Prescribing Guide 511R - 2014 (11/01/2014) INTRODUCTION....................................................................................................................................................................................................... 4 PREFACE ................................................................................................................................................................................................................. 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ...................................................................................................................................... 5 DRUG LIST PRODUCT DESCRIPTIONS ................................................................................................................................................................ 5 GENERIC SUBSTITUTION ...................................................................................................................................................................................... 5 LEGEND ................................................................................................................................................................................................................... 6 NOTICE..................................................................................................................................................................................................................... 6 ANALGESICS........................................................................................................................................................................................................... 7 NSAIDs ........................................................................................................................................................................................................... 7 NSAIDs, COMBINATIONS ............................................................................................................................................................................. 7 NSAIDs, TOPICAL ......................................................................................................................................................................................... 7 COX-2 INHIBITORS ....................................................................................................................................................................................... 7 GOUT ............................................................................................................................................................................................................. 7 OPIOID ANALGESICS ................................................................................................................................................................................... 7 NON-OPIOID ANALGESICS.......................................................................................................................................................................... 8 VISCOSUPPLEMENTS ................................................................................................................................................................................. 8 ANTI-INFECTIVES ................................................................................................................................................................................................... 8 ANTIBACTERIALS ......................................................................................................................................................................................... 8 ANTIFUNGALS .............................................................................................................................................................................................. 9 ANTIMALARIALS ........................................................................................................................................................................................... 9 ANTIRETROVIRAL AGENTS ........................................................................................................................................................................ 9 ANTITUBERCULAR AGENTS ..................................................................................................................................................................... 10 ANTIVIRALS................................................................................................................................................................................................. 10 MISCELLANEOUS ....................................................................................................................................................................................... 11 ANTINEOPLASTIC AGENTS ................................................................................................................................................................................ 11 ALKYLATING AGENTS ............................................................................................................................................................................... 11 ANTIMETABOLITES .................................................................................................................................................................................... 11 HORMONAL ANTINEOPLASTIC AGENTS ................................................................................................................................................. 11 IMMUNOMODULATORS ............................................................................................................................................................................. 12 KINASE INHIBITORS ................................................................................................................................................................................... 12 TOPOISOMERASE INHIBITORS ................................................................................................................................................................ 12 MISCELLANEOUS ....................................................................................................................................................................................... 12 CARDIOVASCULAR .............................................................................................................................................................................................. 12 ACE INHIBITORS......................................................................................................................................................................................... 12 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ........................................................................................................ 13 ACE INHIBITOR/DIURETIC COMBINATIONS ............................................................................................................................................ 13 ADRENOLYTICS, CENTRAL....................................................................................................................................................................... 13 ALDOSTERONE RECEPTOR ANTAGONISTS .......................................................................................................................................... 13 ALPHA BLOCKERS ..................................................................................................................................................................................... 13 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ........................................................................................... 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ......................................................... 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ....................................... 14 ANTIARRHYTHMICS ................................................................................................................................................................................... 14 ANTILIPEMICS............................................................................................................................................................................................. 14 BETA-BLOCKERS ....................................................................................................................................................................................... 15 BETA-BLOCKER/DIURETIC COMBINATIONS ........................................................................................................................................... 15 CALCIUM CHANNEL BLOCKERS .............................................................................................................................................................. 15 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS ............................................................................................................ 15 DIGITALIS GLYCOSIDES ............................................................................................................................................................................ 15 DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS ....................................................................................................................... 15 DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ...................................................................................... 15 DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS .................................................................... 15 DIURETICS .................................................................................................................................................................................................. 16 NITRATES .................................................................................................................................................................................................... 16 NITRATE/VASODILATOR COMBINATIONS .............................................................................................................................................. 16 PULMONARY ARTERIAL HYPERTENSION .............................................................................................................................................. 16 MISCELLANEOUS ....................................................................................................................................................................................... 17 1 CENTRAL NERVOUS SYSTEM ............................................................................................................................................................................ 17 ANTIANXIETY .............................................................................................................................................................................................. 17 ANTICONVULSANTS .................................................................................................................................................................................. 17 ANTIDEMENTIA ........................................................................................................................................................................................... 17 ANTIDEPRESSANTS .................................................................................................................................................................................. 18 ANTIPARKINSONIAN AGENTS .................................................................................................................................................................. 18 ANTIPSYCHOTICS ...................................................................................................................................................................................... 19 ATTENTION DEFICIT HYPERACTIVITY DISORDER ................................................................................................................................ 19 FIBROMYALGIA........................................................................................................................................................................................... 19 HUNTINGTON'S DISEASE AGENTS .......................................................................................................................................................... 20 HYPNOTICS................................................................................................................................................................................................. 20 MIGRAINE .................................................................................................................................................................................................... 20 MOOD STABILIZERS .................................................................................................................................................................................. 20 MULTIPLE SCLEROSIS AGENTS .............................................................................................................................................................. 20 MUSCULOSKELETAL THERAPY AGENTS ............................................................................................................................................... 20 MYASTHENIA GRAVIS ............................................................................................................................................................................... 21 NARCOLEPSY/CATAPLEXY....................................................................................................................................................................... 21 POSTHERPETIC NEURALGIA (PHN)......................................................................................................................................................... 21 PSYCHOTHERAPEUTIC-MISCELLANEOUS ............................................................................................................................................. 21 ENDOCRINE AND METABOLIC ........................................................................................................................................................................... 21 ANDROGENS .............................................................................................................................................................................................. 21 ANTIDIABETICS .......................................................................................................................................................................................... 