2021 Core Formulary Effective 10/01/2021

Southern Scripts – Core Formulary

2021 Core Formulary Effective 10/01/2021

This Core Formulary list includes common FDA-approved generic (Tier 1) and brand preferred (Tier 2) drugs within select therapeutic categories. Brand drugs not identified on this list as generic or brand preferred are designated as non-preferred brands (Tier 3). This Core Formulary list is not a complete list of medications, nor may be covered by your plan. Please refer to your benefit plan documents provided by your employer or plan sponsors for benefit coverage and restrictions.

The Core Formulary list is revised periodically as new drugs and new prescribing information becomes available and may change at any time during the year. You may receive notice when necessary. To get updated formulary information covered by your plan, please contact us at 1-800-710-9341.

RESTRICTIONS/LIMITATIONS

Southern Scripts incorporates drug utilization management programs such as prior authorization, step therapy and quantity limits. Some covered generics and brand medications may enforce these coverage restrictions or limitations.

Prior Authorization (PA): it is a program that promotes the use of safe, effective and reasonably-priced drug therapy. This ensures the member has met specific criteria based on the most current evidence-based medical literature and prescription drugs are prescribed appropriately and are medically necessary. Your healthcare provider is required to provide additional medical information to determine coverage. If your prior authorization is denied, please consult with your healthcare provider if the alternative, preferred drug therapy is appropriate for you.

Step Therapy (ST): it is a program that requires members to initially try preferred, medically proven and less expensive prescription drugs before “stepping up” to more expensive drugs. The goal of step therapy is to control costs and to save dollars for both member and plan. Step Therapy is an automatic process in our system, however, some costly, step therapy drugs will require a prior authorization.

Quantity Limit (QL): it is a program that ensures the drug is prescribed correctly and safely. Generics and Brands may be limited to a certain quantity per month or over a specific amount of time. We use FDA-approved recommendations and clinical guidelines to set our quantity limits. A prior authorization will be required if the drug is beyond our quantity limit and will require documentation as to why you need to exceed the quantity limit.

Southern Scripts – Core Formulary

HOW TO USE THIS FORMULARY

Core Formulary is organized by:

DRUG GROUP DRUG CLASS

DRUG NAME, FORM AND STRENGTH

TIER INFORMATION Note: Some benefits may require a deductible be met before copays apply. Please refer to your benefit plan documents for additional information.

Generics (Tier 1)- $

Generics are shown in lower-case and boldface type. They are as safe and effective as brands at a reduced cost. Not all generics may be included in the Core Formulary. Some generics are followed by a reference brand drug in (parentheses). The reference brand drug is not classified as a generic, rather the intent is for completion purposes. Specialty Generics are listed as generics and are subject to a specialty generic copay. Restrictions/Limitations (PA, ST, QL) may apply.

Brand Preferred (Tier 2) - $$

Brand-Preferred Drugs are shown in UPPERCASE. They are a higher cost than generics. Not all brand preferred drugs may be included in the Core Formulary. Specialty brand preferred drugs are listed as brand preferred and are subject to a specialty brand preferred copay. Restrictions/Limitations (PA, ST, QL) may apply.

ABBREVIATION/ACRONYM KEY:

caps- capsules inhal- inhalation sa – sustained action chew – chewable inj- injection sl – sublingual conc- concentrate liq- liquid soln – solution

CR- controlled release lotn- lotion SR- sustained release DR – delayed release nebu- nebulizer suppos – suppositories

EC- enteric coated ODT- orally disintegrating tablet susp – suspension effe- effervescent oint- ointment tab – tablets equiv- equivalent osm- osmotic release td - transdermal

ER- extended release powd - powder

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ANTI-INFECTIVE AGENTSPENICILLINSAMOXICILLIN – amoxicillin

(trihydrate) chew tab 125 mgAMOXICILLIN – amoxicillin

(trihydrate) chew tab 250 mgamoxicillin (trihydrate) cap 250 mgamoxicillin (trihydrate) cap 500 mgamoxicillin (trihydrate) for susp

125 mg/5mlamoxicillin (trihydrate) for susp



400 mg/5mlamoxicillin (trihydrate) tab 500 mgamoxicillin (trihydrate) tab 875 mgamoxicillin & k clavulanate for susp

200-28.5 mg/5mlamoxicillin & k clavulanate for susp

250-62.5 mg/5ml (Augmentin)amoxicillin & k clavulanate for susp

400-57 mg/5mlamoxicillin & k clavulanate for

susp 600-42.9 mg/5ml (Augmentines-600)

amoxicillin & k clavulanate tab250-125 mg

amoxicillin & k clavulanate tab500-125 mg (Augmentin)

amoxicillin & k clavulanate tab875-125 mg (Augmentin)

AMOXICILLIN/CLAVULANATE P –amoxicillin & k clavulanate tab er12hr 1000-62.5 mg

AMOXICILLIN/CLAVULANATE P –amoxicillin & k clavulanate chew tab200-28.5 mg

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AMOXICILLIN/CLAVULANATE P –amoxicillin & k clavulanate chew tab400-57 mg

AMPICILLIN – ampicillin cap 500 mgAUGMENTIN – amoxicillin & k

clavulanate for susp 125-31.25mg/5ml

dicloxacillin sodium cap 250 mgdicloxacillin sodium cap 500 mgPENICILLIN V POTASSIUM –

penicillin v potassium for soln 125mg/5ml

PENICILLIN V POTASSIUM –penicillin v potassium for soln 250mg/5ml

penicillin v potassium tab 250 mgpenicillin v potassium tab 500 mgCEPHALOSPORINSCEFACLOR – cefaclor cap 250 mgCEFACLOR – cefaclor cap 500 mgCEFADROXIL – cefadroxil tab 1 gmcefadroxil cap 500 mgcefadroxil for susp 250 mg/5mlcefadroxil for susp 500 mg/5mlcefdinir cap 300 mgcefdinir for susp 125 mg/5mlcefdinir for susp 250 mg/5mlcefixime cap 400 mg (Suprax)cefixime for susp 100 mg/5ml

(Suprax)cefixime for susp 200 mg/5ml

(Suprax)cefpodoxime proxetil for susp

50 mg/5mlcefpodoxime proxetil for susp

100 mg/5mlcefpodoxime proxetil tab 100 mgcefpodoxime proxetil tab 200 mgcefprozil for susp 125 mg/5ml

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cefprozil for susp 250 mg/5mlcefprozil tab 250 mgcefprozil tab 500 mgceftriaxone sodium for inj 250 mgceftriaxone sodium for inj 500 mg

(Rocephin)ceftriaxone sodium for inj 1 gm

(Rocephin)ceftriaxone sodium for inj 2 gmcefuroxime axetil tab 250 mg

(Ceftin)cefuroxime axetil tab 500 mg

(Ceftin)cephalexin cap 250 mg (Keflex)cephalexin cap 500 mg (Keflex)cephalexin for susp 125 mg/5mlcephalexin for susp 250 mg/5mlSUPRAX – cefixime for susp 500

mg/5mlSUPRAX – cefixime chew tab 100 mgSUPRAX – cefixime chew tab 200 mgMACROLIDESAZITHROMYCIN – azithromycin powd

pack for susp 1 gmazithromycin for susp 100 mg/5ml

(Zithromax)azithromycin for susp 200 mg/5ml

(Zithromax)azithromycin tab 250 mg (Zithromax)azithromycin tab 500 mg (Zithromax)azithromycin tab 600 mg (Zithromax)CLARITHROMYCIN – clarithromycin

for susp 125 mg/5mlCLARITHROMYCIN – clarithromycin

for susp 250 mg/5mlclarithromycin tab er 24hr 500 mgclarithromycin tab 250 mg (Biaxin)clarithromycin tab 500 mg (Biaxin)

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TETRACYCLINESdemeclocycline hcl tab 150 mgdemeclocycline hcl tab 300 mgdoxycycline hyclate cap 50 mgdoxycycline hyclate cap 100 mg

(Vibramycin)doxycycline hyclate tab 20 mgdoxycycline hyclate tab 100 mgdoxycycline monohydrate cap

50 mgdoxycycline monohydrate cap

100 mg (Monodox)doxycycline monohydrate tab

50 mg (Adoxa)doxycycline monohydrate tab

75 mg (Adoxa)doxycycline monohydrate tab

100 mg (Adoxa pak 1/100)doxycycline monohydrate tab

150 mg (Adoxa pak 1/150)minocycline hcl cap 50 mg (Minocin)minocycline hcl cap 75 mg (Minocin)minocycline hcl cap 100 mg

(Minocin)tetracycline hcl cap 250 mg

(Tetracycline hcl)tetracycline hcl cap 500 mg

(Tetracycline hcl)FLUOROQUINOLONESCIPRO – ciprofloxacin for oral susp

500 mg/5ml (10%) (10 gm/100ml)CIPROFLOXACIN HCL –

ciprofloxacin hcl tab 100 mg (baseequiv)

ciprofloxacin hcl tab 250 mg (baseequiv) (Cipro)

ciprofloxacin hcl tab 500 mg (baseequiv) (Cipro)

ciprofloxacin hcl tab 750 mg (baseequiv)

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levofloxacin oral soln 25 mg/ml(Levaquin)

levofloxacin tab 250 mg (Levaquin)levofloxacin tab 500 mg (Levaquin)levofloxacin tab 750 mg (Levaquin)ofloxacin tab 400 mgAMINOGLYCOSIDESneomycin sulfate tab 500 mgPAROMOMYCIN SULFATE –

paromomycin sulfate cap 250 mgtobramycin nebu soln 300 mg/5ml

(Tobi)•

SULFADIAZINE – sulfadiazine tab500 mg

ANTIMYCOBACTERIAL AGENTSethambutol hcl tab 100 mg

(Myambutol)ethambutol hcl tab 400 mg

(Myambutol)ISONIAZID – isoniazid tab 100 mgISONIAZID – isoniazid syrup 50

mg/5mlisoniazid tab 300 mgPRIFTIN – rifapentine tab 150 mgPYRAZINAMIDE – pyrazinamide tab

500 mgrifabutin cap 150 mg (Mycobutin)rifampin cap 150 mg (Rifadin)rifampin cap 300 mg (Rifadin)ANTIFUNGALSfluconazole for susp 10 mg/ml

(Diflucan)fluconazole for susp 40 mg/ml

(Diflucan)fluconazole tab 50 mg (Diflucan)fluconazole tab 100 mg (Diflucan)fluconazole tab 150 mg (Diflucan)fluconazole tab 200 mg (Diflucan)

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flucytosine cap 250 mg (Ancobon)flucytosine cap 500 mg (Ancobon)griseofulvin microsize susp

125 mg/5mlgriseofulvin microsize tab 500 mg

(Grifulvin v)itraconazole cap 100 mg (Sporanox)itraconazole oral soln 10 mg/ml

(Sporanox)NOXAFIL – posaconazole susp 40

mg/mlnystatin tab 500000 unitposaconazole tab delayed release

100 mg (Noxafil)terbinafine hcl tab 250 mg (Lamisil)voriconazole for susp 40 mg/ml

(Vfend)voriconazole tab 50 mg (Vfend)voriconazole tab 200 mg (Vfend)ANTIVIRALSabacavir sulfate soln 20 mg/ml

(base equiv) (Ziagen)abacavir sulfate tab 300 mg (base

equiv) (Ziagen)abacavir sulfate-lamivudine tab

600-300 mg (Epzicom)abacavir sulfate-lamivudine-

zidovudine tab 300-150-300 mg(Trizivir)

acyclovir cap 200 mg (Zovirax)acyclovir susp 200 mg/5ml (Zovirax)acyclovir tab 400 mg (Zovirax)acyclovir tab 800 mg (Zovirax)adefovir dipivoxil tab 10 mg

(Hepsera)atazanavir sulfate cap 150 mg (base

equiv) (Reyataz)atazanavir sulfate cap 200 mg (base

equiv) (Reyataz)

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atazanavir sulfate cap 300 mg (baseequiv) (Reyataz)

BARACLUDE – entecavir oral soln0.05 mg/ml

BIKTARVY – bictegravir-emtricitabine-tenofovir af tab 50-200-25 mg

CIMDUO – lamivudine-tenofovirdisoproxil fumarate tab 300-300 mg

DELSTRIGO – doravirine-lamivudine-tenofovir df tab 100-300-300 mg

DESCOVY – emtricitabine-tenofoviralafenamide fumarate tab 200-25mg

DOVATO – dolutegravir sodium-lamivudine tab 50-300 mg (base eq)

efavirenz cap 50 mg (Sustiva)efavirenz cap 200 mg (Sustiva)efavirenz tab 600 mg (Sustiva)efavirenz-emtricitabine-tenofovir df

tab 600-200-300 mg (Atripla)efavirenz-lamivudine-tenofovir df

tab 400-300-300 mg (Symfi lo)efavirenz-lamivudine-tenofovir df

tab 600-300-300 mg (Symfi)emtricitabine-tenofovir disoproxil

fumarate tab 100-150 mg(Truvada)

emtricitabine-tenofovir disoproxilfumarate tab 133-200 mg(Truvada)



entecavir tab 0.5 mg (Baraclude)entecavir tab 1 mg (Baraclude)EPCLUSA – sofosbuvir-velpatasvir

tab 200-50 mg• • •

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EPCLUSA – sofosbuvir-velpatasvirtab 400-100 mg

• • •

EPIVIR HBV – lamivudine oral soln 5mg/ml (hbv)

EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg (baseequiv)

famciclovir tab 125 mg (Famvir)famciclovir tab 250 mg (Famvir)famciclovir tab 500 mg (Famvir)GENVOYA – elvitegrav-cobic-

emtricitab-tenofov af tab150-150-200-10 mg

HARVONI – ledipasvir-sofosbuvir tab45-200 mg

• • •

HARVONI – ledipasvir-sofosbuvir tab90-400 mg

• • •

HARVONI – ledipasvir-sofosbuvirpellet pack 33.75-150 mg

• • •

HARVONI – ledipasvir-sofosbuvirpellet pack 45-200 mg

• • •

INTELENCE – etravirine tab 25 mgINTELENCE – etravirine tab 100 mgINTELENCE – etravirine tab 200 mgISENTRESS – raltegravir potassium

packet for susp 100 mg (base equiv)ISENTRESS – raltegravir potassium

tab 400 mg (base equiv)ISENTRESS – raltegravir potassium

chew tab 25 mg (base equiv)ISENTRESS – raltegravir potassium

chew tab 100 mg (base equiv)ISENTRESS HD – raltegravir

potassium tab 600 mg (base equiv)JULUCA – dolutegravir sodium-

rilpivirine hcl tab 50-25 mg (base eq)KALETRA – lopinavir-ritonavir tab

100-25 mgKALETRA – lopinavir-ritonavir tab

200-50 mg

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lamivudine oral soln 10 mg/ml(Epivir)

lamivudine tab 100 mg (hbv) (Epivirhbv)

lamivudine tab 150 mg (Epivir)lamivudine tab 300 mg (Epivir)lamivudine-zidovudine tab

150-300 mg (Combivir)LEDIPASVIR/SOFOSBUVIR –

ledipasvir-sofosbuvir tab 90-400 mg• • •

lopinavir-ritonavir soln400-100 mg/5ml (80-20 mg/ml)(Kaletra)

MAVYRET – glecaprevir-pibrentasvirtab 100-40 mg

• • •

NEVIRAPINE ER – nevirapine tab er24hr 100 mg

nevirapine susp 50 mg/5ml(Viramune)

nevirapine tab er 24hr 400 mg(Viramune xr)

nevirapine tab 200 mg (Viramune)NORVIR – ritonavir oral soln 80 mg/mlNORVIR – ritonavir powder packet

100 mgODEFSEY – emtricitabine-rilpivirine-

tenofovir af tab 200-25-25 mgoseltamivir phosphate cap 30 mg

(base equiv) (Tamiflu)oseltamivir phosphate cap 45 mg

(base equiv) (Tamiflu)oseltamivir phosphate cap 75 mg

(base equiv) (Tamiflu)oseltamivir phosphate for susp

6 mg/ml (base equiv) (Tamiflu)PEGASYS – peginterferon alfa-2a inj

180 mcg/ml• •

PEGASYS – peginterferon alfa-2a inj180 mcg/0.5ml

• •

PREZCOBIX – darunavir-cobicistattab 800-150 mg

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PREZISTA – darunavir ethanolatesusp 100 mg/ml (base equiv)

PREZISTA – darunavir ethanolate tab75 mg (base equiv)




ribavirin cap 200 mg (Rebetol) •ribavirin tab 200 mg (Copegus) •ritonavir tab 100 mg (Norvir)SOFOSBUVIR/VELPATASVIR –

sofosbuvir-velpatasvir tab 400-100mg

• • •

SOVALDI – sofosbuvir tab 200 mg • • •SOVALDI – sofosbuvir tab 400 mg • • •SOVALDI – sofosbuvir pellet pack 150

mg• • •

SOVALDI – sofosbuvir pellet pack 200mg

• • •

STAVUDINE – stavudine cap 15 mgSTAVUDINE – stavudine cap 20 mgSTAVUDINE – stavudine cap 30 mgSTAVUDINE – stavudine cap 40 mgSYMTUZA – darunavir-cobic-

emtricitab-tenofov af tab800-150-200-10 mg

TEMIXYS – lamivudine-tenofovirdisoproxil fumarate tab 300-300 mg

tenofovir disoproxil fumarate tab300 mg (Viread)

TIVICAY – dolutegravir sodium tab 10mg (base equiv)



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TIVICAY PD – dolutegravir sodium tabfor oral susp 5 mg (base equiv)

TRIUMEQ – abacavir-dolutegravir-lamivudine tab 600-50-300 mg

TRUVADA – emtricitabine-tenofovirdisoproxil fumarate tab 100-150 mg




valacyclovir hcl tab 500 mg (Valtrex)valacyclovir hcl tab 1 gm (Valtrex)valganciclovir hcl for soln 50 mg/ml

(base equiv) (Valcyte)valganciclovir hcl tab 450 mg (base

equivalent) (Valcyte)VIREAD – tenofovir disoproxil

fumarate oral powder 40 mg/gmVIREAD – tenofovir disoproxil

fumarate tab 150 mgVIREAD – tenofovir disoproxil

fumarate tab 200 mgVIREAD – tenofovir disoproxil

fumarate tab 250 mgVOSEVI – sofosbuvir-velpatasvir-

voxilaprevir tab 400-100-100 mg• • •

zidovudine cap 100 mg (Retrovir)zidovudine syrup 10 mg/ml

(Retrovir)zidovudine tab 300 mgANTIMALARIALSatovaquone-proguanil hcl tab

62.5-25 mg (Malarone)atovaquone-proguanil hcl tab

250-100 mg (Malarone)CHLOROQUINE PHOSPHATE –

chloroquine phosphate tab 500 mgchloroquine phosphate tab 250 mg

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COARTEM – artemether-lumefantrinetab 20-120 mg

hydroxychloroquine sulfate tab200 mg (Plaquenil)

MEFLOQUINE HCL – mefloquine hcltab 250 mg

primaquine phosphate tab 26.3 mg(15 mg base) (Primaquinephosphate)

pyrimethamine tab 25 mg(Daraprim)

SOLOSEC – secnidazole granulespacket 2 gm

ANTHELMINTICSalbendazole tab 200 mg (Albenza)BENZNIDAZOLE – benznidazole tab

12.5 mgBENZNIDAZOLE – benznidazole tab

100 mgivermectin tab 3 mg (Stromectol)praziquantel tab 600 mg (Biltricide)ANTI-INFECTIVE AGENTS - MISC.ALINIA – nitazoxanide tab 500 mgALINIA – nitazoxanide for susp 100

mg/5mlclindamycin hcl cap 75 mg (Cleocin)clindamycin hcl cap 150 mg

(Cleocin)clindamycin hcl cap 300 mg

(Cleocin)clindamycin palmitate hcl for soln

75 mg/5ml (base equiv) (Cleocinpediatric gr)

dapsone tab 25 mgdapsone tab 100 mgIMPAVIDO – miltefosine cap 50 mglinezolid for susp 100 mg/5ml

(Zyvox)linezolid tab 600 mg (Zyvox)metronidazole tab 250 mg (Flagyl)

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metronidazole tab 500 mg (Flagyl)nitazoxanide tab 500 mg (Alinia)nitrofurantoin macrocrystalline cap

25 mg (Macrodantin)nitrofurantoin macrocrystalline cap

50 mg (Macrodantin)nitrofurantoin macrocrystalline cap

100 mg (Macrodantin)nitrofurantoin monohydrate

macrocrystalline cap 100 mg(Macrobid)

nitrofurantoin susp 25 mg/5mlpentamidine isethionate for

nebulization soln 300 mg(Nebupent)

SIVEXTRO – tedizolid phosphate tab200 mg

sulfamethoxazole-trimethoprimsusp 200-40 mg/5ml

sulfamethoxazole-trimethoprim tab400-80 mg (Bactrim)

sulfamethoxazole-trimethoprim tab800-160 mg (Bactrim ds)

trimethoprim tab 100 mgvancomycin hcl cap 125 mg (base

equivalent) (Vancocin hcl)vancomycin hcl cap 250 mg (base

equivalent) (Vancocin hcl)XIFAXAN – rifaximin tab 550 mgBIOLOGICALSPASSIVE IMMUNIZING AGENTSSYNAGIS – palivizumab im soln 50

mg/0.5ml•

SYNAGIS – palivizumab im soln 100mg/ml

•

ANTINEOPLASTIC AGENTSANTINEOPLASTICSabiraterone acetate tab 250 mg

(Zytiga)•

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abiraterone acetate tab 500 mg(Zytiga)

•

ACTIMMUNE – interferon gamma-1binj 100 mcg/0.5ml (2000000unit/0.5ml)

•

AFINITOR – everolimus tab 10 mg •AFINITOR DISPERZ – everolimus tab

for oral susp 2 mg•

AFINITOR DISPERZ – everolimus tabfor oral susp 3 mg

•

AFINITOR DISPERZ – everolimus tabfor oral susp 5 mg

•

ALECENSA – alectinib hcl cap 150mg (base equivalent)

•

ALUNBRIG – brigatinib tab initiationtherapy pack 90 mg & 180 mg

•

ALUNBRIG – brigatinib tab 30 mg •ALUNBRIG – brigatinib tab 90 mg •ALUNBRIG – brigatinib tab 180 mg •anastrozole tab 1 mg (Arimidex)AYVAKIT – avapritinib tab 100 mg •AYVAKIT – avapritinib tab 200 mg •AYVAKIT – avapritinib tab 300 mg •bexarotene cap 75 mg (Targretin) •bicalutamide tab 50 mg (Casodex) •BOSULIF – bosutinib tab 100 mg •BOSULIF – bosutinib tab 400 mg •BOSULIF – bosutinib tab 500 mg •CABOMETYX – cabozantinib s-

malate tab 20 mg (base equivalent)•

CABOMETYX – cabozantinib s-malate tab 40 mg (base equivalent)

•

CABOMETYX – cabozantinib s-malate tab 60 mg (base equivalent)

•

capecitabine tab 150 mg (Xeloda) •capecitabine tab 500 mg (Xeloda) •CAPRELSA – vandetanib tab 100 mg •CAPRELSA – vandetanib tab 300 mg •

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COMETRIQ – cabozantinib s-malatecap 3 x 20 mg (60 mg dose) kit

•

COMETRIQ – cabozantinib s-mal cap1 x 80 mg & 1 x 20 mg (100 dose)kit

•

COMETRIQ – cabozantinib s-mal cap1 x 80 mg & 3 x 20 mg (140 dose)kit

•

COTELLIC – cobimetinib fumarate tab20 mg (base equivalent)

•

cyclophosphamide cap 25 mg(Cyclophosphamide)

•

cyclophosphamide cap 50 mg(Cyclophosphamide)

•

EMCYT – estramustine phosphatesodium cap 140 mg

•

ERIVEDGE – vismodegib cap 150 mg •ERLEADA – apalutamide tab 60 mg •erlotinib hcl tab 25 mg (base

equivalent) (Tarceva)•

erlotinib hcl tab 100 mg (baseequivalent) (Tarceva)

•

erlotinib hcl tab 150 mg (baseequivalent) (Tarceva)

•

ETOPOSIDE – etoposide cap 50 mg •everolimus tab 2.5 mg (Afinitor) •everolimus tab 5 mg (Afinitor) •everolimus tab 7.5 mg (Afinitor) •exemestane tab 25 mg (Aromasin)FARYDAK – panobinostat lactate cap

10 mg (base equivalent)•

FARYDAK – panobinostat lactate cap15 mg (base equivalent)

•

FARYDAK – panobinostat lactate cap20 mg (base equivalent)

•

FLUTAMIDE – flutamide cap 125 mg •GILOTRIF – afatinib dimaleate tab 20

mg (base equivalent)•

GILOTRIF – afatinib dimaleate tab 30mg (base equivalent)

•

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GILOTRIF – afatinib dimaleate tab 40mg (base equivalent)

•

GLEOSTINE – lomustine cap 10 mg •GLEOSTINE – lomustine cap 40 mg •GLEOSTINE – lomustine cap 100 mg •HYCAMTIN – topotecan hcl cap 0.25

mg (base equiv)•

HYCAMTIN – topotecan hcl cap 1 mg(base equiv)

•

hydroxyurea cap 500 mg (Hydrea) •IBRANCE – palbociclib cap 75 mg •IBRANCE – palbociclib cap 100 mg •IBRANCE – palbociclib cap 125 mg •IBRANCE – palbociclib tab 75 mg •IBRANCE – palbociclib tab 100 mg •IBRANCE – palbociclib tab 125 mg •ICLUSIG – ponatinib hcl tab 10 mg

(base equiv)•

ICLUSIG – ponatinib hcl tab 15 mg(base equiv)

•


•


•

imatinib mesylate tab 100 mg (baseequivalent) (Gleevec)

•

imatinib mesylate tab 400 mg (baseequivalent) (Gleevec)

•

IMBRUVICA – ibrutinib cap 70 mg •IMBRUVICA – ibrutinib cap 140 mg •IMBRUVICA – ibrutinib tab 140 mg •IMBRUVICA – ibrutinib tab 280 mg •IMBRUVICA – ibrutinib tab 420 mg •IMBRUVICA – ibrutinib tab 560 mg •INLYTA – axitinib tab 1 mg •INLYTA – axitinib tab 5 mg •IRESSA – gefitinib tab 250 mg •

2021

FID 568 July 2021 9

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JAKAFI – ruxolitinib phosphate tab 5mg (base equivalent)

•


•


•


•


•

KISQALI – ribociclib succinate tabpack 200 mg daily dose

•

KISQALI – ribociclib succinate tabpack 400 mg daily dose (200 mgtab)

•

KISQALI – ribociclib succinate tabpack 600 mg daily dose (200 mgtab)

•

KISQALI FEMARA 200 DOSE –ribociclib 200 mg dose (200 mg tab)& letrozole 2.5 mg tbpk

•


•


•

lapatinib ditosylate tab 250 mg(base equiv) (Tykerb)

•

LENVIMA 10 MG DAILY DOSE –lenvatinib cap therapy pack 10 mg(10 mg daily dose)

•

LENVIMA 12MG DAILY DOSE –lenvatinib cap therapy pack 3 x 4mg (12 mg daily dose)

•

LENVIMA 14 MG DAILY DOSE –lenvatinib cap therapy pack 10 & 4mg (14 mg daily dose)

•

LENVIMA 18 MG DAILY DOSE –lenvatinib cap ther pack 10 mg & 2 x4 mg (18 mg daily dose)

•

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LENVIMA 20 MG DAILY DOSE –lenvatinib cap therapy pack 2 x 10mg (20 mg daily dose)

•

LENVIMA 24 MG DAILY DOSE –lenvatinib cap ther pack 2 x 10 mg &4 mg (24 mg daily dose)

•

LENVIMA 4 MG DAILY DOSE –lenvatinib cap therapy pack 4 mg (4mg daily dose)

•

LENVIMA 8 MG DAILY DOSE –lenvatinib cap therapy pack 2 x 4mg (8 mg daily dose)

•

letrozole tab 2.5 mg (Femara)leucovorin calcium tab 5 mgleucovorin calcium tab 10 mgleucovorin calcium tab 15 mgleucovorin calcium tab 25 mgLEUKERAN – chlorambucil tab 2 mg •LONSURF – trifluridine-tipiracil tab

15-6.14 mg•

LONSURF – trifluridine-tipiracil tab20-8.19 mg

•

LYNPARZA – olaparib tab 100 mg •LYNPARZA – olaparib tab 150 mg •LYSODREN – mitotane tab 500 mg •MATULANE – procarbazine hcl cap 50

mg•

megestrol acetate susp 40 mg/ml(Megace oral)

megestrol acetate tab 20 mgmegestrol acetate tab 40 mgMEKINIST – trametinib dimethyl

sulfoxide tab 0.5 mg (baseequivalent)

•

MEKINIST – trametinib dimethylsulfoxide tab 2 mg (base equivalent)

•

melphalan tab 2 mg (Alkeran) •mercaptopurine tab 50 mg

(Purinethol)•

MESNEX – mesna tab 400 mg

2021

FID 568 July 2021 10

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methotrexate sodium tab 2.5 mg(base equiv)

MYLERAN – busulfan tab 2 mg •NEXAVAR – sorafenib tosylate tab


nilutamide tab 150 mg (Nilandron) •NINLARO – ixazomib citrate cap 2.3


NINLARO – ixazomib citrate cap 3 mg(base equivalent)

•

NINLARO – ixazomib citrate cap 4 mg(base equivalent)

•

NUBEQA – darolutamide tab 300 mg •ODOMZO – sonidegib phosphate cap


PIQRAY 200MG DAILY DOSE –alpelisib tab therapy pack 200 mgdaily dose

•

PIQRAY 250MG DAILY DOSE –alpelisib tab pack 250 mg daily dose(200 mg & 50 mg tabs)

•

PIQRAY 300MG DAILY DOSE –alpelisib tab pack 300 mg daily dose(2x150 mg tab)

•

POMALYST – pomalidomide cap 1 mg •POMALYST – pomalidomide cap 2 mg •POMALYST – pomalidomide cap 3 mg •POMALYST – pomalidomide cap 4 mg •PURIXAN – mercaptopurine susp

2000 mg/100ml (20 mg/ml)•

RETEVMO – selpercatinib cap 40 mg •RETEVMO – selpercatinib cap 80 mg •ROZLYTREK – entrectinib cap 100

mg•

ROZLYTREK – entrectinib cap 200mg

•

RUBRACA – rucaparib camsylate tab200 mg (base equivalent)

•


•

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•

RYDAPT – midostaurin cap 25 mg •SOLTAMOX – tamoxifen citrate oral

soln 10 mg/5ml (base equivalent)SPRYCEL – dasatinib tab 20 mg •SPRYCEL – dasatinib tab 50 mg •SPRYCEL – dasatinib tab 70 mg •SPRYCEL – dasatinib tab 80 mg •SPRYCEL – dasatinib tab 100 mg •SPRYCEL – dasatinib tab 140 mg •STIVARGA – regorafenib tab 40 mg •SUTENT – sunitinib malate cap 12.5


SUTENT – sunitinib malate cap 25 mg(base equivalent)

•

SUTENT – sunitinib malate cap 37.5mg (base equivalent)

•

SUTENT – sunitinib malate cap 50 mg(base equivalent)

•

TABLOID – thioguanine tab 40 mg •TABRECTA – capmatinib hcl tab 150

mg•

TABRECTA – capmatinib hcl tab 200mg

•

TAFINLAR – dabrafenib mesylate cap50 mg (base equivalent)

•

TAFINLAR – dabrafenib mesylate cap75 mg (base equivalent)

•

TAGRISSO – osimertinib mesylate tab40 mg (base equivalent)

•

TAGRISSO – osimertinib mesylate tab80 mg (base equivalent)

•

TALZENNA – talazoparib tosylate cap0.25 mg (base equivalent)

•

TALZENNA – talazoparib tosylate cap1 mg (base equivalent)

•

tamoxifen citrate tab 10 mg (baseequivalent)

2021

FID 568 July 2021 11

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tamoxifen citrate tab 20 mg (baseequivalent)

TASIGNA – nilotinib hcl cap 50 mg(base equivalent)

•


•


•

temozolomide cap 5 mg (Temodar) •temozolomide cap 20 mg (Temodar) •temozolomide cap 100 mg

(Temodar)•

temozolomide cap 140 mg(Temodar)

•


•


•

toremifene citrate tab 60 mg (baseequivalent) (Fareston)

•

tretinoin cap 10 mg •VENCLEXTA – venetoclax tab 10 mg •VENCLEXTA – venetoclax tab 50 mg •VENCLEXTA – venetoclax tab 100 mg •VENCLEXTA STARTING PACK –

venetoclax tab therapy starter pack10 & 50 & 100 mg

•

VERZENIO – abemaciclib tab 50 mg •VERZENIO – abemaciclib tab 100 mg •VERZENIO – abemaciclib tab 150 mg •VERZENIO – abemaciclib tab 200 mg •VITRAKVI – larotrectinib sulfate oral

soln 20 mg/ml (base equivalent)•

VITRAKVI – larotrectinib sulfate cap25 mg (base equivalent)

•

VITRAKVI – larotrectinib sulfate cap100 mg (base equivalent)

•

VOTRIENT – pazopanib hcl tab 200mg (base equiv)

•

XALKORI – crizotinib cap 200 mg •

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XALKORI – crizotinib cap 250 mg •XTANDI – enzalutamide cap 40 mg •XTANDI – enzalutamide tab 40 mg •XTANDI – enzalutamide tab 80 mg •YONSA – abiraterone acetate tab 125

mg•

ZELBORAF – vemurafenib tab 240mg

•

ZOLINZA – vorinostat cap 100 mg •ZYDELIG – idelalisib tab 100 mg •ZYDELIG – idelalisib tab 150 mg •ZYKADIA – ceritinib tab 150 mg •ZYTIGA – abiraterone acetate tab 500

mg•

ENDOCRINE & METABOLIC DRUGSCORTICOSTEROIDSbudesonide delayed release

particles cap 3 mg (Entocort ec)DEXAMETHASONE –

dexamethasone soln 0.5 mg/5mlDEXAMETHASONE –

dexamethasone tab 1 mgDEXAMETHASONE –

dexamethasone tab 2 mgdexamethasone elixir 0.5 mg/5mlDEXAMETHASONE INTENSOL –

dexamethasone conc 1 mg/mldexamethasone tab 0.5 mgdexamethasone tab 0.75 mgdexamethasone tab 1.5 mgdexamethasone tab 4 mgdexamethasone tab 6 mgfludrocortisone acetate tab 0.1 mghydrocortisone tab 5 mg (Cortef)hydrocortisone tab 10 mg (Cortef)hydrocortisone tab 20 mg (Cortef)methylprednisolone tab therapy

pack 4 mg (21) (Medrol dosepak)

2021

FID 568 July 2021 12

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methylprednisolone tab 4 mg(Medrol)




PREDNISOLONE – prednisolonesyrup 15 mg/5ml (usp solutionequivalent)

prednisolone sod phosph oralsoln 6.7 mg/5ml (5 mg/5ml base)(Pediapred)

prednisolone sod phosphate oralsoln 15 mg/5ml (base equiv)(Orapred)

PREDNISONE – prednisone oral soln5 mg/5ml

prednisone tab therapy pack 5 mg(21)




prednisone tab 1 mgprednisone tab 2.5 mgprednisone tab 5 mgprednisone tab 10 mgprednisone tab 20 mgprednisone tab 50 mgANDROGEN-ANABOLICdanazol cap 50 mgdanazol cap 100 mgdanazol cap 200 mgtestosterone cypionate im inj in oil

100 mg/ml (Depo-testosterone)

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testosterone cypionate im inj in oil200 mg/ml (Depo-testosterone)

TESTOSTERONE ENANTHATE –testosterone enanthate im inj in oil200 mg/ml

testosterone td gel 25 mg/2.5gm(1%) (Androgel)

testosterone td gel 50 mg/5gm (1%)(Androgel)

testosterone td gel 12.5 mg/act (1%)(Androgel pump)

testosterone td gel20.25 mg/1.25gm (1.62%)(Androgel)

testosterone td gel 40.5 mg/2.5gm(1.62%) (Androgel)

testosterone td gel 20.25 mg/act(1.62%) (Androgel pump)

testosterone td soln 30 mg/act(Axiron)

ESTROGENSCLIMARA PRO – estradiol-

levonorgestrel td patch weekly0.045-0.015 mg/day

DIVIGEL – estradiol td gel 0.25mg/0.25gm (0.1%)



DIVIGEL – estradiol td gel 1 mg/gm(0.1%)


DUAVEE – conjugated estrogens-bazedoxifene tab 0.45-20 mg

estradiol & norethindrone acetatetab 0.5-0.1 mg (Activella)

estradiol & norethindrone acetatetab 1-0.5 mg (Activella)

estradiol tab 0.5 mg (Estrace)

2021

FID 568 July 2021 13

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estradiol tab 1 mg (Estrace)estradiol tab 2 mg (Estrace)estradiol td patch twice weekly

0.025 mg/24hr (Vivelle-dot)estradiol td patch twice weekly




0.1 mg/24hr (Vivelle-dot)estradiol td patch weekly

0.025 mg/24hr (Climara)estradiol td patch weekly

0.0375 mg/24hr (37.5 mcg/24hr)(Climara)

estradiol td patch weekly0.05 mg/24hr (Climara)




ESTROGEL – estradiol gel 0.06%(0.75 mg/1.25 gm metered-dosepump)

norethindrone acetate-ethinylestradiol tab 0.5 mg-2.5 mcg(Femhrt low dose)

norethindrone acetate-ethinylestradiol tab 1 mg-5 mcg

ORIAHNN – elagolix-estrad-noreth300-1-0.5mg & elagolix 300mg cappack

PREMARIN – estrogens, conjugatedtab 0.3 mg


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PREMPHASE – conj est 0.625(14)/conj est-medroxypro ac tab0.625-5mg(14)

PREMPRO – conjugated estrogen-medroxyprogest acetate tab 0.3-1.5mg

PREMPRO – conjugated estrogen-medroxyprogest acetate tab0.45-1.5 mg

PREMPRO – conjugated estrogen-medroxyprogest acetate tab0.625-2.5 mg

PREMPRO – conjugated estrogen-medroxyprogest acetate tab 0.625-5mg

CONTRACEPTIVESdesogest-eth estrad & eth estrad

tab 0.15-0.02/0.01 mg(21/5)(Mircette)

desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg (Cyclessa)

desogestrel & ethinyl estradiol tab0.15 mg-30 mcg (Desogen)

drospirenone-ethinyl estradiol tab3-0.02 mg (Yaz)

drospirenone-ethinyl estradiol tab3-0.03 mg (Yasmin 28)

ELLA – ulipristal acetate tab 30 mgethynodiol diacetate & ethinyl

estradiol tab 1 mg-35 mcgethynodiol diacetate & ethinyl

estradiol tab 1 mg-50 mcg (Zovia1/50e)

2021

FID 568 July 2021 14

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levonorg-eth est tab 0.1-0.02mg(84)& eth est tab 0.01mg(7)(Loseasonique)

levonorg-eth est tab0.15-0.03mg(84) & eth est tab0.01mg(7) (Seasonique)

levonorgestrel & ethinyl estradiol(91-day) tab 0.15-0.03 mg

levonorgestrel & ethinyl estradioltab 0.1 mg-20 mcg

levonorgestrel & ethinyl estradioltab 0.15 mg-30 mcg

levonorgestrel-eth estra tab0.05-30/0.075-40/0.125-30mg-mcg

medroxyprogesterone acetate imsusp prefilled syr 150 mg/ml(Depo-provera contrac)

medroxyprogesterone acetate imsusp 150 mg/ml (Depo-proveracontrac)

MIRENA – levonorgestrel releasingiud 20 mcg/day (52 mg total)

norelgestromin-ethinyl estradiol tdptwk 150-35 mcg/24hr

norethindrone & ethinyl estradioltab 0.4 mg-35 mcg (Ovcon-35)

norethindrone & ethinyl estradioltab 0.5 mg-35 mcg (Brevicon-28)

norethindrone & ethinyl estradioltab 1 mg-35 mcg (Norinyl 1+35)

norethindrone & ethinyl estradiol-fechew tab 0.4 mg-35 mcg (Femconfe)

norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35 mg-mcg(Estrostep fe)

norethindrone ace & ethinylestradiol tab 1 mg-20 mcg(Loestrin 1/20-21)

norethindrone ace & ethinylestradiol tab 1.5 mg-30 mcg(Loestrin 1.5/30-21)

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norethindrone ace & ethinylestradiol-fe tab 1 mg-20 mcg(Loestrin fe 1/20)

norethindrone ace & ethinylestradiol-fe tab 1.5 mg-30 mcg(Loestrin fe 1.5/30)

norethindrone tab 0.35 mg (Nor-qd)norethindrone-eth estradiol tab

0.5-35/0.75-35/1-35 mg-mcg(Ortho-novum 7/7/7)

norethindrone-eth estradiol tab0.5-35/1-35/0.5-35 mg-mcg (Tri-norinyl 28)

norgestimate & ethinyl estradiol tab0.25 mg-35 mcg (Ortho-cyclen)

norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg(Ortho tri-cyclen lo)

norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg(Ortho tri-cyclen)

norgestrel & ethinyl estradiol tab0.3 mg-30 mcg

NUVARING – etonogestrel-ethinylestradiol va ring 0.120-0.015mg/24hr

SKYLA – levonorgestrel releasing iud14 mcg/day (13.5 mg total)

TYBLUME – levonorgestrel & ethinylestradiol chew tab 0.1 mg-20 mcg

PROGESTINSmedroxyprogesterone acetate tab

2.5 mg (Provera)medroxyprogesterone acetate tab

5 mg (Provera)medroxyprogesterone acetate tab

10 mg (Provera)norethindrone acetate tab 5 mg

(Aygestin)progesterone cap 100 mg

(Prometrium)

2021

FID 568 July 2021 15

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progesterone cap 200 mg(Prometrium)

ANTIDIABETICSacarbose tab 25 mg (Precose)acarbose tab 50 mg (Precose)acarbose tab 100 mg (Precose)BAQSIMI ONE PACK – glucagon

nasal powder 3 mg/doseBAQSIMI TWO PACK – glucagon

nasal powder 3 mg/dosediazoxide susp 50 mg/ml

(Proglycem)FARXIGA – dapagliflozin propanediol

tab 5 mg (base equivalent)FARXIGA – dapagliflozin propanediol

tab 10 mg (base equivalent)glimepiride tab 1 mg (Amaryl)glimepiride tab 2 mg (Amaryl)glimepiride tab 4 mg (Amaryl)glipizide tab er 24hr 2.5 mg

(Glucotrol xl)glipizide tab er 24hr 5 mg (Glucotrol

xl)glipizide tab er 24hr 10 mg

(Glucotrol xl)glipizide tab 5 mg (Glucotrol)glipizide tab 10 mg (Glucotrol)glipizide-metformin hcl tab

2.5-250 mgglipizide-metformin hcl tab

2.5-500 mgglipizide-metformin hcl tab

5-500 mgglucagon (rdna) for inj kit 1 mg

(Glucagon emergency k)GLUCAGON EMERGENCY KIT –

glucagon (rdna) for inj kit 1 mgGLUCAGON EMERGENCY KIT FO –

glucagon hcl for inj 1 mg

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glyburide micronized tab 1.5 mg(Glynase)

glyburide micronized tab 3 mg(Glynase)

glyburide micronized tab 6 mg(Glynase)

glyburide tab 1.25 mgglyburide tab 2.5 mgglyburide tab 5 mgglyburide-metformin tab

