Additional drug coverage
Transcript of Additional drug coverage
Additional drug coverage
Additional prescription drug coverage
Your plan includes extra coverage for certain drugs and supplies as shown below.
This is not a complete list of prescription drugs and supplies covered by our plan. For a complete
list, please call Customer Service toll-free at 1-888-803-9217, TTY 711, 8 a.m. – 8 p.m. local time,
Monday – Friday.
Lower-cost Medicare prescription drugs and supplies
Your plan covers some of your Medicare prescription drugs and supplies at a lower drug copay
than in your drug list (formulary).
The amount you pay for these prescription drugs and supplies does apply to your Medicare
prescription drug out-of-pocket costs. Payments for these prescription drugs (made by you or the
plan) are treated the same as payments made for drugs in your plan’s drug list (formulary).1
These drugs and supplies are part of your Medicare prescription drug coverage.1
Birth Control
All contraceptive medications and devices
Blood Glucose Meters, Test Strips and
Lancets
ACCU-CHEK® Aviva Plus Test Strips
ACCU-CHEK® Guide Meter & Test Strips
ACCU-CHEK® Guide Me Meter
ACCU-CHEK® SmartView Test Strips
Lancets
Lancing devices
OneTouch Ultra® Test Strips
OneTouch Ultra 2® Meter
OneTouch Verio® Flex™ Meter
OneTouch Verio® Meter & Test Strips
OneTouch Verio® Reflect™ Meter
Diabetes drugs and supplies
Acarbose Tablet
Actoplus Met (XR) Tablet
Actos Tablet
Adlyxin Injection
Admelog Injection
Afrezza Inhalation Powder
Alcohol Swabs
Alogliptin Tablet
Alogliptin/Metformin Tablet
Alogliptin/Pioglitazone Tablet
Amaryl Tablet
Apidra Injection
Avandia Tablet
Baqsimi Nasal Powder
Basaglar Injection
Bydureon Injection
Byetta Injection
Cycloset Tablet
Diazoxide Suspension
Duetact Tablet
Farxiga Tablet
Fiasp Injection
Gauze Pads 2"X2"
Glimepiride Tablet
Glipizide (ER & XL) Tablet
Glipizide/Metformin Tablet
Glucagen Hypokit
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Glucagon Emergency Kit
Glucotrol (XL) Tablet
Glyburide (Micronized) Tablet
Glyburide/Metformin Tablet
Glynase Tablet
Glyxambi Tablet
Gvoke Injection
Humalog Injection
Humulin Injection
InPen Insulin Pen
Insulin Syringes
Invokamet (XR) Tablet
Invokana Tablet
Janumet (XR) Tablet
Januvia Tablet
Jardiance Tablet
Jentadueto (XR) Tablet
Kazano Tablet
Kombiglyze XR Tablet
Korlym Tablet
Lantus Injection
Levemir Injection
Lyumjev Injection
Metformin (ER) Tablet
Miglitol Tablet
Myxredlin
Nateglinide Tablet
Nesina Tablet
Novolin Injection
Novolog Injection
Omnipod System
Onglyza Tablet
Oseni Tablet
Ozempic Injection
Pen Needles
Pioglitazone Tablet
Pioglitazone/Glimepiride Tablet
Pioglitazone/Metformin Tablet
Precose Tablet
Proglycem Suspension
Qtern Tablet
Repaglinide Tablet
Riomet Solution
Rybelsus Tablet
Segluromet Tablet
Semglee Injection
Soliqua Injection
Starlix Tablet
Steglatro Tablet
Steglujan Tablet
Symlinpen Injection
Synjardy (XR) Tablet
Tolbutamide Tablet
Toujeo Injection
Tradjenta Tablet
Tresiba Injection
Trijardy XR Tablet
Trulicity Injection
V-Go Device
Victoza Injection
Xigduo XR Tablet
Xultophy Injection
Tobacco Cessation
Bupropion 150 SR Tablet
Chantix Tablet
Nicotrol Inhaler
Nicotrol Nasal Spray
Vaccines
All vaccines
Bold type = Brand name drug Plain type = Generic drug
The drugs listed below to treat asthma or COPD, heart disease/heart failure, hypertension and
cholesterol are available at a reduced copay. See your Evidence of Coverage for information about
copays.
Asthma or Chronic Obstructive Pulmonary
Disease (COPD)
Accolate Tablets
Advair Diskus & HFA
Airduo Respiclick
Albuterol Inhaler, Syrup and (ER) Tablet
Alvesco Inhaler
Aminophylline Injection
Anoro Ellipta
Armonair Inhaler
Arnuity Ellipta
Asmanex HFA & Twisthaler
Atrovent HFA
Bevespi Aerosphere
Breo Ellipta
Breztri Aerosphere
Budesonide/Formoterol Inhaler
Cinqair Injection
Combivent Respimat
Daliresp Tablet
Duaklir Inhaler
Dulera Inhaler
Dupixent Injection
Elixophyllin Elixir
Fasenra Injection
Flovent Diskus & HFA
Fluticasone Propionate/Salmeterol Diskus &
HFA
Incruse Ellipta
Levalbuterol Tartrate HFA
Lonhala Magnair Solution
Montelukast Granules & (Chewable) Tablet
Nucala Injection
Proair HFA & Respiclick
Proventil HFA
Pulmicort Flexhaler
Qvar Inhaler & RediHaler
Seebri Neohaler
Serevent Diskus
Singulair Granules & (Chewable) Tablets
Spiriva Handihaler & Respimat
Stiolto Respimat
Striverdi Respimat
Symbicort Inhaler
Terbutaline Injection & Tablet
Theo-24 CR & ER Capsule
Theophylline Injection, Oral Solution, CR & ER
Tablet
Trelegy Ellipta
Tudorza Pressair
Ventolin HFA
Wixela Inhub
Xolair Injection
Xopenex HFA
Yupelri Inhalation
Zafirlukast Tablet
Zileuton ER Tablet
Zyflo (CR) Tablet
Hyperlipidemia (high cholesterol)
Altoprev ER Tablet
Antara Capsule
Atorvastatin Tablet
Cholestyramine (Light) Powder
Colesevelam Tablet
Colestid Granules & Tablet
Colestipol Granules & Tablet
Crestor Tablet
Evkeeza Injection
Ezallor Sprinkle Capsule
Ezetimibe Tablet
Ezetimibe/Simvastatin Tablet
Fenofibrate Tablet & Capsule
Fenofibric Acid DR Capsule & Tablet
Fenoglide Tablet
Flolipid Suspension
Fluvastatin Capsule & ER Tablet
Gemfibrozil Tablet
Icosapent Capsule
Juxtapid Capsule
Lescol XL Tablet
Lipitor Tablet
Lipofen Capsule
Livalo Tablet
Lopid Tablet
Lovastatin Tablet
Lovaza Capsule
Nexletol Tablet
Nexlizet Tablet
Niacin (ER) Tablet
Niacor Tablet
Niaspan ER Tablet
Omega-3-Acid Ethyl Esters Capsule
Praluent Injection
Pravachol Tablet
Pravastatin Tablet
Prevalite Powder
Questran (Light) Powder
Repatha Injection
Rosuvastatin Tablet