21 ANTIOBESITY .............................................................................................................................................................................................. 23 CALCIUM REGULATORS ........................................................................................................................................................................... 23 CONTRACEPTIVES .................................................................................................................................................................................... 23 ENDOMETRIOSIS ....................................................................................................................................................................................... 24 ESTROGENS ............................................................................................................................................................................................... 24 ESTROGEN/PROGESTINS ......................................................................................................................................................................... 25 ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS ............................................................................. 25 FERTILITY REGULATORS.......................................................................................................................................................................... 25 GLUCOCORTICOIDS .................................................................................................................................................................................. 25 GLUCOSE ELEVATING AGENTS ............................................................................................................................................................... 25 HUMAN GROWTH HORMONES ................................................................................................................................................................. 25 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ................................................................................................................. 25 PHENYLKETONURIA TREATMENT AGENTS ........................................................................................................................................... 26 PHOSPHATE BINDER AGENTS ................................................................................................................................................................. 26 PROGESTINS .............................................................................................................................................................................................. 26 SELECTIVE ESTROGEN RECEPTOR MODULATORS ............................................................................................................................. 26 THYROID AGENTS ..................................................................................................................................................................................... 26 VASOPRESSINS ......................................................................................................................................................................................... 26 MISCELLANEOUS ....................................................................................................................................................................................... 26 GASTROINTESTINAL ........................................................................................................................................................................................... 26 ANTIDIARRHEALS ...................................................................................................................................................................................... 26 ANTIEMETICS ............................................................................................................................................................................................. 26 ANTISPASMODICS ..................................................................................................................................................................................... 27 CHOLELITHOLYTICS .................................................................................................................................................................................. 27 H2 RECEPTOR ANTAGONISTS .................................................................................................................................................................. 27 INFLAMMATORY BOWEL DISEASE .......................................................................................................................................................... 27 IRRITABLE BOWEL SYNDROME ............................................................................................................................................................... 27 LAXATIVES .................................................................................................................................................................................................. 27 PANCREATIC ENZYMES ............................................................................................................................................................................ 28 PROSTAGLANDINS .................................................................................................................................................................................... 28 PROTON PUMP INHIBITORS ..................................................................................................................................................................... 28 SALIVA STIMULANTS ................................................................................................................................................................................. 28 STEROIDS, RECTAL ................................................................................................................................................................................... 28 ULCER THERAPY COMBINATIONS .......................................................................................................................................................... 28 MISCELLANEOUS ....................................................................................................................................................................................... 28 GENITOURINARY .................................................................................................................................................................................................. 28 BENIGN PROSTATIC HYPERPLASIA ........................................................................................................................................................ 28 ERECTILE DYSFUNCTION ......................................................................................................................................................................... 28 URINARY ANTISPASMODICS .................................................................................................................................................................... 29 VAGINAL ANTI-INFECTIVES ...................................................................................................................................................................... 29 MISCELLANEOUS ....................................................................................................................................................................................... 29 HEMATOLOGIC ..................................................................................................................................................................................................... 29 ANTICOAGULANTS .................................................................................................................................................................................... 29 2 HEMATOPOIETIC GROWTH FACTORS .................................................................................................................................................... 29 IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS ...................................................................................................................... 30 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS ........................................................................................................ 30 PLATELET AGGREGATION INHIBITORS .................................................................................................................................................. 30 PLATELET SYNTHESIS INHIBITORS ........................................................................................................................................................ 30 STEM CELL MOBILIZERS ........................................................................................................................................................................... 30 MISCELLANEOUS ....................................................................................................................................................................................... 30 IMMUNOLOGIC AGENTS...................................................................................................................................................................................... 30 BIOLOGIC DISEASE-MODIFYING AGENTS .............................................................................................................................................. 30 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ................................................................................................................. 30 IMMUNOMODULATORS ............................................................................................................................................................................. 30 IMMUNOSUPPRESSANTS ......................................................................................................................................................................... 30 NUTRITIONAL/SUPPLEMENTS............................................................................................................................................................................ 31 ELECTROLYTES ......................................................................................................................................................................................... 31 VITAMINS AND MINERALS ........................................................................................................................................................................ 31 RESPIRATORY ...................................................................................................................................................................................................... 31 ANAPHYLAXIS TREATMENT AGENTS ..................................................................................................................................................... 31 ANTICHOLINERGICS .................................................................................................................................................................................. 32 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ............................................................................................................................ 32 ANTIHISTAMINES, LOW SEDATING.......................................................................................................................................................... 32 ANTIHISTAMINES, SEDATING ................................................................................................................................................................... 32 ANTITUSSIVES............................................................................................................................................................................................ 32 ANTITUSSIVE COMBINATIONS ................................................................................................................................................................. 32 BETA AGONISTS ........................................................................................................................................................................................ 32 CYSTIC FIBROSIS ...................................................................................................................................................................................... 32 LEUKOTRIENE RECEPTOR ANTAGONISTS ............................................................................................................................................ 32 MAST CELL STABILIZERS ......................................................................................................................................................................... 33 NASAL ANTIHISTAMINES .......................................................................................................................................................................... 33 NASAL STEROIDS ...................................................................................................................................................................................... 33 PHOSPHODIESTERASE-4 INHIBITORS .................................................................................................................................................... 33 STEROID/BETA AGONIST COMBINATIONS ............................................................................................................................................. 33 STEROID INHALANTS ................................................................................................................................................................................ 33 XANTHINES ................................................................................................................................................................................................. 33 MISCELLANEOUS ....................................................................................................................................................................................... 33 TOPICAL ................................................................................................................................................................................................................ 