1.25-250 mg (Glucovance)glyburide-metformin tab 2.5-500 mg

(Glucovance)glyburide-metformin tab 5-500 mg

(Glucovance)GLYXAMBI – empagliflozin-linagliptin

tab 10-5 mg• •

GLYXAMBI – empagliflozin-linagliptintab 25-5 mg

• •

GVOKE HYPOPEN 1-PACK –glucagon subcutaneous solutionauto-injector 0.5 mg/0.1ml

GVOKE HYPOPEN 1-PACK –glucagon subcutaneous solutionauto-injector 1 mg/0.2ml

GVOKE HYPOPEN 2-PACK –glucagon subcutaneous solutionauto-injector 0.5 mg/0.1ml

GVOKE HYPOPEN 2-PACK –glucagon subcutaneous solutionauto-injector 1 mg/0.2ml

GVOKE PFS – glucagonsubcutaneous soln pref syringe 0.5mg/0.1ml

GVOKE PFS – glucagonsubcutaneous soln pref syringe 1mg/0.2ml

INVOKAMET – canagliflozin-metformin hcl tab 50-500 mg


2021

FID 568 July 2021 16

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INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr 50-500 mg

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr 50-1000mg



INVOKANA – canagliflozin tab 100 mgINVOKANA – canagliflozin tab 300 mgJANUMET – sitagliptin-metformin hcl

tab 50-500 mg•

JANUMET – sitagliptin-metformin hcltab 50-1000 mg

•

JANUMET XR – sitagliptin-metforminhcl tab er 24hr 50-500 mg

•


•


•

JANUVIA – sitagliptin phosphate tab25 mg (base equiv)

•


•


•

JARDIANCE – empagliflozin tab 10mg

JARDIANCE – empagliflozin tab 25mg

metformin hcl tab er 24hr 500 mg(Glucophage xr)

metformin hcl tab er 24hr 750 mg(Glucophage xr)

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metformin hcl tab 500 mg(Glucophage)



nateglinide tab 60 mg (Starlix)nateglinide tab 120 mg (Starlix)OZEMPIC – semaglutide soln pen-inj

0.25 or 0.5 mg/dose (2 mg/1.5ml)OZEMPIC – semaglutide soln pen-inj

1 mg/dose (2 mg/1.5ml)OZEMPIC – semaglutide soln pen-inj

1 mg/dose (4 mg/3ml)pioglitazone hcl tab 15 mg (base

equiv) (Actos)pioglitazone hcl tab 30 mg (base

equiv) (Actos)pioglitazone hcl tab 45 mg (base

equiv) (Actos)pioglitazone hcl-metformin hcl tab

15-500 mg (Actoplus met)pioglitazone hcl-metformin hcl tab

15-850 mg (Actoplus met)repaglinide tab 0.5 mg (Prandin)repaglinide tab 1 mg (Prandin)repaglinide tab 2 mg (Prandin)RYBELSUS – semaglutide tab 3 mgRYBELSUS – semaglutide tab 7 mgRYBELSUS – semaglutide tab 14 mgSOLIQUA 100/33 – insulin glargine-

lixisenatide sol pen-inj 100-33 unit-mcg/ml

SYNJARDY – empagliflozin-metforminhcl tab 5-500 mg

SYNJARDY – empagliflozin-metforminhcl tab 5-1000 mg

SYNJARDY – empagliflozin-metforminhcl tab 12.5-500 mg

2021

FID 568 July 2021 17

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SYNJARDY – empagliflozin-metforminhcl tab 12.5-1000 mg

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr 5-1000 mg

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr 10-1000mg

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr 12.5-1000mg

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr 25-1000mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr5-2.5-1000mg

• •

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr10-5-1000 mg

• •

TRIJARDY XR – empagliflozin-linaglip-metformin tab er 24hr12.5-2.5-1000mg

• •

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr25-5-1000 mg

• •

TRULICITY – dulaglutide soln pen-injector 0.75 mg/0.5ml


TRULICITY – dulaglutide soln pen-injector 3 mg/0.5ml


VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)

XIGDUO XR – dapagliflozin-metforminhcl tab er 24hr 2.5-1000 mg

XIGDUO XR – dapagliflozin-metforminhcl tab er 24hr 5-500 mg


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XULTOPHY 100/3.6 – insulindegludec-liraglutide sol pen-inj100-3.6 unit-mg/ml

•

FIASP & FIASP FLEXTOUCH – insulin aspart (with niacinamide) soln inj 100 unit/ml

•

FIASP PENFILL – insulin aspart (withniacinamide) soln cartridge 100 unit/ml

•

INSULIN ASPART – 100 unity/ml all dosage forms

•

INSULIN LISPRO – 100 unit/ml all dosage forms

•

•NOVOLOG – insulin aspart inj 100unit/ml

•NOVOLOG FLEXPEN – insulin aspartsoln pen-injector 100 unit/ml

•NOVOLOG PENFILL – insulin aspartsoln cartridge 100 unit/ml

•

Short-Acting InsulinsHUMULIN R U-500 (CONCENTR –

insulin regular (human) inj 500 unit/ml

•

HUMULIN R U-500 KWIKPEN –insulin regular (human) soln pen-injector 500 unit/ml

•

NOVOLIN R – insulin regular (human)inj 100 unit/ml

•

NOVOLIN R FLEXPEN – insulinregular (human) soln pen-injector100 unit/ml

Intermediate-Acting Insulins

Rapid-Acting Insulins

ZEGALOGUE – dasiglucagon subq soln 0.6mg/0.6ml

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FID 568 July 2021 18

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INSULIN ASPART PROTAMINE/ –insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)

•

INSULIN ASPART PROTAMINE/ –insulin aspart prot & aspart (human)inj 100 unit/ml (70-30)

•

NOVOLIN N – insulin nph (human)(isophane) inj 100 unit/ml

•

NOVOLIN N FLEXPEN – insulin nph(human) (isophane) susp pen-injector 100 unit/ml

•

NOVOLIN 70/30 – insulin nphisophane & regular human inj 100unit/ml (70-30)

•

NOVOLIN 70/30 FLEXPEN – insulinnph & regular susp pen-inj 100 unit/ml (70-30)

•

NOVOLOG MIX 70/30 – insulin aspartprot & aspart (human) inj 100 unit/ml(70-30)

•

NOVOLOG MIX 70/30 PREFILL –insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)

•

Basal InsulinsLANTUS – insulin glargine inj 100

unit/ml•

LANTUS SOLOSTAR – insulinglargine soln pen-injector 100 unit/ml

•

LEVEMIR – insulin detemir inj 100unit/ml

•

LEVEMIR FLEXTOUCH – insulindetemir soln pen-injector 100 unit/ml

•

TOUJEO MAX SOLOSTAR – insulinglargine soln pen-injector 300 unit/ml (2 unit dial)

•

TOUJEO SOLOSTAR – insulinglargine soln pen-injector 300 unit/ml (1 unit dial)

•

TRESIBA – insulin degludec inj 100unit/ml

•

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TRESIBA FLEXTOUCH – insulindegludec soln pen-injector 100 unit/ml

•

TRESIBA FLEXTOUCH – insulindegludec soln pen-injector 200 unit/ml

•

THYROID AGENTSlevothyroxine sodium tab 25 mcg

(Synthroid)levothyroxine sodium tab 50 mcg











(Synthroid)liothyronine sodium tab 5 mcg

(Cytomel)liothyronine sodium tab 25 mcg

(Cytomel)liothyronine sodium tab 50 mcg

(Cytomel)methimazole tab 5 mg (Tapazole)methimazole tab 10 mg (Tapazole)propylthiouracil tab 50 mgSYNTHROID – levothyroxine all strengths

2021

FID 568 July 2021 19

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methylergonovine maleate tab0.2 mg

ENDOCRINE & METABOLIC AGENTS - MISC.ALENDRONATE SODIUM –

alendronate sodium tab 5 mgalendronate sodium tab 10 mgalendronate sodium tab 35 mgalendronate sodium tab 70 mg

(Fosamax)cabergoline tab 0.5 mgcalcitonin (salmon) nasal soln 200

unit/act (Miacalcin)calcitriol cap 0.25 mcg (Rocaltrol)calcitriol cap 0.5 mcg (Rocaltrol)calcitriol oral soln 1 mcg/ml

(Rocaltrol)CARBAGLU – carglumic acid tab 200

mg•

CHORIONIC GONADOTROPIN –chorionic gonadotropin for im inj10000 unit

•

cinacalcet hcl tab 30 mg (baseequiv) (Sensipar)

•


•


•

CLOMIPHENE CITRATE –clomiphene citrate tab 50 mg

CYSTADANE – betaine powder fororal solution

•

desmopressin acetate nasal spraysoln 0.01% (Ddavp)

desmopressin acetate nasal spraysoln 0.01% (refrigerated)

desmopressin acetate tab 0.1 mg(Ddavp)

desmopressin acetate tab 0.2 mg(Ddavp)

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FOLLISTIM AQ – follitropin beta inj300 unit/0.36ml

•

•


•

ganirelix acetate soln prefilledsyringe 250 mcg/0.5ml (Ganirelixacetate)

•

ibandronate sodium tab 150 mg(base equivalent) (Boniva)

INCRELEX – mecasermin inj 40mg/4ml (10 mg/ml)

•

levocarnitine oral soln 1 gm/10ml(10%) (Carnitor)

levocarnitine tab 330 mg (Carnitor)MENOPUR – menotropins for

subcutaneous inj 75 unit

•

nitisinone cap 2 mg (Orfadin)•



NITYR – nitisinone tab 2 mg•



NORDITROPIN FLEXPRO –somatropin solution pen-injector 5mg/1.5ml

• •


• •


• •

NORDITROPIN FLEXPRO –somatropin solution pen-injector 30mg/3ml

• •

NOVAREL – chorionic gonadotropinfor im inj 5000 unit

•

NOVAREL – chorionic gonadotropinfor im inj 10000 unit

•


FORTEO – teriparatide subq inj.

OXYTOCICS

2021

FID 568 July 2021 20

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octreotide acetate inj 50 mcg/ml(0.05 mg/ml) (Sandostatin)

•


•


•


•

octreotide acetate inj 1000 mcg/ml(1 mg/ml) (Sandostatin)

•

ORFADIN – nitisinone cap 20 mg •ORFADIN – nitisinone susp 4 mg/ml •ORILISSA – elagolix sodium tab 150

mg (base equiv)ORILISSA – elagolix sodium tab 200

mg (base equiv)paricalcitol cap 1 mcg (Zemplar)paricalcitol cap 2 mcg (Zemplar)paricalcitol cap 4 mcg (Zemplar)PREGNYL W/DILUENT BENZYL –

chorionic gonadotropin for im inj10000 unit

•

raloxifene hcl tab 60 mg (Evista)REVCOVI – elapegademase-lvlr im

soln 2.4 mg/1.5ml (1.6 mg/ml)•

risedronate sodium tab 5 mg(Actonel)




SANDOSTATIN LAR DEPOT –octreotide acetate for im inj kit 10mg

•


•

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•

STIMATE – desmopressin acetatenasal soln 1.5 mg/ml

STRENSIQ – asfotase alfasubcutaneous inj 18 mg/0.45ml

•


•

STRENSIQ – asfotase alfasubcutaneous inj 40 mg/ml

•


•

TYMLOS – abaloparatidesubcutaneous soln pen-injector3120 mcg/1.56ml

•

CARDIOVASCULAR AGENTSCARDIOTONICSdigoxin oral soln 0.05 mg/ml

(Digoxin)digoxin tab 125 mcg (0.125 mg)

(Lanoxin)digoxin tab 250 mcg (0.25 mg)

(Lanoxin)ANTIANGINAL AGENTSisosorbide dinitrate tab 5 mg (Isordil

titradose)isosorbide dinitrate tab 10 mgisosorbide dinitrate tab 20 mgisosorbide dinitrate tab 30 mgisosorbide mononitrate tab er 24hr

30 mgisosorbide mononitrate tab er 24hr

60 mgisosorbide mononitrate tab er 24hr

120 mgisosorbide mononitrate tab 10 mgisosorbide mononitrate tab 20 mgNITRO-BID – nitroglycerin oint 2%nitroglycerin sl tab 0.3 mg (Nitrostat)

2021

FID 568 July 2021 21

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nitroglycerin sl tab 0.4 mg (Nitrostat)nitroglycerin sl tab 0.6 mg (Nitrostat)nitroglycerin td patch 24hr 0.1 mg/

hr (Nitro-dur)nitroglycerin td patch 24hr 0.2 mg/



hr (Nitro-dur)BETA BLOCKERSacebutolol hcl cap 200 mg (Sectral)acebutolol hcl cap 400 mg (Sectral)atenolol tab 25 mg (Tenormin)atenolol tab 50 mg (Tenormin)atenolol tab 100 mg (Tenormin)bisoprolol fumarate tab 5 mg

(Zebeta)bisoprolol fumarate tab 10 mg

(Zebeta)carvedilol tab 3.125 mg (Coreg)carvedilol tab 6.25 mg (Coreg)carvedilol tab 12.5 mg (Coreg)carvedilol tab 25 mg (Coreg)labetalol hcl tab 100 mg (Trandate)labetalol hcl tab 200 mg (Trandate)labetalol hcl tab 300 mg (Trandate)metoprolol succinate tab er 24hr

25 mg (tartrate equiv) (Toprol xl)metoprolol succinate tab er 24hr



200 mg (tartrate equiv) (Toprol xl)metoprolol tartrate tab 25 mgmetoprolol tartrate tab 50 mg

(Lopressor)

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metoprolol tartrate tab 100 mg(Lopressor)

nadolol tab 20 mg (Corgard)nadolol tab 40 mg (Corgard)nadolol tab 80 mg (Corgard)pindolol tab 5 mgpindolol tab 10 mgPROPRANOLOL HCL – propranolol

hcl oral soln 20 mg/5mlPROPRANOLOL HCL – propranolol

hcl oral soln 40 mg/5mlpropranolol hcl cap er 24hr 60 mg

(Inderal la)propranolol hcl cap er 24hr 80 mg



(Inderal la)propranolol hcl tab 10 mgpropranolol hcl tab 20 mgpropranolol hcl tab 40 mgpropranolol hcl tab 60 mgpropranolol hcl tab 80 mgsotalol hcl (afib/afl) tab 80 mg

(Betapace af)sotalol hcl (afib/afl) tab 120 mg

(Betapace af)sotalol hcl (afib/afl) tab 160 mg

(Betapace af)sotalol hcl tab 80 mg (Betapace)sotalol hcl tab 120 mg (Betapace)sotalol hcl tab 160 mg (Betapace)sotalol hcl tab 240 mgtimolol maleate tab 5 mgtimolol maleate tab 10 mgtimolol maleate tab 20 mgCALCIUM CHANNEL BLOCKERS

2021

FID 568 July 2021 22

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amlodipine besylate tab 2.5 mg(base equivalent) (Norvasc)

amlodipine besylate tab 5 mg (baseequivalent) (Norvasc)

amlodipine besylate tab 10 mg(base equivalent) (Norvasc)

diltiazem hcl cap er 24hr 120 mgdiltiazem hcl cap er 24hr 180 mgdiltiazem hcl cap er 24hr 240 mgdiltiazem hcl coated beads cap er

24hr 120 mg (Cardizem cd)diltiazem hcl coated beads cap er




24hr 360 mg (Cardizem cd)diltiazem hcl extended release

beads cap er 24hr 120 mg (Tiazac)diltiazem hcl extended release





beads cap er 24hr 420 mg (Tiazac)diltiazem hcl tab 30 mg (Cardizem)diltiazem hcl tab 60 mg (Cardizem)diltiazem hcl tab 90 mgdiltiazem hcl tab 120 mg (Cardizem)felodipine tab er 24hr 2.5 mgfelodipine tab er 24hr 5 mgfelodipine tab er 24hr 10 mgnifedipine tab er 24hr 30 mg

Drug Name Spe

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nifedipine tab er 24hr 60 mgnifedipine tab er 24hr 90 mgnifedipine tab er 24hr osmotic

release 30 mg (Procardia xl)nifedipine tab er 24hr osmotic

release 60 mg (Procardia xl)nifedipine tab er 24hr osmotic

release 90 mg (Procardia xl)nimodipine cap 30 mgverapamil hcl cap er 24hr 120 mg

(Verelan)verapamil hcl cap er 24hr 180 mg

(Verelan)verapamil hcl cap er 24hr 240 mg

(Verelan)VERAPAMIL HCL SR – verapamil hcl

cap er 24hr 360 mgverapamil hcl tab er 120 mg (Calan

sr)verapamil hcl tab er 180 mg (Calan

sr)verapamil hcl tab er 240 mg (Calan

sr)verapamil hcl tab 40 mgverapamil hcl tab 80 mg (Calan)verapamil hcl tab 120 mg (Calan)ANTIARRHYTHMICSamiodarone hcl tab 100 mgamiodarone hcl tab 200 mg

(Cordarone)amiodarone hcl tab 400 mgdisopyramide phosphate cap

100 mg (Norpace)disopyramide phosphate cap

150 mg (Norpace)flecainide acetate tab 50 mgflecainide acetate tab 100 mgflecainide acetate tab 150 mgmexiletine hcl cap 150 mg

2021

FID 568 July 2021 23

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mexiletine hcl cap 200 mgmexiletine hcl cap 250 mgMULTAQ – dronedarone hcl tab 400

mg (base equivalent)propafenone hcl cap er 12hr

225 mg (Rythmol sr)propafenone hcl cap er 12hr

325 mg (Rythmol sr)propafenone hcl cap er 12hr

425 mg (Rythmol sr)propafenone hcl tab 150 mg

(Rythmol)propafenone hcl tab 225 mg

(Rythmol)propafenone hcl tab 300 mgquinidine gluconate tab er 324 mgQUINIDINE SULFATE – quinidine

sulfate tab 200 mgQUINIDINE SULFATE – quinidine

sulfate tab 300 mgANTIHYPERTENSIVESamlodipine besylate-benazepril hcl

cap 2.5-10 mg (Lotrel)amlodipine besylate-benazepril hcl

cap 5-10 mg (Lotrel)amlodipine besylate-benazepril hcl




cap 10-40 mg (Lotrel)amlodipine besylate-valsartan tab

5-160 mg (Exforge)amlodipine besylate-valsartan tab

5-320 mg (Exforge)amlodipine besylate-valsartan tab

10-160 mg (Exforge)

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amlodipine besylate-valsartan tab10-320 mg (Exforge)

amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)

amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg (Exforge hct)

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct)



atenolol & chlorthalidone tab50-25 mg (Tenoretic 50)

atenolol & chlorthalidone tab100-25 mg (Tenoretic 100)

benazepril & hydrochlorothiazidetab 5-6.25 mg

benazepril & hydrochlorothiazidetab 10-12.5 mg (Lotensin hct)

benazepril & hydrochlorothiazidetab 20-12.5 mg (Lotensin hct)

benazepril & hydrochlorothiazidetab 20-25 mg (Lotensin hct)

benazepril hcl tab 5 mgbenazepril hcl tab 10 mg (Lotensin)benazepril hcl tab 20 mg (Lotensin)benazepril hcl tab 40 mg (Lotensin)bisoprolol & hydrochlorothiazide

tab 2.5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide

tab 5-6.25 mg (Ziac)bisoprolol & hydrochlorothiazide

tab 10-6.25 mg (Ziac)candesartan cilexetil tab 4 mg

(Atacand)

2021

FID 568 July 2021 24

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candesartan cilexetil tab 8 mg(Atacand)



candesartan cilexetil-hydrochlorothiazide tab16-12.5 mg (Atacand hct)

candesartan cilexetil-hydrochlorothiazide tab32-12.5 mg (Atacand hct)

candesartan cilexetil-hydrochlorothiazide tab 32-25 mg(Atacand hct)

captopril tab 12.5 mgcaptopril tab 25 mgcaptopril tab 50 mgcaptopril tab 100 mgCAPTOPRIL/HYDROCHLOROTHIA –

captopril & hydrochlorothiazide tab25-15 mg

CAPTOPRIL/HYDROCHLOROTHIA –captopril & hydrochlorothiazide tab25-25 mg



clonidine hcl tab 0.1 mg (Catapres)clonidine hcl tab 0.2 mg (Catapres)clonidine hcl tab 0.3 mg (Catapres)clonidine td patch weekly

0.1 mg/24hr (Catapres-tts-1)clonidine td patch weekly

0.2 mg/24hr (Catapres-tts-2)clonidine td patch weekly

0.3 mg/24hr (Catapres-tts-3)

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doxazosin mesylate tab 1 mg(Cardura)




enalapril maleate &hydrochlorothiazide tab 5-12.5 mg

enalapril maleate &hydrochlorothiazide tab 10-25 mg(Vaseretic)

enalapril maleate tab 2.5 mg(Vasotec)

enalapril maleate tab 5 mg (Vasotec)enalapril maleate tab 10 mg

(Vasotec)enalapril maleate tab 20 mg

(Vasotec)eplerenone tab 25 mg (Inspra)eplerenone tab 50 mg (Inspra)fosinopril sodium &

hydrochlorothiazide tab10-12.5 mg

fosinopril sodium &hydrochlorothiazide tab20-12.5 mg

fosinopril sodium tab 10 mgfosinopril sodium tab 20 mgfosinopril sodium tab 40 mgguanfacine hcl tab 1 mg (Tenex)guanfacine hcl tab 2 mg (Tenex)hydralazine hcl tab 10 mghydralazine hcl tab 25 mghydralazine hcl tab 50 mghydralazine hcl tab 100 mgirbesartan tab 75 mg (Avapro)irbesartan tab 150 mg (Avapro)

2021

FID 568 July 2021 25

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irbesartan tab 300 mg (Avapro)irbesartan-hydrochlorothiazide tab

150-12.5 mg (Avalide)irbesartan-hydrochlorothiazide tab

300-12.5 mg (Avalide)lisinopril & hydrochlorothiazide tab

10-12.5 mg (Zestoretic)lisinopril & hydrochlorothiazide tab

20-12.5 mg (Zestoretic)lisinopril & hydrochlorothiazide tab

20-25 mg (Zestoretic)lisinopril tab 2.5 mg (Zestril)lisinopril tab 5 mg (Prinivil)lisinopril tab 10 mg (Prinivil)lisinopril tab 20 mg (Prinivil)lisinopril tab 30 mg (Zestril)lisinopril tab 40 mg (Zestril)losartan potassium &

hydrochlorothiazide tab50-12.5 mg (Hyzaar)

losartan potassium &hydrochlorothiazide tab100-12.5 mg (Hyzaar)

losartan potassium &hydrochlorothiazide tab100-25 mg (Hyzaar)

losartan potassium tab 25 mg(Cozaar)



methyldopa tab 250 mgmethyldopa tab 500 mgmetoprolol & hydrochlorothiazide

tab 50-25 mg (Lopressor hct)metoprolol & hydrochlorothiazide

tab 100-25 mg (Lopressor hct)

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METOPROLOL/HYDROCHLOROTHI– metoprolol & hydrochlorothiazidetab 100-50 mg

minoxidil tab 2.5 mgminoxidil tab 10 mgmoexipril hcl tab 7.5 mg (Univasc)moexipril hcl tab 15 mg (Univasc)olmesartan medoxomil tab 5 mg

(Benicar)olmesartan medoxomil tab 20 mg

(Benicar)olmesartan medoxomil tab 40 mg

(Benicar)olmesartan medoxomil-

hydrochlorothiazide tab20-12.5 mg (Benicar hct)

olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg (Benicar hct)

olmesartan medoxomil-hydrochlorothiazide tab 40-25 mg(Benicar hct)

perindopril erbumine tab 2 mgperindopril erbumine tab 4 mg

(Aceon)perindopril erbumine tab 8 mg

(Aceon)phenoxybenzamine hcl cap 10 mg

(Dibenzyline)prazosin hcl cap 1 mg (Minipress)prazosin hcl cap 2 mg (Minipress)prazosin hcl cap 5 mg (Minipress)PROPRANOLOL/

HYDROCHLOROTH – propranolol& hydrochlorothiazide tab 40-25 mg

PROPRANOLOL/HYDROCHLOROTH – propranolol& hydrochlorothiazide tab 80-25 mg

quinapril hcl tab 5 mg (Accupril)quinapril hcl tab 10 mg (Accupril)

2021

FID 568 July 2021 26

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quinapril hcl tab 20 mg (Accupril)quinapril hcl tab 40 mg (Accupril)quinapril-hydrochlorothiazide tab

10-12.5 mg (Accuretic)quinapril-hydrochlorothiazide tab

20-12.5 mg (Accuretic)quinapril-hydrochlorothiazide tab

20-25 mg (Accuretic)ramipril cap 1.25 mg (Altace)ramipril cap 2.5 mg (Altace)ramipril cap 5 mg (Altace)ramipril cap 10 mg (Altace)telmisartan tab 20 mg (Micardis)telmisartan tab 40 mg (Micardis)telmisartan tab 80 mg (Micardis)telmisartan-hydrochlorothiazide tab

40-12.5 mg (Micardis hct)telmisartan-hydrochlorothiazide tab

80-12.5 mg (Micardis hct)telmisartan-hydrochlorothiazide tab

80-25 mg (Micardis hct)terazosin hcl cap 1 mg (base

equivalent)terazosin hcl cap 2 mg (base



equivalent)trandolapril tab 1 mg (Mavik)trandolapril tab 2 mg (Mavik)trandolapril tab 4 mg (Mavik)valsartan tab 40 mg (Diovan)valsartan tab 80 mg (Diovan)valsartan tab 160 mg (Diovan)valsartan tab 320 mg (Diovan)valsartan-hydrochlorothiazide tab

80-12.5 mg (Diovan hct)

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valsartan-hydrochlorothiazide tab160-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab160-25 mg (Diovan hct)

valsartan-hydrochlorothiazide tab320-12.5 mg (Diovan hct)

valsartan-hydrochlorothiazide tab320-25 mg (Diovan hct)

DIURETICSacetazolamide cap er 12hr 500 mgacetazolamide tab 125 mgacetazolamide tab 250 mgamiloride & hydrochlorothiazide tab

5-50 mgamiloride hcl tab 5 mgbumetanide tab 0.5 mgbumetanide tab 1 mgbumetanide tab 2 mgchlorthalidone tab 25 mgchlorthalidone tab 50 mgfurosemide oral soln 10 mg/mlfurosemide tab 20 mg (Lasix)furosemide tab 40 mg (Lasix)furosemide tab 80 mg (Lasix)hydrochlorothiazide cap 12.5 mg

(Microzide)hydrochlorothiazide tab 12.5 mghydrochlorothiazide tab 25 mghydrochlorothiazide tab 50 mgindapamide tab 1.25 mgindapamide tab 2.5 mgmethazolamide tab 25 mg

(Neptazane)methazolamide tab 50 mg

(Neptazane)metolazone tab 2.5 mg (Zaroxolyn)metolazone tab 5 mg (Zaroxolyn)metolazone tab 10 mg

2021

FID 568 July 2021 27

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spironolactone &hydrochlorothiazide tab 25-25 mg(Aldactazide)

spironolactone tab 25 mg(Aldactone)



torsemide tab 5 mg (Demadex)torsemide tab 10 mg (Demadex)torsemide tab 20 mg (Demadex)torsemide tab 100 mg (Demadex)triamterene & hydrochlorothiazide

cap 37.5-25 mg (Dyazide)triamterene & hydrochlorothiazide

tab 37.5-25 mg (Maxzide-25)triamterene & hydrochlorothiazide

tab 75-50 mg (Maxzide)VASOPRESSORSepinephrine solution auto-injector

0.15 mg/0.3ml (1:2000) (Epipen-jr2-pak)

epinephrine solution auto-injector0.3 mg/0.3ml (1:1000) (Epipen 2-pak)

midodrine hcl tab 2.5 mgmidodrine hcl tab 5 mgmidodrine hcl tab 10 mgSYMJEPI – epinephrine soln prefilled

syringe 0.15 mg/0.3ml (1:2000)SYMJEPI – epinephrine solution

prefilled syringe 0.3 mg/0.3ml(1:1000)

ANTIHYPERLIPIDEMICSatorvastatin calcium tab 10 mg

(base equivalent) (Lipitor)atorvastatin calcium tab 20 mg

(base equivalent) (Lipitor)

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atorvastatin calcium tab 40 mg(base equivalent) (Lipitor)

atorvastatin calcium tab 80 mg(base equivalent) (Lipitor)

cholestyramine light powderpackets 4 gm

cholestyramine light powder 4 gm/dose (Questran light)

cholestyramine powder packets4 gm (Questran)

cholestyramine powder 4 gm/dose(Questran)

choline fenofibrate cap dr 45 mg(fenofibric acid equiv) (Trilipix)

colesevelam hcl packet for susp3.75 gm (Welchol)

colesevelam hcl tab 625 mg(Welchol)

colestipol hcl granule packets 5 gm(Colestid flavored)

colestipol hcl granules 5 gm(Colestid flavored)

colestipol hcl tab 1 gm (Colestid)ezetimibe tab 10 mg (Zetia)ezetimibe-simvastatin tab 10-10 mg

(Vytorin)ezetimibe-simvastatin tab 10-20 mg



(Vytorin)fenofibrate micronized cap 67 mg

(Lofibra)fenofibrate micronized cap 134 mg

(Lofibra)fenofibrate micronized cap 200 mg

(Lofibra)fenofibrate tab 48 mg (Tricor)fenofibrate tab 54 mg (Lofibra)

2021

FID 568 July 2021 28

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fenofibrate tab 145 mg (Tricor)fenofibrate tab 160 mg (Lofibra)gemfibrozil tab 600 mg (Lopid)lovastatin tab 10 mglovastatin tab 20 mg (Mevacor)lovastatin tab 40 mg (Mevacor)NEXLETOL – bempedoic acid tab 180

mgNEXLIZET – bempedoic acid-

ezetimibe tab 180-10 mgniacin tab er 500 mg

(antihyperlipidemic) (Niaspan)niacin tab er 750 mg

(antihyperlipidemic) (Niaspan)niacin tab er 1000 mg

(antihyperlipidemic) (Niaspan)pravastatin sodium tab 10 mgpravastatin sodium tab 20 mg

(Pravachol)pravastatin sodium tab 40 mg

(Pravachol)pravastatin sodium tab 80 mg

(Pravachol)REPATHA – evolocumab

subcutaneous soln prefilled syringe140 mg/ml

REPATHA PUSHTRONEX SYSTEM– evolocumab subcutaneous solncartridge/infusor 420 mg/3.5ml

REPATHA SURECLICK – evolocumabsubcutaneous soln auto-injector 140mg/ml

rosuvastatin calcium tab 5 mg(Crestor)




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simvastatin tab 5 mg (Zocor)simvastatin tab 10 mg (Zocor)simvastatin tab 20 mg (Zocor)simvastatin tab 40 mg (Zocor)simvastatin tab 80 mg (Zocor)CARDIOVASCULAR AGENTS - MISC.ambrisentan tab 5 & 10 mg (Letairis) •

•bosentan tab 62.5 mg (Tracleer)

•bosentan tab 125 mg (Tracleer)

•CORLANOR – ivabradine hcl oral soln

5 mg/5ml (base equiv)CORLANOR – ivabradine hcl tab 5

mg (base equiv)CORLANOR – ivabradine hcl tab 7.5

mg (base equiv)ENTRESTO – sacubitril-valsartan tab

24-26 mgENTRESTO – sacubitril-valsartan tab

49-51 mgENTRESTO – sacubitril-valsartan tab

97-103 mgOPSUMIT – macitentan tab 10 mg •sildenafil citrate tab 20 mg (Revatio) •tadalafil tab 20 mg (pah) (Adcirca) •tadalafil tab 2.5 mg (Cialis)tadalafil tab 5 mg (Cialis)tadalafil tab 10 mg (Cialis)tadalafil tab 20 mg (Cialis)TRACLEER – bosentan tab for oral

susp 32 mg•

UPTRAVI – selexipag tab therapypack 200 mcg (140) & 800 mcg (60)

•

UPTRAVI – selexipag tab 200mcg, 400mcg, 600mcg, 800mcg, 1000mcg, 1200mcg, 1400mcg, 1600mcg

•••••

BYSTOLIC – nebivolol tab all strengths

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VERQUVO – vericiguat tab 2.5 mg •VERQUVO – vericiguat tab 5 mg •VERQUVO – vericiguat tab 10 mg •VYNDAMAX – tafamidis cap 61 mg •VYNDAQEL – tafamidis meglumine

(cardiac) cap 20 mg•

RESPIRATORY AGENTSANTIHISTAMINEScetirizine hcl oral soln 1 mg/ml

(5 mg/5ml)cyproheptadine hcl syrup 2 mg/5mlcyproheptadine hcl tab 4 mgDESLORATADINE ODT –

desloratadine tab orallydisintegrating 2.5 mg

DESLORATADINE ODT –desloratadine tab orallydisintegrating 5 mg

desloratadine tab 5 mg (Clarinex)levocetirizine dihydrochloride soln

2.5 mg/5ml (0.5 mg/ml) (Xyzal)levocetirizine dihydrochloride tab

5 mg (Xyzal)promethazine hcl suppos 12.5 mgpromethazine hcl suppos 25 mgpromethazine hcl syrup

6.25 mg/5mlpromethazine hcl tab 12.5 mgpromethazine hcl tab 25 mgpromethazine hcl tab 50 mgPROMETHEGAN – promethazine hcl

suppos 50 mg

azelastine hcl nasal spray 0.1%(137 mcg/spray)

azelastine hcl nasal spray 0.15%(205.5 mcg/spray) (Astepro)

FLUNISOLIDE – flunisolide nasal soln25 mcg/act (0.025%)

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fluticasone propionate nasal susp50 mcg/act (Flonase)

ipratropium bromide nasal soln0.03% (21 mcg/spray) (Atrovent)

ipratropium bromide nasal soln0.06% (42 mcg/spray) (Atrovent)

mometasone furoate nasal susp50 mcg/act (Nasonex)

COUGH/COLD/ALLERGYacetylcysteine inhal soln 10%acetylcysteine inhal soln 20%sodium chloride soln nebu 3%sodium chloride soln nebu 7%

(Hyper-sal)ANTIASTHMATIC and BRONCHODILATOR AGENTSADVAIR HFA – fluticasone-salmeterol

inhal aerosol 45-21 mcg/actADVAIR HFA – fluticasone-salmeterol

inhal aerosol 115-21 mcg/actADVAIR HFA – fluticasone-salmeterol

inhal aerosol 230-21 mcg/actalbuterol sulfate inhal aero

108 mcg/act (90mcg base equiv)(Proventil hfa)

albuterol sulfate soln nebu 0.083%(2.5 mg/3ml)

albuterol sulfate soln nebu 0.5%(5 mg/ml)

albuterol sulfate soln nebu0.63 mg/3ml (base equiv)

albuterol sulfate soln nebu1.25 mg/3ml (base equiv)

albuterol sulfate syrup 2 mg/5mlalbuterol sulfate tab 2 mgalbuterol sulfate tab 4 mgANORO ELLIPTA – umeclidinium-

vilanterol aero powd ba 62.5-25mcg/inh

NASAL AGENTS - SYSTEMIC & TOPICAL

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ARNUITY ELLIPTA – fluticasonefuroate aerosol powder breath activ50 mcg/act



ASMANEX HFA – mometasonefuroate inhal aerosol suspension 50mcg/act

ASMANEX HFA – mometasonefuroate inhal aerosol suspension100 mcg/act

ASMANEX HFA – mometasonefuroate inhal aerosol suspension200 mcg/act

ASMANEX TWISTHALER 120 ME –mometasone furoate inhal powd 220mcg/inh (breath activated)

ASMANEX TWISTHALER 30 MET –mometasone furoate inhal powd 110mcg/inh (breath activated)



ATROVENT HFA – ipratropiumbromide hfa inhal aerosol 17 mcg/act

BREO ELLIPTA – fluticasone furoate-vilanterol aero powd ba 100-25 mcg/inh

BREO ELLIPTA – fluticasone furoate-vilanterol aero powd ba 200-25 mcg/inh

BREZTRI AEROSPHERE –budesonide-glycopyrrolate-formoterol aers 160-9-4.8 mcg/act

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budesonide inhalation susp0.25 mg/2ml (Pulmicort)

budesonide inhalation susp0.5 mg/2ml (Pulmicort)

budesonide inhalation susp1 mg/2ml (Pulmicort)

COMBIVENT RESPIMAT –ipratropium-albuterol inhal aerosolsoln 20-100 mcg/act

cromolyn sodium soln nebu20 mg/2ml

DULERA – mometasone furoate-formoterol fumarate aerosol 50-5mcg/act



FLOVENT DISKUS – fluticasonepropionate aer pow ba 50 mcg/blister



FLOVENT HFA – fluticasonepropionate hfa inhal aero 44 mcg/act (50/valve)

FLOVENT HFA – fluticasonepropionate hfa inhal aer 110 mcg/act(125/valve)

FLOVENT HFA – fluticasonepropionate hfa inhal aer 220 mcg/act (250/valve)

FLUTICASONE PROPIONATE/SA –fluticasone-salmeterol aer powderba 55-14 mcg/act

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INCRUSE ELLIPTA – umeclidinium braero powd breath act 62.5 mcg/inh(base eq)

ipratropium bromide inhal soln0.02%

ipratropium-albuterol nebu soln0.5-2.5(3) mg/3ml (Duoneb)

levalbuterol hcl soln nebu conc1.25 mg/0.5ml (base equiv)

levalbuterol hcl soln nebu0.31 mg/3ml (base equiv)(Xopenex)



montelukast sodium chew tab 4 mg(base equiv) (Singulair)

montelukast sodium chew tab 5 mg(base equiv) (Singulair)

montelukast sodium oral granulespacket 4 mg (base equiv)(Singulair)

montelukast sodium tab 10 mg(base equiv) (Singulair)

QVAR REDIHALER –beclomethasone diprop hfa breathact inh aer 40 mcg/act

QVAR REDIHALER –beclomethasone diprop hfa breathact inh aer 80 mcg/act

SEREVENT DISKUS – salmeterolxinafoate aer pow ba 50 mcg/dose(base equiv)

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SPIRIVA HANDIHALER – tiotropiumbromide monohydrate inhal cap 18mcg (base equiv)

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhal aerosol1.25 mcg/act

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhal aerosol2.5 mcg/act

STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aero soln 2.5-2.5mcg/act

SYMBICORT – budesonide-formoterolfumarate dihyd aerosol 80-4.5 mcg/act

SYMBICORT – budesonide-formoterolfumarate dihyd aerosol 160-4.5mcg/act

terbutaline sulfate tab 2.5 mgterbutaline sulfate tab 5 mgTHEOPHYLLINE ER – theophylline

tab er 12hr 300 mgTHEOPHYLLINE ER – theophylline

tab er 12hr 450 mgtheophylline tab er 24hr 400 mgtheophylline tab er 24hr 600 mgTRELEGY ELLIPTA – fluticasone-

umeclidinium-vilanterol aepb100-62.5-25 mcg/inh

TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol aepb200-62.5-25 mcg/inh

VENTOLIN HFA – albuterol sulfateinhal aero 108 mcg/act (90mcg baseequiv)

zafirlukast tab 10 mg (Accolate)zafirlukast tab 20 mg (Accolate)RESPIRATORY AGENTS - MISC.KALYDECO – ivacaftor tab 150 mg •KALYDECO – ivacaftor packet 25 mg •KALYDECO – ivacaftor packet 50 mg •

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KALYDECO – ivacaftor packet 75 mg •PULMOZYME – dornase alfa inhal

soln 1 mg/ml•

SYMDEKO – tezacaftor-ivacaftor50-75 mg & ivacaftor 75 mg tab tbpk

•

SYMDEKO – tezacaftor-ivacaftor100-150 mg & ivacaftor 150 mg tabtbpk

•

TRIKAFTA – elexacaf-tezacaf-ivacaf100-50-75 mg &ivacaftor 150 mgtbpk

•

GASTROINTESTINAL AGENTSLAXATIVESGAVILYTE-C – peg 3350-kcl-na

bicarb-nacl-na sulfate for soln 240gm

lactulose solution 10 gm/15mlpeg 3350-kcl-sod bicarb-nacl for

soln 420 gm (Nulytely/flavor pack)peg 3350-kcl-na bicarb-nacl-na

sulfate for soln 236 gm (Golytely)ANTIDIARRHEALSdiphenoxylate w/ atropine tab

2.5-0.025 mg (Lomotil)DIPHENOXYLATE/ATROPINE

– diphenoxylate w/ atropine liq2.5-0.025 mg/5ml

loperamide hcl cap 2 mgULCER DRUGScimetidine hcl soln 300 mg/5mlcimetidine tab 300 mgcimetidine tab 400 mgcimetidine tab 800 mgdicyclomine hcl cap 10 mg (Bentyl)dicyclomine hcl oral soln

10 mg/5mldicyclomine hcl tab 20 mg (Bentyl)esomeprazole magnesium cap

delayed release 20 mg (base eq)(Nexium)

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esomeprazole magnesium capdelayed release 40 mg (base eq)(Nexium)

esomeprazole magnesium fordelayed release susp packet10 mg (Nexium)



famotidine for susp 40 mg/5mlfamotidine tab 20 mg (Pepcid)famotidine tab 40 mg (Pepcid)glycopyrrolate tab 1 mg (Robinul)glycopyrrolate tab 2 mg (Robinul

forte)lansoprazole cap delayed release

15 mg (Prevacid)lansoprazole cap delayed release

30 mg (Prevacid)methscopolamine bromide tab

2.5 mg (Pamine)methscopolamine bromide tab

5 mg (Pamine forte)misoprostol tab 100 mcg (Cytotec)misoprostol tab 200 mcg (Cytotec)NEXIUM – esomeprazole magnesium

for delayed release susp pack 2.5mg

NEXIUM – esomeprazole magnesiumfor delayed release susp packet 5mg

omeprazole cap delayed release10 mg (Prilosec)



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pantoprazole sodium ec tab 20 mg(base equiv) (Protonix)

pantoprazole sodium ec tab 40 mg(base equiv) (Protonix)

sucralfate tab 1 gm (Carafate)ANTIEMETICSaprepitant capsule therapy pack 80

& 125 mg (Emend)aprepitant capsule 40 mg (Emend)aprepitant capsule 80 mg (Emend)aprepitant capsule 125 mg (Emend)EMEND – aprepitant for oral susp 125

mg (125 mg/5ml)fosaprepitant dimeglumine for

iv infusion 150 mg (base eq)(Emend)

granisetron hcl tab 1 mgmeclizine hcl tab 12.5 mgmeclizine hcl tab 25 mgONDANSETRON HCL – ondansetron

hcl tab 24 mgondansetron hcl oral soln 4 mg/5ml

(Zofran)ondansetron hcl tab 4 mg (Zofran)ondansetron hcl tab 8 mg (Zofran)ondansetron orally disintegrating

tab 4 mg (Zofran odt)ondansetron orally disintegrating

tab 8 mg (Zofran odt)scopolamine td patch 72hr

1 mg/3days (Transderm-scop)trimethobenzamide hcl cap 300 mg

(Tigan)DIGESTIVE AIDSCREON – pancrelipase (lip-prot-amyl)

dr cap 3000-9500-15000 unitCREON – pancrelipase (lip-prot-amyl)

dr cap 6000-19000-30000 unitCREON – pancrelipase (lip-prot-amyl)

dr cap 12000-38000-60000 unit

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CREON – pancrelipase (lip-prot-amyl)dr cap 24000-76000-120000 unit

