Cigna-HealthSpring Rx (PDP) 2020 Cigna-HealthSpring Rx ... · This drug list was updated September...

This drug list was updated September 2019. For more recent information or other questions, please contact Cigna-HealthSpring Customer Service, at 1-800-558-9562 or, for TTY users, 711, 8 a.m. – 8 p.m., local time, 7 days a week. Our automated phone system may answer your call during weekends from April 1 – Sept 30, or visit CignaMedicare.com/group/PDPResources. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal.

INT_20_XXXXX_C 20_GF_FCG

Fairfax County Government

Cigna-HealthSpring Rx (PDP)

2020 Cigna-HealthSpring Rx (PDP) Drug List (Formulary)

Base Plus Drug List

Please read: This document contains information about the drugs we cover in this plan.

http://www.cignamedicare.com/group/PDPresources

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What is the Cigna-HealthSpring RX PDP Comprehensive Drug List? A drug list is a list of covered drugs selected by Cigna-HealthSpring Rx (PDP) in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Cigna-HealthSpring Rx (PDP) will generally cover the drugs listed in our drug list as long as the drug is medically necessary, the prescription is filled at a Cigna-HealthSpring Rx (PDP) network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Drug List (formulary) change? Most changes in drug coverage happen on January 1, but we may add or remove drugs on the drug list during the year, move them to different cost-sharing tiers, or add new restrictions. Changes that can affect you this year. In the below cases, you will be affected by the coverage changes during the year:

• New Generic Drugs. We may immediately remove a brand name drug on our drug list if we are replacing it with a new generic drug that will appear on the same or lower cost-sharing tier and with the same or fewer restrictions. Also, when adding the new generic drug, we may decide to keep the brand name drug on our drug list, but immediately move it to a different cost-sharing tier or add new restrictions. If you are currently taking that brand name drug, we may not tell you in advance before we make that change, but we will later provide you with information about the specific change(s) we have made. o If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand

name drug for you. The notice we provide you will also include information on the steps you may take to request an exception, and you can also find information in the following section entitled “How do I request and exception to the Cigna-HealthSpring Rx (PDP) Drug List?”

• Drugs removed from the market. If the Food and Drug Administration (FDA) deems a drug on our drug list to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our drug list and provide notice to customers who take the drug.

• Other changes. We may make other changes that affect customers currently taking a drug. For instance, we may add a generic drug that is not new to the market to replace a brand name drug currently on the drug list or add new restrictions to the brand name drug or move it to a different cost-sharing tier. We may also make changes based on new clinical guidelines and/or studies. If we remove drugs from our drug list, add prior authorization, quantity limits, and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected customers of the change at least 30 days before the change becomes effective, or at the time the customer requests a refill of the drug, at which time the customer will receive a 30-day supply of the drug. o If we make these other changes, you or your prescriber can ask us to make an exception and continue to cover the

brand name drug for you. The notice we provide you will also include information on how to request an exception, and

Note to existing customers: This drug list has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to “we,” “us” or “our,” it means Cigna. When it refers to “plan” or “our plan,” it means Cigna-HealthSpring Rx (PDP). This document includes a list of the drugs (formulary) for our plans, which is current as of September 2019. If you have any questions, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2021, and from time to time during the year.

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you can also find information in the section below entitled “How do I request an exception to the Cigna-HealthSpring Rx (PDP) Drug List?”

Changes that will not affect you if you are currently taking the drug. Generally, if you are taking a drug on our 2020 drug list that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2020 coverage year except as described above. This means these drugs will remain available at the same cost-sharing and with no new restrictions for those customers taking them for the remainder of the coverage year. The enclosed drug list is current as of September 2019. To get updated information about the drugs covered by Cigna-HealthSpring Rx (PDP), please contact us. Our contact information appears on the front and back cover pages. If there are significant changes made to the printed drug list within the covered year, you may be notified by mail identifying the changes. How do I use the Drug List? There are two ways to find your drug within the drug list: Medical Condition The drug list begins on page 8. The drugs in this drug list are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, “CARDIOVASCULAR, HYPERTENSION / LIPIDS”. If you know what your drug is used for, look for the category name in the list that begins on page 8. Then look under the category name for your drug. Covered Drug Index If you are not sure what category to look under, you should look for your drug in the Covered Drugs Index that begins on page 100. The Covered Drugs Index provides a list of all of the drugs included in this document. Both brand name drugs and generic drugs are in the Drug List. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Covered Drug Index and find the name of your drug in the drug name column of the list. What are generic drugs? Cigna-HealthSpring Rx (PDP) covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

• Prior Authorization: The plan requires you or your doctor to get prior authorization for some drugs. This means that you will need to get approval from the plan before you fill these prescriptions. If you do not get approval, Cigna-HealthSpring Rx (PDP) may not cover the drug.

• Quantity Limits: For certain drugs, the plan limits the amount of the drug that Cigna-HealthSpring Rx (PDP) will cover. For example, the plan allows for 1 tablet per day for BYSTOLIC 10MG. This applies to a standard one-month supply (for total quantity of 30 per 30 days) or three-month supply (for total quantity of 90 per 90 days).

• Step Therapy: In some cases, the plan requires you first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Cigna-HealthSpring Rx (PDP) may not cover Drug B unless you try Drug A first. If Drug A does not work for you, the plan will then cover Drug B.