33 DERMATOLOGY.......................................................................................................................................................................................... 33 MOUTH/THROAT/DENTAL AGENTS ......................................................................................................................................................... 36 OPHTHALMIC .............................................................................................................................................................................................. 36 OTIC ............................................................................................................................................................................................................. 38 WEBSITES ............................................................................................................................................................................................................. 39 INDEX ..................................................................................................................................................................................................................... 41 3 INTRODUCTION We are pleased to provide the 2014 Prescribing Guide as a useful reference and informational tool. The Prescribing Guide can assist practitioners in selecting clinically appropriate and cost-effective products for their patients. The drugs represented have been reviewed by a National Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The Prescribing Guide is reflective of current medical practice as of the date of review. The information contained in this Prescribing Guide and its appendices is provided solely for the convenience of medical providers. We do not warrant or assure accuracy of such information nor is it intended to be comprehensive in nature. This Prescribing Guide is not intended to be a substitute for the knowledge, expertise, skill and judgment of the medical provider in his or her choice of prescription drugs. All the information in the Prescribing Guide is provided as a reference for drug therapy selection. Specific drug selection for an individual patient rests solely with the prescriber. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information. National guidelines can be found on the National Guideline Clearinghouse site at http://www.guideline.gov, on the websites listed under each therapeutic class and on the sites listed in the WEBSITES section of this publication. PREFACE The Prescribing Guide is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless exceptions are noted, generally all applicable dosage forms and strengths of the drug cited are included in the Prescribing Guide. Generics should be considered the first line of prescribing. Individual pharmacy benefit plans may impose restrictions or not reimburse some products. In addition, overthe-counter (OTC) products, with the exception of insulin and diabetes monitoring products, are usually not included in the pharmacy benefit. Pharmacy law requires a valid prescription for the purchase of needles and syringes in certain states. OTC products are listed for informational purposes. If covered in the pharmacy benefit, OTC products require a valid prescription. Drugs represented in the Prescribing Guide may have varying cost to the plan member. Generic medications typically are available at the lowest cost, brand-name medications on the Prescribing Guide will generally cost more than generics, and brand-name medications not on the list will generally cost the most. The tiered format places drugs into tiers or levels of cost sharing by the plan member in the following manner: Tier 1: Tier 2: Tier 3: Lowest plan member copayment: All generic drugs, including those on the Prescribing Guide. Intermediate plan member copayment: Preferred brand-name products on the Prescribing Guide selected for Tier 2. Highest plan member copayment: Brand-name products on the Prescribing Guide not selected for Tier 2, and all non-preferred brand-name products. In most cases, there will be reasonable alternatives in Tier 1 or Tier 2 for products found in this highest tier. 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE The services of an independent National Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an external advisory body of experts from across the United States. The P&T Committee's voting members include physicians, pharmacists, a pharmacoeconomist and a medical ethicist, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Employees with significant clinical expertise are invited to meet with the P&T Committee, but no employee may vote on issues before the P&T Committee. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers. DRUG LIST PRODUCT DESCRIPTIONS To assist in understanding which specific strengths and dosage forms are on the Prescribing Guide, examples are noted below. The general principles shown in the examples can usually be extended to other entries in the book. Any exceptions are noted. Products on the Prescribing Guide include all strengths and dosage forms of the cited brand-name product. aripiprazole Abilify Oral tablets, oral disintegrating tablets, solution and all strengths of Abilify would be included in this listing. When a strength or dosage form is specified, only the specified strength and dosage form is on the Prescribing Guide. Other strengths/dosage forms of the reference product are not. acyclovir caps, tabs Zovirax The capsules and tablets of Zovirax are on the Prescribing Guide. From this entry, the cream and ointment cannot be assumed to be on the list unless there is a specific entry. Extended-release and delayed-release products require their own entry. sitagliptin/metformin Janumet The immediate-release product listing of Janumet alone would not include the extended-release product Janumet XR. sitagliptin/metformin ext-rel Janumet XR A separate entry for Janumet XR confirms that the extended-release product is on the Prescribing Guide. Dosage forms on the Prescribing Guide will be consistent with the category and use where listed. neomycin/polymyxin B/hydrocortisone Cortisporin Since Cortisporin is listed only in the OTIC section, it is limited to the otic solution and suspension. From this entry the topical cream cannot be assumed to be on the list unless there is an entry for this product in the DERMATOLOGY section of the Prescribing Guide. GENERIC SUBSTITUTION Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In addition, boldface type may indicate that the brand name cited is a generic. Examples of the latter include Levoxyl and Trivora. One way to reduce out-of-pocket cost is by requesting a generic drug. Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are: Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs. Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug. Manufactured in the same strength and dosage form as the brand-name drugs. 5 When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug. Brand-name drugs having a generic available may: Incur higher copayment (tier 3) Require payment of the difference in price between generic and brand, in addition to copayment Require mandatory generic dispensing LEGEND OTC boldface delayed-rel ext-rel Over the counter Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification Extended-release (also known as sustained-release), refer to the reference brand listed for clarification NOTICE The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2014. All rights reserved. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. When viewing the Prescribing Guide via the Internet, please be advised that the Prescribing Guide is updated periodically and changes may appear prior to their effective date to allow for client notification. 6 ANALGESICS Practice guidelines of pain management are available at: http://www.asahq.org NSAIDs diclofenac sodium delayed-rel diflunisal etodolac ibuprofen nabumetone meloxicam naproxen naproxen sodium oxaprozin sulindac Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 MOBIC NAPROSYN ANAPROX DAYPRO CLINORIL NSAIDs, COMBINATIONS diclofenac sodium delayed-rel/misoprostol naproxen/esomeprazole delayed-rel Tier 1 Tier 2 VIMOVO NSAIDs, TOPICAL diclofenac sodium gel diclofenac sodium soln Tier 2 VOLTAREN GEL Tier 2 PENNSAID COX-2 INHIBITORS celecoxib Tier 2 CELEBREX GOUT probenecid colchicine febuxostat allopurinol Tier 1 Tier 2 COLCRYS Tier 2 ULORIC Tier 3 ZYLOPRIM OPIOID ANALGESICS Practice Guidelines for Cancer Pain Management (includes WHO analgesic ladder) are available at: http://www.asahq.org http://www.nccn.org Opioid guidelines in the management of chronic non-malignant pain are available at: http://www.asipp.org/Guidelines.htm fentanyl transmucosal lozenge methadone morphine morphine supp oxycodone caps, tabs 5 mg oxycodone concentrate 20 mg/mL tramadol ext-rel buprenorphine transdermal fentanyl citrate buccal fentanyl citrate nasal spray oxycodone ext-rel oxymorphone ext-rel tapentadol tapentadol ext-rel codeine/acetaminophen fentanyl transdermal hydrocodone/acetaminophen Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 BUTRANS FENTORA LAZANDA OXYCONTIN OPANA ER NUCYNTA NUCYNTA ER TYLENOL w/CODEINE DURAGESIC NORCO 7 hydromorphone hydromorphone ext-rel morphine ext-rel morphine ext-rel morphine ext-rel oxycodone tabs 15 mg, 30 mg, soln 5 mg/5 mL oxycodone/acetaminophen 5/325 tramadol Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 DILAUDID EXALGO AVINZA KADIAN MS CONTIN ROXICODONE PERCOCET ULTRAM NON-OPIOID ANALGESICS butalbital/acetaminophen/caffeine tabs butalbital/aspirin/caffeine Tier 3 ESGIC Tier 3 FIORINAL VISCOSUPPLEMENTS sodium hyaluronate sodium hyaluronate sodium hyaluronate Tier 2 GEL-ONE Tier 2 HYALGAN Tier 2 SUPARTZ ANTI-INFECTIVES Hepatitis: CDC recommendations on the treatment of hepatitis are available at: http://www.cdc.gov/hepatitis/Resources/ Guidelines for the management of chronic hepatitis by the American Association for the Study of Liver Disease are available at: http://www.aasld.org HIV/AIDS: Guidelines for the treatment of HIV patients by the U.S. Department of Health and Human Services are available at: http://www.aidsinfo.nih.gov Infective Endocarditis: American Heart Association recommendations for the prevention of bacterial endocarditis are available at: http://www.myamericanheart.org Influenza: Recommendations of the Advisory Committee on Immunization Practices are available at: http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm International Travel: CDC recommendations for international travel are available at: http://www.cdc.gov/travel Sexually Transmitted Diseases: CDC Sexually Transmitted Diseases Guidelines are available at: http://www.cdc.gov/std/treatment/default.htm Respiratory Tract Infection/Antibiotic Use/Community Acquired Pneumonia/Other: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infection in adults are available at: http://www.cdc.gov/flu/ Practice guidelines and statements developed and endorsed by the Infectious Diseases Society of America are available at: http://www.idsociety.org ANTIBACTERIALS Cephalosporins First Generation cefadroxil cephalexin Tier 1 Tier 3 KEFLEX Second Generation cefprozil cefuroxime axetil Tier 1 Tier 3 CEFTIN 8 Third Generation cefdinir cefixime Tier 1 Tier 2 SUPRAX Erythromycins/Macrolides erythromycin delayed-rel erythromycin stearate erythromycin/sulfisoxazole fidaxomicin azithromycin clarithromycin clarithromycin ext-rel erythromycin ethylsuccinate Tier 1 Tier 1 Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Fluoroquinolones ciprofloxacin ext-rel ciprofloxacin levofloxacin moxifloxacin Tier 1 Tier 3 CIPRO Tier 3 LEVAQUIN Tier 3 AVELOX DIFICID ZITHROMAX BIAXIN BIAXIN XL E.E.S. Penicillins amoxicillin amoxicillin/clavulanate ext-rel ampicillin dicloxacillin penicillin VK amoxicillin/clavulanate Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 AUGMENTIN Tetracyclines doxycycline hyclate 20 mg tetracycline doxycycline hyclate minocycline Tier 1 Tier 1 Tier 3 VIBRAMYCIN Tier 3 MINOCIN ANTIFUNGALS clotrimazole troches ketoconazole nystatin fluconazole griseofulvin ultramicrosize itraconazole terbinafine tabs voriconazole Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 ANTIMALARIALS mefloquine artemether/lumefantrine atovaquone/proguanil chloroquine Tier 1 Tier 2 COARTEM Tier 3 MALARONE Tier 3 ARALEN ANTIRETROVIRAL AGENTS Antiretroviral Combinations efavirenz/emtricitabine/tenofovir elvitegravir/cobicistat/emtricitabine/tenofovir emtricitabine/tenofovir lamivudine/zidovudine Tier 2 Tier 2 Tier 2 Tier 3 DIFLUCAN GRIS-PEG SPORANOX LAMISIL VFEND ATRIPLA STRIBILD TRUVADA COMBIVIR 9 Fusion Inhibitors enfuvirtide Tier 2 FUZEON Integrase Inhibitors raltegravir Tier 2 ISENTRESS Non-nucleoside Reverse Transcriptase Inhibitors delavirdine efavirenz etravirine nevirapine ext-rel rilpivirine nevirapine Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 RESCRIPTOR SUSTIVA INTELENCE VIRAMUNE XR EDURANT VIRAMUNE Nucleoside Reverse Transcriptase Inhibitors emtricitabine abacavir tabs didanosine delayed-rel lamivudine stavudine zidovudine Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 EMTRIVA ZIAGEN tabs VIDEX EC EPIVIR ZERIT RETROVIR Nucleotide Reverse Transcriptase Inhibitors tenofovir Tier 2 VIREAD Protease Inhibitors atazanavir darunavir lopinavir/ritonavir ritonavir Tier 2 Tier 2 Tier 2 Tier 2 ANTITUBERCULAR AGENTS isoniazid pyrazinamide ethambutol rifampin Tier 1 Tier 1 Tier 3 MYAMBUTOL Tier 3 RIFADIN ANTIVIRALS Cytomegalovirus Agents valganciclovir Tier 2 VALCYTE Hepatitis Agents Hepatitis B entecavir lamivudine Tier 2 BARACLUDE Tier 3 EPIVIR-HBV REYATAZ PREZISTA KALETRA NORVIR Hepatitis C boceprevir ribavirin oral soln sofosbuvir telaprevir ribavirin caps ribavirin tabs Herpes Agents valacyclovir acyclovir caps, tabs famciclovir Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 VICTRELIS REBETOL SOVALDI INCIVEK REBETOL COPEGUS Tier 1 Tier 3 ZOVIRAX Tier 3 FAMVIR 10 Influenza Agents amantadine oseltamivir zanamivir rimantadine Tier 1 Tier 2 TAMIFLU Tier 2 RELENZA Tier 3 FLUMADINE MISCELLANEOUS dapsone sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS trimethoprim rifaximin clindamycin linezolid metronidazole nitazoxanide nitrofurantoin ext-rel nitrofurantoin macrocrystals nitrofurantoin susp tinidazole vancomycin Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 XIFAXAN 550 mg CLEOCIN ZYVOX FLAGYL ALINIA MACROBID MACRODANTIN FURADANTIN TINDAMAX VANCOCIN ALKYLATING AGENTS cyclophosphamide altretamine busulfan chlorambucil lomustine melphalan temozolomide Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 HEXALEN MYLERAN LEUKERAN CEENU ALKERAN TEMODAR ANTIMETABOLITES methotrexate thioguanine capecitabine mercaptopurine Tier 2 Tier 2 Tier 3 Tier 3 TREXALL TABLOID XELODA PURINETHOL HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens flutamide bicalutamide Tier 1 Tier 3 CASODEX Antiestrogens tamoxifen fulvestrant toremifene Tier 1 Tier 2 FASLODEX Tier 2 FARESTON Aromatase Inhibitors anastrozole