CREON – pancrelipase (lip-prot-amyl)dr cap 36000-114000-180000 unit

ZENPEP – pancrelipase (lip-prot-amyl) dr cap 3000-10000-14000 unit

ZENPEP – pancrelipase (lip-prot-amyl) dr cap 5000-17000-24000 unit

ZENPEP – pancrelipase (lip-prot-amyl) dr cap 10000-32000-42000unit





GASTROINTESTINAL AGENTS-MISC.balsalazide disodium cap 750 mg

(Colazal)calcium acetate (phosphate binder)

cap 667 mg (169 mg ca) (Phoslo)calcium acetate (phosphate binder)

tab 667 mg (Eliphos)CHENODAL – chenodiol tab 250 mg •lactulose (encephalopathy) solution

10 gm/15ml

mesalamine cap dr 400 mg(Delzicol)

mesalamine suppos 1000 mg(Canasa)

mesalamine enema 4 gm

mesalamine cap er 24hr 0.375 gm(Apriso)

LINZESS – linaclotide cap 72mcg, 145mcg, & 290mcg

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mesalamine tab delayed release800 mg (Asacol hd)

mesalamine tab delayed release1.2 gm (Lialda)

metoclopramide hcl soln 5 mg/5ml(10 mg/10ml) (base equiv)

metoclopramide hcl tab 5mg, 10mg(base equivalent) (Reglan)

sevelamer carbonate packet 0.8 gm(Renvela)

sevelamer carbonate packet 2.4 gm(Renvela)

sevelamer carbonate tab 800 mg(Renvela)

sulfasalazine tab delayed release500 mg (Azulfidine en-tabs)

sulfasalazine tab 500 mg (Azulfidine)SYMPROIC – naldemedine tosylate

tab 0.2 mg (base equivalent)TRULANCE – plecanatide tab 3 mgursodiol cap 300 mg (Actigall)ursodiol tab 250 mg (Urso 250)ursodiol tab 500 mg (Urso forte)VELPHORO – sucroferric

oxyhydroxide chew tab 500 mgVIBERZI – eluxadoline tab 75 mgVIBERZI – eluxadoline tab 100 mgGENITOURINARY AGENTSURINARY ANTISPASMODICSoxybutynin chloride syrup

5 mg/5mloxybutynin chloride tab er 24hr

5 mg (Ditropan xl)oxybutynin chloride tab er 24hr

10 mg (Ditropan xl)oxybutynin chloride tab er 24hr

15 mgoxybutynin chloride tab 5 mg

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solifenacin succinate tab 5 mg(Vesicare)

solifenacin succinate tab 10 mg(Vesicare)

tolterodine tartrate cap er 24hr2 mg (Detrol la)

tolterodine tartrate cap er 24hr4 mg (Detrol la)

tolterodine tartrate tab 1 mg (Detrol)tolterodine tartrate tab 2 mg (Detrol)VAGINAL PRODUCTSclindamycin phosphate vaginal

cream 2% (Cleocin)ENDOMETRIN – progesterone

vaginal insert 100 mgestradiol vaginal cream 0.1 mg/gm

(Estrace)ESTRING – estradiol vaginal ring 2

mg (7.5 mcg/24hrs)metronidazole vaginal gel 0.75%

(Metrogel-vaginal)terconazole vaginal cream 0.4%

(Terazol 7)terconazole vaginal cream 0.8%terconazole vaginal suppos 80 mg

(Terazol 3)VAGIFEM – estradiol vaginal tab 10

mcgGENITOURINARY AGENTS - MISC.alfuzosin hcl tab er 24hr 10 mg

(Uroxatral)CYSTAGON – cysteamine bitartrate

cap 50 mg•

CYSTAGON – cysteamine bitartratecap 150 mg

•

dutasteride cap 0.5 mg (Avodart)finasteride tab 5 mg (Proscar)K-PHOS NO 2 – potassium & sodium

acid phosphates tab 305-700 mg

MOVANTIK – naloxegol tab 12.5mg 25mg

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potassium citrate tab er 5 meq(540 mg) (Urocit-k 5)



sodium citrate & citric acid soln500-334 mg/5ml (Shohls solutionmodi)

tamsulosin hcl cap 0.4 mg (Flomax)CENTRAL NERVOUS SYSTEM DRUGSANTIANXIETY AGENTSalprazolam tab er 24hr 0.5 mg

(Xanax xr)alprazolam tab er 24hr 1 mg (Xanax

xr)alprazolam tab er 24hr 2 mg (Xanax

xr)alprazolam tab er 24hr 3 mg (Xanax

xr)alprazolam tab 0.25 mg (Xanax)alprazolam tab 0.5 mg (Xanax)alprazolam tab 1 mg (Xanax)alprazolam tab 2 mg (Xanax)buspirone hcl tab 5 mgbuspirone hcl tab 10 mgbuspirone hcl tab 15 mgbuspirone hcl tab 30 mgdiazepam oral soln 1 mg/mldiazepam tab 2 mg (Valium)diazepam tab 5 mg (Valium)diazepam tab 10 mg (Valium)hydroxyzine hcl syrup 10 mg/5mlhydroxyzine hcl tab 10 mghydroxyzine hcl tab 25 mghydroxyzine hcl tab 50 mgHYDROXYZINE PAMOATE –

hydroxyzine pamoate cap 100 mg

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hydroxyzine pamoate cap 25 mg(Vistaril)

hydroxyzine pamoate cap 50 mg(Vistaril)

lorazepam conc 2 mg/ml(Lorazepam intensol)

lorazepam tab 0.5 mg (Ativan)lorazepam tab 1 mg (Ativan)lorazepam tab 2 mg (Ativan)ANTIDEPRESSANTSamitriptyline hcl tab 10 mgamitriptyline hcl tab 25 mgamitriptyline hcl tab 50 mgamitriptyline hcl tab 75 mgamitriptyline hcl tab 100 mgamitriptyline hcl tab 150 mgbupropion hcl tab er 12hr 100 mg

(Wellbutrin sr)bupropion hcl tab er 12hr 150 mg



(Wellbutrin xl)bupropion hcl tab er 24hr 300 mg

(Wellbutrin xl)bupropion hcl tab 75 mg (Wellbutrin)bupropion hcl tab 100 mg

(Wellbutrin)citalopram hydrobromide oral soln

10 mg/5mlcitalopram hydrobromide tab 10 mg

(base equiv) (Celexa)citalopram hydrobromide tab 20 mg

(base equiv) (Celexa)citalopram hydrobromide tab 40 mg

(base equiv) (Celexa)clomipramine hcl cap 25 mg

(Anafranil)

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clomipramine hcl cap 50 mg(Anafranil)

clomipramine hcl cap 75 mg(Anafranil)

desipramine hcl tab 10 mg(Norpramin)






desvenlafaxine succinate tab er24hr 25 mg (base equiv) (Pristiq)



doxepin hcl cap 10 mgdoxepin hcl cap 25 mgdoxepin hcl cap 50 mgdoxepin hcl cap 75 mgdoxepin hcl cap 100 mgdoxepin hcl conc 10 mg/mlduloxetine hcl enteric coated

pellets cap 20 mg (base eq)(Cymbalta)

duloxetine hcl enteric coatedpellets cap 30 mg (base eq)(Cymbalta)

duloxetine hcl enteric coatedpellets cap 60 mg (base eq)(Cymbalta)

escitalopram oxalate soln 5 mg/5ml(base equiv) (Lexapro)

escitalopram oxalate tab 5 mg(base equiv) (Lexapro)

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fluoxetine hcl cap 10 mg (Prozac)fluoxetine hcl cap 20 mg (Prozac)fluoxetine hcl cap 40 mg (Prozac)fluoxetine hcl solution 20 mg/5mlfluvoxamine maleate tab 25 mgfluvoxamine maleate tab 50 mgfluvoxamine maleate tab 100 mgimipramine hcl tab 10 mg (Tofranil)imipramine hcl tab 25 mg (Tofranil)imipramine hcl tab 50 mg (Tofranil)mirtazapine tab 7.5 mgmirtazapine tab 15 mg (Remeron)mirtazapine tab 30 mg (Remeron)mirtazapine tab 45 mg (Remeron)NORTRIPTYLINE HCL – nortriptyline

hcl soln 10 mg/5mlnortriptyline hcl cap 10 mg

(Pamelor)nortriptyline hcl cap 25 mg



(Pamelor)paroxetine hcl tab er 24hr 12.5 mg

(Paxil cr)paroxetine hcl tab er 24hr 25 mg

(Paxil cr)paroxetine hcl tab er 24hr 37.5 mg

(Paxil cr)paroxetine hcl tab 10 mg (Paxil)paroxetine hcl tab 20 mg (Paxil)paroxetine hcl tab 30 mg (Paxil)paroxetine hcl tab 40 mg (Paxil)

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phenelzine sulfate tab 15 mg(Nardil)

sertraline hcl oral concentrate forsolution 20 mg/ml (Zoloft)

sertraline hcl tab 25 mg (Zoloft)sertraline hcl tab 50 mg (Zoloft)sertraline hcl tab 100 mg (Zoloft)tranylcypromine sulfate tab 10 mg

(Parnate)trazodone hcl tab 50 mgtrazodone hcl tab 100 mgtrazodone hcl tab 150 mgtrazodone hcl tab 300 mgvenlafaxine hcl cap er 24hr 37.5 mg

(base equivalent) (Effexor xr)venlafaxine hcl cap er 24hr 75 mg

(base equivalent) (Effexor xr)venlafaxine hcl cap er 24hr 150 mg

(base equivalent) (Effexor xr)venlafaxine hcl tab 25 mg (base

equivalent)venlafaxine hcl tab 37.5 mg (base

equivalent)venlafaxine hcl tab 50 mg (base



equivalent)ANTIPSYCHOTICSaripiprazole tab 2 mg (Abilify)aripiprazole tab 5 mg (Abilify)aripiprazole tab 10 mg (Abilify)aripiprazole tab 15 mg (Abilify)aripiprazole tab 20 mg (Abilify)aripiprazole tab 30 mg (Abilify)chlorpromazine hcl tab 10 mgchlorpromazine hcl tab 25 mgchlorpromazine hcl tab 50 mg

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chlorpromazine hcl tab 100 mgchlorpromazine hcl tab 200 mgclozapine tab 25 mg (Clozaril)clozapine tab 50 mgclozapine tab 100 mg (Clozaril)clozapine tab 200 mgfluphenazine decanoate inj 25 mg/

mlFLUPHENAZINE HCL – fluphenazine

hcl oral conc 5 mg/mlfluphenazine hcl tab 1 mgfluphenazine hcl tab 2.5 mgfluphenazine hcl tab 5 mgfluphenazine hcl tab 10 mgFLUPHENAZINE HYDROCHLORID –

fluphenazine hcl elixir 2.5 mg/5mlhaloperidol decanoate im soln

50 mg/ml (Haldol decanoate 50)haloperidol decanoate im soln

100 mg/ml (Haldol decanoate 100)haloperidol lactate oral conc 2 mg/

mlhaloperidol tab 0.5 mghaloperidol tab 1 mghaloperidol tab 2 mghaloperidol tab 5 mghaloperidol tab 10 mghaloperidol tab 20 mgLATUDA – lurasidone hcl tab 20 mgLATUDA – lurasidone hcl tab 40 mgLATUDA – lurasidone hcl tab 60 mgLATUDA – lurasidone hcl tab 80 mgLATUDA – lurasidone hcl tab 120 mgLITHIUM – lithium oral solution 8

meq/5mlLITHIUM CARBONATE – lithium

carbonate cap 150 mg

2021

FID 568 July 2021 38

Drug Name Spe

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Lim

its

lithium carbonate cap 150 mg(Lithium carbonate)

lithium carbonate cap 300 mglithium carbonate cap 600 mg

(Lithium carbonate)lithium carbonate tab er 300 mg

(Lithobid)lithium carbonate tab er 450 mglithium carbonate tab 300 mgloxapine succinate cap 5 mg

(Loxitane)loxapine succinate cap 10 mgloxapine succinate cap 25 mgloxapine succinate cap 50 mgolanzapine orally disintegrating tab

5 mg (Zyprexa zydis)olanzapine orally disintegrating tab



20 mg (Zyprexa zydis)olanzapine tab 2.5 mg (Zyprexa)olanzapine tab 5 mg (Zyprexa)olanzapine tab 7.5 mg (Zyprexa)olanzapine tab 10 mg (Zyprexa)olanzapine tab 15 mg (Zyprexa)olanzapine tab 20 mg (Zyprexa)perphenazine tab 2 mgperphenazine tab 4 mgperphenazine tab 8 mgperphenazine tab 16 mgprochlorperazine maleate tab 5 mg

(base equivalent)prochlorperazine maleate tab 10 mg

(base equivalent)prochlorperazine suppos 25 mgquetiapine fumarate tab er 24hr

50 mg (Seroquel xr)

Drug Name Spe

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Lim

its

quetiapine fumarate tab er 24hr150 mg (Seroquel xr)




quetiapine fumarate tab 25 mg(Seroquel)






RISPERIDONE ODT – risperidoneorally disintegrating tab 0.25 mg

risperidone orally disintegrating tab0.5 mg (Risperdal m-tab)

risperidone orally disintegrating tab1 mg (Risperdal m-tab)




risperidone soln 1 mg/ml (Risperdal)risperidone tab 0.25 mg (Risperdal)risperidone tab 0.5 mg (Risperdal)risperidone tab 1 mg (Risperdal)risperidone tab 2 mg (Risperdal)risperidone tab 3 mg (Risperdal)risperidone tab 4 mg (Risperdal)thiothixene cap 1 mg

2021

FID 568 July 2021 39

Drug Name Spe

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ing

Lim

its

thiothixene cap 2 mgthiothixene cap 5 mgthiothixene cap 10 mgtrifluoperazine hcl tab 1 mg (base

equivalent)trifluoperazine hcl tab 2 mg (base



equivalent)ziprasidone hcl cap 20 mg (Geodon)ziprasidone hcl cap 40 mg (Geodon)ziprasidone hcl cap 60 mg (Geodon)ziprasidone hcl cap 80 mg (Geodon)HYPNOTICSBELSOMRA – suvorexant tab 5 mgBELSOMRA – suvorexant tab 10 mgBELSOMRA – suvorexant tab 15 mgBELSOMRA – suvorexant tab 20 mgestazolam tab 1 mgestazolam tab 2 mgeszopiclone tab 1 mg (Lunesta)eszopiclone tab 2 mg (Lunesta)eszopiclone tab 3 mg (Lunesta)phenobarbital elixir 20 mg/5mlphenobarbital tab 15 mgphenobarbital tab 16.2 mgphenobarbital tab 30 mgphenobarbital tab 32.4 mgphenobarbital tab 60 mgphenobarbital tab 100 mgtemazepam cap 15 mg (Restoril)temazepam cap 30 mg (Restoril)zaleplon cap 5 mg (Sonata)zaleplon cap 10 mg (Sonata)

Drug Name Spe

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ty

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ing

Lim

its

zolpidem tartrate tab er 6.25 mg(Ambien cr)

zolpidem tartrate tab er 12.5 mg(Ambien cr)

zolpidem tartrate tab 5 mg (Ambien)zolpidem tartrate tab 10 mg

(Ambien)ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTSADDERALL XR – amphetamine-

dextroamphetamine cap er 24hr 5mg

ADDERALL XR – amphetamine-dextroamphetamine cap er 24hr 10mg





amphetamine-dextroamphetaminecap er 24hr 5 mg (Adderall xr)






amphetamine-dextroamphetaminetab 5 mg (Adderall)

2021

FID 568 July 2021 40

Drug Name Spe

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Lim

its

amphetamine-dextroamphetaminetab 7.5 mg (Adderall)


amphetamine-dextroamphetaminetab 12.5 mg (Adderall)




armodafinil tab 50 mg (Nuvigil)armodafinil tab 150 mg (Nuvigil)armodafinil tab 200 mg (Nuvigil)armodafinil tab 250 mg (Nuvigil)atomoxetine hcl cap 10 mg (base

equiv) (Strattera)atomoxetine hcl cap 18 mg (base






equiv) (Strattera)caffeine citrate oral soln 60 mg/3ml

(10 mg/ml base equiv) (Cafcit)dexmethylphenidate hcl cap er 24

hr 5 mg (Focalin xr)dexmethylphenidate hcl cap er 24



hr 20 mg (Focalin xr)

Drug Name Spe

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Lim

its

dexmethylphenidate hcl cap er 24hr 25 mg (Focalin xr)




dexmethylphenidate hcl tab 2.5 mg(Focalin)

dexmethylphenidate hcl tab 5 mg(Focalin)

dexmethylphenidate hcl tab 10 mg(Focalin)

dextroamphetamine sulfate cap er24hr 5 mg (Dexedrine)



dextroamphetamine sulfate tab5 mg

dextroamphetamine sulfate tab10 mg

guanfacine hcl tab er 24hr 1 mg(base equiv) (Intuniv)




methylphenidate hcl tab er osmoticrelease (osm) 18 mg (Concerta)




methylphenidate hcl tab er 10 mg

2021

FID 568 July 2021 41

Drug Name Spe

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Lim

its

methylphenidate hcl tab er 20 mgmethylphenidate hcl tab 5 mg

(Ritalin)methylphenidate hcl tab 10 mg

(Ritalin)methylphenidate hcl tab 20 mg

(Ritalin)modafinil tab 100 mg (Provigil)modafinil tab 200 mg (Provigil)SUNOSI – solriamfetol hcl tab 75 mg

(base equiv)SUNOSI – solriamfetol hcl tab 150 mg

(base equiv)VYVANSE – lisdexamfetamine

dimesylate cap 10 mgVYVANSE – lisdexamfetamine







dimesylate chew tab 10 mgVYVANSE – lisdexamfetamine





dimesylate chew tab 60 mgPSYCHOTHERAPEUTIC and NEUROLOGICALAGENTS - MISC.

Drug Name Spe

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ing

Lim

its

acamprosate calcium tab delayedrelease 333 mg (Campral)

AUBAGIO – teriflunomide tab 7 mg • • •AUBAGIO – teriflunomide tab 14 mg • • •AVONEX – interferon beta-1a im

prefilled syringe kit 30 mcg/0.5ml• • •

AVONEX PEN – interferon beta-1a imauto-injector kit 30 mcg/0.5ml

• • •

BETASERON – interferon beta-1b forinj kit 0.3 mg

• • •

bupropion hcl (smoking deterrent)tab er 12hr 150 mg (Zyban)

CHANTIX – varenicline tartrate tab 0.5mg (base equiv)

CHANTIX – varenicline tartrate tab 1mg (base equiv)

CHANTIX CONTINUING MONTH –varenicline tartrate tab 1 mg (baseequiv)

CHANTIX STARTING MONTH PA –varenicline tartrate tab 0.5 mg x 11& tab 1 mg x 42 pack

dimethyl fumarate capsule delayedrelease 120 mg (Tecfidera)

• • •

dimethyl fumarate capsule delayedrelease 240 mg (Tecfidera)

• • •

dimethyl fumarate capsule drstarter pack 120 mg & 240 mg(Tecfidera starter pa)

• • •

disulfiram tab 250 mg (Antabuse)disulfiram tab 500 mg (Antabuse)donepezil hydrochloride orally

disintegrating tab 5 mg (Ariceptodt)

donepezil hydrochloride orallydisintegrating tab 10 mg (Ariceptodt)

donepezil hydrochloride tab 5 mg(Aricept)

donepezil hydrochloride tab 10 mg(Aricept)

2021

FID 568 July 2021 42

Drug Name Spe

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its

GALANTAMINE HYDROBROMIDE –galantamine hydrobromide oral soln4 mg/ml

galantamine hydrobromide cap er24hr 8 mg (Razadyne er)



galantamine hydrobromide tab4 mg (Razadyne)



GILENYA – fingolimod hcl cap 0.5 mg(base equiv)

• • •

glatiramer acetate soln prefilledsyringe 20 mg/ml (Copaxone)

• • •

glatiramer acetate soln prefilledsyringe 40 mg/ml (Copaxone)

• • •

• • •

• • •

MAVENCLAD – cladribine tab therapy • • •




• • •

• • •

• • •

MAYZENT – siponimod fumarate tab 2 or 0.25mg (base equiv)

• • •

Drug Name Spe

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its

MAYZENT STARTER PACK –siponimod fumarate tab 0.25 mg(12) starter pack

• • •

memantine hcl oral solution 2 mg/ml (Namenda)

memantine hcl tab 5 mg (Namenda)memantine hcl tab 10 mg

(Namenda)memantine hcl tab 28 x 5 mg & 21

x 10 mg titration pack (Namendatitration pa)

NICOTROL INHALER – nicotineinhaler system 10 mg (4 mgdelivered)

NICOTROL NS – nicotine nasal spray10 mg/ml (0.5 mg/spray)

PIMOZIDE – pimozide tab 1 mgPIMOZIDE – pimozide tab 2 mgPLEGRIDY – peginterferon beta-1a

soln pen-injector 125 mcg/0.5ml• • •

PLEGRIDY – peginterferon beta-1asoln prefilled syringe 125 mcg/0.5ml

• • •

PLEGRIDY – peginterferon beta-1a imsoln prefilled syr 125 mcg/0.5ml

• • •

PLEGRIDY STARTER PACK –peginterferon beta-1a soln pen-inj63 & 94 mcg/0.5ml pack

• • •

PLEGRIDY STARTER PACK –peginterferon beta-1a soln pref syr63 & 94 mcg/0.5ml pack

• • •

REBIF – interferon beta-1a soln prefsyr 22 mcg/0.5ml (12mu/ml)

• • •

REBIF – interferon beta-1a soln prefsyr 44 mcg/0.5ml (24mu/ml)

• • •

REBIF REBIDOSE – interferonbeta-1a soln auto-inj 22 mcg/0.5ml(12mu/ml)

• • •

REBIF REBIDOSE – interferonbeta-1a soln auto-inj 44 mcg/0.5ml(24mu/ml)

• • •MAVENCLAD – cladribine tab therapypack 10 mg (10 tabs)

MAVENCLAD – cladribine tab therapypack 10 mg (9 tabs)

pack 10 mg (4 tabs)

pack 10 mg (5 tabs)

pack 10 mg (6 tabs)

pack 10 mg (7 tabs)

pack 10 mg (8 tabs)MAVENCLAD – cladribine tab therapy

injector 20 mg/0.4mlKESIMPTA – ofatumumab soln auto-

HETLIOZ LQ – tasimelteon oral suspension & capsules

2021

FID 568 July 2021 43

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REBIF REBIDOSE TITRATION –interferon beta-1a auto-inj 6x8.8mcg/0.2ml & 6x22 mcg/0.5ml

• • •

REBIF TITRATION PACK – interferonbeta-1a pref syr 6x8.8 mcg/0.2ml &6x22 mcg/0.5ml

• • •

rivastigmine tartrate cap 1.5 mg(base equivalent)

rivastigmine tartrate cap 3 mg(base equivalent)

rivastigmine tartrate cap 4.5 mg(base equivalent)

rivastigmine tartrate cap 6 mg(base equivalent)

tetrabenazine tab 12.5 mg(Xenazine)

•

tetrabenazine tab 25 mg (Xenazine) •ZEPOSIA – ozanimod hcl cap 0.92

mg• • •

ZEPOSIA STARTER KIT – ozanimodcap pack 4 x 0.23 mg & 3 x 0.46 mg& 30 x 0.92 mg

• • •

ZEPOSIA 7-DAY STARTER PAC –ozanimod cap pack 4 x 0.23 mg & 3x 0.46 mg

• • •

ANALGESICS AND ANESTHETICSANALGESICS - NON-NARCOTICbutalbital-acetaminophen tab

50-325 mgbutalbital-acetaminophen-caffeine

tab 50-325-40 mg (Esgic)butalbital-aspirin-caffeine cap

50-325-40 mg (Fiorinal)TENCON – butalbital-acetaminophen

tab 50-325 mgANALGESICS - NARCOTICacetaminophen w/ codeine soln

120-12 mg/5mlacetaminophen w/ codeine tab

300-15 mg (Tylenol/codeine)

Drug Name Spe

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its

acetaminophen w/ codeine tab300-30 mg (Tylenol/codeine #3)

acetaminophen w/ codeine tab300-60 mg (Tylenol/codeine #4)

buprenorphine hcl sl tab 2 mg(base equiv)

buprenorphine hcl sl tab 8 mg(base equiv)

butalbital-aspirin-caff w/ codeinecap 50-325-40-30 mg (Fiorinal/codeine #3)

codeine sulfate tab 30 mgfentanyl citrate lozenge on a handle

200 mcg (Actiq)fentanyl citrate lozenge on a handle





1600 mcg (Actiq)fentanyl td patch 72hr 12 mcg/hr

(Duragesic)fentanyl td patch 72hr 25 mcg/hr




(Duragesic)hydrocodone-acetaminophen soln

7.5-325 mg/15ml (Hycet)hydrocodone-acetaminophen tab

10-325 mg (Norco)hydrocodone-acetaminophen tab

5-325 mg (Norco)

2021

FID 568 July 2021 44

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its

hydrocodone-acetaminophen tab7.5-325 mg (Norco)

hydrocodone-ibuprofen tab7.5-200 mg (Vicoprofen)

hydrocodone-ibuprofen tab10-200 mg (Ibudone)

HYDROCODONE/IBUPROFEN –hydrocodone-ibuprofen tab 5-200mg

hydromorphone hcl liqd 1 mg/ml(Dilaudid)

hydromorphone hcl tab 2 mg(Dilaudid)



methadone hcl conc 10 mg/ml(Methadose)

methadone hcl soln 5 mg/5ml(Methadone hcl)

methadone hcl soln 10 mg/5ml(Methadone hcl)

methadone hcl tab for oral susp40 mg

methadone hcl tab 5 mg (Dolophinehcl)

methadone hcl tab 10 mg(Dolophine)

MORPHINE SULFATE ER – morphinesulfate beads cap er 24hr 30 mg






Drug Name Spe

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its

morphine sulfate oral soln10 mg/5ml

morphine sulfate oral soln20 mg/5ml

morphine sulfate oral soln100 mg/5ml (20 mg/ml)

morphine sulfate tab er 15 mg (Mscontin)





morphine sulfate tab 15 mg(Morphine sulfate)

morphine sulfate tab 30 mg(Morphine sulfate)

NUCYNTA ER – tapentadol hcl tab er12hr 50 mg





oxycodone hcl cap 5 mgoxycodone hcl conc 100 mg/5ml

(20 mg/ml) (Oxycodone hcl)oxycodone hcl soln 5 mg/5ml

(Oxycodone hcl)oxycodone hcl tab 5 mg

(Roxicodone)oxycodone hcl tab 10 mgoxycodone hcl tab 15 mg

(Roxicodone)oxycodone hcl tab 20 mg

2021

FID 568 July 2021 45

Drug Name Spe

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Lim

its

oxycodone hcl tab 30 mg(Roxicodone)

oxycodone w/ acetaminophen tab5-325 mg (Percocet)

oxycodone w/ acetaminophen tab7.5-325 mg (Percocet)

oxycodone w/ acetaminophen tab10-325 mg (Percocet)

OXYCODONE/ASPIRIN – oxycodone-aspirin tab 4.8355-325 mg

tramadol hcl tab er 24hr 100 mgtramadol hcl tab er 24hr 200 mgtramadol hcl tab er 24hr 300 mgtramadol hcl tab 50 mg (Ultram)tramadol-acetaminophen tab

37.5-325 mg (Ultracet)XTAMPZA ER – oxycodone cap er

12hr abuse-deterrent 9 mgXTAMPZA ER – oxycodone cap er

12hr abuse-deterrent 13.5 mgXTAMPZA ER – oxycodone cap er



12hr abuse-deterrent 36 mgANALGESICS - ANTI-INFLAMMATORYACTEMRA – tocilizumab

subcutaneous soln prefilled syringe162 mg/0.9ml

• • •

ACTEMRA ACTPEN – tocilizumabsubcutaneous soln auto-injector 162mg/0.9ml

• • •

celecoxib cap 50 mg (Celebrex)celecoxib cap 100 mg (Celebrex)celecoxib cap 200 mg (Celebrex)celecoxib cap 400 mg (Celebrex)diclofenac potassium tab 50 mg

(Cataflam)

Drug Name Spe

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Lim

its

diclofenac sodium tab delayedrelease 25 mg



ENBREL – etanercept subcutaneousinj 25 mg/0.5ml

• • •

ENBREL – etanercept forsubcutaneous inj 25 mg

• • •

ENBREL – etanercept subcutaneoussoln prefilled syringe 25 mg/0.5ml

• • •

ENBREL – etanercept subcutaneoussoln prefilled syringe 50 mg/ml

• • •

ENBREL MINI – etanerceptsubcutaneous solution cartridge 50mg/ml

• • •

ENBREL SURECLICK – etanerceptsubcutaneous solution auto-injector50 mg/ml

• • •

etodolac cap 200 mgetodolac cap 300 mgetodolac tab er 24hr 400 mgetodolac tab er 24hr 500 mgetodolac tab er 24hr 600 mgetodolac tab 400 mgetodolac tab 500 mgFLURBIPROFEN – flurbiprofen tab 50

mgflurbiprofen tab 100 mgHUMIRA – adalimumab prefilled

syringe kit 10 mg/0.1ml• • •

HUMIRA – adalimumab prefilledsyringe kit 20 mg/0.2ml

• • •


• • •


• • •

2021

FID 568 July 2021 46

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HUMIRA PEDIATRIC CROHNS D –adalimumab prefilled syringe kit 80mg/0.8ml

• • •

HUMIRA PEDIATRIC CROHNS D –adalimumab prefilled syringe kit 80mg/0.8ml & 40 mg/0.4ml

• • •

HUMIRA PEN – adalimumab pen-injector kit 40 mg/0.8ml

• • •


• • •


• • •

HUMIRA PEN-CD/UC/HS START– adalimumab pen-injector kit 40mg/0.8ml

• • •

HUMIRA PEN-CD/UC/HS START– adalimumab pen-injector kit 80mg/0.8ml

• • •

HUMIRA PEN-PEDIATRIC UC S– adalimumab pen-injector kit 80mg/0.8ml

• • •

HUMIRA PEN-PS/UV STARTER –adalimumab pen-injector kit 40mg/0.8ml

• • •

HUMIRA PEN-PS/UV STARTER –adalimumab pen-injector kit 80mg/0.8ml & 40 mg/0.4ml

• • •

ibuprofen susp 100 mg/5mlibuprofen tab 400 mgibuprofen tab 600 mgibuprofen tab 800 mgILARIS – canakinumab subcutaneous

inj 150 mg/ml•

indomethacin cap 25 mgindomethacin cap 50 mgleflunomide tab 10 mg (Arava)leflunomide tab 20 mg (Arava)meloxicam tab 7.5 mg (Mobic)meloxicam tab 15 mg (Mobic)nabumetone tab 500 mg

Drug Name Spe

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Lim

its

nabumetone tab 750 mgnaproxen sodium tab 275 mg

(Anaprox)naproxen sodium tab 550 mg

(Anaprox ds)naproxen tab ec 375 mg (Ec-

naprosyn)naproxen tab ec 500 mg (Ec-

naprosyn)naproxen tab 250 mg (Naprosyn)naproxen tab 375 mg (Naprosyn)naproxen tab 500 mg (Naprosyn)OTEZLA – apremilast tab starter

therapy pack 10 mg & 20 mg & 30mg

• • •

OTEZLA – apremilast tab 30 mg • • •OTREXUP – methotrexate soln pf

auto-injector 10 mg/0.4mlOTREXUP – methotrexate soln pf

auto-injector 12.5 mg/0.4mlOTREXUP – methotrexate soln pf





auto-injector 25 mg/0.4mloxaprozin tab 600 mg (Daypro)piroxicam cap 10 mg (Feldene)piroxicam cap 20 mg (Feldene)REDITREX – methotrexate soln

prefilled syringe 7.5 mg/0.3mlREDITREX – methotrexate soln

prefilled syringe 10 mg/0.4mlREDITREX – methotrexate soln

prefilled syringe 12.5 mg/0.5ml

2021

FID 568 July 2021 47

Drug Name Spe

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REDITREX – methotrexate solnprefilled syringe 15 mg/0.6ml

REDITREX – methotrexate solnprefilled syringe 17.5 mg/0.7ml

REDITREX – methotrexate solnprefilled syringe 20 mg/0.8ml

REDITREX – methotrexate solnprefilled syringe 22.5 mg/0.9ml

REDITREX – methotrexate solnprefilled syringe 25 mg/ml

RINVOQ – upadacitinib tab er 24hr 15mg

• • •

SIMPONI – golimumab subcutaneoussoln auto-injector 100 mg/ml

• • •

SIMPONI – golimumab subcutaneoussoln prefilled syringe 100 mg/ml

• • •

sulindac tab 150 mgsulindac tab 200 mgXELJANZ – tofacitinib citrate oral soln

1 mg/ml (base equivalent)• • •

XELJANZ – tofacitinib citrate tab 5 mg(base equivalent)

• • •

XELJANZ – tofacitinib citrate tab 10mg (base equivalent)

• • •

XELJANZ XR – tofacitinib citrate taber 24hr 11 mg (base equivalent)

• • •

XELJANZ XR – tofacitinib citrate taber 24hr 22 mg (base equivalent)

• • •

MIGRAINE PRODUCTSAIMOVIG – erenumab-aooe

subcutaneous soln auto-injector 70mg/ml

• •

AIMOVIG – erenumab-aooesubcutaneous soln auto-injector 140mg/ml

• •

dihydroergotamine mesylate inj1 mg/ml (D.h.e. 45)

dihydroergotamine mesylate nasalspray 4 mg/ml (Migranal)

eletriptan hydrobromide tab 20 mg(base equivalent) (Relpax)

Drug Name Spe

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its

eletriptan hydrobromide tab 40 mg(base equivalent) (Relpax)

EMGALITY – galcanezumab-gnlmsubcutaneous soln auto-injector 120mg/ml

• •

EMGALITY – galcanezumab-gnlmsubcutaneous soln prefilled syr 100mg/ml

• •

EMGALITY – galcanezumab-gnlmsubcutaneous soln prefilled syr 120mg/ml

• •

naratriptan hcl tab 1 mg (baseequiv) (Amerge)

naratriptan hcl tab 2.5 mg (baseequiv) (Amerge)

rizatriptan benzoate oraldisintegrating tab 5 mg (base eq)(Maxalt-mlt)

rizatriptan benzoate oraldisintegrating tab 10 mg (base eq)(Maxalt-mlt)

rizatriptan benzoate tab 5 mg (baseequivalent)

rizatriptan benzoate tab 10 mg(base equivalent) (Maxalt)

sumatriptan nasal spray 5 mg/act(Imitrex)

sumatriptan nasal spray 20 mg/act(Imitrex)

SUMATRIPTAN SUCCINATE –sumatriptan succinate solutionprefilled syringe 6 mg/0.5ml

sumatriptan succinate inj6 mg/0.5ml (Imitrex statdose ref)

sumatriptan succinate solutionauto-injector 4 mg/0.5ml (Imitrexstatdose sys)

sumatriptan succinate solutionauto-injector 6 mg/0.5ml (Imitrexstatdose sys)

2021

FID 568 July 2021 48

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Lim

its

sumatriptan succinate solutioncartridge 4 mg/0.5ml (Imitrexstatdose ref)

sumatriptan succinate solutioncartridge 6 mg/0.5ml (Imitrexstatdose ref)

sumatriptan succinate tab 25 mg(Imitrex)



GOUT AGENTSallopurinol tab 100 mg (Zyloprim)allopurinol tab 300 mg (Zyloprim)colchicine w/ probenecid tab

0.5-500 mgMITIGARE – colchicine cap 0.6 mgprobenecid tab 500 mgNEUROMUSCULAR DRUGSANTICONVULSANTSBANZEL – rufinamide 200mg, 400mgBRIVIACT – briveracetam tab, solncarbamazepine cap er 12hr 100 mg

(Carbatrol)carbamazepine cap er 12hr 200 mg

(Carbatrol)carbamazepine cap er 12hr 300 mg

(Carbatrol)carbamazepine chew tab 100 mgcarbamazepine susp 100 mg/5ml

(Tegretol)carbamazepine tab er 12hr 100 mg

(Tegretol-xr)carbamazepine tab er 12hr 200 mg

(Tegretol-xr)carbamazepine tab er 12hr 400 mg

(Tegretol-xr)carbamazepine tab 200 mg

(Tegretol)

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CELONTIN – methsuximide cap 300mg

clonazepam tab 0.5 mg (Klonopin)clonazepam tab 1 mg (Klonopin)clonazepam tab 2 mg (Klonopin)DIASTAT ACUDIAL – diazepam rectal

gel delivery system 10 mgDIASTAT ACUDIAL – diazepam rectal

gel delivery system 20 mgDIASTAT PEDIATRIC – diazepam

rectal gel delivery system 2.5 mgDILANTIN – phenytoin sodium

extended cap 30 mgDILANTIN – phenytoin sodium

extended cap 100 mgDILANTIN-125 – phenytoin susp 125

mg/5mldivalproex sodium cap delayed

release sprinkle 125 mg (Depakotesprinkles)

divalproex sodium tab delayedrelease 125 mg (Depakote)



divalproex sodium tab er 24 hr250 mg (Depakote er)

divalproex sodium tab er 24 hr500 mg (Depakote er)

EPIDIOLEX – cannabidiol soln 100mg/ml

•

ethosuximide cap 250 mg (Zarontin)ethosuximide soln 250 mg/5ml

(Zarontin)gabapentin cap 100 mg (Neurontin)gabapentin cap 300 mg (Neurontin)gabapentin cap 400 mg (Neurontin)gabapentin oral soln 250 mg/5ml

(Neurontin)

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FID 568 July 2021 49

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gabapentin tab 600 mg (Neurontin)gabapentin tab 800 mg (Neurontin)lamotrigine tab chewable

dispersible 5 mg (Lamictalchewable di)

lamotrigine tab chewabledispersible 25 mg (Lamictalchewable di)

lamotrigine tab 25 mg (Lamictal)lamotrigine tab 100 mg (Lamictal)lamotrigine tab 150 mg (Lamictal)lamotrigine tab 200 mg (Lamictal)levetiracetam oral soln 100 mg/ml

(Keppra)levetiracetam tab er 24hr 500 mg

(Keppra xr)levetiracetam tab er 24hr 750 mg

(Keppra xr)levetiracetam tab 250 mg (Keppra)levetiracetam tab 500 mg (Keppra)levetiracetam tab 750 mg (Keppra)levetiracetam tab 1000 mg (Keppra)oxcarbazepine susp 300 mg/5ml

(60 mg/ml) (Trileptal)oxcarbazepine tab 150 mg (Trileptal)oxcarbazepine tab 300 mg (Trileptal)oxcarbazepine tab 600 mg (Trileptal)phenytoin chew tab 50 mg (Dilantin

infatabs)phenytoin sodium extended cap

100 mg (Dilantin)phenytoin sodium extended cap

200 mg (Phenytek)phenytoin sodium extended cap

300 mg (Phenytek)phenytoin susp 125 mg/5ml

(Dilantin)pregabalin cap 25 mg (Lyrica)pregabalin cap 50 mg (Lyrica)

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pregabalin cap 75 mg (Lyrica)pregabalin cap 100 mg (Lyrica)pregabalin cap 150 mg (Lyrica)pregabalin cap 200 mg (Lyrica)pregabalin cap 225 mg (Lyrica)pregabalin cap 300 mg (Lyrica)pregabalin soln 20 mg/ml (Lyrica)primidone tab 50 mg (Mysoline)primidone tab 250 mg (Mysoline)topiramate sprinkle cap 15 mg

(Topamax sprinkle)topiramate sprinkle cap 25 mg

(Topamax sprinkle)topiramate tab 25 mg (Topamax)topiramate tab 50 mg (Topamax)topiramate tab 100 mg (Topamax)topiramate tab 200 mg (Topamax)valproate sodium oral soln

250 mg/5ml (base equiv)(Depakene)

valproic acid cap 250 mg(Depakene)

vigabatrin powd pack 500 mg(Sabril)

•

vigabatrin tab 500 mg (Sabril) •VIMPAT – lacosamide oral solution 10

mg/mlVIMPAT – lacosamide tab 50 mgVIMPAT – lacosamide tab 100 mgVIMPAT – lacosamide tab 150 mgVIMPAT – lacosamide tab 200 mgzonisamide cap 25 mg (Zonegran)zonisamide cap 50 mgzonisamide cap 100 mg (Zonegran)ANTIPARKINSON AGENTSamantadine hcl cap 100 mgamantadine hcl syrup 50 mg/5ml

2021

FID 568 July 2021 50

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benztropine mesylate tab 0.5 mgbenztropine mesylate tab 1 mgbenztropine mesylate tab 2 mgcarbidopa & levodopa orally

disintegrating tab 10-100 mg(Parcopa)

carbidopa & levodopa orallydisintegrating tab 25-100 mg(Parcopa)

carbidopa & levodopa orallydisintegrating tab 25-250 mg(Parcopa)

carbidopa & levodopa tab er25-100 mg

carbidopa & levodopa tab er50-200 mg

carbidopa & levodopa tab10-100 mg (Sinemet)



CARBIDOPA/LEVODOPA/ENTACA– carbidopa-levodopa-entacaponetabs 12.5-50-200 mg


CARBIDOPA/LEVODOPA/ENTACA– carbidopa-levodopa-entacaponetabs 25-100-200 mg



CARBIDOPA/LEVODOPA/ENTACA– carbidopa-levodopa-entacaponetabs 50-200-200 mg

entacapone tab 200 mg (Comtan)

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INBRIJA – levodopa inhal powder cap42 mg

•

KYNMOBI – apomorphinehydrochloride film 10 mg





pramipexole dihydrochloride tab0.125 mg (Mirapex)




pramipexole dihydrochloride tab1 mg (Mirapex)


rasagiline mesylate tab 0.5 mg(base equiv) (Azilect)

rasagiline mesylate tab 1 mg (baseequiv) (Azilect)

ropinirole hydrochloride tab0.25 mg (Requip)

ropinirole hydrochloride tab 0.5 mg(Requip)

ropinirole hydrochloride tab 1 mg(Requip)




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FID 568 July 2021 51

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SELEGILINE HCL – selegiline hcl tab5 mg

selegiline hcl cap 5 mg (Eldepryl)trihexyphenidyl hcl oral soln

0.4 mg/mltrihexyphenidyl hcl tab 2 mgtrihexyphenidyl hcl tab 5 mgNEUROMUSCULAR AGENTSriluzole tab 50 mg (Rilutek) •MUSCULOSKELETAL THERAPY AGENTSbaclofen tab 10 mgbaclofen tab 20 mgchlorzoxazone tab 500 mgcyclobenzaprine hcl tab 5 mgcyclobenzaprine hcl tab 10 mgdantrolene sodium cap 25 mg