• Non-Extended Days Supply: For certain drugs, Cigna-HealthSpring Rx (PDP) limits the amount of the drug that we will cover to only a 30-day supply or less, at one time. For example, customers who have not had any recent fill of opioid pain medications within the past 120 days (referred to as “opioid naïve”) are limited to a maximum of 7 days’ supply of opioid pain medication. Customers who have received a recent fill of an opioid pain medication (not opioid naïve) are limited to up to a month’s supply of that medication at one time. Other high cost drugs may be subject to a non-extended day supply restriction, as well.

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You can find out if your drug has any additional requirements or limits by looking in the drug list that begins on page 8. You can also get more information about the restrictions applied to specific covered drugs by visiting CignaMedicare.com/group/PDPresources and choose the formulary noted on the cover of this document. We have posted online documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the drug list, appears on the front and back cover pages. You can ask Cigna-HealthSpring Rx (PDP) to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, “How do I request an exception to the plan drug list?” on the next page for information about how to request an exception. Options for Maintenance Medications Taking the medications prescribed by your doctor is important to your health. We are committed to helping you achieve control of chronic conditions by making it easy for you to receive your maintenance medications. There are several ways we can work together to accomplish this goal:

• Talk with your doctor about whether a 90-day supply of your ongoing, stable medications may be appropriate. [Taking these medications every day as prescribed is important for your overall health, and getting 90-day prescriptions of these medications can ensure that you don’t miss a dose.]

• You can receive a 90-day supply at most retail pharmacies or through one of our mail-order pharmacies. • Talk to your pharmacist if you are experiencing any new challenges with your maintenance medications.

How can I use my prescription drug coverage to save money on my medications? There may be opportunities for you to save money on your medications using your plan coverage.

• Ask your doctor (or other prescriber) if there are any lower-cost generic alternatives available for any of your current medications.

• Check the Drug Tier and Cost-Share Tables to see if your plan offers copay savings with mail order.

• Explore whether the ‘CMS Extra Help’ program may offer additional financial support for your medications.

• If your medication is not covered on the plan drug list, talk with your doctor about alternative medications which are covered in the drug list.

What if my drug is not in the Drug List? If your drug is not included in this drug list, you should first contact Customer Service to ask if your drug is covered. If you learn that the plan does not cover your drug, you have two options:

• You can ask Customer Service for a list of similar drugs that are covered by the plan. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by the plan.

• You can ask the plan to make an exception to cover your drug. See below for information about how to request an exception.

How do I request an exception to the plan Drug List? You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.

• You can ask us to cover a drug even if it is not in our drug list. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level.

• You can ask us to waive coverage restrictions or limits on your drug. For example, there are certain drugs that the plan limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.

• You can ask us to provide a tiering exception for a drug to be covered at a lower cost-sharing tier.


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o If the drug you’re taking is a brand name drug you can ask us to cover your drug at the cost-sharing amount that applies to the lowest tier that contains brand name alternatives for treating your condition.

o If the drug you’re taking is a generic drug you can ask us to cover your drug at the cost-sharing amount that applies to the lowest tier that contains either brand or generic alternatives for treating your condition.

o If the drug you’re taking is a biological product you can ask us to cover your drug at the cost-sharing amount that applies to the lowest tier that contains biological product alternatives for treating your condition.

These exceptions would lower the amount you must pay for your drug.

In order to request an exception, you can visit CignaMedicare.com/group/PDPresources to print the exception request form. Once you have completed the form, you can mail it the address listed on the form. Please note, if we grant your request to cover a drug that is not in our drug list, you may not ask us to provide a higher level of coverage of the drug. Also, you may not ask us to provide a higher level of coverage for drugs that are in the Specialty tier. Generally, we will only approve your request for an exception if the alternative drug is included on the plan’s drug list, the lower cost-sharing drug or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a drug list, tiering or utilization restriction exception. When you request a drug list, tiering or utilization restriction exception, you should submit a statement from your prescriber or doctor supporting your request. Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor or other prescriber. What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or existing customer in our plan, you may either be taking drugs that are not in our drug list or taking a drug that is in our drug list but your ability to get it is limited. If this is the case, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide whether you should switch to an alternative drug that we cover or request a drug list exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug up to a 30-day supply, in certain cases during the first 90 days you are a customer of our plan. For each of your drugs that are not on our drug list or if your ability to get your drugs is limited, we will cover a temporary 30-day supply. If your prescription is written for fewer days, we’ll allow refills to provide up to a maximum 30-day supply of medication. After your first 30-day supply, we will not pay for these drugs without a drug list exception, even if you have been a customer of the plan less than 90 days. If you are a resident of a long-term care facility and you need a drug that is not in our drug list or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug while you pursue a drug list exception. In order to accommodate unexpected transitions of our customers that do not leave time for advanced planning, such as level-of-care changes due to discharge from a hospital to a nursing facility or to a home, we will allow a one-time 31-day supply (unless the prescription is written for fewer days).

Cigna-HealthSpring Rx (PDP) Drug List The drug list that begins on page 8 provides coverage information about of the drugs covered by Cigna-HealthSpring Rx (PDP). If you have trouble finding your drug in the list, turn to the Covered Drug Index that begins on page 100. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., TRELEGY ELLIPTA) and generic drugs are listed in lower-case italics (e.g., candesartan). The information in the Requirements/Limits column tells you if we have any special requirements for coverage of your drug.


