AultCare - Non-Medicare - Formulary

2022 List of Covered Drugs (Abridged formulary)The use of generic medications are encouraged. AultCare/Aultra offers our members an open formulary design (which means the health plan may cover the costs of drugs not on the formulary list). Therefore, tier exceptions are not applicable. For example, a higher tier (Non-Preferred) medication may not be requested at a lower tier (Preferred) copay. Medication tiering may change due to generic availability. Medications listed under the Vigilant Drug Program are not covered under the plan. These medications offer little to no added clinical value over existing, less expensive alternatives that are covered under the formulary. See your plan guidelines for specific plan limitations. Certain medications may require Prior Authorizations, Step Therapy, or have Quantity Limitations. This list is subject to change. For the most current comprehensive list of medications, please visit our website.

CommercialCommercialFormularyFormulary

7404/21

AultCare Customer Service: 330-363-6360 or 1-800-344-8858 www.aultcare.comAultra Customer Service: 330-363-2050 or 1-855-270-8497www.aultragroup.com

5-Tier Plan Design Formulary Coding

GP = Generic Preferred (Tier 1)GNP = Generic Non-Preferred (Tier 2) (Not listed)BP = Brand Preferred (Tier 3)BNP = Brand Non-Preferred 4th & 5th Tiers Not ListedSP = SpecialtySNP = Specialty Non-Preferred (Not listed)

All Other Plan Design Formulary Coding

GP and GNP= Generic (Tier 1) (GNP not listed)BP = Brand Preferred (Tier 2)BNP = Brand Non-Preferred Not ListedSP = SpecialtySNP = Specialty Non-Preferred (Not listed)

1

AultCare Health Plans

Table of Contents

Analgesics - Drugs for Pain.................................................................................................................................. 3

Analgesics - Drugs for Pain and Inflammation ..................................................................................................... 4

Anesthetics .......................................................................................................................................................... 5

Anti-Addiction / Substance Abuse Treatment Agents ........................................................................................... 6

Antibacterials ....................................................................................................................................................... 6

Anticoagulants ..................................................................................................................................................... 9

Anticonvulsants - Drugs for Seizures ................................................................................................................... 9

Antidementia Agents - Drugs for Alzheimer's Disease and Dementia ................................................................ 10

Antidepressants ................................................................................................................................................. 10

Antiemetics - Drugs for Nausea and Vomiting .................................................................................................... 11

Antifungals ......................................................................................................................................................... 11

Antigout Agents ................................................................................................................................................. 12

Antimigraine Agents ........................................................................................................................................... 12

Antimyasthenic Agents ...................................................................................................................................... 12

Antimycobacterials ............................................................................................................................................. 13

Antineoplastics - Drugs for Cancer..................................................................................................................... 13

Antiparasitics ..................................................................................................................................................... 17

Antiparkinson Agents ......................................................................................................................................... 17

Antiplatelets ....................................................................................................................................................... 17

Antipsychotics - Drugs for Mood Disorders ........................................................................................................ 17

Antivirals ............................................................................................................................................................ 18

Anxiolytics - Drugs for Anxiety ........................................................................................................................... 19

Bipolar Agents - Drugs for Mood Disorders ........................................................................................................ 20

Blood Products and Modifiers - Drugs for Blood Disorders ................................................................................ 20

Cardiovascular Agents - Drugs for Heart and Circulation Conditions ................................................................. 21

Central Nervous System Agents - Drugs for Attention Deficit Disorder .............................................................. 24

Central Nervous System Agents - Drugs for Multiple Sclerosis .......................................................................... 25

Central Nervous System Agents - Miscellaneous............................................................................................... 25

Dental and Oral Agents - Drugs for Mouth and Throat Conditions ..................................................................... 25

Dermatological Agents - Drugs for Skin Conditions............................................................................................ 26

Diabetes - Antidiabetic Agents ........................................................................................................................... 28

Diabetes - Glucose Monitoring ........................................................................................................................... 29

Diabetes - Glycemic Agents ............................................................................................................................... 29

Diabetes - Insulins ............................................................................................................................................. 29

Electrolytes / Minerals / Metals / Vitamins .......................................................................................................... 30

Gastrointestinal Agents - Drugs for Acid Reflux and Ulcer ................................................................................. 33

Gastrointestinal Agents - Drugs for Bowel, Intestine and Stomach Conditions .................................................. 33

Genetic or Enzyme Disorder - Drugs for Replacement, Modification, Treatment ............................................... 34

Genitourinary Agents - Drugs for Bladder, Genital and Kidney Conditions......................................................... 35

Genitourinary Agents - Drugs for Prostate Conditions ........................................................................................ 35

Hormonal Agents - Adrenal ................................................................................................................................ 36

Hormonal Agents - Men's Health ....................................................................................................................... 36

Hormonal Agents - Osteoporosis ....................................................................................................................... 36

Hormonal Agents - Pituitary ............................................................................................................................... 36

Hormonal Agents - Sex Hormones and Birth Control ......................................................................................... 38

Hormonal Agents - Thyroid ................................................................................................................................ 41

Immunological Agents - Drugs for Immune System Stimulation or Suppression ................................................ 41

Inflammatory Bowel Disease Agents .................................................................................................................. 43

Metabolic Bone Disease Agents - Drugs for Osteoporosis ................................................................................. 43

Metabolic Bone Disease Agents - Other ............................................................................................................ 44

2

Miscellaneous Therapeutic Agents .................................................................................................................... 44

Ophthalmic Agents - Drugs for Eye Allergy, Infection and Inflammation ............................................................ 45

Ophthalmic Agents - Drugs for Glaucoma .......................................................................................................... 45

Ophthalmic Agents - Drugs for Miscellaneous Eye Conditions........................................................................... 45

Otic Agents - Drugs for Ear Conditions .............................................................................................................. 46

Respiratory Tract / Pulmonary Agents - Drugs for Allergies, Cough, Cold ......................................................... 46

Respiratory Tract / Pulmonary Agents - Drugs for Asthma and Other Lung Conditions ..................................... 47

Respiratory Tract / Pulmonary Agents - Drugs for Cystic Fibrosis ...................................................................... 49

Respiratory Tract / Pulmonary Agents - Drugs for Pulmonary Hypertension ...................................................... 49

Skeletal Muscle Relaxants - Drugs for Muscle Pain and Spasm ........................................................................ 49

Sleep Disorder Agents ....................................................................................................................................... 50

3

Last Updated 1/1/22

Not all non-preferred brands/generics listed

Drug Name Drug Tier Notes

butorphanol tartrate

injection GP QL

butorphanol tartrate

nasal GP QL

carisoprodol-aspirin-

codeine GP QL

clonidine hcl

(analgesia) GP

codeine sulfate GP QL

duramorph GP QL

endocet GP PA; QL

fentanyl citrate buccal

lozenge on a handle GP PA; QL

FENTANYL CITRATE-

NACL INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

10-0.9 MCG/ML-%

GP

QL

fentanyl transdermal

patch 72 hour 100

mcg/hr, 12 mcg/hr, 25

mcg/hr, 50 mcg/hr, 75

mcg/hr

GP

ST; QL

fentanyl transdermal

patch 72 hour 37.5

mcg/hr, 62.5 mcg/hr,

87.5 mcg/hr

GP

QL

hydrocodone bitartrate

er GP QL

hydrocodone-

acetaminophen GP QL

hydrocodone-ibuprofen GP QL

hydromorphone hcl er GP ST; QL

hydromorphone hcl

injection solution 1

mg/ml, 2 mg/ml, 4

mg/ml

GP

QL

hydromorphone hcl oral GP QL

hydromorphone hcl pf GP QL

levorphanol tartrate oral

tablet 2 mg GP ST; QL


Analgesics - Drugs

for Pain

acetaminophen

intravenous solution GP

acetaminophen-

codeine GP QL

acetaminophen-

codeine #2 GP QL

acetaminophen-

codeine #3 GP QL

acetaminophen-

codeine #4 GP QL

alfentanil hcl GP

apap-caff-

dihydrocodeine GP QL

ascomp-codeine GP QL

bac GP

buprenorphine GP ST; QL

buprenorphine hcl

injection GP QL

butalbital-

acetaminophen capsule

50-300 mg oral

GP

BUTALBITAL-

ACETAMINOPHEN

CAPSULE 50-300 MG

ORAL

GP

butalbital-

acetaminophen oral

tablet 25-325 mg, 50-

300 mg

GP

butalbital-

acetaminophen oral

tablet 50-325 mg

GP

QL

butalbital-apap-caff-cod GP QL

butalbital-apap-caffeine GP

butalbital-asa-caff-

codeine GP QL

butalbital-aspirin-

caffeine GP

4

Last Updated 1/1/22



oxycodone hcl oral

capsule GP QL

oxycodone hcl oral

concentrate 100

mg/5ml

GP

QL

oxycodone hcl oral

solution GP QL

oxycodone hcl oral

tablet GP QL

oxycodone-

acetaminophen oral

tablet 10-325 mg, 2.5-

325 mg, 5-325 mg, 7.5-

325 mg

GP

PA; QL

OXYCONTIN BP ST; QL

oxymorphone hcl GP QL

pentazocine-naloxone

hcl GP QL

PRIALT SP

remifentanil hcl GP

tramadol hcl er

(biphasic) GP ST; QL

tramadol hcl er oral

tablet extended release

24 hour

GP

ST; QL

tramadol hcl ir GP QL

tramadol-

acetaminophen GP QL

Analgesics - Drugs

for Pain and

Inflammation

celecoxib oral GP

diclofenac potassium GP

diclofenac sodium er GP

diclofenac sodium

external gel 1 % GP QL

diclofenac sodium

external solution GP PA; QL

diclofenac sodium oral GP

diclofenac-misoprostol GP


levorphanol tartrate oral

tablet 3 mg GP QL

meperidine hcl injection GP QL

meperidine hcl oral GP QL

methadone hcl injection GP QL

methadone hcl intensol GP QL

methadone hcl oral

concentrate GP QL

methadone hcl oral

solution GP QL

methadone hcl oral

tablet GP ST; QL

methadone hcl oral

tablet soluble GP QL

methadose oral

concentrate 10 mg/ml GP QL

methadose oral tablet

soluble GP QL

methadose sugar-free GP QL

morphine sulfate

(concentrate) oral

solution 100 mg/5ml,

20 mg/ml

GP

QL

morphine sulfate (pf) GP QL

morphine sulfate er

beads GP QL

morphine sulfate er oral

tablet extended release GP ST; QL

morphine sulfate


mg/ml, 4 mg/ml

GP

QL

morphine sulfate

intravenous solution 4

mg/ml, 8 mg/ml

GP

QL

morphine sulfate oral GP QL

nalbuphine hcl injection GP QL

NUCYNTA BP QL

NUCYNTA ER BP ST; QL

OXYCODONE HCL ER BP ST; QL

5

Last Updated 1/1/22



naproxen oral

suspension GP

naproxen oral tablet GP

naproxen oral tablet

delayed release GP ST

naproxen sodium oral

tablet 275 mg, 550 mg GP ST

sulindac oral GP

Anesthetics

bupivacaine

fisiopharma GP

bupivacaine hcl (pf) GP

bupivacaine hcl

injection solution 0.25

%, 0.5 %

GP

bupivacaine in dextrose GP

bupivacaine spinal GP

bupivacaine-

epinephrine GP

bupivacaine-

epinephrine (pf) GP

chloroprocaine hcl (pf) GP

ethyl chloride GP

glydo GP

lidocaine external

ointment 5 % GP QL

lidocaine external patch

5 % GP ST

lidocaine hcl (cardiac)

intravenous solution

prefilled syringe 100

mg/5ml, 50 mg/5ml

GP

lidocaine hcl (cardiac)

pf GP

lidocaine hcl (pf) GP

lidocaine hcl external

solution GP

lidocaine hcl injection

solution GP


diflunisal oral GP

ec-naproxen GP ST

etodolac er GP ST

fenoprofen calcium oral

tablet GP ST

flurbiprofen oral GP

ibuprofen lysine GP

ibuprofen oral

suspension 100 mg/5ml GP

ibuprofen oral tablet

400 mg, 600 mg, 800

mg

GP

indomethacin er GP

indomethacin oral

capsule 25 mg, 50 mg GP

indomethacin sodium GP

ketoprofen er GP

ketoprofen oral capsule

25 mg GP PA; QL

ketoprofen oral capsule

50 mg, 75 mg GP PA

ketorolac tromethamine

injection GP PA


intramuscular GP PA


oral GP QL

meclofenamate sodium

oral GP

mefenamic acid oral GP ST

meloxicam oral capsule

10 mg GP

meloxicam oral capsule

5 mg GP QL

meloxicam oral tablet

15 mg GP

meloxicam oral tablet

7.5 mg GP QL

nabumetone oral GP

6

Last Updated 1/1/22



Antibacterials

amikacin sulfate

injection GP

amoxicillin GP

amoxicillin-potassium

clavulanate GP


clavulanate er GP

ampicillin GP

ampicillin sodium GP

ampicillin-sulbactam

sodium GP

avidoxy GP

azithromycin

intravenous GP

azithromycin oral GP

aztreonam GP

bacitracin intramuscular GP

cefaclor GP

cefaclor er GP

cefadroxil GP

cefazolin sodium

injection GP

cefazolin sodium


reconstituted

GP

cefazolin sodium-

dextrose intravenous

solution 1-4 gm/50ml-

%, 2-4 gm/100ml-%

GP

cefazolin sodium-


solution reconstituted

GP

cefdinir GP

cefepime hcl injection GP

cefepime hcl


cefixime GP

cefotaxime sodium GP


lidocaine hcl

urethral/mucosal

external gel

GP

QL

lidocaine hcl

urethral/mucosal

external prefilled

syringe

GP

lidocaine in d5w

intravenous solution 4-

5 mg/ml-%, 8-5 mg/ml-

%

GP

LIDOCAINE IN

DEXTROSE GP

lidocaine-epinephrine

injection GP

lidocaine-prilocaine

external cream GP QL

polocaine GP

polocaine-mpf GP

ropivacaine hcl

injection solution GP

sensorcaine-mpf

injection solution 0.5 % GP

tetracaine hcl injection GP

Anti-Addiction /

Substance Abuse

Treatment Agents

acamprosate calcium GP

buprenorphine hcl

sublingual GP

buprenorphine hcl-

naloxone hcl GP QL

bupropion hcl er

(smoking det) GP

disulfiram oral GP

naloxone hcl injection GP

naltrexone hcl oral GP

varenicline tartrate GP

VIVITROL SP PA

7

Last Updated 1/1/22



coremino GP PA

daptomycin intravenous

solution reconstituted

500 mg

GP

dicloxacillin sodium GP

DIFICID ORAL

TABLET BP PA

doxy 100 GP

doxycycline hyclate

intravenous GP

doxycycline hyclate oral

capsule GP

doxycycline

monohydrate oral GP

ertapenem sodium GP

ERY-TAB ORAL

TABLET DELAYED

RELEASE 250 MG

GP

ERYTHROCIN

STEARATE GP

erythromycin base oral

tablet delayed release GP

erythromycin oral GP

FIRST-

METRONIDAZOLE GP

FIRVANQ BP

fosfomycin

tromethamine GP

gentamicin in saline GP

gentamicin sulfate

external GP

gentamicin sulfate

injection GP

imipenem-cilastatin GP

iodine tincture external

tincture 2 % GP

levofloxacin in d5w GP

levofloxacin

intravenous GP

levofloxacin oral GP


cefotetan disodium GP

cefoxitin sodium GP

CEFOXITIN SODIUM-

DEXTROSE GP

cefpodoxime proxetil GP

cefprozil GP

ceftazidime injection GP

ceftazidime intravenous GP

ceftriaxone sodium in

dextrose GP

ceftriaxone sodium

injection GP

ceftriaxone sodium

intravenous GP

ceftriaxone sodium-

dextrose GP

cefuroxime axetil GP

cefuroxime sodium GP

cephalexin oral

suspension

reconstituted

GP

cephalexin oral tablet GP

chloramphenicol sod

succinate GP

ciprofloxacin hcl oral GP

ciprofloxacin in d5w GP

clarithromycin er GP

clarithromycin oral GP

clindamycin hcl oral GP

clindamycin palmitate

hcl GP

clindamycin phosphate

in d5w GP


injection GP


vaginal GP

colistimethate sodium

(cba) GP

8

Last Updated 1/1/22



oxacillin sodium GP

OXACILLIN SODIUM

IN DEXTROSE GP

paromomycin sulfate

oral GP

penicillin g potassium GP

penicillin g procaine GP

penicillin g sodium GP

penicillin v potassium GP

PFIZERPEN GP

piperacillin sod-

tazobactam so GP

polymyxin b sulfate

injection GP

silver sulfadiazine

external GP

SIVEXTRO SP PA

ssd GP

sulfadiazine oral GP

sulfamethoxazole-

trimethoprim GP

sulfatrim pediatric GP

tazicef injection GP

tazicef intravenous

solution reconstituted GP

tigecycline GP

tinidazole oral GP

tobramycin sulfate

injection GP

trimethoprim oral GP

vancomycin hcl


reconstituted 1 gm,

1.25 gm, 1.5 gm, 10

gm, 100 gm, 1000 mg,

5 gm, 500 mg, 750 mg

GP

vancomycin hcl oral

capsule GP ST

vancomycin hcl oral

solution reconstituted GP


lincomycin hcl injection GP

linezolid GP

linezolid in sodium

chloride GP

mafenide acetate

external GP

meropenem GP

methenamine hippurate GP

METRONIDAZOLE

BENZO+SYRSPEND GP

metronidazole in nacl GP

metronidazole oral GP

metronidazole vaginal GP

minocycline hcl er oral

tablet extended release

24 hour 105 mg, 115

mg, 55 mg, 65 mg, 80

mg

GP

PA

minocycline hcl oral

capsule GP

minocycline hcl oral

tablet GP PA

mondoxyne nl GP

morgidox oral GP

moxifloxacin hcl in nacl GP

mupirocin calcium GP

mupirocin external GP

nafcillin sodium GP

NAFCILLIN SODIUM

IN DEXTROSE GP

neomycin sulfate oral GP

neomycin-polymyxin b

gu GP

nitrofurantoin GP

nitrofurantoin

macrocrystal GP

nitrofurantoin

monohydrate

macrocrystals

GP

9

Last Updated 1/1/22



epitol GP

ethosuximide oral GP

fosphenytoin sodium GP

gabapentin oral GP

KEPPRA BP

lamotrigine er GP

lamotrigine oral kit GP

lamotrigine oral tablet GP

lamotrigine oral tablet

chewable GP

lamotrigine starter kit-

blue GP


green GP


orange GP

levetiracetam er GP

levetiracetam in nacl GP

levetiracetam

intravenous GP

levetiracetam oral GP

oxcarbazepine GP

pentobarbital sodium

injection GP

phenobarbital oral GP

phenobarbital sodium

injection GP

phenytoin infatabs GP

phenytoin oral

suspension 125 mg/5ml GP

phenytoin oral tablet

chewable GP

phenytoin sodium

extended GP

phenytoin sodium

injection GP

primidone oral GP

roweepra GP

rufinamide GP


vandazole GP

Anticoagulants

bivalirudin

trifluoroacetate GP

ELIQUIS BP

enoxaparin sodium SP

fondaparinux sodium SP

FRAGMIN SP

heparin (porcine) in

nacl intravenous

solution

GP

heparin sod (porcine) in

d5w GP

heparin sodium

(porcine) injection

solution

GP

heparin sodium

(porcine) pf GP

jantoven GP

warfarin sodium oral GP

XARELTO BP

XARELTO STARTER

PACK BP

Anticonvulsants -

Drugs for Seizures

BANZEL ORAL

SUSPENSION BP

BRIVIACT BP

carbamazepine er GP

carbamazepine oral GP

clobazam GP

DIACOMIT SP

diazepam rectal GP

DILANTIN BP

DILANTIN INFATABS BP

divalproex sodium er GP

divalproex sodium oral GP

EPIDIOLEX SP PA

10

Last Updated 1/1/22



bupropion hcl er (sr) GP QL

bupropion hcl er (xl)