(Dantrium)dantrolene sodium cap 50 mg

(Dantrium)dantrolene sodium cap 100 mg

(Dantrolene sodium)EUFLEXXA – sodium hyaluronate

intra-articular soln pref syr 20mg/2ml

methocarbamol tab 500 mg(Robaxin)

methocarbamol tab 750 mg(Robaxin-750)

orphenadrine citrate tab er 12hr100 mg

SYNVISC – hylan intra-articularsolution prefilled syringe 16 mg/2ml

SYNVISC ONE – hylan intra-articularsolution prefilled syringe 48 mg/6ml

tizanidine hcl tab 2 mg (baseequivalent)

tizanidine hcl tab 4 mg (baseequivalent) (Zanaflex)

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ANTIMYASTHENIC AGENTSpyridostigmine bromide tab 60 mg

(Mestinon)NUTRITIONAL PRODUCTSVITAMINSergocalciferol cap 1.25 mg (50000

unit) (Drisdol)phytonadione tab 5 mg (Mephyton)MULTIVITAMINSKOSHER PRENATAL PLUS IRON –

prenatal vit w/ iron carbonyl-fa tab30-1 mg

PRENATABS RX – prenatal vit w/ ironcarbonyl-fa tab 29-1 mg

PRENATAL PLUS IRON – prenatal vitw/ iron carbonyl-fa tab 29-1 mg

PRENATAL VITAMINS PLUS LO –prenatal vit w/ fe fumarate-fa tab27-1 mg

PRENATAL 19 – prenatal vit w/ fefumarate-fa chew tab 29-1 mg

PRENATAL 19 – prenatal vit w/ dss-fefumarate-fa tab 29-1 mg

PRENATAL-U – prenatal w/o a vit w/fe fumarate-fa cap 106.5-1 mg

SE-NATAL 19 – prenatal vit w/ fefumarate-fa chew tab 29-1 mg

SE-NATAL 19 – prenatal vit w/ dss-fefumarate-fa tab 29-1 mg

TRINATE – prenatal vit w/ fefumarate-fa tab 28-1 mg

VINATE II – prenatal vit w/ febisglycinate chelate-fa tab 29-1 mg

VINATE ONE – prenatal vit w/ fefumarate-fa tab 60-1 mg

MINERALS and ELECTROLYTESK-PHOS – potassium phosphate

monobasic tab 500 mgpot phos monobasic w/sod phos di

& monobas tab 155-852-130mg(K-phos neutral)

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FID 568 July 2021 52

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potassium chloride cap er 8 meqpotassium chloride cap er 10 meqPOTASSIUM CHLORIDE ER –

potassium chloride tab er 8 meq(600 mg)

potassium chloridemicroencapsulated crys er tab 10meq

potassium chloridemicroencapsulated crys er tab 20meq

potassium chloride oral soln 10%(20 meq/15ml)

potassium chloride oral soln 20%(40 meq/15ml)

potassium chloride powder packet20 meq (K-lor hospital pack)

potassium chloride tab er 8 meq(600 mg)

potassium chloride tab er 10 meq(K-tab)

SODIUM FLUORIDE – sodiumfluoride tab 0.5 mg f (from 1.1 mgnaf)

SODIUM FLUORIDE – sodiumfluoride tab 1 mg f (from 2.2 mg naf)

sodium fluoride chew tab 0.25 mg f(from 0.55 mg naf) (Luride)

sodium fluoride chew tab 0.5 mg f(from 1.1 mg naf) (Luride)

sodium fluoride chew tab 1 mg f(from 2.2 mg naf) (Luride)

sodium fluoride soln 0.125 mg/dropf (0.275 mg/drop naf)

sodium fluoride soln 0.5 mg/ml f(from 1.1 mg/ml naf) (Luride)

HEMATOLOGICAL AGENTSHEMATOPOIETIC AGENTSARANESP ALBUMIN FREE –

darbepoetin alfa soln prefilledsyringe 10 mcg/0.4ml

•

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ARANESP ALBUMIN FREE –darbepoetin alfa soln prefilledsyringe 25 mcg/0.42ml

•


•


•


•


•


•


•

ARANESP ALBUMIN FREE –darbepoetin alfa soln prefilledsyringe 500 mcg/ml

•

ARANESP ALBUMIN FREE –darbepoetin alfa soln inj 25 mcg/ml

•


•


•


•


•


•

CERDELGA – eliglustat tartrate cap84 mg (base equivalent)

•

cyanocobalamin inj 1000 mcg/mlfolic acid tab 1 mgFULPHILA – pegfilgrastim-jmdb soln

prefilled syringe 6 mg/0.6ml•

2021

FID 568 July 2021 53

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GRANIX – tbo-filgrastim soln prefilledsyringe 300 mcg/0.5ml

•

GRANIX – tbo-filgrastim soln prefilledsyringe 480 mcg/0.8ml

•

GRANIX – tbo-filgrastimsubcutaneous inj 300 mcg/ml

•

GRANIX – tbo-filgrastimsubcutaneous inj 480 mcg/1.6ml(300 mcg/ml)

•

NEULASTA – pegfilgrastim solnprefilled syringe 6 mg/0.6ml

•

NEULASTA ONPRO KIT –pegfilgrastim soln prefilled syringekit 6 mg/0.6ml

•

NEUPOGEN – filgrastim soln prefilledsyringe 300 mcg/0.5ml

•

NEUPOGEN – filgrastim soln prefilledsyringe 480 mcg/0.8ml (600 mcg/ml)

•

NEUPOGEN – filgrastim inj 300 mcg/ml

•

NEUPOGEN – filgrastim inj 480mcg/1.6ml (300 mcg/ml)

•

NIVESTYM – filgrastim-aafi solnprefilled syringe 300 mcg/0.5ml

•

NIVESTYM – filgrastim-aafi solnprefilled syringe 480 mcg/0.8ml

•

NIVESTYM – filgrastim-aafi inj 300mcg/ml

•

NIVESTYM – filgrastim-aafi inj 480mcg/1.6ml (300 mcg/ml)

•

NYVEPRIA – pegfilgrastim-apgf solnprefilled syringe 6 mg/0.6ml

•

PROCRIT – epoetin alfa inj 2000 unit/ml

•


•


•

PROCRIT – epoetin alfa inj 10000unit/ml

•

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•


•

RETACRIT – epoetin alfa-epbx inj2000 unit/ml

•


•


•


•


•


•

UDENYCA – pegfilgrastim-cbqv solnprefilled syringe 6 mg/0.6ml

•

ZARXIO – filgrastim-sndz solnprefilled syringe 300 mcg/0.5ml

•

ZARXIO – filgrastim-sndz solnprefilled syringe 480 mcg/0.8ml

•

ZIEXTENZO – pegfilgrastim-bmezsoln prefilled syringe 6 mg/0.6ml

•

ANTICOAGULANTSELIQUIS – apixaban tab 2.5 mgELIQUIS – apixaban tab 5 mgELIQUIS STARTER PACK – apixaban

tab starter pack 5 mgenoxaparin sodium inj 30 mg/0.3ml

(Lovenox)enoxaparin sodium inj 40 mg/0.4ml



(Lovenox)enoxaparin sodium inj 100 mg/ml

(Lovenox)enoxaparin sodium inj

120 mg/0.8ml (Lovenox)

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enoxaparin sodium inj 150 mg/ml(Lovenox)

enoxaparin sodium inj 300 mg/3ml(Lovenox)

warfarin sodium tab 1 mg(Coumadin)


warfarin sodium tab 2.5 mg(Coumadin)





warfarin sodium tab 7.5 mg(Coumadin)


XARELTO – rivaroxaban tab 2.5 mgXARELTO – rivaroxaban tab 10 mgXARELTO – rivaroxaban tab 15 mgXARELTO – rivaroxaban tab 20 mgXARELTO STARTER PACK –

rivaroxaban tab starter therapy pack15 mg & 20 mg

HEMATOLOGICAL AGENTS - MISC.ADVATE – antihemophilic factor

recomb (rahf-pfm) for inj 250 unit•

ADVATE – antihemophilic factorrecomb (rahf-pfm) for inj 500 unit

•


•


•


•

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•


•

AFSTYLA – antihemophilic fact rcmbsingle chain for inj kit 250 unit

•


•


•


•


•


•


•

anagrelide hcl cap 0.5 mg (Agrylin)anagrelide hcl cap 1 mgBENEFIX – coagulation factor ix

(recombinant) for inj kit 250 unit•

BENEFIX – coagulation factor ix(recombinant) for inj kit 500 unit

•


•


•


•

BRILINTA – ticagrelor tab 60 mgBRILINTA – ticagrelor tab 90 mgcilostazol tab 50 mg (Pletal)cilostazol tab 100 mg (Pletal)CINRYZE – c1 esterase inhibitor

(human) for iv inj 500 unit•

clopidogrel bisulfate tab 75 mg(base equiv) (Plavix)

COAGADEX – coagulation factor x(human) for inj 250 unit

•

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COAGADEX – coagulation factor x(human) for inj 500 unit

•

CORIFACT – factor xiii concentrate(human) for inj kit 1000-1600 unit

•

dipyridamole tab 25 mg (Persantine)dipyridamole tab 50 mg (Persantine)dipyridamole tab 75 mg (Persantine)ELOCTATE – antihemophilic factor

rcmb (bdd-rfviiifc) for inj 250 unit•

ELOCTATE – antihemophilic factorrcmb (bdd-rfviiifc) for inj 500 unit

•


•


•


•


•


•


•


•


•

ESPEROCT – antihemophilic factorrecomb glycopeg-exei for inj 500unit

•


•


•


•

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FEIBA – antiinhibitor coagulantcomplex for iv soln 500 unit

•


•


•

HAEGARDA – c1 esterase inhibitor(human) for subcutaneous inj 2000unit

•

HAEGARDA – c1 esterase inhibitor(human) for subcutaneous inj 3000unit

•

HUMATE-P – antihemophilic factor/vwf (human) for inj 250-600 unit

•


•


•

icatibant acetate inj 30 mg/3ml(base equivalent) (Firazyr)

•

JIVI – antihemophil fact rcmb(bdd-rfviiipeg-aucl) for inj 500 unit

•

JIVI – antihemophil fact rcmb(bdd-rfviiipeg-aucl)for inj 1000 unit

•


•


•

KOGENATE FS – antihemophilicfactor recomb (rfviii) for inj kit 250unit

•


•


•

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FID 568 July 2021 56

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•


•

KOVALTRY – antihemophilic factorrecomb (rahf-pfm) for inj 250 unit

•


•


•


•


•

NOVOEIGHT – antihemophilic factrcmb (bd trunc-rfviii) for inj 250 unit

•


•


•


•


•


•

NOVOSEVEN RT – coagulation factorviia (recomb) for inj 1 mg (1000mcg)

•


•


•


•

OBIZUR – antihemophilic factor(recomb porc) rpfviii for inj 500 unit

•

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pentoxifylline tab er 400 mgprasugrel hcl tab 5 mg (base equiv)

(Effient)prasugrel hcl tab 10 mg (base

equiv) (Effient)TAKHZYRO – lanadelumab-flyo inj

300 mg/2ml (150 mg/ml)•

TRETTEN – coagulation factor xiii a-subunit for inj 2000-3125 unit

•

VONVENDI – von willebrand factor(recombinant) for inj 650 unit

•

VONVENDI – von willebrand factor(recombinant) for inj 1300 unit

•

TOPICAL PRODUCTSOPHTHALMIC AGENTSALPHAGAN P – brimonidine tartrate

ophth soln 0.1%ALREX – loteprednol etabonate ophth

susp 0.2%ATROPINE SULFATE – atropine

sulfate ophth soln 1%azelastine hcl ophth soln 0.05%

(Optivar)AZOPT – brinzolamide ophth susp 1%BACITRACIN – bacitracin ophth oint

500 unit/gmbacitracin-polymyxin b ophth ointbacitracin-polymyxin-neomycin-hc

ophth oint 1%brimonidine tartrate ophth soln

0.15% (Alphagan p)brimonidine tartrate ophth soln

0.2%brinzolamide ophth susp 1% (Azopt)CARTEOLOL HCL – carteolol hcl

ophth soln 1%CILOXAN – ciprofloxacin hcl ophth

oint 0.3%ciprofloxacin hcl ophth soln 0.3%

(base equivalent) (Ciloxan)

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cromolyn sodium ophth soln 4%cyclopentolate hcl ophth soln 1%

(Cyclogyl)DEXAMETHASONE SODIUM

PHOS – dexamethasone sodiumphosphate ophth soln 0.1%

diclofenac sodium ophth soln 0.1%dorzolamide hcl ophth soln 2%

(Trusopt)dorzolamide hcl-timolol maleate

ophth soln 22.3-6.8 mg/ml(Cosopt)

erythromycin ophth oint 5 mg/gmfluorometholone ophth susp 0.1%

(Fml liquifilm)FLURBIPROFEN SODIUM –

flurbiprofen sodium ophth soln0.03%

GENTAK – gentamicin sulfate ophthoint 0.3%

gentamicin sulfate ophth soln 0.3%(Garamycin)

ketorolac tromethamine ophth soln0.4% (Acular ls)

ketorolac tromethamine ophth soln0.5% (Acular)

latanoprost ophth soln 0.005%(Xalatan)

LEVOBUNOLOL HCL – levobunololhcl ophth soln 0.5%

LOTEMAX – loteprednol etabonateophth oint 0.5%

LOTEMAX – loteprednol etabonateophth gel 0.5%

LOTEMAX SM – loteprednoletabonate ophth gel 0.38%

loteprednol etabonate ophth gel0.5% (Lotemax)

loteprednol etabonate ophth susp0.5% (Lotemax)

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LUMIGAN – bimatoprost ophth soln0.01%

moxifloxacin hcl ophth soln 0.5%(base equiv) (Vigamox)

NATACYN – natamycin ophth susp5%

neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt op oin

neomycin-polymyxin-dexamethasone ophth oint 0.1%(Maxitrol)

neomycin-polymyxin-dexamethasone ophth susp 0.1%(Maxitrol)

NEOMYCIN/POLYMYXIN/GRAMIC –neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml

ofloxacin ophth soln 0.3% (Ocuflox)pilocarpine hcl ophth soln 1%

(Isopto carpine)pilocarpine hcl ophth soln 2%

(Isopto carpine)pilocarpine hcl ophth soln 4%

(Isopto carpine)polymyxin b-trimethoprim ophth

soln 10000 unit/ml-0.1% (Polytrim)PREDNISOLONE ACETATE –

prednisolone acetate ophth susp 1%SIMBRINZA – brinzolamide-

brimonidine tartrate ophth susp1-0.2%

sulfacetamide sodium ophth soln10% (Bleph-10)

SULFACETAMIDE SODIUM/PRED –sulfacetamide sodium-prednisoloneophth soln 10-0.23(0.25)%

timolol maleate ophth soln 0.25%(Timoptic)

timolol maleate ophth soln 0.5%(Timoptic)

tobramycin ophth soln 0.3%(Tobrex)

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tobramycin-dexamethasone ophthsusp 0.3-0.1% (Tobradex)

travoprost ophth soln 0.004%(benzalkonium free) (bak free)(Travatan z)

TRIFLURIDINE – trifluridine ophthsoln 1%

tropicamide ophth soln 0.5%tropicamide ophth soln 1%

(Mydriacyl)ZYLET – loteprednol etabonate-

tobramycin ophth susp 0.5-0.3%OTIC AGENTSacetic acid otic soln 2%CIPRO HC – ciprofloxacin-

hydrocortisone otic susp 0.2-1%ciprofloxacin-dexamethasone otic

susp 0.3-0.1% (Ciprodex)hydrocortisone w/ acetic acid otic

soln 1-2% (Vosol hc)neomycin-polymyxin-hc otic soln

1% (Cortisporin)neomycin-polymyxin-hc otic susp

3.5 mg/ml-10000 unit/ml-1%ofloxacin otic soln 0.3%MOUTH/THROAT/DENTAL AGENTScevimeline hcl cap 30 mg (Evoxac)chlorhexidine gluconate soln 0.12%

(Peridex)clotrimazole troche 10 mglidocaine hcl viscous soln 2%nystatin susp 100000 unit/mlpilocarpine hcl tab 5 mg (Salagen)pilocarpine hcl tab 7.5 mg (Salagen)sodium fluoride cream 1.1%

(Prevident 5000 plus)sodium fluoride gel 1.1% (0.5% f)

(Prevident fluoride)triamcinolone acetonide dental

paste 0.1%

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ANORECTAL AGENTSCORTIFOAM – hydrocortisone

acetate perianal foam 10% (90 mg/dose)

hydrocortisone acetate suppos25 mg

hydrocortisone enema 100 mg/60ml(Cortenema)

hydrocortisone perianal cream2.5% (Anusol-hc)

DERMATOLOGICALSacitretin cap 10 mg (Soriatane)acitretin cap 17.5 mg (Soriatane)acitretin cap 25 mg (Soriatane)adapalene cream 0.1% (Differin)adapalene gel 0.1% (Differin)adapalene gel 0.3% (Differin)adapalene-benzoyl peroxide gel

0.1-2.5% (Epiduo)alclometasone dipropionate cream

0.05% (Aclovate)alclometasone dipropionate oint

0.05%AMCINONIDE – amcinonide cream

0.1%AUGMENTED BETAMETHASONE

D – betamethasone dipropionateaugmented gel 0.05%

azelaic acid gel 15% (Finacea)betamethasone dipropionate

augmented cream 0.05%(Diprolene af)

betamethasone dipropionateaugmented lotion 0.05%(Diprolene)

betamethasone dipropionateaugmented oint 0.05% (Diprolene)

betamethasone dipropionate cream0.05%

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betamethasone dipropionate lotion0.05%

betamethasone dipropionate oint0.05%

betamethasone valerate cream0.1% (base equivalent)

betamethasone valerate lotion 0.1%(base equivalent)

betamethasone valerate oint 0.1%(base equivalent)

calcipotriene cream 0.005%(Dovonex)

calcipotriene oint 0.005%calcipotriene soln 0.005% (50 mcg/

ml)CARAC – fluorouracil cream 0.5%ciclopirox gel 0.77% (Loprox)ciclopirox olamine cream 0.77%

(base equiv)ciclopirox olamine susp 0.77%

(base equiv)ciclopirox shampoo 1% (Loprox

shampoo)ciclopirox solution 8% (Penlac nail

lacquer)clindamycin phosph-benzoyl

peroxide (refrig) gel 1.2 (1)-5%(Duac)

clindamycin phosphate gel 1%(Cleocin-t)

clindamycin phosphate lotion 1%(Cleocin-t)

clindamycin phosphate soln 1%(Cleocin-t)

clindamycin phosphate swab 1%(Cleocin-t)

clobetasol propionate cream 0.05%(Temovate)

clobetasol propionate emollientbase cream 0.05% (Temovate e)

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clobetasol propionate foam 0.05%(Olux)

clobetasol propionate gel 0.05%(Temovate)

clobetasol propionate oint 0.05%(Temovate)

clobetasol propionate soln 0.05%(Temovate)

COSENTYX – secukinumabsubcutaneous soln prefilled syringe150 mg/ml

• • •

COSENTYX – secukinumabsubcutaneous pref syr 150 mg/ml(300 mg dose)

• • •

COSENTYX SENSOREADY PEN –secukinumab subcutaneous solnauto-injector 150 mg/ml

• • •

COSENTYX SENSOREADY PEN –secukinumab subcutaneous auto-inj150 mg/ml (300 mg dose)

• • •

desonide cream 0.05% (Desowen)desonide lotion 0.05% (Desowen)desonide oint 0.05% (Desowen)desoximetasone cream 0.25%

(Topicort)desoximetasone oint 0.25%

(Topicort)diclofenac sodium (actinic

keratoses) gel 3% (Solaraze)DIFFERIN – adapalene lotion 0.1%econazole nitrate cream 1%ENSTILAR – calcipotriene-

betamethasone dipropionate foam0.005-0.064%

EPIDUO FORTE – adapalene-benzoylperoxide gel 0.3-2.5%

ERY – erythromycin pads 2%erythromycin gel 2% (Erygel)erythromycin soln 2%fluocinolone acetonide cream

0.01%

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fluocinolone acetonide cream0.025% (Synalar)

fluocinolone acetonide oil 0.01%(body oil) (Derma-smoothe/fs bod)

fluocinolone acetonide oil 0.01%(scalp oil) (Derma-smoothe/fs sca)

fluocinolone acetonide oint 0.025%(Synalar)

fluocinolone acetonide soln 0.01%(Synalar)

fluocinonide cream 0.05%fluocinonide emulsified base cream

0.05%fluocinonide gel 0.05%fluocinonide oint 0.05%fluocinonide soln 0.05%FLUOROPLEX – fluorouracil cream

1%FLUOROURACIL – fluorouracil soln

2%FLUOROURACIL – fluorouracil soln

5%fluorouracil cream 5% (Efudex)fluticasone propionate cream 0.05%

(Cutivate)fluticasone propionate oint 0.005%

(Cutivate)gentamicin sulfate cream 0.1%gentamicin sulfate oint 0.1%halobetasol propionate cream

0.05% (Ultravate)halobetasol propionate oint 0.05%

(Ultravate)hydrocortisone cream 2.5%hydrocortisone lotion 2.5%hydrocortisone oint 2.5%hydrocortisone valerate cream

0.2%hydrocortisone valerate oint 0.2%

(Westcort)

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imiquimod cream 3.75% (Zyclara)imiquimod cream 5% (Aldara)isotretinoin cap 10 mgisotretinoin cap 20 mgisotretinoin cap 30 mg (Claravis)isotretinoin cap 40 mgketoconazole cream 2%ketoconazole shampoo 2% (Nizoral)lidocaine hcl gel 2%lidocaine hcl soln 4% (Xylocaine)lidocaine oint 5%lidocaine patch 5% (Lidoderm)lidocaine-prilocaine cream 2.5-2.5%

(Emla)LINDANE – lindane shampoo 1%malathion lotion 0.5% (Ovide)metronidazole cream 0.75%

(Metrocream)metronidazole gel 0.75%metronidazole gel 1% (Metrogel)metronidazole lotion 0.75%

(Metrolotion)mometasone furoate cream 0.1%

(Elocon)mometasone furoate oint 0.1%

(Elocon)mometasone furoate solution 0.1%

(lotion) (Elocon)mupirocin oint 2% (Bactroban)nystatin cream 100000 unit/gmnystatin oint 100000 unit/gmnystatin topical powder 100000

unit/gmnystatin-triamcinolone cream

100000-0.1 unit/gm-%nystatin-triamcinolone oint

100000-0.1 unit/gm-%

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ORACEA – doxycycline (rosacea) capdelayed release 40 mg

permethrin cream 5% (Elimite)pimecrolimus cream 1% (Elidel)podofilox soln 0.5% (Condylox)selenium sulfide lotion 2.5%silver sulfadiazine cream 1%

(Silvadene)SKYRIZI – risankizumab-rzaa sol

prefilled syringe 2 x 75 mg/0.83mlkit

• • •

SOOLANTRA – ivermectin cream 1%STELARA – ustekinumab inj 45

mg/0.5ml• • •

STELARA – ustekinumab solnprefilled syringe 45 mg/0.5ml

• • •

STELARA – ustekinumab solnprefilled syringe 90 mg/ml

• • •

sulfacetamide sodium lotion 10%(acne) (Klaron)

tacrolimus oint 0.03% (Protopic)tacrolimus oint 0.1% (Protopic)tazarotene cream 0.1% (Tazorac)TAZORAC – tazarotene cream 0.05%TAZORAC – tazarotene gel 0.05%TAZORAC – tazarotene gel 0.1%TREMFYA – guselkumab soln pen-

injector 100 mg/ml• • •

TREMFYA – guselkumab soln prefilledsyringe 100 mg/ml

• • •

tretinoin cream 0.025% (Retin-a)tretinoin cream 0.05% (Retin-a)tretinoin cream 0.1% (Retin-a)tretinoin gel 0.01% (Retin-a)tretinoin gel 0.025%, nf = avita

(Retin-a)triamcinolone acetonide cream

0.025%

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triamcinolone acetonide cream0.1%

triamcinolone acetonide cream0.5%

triamcinolone acetonide lotion0.025%

triamcinolone acetonide lotion 0.1%triamcinolone acetonide oint

0.025%triamcinolone acetonide oint 0.1%triamcinolone acetonide oint 0.5%VALCHLOR – mechlorethamine hcl

gel 0.016% (base equivalent)•

ZYCLARA – imiquimod cream 3.75%ZYCLARA PUMP – imiquimod cream

2.5%ZYCLARA PUMP – imiquimod cream

3.75%MISCELLANEOUS PRODUCTSANTIDOTESCHEMET – succimer cap 100 mgNALOXONE HCL – naloxone hcl soln

cartridge 0.4 mg/mlnaloxone hcl inj 0.4 mg/mlnaloxone hcl inj 4 mg/10mlnaltrexone hcl tab 50 mg (Revia)NARCAN – naloxone hcl nasal spray

4 mg/0.1mlDIABETIC SUPPLIESASCENSIA CONTOUR, CONTOUR

ASCENSIA CONTOUR, CONTOURNEXT, TRUE METRIX test strips

•

ASCENSIA CONTOUR, CONTOURNEXT/EZ/LINK/ONE, TRUE METRIX blood glucose meter

ASCENSIA DIASTIX, KETO-DIASTIX,KETOSTIX urine test products

DEXCOM G5/G6 RECEIVER/SENSOR/TRANSMITTER

NEXT, TRUE METRIX calibration liquid

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FREESTYLE LIBRE/2, 14 READER/SENSOR/FLASH - continuous glucose monitoring system

INSULIN PEN NEEDLES - various

INSULIN SYRINGES - variousLANCET DEVICES - various

LANCETS - various

MEDICAL DEVICESINHALER ASSIST DEVICES -

SPACERSASSORTED CLASSESazathioprine tab 50 mg (Imuran)buprenorphine hcl-naloxone hcl

sl film 2-0.5 mg (base equiv)(Suboxone)

buprenorphine hcl-naloxonehcl sl film 4-1 mg (base equiv)(Suboxone)

buprenorphine hcl-naloxonehcl sl film 8-2 mg (base equiv)(Suboxone)

buprenorphine hcl-naloxone hclsl film 12-3 mg (base equiv)(Suboxone)

buprenorphine hcl-naloxone hcl sltab 2-0.5 mg (base equiv)

buprenorphine hcl-naloxone hcl sltab 8-2 mg (base equiv)

cyclosporine cap 25 mg(Sandimmune)

cyclosporine cap 100 mg(Sandimmune)

cyclosporine modified cap 25 mg(Neoral)

cyclosporine modified cap 50 mg(Cyclosporine modifie)

cyclosporine modified cap 100 mg(Neoral)

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cyclosporine modified oral soln100 mg/ml (Neoral)

everolimus tab 0.25 mg (Zortress)everolimus tab 0.5 mg (Zortress)everolimus tab 0.75 mg (Zortress)LOKELMA – sodium zirconium

cyclosilicate for susp packet 5 gmLOKELMA – sodium zirconium

cyclosilicate for susp packet 10 gmmycophenolate mofetil cap 250 mg

(Cellcept)mycophenolate mofetil for oral

susp 200 mg/ml (Cellcept)mycophenolate mofetil tab 500 mg

(Cellcept)mycophenolate sodium tab dr

180 mg (mycophenolic acidequiv) (Myfortic)

mycophenolate sodium tab dr360 mg (mycophenolic acidequiv) (Myfortic)

penicillamine tab 250 mg (Depentitratabs)

•

REVLIMID – lenalidomide caps 2.5mg

•

REVLIMID – lenalidomide cap 5 mg •REVLIMID – lenalidomide cap 10 mg •REVLIMID – lenalidomide cap 15 mg •REVLIMID – lenalidomide cap 20 mg •REVLIMID – lenalidomide cap 25 mg •sirolimus oral soln 1 mg/ml

(Rapamune)sirolimus tab 0.5 mg (Rapamune)sirolimus tab 1 mg (Rapamune)sirolimus tab 2 mg (Rapamune)sodium polystyrene sulfonate

powderSPS – sodium polystyrene sulfonate

oral susp 15 gm/60mltacrolimus cap 0.5 mg (Prograf)

OMNIPOD DASH

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tacrolimus cap 1 mg (Prograf)tacrolimus cap 5 mg (Prograf)THALOMID – thalidomide cap 50 mg •THALOMID – thalidomide cap 100 mg •THALOMID – thalidomide cap 150 mg •THALOMID – thalidomide cap 200 mg •VELTASSA – patiromer sorbitex

calcium for susp packet 8.4 gm(base eq)

VELTASSA – patiromer sorbitexcalcium for susp packet 16.8 gm(base eq)

VELTASSA – patiromer sorbitexcalcium for susp packet 25.2 gm(base eq)

ZOKINVY – lonafarnib cap 50 mg •ZOKINVY – lonafarnib cap 75 mg •ZORTRESS – everolimus tab 1 mg

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FID 568 July 2021 64

INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg

(Epzicom)......................................................................... 3abacavir sulfate-lamivudine-zidovudine tab

300-150-300 mg (Trizivir)................................................3abacavir sulfate soln 20 mg/ml (base equiv)

(Ziagen).............................................................................3abacavir sulfate tab 300 mg (base equiv) (Ziagen)........3abiraterone acetate tab 250 mg (Zytiga)......................... 7abiraterone acetate tab 500 mg (Zytiga)......................... 7acamprosate calcium tab delayed release 333 mg

(Campral)........................................................................41acarbose tab 25 mg (Precose)....................................... 15acarbose tab 50 mg (Precose)....................................... 15acarbose tab 100 mg (Precose)..................................... 15acebutolol hcl cap 200 mg (Sectral)..............................21acebutolol hcl cap 400 mg (Sectral)..............................21acetaminophen w/ codeine soln 120-12 mg/5ml..........43acetaminophen w/ codeine tab 300-15 mg (Tylenol/

codeine)..........................................................................43acetaminophen w/ codeine tab 300-30 mg (Tylenol/

codeine #3).................................................................... 43acetaminophen w/ codeine tab 300-60 mg (Tylenol/

codeine #4).................................................................... 43acetazolamide cap er 12hr 500 mg................................26acetazolamide tab 125 mg..............................................26acetazolamide tab 250 mg..............................................26acetic acid otic soln 2%..................................................58acetylcysteine inhal soln 10%........................................29acetylcysteine inhal soln 20%........................................29acitretin cap 10 mg (Soriatane)......................................58acitretin cap 17.5 mg (Soriatane)...................................58acitretin cap 25 mg (Soriatane)......................................58ACTEMRA ACTPEN – tocilizumab subcutaneous soln

auto-injector 162 mg/0.9ml.............................................45ACTEMRA – tocilizumab subcutaneous soln prefilled

syringe 162 mg/0.9ml..................................................... 45ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml

(2000000 unit/0.5ml).........................................................7acyclovir cap 200 mg (Zovirax)........................................3acyclovir susp 200 mg/5ml (Zovirax).............................. 3acyclovir tab 400 mg (Zovirax)........................................ 3acyclovir tab 800 mg (Zovirax)........................................ 3adapalene-benzoyl peroxide gel 0.1-2.5%

(Epiduo).......................................................................... 58adapalene cream 0.1% (Differin)....................................58adapalene gel 0.1% (Differin)......................................... 58adapalene gel 0.3% (Differin)......................................... 58ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 5 mg...................................................................39ADDERALL XR – amphetamine-dextroamphetamine cap

er 24hr 10 mg.................................................................39

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 15 mg.................................................................39




adefovir dipivoxil tab 10 mg (Hepsera)...........................3ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21

mcg/act............................................................................ 29ADVAIR HFA – fluticasone-salmeterol inhal aerosol

115-21 mcg/act............................................................... 29ADVAIR HFA – fluticasone-salmeterol inhal aerosol

230-21 mcg/act............................................................... 29ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

250 unit........................................................................... 54ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

500 unit........................................................................... 54ADVATE – antihemophilic factor recomb (rahf-pfm) for inj

1000 unit......................................................................... 54ADVATE – antihemophilic factor recomb (rahf-pfm) for inj




4000 unit......................................................................... 54AFINITOR DISPERZ – everolimus tab for oral susp 2

mg......................................................................................7AFINITOR DISPERZ – everolimus tab for oral susp 3

mg......................................................................................7AFINITOR DISPERZ – everolimus tab for oral susp 5

mg......................................................................................7AFINITOR – everolimus tab 10 mg.....................................7AFSTYLA – antihemophilic fact rcmb single chain for inj

kit 250 unit...................................................................... 54AFSTYLA – antihemophilic fact rcmb single chain for inj

kit 500 unit...................................................................... 54AFSTYLA – antihemophilic fact rcmb single chain for inj

kit 1000 unit.................................................................... 54AFSTYLA – antihemophilic fact rcmb single chain for inj




kit 3000 unit.................................................................... 54AIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 70 mg/ml............................................................ 47AIMOVIG – erenumab-aooe subcutaneous soln auto-

injector 140 mg/ml.......................................................... 47albendazole tab 200 mg (Albenza).................................. 6albuterol sulfate inhal aero 108 mcg/act (90mcg base

equiv) (Proventil hfa)....................................................29

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FID 568 July 2021 65

albuterol sulfate soln nebu 0.083% (2.5 mg/3ml).........29albuterol sulfate soln nebu 0.5% (5 mg/ml)..................29albuterol sulfate soln nebu 0.63 mg/3ml (base

equiv).............................................................................. 29albuterol sulfate soln nebu 1.25 mg/3ml (base

equiv).............................................................................. 29albuterol sulfate syrup 2 mg/5ml...................................29albuterol sulfate tab 2 mg...............................................29albuterol sulfate tab 4 mg...............................................29alclometasone dipropionate cream 0.05%

(Aclovate)....................................................................... 58alclometasone dipropionate oint 0.05%........................58ALECENSA – alectinib hcl cap 150 mg (base

equivalent)......................................................................... 7ALENDRONATE SODIUM – alendronate sodium tab 5

mg....................................................................................19alendronate sodium tab 10 mg...................................... 19alendronate sodium tab 35 mg...................................... 19alendronate sodium tab 70 mg (Fosamax)...................19alfuzosin hcl tab er 24hr 10 mg (Uroxatral)..................34ALINIA – nitazoxanide for susp 100 mg/5ml.......................6ALINIA – nitazoxanide tab 500 mg..................................... 6allopurinol tab 100 mg (Zyloprim)................................. 48allopurinol tab 300 mg (Zyloprim)................................. 48ALPHAGAN P – brimonidine tartrate ophth soln 0.1%..... 56alprazolam tab er 24hr 0.5 mg (Xanax xr).....................35alprazolam tab er 24hr 1 mg (Xanax xr)........................35alprazolam tab er 24hr 2 mg (Xanax xr)........................35alprazolam tab er 24hr 3 mg (Xanax xr)........................35alprazolam tab 0.25 mg (Xanax).................................... 35alprazolam tab 0.5 mg (Xanax)...................................... 35alprazolam tab 1 mg (Xanax)..........................................35alprazolam tab 2 mg (Xanax)..........................................35ALREX – loteprednol etabonate ophth susp 0.2%........... 56ALUNBRIG – brigatinib tab initiation therapy pack 90 mg

& 180 mg.......................................................................... 7ALUNBRIG – brigatinib tab 30 mg......................................7ALUNBRIG – brigatinib tab 90 mg......................................7ALUNBRIG – brigatinib tab 180 mg....................................7amantadine hcl cap 100 mg........................................... 49amantadine hcl syrup 50 mg/5ml.................................. 49ambrisentan tab 5 mg (Letairis).....................................28ambrisentan tab 10 mg (Letairis)...................................28AMCINONIDE – amcinonide cream 0.1%........................ 58amiloride & hydrochlorothiazide tab 5-50 mg..............26amiloride hcl tab 5 mg.................................................... 26amiodarone hcl tab 100 mg............................................22amiodarone hcl tab 400 mg............................................22amiodarone hcl tab 200 mg (Cordarone)......................22amitriptyline hcl tab 10 mg.............................................35amitriptyline hcl tab 25 mg.............................................35amitriptyline hcl tab 50 mg.............................................35amitriptyline hcl tab 75 mg.............................................35amitriptyline hcl tab 100 mg...........................................35amitriptyline hcl tab 150 mg...........................................35amlodipine besylate-benazepril hcl cap 2.5-10 mg

(Lotrel)............................................................................ 23

amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)............................................................................ 23





amlodipine besylate tab 2.5 mg (base equivalent)(Norvasc)........................................................................22

amlodipine besylate tab 5 mg (base equivalent)(Norvasc)........................................................................22

amlodipine besylate tab 10 mg (base equivalent)(Norvasc)........................................................................22

amlodipine besylate-valsartan tab 5-160 mg(Exforge).........................................................................23




amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)........................................ 23

amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg (Exforge hct)........................................... 23

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct)...................................... 23

amlodipine-valsartan-hydrochlorothiazide tab10-160-25 mg (Exforge hct)......................................... 23

amlodipine-valsartan-hydrochlorothiazide tab10-320-25 mg (Exforge hct)......................................... 23

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 200-28.5 mg.................................. 1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 400-57 mg..................................... 1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate tab er 12hr 1000-62.5 mg.............................1

amoxicillin & k clavulanate for susp 200-28.5mg/5ml.............................................................................. 1

amoxicillin & k clavulanate for susp 400-57 mg/5ml..... 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml

(Augmentin)..................................................................... 1amoxicillin & k clavulanate for susp 600-42.9 mg/5ml

(Augmentin es-600)........................................................ 1amoxicillin & k clavulanate tab 250-125 mg................... 1amoxicillin & k clavulanate tab 500-125 mg

(Augmentin)..................................................................... 1amoxicillin & k clavulanate tab 875-125 mg

(Augmentin)..................................................................... 1AMOXICILLIN – amoxicillin (trihydrate) chew tab 125

mg......................................................................................1AMOXICILLIN – amoxicillin (trihydrate) chew tab 250

mg......................................................................................1amoxicillin (trihydrate) cap 250 mg.................................1

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FID 568 July 2021 66

amoxicillin (trihydrate) cap 500 mg.................................1amoxicillin (trihydrate) for susp 125 mg/5ml..................1amoxicillin (trihydrate) for susp 200 mg/5ml..................1amoxicillin (trihydrate) for susp 250 mg/5ml..................1amoxicillin (trihydrate) for susp 400 mg/5ml..................1amoxicillin (trihydrate) tab 500 mg..................................1amoxicillin (trihydrate) tab 875 mg..................................1amphetamine-dextroamphetamine cap er 24hr 5 mg

(Adderall xr)...................................................................39amphetamine-dextroamphetamine cap er 24hr 10 mg





(Adderall xr)...................................................................39amphetamine-dextroamphetamine tab 5 mg

(Adderall)........................................................................39amphetamine-dextroamphetamine tab 7.5 mg

(Adderall)........................................................................40amphetamine-dextroamphetamine tab 10 mg

(Adderall)........................................................................40amphetamine-dextroamphetamine tab 12.5 mg




(Adderall)........................................................................40AMPICILLIN – ampicillin cap 500 mg................................. 1anagrelide hcl cap 1 mg................................................. 54anagrelide hcl cap 0.5 mg (Agrylin).............................. 54anastrozole tab 1 mg (Arimidex)..................................... 7ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba

62.5-25 mcg/inh.............................................................. 29aprepitant capsule 40 mg (Emend)............................... 33aprepitant capsule 80 mg (Emend)............................... 33aprepitant capsule 125 mg (Emend)............................. 33aprepitant capsule therapy pack 80 & 125 mg

(Emend).......................................................................... 33ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25

mcg/ml............................................................................. 52ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40

mcg/ml............................................................................. 52ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60

mcg/ml............................................................................. 52ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

100 mcg/ml......................................................................52ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

200 mcg/ml......................................................................52ARANESP ALBUMIN FREE – darbepoetin alfa soln inj

300 mcg/ml......................................................................52

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 10 mcg/0.4ml....................................... 52

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 25 mcg/0.42ml..................................... 52







ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 500 mcg/ml.......................................... 52

aripiprazole tab 2 mg (Abilify)........................................37aripiprazole tab 5 mg (Abilify)........................................37aripiprazole tab 10 mg (Abilify)......................................37aripiprazole tab 15 mg (Abilify)......................................37aripiprazole tab 20 mg (Abilify)......................................37aripiprazole tab 30 mg (Abilify)......................................37armodafinil tab 50 mg (Nuvigil)......................................40armodafinil tab 150 mg (Nuvigil)................................... 40armodafinil tab 200 mg (Nuvigil)................................... 40armodafinil tab 250 mg (Nuvigil)................................... 40ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 50 mcg/act.................................................. 30ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 100 mcg/act................................................30ARNUITY ELLIPTA – fluticasone furoate aerosol powder

breath activ 200 mcg/act................................................30ASCENSIA CONTOUR, CONTOUR NEXT/EZ/LINK/ONE

blood glucose meter....................................................... 61ASCENSIA CONTOUR, CONTOUR NEXT calibration

liquid................................................................................ 61ASCENSIA CONTOUR, CONTOUR NEXT test strips......61ASCENSIA DIASTIX, KETO-DIASTIX, KETOSTIX urine

test products....................................................................61ASMANEX HFA – mometasone furoate inhal aerosol

suspension 50 mcg/act...................................................30ASMANEX HFA – mometasone furoate inhal aerosol

suspension 100 mcg/act.................................................30ASMANEX HFA – mometasone furoate inhal aerosol

suspension 200 mcg/act.................................................30ASMANEX TWISTHALER 120 ME – mometasone furoate

inhal powd 220 mcg/inh (breath activated)....................30ASMANEX TWISTHALER 30 MET – mometasone furoate

inhal powd 110 mcg/inh (breath activated).................... 30ASMANEX TWISTHALER 30 MET – mometasone furoate

inhal powd 220 mcg/inh (breath activated)....................30ASMANEX TWISTHALER 60 MET – mometasone furoate

inhal powd 220 mcg/inh (breath activated)....................30atazanavir sulfate cap 150 mg (base equiv)

(Reyataz)...........................................................................3

2021

FID 568 July 2021 67

atazanavir sulfate cap 200 mg (base equiv)(Reyataz)...........................................................................3

atazanavir sulfate cap 300 mg (base equiv)(Reyataz)...........................................................................4

atenolol & chlorthalidone tab 50-25 mg (Tenoretic50)....................................................................................23

atenolol & chlorthalidone tab 100-25 mg (Tenoretic100)..................................................................................23

atenolol tab 25 mg (Tenormin).......................................21atenolol tab 50 mg (Tenormin).......................................21atenolol tab 100 mg (Tenormin).....................................21atomoxetine hcl cap 10 mg (base equiv)

(Strattera)....................................................................... 40atomoxetine hcl cap 18 mg (base equiv)






(Strattera)....................................................................... 40atorvastatin calcium tab 10 mg (base equivalent)

(Lipitor)........................................................................... 27atorvastatin calcium tab 20 mg (base equivalent)



(Lipitor)........................................................................... 27atovaquone-proguanil hcl tab 62.5-25 mg

(Malarone)........................................................................ 6atovaquone-proguanil hcl tab 250-100 mg

(Malarone)........................................................................ 6ATROPINE SULFATE – atropine sulfate ophth soln

1%....................................................................................56ATROVENT HFA – ipratropium bromide hfa inhal aerosol