Roszet Tablet
Simvastatin Tablet
Tricor Tablet
Trilipix Capsule
Vascepa Capsule
Vytorin Tablet
Welchol Packet and Tablet
Zetia Tablet
Zocor Tablet
Zypitamag Tablet
Heart Disease or Heart Failure
Acetazolamide ER Capsule, Injection and Tablet
Aldactazide Tablet
Aldactone Tablet
Amiloride Tablet
Amiloride/Hydrochlorothiazide Tablet
Amlodipine/Atorvastatin Tablet
Betapace (AF) Tablet
Bidil Tablet
Bumetanide Injection & Tablet
Bumex Tablet
Caduet Tablet
Carospir Suspension
Chlorothiazide Injection & Tablet
Chlorthalidone Tablet
Corlanor Tablet
Digitek Tablet
Digox Tablet
Digoxin Injection, Oral Solution & Tablet
Diuril Suspension
Dyazide Capsule
Dyrenium Capsule
Edecrin Tablet
Eplerenone Tablet
Ethacrynate Sodium Injection
Ethacrynic Acid Tablet
Furosemide Injection, Oral Solution & Tablet
Hydrochlorothiazide Capsule & Tablet
Indapamide Tablet
Inspra Tablet
Isoproterenol Injection
Isuprel Injection
Lanoxin Injection & Tablet
Lasix Tablet
Mannitol Injection
Maxzide Tablet
Methazolamide
Metolazone Tablet
Osmitrol Injection
Sodium Diuril Injection
Sodium Edecrin Injection
Sorine Tablet
Sotalol Injection & (AF) Tablet
Sotylize Solution
Spironolactone Tablet
Spironolactone/Hydrochlorothiazide Tablet
Torsemide Tablet
Triamterene/Hydrochlorothiazide Capsule &
Tablet
Verquvo Tablet
Hypertension (high blood pressure)
Accupril Tablet
Accuretic Tablet
Acebutolol Capsule
Aliskiren Tablet
Altace Capsule
Amlodipine Tablet
Amlodipine/Benazepril Capsule
Amlodipine/Olmesartan Tablet
Amlodipine/Valsartan Tablet
Amlodipine/Valsartan/Hydrochlorothiazide
Tablet
Atacand (HCT) Tablet
Atenolol Tablet
Atenolol/Chlorthalidone Tablet
Avalide Tablet
Avapro Tablet
Azor Tablet
Benazepril Tablet
Benazepril/Hydrochlorothiazide Tablet
Benicar (HCT) Tablet
Betaxolol Tablet
Bisoprolol Tablet
Bisoprolol/Hydrochlorothiazide Tablet
Brevibloc Injection & IV Solution
Bystolic Tablet
Calan (SR) Tablet
Candesartan Tablet
Candesartan/Hydrochlorothiazide Tablet
Captopril Tablet
Cardene IV Solution
Cardizem (LA) Tablet & CD Capsule
Cardura Tablet
Cartia XT Capsule
Carvedilol ER Capsule & Tablet
Catapres Tablet & TTS Patch
Cleviprex IV Emulsion
Clonidine Tablet & Patch
Coreg CR Capsule & Tablet
Corgard Tablet
Corlopam Injection
Cozaar Tablet
Diltiazem CD & ER Capsule, Injection, & (ER)
Tablet
Dilt-XR Capsule
Diovan (HCT) Tablet
Doxazosin Tablet
Dutoprol Tablet
Edarbi Tablet
Edarbyclor Tablet
Enalapril Tablet
Enalapril/Hydrochlorothiazide Tablet
Enalaprilat Injection
Entresto Tablet
Epaned Solution
Esmolol Injection
Exforge (HCT) Tablet
Felodipine ER Tablet
Fosinopril Tablet
Fosinopril/Hydrochlorothiazide Tablet
Guanfacine Tablet
Hemangeol Oral Solution
Hydralazine Injection & Tablet
Hyzaar Tablet
Inderal LA and XL Capsule
Innopran XL Capsule
Irbesartan Tablet
Irbesartan/Hydrochlorothiazide Tablet
Isradipine Capsule
Kapspargo Capsule
Katerzia Suspension
Labetalol Tablet & Injection
Lisinopril Tablet
Lisinopril/Hydrochlorothiazide Tablet
Lopressor (HCT) Tablet
Losartan Tablet
Losartan/Hydrochlorothiazide Tablet
Lotensin (HCT) Tablet
Lotrel Capsule
Matzim LA Tablet
Methyldopa Tablet
Methyldopa/Hydrochlorothiazide Tablet
Metoprolol Succinate ER Tablet
Metoprolol Tartrate Injection & (HCT) Tablet
Metoprolol/Hydrochlorothiazide Tablet
Micardis (HCT) Tablet
Minipress Capsule
Minoxidil Tablet
Moexipril Tablet
Nadolol Tablet
Nicardipine Capsule & Injection
Nifedipine Capsule & ER Tablet
Nimodipine Capsule
Nisoldipine ER Tablet
Norvasc Tablet
Olmesartan Tablet
Olmesartan/Amlodipine/Hydrochlorothiazide
Tablet
Olmesartan/Hydrochlorothiazide Tablet
Perindopril Tablet
Pindolol Tablet
Prazosin Capsule
Prinivil Tablet
Procardia Capsule & XL Tablet
Propranolol ER Capsule, Injection, Oral Solution
& Tablet
Propranolol/Hydrochlorothiazide Tablet
Qbrelis Oral Solution
Quinapril Tablet
Quinapril/Hydrochlorothiazide Tablet
Ramipril Capsule
Sodium Nitroprusside Injection
Sular Tablet
Tarka CR Tablet
Taztia XT Capsule
Tekturna Tablet
Tekturna (HCT) Tablet
Telmisartan Tablet
Telmisartan/Amlodipine Tablet
Telmisartan/Hydrochlorothiazide Tablet
Tenoretic Tablet
Tenormin Tablet
Terazosin Capsule
Tiazac Capsule
Timolol Maleate Tablet
Toprol XL Tablet
Trandolapril Tablet
Trandolapril/Verapamil ER Tablet
Tribenzor Tablet
Twynsta Tablet
Valsartan Tablet
Valsartan/Hydrochlorothiazide Tablet
Vaseretic Tablet
Vasotec Tablet
Vecamyl Tablet
Verapamil ER & SR Capsule, Injection & (ER)
Tablet
Verelan (PM) Capsule
Zestoretic Tablet
Zestril Tablet
Ziac Tablet
Bold type = Brand name drug Plain type = Generic drug
Lower-cost non-Medicare prescription drugs and supplies
These prescription drugs and supplies are covered in addition to the drugs in your plan’s drug list
(formulary).2
Your plan covers these prescription drugs at a $0 copay.
Drug name
Cholera Vaccine
Nicotine Gum
Nicotine Lozenges
Nicotine Patches
Oral Typhoid Vaccine
1Information about the appeals and grievance process for these prescription drugs and supplies
can be found in your Evidence of Coverage.
2This non-Medicare drug coverage is in addition to your Medicare drug coverage. Unlike your Medicare drug coverage,
you cannot file a Medicare appeal or grievance for non-Medicare drug coverage. If you have questions, please call
Customer Service toll-free at 1-888-803-9217, TTY 711, 8 a.m. – 8 p.m. local time, Monday – Friday.
Bonus drug list
The Plan offers a bonus drug list. The prescription drugs on this list are covered in addition to the
drugs on the plan’s drug list (formulary).
The drug tier for each prescription drug is shown on the list.
