5 Proglycem, 5 Promacta, 7 promethazine HCL, 11 promethazine HCL plain, 11 promethegan, 11 pronutrients vitamin d3, 11 propafenone HCL, 3 propafenone HCL ER, 3 Propantheline Bromide, 6 proparacaine HCL, 9 propranolol HCL, 2 propranolol HCL ER, 2 Propranolol/Hydrochlorothiazide, 3 propylthiouracil, 6 Prostigmin, 9 Prostin E2, 9 Protopic, 4 protriptyline HCL, 8 Prudoxin, 4 Pulmicort, 11 Pulmicort Flexhaler, 11 pulmosal, 11 Pulmozyme, 11 px aspirin, 10 px enteric aspirin, 10 Pylera, 6 pyrazinamide, 1 pyridostigmine bromide, 9 Pyrogallic Acid, 4 Q qc aspirin, 10 qc aspirin low dose, 10 qc childrens aspirin, 10 Quartette, 5 quasense, 5 quetiapine fumarate, 8 quinapril HCL, 3 quinapril/hydrochlorothiazide, 3 quinidine gluconate CR, 3 quinidine gluconate ER, 3 quinidine sulfate, 3 Quinidine Sulfate ER, 3 quinine sulfate, 2 Qvar, 11 R ra aspirin, 10 ra aspirin adult low dose, 10 ra aspirin adult low strength, 10 ra aspirin childrens, 10 ra aspirin EC, 10 ra aspirin EC adult low strength, 10 ra childrens aspirin, 10 ra lansoprazole, 6 ra vitamin d-3, 11 raloxifene hydrochloride, 5 ramipril, 3 Ranexa, 2 ranitidine HCL, 6 Rapamune, 2 Rayos, 4 Rebetol, 1 reclipsen, 5 Rectiv, 7 Relagesic, 10 Relenza Diskhaler, 1 Relistor, 7 Renagel, 7 Renvela, 7 repaglinide, 5 repan, 10 reprexain, 10 Rescriptor, 1 Revlimid, 2 Reyataz, 1 Rhinoflex-650, 10 ribasphere, 1 Ribasphere, 1 Ribasphere Ribapak, 1 Ribatab, 1 ribavirin, 1 Ridaura, 10 rifabutin, 1 Rifamate, 1 rifampin, 1 Rifater, 1 riluzole, 9 rimantadine HCL, 1 Riomet, 5 Risperdal Consta, 8 risperidone, 8 risperidone M-TAB, 8 risperidone odt, 8 Ritalin LA, 8 Riteflo, 12 rivastigmine tartrate, 8 rizatriptan benzoate, 10 rizatriptan benzoate odt, 10 romycin, 9 ropinirole ER, 8 ropinirole HCL, 8 rosadan, 3 roxicet, 10 Roxicet, 10 Rozerem, 8 S Sabril, 8 Saizen, 6 Saizen Click.easy, 6 salsalate, 10 Samsca, 6 Sancuso, 6 Sandimmune, 2 Saphris, 8 Savella, 9 Savella Titration Pack, 9 SB aspirin, 10 SB aspirin EC, 10 SB childrens aspirin, 10 SB low dose asa EC, 10 selegiline HCL, 8 selenium sulfide, 4 Selzentry, 1 Sensipar, 6 Serevent Diskus, 11 Seromycin, 1 Seroquel XR, 8 Serostim, 6 sertraline HCL, 8 Sevelamer Carbonate, 7 SF, 7 SF 5000 plus, 7 sildenafil, 3 sildenafil citrate, 3 simvastatin, 3 sirolimus, 2 Skelid, 5 Sklice, 4 sm aspirin, 10 sm aspirin adult low strength, 10 sm aspirin EC low strength, 10 sm aspirin enteric coated, 10 sm aspirin low dose, 10 sm childrens aspirin, 10 sm lansoprazole, 6 sm vitamin d, 11 sm vitamin d3, 11 sodium chloride, 7, 11 sodium chloride 0.9%, 7 sodium phenylbutyrate, 6 sodium