17 mcg/act.......................................................................30AUBAGIO – teriflunomide tab 7 mg..................................41AUBAGIO – teriflunomide tab 14 mg................................41AUGMENTED BETAMETHASONE D – betamethasone

dipropionate augmented gel 0.05%............................... 58AUGMENTIN – amoxicillin & k clavulanate for susp

125-31.25 mg/5ml.............................................................1AVONEX – interferon beta-1a im prefilled syringe kit 30

mcg/0.5ml........................................................................41AVONEX PEN – interferon beta-1a im auto-injector kit 30

mcg/0.5ml........................................................................41AYVAKIT – avapritinib tab 100 mg......................................7AYVAKIT – avapritinib tab 200 mg......................................7AYVAKIT – avapritinib tab 300 mg......................................7azathioprine tab 50 mg (Imuran)....................................62azelaic acid gel 15% (Finacea).......................................58azelastine hcl nasal spray 0.1% (137 mcg/spray)........ 29

azelastine hcl nasal spray 0.15% (205.5 mcg/spray)(Astepro).........................................................................29

azelastine hcl ophth soln 0.05% (Optivar)....................56AZITHROMYCIN – azithromycin powd pack for susp 1

gm......................................................................................2azithromycin for susp 100 mg/5ml (Zithromax)............. 2azithromycin for susp 200 mg/5ml (Zithromax)............. 2azithromycin tab 250 mg (Zithromax)............................. 2azithromycin tab 500 mg (Zithromax)............................. 2azithromycin tab 600 mg (Zithromax)............................. 2AZOPT – brinzolamide ophth susp 1%.............................56

BBACITRACIN – bacitracin ophth oint 500 unit/gm............ 56bacitracin-polymyxin b ophth oint................................ 56bacitracin-polymyxin-neomycin-hc ophth oint 1%......56baclofen tab 10 mg..........................................................51baclofen tab 20 mg..........................................................51balsalazide disodium cap 750 mg (Colazal)................. 33BANZEL – rufinamide tab 200 mg.................................... 48BANZEL – rufinamide tab 400 mg.................................... 48BAQSIMI ONE PACK – glucagon nasal powder 3 mg/

dose................................................................................. 15BAQSIMI TWO PACK – glucagon nasal powder 3 mg/

dose................................................................................. 15BARACLUDE – entecavir oral soln 0.05 mg/ml..................4BELSOMRA – suvorexant tab 5 mg................................. 39BELSOMRA – suvorexant tab 10 mg............................... 39BELSOMRA – suvorexant tab 15 mg............................... 39BELSOMRA – suvorexant tab 20 mg............................... 39benazepril & hydrochlorothiazide tab 5-6.25 mg......... 23benazepril & hydrochlorothiazide tab 10-12.5 mg

(Lotensin hct)................................................................ 23benazepril & hydrochlorothiazide tab 20-12.5 mg

(Lotensin hct)................................................................ 23benazepril & hydrochlorothiazide tab 20-25 mg

(Lotensin hct)................................................................ 23benazepril hcl tab 5 mg.................................................. 23benazepril hcl tab 10 mg (Lotensin)..............................23benazepril hcl tab 20 mg (Lotensin)..............................23benazepril hcl tab 40 mg (Lotensin)..............................23BENEFIX – coagulation factor ix (recombinant) for inj kit

250 unit........................................................................... 54BENEFIX – coagulation factor ix (recombinant) for inj kit

500 unit........................................................................... 54BENEFIX – coagulation factor ix (recombinant) for inj kit

1000 unit......................................................................... 54BENEFIX – coagulation factor ix (recombinant) for inj kit

2000 unit......................................................................... 54BENEFIX – coagulation factor ix (recombinant) for inj kit

3000 unit......................................................................... 54BENZNIDAZOLE – benznidazole tab 12.5 mg................... 6BENZNIDAZOLE – benznidazole tab 100 mg.................... 6benztropine mesylate tab 0.5 mg.................................. 50benztropine mesylate tab 1 mg..................................... 50benztropine mesylate tab 2 mg..................................... 50

2021

FID 568 July 2021 68

betamethasone dipropionate augmented cream 0.05%(Diprolene af).................................................................58

betamethasone dipropionate augmented lotion 0.05%(Diprolene)......................................................................58

betamethasone dipropionate augmented oint 0.05%(Diprolene)......................................................................58

betamethasone dipropionate cream 0.05%.................. 58betamethasone dipropionate lotion 0.05%...................59betamethasone dipropionate oint 0.05%...................... 59betamethasone valerate cream 0.1% (base

equivalent)......................................................................59betamethasone valerate lotion 0.1% (base

equivalent)......................................................................59betamethasone valerate oint 0.1% (base

equivalent)......................................................................59BETASERON – interferon beta-1b for inj kit 0.3 mg......... 41bexarotene cap 75 mg (Targretin)....................................7bicalutamide tab 50 mg (Casodex)..................................7BIKTARVY – bictegravir-emtricitabine-tenofovir af tab

50-200-25 mg....................................................................4bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg

(Ziac)............................................................................... 23bisoprolol & hydrochlorothiazide tab 5-6.25 mg

(Ziac)............................................................................... 23bisoprolol & hydrochlorothiazide tab 10-6.25 mg

(Ziac)............................................................................... 23bisoprolol fumarate tab 5 mg (Zebeta)..........................21bisoprolol fumarate tab 10 mg (Zebeta)........................21bosentan tab 62.5 mg (Tracleer).................................... 28bosentan tab 125 mg (Tracleer)..................................... 28BOSULIF – bosutinib tab 100 mg....................................... 7BOSULIF – bosutinib tab 400 mg....................................... 7BOSULIF – bosutinib tab 500 mg....................................... 7BREO ELLIPTA – fluticasone furoate-vilanterol aero powd

ba 100-25 mcg/inh..........................................................30BREO ELLIPTA – fluticasone furoate-vilanterol aero powd

ba 200-25 mcg/inh..........................................................30BREZTRI AEROSPHERE – budesonide-glycopyrrolate-

formoterol aers 160-9-4.8 mcg/act.................................30BRILINTA – ticagrelor tab 60 mg...................................... 54BRILINTA – ticagrelor tab 90 mg...................................... 54brimonidine tartrate ophth soln 0.2%........................... 56brimonidine tartrate ophth soln 0.15% (Alphagan

p)......................................................................................56brinzolamide ophth susp 1% (Azopt)............................56budesonide delayed release particles cap 3 mg

(Entocort ec)..................................................................11budesonide inhalation susp 0.25 mg/2ml

(Pulmicort)......................................................................30budesonide inhalation susp 0.5 mg/2ml

(Pulmicort)......................................................................30budesonide inhalation susp 1 mg/2ml (Pulmicort)......30bumetanide tab 0.5 mg................................................... 26bumetanide tab 1 mg...................................................... 26bumetanide tab 2 mg...................................................... 26buprenorphine hcl-naloxone hcl sl film 2-0.5 mg (base

equiv) (Suboxone).........................................................62

buprenorphine hcl-naloxone hcl sl film 4-1 mg (baseequiv) (Suboxone).........................................................62



buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (baseequiv).............................................................................. 62

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv).............................................................................. 62

buprenorphine hcl sl tab 2 mg (base equiv)................ 43buprenorphine hcl sl tab 8 mg (base equiv)................ 43bupropion hcl (smoking deterrent) tab er 12hr 150 mg

(Zyban)............................................................................41bupropion hcl tab er 12hr 100 mg (Wellbutrin sr)........35bupropion hcl tab er 12hr 150 mg (Wellbutrin sr)........35bupropion hcl tab er 12hr 200 mg (Wellbutrin sr)........35bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)........ 35bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)........ 35bupropion hcl tab 75 mg (Wellbutrin)........................... 35bupropion hcl tab 100 mg (Wellbutrin)......................... 35buspirone hcl tab 5 mg...................................................35buspirone hcl tab 10 mg.................................................35buspirone hcl tab 15 mg.................................................35buspirone hcl tab 30 mg.................................................35butalbital-acetaminophen-caffeine tab 50-325-40 mg

(Esgic).............................................................................43butalbital-acetaminophen tab 50-325 mg......................43butalbital-aspirin-caffeine cap 50-325-40 mg

(Fiorinal)......................................................................... 43butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg

(Fiorinal/codeine #3).....................................................43Ccabergoline tab 0.5 mg................................................... 19CABOMETYX – cabozantinib s-malate tab 20 mg (base

equivalent)......................................................................... 7CABOMETYX – cabozantinib s-malate tab 40 mg (base

equivalent)......................................................................... 7CABOMETYX – cabozantinib s-malate tab 60 mg (base

equivalent)......................................................................... 7caffeine citrate oral soln 60 mg/3ml (10 mg/ml base

equiv) (Cafcit)................................................................ 40calcipotriene cream 0.005% (Dovonex).........................59calcipotriene oint 0.005%................................................59calcipotriene soln 0.005% (50 mcg/ml)......................... 59calcitonin (salmon) nasal soln 200 unit/act

(Miacalcin)......................................................................19calcitriol cap 0.25 mcg (Rocaltrol).................................19calcitriol cap 0.5 mcg (Rocaltrol)...................................19calcitriol oral soln 1 mcg/ml (Rocaltrol)........................19calcium acetate (phosphate binder) cap 667 mg (169

mg ca) (Phoslo).............................................................33calcium acetate (phosphate binder) tab 667 mg

(Eliphos)......................................................................... 33candesartan cilexetil-hydrochlorothiazide tab 16-12.5

mg (Atacand hct).......................................................... 24

2021

FID 568 July 2021 69

candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg (Atacand hct).......................................................... 24

candesartan cilexetil-hydrochlorothiazide tab 32-25mg (Atacand hct).......................................................... 24

candesartan cilexetil tab 4 mg (Atacand)..................... 23candesartan cilexetil tab 8 mg (Atacand)..................... 24candesartan cilexetil tab 16 mg (Atacand)................... 24candesartan cilexetil tab 32 mg (Atacand)................... 24capecitabine tab 150 mg (Xeloda)................................... 7capecitabine tab 500 mg (Xeloda)................................... 7CAPRELSA – vandetanib tab 100 mg................................ 7CAPRELSA – vandetanib tab 300 mg................................ 7CAPTOPRIL/HYDROCHLOROTHIA – captopril &

hydrochlorothiazide tab 25-15 mg..................................24CAPTOPRIL/HYDROCHLOROTHIA – captopril &



hydrochlorothiazide tab 50-25 mg..................................24captopril tab 12.5 mg...................................................... 24captopril tab 25 mg......................................................... 24captopril tab 50 mg......................................................... 24captopril tab 100 mg....................................................... 24CARAC – fluorouracil cream 0.5%....................................59CARBAGLU – carglumic acid tab 200 mg........................19carbamazepine cap er 12hr 100 mg (Carbatrol)...........48carbamazepine cap er 12hr 200 mg (Carbatrol)...........48carbamazepine cap er 12hr 300 mg (Carbatrol)...........48carbamazepine chew tab 100 mg.................................. 48carbamazepine susp 100 mg/5ml (Tegretol).................48carbamazepine tab er 12hr 100 mg (Tegretol-xr)......... 48carbamazepine tab er 12hr 200 mg (Tegretol-xr)......... 48carbamazepine tab er 12hr 400 mg (Tegretol-xr)......... 48carbamazepine tab 200 mg (Tegretol)...........................48CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 12.5-50-200 mg.................. 50CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 18.75-75-200 mg................ 50CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 25-100-200 mg................... 50CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 31.25-125-200 mg.............. 50CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 37.5-150-200 mg................ 50CARBIDOPA/LEVODOPA/ENTACA – carbidopa-

levodopa-entacapone tabs 50-200-200 mg................... 50carbidopa & levodopa orally disintegrating tab 10-100

mg (Parcopa)................................................................. 50carbidopa & levodopa orally disintegrating tab 25-100

mg (Parcopa)................................................................. 50carbidopa & levodopa orally disintegrating tab 25-250

mg (Parcopa)................................................................. 50carbidopa & levodopa tab er 25-100 mg.......................50carbidopa & levodopa tab er 50-200 mg.......................50carbidopa & levodopa tab 10-100 mg (Sinemet)..........50carbidopa & levodopa tab 25-100 mg (Sinemet)..........50

carbidopa & levodopa tab 25-250 mg (Sinemet)..........50CARTEOLOL HCL – carteolol hcl ophth soln 1%.............56carvedilol tab 3.125 mg (Coreg).....................................21carvedilol tab 6.25 mg (Coreg).......................................21carvedilol tab 12.5 mg (Coreg).......................................21carvedilol tab 25 mg (Coreg)..........................................21CEFACLOR – cefaclor cap 250 mg.................................... 1CEFACLOR – cefaclor cap 500 mg.................................... 1cefadroxil cap 500 mg.......................................................1CEFADROXIL – cefadroxil tab 1 gm...................................1cefadroxil for susp 250 mg/5ml....................................... 1cefadroxil for susp 500 mg/5ml....................................... 1cefdinir cap 300 mg...........................................................1cefdinir for susp 125 mg/5ml........................................... 1cefdinir for susp 250 mg/5ml........................................... 1cefixime cap 400 mg (Suprax)......................................... 1cefixime for susp 100 mg/5ml (Suprax).......................... 1cefixime for susp 200 mg/5ml (Suprax).......................... 1cefpodoxime proxetil for susp 50 mg/5ml......................1cefpodoxime proxetil for susp 100 mg/5ml....................1cefpodoxime proxetil tab 100 mg.................................... 1cefpodoxime proxetil tab 200 mg.................................... 1cefprozil for susp 125 mg/5ml..........................................1cefprozil for susp 250 mg/5ml..........................................2cefprozil tab 250 mg..........................................................2cefprozil tab 500 mg..........................................................2ceftriaxone sodium for inj 2 gm.......................................2ceftriaxone sodium for inj 1 gm (Rocephin)...................2ceftriaxone sodium for inj 250 mg...................................2ceftriaxone sodium for inj 500 mg (Rocephin)...............2cefuroxime axetil tab 250 mg (Ceftin)............................. 2cefuroxime axetil tab 500 mg (Ceftin)............................. 2celecoxib cap 50 mg (Celebrex).................................... 45celecoxib cap 100 mg (Celebrex).................................. 45celecoxib cap 200 mg (Celebrex).................................. 45celecoxib cap 400 mg (Celebrex).................................. 45CELONTIN – methsuximide cap 300 mg..........................48cephalexin cap 250 mg (Keflex).......................................2cephalexin cap 500 mg (Keflex).......................................2cephalexin for susp 125 mg/5ml......................................2cephalexin for susp 250 mg/5ml......................................2CERDELGA – eliglustat tartrate cap 84 mg (base

equivalent).......................................................................52cetirizine hcl oral soln 1 mg/ml (5 mg/5ml).................. 29cevimeline hcl cap 30 mg (Evoxac)...............................58CHANTIX CONTINUING MONTH – varenicline tartrate

tab 1 mg (base equiv).................................................... 41CHANTIX STARTING MONTH PA – varenicline tartrate

tab 0.5 mg x 11 & tab 1 mg x 42 pack...........................41CHANTIX – varenicline tartrate tab 0.5 mg (base

equiv)...............................................................................41CHANTIX – varenicline tartrate tab 1 mg (base equiv).....41CHEMET – succimer cap 100 mg.................................... 61CHENODAL – chenodiol tab 250 mg............................... 33chlorhexidine gluconate soln 0.12% (Peridex).............58CHLOROQUINE PHOSPHATE – chloroquine phosphate

tab 500 mg........................................................................6

2021

FID 568 July 2021 70

chloroquine phosphate tab 250 mg................................ 6chlorpromazine hcl tab 10 mg....................................... 37chlorpromazine hcl tab 25 mg....................................... 37chlorpromazine hcl tab 50 mg....................................... 37chlorpromazine hcl tab 100 mg..................................... 37chlorpromazine hcl tab 200 mg..................................... 37chlorthalidone tab 25 mg................................................26chlorthalidone tab 50 mg................................................26chlorzoxazone tab 500 mg..............................................51cholestyramine light powder 4 gm/dose (Questran

light)................................................................................ 27cholestyramine light powder packets 4 gm................. 27cholestyramine powder 4 gm/dose (Questran)............27cholestyramine powder packets 4 gm (Questran).......27choline fenofibrate cap dr 45 mg (fenofibric acid

equiv) (Trilipix).............................................................. 27CHORIONIC GONADOTROPIN – chorionic gonadotropin

for im inj 10000 unit........................................................19ciclopirox gel 0.77% (Loprox)........................................ 59ciclopirox olamine cream 0.77% (base equiv)..............59ciclopirox olamine susp 0.77% (base equiv)................59ciclopirox shampoo 1% (Loprox shampoo)................. 59ciclopirox solution 8% (Penlac nail lacquer)................59cilostazol tab 50 mg (Pletal)...........................................54cilostazol tab 100 mg (Pletal).........................................54CILOXAN – ciprofloxacin hcl ophth oint 0.3%.................. 56CIMDUO – lamivudine-tenofovir disoproxil fumarate tab

300-300 mg.......................................................................4cimetidine hcl soln 300 mg/5ml..................................... 32cimetidine tab 300 mg.....................................................32cimetidine tab 400 mg.....................................................32cimetidine tab 800 mg.....................................................32cinacalcet hcl tab 30 mg (base equiv) (Sensipar)........19cinacalcet hcl tab 60 mg (base equiv) (Sensipar)........19cinacalcet hcl tab 90 mg (base equiv) (Sensipar)........19CINRYZE – c1 esterase inhibitor (human) for iv inj 500

unit................................................................................... 54CIPRO – ciprofloxacin for oral susp 500 mg/5ml (10%)

(10 gm/100ml)...................................................................2ciprofloxacin-dexamethasone otic susp 0.3-0.1%

(Ciprodex).......................................................................58CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg

(base equiv)...................................................................... 2ciprofloxacin hcl ophth soln 0.3% (base equivalent)

(Ciloxan)......................................................................... 56ciprofloxacin hcl tab 750 mg (base equiv)..................... 2ciprofloxacin hcl tab 250 mg (base equiv) (Cipro).........2ciprofloxacin hcl tab 500 mg (base equiv) (Cipro).........2CIPRO HC – ciprofloxacin-hydrocortisone otic susp

0.2-1%............................................................................. 58citalopram hydrobromide oral soln 10 mg/5ml............35citalopram hydrobromide tab 10 mg (base equiv)

(Celexa)...........................................................................35citalopram hydrobromide tab 20 mg (base equiv)

(Celexa)...........................................................................35citalopram hydrobromide tab 40 mg (base equiv)

(Celexa)...........................................................................35

CLARITHROMYCIN – clarithromycin for susp 125mg/5ml...............................................................................2

CLARITHROMYCIN – clarithromycin for susp 250mg/5ml...............................................................................2

clarithromycin tab er 24hr 500 mg.................................. 2clarithromycin tab 250 mg (Biaxin)................................. 2clarithromycin tab 500 mg (Biaxin)................................. 2CLIMARA PRO – estradiol-levonorgestrel td patch weekly

0.045-0.015 mg/day........................................................12clindamycin hcl cap 75 mg (Cleocin)..............................6clindamycin hcl cap 150 mg (Cleocin)............................6clindamycin hcl cap 300 mg (Cleocin)............................6clindamycin palmitate hcl for soln 75 mg/5ml (base

equiv) (Cleocin pediatric gr)..........................................6clindamycin phosphate gel 1% (Cleocin-t)...................59clindamycin phosphate lotion 1% (Cleocin-t).............. 59clindamycin phosphate soln 1% (Cleocin-t).................59clindamycin phosphate swab 1% (Cleocin-t)............... 59clindamycin phosphate vaginal cream 2%

(Cleocin)......................................................................... 34clindamycin phosph-benzoyl peroxide (refrig) gel 1.2

(1)-5% (Duac)................................................................. 59clobetasol propionate cream 0.05% (Temovate)..........59clobetasol propionate emollient base cream 0.05%

(Temovate e).................................................................. 59clobetasol propionate foam 0.05% (Olux).................... 59clobetasol propionate gel 0.05% (Temovate)............... 59clobetasol propionate oint 0.05% (Temovate)..............59clobetasol propionate soln 0.05% (Temovate)............. 59CLOMIPHENE CITRATE – clomiphene citrate tab 50

mg....................................................................................19clomipramine hcl cap 25 mg (Anafranil).......................35clomipramine hcl cap 50 mg (Anafranil).......................36clomipramine hcl cap 75 mg (Anafranil).......................36clonazepam tab 0.5 mg (Klonopin)................................48clonazepam tab 1 mg (Klonopin)...................................48clonazepam tab 2 mg (Klonopin)...................................48clonidine hcl tab 0.1 mg (Catapres).............................. 24clonidine hcl tab 0.2 mg (Catapres).............................. 24clonidine hcl tab 0.3 mg (Catapres).............................. 24clonidine td patch weekly 0.1 mg/24hr (Catapres-

tts-1)................................................................................24clonidine td patch weekly 0.2 mg/24hr (Catapres-

tts-2)................................................................................24clonidine td patch weekly 0.3 mg/24hr (Catapres-

tts-3)................................................................................24clopidogrel bisulfate tab 75 mg (base equiv)

(Plavix)............................................................................54clotrimazole troche 10 mg..............................................58clozapine tab 50 mg........................................................ 37clozapine tab 200 mg...................................................... 37clozapine tab 25 mg (Clozaril)........................................37clozapine tab 100 mg (Clozaril)..................................... 37COAGADEX – coagulation factor x (human) for inj 250

unit................................................................................... 54COAGADEX – coagulation factor x (human) for inj 500

unit................................................................................... 55

2021

FID 568 July 2021 71

COARTEM – artemether-lumefantrine tab 20-120 mg....... 6codeine sulfate tab 30 mg.............................................. 43colchicine w/ probenecid tab 0.5-500 mg..................... 48colesevelam hcl packet for susp 3.75 gm

(Welchol)........................................................................ 27colesevelam hcl tab 625 mg (Welchol)......................... 27colestipol hcl granule packets 5 gm (Colestid

flavored)......................................................................... 27colestipol hcl granules 5 gm (Colestid flavored).........27colestipol hcl tab 1 gm (Colestid)..................................27COMBIVENT RESPIMAT – ipratropium-albuterol inhal

aerosol soln 20-100 mcg/act..........................................30COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60

mg dose) kit...................................................................... 8COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20

mg (100 dose) kit..............................................................8COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20

mg (140 dose) kit..............................................................8CORIFACT – factor xiii concentrate (human) for inj kit

1000-1600 unit................................................................ 55CORLANOR – ivabradine hcl oral soln 5 mg/5ml (base

equiv)...............................................................................28CORLANOR – ivabradine hcl tab 5 mg (base equiv)....... 28CORLANOR – ivabradine hcl tab 7.5 mg (base

equiv)...............................................................................28CORTIFOAM – hydrocortisone acetate perianal foam

10% (90 mg/dose).......................................................... 58COSENTYX – secukinumab subcutaneous pref syr 150

mg/ml (300 mg dose)..................................................... 59COSENTYX – secukinumab subcutaneous soln prefilled

syringe 150 mg/ml.......................................................... 59COSENTYX SENSOREADY PEN – secukinumab

subcutaneous auto-inj 150 mg/ml (300 mg dose)..........59COSENTYX SENSOREADY PEN – secukinumab

subcutaneous soln auto-injector 150 mg/ml.................. 59COTELLIC – cobimetinib fumarate tab 20 mg (base

equivalent)......................................................................... 8CREON – pancrelipase (lip-prot-amyl) dr cap

3000-9500-15000 unit.....................................................33CREON – pancrelipase (lip-prot-amyl) dr cap

6000-19000-30000 unit...................................................33CREON – pancrelipase (lip-prot-amyl) dr cap

12000-38000-60000 unit................................................ 33CREON – pancrelipase (lip-prot-amyl) dr cap

24000-76000-120000 unit.............................................. 33CREON – pancrelipase (lip-prot-amyl) dr cap

36000-114000-180000 unit.............................................33cromolyn sodium ophth soln 4%...................................57cromolyn sodium soln nebu 20 mg/2ml....................... 30cyanocobalamin inj 1000 mcg/ml.................................. 52cyclobenzaprine hcl tab 5 mg........................................51cyclobenzaprine hcl tab 10 mg......................................51cyclopentolate hcl ophth soln 1% (Cyclogyl)...............57cyclophosphamide cap 25 mg

(Cyclophosphamide).......................................................8cyclophosphamide cap 50 mg

(Cyclophosphamide).......................................................8

cyclosporine cap 25 mg (Sandimmune)....................... 62cyclosporine cap 100 mg (Sandimmune)..................... 62cyclosporine modified cap 50 mg (Cyclosporine

modifie)...........................................................................62cyclosporine modified cap 25 mg (Neoral)...................62cyclosporine modified cap 100 mg (Neoral).................62cyclosporine modified oral soln 100 mg/ml

(Neoral)........................................................................... 62cyproheptadine hcl syrup 2 mg/5ml..............................29cyproheptadine hcl tab 4 mg......................................... 29CYSTADANE – betaine powder for oral solution..............19CYSTAGON – cysteamine bitartrate cap 50 mg...............34CYSTAGON – cysteamine bitartrate cap 150 mg.............34

Ddanazol cap 50 mg.......................................................... 12danazol cap 100 mg........................................................ 12danazol cap 200 mg........................................................ 12dantrolene sodium cap 25 mg (Dantrium)....................51dantrolene sodium cap 50 mg (Dantrium)....................51dantrolene sodium cap 100 mg (Dantrolene

sodium)...........................................................................51dapsone tab 25 mg............................................................6dapsone tab 100 mg..........................................................6DELSTRIGO – doravirine-lamivudine-tenofovir df tab

100-300-300 mg................................................................4demeclocycline hcl tab 150 mg....................................... 2demeclocycline hcl tab 300 mg....................................... 2DESCOVY – emtricitabine-tenofovir alafenamide

fumarate tab 200-25 mg...................................................4desipramine hcl tab 10 mg (Norpramin)....................... 36desipramine hcl tab 25 mg (Norpramin)....................... 36desipramine hcl tab 50 mg (Norpramin)....................... 36desipramine hcl tab 75 mg (Norpramin)....................... 36desipramine hcl tab 100 mg (Norpramin)..................... 36desipramine hcl tab 150 mg (Norpramin)..................... 36DESLORATADINE ODT – desloratadine tab orally

disintegrating 2.5 mg...................................................... 29DESLORATADINE ODT – desloratadine tab orally

disintegrating 5 mg......................................................... 29desloratadine tab 5 mg (Clarinex)................................. 29desmopressin acetate nasal spray soln 0.01%

(Ddavp)........................................................................... 19desmopressin acetate nasal spray soln 0.01%

(refrigerated).................................................................. 19desmopressin acetate tab 0.1 mg (Ddavp)...................19desmopressin acetate tab 0.2 mg (Ddavp)...................19desogest-eth estrad & eth estrad tab 0.15-0.02/0.01

mg(21/5) (Mircette)........................................................13desogest-ethin est tab

0.1-0.025/0.125-0.025/0.15-0.025mg-mg(Cyclessa).......................................................................13

desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg(Desogen).......................................................................13

desonide cream 0.05% (Desowen)................................ 59desonide lotion 0.05% (Desowen)................................. 59desonide oint 0.05% (Desowen).................................... 59

2021

FID 568 July 2021 72

desoximetasone cream 0.25% (Topicort)......................59desoximetasone oint 0.25% (Topicort)..........................59desvenlafaxine succinate tab er 24hr 25 mg (base

equiv) (Pristiq)...............................................................36desvenlafaxine succinate tab er 24hr 50 mg (base

equiv) (Pristiq)...............................................................36desvenlafaxine succinate tab er 24hr 100 mg (base

equiv) (Pristiq)...............................................................36DEXAMETHASONE – dexamethasone soln 0.5

mg/5ml.............................................................................11DEXAMETHASONE – dexamethasone tab 1 mg.............11DEXAMETHASONE – dexamethasone tab 2 mg.............11dexamethasone elixir 0.5 mg/5ml.................................. 11DEXAMETHASONE INTENSOL – dexamethasone conc

1 mg/ml........................................................................... 11DEXAMETHASONE SODIUM PHOS – dexamethasone

sodium phosphate ophth soln 0.1%...............................57dexamethasone tab 0.5 mg............................................ 11dexamethasone tab 0.75 mg.......................................... 11dexamethasone tab 1.5 mg............................................ 11dexamethasone tab 4 mg............................................... 11dexamethasone tab 6 mg............................................... 11DEXCOM G5/G6 RECEIVER/SENSOR/TRANSMITTER –

continuous blood glucose system.................................. 62dexmethylphenidate hcl cap er 24 hr 5 mg (Focalin

xr).................................................................................... 40dexmethylphenidate hcl cap er 24 hr 10 mg (Focalin







xr).................................................................................... 40dexmethylphenidate hcl tab 2.5 mg (Focalin).............. 40dexmethylphenidate hcl tab 5 mg (Focalin)................. 40dexmethylphenidate hcl tab 10 mg (Focalin)............... 40dextroamphetamine sulfate cap er 24hr 5 mg

(Dexedrine).....................................................................40dextroamphetamine sulfate cap er 24hr 10 mg

(Dexedrine).....................................................................40dextroamphetamine sulfate cap er 24hr 15 mg

(Dexedrine).....................................................................40dextroamphetamine sulfate tab 5 mg........................... 40dextroamphetamine sulfate tab 10 mg......................... 40DIASTAT ACUDIAL – diazepam rectal gel delivery system

10 mg.............................................................................. 48DIASTAT ACUDIAL – diazepam rectal gel delivery system

20 mg.............................................................................. 48DIASTAT PEDIATRIC – diazepam rectal gel delivery

system 2.5 mg................................................................ 48

diazepam oral soln 1 mg/ml........................................... 35diazepam tab 2 mg (Valium)...........................................35diazepam tab 5 mg (Valium)...........................................35diazepam tab 10 mg (Valium).........................................35diazoxide susp 50 mg/ml (Proglycem)..........................15diclofenac potassium tab 50 mg (Cataflam).................45diclofenac sodium (actinic keratoses) gel 3%

(Solaraze)....................................................................... 59diclofenac sodium ophth soln 0.1%..............................57diclofenac sodium tab delayed release 25 mg.............45diclofenac sodium tab delayed release 50 mg.............45diclofenac sodium tab delayed release 75 mg.............45dicloxacillin sodium cap 250 mg..................................... 1dicloxacillin sodium cap 500 mg..................................... 1dicyclomine hcl cap 10 mg (Bentyl)..............................32dicyclomine hcl oral soln 10 mg/5ml............................ 32dicyclomine hcl tab 20 mg (Bentyl)...............................32DIFFERIN – adapalene lotion 0.1%..................................59digoxin oral soln 0.05 mg/ml (Digoxin).........................20digoxin tab 125 mcg (0.125 mg) (Lanoxin)................... 20digoxin tab 250 mcg (0.25 mg) (Lanoxin)..................... 20dihydroergotamine mesylate inj 1 mg/ml (D.h.e.

45)....................................................................................47dihydroergotamine mesylate nasal spray 4 mg/ml

(Migranal)....................................................................... 47DILANTIN – phenytoin sodium extended cap 30 mg........48DILANTIN – phenytoin sodium extended cap 100 mg......48DILANTIN-125 – phenytoin susp 125 mg/5ml.................. 48diltiazem hcl cap er 24hr 120 mg...................................22diltiazem hcl cap er 24hr 180 mg...................................22diltiazem hcl cap er 24hr 240 mg...................................22diltiazem hcl coated beads cap er 24hr 120 mg

(Cardizem cd)................................................................ 22diltiazem hcl coated beads cap er 24hr 180 mg




(Cardizem cd)................................................................ 22diltiazem hcl extended release beads cap er 24hr 120

mg (Tiazac).................................................................... 22diltiazem hcl extended release beads cap er 24hr 180





mg (Tiazac).................................................................... 22diltiazem hcl tab 90 mg...................................................22diltiazem hcl tab 30 mg (Cardizem)...............................22diltiazem hcl tab 60 mg (Cardizem)...............................22diltiazem hcl tab 120 mg (Cardizem).............................22

2021

FID 568 July 2021 73

dimethyl fumarate capsule delayed release 120 mg(Tecfidera)...................................................................... 41

dimethyl fumarate capsule delayed release 240 mg(Tecfidera)...................................................................... 41

dimethyl fumarate capsule dr starter pack 120 mg &240 mg (Tecfidera starter pa)......................................41

DIPHENOXYLATE/ATROPINE – diphenoxylate w/atropine liq 2.5-0.025 mg/5ml.........................................32

diphenoxylate w/ atropine tab 2.5-0.025 mg(Lomotil)......................................................................... 32

dipyridamole tab 25 mg (Persantine)............................ 55dipyridamole tab 50 mg (Persantine)............................ 55dipyridamole tab 75 mg (Persantine)............................ 55disopyramide phosphate cap 100 mg (Norpace).........22disopyramide phosphate cap 150 mg (Norpace).........22disulfiram tab 250 mg (Antabuse)................................. 41disulfiram tab 500 mg (Antabuse)................................. 41divalproex sodium cap delayed release sprinkle 125

mg (Depakote sprinkles)..............................................48divalproex sodium tab delayed release 125 mg

(Depakote)......................................................................48divalproex sodium tab delayed release 250 mg

(Depakote)......................................................................48divalproex sodium tab delayed release 500 mg

(Depakote)......................................................................48divalproex sodium tab er 24 hr 250 mg (Depakote

er).................................................................................... 48divalproex sodium tab er 24 hr 500 mg (Depakote

er).................................................................................... 48DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%)..........12DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%)..............12DIVIGEL – estradiol td gel 0.75 mg/0.75gm (0.1%)..........12DIVIGEL – estradiol td gel 1 mg/gm (0.1%)......................12DIVIGEL – estradiol td gel 1.25 mg/1.25gm (0.1%)..........12donepezil hydrochloride orally disintegrating tab 5

mg (Aricept odt)............................................................41donepezil hydrochloride orally disintegrating tab 10

mg (Aricept odt)............................................................41donepezil hydrochloride tab 5 mg (Aricept).................41donepezil hydrochloride tab 10 mg (Aricept)...............41dorzolamide hcl ophth soln 2% (Trusopt).................... 57dorzolamide hcl-timolol maleate ophth soln 22.3-6.8

mg/ml (Cosopt)..............................................................57DOVATO – dolutegravir sodium-lamivudine tab 50-300

mg (base eq).....................................................................4doxazosin mesylate tab 1 mg (Cardura).......................24doxazosin mesylate tab 2 mg (Cardura).......................24doxazosin mesylate tab 4 mg (Cardura).......................24doxazosin mesylate tab 8 mg (Cardura).......................24doxepin hcl cap 10 mg....................................................36doxepin hcl cap 25 mg....................................................36doxepin hcl cap 50 mg....................................................36doxepin hcl cap 75 mg....................................................36doxepin hcl cap 100 mg..................................................36doxepin hcl conc 10 mg/ml............................................ 36doxycycline hyclate cap 50 mg....................................... 2doxycycline hyclate cap 100 mg (Vibramycin)...............2

doxycycline hyclate tab 20 mg........................................ 2doxycycline hyclate tab 100 mg...................................... 2doxycycline monohydrate cap 50 mg............................. 2doxycycline monohydrate cap 100 mg (Monodox)........2doxycycline monohydrate tab 50 mg (Adoxa)............... 2doxycycline monohydrate tab 75 mg (Adoxa)............... 2doxycycline monohydrate tab 100 mg (Adoxa pak

1/100).................................................................................2doxycycline monohydrate tab 150 mg (Adoxa pak

1/150).................................................................................2drospirenone-ethinyl estradiol tab 3-0.03 mg (Yasmin

28)....................................................................................13drospirenone-ethinyl estradiol tab 3-0.02 mg (Yaz).....13DUAVEE – conjugated estrogens-bazedoxifene tab

0.45-20 mg......................................................................12DULERA – mometasone furoate-formoterol fumarate

aerosol 50-5 mcg/act......................................................30DULERA – mometasone furoate-formoterol fumarate

aerosol 100-5 mcg/act....................................................30DULERA – mometasone furoate-formoterol fumarate

aerosol 200-5 mcg/act....................................................30duloxetine hcl enteric coated pellets cap 20 mg (base

eq) (Cymbalta)............................................................... 36duloxetine hcl enteric coated pellets cap 30 mg (base

eq) (Cymbalta)............................................................... 36duloxetine hcl enteric coated pellets cap 60 mg (base

eq) (Cymbalta)............................................................... 36dutasteride cap 0.5 mg (Avodart).................................. 34Eeconazole nitrate cream 1%........................................... 59efavirenz cap 50 mg (Sustiva)..........................................4efavirenz cap 200 mg (Sustiva)........................................4efavirenz-emtricitabine-tenofovir df tab 600-200-300

mg (Atripla)......................................................................4efavirenz-lamivudine-tenofovir df tab 600-300-300 mg

(Symfi)...............................................................................4efavirenz-lamivudine-tenofovir df tab 400-300-300 mg

(Symfi lo)..........................................................................4efavirenz tab 600 mg (Sustiva)........................................ 4eletriptan hydrobromide tab 20 mg (base equivalent)

(Relpax).......................................................................... 47eletriptan hydrobromide tab 40 mg (base equivalent)

(Relpax).......................................................................... 47ELIQUIS – apixaban tab 2.5 mg....................................... 53ELIQUIS – apixaban tab 5 mg.......................................... 53ELIQUIS STARTER PACK – apixaban tab starter pack 5

mg....................................................................................53ELLA – ulipristal acetate tab 30 mg..................................13ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for

inj 250 unit...................................................................... 55ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) for



inj 1000 unit.................................................................... 55

2021

FID 568 July 2021 74

ELOCTATE – antihemophilic factor rcmb (bdd-rfviiifc) forinj 1500 unit.................................................................... 55






EMCYT – estramustine phosphate sodium cap 140mg......................................................................................8

EMEND – aprepitant for oral susp 125 mg (125mg/5ml)............................................................................33

EMGALITY – galcanezumab-gnlm subcutaneous solnauto-injector 120 mg/ml..................................................47

EMGALITY – galcanezumab-gnlm subcutaneous solnprefilled syr 100 mg/ml................................................... 47

EMGALITY – galcanezumab-gnlm subcutaneous solnprefilled syr 120 mg/ml................................................... 47

emtricitabine-tenofovir disoproxil fumarate tab100-150 mg (Truvada).....................................................4




enalapril maleate & hydrochlorothiazide tab 5-12.5mg................................................................................... 24

enalapril maleate & hydrochlorothiazide tab 10-25 mg(Vaseretic)...................................................................... 24

enalapril maleate tab 2.5 mg (Vasotec).........................24enalapril maleate tab 5 mg (Vasotec)............................24enalapril maleate tab 10 mg (Vasotec)..........................24enalapril maleate tab 20 mg (Vasotec)..........................24ENBREL – etanercept for subcutaneous inj 25 mg.......... 45ENBREL – etanercept subcutaneous inj 25 mg/0.5ml......45ENBREL – etanercept subcutaneous soln prefilled

syringe 25 mg/0.5ml....................................................... 45ENBREL – etanercept subcutaneous soln prefilled

syringe 50 mg/ml............................................................ 45ENBREL MINI – etanercept subcutaneous solution

cartridge 50 mg/ml..........................................................45ENBREL SURECLICK – etanercept subcutaneous

solution auto-injector 50 mg/ml...................................... 45ENDOMETRIN – progesterone vaginal insert 100 mg..... 34enoxaparin sodium inj 30 mg/0.3ml (Lovenox)............53enoxaparin sodium inj 40 mg/0.4ml (Lovenox)............53enoxaparin sodium inj 60 mg/0.6ml (Lovenox)............53enoxaparin sodium inj 80 mg/0.8ml (Lovenox)............53enoxaparin sodium inj 100 mg/ml (Lovenox)...............53enoxaparin sodium inj 120 mg/0.8ml (Lovenox)..........53enoxaparin sodium inj 150 mg/ml (Lovenox)...............54enoxaparin sodium inj 300 mg/3ml (Lovenox).............54

ENSTILAR – calcipotriene-betamethasone dipropionatefoam 0.005-0.064%........................................................ 59

entacapone tab 200 mg (Comtan)................................. 50entecavir tab 0.5 mg (Baraclude).....................................4entecavir tab 1 mg (Baraclude)........................................4ENTRESTO – sacubitril-valsartan tab 24-26 mg.............. 28ENTRESTO – sacubitril-valsartan tab 49-51 mg.............. 28ENTRESTO – sacubitril-valsartan tab 97-103 mg............ 28EPCLUSA – sofosbuvir-velpatasvir tab 200-50 mg............ 4EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg.......... 4EPIDIOLEX – cannabidiol soln 100 mg/ml....................... 48EPIDUO FORTE – adapalene-benzoyl peroxide gel

0.3-2.5%.......................................................................... 59epinephrine solution auto-injector 0.15 mg/0.3ml

(1:2000) (Epipen-jr 2-pak)............................................ 27epinephrine solution auto-injector 0.3 mg/0.3ml

(1:1000) (Epipen 2-pak)................................................ 27EPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv).............4eplerenone tab 25 mg (Inspra).......................................24eplerenone tab 50 mg (Inspra).......................................24ergocalciferol cap 1.25 mg (50000 unit) (Drisdol)........51ERIVEDGE – vismodegib cap 150 mg............................... 8ERLEADA – apalutamide tab 60 mg.................................. 8erlotinib hcl tab 25 mg (base equivalent) (Tarceva).......8erlotinib hcl tab 100 mg (base equivalent) (Tarceva).....8erlotinib hcl tab 150 mg (base equivalent) (Tarceva).....8ERY – erythromycin pads 2%........................................... 59erythromycin gel 2% (Erygel).........................................59erythromycin ophth oint 5 mg/gm.................................57erythromycin soln 2%..................................................... 59escitalopram oxalate soln 5 mg/5ml (base equiv)

(Lexapro)........................................................................ 36escitalopram oxalate tab 5 mg (base equiv)



(Lexapro)........................................................................ 36esomeprazole magnesium cap delayed release 20 mg

(base eq) (Nexium)....................................................... 32esomeprazole magnesium cap delayed release 40 mg

(base eq) (Nexium)....................................................... 32esomeprazole magnesium for delayed release susp

packet 10 mg (Nexium)................................................32esomeprazole magnesium for delayed release susp

packet 20 mg (Nexium)................................................32esomeprazole magnesium for delayed release susp

packet 40 mg (Nexium)................................................32ESPEROCT – antihemophilic factor recomb glycopeg-

exei for inj 500 unit.........................................................55ESPEROCT – antihemophilic factor recomb glycopeg-

exei for inj 1000 unit.......................................................55ESPEROCT – antihemophilic factor recomb glycopeg-

exei for inj 1500 unit.......................................................55ESPEROCT – antihemophilic factor recomb glycopeg-

exei for inj 2000 unit.......................................................55

2021

FID 568 July 2021 75

ESPEROCT – antihemophilic factor recomb glycopeg-exei for inj 3000 unit.......................................................55

estazolam tab 1 mg......................................................... 39estazolam tab 2 mg......................................................... 39estradiol & norethindrone acetate tab 0.5-0.1 mg

(Activella)....................................................................... 12estradiol & norethindrone acetate tab 1-0.5 mg

(Activella)....................................................................... 12estradiol tab 0.5 mg (Estrace)........................................12estradiol tab 1 mg (Estrace)...........................................13estradiol tab 2 mg (Estrace)...........................................13estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-

dot).................................................................................. 13estradiol td patch twice weekly 0.0375 mg/24hr