Although you pay the same copay for these drugs as shown in the Summary of Benefits and
Evidence of Coverage, the amount you pay for these additional prescription drugs does not apply
to your Medicare Part D out-of-pocket costs. Payments for these additional prescription drugs
(made by you or the plan) are treated differently from payments made for other prescription drugs.
Coverage for the prescription drugs on the bonus drug list is in addition to your Part D drug
coverage. Unlike your Part D drug coverage, you are unable to file a Medicare appeal or grievance
for drugs on the bonus drug list. If you have questions, please call Customer Service toll-free at
1-888-803-9217, TTY 711, 8 a.m. – 8 p.m. local time, Monday – Friday.
If you get Extra Help from Medicare to pay for your prescription drugs, it will not apply to the drugs
on this bonus drug list.
This is not a complete list of the prescription drugs available to you or the restrictions and
limitations that may apply through the bonus drug list. If your drug has any coverage rules or limits,
there will be code(s) in the “Coverage Rules or Limits on use” column of the chart. The codes and
what they mean are shown below. If you have questions about drug coverage, please call Customer
Service toll-free at 1-888-803-9217, TTY 711, 8 a.m. – 8 p.m. local time, Monday – Friday.
QL - Quantity limits
The plan only covers a certain amount of this drug for one copay or over a certain number of days.
These limits may be in place to ensure safe and effective use of the drug.
MME - Morphine milligram equivalent
Additional quantity limits may apply across all drugs in the opioid class used for the treatment of
pain. This additional limit is called a cumulative morphine milligram equivalent (MME), and is
designed to monitor safe dosing levels of opioids for individuals who may be taking more than one
opioid drug for pain management. If your doctor prescribes more than this amount or thinks the
limit is not right for your situation, you or your doctor can ask the plan to cover the additional
quantity.
7D - 7-day limit
An opioid drug used for the treatment of acute pain may be limited to a 7-day supply for members
with no recent history of opioid use. This limit is intended to minimize long-term opioid use. For
members who are new to the plan, and have a recent history of using opioids, the limit may be
overridden by having the pharmacy contact the plan.
DL - Dispensing limit
Dispensing limits apply to this drug. This drug is limited to a one-month supply per prescription.
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Drug nameDrug
tierCoverage rules or limits on use
Analgesics - drugs to treat pain, inflammation, and muscle and joint conditions
Inflammation
Salsalate 1
Urinary Tract Pain
Phenazopyridine 1
Anticoagulants - drugs to prevent clotting
Heparin Lock Flush 1
Dermatological agents - drugs to treat skin conditions
Dry Skin
Sulfacetamide Sodium w/Sulfur Cream 10-5% 1
Urea 40% Cream 1
Itching or Pain
Pramoxine/Hydrocortisone Cream 1-2.5% 1
Fungal Infections
Iodoquinol-HC Cream 1% 1
Gastrointestinal agents - drugs to treat bowel, intestine and stomach conditions
Hemorrhoids
Hydrocortisone Acetate Suppository 25mg 1
Lidocaine/Hydrocortisone Perianal Cream
3%-0.5%1
Irritable Bowel or Ulcers
Hyoscyamine Sulfate 1
Levbid 3
Genitourinary agents - drugs to treat bladder, genital and kidney conditions
Erectile Dysfunction
Edex 4QL (maximum of 20 cartridges per
75 days)
Bold type = Brand name drug Plain type = Generic drug
Drug nameDrug
tierCoverage rules or limits on use
Sildenafil (25 mg, 50 mg, 100 mg) 1QL (maximum of 20 tablets per 75
days)
Tadalafil 1QL (maximum of 20 tablets per 75
days)
Vardenafil 1QL (maximum of 20 tablets per 75
days)
Sexual Desire Disorder
Addyi 4 QL (maximum of 1 tablet per day)
Urinary Tract Infection
Methenamine/Hyoscamine/Methyl Blue/Sod
Phosphate/Phenyl Salicylate Cap 118 mg1
Urinary Tract Spasm and Pain
Belladonna Alkaloids & Opium Suppositories 1 MME, 7D, DL
Hormonal agents - hormone replacement/modifying drugs
Thyroid Supplement
Armour Thyroid 4
NP Thyroid 1
Nutritional supplements - drugs to treat vitamin & mineral deficiencies
Potassium Supplement
K-Phos Tab 4
Potassium Bicarbonate Effervescent Tab 25
mEq1
Vitamins and Minerals
Cyanocobalamin Injection (Vitamin B12) 1000
mcg1
Folic Acid 1mg (Rx only) 1
Folic Acid-Vitamin B6-Vitamin B12 Tab 2.5-25-1
mg1
Phytonadione Tab 1
Bold type = Brand name drug Plain type = Generic drug
Drug nameDrug
tierCoverage rules or limits on use
Reno Cap 1
Vitamin D 50,000 unit (Rx only) 1
Respiratory tract agents - drugs to treat allergies, cough, cold and lung conditions
Cough and Cold
Benzonatate (100mg, 200mg) 1
Brompheniramine/Pseudoephedrine/
Dextromethorphan Syrup1
Guaifenesin/Codeine Syrup 1 DL
Hydrocodone Polst/Chlorpheniramine ER Susp
(generic for Tussionex)1 DL
Hydrocodone/Homatropine 1 DL
Promethazine/Codeine Syrup 1 DL
Promethazine/Dextromethorphan Syrup 1
Bold type = Brand name drug Plain type = Generic drug
BDL: Custom CT
Y0066_210604_021600_C
Maintenance drug list
January 1, 2022
The following drugs and supplies may be dispensed in quantities up to but not more than a 90-day
supply for members covered under the UnitedHealthcare Maintenance Drug List. Prior
authorization may be required for certain drugs. See your Evidence of Coverage for information
about copays. Medications in this list are subject to change without notice. If your drug is not
included in this Maintenance Drug List or to confirm that your drugs and supplies are covered,
please call Customer Service toll-free at 1-888-803-9217, TTY 711, 8 a.m. – 8 p.m. local time,
Monday – Friday.