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Some plans offer additional prescription drug coverage in the coverage gap. Please refer to your Evidence of Coverage Snapshot to see if your plan has this coverage and for more information. We specify quantity limits on certain drugs which are indicated with a QL in the drug list that begins on page 8, along with the amount dispensed per the days supplied. (For example: candesartan 32MG QL 30/30; this means the drug candesartan 32MG is limited to 30 tablets per 30 days. For 90-day supplies, this quantity limit would be expanded to 90 tablets per 90 days).

For more information For more detailed information about your Cigna-HealthSpring Rx (PDP) coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Cigna-HealthSpring Rx (PDP), please contact us. Our contact information, along with the date we last updated the drug list, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. Or, visit http://www.medicare.gov.

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2020 Drug Tier and Cost-Share Table The following table represents the plan name, the drug tier number as it appears in the drug list and the cost-share amount for that tier number. You may also refer to Evidence of Coverage and snapshot for additional details. Cigna-HealthSpring Rx (PDP) is not always able to keep all generic medications in the Generic drug tiers. Some generic medications may be in the Preferred Brand (Tier 2) and Specialty Drug (Tier 4) tiers. Keep in mind that the name of the tier is just a description of the majority of the drugs in the tier; it does not mean that there are only generic or only brand drugs in either tier. For customers receiving Extra Help: Your Low Income Subsidy (LIS) copay level will be based on how the Food and Drug Administration (FDA) classifies certain drugs. Due to this, a generic drug may receive a preferred brand drug copay, or a preferred brand drug may receive a generic drug copay. Please see your LIS Rider for additional information on these copay levels. Or call Customer Service for further clarification regarding a specific drug.

Fairfax County Government Base Plus Drug List

Cigna-HealthSpring Rx (PDP)

Retail Cost Share 30 / 60 / 90 Days

Mail Order Cost Share 30 / 60 / 90 Days

Out of Network*

30-day supply

Tier 1: Preferred Generic Drugs $7 / $14 / $21 $7 / $14 / $14 30%

Tier 2: Preferred Brand Drugs 20% ($50 max) / 20% ($100 max) / 20% ($150 max)

20% ($50 max) / 20% ($100 max) / 20% ($100 max)

30%

Tier 3: Non-Preferred Generic and Brand Drugs

30% ($100 max) / 30% ($200 max) / 30% ($300 max)

30% ($100 max) / 30% ($200 max) / 30% ($200 max)

30%

Tier 4: Specialty Generic and Brand Drugs**

30% ($100 max) / N/A / N/A

30% ($100 max) / N/A / N/A 30%

*You will pay the copay or percentage of the drug cost shown above plus the difference between the Out-of-Network pharmacy billed charge and our typical Standard Retail pharmacy billed cost. **Specialty Generic and Brand drugs are limited to a 30-day supply.

This drug list contains the following additional drugs:

Expanded Coverage (EC) – Supplemental brand drugs that are not standardly offered or offered at a higher tier on the Cigna Medicare Part D drug list

This prescription drug has a Part B versus D administrative prior authorization requirement. This drug may be covered under Medicare Part B or D depending on circumstances.

B/D

This drug requires prior authorization.PA

This drug has quantity limits.QL

This High Risk Medication (HRM) requires prior authorization.PA HRM

ST

Symbol Key - Utilization Management Requirements/ Limits

This prescription drug is not normally covered in a Medicare Prescription Drug Plan. The amount you pay when you fill a prescription for this drug does not count towards your total drug costs (that is, the amount you pay does not help you qualify for catastrophic coverage). In addition, if you are receiving extra help to pay for your prescriptions, you will not get any extra help to pay for this drug.

2020 Comprehensive Formulary

Tier 1: Preferred Generic Drugs Tier 2: Preferred Brand DrugsTier 3: Non-Preferred Generic and Brand DrugsTier 4: Specialty Generic and Brand Drugs

Cost-Sharing Tier Description

This drug has step therapy requirements.

+

Generally all medications in the drug list are available through mail order, except when special circumstances or situations prohibit mailing a particular medication to your home.

Supplemental brand drugs that are not standardly offered on the Cigna Medicare Part D drug list.BPThis prescription drug has a Part D versus Exclusion administrative prior authorization requirement. This drug may be covered under Medicare Part D depending on circumstances.

D/E

Supplemental brand drugs that are not standardly offered or offered at a higher tier on the Cigna Medicare Part D drug list.

EC

* Opioid medication available as a 7-day supply or less for first time opioid user. For continued use this drug may only be available as a month supply.

Drug NameDrug Tier

Requirements/ Limits


Drug NameDrug Tier


ADJUNCTIVE AGENTSleucovorin cal 500 mg/50 ml vl 1leucovorin calcium 10 mg tab 1leucovorin calcium 100 mg vial 1leucovorin calcium 15 mg tab 1leucovorin calcium 25 mg tab 1leucovorin calcium 350 mg vial 1leucovorin calcium 5 mg tab 1leucovorin calcium 50 mg vial 1leucovorin calcium 500 mg vl 1mesna 1 gram/10 ml vial 1 PA,B/DMESNEX 400 MG TABLET 4XGEVA 120 MG/1.7 ML VIAL 4 PA,QL