(Vivelle-dot)....................................................................13estradiol td patch twice weekly 0.05 mg/24hr (Vivelle-

dot).................................................................................. 13estradiol td patch twice weekly 0.075 mg/24hr (Vivelle-

dot).................................................................................. 13estradiol td patch twice weekly 0.1 mg/24hr (Vivelle-

dot).................................................................................. 13estradiol td patch weekly 0.025 mg/24hr (Climara)......13estradiol td patch weekly 0.05 mg/24hr (Climara)........13estradiol td patch weekly 0.06 mg/24hr (Climara)........13estradiol td patch weekly 0.075 mg/24hr (Climara)......13estradiol td patch weekly 0.1 mg/24hr (Climara)..........13estradiol td patch weekly 0.0375 mg/24hr (37.5

mcg/24hr) (Climara)...................................................... 13estradiol vaginal cream 0.1 mg/gm (Estrace)...............34ESTRING – estradiol vaginal ring 2 mg (7.5

mcg/24hrs).......................................................................34ESTROGEL – estradiol gel 0.06% (0.75 mg/1.25 gm

metered-dose pump)...................................................... 13eszopiclone tab 1 mg (Lunesta).................................... 39eszopiclone tab 2 mg (Lunesta).................................... 39eszopiclone tab 3 mg (Lunesta).................................... 39ethambutol hcl tab 100 mg (Myambutol)........................ 3ethambutol hcl tab 400 mg (Myambutol)........................ 3ethosuximide cap 250 mg (Zarontin)............................ 48ethosuximide soln 250 mg/5ml (Zarontin).................... 48ethynodiol diacetate & ethinyl estradiol tab 1 mg-35

mcg................................................................................. 13ethynodiol diacetate & ethinyl estradiol tab 1 mg-50

mcg (Zovia 1/50e)......................................................... 13etodolac cap 200 mg....................................................... 45etodolac cap 300 mg....................................................... 45etodolac tab er 24hr 400 mg.......................................... 45etodolac tab er 24hr 500 mg.......................................... 45etodolac tab er 24hr 600 mg.......................................... 45etodolac tab 400 mg........................................................45etodolac tab 500 mg........................................................45ETOPOSIDE – etoposide cap 50 mg..................................8EUFLEXXA – sodium hyaluronate intra-articular soln pref

syr 20 mg/2ml................................................................. 51everolimus tab 2.5 mg (Afinitor)...................................... 8everolimus tab 5 mg (Afinitor)......................................... 8everolimus tab 7.5 mg (Afinitor)...................................... 8

everolimus tab 0.25 mg (Zortress)................................ 62everolimus tab 0.5 mg (Zortress).................................. 62everolimus tab 0.75 mg (Zortress)................................ 62EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg

(base equiv)...................................................................... 4exemestane tab 25 mg (Aromasin)..................................8ezetimibe-simvastatin tab 10-10 mg (Vytorin)..............27ezetimibe-simvastatin tab 10-20 mg (Vytorin)..............27ezetimibe-simvastatin tab 10-40 mg (Vytorin)..............27ezetimibe-simvastatin tab 10-80 mg (Vytorin)..............27ezetimibe tab 10 mg (Zetia)............................................ 27Ffamciclovir tab 125 mg (Famvir)...................................... 4famciclovir tab 250 mg (Famvir)...................................... 4famciclovir tab 500 mg (Famvir)...................................... 4famotidine for susp 40 mg/5ml...................................... 32famotidine tab 20 mg (Pepcid).......................................32famotidine tab 40 mg (Pepcid).......................................32FARXIGA – dapagliflozin propanediol tab 5 mg (base

equivalent).......................................................................15FARXIGA – dapagliflozin propanediol tab 10 mg (base

equivalent).......................................................................15FARYDAK – panobinostat lactate cap 10 mg (base

equivalent)......................................................................... 8FARYDAK – panobinostat lactate cap 15 mg (base

equivalent)......................................................................... 8FARYDAK – panobinostat lactate cap 20 mg (base

equivalent)......................................................................... 8FEIBA – antiinhibitor coagulant complex for iv soln 500

unit................................................................................... 55FEIBA – antiinhibitor coagulant complex for iv soln 1000

unit................................................................................... 55FEIBA – antiinhibitor coagulant complex for iv soln 2500

unit................................................................................... 55felodipine tab er 24hr 2.5 mg......................................... 22felodipine tab er 24hr 5 mg............................................ 22felodipine tab er 24hr 10 mg.......................................... 22fenofibrate micronized cap 67 mg (Lofibra)................. 27fenofibrate micronized cap 134 mg (Lofibra)............... 27fenofibrate micronized cap 200 mg (Lofibra)............... 27fenofibrate tab 54 mg (Lofibra)...................................... 27fenofibrate tab 160 mg (Lofibra).................................... 28fenofibrate tab 48 mg (Tricor)........................................ 27fenofibrate tab 145 mg (Tricor)...................................... 28fentanyl citrate lozenge on a handle 200 mcg

(Actiq)............................................................................. 43fentanyl citrate lozenge on a handle 400 mcg





(Actiq)............................................................................. 43

2021

FID 568 July 2021 76

fentanyl td patch 72hr 12 mcg/hr (Duragesic)..............43fentanyl td patch 72hr 25 mcg/hr (Duragesic)..............43fentanyl td patch 72hr 50 mcg/hr (Duragesic)..............43fentanyl td patch 72hr 75 mcg/hr (Duragesic)..............43fentanyl td patch 72hr 100 mcg/hr (Duragesic)............43FIASP FLEXTOUCH – insulin aspart (with niacinamide)

sol pen-inj 100 unit/ml.................................................... 17FIASP – insulin aspart (with niacinamide) inj 100 unit/

ml..................................................................................... 17FIASP PENFILL – insulin aspart (with niacinamide) soln

cartridge 100 unit/ml.......................................................17finasteride tab 5 mg (Proscar)....................................... 34flecainide acetate tab 50 mg.......................................... 22flecainide acetate tab 100 mg........................................ 22flecainide acetate tab 150 mg........................................ 22FLOVENT DISKUS – fluticasone propionate aer pow ba

50 mcg/blister..................................................................30FLOVENT DISKUS – fluticasone propionate aer pow ba

100 mcg/blister................................................................30FLOVENT DISKUS – fluticasone propionate aer pow ba

250 mcg/blister................................................................30FLOVENT HFA – fluticasone propionate hfa inhal aer 110

mcg/act (125/valve)........................................................ 30FLOVENT HFA – fluticasone propionate hfa inhal aer 220

mcg/act (250/valve)........................................................ 30FLOVENT HFA – fluticasone propionate hfa inhal aero 44

mcg/act (50/valve)...........................................................30fluconazole for susp 10 mg/ml (Diflucan).......................3fluconazole for susp 40 mg/ml (Diflucan).......................3fluconazole tab 50 mg (Diflucan).....................................3fluconazole tab 100 mg (Diflucan)...................................3fluconazole tab 150 mg (Diflucan)...................................3fluconazole tab 200 mg (Diflucan)...................................3flucytosine cap 250 mg (Ancobon)................................. 3flucytosine cap 500 mg (Ancobon)................................. 3fludrocortisone acetate tab 0.1 mg............................... 11FLUNISOLIDE – flunisolide nasal soln 25 mcg/act

(0.025%).......................................................................... 29fluocinolone acetonide cream 0.01%............................ 59fluocinolone acetonide cream 0.025% (Synalar)..........60fluocinolone acetonide oil 0.01% (body oil) (Derma-

smoothe/fs bod)............................................................60fluocinolone acetonide oil 0.01% (scalp oil) (Derma-

smoothe/fs sca).............................................................60fluocinolone acetonide oint 0.025% (Synalar)..............60fluocinolone acetonide soln 0.01% (Synalar)...............60fluocinonide cream 0.05%.............................................. 60fluocinonide emulsified base cream 0.05%..................60fluocinonide gel 0.05%....................................................60fluocinonide oint 0.05%.................................................. 60fluocinonide soln 0.05%..................................................60fluorometholone ophth susp 0.1% (Fml liquifilm)....... 57FLUOROPLEX – fluorouracil cream 1%........................... 60fluorouracil cream 5% (Efudex)..................................... 60FLUOROURACIL – fluorouracil soln 2%.......................... 60FLUOROURACIL – fluorouracil soln 5%.......................... 60fluoxetine hcl cap 10 mg (Prozac).................................36

fluoxetine hcl cap 20 mg (Prozac).................................36fluoxetine hcl cap 40 mg (Prozac).................................36fluoxetine hcl solution 20 mg/5ml................................. 36fluphenazine decanoate inj 25 mg/ml........................... 37FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/

ml..................................................................................... 37fluphenazine hcl tab 1 mg.............................................. 37fluphenazine hcl tab 2.5 mg........................................... 37fluphenazine hcl tab 5 mg.............................................. 37fluphenazine hcl tab 10 mg............................................ 37FLUPHENAZINE HYDROCHLORID – fluphenazine hcl

elixir 2.5 mg/5ml............................................................. 37FLURBIPROFEN – flurbiprofen tab 50 mg....................... 45FLURBIPROFEN SODIUM – flurbiprofen sodium ophth

soln 0.03%...................................................................... 57flurbiprofen tab 100 mg.................................................. 45FLUTAMIDE – flutamide cap 125 mg................................. 8FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 55-14 mcg/act...................... 30FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 113-14 mcg/act.....................31FLUTICASONE PROPIONATE/SA – fluticasone-

salmeterol aer powder ba 232-14 mcg/act.................... 31fluticasone propionate cream 0.05% (Cutivate)...........60fluticasone propionate nasal susp 50 mcg/act

(Flonase).........................................................................29fluticasone propionate oint 0.005% (Cutivate)............. 60fluvoxamine maleate tab 25 mg.....................................36fluvoxamine maleate tab 50 mg.....................................36fluvoxamine maleate tab 100 mg...................................36folic acid tab 1 mg...........................................................52FOLLISTIM AQ – follitropin beta inj 300 unit/0.36ml.........19FOLLISTIM AQ – follitropin beta inj 600 unit/0.72ml.........19FOLLISTIM AQ – follitropin beta inj 900 unit/1.08ml.........19fosaprepitant dimeglumine for iv infusion 150 mg

(base eq) (Emend)........................................................ 33fosinopril sodium & hydrochlorothiazide tab 10-12.5

mg................................................................................... 24fosinopril sodium & hydrochlorothiazide tab 20-12.5

mg................................................................................... 24fosinopril sodium tab 10 mg.......................................... 24fosinopril sodium tab 20 mg.......................................... 24fosinopril sodium tab 40 mg.......................................... 24FREESTYLE LIBRE/2, 14 READER/SENSOR/FLASH –

continuous blood glucose system.................................. 62FULPHILA – pegfilgrastim-jmdb soln prefilled syringe 6

mg/0.6ml..........................................................................52furosemide oral soln 10 mg/ml...................................... 26furosemide tab 20 mg (Lasix)........................................ 26furosemide tab 40 mg (Lasix)........................................ 26furosemide tab 80 mg (Lasix)........................................ 26Ggabapentin cap 100 mg (Neurontin)..............................48gabapentin cap 300 mg (Neurontin)..............................48gabapentin cap 400 mg (Neurontin)..............................48gabapentin oral soln 250 mg/5ml (Neurontin)..............48

2021

FID 568 July 2021 77

gabapentin tab 600 mg (Neurontin)...............................49gabapentin tab 800 mg (Neurontin)...............................49galantamine hydrobromide cap er 24hr 8 mg

(Razadyne er)................................................................ 42galantamine hydrobromide cap er 24hr 16 mg

(Razadyne er)................................................................ 42galantamine hydrobromide cap er 24hr 24 mg

(Razadyne er)................................................................ 42GALANTAMINE HYDROBROMIDE – galantamine

hydrobromide oral soln 4 mg/ml.................................... 42galantamine hydrobromide tab 4 mg (Razadyne)........42galantamine hydrobromide tab 8 mg (Razadyne)........42galantamine hydrobromide tab 12 mg (Razadyne)......42ganirelix acetate soln prefilled syringe 250 mcg/0.5ml

(Ganirelix acetate).........................................................19GAVILYTE-C – peg 3350-kcl-na bicarb-nacl-na sulfate for

soln 240 gm.................................................................... 32gemfibrozil tab 600 mg (Lopid)......................................28GENTAK – gentamicin sulfate ophth oint 0.3%................ 57gentamicin sulfate cream 0.1%......................................60gentamicin sulfate oint 0.1%..........................................60gentamicin sulfate ophth soln 0.3% (Garamycin)........57GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab

150-150-200-10 mg.......................................................... 4GILENYA – fingolimod hcl cap 0.5 mg (base equiv).........42GILOTRIF – afatinib dimaleate tab 20 mg (base

equivalent)......................................................................... 8GILOTRIF – afatinib dimaleate tab 30 mg (base

equivalent)......................................................................... 8GILOTRIF – afatinib dimaleate tab 40 mg (base

equivalent)......................................................................... 8glatiramer acetate soln prefilled syringe 20 mg/ml

(Copaxone).....................................................................42glatiramer acetate soln prefilled syringe 40 mg/ml

(Copaxone).....................................................................42GLEOSTINE – lomustine cap 10 mg.................................. 8GLEOSTINE – lomustine cap 40 mg.................................. 8GLEOSTINE – lomustine cap 100 mg................................ 8glimepiride tab 1 mg (Amaryl)........................................15glimepiride tab 2 mg (Amaryl)........................................15glimepiride tab 4 mg (Amaryl)........................................15glipizide-metformin hcl tab 2.5-250 mg.........................15glipizide-metformin hcl tab 2.5-500 mg.........................15glipizide-metformin hcl tab 5-500 mg............................15glipizide tab er 24hr 2.5 mg (Glucotrol xl).................... 15glipizide tab er 24hr 5 mg (Glucotrol xl)....................... 15glipizide tab er 24hr 10 mg (Glucotrol xl)..................... 15glipizide tab 5 mg (Glucotrol).........................................15glipizide tab 10 mg (Glucotrol).......................................15GLUCAGON EMERGENCY KIT FO – glucagon hcl for inj

1 mg................................................................................ 15GLUCAGON EMERGENCY KIT – glucagon (rdna) for inj

kit 1 mg........................................................................... 15glucagon (rdna) for inj kit 1 mg (Glucagon emergency

k)......................................................................................15glyburide-metformin tab 1.25-250 mg

(Glucovance)..................................................................15

glyburide-metformin tab 2.5-500 mg (Glucovance)..... 15glyburide-metformin tab 5-500 mg (Glucovance)........ 15glyburide micronized tab 1.5 mg (Glynase)..................15glyburide micronized tab 3 mg (Glynase).....................15glyburide micronized tab 6 mg (Glynase).....................15glyburide tab 1.25 mg..................................................... 15glyburide tab 2.5 mg....................................................... 15glyburide tab 5 mg.......................................................... 15glycopyrrolate tab 1 mg (Robinul).................................32glycopyrrolate tab 2 mg (Robinul forte)........................32GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg.......... 15GLYXAMBI – empagliflozin-linagliptin tab 25-5 mg.......... 15granisetron hcl tab 1 mg................................................ 33GRANIX – tbo-filgrastim soln prefilled syringe 300

mcg/0.5ml........................................................................53GRANIX – tbo-filgrastim soln prefilled syringe 480

mcg/0.8ml........................................................................53GRANIX – tbo-filgrastim subcutaneous inj 300 mcg/

ml..................................................................................... 53GRANIX – tbo-filgrastim subcutaneous inj 480 mcg/1.6ml

(300 mcg/ml)................................................................... 53griseofulvin microsize susp 125 mg/5ml........................ 3griseofulvin microsize tab 500 mg (Grifulvin v).............3guanfacine hcl tab er 24hr 1 mg (base equiv)

(Intuniv).......................................................................... 40guanfacine hcl tab er 24hr 2 mg (base equiv)



(Intuniv).......................................................................... 40guanfacine hcl tab 1 mg (Tenex)................................... 24guanfacine hcl tab 2 mg (Tenex)................................... 24GVOKE HYPOPEN 1-PACK – glucagon subcutaneous

solution auto-injector 0.5 mg/0.1ml................................ 15GVOKE HYPOPEN 1-PACK – glucagon subcutaneous

solution auto-injector 1 mg/0.2ml................................... 15GVOKE HYPOPEN 2-PACK – glucagon subcutaneous

solution auto-injector 0.5 mg/0.1ml................................ 15GVOKE HYPOPEN 2-PACK – glucagon subcutaneous

solution auto-injector 1 mg/0.2ml................................... 15GVOKE PFS – glucagon subcutaneous soln pref syringe

0.5 mg/0.1ml................................................................... 15GVOKE PFS – glucagon subcutaneous soln pref syringe

1 mg/0.2ml...................................................................... 15

HHAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 2000 unit............................................ 55HAEGARDA – c1 esterase inhibitor (human) for

subcutaneous inj 3000 unit............................................ 55halobetasol propionate cream 0.05% (Ultravate).........60halobetasol propionate oint 0.05% (Ultravate).............60haloperidol decanoate im soln 50 mg/ml (Haldol

decanoate 50)................................................................ 37haloperidol decanoate im soln 100 mg/ml (Haldol

decanoate 100)..............................................................37

2021

FID 568 July 2021 78

haloperidol lactate oral conc 2 mg/ml...........................37haloperidol tab 0.5 mg.................................................... 37haloperidol tab 1 mg....................................................... 37haloperidol tab 2 mg....................................................... 37haloperidol tab 5 mg....................................................... 37haloperidol tab 10 mg..................................................... 37haloperidol tab 20 mg..................................................... 37HARVONI – ledipasvir-sofosbuvir pellet pack 33.75-150

mg......................................................................................4HARVONI – ledipasvir-sofosbuvir pellet pack 45-200

mg......................................................................................4HARVONI – ledipasvir-sofosbuvir tab 45-200 mg...............4HARVONI – ledipasvir-sofosbuvir tab 90-400 mg...............4HUMATE-P – antihemophilic factor/vwf (human) for inj

250-600 unit.................................................................... 55HUMATE-P – antihemophilic factor/vwf (human) for inj

500-1200 unit.................................................................. 55HUMATE-P – antihemophilic factor/vwf (human) for inj

1000-2400 unit................................................................ 55HUMIRA – adalimumab prefilled syringe kit 10

mg/0.1ml..........................................................................45HUMIRA – adalimumab prefilled syringe kit 20



mg/0.4ml..........................................................................45HUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8ml.................................................. 46HUMIRA PEDIATRIC CROHNS D – adalimumab prefilled

syringe kit 80 mg/0.8ml & 40 mg/0.4ml......................... 46HUMIRA PEN – adalimumab pen-injector kit 40

mg/0.8ml..........................................................................46HUMIRA PEN – adalimumab pen-injector kit 40

mg/0.4ml..........................................................................46HUMIRA PEN – adalimumab pen-injector kit 80

mg/0.8ml..........................................................................46HUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 40 mg/0.8ml.................................................. 46HUMIRA PEN-CD/UC/HS START – adalimumab pen-

injector kit 80 mg/0.8ml.................................................. 46HUMIRA PEN-PEDIATRIC UC S – adalimumab pen-

injector kit 80 mg/0.8ml.................................................. 46HUMIRA PEN-PS/UV STARTER – adalimumab pen-

injector kit 40 mg/0.8ml.................................................. 46HUMIRA PEN-PS/UV STARTER – adalimumab pen-

injector kit 80 mg/0.8ml & 40 mg/0.4ml......................... 46HUMULIN R U-500 (CONCENTR – insulin regular

(human) inj 500 unit/ml...................................................17HUMULIN R U-500 KWIKPEN – insulin regular (human)

soln pen-injector 500 unit/ml.......................................... 17HYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)...... 8HYCAMTIN – topotecan hcl cap 1 mg (base equiv)........... 8hydralazine hcl tab 10 mg.............................................. 24hydralazine hcl tab 25 mg.............................................. 24hydralazine hcl tab 50 mg.............................................. 24hydralazine hcl tab 100 mg............................................ 24

hydrochlorothiazide cap 12.5 mg (Microzide).............. 26hydrochlorothiazide tab 12.5 mg................................... 26hydrochlorothiazide tab 25 mg...................................... 26hydrochlorothiazide tab 50 mg...................................... 26HYDROCODONE/IBUPROFEN – hydrocodone-ibuprofen

tab 5-200 mg...................................................................44hydrocodone-acetaminophen soln 7.5-325 mg/15ml

(Hycet).............................................................................43hydrocodone-acetaminophen tab 7.5-325 mg

(Norco)............................................................................44hydrocodone-acetaminophen tab 5-325 mg

(Norco)............................................................................43hydrocodone-acetaminophen tab 10-325 mg

(Norco)............................................................................43hydrocodone-ibuprofen tab 10-200 mg (Ibudone)....... 44hydrocodone-ibuprofen tab 7.5-200 mg

(Vicoprofen)................................................................... 44hydrocortisone acetate suppos 25 mg......................... 58hydrocortisone cream 2.5%............................................60hydrocortisone enema 100 mg/60ml (Cortenema).......58hydrocortisone lotion 2.5%............................................ 60hydrocortisone oint 2.5%................................................60hydrocortisone perianal cream 2.5% (Anusol-hc)....... 58hydrocortisone tab 5 mg (Cortef).................................. 11hydrocortisone tab 10 mg (Cortef)................................ 11hydrocortisone tab 20 mg (Cortef)................................ 11hydrocortisone valerate cream 0.2%.............................60hydrocortisone valerate oint 0.2% (Westcort)..............60hydrocortisone w/ acetic acid otic soln 1-2% (Vosol

hc)................................................................................... 58hydromorphone hcl liqd 1 mg/ml (Dilaudid).................44hydromorphone hcl tab 2 mg (Dilaudid).......................44hydromorphone hcl tab 4 mg (Dilaudid).......................44hydromorphone hcl tab 8 mg (Dilaudid).......................44hydroxychloroquine sulfate tab 200 mg (Plaquenil)......6hydroxyurea cap 500 mg (Hydrea).................................. 8hydroxyzine hcl syrup 10 mg/5ml................................. 35hydroxyzine hcl tab 10 mg............................................. 35hydroxyzine hcl tab 25 mg............................................. 35hydroxyzine hcl tab 50 mg............................................. 35hydroxyzine pamoate cap 25 mg (Vistaril)................... 35hydroxyzine pamoate cap 50 mg (Vistaril)................... 35HYDROXYZINE PAMOATE – hydroxyzine pamoate cap

100 mg............................................................................ 35

Iibandronate sodium tab 150 mg (base equivalent)

(Boniva).......................................................................... 19IBRANCE – palbociclib cap 75 mg..................................... 8IBRANCE – palbociclib cap 100 mg................................... 8IBRANCE – palbociclib cap 125 mg................................... 8IBRANCE – palbociclib tab 75 mg...................................... 8IBRANCE – palbociclib tab 100 mg.................................... 8IBRANCE – palbociclib tab 125 mg.................................... 8ibuprofen susp 100 mg/5ml............................................46ibuprofen tab 400 mg...................................................... 46ibuprofen tab 600 mg...................................................... 46

2021

FID 568 July 2021 79

ibuprofen tab 800 mg...................................................... 46icatibant acetate inj 30 mg/3ml (base equivalent)

(Firazyr).......................................................................... 55ICLUSIG – ponatinib hcl tab 10 mg (base equiv)............... 8ICLUSIG – ponatinib hcl tab 15 mg (base equiv)............... 8ICLUSIG – ponatinib hcl tab 30 mg (base equiv)............... 8ICLUSIG – ponatinib hcl tab 45 mg (base equiv)............... 8ILARIS – canakinumab subcutaneous inj 150 mg/ml....... 46imatinib mesylate tab 100 mg (base equivalent)

(Gleevec).......................................................................... 8imatinib mesylate tab 400 mg (base equivalent)

(Gleevec).......................................................................... 8IMBRUVICA – ibrutinib cap 70 mg..................................... 8IMBRUVICA – ibrutinib cap 140 mg................................... 8IMBRUVICA – ibrutinib tab 140 mg.................................... 8IMBRUVICA – ibrutinib tab 280 mg.................................... 8IMBRUVICA – ibrutinib tab 420 mg.................................... 8IMBRUVICA – ibrutinib tab 560 mg.................................... 8imipramine hcl tab 10 mg (Tofranil).............................. 36imipramine hcl tab 25 mg (Tofranil).............................. 36imipramine hcl tab 50 mg (Tofranil).............................. 36imiquimod cream 5% (Aldara)........................................60imiquimod cream 3.75% (Zyclara)................................. 60IMPAVIDO – miltefosine cap 50 mg....................................6INBRIJA – levodopa inhal powder cap 42 mg.................. 50INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml)........19INCRUSE ELLIPTA – umeclidinium br aero powd breath

act 62.5 mcg/inh (base eq)............................................ 31indapamide tab 1.25 mg..................................................26indapamide tab 2.5 mg....................................................26indomethacin cap 25 mg................................................ 46indomethacin cap 50 mg................................................ 46INHALER ASSIST DEVICES -..........................................62INLYTA – axitinib tab 1 mg..................................................8INLYTA – axitinib tab 5 mg..................................................8INSULIN ASPART FLEXPEN – insulin aspart soln pen-

injector 100 unit/ml......................................................... 17INSULIN ASPART – insulin aspart inj 100 unit/ml............ 17INSULIN ASPART PENFILL – insulin aspart soln

cartridge 100 unit/ml.......................................................17INSULIN ASPART PROTAMINE/ – insulin aspart prot &

aspart (human) inj 100 unit/ml (70-30)...........................18INSULIN ASPART PROTAMINE/ – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)........................... 18INSULIN PEN NEEDLES - various...................................62INSULIN SYRINGES - various..........................................62INTELENCE – etravirine tab 25 mg....................................4INTELENCE – etravirine tab 100 mg..................................4INTELENCE – etravirine tab 200 mg..................................4INVOKAMET – canagliflozin-metformin hcl tab 50-500

mg....................................................................................15INVOKAMET – canagliflozin-metformin hcl tab 50-1000



mg....................................................................................16

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-500 mg.......................................................................16

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-1000 mg.....................................................................16

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr150-500 mg.....................................................................16

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr150-1000 mg...................................................................16

INVOKANA – canagliflozin tab 100 mg.............................16INVOKANA – canagliflozin tab 300 mg.............................16ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml

(Duoneb).........................................................................31ipratropium bromide inhal soln 0.02%..........................31ipratropium bromide nasal soln 0.03% (21 mcg/spray)

(Atrovent)....................................................................... 29ipratropium bromide nasal soln 0.06% (42 mcg/spray)

(Atrovent)....................................................................... 29irbesartan-hydrochlorothiazide tab 150-12.5 mg

(Avalide)..........................................................................25irbesartan-hydrochlorothiazide tab 300-12.5 mg

(Avalide)..........................................................................25irbesartan tab 75 mg (Avapro)....................................... 24irbesartan tab 150 mg (Avapro)..................................... 24irbesartan tab 300 mg (Avapro)..................................... 25IRESSA – gefitinib tab 250 mg........................................... 8ISENTRESS HD – raltegravir potassium tab 600 mg

(base equiv)...................................................................... 4ISENTRESS – raltegravir potassium chew tab 25 mg

(base equiv)...................................................................... 4ISENTRESS – raltegravir potassium chew tab 100 mg

(base equiv)...................................................................... 4ISENTRESS – raltegravir potassium packet for susp 100

mg (base equiv)................................................................4ISENTRESS – raltegravir potassium tab 400 mg (base

equiv)................................................................................. 4ISONIAZID – isoniazid syrup 50 mg/5ml............................ 3ISONIAZID – isoniazid tab 100 mg.....................................3isoniazid tab 300 mg......................................................... 3isosorbide dinitrate tab 10 mg.......................................20isosorbide dinitrate tab 20 mg.......................................20isosorbide dinitrate tab 30 mg.......................................20isosorbide dinitrate tab 5 mg (Isordil titradose).......... 20isosorbide mononitrate tab er 24hr 30 mg................... 20isosorbide mononitrate tab er 24hr 60 mg................... 20isosorbide mononitrate tab er 24hr 120 mg................. 20isosorbide mononitrate tab 10 mg................................ 20isosorbide mononitrate tab 20 mg................................ 20isotretinoin cap 10 mg.................................................... 60isotretinoin cap 20 mg.................................................... 60isotretinoin cap 40 mg.................................................... 60isotretinoin cap 30 mg (Claravis).................................. 60itraconazole cap 100 mg (Sporanox).............................. 3itraconazole oral soln 10 mg/ml (Sporanox).................. 3ivermectin tab 3 mg (Stromectol).................................... 6

2021

FID 568 July 2021 80

JJAKAFI – ruxolitinib phosphate tab 5 mg (base

equivalent)......................................................................... 9JAKAFI – ruxolitinib phosphate tab 10 mg (base




equivalent)......................................................................... 9JANUMET – sitagliptin-metformin hcl tab 50-500 mg.......16JANUMET – sitagliptin-metformin hcl tab 50-1000 mg.....16JANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-500 mg.......................................................................16JANUMET XR – sitagliptin-metformin hcl tab er 24hr

50-1000 mg.....................................................................16JANUMET XR – sitagliptin-metformin hcl tab er 24hr

100-1000 mg...................................................................16JANUVIA – sitagliptin phosphate tab 25 mg (base

equiv)...............................................................................16JANUVIA – sitagliptin phosphate tab 50 mg (base

equiv)...............................................................................16JANUVIA – sitagliptin phosphate tab 100 mg (base

equiv)...............................................................................16JARDIANCE – empagliflozin tab 10 mg............................16JARDIANCE – empagliflozin tab 25 mg............................16JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj

1000 unit......................................................................... 55JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj

2000 unit......................................................................... 55JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl)for inj

3000 unit......................................................................... 55JIVI – antihemophil fact rcmb(bdd-rfviii peg-aucl) for inj

500 unit........................................................................... 55JULUCA – dolutegravir sodium-rilpivirine hcl tab 50-25

mg (base eq).....................................................................4

KKALETRA – lopinavir-ritonavir tab 100-25 mg....................4KALETRA – lopinavir-ritonavir tab 200-50 mg....................4KALYDECO – ivacaftor packet 25 mg.............................. 31KALYDECO – ivacaftor packet 50 mg.............................. 31KALYDECO – ivacaftor packet 75 mg.............................. 32KALYDECO – ivacaftor tab 150 mg..................................31KESIMPTA – ofatumumab soln auto-injector 20

mg/0.4ml..........................................................................42ketoconazole cream 2%.................................................. 60ketoconazole shampoo 2% (Nizoral).............................60ketorolac tromethamine ophth soln 0.5% (Acular)......57ketorolac tromethamine ophth soln 0.4% (Acular

ls).....................................................................................57KISQALI FEMARA 200 DOSE – ribociclib 200 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk.............................. 9KISQALI FEMARA 400 DOSE – ribociclib 400 mg dose

(200 mg tab) & letrozole 2.5 mg tbpk.............................. 9

KISQALI FEMARA 600 DOSE – ribociclib 600 mg dose(200 mg tab) & letrozole 2.5 mg tbpk.............................. 9

KISQALI – ribociclib succinate tab pack 200 mg dailydose................................................................................... 9

KISQALI – ribociclib succinate tab pack 400 mg dailydose (200 mg tab)............................................................ 9

KISQALI – ribociclib succinate tab pack 600 mg dailydose (200 mg tab)............................................................ 9

KOGENATE FS – antihemophilic factor recomb (rfviii) forinj kit 250 unit................................................................. 55

KOGENATE FS – antihemophilic factor recomb (rfviii) forinj kit 500 unit................................................................. 55

KOGENATE FS – antihemophilic factor recomb (rfviii) forinj kit 1000 unit............................................................... 55



KOSHER PRENATAL PLUS IRON – prenatal vit w/ ironcarbonyl-fa tab 30-1 mg................................................. 51

KOVALTRY – antihemophilic factor recomb (rahf-pfm) forinj 250 unit...................................................................... 56

KOVALTRY – antihemophilic factor recomb (rahf-pfm) forinj 500 unit...................................................................... 56

KOVALTRY – antihemophilic factor recomb (rahf-pfm) forinj 1000 unit.................................................................... 56



K-PHOS NO 2 – potassium & sodium acid phosphatestab 305-700 mg.............................................................. 34

K-PHOS – potassium phosphate monobasic tab 500mg....................................................................................51

KYNMOBI – apomorphine hydrochloride film 10 mg........ 50KYNMOBI – apomorphine hydrochloride film 15 mg........ 50KYNMOBI – apomorphine hydrochloride film 20 mg........ 50KYNMOBI – apomorphine hydrochloride film 25 mg........ 50KYNMOBI – apomorphine hydrochloride film 30 mg........ 50

Llabetalol hcl tab 100 mg (Trandate)...............................21labetalol hcl tab 200 mg (Trandate)...............................21labetalol hcl tab 300 mg (Trandate)...............................21lactulose (encephalopathy) solution 10 gm/15ml........33lactulose solution 10 gm/15ml....................................... 32lamivudine oral soln 10 mg/ml (Epivir)........................... 5lamivudine tab 150 mg (Epivir)........................................ 5lamivudine tab 300 mg (Epivir)........................................ 5lamivudine tab 100 mg (hbv) (Epivir hbv).......................5lamivudine-zidovudine tab 150-300 mg (Combivir)....... 5lamotrigine tab chewable dispersible 5 mg (Lamictal

chewable di).................................................................. 49lamotrigine tab chewable dispersible 25 mg (Lamictal

chewable di).................................................................. 49lamotrigine tab 25 mg (Lamictal)...................................49lamotrigine tab 100 mg (Lamictal).................................49

2021

FID 568 July 2021 81

lamotrigine tab 150 mg (Lamictal).................................49lamotrigine tab 200 mg (Lamictal).................................49LANCET DEVICES - various.............................................62LANCETS - various........................................................... 62lansoprazole cap delayed release 15 mg

(Prevacid)....................................................................... 32lansoprazole cap delayed release 30 mg

(Prevacid)....................................................................... 32LANTUS – insulin glargine inj 100 unit/ml........................ 18LANTUS SOLOSTAR – insulin glargine soln pen-injector

100 unit/ml.......................................................................18lapatinib ditosylate tab 250 mg (base equiv)

(Tykerb).............................................................................9latanoprost ophth soln 0.005% (Xalatan)......................57LATUDA – lurasidone hcl tab 20 mg.................................37LATUDA – lurasidone hcl tab 40 mg.................................37LATUDA – lurasidone hcl tab 60 mg.................................37LATUDA – lurasidone hcl tab 80 mg.................................37LATUDA – lurasidone hcl tab 120 mg...............................37LEDIPASVIR/SOFOSBUVIR – ledipasvir-sofosbuvir tab

90-400 mg......................................................................... 5leflunomide tab 10 mg (Arava).......................................46leflunomide tab 20 mg (Arava).......................................46LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapy

pack 10 & 4 mg (14 mg daily dose).................................9LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapy

pack 10 mg (10 mg daily dose)....................................... 9LENVIMA 4 MG DAILY DOSE – lenvatinib cap therapy

pack 4 mg (4 mg daily dose)........................................... 9LENVIMA 12MG DAILY DOSE – lenvatinib cap therapy

pack 3 x 4 mg (12 mg daily dose)................................... 9LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapy

pack 2 x 10 mg (20 mg daily dose)................................. 9LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapy

pack 2 x 4 mg (8 mg daily dose)..................................... 9LENVIMA 18 MG DAILY DOSE – lenvatinib cap ther pack

10 mg & 2 x 4 mg (18 mg daily dose)............................. 9LENVIMA 24 MG DAILY DOSE – lenvatinib cap ther pack

2 x 10 mg & 4 mg (24 mg daily dose)............................. 9letrozole tab 2.5 mg (Femara).......................................... 9leucovorin calcium tab 5 mg............................................9leucovorin calcium tab 10 mg..........................................9leucovorin calcium tab 15 mg..........................................9leucovorin calcium tab 25 mg..........................................9LEUKERAN – chlorambucil tab 2 mg................................. 9levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (base

equiv).............................................................................. 31levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)

(Xopenex)....................................................................... 31levalbuterol hcl soln nebu 0.63 mg/3ml (base equiv)

(Xopenex)....................................................................... 31levalbuterol hcl soln nebu 1.25 mg/3ml (base equiv)

(Xopenex)....................................................................... 31LEVEMIR FLEXTOUCH – insulin detemir soln pen-

injector 100 unit/ml......................................................... 18LEVEMIR – insulin detemir inj 100 unit/ml........................18levetiracetam oral soln 100 mg/ml (Keppra).................49

levetiracetam tab er 24hr 500 mg (Keppra xr)..............49levetiracetam tab er 24hr 750 mg (Keppra xr)..............49levetiracetam tab 250 mg (Keppra)............................... 49levetiracetam tab 500 mg (Keppra)............................... 49levetiracetam tab 750 mg (Keppra)............................... 49levetiracetam tab 1000 mg (Keppra)............................. 49LEVOBUNOLOL HCL – levobunolol hcl ophth soln

0.5%.................................................................................57levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)..... 19levocarnitine tab 330 mg (Carnitor)...............................19levocetirizine dihydrochloride soln 2.5 mg/5ml (0.5

mg/ml) (Xyzal)................................................................29levocetirizine dihydrochloride tab 5 mg (Xyzal)...........29levofloxacin oral soln 25 mg/ml (Levaquin)................... 3levofloxacin tab 250 mg (Levaquin)................................ 3levofloxacin tab 500 mg (Levaquin)................................ 3levofloxacin tab 750 mg (Levaquin)................................ 3levonorgestrel & ethinyl estradiol (91-day) tab

0.15-0.03 mg.................................................................. 14levonorgestrel & ethinyl estradiol tab 0.1 mg-20

mcg................................................................................. 14levonorgestrel & ethinyl estradiol tab 0.15 mg-30

mcg................................................................................. 14levonorgestrel-eth estra tab

0.05-30/0.075-40/0.125-30mg-mcg...............................14levonorg-eth est tab 0.1-0.02mg(84) & eth est tab

0.01mg(7) (Loseasonique)........................................... 14levonorg-eth est tab 0.15-0.03mg(84) & eth est tab

0.01mg(7) (Seasonique)............................................... 14levothyroxine sodium tab 25 mcg (Synthroid).............18levothyroxine sodium tab 50 mcg (Synthroid).............18levothyroxine sodium tab 75 mcg (Synthroid).............18levothyroxine sodium tab 88 mcg (Synthroid).............18levothyroxine sodium tab 100 mcg (Synthroid)...........18levothyroxine sodium tab 112 mcg (Synthroid)...........18levothyroxine sodium tab 125 mcg (Synthroid)...........18levothyroxine sodium tab 137 mcg (Synthroid)...........18levothyroxine sodium tab 150 mcg (Synthroid)...........18levothyroxine sodium tab 175 mcg (Synthroid)...........18levothyroxine sodium tab 200 mcg (Synthroid)...........18levothyroxine sodium tab 300 mcg (Synthroid)...........18lidocaine hcl gel 2%........................................................ 60lidocaine hcl soln 4% (Xylocaine)................................. 60lidocaine hcl viscous soln 2%....................................... 58lidocaine oint 5%............................................................. 60lidocaine patch 5% (Lidoderm)...................................... 60lidocaine-prilocaine cream 2.5-2.5% (Emla)................. 60LINDANE – lindane shampoo 1%.....................................60linezolid for susp 100 mg/5ml (Zyvox)............................6linezolid tab 600 mg (Zyvox)............................................ 6liothyronine sodium tab 5 mcg (Cytomel).................... 18liothyronine sodium tab 25 mcg (Cytomel).................. 18liothyronine sodium tab 50 mcg (Cytomel).................. 18lisinopril & hydrochlorothiazide tab 10-12.5 mg

(Zestoretic).....................................................................25lisinopril & hydrochlorothiazide tab 20-12.5 mg

(Zestoretic).....................................................................25

2021

FID 568 July 2021 82

lisinopril & hydrochlorothiazide tab 20-25 mg(Zestoretic).....................................................................25

lisinopril tab 5 mg (Prinivil)............................................25lisinopril tab 10 mg (Prinivil)..........................................25lisinopril tab 20 mg (Prinivil)..........................................25lisinopril tab 2.5 mg (Zestril).......................................... 25lisinopril tab 30 mg (Zestril)........................................... 25lisinopril tab 40 mg (Zestril)........................................... 25lithium carbonate cap 300 mg....................................... 38lithium carbonate cap 150 mg (Lithium carbonate).....38lithium carbonate cap 600 mg (Lithium carbonate).....38LITHIUM CARBONATE – lithium carbonate cap 150

mg....................................................................................37lithium carbonate tab er 450 mg....................................38lithium carbonate tab er 300 mg (Lithobid).................. 38lithium carbonate tab 300 mg........................................ 38LITHIUM – lithium oral solution 8 meq/5ml.......................37LOKELMA – sodium zirconium cyclosilicate for susp

packet 5 gm.................................................................... 62LOKELMA – sodium zirconium cyclosilicate for susp

packet 10 gm.................................................................. 62LONSURF – trifluridine-tipiracil tab 15-6.14 mg..................9LONSURF – trifluridine-tipiracil tab 20-8.19 mg..................9loperamide hcl cap 2 mg................................................ 32lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)

(Kaletra)............................................................................ 5lorazepam conc 2 mg/ml (Lorazepam intensol)...........35lorazepam tab 0.5 mg (Ativan)....................................... 35lorazepam tab 1 mg (Ativan).......................................... 35lorazepam tab 2 mg (Ativan).......................................... 35losartan potassium & hydrochlorothiazide tab 50-12.5

mg (Hyzaar)....................................................................25losartan potassium & hydrochlorothiazide tab

100-12.5 mg (Hyzaar)....................................................25losartan potassium & hydrochlorothiazide tab 100-25

mg (Hyzaar)....................................................................25losartan potassium tab 25 mg (Cozaar)........................25losartan potassium tab 50 mg (Cozaar)........................25losartan potassium tab 100 mg (Cozaar)......................25LOTEMAX – loteprednol etabonate ophth gel 0.5%.........57LOTEMAX – loteprednol etabonate ophth oint 0.5%........57LOTEMAX SM – loteprednol etabonate ophth gel

0.38%...............................................................................57loteprednol etabonate ophth gel 0.5% (Lotemax)........57loteprednol etabonate ophth susp 0.5%

(Lotemax)....................................................................... 57lovastatin tab 10 mg........................................................28lovastatin tab 20 mg (Mevacor)..................................... 28lovastatin tab 40 mg (Mevacor)..................................... 28loxapine succinate cap 10 mg....................................... 38loxapine succinate cap 25 mg....................................... 38loxapine succinate cap 50 mg....................................... 38loxapine succinate cap 5 mg (Loxitane).......................38LUMIGAN – bimatoprost ophth soln 0.01%......................57LYNPARZA – olaparib tab 100 mg......................................9LYNPARZA – olaparib tab 150 mg......................................9LYSODREN – mitotane tab 500 mg....................................9