Drug name
Abacavir Solution & Tablet
Abacavir/Lamivudine Tablet
Abacavir/Lamivudine/Zidovudine Tablet
Abilify Maintenance Injection & Mycite & Tablet
Acamprosate DR Tablet
Acarbose Tablet
Accolate Tablet
Accupril Tablet
Accuretic Tablet
Acebutolol Capsule
Acetazolamide ER Capsule & Tablet
Aciphex Sprinkles & Tablet
Actemra Injection
Actigall Capsule
Actimmune Injection
Activella Tablet
Actonel Tablet
Actoplus Met (XR) Tablet
Actos Tablet
Adcirca Tablet
Adderall XR Capsule & Tablet
Drug name
Addyi Tablet
Adefovir Dipivoxil Tablet
Adempas Tablet
Adlyxin Injection
Admelog Injection
Advair Diskus & HFA
Adzenys ER Suspension & XR ODT Tablet
Afrezza Inhalation Powder
Aggrenox Capsule
Agrylin Capsule
Aimovig Injection
Airduo Respiclick
Ajovy Injection
Albuterol Inhalation, Syrup and (ER) Tablet
Alcohol Swabs
Aldactazide Tablet
Aldactone Tablet
Alendronate Solution & Tablet
Alfuzosin ER Tablet
Aliskiren Tablet
Alkindi Sprinkle Capsule
Drug name
Allopurinol Tablet
Alogliptin Tablet
Alogliptin/Metformin Tablet
Alogliptin/Pioglitazone Tablet
Alora Patch
Alosetron Tablet
Alphagan P Ophthalmic Solution
Altace Capsule
Altoprev ER Tablet
Alvesco Inhaler
Alyq Tablet
Amabelz Tablet
Amantadine Capsule, Syrup & Tablet
Amaryl Tablet
Ambrisentan Tablet
Amiloride Tablet
Amiloride/Hydrochlorothiazide Tablet
Aminobenzoate Potassium Capsule & Packet
Amiodarone Tablet
Amitiza Capsule
Amitriptyline Tablet
Amlodipine Tablet
Amlodipine/Atorvastatin Tablet
Amlodipine/Benazepril Capsule
Amlodipine/Olmesartan Tablet
Amlodipine/Valsartan Tablet
Amlodipine/Valsartan/Hydrochlorothiazide
Tablet
Drug name
Amoxapine Tablet
Amphetamine/Dextroamphetamine ER Capsule
& Tablet
Ampyra Tablet
Anafranil Capsule
Anagrelide Capsule
Anaspaz Tablet
Anastrozole Tablet
Androderm Patch
Androgel Gel & Pump
Angeliq Tablet
Anoro Ellipta
Antabuse Tablet
Antara Capsule
Apidra Injection
Aplenzin Tablet
Apriso Capsule
Aptensio XR Capsule
Aptiom Tablet
Aptivus Capsule & Solution
Arava Tablet
Arcalyst Injection
Arformoterol Inhalation
Aricept Tablet
Arimidex Tablet
Aripiprazole Solution & (ODT) Tablet
Aristada Injection
Armodafinil Tablet
Drug name
Armonair Inhalation
Armour Thyroid Tablet
Arnuity Ellipta
Aromasin Tablet
Arthrotec Tablet
Asenapine Tablet
Asmanex HFA & Twisthaler
Aspirin/Dipyridamole Capsule
Astagraf XL Capsule
Atacand (HCT) Tablet
Atazanavir Capsule
Atelvia Tablet
Atenolol Tablet
Atenolol/Chlorthalidone Tablet
Atomoxetine Capsule
Atorvastatin Tablet
Atripla Tablet
Atropine Sulfate Ophthalmic Solution
Atrovent HFA
Aubagio Tablet
Auryxia Tablet
Austedo Tablet
Avalide Tablet
Avandia Tablet
Avapro Tablet
Aveed Injection
Avodart Capsule
Avonex Injection
Drug name
Aygestin Tablet
Azasan Tablet
Azathioprine Tablet
Azilect Tablet
Azopt Ophthalmic Suspension
Azor Tablet
Azulfidine (EN) Tablet
Bafiertam Capsule
Banzel Suspension & Tablet
Baraclude Solution
Basaglar Injection
Benazepril (HCT) Tablet
Benicar (HCT) Tablet
Benlysta Injection
Benztropine Tablet
Betapace (AF) Tablet
Betaseron Injection
Betaxolol Ophthalmic Solution & Tablet
Bethkis Inhalation
Betimol Ophthalmic Solution
Betoptic-S Ophthalmic Suspension
Bevespi Aerosphere
Bidil Tablet
Bijuva Capsule
Biktarvy Tablet
Bimatoprost Ophthalmic Solution
Bisoprolol Tablet
Bisoprolol/Hydrochlorothiazide Tablet
Drug name
Boniva Tablet
Bosentan Tablet
Breo Ellipta
Breztri Inhaler
Brilinta Tablet
Brimonidine Ophthalmic Solution
Brinzolamide Ophthalmic Solution
Brisdelle Capsule
Briviact Solution & Tablet
Bromocriptine Capsule & Tablet
Bronchitol Capsule
Brovana Inhalation
Budesonide Inhalation
Budesonide/Formoterol Inhaler
Bumetanide Tablet
Bumex Tablet
Buphenyl Oral Powder & Tablet
Bupropion (SR & XL) Tablet
Bydureon Injection
Byetta Injection
Bynfezia Injection
Bystolic Tablet
Caduet Tablet
Calan (SR) Tablet
Calcitonin Spray
Calcitriol Capsule & Solution
Calcium Acetate Capsule & Tablet
Candesartan (HCT) Tablet
Drug name
Caplyta Capsule
Captopril Tablet
Carafate Suspension & Tablet
Carbaglu Tablet
Carbamazepine ER Capaule, Suspension &
(ER) Tablet
Carbatrol Capsule
Carbidopa Tablet
Carbidopa/Levodopa (ER & ODT) Tablet
Carbidopa/Levodopa/Entacapone Tablet
Cardizem (LA) Tablet & CD Capsule
Cardura (XL) Tablet
Carnitor Solution & Tablet
Carospir Suspension
Carteolol Ophthalmic Solution
Cartia XT Capsule
Carvedilol ER Capsule & Tablet
Catapres Tablet & TTS Patch
Celebrex Capsule
Celecoxib Capsule
Celexa Tablet
Cellcept Capsule, Suspension & Tablet
Celontin Capsule
Cequa Ophthalmic Solution
Cerdelga Capsule
Cevimeline Capsule
Chlordiazepoxide/Amitriptyline Tablet
Chloroquine Tablet
Drug name
Chlorpromazine Tablet
Chlorthalidone Tablet
Cholbam Capsule
Cholestyramine (Light) Powder
Cialis Tablet
Cilostazol Tablet
Cimduo Tablet
Cimetidine Solution & Tablet
Cimzia Injection
Cinacalcet Tablet
Cinqair Injection
Citalopram Solution & Tablet
Climara (Pro) Patch
Clobazam Tablet
Clomipramine Capsule
Clonidine Patch & (ER) Tablet
Clopidrogel Tablet
Colesevelam Tablet
Colestid Granules, Powder & Tablet
Colestipol Granules & Tablet
Combigan Ophthalmic Solution
Combipatch
Combivent Respimat
Combivir Tablet
Complera Tablet
Comtan Tablet
Concerta Tablet
Copaxone Injection
Drug name
Coreg CR Capsule & Tablet
Corgard Tablet
Corlanor Tablet
Cosentyx Injection
Cosopt (PF) Ophthalmic Solution
Cotempla XR ODT Tablet
Covaryx (HS) Tablet
Cozaar Tablet
Creon Capsule
Crestor Tablet