sulfacetamide, 3, 9 solia, 5 Somavert, 6 sorine, 2 sotalol HCL, 2 Sovaldi, 1 Spectracef, 1 Spinosad, 4 spironolactone, 3 spironolactone/hydrochlorothiazide, 3 Sporanox, 1 sprintec 28, 5 Sprycel, 2 sronyx, 5 st joseph aspirin, 10 stagesic, 10 Stalevo 100, 8 Stalevo 125, 8 Stalevo 150, 8 Stalevo 200, 8 Stalevo 50, 8 Stalevo 75, 8 stannous fluoride oral rinse, 7 stavudine, 1 Stavzor, 8 Stimate, 6 Stivarga, 2 Stribild, 1 Stromectol, 2 Suclear, 6 Sucraid, 6 sucralfate, 6 sulfacetamide sodium, 3, 9 sulfacetamide sodium/prednisolone sodium phosphate, 9 Sulfadiazine, 1 sulfamethoxazole/trimethoprim, 2 sulfamethoxazole/trimethoprim DS, 2 sulfasalazine, 6 sulfatrim pediatric, 2 sulfazine, 6 sulfazine EC, 6 sulindac, 10 sumatriptan succinate, 10 Sumatriptan Succinate, 10 sumatriptan succinate refill, 10 Suprax, 1 Suprep Bowel Prep, 6 Surmontil, 8 Sustiva, 1 Sutent, 2 syeda, 5 Sylatron, 2 symax fastabs, 6 symax-SL, 6 symax-SR, 6 Symbicort, 11 Symlinpen 120, 5 Symlinpen 60, 5 Synalgos-dc, 10 Synarel, 5 Synera, 4 Synribo, 2 Synthroid, 6 T Tabloid, 2 tacrolimus, 2 Tafinlar, 2 take action, 5 Tamiflu, 1 tamoxifen citrate, 2 tamsulosin HCL, 7 Tarceva, 2 Targretin, 2 Tarka, 3 taron-crystals, 7 Tasigna, 2 Tasmar, 8 Tazorac, 4 taztia XT, 3 temazepam, 8 terazosin HCL, 3 terbinafine HCL, 1 terbutaline sulfate, 11 terconazole, 7 Tersi Foam, 4 testosterone cypionate, 4 testosterone enanthate, 4 Tetanus/Diphtheria Toxoids-adsorbed Adult, 11 tetcaine, 9 tetracaine HCL, 9 Tetracycline HCL, 1 tetravisc, 9 tetravisc forte, 9 Tev-tropin, 6 Teveten, 3 Teveten HCT, 3 Texacort, 4 tgt aspirin, 10 tgt aspirin low dose, 10 tgt childrens aspirin, 10 tgt enteric-coated aspirin, 10 th aspirin, 10 th aspirin low dose, 10 th enteric aspirin, 10 th vitamin d3, 11 Thalomid, 2 Theo-24, 11 theochron, 11 theophylline CR, 11 theophylline ER, 11 thera-d 2000, 11 thera-d rapid repletion, 11 Thiola, 7 thioridazine HCL, 8 thiothixene, 8 Thrombate Iii W/20 ML Sterile Water, 7 Thyrolar-1, 6 Thyrolar-1/2, 6 Thyrolar-1/4, 6 Thyrolar-2, 6 Thyrolar-3, 6 tiagabine hydrochloride, 8 ticlopidine HCL, 7 Tikosyn, 3 tilia FE, 5 Timolol Maleate, 2 timolol maleate, 9 timolol maleate ophthalmic gel forming, 9 tinidazole, 2 Tirosint, 6 Tivicay, 1 tizanidine HCL, 9 Tobi Podhaler, 1 tobramycin, 1 tobramycin sulfate, 9 tobramycin/dexamethasone, 9 tolazamide, 5 Tolazamide, 5 Tolbutamide, 5 tolmetin sodium, 10 tolterodine tartrate, 7 topiragen, 8 topiramate, 8 torsemide, 3 Toviaz, 7 Tracleer, 3 Tradjenta, 5 tramadol HCL, 10 tramadol HCL ER, 10 tramadol hydrochloride/acetaminophen, 10 trandolapril, 3 tranexamic