oral tablet extended

release 24 hour 150

mg, 300 mg

GP

QL

bupropion hcl oral GP

chlordiazepoxide-

amitriptyline GP

citalopram

hydrobromide oral

solution

GP

citalopram

hydrobromide oral

tablet

GP

QL

desvenlafaxine

succinate er GP QL

doxepin hcl oral

capsule GP

doxepin hcl oral

concentrate GP

duloxetine hcl oral GP QL

escitalopram oxalate

oral solution GP

escitalopram oxalate

oral tablet GP QL

fluoxetine hcl (pmdd) GP QL

fluoxetine hcl oral

capsule 10 mg, 40 mg GP QL

fluoxetine hcl oral

capsule 20 mg GP

fluoxetine hcl oral

solution GP

fluoxetine hcl oral tablet

10 mg, 20 mg GP QL

fluoxetine hcl oral tablet

60 mg GP

fluvoxamine maleate GP QL

imipramine hcl oral GP

mirtazapine oral tablet GP

nefazodone hcl GP


subvenite GP

subvenite starter kit-

blue GP


green GP


orange GP

SYMPAZAN SP

TEGRETOL-XR BP

tiagabine hcl GP

topiramate er GP

topiramate oral GP

valproate sodium

intravenous GP

valproic acid oral GP

vigabatrin SP PA; QL

vigadrone SP PA; QL

VIMPAT BP

zonisamide oral GP

Antidementia Agents

- Drugs for

Alzheimer's Disease

and Dementia

donepezil hcl GP

EXELON BP

galantamine

hydrobromide GP

galantamine

hydrobromide er GP

memantine hcl er GP ST

memantine hcl oral

solution 2 mg/ml GP

memantine hcl oral

tablet GP

rivastigmine GP

rivastigmine tartrate GP

Antidepressants

amitriptyline hcl oral GP

amoxapine GP

11

Last Updated 1/1/22



metoclopramide hcl

oral GP

ondansetron hcl

injection GP

ondansetron hcl oral

solution GP QL


tablet 24 mg GP


tablet 4 mg, 8 mg GP QL

ondansetron odt GP QL

palonosetron hcl


0.25 mg/2ml

GP

palonosetron hcl


0.25 mg/5ml

GP

QL

palonosetron hcl


prefilled syringe

GP

perphenazine oral GP

prochlorperazine GP

prochlorperazine

edisylate injection GP

prochlorperazine

maleate oral GP

trimethobenzamide hcl

oral GP

Antifungals

amphotericin b

intravenous GP

caspofungin acetate GP

ciclodan GP

ciclopirox external GP

ciclopirox olamine

external GP

clotrimazole external GP

clotrimazole

mouth/throat GP


nortriptyline hcl oral GP

olanzapine-fluoxetine

hcl GP

paroxetine hcl oral

suspension GP

paroxetine hcl oral

tablet GP QL

paroxetine mesylate GP QL

perphenazine-

amitriptyline GP

phenelzine sulfate oral GP

sertraline hcl oral

concentrate GP

sertraline hcl oral tablet GP QL

SPRAVATO (56 MG

DOSE) SP PA

SPRAVATO (84 MG

DOSE) SP PA

tranylcypromine sulfate GP

trazodone hcl oral GP

trimipramine maleate

oral GP ST

venlafaxine hcl GP QL

venlafaxine hcl er GP QL

Antiemetics - Drugs

for Nausea and

Vomiting

aprepitant GP

compro GP

dimenhydrinate

injection GP

dronabinol GP

droperidol injection GP

fosaprepitant

dimeglumine GP

granisetron hcl GP

meclizine hcl oral tablet GP

metoclopramide hcl

injection GP

12

Last Updated 1/1/22



voriconazole oral GP

Antigout Agents

allopurinol oral GP

allopurinol sodium GP

ALOPRIM GP

colchicine oral tablet GP

colchicine-probenecid GP

febuxostat GP ST

KRYSTEXXA SP

probenecid GP

Antimigraine Agents

almotriptan malate GP ST; QL

dihydroergotamine

mesylate injection GP

dihydroergotamine

mesylate nasal GP QL

eletriptan hydrobromide GP ST; QL

frovatriptan succinate GP ST; QL

MIGERGOT GP

naratriptan hcl GP QL

rizatriptan benzoate GP QL

sumatriptan nasal GP QL

sumatriptan succinate

oral GP QL


refill GP QL


subcutaneous GP QL

VYEPTI SP PA

zolmitriptan oral GP QL

Antimyasthenic

Agents

neostigmine

methylsulfate


mg/10ml, 5 mg/10ml

GP


clotrimazole-

betamethasone GP

CRESEMBA SP PA

econazole nitrate

external GP ST

fluconazole in sodium

chloride GP

fluconazole oral GP

flucytosine oral GP

griseofulvin microsize

oral GP

griseofulvin

ultramicrosize GP

itraconazole oral

capsule GP QL

itraconazole oral

solution GP

ketoconazole external GP

ketoconazole oral GP

ketodan external foam GP

micafungin sodium GP

miconazole 3 GP

naftifine hcl external

cream GP ST

nyamyc GP

nystatin external GP

nystatin mouth/throat GP

nystatin oral GP

nystatin-triamcinolone

external cream GP

nystop GP

oxiconazole nitrate GP ST

posaconazole GP PA

tavaborole GP PA

terbinafine hcl oral GP

terconazole GP

voriconazole

intravenous GP

13

Last Updated 1/1/22



arsenic trioxide


mg/6ml

GP

ARZERRA SP PA

AVASTIN SP PA

AYVAKIT SP PA

azacitidine SP

BALVERSA SP PA

BAVENCIO SP

BELEODAQ SP PA

BELRAPZO SP PA

BENDEKA SP PA

bexarotene SP

bicalutamide GP

bleomycin sulfate GP

BLINCYTO SP PA

BORTEZOMIB SP

BOSULIF ORAL

TABLET 100 MG, 500

MG

SP

QL

BOSULIF ORAL

TABLET 400 MG SP

BRAFTOVI SP PA

BRUKINSA SP PA

busulfan GP

CABOMETYX ORAL

TABLET 20 MG SP QL

CABOMETYX ORAL

TABLET 40 MG, 60

MG

SP

capecitabine SP PA; QL

carboplatin GP

carmustine GP

cisplatin intravenous

solution GP

cladribine GP

clofarabine GP

COMETRIQ SP


NEOSTIGMINE

METHYLSULFATE

INTRAVENOUS

SOLUTION 5 MG/5ML

GP

pyridostigmine bromide

er GP


oral solution GP


oral tablet 60 mg GP

REGONOL GP

Antimycobacterials

dapsone oral GP

ethambutol hcl oral GP

isoniazid injection GP

isoniazid oral GP

pyrazinamide oral GP

rifabutin GP

rifampin intravenous GP

rifampin oral GP

Antineoplastics -

Drugs for Cancer

abiraterone acetate oral

tablet 250 mg SP PA; QL

abiraterone acetate oral

tablet 500 mg SP

ABRAXANE SP PA

ADCETRIS SP PA

adriamycin GP

AFINITOR ORAL

TABLET 10 MG SP PA; QL

AFINITOR ORAL

TABLET 2.5 MG, 5

MG, 7.5 MG

SP

QL

ALECENSA SP PA; QL

ALIQOPA SP

ALUNBRIG SP

anastrozole oral GP

ARRANON SP

14

Last Updated 1/1/22



FOLOTYN SP

GAZYVA SP PA

gemcitabine hcl GP

GILOTRIF SP PA; QL

HALAVEN SP PA

HERCEPTIN SP PA

HERCEPTIN

HYLECTA SP PA

hydroxyurea oral GP

IBRANCE ORAL

CAPSULE SP PA; QL

IBRANCE ORAL

TABLET SP QL

ICLUSIG ORAL

TABLET 10 MG, 30

MG

SP

ICLUSIG ORAL

TABLET 15 MG, 45

MG

SP

PA; QL

idarubicin hcl GP

IDHIFA SP PA

ifosfamide GP

imatinib mesylate GP PA; QL

IMBRUVICA ORAL

CAPSULE SP QL

IMFINZI SP

IMLYGIC SP PA

INLYTA SP QL

INREBIC SP

IRESSA SP QL

irinotecan hcl GP

ISTODAX (OVERFILL) SP PA

IXEMPRA KIT SP PA

JAKAFI SP QL

JEVTANA SP PA

KADCYLA SP PA


COPIKTRA SP PA

COTELLIC SP PA; QL

cyclophosphamide

injection GP

cyclophosphamide oral

capsule GP

CYRAMZA SP PA

cytarabine GP

cytarabine (pf) GP

dacarbazine GP

dactinomycin GP

DARZALEX SP PA

DARZALEX FASPRO SP PA

daunorubicin hcl GP

decitabine SP

dexrazoxane hcl GP

docetaxel GP

doxorubicin hcl GP

doxorubicin hcl

liposomal GP

EMPLICITI SP PA

ENHERTU SP PA

epirubicin hcl GP

ERBITUX SP PA

ERIVEDGE SP QL

erlotinib hcl GP PA; QL

ERWINASE SP PA

etoposide intravenous GP

etoposide oral GP

everolimus oral tablet

2.5 mg, 5 mg, 7.5 mg SP QL

EVOMELA SP

FARYDAK SP QL

floxuridine GP

fludarabine phosphate GP

fluorouracil intravenous GP

flutamide GP

15

Last Updated 1/1/22



MVASI SP PA

MYLOTARG SP

NERLYNX SP PA

NEXAVAR SP PA; QL

nilutamide GP PA

NINLARO SP QL

NUBEQA SP PA

ODOMZO SP QL

OGIVRI SP PA

ONIVYDE SP PA

ONTRUZANT SP PA

ONUREG SP

OPDIVO SP PA

oxaliplatin GP

paclitaxel GP

PADCEV SP PA

paraplatin GP

PEMAZYRE SP PA

PERJETA SP PA

PHESGO SP

PIQRAY SP PA

POLIVY SP PA

POMALYST SP

PORTRAZZA SP PA

PROLEUKIN SP

PURIXAN SP

QINLOCK SP

RETEVMO SP PA

REVLIMID SP PA; QL

RITUXAN HYCELA SP PA

ROMIDEPSIN SP PA

ROZLYTREK SP PA

SARCLISA SP PA

SPRYCEL SP PA; QL

STIVARGA SP QL

sunitinib malate SP PA; QL


KANJINTI

INTRAVENOUS

SOLUTION

RECONSTITUTED 420

MG

SP

PA

KEYTRUDA SP PA

KOSELUGO SP PA

KYPROLIS SP PA

lapatinib ditosylate SP PA; QL

LENVIMA ORAL

CAPSULE THERAPY

PACK 10 & 4 MG, 10

MG, 10 MG & 2 X 4

MG, 2 X 10 MG, 2 X 10

MG & 4 MG, 2 X 4 MG

SP

PA; QL

LENVIMA ORAL

CAPSULE THERAPY

PACK 3 X 4 MG, 4 MG

SP

PA

letrozole oral GP

leucovorin calcium

injection GP

leucovorin calcium oral GP

levoleucovorin calcium GP

levoleucovorin calcium

pf GP

LONSURF SP

LORBRENA SP PA

MARQIBO SP

MATULANE SP

MEKINIST SP PA; QL

MEKTOVI SP PA

melphalan GP

melphalan hcl GP

mercaptopurine oral GP

mesna GP

mitomycin intravenous SP PA

mitoxantrone hcl SP

MONJUVI SP

mutamycin SP PA

16

Last Updated 1/1/22



VALCHLOR SP

valrubicin SP

VALSTAR SP

VECTIBIX SP PA

VELCADE SP

VENCLEXTA SP

VENCLEXTA

STARTING PACK SP QL

VERZENIO SP PA

vinblastine sulfate GP

vincristine sulfate GP

vinorelbine tartrate GP

VITRAKVI SP PA

VIZIMPRO SP PA

VOTRIENT SP PA; QL

XALKORI SP PA; QL

XOFIGO SP

XOSPATA SP PA

XPOVIO (100 MG

ONCE WEEKLY) SP PA

XPOVIO (40 MG

ONCE WEEKLY) SP PA

XPOVIO (40 MG

TWICE WEEKLY) SP PA

XPOVIO (60 MG

ONCE WEEKLY) SP PA

XPOVIO (60 MG

TWICE WEEKLY) SP PA

XPOVIO (80 MG

ONCE WEEKLY) SP PA

XPOVIO (80 MG

TWICE WEEKLY) SP PA

XTANDI ORAL

CAPSULE SP QL

YERVOY SP PA

YONDELIS SP PA

YONSA SP

ZALTRAP SP PA


SYLVANT SP PA

SYNRIBO SP

TABRECTA SP PA

TAFINLAR SP PA; QL

TALZENNA SP PA

tamoxifen citrate oral GP

TARGRETIN ORAL SP

TASIGNA ORAL

CAPSULE 150 MG,

200 MG

SP

PA; QL

TASIGNA ORAL

CAPSULE 50 MG SP PA

TAZVERIK SP PA

TECARTUS

INTRAVENOUS

SUSPENSION

200000000 CELLS

SP

TECENTRIQ SP PA

temozolomide SP PA

THALOMID SP PA; QL

thiotepa injection GP

TIBSOVO SP PA

toposar GP

topotecan hcl SP

toremifene citrate GP

TRAZIMERA

INTRAVENOUS

SOLUTION

RECONSTITUTED 150

MG

SP

PA

TREANDA SP PA

tretinoin oral GP

TRODELVY SP PA

TRUXIMA SP PA

TUKYSA SP PA

TURALIO SP PA

UKONIQ SP PA

UNITUXIN SP PA

17

Last Updated 1/1/22



entacapone GP

GOCOVRI SP

INBRIJA SP PA

NEUPRO BP

NOURIANZ SP PA

pramipexole

dihydrochloride GP

pramipexole

dihydrochloride er GP

rasagiline mesylate oral GP

ropinirole hcl GP

selegiline hcl oral GP

trihexyphenidyl hcl GP

Antiplatelets

aspirin-dipyridamole er GP

BRILINTA BP

cilostazol GP

clopidogrel bisulfate

oral GP

dipyridamole oral GP

eptifibatide intravenous

solution 20 mg/10ml,

75 mg/100ml

GP

prasugrel hcl GP

Antipsychotics -

Drugs for Mood

Disorders

ABILIFY MAINTENA BP

ABILIFY MYCITE SP QL

ABILIFY MYCITE

MAINTENANCE KIT SP QL

ABILIFY MYCITE

STARTER KIT SP QL

aripiprazole oral

solution GP

aripiprazole oral tablet GP QL

aripiprazole oral tablet

dispersible GP QL

asenapine maleate GP QL


ZELBORAF SP QL

ZEPZELCA SP

ZOLINZA SP PA

ZYDELIG SP QL

ZYKADIA SP PA

Antiparasitics

atovaquone GP

atovaquone-proguanil

hcl GP

chloroquine phosphate

oral GP

crotan GP

DARAPRIM SP PA

hydroxychloroquine

sulfate oral GP

ivermectin external

lotion GP

ivermectin oral GP PA; QL

mefloquine hcl GP

nitazoxanide oral GP

permethrin external GP

praziquantel oral GP

primaquine phosphate GP

pyrimethamine oral SP PA

spinosad GP

sulfurated lime GP

Antiparkinson Agents

amantadine hcl oral GP

APOKYN SP PA

benztropine mesylate GP

bromocriptine mesylate

oral GP

carbidopa-levodopa GP

carbidopa-levodopa er GP

carbidopa-levodopa-

entacapone GP

DUOPA SP

18

Drug Name Drug Tier Notes Drug Name Drug Tier Notes

chlorpromazine hcl

injection GP

acyclovir sodium GP

adefovir dipivoxil GP PA

chlorpromazine hcl oral GP APTIVUS SP

clozapine GP atazanavir sulfate GP QL

fluphenazine

decanoate injection GP

CABENUVA SP PA

cidofovir intravenous GP fluphenazine hcl GP

COMPLERA SP haloperidol decanoate

intramuscular GP

CRIXIVAN SP

DELSTRIGO SP haloperidol lactate GP

DESCOVY SP haloperidol oral GP

DOVATO SP QL loxapine succinate GP

EDURANT SP molindone hcl GP

efavirenz GP NUPLAZID ORAL

TABLET SP

efavirenz-emtricitab-

tenofovir SP

olanzapine

intramuscular GP

efavirenz-lamivudine-

tenofovir GP

olanzapine oral tablet GP QL

emtricitabine SP paliperidone er GP QL

emtricitabine-tenofovir

df SP QL pimozide GP

quetiapine fumarate GP QL EMTRIVA SP

quetiapine fumarate er GP ST; QL entecavir SP PA

risperidone oral

solution GP

EPCLUSA SP PA; QL

etravirine SP QL risperidone oral tablet GP QL

EVOTAZ SP thioridazine hcl oral GP

famciclovir oral GP QL thiothixene GP

fosamprenavir calcium GP trifluoperazine hcl GP

foscarnet sodium GP PA ziprasidone hcl GP QL

FUZEON SP PA; QL ziprasidone mesylate GP

ganciclovir sodium GP Antivirals

GENVOYA SP abacavir sulfate SP

HARVONI SP PA; QL abacavir sulfate-

lamivudine SP

INTELENCE ORAL

TABLET 25 MG SP QL

abacavir-lamivudine-

zidovudine SP

INTRON A INJECTION

SOLUTION SP PA; QL

acyclovir external GP QL

acyclovir oral GP

Last Updated 1/1/22


19

Last Updated 1/1/22



rimantadine hcl GP

ritonavir GP

RUKOBIA SP

SELZENTRY ORAL

SOLUTION SP

SELZENTRY ORAL

TABLET SP QL

SOFOSBUVIR-

VELPATASVIR SP PA; QL

SOVALDI SP PA; QL

stavudine SP

STRIBILD SP QL

SYMTUZA SP

tenofovir disoproxil

fumarate SP PA; QL

TIVICAY SP

TIVICAY PD SP

TRIUMEQ SP

TYBOST SP

valacyclovir hcl oral GP QL

valganciclovir hcl GP

VIEKIRA PAK SP PA; QL

VIRACEPT SP

VIRAZOLE SP

VOSEVI SP PA; QL

ZEPATIER SP PA

zidovudine SP

Anxiolytics - Drugs

for Anxiety

alprazolam er GP

alprazolam intensol GP

alprazolam oral GP

alprazolam xr GP

buspirone hcl oral GP

chlordiazepoxide hcl GP

clonazepam oral GP


INTRON A INJECTION

SOLUTION

RECONSTITUTED

10000000 UNIT

SP

PA

INTRON A INJECTION

SOLUTION

RECONSTITUTED

18000000 UNIT,

50000000 UNIT

SP

PA; QL

INVIRASE SP QL

ISENTRESS SP

ISENTRESS HD SP

lamivudine oral solution SP

lamivudine oral tablet

100 mg GP

lamivudine oral tablet

150 mg, 300 mg SP

lamivudine-zidovudine SP

LEDIPASVIR-

SOFOSBUVIR SP PA; QL

lopinavir-ritonavir oral

solution SP

lopinavir-ritonavir oral

tablet SP PA

MAVYRET SP PA; QL

nevirapine SP

nevirapine er SP

ODEFSEY SP

oseltamivir phosphate

oral capsule GP QL

oseltamivir phosphate

oral suspension

reconstituted

GP

PEGASYS SP PA; QL

PIFELTRO SP

PREVYMIS ORAL SP PA

PREZCOBIX SP

PREZISTA SP QL

ribavirin inhalation SP

ribavirin oral SP PA

20

Last Updated 1/1/22



aminocaproic acid oral GP

anagrelide hcl GP

ARANESP (ALBUMIN

FREE) SP PA; QL

BENEFIX SP PA

COAGADEX SP

CORIFACT SP PA

ELOCTATE SP

EPOGEN SP PA; QL

FEIBA SP PA

FIBRYGA SP

GRANIX SP PA

HEMLIBRA SP

HEMOFIL M SP PA

hetastarch-nacl GP

HUMATE-P SP PA

IDELVION SP

IXINITY SP

KOATE SP PA

KOATE-DVI SP PA

KOGENATE FS SP PA

KOVALTRY SP PA

LEUKINE SP PA

LMD IN D5W GP

LMD IN NACL GP

MIRCERA SP

MONONINE SP PA

MOZOBIL SP PA

MULPLETA SP PA

NEULASTA SP PA; QL

NEULASTA ONPRO SP PA; QL

NEUPOGEN

INJECTION

SOLUTION

SP

PA


clorazepate

dipotassium GP

diazepam intensol GP

diazepam

intramuscular GP

diazepam oral GP

diazepam solution 5

mg/ml injection GP

DIAZEPAM SOLUTION

5 MG/ML INJECTION GP

estazolam GP QL

hydroxyzine hcl

intramuscular GP

hydroxyzine hcl oral GP

hydroxyzine pamoate

oral GP

lorazepam injection GP

lorazepam intensol GP

lorazepam oral

concentrate 2 mg/ml GP

lorazepam oral tablet GP

meprobamate GP

oxazepam GP

triazolam GP QL

Bipolar Agents -

Drugs for Mood

Disorders

lithium carbonate er GP

lithium carbonate oral GP

Blood Products and

Modifiers - Drugs for

Blood Disorders

ADVATE SP PA

AFSTYLA SP

ALPHANATE SP PA

ALPHANINE SD SP PA

ALPROLIX SP

aminocaproic acid

intravenous GP

21

Last Updated 1/1/22



adenosine intravenous

solution 12 mg/4ml, 6

mg/2ml

GP

aliskiren fumarate GP

alprostadil injection GP

amiloride hcl oral GP

amiloride-

hydrochlorothiazide GP

amiodarone hcl GP

amlodipine besylate

oral GP

amlodipine besylate-

benazepril hcl GP

amlodipine besylate-

valsartan GP

amlodipine-olmesartan GP

amlodipine-valsartan-

hctz GP

atenolol oral GP

atenolol-chlorthalidone GP

atorvastatin calcium

oral GP QL

benazepril hcl oral GP

bisoprolol fumarate oral GP

bisoprolol-


bumetanide GP

cartia xt GP

carvedilol GP

carvedilol phosphate er GP ST

chlorothiazide sodium GP

chlorthalidone GP

cholestyramine light GP

cholestyramine oral GP

clonidine GP QL

clonidine hcl oral GP

colesevelam hcl GP

colestipol hcl GP


NEUPOGEN

INJECTION

SOLUTION

PREFILLED SYRINGE

SP

PA; QL

NIVESTYM

INJECTION

SOLUTION

PREFILLED SYRINGE

SP

PA; QL

NOVOEIGHT SP PA

NOVOSEVEN RT SP PA

NPLATE SP PA

NUWIQ SP

OBIZUR SP

PROCRIT SP PA; QL

PROFILNINE SP

PROMACTA ORAL

TABLET SP PA; QL

protamine sulfate

intravenous GP

RECOMBINATE SP PA

RIASTAP SP

RIXUBIS SP

SOLIRIS SP PA

TAVALISSE SP PA

TRETTEN SP

ULTOMIRIS SP PA

VONVENDI SP

WILATE SP PA

XYNTHA SP PA

XYNTHA SOLOFUSE SP PA

ZARXIO SP PA

ZIEXTENZO SP PA; QL

Cardiovascular

Agents - Drugs for

Heart and Circulation

Conditions

acebutolol hcl oral GP

acetazolamide sodium GP

22

Last Updated 1/1/22



EPINEPHRINE-

DEXTROSE

INTRAVENOUS

SOLUTION

GP

EPINEPHRINE-NACL

INTRAVENOUS

SOLUTION 2-0.9

MG/250ML-%

GP

EPINEPHRINE-NACL

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

GP

eplerenone GP

esmolol hcl intravenous

solution 100 mg/10ml GP

esmolol hcl-sodium

chloride GP

ethacrynic acid GP

ezetimibe GP

ezetimibe-simvastatin GP QL

felodipine er GP

fenofibrate micronized GP

fenofibrate oral capsule

134 mg, 200 mg, 67 mg GP

fenofibrate oral tablet GP

fenofibric acid GP

flecainide acetate GP

fluvastatin sodium GP PA; QL

fosinopril sodium GP

furosemide injection GP

furosemide oral GP

gemfibrozil oral GP

guanfacine hcl GP

HEMANGEOL SP

hydralazine hcl

injection GP

hydralazine hcl oral GP

hydrochlorothiazide

oral GP


digitek GP

digox GP

digoxin injection GP

digoxin oral GP

diltiazem hcl er beads GP

diltiazem hcl er coated

beads GP

diltiazem hcl

intravenous GP

diltiazem hcl oral GP

disopyramide

phosphate GP

dobutamine hcl GP

dobutamine in d5w GP

dofetilide GP

dopamine hcl

intravenous GP

dopamine in d5w GP

doxazosin mesylate

oral GP QL

droxidopa SP PA

enalapril maleate oral GP

enalaprilat GP

enalapril-


ENTRESTO BP QL

ephedrine sulfate

intravenous solution GP PA

EPINEPHRINE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.1 MG/10ML

GP

epinephrine


prefilled syringe 1

mg/10ml

GP

epinephrine pf GP

23

Last Updated 1/1/22



milrinone lactate in

dextrose GP

minitran transdermal

patch 24 hour 0.1

mg/hr

GP

minoxidil oral GP

MULTAQ BP

nebivolol hcl GP

niacin

(antihyperlipidemic) GP

niacin er

(antihyperlipidemic) GP

niacor GP

nicardipine hcl GP

nifedipine er GP

nifedipine er osmotic

release GP

nifedipine oral GP

nimodipine oral GP

NITRO-BID GP

nitroglycerin GP

nitroglycerin in d5w GP

nitroprusside sodium GP

NITROSTAT BP

norepinephrine

bitartrate intravenous GP

NOREPINEPHRINE-

DEXTROSE

INTRAVENOUS

SOLUTION 4-5

MG/250ML-%

GP

NOREPINEPHRINE-

SODIUM CHLORIDE

INTRAVENOUS

SOLUTION 4-0.9

MG/250ML-%

GP

olmesartan medoxomil

oral GP

olmesartan medoxomil-

hctz GP


ibutilide fumarate GP

icosapent ethyl GP

indapamide GP

irbesartan GP

irbesartan-


isosorbide mononitrate GP

isosorbide mononitrate

er GP

JUXTAPID SP PA

LABETALOL HCL

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

GP

labetalol hcl oral GP