Crixivan Capsule
Cromolyn Inhalation & Solution
Crysvita Injection
Curity Gauze Pads 2"x2"
Cuvposa Solution
Cyclogyl Ophthalmic Solution
Cyclopentolate Ophthalmic Solution
Cycloset Tablet
Cyclosporine Capsule & Oral Solution
Cymbalta Capsule
Cystadane Powder
Cystadrops Ophthalmic Solution
Cystagon Capsule
Cystaran Solution
Cytomel Tablet
Cytotec Tablet
Dalfampridine ER Tablet
Daliresp Tablet
Drug name
Dapsone Tablet
Darifenacin ER Tablet
Daypro Tablet
Daytrana Patch
DDAVP Nasal Solution & Tablet
Deferasirox Tablet
Deferiprone Tablet
Delstrigo Tablet
Delzicol Capsule
Depakote Sprinkles & (ER) Tablet
Descovy Tablet
Desipramine Tablet
Desmopressin Nasal Spray and Tablet
Desoxyn Tablet
Desvenlafaxine ER Tablet
Detrol LA Capsule & Tablet
Dexedrine Capsule
Dexilant DR Capsule
Dexmethylphenidate ER Capsule & Tablet
Dextroamphetamine ER Capsule, Solution &
Tablet
Diacomit Capsule
Diazoxide Suspension
Diclofenac (DR & ER) Tablet
Diclofenac/Misoprostol Tablet
Diflunisal Tablet
Digoxin Solution & Tablet
Dilantin Capsule, Suspension & Tablet
Drug name
Dilatrate SR Capsule
Diltiazem CD & ER Capsule, and (ER) Tablet
Dimethyl Fumarate Capsule
Diovan (HCT) Tablet
Dipentum Capsule
Dipyridamole Tablet
Disopyramide Capsule
Disulfiram Tablet
Ditropan XL Tablet
Diuril Suspension
Divalproex Capsule, DR & ER Tablet
Divigel
Dofetilide Capsule
Dojolvi Solution
Donepezil (ODT) Tablet
Dorzolamide Ophthamic Solution
Dorzolamide/Timolol Ophthamic Solution
Dotti Patch
Dovato Tablet
Doxazosin Tablet
Doxepin Capsule & Solution
Doxercalciferol Capsule
Drisdol Capsule
Drizalma Capsule
Droxia Capsule
Duaklir Inhaler
Duavee Tablet
Duetact Tablet
Drug name
Dulera Inhaler
Duloxetine Capsule
Duopa Suspension
Dupixent Injection
Dutasteride Capsule
Dutasteride/Tamsulosin Capsule
Dutoprol Tablet
Dyanavel XR Suspension
Dyazide Capsule
Dyrenium Capsule
Edarbi Tablet
Edarbyclor Tablet
Edecrin Tablet
Edurant Tablet
EEMT (HS) Tablet
Efavirenz Capsule & Tablet
Efavirenz/Emtricitabine/Tenofovir Tablet
Efavirenz/Lamivudine/Tenofovir Tablet
EFFER-K Tablet
Effexor XR Capsule
Effient Tablet
Egrifta Solution
Elestrin Gel
Eliquis Tablet
Elixophyllin Elixir
Eluryng Vaginal Ring
Emgality Injection
Emsam Patch
Drug name
Emtricitabine Capsule
Emtricitabine/Tenofovir Tablet
Emtriva Capsule & Solution
Enalapril Tablet
Enalapril/Hydrochlorothiazide Tablet
Enbrel Injection
Enspryng Injection
Entacapone Tablet
Entecavir Tablet
Entresto Tablet
Envarsus XR Tablet
Epidiolex Solution
Epitol Tablet
Epivir (HBV) Solution & (HBV) Tablet
Eplerenone Tablet
Epzicom Tablet
Equetro Capsule
Ergoloid Mesylates Tablet
Esbriet Capsule & Tablet
Escitalopram Solution & Tablet
Esomeprazole DR Capsule
Esterified Estrogens/Methyltestosterone Tablet
Estrace Vaginal Cream & Tablet
Estradiol Tablet, Patch & Vaginal Tablet
Estradiol/Norethindrone Acetate Tablet
Estring Vaginal Insert
Estrogel Gel
Ethacrynic Acid Tablet
Drug name
Ethosuximide Capsule & Solution
Etodolac Capsule & (ER) Tablet
Etravirine Tablet
Evamist Spray
Evekeo (ODT) Tablet
Everolimus Tablet
Evista Tablet
Evkeeza Injection
Evotaz Tablet
Evoxac Capsule
Evrysdi Solution
Exelon Patch
Exemestane Tablet
Exforge (HCT) Tablet
Exjade Tablet
Exservan Film
Extavia Injection
Ezallor Sprinkle Capsule
Ezetimibe Tablet
Ezetimibe/Simvastatin Tablet
Famotidine Suspension & Tablet
Fareston Tablet
Farxiga Tablet
Fasenra Injection
Febuxostat Tablet
Felbamate Suspension & Tablet
Felbatol Suspension & Tablet
Feldene Capsule
Drug name
Felodipine ER Tablet
Femara Tablet
Femhrt Tablet
Femring Vaginal Insert
Fenofibrate Capsule & Tablet
Fenofibric Acid DR Capsule & Tablet
Fenoglide Tablet
Fenoprofen Capsule & Tablet
Ferriprox Solution & Tablet
Fetzima Capsule
Fiasp Injection
Finasteride Tablet
Fintepla Solution
Flavoxate Tablet
Flecainide Tablet
Flolipid Suspension
Flomax Capsule
Flovent Diskus & HFA
Fludrocortisone Tablet
Fluoxetine (DR) Capsule, Solution & Tablet
Fluphenazine Concentrate, Elixir & Tablet
Flurbiprofen Tablet
Fluticasone Propionate/Salmeterol Powder for
Inhalation
Fluvastatin Capsule & ER Tablet
Fluvoxamine ER Capsule & Tablet
Focalin XR Capsule & Tablet
Folic Acid Tablet
Drug name
Forfivo XL Tablet
Formoterol Inhalation
Forteo Solution
Fortesta Gel
Fosamax (plus D) Tablet
Fosamprenavir Tablet
Fosinopril (HCT) Tablet
Fosrenol Chewable Tablet & Powder
Furosemide Solution & Tablet
Fuzeon Injection
Fycompa Suspension & Tablet
Gabapentin Capsule, Solution & Tablet
Gabitril Tablet
Galafold Capsule
Galantamine ER Capsule, Solution & Tablet
Ganciclovir Injection
Gastrocrom Oral Concentrate
Gattex Injection
Gelnique Pump
Gemfibrozil Tablet
Gemtesa Tablet
Gengraf Capsule & Solution
Genotropin Injection
Genvoya Tablet
Geodon Capsule
Gilenya Capsule
Glatiramer Injection
Glatopa Injection
Drug name
Glimepiride Tablet
Glipizide (ER & XL) Tablet
Glipizide/Metformin Tablet
Glucotrol (XL) Tablet
Glyburide (Micronized) Tablet
Glyburide/Metformin Tablet
Glynase Tablet
Glyxambi Tablet
Gocovri Capsule
Gonitro Sublingual Powder
Gralise Tablet
Grastek Sublingual Tablet
Guanfacine (ER) Tablet
Haloperidol Concentrate & Tablet
Hemangeol Solution
Hepsera Tablet
Hetlioz Capsule
Homatropaire Ophthalmic Solution
Homatropine Ophthalmic Solution
Horizant Tablet
Humalog Injection
Humatrope Injection
Humira Injection
Humulin Injection
Hydralazine Tablet
Hydrochlorothiazide Capsule & Tablet
Hydroxychloroquine Sulfate Tablet