acid, 7 Transderm-scop, 6 tranylcypromine sulfate, 8 Travatan Z, 9 Travoprost, 9 trazodone HCL, 8 Trecator, 1 tretinoin, 2, 3 Trexall, 2 Trezix, 10 tri-estarylla, 5 tri-legest FE, 5 tri-linyah, 5 tri-previfem, 5 tri-sprintec, 5 Tri-vit/Fluoride/Iron, 11 triamcinolone acetonide, 4, 7, 11 Triamcinolone Acetonide, 4 triamcinolone IN orabase, 7 triamterene/hydrochlorothiazide, 3 triazolam, 8 Tricare, 11 Tricitrates, 7 triderm, 4 trifluoperazine HCL, 8 trifluridine, 9 Triglide, 3 trihexyphenidyl HCL, 8 trilyte, 6 trimethobenzamide HCL, 6 trimethoprim, 2 trimethoprim sulfate/polymyxin b sulfate, 9 trimipramine maleate, 8 trinessa, 5 trivora-28, 5 Trokendi XR, 8 tropicamide, 9 trospium chloride, 7 trospium chloride ER, 7 Truvada, 1 Tudorza Pressair, 11 Tykerb, 2 Tyzeka, 1 Tyzine, 11 Tyzine Pediatric Nasal Drops, 11 U Uceris, 4 Ulesfia, 4 Uloric, 10 unithroid, 6 unithroid direct, 6 Urocit-k 10, 7 Urocit-k 15, 7 Urocit-k 5, 7 ursodiol, 6 V Vagifem, 7 valacyclovir HCL, 1 Valcyte, 1 valproic acid, 8 valsartan/hydrochlorothiazide, 3 Valved Holding Chamber, 12 vancomycin HCL, 2 vandazole, 7 Vectical, 4 Veletri, 3 velivet, 5 venlafaxine HCL, 8 venlafaxine HCL ER, 8 Ventavis, 3 Ventolin HFA, 11 verapamil HCL, 3 verapamil HCL ER, 3 verapamil HCL SR, 3 verdrocet, 10 Veregen, 4 Veripred 20, 4 vestura, 5 Vibramycin, 1 vicodin, 10 vicodin ES, 10 vicodin HP, 10 Victoza, 5 Victrelis, 1 Videx Pediatric, 1 Viibryd, 8 Vimizim, 6 Vimpat, 8 viorele, 5 Viracept, 1 Viramune, 1 Viramune XR, 1 Virazole, 1 Viread, 1 vitamin d, 11 vitamin d 400, 11 vitamin d high potency, 11 vitamin d-1000, 11 vitamin d-1000 maximum strength, 11 vitamin d-3, 11 vitamin d-400, 11 vitamin d3, 11 vitamin d3 high potency, 11 vitamin d3 maximum strength, 11 vitamin d3 super strength, 11 Vol-plus, 11 Voltaren, 4 voriconazole, 1 Vortex Valved Holding Chamber, 12 Votrient, 2 Vpriv, 7 Vusion, 4 vyfemla, 5 W warfarin sodium, 7 Watchhaler, 12 wera, 5 wymzya FE, 5 X Xalkori, 2 Xarelto, 7 Xenazine, 9 Xerac Ac, 4 Xifaxan, 2 Xolegel, 4 Xtandi, 2 xulane, 5 xylon, 10 Xyrem, 9 Y Yodoxin, 2 Z zafirlukast, 11 zaleplon, 8 Zantac, 6 zarah, 5 Zavesca, 7 zazole, 7 zebutal, 10 Zelapar, 8 Zelboraf, 2 zenchent, 5 zenchent FE, 5 Zenpep, 6 zenzedi, 8 Zetia, 3 Zgesic, 10 Ziagen, 1 zidovudine, 1 ziprasidone HCL, 8 Zmax, 1 Zoladex, 2 Zolinza, 2 zolpidem tartrate, 8 Zolvit, 10 Zonalon, 4 zonisamide, 8 Zorbtive, 6 Zortress, 2 zovia 1/35e, 5 Zovia 1/50e, 5 Zovirax, 4 Zyflo, 11 Zyflo CR, 11 Zykadia, 2 Zyprexa Relprevv, 8 Zytiga, 2 Zyvox, 2 1 1/2halfprin, 10 8 8-mop, 4
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