labetalol hcl solution 5

mg/ml intravenous GP

LABETALOL HCL

SOLUTION 5 MG/ML

INTRAVENOUS

GP

lisinopril oral GP

lisinopril-


losartan potassium oral GP

losartan potassium-hctz GP

lovastatin oral GP PA; QL

mannitol intravenous GP

matzim la GP

methyldopa GP

metolazone GP

metoprolol succinate er GP

metoprolol tartrate

intravenous GP

metoprolol tartrate oral GP

metyrosine GP

mexiletine hcl oral GP

midodrine hcl GP

milrinone lactate GP

24

Last Updated 1/1/22



spironolactone oral GP

spironolactone-hctz GP

taztia xt GP

TEKTURNA HCT BP

telmisartan GP

telmisartan-amlodipine GP

tiadylt er GP

TIKOSYN BP

torsemide GP

trandolapril GP

trandolapril-verapamil

hcl er GP

triamterene-hctz GP

valsartan GP

valsartan-


VARITHENA SP

verapamil hcl er GP

verapamil hcl

intravenous GP

verapamil hcl oral GP

VYNDAMAX SP PA

VYNDAQEL SP PA

WELCHOL BP

ZETIA BP

Central Nervous

System Agents -

Drugs for Attention

Deficit Disorder

amphetamine sulfate GP

amphetamine-

dextroamphetamine GP

amphetamine-

dextroamphetamine er GP

atomoxetine hcl GP

dexmethylphenidate hcl GP

dextroamphetamine

sulfate oral solution GP


olmesartan-amlodipine-

hctz GP

omega-3-acid ethyl

esters GP

PACERONE GP

pentoxifylline er GP

phenoxybenzamine hcl

oral GP

phentolamine mesylate

injection GP

phenylephrine hcl


mg/ml

GP

pindolol GP

pravastatin sodium GP QL

prazosin hcl oral GP

prevalite GP

procainamide hcl

injection GP

propafenone hcl GP

propafenone hcl er GP

propranolol hcl er GP

propranolol hcl

intravenous GP

propranolol hcl oral GP

quinapril hcl GP

quinapril-


quinidine gluconate er GP

quinidine sulfate GP

ramipril GP

ranolazine er GP

rosuvastatin calcium GP QL

simvastatin oral GP QL

sodium nitroprusside GP

sorine GP

sotalol hcl (af) GP

sotalol hcl oral GP

25

Drug Name Drug Tier Notes Drug Name Drug Tier Notes

guanfacine hcl er GP INGREZZA ORAL

CAPSULE SP PA; QL

methylphenidate hcl er GP

INGREZZA ORAL

CAPSULE THERAPY

PACK

SP

PA

methylphenidate hcl er

(cd) GP

methylphenidate hcl

oral GP

pancuronium bromide GP

phendimetrazine

tartrate GP PA PROCENTRA GP

relexxii GP phendimetrazine

tartrate er GP

Central Nervous

System Agents -

Drugs for Multiple

Sclerosis

phentermine hcl oral

capsule GP

phentermine hcl oral

tablet GP PA AMPYRA SP PA; QL

AVONEX PEN SP PA; QL pregabalin GP

AVONEX PREFILLED SP PA; QL pregabalin er GP PA

BAFIERTAM SP QL RADICAVA SP PA

BETASERON SP PA; QL riluzole GP PA

COPAXONE SP PA; QL rocuronium bromide


dalfampridine er SP PA; QL

dimethyl fumarate oral SP PA; QL succinylcholine chloride

injection solution GP

dimethyl fumarate

starter pack SP PA; QL

TEGSEDI SP PA

glatiramer acetate SP PA; QL tetrabenazine SP PA; QL

glatopa SP PA; QL vecuronium bromide


reconstituted

GP

KESIMPTA SP

VUMERITY SP PA; QL

VYLEESI SP PA Central Nervous

System Agents -

Miscellaneous

Dental and Oral

Agents - Drugs for

Mouth and Throat

Conditions

atracurium besylate GP

benzphetamine hcl GP cavarest GP

caffeine citrate GP chlorhexidine gluconate

mouth/throat GP

cisatracurium besylate GP

cisatracurium besylate

(pf) GP

easygel GP

FIRST-MOUTHWASH

BLM GP

diethylpropion hcl er GP

diethylpropion hcl oral GP fluoridex daily renewal GP

IMCIVREE SP PA KEPIVANCE SP PA

Last Updated 1/1/22


26

Last Updated 1/1/22



benzoyl peroxide-

erythromycin GP

beser external lotion GP

betamethasone

dipropionate aug GP

betamethasone

dipropionate external GP

betamethasone

valerate external GP

calcipotriene external

cream GP PA; QL


ointment GP PA


solution GP PA

calcipotriene-betameth

diprop external

ointment

GP

PA

CALCITRENE GP PA

calcitriol external GP

claravis GP PA

clindacin etz external

swab GP

clindacin-p GP


external GP

clindamycin-tretinoin GP PA

clobetasol prop

emollient base GP QL

clobetasol propionate e GP QL

clobetasol propionate

emulsion GP QL


external cream GP QL


external foam GP QL


external gel GP QL


external ointment GP QL


lidocaine viscous hcl GP

oralone GP

periogard GP

pilocarpine hcl oral GP

sf GP

sf 5000 plus GP

sodium fluoride 5000

enamel GP


plus GP


ppm GP


sensitive GP

sodium fluoride dental GP

triamcinolone acetonide

mouth/throat GP

Dermatological

Agents - Drugs for

Skin Conditions

accutane GP PA

acitretin GP

adapalene external

cream GP ST

adapalene external gel GP ST

ADAPALENE

EXTERNAL PAD GP ST

ADAPALENE

EXTERNAL

SOLUTION

GP

ST

ala-cort GP

alclometasone

dipropionate GP

amcinonide GP

ammonium lactate

external GP

amnesteem GP PA

APEXICON E GP

azelaic acid external GP ST

27

Last Updated 1/1/22



fluocinonide emulsified

base GP

fluocinonide external

gel GP QL


ointment GP QL


solution GP

fluorouracil external

cream 5 % GP

fluorouracil external

solution GP

flurandrenolide external

cream GP ST

flurandrenolide external

lotion GP

fluticasone propionate

external GP

halobetasol propionate

external cream GP

halobetasol propionate

external ointment GP

hydrocortisone butyr

lipo base GP

hydrocortisone butyrate

external cream GP




external solution GP

hydrocortisone external

cream 1 %, 2.5 % GP


lotion 2.5 % GP


ointment 1 %, 2.5 % GP

hydrocortisone valerate GP

imiquimod external GP

isotretinoin oral GP PA

lactic acid e GP



external shampoo GP QL


external solution GP QL

clodan external

shampoo GP QL

desonide external

cream GP ST; QL

desonide external gel GP ST

desonide external lotion GP

desonide external

ointment GP ST

desoximetasone

external cream GP ST

desoximetasone

external gel GP ST

desoximetasone

external liquid GP

desoximetasone

external ointment 0.05

%

GP

desoximetasone

external ointment 0.25

%

GP

ST

desrx GP ST

diflorasone diacetate

external cream GP

diflorasone diacetate

external ointment GP ST

DUPIXENT SP PA

ery GP

ERYGEL GP

erythromycin external GP

fluocinolone acetonide

body GP


external GP


scalp GP

28

Last Updated 1/1/22



Diabetes -

Antidiabetic Agents

acarbose oral GP

BYDUREON BCISE

AUTOINJECTOR BP

BYETTA 10 MCG PEN BP

BYETTA 5 MCG PEN BP

FARXIGA BP ST; QL

glimepiride GP

glipizide er GP

glipizide ir GP

glipizide xl GP

glipizide-metformin hcl GP

glyburide micronized GP

glyburide oral GP

glyburide-metformin GP

GLYXAMBI BP ST; QL

JANUMET BP QL

JANUMET XR BP QL

JANUVIA BP QL

JARDIANCE BP ST; QL

JENTADUETO BP QL

JENTADUETO XR BP QL

metformin hcl er GP

metformin hcl er (mod) GP PA

metformin hcl er (osm) GP PA

metformin hcl ir GP

miglitol GP

nateglinide GP

OZEMPIC BP

pioglitazone hcl GP QL

pioglitazone hcl-

glimepiride GP QL

pioglitazone hcl-

metformin hcl GP PA; QL

repaglinide GP

RYBELSUS BP


lactic acid external GP

methoxsalen rapid GP QL

metronidazole external GP

mometasone furoate

external GP

myorisan GP PA

neuac external gel GP ST

nolix external cream GP ST

nolix external lotion GP

podofilox external GP

prednicarbate GP

rosadan external cream GP

rosadan external gel GP

selenium sulfide

external lotion GP

sulfacetamide sodium

(acne) GP

tacrolimus external GP QL

tazarotene external

cream GP

tovet external foam GP QL

tretinoin external GP PA


external aerosol

solution

GP

PA; QL


external cream GP


external lotion GP



triamcinolone in

absorbase GP

TRI-CHLOR GP

triderm GP

tritocin GP

VEREGEN SP

zenatane GP PA

29

Last Updated 1/1/22



CONTOUR NEXT

TEST STRIPS BP

CONTOUR TEST

STRIPS BP

DEXCOM G4 SENSOR BP

DEXCOM G5 MOB/G4

PLAT SENSOR BP

DEXCOM G6 SENSOR BP

ENLITE GLUCOSE

SENSOR BP

EVERSENSE

SENSOR/HOLDER BP

FREESTYLE LIBRE 14

DAY READER BP

FREESTYLE LIBRE 14

DAY SENSOR BP

FREESTYLE LIBRE 2

READER BP

FREESTYLE LIBRE 2

SENSOR BP

FREESTYLE LIBRE

READER BP

GUARDIAN SENSOR

(3) BP

GUARDIAN SENSOR

3 BP

ONETOUCH ULTRA

TEST STRIPS BP

ONETOUCH VERIO

TEST STRIPS BP

Diabetes - Glycemic

Agents

BAQSIMI ONE PACK BP

BAQSIMI TWO PACK BP

diazoxide oral GP

glucagon emergency kit

injection kit GP

Diabetes - Insulins

AFREZZA BP

HUMALOG BP


SOLIQUA BP ST; QL

SYMLINPEN 120 BP QL

SYMLINPEN 60 BP QL

SYNJARDY BP ST; QL

SYNJARDY XR BP ST; QL

tolbutamide oral tablet

500 mg GP

TRADJENTA BP QL

TRULICITY

SUBCUTANEOUS

SOLUTION PEN-

INJECTOR 0.75

MG/0.5ML, 3

MG/0.5ML, 4.5

MG/0.5ML

BP

TRULICITY

SUBCUTANEOUS

SOLUTION PEN-

INJECTOR 1.5

MG/0.5ML

BP

QL

VICTOZA BP

XIGDUO XR ORAL

TABLET EXTENDED

RELEASE 24 HOUR

10-1000 MG, 10-500

MG, 5-1000 MG, 5-500

MG

BP

ST; QL

XIGDUO XR ORAL

TABLET EXTENDED

RELEASE 24 HOUR

2.5-1000 MG

BP

ST

Diabetes - Glucose

Monitoring

CONTOUR MONITOR

DEVICE BP

CONTOUR NEXT EZ

KIT W/DEVICE BP

CONTOUR NEXT LINK

KIT W/DEVICE BP

CONTOUR NEXT

MONITOR KIT

W/DEVICE

BP

30

Last Updated 1/1/22



calcium chloride

solution 10 %

intravenous

GP

calcium gluconate

intravenous GP

CARBAGLU SP

cardioplegic GP

chromic chloride

intravenous GP

CUPRIC CHLORIDE GP

curity sterile saline GP

cyanocobalamin


mcg/ml

GP

deferasirox SP PA

deferasirox granules SP PA

deferiprone GP

DEXTROSE

5%/ELECTROLYTE

#48

GP

dextrose in lactated

ringers GP


solution 10 %, 20 %, 30

%, 40 %, 5 %, 70 %

GP

DEXTROSE

SOLUTION 250

MG/ML

INTRAVENOUS

GP

dextrose solution 250

mg/ml intravenous GP

DEXTROSE

SOLUTION 50 %

INTRAVENOUS

GP

dextrose solution 50 %

intravenous GP

dextrose-nacl GP

dextrose-sodium

chloride GP

effer-k oral tablet

effervescent 25 meq GP


HUMALOG KWIKPEN BP

HUMALOG MIX 50/50

KWIKPEN BP

HUMALOG MIX 50/50

VIAL BP

HUMALOG MIX 75/25

KWIKPEN BP

HUMALOG MIX 75/25

VIAL BP

HUMULIN 70/30

KWIKPEN BP

HUMULIN 70/30 VIAL BP

HUMULIN N KWIKPEN BP

HUMULIN N VIAL BP

HUMULIN R U-500

KWIKPEN BP

HUMULIN R U-500

VIAL BP

HUMULIN R VIAL BP

LANTUS SOLOSTAR BP

LANTUS U-100 VIAL BP

LEVEMIR U-100

FLEXTOUCH BP ST

LEVEMIR U-100 VIAL BP ST

LYUMJEV KWIKPEN BP

LYUMJEV VIAL BP

TOUJEO MAX

SOLOSTAR BP

TOUJEO SOLOSTAR BP

TRESIBA BP

TRESIBA

FLEXTOUCH BP

Electrolytes / Minerals

/ Metals / Vitamins

argyle sterile saline GP

argyle sterile water GP

CALCIUM CHLORIDE

SOLUTION 10 %

INTRAVENOUS

GP

31

Last Updated 1/1/22



k-prime GP

K-TAB ORAL TABLET

EXTENDED RELEASE

8 MEQ

GP

lactated ringers GP

levocarnitine oral

solution GP

levocarnitine oral tablet GP

levocarnitine sf GP

l-methylfolate GP

l-methylfolate calcium

oral GP

l-methylfolate forte GP

l-methylfolate-algae GP

l-methyl-mc nac GP

magnesium chloride

injection GP

magnesium sulfate

injection GP

magnesium sulfate

intravenous GP

MANGANESE

CHLORIDE GP

MEPHYTON BP

METAFOLBIC PLUS GP

mifepristone GP

monoject flush syringe GP

monoject sodium

chloride flush GP

na ferric gluc cplx in

sucrose GP

nafrinse GP

nafrinse drops GP

normal saline flush GP

PHOSPHA 250

NEUTRAL GP

phosphorous GP

phospho-trin 250

neutral GP


ELFOLATE ORAL

TABLET 7.5 MG GP

ergocalciferol oral

capsule GP

FERRIPROX ORAL

SOLUTION SP

FERRIPROX ORAL

TABLET 1000 MG SP

FERRIPROX TWICE-

A-DAY SP

ferumoxytol GP

fluoritab GP

folic acid injection GP

folic acid oral tablet 1

mg GP

hematinic/folic acid GP

hemocyte-f GP

hydroxocobalamin

acetate GP

iodine strong oral GP

JADENU SP PA

JYNARQUE ORAL

TABLET SP PA; QL

JYNARQUE ORAL

TABLET THERAPY

PACK 15 MG

SP

PA; QL

JYNARQUE ORAL

TABLET THERAPY

PACK 30 & 15 MG, 45

& 15 MG, 60 & 30 MG,

90 & 30 MG

SP

PA

kcl in dextrose-nacl GP

kcl-lactated ringers-d5w GP

klor-con GP

klor-con 10 GP

klor-con m10 GP

klor-con m15 GP

klor-con m20 GP

klor-con/ef GP

32

Last Updated 1/1/22



sodium chloride (pf) GP

sodium chloride

bacteriostatic GP

sodium chloride flush GP

sodium chloride

injection GP

sodium chloride

intravenous GP

sodium chloride

irrigation GP

sodium fluoride oral

solution 1.1 (0.5 f)

mg/ml

GP


tablet GP


tablet chewable GP

sodium polystyrene

sulfonate GP

sps GP

sterile water for

irrigation GP

thiamine hcl injection GP

tis-u-sol GP

TOLVAPTAN ORAL


tolvaptan oral tablet 30

mg SP PA; QL

virt-phos 250 neutral GP

vitamin d

(ergocalciferol) oral

capsule 1.25 mg

(50000 ut)

GP

vitamin k1 injection GP

vp-pnv-dha GP

water for irrigation,

sterile GP

ZINC CHLORIDE

INTRAVENOUS GP


phytonadione injection GP

phytonadione oral GP

potassium acetate

intravenous GP

potassium chloride crys

er GP

potassium chloride er GP

potassium chloride in

dextrose GP

potassium chloride in

nacl GP

potassium chloride

intravenous GP

potassium chloride oral

packet GP

potassium chloride oral

solution 20 meq/15ml

(10%), 40 meq/15ml

(20%)

GP

potassium citrate er GP

potassium

phosphates(71 meq k) GP

prenatal oral tablet 27-1

mg GP

prenatal plus iron GP

prenatal vitamin plus

low iron GP

preplus GP

pyridoxine hcl injection GP

RELNATE DHA GP

ringers GP

ringers irrigation GP

saline bacteriostatic GP

SAMSCA ORAL


sod citrate-citric acid GP

sodium acetate

intravenous GP

sodium bicarbonate

intravenous GP

33

Last Updated 1/1/22



omeprazole oral

capsule delayed

release 40 mg

GP

PA

OMEPRAZOLE+SYRS

PEND SF ALKA GP PA

pantoprazole sodium

intravenous GP PA

pantoprazole sodium

oral packet GP PA

pantoprazole sodium

oral tablet delayed

release 20 mg

GP

QL

pantoprazole sodium

oral tablet delayed

release 40 mg

GP

rabeprazole sodium

oral tablet delayed

release

GP

sucralfate oral GP

Gastrointestinal

Agents - Drugs for

Bowel, Intestine and

Stomach Conditions

alosetron hcl GP

alvimopan GP

AMITIZA BP

amoxicill-clarithro-

lansopraz GP QL

atropine sulfate


mg/20ml

GP

atropine sulfate

injection solution

prefilled syringe

GP

atropine sulfate


ATROPINE SULFATE

INTRAVENOUS

SOLUTION

PREFILLED SYRINGE

0.8 MG/2ML

GP

CHENODAL SP


Gastrointestinal

Agents - Drugs for

Acid Reflux and Ulcer

cimetidine hcl GP

cimetidine oral GP

esomeprazole

magnesium oral

capsule delayed

release 20 mg

GP

QL

esomeprazole

magnesium oral

capsule delayed

release 40 mg

GP

esomeprazole sodium GP

famotidine intravenous GP

famotidine oral

suspension

reconstituted

GP

famotidine oral tablet

20 mg, 40 mg GP

famotidine premixed GP

FIRST-

LANSOPRAZOLE GP PA

FIRST-OMEPRAZOLE GP PA

lansoprazole oral

capsule delayed

release 15 mg

GP

QL

lansoprazole oral

capsule delayed

release 30 mg

GP

lansoprazole oral tablet

delayed release

dispersible 15 mg

GP

PA; QL

lansoprazole oral tablet

delayed release

dispersible 30 mg

GP

PA

misoprostol oral GP

nizatidine oral solution GP

omeprazole oral

capsule delayed

release 10 mg, 20 mg

GP

PA; QL

34

Last Updated 1/1/22



peg-

3350/electrolytes/ascor

bat

GP

peg-kcl-nacl-nasulf-na

asc-c GP

peg-prep GP

SEROSTIM SP PA

sodium bicarbonate

oral powder GP

TRULANCE BP

ursodiol oral capsule

300 mg GP

ursodiol oral tablet GP

ZORBTIVE SP PA

Genetic or Enzyme

Disorder - Drugs for

Replacement,

Modification,

Treatment

ALDURAZYME SP

BUPHENYL ORAL

TABLET BP

CERDELGA SP PA

CEREZYME SP PA

CHOLBAM ORAL

CAPSULE 250 MG SP

CHOLBAM ORAL

CAPSULE 50 MG SP QL

CREON BP

CYSTADANE SP

CYSTAGON SP PA

ELAPRASE SP

ELELYSO SP PA

EXONDYS 51 SP PA

FABRAZYME SP PA

GALAFOLD SP PA

KANUMA SP

KUVAN SP PA

LUMIZYME SP


chlordiazepoxide-

clidinium GP

constulose GP

cromolyn sodium oral GP

dicyclomine hcl

intramuscular GP

dicyclomine hcl oral GP

diphenoxylate-atropine GP

enulose GP

GATTEX SP

gavilyte-c GP

gavilyte-g GP

gavilyte-n with flavor

pack GP

generlac GP

glycopyrrolate injection

solution GP

glycopyrrolate oral GP

glycopyrrolate pf

injection solution

prefilled syringe 0.4

mg/2ml

GP

hyoscyamine sulfate

oral GP

hyoscyamine sulfate sl GP

hyoscyamine sulfate

sublingual GP

hyosyne GP

lactulose GP

lactulose

encephalopathy GP

LINZESS BP

loperamide hcl oral

capsule GP

LUBIPROSTONE BP

peg 3350-kcl-na bicarb-

nacl GP

peg-3350/electrolytes GP

35

Last Updated 1/1/22



darifenacin

hydrobromide er GP ST

ELMIRON BP

flavoxate hcl GP

glycine irrigation GP

glycine urologic GP

lanthanum carbonate GP

MYRBETRIQ ORAL

TABLET EXTENDED

RELEASE 24 HOUR

BP

OXLUMO SP PA

oxybutynin chloride er GP

oxybutynin chloride oral GP

penicillamine oral tablet GP

phenazo oral tablet 200

mg GP

phenazopyridine hcl

oral tablet 100 mg, 200

mg

GP

sevelamer carbonate GP

sevelamer hcl GP

sildenafil citrate oral

tablet 100 mg, 25 mg,

50 mg

GP

PA

solifenacin succinate GP ST

tiopronin oral GP PA

tolterodine tartrate GP

tolterodine tartrate er GP

trospium chloride GP

trospium chloride er GP

vardenafil hcl GP

Genitourinary Agents

- Drugs for Prostate

Conditions

alfuzosin hcl er GP

dutasteride oral GP

dutasteride-tamsulosin

hcl GP


miglustat SP PA; QL

MYALEPT SP

NAGLAZYME SP

nitisinone SP PA

OCALIVA SP PA; QL

ORFADIN ORAL

CAPSULE 10 MG, 2

MG, 5 MG

SP

PA

ORFADIN ORAL

CAPSULE 20 MG SP

ORFADIN ORAL

SUSPENSION SP

PROCYSBI SP PA

RAVICTI SP

sapropterin

dihydrochloride GP PA

sod benz-sod

phenylacet GP

sodium phenylbutyrate

oral GP

STRENSIQ SP PA

SUCRAID SP PA

VIMIZIM SP

VPRIV SP PA

VYONDYS 53 SP PA

XURIDEN SP

ZOLGENSMA SP PA

Genitourinary Agents

- Drugs for Bladder,

Genital and Kidney

Conditions

acetic acid irrigation GP

bethanechol chloride

oral GP

calcium acetate (phos

binder) GP

calcium acetate oral

tablet 667 mg GP

36

Last Updated 1/1/22



prednisolone sodium

phosphate oral solution GP

prednisone intensol GP

prednisone oral GP


injection suspension 40

mg/ml

GP

Hormonal Agents -

Men's Health

AVEED SP

danazol oral GP

methyltestosterone oral GP

oxandrolone oral GP

TESTOPEL SP

testosterone cypionate

intramuscular GP

testosterone enanthate

intramuscular GP

testosterone

transdermal GP

Hormonal Agents -

Osteoporosis

raloxifene hcl GP

Hormonal Agents -

Pituitary

ACTHAR SP PA

cabergoline GP QL

CETROTIDE SP PA

CHORIONIC

GONADOTROPIN

INTRAMUSCULAR

SP

PA; QL

clomiphene citrate oral GP

desmopressin ace

spray refrig GP

desmopressin acetate

injection SP


oral GP


pf SP


finasteride oral tablet 5

mg GP

silodosin GP ST

tamsulosin hcl GP

terazosin hcl GP QL

Hormonal Agents -

Adrenal

betamethasone sod

phos & acet injection

suspension 6 (3-3)

mg/ml

GP

DECADRON ORAL

TABLET 0.5 MG GP

dexamethasone

intensol GP

dexamethasone oral

elixir GP

dexamethasone oral

solution GP

dexamethasone oral

tablet GP

dexamethasone sod

phosphate pf injection

solution

GP

dexamethasone

sodium phosphate

injection

GP

fludrocortisone acetate

oral GP

hydrocortisone oral GP

methylprednisolone

acetate injection

suspension 40 mg/ml,

80 mg/ml

GP

methylprednisolone

oral GP

methylprednisolone

sodium succ GP

MILLIPRED GP

prednisolone oral

solution GP

37

Last Updated 1/1/22



LUPRON DEPOT (1-

MONTH) SP PA; QL

LUPRON DEPOT (3-

MONTH) SP PA; QL

LUPRON DEPOT (4-

MONTH)