1.7/28

ADRENAL HORMONESCORTEF 10 MG TABLET 2 ECCORTEF 20 MG TABLET 2 ECCORTEF 5 MG TABLET 2 ECcortisone 25 mg tablet 1DEPO-MEDROL 20 MG/ML VIAL 3dexamethasone 0.5 mg tablet 1dexamethasone 0.5 mg/5 ml elx 1dexamethasone 0.5 mg/5 ml liq 1dexamethasone 0.75 mg tablet 1dexamethasone 1 mg tablet 1dexamethasone 1.5 mg tablet 1dexamethasone 10 mg/ml vial 1dexamethasone 100 mg/10 ml vl 1dexamethasone 120 mg/30 ml vl 1

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Drug NameDrug Tier



Drug NameDrug Tier


dexamethasone 2 mg tablet 1dexamethasone 20 mg/5 ml vial 1dexamethasone 4 mg tablet 1dexamethasone 4 mg/ml vial 1dexamethasone 6 mg tablet 1DEXAMETHASONE INTENSOL 1 MG/ML

1

fludrocortisone 0.1 mg tablet 1HP ACTHAR GEL 80 UNIT/ML VIAL

4 PA,DvE

hydrocortisone 10 mg tablet 1hydrocortisone 20 mg tablet 1hydrocortisone 5 mg tablet 1KENALOG-10 50 MG/5 ML VIAL 3MEDROL 2 MG TABLET 2methylprednisolone 16 mg tab 1methylprednisolone 32 mg tab 1methylprednisolone 4 mg dosepk 1methylprednisolone 4 mg tablet 1methylprednisolone 40 mg/ml vl 1methylprednisolone 8 mg tab 1methylprednisolone 80 mg/ml vl 1methylprednisolone ss 125 mg 1methylprednisolone ss 40 mg vl 1prednisolone 15 mg/5 ml soln 1prednisolone 5 mg/5 ml soln 1prednisolone odt 10 mg tablet 1prednisolone odt 15 mg tablet 1prednisolone odt 30 mg tablet 1prednisolone sod ph 25 mg/5 ml 1prednisone 1 mg tablet 1prednisone 10 mg tab dose pack 1prednisone 10 mg tablet 1prednisone 2.5 mg tablet 1prednisone 20 mg tablet 1prednisone 5 mg tab dose pack 1prednisone 5 mg tablet 1prednisone 5 mg/5 ml solution 1prednisone 50 mg tablet 1PREDNISONE INTENSOL 5 MG/ML

1

SOLU-CORTEF 1,000 MG ACT-O-VL

3

SOLU-CORTEF 100 MG ACT-O-VIAL

3


3


3

triamcinolone acet 200 mg/5 ml 1triamcinolone acet 40mg/ml vl 1

AGENTS FOR STOMATOLOGICAL USEDEBACTEROL SOLUTION 2 +DEBACTEROL SWABSTICK 2 +

ANOREXIANTSXENICAL 120 MG CAPSULE 2 PA,DvE

ANTIARRHYTHMIC AGENTSamiodarone 150 mg/3 ml vial 1amiodarone 450 mg/9 ml vial 1amiodarone 900 mg/18 ml vial 1amiodarone hcl 100 mg tablet 1amiodarone hcl 200 mg tablet 1amiodarone hcl 400 mg tablet 1disopyramide 100 mg capsule 1disopyramide 150 mg capsule 1dofetilide 125 mcg capsule 1dofetilide 250 mcg capsule 1dofetilide 500 mcg capsule 1flecainide acetate 100 mg tab 1flecainide acetate 150 mg tab 1flecainide acetate 50 mg tab 1lidocaine hcl 1% abboject 1lidocaine hcl 2% luer-jet 1mexiletine 150 mg capsule 1mexiletine 200 mg capsule 1mexiletine 250 mg capsule 1MULTAQ 400 MG TABLET 2 QL 60/30NORPACE CR 100 MG CAPSULE 3NORPACE CR 150 MG CAPSULE 3PACERONE 100 MG TABLET 1PACERONE 200 MG TABLET 1PACERONE 400 MG TABLET 1

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Drug NameDrug Tier



Drug NameDrug Tier


propafenone hcl 150 mg tablet 1propafenone hcl 225 mg tab 1propafenone hcl 300 mg tab 1propafenone hcl er 225 mg cap 1propafenone hcl er 325 mg cap 1propafenone hcl er 425 mg cap 1quinidine gluc er 324 mg tab 1quinidine sulfate 200 mg tab 1quinidine sulfate 300 mg tab 1SORINE 120 MG TABLET 1SORINE 160 MG TABLET 1SORINE 240 MG TABLET 1SORINE 80 MG TABLET 1sotalol 120 mg tablet 1sotalol 160 mg tablet 1sotalol 240 mg tablet 1sotalol 80 mg tablet 1sotalol af 120 mg tablet 1sotalol af 160 mg tablet 1sotalol af 80 mg tablet 1

ANTIBIOTICSAK-POLY-BAC EYE OINTMENT 1AZASITE 1% EYE DROPS 2bacitracin 500 unit/gm ophth 1bacitracin-polymyxin eye oint 1BESIVANCE 0.6% SUSP 3CILOXAN 0.3% OINTMENT 2ciprofloxacin 0.3% eye drop 1erythromycin 0.5% eye ointment 1gatifloxacin 0.5% eye drops 1GENTAK 0.3 % EYE OINTMENT 1gentamicin 3 mg/ml eye drop 1levofloxacin 0.5% eye drops 1MOXEZA 0.5% EYE DROPS 3moxifloxacin 0.5% eye drops 1NATACYN EYE DROPS 2neomyc-bacit-polymix eye oint 1neomyc-polym-gramicid eye drop