Mmalathion lotion 0.5% (Ovide)........................................60MATULANE – procarbazine hcl cap 50 mg........................ 9MAVENCLAD – cladribine tab therapy pack 10 mg (4

tabs).................................................................................42MAVENCLAD – cladribine tab therapy pack 10 mg (5






tabs).................................................................................42MAVYRET – glecaprevir-pibrentasvir tab 100-40 mg......... 5MAYZENT – siponimod fumarate tab 0.25 mg (base

equiv)...............................................................................42MAYZENT – siponimod fumarate tab 2 mg (base

equiv)...............................................................................42MAYZENT STARTER PACK – siponimod fumarate tab

0.25 mg (12) starter pack...............................................42meclizine hcl tab 12.5 mg...............................................33meclizine hcl tab 25 mg..................................................33medroxyprogesterone acetate im susp 150 mg/ml

(Depo-provera contrac)................................................14medroxyprogesterone acetate im susp prefilled syr

150 mg/ml (Depo-provera contrac).............................14medroxyprogesterone acetate tab 2.5 mg

(Provera).........................................................................14medroxyprogesterone acetate tab 5 mg (Provera)......14medroxyprogesterone acetate tab 10 mg

(Provera).........................................................................14MEFLOQUINE HCL – mefloquine hcl tab 250 mg..............6megestrol acetate susp 40 mg/ml (Megace oral)........... 9megestrol acetate tab 20 mg............................................9megestrol acetate tab 40 mg............................................9MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg

(base equivalent).............................................................. 9MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (base

equivalent)......................................................................... 9meloxicam tab 7.5 mg (Mobic).......................................46meloxicam tab 15 mg (Mobic)........................................46melphalan tab 2 mg (Alkeran)..........................................9memantine hcl oral solution 2 mg/ml (Namenda)........42memantine hcl tab 5 mg (Namenda)............................. 42memantine hcl tab 10 mg (Namenda)........................... 42memantine hcl tab 28 x 5 mg & 21 x 10 mg titration

pack (Namenda titration pa)........................................42MENOPUR – menotropins for subcutaneous inj 75

unit................................................................................... 19mercaptopurine tab 50 mg (Purinethol)..........................9mesalamine cap dr 400 mg (Delzicol)........................... 33mesalamine cap er 24hr 0.375 gm (Apriso)..................33

2021

FID 568 July 2021 83

mesalamine enema 4 gm................................................33mesalamine suppos 1000 mg (Canasa)........................ 33mesalamine tab delayed release 1.2 gm (Lialda).........34mesalamine tab delayed release 800 mg (Asacol

hd)................................................................................... 34MESNEX – mesna tab 400 mg...........................................9metformin hcl tab er 24hr 500 mg (Glucophage xr).....16metformin hcl tab er 24hr 750 mg (Glucophage xr).....16metformin hcl tab 500 mg (Glucophage)...................... 16metformin hcl tab 850 mg (Glucophage)...................... 16metformin hcl tab 1000 mg (Glucophage).................... 16methadone hcl conc 10 mg/ml (Methadose)................ 44methadone hcl soln 5 mg/5ml (Methadone hcl)...........44methadone hcl soln 10 mg/5ml (Methadone hcl).........44methadone hcl tab for oral susp 40 mg........................44methadone hcl tab 10 mg (Dolophine)..........................44methadone hcl tab 5 mg (Dolophine hcl)..................... 44methazolamide tab 25 mg (Neptazane).........................26methazolamide tab 50 mg (Neptazane).........................26methimazole tab 5 mg (Tapazole)..................................18methimazole tab 10 mg (Tapazole)................................18methocarbamol tab 750 mg (Robaxin-750)...................51methocarbamol tab 500 mg (Robaxin)..........................51methotrexate sodium tab 2.5 mg (base equiv).............10methscopolamine bromide tab 2.5 mg (Pamine)......... 32methscopolamine bromide tab 5 mg (Pamine

forte)................................................................................32methyldopa tab 250 mg.................................................. 25methyldopa tab 500 mg.................................................. 25methylergonovine maleate tab 0.2 mg..........................19methylphenidate hcl tab er 10 mg.................................40methylphenidate hcl tab er 20 mg.................................41methylphenidate hcl tab er osmotic release (osm) 18

mg (Concerta)................................................................40methylphenidate hcl tab er osmotic release (osm) 27



mg (Concerta)................................................................40methylphenidate hcl tab 5 mg (Ritalin).........................41methylphenidate hcl tab 10 mg (Ritalin).......................41methylphenidate hcl tab 20 mg (Ritalin).......................41methylprednisolone tab 4 mg (Medrol).........................12methylprednisolone tab 8 mg (Medrol).........................12methylprednisolone tab 16 mg (Medrol).......................12methylprednisolone tab 32 mg (Medrol).......................12methylprednisolone tab therapy pack 4 mg (21)

(Medrol dosepak).......................................................... 11metoclopramide hcl soln 5 mg/5ml (10 mg/10ml) (base

equiv).............................................................................. 34metoclopramide hcl tab 5 mg (base equivalent)

(Reglan).......................................................................... 34metoclopramide hcl tab 10 mg (base equivalent)

(Reglan).......................................................................... 34metolazone tab 10 mg.....................................................26metolazone tab 2.5 mg (Zaroxolyn)...............................26

metolazone tab 5 mg (Zaroxolyn)..................................26METOPROLOL/HYDROCHLOROTHI – metoprolol &

hydrochlorothiazide tab 100-50 mg................................25metoprolol & hydrochlorothiazide tab 50-25 mg

(Lopressor hct)..............................................................25metoprolol & hydrochlorothiazide tab 100-25 mg

(Lopressor hct)..............................................................25metoprolol succinate tab er 24hr 25 mg (tartrate

equiv) (Toprol xl)...........................................................21metoprolol succinate tab er 24hr 50 mg (tartrate



equiv) (Toprol xl)...........................................................21metoprolol tartrate tab 25 mg........................................ 21metoprolol tartrate tab 50 mg (Lopressor)................... 21metoprolol tartrate tab 100 mg (Lopressor)................. 21metronidazole cream 0.75% (Metrocream)................... 60metronidazole gel 0.75%.................................................60metronidazole gel 1% (Metrogel)................................... 60metronidazole lotion 0.75% (Metrolotion).....................60metronidazole tab 250 mg (Flagyl).................................. 6metronidazole tab 500 mg (Flagyl).................................. 7metronidazole vaginal gel 0.75% (Metrogel-

vaginal)........................................................................... 34mexiletine hcl cap 150 mg..............................................22mexiletine hcl cap 200 mg..............................................23mexiletine hcl cap 250 mg..............................................23midodrine hcl tab 2.5 mg................................................27midodrine hcl tab 5 mg...................................................27midodrine hcl tab 10 mg.................................................27minocycline hcl cap 50 mg (Minocin)............................. 2minocycline hcl cap 75 mg (Minocin)............................. 2minocycline hcl cap 100 mg (Minocin)........................... 2minoxidil tab 2.5 mg........................................................25minoxidil tab 10 mg.........................................................25MIRENA – levonorgestrel releasing iud 20 mcg/day (52

mg total).......................................................................... 14mirtazapine tab 7.5 mg....................................................36mirtazapine tab 15 mg (Remeron)................................. 36mirtazapine tab 30 mg (Remeron)................................. 36mirtazapine tab 45 mg (Remeron)................................. 36misoprostol tab 100 mcg (Cytotec)............................... 32misoprostol tab 200 mcg (Cytotec)............................... 32MITIGARE – colchicine cap 0.6 mg..................................48modafinil tab 100 mg (Provigil)......................................41modafinil tab 200 mg (Provigil)......................................41moexipril hcl tab 7.5 mg (Univasc)................................25moexipril hcl tab 15 mg (Univasc).................................25mometasone furoate cream 0.1% (Elocon).................. 60mometasone furoate nasal susp 50 mcg/act

(Nasonex)....................................................................... 29mometasone furoate oint 0.1% (Elocon)...................... 60mometasone furoate solution 0.1% (lotion)

(Elocon).......................................................................... 60

2021

FID 568 July 2021 84

montelukast sodium chew tab 4 mg (base equiv)(Singulair).......................................................................31

montelukast sodium chew tab 5 mg (base equiv)(Singulair).......................................................................31

montelukast sodium oral granules packet 4 mg (baseequiv) (Singulair)...........................................................31

montelukast sodium tab 10 mg (base equiv)(Singulair).......................................................................31

MORPHINE SULFATE ER – morphine sulfate beads caper 24hr 30 mg.................................................................44





MORPHINE SULFATE ER – morphine sulfate beads caper 24hr 120 mg...............................................................44

morphine sulfate oral soln 10 mg/5ml.......................... 44morphine sulfate oral soln 20 mg/5ml.......................... 44morphine sulfate oral soln 100 mg/5ml (20 mg/ml)..... 44morphine sulfate tab er 15 mg (Ms contin).................. 44morphine sulfate tab er 30 mg (Ms contin).................. 44morphine sulfate tab er 60 mg (Ms contin).................. 44morphine sulfate tab er 100 mg (Ms contin)................ 44morphine sulfate tab er 200 mg (Ms contin)................ 44morphine sulfate tab 15 mg (Morphine sulfate)...........44morphine sulfate tab 30 mg (Morphine sulfate)...........44moxifloxacin hcl ophth soln 0.5% (base equiv)

(Vigamox)....................................................................... 57MULTAQ – dronedarone hcl tab 400 mg (base

equivalent).......................................................................23mupirocin oint 2% (Bactroban)......................................60mycophenolate mofetil cap 250 mg (Cellcept).............62mycophenolate mofetil for oral susp 200 mg/ml

(Cellcept)........................................................................ 62mycophenolate mofetil tab 500 mg (Cellcept)..............62mycophenolate sodium tab dr 180 mg (mycophenolic

acid equiv) (Myfortic)................................................... 62mycophenolate sodium tab dr 360 mg (mycophenolic

acid equiv) (Myfortic)................................................... 62MYLERAN – busulfan tab 2 mg........................................10

Nnabumetone tab 500 mg................................................. 46nabumetone tab 750 mg................................................. 46nadolol tab 20 mg (Corgard).......................................... 21nadolol tab 40 mg (Corgard).......................................... 21nadolol tab 80 mg (Corgard).......................................... 21naloxone hcl inj 0.4 mg/ml............................................. 61naloxone hcl inj 4 mg/10ml............................................ 61NALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/

ml..................................................................................... 61naltrexone hcl tab 50 mg (Revia)...................................61naproxen sodium tab 275 mg (Anaprox)...................... 46

naproxen sodium tab 550 mg (Anaprox ds).................46naproxen tab ec 375 mg (Ec-naprosyn)........................46naproxen tab ec 500 mg (Ec-naprosyn)........................46naproxen tab 250 mg (Naprosyn).................................. 46naproxen tab 375 mg (Naprosyn).................................. 46naproxen tab 500 mg (Naprosyn).................................. 46naratriptan hcl tab 1 mg (base equiv) (Amerge).......... 47naratriptan hcl tab 2.5 mg (base equiv) (Amerge)....... 47NARCAN – naloxone hcl nasal spray 4 mg/0.1ml............ 61NATACYN – natamycin ophth susp 5%............................ 57nateglinide tab 60 mg (Starlix).......................................16nateglinide tab 120 mg (Starlix).....................................16NEOMYCIN/POLYMYXIN/GRAMIC – neomycin-polymy-

gramicid op sol 1.75-10000-0.025mg-unt-mg/ml........... 57neomycin-bacitrac zn-polymyx

5(3.5)mg-400unt-10000unt op oin............................... 57neomycin-polymyxin-dexamethasone ophth oint 0.1%

(Maxitrol)........................................................................ 57neomycin-polymyxin-dexamethasone ophth susp

0.1% (Maxitrol)...............................................................57neomycin-polymyxin-hc otic soln 1%

(Cortisporin)...................................................................58neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000

unit/ml-1%...................................................................... 58neomycin sulfate tab 500 mg...........................................3NEULASTA ONPRO KIT – pegfilgrastim soln prefilled

syringe kit 6 mg/0.6ml.................................................... 53NEULASTA – pegfilgrastim soln prefilled syringe 6

mg/0.6ml..........................................................................53NEUPOGEN – filgrastim inj 300 mcg/ml...........................53NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/

ml)....................................................................................53NEUPOGEN – filgrastim soln prefilled syringe 300

mcg/0.5ml........................................................................53NEUPOGEN – filgrastim soln prefilled syringe 480

mcg/0.8ml (600 mcg/ml).................................................53NEVIRAPINE ER – nevirapine tab er 24hr 100 mg............ 5nevirapine susp 50 mg/5ml (Viramune).......................... 5nevirapine tab er 24hr 400 mg (Viramune xr).................5nevirapine tab 200 mg (Viramune)...................................5NEXAVAR – sorafenib tosylate tab 200 mg (base

equivalent).......................................................................10NEXIUM – esomeprazole magnesium for delayed release

susp packet 5 mg........................................................... 32NEXIUM – esomeprazole magnesium for delayed release

susp pack 2.5 mg........................................................... 32NEXLETOL – bempedoic acid tab 180 mg.......................28NEXLIZET – bempedoic acid-ezetimibe tab 180-10

mg....................................................................................28niacin tab er 500 mg (antihyperlipidemic)

(Niaspan)........................................................................ 28niacin tab er 750 mg (antihyperlipidemic)

(Niaspan)........................................................................ 28niacin tab er 1000 mg (antihyperlipidemic)

(Niaspan)........................................................................ 28NICOTROL INHALER – nicotine inhaler system 10 mg (4

mg delivered).................................................................. 42

2021

FID 568 July 2021 85

NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/spray)...............................................................................42

nifedipine tab er 24hr 30 mg.......................................... 22nifedipine tab er 24hr 60 mg.......................................... 22nifedipine tab er 24hr 90 mg.......................................... 22nifedipine tab er 24hr osmotic release 30 mg

(Procardia xl)................................................................. 22nifedipine tab er 24hr osmotic release 60 mg

(Procardia xl)................................................................. 22nifedipine tab er 24hr osmotic release 90 mg

(Procardia xl)................................................................. 22nilutamide tab 150 mg (Nilandron)................................ 10nimodipine cap 30 mg.....................................................22NINLARO – ixazomib citrate cap 2.3 mg (base

equivalent).......................................................................10NINLARO – ixazomib citrate cap 3 mg (base

equivalent).......................................................................10NINLARO – ixazomib citrate cap 4 mg (base

equivalent).......................................................................10nitazoxanide tab 500 mg (Alinia)..................................... 7nitisinone cap 2 mg (Orfadin)........................................ 19nitisinone cap 5 mg (Orfadin)........................................ 19nitisinone cap 10 mg (Orfadin)...................................... 19NITRO-BID – nitroglycerin oint 2%................................... 20nitrofurantoin macrocrystalline cap 25 mg

(Macrodantin)...................................................................7nitrofurantoin macrocrystalline cap 50 mg

(Macrodantin)...................................................................7nitrofurantoin macrocrystalline cap 100 mg

(Macrodantin)...................................................................7nitrofurantoin monohydrate macrocrystalline cap 100

mg (Macrobid)................................................................. 7nitrofurantoin susp 25 mg/5ml.........................................7nitroglycerin sl tab 0.3 mg (Nitrostat)........................... 20nitroglycerin sl tab 0.4 mg (Nitrostat)........................... 21nitroglycerin sl tab 0.6 mg (Nitrostat)........................... 21nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur).........21nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur).........21nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur).........21nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur).........21NITYR – nitisinone tab 2 mg.............................................19NITYR – nitisinone tab 5 mg.............................................19NITYR – nitisinone tab 10 mg...........................................19NIVESTYM – filgrastim-aafi inj 300 mcg/ml......................53NIVESTYM – filgrastim-aafi inj 480 mcg/1.6ml (300 mcg/

ml)....................................................................................53NIVESTYM – filgrastim-aafi soln prefilled syringe 300

mcg/0.5ml........................................................................53NIVESTYM – filgrastim-aafi soln prefilled syringe 480

mcg/0.8ml........................................................................53NORDITROPIN FLEXPRO – somatropin solution pen-

injector 5 mg/1.5ml......................................................... 19NORDITROPIN FLEXPRO – somatropin solution pen-

injector 10 mg/1.5ml....................................................... 19NORDITROPIN FLEXPRO – somatropin solution pen-

injector 15 mg/1.5ml....................................................... 19

NORDITROPIN FLEXPRO – somatropin solution pen-injector 30 mg/3ml.......................................................... 19

norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr.........................................................................14

norethindrone & ethinyl estradiol-fe chew tab 0.4mg-35 mcg (Femcon fe)...............................................14

norethindrone & ethinyl estradiol tab 0.5 mg-35 mcg(Brevicon-28)................................................................. 14

norethindrone & ethinyl estradiol tab 1 mg-35 mcg(Norinyl 1+35)................................................................ 14

norethindrone & ethinyl estradiol tab 0.4 mg-35 mcg(Ovcon-35)......................................................................14

norethindrone ace & ethinyl estradiol-fe tab 1 mg-20mcg (Loestrin fe 1/20).................................................. 14

norethindrone ace & ethinyl estradiol-fe tab 1.5 mg-30mcg (Loestrin fe 1.5/30)...............................................14

norethindrone ace & ethinyl estradiol tab 1 mg-20mcg (Loestrin 1/20-21)................................................. 14

norethindrone ace & ethinyl estradiol tab 1.5 mg-30mcg (Loestrin 1.5/30-21).............................................. 14

norethindrone acetate-ethinyl estradiol tab 1 mg-5mcg................................................................................. 13

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5mcg (Femhrt low dose)................................................13

norethindrone acetate tab 5 mg (Aygestin)..................14norethindrone ac-ethinyl estrad-fe tab 1-20/1-30/1-35

mg-mcg (Estrostep fe)................................................. 14norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35

mg-mcg (Ortho-novum 7/7/7)...................................... 14norethindrone-eth estradiol tab 0.5-35/1-35/0.5-35 mg-

mcg (Tri-norinyl 28)...................................................... 14norethindrone tab 0.35 mg (Nor-qd)..............................14norgestimate & ethinyl estradiol tab 0.25 mg-35 mcg

(Ortho-cyclen)................................................................14norgestimate-eth estrad tab 0.18-35/0.215-35/0.25-35

mg-mcg (Ortho tri-cyclen)........................................... 14norgestimate-eth estrad tab 0.18-25/0.215-25/0.25-25

mg-mcg (Ortho tri-cyclen lo).......................................14norgestrel & ethinyl estradiol tab 0.3 mg-30 mcg........14nortriptyline hcl cap 10 mg (Pamelor)...........................36nortriptyline hcl cap 25 mg (Pamelor)...........................36nortriptyline hcl cap 50 mg (Pamelor)...........................36nortriptyline hcl cap 75 mg (Pamelor)...........................36NORTRIPTYLINE HCL – nortriptyline hcl soln 10

mg/5ml.............................................................................36NORVIR – ritonavir oral soln 80 mg/ml...............................5NORVIR – ritonavir powder packet 100 mg........................5NOVAREL – chorionic gonadotropin for im inj 5000

unit................................................................................... 19NOVAREL – chorionic gonadotropin for im inj 10000

unit................................................................................... 19NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii)

for inj 250 unit.................................................................56NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii)

for inj 500 unit.................................................................56NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii)

for inj 1000 unit...............................................................56

2021

FID 568 July 2021 86

NOVOEIGHT – antihemophilic fact rcmb (bd trunc-rfviii)for inj 1500 unit...............................................................56



NOVOLIN 70/30 FLEXPEN – insulin nph & regular susppen-inj 100 unit/ml (70-30)............................................. 18

NOVOLIN 70/30 – insulin nph isophane & regular humaninj 100 unit/ml (70-30).................................................... 18

NOVOLIN N FLEXPEN – insulin nph (human) (isophane)susp pen-injector 100 unit/ml......................................... 18

NOVOLIN N – insulin nph (human) (isophane) inj 100unit/ml.............................................................................. 18

NOVOLIN R FLEXPEN – insulin regular (human) solnpen-injector 100 unit/ml.................................................. 17

NOVOLIN R – insulin regular (human) inj 100 unit/ml...... 17NOVOLOG FLEXPEN – insulin aspart soln pen-injector

100 unit/ml.......................................................................17NOVOLOG – insulin aspart inj 100 unit/ml....................... 17NOVOLOG MIX 70/30 – insulin aspart prot & aspart

(human) inj 100 unit/ml (70-30)......................................18NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &

aspart sus pen-inj 100 unit/ml (70-30)........................... 18NOVOLOG PENFILL – insulin aspart soln cartridge 100

unit/ml.............................................................................. 17NOVOSEVEN RT – coagulation factor viia (recomb) for inj

1 mg (1000 mcg)............................................................ 56NOVOSEVEN RT – coagulation factor viia (recomb) for inj



8 mg (8000 mcg)............................................................ 56NOXAFIL – posaconazole susp 40 mg/ml..........................3NUBEQA – darolutamide tab 300 mg...............................10NUCYNTA ER – tapentadol hcl tab er 12hr 50 mg...........44NUCYNTA ER – tapentadol hcl tab er 12hr 100 mg.........44NUCYNTA ER – tapentadol hcl tab er 12hr 150 mg.........44NUCYNTA ER – tapentadol hcl tab er 12hr 200 mg.........44NUCYNTA ER – tapentadol hcl tab er 12hr 250 mg.........44NUVARING – etonogestrel-ethinyl estradiol va ring

0.120-0.015 mg/24hr...................................................... 14nystatin cream 100000 unit/gm......................................60nystatin oint 100000 unit/gm..........................................60nystatin susp 100000 unit/ml......................................... 58nystatin tab 500000 unit....................................................3nystatin topical powder 100000 unit/gm.......................60nystatin-triamcinolone cream 100000-0.1 unit/gm-

%......................................................................................60nystatin-triamcinolone oint 100000-0.1 unit/gm-%...... 60NYVEPRIA – pegfilgrastim-apgf soln prefilled syringe 6

mg/0.6ml..........................................................................53

OOBIZUR – antihemophilic factor (recomb porc) rpfviii for

inj 500 unit...................................................................... 56

octreotide acetate inj 50 mcg/ml (0.05 mg/ml)(Sandostatin)................................................................. 20




octreotide acetate inj 1000 mcg/ml (1 mg/ml)(Sandostatin)................................................................. 20

ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg....................................................................5

ODOMZO – sonidegib phosphate cap 200 mg (baseequivalent).......................................................................10

ofloxacin ophth soln 0.3% (Ocuflox).............................57ofloxacin otic soln 0.3%..................................................58ofloxacin tab 400 mg.........................................................3olanzapine orally disintegrating tab 5 mg (Zyprexa

zydis)...............................................................................38olanzapine orally disintegrating tab 10 mg (Zyprexa



zydis)...............................................................................38olanzapine tab 2.5 mg (Zyprexa)................................... 38olanzapine tab 5 mg (Zyprexa)...................................... 38olanzapine tab 7.5 mg (Zyprexa)................................... 38olanzapine tab 10 mg (Zyprexa).................................... 38olanzapine tab 15 mg (Zyprexa).................................... 38olanzapine tab 20 mg (Zyprexa).................................... 38olmesartan medoxomil-hydrochlorothiazide tab

20-12.5 mg (Benicar hct)..............................................25olmesartan medoxomil-hydrochlorothiazide tab

40-12.5 mg (Benicar hct)..............................................25olmesartan medoxomil-hydrochlorothiazide tab 40-25

mg (Benicar hct)........................................................... 25olmesartan medoxomil tab 5 mg (Benicar).................. 25olmesartan medoxomil tab 20 mg (Benicar)................ 25olmesartan medoxomil tab 40 mg (Benicar)................ 25omeprazole cap delayed release 10 mg (Prilosec)...... 32omeprazole cap delayed release 20 mg (Prilosec)...... 32omeprazole cap delayed release 40 mg (Prilosec)...... 32ONDANSETRON HCL – ondansetron hcl tab 24 mg....... 33ondansetron hcl oral soln 4 mg/5ml (Zofran)...............33ondansetron hcl tab 4 mg (Zofran)................................33ondansetron hcl tab 8 mg (Zofran)................................33ondansetron orally disintegrating tab 4 mg (Zofran

odt).................................................................................. 33ondansetron orally disintegrating tab 8 mg (Zofran

odt).................................................................................. 33OPSUMIT – macitentan tab 10 mg...................................28ORACEA – doxycycline (rosacea) cap delayed release 40

mg....................................................................................61ORFADIN – nitisinone cap 20 mg.....................................20ORFADIN – nitisinone susp 4 mg/ml................................ 20

2021

FID 568 July 2021 87

ORIAHNN – elagolix-estrad-noreth 300-1-0.5mg &elagolix 300mg cap pack................................................13

ORILISSA – elagolix sodium tab 150 mg (base equiv).....20ORILISSA – elagolix sodium tab 200 mg (base equiv).....20orphenadrine citrate tab er 12hr 100 mg...................... 51oseltamivir phosphate cap 30 mg (base equiv)

(Tamiflu)............................................................................5oseltamivir phosphate cap 45 mg (base equiv)

(Tamiflu)............................................................................5oseltamivir phosphate cap 75 mg (base equiv)

(Tamiflu)............................................................................5oseltamivir phosphate for susp 6 mg/ml (base equiv)

(Tamiflu)............................................................................5OTEZLA – apremilast tab 30 mg...................................... 46OTEZLA – apremilast tab starter therapy pack 10 mg &

20 mg & 30 mg...............................................................46OTREXUP – methotrexate soln pf auto-injector 10

mg/0.4ml..........................................................................46OTREXUP – methotrexate soln pf auto-injector 12.5

mg/0.4ml..........................................................................46OTREXUP – methotrexate soln pf auto-injector 15





mg/0.4ml..........................................................................46oxaprozin tab 600 mg (Daypro)..................................... 46oxcarbazepine susp 300 mg/5ml (60 mg/ml)

(Trileptal)........................................................................ 49oxcarbazepine tab 150 mg (Trileptal)............................ 49oxcarbazepine tab 300 mg (Trileptal)............................ 49oxcarbazepine tab 600 mg (Trileptal)............................ 49oxybutynin chloride syrup 5 mg/5ml............................ 34oxybutynin chloride tab er 24hr 15 mg.........................34oxybutynin chloride tab er 24hr 5 mg (Ditropan xl).....34oxybutynin chloride tab er 24hr 10 mg (Ditropan

xl).....................................................................................34oxybutynin chloride tab 5 mg........................................ 34OXYCODONE/ASPIRIN – oxycodone-aspirin tab

4.8355-325 mg................................................................45oxycodone hcl cap 5 mg................................................ 44oxycodone hcl conc 100 mg/5ml (20 mg/ml)

(Oxycodone hcl)............................................................44oxycodone hcl soln 5 mg/5ml (Oxycodone hcl)...........44oxycodone hcl tab 10 mg............................................... 44oxycodone hcl tab 20 mg............................................... 44oxycodone hcl tab 5 mg (Roxicodone).........................44oxycodone hcl tab 15 mg (Roxicodone).......................44oxycodone hcl tab 30 mg (Roxicodone).......................45oxycodone w/ acetaminophen tab 5-325 mg

(Percocet).......................................................................45oxycodone w/ acetaminophen tab 7.5-325 mg

(Percocet).......................................................................45

oxycodone w/ acetaminophen tab 10-325 mg(Percocet).......................................................................45

OZEMPIC – semaglutide soln pen-inj 1 mg/dose (2mg/1.5ml).........................................................................16

OZEMPIC – semaglutide soln pen-inj 1 mg/dose (4mg/3ml)............................................................................16

OZEMPIC – semaglutide soln pen-inj 0.25 or 0.5 mg/dose(2 mg/1.5ml)....................................................................16

Ppantoprazole sodium ec tab 20 mg (base equiv)

(Protonix)........................................................................33pantoprazole sodium ec tab 40 mg (base equiv)

(Protonix)........................................................................33paricalcitol cap 1 mcg (Zemplar)................................... 20paricalcitol cap 2 mcg (Zemplar)................................... 20paricalcitol cap 4 mcg (Zemplar)................................... 20PAROMOMYCIN SULFATE – paromomycin sulfate cap

250 mg.............................................................................. 3paroxetine hcl tab er 24hr 12.5 mg (Paxil cr)............... 36paroxetine hcl tab er 24hr 25 mg (Paxil cr).................. 36paroxetine hcl tab er 24hr 37.5 mg (Paxil cr)............... 36paroxetine hcl tab 10 mg (Paxil)....................................36paroxetine hcl tab 20 mg (Paxil)....................................36paroxetine hcl tab 30 mg (Paxil)....................................36paroxetine hcl tab 40 mg (Paxil)....................................36PEGASYS – peginterferon alfa-2a inj 180 mcg/ml............. 5PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml........ 5peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236

gm (Golytely)................................................................. 32peg 3350-kcl-sod bicarb-nacl for soln 420 gm

(Nulytely/flavor pack)................................................... 32penicillamine tab 250 mg (Depen titratabs)..................62PENICILLIN V POTASSIUM – penicillin v potassium for

soln 125 mg/5ml............................................................... 1PENICILLIN V POTASSIUM – penicillin v potassium for

soln 250 mg/5ml............................................................... 1penicillin v potassium tab 250 mg...................................1penicillin v potassium tab 500 mg...................................1pentamidine isethionate for nebulization soln 300 mg

(Nebupent)........................................................................7pentoxifylline tab er 400 mg...........................................56perindopril erbumine tab 2 mg...................................... 25perindopril erbumine tab 4 mg (Aceon)........................25perindopril erbumine tab 8 mg (Aceon)........................25permethrin cream 5% (Elimite)...................................... 61perphenazine tab 2 mg................................................... 38perphenazine tab 4 mg................................................... 38perphenazine tab 8 mg................................................... 38perphenazine tab 16 mg................................................. 38phenelzine sulfate tab 15 mg (Nardil)........................... 37phenobarbital elixir 20 mg/5ml...................................... 39phenobarbital tab 15 mg.................................................39phenobarbital tab 16.2 mg..............................................39phenobarbital tab 30 mg.................................................39phenobarbital tab 32.4 mg..............................................39phenobarbital tab 60 mg.................................................39

2021

FID 568 July 2021 88

phenobarbital tab 100 mg...............................................39phenoxybenzamine hcl cap 10 mg (Dibenzyline)........ 25phenytoin chew tab 50 mg (Dilantin infatabs)..............49phenytoin sodium extended cap 100 mg (Dilantin).....49phenytoin sodium extended cap 200 mg

(Phenytek)...................................................................... 49phenytoin sodium extended cap 300 mg

(Phenytek)...................................................................... 49phenytoin susp 125 mg/5ml (Dilantin).......................... 49phytonadione tab 5 mg (Mephyton).............................. 51pilocarpine hcl ophth soln 1% (Isopto carpine)...........57pilocarpine hcl ophth soln 2% (Isopto carpine)...........57pilocarpine hcl ophth soln 4% (Isopto carpine)...........57pilocarpine hcl tab 5 mg (Salagen)................................58pilocarpine hcl tab 7.5 mg (Salagen).............................58pimecrolimus cream 1% (Elidel).................................... 61PIMOZIDE – pimozide tab 1 mg....................................... 42PIMOZIDE – pimozide tab 2 mg....................................... 42pindolol tab 5 mg.............................................................21pindolol tab 10 mg...........................................................21pioglitazone hcl-metformin hcl tab 15-500 mg

(Actoplus met)...............................................................16pioglitazone hcl-metformin hcl tab 15-850 mg

(Actoplus met)...............................................................16pioglitazone hcl tab 15 mg (base equiv) (Actos)..........16pioglitazone hcl tab 30 mg (base equiv) (Actos)..........16pioglitazone hcl tab 45 mg (base equiv) (Actos)..........16PIQRAY 250MG DAILY DOSE – alpelisib tab pack 250

mg daily dose (200 mg & 50 mg tabs)...........................10PIQRAY 300MG DAILY DOSE – alpelisib tab pack 300

mg daily dose (2x150 mg tab)....................................... 10PIQRAY 200MG DAILY DOSE – alpelisib tab therapy

pack 200 mg daily dose................................................. 10piroxicam cap 10 mg (Feldene)..................................... 46piroxicam cap 20 mg (Feldene)..................................... 46PLEGRIDY – peginterferon beta-1a im soln prefilled syr

125 mcg/0.5ml................................................................ 42PLEGRIDY – peginterferon beta-1a soln pen-injector 125

mcg/0.5ml........................................................................42PLEGRIDY – peginterferon beta-1a soln prefilled syringe

125 mcg/0.5ml................................................................ 42PLEGRIDY STARTER PACK – peginterferon beta-1a soln

pen-inj 63 & 94 mcg/0.5ml pack.................................... 42PLEGRIDY STARTER PACK – peginterferon beta-1a soln

pref syr 63 & 94 mcg/0.5ml pack...................................42podofilox soln 0.5% (Condylox).....................................61polymyxin b-trimethoprim ophth soln 10000 unit/

ml-0.1% (Polytrim)........................................................ 57POMALYST – pomalidomide cap 1 mg............................ 10POMALYST – pomalidomide cap 2 mg............................ 10POMALYST – pomalidomide cap 3 mg............................ 10POMALYST – pomalidomide cap 4 mg............................ 10posaconazole tab delayed release 100 mg (Noxafil)..... 3potassium chloride cap er 8 meq..................................52potassium chloride cap er 10 meq................................52POTASSIUM CHLORIDE ER – potassium chloride tab er

8 meq (600 mg)..............................................................52

potassium chloride microencapsulated crys er tab 10meq................................................................................. 52

potassium chloride microencapsulated crys er tab 20meq................................................................................. 52

potassium chloride oral soln 10% (20 meq/15ml)........52potassium chloride oral soln 20% (40 meq/15ml)........52potassium chloride powder packet 20 meq (K-lor

hospital pack)................................................................52potassium chloride tab er 10 meq (K-tab).................... 52potassium chloride tab er 8 meq (600 mg)...................52potassium citrate tab er 5 meq (540 mg) (Urocit-k

5)......................................................................................35potassium citrate tab er 10 meq (1080 mg) (Urocit-k

10)....................................................................................35potassium citrate tab er 15 meq (1620 mg) (Urocit-k

15)....................................................................................35pot phos monobasic w/sod phos di & monobas tab

155-852-130mg (K-phos neutral).................................51pramipexole dihydrochloride tab 0.125 mg

(Mirapex).........................................................................50pramipexole dihydrochloride tab 0.25 mg

(Mirapex).........................................................................50pramipexole dihydrochloride tab 0.5 mg (Mirapex).....50pramipexole dihydrochloride tab 0.75 mg

(Mirapex).........................................................................50pramipexole dihydrochloride tab 1 mg (Mirapex)........50pramipexole dihydrochloride tab 1.5 mg (Mirapex).....50prasugrel hcl tab 5 mg (base equiv) (Effient)...............56prasugrel hcl tab 10 mg (base equiv) (Effient).............56pravastatin sodium tab 10 mg....................................... 28pravastatin sodium tab 20 mg (Pravachol)...................28pravastatin sodium tab 40 mg (Pravachol)...................28pravastatin sodium tab 80 mg (Pravachol)...................28praziquantel tab 600 mg (Biltricide)................................ 6prazosin hcl cap 1 mg (Minipress)................................ 25prazosin hcl cap 2 mg (Minipress)................................ 25prazosin hcl cap 5 mg (Minipress)................................ 25PREDNISOLONE ACETATE – prednisolone acetate

ophth susp 1%................................................................57PREDNISOLONE – prednisolone syrup 15 mg/5ml (usp

solution equivalent).........................................................12prednisolone sod phosphate oral soln 15 mg/5ml

(base equiv) (Orapred)................................................. 12prednisolone sod phosph oral soln 6.7 mg/5ml (5

mg/5ml base) (Pediapred)............................................12PREDNISONE – prednisone oral soln 5 mg/5ml..............12prednisone tab 1 mg....................................................... 12prednisone tab 2.5 mg.................................................... 12prednisone tab 5 mg....................................................... 12prednisone tab 10 mg..................................................... 12prednisone tab 20 mg..................................................... 12prednisone tab 50 mg..................................................... 12prednisone tab therapy pack 5 mg (21)........................ 12prednisone tab therapy pack 5 mg (48)........................ 12prednisone tab therapy pack 10 mg (21)...................... 12prednisone tab therapy pack 10 mg (48)...................... 12pregabalin cap 25 mg (Lyrica)....................................... 49

2021

FID 568 July 2021 89

pregabalin cap 50 mg (Lyrica)....................................... 49pregabalin cap 75 mg (Lyrica)....................................... 49pregabalin cap 100 mg (Lyrica)..................................... 49pregabalin cap 150 mg (Lyrica)..................................... 49pregabalin cap 200 mg (Lyrica)..................................... 49pregabalin cap 225 mg (Lyrica)..................................... 49pregabalin cap 300 mg (Lyrica)..................................... 49pregabalin soln 20 mg/ml (Lyrica)................................. 49PREGNYL W/DILUENT BENZYL – chorionic

gonadotropin for im inj 10000 unit................................. 20PREMARIN – estrogens, conjugated tab 0.3 mg............. 13PREMARIN – estrogens, conjugated tab 0.45 mg........... 13PREMARIN – estrogens, conjugated tab 0.625 mg......... 13PREMARIN – estrogens, conjugated tab 0.9 mg............. 13PREMARIN – estrogens, conjugated tab 1.25 mg........... 13PREMPHASE – conj est 0.625(14)/conj est-medroxypro

ac tab 0.625-5mg(14)..................................................... 13PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.3-1.5 mg................................................... 13PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.45-1.5 mg................................................. 13PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.625-2.5 mg............................................... 13PREMPRO – conjugated estrogen-medroxyprogest

acetate tab 0.625-5 mg.................................................. 13PRENATABS RX – prenatal vit w/ iron carbonyl-fa tab

29-1 mg........................................................................... 51PRENATAL PLUS IRON – prenatal vit w/ iron carbonyl-fa

tab 29-1 mg.....................................................................51PRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab

29-1 mg........................................................................... 51PRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab

29-1 mg........................................................................... 51PRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap

106.5-1 mg......................................................................51PRENATAL VITAMINS PLUS LO – prenatal vit w/ fe

fumarate-fa tab 27-1 mg.................................................51PREZCOBIX – darunavir-cobicistat tab 800-150 mg..........5PREZISTA – darunavir ethanolate susp 100 mg/ml (base

equiv)................................................................................. 5PREZISTA – darunavir ethanolate tab 75 mg (base




equiv)................................................................................. 5PRIFTIN – rifapentine tab 150 mg...................................... 3primaquine phosphate tab 26.3 mg (15 mg base)

(Primaquine phosphate).................................................6primidone tab 50 mg (Mysoline).................................... 49primidone tab 250 mg (Mysoline).................................. 49probenecid tab 500 mg................................................... 48prochlorperazine maleate tab 5 mg (base

equivalent)......................................................................38

prochlorperazine maleate tab 10 mg (baseequivalent)......................................................................38

prochlorperazine suppos 25 mg....................................38PROCRIT – epoetin alfa inj 2000 unit/ml..........................53PROCRIT – epoetin alfa inj 3000 unit/ml..........................53PROCRIT – epoetin alfa inj 4000 unit/ml..........................53PROCRIT – epoetin alfa inj 10000 unit/ml........................53PROCRIT – epoetin alfa inj 20000 unit/ml........................53PROCRIT – epoetin alfa inj 40000 unit/ml........................53progesterone cap 100 mg (Prometrium).......................14progesterone cap 200 mg (Prometrium).......................15promethazine hcl suppos 12.5 mg................................ 29promethazine hcl suppos 25 mg................................... 29promethazine hcl syrup 6.25 mg/5ml............................ 29promethazine hcl tab 12.5 mg........................................29promethazine hcl tab 25 mg...........................................29promethazine hcl tab 50 mg...........................................29PROMETHEGAN – promethazine hcl suppos 50 mg.......29propafenone hcl cap er 12hr 225 mg (Rythmol sr)...... 23propafenone hcl cap er 12hr 325 mg (Rythmol sr)...... 23propafenone hcl cap er 12hr 425 mg (Rythmol sr)...... 23propafenone hcl tab 300 mg.......................................... 23propafenone hcl tab 150 mg (Rythmol)........................ 23propafenone hcl tab 225 mg (Rythmol)........................ 23PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 40-25 mg..................................25PROPRANOLOL/HYDROCHLOROTH – propranolol &

hydrochlorothiazide tab 80-25 mg..................................25propranolol hcl cap er 24hr 60 mg (Inderal la).............21propranolol hcl cap er 24hr 80 mg (Inderal la).............21propranolol hcl cap er 24hr 120 mg (Inderal la)...........21propranolol hcl cap er 24hr 160 mg (Inderal la)...........21PROPRANOLOL HCL – propranolol hcl oral soln 20

mg/5ml.............................................................................21PROPRANOLOL HCL – propranolol hcl oral soln 40

mg/5ml.............................................................................21propranolol hcl tab 10 mg.............................................. 21propranolol hcl tab 20 mg.............................................. 21propranolol hcl tab 40 mg.............................................. 21propranolol hcl tab 60 mg.............................................. 21propranolol hcl tab 80 mg.............................................. 21propylthiouracil tab 50 mg............................................. 18PULMOZYME – dornase alfa inhal soln 1 mg/ml............. 32PURIXAN – mercaptopurine susp 2000 mg/100ml (20

mg/ml)..............................................................................10PYRAZINAMIDE – pyrazinamide tab 500 mg.....................3pyridostigmine bromide tab 60 mg (Mestinon)............51pyrimethamine tab 25 mg (Daraprim)............................. 6Qquetiapine fumarate tab er 24hr 50 mg (Seroquel

xr).................................................................................... 38quetiapine fumarate tab er 24hr 150 mg (Seroquel

xr).................................................................................... 38quetiapine fumarate tab er 24hr 200 mg (Seroquel

xr).................................................................................... 38

2021

FID 568 July 2021 90

quetiapine fumarate tab er 24hr 300 mg (Seroquelxr).................................................................................... 38

quetiapine fumarate tab er 24hr 400 mg (Seroquelxr).................................................................................... 38

quetiapine fumarate tab 25 mg (Seroquel)................... 38quetiapine fumarate tab 50 mg (Seroquel)................... 38quetiapine fumarate tab 100 mg (Seroquel)................. 38quetiapine fumarate tab 200 mg (Seroquel)................. 38quetiapine fumarate tab 300 mg (Seroquel)................. 38quetiapine fumarate tab 400 mg (Seroquel)................. 38quinapril hcl tab 5 mg (Accupril)...................................25quinapril hcl tab 10 mg (Accupril).................................25quinapril hcl tab 20 mg (Accupril).................................26quinapril hcl tab 40 mg (Accupril).................................26quinapril-hydrochlorothiazide tab 10-12.5 mg

(Accuretic)......................................................................26quinapril-hydrochlorothiazide tab 20-12.5 mg

(Accuretic)......................................................................26quinapril-hydrochlorothiazide tab 20-25 mg

(Accuretic)......................................................................26quinidine gluconate tab er 324 mg................................23QUINIDINE SULFATE – quinidine sulfate tab 200 mg......23QUINIDINE SULFATE – quinidine sulfate tab 300 mg......23QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 40 mcg/act....................................................31QVAR REDIHALER – beclomethasone diprop hfa breath

act inh aer 80 mcg/act....................................................31

Rraloxifene hcl tab 60 mg (Evista)...................................20ramipril cap 1.25 mg (Altace)......................................... 26ramipril cap 2.5 mg (Altace)........................................... 26ramipril cap 5 mg (Altace).............................................. 26ramipril cap 10 mg (Altace)............................................ 26rasagiline mesylate tab 0.5 mg (base equiv)