INTRAMUSCULAR KIT

30MG

SP

PA; QL

LUPRON DEPOT (6-

MONTH)

INTRAMUSCULAR KIT

45MG

SP

PA; QL

LUPRON DEPOT-PED

(1-MONTH) SP PA; QL

LUPRON DEPOT-PED

(3-MONTH) SP PA; QL

MENOPUR SP PA

MYCAPSSA SP PA

NORDITROPIN

FLEXPRO SP PA; QL

NOVAREL SP PA; QL

NUTROPIN AQ

NUSPIN 10 SP PA

NUTROPIN AQ

NUSPIN 20 SP PA

NUTROPIN AQ

NUSPIN 5 SP PA

octreotide acetate SP PA

OMNITROPE

SUBCUTANEOUS

SOLUTION

RECONSTITUTED

SP

PA

OVIDREL SP PA

oxytocin injection GP

PREGNYL SP PA; QL

SAIZEN SP PA

SAIZENPREP SP PA

SIGNIFOR SP

SOMATULINE DEPOT SP PA; QL

SOMAVERT SP PA



spray GP

ELIGARD

SUBCUTANEOUS KIT

22.5 MG, 30 MG, 45

MG

SP

PA; QL

ELIGARD

SUBCUTANEOUS KIT

7.5 MG

SP

PA

FENSOLVI (6 MONTH) SP PA

FIRMAGON SP

FIRMAGON (240 MG

DOSE) SP

FOLLISTIM AQ SP PA

ganirelix acetate SP PA

GENOTROPIN SP

GENOTROPIN

MINIQUICK

SUBCUTANEOUS

SOLUTION

RECONSTITUTED 0.2

MG, 0.4 MG, 0.6 MG,

0.8 MG, 1.2 MG, 1.4

MG, 1.6 MG, 1.8 MG, 2

MG

SP

GENOTROPIN

MINIQUICK

SUBCUTANEOUS

SOLUTION

RECONSTITUTED 1

MG

SP

PA

GONAL-F SP PA

GONAL-F RFF SP PA

GONAL-F RFF

REDIJECT SP PA

HUMATROPE SP

INCRELEX SP PA

ISTURISA SP PA

leuprolide acetate

injection SP PA

LUPANETA PACK SP PA

38

Last Updated 1/1/22



camrese lo GP

caziant GP

charlotte 24 fe GP

chateal GP

chateal eq GP

COMBIPATCH BP

CRINONE SP

cryselle-28 GP

cyclafem 1/35 GP

cyclafem 7/7/7 GP

cyred GP

cyred eq GP

dasetta 1/35 GP

dasetta 7/7/7 GP

daysee GP

deblitane GP

delyla GP

desogestrel-ethinyl

estradiol GP

dolishale GP

dotti GP QL

drospiren-eth estrad-

levomefol GP

drospirenone-ethinyl

estradiol GP

elinest GP

eluryng GP

emoquette GP

ENDOMETRIN SP

enpresse-28 GP

enskyce GP

errin GP

estarylla GP

estradiol oral GP

estradiol transdermal

patch twice weekly GP QL


STIMATE SP

SUPPRELIN LA SP

TEPEZZA SP PA

ZOLADEX SP

ZOMACTON SP

ZOMACTON (FOR

ZOMA-JET 10) SP

Hormonal Agents -

Sex Hormones and

Birth Control

afirmelle GP

altavera GP

alyacen 1/35 GP

alyacen 7/7/7 GP

amabelz GP

amethia GP

amethyst GP

apri GP

aranelle GP

ashlyna GP

aubra GP

aubra eq GP

aurovela 1.5/30 GP

aurovela 1/20 GP

aurovela 24 fe GP

aurovela fe 1.5/30 GP

aurovela fe 1/20 GP

aviane GP

ayuna GP

azurette GP

balziva GP

blisovi 24 fe GP

blisovi fe 1.5/30 GP

blisovi fe 1/20 GP

briellyn GP

camila GP

camrese GP

39

Last Updated 1/1/22



jasmiel GP

jencycla GP

jinteli GP

jolessa GP

juleber GP

junel 1.5/30 GP

junel 1/20 GP

junel fe 1.5/30 GP

junel fe 1/20 GP

junel fe 24 GP

kaitlib fe GP

kalliga GP

kariva GP

kelnor 1/35 GP

kelnor 1/50 GP

kurvelo GP

KYLEENA SP

larin 1.5/30 GP

larin 1/20 GP

larin 24 fe GP

larin fe 1.5/30 GP

larin fe 1/20 GP

larissia GP

layolis fe GP

leena GP

lessina GP

levonest GP

levonorgest-eth est &

eth est GP

levonorgest-eth estrad

91-day GP

levonorgestrel-ethinyl

estrad GP

levonorg-eth estrad

triphasic GP

levora 0.15/30 (28) GP

LILETTA (52 MG) SP



patch weekly 0.025

mg/24hr

GP

QL


patch weekly 0.0375

mg/24hr, 0.05 mg/24hr,

0.06 mg/24hr, 0.075

mg/24hr, 0.1 mg/24hr

GP

estradiol vaginal GP

estradiol valerate

intramuscular GP

estradiol-norethindrone

acet GP

ethynodiol diac-eth

estradiol GP

etonogestrel-ethinyl

estradiol GP

falmina GP

fayosim GP

femynor GP

FIRST-

PROGESTERONE

VGS

GP

gemmily GP

hailey 1.5/30 GP

hailey 24 fe GP

hailey fe 1.5/30 GP

hailey fe 1/20 GP

heather GP

hydroxyprogesterone

caproate intramuscular

oil

SP

PA

hydroxyprogesterone

caproate intramuscular

solution

SP

iclevia GP

incassia GP

introvale GP

isibloom GP

jaimiess GP

40

Last Updated 1/1/22



norethin-eth estradiol-fe GP

norgestimate-eth

estradiol GP

norgestimate-ethinyl

estradiol triphasic GP

norlyda GP

norlyroc GP

nortrel 0.5/35 (28) GP

nortrel 1/35 (21) GP

nortrel 1/35 (28) GP

nortrel 7/7/7 GP

NUVARING BP

nylia 7/7/7 GP

nymyo GP

ocella GP

orsythia GP

PARAGARD

INTRAUTERINE

COPPER

SP

philith GP

pimtrea GP

pirmella 1/35 GP

pirmella 7/7/7 GP

portia-28 GP

PREMARIN

INJECTION BP

PREMARIN ORAL BP ST

PREMARIN VAGINAL BP

PREMPHASE BP

PREMPRO BP

previfem GP

progesterone

intramuscular SP

progesterone oral GP

reclipsen GP

rivelsa GP

setlakin GP


lillow GP

lojaimiess GP

loryna GP

low-ogestrel GP

lo-zumandimine GP

lutera GP

lyleq GP

lyllana GP QL

lyza GP

marlissa GP

medroxyprogesterone

acetate intramuscular GP QL

medroxyprogesterone

acetate oral GP

megestrol acetate oral GP

merzee GP

mibelas 24 fe GP

microgestin 1.5/30 GP

microgestin 1/20 GP

microgestin 24 fe GP

microgestin fe 1.5/30 GP

microgestin fe 1/20 GP

mili GP

mimvey GP

MIRENA (52 MG) SP

mono-linyah GP

necon 0.5/35 (28) GP

NEXPLANON SP

nikki GP

nora-be GP

norethin ace-eth

estrad-fe GP

norethindrone acetate

oral GP

norethindrone acet-

ethinyl est GP

norethindrone oral GP

41

Last Updated 1/1/22



vylibra GP

wera GP

wymzya fe GP

xulane GP

yuvafem GP

zafemy GP

zarah GP

zovia 1/35 (28) GP

zovia 1/35e (28) GP

zumandimine GP

Hormonal Agents -

Thyroid

ARMOUR THYROID BP

euthyrox GP

levo-t GP

levothyroxine sodium


reconstituted

GP

levothyroxine sodium

oral tablet GP

levoxyl GP

liothyronine sodium

intravenous GP

liothyronine sodium oral GP

methimazole oral GP

np thyroid GP

propylthiouracil oral GP

SYNTHROID BP

unithroid GP

Immunological

Agents - Drugs for

Immune System

Stimulation or

Suppression

ACTEMRA SNP PA; QL

ACTEMRA ACTPEN SNP PA; QL

ACTIMMUNE SP PA

ARCALYST SP PA


sharobel GP

simliya GP

simpesse GP

SKYLA SP

sprintec 28 GP

sronyx GP

syeda GP

tarina 24 fe GP

tarina fe 1/20 GP

tarina fe 1/20 eq GP

taysofy GP

tilia fe GP

tri femynor GP

tri-estarylla GP

tri-legest fe GP

tri-linyah GP

tri-lo-estarylla GP

tri-lo-marzia GP

tri-lo-mili GP

tri-lo-sprintec GP

tri-mili GP

tri-nymyo GP

tri-previfem GP

tri-sprintec GP

trivora (28) GP

tri-vylibra GP

tri-vylibra lo GP

tulana GP

tyblume GP

tydemy GP

velivet GP

vestura GP

vienva GP

viorele GP

volnea GP

vyfemla GP

42

Last Updated 1/1/22



HAEGARDA SP

HIZENTRA SP PA

HUMIRA SP PA; QL

HUMIRA PEDIATRIC

CROHNS START SP PA; QL

HUMIRA PEN SP PA; QL

HUMIRA PEN-

CD/UC/HS STARTER SP PA; QL

HUMIRA PEN-

PEDIATRIC UC

START

SP

PA; QL

HUMIRA PEN-

PS/UV/ADOL HS

START

SP

PA; QL

HUMIRA PEN-

PSOR/UVEIT

STARTER

SP

PA; QL

HYQVIA SP PA

icatibant acetate SP PA

KALBITOR SP

KYMRIAH SP PA

leflunomide oral GP QL

LUPKYNIS SP PA

methotrexate oral GP

methotrexate sodium GP

methotrexate sodium

(pf) GP

mycophenolate mofetil

hcl SP


intravenous SP


oral SP

mycophenolate sodium SP PA

NULOJIX SP

OCTAGAM SP PA

ORENCIA CLICKJECT SNP PA; QL

ORENCIA

INTRAVENOUS SNP PA


ASTAGRAF XL SP

AVSOLA SP PA

AZASAN SP

azathioprine oral SP

azathioprine sodium SP

BENLYSTA SP PA

BERINERT SP PA

BIVIGAM SP PA

CIMZIA SP PA; QL

CIMZIA PREFILLED

KIT SP PA; QL

CIMZIA STARTER KIT SP PA

CINRYZE SP PA

CUTAQUIG SP PA

CUVITRU SP PA

cyclosporine

intravenous SP

cyclosporine modified SP

cyclosporine oral SP

CYTOGAM SP

ENSPRYNG SP

ENVARSUS XR SP

everolimus oral tablet

0.25 mg, 0.5 mg, 0.75

mg

SP

FLEBOGAMMA DIF SP PA

GAMASTAN SP PA

GAMMAGARD SP PA

GAMMAGARD S/D

LESS IGA

INTRAVENOUS

SOLUTION

RECONSTITUTED 10

GM

SP

PA

GAMMAKED SP PA

GAMMAPLEX SP PA

GAMUNEX-C SP PA

gengraf SP

43

Last Updated 1/1/22



budesonide oral GP

DELZICOL BP

hydrocortisone

(perianal) GP

hydrocortisone ace-

pramoxine external

cream 1-1 %

GP

hydrocortisone rectal GP

mesalamine oral tablet

delayed release GP

mesalamine rectal GP

mesalamine-cleanser GP

PENTASA BP

procto-med hc GP

procto-pak GP

proctosol hc GP

proctozone-hc GP

sulfasalazine oral GP

Metabolic Bone

Disease Agents -

Drugs for

Osteoporosis

alendronate sodium GP QL

calcitonin (salmon) GP

EVENITY SP PA

FORTEO SP PA; QL

ibandronate sodium

intravenous SP PA

ibandronate sodium

oral GP QL

pamidronate disodium GP

PROLIA SP PA

risedronate sodium oral

tablet 150 mg, 30 mg,

35 mg

GP

QL

TERIPARATIDE

(RECOMBINANT) SP PA; QL

TYMLOS SP PA

XGEVA SP


ORENCIA

SUBCUTANEOUS SNP PA; QL

ORLADEYO SP PA; QL

OTEZLA SP PA; QL

PRIVIGEN SP PA

PROVENGE SP PA

RENFLEXIS SP PA

RINVOQ SP PA; QL

RUCONEST SP PA

sajazir SP PA

SIMPONI SP PA; QL

SIMPONI ARIA SP PA

sirolimus oral SP

SKYRIZI SP PA; QL

SKYRIZI (150 MG

DOSE) SP PA; QL

SKYRIZI PEN SP PA; QL

STELARA SP PA; QL

SYNAGIS SP PA

tacrolimus oral SP

TAKHZYRO SP

TALTZ SNP PA; QL

temsirolimus SP

THYMOGLOBULIN SP

TREMFYA SP PA; QL

UPLIZNA SP

XELJANZ ORAL

SOLUTION SP

XELJANZ ORAL

TABLET SP PA; QL

XELJANZ XR SP PA; QL

ZORTRESS SP

Inflammatory Bowel

Disease Agents

ASACOL HD BP

balsalazide disodium GP

budesonide er GP

44

Last Updated 1/1/22



formaldehyde external

solution 37 % GP

GEL-ONE SP PA

GENVISC 850 SP PA

GIVLAARI SP PA

heparin lock flush GP

heparin sodium lock

flush GP

HYALGAN SP PA

HYMOVIS SP PA

methergine GP

methylergonovine

maleate GP

MONOVISC SP PA

MYOBLOC SP PA

ORTHOVISC SP PA

OXBRYTA SP PA

RUZURGI SP PA

sodium saccharin

powder GP

sodium thiosulfate

intravenous GP

SPINRAZA SP

sterile

diluent/epoprostenol GP

sterile water for

injection GP

SUPARTZ FX SP PA

SYNVISC SP PA

SYNVISC ONE SP PA

TRILURON SP PA

TRIVISC SP PA

VISCO-3 SP PA

VISTOGARD SP

XEOMIN SP PA

XIAFLEX SP

ZOKINVY SP PA


zoledronic acid SP

Metabolic Bone

Disease Agents -

Other

calcitriol intravenous GP

calcitriol oral GP

cinacalcet hcl GP QL

doxercalciferol

intravenous GP

NATPARA SP

paricalcitol intravenous GP

Miscellaneous

Therapeutic Agents

acetylcysteine

intravenous GP

ADAKVEO SP PA

ALCOHOL PREP

PADS SHEET 70 % BP

asilnasalrms GP

BACTERIOSTATIC

WATER(BENZ ALC) GP

BOTOX SP PA

deferoxamine mesylate GP

dexmedetomidine hcl in

nacl intravenous

solution

GP

dexmedetomidine hcl


200 mcg/2ml

GP

diluent for treprostinil GP

DOJOLVI SP

DUROLANE SP PA

DYSPORT SP PA

ergoloid mesylates oral GP

EUFLEXXA SP PA

FIRDAPSE SP PA

flumazenil intravenous GP

fomepizole GP

45

Last Updated 1/1/22



tobramycin ophthalmic GP

trifluridine GP

Ophthalmic Agents -

Drugs for Glaucoma

acetazolamide er GP

acetazolamide oral GP

betaxolol hcl

ophthalmic GP

bimatoprost ophthalmic GP ST

brimonidine tartrate

ophthalmic GP

carteolol hcl GP

dorzolamide hcl

ophthalmic GP

dorzolamide hcl-timolol

mal GP

dorzolamide hcl-timolol

mal pf GP

ISOPTO CARPINE BP

KEVEYIS SP PA

latanoprost ophthalmic GP

levobunolol hcl GP

methazolamide oral GP

pilocarpine hcl

ophthalmic GP

timolol maleate

ocudose GP

timolol maleate

ophthalmic GP

timolol maleate pf GP

Ophthalmic Agents -

Drugs for

Miscellaneous Eye

Conditions

ak-poly-bac GP

altafrin GP

atropine sulfate

ophthalmic ointment GP


Ophthalmic Agents -

Drugs for Eye Allergy,

Infection and

Inflammation

bacitracin ophthalmic GP

ciprofloxacin hcl

ophthalmic GP

cromolyn sodium

ophthalmic GP ST

dexamethasone

sodium phosphate

ophthalmic

GP

diclofenac sodium

ophthalmic GP

difluprednate GP

erythromycin

ophthalmic GP

fluorometholone GP

flurbiprofen sodium GP

gentak GP

gentamicin sulfate

ophthalmic GP


ophthalmic GP

levofloxacin ophthalmic GP

loteprednol etabonate

ophthalmic gel GP

moxifloxacin hcl (2x

day) GP

moxifloxacin hcl

ophthalmic solution GP

ofloxacin ophthalmic GP

olopatadine hcl

ophthalmic GP ST

prednisolone acetate

ophthalmic GP

prednisolone sodium

phosphate ophthalmic GP

sulfacetamide sodium

ophthalmic GP

46

Last Updated 1/1/22



proparacaine hcl

ophthalmic GP

sulfacetamide-

prednisolone

ophthalmic solution

GP

tetracaine hcl

ophthalmic GP

tobramycin-

dexamethasone GP

VISUDYNE SP

Otic Agents - Drugs

for Ear Conditions

acetic acid otic GP

CIPRODEX BP

ciprofloxacin hcl otic GP

ciprofloxacin-

dexamethasone GP

cortic-nd GP

flac GP


otic GP

hydrocortisone-acetic

acid GP

ofloxacin otic GP

Respiratory Tract /

Pulmonary Agents -

Drugs for Allergies,

Cough, Cold

azelastine hcl nasal

solution 0.1 %, 137

mcg/spray

GP

QL

azelastine hcl nasal

solution 0.15 % GP ST

azelastine-fluticasone GP QL

benzonatate GP

carbinoxamine maleate GP

cetirizine hcl oral

solution GP

CINQAIR SP PA


atropine sulfate

ophthalmic solution 1 % GP

bacitracin-polymyxin b

ophthalmic GP

bacitra-neomycin-

polymyxin-hc GP

balanced salt GP

BEOVU SP PA

BEVACIZUMAB

INTRAVITREAL

SOLUTION

PREFILLED SYRINGE

3 MG/0.12ML

SP

PA

cyclopentolate hcl

ophthalmic GP

CYSTARAN SP PA

EYLEA SP PA

homatropaire GP

LUCENTIS SP PA

MIOSTAT GP

neomycin-bacitracin zn-

polymyx GP

neomycin-polymyxin-

dexameth ophthalmic

ointment

GP

neomycin-polymyxin-

dexameth ophthalmic

suspension 3.5-10000-

0.1

GP

neomycin-polymyxin-

gramicidin GP

neo-polycin GP

neo-polycin hc GP

OXERVATE SP PA

phenylephrine hcl

ophthalmic GP

polycin GP

polymyxin b-

trimethoprim GP

47

Last Updated 1/1/22



NUCALA

SUBCUTANEOUS

SOLUTION

RECONSTITUTED

SP

PA; QL

olopatadine hcl nasal GP ST; QL

promethazine hcl

injection GP

promethazine hcl oral GP

promethazine hcl rectal GP

promethazine vc GP

promethazine

vc/codeine GP

promethazine-codeine GP

promethazine-dm GP

promethazine-

phenyleph-codeine GP

promethazine-

phenylephrine GP

promethegan GP

pseudoephedrine-

bromphen-dm GP

ryvent GP

sodium chloride

inhalation GP

XOLAIR SP PA

Respiratory Tract /

Pulmonary Agents -

Drugs for Asthma and

Other Lung

Conditions

acetylcysteine

inhalation GP

ADRENALIN

INJECTION GP

ADVAIR DISKUS BP ST; QL

ADVAIR HFA BP QL

albuterol sulfate hfa GP

albuterol sulfate

inhalation GP

albuterol sulfate oral GP


clemastine fumarate

oral syrup GP

clemastine fumarate

oral tablet 2.68 mg GP

cyproheptadine hcl oral GP

dexchlorpheniramine

maleate oral GP

di-phen GP

diphen oral elixir GP

diphenhydramine hcl

injection GP

diphenhydramine hcl

oral elixir GP

FASENRA SP PA

FASENRA PEN SP PA

flunisolide nasal GP QL

fluticasone propionate

nasal GP QL

hydrocodone polst-

chlorphen polst er susp GP

hydrocodone-

homatropine GP

hydromet GP

ipratropium bromide

nasal GP QL

levocetirizine

dihydrochloride oral

solution

GP

levocetirizine

dihydrochloride oral

tablet

GP

QL

mometasone furoate

nasal GP QL

NUCALA

SUBCUTANEOUS

SOLUTION AUTO-

INJECTOR

SP

PA

NUCALA

SUBCUTANEOUS

SOLUTION

PREFILLED SYRINGE

SP

PA

48

Last Updated 1/1/22



fluticasone-salmeterol

inhalation aerosol

powder breath

activated 100-50

mcg/dose, 250-50

mcg/dose, 500-50

mcg/dose

GP

QL

FLUTICASONE-

SALMETEROL

INHALATION

AEROSOL POWDER

BREATH ACTIVATED

113-14 MCG/ACT, 232-

14 MCG/ACT, 55-14

MCG/ACT

GP

formoterol fumarate

inhalation GP QL

GLASSIA SP PA

ipratropium bromide

inhalation GP

ipratropium-albuterol GP QL

isoproterenol hcl

injection GP

montelukast sodium

oral GP

OFEV SP QL

PROAIR HFA BP

PROAIR RESPICLICK BP QL

PROLASTIN-C SP PA

PULMICORT

FLEXHALER BP QL

PULMICORT

SUSPENSION BP QL

QVAR REDIHALER BP QL

SEREVENT DISKUS BP QL

SPIRIVA

HANDIHALER BP QL

SPIRIVA RESPIMAT BP QL

STIOLTO RESPIMAT BP QL

SYMBICORT BP QL


aminophylline GP

ANORO ELLIPTA BP QL

ARALAST NP SP PA

arformoterol tartrate GP QL

ARNUITY ELLIPTA

INHALATION

AEROSOL POWDER

BREATH ACTIVATED

100 MCG/ACT, 200

MCG/ACT

BP

QL

ARNUITY ELLIPTA

INHALATION

AEROSOL POWDER

BREATH ACTIVATED

50 MCG/ACT

BP

ATROVENT HFA BP QL

BEVESPI

AEROSPHERE BP QL

BREO ELLIPTA BP QL

budesonide inhalation GP QL

COMBIVENT

RESPIMAT BP QL

cromolyn sodium

inhalation GP

epinephrine

(anaphylaxis) GP

epinephrine injection

solution auto-injector GP QL

EPIPEN 2-PAK BP QL

EPIPEN JR 2-PAK BP QL

ESBRIET ORAL

CAPSULE SP PA; QL

FLOVENT DISKUS

INHALATION

AEROSOL POWDER

BREATH ACTIVATED

100 MCG/BLIST, 50

MCG/BLIST

BP

QL

FLOVENT HFA BP QL

49

Last Updated 1/1/22



Respiratory Tract /

Pulmonary Agents -

Drugs for Pulmonary

Hypertension

ADEMPAS SP PA; QL

alyq SP PA; QL

ambrisentan SP PA; QL

bosentan SP PA; QL

epoprostenol sodium SP PA

OPSUMIT SP PA

ORENITRAM SP PA; QL

REVATIO

INTRAVENOUS SP PA

REVATIO ORAL

TABLET SP PA; QL

sildenafil citrate

intravenous SP PA


suspension

reconstituted

SP

PA; QL


tablet 20 mg SP PA; QL

tadalafil (pah) SP PA; QL

treprostinil SP PA

TYVASO SP

TYVASO REFILL SP

TYVASO STARTER SP

UPTRAVI ORAL SP PA

VENTAVIS SP PA; QL

Skeletal Muscle

Relaxants - Drugs for

Muscle Pain and

Spasm

baclofen intrathecal GP

baclofen oral GP

chlorzoxazone GP

cyclobenzaprine hcl er GP

cyclobenzaprine hcl

oral GP


terbutaline sulfate

injection GP

terbutaline sulfate oral GP

theophylline GP

theophylline er GP

TRELEGY ELLIPTA BP

TUDORZA PRESSAIR BP QL

VENTOLIN HFA BP

wixela inhub GP QL

zafirlukast GP

ZEMAIRA SP PA

Respiratory Tract /

Pulmonary Agents -

Drugs for Cystic

Fibrosis

BETHKIS SP QL

CAYSTON SP QL

KALYDECO SP PA; QL

KITABIS PAK SP PA; QL

ORKAMBI ORAL

TABLET SP PA; QL

PULMOZYME SP PA

SYMDEKO SP PA

TOBI NEBULIZER SP PA; QL

TOBI PODHALER SP QL

tobramycin inhalation

nebulization solution

300 mg/4ml

SP

QL

tobramycin nebulization

solution 300 mg/5ml

inhalation

SP

PA; QL

TOBRAMYCIN

NEBULIZATION

SOLUTION 300

MG/5ML INHALATION

SP

PA; QL

TRIKAFTA SP PA; QL

50


dantrolene sodium

intravenous GP

dantrolene sodium oral GP

FIRST-BACLOFEN GP

methocarbamol

injection GP

methocarbamol oral GP

orphenadrine citrate er GP

orphenadrine citrate

injection GP

revonto GP

tizanidine hcl oral tablet GP

Sleep Disorder

Agents

armodafinil GP

eszopiclone GP QL

flurazepam hcl GP QL

HETLIOZ SP PA; QL

modafinil GP

WAKIX SP PA

XYREM SP PA

zaleplon GP QL

zolpidem tartrate er GP ST; QL

zolpidem tartrate oral GP QL

Last Updated 1/1/22


51

Index of Drugs

abacavir sulfate ......................... 18

abacavir sulfate-lamivudine ....... 18

abacavir-lamivudine-

zidovudine ................................. 18

ABILIFY MAINTENA .................. 17

ABILIFY MYCITE ....................... 17

ABILIFY MYCITE

MAINTENANCE KIT .................. 17

ABILIFY MYCITE STARTER

KIT ............................................. 17

abiraterone acetate .................... 13

ABRAXANE ............................... 13

acamprosate calcium ................... 6

acarbose .................................... 28

accutane .................................... 26

acebutolol hcl............................. 21

acetaminophen ............................ 3

acetaminophen-codeine ............... 3

acetaminophen-codeine #2 ......... 3



acetazolamide............................ 45

acetazolamide er ....................... 45

acetazolamide sodium ............... 21

acetic acid ........................... 35, 46

acetylcysteine ...................... 44, 47

acitretin ...................................... 26

ACTEMRA ................................. 41

ACTEMRA ACTPEN ................. 41

ACTHAR .................................... 36

ACTIMMUNE ............................. 41

acyclovir..................................... 18

acyclovir sodium ........................ 18

ADAKVEO ................................. 44

adapalene .................................. 26

ADAPALENE ............................. 26

ADCETRIS ................................ 13

adefovir dipivoxil ........................ 18

ADEMPAS ................................. 49

adenosine .................................. 21

ADRENALIN .............................. 47

adriamycin ................................. 13

ADVAIR DISKUS ....................... 47

ADVAIR HFA ............................. 47

ADVATE .................................... 20

AFINITOR .................................. 13

afirmelle ..................................... 38

AFREZZA .................................. 29

AFSTYLA ................................... 20

ak-poly-bac ................................ 45

ala-cort ...................................... 26

albuterol sulfate ......................... 47

albuterol sulfate hfa ................... 47

alclometasone dipropionate ....... 26

ALCOHOL PREP PADS ............ 44

ALDURAZYME .......................... 34

ALECENSA ................................ 13

alendronate sodium ................... 43

alfentanil hcl ................................. 3

alfuzosin hcl er ........................... 35

ALIQOPA ................................... 13

aliskiren fumarate ...................... 21

allopurinol .................................. 12

allopurinol sodium ...................... 12

almotriptan malate ..................... 12

ALOPRIM ................................... 12

alosetron hcl .............................. 33

ALPHANATE ............................. 20

ALPHANINE SD ........................ 20

alprazolam ................................. 19

alprazolam er ............................. 19

alprazolam intensol .................... 19

alprazolam xr ............................. 19

ALPROLIX ................................. 20

alprostadil .................................. 21

altafrin ........................................ 45

altavera ...................................... 38

ALUNBRIG ................................ 13

alvimopan .................................. 33

alyacen 1/35 .............................. 38

alyacen 7/7/7 ............................. 38

alyq ............................................ 49

amabelz ..................................... 38

amantadine hcl .......................... 17

ambrisentan ............................... 49

amcinonide ................................ 26

amethia ...................................... 38

amethyst .................................... 38

amikacin sulfate ........................... 6

amiloride hcl............................... 21

amiloride-hydrochlorothiazide .... 21

aminocaproic acid ...................... 20

aminophylline ............................. 48

amiodarone hcl .......................... 21

AMITIZA..................................... 33

amitriptyline hcl .......................... 10

amlodipine besylate ................... 21

amlodipine besylate-benazepril

hcl .............................................. 21

amlodipine besylate-valsartan 21

amlodipine-olmesartan ............... 21

amlodipine-valsartan-hctz .......... 21

ammonium lactate ..................... 26

amnesteem ................................ 26

amoxapine ................................. 10

amoxicill-clarithro-lansopraz ....... 33

amoxicillin ................................... 6


clavulanate .................................. 6


clavulanate er.............................. 6

amphetamine sulfate ................. 24

amphetamine-

dextroamphetamine .................. 24

amphetamine-

dextroamphetamine er .............. 24

amphotericin b .......................... 11

ampicillin ..................................... 6

ampicillin sodium ......................... 6

ampicillin-sulbactam sodium ....... 6

AMPYRA ................................... 25

anagrelide hcl............................ 20

anastrozole ............................... 13

ANORO ELLIPTA ..................... 48

apap-caff-dihydrocodeine ............ 3

APEXICON E ............................ 26

APOKYN ................................... 17

aprepitant .................................. 11

apri ............................................ 38

APTIVUS ................................... 18

ARALAST NP............................ 48

aranelle ..................................... 38

ARANESP (ALBUMIN FREE) ... 20

ARCALYST ............................... 41

arformoterol tartrate .................. 48

argyle sterile saline ................... 30

argyle sterile water .................... 30

aripiprazole ............................... 17

armodafinil ................................ 50

ARMOUR THYROID ................. 41

ARNUITY ELLIPTA ................... 48

ARRANON ................................ 13

arsenic trioxide .......................... 13