1

NEO-POLYCIN EYE OINTMENT 1

ofloxacin 0.3% ear drops 1ofloxacin 0.3% eye drops 1POLYCIN EYE OINTMENT 1polymyxin b-tmp eye drops 1tobramycin 0.3% eye drop 1TOBREX 0.3% EYE OINTMENT 2

ANTICHOLINERGICS / ANTISPASMODICSdarifenacin er 15 mg tablet 1darifenacin er 7.5 mg tablet 1DETROL LA 2 MG CAPSULE 2 QL

30/30,ECDETROL LA 4 MG CAPSULE 2 QL

30/30,ECflavoxate hcl 100 mg tablet 1GELNIQUE 10% GEL PUMP 3 QL 30/30MYRBETRIQ ER 25 MG TABLET 2 QL 60/30MYRBETRIQ ER 50 MG TABLET 2 QL 30/30oxybutynin 5 mg tablet 1oxybutynin 5 mg/5 ml syrup 1 QL 600/30oxybutynin cl er 10 mg tablet 1 QL 60/30oxybutynin cl er 15 mg tablet 1 QL 60/30oxybutynin cl er 5 mg tablet 1 QL 60/30solifenacin 10 mg tablet 1 QL 30/30solifenacin 5 mg tablet 1 QL 30/30tolterodine tart er 2 mg cap 1 QL 30/30tolterodine tart er 4 mg cap 1 QL 30/30tolterodine tartrate 1 mg tab 1tolterodine tartrate 2 mg tab 1TOVIAZ ER 4 MG TABLET 2 QL 30/30TOVIAZ ER 8 MG TABLET 2 QL 30/30trospium chloride 20 mg tablet 1 QL 60/30trospium chloride er 60 mg cap 1 QL 30/30VESICARE 10 MG TABLET 3 QL

30/30,ECVESICARE 5 MG TABLET 3 QL

30/30,EC

ANTICONVULSANTSAPTIOM 200 MG TABLET 4 QL 180/30APTIOM 400 MG TABLET 4 QL 90/30APTIOM 600 MG TABLET 4 QL 60/30APTIOM 800 MG TABLET 4 QL 60/30

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Drug NameDrug Tier



Drug NameDrug Tier


BANZEL 200 MG TABLET 4BANZEL 40 MG/ML SUSPENSION 4 QL 2400/30BANZEL 400 MG TABLET 4BRIVIACT 10 MG TABLET 3 QL 60/30BRIVIACT 10 MG/ML ORAL SOLN 3 QL 600/30BRIVIACT 100 MG TABLET 3 QL 60/30BRIVIACT 25 MG TABLET 3 QL 60/30BRIVIACT 50 MG TABLET 3 QL 60/30BRIVIACT 75 MG TABLET 3 QL 60/30carbamazepine 100 mg tab chew 1carbamazepine 100 mg/5 ml susp 1carbamazepine 200 mg tablet 1carbamazepine er 100 mg cap 1carbamazepine er 100 mg tablet 1carbamazepine er 200 mg cap 1carbamazepine er 200 mg tablet 1carbamazepine er 300 mg cap 1carbamazepine er 400 mg tablet 1CELONTIN 300 MG KAPSEAL 2clobazam 10 mg tablet 1 QL 60/30clobazam 2.5 mg/ml suspension 4 QL 480/30clobazam 20 mg tablet 4 QL 60/30clonazepam 0.125 mg dis tab 1 QL 150/30clonazepam 0.25 mg odt 1 QL 150/30clonazepam 0.5 mg dis tablet 1 QL 150/30clonazepam 0.5 mg tablet 1 QL 150/30clonazepam 1 mg dis tablet 1 QL 150/30clonazepam 1 mg tablet 1 QL 150/30clonazepam 2 mg odt 1 QL 300/30clonazepam 2 mg tablet 1 QL 300/30DEPAKOTE DR 125 MG SPRINKLE CP

2 EC

DEPAKOTE DR 125 MG TABLET 2 ECDEPAKOTE DR 250 MG TABLET 2 ECDEPAKOTE DR 500 MG TABLET 2 ECDEPAKOTE ER 250 MG TABLET 2 ECDEPAKOTE ER 500 MG TABLET 2 ECDIASTAT 2.5 MG PEDI SYSTEM 3 QL 5/30DIASTAT ACUDIAL 12.5-15-20 MG 3 QL 40/30

DIASTAT ACUDIAL 5-7.5-10 MG KT

3 QL 20/30

diazepam 10 mg rectal gel syst 1 QL 20/30diazepam 2.5 mg rectal gel sys 1 QL 5/30diazepam 20 mg rectal gel syst 1 QL 40/30DILANTIN 100 MG CAPSULE 3DILANTIN 30 MG CAPSULE 2DILANTIN 50 MG INFATAB 3divalproex dr 125 mg cap sprnk 1divalproex sod dr 125 mg tab 1divalproex sod dr 250 mg tab 1divalproex sod dr 500 mg tab 1divalproex sod er 250 mg tab 1divalproex sod er 500 mg tab 1EPIDIOLEX 100 MG/ML SOLUTION