exemestane letrozole Tier 3 ARIMIDEX Tier 3 AROMASIN Tier 3 FEMARA ANTINEOPLASTIC AGENTS Clinical practice guidelines in oncology are available at: http://www.asco.org http://www.nccn.org 11 Luteinizing Hormone-releasing Hormone (LHRH) Agonists leuprolide acetate goserelin acetate triptorelin pamoate leuprolide acetate Tier 1 Tier 2 ZOLADEX Tier 2 TRELSTAR Tier 3 LUPRON DEPOT Progestins megestrol acetate megestrol acetate susp Tier 3 MEGACE Tier 3 MEGACE ES IMMUNOMODULATORS lenalidomide pomalidomide thalidomide Tier 2 REVLIMID Tier 2 POMALYST Tier 2 THALOMID KINASE INHIBITORS bosutinib dasatinib erlotinib everolimus imatinib mesylate lapatinib pazopanib ponatinib sorafenib sunitinib Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 TOPOISOMERASE INHIBITORS topotecan caps Tier 2 HYCAMTIN caps MISCELLANEOUS etoposide tretinoin caps bexarotene caps mitotane procarbazine vorinostat hydroxyurea Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 BOSULIF SPRYCEL TARCEVA AFINITOR GLEEVEC TYKERB VOTRIENT ICLUSIG NEXAVAR SUTENT TARGRETIN caps LYSODREN MATULANE ZOLINZA HYDREA CARDIOVASCULAR The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is available at: http://www.nhlbi.nih.gov/guidelines/hypertension Guidelines for the evaluation and management of cardiovascular diseases in adults are available at: http://www.acc.org http://www.heartfailureguideline.org http://www.myamericanheart.org ACE INHIBITORS Guidelines for the use of ACE inhibitors are available at: http://professional.diabetes.org http://www.acc.org http://www.myamericanheart.org http://www.nhlbi.nih.gov/guidelines/hypertension captopril fosinopril Tier 1 Tier 1 12 benazepril enalapril lisinopril perindopril quinapril ramipril trandolapril Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 LOTENSIN VASOTEC ZESTRIL ACEON ACCUPRIL ALTACE MAVIK ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS trandolapril/verapamil ext-rel amlodipine/benazepril Tier 2 TARKA Tier 3 LOTREL ACE INHIBITOR/DIURETIC COMBINATIONS captopril/hydrochlorothiazide fosinopril/hydrochlorothiazide benazepril/hydrochlorothiazide enalapril/hydrochlorothiazide lisinopril/hydrochlorothiazide quinapril/hydrochlorothiazide Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 ADRENOLYTICS, CENTRAL clonidine clonidine transdermal guanfacine Tier 3 CATAPRES Tier 3 CATAPRES-TTS Tier 3 TENEX ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone spironolactone Tier 3 INSPRA Tier 3 ALDACTONE LOTENSIN HCT VASERETIC ZESTORETIC ACCURETIC ALPHA BLOCKERS Guidelines for the use of alpha blockers in various patient populations are available at: http://www.nhlbi.nih.gov/guidelines/hypertension terazosin doxazosin Tier 1 Tier 3 CARDURA ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS Guidelines for the use of angiotensin II receptor antagonists in various patient populations are available at: http://professional.diabetes.org http://www.nhlbi.nih.gov/guidelines/hypertension candesartan candesartan/hydrochlorothiazide eprosartan irbesartan irbesartan/hydrochlorothiazide valsartan/hydrochlorothiazide olmesartan olmesartan/hydrochlorothiazide telmisartan valsartan losartan losartan/hydrochlorothiazide telmisartan/hydrochlorothiazide Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 BENICAR BENICAR HCT MICARDIS DIOVAN COZAAR HYZAAR MICARDIS HCT ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS amlodipine/olmesartan Tier 2 AZOR amlodipine/valsartan Tier 2 EXFORGE 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS amlodipine/valsartan/hydrochlorothiazide Tier 2 EXFORGE HCT olmesartan/amlodipine/hydrochlorothiazide Tier 2 TRIBENZOR ANTIARRHYTHMICS Guidelines for the use of antiarrhythmics and cardiac glycosides in various patient populations are available at: http://www.acc.org dofetilide amiodarone disopyramide disopyramide ext-rel flecainide propafenone propafenone ext-rel sotalol sotalol Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 TIKOSYN CORDARONE NORPACE NORPACE CR TAMBOCOR RYTHMOL RYTHMOL SR BETAPACE BETAPACE AF ANTILIPEMICS The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) is available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm Bile Acid Resins colesevelam cholestyramine colestipol Tier 2 WELCHOL Tier 3 QUESTRAN/QUESTRAN LIGHT Tier 3 COLESTID Cholesterol Absorption Inhibitors ezetimibe Tier 2 ZETIA Fibrates fenofibrate fenofibrate fenofibrate fenofibrate fenofibric acid delayed-rel gemfibrozil Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 ANTARA LIPOFEN LOFIBRA TRILIPIX LOPID HMG-CoA Reductase Inhibitors/Combinations atorvastatin fluvastatin ezetimibe/simvastatin rosuvastatin lovastatin pravastatin simvastatin Tier 1 Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 VYTORIN CRESTOR MEVACOR PRAVACHOL ZOCOR Niacins/Combinations niacin ext-rel/simvastatin niacin ext-rel Tier 2 SIMCOR Tier 3 NIASPAN Omega-3 Fatty Acids omega-3 acid ethyl esters Tier 2 LOVAZA 14 BETA-BLOCKERS Guidelines for the use of beta-blockers and beta-blocker combinations in various patient populations are available at: http://www.acc.org http://www.nhlbi.nih.gov/guidelines/hypertension labetalol pindolol propranolol carvedilol phosphate ext-rel nebivolol atenolol bisoprolol carvedilol metoprolol succinate ext-rel metoprolol tartrate nadolol propranolol ext-rel Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 COREG CR BYSTOLIC TENORMIN ZEBETA COREG TOPROL-XL LOPRESSOR CORGARD INDERAL LA BETA-BLOCKER/DIURETIC COMBINATIONS Guidelines for the use of beta-blockers and diuretic combinations in various patient populations are available at: http://www.acc.org http://www.nhlbi.nih.gov/guidelines/hypertension atenolol/chlorthalidone bisoprolol/hydrochlorothiazide metoprolol/hydrochlorothiazide Tier 3 TENORETIC Tier 3 ZIAC Tier 3 LOPRESSOR HCT CALCIUM CHANNEL BLOCKERS Dihydropyridines felodipine ext-rel amlodipine nifedipine ext-rel nifedipine ext-rel Tier 1 Tier 3 NORVASC Tier 3 ADALAT CC Tier 3 PROCARDIA XL Nondihydropyridines diltiazem ext-rel diltiazem ext-rel diltiazem ext-rel verapamil ext-rel Tier 3 Tier 3 Tier 3 Tier 3 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS amlodipine/atorvastatin Tier 3 CADUET DIGITALIS GLYCOSIDES digoxin ped elixir digoxin Tier 1 Tier 3 LANOXIN DIRECT RENIN INHIBITORS/DIURETIC COMBINATIONS aliskiren aliskiren/hydrochlorothiazide Tier 2 TEKTURNA Tier 2 TEKTURNA HCT CARDIZEM CD CARDIZEM LA TIAZAC CALAN SR DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS aliskiren/amlodipine Tier 2 TEKAMLO DIRECT RENIN INHIBITOR/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS aliskiren/amlodipine/hydrochlorothiazide Tier 2 AMTURNIDE 15 DIURETICS Carbonic Anhydrase Inhibitors acetazolamide methazolamide acetazolamide ext-rel Tier 1 Tier 1 Tier 3 DIAMOX SEQUELS Loop Diuretics bumetanide furosemide torsemide Tier 1 Tier 3 LASIX Tier 3 DEMADEX Potassium-sparing Diuretics amiloride Tier 1 Thiazides and Thiazide-like Diuretics chlorthalidone hydrochlorothiazide indapamide metolazone Tier 1 Tier 1 Tier 1 Tier 3 ZAROXOLYN Diuretic Combinations amiloride/hydrochlorothiazide spironolactone/hydrochlorothiazide triamterene/hydrochlorothiazide triamterene/hydrochlorothiazide Tier 1 Tier 3 ALDACTAZIDE Tier 3 DYAZIDE Tier 3 MAXZIDE NITRATES Oral isosorbide dinitrate ext-rel tabs isosorbide mononitrate isosorbide dinitrate oral isosorbide mononitrate ext-rel Tier 1 Tier 1 Tier 3 ISORDIL Tier 3 IMDUR nitroglycerin sublingual nitroglycerin sublingual spray Tier 2 NITROSTAT Tier 2 NITROLINGUAL Sublingual Transdermal nitroglycerin transdermal nitroglycerin transdermal Tier 1 Tier 3 NITRO-DUR NITRATE/VASODILATOR COMBINATIONS isosorbide dinitrate/hydralazine Tier 2 BIDIL PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists ambrisentan bosentan Tier 2 LETAIRIS Tier 2 TRACLEER Phosphodiesterase Inhibitors tadalafil sildenafil Tier 2 ADCIRCA Tier 3 REVATIO Prostaglandin Vasodilators iloprost treprostinil treprostinil epoprostenol sodium Tier 2 Tier 2 Tier 2 Tier 3 VENTAVIS REMODULIN TYVASO FLOLAN 16 MISCELLANEOUS hydralazine methyldopa midodrine ranolazine ext-rel Tier 1 Tier 1 Tier 1 Tier 2 RANEXA CENTRAL NERVOUS SYSTEM Practice guidelines for psychiatric disorders are available at: http://www.psych.org ANTIANXIETY Benzodiazepines oxazepam alprazolam clonazepam tabs diazepam lorazepam Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Miscellaneous buspirone fluvoxamine clomipramine Tier 1 Tier 1 Tier 3 ANAFRANIL XANAX KLONOPIN VALIUM ATIVAN ANTICONVULSANTS Practice guidelines for the treatment of epilepsy are available at: http://www.aan.com phenobarbital lacosamide lamotrigine ext-rel lamotrigine orally disintegrating tabs carbamazepine carbamazepine ext-rel carbamazepine ext-rel diazepam rectal gel divalproex sodium delayed-rel divalproex sodium ext-rel ethosuximide gabapentin lamotrigine levetiracetam levetiracetam ext-rel oxcarbazepine phenytoin phenytoin sodium extended primidone tiagabine topiramate valproic acid zonisamide Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 VIMPAT LAMICTAL XR LAMICTAL ODT TEGRETOL CARBATROL TEGRETOL-XR DIASTAT DEPAKOTE DEPAKOTE ER ZARONTIN NEURONTIN LAMICTAL KEPPRA KEPPRA XR TRILEPTAL DILANTIN INFATABS DILANTIN MYSOLINE GABITRIL TOPAMAX DEPAKENE ZONEGRAN ANTIDEMENTIA Practice guidelines for the management of dementia are available at: http://www.aan.com memantine memantine ext-rel rivastigmine transdermal Tier 2 NAMENDA Tier 2 NAMENDA XR Tier 2 EXELON PATCH 17 donepezil galantamine galantamine ext-rel rivastigmine Tier 3 Tier 3 Tier 3 Tier 3 ARICEPT RAZADYNE RAZADYNE ER EXELON ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder. Guidelines for the evaluation and management of bipolar and depressive disorders are available at: http://www.psych.org Monoamine Oxidase Inhibitors (MAOIs) isocarboxazid phenelzine tranylcypromine Tier 2 MARPLAN Tier 3 NARDIL Tier 3 PARNATE Selective Serotonin Reuptake Inhibitors (SSRIs) fluoxetine vilazodone citalopram escitalopram fluoxetine paroxetine HCl paroxetine HCl ext-rel sertraline Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) venlafaxine desvenlafaxine ext-rel duloxetine delayed-rel venlafaxine ext-rel Tier 1 Tier 2 PRISTIQ Tier 3 CYMBALTA Tier 3 EFFEXOR XR Tricyclic Antidepressants (TCAs) amitriptyline doxepin desipramine imipramine HCl nortriptyline Tier 1 Tier 1 Tier 3 NORPRAMIN Tier 3 TOFRANIL Tier 3 PAMELOR Miscellaneous Agents trazodone bupropion bupropion ext-rel bupropion ext-rel mirtazapine Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 FLUOXETINE 60 mg VIIBRYD CELEXA LEXAPRO PROZAC PAXIL PAXIL CR ZOLOFT WELLBUTRIN WELLBUTRIN SR WELLBUTRIN XL REMERON ANTIPARKINSONIAN AGENTS Practice guidelines for the diagnosis and treatment of Parkinson's disease are available at: http://www.aan.com amantadine benztropine selegiline trihexyphenidyl pramipexole ext-rel rasagiline mesylate rotigotine transdermal Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 MIRAPEX ER Tier 2 AZILECT Tier 2 NEUPRO 18 selegiline orally disintegrating tabs bromocriptine carbidopa/levodopa carbidopa/levodopa ext-rel carbidopa/levodopa orally disintegrating tabs carbidopa/levodopa/entacapone entacapone pramipexole ropinirole ropinirole ext-rel Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 ZELAPAR PARLODEL SINEMET SINEMET CR PARCOPA STALEVO COMTAN MIRAPEX REQUIP REQUIP XL ANTIPSYCHOTICS Atypicals aripiprazole aripiprazole inj lurasidone quetiapine ext-rel risperidone long-acting injection clozapine olanzapine quetiapine risperidone ziprasidone Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 ABILIFY ABILIFY injection LATUDA SEROQUEL XR RISPERDAL CONSTA CLOZARIL ZYPREXA SEROQUEL RISPERDAL GEODON Miscellaneous chlorpromazine fluphenazine haloperidol perphenazine thiothixene trifluoperazine Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 ATTENTION DEFICIT HYPERACTIVITY DISORDER Guidelines for the evaluation and management of attention deficit disorder are available at: http://www.aacap.org http://www.aap.org amphetamine/dextroamphetamine mixed salts dextroamphetamine methylphenidate ext-rel 10 mg atomoxetine guanfacine ext-rel lisdexamfetamine methylphenidate ext-rel susp methylphenidate transdermal amphetamine/dextroamphetamine mixed salts ext-rel dexmethylphenidate dexmethylphenidate ext-rel dextroamphetamine ext-rel methylphenidate methylphenidate methylphenidate ext-rel methylphenidate ext-rel FIBROMYALGIA milnacipran pregabalin Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 STRATTERA INTUNIV VYVANSE QUILLIVANT XR DAYTRANA ADDERALL XR FOCALIN FOCALIN XR DEXEDRINE SPANSULE METHYLIN RITALIN CONCERTA RITALIN LA Tier 2 SAVELLA Tier 2 LYRICA 19 HUNTINGTON'S DISEASE AGENTS tetrabenazine Tier 2 XENAZINE HYPNOTICS Practice parameters for the treatment of sleep disorders and clinical guidelines for the evaluation and management of chronic insomnia in adults are available at: http://www.aasmnet.org Benzodiazepines temazepam Tier 3 RESTORIL Nonbenzodiazepines zolpidem zolpidem ext-rel Tier 3 AMBIEN Tier 3 AMBIEN CR Tricyclics doxepin Tier 2 SILENOR MIGRAINE Guidelines for prevention and management of migraine headaches are available at: http://www.aan.com Ergotamine Derivatives dihydroergotamine inj dihydroergotamine spray ergotamine/caffeine Tier 3 D.H.E. 45 Tier 3 MIGRANAL Tier 3 CAFERGOT Selective Serotonin Agonists naratriptan eletriptan sumatriptan inj zolmitriptan nasal spray rizatriptan sumatriptan sumatriptan inj sumatriptan nasal spray zolmitriptan Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 RELPAX SUMAVEL DOSEPRO ZOMIG MAXALT IMITREX IMITREX IMITREX ZOMIG Selective Serotonin Agonist/Nonsteroidal Anti-inflammatory Drug (NSAID) Combinations sumatriptan/naproxen sodium Tier 2 TREXIMET MOOD STABILIZERS lithium carbonate lithium carbonate ext-rel tabs 450 mg lithium carbonate ext-rel tabs 300 mg Tier 1 Tier 1 Tier 3 LITHOBID MULTIPLE SCLEROSIS AGENTS Practice guidelines for multiple sclerosis are available at: http://www.aan.com dimethyl fumarate delayed-rel fingolimod glatiramer interferon beta-1a interferon beta-1b MUSCULOSKELETAL THERAPY AGENTS baclofen Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 TECFIDERA GILENYA COPAXONE AVONEX EXTAVIA Tier 1 20 carisoprodol cyclobenzaprine orphenadrine/aspirin/caffeine chlorzoxazone dantrolene metaxalone methocarbamol tizanidine Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 PARAFON FORTE DSC DANTRIUM SKELAXIN ROBAXIN ZANAFLEX tabs MYASTHENIA GRAVIS pyridostigmine pyridostigmine ext-rel Tier 3 MESTINON Tier 3 MESTINON TIMESPAN NARCOLEPSY/CATAPLEXY armodafinil sodium oxybate Tier 2 NUVIGIL Tier 2 XYREM POSTHERPETIC NEURALGIA (PHN) gabapentin ext-rel Tier 2 GRALISE PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents acamprosate calcium disulfiram Tier 3 CAMPRAL Tier 3 ANTABUSE Opioid Antagonists naltrexone Tier 3 REVIA Partial Opioid Agonist/Opioid Antagonist Combinations buprenorphine/naloxone sublingual tabs buprenorphine/naloxone sublingual tabs Tier 1 Tier 2 ZUBSOLV Smoking Deterrents bupropion ext-rel varenicline Tier 3 ZYBAN Tier 3 CHANTIX ENDOCRINE AND METABOLIC ANDROGENS Clinical practice guidelines for the treatment of hypogonadism are available at: http://www.aace.com testosterone cypionate testosterone enanthate testosterone gel testosterone soln testosterone transdermal Tier 1 Tier 1 Tier 2 FORTESTA Tier 2 AXIRON Tier 2 ANDRODERM ANTIDIABETICS Guidelines of treatment and management of diabetes are available at: http://professional.diabetes.org Alpha-glucosidase Inhibitors acarbose Tier 3 PRECOSE Amylin Analogs pramlintide Tier 2 SYMLINPEN 21 Biguanides metformin metformin ext-rel Tier 3 GLUCOPHAGE Tier 3 GLUCOPHAGE XR Biguanide/Sulfonylurea Combinations glipizide/metformin Tier 3 METAGLIP Dipeptidyl Peptidase-4 (DPP-4) Inhibitors linagliptin sitagliptin phosphate Tier 2 TRADJENTA Tier 2 JANUVIA Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations linagliptin/metformin sitagliptin/metformin sitagliptin/metformin ext-rel Tier 2 JENTADUETO Tier 2 JANUMET Tier 2 JANUMET XR Incretin Mimetic Agents exenatide ext-rel liraglutide exenatide Tier 2 BYDUREON Tier 2 VICTOZA Tier 3 BYETTA Insulins OTC OTC OTC insulin aspart insulin aspart protamine 70%/insulin aspart 30% insulin detemir insulin glargine insulin glulisine insulin human insulin human insulin isophane human insulin isophane human 70%/regular 30% Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 NOVOLOG NOVOLOG MIX 70/30 LEVEMIR LANTUS APIDRA HUMULIN R U-500 NOVOLIN R NOVOLIN N NOVOLIN 70/30 Insulin Sensitizers pioglitazone Tier 1 Insulin Sensitizer/Biguanide Combinations pioglitazone/metformin Tier 3 ACTOPLUS MET Insulin Sensitizer/Sulfonylurea Combinations pioglitazone/glimepiride Tier 3 DUETACT Meglitinides nateglinide repaglinide Tier 1 Tier 3 PRANDIN Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors canagliflozin Tier 2 INVOKANA Sulfonylureas glyburide glimepiride glipizide glipizide ext-rel Tier 1 Tier 3 AMARYL Tier 3 GLUCOTROL Tier 3 GLUCOTROL XL Supplies OTC blood glucose continuous monitoring receivers, sensors, transmitters blood glucose monitoring kits, test strips Tier 2 DEXCOM G4 Tier 2 ACCU-CHEK kits and test strips 22 OTC OTC OTC blood glucose monitoring kits, test strips insulin syringes, needles lancets Tier 2 ONETOUCH kits and test strips Tier 2 BD insulin syringes and needles Tier 2 LANCETS ANTIOBESITY Guidelines of treatment and management of obesity are available at: http://www.aace.com http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm Anorexiant Combinations phentermine/topiramate ext-rel Tier 2 QSYMIA CALCIUM REGULATORS Guidelines of treatment and management of osteoporosis are available at: http://www.aace.com http://www.nof.org Bisphosphonates risedronate risedronate delayed-rel alendronate ibandronate Tier 2 Tier 2 Tier 3 Tier 3 ACTONEL ATELVIA FOSAMAX BONIVA Calcitonins calcitonin-salmon Parathyroid Hormones teriparatide Tier 3 MIACALCIN Tier 2 FORTEO CONTRACEPTIVES EE = ethinyl estradiol ME = mestranol Monophasic 10 mcg Estrogen norethindrone acetate/EE 1/10 and EE 10 and iron Tier 2 LO LOESTRIN FE 20 mcg Estrogen levonorgestrel/EE 0.1/20 - Lessina norethindrone acetate/EE 1/20 and iron - Lomedia 24 Fe drospirenone/EE/levomefolate 3/20 and levomefolate norethindrone acetate/EE 1/20 and iron chewable drospirenone/EE 3/20 norethindrone acetate/EE 1/20 norethindrone acetate/EE 1/20 and iron Tier 1 Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 BEYAZ MINASTRIN 24 FE YAZ LOESTRIN 1/20 LOESTRIN FE 1/20 30 mcg Estrogen levonorgestrel/EE 0.15/30 - Levora norgestrel/EE 0.3/30 - Low-Ogestrel desogestrel/EE 0.15/30 drospirenone/EE 3/30 norethindrone acetate/EE 1.5/30 norethindrone acetate/EE 1.5/30 and iron Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 ORTHO-CEPT YASMIN LOESTRIN 1.5/30 LOESTRIN FE 1.5/30 35 mcg Estrogen ethynodiol diacetate/EE 1/35 - Zovia 1/35 norethindrone/EE 0.5/35 norethindrone/EE 0.5/35 Tier 1 Tier 3 BREVICON Tier 3 MODICON 23 norethindrone/EE 1/35 norethindrone/EE 1/35 norgestimate/EE 0.25/35 50 mcg Estrogen ethynodiol diacetate/EE 1/50 - Zovia 1/50 norethindrone/ME 1/50 Tier 3 NORINYL 1+35 Tier 3 ORTHO-NOVUM 1/35 Tier 3 ORTHO-CYCLEN Tier 1 Tier 3 NORINYL 1+50 Biphasic desogestrel/EE Tier 3 MIRCETTE levonorgestrel/EE - Trivora norgestimate/EE desogestrel/EE norethindrone/EE norethindrone/EE norgestimate/EE Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 estradiol valerate and dienogest/estradiol valerate Tier 2 NATAZIA Triphasic ORTHO TRI-CYCLEN LO CYCLESSA ORTHO-NOVUM 7/7/7 TRI-NORINYL ORTHO TRI-CYCLEN Four Phase Extended Cycle levonorgestrel/EE 0.15/30 levonorgestrel/EE 0.1/20 and EE 10 levonorgestrel/EE 0.15/30 and EE 10 Tier 1 Tier 3 LOSEASONIQUE Tier 3 SEASONIQUE Progestin Only norethindrone norethindrone Tier 3 NOR-QD Tier 3 ORTHO MICRONOR Injectable medroxyprogesterone acetate 150 mg/mL Tier 3 DEPO-PROVERA Progestin Intrauterine Device levonorgestrel releasing IUD Tier 3 MIRENA Transdermal norelgestromin/EE Tier 3 ORTHO EVRA Vaginal etonogestrel/EE ring ENDOMETRIOSIS danazol nafarelin Tier 2 NUVARING Tier 1 Tier 3 SYNAREL ESTROGENS Guidelines of treatment and management of hormone therapy and menopause are available at: http://www.menopause.org Oral estropipate estrogens, conjugated estradiol Transdermal estradiol Tier 1 Tier 2 PREMARIN Tier 3 ESTRACE Tier 2 DIVIGEL 24 estradiol estradiol estradiol estradiol Tier 2 Tier 2 Tier 2 Tier 3 EVAMIST MINIVELLE VIVELLE-DOT CLIMARA estradiol vaginal crm estradiol vaginal tabs estrogens, conjugated crm Tier 2 ESTRACE Tier 2 VAGIFEM Tier 2 PREMARIN crm Vaginal ESTROGEN/PROGESTINS Oral EE/norethindrone acetate - Jinteli estradiol/norethindrone estrogens, conjugated/medroxyprogesterone estrogens, conjugated/medroxyprogesterone EE/norethindrone acetate Tier 1 Tier 1 Tier 2 PREMPHASE Tier 2 PREMPRO Tier 3 FEMHRT ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS conjugated estrogens/bazedoxifene Tier 2 DUAVEE FERTILITY REGULATORS GNRH/LHRH Antagonists cetrorelix ganirelix Tier 2 CETROTIDE Tier 3 Ovulation Stimulants, Gonadotropins chorionic gonadotropin - Novarel choriogonadotropin alfa follitropin beta Tier 1 Tier 2 OVIDREL Tier 2 FOLLISTIM AQ Ovulation Stimulants, Synthetic clomiphene Tier 3 CLOMID GLUCOCORTICOIDS dexamethasone fludrocortisone prednisolone sodium phosphate 5 mg/5 mL prednisone hydrocortisone methylprednisolone prednisolone sodium phosphate prednisolone syrup Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 GLUCOSE ELEVATING AGENTS glucagon, human recombinant glucagon, human recombinant Tier 2 GLUCAGEN HYPOKIT Tier 2 GLUCAGON EMERGENCY KIT CORTEF MEDROL ORAPRED PRELONE HUMAN GROWTH HORMONES Guidelines for use of growth hormone are available at: http://www.aace.com/publications/guidelines somatropin somatropin HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS calcitriol (1,25-D3) doxercalciferol Tier 2 HUMATROPE Tier 2 NORDITROPIN Tier 3 ROCALTROL Tier 3 HECTOROL 25 paricalcitol Tier 3 ZEMPLAR PHENYLKETONURIA TREATMENT AGENTS sapropterin Tier 2 KUVAN PHOSPHATE BINDER AGENTS calcium acetate tabs calcium acetate sevelamer carbonate sucroferric oxyhydroxide calcium acetate Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 PROGESTINS Oral medroxyprogesterone acetate norethindrone acetate progesterone, micronized Tier 3 PROVERA Tier 3 AYGESTIN Tier 3 PROMETRIUM PHOSLYRA RENVELA VELPHORO PHOSLO Vaginal progesterone gel Tier 2 CRINONE SELECTIVE ESTROGEN RECEPTOR MODULATORS ospemifene raloxifene Tier 2 OSPHENA Tier 3 EVISTA THYROID AGENTS Antithyroid Agents propylthiouracil methimazole Tier 1 Tier 3 TAPAZOLE Thyroid Supplements levothyroxine levothyroxine - Levoxyl levothyroxine liothyronine Tier 1 Tier 1 Tier 2 SYNTHROID Tier 3 CYTOMEL VASOPRESSINS desmopressin spray, tabs Tier 3 DDAVP MISCELLANEOUS cabergoline levocarnitine Tier 1 Tier 3 CARNITOR GASTROINTESTINAL Guidelines for the treatment and management of various gastrointestinal diseases/conditions are available at: http://www.acg.gi.org http://www.gastro.org ANTIDIARRHEALS loperamide diphenoxylate/atropine Tier 1 Tier 3 LOMOTIL ANTIEMETICS granisetron prochlorperazine promethazine doxylamine/pyridoxine delayed-rel granisetron transdermal Tier 1 Tier 1 Tier 1 Tier 2 DICLEGIS Tier 2 SANCUSO 26 scopolamine dronabinol meclizine metoclopramide ondansetron trimethobenzamide Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 TRANSDERM SCOP MARINOL ANTIVERT REGLAN ZOFRAN TIGAN ANTISPASMODICS chlordiazepoxide/clidinium hyoscyamine sulfate ext-rel caps hyoscyamine sulfate orally disintegrating tabs dicyclomine hyoscyamine sulfate hyoscyamine sulfate ext-rel Tier 1 Tier 1 Tier 1 Tier 3 BENTYL Tier 3 LEVSIN Tier 3 LEVBID CHOLELITHOLYTICS ursodiol ursodiol Tier 3 ACTIGALL Tier 3 URSO H2 RECEPTOR ANTAGONISTS cimetidine famotidine ranitidine Tier 1 Tier 3 PEPCID Tier 3 ZANTAC INFLAMMATORY BOWEL DISEASE Oral Agents balsalazide budesonide delayed-rel caps mesalamine delayed-rel tabs mesalamine ext-rel caps mesalamine ext-rel caps olsalazine sulfasalazine sulfasalazine delayed-rel Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 LIALDA APRISO PENTASA DIPENTUM AZULFIDINE AZULFIDINE EN-TABS Rectal Agents hydrocortisone enema hydrocortisone acetate foam mesalamine rectal susp mesalamine supp mesalamine rectal susp Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 CORTIFOAM SFROWASA CANASA ROWASA IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation linaclotide lubiprostone Tier 2 LINZESS Tier 2 AMITIZA Irritable Bowel Syndrome with Diarrhea * alosetron Tier 2 LOTRONEX * For safety reasons, to prescribe Lotronex, the physician must be enrolled in the Prescribing Program for Lotronex. Physicians must understand the benefits and risks of treatment with Lotronex for severe diarrhea-predominant IBS, including the information in the Prescribing Information, Medication Guide and Patient-Physician Agreement for Lotronex. To enroll or for more information on the Prescribing Program for Lotronex, call toll-free: 1-888-423-5227 or visit www.lotronex.com to complete the Physician Enrollment Form. LAXATIVES lactulose Tier 1 27 peg 3350/electrolytes peg 3350/electrolytes sodium sulfate/potassium sulfate/magnesium sulfate peg 3350/electrolytes peg 3350/electrolytes polyethylene glycol 3350 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 MOVIPREP SUCLEAR SUPREP GOLYTELY NULYTELY MIRALAX PANCREATIC ENZYMES pancrelipase pancrelipase delayed-rel pancrelipase delayed-rel pancrelipase delayed-rel Tier 2 Tier 2 Tier 2 Tier 2 VIOKACE CREON ULTRESA ZENPEP PROSTAGLANDINS misoprostol Tier 3 CYTOTEC PROTON PUMP INHIBITORS lansoprazole delayed-rel omeprazole/sodium bicarbonate caps pantoprazole delayed-rel dexlansoprazole delayed-rel esomeprazole delayed-rel omeprazole delayed-rel Tier 1 Tier 1 Tier 1 Tier 2 DEXILANT Tier 2 NEXIUM Tier 3 PRILOSEC SALIVA STIMULANTS cevimeline pilocarpine tabs Tier 3 EVOXAC Tier 3 SALAGEN STEROIDS, RECTAL hydrocortisone acetate/pramoxine foam hydrocortisone crm Tier 3 PROCTOFOAM-HC Tier 3 ANUSOL-HC ULCER THERAPY COMBINATIONS bismuth/metronidazole/tetracycline lansoprazole + amoxicillin + clarithromycin Tier 3 PYLERA Tier 3 PREVPAC MISCELLANEOUS methylnaltrexone sucralfate Tier 2 RELISTOR Tier 3 CARAFATE GENITOURINARY BENIGN PROSTATIC HYPERPLASIA Guidelines for the management of BPH are available at: http://www.auanet.org/guidelines alfuzosin ext-rel dutasteride silodosin finasteride tamsulosin Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 AVODART RAPAFLO PROSCAR FLOMAX ERECTILE DYSFUNCTION Guidelines for the management of erectile dysfunction are available at: http://www.auanet.org/guidelines Alprostadil Agents alprostadil inj alprostadil supp Tier 3 EDEX Tier 3 MUSE 28 Phosphodiesterase Inhibitors sildenafil tadalafil Tier 3 VIAGRA Tier 3 CIALIS URINARY ANTISPASMODICS oxybutynin tolterodine ext-rel trospium trospium ext-rel oxybutynin gel solifenacin succinate oxybutynin ext-rel tolterodine Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 GELNIQUE VESICARE DITROPAN XL DETROL VAGINAL ANTI-INFECTIVES clindamycin crm clindamycin supp metronidazole terconazole terconazole Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 CLEOCIN CLEOCIN METROGEL-VAGINAL TERAZOL 3 TERAZOL 7 MISCELLANEOUS pentosan polysulfate sodium bethanechol phenazopyridine potassium citrate ext-rel Tier 2 Tier 3 Tier 3 Tier 3 ELMIRON URECHOLINE PYRIDIUM UROCIT-K HEMATOLOGIC Guidelines of treatment and management of hemophilia are available at: http://www.hemophilia.org ANTICOAGULANTS Injectable dalteparin enoxaparin Tier 3 FRAGMIN Tier 3 LOVENOX Oral apixaban dabigatran etexilate rivaroxaban warfarin Synthetic Heparinoid-like Agents fondaparinux Tier 2 Tier 2 Tier 2 Tier 3 ELIQUIS PRADAXA XARELTO COUMADIN Tier 3 ARIXTRA HEMATOPOIETIC GROWTH FACTORS Guidelines for the management of neutropenia are available at: http://www.asco.org Guidelines for the management of anemia associated with chronic kidney disease are available at: http://www.kidney.org/professionals/kdoqi/guidelines_commentaries.cfm#guidelines darbepoetin alfa Tier 2 ARANESP epoetin alfa Tier 2 PROCRIT filgrastim Tier 2 NEUPOGEN pegfilgrastim Tier 2 NEULASTA 29 IDIOPATHIC THROMBOCYTOPENIC PURPURA AGENTS eltrombopag PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS eculizumab Tier 2 PROMACTA Tier 3 SOLIRIS PLATELET AGGREGATION INHIBITORS clopidogrel dipyridamole ext-rel/aspirin prasugrel ticagrelor dipyridamole Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 PLATELET SYNTHESIS INHIBITORS anagrelide Tier 3 AGRYLIN STEM CELL MOBILIZERS plerixafor Tier 2 MOZOBIL MISCELLANEOUS cilostazol Tier 3 PLETAL AGGRENOX EFFIENT BRILINTA PERSANTINE IMMUNOLOGIC AGENTS Guidelines for the management of rheumatic diseases are available at: http://www.rheumatology.org BIOLOGIC DISEASE-MODIFYING AGENTS adalimumab etanercept anakinra certolizumab pegol golimumab Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) methotrexate methotrexate hydroxychloroquine leflunomide Tier 1 Tier 2 RHEUMATREX Tier 3 PLAQUENIL Tier 3 ARAVA HUMIRA ENBREL KINERET CIMZIA SIMPONI IMMUNOMODULATORS CDC recommendations on the treatment of hepatitis are available at: http://www.cdc.gov/hepatitis/Resources/ Guidelines for the management of hepatitis are available at: http://www.aasld.org Interferons interferon alfa-2b peginterferon alfa-2a peginterferon alfa-2b peginterferon alfa-2b Tier 2 Tier 2 Tier 2 Tier 2 INTRON A PEGASYS PEGINTRON SYLATRON Miscellaneous canakinumab Tier 2 ILARIS IMMUNOSUPPRESSANTS Antimetabolites azathioprine mycophenolate sodium delayed-rel Tier 2 AZASAN Tier 2 MYFORTIC 30 azathioprine mycophenolate mofetil Calcineurin Inhibitors cyclosporine cyclosporine, modified tacrolimus Rapamycin Derivatives sirolimus Tier 3 IMURAN Tier 3 CELLCEPT Tier 3 SANDIMMUNE Tier 3 NEORAL Tier 3 PROGRAF Tier 2 RAPAMUNE NUTRITIONAL/SUPPLEMENTS ELECTROLYTES Potassium potassium chloride ext-rel potassium chloride liquid Tier 1 Tier 1 VITAMINS AND MINERALS Folic Acid/Combinations folic acid folic acid/vitamin B6/vitamin B12 Tier 1 Tier 1 Prenatal Vitamins prenatal vitamins prenatal vitamins/DHA/docusate/folic acid prenatal vitamins/DHA/docusate/folic acid prenatal vitamins/DHA/docusate/folic acid prenatal vitamins/docusate/folic acid prenatal vitamins/docusate/folic acid + DHA prenatal vitamins/folic acid + pyridoxine Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 