ARZERRA ................................. 13

ASACOL HD ............................. 43

ascomp-codeine .......................... 3

asenapine maleate .................... 17

ashlyna ..................................... 38

asilnasalrms .............................. 44

aspirin-dipyridamole er .............. 17

ASTAGRAF XL ......................... 42

atazanavir sulfate ...................... 18

atenolol ..................................... 21

atenolol-chlorthalidone .............. 21

atomoxetine hcl ......................... 24

atorvastatin calcium .................. 21

atovaquone ............................... 17

atovaquone-proguanil hcl .......... 17

atracurium besylate ................... 25

atropine sulfate .............. 33, 45, 46

ATROPINE SULFATE ............... 33

ATROVENT HFA ....................... 48

aubra ......................................... 38

aubra eq .................................... 38

aurovela 1.5/30 .......................... 38

aurovela 1/20 ............................. 38

aurovela 24 fe ............................ 38

aurovela fe 1.5/30 ...................... 38

aurovela fe 1/20 ......................... 38

AVASTIN ................................... 13

AVEED ...................................... 36

aviane ........................................ 38

avidoxy ........................................ 6

AVONEX PEN ........................... 25

AVONEX PREFILLED ............... 25

AVSOLA .................................... 42

ayuna ......................................... 38

AYVAKIT ................................... 13

azacitidine .................................. 13

AZASAN .................................... 42

azathioprine ............................... 42

azathioprine sodium ................... 42

azelaic acid ................................ 26

azelastine hcl ............................. 46

azelastine-fluticasone ................ 46

azithromycin ................................ 6

aztreonam .................................... 6

azurette...................................... 38

bac ............................................... 3

bacitracin ............................... 6, 45

bacitracin-polymyxin b ............... 46

bacitra-neomycin-polymyxin-hc 46

baclofen ..................................... 49

BACTERIOSTATIC

WATER(BENZ ALC) .................. 44

BAFIERTAM .............................. 25

balanced salt ............................. 46

balsalazide disodium ................. 43

BALVERSA ................................ 13

balziva ....................................... 38

BANZEL....................................... 9

BAQSIMI ONE PACK ................ 29

BAQSIMI TWO PACK ................ 29

BAVENCIO ................................ 13

BELEODAQ ............................... 13

BELRAPZO ............................... 13

benazepril hcl ............................ 21

BENDEKA ................................. 13

BENEFIX ................................... 20

BENLYSTA ................................ 42

benzonatate ............................... 46

benzoyl peroxide-erythromycin. 26

benzphetamine hcl ..................... 25

benztropine mesylate ................. 17

BEOVU ...................................... 46

BERINERT ................................. 42

beser .......................................... 26

betamethasone dipropionate ..... 26

betamethasone dipropionate

aug ............................................. 26

betamethasone sod phos &

acet ............................................ 36

betamethasone valerate ............ 26

BETASERON ............................. 25

betaxolol hcl ............................... 45

bethanechol chloride .................. 35

BETHKIS ................................... 49

BEVACIZUMAB ......................... 46

BEVESPI AEROSPHERE .......... 48

bexarotene ................................. 13

bicalutamide ............................... 13

bimatoprost ................................ 45

bisoprolol fumarate .................... 21

bisoprolol-hydrochlorothiazide 21

bivalirudin trifluoroacetate ............ 9

BIVIGAM .................................... 42

bleomycin sulfate ....................... 13

BLINCYTO ................................. 13

blisovi 24 fe ................................ 38

blisovi fe 1.5/30 .......................... 38

blisovi fe 1/20 ............................. 38

BORTEZOMIB ........................... 13

bosentan .................................... 49

BOSULIF ................................... 13

BOTOX ...................................... 44

BRAFTOVI ................................. 13

BREO ELLIPTA ......................... 48

briellyn ....................................... 38

BRILINTA ................................... 17

brimonidine tartrate .................... 45

BRIVIACT .................................... 9

bromocriptine mesylate .............. 17

BRUKINSA ................................ 13

budesonide .......................... 43, 48

budesonide er ............................ 43

bumetanide ................................ 21

BUPHENYL ............................... 34

bupivacaine fisiopharma .............. 5

bupivacaine hcl ............................ 5

bupivacaine hcl (pf) ...................... 5

bupivacaine in dextrose ............... 5

bupivacaine spinal ....................... 5

bupivacaine-epinephrine .............. 5

bupivacaine-epinephrine (pf) ........ 5

buprenorphine .............................. 3

buprenorphine hcl ................... 3, 6

buprenorphine hcl-naloxone

hcl ............................................... 6

bupropion hcl ............................ 10

bupropion hcl er (smoking det) ... 6

bupropion hcl er (sr) .................. 10

bupropion hcl er (xl) .................. 10

buspirone hcl............................. 19

busulfan .................................... 13

butalbital-acetaminophen ............ 3

BUTALBITAL-

ACETAMINOPHEN ..................... 3

butalbital-apap-caff-cod ............... 3

butalbital-apap-caffeine ............... 3

butalbital-asa-caff-codeine .......... 3

butalbital-aspirin-caffeine ............ 3

butorphanol tartrate ..................... 3

BYDUREON BCISE

AUTOINJECTOR ...................... 28

BYETTA 10 MCG PEN ............. 28

BYETTA 5 MCG PEN ............... 28

CABENUVA .............................. 18

cabergoline ............................... 36

CABOMETYX ........................... 13

caffeine citrate........................... 25

calcipotriene .............................. 26

calcipotriene-betameth diprop ... 26

calcitonin (salmon) .................... 43

CALCITRENE ........................... 26

calcitriol ............................... 26, 44

calcium acetate ......................... 35

calcium acetate (phos binder) ... 35

CALCIUM CHLORIDE .............. 30

calcium chloride ........................ 30

calcium gluconate ..................... 30

camila ....................................... 38

camrese .................................... 38

camrese lo ................................ 38

capecitabine .............................. 13

CARBAGLU .............................. 30

carbamazepine............................ 9

carbamazepine er ....................... 9

carbidopa-levodopa ................... 17

carbidopa-levodopa er .............. 17

carbidopa-levodopa-

entacapone ............................... 17

carbinoxamine maleate ............. 46

carboplatin ................................ 13

cardioplegic ............................... 30

carisoprodol-aspirin-codeine ....... 3

carmustine ................................ 13

carteolol hcl ............................... 45

cartia xt ..................................... 21

52

carvedilol ................................... 21

carvedilol phosphate er ............. 21

caspofungin acetate .................. 11

cavarest ..................................... 25

CAYSTON ................................. 49

caziant ....................................... 38

cefaclor ........................................ 6

cefaclor er .................................... 6

cefadroxil ..................................... 6

cefazolin sodium .......................... 6

cefazolin sodium-dextrose ........... 6

cefdinir ......................................... 6

cefepime hcl ................................ 6

cefixime ....................................... 6

cefotaxime sodium ....................... 6

cefotetan disodium ...................... 7

cefoxitin sodium ........................... 7

CEFOXITIN SODIUM-

DEXTROSE ................................. 7

cefpodoxime proxetil .................... 7

cefprozil ....................................... 7

ceftazidime .................................. 7

ceftriaxone sodium ...................... 7

ceftriaxone sodium in dextrose .... 7

ceftriaxone sodium-dextrose ........ 7

cefuroxime axetil .......................... 7

cefuroxime sodium ...................... 7

celecoxib ...................................... 4

cephalexin ................................... 7

CERDELGA ............................... 34

CEREZYME ............................... 34

cetirizine hcl ............................... 46

CETROTIDE .............................. 36

charlotte 24 fe ............................ 38

chateal ....................................... 38

chateal eq .................................. 38

CHENODAL ............................... 33

chloramphenicol sod succinate ... 7

chlordiazepoxide hcl .................. 19

chlordiazepoxide-amitriptyline .... 10

chlordiazepoxide-clidinium ......... 34

chlorhexidine gluconate ............. 25

chloroprocaine hcl (pf) ................. 5

chloroquine phosphate .............. 17

chlorothiazide sodium ................ 21

chlorpromazine hcl .................... 18

chlorthalidone ............................ 21

chlorzoxazone............................ 49

CHOLBAM ................................. 34

cholestyramine........................... 21

cholestyramine light ................... 21

CHORIONIC

GONADOTROPIN ..................... 36

chromic chloride ......................... 30

ciclodan...................................... 11

ciclopirox .................................... 11

ciclopirox olamine ...................... 11

cidofovir ..................................... 18

cilostazol .................................... 17

cimetidine ................................... 33

cimetidine hcl ............................. 33

CIMZIA ...................................... 42

CIMZIA PREFILLED KIT ........... 42

CIMZIA STARTER KIT .............. 42

cinacalcet hcl ............................. 44

CINQAIR .................................... 46

CINRYZE ................................... 42

CIPRODEX ................................ 46

ciprofloxacin hcl ...............7, 45, 46

ciprofloxacin in d5w ..................... 7

ciprofloxacin-dexamethasone ..... 46

cisatracurium besylate ............... 25

cisatracurium besylate (pf) ......... 25

cisplatin ...................................... 13

citalopram hydrobromide ........... 10

cladribine ................................... 13

claravis ...................................... 26

clarithromycin ............................... 7

clarithromycin er .......................... 7

clemastine fumarate .................. 47

clindacin etz ............................... 26

clindacin-p .................................. 26

clindamycin hcl ............................ 7

clindamycin palmitate hcl ............. 7

clindamycin phosphate .......... 7, 26

clindamycin phosphate in d5w ..... 7

clindamycin-tretinoin .................. 26

clobazam ..................................... 9

clobetasol prop emollient base. 26

clobetasol propionate ........... 26, 27

clobetasol propionate e .............. 26

clobetasol propionate emulsion 26

clodan ........................................ 27

clofarabine ................................. 13

clomiphene citrate ...................... 36

clonazepam ............................... 19

clonidine..................................... 21

clonidine hcl ............................... 21

clonidine hcl (analgesia) .............. 3

clopidogrel bisulfate ................... 17

clorazepate dipotassium ............ 20

clotrimazole ................................ 11

clotrimazole-betamethasone ...... 12

clozapine .................................... 18

COAGADEX .............................. 20

codeine sulfate ............................. 3

colchicine .................................. 12

colchicine-probenecid................ 12

colesevelam hcl......................... 21

colestipol hcl ............................. 21

colistimethate sodium (cba) ........ 7

COMBIPATCH .......................... 38

COMBIVENT RESPIMAT .......... 48

COMETRIQ ............................... 13

COMPLERA .............................. 18

compro ...................................... 11

constulose ................................. 34

CONTOUR MONITOR

DEVICE..................................... 29

CONTOUR NEXT EZ KIT

W/DEVICE ................................ 29

CONTOUR NEXT LINK KIT

W/DEVICE ................................ 29

CONTOUR NEXT MONITOR

KIT W/DEVICE .......................... 29

CONTOUR NEXT TEST

STRIPS ..................................... 29

CONTOUR TEST STRIPS ........ 29

COPAXONE .............................. 25

COPIKTRA ................................ 14

coremino ..................................... 7

CORIFACT ................................ 20

cortic-nd .................................... 46

COTELLIC ................................ 14

CREON ..................................... 34

CRESEMBA .............................. 12

CRINONE ................................. 38

CRIXIVAN ................................. 18

cromolyn sodium ........... 34, 45, 48

crotan ........................................ 17

cryselle-28 ................................. 38

CUPRIC CHLORIDE ................. 30

curity sterile saline .................... 30

CUTAQUIG ............................... 42

CUVITRU .................................. 42

cyanocobalamin ........................ 30

cyclafem 1/35 ............................ 38

cyclafem 7/7/7 ........................... 38

cyclobenzaprine hcl ................... 49

cyclobenzaprine hcl er .............. 49

cyclopentolate hcl ..................... 46

cyclophosphamide .................... 14

cyclosporine .............................. 42

cyclosporine modified ................ 42

cyproheptadine hcl .................... 47

CYRAMZA ................................ 14

cyred ......................................... 38

cyred eq .................................... 38

CYSTADANE ............................ 34

53

CYSTAGON .............................. 34

CYSTARAN ............................... 46

cytarabine .................................. 14

cytarabine (pf)............................ 14

CYTOGAM ................................ 42

dacarbazine ............................... 14

dactinomycin .............................. 14

dalfampridine er ......................... 25

danazol ...................................... 36

dantrolene sodium ..................... 50

dapsone ..................................... 13

daptomycin .................................. 7

DARAPRIM ................................ 17

darifenacin hydrobromide er ...... 35

DARZALEX ................................ 14

DARZALEX FASPRO ................ 14

dasetta 1/35 ............................... 38

dasetta 7/7/7 .............................. 38

daunorubicin hcl ........................ 14

daysee ....................................... 38

deblitane .................................... 38

DECADRON .............................. 36

decitabine .................................. 14

deferasirox ................................. 30

deferasirox granules .................. 30

deferiprone ................................ 30

deferoxamine mesylate .............. 44

DELSTRIGO .............................. 18

delyla ......................................... 38

DELZICOL ................................. 43

DESCOVY ................................. 18

desmopressin ace spray refrig 36

desmopressin acetate ................ 36

desmopressin acetate pf ............ 36

desmopressin acetate spray ...... 37

desogestrel-ethinyl estradiol ...... 38

desonide .................................... 27

desoximetasone ......................... 27

desrx .......................................... 27

desvenlafaxine succinate er ...... 10

dexamethasone ......................... 36

dexamethasone intensol ............ 36

dexamethasone sod

phosphate pf .............................. 36

dexamethasone sodium

phosphate ............................ 36, 45

dexchlorpheniramine maleate .... 47

DEXCOM G4 SENSOR ............. 29

DEXCOM G5 MOB/G4 PLAT

SENSOR ................................... 29

DEXCOM G6 SENSOR ............. 29

dexmedetomidine hcl ................. 44

dexmedetomidine hcl in nacl ..... 44

dexmethylphenidate hcl ............. 24

dexrazoxane hcl ......................... 14

dextroamphetamine sulfate ........ 24

dextrose ..................................... 30

DEXTROSE ............................... 30

DEXTROSE

5%/ELECTROLYTE #48 ............ 30

dextrose in lactated ringers ........ 30

dextrose-nacl ............................. 30

dextrose-sodium chloride ........... 30

DIACOMIT ................................... 9

diazepam ............................... 9, 20

DIAZEPAM ................................ 20

diazepam intensol ...................... 20

diazoxide .................................... 29

diclofenac potassium ................... 4

diclofenac sodium .................. 4, 45

diclofenac sodium er .................... 4

diclofenac-misoprostol ................. 4

dicloxacillin sodium ...................... 7

dicyclomine hcl .......................... 34

diethylpropion hcl ....................... 25

diethylpropion hcl er................... 25

DIFICID ........................................ 7

diflorasone diacetate .................. 27

diflunisal ....................................... 5

difluprednate .............................. 45

digitek ........................................ 22

digox .......................................... 22

digoxin ....................................... 22

dihydroergotamine mesylate ...... 12

DILANTIN .................................... 9

DILANTIN INFATABS .................. 9

diltiazem hcl ............................... 22

diltiazem hcl er beads ................ 22

diltiazem hcl er coated beads .... 22

diluent for treprostinil ................. 44

dimenhydrinate .......................... 11

dimethyl fumarate ...................... 25

dimethyl fumarate starter pack 25

diphen ........................................ 47

di-phen ....................................... 47

diphenhydramine hcl .................. 47

diphenoxylate-atropine ............... 34

dipyridamole .............................. 17

disopyramide phosphate ............ 22

disulfiram ..................................... 6

divalproex sodium ........................ 9

divalproex sodium er .................... 9

dobutamine hcl .......................... 22

dobutamine in d5w..................... 22

docetaxel ................................... 14

dofetilide .................................... 22

DOJOLVI ................................... 44

dolishale .................................... 38

donepezil hcl ............................. 10

dopamine hcl............................. 22

dopamine in d5w ....................... 22

dorzolamide hcl ......................... 45

dorzolamide hcl-timolol mal ...... 45

dorzolamide hcl-timolol mal pf 45

dotti ........................................... 38

DOVATO ................................... 18

doxazosin mesylate .................. 22

doxepin hcl ................................ 10

doxercalciferol ........................... 44

doxorubicin hcl .......................... 14

doxorubicin hcl liposomal .......... 14

doxy 100 ..................................... 7

doxycycline hyclate ..................... 7

doxycycline monohydrate ............ 7

dronabinol ................................. 11

droperidol .................................. 11

drospiren-eth estrad-levomefol. 38

drospirenone-ethinyl estradiol ... 38

droxidopa .................................. 22

duloxetine hcl ............................ 10

DUOPA ..................................... 17

DUPIXENT ................................ 27

duramorph ................................... 3

DUROLANE .............................. 44

dutasteride ................................ 35

dutasteride-tamsulosin hcl ........ 35

DYSPORT ................................. 44

easygel ..................................... 25

ec-naproxen ................................ 5

econazole nitrate ....................... 12

EDURANT ................................. 18

efavirenz ................................... 18

efavirenz-emtricitab-tenofovir .... 18

efavirenz-lamivudine-tenofovir 18

effer-k ........................................ 30

ELAPRASE ............................... 34

ELELYSO .................................. 34

eletriptan hydrobromide ............ 12

ELFOLATE ................................ 31

ELIGARD .................................. 37

elinest ....................................... 38

ELIQUIS ...................................... 9

ELMIRON .................................. 35

ELOCTATE ............................... 20

eluryng ...................................... 38

emoquette ................................. 38

EMPLICITI ................................ 14

emtricitabine .............................. 18

emtricitabine-tenofovir df ........... 18

54

EMTRIVA ................................... 18

enalapril maleate ....................... 22

enalaprilat .................................. 22

enalapril-hydrochlorothiazide ..... 22

endocet ........................................ 3

ENDOMETRIN ........................... 38

ENHERTU ................................. 14

ENLITE GLUCOSE SENSOR ... 29

enoxaparin sodium ...................... 9

enpresse-28 ............................... 38

enskyce ..................................... 38

ENSPRYNG .............................. 42

entacapone ................................ 17

entecavir .................................... 18

ENTRESTO ............................... 22

enulose ...................................... 34

ENVARSUS XR ......................... 42

EPCLUSA .................................. 18

ephedrine sulfate ....................... 22

EPIDIOLEX .................................. 9

EPINEPHRINE .......................... 22

epinephrine .......................... 22, 48

epinephrine (anaphylaxis) .......... 48

epinephrine pf ............................ 22

EPINEPHRINE-DEXTROSE ...... 22

EPINEPHRINE-NACL ................ 22

EPIPEN 2-PAK .......................... 48

EPIPEN JR 2-PAK ..................... 48

epirubicin hcl.............................. 14

epitol ............................................ 9

eplerenone ................................. 22

EPOGEN ................................... 20

epoprostenol sodium ................. 49

eptifibatide ................................. 17

ERBITUX ................................... 14

ergocalciferol ............................. 31

ergoloid mesylates ..................... 44

ERIVEDGE ................................ 14

erlotinib hcl ................................ 14