4 PA

EPITOL 200 MG TABLET 1EQUETRO 100 MG CAPSULE 2 ECEQUETRO 200 MG CAPSULE 2 ECEQUETRO 300 MG CAPSULE 2 ECethosuximide 250 mg capsule 1ethosuximide 250 mg/5 ml soln 1felbamate 400 mg tablet 1felbamate 600 mg tablet 1felbamate 600 mg/5 ml susp 4FYCOMPA 0.5 MG/ML ORAL SUSP

3 QL 720/30

FYCOMPA 10 MG TABLET 3 QL 30/30FYCOMPA 12 MG TABLET 3 QL 30/30FYCOMPA 2 MG TABLET 3 QL 60/30FYCOMPA 4 MG TABLET 3 QL 60/30FYCOMPA 6 MG TABLET 3 QL 60/30FYCOMPA 8 MG TABLET 3 QL 30/30gabapentin 100 mg capsule 1 QL 270/30gabapentin 250 mg/5 ml soln 1 QL 2160/30gabapentin 300 mg capsule 1 QL 360/30gabapentin 400 mg capsule 1 QL 270/30gabapentin 600 mg tablet 1 QL 180/30gabapentin 800 mg tablet 1GABITRIL 2 MG TABLET 2 ECGABITRIL 4 MG TABLET 2 EC

11

Drug NameDrug Tier



Drug NameDrug Tier


GRALISE 30-DAY STARTER PACK

2 QL 156/365

GRALISE ER 300 MG TABLET 2GRALISE ER 600 MG TABLET 2KEPPRA 1,000 MG TABLET 2 ECKEPPRA 100 MG/ML ORAL SOLN 2 ECKEPPRA 250 MG TABLET 2 ECKEPPRA 500 MG TABLET 2 ECKEPPRA 750 MG TABLET 2 ECKEPPRA XR 500 MG TABLET 2 QL

180/30,ECKEPPRA XR 750 MG TABLET 2 QL

120/30,ECLAMICTAL 100 MG TABLET 2 ECLAMICTAL 150 MG TABLET 2 ECLAMICTAL 200 MG TABLET 2 ECLAMICTAL 25 MG DISPER TABLET

2 EC

LAMICTAL 25 MG TABLET 2 ECLAMICTAL 5 MG DISPER TABLET 2 ECLAMICTAL TAB START KIT (BLUE)

2 EC

LAMICTAL TAB START KIT (GREEN)

2 EC

LAMICTAL TB START KIT (ORANGE)

2 EC

LAMICTAL XR 100 MG TABLET 2 ECLAMICTAL XR 200 MG TABLET 2 ECLAMICTAL XR 25 MG TABLET 2 ECLAMICTAL XR 250 MG TABLET 2 ECLAMICTAL XR 300 MG TABLET 2 ECLAMICTAL XR 50 MG TABLET 2 ECLAMICTAL XR START KIT (BLUE) 2 ECLAMICTAL XR START KIT (GREEN)

2 EC

LAMICTAL XR START KIT (ORANGE)

2 EC

lamotrigine 100 mg tablet 1lamotrigine 150 mg tablet 1lamotrigine 200 mg tablet 1lamotrigine 25 mg disper tab 1

lamotrigine 25 mg tablet 1lamotrigine 5 mg disper tablet 1lamotrigine er 100 mg tablet 1lamotrigine er 200 mg tablet 1lamotrigine er 25 mg tablet 1lamotrigine er 250 mg tablet 1lamotrigine er 300 mg tablet 1lamotrigine er 50 mg tablet 1lamotrigine odt 100 mg tablet 1lamotrigine odt 200 mg tablet 1lamotrigine odt 25 mg tablet 1lamotrigine odt 50 mg tablet 1lamotrigine tab start kit-blue 1lamotrigine tab start kt-green 1lamotrigine tab start kt-orang 1levetiracetam 1,000 mg tablet 1levetiracetam 100 mg/ml soln 1levetiracetam 250 mg tablet 1levetiracetam 500 mg tablet 1levetiracetam 500 mg/5 ml vial 1levetiracetam 750 mg tablet 1levetiracetam er 500 mg tablet 1levetiracetam er 750 mg tablet 1levetiracetam-nacl 1,000mg/100 1levetiracetam-nacl 1,500mg/100 1levetiracetam-nacl 500 mg/100 1LYRICA 100 MG CAPSULE 2 QL 90/30LYRICA 150 MG CAPSULE 2 QL 90/30LYRICA 20 MG/ML ORAL SOLUTION

2 QL 900/30

LYRICA 200 MG CAPSULE 2LYRICA 225 MG CAPSULE 2 QL 60/30LYRICA 25 MG CAPSULE 2 QL 90/30LYRICA 300 MG CAPSULE 2 QL 60/30LYRICA 50 MG CAPSULE 2 QL 90/30LYRICA 75 MG CAPSULE 2 QL 120/30LYRICA CR 165 MG TABLET 2 QL 90/30LYRICA CR 330 MG TABLET 2 QL 60/30LYRICA CR 82.5 MG TABLET 2 QL 90/30