CITRANATAL 90 DHA CITRANATAL DHA CITRANATAL HARMONY CITRANATAL RX CITRANATAL ASSURE CITRANATAL B-CALM Miscellaneous cyanocobalamin inj multivitamins/fluoride drops, tabs multivitamins/fluoride/iron drops, tabs vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops ergocalciferol (D2) fluoride drops fluoride tabs phytonadione Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 Tier 3 Tier 3 Tier 3 DRISDOL LURIDE LURIDE LOZI-TABS MEPHYTON RESPIRATORY Guidelines to the management, prevention, or treatment of COPD and asthma are available at: http://www.aaaai.org http://www.ginasthma.com http://www.goldcopd.com http://www.nhlbi.nih.gov The Allergy Report and guidelines for allergy-related conditions are available at: http://www.aaaai.org ANAPHYLAXIS TREATMENT AGENTS epinephrine epinephrine epinephrine Tier 2 AUVI-Q Tier 2 EPIPEN Tier 2 EPIPEN JR. 31 ANTICHOLINERGICS ipratropium soln tiotropium ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ipratropium/albuterol, CFC-free aerosol umeclidinium/vilanterol ipratropium/albuterol soln Tier 1 Tier 2 SPIRIVA Tier 2 COMBIVENT RESPIMAT Tier 2 ANORO ELLIPTA Tier 3 DUONEB ANTIHISTAMINES, LOW SEDATING levocetirizine Tier 3 XYZAL ANTIHISTAMINES, SEDATING clemastine 2.68 mg cyproheptadine hydroxyzine HCl Tier 1 Tier 1 Tier 1 ANTITUSSIVES benzonatate Tier 3 TESSALON ANTITUSSIVE COMBINATIONS Opioid codeine/chlorpheniramine/pseudoephedrine codeine/guaifenesin liquid codeine/guaifenesin/pseudoephedrine codeine/promethazine codeine/promethazine/phenylephrine hydrocodone/homatropine Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Non-opioid dextromethorphan/brompheniramine/pseudoephedrine dextromethorphan/promethazine BETA AGONISTS Inhalants Short Acting albuterol soln albuterol sulfate, CFC-free aerosol albuterol sulfate, CFC-free aerosol Tier 1 Tier 1 Tier 1 Tier 2 PROAIR HFA Tier 2 PROVENTIL HFA Long Acting formoterol inhalation caps formoterol inhalation soln indacaterol salmeterol xinafoate Tier 2 Tier 2 Tier 2 Tier 2 FORADIL PERFOROMIST ARCAPTA NEOHALER SEREVENT albuterol terbutaline albuterol ext-rel Tier 1 Tier 1 Tier 3 VOSPIRE ER CYSTIC FIBROSIS dornase alfa tobramycin inhalation soln Tier 3 PULMOZYME Tier 3 TOBI LEUKOTRIENE RECEPTOR ANTAGONISTS zafirlukast montelukast Tier 1 Tier 3 SINGULAIR Oral Agents 32 MAST CELL STABILIZERS cromolyn soln Tier 1 NASAL ANTIHISTAMINES azelastine spray azelastine spray olopatadine spray Tier 1 Tier 2 ASTEPRO Tier 2 PATANASE NASAL STEROIDS flunisolide spray mometasone spray fluticasone spray triamcinolone acetonide spray Tier 1 Tier 2 NASONEX Tier 3 FLONASE Tier 3 NASACORT AQ PHOSPHODIESTERASE-4 INHIBITORS roflumilast Tier 2 DALIRESP STEROID/BETA AGONIST COMBINATIONS budesonide/formoterol fluticasone/salmeterol fluticasone/salmeterol, CFC-free aerosol mometasone/formoterol Tier 2 Tier 2 Tier 2 Tier 2 SYMBICORT ADVAIR ADVAIR HFA DULERA STEROID INHALANTS beclomethasone, CFC-free aerosol budesonide fluticasone fluticasone, CFC-free aerosol mometasone budesonide inh susp Tier 2 Tier 2 Tier 2 Tier 2 Tier 2 Tier 3 QVAR PULMICORT FLEXHALER FLOVENT DISKUS FLOVENT HFA ASMANEX PULMICORT RESPULES XANTHINES theophylline ext-rel tabs theophylline ext-rel caps theophylline liquid Tier 1 Tier 3 THEO-24 Tier 3 ELIXOPHYLLIN MISCELLANEOUS ipratropium spray omalizumab Tier 3 ATROVENT spray Tier 3 XOLAIR TOPICAL DERMATOLOGY Acne Guidelines for the care and treatment of acne vulgaris are available at: http://www.aad.org/education-and-quality-care/clinical-guidelines Oral isotretinoin Tier 1 erythromycin gel 2% erythromycin soln sulfacetamide/sulfur crm, gel, lotion, pads tretinoin adapalene adapalene/benzoyl peroxide clindamycin/benzoyl peroxide clindamycin/benzoyl peroxide Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 2 Topical AVITA DIFFERIN EPIDUO ACANYA BENZACLIN 33 tazarotene tretinoin tretinoin gel microsphere benzoyl peroxide clindamycin gel, lotion, soln clindamycin/benzoyl peroxide erythromycin/benzoyl peroxide sulfacetamide lotion 10% tretinoin Actinic Keratosis fluorouracil crm, soln 5%, soln 2% fluorouracil imiquimod ingenol mebutate Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 TAZORAC ATRALIN RETIN-A MICRO BENZAC AC CLEOCIN T DUAC BENZAMYCIN KLARON RETIN-A Tier 1 Tier 2 CARAC Tier 2 ZYCLARA Tier 2 PICATO Antibiotics gentamicin mupirocin silver sulfadiazine Tier 1 Tier 3 BACTROBAN Tier 3 SILVADENE clotrimazole econazole ketoconazole nystatin butenafine ciclopirox Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 MENTAX Tier 3 LOPROX Antifungals Antipsoriatics Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: http://www.aad.org Injectable ustekinumab Tier 3 STELARA methoxsalen oral acitretin Tier 2 OXSORALEN-ULTRA Tier 3 SORIATANE calcipotriene calcipotriene Tier 2 SORILUX Tier 3 DOVONEX Oral Topical Antiseborrheics ketoconazole shampoo 2% selenium sulfide shampoo 2.5% Tier 3 NIZORAL SHAMPOO Tier 3 SELSUN Corticosteroids Low Potency fluocinolone acetonide soln 0.01% hydrocortisone crm 2.5% hydrocortisone lotion 1% alclometasone crm, oint 0.05% desonide crm, lotion, oint 0.05% Tier 1 Tier 1 Tier 1 Tier 3 ACLOVATE Tier 3 DESOWEN Medium Potency betamethasone valerate crm, lotion, oint 0.1% Tier 1 34 fluocinolone acetonide crm, oint 0.025% triamcinolone acetonide crm, lotion 0.025% triamcinolone acetonide crm, lotion, oint 0.1% clocortolone crm 0.1% hydrocortisone butyrate crm 0.1% hydrocortisone butyrate lotion 0.1% desoximetasone crm, oint 0.05% fluticasone propionate crm, lotion 0.05%, oint 0.005% hydrocortisone butyrate crm, oint, soln 0.1% hydrocortisone valerate crm, oint 0.2% mometasone crm, lotion, oint 0.1% Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 CLODERM LOCOID LIPOCREAM LOCOID TOPICORT LP CUTIVATE LOCOID WESTCORT ELOCON High Potency betamethasone dipropionate crm, lotion, oint 0.05% diflorasone diacetate crm 0.05% fluocinonide crm, gel, oint, soln 0.05% triamcinolone acetonide crm 0.5% betamethasone dipropionate augmented crm 0.05% betamethasone dipropionate augmented lotion 0.05% desoximetasone crm, oint 0.25%, gel 0.05% Tier 1 Tier 1 Tier 1 Tier 1 Tier 3 DIPROLENE AF Tier 3 DIPROLENE Tier 3 TOPICORT Very High Potency clobetasol propionate foam 0.05% diflorasone diacetate oint 0.05% clobetasol propionate spray 0.05% betamethasone dipropionate augmented gel, oint 0.05% clobetasol propionate crm, gel, oint, soln 0.05% clobetasol propionate lotion, shampoo 0.05% halobetasol propionate crm, oint 0.05% Tier 1 Tier 1 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 CLOBEX DIPROLENE TEMOVATE CLOBEX ULTRAVATE Emollients ammonium lactate 12% Tier 3 LAC-HYDRIN Immunomodulators Guidelines for the treatment of atopic dermatitis are available at: http://www.aad.org pimecrolimus tacrolimus Tier 2 ELIDEL Tier 2 PROTOPIC Local Analgesics lidocaine patch Tier 3 LIDODERM Local Anesthetics lidocaine/prilocaine Tier 1 Rosacea metronidazole gel 0.75% sulfacetamide/sulfur azelaic acid gel doxycycline monohydrate metronidazole crm 0.75% metronidazole gel 1% metronidazole lotion 0.75% Scabicides and Pediculicides permethrin 5% malathion Tier 1 Tier 1 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 FINACEA ORACEA METROCREAM METROGEL METROLOTION Tier 1 Tier 3 OVIDE 35 Miscellaneous Skin and Mucous Membrane imiquimod podofilox Tier 3 ALDARA Tier 3 CONDYLOX MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral lidocaine viscous Tier 1 Protectants - Mouth/Throat benzyl alcohol/carbomer 941/glycerin soy phospholipid/glycerol dioleate Tier 2 MUGARD Tier 2 EPISIL Steroids - Mouth/Throat triamcinolone paste Tier 1 OPHTHALMIC Preferred Practice Pattern Guidelines for the treatment of various ophthalmic conditions are available at: http://one.aao.org Antiallergics cromolyn sodium olopatadine olopatadine azelastine Tier 1 Tier 2 PATADAY Tier 2 PATANOL Tier 3 OPTIVAR Antifungals natamycin Tier 2 NATACYN Anti-infectives bacitracin erythromycin gentamicin levofloxacin polymyxin B/bacitracin sulfacetamide oint 10% besifloxacin moxifloxacin moxifloxacin ciprofloxacin neomycin/polymyxin B/gramicidin ofloxacin polymyxin B/trimethoprim sulfacetamide soln 10% tobramycin Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 Tier 3 BESIVANCE MOXEZA VIGAMOX CILOXAN NEOSPORIN OCUFLOX POLYTRIM BLEPH-10 TOBREX Anti-infective/Anti-inflammatory Combinations neomycin/polymyxin B/bacitracin/hydrocortisone oint neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate 10%/0.25% tobramycin/dexamethasone oint 0.3%/0.1% tobramycin/dexamethasone susp 0.3%/0.05% tobramycin/loteprednol neomycin/polymyxin B/dexamethasone tobramycin/dexamethasone susp 0.3%/0.1% Tier 1 Tier 1 Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 TOBRADEX OINTMENT TOBRADEX ST ZYLET MAXITROL TOBRADEX SUSPENSION 36 Anti-inflammatories Nonsteroidal bromfenac sodium diclofenac sodium ketorolac Steroidal dexamethasone sodium phosphate difluprednate loteprednol 0.2% loteprednol 0.5% fluorometholone prednisolone acetate 1% prednisolone phosphate 1% Tier 1 Tier 1 Tier 3 ACULAR Tier 1 Tier 2 Tier 2 Tier 2 Tier 3 Tier 3 Tier 3 DUREZOL ALREX LOTEMAX FML PRED FORTE Antivirals trifluridine Beta-blockers Nonselective timolol hemihydrate levobunolol metipranolol timolol maleate timolol maleate gel Tier 3 VIROPTIC Tier 2 Tier 3 Tier 3 Tier 3 Tier 3 BETIMOL BETAGAN OPTIPRANOLOL TIMOPTIC TIMOPTIC-XE Selective betaxolol Tier 2 BETOPTIC S Carbonic Anhydrase Inhibitors Topical brinzolamide dorzolamide Tier 2 AZOPT Tier 3 TRUSOPT Carbonic Anhydrase Inhibitor/Beta-blocker Combinations dorzolamide/timolol maleate/preservative-free dorzolamide/timolol maleate Tier 2 COSOPT PF Tier 3 COSOPT Carbonic Anhydrase Inhibitor/Sympathomimetic Combinations brinzolamide/brimonidine Tier 2 SIMBRINZA Immunomodulators cyclosporine, emulsion Tier 2 RESTASIS Prostaglandins travoprost tafluprost travoprost latanoprost Tier 1 Tier 2 ZIOPTAN Tier 2 TRAVATAN Z Tier 3 XALATAN Sympathomimetics brimonidine 0.2% brimonidine 0.1% brimonidine 0.15% Tier 1 Tier 2 ALPHAGAN P Tier 2 ALPHAGAN P Sympathomimetic/Beta-blocker Combinations brimonidine/timolol Tier 2 COMBIGAN 37 OTIC Clinical practice guidelines for the treatment of otitis media are available at: http://www.aap.org Anti-infectives acetic acid acetic acid/aluminum acetate ofloxacin otic Tier 1 Tier 1 Tier 1 Anti-infective/Anti-inflammatory Combinations ciprofloxacin/dexamethasone neomycin/polymyxin B/hydrocortisone Tier 2 CIPRODEX Tier 3 CORTISPORIN OTIC 38 WEBSITES Agency for Healthcare Research and Quality http://www.ahrq.gov Alzheimer's Association http://www.alz.org American Academy of Allergy, Asthma and Immunology http://www.aaaai.org American Academy of Child & Adolescent Psychiatry http://www.aacap.org American Academy of Dermatology http://www.aad.org American Academy of Neurology http://www.aan.com American Academy of Ophthalmology http://www.aao.org American Academy of Pediatrics http://www.aap.org American Association for the Study of Liver Disease http://www.aasld.org American Association of Clinical Endocrinologists http://www.aace.com American Association of Diabetes Educators http://www.diabeteseducator.org American Cancer Society http://www.cancer.org American College of Allergy, Asthma and Immunology http://www.acaai.org American College of Cardiology http://www.acc.org American College of Chest Physicians http://www.chestnet.org American Congress of Obstetricians and Gynecologists http://www.acog.org American Diabetes Association http://www.diabetes.org American Gastroenterological Association http://www.gastro.org American Headache Society Committee for Headache Education http://www.achenet.org American Heart Association http://www.myamericanheart.org American Lung Association http://www.lungusa.org American Medical Association http://www.ama-assn.org American Psychiatric Association http://www.psych.org American Society of Anesthesiologists http://www.asahq.org American Society of Clinical Oncology http://www.asco.org American Society of Interventional Pain Physicians http://www.asipp.org American Urological Association http://www.auanet.org Centers for Disease Control and Prevention http://www.cdc.gov Centers for Disease Control and Prevention Guideline topics: AIDS http://www.cdc.gov/hiv/resources/guidelines/index.htm American College of Gastroenterology http://www.acg.gi.org Centers for Disease Control and Prevention Guideline topics: Sexually Transmitted Diseases http://www.cdc.gov/std/treatment/default.htm American College of Physicians http://www.acponline.org The Food and Drug Administration http://www.fda.gov American College of Rheumatology http://www.rheumatology.org Global Initiative for Asthma http://www.ginasthma.com 39 Infectious Diseases Society of America http://www.idsociety.org National Guideline Clearinghouse http://www.guideline.gov Institute for Safe Medication Practices http://www.ismp.org National Heart, Lung and Blood Institute http://www.nhlbi.nih.gov Johns Hopkins AIDS Service http://www.thebody.com/content/art12096.html National Institutes of Health http://www.nih.gov Juvenile Diabetes Research Foundation International http://www.jdf.org National Kidney Foundation http://www.kidney.org MedWatch http://www.fda.gov/medwatch National Osteoporosis Foundation http://www.nof.org National Agricultural Library http://www.nal.usda.gov North American Menopause Society http://www.menopause.org National Cancer Institute http://www.cancer.gov/cancerinformation United States Department of Health and Human Services http://www.hhs.gov National Comprehensive Cancer Network http://www.nccn.org World Health Organization http://www.who.int National Foundation for Infectious Diseases http://www.nfid.org 40 INDEX A abacavir tabs, 10 ABILIFY, 19 ABILIFY injection, 19 acamprosate calcium, 21 ACANYA, 33 acarbose, 21 ACCU-CHEK kits and test strips, 22 ACCUPRIL, 13 ACCURETIC, 13 ACEON, 13 acetazolamide, 16 acetazolamide ext-rel, 16 acetic acid, 37 acetic acid/aluminum acetate, 38 acitretin, 34 ACLOVATE, 34 ACTIGALL, 27 ACTONEL, 23 ACTOPLUS MET, 22 ACULAR, 36 acyclovir caps, tabs, 10 ADALAT CC, 15 adalimumab, 30 adapalene, 33 adapalene/benzoyl peroxide, 33 ADCIRCA, 16 ADDERALL XR, 19 ADVAIR, 33 ADVAIR HFA, 33 AFINITOR, 12 AGGRENOX, 30 AGRYLIN, 30 albuterol, 32 albuterol ext-rel, 32 albuterol soln, 32 albuterol sulfate, CFC-free aerosol, 32 alclometasone crm, oint 0.05%, 34 ALDACTAZIDE, 16 ALDACTONE, 13 ALDARA, 35 alendronate, 23 alfuzosin ext-rel, 28 ALINIA, 11 aliskiren, 15 aliskiren/amlodipine, 15 aliskiren/amlodipine/hydrochlorothiazide, 15 aliskiren/hydrochlorothiazide, 15 ALKERAN, 11 allopurinol, 7 alosetron, 27 ALPHAGAN P, 37 alprazolam, 17 alprostadil inj, 28 alprostadil supp, 28 ALREX, 37 ALTACE, 13 altretamine, 11 amantadine, 11, 18 AMARYL, 22 AMBIEN, 20 AMBIEN CR, 20 ambrisentan, 16 amiloride, 16 amiloride/hydrochlorothiazide, 16 amiodarone, 14 AMITIZA, 27 amitriptyline, 18 amlodipine, 15 amlodipine/atorvastatin, 15 amlodipine/benazepril, 13 amlodipine/olmesartan, 13 amlodipine/valsartan, 13 amlodipine/valsartan/hydrochlorothiazide, 14 ammonium lactate 12%, 35 amoxicillin, 9 amoxicillin/clavulanate, 9 amoxicillin/clavulanate ext-rel, 9 amphetamine/dextroamphetamine mixed salts, 19 