errin ........................................... 38

ertapenem sodium ....................... 7

ERWINASE ............................... 14

ery ............................................. 27

ERYGEL .................................... 27

ERY-TAB ..................................... 7

ERYTHROCIN STEARATE ......... 7

erythromycin .................... 7, 27, 45

erythromycin base ....................... 7

ESBRIET ................................... 48

escitalopram oxalate .................. 10

esmolol hcl ................................ 22

esmolol hcl-sodium chloride ...... 22

esomeprazole magnesium ......... 33

esomeprazole sodium ................ 33

estarylla ..................................... 38

estazolam .................................. 20

estradiol ............................... 38, 39

estradiol valerate ........................ 39

estradiol-norethindrone acet ...... 39

eszopiclone ................................ 50

ethacrynic acid ........................... 22

ethambutol hcl ........................... 13

ethosuximide ................................ 9

ethyl chloride ................................ 5

ethynodiol diac-eth estradiol ...... 39

etodolac er ................................... 5

etonogestrel-ethinyl estradiol ..... 39

etoposide ................................... 14

etravirine .................................... 18

EUFLEXXA ................................ 44

euthyrox ..................................... 41

EVENITY ................................... 43

everolimus ........................... 14, 42

EVERSENSE

SENSOR/HOLDER .................... 29

EVOMELA ................................. 14

EVOTAZ .................................... 18

EXELON .................................... 10

EXONDYS 51 ............................ 34

EYLEA ....................................... 46

ezetimibe ................................... 22

ezetimibe-simvastatin ................. 22

FABRAZYME ............................. 34

falmina ....................................... 39

famciclovir .................................. 18

famotidine .................................. 33

famotidine premixed .................. 33

FARXIGA ................................... 28

FARYDAK .................................. 14

FASENRA .................................. 47

FASENRA PEN.......................... 47

fayosim ...................................... 39

febuxostat .................................. 12

FEIBA ........................................ 20

felodipine er ............................... 22

femynor ...................................... 39

fenofibrate .................................. 22

fenofibrate micronized ............... 22

fenofibric acid............................. 22

fenoprofen calcium ....................... 5

FENSOLVI (6 MONTH) .............. 37

fentanyl ........................................ 3

fentanyl citrate ............................. 3

FENTANYL CITRATE-NACL ....... 3

FERRIPROX .............................. 31

FERRIPROX TWICE-A-DAY ..... 31

ferumoxytol ............................... 31

FIBRYGA .................................. 20

finasteride ................................. 36

FIRDAPSE ................................ 44

FIRMAGON ............................... 37

FIRMAGON (240 MG DOSE) ... 37

FIRST-BACLOFEN ................... 50

FIRST-LANSOPRAZOLE .......... 33

FIRST-METRONIDAZOLE .......... 7

FIRST-MOUTHWASH BLM ...... 25

FIRST-OMEPRAZOLE .............. 33

FIRST-PROGESTERONE

VGS .......................................... 39

FIRVANQ .................................... 7

flac ............................................ 46

flavoxate hcl .............................. 35

FLEBOGAMMA DIF .................. 42

flecainide acetate ...................... 22

FLOVENT DISKUS ................... 48

FLOVENT HFA ......................... 48

floxuridine .................................. 14

fluconazole ................................ 12

fluconazole in sodium chloride 12

flucytosine ................................. 12

fludarabine phosphate ............... 14

fludrocortisone acetate .............. 36

flumazenil .................................. 44

flunisolide .................................. 47

fluocinolone acetonide ........ 27, 46

fluocinolone acetonide body ..... 27

fluocinolone acetonide scalp ..... 27

fluocinonide ............................... 27

fluocinonide emulsified base ..... 27

fluoridex daily renewal .............. 25

fluoritab ..................................... 31

fluorometholone ........................ 45

fluorouracil .......................... 14, 27

fluoxetine hcl ............................. 10

fluoxetine hcl (pmdd)................. 10

fluphenazine decanoate ............ 18

fluphenazine hcl ........................ 18

flurandrenolide .......................... 27

flurazepam hcl ........................... 50

flurbiprofen .................................. 5

flurbiprofen sodium ................... 45

flutamide ................................... 14

fluticasone propionate ......... 27, 47

fluticasone-salmeterol ............... 48

FLUTICASONE-

SALMETEROL .......................... 48

fluvastatin sodium ..................... 22

fluvoxamine maleate ................. 10

folic acid .................................... 31

55

FOLLISTIM AQ .......................... 37

FOLOTYN .................................. 14

fomepizole ................................. 44

fondaparinux sodium ................... 9

formaldehyde ............................. 44

formoterol fumarate ................... 48

FORTEO .................................... 43

fosamprenavir calcium ............... 18

fosaprepitant dimeglumine ......... 11

foscarnet sodium ....................... 18

fosfomycin tromethamine ............. 7

fosinopril sodium ........................ 22

fosphenytoin sodium .................... 9

FRAGMIN .................................... 9

FREESTYLE LIBRE 14 DAY

READER .................................... 29

FREESTYLE LIBRE 14 DAY

SENSOR ................................... 29

FREESTYLE LIBRE 2

READER .................................... 29

FREESTYLE LIBRE 2

SENSOR ................................... 29

FREESTYLE LIBRE READER 29

frovatriptan succinate ................ 12

furosemide ................................. 22

FUZEON .................................... 18

gabapentin ................................... 9

GALAFOLD ............................... 34

galantamine hydrobromide ........ 10

galantamine hydrobromide er .... 10

GAMASTAN .............................. 42

GAMMAGARD ........................... 42

GAMMAGARD S/D LESS IGA 42

GAMMAKED .............................. 42

GAMMAPLEX ............................ 42

GAMUNEX-C ............................. 42

ganciclovir sodium ..................... 18

ganirelix acetate ........................ 37

GATTEX .................................... 34

gavilyte-c ................................... 34

gavilyte-g ................................... 34

gavilyte-n with flavor pack ......... 34

GAZYVA .................................... 14

GEL-ONE .................................. 44

gemcitabine hcl .......................... 14

gemfibrozil ................................. 22

gemmily ..................................... 39

generlac ..................................... 34

gengraf ...................................... 42

GENOTROPIN ........................... 37

GENOTROPIN MINIQUICK ....... 37

gentak ........................................ 45

gentamicin in saline ..................... 7

gentamicin sulfate .................. 7, 45

GENVISC 850 ............................ 44

GENVOYA ................................. 18

GILOTRIF .................................. 14

GIVLAARI .................................. 44

GLASSIA ................................... 48

glatiramer acetate ...................... 25

glatopa ....................................... 25

glimepiride ................................. 28

glipizide er .................................. 28

glipizide ir ................................... 28

glipizide xl .................................. 28

glipizide-metformin hcl ............... 28

glucagon emergency kit ............. 29

glyburide .................................... 28

glyburide micronized .................. 28

glyburide-metformin ................... 28

glycine ....................................... 35

glycine urologic .......................... 35

glycopyrrolate ............................ 34

glycopyrrolate pf ......................... 34

glydo ............................................ 5

GLYXAMBI ................................ 28

GOCOVRI .................................. 17

GONAL-F ................................... 37

GONAL-F RFF ........................... 37

GONAL-F RFF REDIJECT......... 37

granisetron hcl ........................... 11

GRANIX ..................................... 20

griseofulvin microsize ................. 12

griseofulvin ultramicrosize .......... 12

guanfacine hcl ............................ 22

guanfacine hcl er........................ 25

GUARDIAN SENSOR (3) .......... 29

GUARDIAN SENSOR 3 ............. 29

HAEGARDA ............................... 42

hailey 1.5/30 .............................. 39

hailey 24 fe ................................ 39

hailey fe 1.5/30 .......................... 39

hailey fe 1/20 ............................. 39

HALAVEN .................................. 14

halobetasol propionate ............... 27

haloperidol ................................. 18

haloperidol decanoate ................ 18

haloperidol lactate ...................... 18

HARVONI .................................. 18

heather ...................................... 39

HEMANGEOL ............................ 22

hematinic/folic acid ..................... 31

HEMLIBRA ................................ 20

hemocyte-f ................................. 31

HEMOFIL M ............................... 20

heparin (porcine) in nacl .............. 9

heparin lock flush ...................... 44

heparin sod (porcine) in d5w ...... 9

heparin sodium (porcine) ............ 9

heparin sodium (porcine) pf ........ 9

heparin sodium lock flush .......... 44

HERCEPTIN ............................. 14

HERCEPTIN HYLECTA ............ 14

hetastarch-nacl.......................... 20

HETLIOZ ................................... 50

HIZENTRA ................................ 42

homatropaire ............................. 46

HUMALOG ................................ 29

HUMALOG KWIKPEN .............. 30

HUMALOG MIX 50/50

KWIKPEN ................................. 30

HUMALOG MIX 50/50 VIAL...... 30

HUMALOG MIX 75/25

KWIKPEN ................................. 30

HUMALOG MIX 75/25 VIAL...... 30

HUMATE-P ............................... 20

HUMATROPE ........................... 37

HUMIRA .................................... 42

HUMIRA PEDIATRIC

CROHNS START ...................... 42

HUMIRA PEN ........................... 42

HUMIRA PEN-CD/UC/HS

STARTER ................................. 42

HUMIRA PEN-PEDIATRIC UC

START ...................................... 42

HUMIRA PEN-PS/UV/ADOL

HS START ................................ 42

HUMIRA PEN-PSOR/UVEIT

STARTER ................................. 42

HUMULIN 70/30 KWIKPEN ...... 30

HUMULIN 70/30 VIAL ............... 30

HUMULIN N KWIKPEN ............ 30

HUMULIN N VIAL ..................... 30

HUMULIN R U-500 KWIKPEN 30

HUMULIN R U-500 VIAL ........... 30

HUMULIN R VIAL ..................... 30

HYALGAN ................................. 44

hydralazine hcl .......................... 22

hydrochlorothiazide ................... 22

hydrocodone bitartrate er ............ 3

hydrocodone polst-chlorphen

polst er susp ............................. 47

hydrocodone-acetaminophen ...... 3

hydrocodone-homatropine ........ 47

hydrocodone-ibuprofen ............... 3

hydrocortisone............... 27, 36, 43

hydrocortisone (perianal) .......... 43

hydrocortisone ace-pramoxine 43

hydrocortisone butyr lipo base 27

56

hydrocortisone butyrate ............. 27

hydrocortisone valerate ............. 27

hydrocortisone-acetic acid ......... 46

hydromet .................................... 47

hydromorphone hcl ...................... 3

hydromorphone hcl er .................. 3

hydromorphone hcl pf .................. 3

hydroxocobalamin acetate ......... 31

hydroxychloroquine sulfate ........ 17

hydroxyprogesterone caproate. 39

hydroxyurea ............................... 14

hydroxyzine hcl .......................... 20

hydroxyzine pamoate ................ 20

HYMOVIS .................................. 44

hyoscyamine sulfate .................. 34

hyoscyamine sulfate sl .............. 34

hyosyne ..................................... 34

HYQVIA ..................................... 42

ibandronate sodium ................... 43

IBRANCE ................................... 14

ibuprofen ...................................... 5

ibuprofen lysine ........................... 5

ibutilide fumarate ....................... 23

icatibant acetate ........................ 42

iclevia ........................................ 39

ICLUSIG .................................... 14

icosapent ethyl ........................... 23

idarubicin hcl.............................. 14

IDELVION .................................. 20

IDHIFA ....................................... 14

ifosfamide .................................. 14

imatinib mesylate ....................... 14

IMBRUVICA ............................... 14

IMCIVREE ................................. 25

IMFINZI...................................... 14

imipenem-cilastatin ...................... 7

imipramine hcl ........................... 10

imiquimod .................................. 27

IMLYGIC .................................... 14

INBRIJA ..................................... 17

incassia...................................... 39

INCRELEX ................................. 37

indapamide ................................ 23

indomethacin ............................... 5

indomethacin er ........................... 5

indomethacin sodium ................... 5

INGREZZA ................................ 25

INLYTA ...................................... 14

INREBIC .................................... 14

INTELENCE .............................. 18

INTRON A ........................... 18, 19

introvale ..................................... 39

INVIRASE .................................. 19

iodine strong .............................. 31

iodine tincture .............................. 7

ipratropium bromide ............. 47, 48

ipratropium-albuterol .................. 48

irbesartan ................................... 23

irbesartan-hydrochlorothiazide 23

IRESSA...................................... 14

irinotecan hcl .............................. 14

ISENTRESS .............................. 19

ISENTRESS HD ........................ 19

isibloom...................................... 39

isoniazid ..................................... 13

isoproterenol hcl ......................... 48

ISOPTO CARPINE .................... 45

isosorbide mononitrate ............... 23

isosorbide mononitrate er .......... 23

isotretinoin ................................. 27

ISTODAX (OVERFILL)............... 14

ISTURISA .................................. 37

itraconazole ............................... 12

ivermectin .................................. 17

IXEMPRA KIT ............................ 14

IXINITY ...................................... 20

JADENU .................................... 31

jaimiess ...................................... 39

JAKAFI ...................................... 14

jantoven ....................................... 9

JANUMET .................................. 28

JANUMET XR ............................ 28

JANUVIA .................................... 28

JARDIANCE .............................. 28

jasmiel ....................................... 39

jencycla ...................................... 39

JENTADUETO ........................... 28

JENTADUETO XR ..................... 28

JEVTANA ................................... 14

jinteli .......................................... 39

jolessa ....................................... 39

juleber ........................................ 39

junel 1.5/30 ................................ 39

junel 1/20 ................................... 39

junel fe 1.5/30 ............................ 39

junel fe 1/20 ............................... 39

junel fe 24 .................................. 39

JUXTAPID ................................. 23

JYNARQUE ............................... 31

KADCYLA .................................. 14

kaitlib fe ..................................... 39

KALBITOR ................................. 42

kalliga ........................................ 39

KALYDECO ............................... 49

KANJINTI ................................... 15

KANUMA ................................... 34

kariva ........................................ 39

kcl in dextrose-nacl ................... 31

kcl-lactated ringers-d5w ............ 31

kelnor 1/35 ................................ 39

kelnor 1/50 ................................ 39

KEPIVANCE ............................. 25

KEPPRA ..................................... 9

KESIMPTA ................................ 25

ketoconazole ............................. 12

ketodan ..................................... 12

ketoprofen ................................... 5

ketoprofen er ............................... 5

ketorolac tromethamine......... 5, 45

KEVEYIS ................................... 45

KEYTRUDA .............................. 15

KITABIS PAK ............................ 49

klor-con ..................................... 31

klor-con 10 ................................ 31

klor-con m10 ............................. 31

klor-con m15 ............................. 31

klor-con m20 ............................. 31

klor-con/ef ................................. 31

KOATE ...................................... 20

KOATE-DVI ............................... 20

KOGENATE FS ........................ 20

KOSELUGO .............................. 15

KOVALTRY ............................... 20

k-prime ...................................... 31

KRYSTEXXA ............................ 12

K-TAB ....................................... 31

kurvelo ...................................... 39

KUVAN ..................................... 34

KYLEENA ................................. 39

KYMRIAH .................................. 42

KYPROLIS ................................ 15

LABETALOL HCL ..................... 23

labetalol hcl ............................... 23

lactated ringers ......................... 31

lactic acid .................................. 28

lactic acid e ............................... 27

lactulose .................................... 34

lactulose encephalopathy .......... 34

lamivudine ................................. 19

lamivudine-zidovudine ............... 19

lamotrigine .................................. 9

lamotrigine er .............................. 9

lamotrigine starter kit-blue ........... 9

lamotrigine starter kit-green......... 9

lamotrigine starter kit-orange....... 9

lansoprazole .............................. 33

lanthanum carbonate ................ 35

LANTUS SOLOSTAR ............... 30

LANTUS U-100 VIAL ................ 30

57

lapatinib ditosylate ..................... 15

larin 1.5/30 ................................. 39

larin 1/20 .................................... 39

larin 24 fe ................................... 39

larin fe 1.5/30 ............................. 39

larin fe 1/20 ................................ 39

larissia ....................................... 39

latanoprost ................................. 45

layolis fe .................................... 39

LEDIPASVIR-SOFOSBUVIR ..... 19

leena .......................................... 39

leflunomide ................................ 42

LENVIMA ................................... 15

lessina ....................................... 39

letrozole ..................................... 15

leucovorin calcium ..................... 15

LEUKINE ................................... 20

leuprolide acetate ...................... 37

LEVEMIR U-100 FLEXTOUCH.30

LEVEMIR U-100 VIAL ............... 30

levetiracetam ............................... 9

levetiracetam er ........................... 9

levetiracetam in nacl .................... 9

levobunolol hcl ........................... 45

levocarnitine .............................. 31

levocarnitine sf ........................... 31

levocetirizine dihydrochloride ..... 47

levofloxacin ............................ 7, 45

levofloxacin in d5w ...................... 7

levoleucovorin calcium............... 15

levoleucovorin calcium pf ........... 15

levonest ..................................... 39

levonorgest-eth est & eth est ..... 39

levonorgest-eth estrad 91-day 39

levonorgestrel-ethinyl estrad ...... 39

levonorg-eth estrad triphasic ..... 39

levora 0.15/30 (28) ..................... 39

levorphanol tartrate .................. 3, 4

levo-t .......................................... 41

levothyroxine sodium ................. 41

levoxyl ....................................... 41

lidocaine ...................................... 5

lidocaine hcl ................................. 5

lidocaine hcl (cardiac) .................. 5

lidocaine hcl (cardiac) pf .............. 5

lidocaine hcl (pf)........................... 5

lidocaine hcl urethral/mucosal ..... 6

lidocaine in d5w ........................... 6

LIDOCAINE IN DEXTROSE ........ 6

lidocaine viscous hcl .................. 26

lidocaine-epinephrine ................... 6

lidocaine-prilocaine ...................... 6

LILETTA (52 MG) ...................... 39

lillow ........................................... 40

lincomycin hcl .............................. 8

linezolid ........................................ 8

linezolid in sodium chloride .......... 8

LINZESS .................................... 34

liothyronine sodium .................... 41

lisinopril ...................................... 23

lisinopril-hydrochlorothiazide ...... 23

lithium carbonate ....................... 20

lithium carbonate er ................... 20

LMD IN D5W .............................. 20

LMD IN NACL ............................ 20

l-methylfolate ............................. 31

l-methylfolate calcium ................ 31

l-methylfolate forte ..................... 31

l-methylfolate-algae .................... 31

l-methyl-mc nac.......................... 31

lojaimiess ................................... 40

LONSURF .................................. 15

loperamide hcl ........................... 34

lopinavir-ritonavir ........................ 19

lorazepam .................................. 20

lorazepam intensol ..................... 20

LORBRENA ............................... 15

loryna ......................................... 40

losartan potassium ..................... 23

losartan potassium-hctz ............. 23

loteprednol etabonate ................ 45

lovastatin .................................... 23

low-ogestrel ............................... 40

loxapine succinate ..................... 18

lo-zumandimine .......................... 40

LUBIPROSTONE ....................... 34

LUCENTIS ................................. 46

LUMIZYME ................................ 34

LUPANETA PACK ..................... 37

LUPKYNIS ................................. 42

LUPRON DEPOT (1-MONTH) 37

LUPRON DEPOT (3-MONTH) 37

LUPRON DEPOT (4-MONTH)

INTRAMUSCULAR KIT 30MG 37

LUPRON DEPOT (6-MONTH)