Hyoscyamine Drops, Elixir, Solution & (SL & ER)
Drug name
Tablet
Hyzaar Tablet
Ibandronate Tablet
Ibuprofen Tablet
Icosapent Capsule
Ilumya Injection
Imipramine Capsule & Tablet
Imuran Tablet
Imvexxy Suppository
Inbrija Capsule
Increlex Injection
Incruse Ellipta
Indapamide Tablet
Inderal LA & XL Capsule
Indocin Suppository & Suspension
Indomethacin (ER) Capsule
Ingrezza Capsule
Innopran XL Capsule
Inspra Tablet
Insulin Syringes
Intelence Tablet
Intrarosa Vaginal Insert
Intron A Injection
Intuniv Tablet
Invega Tablet
Invirase Capsule & Tablet
Invokamet (XR) Tablet
Invokana Tablet
Drug name
Ipratropium Bromide Inhalation
Ipratropium Bromide Nasal Spray
Ipratropium Bromide/Albuterol Inhalation
Irbesartan Tablet
Irbesartan/Hydrochlorothiazide Tablet
Isentress HD Tablet
Isentress Suspension & Tablet
Isoniazid Syrup & Tablet
Isopto Atropine Ophthalmic Solution
Isopto Carpine Ophthalmic Solution
Isordil Tablet
Isosorbide (ER) Tablet
Isoxsuprine Tablet
Isradipine Capsule
Istalol Ophthalmic Solution
Isturisa Tablet
Jadenu Sprinkles & Tablet
Jalyn Capsule
Janumet (XR) Tablet
Januvia Tablet
Jardiance Tablet
Jatenzo Capsule
Jentadueto (XR) Tablet
Jinteli Tablet
Jornay PM Capsule
Juluca Tablet
Juxtapid Capsule
Kaletra Solution & Tablet
Drug name
Kalydeco Granules & Tablet
Kapspargo Sprinkle Capsule
Kapvay Tablet
Katerzia Suspension
Kazano Tablet
Keppra Solution and (XR) Tablet
Kesimpta Injection
Ketoprofen (ER) Capsule
Kevzara Injection
Kineret Injection
Kitabis Inhalation Solution
Klor-Con Tablet
Kombiglyze XR Tablet
Korlym Tablet
K-Phos (Neutral) Tablet
Kristalose Packet
K-Tab Tablet
Kuvan Powder & Tablet
Labetalol Tablet
Lactulose Solution
Lamictal (ODT) Tablet
Lamivudine Solution & Tablet
Lamivudine/Zidovudine Tablet
Lamotrigine (ER & ODT) Tablet
Lanoxin Tablet
Lansoprazole DR Capsule & ODT Tablet
Lanthanum Chew Tablet
Lantus Injection
Drug name
Lasix Tablet
Latanoprost Ophthalmic Solution
Latuda Tablet
Leflunomide Tablet
Lescol XL Tablet
Letairis Tablet
Letrozole Tablet
Levalbuterol Tartrate HFA & Inhalation
Levbid Tablet
Levemir Injection
Levetiracetam Solution & (ER) Tablet
Levobunolol Ophthalmic Solution
Levocarnitine Solution & Tablet
Levothyroxine Tablet
Levsin (SL) Tablet
Lexapro Oral Solution & Tablet
Lexiva Suspension & Tablet
Lialda Tablet
Linzess Capsule
Liothyronine Tablet
Lipitor Tablet
Lipofen Capsule
Lisinopril Tablet
Lisinopril/Hydrochlorothiazide Tablet
Lithium Carbonate Capsule, Solution & (ER)
Tablet
Lithobid CR Tablet
Lithostat Tablet
Drug name
Livalo Tablet
Lodine Tablet
Lodosyn Tablet
Lokelma Packet
Lonhala Magnair Solution
Lopid Tablet
Lopinavir/Ritonavir Solution
Lopreeza Tablet
Lopressor (HCT) Tablet
Losartan Tablet
Losartan/Hydrochlorothiazide Tablet
Lotensin (HCT) Tablet
Lotrel Capsule
Lotronex Tablet
Lovastatin Tablet
Lovaza Capsule
Loxapine Capsule
Lubiprostone Capsule
Lumigan Ophthalmic Solution
Lupkynis Capsule
Lyrica Capsule, CR Tablet, & Solution
Lyumjev Injection
Maprotiline Tablet
Marplan Tablet
Maxzide Tablet
Mayzent Tablet
Meclofenamate Capsule
Medroxyprogesterone Acetate Tablet
Drug name
Mefenamic Acid Capsule
Mefloquine Tablet
Megesterol Suspension
Meloxicam Tablet
Memantine XR Capsule, Solution & Tablet
Menest Tablet
Menostar Patch
Mesalamine DR Tablet
Metformin (ER) Tablet
Methamphetamine Tablet
Methazolamide Tablet
Methimazole Tablet
Methitest Tablet
Methyldopa Tablet
Methyldopa/Hydrochlorothiazide Tablet
Methylin Solution
Methylphenidate CD & ER Capsule, Solution
and (ER & SR) Tablet
Methyltestosterone Capsule
Metolazone Tablet
Metoprolol (ER) & (HCT) Tablet
Mexiletine Capsule
Micardis (HCT) Tablet
Miglitol Tablet
Miglustat Capsule
Minipress Capsule
Minitran Patch
Minivelle Patch
Drug name
Minoxidil Tablet
Mirapex (ER) Tablet
Mirtazapine (ODT) Tablet
Misoprostol Tablet
Mobic Tablet
Modafinil Tablet
Moexipril Tablet
Molindone Tablet
Montelukast Granules & (Chewable) Tablet
Motegrity Tablet
Multaq Tablet
Myalept Injection
Mycapssa Capsule
Mycophenolate Capsule, Suspension & Tablet
Mycophenolic Acid DR Tablet
Mydayis Capsule
Myfortic Tablet
Myrbetriq Tablet
Mysoline Tablet
Mytesi Tablet
Nabumetone Tablet
Nadolol Tablet
Nalfon Capsule
Namenda XR Capsule & Tablet
Namzaric Capsule
Naprelan CR Tablet
Naproxen Suspension and (CR, DR & ER)
Tablet
Drug name
Naproxen/Esomeprazole Tablet
Nardil Tablet
Nateglinide Tablet
Natesto Gel
Natpara Injection
Nature-Thyroid Tablet
Nefazodone Tablet
Neoral Capsule & Solution
Nesina Tablet
Neupro Patch
Neurontin Capsule, Solution & Tablet
Nevirapine (ER) Tablet
Nexium Capsule & DR Granules
Nexletol Tablet
Nexlizet Tablet
Niacin ER Tablet
Niaspan ER Tablet
Nicardipine Capsule
Nifedipine Capsule & ER Tablet
Nisoldipine ER Tablet
Nitisinone Capsule
Nitro-Bid Ointment
Nitro-Dur Patch
Nitroglycerin Patch, SL Tablet & Spray
Nitrostat Tablet
Nityr Tablet
Nizatidine Capsule & Solution
Nocdurna SL Tablet
Drug name
Norditropin Injection
Norethindrone Tablet
Norpace (CR) Capsule
Norpramin Tablet
Nortriptyline Capsule & Solution
Norvasc Tablet
Norvir Capsule, Solution & Tablet
Nourianz Tablet
Novolin Injection
Novolog Injection
Noxafil Injection, Suspension & Tablet
NP Thyroid Tablet
Nucala Injection
Nuedexta Capsule
Nulibry Injection
Nuplazid Tablet & Capsule
Nutropin AQ Injection
Nuvigil Tablet
Ocaliva Tablet
Octreotide Injection
Odactra Sublingual Tablet
Odefsey Tablet
Ofev Capsule
Olanzapine (ODT) Tablet