amphetamine/dextroamphetamine mixed salts ext-rel, 19 ampicillin, 9 AMTURNIDE, 15 ANAFRANIL, 17 anagrelide, 30 anakinra, 30 ANAPROX, 7 anastrozole, 11 ANDRODERM, 21 ANORO ELLIPTA, 32 ANTABUSE, 21 ANTARA, 14 ANTIVERT, 27 ANUSOL-HC, 28 APIDRA, 22 apixaban, 29 APRISO, 27 ARALEN, 9 ARANESP, 29 ARAVA, 30 ARCAPTA NEOHALER, 32 ARICEPT, 18 ARIMIDEX, 11 aripiprazole, 19 aripiprazole inj, 19 ARIXTRA, 29 armodafinil, 21 AROMASIN, 11 artemether/lumefantrine, 9 ASMANEX, 33 ASTEPRO, 33 atazanavir, 10 ATELVIA, 23 atenolol, 15 atenolol/chlorthalidone, 15 ATIVAN, 17 atomoxetine, 19 atorvastatin, 14 atovaquone/proguanil, 9 ATRALIN, 33 ATRIPLA, 9 ATROVENT spray, 33 AUGMENTIN, 9 AUVI-Q, 31 AVELOX, 9 AVINZA, 8 41 AVITA, 33 AVODART, 28 AVONEX, 20 AXIRON, 21 AYGESTIN, 26 AZASAN, 30 azathioprine, 30 azelaic acid gel, 35 azelastine, 36 azelastine spray, 33 AZILECT, 18 azithromycin, 9 AZOPT, 37 AZOR, 13 AZULFIDINE, 27 AZULFIDINE EN-TABS, 27 B bacitracin, 36 baclofen, 20 BACTROBAN, 34 balsalazide, 27 BARACLUDE, 10 BD insulin syringes and needles, 22 beclomethasone, CFC-free aerosol, 33 benazepril, 13 benazepril/hydrochlorothiazide, 13 BENICAR, 13 BENICAR HCT, 13 BENTYL, 27 BENZAC AC, 34 BENZACLIN, 33 BENZAMYCIN, 34 benzonatate, 32 benzoyl peroxide, 34 benztropine, 18 benzyl alcohol/carbomer 941/glycerin, 36 besifloxacin, 36 BESIVANCE, 36 BETAGAN, 37 betamethasone dipropionate augmented crm 0.05%, 35 betamethasone dipropionate augmented gel, oint 0.05%, 35 betamethasone dipropionate augmented lotion 0.05%, 35 betamethasone dipropionate crm, lotion, oint 0.05%, 35 betamethasone valerate crm, lotion, oint 0.1%, 34 BETAPACE, 14 BETAPACE AF, 14 betaxolol, 37 bethanechol, 29 BETIMOL, 37 BETOPTIC S, 37 bexarotene caps, 12 BEYAZ, 23 BIAXIN, 9 BIAXIN XL, 9 bicalutamide, 11 BIDIL, 16 bismuth/metronidazole/tetracycline, 28 bisoprolol, 15 bisoprolol/hydrochlorothiazide, 15 BLEPH-10, 36 blood glucose continuous monitoring receivers, sensors, transmitters, 22 blood glucose monitoring kits, test strips, 22 boceprevir, 10 BONIVA, 23 bosentan, 16 BOSULIF, 12 bosutinib, 12 BREVICON, 23 BRILINTA, 30 brimonidine 0.1%, 37 brimonidine 0.15%, 37 brimonidine 0.2%, 37 brimonidine/timolol, 37 brinzolamide, 37 brinzolamide/brimonidine, 37 bromfenac sodium, 36 bromocriptine, 19 budesonide, 33 budesonide delayed-rel caps, 27 budesonide inh susp, 33 budesonide/formoterol, 33 bumetanide, 16 buprenorphine transdermal, 7 buprenorphine/naloxone sublingual tabs, 21 bupropion, 18 bupropion ext-rel, 18, 21 buspirone, 17 busulfan, 11 butalbital/acetaminophen/caffeine tabs, 8 butalbital/aspirin/caffeine, 8 butenafine, 34 BUTRANS, 7 BYDUREON, 22 BYETTA, 22 BYSTOLIC, 15 C cabergoline, 26 CADUET, 15 CAFERGOT, 20 CALAN SR, 15 calcipotriene, 34 calcitonin-salmon, 23 calcitriol (1,25-D3), 25 calcium acetate, 26 calcium acetate tabs, 26 CAMPRAL, 21 canagliflozin, 22 canakinumab, 30 CANASA, 27 candesartan, 13 candesartan/hydrochlorothiazide, 13 capecitabine, 11 captopril, 12 captopril/hydrochlorothiazide, 13 CARAC, 34 CARAFATE, 28 carbamazepine, 17 carbamazepine ext-rel, 17 CARBATROL, 17 carbidopa/levodopa, 19 carbidopa/levodopa ext-rel, 19 carbidopa/levodopa orally disintegrating tabs, 19 carbidopa/levodopa/entacapone, 19 CARDIZEM CD, 15 CARDIZEM LA, 15 CARDURA, 13 carisoprodol, 21 CARNITOR, 26 carvedilol, 15 42 carvedilol phosphate ext-rel, 15 CASODEX, 11 CATAPRES, 13 CATAPRES-TTS, 13 CEENU, 11 cefadroxil, 8 cefdinir, 9 cefixime, 9 cefprozil, 8 CEFTIN, 8 cefuroxime axetil, 8 CELEBREX, 7 celecoxib, 7 CELEXA, 18 CELLCEPT, 30 cephalexin, 8 certolizumab pegol, 30 cetrorelix, 25 CETROTIDE, 25 cevimeline, 28 CHANTIX, 21 chlorambucil, 11 chlordiazepoxide/clidinium, 27 chloroquine, 9 chlorpromazine, 19 chlorthalidone, 16 chlorzoxazone, 21 cholestyramine, 14 choriogonadotropin alfa, 25 chorionic gonadotropin - Novarel, 25 CIALIS, 29 ciclopirox, 34 cilostazol, 30 CILOXAN, 36 cimetidine, 27 CIMZIA, 30 CIPRO, 9 CIPRODEX, 38 ciprofloxacin, 9, 36 ciprofloxacin ext-rel, 9 ciprofloxacin/dexamethasone, 38 citalopram, 18 CITRANATAL 90 DHA, 31 CITRANATAL ASSURE, 31 CITRANATAL B-CALM, 31 CITRANATAL DHA, 31 CITRANATAL HARMONY, 31 CITRANATAL RX, 31 clarithromycin, 9 clarithromycin ext-rel, 9 clemastine 2.68 mg, 32 CLEOCIN, 11, 29 CLEOCIN T, 34 CLIMARA, 25 clindamycin, 11 clindamycin crm, 29 clindamycin gel, lotion, soln, 34 clindamycin supp, 29 clindamycin/benzoyl peroxide, 33, 34 CLINORIL, 7 clobetasol propionate crm, gel, oint, soln 0.05%, 35 clobetasol propionate foam 0.05%, 35 clobetasol propionate lotion, shampoo 0.05%, 35 clobetasol propionate spray 0.05%, 35 CLOBEX, 35 clocortolone crm 0.1%, 35 CLODERM, 35 CLOMID, 25 clomiphene, 25 clomipramine, 17 clonazepam tabs, 17 clonidine, 13 clonidine transdermal, 13 clopidogrel, 30 clotrimazole, 34 clotrimazole troches, 9 clozapine, 19 CLOZARIL, 19 COARTEM, 9 codeine/acetaminophen, 7 codeine/chlorpheniramine/pseudoephedrine, 32 codeine/guaifenesin liquid, 32 codeine/guaifenesin/pseudoephedrine, 32 codeine/promethazine, 32 codeine/promethazine/phenylephrine, 32 colchicine, 7 COLCRYS, 7 colesevelam, 14 COLESTID, 14 colestipol, 14 COMBIGAN, 37 COMBIVENT RESPIMAT, 32 COMBIVIR, 9 COMTAN, 19 CONCERTA, 19 CONDYLOX, 36 conjugated estrogens/bazedoxifene, 25 COPAXONE, 20 COPEGUS, 10 CORDARONE, 14 COREG, 15 COREG CR, 15 CORGARD, 15 CORTEF, 25 CORTIFOAM, 27 CORTISPORIN OTIC, 38 COSOPT, 37 COSOPT PF, 37 COUMADIN, 29 COZAAR, 13 CREON, 28 CRESTOR, 14 CRINONE, 26 cromolyn sodium, 36 cromolyn soln, 32 CUTIVATE, 35 cyanocobalamin inj, 31 CYCLESSA, 24 cyclobenzaprine, 21 cyclophosphamide, 11 cyclosporine, 31 cyclosporine, emulsion, 37 cyclosporine, modified, 31 CYMBALTA, 18 cyproheptadine, 32 CYTOMEL, 26 CYTOTEC, 28 D D.H.E. 45, 20 dabigatran etexilate, 29 DALIRESP, 33 43 dalteparin, 29 danazol, 24 DANTRIUM, 21 dantrolene, 21 dapsone, 11 darbepoetin alfa, 29 darunavir, 10 dasatinib, 12 DAYPRO, 7 DAYTRANA, 19 DDAVP, 26 delavirdine, 10 DEMADEX, 16 DEPAKENE, 17 DEPAKOTE, 17 DEPAKOTE ER, 17 DEPO-PROVERA, 24 desipramine, 18 desmopressin spray, tabs, 26 desogestrel/EE, 24 desogestrel/EE 0.15/30, 23 desonide crm, lotion, oint 0.05%, 34 DESOWEN, 34 desoximetasone crm, oint 0.05%, 35 desoximetasone crm, oint 0.25%, gel 0.05%, 35 desvenlafaxine ext-rel, 18 DETROL, 29 dexamethasone, 25 dexamethasone sodium phosphate, 37 DEXCOM G4, 22 DEXEDRINE SPANSULE, 19 DEXILANT, 28 dexlansoprazole delayed-rel, 28 dexmethylphenidate, 19 dexmethylphenidate ext-rel, 19 dextroamphetamine, 19 dextroamphetamine ext-rel, 19 dextromethorphan/brompheniramine/pseudoephedrine, 32 dextromethorphan/promethazine, 32 DIAMOX SEQUELS, 16 DIASTAT, 17 diazepam, 17 diazepam rectal gel, 17 DICLEGIS, 26 diclofenac sodium, 36 diclofenac sodium delayed-rel, 7 diclofenac sodium delayed-rel/misoprostol, 7 diclofenac sodium gel, 7 diclofenac sodium soln, 7 dicloxacillin, 9 dicyclomine, 27 didanosine delayed-rel, 10 DIFFERIN, 33 DIFICID, 9 diflorasone diacetate crm 0.05%, 35 diflorasone diacetate oint 0.05%, 35 DIFLUCAN, 9 diflunisal, 7 difluprednate, 37 digoxin, 15 digoxin ped elixir, 15 dihydroergotamine inj, 20 dihydroergotamine spray, 20 DILANTIN, 17 DILANTIN INFATABS, 17 DILAUDID, 8 diltiazem ext-rel, 15 dimethyl fumarate delayed-rel, 20 DIOVAN, 13 DIPENTUM, 27 diphenoxylate/atropine, 26 DIPROLENE, 35 DIPROLENE AF, 35 dipyridamole, 30 dipyridamole ext-rel/aspirin, 30 disopyramide, 14 disopyramide ext-rel, 14 disulfiram, 21 DITROPAN XL, 29 divalproex sodium delayed-rel, 17 divalproex sodium ext-rel, 17 DIVIGEL, 24 dofetilide, 14 donepezil, 18 dornase alfa, 32 dorzolamide, 37 dorzolamide/timolol maleate, 37 dorzolamide/timolol maleate/preservative-free, 37 DOVONEX, 34 doxazosin, 13 doxepin, 18, 20 doxercalciferol, 25 doxycycline hyclate, 9 doxycycline hyclate 20 mg, 9 doxycycline monohydrate, 35 doxylamine/pyridoxine delayed-rel, 26 DRISDOL, 31 dronabinol, 26 drospirenone/EE 3/20, 23 drospirenone/EE 3/30, 23 drospirenone/EE/levomefolate 3/20 and levomefolate, 23 DUAC, 34 DUAVEE, 25 DUETACT, 22 DULERA, 33 duloxetine delayed-rel, 18 DUONEB, 32 DURAGESIC, 7 DUREZOL, 37 dutasteride, 28 DYAZIDE, 16 E E.E.S., 9 econazole, 34 eculizumab, 30 EDEX, 28 EDURANT, 10 EE/norethindrone acetate, 25 EE/norethindrone acetate - Jinteli, 25 efavirenz, 10 efavirenz/emtricitabine/tenofovir, 9 EFFEXOR XR, 18 EFFIENT, 30 eletriptan, 20 ELIDEL, 35 ELIQUIS, 29 ELIXOPHYLLIN, 33 ELMIRON, 29 ELOCON, 35 eltrombopag, 29 elvitegravir/cobicistat/emtricitabine/tenofovir, 9 44 emtricitabine, 10 emtricitabine/tenofovir, 9 EMTRIVA, 10 enalapril, 13 enalapril/hydrochlorothiazide, 13 ENBREL, 30 enfuvirtide, 10 enoxaparin, 29 entacapone, 19 entecavir, 10 EPIDUO, 33 epinephrine, 31 EPIPEN, 31 EPIPEN JR., 31 EPISIL, 36 EPIVIR, 10 EPIVIR-HBV, 10 eplerenone, 13 epoetin alfa, 29 epoprostenol sodium, 16 eprosartan, 13 ergocalciferol (D2), 31 ergotamine/caffeine, 20 erlotinib, 12 erythromycin, 36 erythromycin delayed-rel, 9 erythromycin ethylsuccinate, 9 erythromycin gel 2%, 33 erythromycin soln, 33 erythromycin stearate, 9 erythromycin/benzoyl peroxide, 34 erythromycin/sulfisoxazole, 9 escitalopram, 18 ESGIC, 8 esomeprazole delayed-rel, 28 ESTRACE, 24, 25 estradiol, 24, 25 estradiol vaginal crm, 25 estradiol vaginal tabs, 25 estradiol valerate and dienogest/estradiol valerate, 24 estradiol/norethindrone, 25 estrogens, conjugated, 24 estrogens, conjugated crm, 25 estrogens, conjugated/medroxyprogesterone, 25 estropipate, 24 etanercept, 30 ethambutol, 10 ethosuximide, 17 ethynodiol diacetate/EE 1/35 - Zovia 1/35, 23 ethynodiol diacetate/EE 1/50 - Zovia 1/50, 24 etodolac, 7 etonogestrel/EE ring, 24 etoposide, 12 etravirine, 10 EVAMIST, 24 everolimus, 12 EVISTA, 26 EVOXAC, 28 EXALGO, 8 EXELON, 18 EXELON PATCH, 17 exemestane, 11 exenatide, 22 exenatide ext-rel, 22 EXFORGE, 13 EXFORGE HCT, 14 EXTAVIA, 20 ezetimibe, 14 ezetimibe/simvastatin, 14 F famciclovir, 10 famotidine, 27 FAMVIR, 10 FARESTON, 11 FASLODEX, 11 febuxostat, 7 felodipine ext-rel, 15 FEMARA, 11 FEMHRT, 25 fenofibrate, 14 fenofibric acid delayed-rel, 14 fentanyl citrate buccal, 7 fentanyl citrate nasal spray, 7 fentanyl transdermal, 7 fentanyl transmucosal lozenge, 7 FENTORA, 7 fidaxomicin, 9 filgrastim, 29 FINACEA, 35 finasteride, 28 fingolimod, 20 FIORINAL, 8 FLAGYL, 11 flecainide, 14 FLOLAN, 16 FLOMAX, 28 FLONASE, 33 FLOVENT DISKUS, 33 FLOVENT HFA, 33 fluconazole, 9 fludrocortisone, 25 FLUMADINE, 11 flunisolide spray, 33 fluocinolone acetonide crm, oint 0.025%, 34 fluocinolone acetonide soln 0.01%, 34 fluocinonide crm, gel, oint, soln 0.05%, 35 fluoride drops, 31 fluoride tabs, 31 fluorometholone, 37 fluorouracil, 34 fluorouracil crm, soln 5%, soln 2%, 34 fluoxetine, 18 FLUOXETINE 60 mg, 18 fluphenazine, 19 flutamide, 11 fluticasone, 33 fluticasone propionate crm, lotion 0.05%, oint 0.005%, 35 fluticasone spray, 33 fluticasone, CFC-free aerosol, 33 fluticasone/salmeterol, 33 fluticasone/salmeterol, CFC-free aerosol, 33 fluvastatin, 14 fluvoxamine, 17 FML, 37 FOCALIN, 19 FOCALIN XR, 19 folic acid, 31 folic acid/vitamin B6/vitamin B12, 31 FOLLISTIM AQ, 25 follitropin beta, 25 fondaparinux, 29 45 FORADIL, 32 formoterol inhalation caps, 32 formoterol inhalation soln, 32 FORTEO, 23 FORTESTA, 21 FOSAMAX, 23 fosinopril, 12 fosinopril/hydrochlorothiazide, 13 FRAGMIN, 29 fulvestrant, 11 FURADANTIN, 11 furosemide, 16 FUZEON, 10 G gabapentin, 17 gabapentin ext-rel, 21 GABITRIL, 17 galantamine, 18 galantamine ext-rel, 18 ganirelix, 25 GELNIQUE, 29 GEL-ONE, 8 gemfibrozil, 14 gentamicin, 34, 36 GEODON, 19 GILENYA, 20 glatiramer, 20 GLEEVEC, 12 glimepiride, 22 glipizide, 22 glipizide ext-rel, 22 glipizide/metformin, 22 GLUCAGEN HYPOKIT, 25 GLUCAGON EMERGENCY KIT, 25 glucagon, human recombinant, 25 GLUCOPHAGE, 21 GLUCOPHAGE XR, 22 GLUCOTROL, 22 GLUCOTROL XL, 22 glyburide, 22 golimumab, 30 GOLYTELY, 28 goserelin acetate, 12 GRALISE, 21 granisetron, 26 granisetron transdermal, 26 griseofulvin ultramicrosize, 9 GRIS-PEG, 9 guanfacine, 13 guanfacine ext-rel, 19 H halobetasol propionate crm, oint 0.05%, 35 haloperidol, 19 HECTOROL, 25 HEXALEN, 11 HUMATROPE, 25 HUMIRA, 30 HUMULIN R U-500, 22 HYALGAN, 8 HYCAMTIN caps, 12 hydralazine, 17 HYDREA, 12 hydrochlorothiazide, 16 hydrocodone/acetaminophen, 7 hydrocodone/homatropine, 32 hydrocortisone, 25 hydrocortisone acetate foam, 27 hydrocortisone acetate/pramoxine foam, 28 hydrocortisone butyrate crm 0.1%, 35 hydrocortisone butyrate crm, oint, soln 0.1%, 35 hydrocortisone butyrate lotion 0.1%, 35 hydrocortisone crm, 28 hydrocortisone crm 2.5%, 34 hydrocortisone enema, 27 hydrocortisone lotion 1%, 34 hydrocortisone valerate crm, oint 0.2%, 35 hydromorphone, 8 hydromorphone ext-rel, 8 hydroxychloroquine, 30 hydroxyurea, 12 hydroxyzine HCl, 32 hyoscyamine sulfate, 27 hyoscyamine sulfate ext-rel, 27 hyoscyamine sulfate ext-rel caps, 27 hyoscyamine sulfate orally disintegrating tabs, 27 HYZAAR, 13 I ibandronate, 23 ibuprofen, 7 ICLUSIG, 12 ILARIS, 30 iloprost, 16 imatinib mesylate, 12 IMDUR, 16 imipramine HCl, 18 imiquimod, 34, 35 IMITREX, 20 IMURAN, 30 INCIVEK, 10 indacaterol, 32 indapamide, 16 INDERAL LA, 15 ingenol mebutate, 34 INSPRA, 13 insulin aspart, 22 insulin aspart protamine 70%/insulin aspart 30%, 22 insulin detemir, 22 insulin glargine, 22 insulin glulisine, 22 insulin human, 22 insulin isophane human, 22 insulin isophane human 70%/regular 30%, 22 insulin syringes, needles, 22 INTELENCE, 10 interferon alfa-2b, 30 interferon beta-1a, 20 interferon beta-1b, 20 INTRON A, 30 INTUNIV, 19 INVOKANA, 22 ipratropium soln, 31 ipratropium spray, 33 ipratropium/albuterol soln, 32 ipratropium/albuterol, CFC-free aerosol, 32 irbesartan, 13 irbesartan/hydrochlorothiazide, 13 ISENTRESS, 10 isocarboxazid, 18 isoniazid, 10 ISORDIL, 16 46 isosorbide dinitrate ext-rel tabs, 16 isosorbide dinitrate oral, 16 isosorbide dinitrate/hydralazine, 16 isosorbide mononitrate, 16 isosorbide mononitrate ext-rel, 16 isotretinoin, 33 itraconazole, 9 J JANUMET, 22 JANUMET XR, 22 JANUVIA, 22 JENTADUETO, 22 K KADIAN, 8 KALETRA, 10 KEFLEX, 8 KEPPRA, 17 KEPPRA XR, 17 ketoconazole, 9, 34 ketoconazole shampoo 2%, 34 ketorolac, 36 KINERET, 30 KLARON, 34 KLONOPIN, 17 KUVAN, 26 L labetalol, 15 LAC-HYDRIN, 35 lacosamide, 17 lactulose, 27 LAMICTAL, 17 LAMICTAL ODT, 17 LAMICTAL XR, 17 LAMISIL, 9 lamivudine, 10 lamivudine/zidovudine, 9 lamotrigine, 17 lamotrigine ext-rel, 17 lamotrigine orally disintegrating tabs, 17 lancets, 23 LANCETS, 23 LANOXIN, 15 lansoprazole + amoxicillin + clarithromycin, 28 lansoprazole delayed-rel, 28 LANTUS, 22 lapatinib, 12 LASIX, 16 latanoprost, 37 LATUDA, 19 LAZANDA, 7 leflunomide, 30 lenalidomide, 12 LETAIRIS, 16 letrozole, 11 LEUKERAN, 11 leuprolide acetate, 12 LEVAQUIN, 9 LEVBID, 27 LEVEMIR, 22 levetiracetam, 17 levetiracetam ext-rel, 17 levobunolol, 37 levocarnitine, 26 levocetirizine, 32 levofloxacin, 9, 36 levonorgestrel releasing IUD, 24 levonorgestrel/EE - Trivora, 24 levonorgestrel/EE 0.1/20 - Lessina, 23 levonorgestrel/EE 0.1/20 and EE 10, 24 levonorgestrel/EE 0.15/30, 24 levonorgestrel/EE 0.15/30 - Levora, 23 levonorgestrel/EE 0.15/30 and EE 10, 24 levothyroxine, 26 levothyroxine - Levoxyl, 26 LEVSIN, 27 LEXAPRO, 18 LIALDA, 27 lidocaine patch, 35 lidocaine viscous, 36 lidocaine/prilocaine, 35 LIDODERM, 35 linaclotide, 27 linagliptin, 22 linagliptin/metformin, 