12

Drug NameDrug Tier



Drug NameDrug Tier


NEURONTIN 100 MG CAPSULE 2 QL 180/30,EC



NEURONTIN 600 MG TABLET 2 QL 180/30,EC

NEURONTIN 800 MG TABLET 2 ECoxcarbazepine 150 mg tablet 1oxcarbazepine 300 mg tablet 1oxcarbazepine 300 mg/5 ml susp 1oxcarbazepine 600 mg tablet 1OXTELLAR XR 150 MG TABLET 3OXTELLAR XR 300 MG TABLET 3OXTELLAR XR 600 MG TABLET 3PEGANONE 250 MG TABLET 2phenobarbital 100 mg tablet 1 QL 120/30phenobarbital 15 mg tablet 1 QL 120/30phenobarbital 16.2 mg tablet 1 QL 120/30phenobarbital 20 mg/5 ml elix 1 QL 1500/30phenobarbital 30 mg tablet 1 QL 120/30phenobarbital 32.4 mg tablet 1 QL 120/30phenobarbital 60 mg tablet 1 QL 120/30phenobarbital 64.8 mg tablet 1 QL 120/30phenobarbital 97.2 mg tablet 1 QL 120/30PHENYTEK 200 MG CAPSULE 2 ECPHENYTEK 300 MG CAPSULE 2 ECphenytoin 125 mg/5 ml susp 1phenytoin 50 mg infatab 1phenytoin 50 mg tablet chew 1phenytoin sod ext 100 mg cap 1phenytoin sod ext 200 mg cap 1phenytoin sod ext 300 mg cap 1pregabalin 100 mg capsule 1 QL 90/30pregabalin 150 mg capsule 1 QL 90/30pregabalin 20 mg/ml solution 1 QL 900/30pregabalin 200 mg capsule 1 QL 90/30pregabalin 225 mg capsule 1 QL 60/30pregabalin 25 mg capsule 1 QL 90/30pregabalin 300 mg capsule 1 QL 60/30

pregabalin 50 mg capsule 1 QL 90/30pregabalin 75 mg capsule 1 QL 90/30primidone 250 mg tablet 1primidone 50 mg tablet 1ROWEEPRA 1,000 MG TABLET 1ROWEEPRA 500 MG TABLET 1ROWEEPRA 750 MG TABLET 1ROWEEPRA XR 500 MG TABLET 1ROWEEPRA XR 750 MG TABLET 1SPRITAM 1,000 MG TABLET 3 QL 60/30SPRITAM 250 MG TABLET 3 QL 60/30SPRITAM 500 MG TABLET 3 QL 60/30SPRITAM 750 MG TABLET 3 QL 120/30SYMPAZAN 10 MG FILM 4 PA,QL

60/30SYMPAZAN 20 MG FILM 4 PA,QL

60/30SYMPAZAN 5 MG FILM 4 PA,QL

60/30TEGRETOL XR 100 MG TABLET 2 ECtiagabine hcl 12 mg tablet 1tiagabine hcl 16 mg tablet 1tiagabine hcl 2 mg tablet 1tiagabine hcl 4 mg tablet 1TOPAMAX 100 MG TABLET 2 ECTOPAMAX 15 MG SPRINKLE CAP 2 ECTOPAMAX 200 MG TABLET 2 ECTOPAMAX 25 MG SPRINKLE CAP 2 ECTOPAMAX 25 MG TABLET 2 ECTOPAMAX 50 MG TABLET 2 ECtopiramate 100 mg tablet 1topiramate 15 mg sprinkle cap 1topiramate 200 mg tablet 1topiramate 25 mg sprinkle cap 1topiramate 25 mg tablet 1topiramate 50 mg tablet 1TRILEPTAL 150 MG TABLET 2 ECTRILEPTAL 300 MG TABLET 2 ECTRILEPTAL 300 MG/5 ML SUSP 2 ECTRILEPTAL 600 MG TABLET 2 ECTROKENDI XR 100 MG CAPSULE 3 QL 30/30

13

Drug NameDrug Tier



Drug NameDrug Tier


TROKENDI XR 200 MG CAPSULE 4 QL 60/30TROKENDI XR 25 MG CAPSULE 3 QL 30/30TROKENDI XR 50 MG CAPSULE 3 QL 30/30valproic acid 250 mg capsule 1valproic acid 250 mg/5 ml soln 1vigabatrin 500 mg powder packt 4 QL 180/30vigabatrin 500 mg tablet 4 QL 180/30VIGADRONE 500 MG POWDER PACKET

4 QL 180/30

VIMPAT 10 MG/ML SOLUTION 2 QL 1200/30VIMPAT 100 MG TABLET 2 QL 60/30VIMPAT 150 MG TABLET 2 QL 60/30VIMPAT 200 MG TABLET 2 QL 60/30VIMPAT 200 MG/20 ML VIAL 2 QL 1200/30VIMPAT 50 MG TABLET 2 QL 120/30zonisamide 100 mg capsule 1zonisamide 25 mg capsule 1zonisamide 50 mg capsule 1

ANTIDIARRHEALS / ANTISPASMODICSANASPAZ 0.125 MG TABLET ODT 1 +atropine 1 mg/ml vial 1atropine 8 mg/20 ml vial 1belladonna-opium 16.2-30 supp 1belladonna-opium 16.2-60 supp 1chlordiazepoxide-clidinium cap 1dicyclomine 10 mg capsule 1dicyclomine 10 mg/5 ml soln 1dicyclomine 20 mg tablet 1diphenoxylat-atrop 2.5-0.025/5 1diphenoxylate-atrop 2.5-0.025 1ED-SPAZ 0.125 MG ODT 1 +glycopyrrolate 0.2 mg/ml syrng 1glycopyrrolate 0.2 mg/ml vial 1glycopyrrolate 0.4 mg/2 ml syr 1glycopyrrolate 1 mg tablet 1glycopyrrolate 2 mg tablet 1glycopyrrolate 4 mg/20 ml vial 1hyoscyamine 0.125 mg odt 1 +hyoscyamine 0.125 mg tab sl 1 +hyoscyamine 0.125 mg/5 ml elix 1 +

hyoscyamine 0.125 mg/ml drop 1 +hyoscyamine sr 0.375 mg tab 1 +hyoscyamine sulf 0.125 mg tab 1 +LIBRAX CAPSULE 2loperamide 2 mg capsule 1methscopolamine brom 2.5 mg tb 1methscopolamine brom 5 mg tab 1NULEV 0.125 MG CHEWABLE MELT