INTRAMUSCULAR KIT 45MG 37

LUPRON DEPOT-PED (1-

MONTH) .................................... 37

LUPRON DEPOT-PED (3-

MONTH) .................................... 37

lutera .......................................... 40

lyleq ........................................... 40

lyllana ........................................ 40

LYUMJEV KWIKPEN ................. 30

LYUMJEV VIAL ......................... 30

lyza ............................................ 40

mafenide acetate ........................ 8

magnesium chloride .................. 31

magnesium sulfate .................... 31

MANGANESE CHLORIDE ........ 31

mannitol .................................... 23

marlissa..................................... 40

MARQIBO ................................. 15

MATULANE .............................. 15

matzim la .................................. 23

MAVYRET ................................. 19

meclizine hcl ............................. 11

meclofenamate sodium ............... 5

medroxyprogesterone acetate 40

mefenamic acid ........................... 5

mefloquine hcl ........................... 17

megestrol acetate ..................... 40

MEKINIST ................................. 15

MEKTOVI .................................. 15

meloxicam ................................... 5

melphalan ................................. 15

melphalan hcl ............................ 15

memantine hcl........................... 10

memantine hcl er ...................... 10

MENOPUR ................................ 37

meperidine hcl............................. 4

MEPHYTON .............................. 31

meprobamate ............................ 20

mercaptopurine ......................... 15

meropenem ................................. 8

merzee ...................................... 40

mesalamine ............................... 43

mesalamine-cleanser ................ 43

mesna ....................................... 15

METAFOLBIC PLUS ................. 31

metformin hcl er ........................ 28

metformin hcl er (mod) .............. 28

metformin hcl er (osm) .............. 28

metformin hcl ir ......................... 28

methadone hcl ............................ 4

methadone hcl intensol ............... 4

methadose .................................. 4

methadose sugar-free ................. 4

methazolamide .......................... 45

methenamine hippurate .............. 8

methergine ................................ 44

methimazole .............................. 41

methocarbamol ......................... 50

methotrexate ............................. 42

methotrexate sodium ................ 42

methotrexate sodium (pf) .......... 42

methoxsalen rapid ..................... 28

methyldopa ............................... 23

methylergonovine maleate ........ 44

58

methylphenidate hcl ................... 25

methylphenidate hcl er .............. 25

methylphenidate hcl er (cd) ....... 25

methylprednisolone .................... 36

methylprednisolone acetate ....... 36

methylprednisolone sodium

succ ........................................... 36

methyltestosterone .................... 36

metoclopramide hcl ................... 11

metolazone ................................ 23

metoprolol succinate er ............. 23

metoprolol tartrate ..................... 23

metronidazole ........................ 8, 28

METRONIDAZOLE

BENZO+SYRSPEND ................... 8

metronidazole in nacl ................... 8

metyrosine ................................. 23

mexiletine hcl ............................. 23

mibelas 24 fe ............................. 40

micafungin sodium ..................... 12

miconazole 3 ............................. 12

microgestin 1.5/30 ..................... 40

microgestin 1/20 ........................ 40

microgestin 24 fe ....................... 40

microgestin fe 1.5/30 ................. 40

microgestin fe 1/20 .................... 40

midodrine hcl ............................. 23

mifepristone ............................... 31

MIGERGOT ............................... 12

miglitol ....................................... 28

miglustat .................................... 35

mili ............................................. 40

MILLIPRED ................................ 36

milrinone lactate ........................ 23

milrinone lactate in dextrose ...... 23

mimvey ...................................... 40

minitran ...................................... 23

minocycline hcl ............................ 8

minocycline hcl er ........................ 8

minoxidil..................................... 23

MIOSTAT ................................... 46

MIRCERA .................................. 20

MIRENA (52 MG) ...................... 40

mirtazapine ................................ 10

misoprostol ................................ 33

mitomycin .................................. 15

mitoxantrone hcl ........................ 15

modafinil .................................... 50

molindone hcl ............................ 18

mometasone furoate ............ 28, 47

mondoxyne nl .............................. 8

MONJUVI .................................. 15

monoject flush syringe ............... 31

monoject sodium chloride flush.31

mono-linyah ............................... 40

MONONINE ............................... 20

MONOVISC ............................... 44

montelukast sodium ................... 48

morgidox ...................................... 8

morphine sulfate .......................... 4

morphine sulfate (concentrate) .... 4

morphine sulfate (pf) .................... 4

morphine sulfate er ...................... 4

morphine sulfate er beads ........... 4

moxifloxacin hcl.......................... 45

moxifloxacin hcl (2x day) ............ 45

moxifloxacin hcl in nacl ................ 8

MOZOBIL ................................... 20

MULPLETA ................................ 20

MULTAQ .................................... 23

mupirocin ..................................... 8

mupirocin calcium ........................ 8

mutamycin ................................. 15

MVASI ....................................... 15

MYALEPT .................................. 35

MYCAPSSA ............................... 37

mycophenolate mofetil ............... 42

mycophenolate mofetil hcl ......... 42

mycophenolate sodium .............. 42

MYLOTARG ............................... 15

MYOBLOC ................................. 44

myorisan .................................... 28

MYRBETRIQ ............................. 35

na ferric gluc cplx in sucrose ..... 31

nabumetone ................................. 5

nafcillin sodium ............................ 8

NAFCILLIN SODIUM IN

DEXTROSE ................................. 8

nafrinse ...................................... 31

nafrinse drops ............................ 31

naftifine hcl ................................ 12

NAGLAZYME ............................. 35

nalbuphine hcl.............................. 4

naloxone hcl ................................ 6

naltrexone hcl .............................. 6

naproxen ...................................... 5

naproxen sodium ......................... 5

naratriptan hcl ............................ 12

nateglinide ................................. 28

NATPARA .................................. 44

nebivolol hcl ............................... 23

necon 0.5/35 (28) ...................... 40

nefazodone hcl .......................... 10

neomycin sulfate .......................... 8

neomycin-bacitracin zn-

polymyx...................................... 46

neomycin-polymyxin b gu ........... 8

neomycin-polymyxin-dexameth 46

neomycin-polymyxin-

gramicidin .................................. 46

neo-polycin ................................ 46

neo-polycin hc ........................... 46

neostigmine methylsulfate ......... 12

NEOSTIGMINE

METHYLSULFATE ................... 13

NERLYNX ................................. 15

neuac ........................................ 28

NEULASTA ............................... 20

NEULASTA ONPRO ................. 20

NEUPOGEN ....................... 20, 21

NEUPRO ................................... 17

nevirapine ................................. 19

nevirapine er ............................. 19

NEXAVAR ................................. 15

NEXPLANON ............................ 40

niacin (antihyperlipidemic) ......... 23

niacin er (antihyperlipidemic) .... 23

niacor ........................................ 23

nicardipine hcl ........................... 23

nifedipine ................................... 23

nifedipine er .............................. 23

nifedipine er osmotic release .... 23

nikki ........................................... 40

nilutamide .................................. 15

nimodipine ................................. 23

NINLARO .................................. 15

nitazoxanide .............................. 17

nitisinone ................................... 35

NITRO-BID ................................ 23

nitrofurantoin ............................... 8

nitrofurantoin macrocrystal .......... 8

nitrofurantoin monohydrate

macrocrystals .............................. 8

nitroglycerin ............................... 23

nitroglycerin in d5w ................... 23

nitroprusside sodium ................. 23

NITROSTAT .............................. 23

NIVESTYM ................................ 21

nizatidine ................................... 33

nolix .......................................... 28

nora-be ..................................... 40

NORDITROPIN FLEXPRO ....... 37

norepinephrine bitartrate ........... 23

NOREPINEPHRINE-

DEXTROSE .............................. 23

NOREPINEPHRINE-SODIUM

CHLORIDE ............................... 23

norethin ace-eth estrad-fe ......... 40

norethindrone ............................ 40

59

norethindrone acetate ................ 40

norethindrone acet-ethinyl est 40

norethin-eth estradiol-fe ............. 40

norgestimate-eth estradiol ......... 40

norgestimate-ethinyl estradiol

triphasic ..................................... 40

norlyda ....................................... 40

norlyroc ...................................... 40

normal saline flush..................... 31

nortrel 0.5/35 (28) ...................... 40

nortrel 1/35 (21) ......................... 40

nortrel 1/35 (28) ......................... 40

nortrel 7/7/7 ............................... 40

nortriptyline hcl .......................... 11

NOURIANZ ................................ 17

NOVAREL ................................. 37

NOVOEIGHT ............................. 21

NOVOSEVEN RT ...................... 21

np thyroid ................................... 41

NPLATE..................................... 21

NUBEQA ................................... 15

NUCALA .................................... 47

NUCYNTA ................................... 4

NUCYNTA ER ............................. 4

NULOJIX ................................... 42

NUPLAZID ................................. 18

NUTROPIN AQ NUSPIN 10 ...... 37

NUTROPIN AQ NUSPIN 20 ...... 37

NUTROPIN AQ NUSPIN 5 ........ 37

NUVARING ................................ 40

NUWIQ ...................................... 21

nyamyc ...................................... 12

nylia 7/7/7 .................................. 40

nymyo ........................................ 40

nystatin ...................................... 12

nystatin-triamcinolone ................ 12

nystop ........................................ 12

OBIZUR ..................................... 21

OCALIVA ................................... 35

ocella ......................................... 40

OCTAGAM ................................ 42

octreotide acetate ...................... 37

ODEFSEY ................................. 19

ODOMZO .................................. 15

OFEV ......................................... 48

ofloxacin .............................. 45, 46

OGIVRI ...................................... 15

olanzapine ................................. 18

olanzapine-fluoxetine hcl ........... 11

olmesartan medoxomil ............... 23

olmesartan medoxomil-hctz ....... 23

olmesartan-amlodipine-hctz ....... 24

olopatadine hcl .................... 45, 47

omega-3-acid ethyl esters .......... 24

omeprazole ................................ 33

OMEPRAZOLE+SYRSPEND

SF ALKA .................................... 33

OMNITROPE ............................. 37

ondansetron hcl ......................... 11

ondansetron odt ......................... 11

ONETOUCH ULTRA TEST

STRIPS ...................................... 29

ONETOUCH VERIO KIT

W/DEVICE ................................. 29

ONIVYDE ................................... 15

ONTRUZANT ............................. 15

ONUREG ................................... 15

OPDIVO ..................................... 15

OPSUMIT .................................. 49

oralone ....................................... 26

ORENCIA ............................ 42, 43

ORENCIA CLICKJECT .............. 42

ORENITRAM ............................. 49

ORFADIN ................................... 35

ORKAMBI .................................. 49

ORLADEYO ............................... 43

orphenadrine citrate ................... 50

orphenadrine citrate er ............... 50

orsythia ...................................... 40

ORTHOVISC ............................. 44

oseltamivir phosphate ................ 19

OTEZLA ..................................... 43

OVIDREL ................................... 37

oxacillin sodium ........................... 8

OXACILLIN SODIUM IN

DEXTROSE ................................. 8

oxaliplatin ................................... 15

oxandrolone ............................... 36

oxazepam .................................. 20

OXBRYTA .................................. 44

oxcarbazepine.............................. 9

OXERVATE ............................... 46

oxiconazole nitrate ..................... 12

OXLUMO ................................... 35

oxybutynin chloride .................... 35

oxybutynin chloride er ................ 35

oxycodone hcl .............................. 4

OXYCODONE HCL ER ............... 4

oxycodone-acetaminophen .......... 4

OXYCONTIN ............................... 4

oxymorphone hcl .......................... 4

oxytocin...................................... 37

OZEMPIC .................................. 28

PACERONE ............................... 24

paclitaxel .................................... 15

PADCEV .................................... 15

paliperidone er .......................... 18

palonosetron hcl ........................ 11

pamidronate disodium ............... 43

pancuronium bromide ............... 25

pantoprazole sodium ................. 33

PARAGARD INTRAUTERINE

COPPER ................................... 40

paraplatin .................................. 15

paricalcitol ................................. 44

paromomycin sulfate ................... 8

paroxetine hcl............................ 11

paroxetine mesylate .................. 11

peg 3350-kcl-na bicarb-nacl ...... 34

peg-3350/electrolytes ................ 34

peg-3350/electrolytes/ascorbat. 34

PEGASYS ................................. 19

peg-kcl-nacl-nasulf-na asc-c ..... 34

peg-prep.................................... 34

PEMAZYRE .............................. 15

penicillamine ............................. 35

penicillin g potassium .................. 8

penicillin g procaine .................... 8

penicillin g sodium....................... 8

penicillin v potassium .................. 8

PENTASA ................................. 43

pentazocine-naloxone hcl ........... 4

pentobarbital sodium ................... 9

pentoxifylline er ......................... 24

periogard ................................... 26

PERJETA .................................. 15

permethrin ................................. 17

perphenazine ............................ 11

perphenazine-amitriptyline ........ 11

PFIZERPEN ................................ 8

phenazo .................................... 35

phenazopyridine hcl .................. 35

phendimetrazine tartrate ........... 25

phendimetrazine tartrate er ....... 25

phenelzine sulfate ..................... 11

phenobarbital .............................. 9

phenobarbital sodium .................. 9

phenoxybenzamine hcl.............. 24

phentermine hcl......................... 25

phentolamine mesylate ............. 24

phenylephrine hcl ................ 24, 46

phenytoin .................................... 9

phenytoin infatabs ....................... 9

phenytoin sodium ........................ 9

phenytoin sodium extended ........ 9

PHESGO ................................... 15

philith ........................................ 40

PHOSPHA 250 NEUTRAL ........ 31

phosphorous ............................. 31

60

phospho-trin 250 neutral ............ 31

phytonadione ............................. 32

PIFELTRO ................................. 19

pilocarpine hcl ...................... 26, 45

pimozide .................................... 18

pimtrea ...................................... 40

pindolol ...................................... 24

pioglitazone hcl .......................... 28

pioglitazone hcl-glimepiride ....... 28

pioglitazone hcl-metformin hcl 28

piperacillin sod-tazobactam so .... 8

PIQRAY ..................................... 15

pirmella 1/35 .............................. 40

pirmella 7/7/7 ............................. 40

podofilox .................................... 28

POLIVY...................................... 15

polocaine ..................................... 6

polocaine-mpf .............................. 6

polycin ....................................... 46

polymyxin b sulfate ...................... 8

polymyxin b-trimethoprim ........... 46

POMALYST ............................... 15

portia-28 .................................... 40

PORTRAZZA ............................. 15

posaconazole ............................ 12

potassium acetate ..................... 32

potassium chloride ..................... 32

potassium chloride crys er ......... 32

potassium chloride er ................ 32

potassium chloride in dextrose. 32

potassium chloride in nacl ......... 32

potassium citrate er ................... 32

potassium phosphates(71 meq

k) ............................................... 32

pramipexole dihydrochloride ...... 17

pramipexole dihydrochloride er. 17

prasugrel hcl .............................. 17

pravastatin sodium .................... 24

praziquantel ............................... 17

prazosin hcl ............................... 24

prednicarbate ............................. 28

prednisolone .............................. 36

prednisolone acetate ................. 45

prednisolone sodium

phosphate ............................ 36, 45

prednisone ................................. 36

prednisone intensol ................... 36

pregabalin .................................. 25

pregabalin er.............................. 25

PREGNYL ................................. 37

PREMARIN ................................ 40

PREMPHASE ............................ 40

PREMPRO ................................ 40

prenatal ...................................... 32

prenatal plus iron ....................... 32

prenatal vitamin plus low iron .... 32

preplus ....................................... 32

prevalite ..................................... 24

previfem ..................................... 40

PREVYMIS ................................ 19

PREZCOBIX .............................. 19

PREZISTA ................................. 19

PRIALT ........................................ 4

primaquine phosphate ............... 17

primidone ..................................... 9

PRIVIGEN .................................. 43

PROAIR HFA ............................. 48

PROAIR RESPICLICK ............... 48

probenecid ................................. 12

procainamide hcl ........................ 24

PROCENTRA ............................ 25

prochlorperazine ........................ 11

prochlorperazine edisylate ......... 11

prochlorperazine maleate .......... 11

PROCRIT ................................... 21

procto-med hc ............................ 43

procto-pak .................................. 43

proctosol hc ............................... 43

proctozone-hc ............................ 43

PROCYSBI ................................ 35

PROFILNINE ............................. 21

progesterone .............................. 40

PROLASTIN-C ........................... 48

PROLEUKIN .............................. 15

PROLIA...................................... 43

PROMACTA .............................. 21

promethazine hcl ....................... 47

promethazine vc ........................ 47

promethazine vc/codeine ........... 47

promethazine-codeine ................ 47

promethazine-dm ....................... 47

promethazine-phenyleph-

codeine ...................................... 47

promethazine-phenylephrine ...... 47

promethegan .............................. 47

propafenone hcl ......................... 24

propafenone hcl er ..................... 24

proparacaine hcl ........................ 46

propranolol hcl ........................... 24

propranolol hcl er ....................... 24

propylthiouracil ........................... 41

protamine sulfate ....................... 21

PROVENGE .............................. 43

pseudoephedrine-bromphen-

dm .............................................. 47

PULMICORT FLEXHALER ........ 48

PULMICORT SUSPENSION ..... 48

PULMOZYME ........................... 49

PURIXAN .................................. 15

pyrazinamide ............................. 13

pyridostigmine bromide ............. 13

pyridostigmine bromide er ......... 13

pyridoxine hcl ............................ 32

pyrimethamine........................... 17

QINLOCK .................................. 15

quetiapine fumarate .................. 18

quetiapine fumarate er .............. 18

quinapril hcl ............................... 24

quinapril-hydrochlorothiazide ..... 24

quinidine gluconate er ............... 24

quinidine sulfate ........................ 24

QVAR REDIHALER .................. 48

rabeprazole sodium .................. 33

RADICAVA ................................ 25

raloxifene hcl ............................. 36

ramipril ...................................... 24

ranolazine er ............................. 24

rasagiline mesylate ................... 17

RAVICTI .................................... 35

reclipsen.................................... 40

RECOMBINATE ........................ 21

REGONOL ................................ 13

relexxii ....................................... 25

RELNATE DHA ......................... 32

remifentanil hcl ............................ 4

RENFLEXIS .............................. 43

repaglinide ................................ 28

RETEVMO ................................ 15

REVATIO .................................. 49

REVLIMID ................................. 15

revonto ...................................... 50

RIASTAP ................................... 21

ribavirin ..................................... 19

rifabutin ..................................... 13

rifampin ..................................... 13

riluzole ...................................... 25

rimantadine hcl .......................... 19

ringers ....................................... 32

ringers irrigation ........................ 32

RINVOQ .................................... 43

risedronate sodium .................... 43

risperidone ................................ 18

ritonavir ..................................... 19

RITUXAN HYCELA ................... 15

rivastigmine ............................... 10

rivastigmine tartrate ................... 10

rivelsa ....................................... 40

RIXUBIS.................................... 21

rizatriptan benzoate .................. 12

61

rocuronium bromide ................... 25

ROMIDEPSIN ............................ 15

ropinirole hcl .............................. 17

ropivacaine hcl ............................. 6

rosadan...................................... 28

rosuvastatin calcium .................. 24

roweepra ...................................... 9

ROZLYTREK ............................. 15

RUCONEST .............................. 43

rufinamide .................................... 9

RUKOBIA .................................. 19

RUZURGI .................................. 44

RYBELSUS ............................... 28

ryvent ......................................... 47

SAIZEN...................................... 37

SAIZENPREP ............................ 37

sajazir ........................................ 43

saline bacteriostatic ................... 32

SAMSCA ................................... 32

sapropterin dihydrochloride ....... 35

SARCLISA ................................. 15

selegiline hcl .............................. 17

selenium sulfide ......................... 28

SELZENTRY ............................. 19

sensorcaine-mpf .......................... 6

SEREVENT DISKUS ................. 48

SEROSTIM ................................ 34