Olanzapine/Fluoxetine Capsule
Olmesartan (HCT) Tablet
Olmesartan/Amlodipine/Hydrochlorothiazide
Tablet
Drug name
Olumiant Tablet
Omega-3-Acid Ethyl Esters Capsule
Omeprazole Capsule
Omeprazole/Sodium Bicarbonate Packet
Omnipod System
Omnitrope Injection
Onfi Suspension & Tablet
Ongentys Capsule
Onglyza Tablet
Onpattro Injection
Opsumit Tablet
Oral Contraceptives
Oralair IR Tablet
Orencia Injection
Orenitram Tablet
Orfadin Capsule & Suspension
Orkambi Tablet
Orladeyo Capsule
Oseni Tablet
Osmolex ER Tablet
Osphena Tablet
Otezla Tablet
Otrexup Injection
Oxaprozin Tablet
Oxbryta Tablet
Oxcarbazepine Tablet & Suspension
Oxlumo Injection
Oxtellar XR Tablet
Drug name
Oxybutynin Patch, Syrup and (ER) Tablet
Oxytrol Patch
Ozempic Injection
Pacerone Tablet
Paliperidone ER Tablet
Palynziq Injection
Pamelor Capsule
Pancreaze Capsule
Pantoprazole Tablet
Paricalcitol Capsule
Parlodel Capsule & Tablet
Parnate Tablet
Paroxetine (ER) Tablet
Paxil Suspension and (CR) Tablet
Peganone Tablet
Pen Needles
Pentasa Capsule
Pentoxifylline ER Tablet
Pepcid Suspension & Tablet
Perforomist Inhalation
Perindopril Tablet
Perphenazine Tablet
Perphenazine/Amitriptyline Tablet
Perseris Injection
Pertzye Capsule
Pexeva Tablet
Phenelzine Tablet
Phenobarbital Tablet
Drug name
Phenytek Capsule
Phenytoin EX Capsule, Suspension & Tablet
Phoslyra Solution
Phospha 250 Neutral Tablet
Phosphorous Tablet
Pifeltro Tablet
Pilocarpine Ophthalmic Solution & Tablet
Pimozide Tablet
Pindolol Tablet
Pioglitazone Tablet
Pioglitazone/Glimepiride Tablet
Pioglitazone/Metformin Tablet
Piroxicam Capsule
Plaquenil Tablet
Plavix Tablet
Plegridy Injection
Ponvory Tablet
Posaconazole DR Tablet
Potaba Capsule
Potassium Chloride ER Capsule, Liquid,
Packets and CR, ER & SR Tablet
Potassum Chloride Effervescent Tablet
Pradaxa Capsule
Praluent Injection
Pramiprexole (ER) Tablet
Prasugrel Tablet
Pravachol Tablet
Pravastatin Tablet
Drug name
Prazosin Capsule
Precose Tablet
Prefest Tablet
Pregabalin (ER) Capsule
Premarin Vaginal Cream & Tablet
Premphase Tablet
Prempro Tablet
Prevacid Capsule & Tablet
Prevymis Tablet
Prezcobix Tablet
Prezista Suspension & Tablet
Prilosec Powder
Primidone Tablet
Prinivil Tablet
Pristiq Tablet
Proair HFA & Respiclick
Probenecid Tablet
Probenecid/Colchicine Tablet
Procardia Capsule & XL Tablet
Procentra Solution
Prochlorperazine Tablet
Procysbi Capsule
Progesterone Capsule
Proglycem Suspension
Prograf Capsule
Promacta Tablet
Prometrium Capsule
Propafenone ER Capsule & Tablet
Drug name
Propranolol ER Capsule, Solution & Tablet
Propranolol/Hydrochlorothiazide Tablet
Propylthiouracil Tablet
Proscar Tablet
Protonix Packet & Tablet
Protriptyline Tablet
Proventil HFA
Provera Tablet
Provigil Tablet
Prozac Capsule
Pulmicort Flexhaler & Inhalation
Pulmozyme Solution
Qbrelis Solution
Qmiiz ODT Tablet
Qtern Tablet
Qudexy XR Capsule
Questran (Light) Powder
Quetiapine (ER) Tablet
Quillichew ER Tablet
Quillivant Suspension
Quinapril Tablet
Quinapril/Hydrochlorothiazide Tablet
Quinidine Gluconate CR & ER Tablet
Quinidine Sulfate Tablet
Qvar Inhaler
Rabeprazole Tablet
Radicava Injection
Ragwitek Sublingual Tablet
Drug name
Raloxifene Tablet
Ramipril Capsule
Ranexa Tablet
Ranitidine Capsule, Syrup & Tablet
Ranolazine ER Tablet
Rapaflo Capsule
Rapamune Solution & Tablet
Rasagiline Tablet
Rasuvo Injection
Ravicti Liquid
Rayaldee Capsule
Razadyne ER Capsule & Tablet
Rebif Injection
Reblozyl Injection
Reditrex Injection
Relafen DS Tablet
Relexxii Tablet
Reltone Capsule
Remeron (Solutab) Tablet
Renagel Tablet
Renvela Packet & Tablet
Repaglinide Tablet
Repatha Injection
Restasis Ophthalmic Emulsion
Retrovir Capsule & Syrup
Revatio Tablet & Suspension
Rexulti Tablet
Reyataz Capsule & Powder
Drug name
Rhopressa Ophthalmic Solution
Ridaura Capsule
Rilutek Tablet
Riluzole Tablet
Rinvoq Tablet
Riomet Solution
Risedronate (DR) Tablet
Risperdal Solution & Tablet
Risperidone Solution and (ODT) Tablet
Ritalin LA Capsule & Tablet
Ritonavir Tablet
Rivastigmine Capsule & Patch
Rocaltrol Capsule & Solution
Rocklatan Ophthalmic Solution
Ropinirole (ER) Tablet
Rosuvastatin Tablet
Roxzet Tablet
Roweepra (XR) Tablet
Rufinamide Tablet
Rukobia ER Tablet
Ruzurgi Tablet
Rybelsus Tablet
Rytary Capsule
Rythmol SR Capsule
Sabril Powder & Tablet
Safyral Tablet
Saizen Injection
Salagen Tablet
Drug name
Salsalate Tablet
Sandimmune Capsule & Solution
Sandostatin Injection
Saphris Sublingual Tablet
Sapropterin Tablet
Savaysa Tablet
Savella Tablet
Secuado Patch
Seebri Neohaler
Segluromet Tablet
Selegiline Capsule & Tablet
Selzentry Solution & Tablet
Semglee Injection
Sensipar Tablet
Serevent Diskus
Seroquel (XR) Tablet
Serostim Injection
Sertraline Concentrate & Tablet
Sevelamer Packet & Tablet
Signifor Injection
Sildenafil Tablet
Siliq Injection
Silodosin Capsule
Simbrinza Ophthalmic Suspension
Simponi Injection & Simponi Aria Solution
Simvastatin Tablet
Sinemet (CR) Tablet
Singulair Granules & (Chewable) Tablets
Drug name
Sirolimus Tablet
Skyrizi Injection
Sodium Fluoride Cream, Gel, Paste, Rinse,
Solution & Tablet
Sodium Phenylbutyrate Tablet
Solifenacin Tablet
Soliqua Injection
Soltamox Oral Solution
Somavert Injection
Sotalol (AF) Tablet
Sotylize Oral Solution
Spinraza Injection
Spiriva Handihaler & Respimat
Spironolactone Tablet
Spironolactone/Hydrochlorothiazide Tablet
Spravato Nasal Solution
Spritam Tablet
Stalevo Tablet
Starlix Tablet