22 linezolid, 11 LINZESS, 27 liothyronine, 26 LIPOFEN, 14 liraglutide, 22 lisdexamfetamine, 19 lisinopril, 13 lisinopril/hydrochlorothiazide, 13 lithium carbonate, 20 lithium carbonate ext-rel tabs 300 mg, 20 lithium carbonate ext-rel tabs 450 mg, 20 LITHOBID, 20 LO LOESTRIN FE, 23 LOCOID, 35 LOCOID LIPOCREAM, 35 LOESTRIN 1.5/30, 23 LOESTRIN 1/20, 23 LOESTRIN FE 1.5/30, 23 LOESTRIN FE 1/20, 23 LOFIBRA, 14 LOMOTIL, 26 lomustine, 11 loperamide, 26 LOPID, 14 lopinavir/ritonavir, 10 LOPRESSOR, 15 LOPRESSOR HCT, 15 LOPROX, 34 lorazepam, 17 losartan, 13 losartan/hydrochlorothiazide, 13 LOSEASONIQUE, 24 LOTEMAX, 37 LOTENSIN, 13 LOTENSIN HCT, 13 loteprednol 0.2%, 37 loteprednol 0.5%, 37 LOTREL, 13 LOTRONEX, 27 lovastatin, 14 LOVAZA, 14 LOVENOX, 29 lubiprostone, 27 LUPRON DEPOT, 12 lurasidone, 19 LURIDE, 31 47 LURIDE LOZI-TABS, 31 LYRICA, 19 LYSODREN, 12 M MACROBID, 11 MACRODANTIN, 11 MALARONE, 9 malathion, 35 MARINOL, 26 MARPLAN, 18 MATULANE, 12 MAVIK, 13 MAXALT, 20 MAXITROL, 36 MAXZIDE, 16 meclizine, 27 MEDROL, 25 medroxyprogesterone acetate, 26 medroxyprogesterone acetate 150 mg/mL, 24 mefloquine, 9 MEGACE, 12 MEGACE ES, 12 megestrol acetate, 12 megestrol acetate susp, 12 meloxicam, 7 melphalan, 11 memantine, 17 memantine ext-rel, 17 MENTAX, 34 MEPHYTON, 31 mercaptopurine, 11 mesalamine delayed-rel tabs, 27 mesalamine ext-rel caps, 27 mesalamine rectal susp, 27 mesalamine supp, 27 MESTINON, 21 MESTINON TIMESPAN, 21 METAGLIP, 22 metaxalone, 21 metformin, 21 metformin ext-rel, 22 methadone, 7 methazolamide, 16 methimazole, 26 methocarbamol, 21 methotrexate, 11, 30 methoxsalen oral, 34 methyldopa, 17 METHYLIN, 19 methylnaltrexone, 28 methylphenidate, 19 methylphenidate ext-rel, 19 methylphenidate ext-rel 10 mg, 19 methylphenidate ext-rel susp, 19 methylphenidate transdermal, 19 methylprednisolone, 25 metipranolol, 37 metoclopramide, 27 metolazone, 16 metoprolol succinate ext-rel, 15 metoprolol tartrate, 15 metoprolol/hydrochlorothiazide, 15 METROCREAM, 35 METROGEL, 35 METROGEL-VAGINAL, 29 METROLOTION, 35 metronidazole, 11, 29 metronidazole crm 0.75%, 35 metronidazole gel 0.75%, 35 metronidazole gel 1%, 35 metronidazole lotion 0.75%, 35 MEVACOR, 14 MIACALCIN, 23 MICARDIS, 13 MICARDIS HCT, 13 midodrine, 17 MIGRANAL, 20 milnacipran, 19 MINASTRIN 24 FE, 23 MINIVELLE, 24 MINOCIN, 9 minocycline, 9 MIRALAX, 28 MIRAPEX, 19 MIRAPEX ER, 18 MIRCETTE, 24 MIRENA, 24 mirtazapine, 18 misoprostol, 28 mitotane, 12 MOBIC, 7 MODICON, 23 mometasone, 33 mometasone crm, lotion, oint 0.1%, 35 mometasone spray, 33 mometasone/formoterol, 33 montelukast, 32 morphine, 7 morphine ext-rel, 8 morphine supp, 7 MOVIPREP, 27 MOXEZA, 36 moxifloxacin, 9, 36 MOZOBIL, 30 MS CONTIN, 8 MUGARD, 36 multivitamins/fluoride drops, tabs, 31 multivitamins/fluoride/iron drops, tabs, 31 mupirocin, 34 MUSE, 28 MYAMBUTOL, 10 mycophenolate mofetil, 30 mycophenolate sodium delayed-rel, 30 MYFORTIC, 30 MYLERAN, 11 MYSOLINE, 17 N nabumetone, 7 nadolol, 15 nafarelin, 24 naltrexone, 21 NAMENDA, 17 NAMENDA XR, 17 NAPROSYN, 7 naproxen, 7 naproxen sodium, 7 naproxen/esomeprazole delayed-rel, 7 naratriptan, 20 NARDIL, 18 NASACORT AQ, 33 48 NASONEX, 33 NATACYN, 36 natamycin, 36 NATAZIA, 24 nateglinide, 22 nebivolol, 15 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 36 neomycin/polymyxin B/dexamethasone, 36 neomycin/polymyxin B/gramicidin, 36 neomycin/polymyxin B/hydrocortisone, 38 neomycin/polymyxin B/hydrocortisone susp, 36 NEORAL, 31 NEOSPORIN, 36 NEULASTA, 29 NEUPOGEN, 29 NEUPRO, 18 NEURONTIN, 17 nevirapine, 10 nevirapine ext-rel, 10 NEXAVAR, 12 NEXIUM, 28 niacin ext-rel, 14 niacin ext-rel/simvastatin, 14 NIASPAN, 14 nifedipine ext-rel, 15 nitazoxanide, 11 NITRO-DUR, 16 nitrofurantoin ext-rel, 11 nitrofurantoin macrocrystals, 11 nitrofurantoin susp, 11 nitroglycerin sublingual, 16 nitroglycerin sublingual spray, 16 nitroglycerin transdermal, 16 NITROLINGUAL, 16 NITROSTAT, 16 NIZORAL SHAMPOO, 34 NORCO, 7 NORDITROPIN, 25 norelgestromin/EE, 24 norethindrone, 24 norethindrone acetate, 26 norethindrone acetate/EE 1.5/30, 23 norethindrone acetate/EE 1.5/30 and iron, 23 norethindrone acetate/EE 1/10 and EE 10 and iron, 23 norethindrone acetate/EE 1/20, 23 norethindrone acetate/EE 1/20 and iron, 23 norethindrone acetate/EE 1/20 and iron - Lomedia 24 Fe, 23 norethindrone acetate/EE 1/20 and iron chewable, 23 norethindrone/EE, 24 norethindrone/EE 0.5/35, 23 norethindrone/EE 1/35, 23 norethindrone/ME 1/50, 24 norgestimate/EE, 24 norgestimate/EE 0.25/35, 24 norgestrel/EE 0.3/30 - Low-Ogestrel, 23 NORINYL 1+35, 23 NORINYL 1+50, 24 NORPACE, 14 NORPACE CR, 14 NORPRAMIN, 18 NOR-QD, 24 nortriptyline, 18 NORVASC, 15 NORVIR, 10 NOVOLIN 70/30, 22 NOVOLIN N, 22 NOVOLIN R, 22 NOVOLOG, 22 NOVOLOG MIX 70/30, 22 NUCYNTA, 7 NUCYNTA ER, 7 NULYTELY, 28 NUVARING, 24 NUVIGIL, 21 nystatin, 9, 34 O OCUFLOX, 36 ofloxacin, 36 ofloxacin otic, 38 olanzapine, 19 olmesartan, 13 olmesartan/amlodipine/hydrochlorothiazide, 14 olmesartan/hydrochlorothiazide, 13 olopatadine, 36 olopatadine spray, 33 olsalazine, 27 omalizumab, 33 omega-3 acid ethyl esters, 14 omeprazole delayed-rel, 28 omeprazole/sodium bicarbonate caps, 28 ondansetron, 27 ONETOUCH kits and test strips, 22 OPANA ER, 7 OPTIPRANOLOL, 37 OPTIVAR, 36 ORACEA, 35 ORAPRED, 25 orphenadrine/aspirin/caffeine, 21 ORTHO EVRA, 24 ORTHO MICRONOR, 24 ORTHO TRI-CYCLEN, 24 ORTHO TRI-CYCLEN LO, 24 ORTHO-CEPT, 23 ORTHO-CYCLEN, 24 ORTHO-NOVUM 1/35, 23 ORTHO-NOVUM 7/7/7, 24 oseltamivir, 11 ospemifene, 26 OSPHENA, 26 OVIDE, 35 OVIDREL, 25 oxaprozin, 7 oxazepam, 17 oxcarbazepine, 17 OXSORALEN-ULTRA, 34 oxybutynin, 29 oxybutynin ext-rel, 29 oxybutynin gel, 29 oxycodone caps, tabs 5 mg, 7 oxycodone concentrate 20 mg/mL, 7 oxycodone ext-rel, 7 oxycodone tabs 15 mg, 30 mg, soln 5 mg/5 mL, 8 oxycodone/acetaminophen 5/325, 8 OXYCONTIN, 7 oxymorphone ext-rel, 7 P PAMELOR, 18 pancrelipase, 28 pancrelipase delayed-rel, 28 pantoprazole delayed-rel, 28 PARAFON FORTE DSC, 21 49 PARCOPA, 19 paricalcitol, 25 PARLODEL, 19 PARNATE, 18 paroxetine HCl, 18 paroxetine HCl ext-rel, 18 PATADAY, 36 PATANASE, 33 PATANOL, 36 PAXIL, 18 PAXIL CR, 18 pazopanib, 12 peg 3350/electrolytes, 27, 28 PEGASYS, 30 pegfilgrastim, 29 peginterferon alfa-2a, 30 peginterferon alfa-2b, 30 PEGINTRON, 30 penicillin VK, 9 PENNSAID, 7 PENTASA, 27 pentosan polysulfate sodium, 29 PEPCID, 27 PERCOCET, 8 PERFOROMIST, 32 perindopril, 13 permethrin 5%, 35 perphenazine, 19 PERSANTINE, 30 phenazopyridine, 29 phenelzine, 18 phenobarbital, 17 phentermine/topiramate ext-rel, 23 phenytoin, 17 phenytoin sodium extended, 17 PHOSLO, 26 PHOSLYRA, 26 phytonadione, 31 PICATO, 34 pilocarpine tabs, 28 pimecrolimus, 35 pindolol, 15 pioglitazone, 22 pioglitazone/glimepiride, 22 pioglitazone/metformin, 22 PLAQUENIL, 30 plerixafor, 30 PLETAL, 30 podofilox, 36 polyethylene glycol 3350, 28 polymyxin B/bacitracin, 36 polymyxin B/trimethoprim, 36 POLYTRIM, 36 pomalidomide, 12 POMALYST, 12 ponatinib, 12 potassium chloride ext-rel, 31 potassium chloride liquid, 31 potassium citrate ext-rel, 29 PRADAXA, 29 pramipexole, 19 pramipexole ext-rel, 18 pramlintide, 21 PRANDIN, 22 prasugrel, 30 PRAVACHOL, 14 pravastatin, 14 PRECOSE, 21 PRED FORTE, 37 prednisolone acetate 1%, 37 prednisolone phosphate 1%, 37 prednisolone sodium phosphate, 25 prednisolone sodium phosphate 5 mg/5 mL, 25 prednisolone syrup, 25 prednisone, 25 pregabalin, 19 PRELONE, 25 PREMARIN, 24 PREMARIN crm, 25 PREMPHASE, 25 PREMPRO, 25 prenatal vitamins, 31 prenatal vitamins/DHA/docusate/folic acid, 31 prenatal vitamins/docusate/folic acid, 31 prenatal vitamins/docusate/folic acid + DHA, 31 prenatal vitamins/folic acid + pyridoxine, 31 PREVPAC, 28 PREZISTA, 10 PRILOSEC, 28 primidone, 17 PRISTIQ, 18 PROAIR HFA, 32 probenecid, 7 procarbazine, 12 PROCARDIA XL, 15 prochlorperazine, 26 PROCRIT, 29 PROCTOFOAM-HC, 28 progesterone gel, 26 progesterone, micronized, 26 PROGRAF, 31 PROMACTA, 29 promethazine, 26 PROMETRIUM, 26 propafenone, 14 propafenone ext-rel, 14 propranolol, 15 propranolol ext-rel, 15 propylthiouracil, 26 PROSCAR, 28 PROTOPIC, 35 PROVENTIL HFA, 32 PROVERA, 26 PROZAC, 18 PULMICORT FLEXHALER, 33 PULMICORT RESPULES, 33 PULMOZYME, 32 PURINETHOL, 11 PYLERA, 28 pyrazinamide, 10 PYRIDIUM, 29 pyridostigmine, 21 pyridostigmine ext-rel, 21 Q QSYMIA, 23 QUESTRAN/QUESTRAN LIGHT, 14 quetiapine, 19 quetiapine ext-rel, 19 QUILLIVANT XR, 19 quinapril, 13 quinapril/hydrochlorothiazide, 13 50 QVAR, 33 R raloxifene, 26 raltegravir, 10 ramipril, 13 RANEXA, 17 ranitidine, 27 ranolazine ext-rel, 17 RAPAFLO, 28 RAPAMUNE, 31 rasagiline mesylate, 18 RAZADYNE, 18 RAZADYNE ER, 18 REBETOL, 10 REGLAN, 27 RELENZA, 11 RELISTOR, 28 RELPAX, 20 REMERON, 18 REMODULIN, 16 RENVELA, 26 repaglinide, 22 REQUIP, 19 REQUIP XL, 19 RESCRIPTOR, 10 RESTASIS, 37 RESTORIL, 20 RETIN-A, 34 RETIN-A MICRO, 33 RETROVIR, 10 REVATIO, 16 REVIA, 21 REVLIMID, 12 REYATAZ, 10 RHEUMATREX, 30 ribavirin caps, 10 ribavirin oral soln, 10 ribavirin tabs, 10 RIFADIN, 10 rifampin, 10 rifaximin, 11 rilpivirine, 10 rimantadine, 11 risedronate, 23 risedronate delayed-rel, 23 RISPERDAL, 19 RISPERDAL CONSTA, 19 risperidone, 19 risperidone long-acting injection, 19 RITALIN, 19 RITALIN LA, 19 ritonavir, 10 rivaroxaban, 29 rivastigmine, 18 rivastigmine transdermal, 17 rizatriptan, 20 ROBAXIN, 21 ROCALTROL, 25 roflumilast, 33 ropinirole, 19 ropinirole ext-rel, 19 rosuvastatin, 14 rotigotine transdermal, 18 ROWASA, 27 ROXICODONE, 8 RYTHMOL, 14 RYTHMOL SR, 14 S SALAGEN, 28 salmeterol xinafoate, 32 SANCUSO, 26 SANDIMMUNE, 31 sapropterin, 26 SAVELLA, 19 scopolamine, 26 SEASONIQUE, 24 selegiline, 18 selegiline orally disintegrating tabs, 19 selenium sulfide shampoo 2.5%, 34 SELSUN, 34 SEREVENT, 32 SEROQUEL, 19 SEROQUEL XR, 19 sertraline, 18 sevelamer carbonate, 26 SFROWASA, 27 sildenafil, 16, 29 SILENOR, 20 silodosin, 28 SILVADENE, 34 silver sulfadiazine, 34 SIMBRINZA, 37 SIMCOR, 14 SIMPONI, 30 simvastatin, 14 SINEMET, 19 SINEMET CR, 19 SINGULAIR, 32 sirolimus, 31 sitagliptin phosphate, 22 sitagliptin/metformin, 22 sitagliptin/metformin ext-rel, 22 SKELAXIN, 21 sodium hyaluronate, 8 sodium oxybate, 21 sodium sulfate/potassium sulfate/magnesium sulfate, 28 sofosbuvir, 10 solifenacin succinate, 29 SOLIRIS, 30 somatropin, 25 sorafenib, 12 SORIATANE, 34 SORILUX, 34 sotalol, 14 SOVALDI, 10 soy phospholipid/glycerol dioleate, 36 SPIRIVA, 31 spironolactone, 13 spironolactone/hydrochlorothiazide, 16 SPORANOX, 9 SPRYCEL, 12 STALEVO, 19 stavudine, 10 STELARA, 34 STRATTERA, 19 STRIBILD, 9 SUCLEAR, 27 sucralfate, 28 sucroferric oxyhydroxide, 26 sulfacetamide lotion 10%, 34 51 sulfacetamide oint 10%, 36 sulfacetamide soln 10%, 36 sulfacetamide/prednisolone phosphate 10%/0.25%, 36 sulfacetamide/sulfur, 35 sulfacetamide/sulfur crm, gel, lotion, pads, 33 sulfamethoxazole/trimethoprim, 11 sulfamethoxazole/trimethoprim DS, 11 sulfasalazine, 27 sulfasalazine delayed-rel, 27 sulindac, 7 sumatriptan, 20 sumatriptan inj, 20 sumatriptan nasal spray, 20 sumatriptan/naproxen sodium, 20 SUMAVEL DOSEPRO, 20 sunitinib, 12 SUPARTZ, 8 SUPRAX, 9 SUPREP, 28 SUSTIVA, 10 SUTENT, 12 SYLATRON, 30 SYMBICORT, 33 SYMLINPEN, 21 SYNAREL, 24 SYNTHROID, 26 T TABLOID, 11 tacrolimus, 31, 35 tadalafil, 16, 29 tafluprost, 37 TAMBOCOR, 14 TAMIFLU, 11 tamoxifen, 11 tamsulosin, 28 TAPAZOLE, 26 tapentadol, 7 tapentadol ext-rel, 7 TARCEVA, 12 TARGRETIN caps, 12 TARKA, 13 tazarotene, 33 TAZORAC, 33 TECFIDERA, 20 TEGRETOL, 17 TEGRETOL-XR, 17 TEKAMLO, 15 TEKTURNA, 15 TEKTURNA HCT, 15 telaprevir, 10 telmisartan, 13 telmisartan/hydrochlorothiazide, 13 temazepam, 20 TEMODAR, 11 TEMOVATE, 35 temozolomide, 11 TENEX, 13 tenofovir, 10 TENORETIC, 15 TENORMIN, 15 TERAZOL 3, 29 TERAZOL 7, 29 terazosin, 13 terbinafine tabs, 9 terbutaline, 32 terconazole, 29 teriparatide, 23 TESSALON, 32 testosterone cypionate, 21 testosterone enanthate, 21 testosterone gel, 21 testosterone soln, 21 testosterone transdermal, 21 tetrabenazine, 20 tetracycline, 9 thalidomide, 12 THALOMID, 12 THEO-24, 33 theophylline ext-rel caps, 33 theophylline ext-rel tabs, 33 theophylline liquid, 33 thioguanine, 11 thiothixene, 19 tiagabine, 17 TIAZAC, 15 ticagrelor, 30 TIGAN, 27 TIKOSYN, 14 timolol hemihydrate, 37 timolol maleate, 37 timolol maleate gel, 37 TIMOPTIC, 37 TIMOPTIC-XE, 37 TINDAMAX, 11 tinidazole, 11 tiotropium, 31 tizanidine, 21 TOBI, 32 TOBRADEX OINTMENT, 36 TOBRADEX ST, 36 TOBRADEX SUSPENSION, 36 tobramycin, 36 tobramycin inhalation soln, 32 tobramycin/dexamethasone oint 0.3%/0.1%, 36 tobramycin/dexamethasone susp 0.3%/0.05%, 36 tobramycin/dexamethasone susp 0.3%/0.1%, 36 tobramycin/loteprednol, 36 TOBREX, 36 TOFRANIL, 18 tolterodine, 29 tolterodine ext-rel, 29 TOPAMAX, 17 TOPICORT, 35 TOPICORT LP, 35 topiramate, 17 topotecan caps, 12 TOPROL-XL, 15 toremifene, 11 torsemide, 16 TRACLEER, 16 TRADJENTA, 22 tramadol, 8 tramadol ext-rel, 7 trandolapril, 13 trandolapril/verapamil ext-rel, 13 TRANSDERM SCOP, 26 tranylcypromine, 18 TRAVATAN Z, 37 travoprost, 37 trazodone, 18 TRELSTAR, 12 52 treprostinil, 16 tretinoin, 33, 34 tretinoin caps, 12 tretinoin gel microsphere, 33 TREXALL, 11 TREXIMET, 20 triamcinolone acetonide crm 0.5%, 35 triamcinolone acetonide crm, lotion 0.025%, 34 triamcinolone acetonide crm, lotion, oint 0.1%, 34 triamcinolone acetonide spray, 33 triamcinolone paste, 36 triamterene/hydrochlorothiazide, 16 TRIBENZOR, 14 trifluoperazine, 19 trifluridine, 37 trihexyphenidyl, 18 TRILEPTAL, 17 TRILIPIX, 14 trimethobenzamide, 27 trimethoprim, 11 TRI-NORINYL, 24 triptorelin pamoate, 12 trospium, 29 trospium ext-rel, 29 TRUSOPT, 37 TRUVADA, 9 TYKERB, 12 TYLENOL w/CODEINE, 7 TYVASO, 16 U ULORIC, 7 ULTRAM, 8 ULTRAVATE, 35 ULTRESA, 28 umeclidinium/vilanterol, 32 URECHOLINE, 29 UROCIT-K, 29 URSO, 27 ursodiol, 27 ustekinumab, 34 V VAGIFEM, 25 valacyclovir, 10 VALCYTE, 10 valganciclovir, 10 VALIUM, 17 valproic acid, 17 valsartan, 13 valsartan/hydrochlorothiazide, 13 VANCOCIN, 11 vancomycin, 11 varenicline, 21 VASERETIC, 13 VASOTEC, 13 VELPHORO, 26 venlafaxine, 18 venlafaxine ext-rel, 18 VENTAVIS, 16 verapamil ext-rel, 15 VESICARE, 29 VFEND, 9 VIAGRA, 29 VIBRAMYCIN, 9 VICTOZA, 22 VICTRELIS, 10 VIDEX EC, 10 VIGAMOX, 36 VIIBRYD, 18 vilazodone, 18 VIMOVO, 7 VIMPAT, 17 VIOKACE, 28 VIRAMUNE, 10 VIRAMUNE XR, 10 VIREAD, 10 VIROPTIC, 37 vitamin ADC/fluoride drops, 31 vitamin ADC/fluoride/iron drops, 31 VIVELLE-DOT, 25 VOLTAREN GEL, 7 voriconazole, 9 vorinostat, 12 VOSPIRE ER, 32 VOTRIENT, 12 VYTORIN, 14 VYVANSE, 19 W warfarin, 29 WELCHOL, 14 WELLBUTRIN, 18 WELLBUTRIN SR, 18 WELLBUTRIN XL, 18 WESTCORT, 35 X XALATAN, 37 XANAX, 17 XARELTO, 29 XELODA, 11 XENAZINE, 20 XIFAXAN 550 mg, 11 XOLAIR, 33 XYREM, 21 XYZAL, 32 Y YASMIN, 23 YAZ, 23 Z zafirlukast, 32 ZANAFLEX tabs, 21 zanamivir, 11 ZANTAC, 27 ZARONTIN, 17 ZAROXOLYN, 16 ZEBETA, 15 ZELAPAR, 19 ZEMPLAR, 25 ZENPEP, 28 ZERIT, 10 ZESTORETIC, 13 ZESTRIL, 13 ZETIA, 14 ZIAC, 15 ZIAGEN tabs, 10 zidovudine, 10 ZIOPTAN, 37 ziprasidone, 19 ZITHROMAX, 9 ZOCOR, 14 ZOFRAN, 27 53 ZOLADEX, 12 ZOLINZA, 12 zolmitriptan, 20 zolmitriptan nasal spray, 20 ZOLOFT, 18 zolpidem, 20 zolpidem ext-rel, 20 ZOMIG, 20 ZONEGRAN, 17 zonisamide, 17 ZOVIRAX, 10 ZUBSOLV, 21 ZYBAN, 21 ZYCLARA, 34 ZYLET, 36 ZYLOPRIM, 7 ZYPREXA, 19 ZYVOX, 11 54
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