sertraline hcl .............................. 11

setlakin ...................................... 40

sevelamer carbonate ................. 35

sevelamer hcl ............................ 35

sf................................................ 26

sf 5000 plus ............................... 26

sharobel ..................................... 41

SIGNIFOR ................................. 37

sildenafil citrate .................... 35, 49

silodosin..................................... 36

silver sulfadiazine ........................ 8

simliya ....................................... 41

simpesse ................................... 41

SIMPONI ................................... 43

SIMPONI ARIA .......................... 43

simvastatin ................................. 24

sirolimus .................................... 43

SIVEXTRO .................................. 8

SKYLA ....................................... 41

SKYRIZI..................................... 43

SKYRIZI (150 MG DOSE) ......... 43

SKYRIZI PEN ............................ 43

sod benz-sod phenylacet ........... 35

sod citrate-citric acid .................. 32

sodium acetate .......................... 32

sodium bicarbonate ............. 32, 34

sodium chloride .................... 32, 47

sodium chloride (pf) ................... 32

sodium chloride bacteriostatic .... 32

sodium chloride flush ................. 32

sodium fluoride .................... 26, 32

sodium fluoride 5000 enamel ..... 26

sodium fluoride 5000 plus .......... 26

sodium fluoride 5000 ppm .......... 26

sodium fluoride 5000 sensitive 26

sodium nitroprusside .................. 24

sodium phenylbutyrate ............... 35

sodium polystyrene sulfonate .... 32

sodium saccharin ....................... 44

sodium thiosulfate ...................... 44

SOFOSBUVIR-VELPATASVIR.19

solifenacin succinate .................. 35

SOLIQUA ................................... 29

SOLIRIS..................................... 21

SOMATULINE DEPOT .............. 37

SOMAVERT ............................... 37

sorine ......................................... 24

sotalol hcl ................................... 24

sotalol hcl (af) ............................ 24

SOVALDI ................................... 19

spinosad .................................... 17

SPINRAZA ................................. 44

SPIRIVA HANDIHALER ............. 48

SPIRIVA RESPIMAT ................. 48

spironolactone............................ 24

spironolactone-hctz .................... 24

SPRAVATO (56 MG DOSE) ...... 11

SPRAVATO (84 MG DOSE) ...... 11

sprintec 28 ................................. 41

SPRYCEL .................................. 15

sps ............................................. 32

sronyx ........................................ 41

ssd ............................................... 8

stavudine ................................... 19

STELARA .................................. 43

sterile diluent/epoprostenol ........ 44

sterile water for injection ............ 44

sterile water for irrigation ............ 32

STIMATE ................................... 38

STIOLTO RESPIMAT ................ 48

STIVARGA ................................. 15

STRENSIQ ................................ 35

STRIBILD ................................... 19

subvenite ................................... 10

subvenite starter kit-blue ............ 10

subvenite starter kit-green ......... 10

subvenite starter kit-orange ....... 10

succinylcholine chloride ............. 25

SUCRAID ................................... 35

sucralfate .................................. 33

sulfacetamide sodium ............... 45

sulfacetamide sodium (acne) .... 28

sulfacetamide-prednisolone....... 46

sulfadiazine ................................. 8

sulfamethoxazole-trimethoprim ... 8

sulfasalazine ............................. 43

sulfatrim pediatric ........................ 8

sulfurated lime ........................... 17

sulindac ....................................... 5

sumatriptan ............................... 12

sumatriptan succinate ............... 12

sumatriptan succinate refill ........ 12

sunitinib malate ......................... 15

SUPARTZ FX ............................ 44

SUPPRELIN LA ........................ 38

syeda ........................................ 41

SYLVANT .................................. 16

SYMBICORT ............................. 48

SYMDEKO ................................ 49

SYMLINPEN 120 ...................... 29

SYMLINPEN 60 ........................ 29

SYMPAZAN .............................. 10

SYMTUZA ................................. 19

SYNAGIS .................................. 43

SYNJARDY ............................... 29

SYNJARDY XR ......................... 29

SYNRIBO .................................. 16

SYNTHROID ............................. 41

SYNVISC .................................. 44

SYNVISC ONE.......................... 44

TABRECTA ............................... 16

tacrolimus ............................ 28, 43

tadalafil (pah) ............................ 49

TAFINLAR ................................. 16

TAKHZYRO .............................. 43

TALTZ ....................................... 43

TALZENNA ............................... 16

tamoxifen citrate ........................ 16

tamsulosin hcl ........................... 36

TARGRETIN ............................. 16

tarina 24 fe ................................ 41

tarina fe 1/20 ............................. 41

tarina fe 1/20 eq ........................ 41

TASIGNA .................................. 16

tavaborole ................................. 12

TAVALISSE .............................. 21

taysofy ...................................... 41

tazarotene ................................. 28

tazicef ......................................... 8

taztia xt ..................................... 24

TAZVERIK ................................ 16

TECARTUS ............................... 16

62

TECENTRIQ .............................. 16

TEGRETOL-XR ......................... 10

TEGSEDI ................................... 25

TEKTURNA HCT ....................... 24

telmisartan ................................. 24

telmisartan-amlodipine ............... 24

temozolomide ............................ 16

temsirolimus .............................. 43

tenofovir disoproxil fumarate ..... 19

TEPEZZA .................................. 38

terazosin hcl .............................. 36

terbinafine hcl ............................ 12

terbutaline sulfate ...................... 49

terconazole ................................ 12

TERIPARATIDE

(RECOMBINANT) ...................... 43

TESTOPEL ................................ 36

testosterone ............................... 36

testosterone cypionate .............. 36

testosterone enanthate .............. 36

tetrabenazine ............................. 25

tetracaine hcl ......................... 6, 46

THALOMID ................................ 16

theophylline ............................... 49

theophylline er ........................... 49

thiamine hcl ............................... 32

thioridazine hcl ........................... 18

thiotepa ...................................... 16

thiothixene ................................. 18

THYMOGLOBULIN .................... 43

tiadylt er ..................................... 24

tiagabine hcl .............................. 10

TIBSOVO ................................... 16

tigecycline .................................... 8

TIKOSYN ................................... 24

tilia fe ......................................... 41

timolol maleate........................... 45

timolol maleate ocudose ............ 45

timolol maleate pf....................... 45

tinidazole ..................................... 8

tiopronin ..................................... 35

tis-u-sol ...................................... 32

TIVICAY..................................... 19

TIVICAY PD ............................... 19

tizanidine hcl .............................. 50

TOBI NEBULIZER ..................... 49

TOBI PODHALER ..................... 49

tobramycin ........................... 45, 49

TOBRAMYCIN ........................... 49

tobramycin sulfate ....................... 8

tobramycin-dexamethasone ....... 46

tolbutamide ................................ 29

tolterodine tartrate ...................... 35

tolterodine tartrate er .................. 35

TOLVAPTAN ............................. 32

tolvaptan .................................... 32

topiramate .................................. 10

topiramate er .............................. 10

toposar ....................................... 16

topotecan hcl ............................. 16

toremifene citrate ....................... 16

torsemide ................................... 24

TOUJEO MAX SOLOSTAR ....... 30

TOUJEO SOLOSTAR ................ 30

tovet ........................................... 28

TRADJENTA .............................. 29

tramadol hcl er ............................. 4

tramadol hcl er (biphasic) ............. 4

tramadol hcl ir .............................. 4

tramadol-acetaminophen ............. 4

trandolapril ................................. 24

trandolapril-verapamil hcl er ....... 24

tranylcypromine sulfate .............. 11

TRAZIMERA .............................. 16

trazodone hcl ............................. 11

TREANDA .................................. 16

TRELEGY ELLIPTA ................... 49

TREMFYA .................................. 43

treprostinil .................................. 49

TRESIBA ................................... 30

TRESIBA FLEXTOUCH ............. 30

tretinoin ................................ 16, 28

TRETTEN .................................. 21

tri femynor .................................. 41

triamcinolone acetonide 26, 28, 36

triamcinolone in absorbase ........ 28

triamterene-hctz ......................... 24

triazolam .................................... 20

TRI-CHLOR ............................... 28

triderm ....................................... 28

tri-estarylla ................................. 41

trifluoperazine hcl ....................... 18

trifluridine ................................... 45

trihexyphenidyl hcl ..................... 17

TRIKAFTA ................................. 49

tri-legest fe ................................. 41

tri-linyah ..................................... 41

tri-lo-estarylla ............................. 41

tri-lo-marzia ................................ 41

tri-lo-mili ..................................... 41

tri-lo-sprintec .............................. 41

TRILURON ................................ 44

trimethobenzamide hcl ............... 11

trimethoprim ................................. 8

tri-mili ......................................... 41

trimipramine maleate ................. 11

tri-nymyo ................................... 41

tri-previfem ................................ 41

tri-sprintec ................................. 41

tritocin ....................................... 28

TRIUMEQ ................................. 19

TRIVISC .................................... 44

trivora (28) ................................ 41

tri-vylibra ................................... 41

tri-vylibra lo ............................... 41

TRODELVY ............................... 16

trospium chloride ....................... 35

trospium chloride er ................... 35

TRULANCE ............................... 34

TRULICITY ............................... 29

TRUXIMA .................................. 16

TUDORZA PRESSAIR .............. 49

TUKYSA.................................... 16

tulana ........................................ 41

TURALIO .................................. 16

tyblume ..................................... 41

TYBOST.................................... 19

tydemy ...................................... 41

TYMLOS ................................... 43

TYVASO ................................... 49

TYVASO REFILL ...................... 49

TYVASO STARTER .................. 49

UKONIQ .................................... 16

ULTOMIRIS .............................. 21

unithroid .................................... 41

UNITUXIN ................................. 16

UPLIZNA ................................... 43

UPTRAVI .................................. 49

ursodiol ..................................... 34

valacyclovir hcl .......................... 19

VALCHLOR ............................... 16

valganciclovir hcl ....................... 19

valproate sodium ....................... 10

valproic acid .............................. 10

valrubicin ................................... 16

valsartan ................................... 24

valsartan-hydrochlorothiazide .... 24

VALSTAR .................................. 16

vancomycin hcl ........................... 8

vandazole .................................... 9

vardenafil hcl ............................. 35

varenicline tartrate ...................... 6

VARITHENA ............................. 24

VECTIBIX .................................. 16

vecuronium bromide .................. 25

VELCADE ................................. 16

velivet ........................................ 41

VENCLEXTA ............................. 16

63

VENCLEXTA STARTING

PACK ......................................... 16

venlafaxine hcl ........................... 11

venlafaxine hcl er....................... 11

VENTAVIS ................................. 49

VENTOLIN HFA ........................ 49

verapamil hcl ............................. 24

verapamil hcl er ......................... 24

VEREGEN ................................. 28

VERZENIO ................................ 16

vestura ....................................... 41

VICTOZA ................................... 29

VIEKIRA PAK ............................ 19

vienva ........................................ 41

vigabatrin ................................... 10

vigadrone ................................... 10

VIMIZIM ..................................... 35

VIMPAT ..................................... 10

vinblastine sulfate ...................... 16

vincristine sulfate ....................... 16

vinorelbine tartrate ..................... 16

viorele ........................................ 41

VIRACEPT ................................. 19

VIRAZOLE ................................. 19

virt-phos 250 neutral .................. 32

VISCO-3 .................................... 44

VISTOGARD ............................. 44

VISUDYNE ................................ 46

vitamin d (ergocalciferol) ........... 32

vitamin k1 .................................. 32

VITRAKVI .................................. 16

VIVITROL .................................... 6

VIZIMPRO ................................. 16

volnea ........................................ 41

VONVENDI ................................ 21

voriconazole .............................. 12

VOSEVI ..................................... 19

VOTRIENT ................................ 16

vp-pnv-dha ................................. 32

VPRIV ........................................ 35

VUMERITY ................................ 25

VYEPTI ...................................... 12

vyfemla ...................................... 41

VYLEESI .................................... 25

vylibra ........................................ 41

VYNDAMAX .............................. 24

VYNDAQEL ............................... 24

VYONDYS 53 ............................ 35

WAKIX ....................................... 50

warfarin sodium ........................... 9

water for irrigation, sterile .......... 32

WELCHOL ................................. 24

wera ........................................... 41

WILATE ..................................... 21

wixela inhub ............................... 49

wymzya fe .................................. 41

XALKORI ................................... 16

XARELTO .................................... 9

XARELTO STARTER PACK ....... 9

XELJANZ ................................... 43

XELJANZ XR ............................. 43

XEOMIN..................................... 44

XGEVA ...................................... 43

XIAFLEX .................................... 44

XIGDUO XR............................... 29

XOFIGO ..................................... 16

XOLAIR...................................... 47

XOSPATA .................................. 16

XPOVIO (100 MG ONCE

WEEKLY) ................................... 16

XPOVIO (40 MG ONCE

WEEKLY) ................................... 16

XPOVIO (40 MG TWICE

WEEKLY) ................................... 16

XPOVIO (60 MG ONCE

WEEKLY) ................................... 16

XPOVIO (60 MG TWICE

WEEKLY) ................................... 16

XPOVIO (80 MG ONCE

WEEKLY) ................................... 16

XPOVIO (80 MG TWICE

WEEKLY) ................................... 16

XTANDI...................................... 16

xulane ........................................ 41

XURIDEN ................................... 35

XYNTHA .................................... 21

XYNTHA SOLOFUSE ................ 21

XYREM ...................................... 50

YERVOY .................................... 16

YONDELIS ................................. 16

YONSA ...................................... 16

yuvafem ..................................... 41

zafemy ....................................... 41

zafirlukast ................................... 49

zaleplon ..................................... 50

ZALTRAP ................................... 16

zarah .......................................... 41

ZARXIO ..................................... 21

ZELBORAF ................................ 17

ZEMAIRA ................................... 49

zenatane .................................... 28

ZEPATIER ................................. 19

ZEPZELCA ................................ 17

ZETIA ........................................ 24

zidovudine .................................. 19

ZIEXTENZO ............................... 21

ZINC CHLORIDE ...................... 32

ziprasidone hcl .......................... 18

ziprasidone mesylate ................ 18

ZOKINVY .................................. 44

ZOLADEX ................................. 38

zoledronic acid .......................... 44

ZOLGENSMA ........................... 35

ZOLINZA ................................... 17

zolmitriptan ................................ 12

zolpidem tartrate ....................... 50

zolpidem tartrate er ................... 50

ZOMACTON ............................. 38

ZOMACTON (FOR ZOMA-JET

10) ............................................. 38

zonisamide ................................ 10

ZORBTIVE ................................ 34

ZORTRESS .............................. 43

zovia 1/35 (28) .......................... 41

zovia 1/35e (28) ........................ 41

zumandimine ............................. 41

ZYDELIG ................................... 17

ZYKADIA ................................... 17

64

AultCare/Aultra General Tag Lines Revised 6/2021 (TTY) 616/16

AultCare/Aultra General Tag Lines for the State of Ohio

English

If you, or someone you are helping, have questions about AultCare/Aultra you have the right to get help and information in your

language at no cost. To speak with an interpreter, call Local: 330.363.6360 Outside Stark County: 1.800.344.8858 TTY Local: 711

Outside Stark County: 711

Spanish

Español

Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca AultCare/Aultra tiene derecho a obtener ayuda e información en

su idioma sin costo alguno. Para hablar con un intérprete, llame al Local : 330.363.6360 Fuera del condado de Stark : 1.800.344.8858

TTY Local : 711 Fuera del condado de Stark : 711

Chinese

中文

如果您，或是您正在協助的對象，有關於 AultCare/Aultra保险公司方面的問題，您有權利免費以您的母語得到幫助和訊息。

洽詢一位翻譯員，請撥電話本地： 330.363.6360 斯塔克縣外： 1.800.344.8858 TTY線本地： 711斯塔克縣外： 711。

German

Deutsche

Falls Sie oder jemand, dem Sie helfen, Fragen zum AultCare/Aultra haben, haben Sie das Recht, kostenlose Hilfe und Informationen in

Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer Local: 330.363.6360 Außerhalb von

Stark County : 1.800.344.8858 TTY –Linie Local: 711 Außerhalb von Stark County : 711 an.

Arabic

العربية فة. للتحدث مع مترجم اتصل ب ، لديك الحق في الحصول على المساعدة والمعلومات الضرورية بلغتك من دون اية تكلالعربية

شركة التأمين إن كان لديك أو لدى شخص تساعده أسئلة بخصوص AultCare/Aultra

1.800.344.8858 330.363.6360خارج مقاطعة ستارك : TTYالخط 711المحلي: 711 .خارج مقاطعة ستارك

Pennsylvania Dutch

Deitsch

Wann du hoscht en Froog, odder ebber, wu du helfscht, hot en Froog baut AultCare/Aultra hoscht du es Recht fer Hilf un Information in

deinre eegne Schprooch griege, un die Hilf koschtet nix. Wann du mit me Interpreter schwetze witt, kannscht du Local: 330.363.6360

Außerhalb von Stark County: 1.800.344.8858 TTY –Linie Local: 711 Außerhalb von Stark County : 711 uffrufe.

Russian

русский

Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Страховая компания AultCare/Aultra, то вы имеете

право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону

Местный: 330.363.6360 Вне Старка County : 1.800.344.8858 TTY линия Местный: 711 Вне Старка County : 711.

French

Français

Si vous, ou quelqu'un que vous êtes en train d’aider, a des questions à propos de Compagnie d'Assurance AultCare/Aultra, vous avez le

droit d'obtenir de l'aide et l'information dans votre langue à aucun coût. Pour parler à un interprète, Appelez Locale 330.363.6360 En

dehors du comté de Stark : 1.800.344.8858 ligne ATS Local : 711 En dehors du comté de Stark : 711.

Vietnamese Việt Nam Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Công ty Bảo hiểm AultCare/Aultra quý vị sẽ có quyền được giúp và có

thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi Địa phương: 330.363.6360 Bên ngoài

của Stark County : 1.800.344.8858 TTY đường dây Địa phương: 711 Bên ngoài của Stark County : 711.

Cushite-Oromo

Isin yookan namni biraa isin deeggartan AultCare/Aultra, irratti gaaffii yo qabaattan, kaffaltii irraa bilisa haala ta’een afaan keessaniin

odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa bilbilaa Local: 330.363.6360

Outside of Stark County: 1.800.344.8858 TTY Line Local: 711 Outside of Stark County: 711 tiin bilbilaa.

AultCare/Aultra General Tag Lines Revised 6/2021 (TTY) 616/16

Korean

한국어

만약 귀하 또는 귀하가 돕고 있는 어떤 사람이 AultCare/Aultra 보험 회사 에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를

귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는 지역 : 330.363.6360 스타크

카운티 의 외부 : 1.800.344.8858 TTY 라인 지역 : 711 스타크 카운티 의 외부 : 711

로 전화하십시오.

Italian

Italiano

Se tu o qualcuno che stai aiutando avete domande su AultCare/Aultra, hai il diritto di ottenere aiuto e informazioni nella tua lingua

gratuitamente. Per parlare con un interprete, puoi chiamare Locale: 330.363.6360 Al di fuori di Stark County : 1.800.344.8858 TTY

linea Locale: 711 Al di fuori di Stark County : 711.

Japanese

日本語

ご本人様、またはお客様の身の回りの方でも AultCare/Aultra保険会社についてご質問がございましたら、ご希望の言語でサ

ポートを受けたり、情報を入手したりすることができます。料金はかかりません。通訳とお話される場合、

ローカル： 330.363.6360 スターク郡の外： 1.800.344.8858 TTYラインローカル： 711 スターク郡の外： 711までお電話くだ

さい。

Dutch

Nederlands

Als u, of iemand die u helpt, vragen heeft over AultCare/Aultra, heeft u het recht om hulp en informatie te krijgen in uw taal zonder

kosten. Om te praten met een tolk, bel Local : 330.363.6360 Buiten Stark County : 1.800.344.8858 TTY Line Local : 711 Buiten

Stark County : 711.

Ukrainian

український

Якщо у Вас чи у когось, хто отримує Вашу допомогу, виникають питання про Страхова компанія AultCare/Aultra, у Вас є

право отримати безкоштовну допомогу та інформацію на Вашій рідній мові. Щоб зв’язатись з перекладачем, задзвоніть на

Місцевий : 330.363.6360 Поза Старка County : 1.800.344.8858 TTY лінія Місцевий : 711 Поза Старка County : 711.

Romanian

Română

Dacă dumneavoastră sau persoana pe care o asistați aveți întrebări privind Compania de Asigurari AultCare/Aultra, aveți dreptul de a

obține gratuit ajutor și informații în limba dumneavoastră. Pentru a vorbi cu un interpret, sunați la Locale : 330.363.6360 In afara Stark

Judet : 1.800.344.8858 TTY linie Locale : 711 In afara Stark Judet : 711.

Non-Discrimination Notice:

AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin,

age, disability, or sex. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age,

disability, or sex. AultCare/Aultra provides free aids and services to people with disabilities to communicate effectively with us, such as:

Qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other

formats). AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters

and information written in other languages.

If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on

the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights

Coordinator, 2600 6th St. S.W. Canton, OH 44710, 330-363-7456, [email protected]. You can file a grievance in

person or by mail, fax, or email. If you need help filing a grievance, our Civil Rights staff is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically

through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

AultCare - Non-Medicare - Formulary

Documents

Transcript of AultCare - Non-Medicare - Formulary