Stavudine Capsule
Steglatro Tablet
Steglujan Tablet
Stelara Injection
Stimate Nasal Solution
Stiolto Respimat
Strattera Capsule
Strensiq Injection
Stribild Tablet
Drug name
Striverdi Respimat
Subvenite Tablet
Sucraid Solution
Sucralfate Suspension & Tablet
Sular Tablet
Sulfasalazine (DR) Tablet
Sulindac Tablet
Sunosi Tablet
Sustiva Capsule
Symbicort Inhaler
Symbyax Capsule
Symdeko Tablet
Symfi (Lo) Tablet
Symlinpen Injection
Sympazan Film
Symtuza Tablet
Synjardy (XR) Tablet
Synthroid Tablet
Tacrolimus Capsule
Tadalafil Tablet
Takhzyro Injection
Taltz Injection
Tamoxifen Tablet
Tamsulosin Capsule
Tapazole Tablet
Tarka CR Tablet
Tasmar Tablet
Tavalisse Tablet
Drug name
Tecfidera Capsule
Tegretol Suspension & (XR) Tablet
Tegsedi Injection
Tekturna (HCT) Tablet
Telmisartan (HCT) Tablet
Telmisartan/Amlodipine Tablet
Temixys Tablet
Tenofovir Tablet
Tenoretic Tablet
Tenormin Tablet
Terazosin Capsule
Terbutaline Tablet
Teriparatide Injection
Testim Gel
Testosterone Gel, Pump & Solution
Tetrabenazine Tablet
Thalomid Capsule
Theo-24 CR & ER Capsule
Theophylline Solution, CR & ER Tablet
Thiola EC Tablet
Thioridazine Tablet
Thiothixene Capsule
Thyquidity Solution
Tiagabine Tablet
Tiazac Capsule
Tiglutik Suspension
Tikosyn Capsule
Timolol Ophthalmic Gel & Solution, Tablet
Drug name
Timoptic (Ocudose & XE) Ophthalmic Solution
Tiopronin Tablet
Tirosint Capsule & Solution
Tivicay Tablet
Tobi Inhalation Solution and Podhaler
Tobramycin Inhalation Solution
Tolbutamide Tablet
Tolcapone Tablet
Tolmetin Capsule & Tablet
Tolterodine ER Capsule & Tablet
Topamax Sprinkles & Tablet
Topiramate (ER) Capsule & Tablet
Toprol XL Tablet
Toremifene Tablet
Torsemide Tablet
Toujeo Injection
Toviaz Tablet
Tracleer Tablet
Tradjenta Tablet
Trandolapril Tablet
Trandolapril/Verapamil ER Tablet
Tranylcypromine Tablet
Travatan Z Ophthalmic Solution
Travoprost Ophthalmic Solution
Trazodone Tablet
Trelegy Ellipta
Tremfya Injection
Tresiba Injection
Drug name
Triamterene/Hydrochlorothiazide Capsule &
Tablet
Tribenzor Tablet
Tricor Tablet
Trifluoperazine Tablet
Trihexyphenidyl Elixir & Tablet
Trijardy XR Tablet
Trikafta Tablet
Trileptal Suspension & Tablet
Trilipix Capsule
Trimipramine Capsule
Trintellix Tablet
Triumeq Tablet
Trizivir Tablet
Trogarzo Injection
Trokendi XR Capsule
Trospium ER Capsule & Tablet
Trulance Tablet
Trulicity Injection
Trusopt Ophthalmic Solution
Truvada Tablet
Tudorza Pressair
Twynsta Tablet
Tybost Tablet
Tymlos Injection
Tyvaso Inhalation Solution
Uloric Tablet
Uptravi Tablet
Drug name
Uroxatral Tablet
Urso (250 & Forte) Tablet
Ursodiol Capsule & Tablet
Vagifem Tablet
Valcyte Solution & Tablet
Valganciclovir Solution & Tablet
Valproic Acid Capsule & Solution
Valsartan (HCT) Tablet
Vascepa Capsule
Vaseretic Tablet
Vasotec Tablet
Vecamyl Tablet
Velphoro Chewable Tablet
Veltassa Powder for Solution
Vemlidy Tablet
Venlafaxine ER Capsule & (ER) Tablet
Ventavis Inhalation Solution
Ventolin HFA
Verapamil ER & SR Capsule, (ER) Tablet
Verelan (PM) Capsule
Verquvo Tablet
Vesicare Tablet
V-Go Kit
Viberzi Tablet
Victoza Injection
Videx EC Capsule & Solution
Vigabatrin Tablet & Powder for Solution
Vigadrone Powder for Solution
Drug name
Viibryd Tablet
Vimovo Tablet
Vimpat Solution & Tablet
Viokace Tablet
Viracept Tablet
Viramune Suspension & (XR) Tablet
Viread Powder & Tablet
Vitamin D Capsule
Vivelle-Dot Patch
Vivlodex Capsule
Vocabria Tablet
Vogelxo Gel Pump
Vraylar Capsule
Vumerity Capsule
Vyndamax Capsule
Vyndaqel Capsule
Vytorin Tablet
Vyvanse Capsule & Chewable Tablet
Vyzulta Ophthalmic Solution
Wakix Tablet
Warfarin Tablet
Welchol Packet & Tablet
Wellbutrin SR & XL Tablet
Wixela Powder for Inhalation
Xadago Tablet
Xalatan Ophthalmic Solution
Xarelto Tablet
Xcopri Tablet
Drug name
Xeljanz (XR) Tablet
Xelpros Ophthalmic Solution
Xenazine Tablet
Xermelo Tablet
Xifaxan Tablet
Xigduo XR Tablet
Xiidra Ophthalmic Solution
Xopenex HFA & Inhalation Solution
Xulane Patch
Xultophy Injection
Xuriden Granules
Xyosted Injection
Yasmin Tablet
Yaz Tablet
Yupelri Inhalation Solution
Yuvafem Vaginal Tablet
Zafirlukast Tablet
Zarontin Capsule & Solution
Zavesca Capsule
Zegerid Capsule & Powder for Suspension
Zelapar Tablet
Zemplar Capsule
Zenpep Capsule
Zenzedi Tablet
Drug name
Zeposia Capsule
Zestoretic Tablet
Zestril Tablet
Zetia Tablet
Ziac Tablet
Ziagen Solution & Tablet
Zidovudine Capsule, Syrup & Tablet
Zileuton ER Tablet
Zioptan Ophthalmic Solution
Ziprasidone Capsule
Zocor Tablet
Zokinvy Capsule
Zoloft Concentrate & Tablet
Zomacton Injection
Zonegran Capsule
Zonisamide Capsule
Zontivity Tablet
Zorbtive Injection
Zortress Tablet
Zorvolex Capsule
Zyflo (CR) Tablet
Zyloprim Tablet
Zypitamag Tablet
Zyprexa (Zydis) Tablet
This is not a complete list of prescription drugs and supplies covered by our plan. For a complete
list, please call Customer Service toll-free at 1-888-803-9217, TTY 711, 8 a.m. – 8 p.m. local time,
Monday – Friday.
This information is not a complete description of benefits. Contact the plan for more information. Limitations,
copayments, and restrictions may apply.
Benefits and/or copayments/coinsurance may change each plan/benefit year.
The drug list may change at any time. You will receive notice when necessary.
This information is available for free in other languages. Please call our Customer Service number on the cover.
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