(Azilect)...........................................................................50rasagiline mesylate tab 1 mg (base equiv)

(Azilect)...........................................................................50REBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml

(12mu/ml)........................................................................ 42REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml

(24mu/ml)........................................................................ 42REBIF REBIDOSE – interferon beta-1a soln auto-inj 22

mcg/0.5ml (12mu/ml)...................................................... 42REBIF REBIDOSE – interferon beta-1a soln auto-inj 44

mcg/0.5ml (24mu/ml)...................................................... 42REBIF REBIDOSE TITRATION – interferon beta-1a auto-

inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml..........................43REBIF TITRATION PACK – interferon beta-1a pref syr

6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml...............................43REDITREX – methotrexate soln prefilled syringe 7.5

mg/0.3ml..........................................................................46REDITREX – methotrexate soln prefilled syringe 10

mg/0.4ml..........................................................................46REDITREX – methotrexate soln prefilled syringe 12.5

mg/0.5ml..........................................................................46

REDITREX – methotrexate soln prefilled syringe 15mg/0.6ml..........................................................................47

REDITREX – methotrexate soln prefilled syringe 17.5mg/0.7ml..........................................................................47

REDITREX – methotrexate soln prefilled syringe 20mg/0.8ml..........................................................................47

REDITREX – methotrexate soln prefilled syringe 22.5mg/0.9ml..........................................................................47

REDITREX – methotrexate soln prefilled syringe 25 mg/ml..................................................................................... 47

repaglinide tab 0.5 mg (Prandin)................................... 16repaglinide tab 1 mg (Prandin)...................................... 16repaglinide tab 2 mg (Prandin)...................................... 16REPATHA – evolocumab subcutaneous soln prefilled

syringe 140 mg/ml.......................................................... 28REPATHA PUSHTRONEX SYSTEM – evolocumab

subcutaneous soln cartridge/infusor 420 mg/3.5ml....... 28REPATHA SURECLICK – evolocumab subcutaneous soln

auto-injector 140 mg/ml..................................................28RETACRIT – epoetin alfa-epbx inj 2000 unit/ml............... 53RETACRIT – epoetin alfa-epbx inj 3000 unit/ml............... 53RETACRIT – epoetin alfa-epbx inj 4000 unit/ml............... 53RETACRIT – epoetin alfa-epbx inj 10000 unit/ml............. 53RETACRIT – epoetin alfa-epbx inj 20000 unit/ml............. 53RETACRIT – epoetin alfa-epbx inj 40000 unit/ml............. 53RETEVMO – selpercatinib cap 40 mg.............................. 10RETEVMO – selpercatinib cap 80 mg.............................. 10REVCOVI – elapegademase-lvlr im soln 2.4 mg/1.5ml

(1.6 mg/ml)......................................................................20REVLIMID – lenalidomide cap 5 mg.................................62REVLIMID – lenalidomide cap 10 mg...............................62REVLIMID – lenalidomide cap 15 mg...............................62REVLIMID – lenalidomide cap 20 mg...............................62REVLIMID – lenalidomide cap 25 mg...............................62REVLIMID – lenalidomide caps 2.5 mg............................ 62ribavirin cap 200 mg (Rebetol).........................................5ribavirin tab 200 mg (Copegus)....................................... 5rifabutin cap 150 mg (Mycobutin)....................................3rifampin cap 150 mg (Rifadin)..........................................3rifampin cap 300 mg (Rifadin)..........................................3riluzole tab 50 mg (Rilutek)............................................ 51RINVOQ – upadacitinib tab er 24hr 15 mg.......................47risedronate sodium tab 5 mg (Actonel)........................ 20risedronate sodium tab 30 mg (Actonel)...................... 20risedronate sodium tab 35 mg (Actonel)...................... 20risedronate sodium tab 150 mg (Actonel).................... 20RISPERIDONE ODT – risperidone orally disintegrating

tab 0.25 mg.....................................................................38risperidone orally disintegrating tab 0.5 mg (Risperdal

m-tab)..............................................................................38risperidone orally disintegrating tab 1 mg (Risperdal



m-tab)..............................................................................38

2021

FID 568 July 2021 91

risperidone orally disintegrating tab 4 mg (Risperdalm-tab)..............................................................................38

risperidone soln 1 mg/ml (Risperdal)............................38risperidone tab 0.25 mg (Risperdal)..............................38risperidone tab 0.5 mg (Risperdal)................................38risperidone tab 1 mg (Risperdal)...................................38risperidone tab 2 mg (Risperdal)...................................38risperidone tab 3 mg (Risperdal)...................................38risperidone tab 4 mg (Risperdal)...................................38ritonavir tab 100 mg (Norvir)............................................5rivastigmine tartrate cap 1.5 mg (base equivalent)..... 43rivastigmine tartrate cap 3 mg (base equivalent)........ 43rivastigmine tartrate cap 4.5 mg (base equivalent)..... 43rivastigmine tartrate cap 6 mg (base equivalent)........ 43rizatriptan benzoate oral disintegrating tab 5 mg (base

eq) (Maxalt-mlt)............................................................. 47rizatriptan benzoate oral disintegrating tab 10 mg

(base eq) (Maxalt-mlt).................................................. 47rizatriptan benzoate tab 5 mg (base equivalent)..........47rizatriptan benzoate tab 10 mg (base equivalent)

(Maxalt)........................................................................... 47ropinirole hydrochloride tab 0.25 mg (Requip)............50ropinirole hydrochloride tab 0.5 mg (Requip)..............50ropinirole hydrochloride tab 1 mg (Requip).................50ropinirole hydrochloride tab 2 mg (Requip).................50ropinirole hydrochloride tab 3 mg (Requip).................50ropinirole hydrochloride tab 4 mg (Requip).................50ropinirole hydrochloride tab 5 mg (Requip).................51rosuvastatin calcium tab 5 mg (Crestor)...................... 28rosuvastatin calcium tab 10 mg (Crestor).................... 28rosuvastatin calcium tab 20 mg (Crestor).................... 28rosuvastatin calcium tab 40 mg (Crestor).................... 28ROZLYTREK – entrectinib cap 100 mg............................ 10ROZLYTREK – entrectinib cap 200 mg............................ 10RUBRACA – rucaparib camsylate tab 200 mg (base

equivalent).......................................................................10RUBRACA – rucaparib camsylate tab 250 mg (base

equivalent).......................................................................10RUBRACA – rucaparib camsylate tab 300 mg (base

equivalent).......................................................................10RYBELSUS – semaglutide tab 3 mg................................ 16RYBELSUS – semaglutide tab 7 mg................................ 16RYBELSUS – semaglutide tab 14 mg.............................. 16RYDAPT – midostaurin cap 25 mg...................................10

SSANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 10 mg.................................................................... 20SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 20 mg.................................................................... 20SANDOSTATIN LAR DEPOT – octreotide acetate for im

inj kit 30 mg.................................................................... 20scopolamine td patch 72hr 1 mg/3days (Transderm-

scop)............................................................................... 33selegiline hcl cap 5 mg (Eldepryl)................................. 51SELEGILINE HCL – selegiline hcl tab 5 mg.....................51selenium sulfide lotion 2.5%.......................................... 61

SE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab29-1 mg........................................................................... 51

SE-NATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg........................................................................... 51

SEREVENT DISKUS – salmeterol xinafoate aer pow ba50 mcg/dose (base equiv)..............................................31

sertraline hcl oral concentrate for solution 20 mg/ml(Zoloft)............................................................................ 37

sertraline hcl tab 25 mg (Zoloft).................................... 37sertraline hcl tab 50 mg (Zoloft).................................... 37sertraline hcl tab 100 mg (Zoloft).................................. 37sevelamer carbonate packet 0.8 gm (Renvela)............ 34sevelamer carbonate packet 2.4 gm (Renvela)............ 34sevelamer carbonate tab 800 mg (Renvela)................. 34sildenafil citrate tab 20 mg (Revatio)............................ 28silver sulfadiazine cream 1% (Silvadene)..................... 61SIMBRINZA – brinzolamide-brimonidine tartrate ophth

susp 1-0.2%.................................................................... 57SIMPONI – golimumab subcutaneous soln auto-injector

100 mg/ml....................................................................... 47SIMPONI – golimumab subcutaneous soln prefilled

syringe 100 mg/ml.......................................................... 47simvastatin tab 5 mg (Zocor)......................................... 28simvastatin tab 10 mg (Zocor)....................................... 28simvastatin tab 20 mg (Zocor)....................................... 28simvastatin tab 40 mg (Zocor)....................................... 28simvastatin tab 80 mg (Zocor)....................................... 28sirolimus oral soln 1 mg/ml (Rapamune)......................62sirolimus tab 0.5 mg (Rapamune)................................. 62sirolimus tab 1 mg (Rapamune).................................... 62sirolimus tab 2 mg (Rapamune).................................... 62SIVEXTRO – tedizolid phosphate tab 200 mg....................7SKYLA – levonorgestrel releasing iud 14 mcg/day (13.5

mg total).......................................................................... 14SKYRIZI – risankizumab-rzaa sol prefilled syringe 2 x 75

mg/0.83ml kit...................................................................61sodium chloride soln nebu 3%...................................... 29sodium chloride soln nebu 7% (Hyper-sal).................. 29sodium citrate & citric acid soln 500-334 mg/5ml

(Shohls solution modi)................................................ 35sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)

(Luride)........................................................................... 52sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)

(Luride)........................................................................... 52sodium fluoride chew tab 1 mg f (from 2.2 mg naf)

(Luride)........................................................................... 52sodium fluoride cream 1.1% (Prevident 5000 plus).....58sodium fluoride gel 1.1% (0.5% f) (Prevident

fluoride).......................................................................... 58SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from

1.1 mg naf)......................................................................52SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from

2.2 mg naf)......................................................................52sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop

naf).................................................................................. 52sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)

(Luride)........................................................................... 52

2021

FID 568 July 2021 92

sodium polystyrene sulfonate powder......................... 62SOFOSBUVIR/VELPATASVIR – sofosbuvir-velpatasvir

tab 400-100 mg................................................................ 5solifenacin succinate tab 5 mg (Vesicare)....................34solifenacin succinate tab 10 mg (Vesicare)..................34SOLIQUA 100/33 – insulin glargine-lixisenatide sol pen-inj

100-33 unit-mcg/ml......................................................... 16SOLOSEC – secnidazole granules packet 2 gm................ 6SOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml (base

equivalent).......................................................................10SOOLANTRA – ivermectin cream 1%.............................. 61sotalol hcl (afib/afl) tab 80 mg (Betapace af)................21sotalol hcl (afib/afl) tab 120 mg (Betapace af)..............21sotalol hcl (afib/afl) tab 160 mg (Betapace af)..............21sotalol hcl tab 240 mg.....................................................21sotalol hcl tab 80 mg (Betapace)...................................21sotalol hcl tab 120 mg (Betapace).................................21sotalol hcl tab 160 mg (Betapace).................................21SOVALDI – sofosbuvir pellet pack 150 mg.........................5SOVALDI – sofosbuvir pellet pack 200 mg.........................5SOVALDI – sofosbuvir tab 200 mg..................................... 5SOVALDI – sofosbuvir tab 400 mg..................................... 5SPIRIVA HANDIHALER – tiotropium bromide

monohydrate inhal cap 18 mcg (base equiv).................31SPIRIVA RESPIMAT – tiotropium bromide monohydrate

inhal aerosol 1.25 mcg/act............................................. 31SPIRIVA RESPIMAT – tiotropium bromide monohydrate

inhal aerosol 2.5 mcg/act............................................... 31spironolactone & hydrochlorothiazide tab 25-25 mg

(Aldactazide).................................................................. 27spironolactone tab 25 mg (Aldactone)..........................27spironolactone tab 50 mg (Aldactone)..........................27spironolactone tab 100 mg (Aldactone)........................27SPRYCEL – dasatinib tab 20 mg......................................10SPRYCEL – dasatinib tab 50 mg......................................10SPRYCEL – dasatinib tab 70 mg......................................10SPRYCEL – dasatinib tab 80 mg......................................10SPRYCEL – dasatinib tab 100 mg....................................10SPRYCEL – dasatinib tab 140 mg....................................10SPS – sodium polystyrene sulfonate oral susp 15

gm/60ml...........................................................................62STAVUDINE – stavudine cap 15 mg...................................5STAVUDINE – stavudine cap 20 mg...................................5STAVUDINE – stavudine cap 30 mg...................................5STAVUDINE – stavudine cap 40 mg...................................5STELARA – ustekinumab inj 45 mg/0.5ml........................61STELARA – ustekinumab soln prefilled syringe 45

mg/0.5ml..........................................................................61STELARA – ustekinumab soln prefilled syringe 90 mg/

ml..................................................................................... 61STIMATE – desmopressin acetate nasal soln 1.5 mg/

ml..................................................................................... 20STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aero

soln 2.5-2.5 mcg/act....................................................... 31STIVARGA – regorafenib tab 40 mg.................................10STRENSIQ – asfotase alfa subcutaneous inj 18

mg/0.45ml........................................................................20

STRENSIQ – asfotase alfa subcutaneous inj 28mg/0.7ml..........................................................................20

STRENSIQ – asfotase alfa subcutaneous inj 40 mg/ml..................................................................................... 20

STRENSIQ – asfotase alfa subcutaneous inj 80mg/0.8ml..........................................................................20

sucralfate tab 1 gm (Carafate)....................................... 33SULFACETAMIDE SODIUM/PRED – sulfacetamide

sodium-prednisolone ophth soln 10-0.23(0.25)%..........57sulfacetamide sodium lotion 10% (acne) (Klaron).......61sulfacetamide sodium ophth soln 10% (Bleph-10)......57SULFADIAZINE – sulfadiazine tab 500 mg........................ 3sulfamethoxazole-trimethoprim susp 200-40

mg/5ml.............................................................................. 7sulfamethoxazole-trimethoprim tab 400-80 mg

(Bactrim)...........................................................................7sulfamethoxazole-trimethoprim tab 800-160 mg

(Bactrim ds)..................................................................... 7sulfasalazine tab delayed release 500 mg (Azulfidine

en-tabs)...........................................................................34sulfasalazine tab 500 mg (Azulfidine)........................... 34sulindac tab 150 mg........................................................ 47sulindac tab 200 mg........................................................ 47sumatriptan nasal spray 5 mg/act (Imitrex)..................47sumatriptan nasal spray 20 mg/act (Imitrex)................47sumatriptan succinate inj 6 mg/0.5ml (Imitrex

statdose ref).................................................................. 47sumatriptan succinate solution auto-injector 4

mg/0.5ml (Imitrex statdose sys)................................. 47sumatriptan succinate solution auto-injector 6

mg/0.5ml (Imitrex statdose sys)................................. 47sumatriptan succinate solution cartridge 4 mg/0.5ml

(Imitrex statdose ref)....................................................48sumatriptan succinate solution cartridge 6 mg/0.5ml

(Imitrex statdose ref)....................................................48SUMATRIPTAN SUCCINATE – sumatriptan succinate

solution prefilled syringe 6 mg/0.5ml............................. 47sumatriptan succinate tab 25 mg (Imitrex)...................48sumatriptan succinate tab 50 mg (Imitrex)...................48sumatriptan succinate tab 100 mg (Imitrex).................48SUNOSI – solriamfetol hcl tab 75 mg (base equiv).......... 41SUNOSI – solriamfetol hcl tab 150 mg (base equiv)........ 41SUPRAX – cefixime chew tab 100 mg............................... 2SUPRAX – cefixime chew tab 200 mg............................... 2SUPRAX – cefixime for susp 500 mg/5ml.......................... 2SUTENT – sunitinib malate cap 12.5 mg (base

equivalent).......................................................................10SUTENT – sunitinib malate cap 25 mg (base

equivalent).......................................................................10SUTENT – sunitinib malate cap 37.5 mg (base

equivalent).......................................................................10SUTENT – sunitinib malate cap 50 mg (base

equivalent).......................................................................10SYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 80-4.5 mcg/act...................................................31SYMBICORT – budesonide-formoterol fumarate dihyd

aerosol 160-4.5 mcg/act.................................................31

2021

FID 568 July 2021 93

SYMDEKO – tezacaftor-ivacaftor 50-75 mg & ivacaftor 75mg tab tbpk.....................................................................32

SYMDEKO – tezacaftor-ivacaftor 100-150 mg & ivacaftor150 mg tab tbpk..............................................................32

SYMJEPI – epinephrine soln prefilled syringe 0.15mg/0.3ml (1:2000)...........................................................27

SYMJEPI – epinephrine solution prefilled syringe 0.3mg/0.3ml (1:1000)...........................................................27

SYMPROIC – naldemedine tosylate tab 0.2 mg (baseequivalent).......................................................................34

SYMTUZA – darunavir-cobic-emtricitab-tenofov af tab800-150-200-10 mg.......................................................... 5

SYNAGIS – palivizumab im soln 50 mg/0.5ml....................7SYNAGIS – palivizumab im soln 100 mg/ml.......................7SYNJARDY – empagliflozin-metformin hcl tab 5-500

mg....................................................................................16SYNJARDY – empagliflozin-metformin hcl tab 5-1000

mg....................................................................................16SYNJARDY – empagliflozin-metformin hcl tab 12.5-500

mg....................................................................................16SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000

mg....................................................................................17SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

5-1000 mg.......................................................................17SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

10-1000 mg.....................................................................17SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

12.5-1000 mg..................................................................17SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr

25-1000 mg.....................................................................17SYNVISC – hylan intra-articular solution prefilled syringe

16 mg/2ml....................................................................... 51SYNVISC ONE – hylan intra-articular solution prefilled

syringe 48 mg/6ml.......................................................... 51

TTABLOID – thioguanine tab 40 mg................................... 10TABRECTA – capmatinib hcl tab 150 mg......................... 10TABRECTA – capmatinib hcl tab 200 mg......................... 10tacrolimus cap 0.5 mg (Prograf).................................... 62tacrolimus cap 1 mg (Prograf)....................................... 63tacrolimus cap 5 mg (Prograf)....................................... 63tacrolimus oint 0.03% (Protopic)................................... 61tacrolimus oint 0.1% (Protopic)..................................... 61tadalafil tab 2.5 mg (Cialis).............................................28tadalafil tab 5 mg (Cialis)................................................28tadalafil tab 10 mg (Cialis)..............................................28tadalafil tab 20 mg (Cialis)..............................................28tadalafil tab 20 mg (pah) (Adcirca)................................ 28TAFINLAR – dabrafenib mesylate cap 50 mg (base

equivalent).......................................................................10TAFINLAR – dabrafenib mesylate cap 75 mg (base

equivalent).......................................................................10TAGRISSO – osimertinib mesylate tab 40 mg (base

equivalent).......................................................................10TAGRISSO – osimertinib mesylate tab 80 mg (base

equivalent).......................................................................10

TAKHZYRO – lanadelumab-flyo inj 300 mg/2ml (150 mg/ml)....................................................................................56

TALZENNA – talazoparib tosylate cap 0.25 mg (baseequivalent).......................................................................10

TALZENNA – talazoparib tosylate cap 1 mg (baseequivalent).......................................................................10

tamoxifen citrate tab 10 mg (base equivalent).............10tamoxifen citrate tab 20 mg (base equivalent).............11tamsulosin hcl cap 0.4 mg (Flomax)............................. 35TASIGNA – nilotinib hcl cap 50 mg (base equivalent)...... 11TASIGNA – nilotinib hcl cap 150 mg (base

equivalent).......................................................................11TASIGNA – nilotinib hcl cap 200 mg (base

equivalent).......................................................................11tazarotene cream 0.1% (Tazorac)...................................61TAZORAC – tazarotene cream 0.05%..............................61TAZORAC – tazarotene gel 0.05%................................... 61TAZORAC – tazarotene gel 0.1%..................................... 61telmisartan-hydrochlorothiazide tab 40-12.5 mg

(Micardis hct).................................................................26telmisartan-hydrochlorothiazide tab 80-12.5 mg

(Micardis hct).................................................................26telmisartan-hydrochlorothiazide tab 80-25 mg

(Micardis hct).................................................................26telmisartan tab 20 mg (Micardis)................................... 26telmisartan tab 40 mg (Micardis)................................... 26telmisartan tab 80 mg (Micardis)................................... 26temazepam cap 15 mg (Restoril)................................... 39temazepam cap 30 mg (Restoril)................................... 39TEMIXYS – lamivudine-tenofovir disoproxil fumarate tab

300-300 mg.......................................................................5temozolomide cap 5 mg (Temodar)...............................11temozolomide cap 20 mg (Temodar).............................11temozolomide cap 100 mg (Temodar)...........................11temozolomide cap 140 mg (Temodar)...........................11temozolomide cap 180 mg (Temodar)...........................11temozolomide cap 250 mg (Temodar)...........................11TENCON – butalbital-acetaminophen tab 50-325 mg...... 43tenofovir disoproxil fumarate tab 300 mg (Viread)........ 5terazosin hcl cap 1 mg (base equivalent).....................26terazosin hcl cap 2 mg (base equivalent).....................26terazosin hcl cap 5 mg (base equivalent).....................26terazosin hcl cap 10 mg (base equivalent)...................26terbinafine hcl tab 250 mg (Lamisil)................................3terbutaline sulfate tab 2.5 mg........................................ 31terbutaline sulfate tab 5 mg........................................... 31terconazole vaginal cream 0.8%.................................... 34terconazole vaginal cream 0.4% (Terazol 7).................34terconazole vaginal suppos 80 mg (Terazol 3).............34testosterone cypionate im inj in oil 100 mg/ml (Depo-

testosterone)..................................................................12testosterone cypionate im inj in oil 200 mg/ml (Depo-

testosterone)..................................................................12TESTOSTERONE ENANTHATE – testosterone

enanthate im inj in oil 200 mg/ml...................................12testosterone td gel 12.5 mg/act (1%) (Androgel

pump)..............................................................................12

2021

FID 568 July 2021 94

testosterone td gel 20.25 mg/act (1.62%) (Androgelpump)..............................................................................12

testosterone td gel 25 mg/2.5gm (1%) (Androgel)....... 12testosterone td gel 50 mg/5gm (1%) (Androgel).......... 12testosterone td gel 20.25 mg/1.25gm (1.62%)

(Androgel)...................................................................... 12testosterone td gel 40.5 mg/2.5gm (1.62%)

(Androgel)...................................................................... 12testosterone td soln 30 mg/act (Axiron)....................... 12tetrabenazine tab 12.5 mg (Xenazine)........................... 43tetrabenazine tab 25 mg (Xenazine).............................. 43tetracycline hcl cap 250 mg (Tetracycline hcl)...............2tetracycline hcl cap 500 mg (Tetracycline hcl)...............2THALOMID – thalidomide cap 50 mg............................... 63THALOMID – thalidomide cap 100 mg............................. 63THALOMID – thalidomide cap 150 mg............................. 63THALOMID – thalidomide cap 200 mg............................. 63THEOPHYLLINE ER – theophylline tab er 12hr 300

mg....................................................................................31THEOPHYLLINE ER – theophylline tab er 12hr 450

mg....................................................................................31theophylline tab er 24hr 400 mg....................................31theophylline tab er 24hr 600 mg....................................31thiothixene cap 1 mg.......................................................38thiothixene cap 2 mg.......................................................39thiothixene cap 5 mg.......................................................39thiothixene cap 10 mg.....................................................39timolol maleate ophth soln 0.25% (Timoptic)...............57timolol maleate ophth soln 0.5% (Timoptic).................57timolol maleate tab 5 mg................................................ 21timolol maleate tab 10 mg.............................................. 21timolol maleate tab 20 mg.............................................. 21TIVICAY – dolutegravir sodium tab 10 mg (base equiv).....5TIVICAY – dolutegravir sodium tab 25 mg (base equiv).....5TIVICAY – dolutegravir sodium tab 50 mg (base equiv).....5TIVICAY PD – dolutegravir sodium tab for oral susp 5 mg

(base equiv)...................................................................... 6tizanidine hcl tab 2 mg (base equivalent).....................51tizanidine hcl tab 4 mg (base equivalent)

(Zanaflex)........................................................................51tobramycin-dexamethasone ophth susp 0.3-0.1%

(Tobradex)...................................................................... 58tobramycin nebu soln 300 mg/5ml (Tobi)....................... 3tobramycin ophth soln 0.3% (Tobrex)...........................57tolterodine tartrate cap er 24hr 2 mg (Detrol la).......... 34tolterodine tartrate cap er 24hr 4 mg (Detrol la).......... 34tolterodine tartrate tab 1 mg (Detrol)............................ 34tolterodine tartrate tab 2 mg (Detrol)............................ 34topiramate sprinkle cap 15 mg (Topamax

sprinkle)..........................................................................49topiramate sprinkle cap 25 mg (Topamax

sprinkle)..........................................................................49topiramate tab 25 mg (Topamax)...................................49topiramate tab 50 mg (Topamax)...................................49topiramate tab 100 mg (Topamax).................................49topiramate tab 200 mg (Topamax).................................49

toremifene citrate tab 60 mg (base equivalent)(Fareston).......................................................................11

torsemide tab 5 mg (Demadex)......................................27torsemide tab 10 mg (Demadex)....................................27torsemide tab 20 mg (Demadex)....................................27torsemide tab 100 mg (Demadex)..................................27TOUJEO MAX SOLOSTAR – insulin glargine soln pen-

injector 300 unit/ml (2 unit dial)......................................18TOUJEO SOLOSTAR – insulin glargine soln pen-injector

300 unit/ml (1 unit dial)...................................................18TRACLEER – bosentan tab for oral susp 32 mg..............28tramadol-acetaminophen tab 37.5-325 mg

(Ultracet).........................................................................45tramadol hcl tab er 24hr 100 mg....................................45tramadol hcl tab er 24hr 200 mg....................................45tramadol hcl tab er 24hr 300 mg....................................45tramadol hcl tab 50 mg (Ultram)....................................45trandolapril tab 1 mg (Mavik)......................................... 26trandolapril tab 2 mg (Mavik)......................................... 26trandolapril tab 4 mg (Mavik)......................................... 26tranylcypromine sulfate tab 10 mg (Parnate)...............37travoprost ophth soln 0.004% (benzalkonium free)

(bak free) (Travatan z).................................................. 58trazodone hcl tab 50 mg.................................................37trazodone hcl tab 100 mg...............................................37trazodone hcl tab 150 mg...............................................37trazodone hcl tab 300 mg...............................................37TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 100-62.5-25 mcg/inh............................................. 31TRELEGY ELLIPTA – fluticasone-umeclidinium-vilanterol

aepb 200-62.5-25 mcg/inh............................................. 31TREMFYA – guselkumab soln pen-injector 100 mg/

ml..................................................................................... 61TREMFYA – guselkumab soln prefilled syringe 100 mg/

ml..................................................................................... 61TRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 100 unit/ml......................................................... 18TRESIBA FLEXTOUCH – insulin degludec soln pen-

injector 200 unit/ml......................................................... 18TRESIBA – insulin degludec inj 100 unit/ml..................... 18tretinoin cap 10 mg......................................................... 11tretinoin cream 0.025% (Retin-a)................................... 61tretinoin cream 0.05% (Retin-a)..................................... 61tretinoin cream 0.1% (Retin-a)....................................... 61tretinoin gel 0.025%, nf = avita (Retin-a).......................61tretinoin gel 0.01% (Retin-a)...........................................61TRETTEN – coagulation factor xiii a-subunit for inj

2000-3125 unit................................................................ 56triamcinolone acetonide cream 0.025%........................61triamcinolone acetonide cream 0.1%............................61triamcinolone acetonide cream 0.5%............................61triamcinolone acetonide dental paste 0.1%................. 58triamcinolone acetonide lotion 0.025%.........................61triamcinolone acetonide lotion 0.1%.............................61triamcinolone acetonide oint 0.025%............................61triamcinolone acetonide oint 0.1%................................ 61triamcinolone acetonide oint 0.5%................................ 61

2021

FID 568 July 2021 95

triamterene & hydrochlorothiazide cap 37.5-25 mg(Dyazide).........................................................................27

triamterene & hydrochlorothiazide tab 37.5-25 mg(Maxzide-25)...................................................................27

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)........................................................................ 27

trifluoperazine hcl tab 1 mg (base equivalent).............39trifluoperazine hcl tab 2 mg (base equivalent).............39trifluoperazine hcl tab 5 mg (base equivalent).............39trifluoperazine hcl tab 10 mg (base equivalent)...........39TRIFLURIDINE – trifluridine ophth soln 1%......................58trihexyphenidyl hcl oral soln 0.4 mg/ml........................51trihexyphenidyl hcl tab 2 mg..........................................51trihexyphenidyl hcl tab 5 mg..........................................51TRIJARDY XR – empagliflozin-linaglip-metformin tab er

24hr 12.5-2.5-1000mg.................................................... 17TRIJARDY XR – empagliflozin-linagliptin-metformin tab er

24hr 5-2.5-1000mg......................................................... 17TRIJARDY XR – empagliflozin-linagliptin-metformin tab er

24hr 10-5-1000 mg.........................................................17TRIJARDY XR – empagliflozin-linagliptin-metformin tab er

24hr 25-5-1000 mg.........................................................17TRIKAFTA – elexacaf-tezacaf-ivacaf 100-50-75 mg

&ivacaftor 150 mg tbpk.................................................. 32trimethobenzamide hcl cap 300 mg (Tigan)................. 33trimethoprim tab 100 mg.................................................. 7TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1 mg..... 51TRIUMEQ – abacavir-dolutegravir-lamivudine tab

600-50-300 mg..................................................................6tropicamide ophth soln 0.5%......................................... 58tropicamide ophth soln 1% (Mydriacyl)........................ 58TRULANCE – plecanatide tab 3 mg................................. 34TRULICITY – dulaglutide soln pen-injector 0.75

mg/0.5ml..........................................................................17TRULICITY – dulaglutide soln pen-injector 1.5

mg/0.5ml..........................................................................17TRULICITY – dulaglutide soln pen-injector 3

mg/0.5ml..........................................................................17TRULICITY – dulaglutide soln pen-injector 4.5

mg/0.5ml..........................................................................17TRUVADA – emtricitabine-tenofovir disoproxil fumarate

tab 100-150 mg................................................................ 6TRUVADA – emtricitabine-tenofovir disoproxil fumarate



tab 200-300 mg................................................................ 6TYBLUME – levonorgestrel & ethinyl estradiol chew tab

0.1 mg-20 mcg................................................................14TYMLOS – abaloparatide subcutaneous soln pen-injector

3120 mcg/1.56ml............................................................ 20

UUDENYCA – pegfilgrastim-cbqv soln prefilled syringe 6

mg/0.6ml..........................................................................53UPTRAVI – selexipag tab 200 mcg...................................28

UPTRAVI – selexipag tab 400 mcg...................................28UPTRAVI – selexipag tab 600 mcg...................................28UPTRAVI – selexipag tab 800 mcg...................................28UPTRAVI – selexipag tab 1000 mcg.................................28UPTRAVI – selexipag tab 1200 mcg.................................29UPTRAVI – selexipag tab 1400 mcg.................................29UPTRAVI – selexipag tab 1600 mcg.................................29UPTRAVI – selexipag tab therapy pack 200 mcg (140) &

800 mcg (60)...................................................................28ursodiol cap 300 mg (Actigall).......................................34ursodiol tab 250 mg (Urso 250)..................................... 34ursodiol tab 500 mg (Urso forte)................................... 34VVAGIFEM – estradiol vaginal tab 10 mcg......................... 34valacyclovir hcl tab 1 gm (Valtrex).................................. 6valacyclovir hcl tab 500 mg (Valtrex).............................. 6VALCHLOR – mechlorethamine hcl gel 0.016% (base

equivalent).......................................................................61valganciclovir hcl for soln 50 mg/ml (base equiv)

(Valcyte)............................................................................6valganciclovir hcl tab 450 mg (base equivalent)

(Valcyte)............................................................................6valproate sodium oral soln 250 mg/5ml (base equiv)

(Depakene)..................................................................... 49valproic acid cap 250 mg (Depakene)...........................49valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovan

hct).................................................................................. 26valsartan-hydrochlorothiazide tab 160-12.5 mg

(Diovan hct)................................................................... 26valsartan-hydrochlorothiazide tab 160-25 mg (Diovan

hct).................................................................................. 26valsartan-hydrochlorothiazide tab 320-12.5 mg

(Diovan hct)................................................................... 26valsartan-hydrochlorothiazide tab 320-25 mg (Diovan

hct).................................................................................. 26valsartan tab 40 mg (Diovan)......................................... 26valsartan tab 80 mg (Diovan)......................................... 26valsartan tab 160 mg (Diovan)....................................... 26valsartan tab 320 mg (Diovan)....................................... 26vancomycin hcl cap 125 mg (base equivalent)

(Vancocin hcl)..................................................................7vancomycin hcl cap 250 mg (base equivalent)

(Vancocin hcl)..................................................................7VELPHORO – sucroferric oxyhydroxide chew tab 500

mg....................................................................................34VELTASSA – patiromer sorbitex calcium for susp packet

8.4 gm (base eq)............................................................ 63VELTASSA – patiromer sorbitex calcium for susp packet

16.8 gm (base eq).......................................................... 63VELTASSA – patiromer sorbitex calcium for susp packet

25.2 gm (base eq).......................................................... 63VENCLEXTA STARTING PACK – venetoclax tab therapy

starter pack 10 & 50 & 100 mg......................................11VENCLEXTA – venetoclax tab 10 mg...............................11VENCLEXTA – venetoclax tab 50 mg...............................11VENCLEXTA – venetoclax tab 100 mg.............................11

2021

FID 568 July 2021 96

venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)(Effexor xr).....................................................................37

venlafaxine hcl cap er 24hr 75 mg (base equivalent)(Effexor xr).....................................................................37

venlafaxine hcl cap er 24hr 150 mg (base equivalent)(Effexor xr).....................................................................37

venlafaxine hcl tab 25 mg (base equivalent)................37venlafaxine hcl tab 37.5 mg (base equivalent).............37venlafaxine hcl tab 50 mg (base equivalent)................37venlafaxine hcl tab 75 mg (base equivalent)................37venlafaxine hcl tab 100 mg (base equivalent)..............37VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/

act (90mcg base equiv)..................................................31verapamil hcl cap er 24hr 120 mg (Verelan).................22verapamil hcl cap er 24hr 180 mg (Verelan).................22verapamil hcl cap er 24hr 240 mg (Verelan).................22VERAPAMIL HCL SR – verapamil hcl cap er 24hr 360

mg....................................................................................22verapamil hcl tab er 120 mg (Calan sr).........................22verapamil hcl tab er 180 mg (Calan sr).........................22verapamil hcl tab er 240 mg (Calan sr).........................22verapamil hcl tab 40 mg................................................. 22verapamil hcl tab 80 mg (Calan)....................................22verapamil hcl tab 120 mg (Calan)..................................22VERZENIO – abemaciclib tab 50 mg............................... 11VERZENIO – abemaciclib tab 100 mg..............................11VERZENIO – abemaciclib tab 150 mg..............................11VERZENIO – abemaciclib tab 200 mg..............................11VIBERZI – eluxadoline tab 75 mg.....................................34VIBERZI – eluxadoline tab 100 mg...................................34VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/

ml)....................................................................................17vigabatrin powd pack 500 mg (Sabril).......................... 49vigabatrin tab 500 mg (Sabril)........................................49VIMPAT – lacosamide oral solution 10 mg/ml...................49VIMPAT – lacosamide tab 50 mg......................................49VIMPAT – lacosamide tab 100 mg....................................49VIMPAT – lacosamide tab 150 mg....................................49VIMPAT – lacosamide tab 200 mg....................................49VINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab

29-1 mg........................................................................... 51VINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1

mg....................................................................................51VIREAD – tenofovir disoproxil fumarate oral powder 40

mg/gm................................................................................6VIREAD – tenofovir disoproxil fumarate tab 150 mg.......... 6VIREAD – tenofovir disoproxil fumarate tab 200 mg.......... 6VIREAD – tenofovir disoproxil fumarate tab 250 mg.......... 6VITRAKVI – larotrectinib sulfate cap 25 mg (base

equivalent).......................................................................11VITRAKVI – larotrectinib sulfate cap 100 mg (base

equivalent).......................................................................11VITRAKVI – larotrectinib sulfate oral soln 20 mg/ml (base

equivalent).......................................................................11VONVENDI – von willebrand factor (recombinant) for inj

650 unit........................................................................... 56

VONVENDI – von willebrand factor (recombinant) for inj1300 unit......................................................................... 56

voriconazole for susp 40 mg/ml (Vfend).........................3voriconazole tab 50 mg (Vfend).......................................3voriconazole tab 200 mg (Vfend).....................................3VOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab

400-100-100 mg................................................................6VOTRIENT – pazopanib hcl tab 200 mg (base equiv)......11VYNDAMAX – tafamidis cap 61 mg................................. 29VYNDAQEL – tafamidis meglumine (cardiac) cap 20

mg....................................................................................29VYVANSE – lisdexamfetamine dimesylate cap 10 mg..... 41VYVANSE – lisdexamfetamine dimesylate cap 20 mg..... 41VYVANSE – lisdexamfetamine dimesylate cap 30 mg..... 41VYVANSE – lisdexamfetamine dimesylate cap 40 mg..... 41VYVANSE – lisdexamfetamine dimesylate cap 50 mg..... 41VYVANSE – lisdexamfetamine dimesylate cap 60 mg..... 41VYVANSE – lisdexamfetamine dimesylate cap 70 mg..... 41VYVANSE – lisdexamfetamine dimesylate chew tab 10

mg....................................................................................41VYVANSE – lisdexamfetamine dimesylate chew tab 20





mg....................................................................................41

Wwarfarin sodium tab 1 mg (Coumadin)......................... 54warfarin sodium tab 2 mg (Coumadin)......................... 54warfarin sodium tab 2.5 mg (Coumadin)...................... 54warfarin sodium tab 3 mg (Coumadin)......................... 54warfarin sodium tab 4 mg (Coumadin)......................... 54warfarin sodium tab 5 mg (Coumadin)......................... 54warfarin sodium tab 6 mg (Coumadin)......................... 54warfarin sodium tab 7.5 mg (Coumadin)...................... 54warfarin sodium tab 10 mg (Coumadin)....................... 54XXALKORI – crizotinib cap 200 mg.................................... 11XALKORI – crizotinib cap 250 mg.................................... 11XARELTO – rivaroxaban tab 2.5 mg.................................54XARELTO – rivaroxaban tab 10 mg..................................54XARELTO – rivaroxaban tab 15 mg..................................54XARELTO – rivaroxaban tab 20 mg..................................54XARELTO STARTER PACK – rivaroxaban tab starter

therapy pack 15 mg & 20 mg........................................ 54XELJANZ – tofacitinib citrate oral soln 1 mg/ml (base

equivalent).......................................................................47XELJANZ – tofacitinib citrate tab 5 mg (base

equivalent).......................................................................47XELJANZ – tofacitinib citrate tab 10 mg (base

equivalent).......................................................................47

2021

FID 568 July 2021 97

XELJANZ XR – tofacitinib citrate tab er 24hr 11 mg (baseequivalent).......................................................................47

XELJANZ XR – tofacitinib citrate tab er 24hr 22 mg (baseequivalent).......................................................................47

XIFAXAN – rifaximin tab 550 mg........................................ 7XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

2.5-1000 mg....................................................................17XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

5-500 mg......................................................................... 17XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

5-1000 mg.......................................................................17XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

10-500 mg.......................................................................17XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr

10-1000 mg.....................................................................17XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

9 mg................................................................................ 45XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

13.5 mg........................................................................... 45XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

18 mg.............................................................................. 45XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

27 mg.............................................................................. 45XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent

36 mg.............................................................................. 45XTANDI – enzalutamide cap 40 mg..................................11XTANDI – enzalutamide tab 40 mg...................................11XTANDI – enzalutamide tab 80 mg...................................11XULTOPHY 100/3.6 – insulin degludec-liraglutide sol pen-

inj 100-3.6 unit-mg/ml.....................................................17

YYONSA – abiraterone acetate tab 125 mg....................... 11

Zzafirlukast tab 10 mg (Accolate).................................... 31zafirlukast tab 20 mg (Accolate).................................... 31zaleplon cap 5 mg (Sonata)............................................39zaleplon cap 10 mg (Sonata)..........................................39ZARXIO – filgrastim-sndz soln prefilled syringe 300

mcg/0.5ml........................................................................53ZARXIO – filgrastim-sndz soln prefilled syringe 480

mcg/0.8ml........................................................................53ZELBORAF – vemurafenib tab 240 mg............................ 11ZENPEP – pancrelipase (lip-prot-amyl) dr cap

3000-10000-14000 unit...................................................33ZENPEP – pancrelipase (lip-prot-amyl) dr cap

5000-17000-24000 unit...................................................33ZENPEP – pancrelipase (lip-prot-amyl) dr cap

10000-32000-42000 unit................................................ 33ZENPEP – pancrelipase (lip-prot-amyl) dr cap



25000-79000-105000 unit.............................................. 33

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-126000-168000 unit............................................ 33

ZEPOSIA 7-DAY STARTER PAC – ozanimod cap pack 4x 0.23 mg & 3 x 0.46 mg............................................... 43

ZEPOSIA – ozanimod hcl cap 0.92 mg............................ 43ZEPOSIA STARTER KIT – ozanimod cap pack 4 x 0.23

mg & 3 x 0.46 mg & 30 x 0.92 mg.................................43zidovudine cap 100 mg (Retrovir)................................... 6zidovudine syrup 10 mg/ml (Retrovir).............................6zidovudine tab 300 mg......................................................6ZIEXTENZO – pegfilgrastim-bmez soln prefilled syringe 6

mg/0.6ml..........................................................................53ziprasidone hcl cap 20 mg (Geodon)............................ 39ziprasidone hcl cap 40 mg (Geodon)............................ 39ziprasidone hcl cap 60 mg (Geodon)............................ 39ziprasidone hcl cap 80 mg (Geodon)............................ 39ZOKINVY – lonafarnib cap 50 mg.................................... 63ZOKINVY – lonafarnib cap 75 mg.................................... 63ZOLINZA – vorinostat cap 100 mg................................... 11zolpidem tartrate tab er 6.25 mg (Ambien cr)...............39zolpidem tartrate tab er 12.5 mg (Ambien cr)...............39zolpidem tartrate tab 5 mg (Ambien).............................39zolpidem tartrate tab 10 mg (Ambien)...........................39zonisamide cap 50 mg.................................................... 49zonisamide cap 25 mg (Zonegran)................................ 49zonisamide cap 100 mg (Zonegran).............................. 49ZORTRESS – everolimus tab 1 mg..................................63ZYCLARA – imiquimod cream 3.75%...............................61ZYCLARA PUMP – imiquimod cream 2.5%..................... 61ZYCLARA PUMP – imiquimod cream 3.75%................... 61ZYDELIG – idelalisib tab 100 mg......................................11ZYDELIG – idelalisib tab 150 mg......................................11ZYKADIA – ceritinib tab 150 mg....................................... 11ZYLET – loteprednol etabonate-tobramycin ophth susp

0.5-0.3%.......................................................................... 58ZYTIGA – abiraterone acetate tab 500 mg.......................11

2021 Core Formulary Effective 10/01/2021

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Transcript of 2021 Core Formulary Effective 10/01/2021