2 +

OSCIMIN 0.125 MG ODT 1 +OSCIMIN 0.125 MG TABLET 1 +OSCIMIN SL 0.125 MG TABLET 1 +OSCIMIN SR 0.375 MG TABLET 1 +paregoric liquid 2 *propantheline 15 mg tablet 1SYMAX-SL 0.125 MG TABLET SL 1 +SYMAX-SR 0.375 MG TABLET 1 +

ANTIFUNGAL AGENTSABELCET 100 MG/20 ML VIAL 4 PA,B/DAMBISOME 50 MG VIAL 4 PA,B/Damphotericin b 50 mg vial 1 PA,B/Dcaspofungin acetate 50 mg vial 4 PAcaspofungin acetate 70 mg vial 4 PAclotrimazole 10 mg troche 1fluconazole 10 mg/ml susp 1fluconazole 100 mg tablet 1fluconazole 150 mg tablet 1fluconazole 200 mg tablet 1fluconazole 40 mg/ml susp 1fluconazole 50 mg tablet 1fluconazole-nacl 200 mg/100 ml 1fluconazole-nacl 400 mg/200 ml 1flucytosine 250 mg capsule 4flucytosine 500 mg capsule 4griseofulvin 125 mg/5 ml susp 1griseofulvin micro 500 mg tab 1griseofulvin ultra 125 mg tab 1griseofulvin ultra 250 mg tab 1itraconazole 10 mg/ml solution 4 PA

14

Drug NameDrug Tier



Drug NameDrug Tier


itraconazole 100 mg capsule 1 PA,QL 120/30

ketoconazole 200 mg tablet 1MYCAMINE 100 MG VIAL 4MYCAMINE 50 MG VIAL 4NOXAFIL 40 MG/ML SUSPENSION

4 PA,QL 600/30

NOXAFIL DR 100 MG TABLET 4 PA,QL 96/30

nystatin 100,000 unit/ml susp 1nystatin 500,000 unit oral tab 1terbinafine hcl 250 mg tablet 1voriconazole 200 mg tablet 3 PAvoriconazole 200 mg vial 4 PAvoriconazole 40 mg/ml susp 4 PA,QL

300/30voriconazole 50 mg tablet 3 PA

ANTIHISTAMINE / ANTIALLERGENIC AGENTScarbinoxamine 4 mg/5 ml liquid 1carbinoxamine maleate 4 mg tab 1CLARINEX 0.5 MG/ML (2.5 MG/5) 2 ECCLARINEX 5 MG TABLET 2 QL

30/30,ECCLARINEX-D 12 HOUR TABLET 3 QL 60/30clemastine fum 2.68 mg tab 1cyproheptadine 2 mg/5 ml syrup 1cyproheptadine 4 mg tablet 1desloratadine 5 mg tablet 1diphenhydramine 50 mg/ml vial 1epinephrine 0.1 mg/ml syringe 1 +epinephrine 0.15 mg auto-injct 1 QL 2/30epinephrine 0.3 mg auto-inject 1 QL 2/30epinephrine 1 mg/ml ampul 1 +epinephrine 1 mg/ml vial 1 +EPIPEN 2-PAK 0.3 MG AUTO-INJCT

2 QL 2/30

EPIPEN JR 2-PAK 0.15 MG INJCTR

2 QL 2/30

hydroxyzine 10 mg/5 ml soln 1hydroxyzine 25 mg/ml vial 1hydroxyzine 50 mg/ml vial 1

hydroxyzine hcl 10 mg tablet 1hydroxyzine hcl 25 mg tablet 1hydroxyzine hcl 50 mg tablet 1hydroxyzine pam 100 mg cap 1hydroxyzine pam 25 mg cap 1hydroxyzine pam 50 mg cap 1levocetirizine 2.5 mg/5 ml sol 1 QL 300/30levocetirizine 5 mg tablet 1 QL 120/30PHENADOZ 12.5 MG SUPPOSITORY

1

PHENADOZ 25 MG SUPPOSITORY

1

promethazine 12.5 mg suppos 1promethazine 12.5 mg tablet 1 PA (HRM)promethazine 25 mg suppository 1promethazine 25 mg tablet 1 PA (HRM)promethazine 50 mg suppository 1promethazine 50 mg tablet 1 PA (HRM)promethazine 50 mg/ml ampul 1 PA (HRM)promethazine 6.25 mg/5 ml soln 1 PA (HRM)promethazine 6.25 mg/5 ml syrp 1 PA (HRM)PROMETHEGAN 12.5 MG SUPPOS

1

PROMETHEGAN 25 MG SUPPOSITORY

1

PROMETHEGAN 50 MG SUPPOSITORY

1

SEMPREX-D 8 MG-60 MG CAPSULE

3

ANTIHYPERTENSIVE THERAPYacebutolol 200 mg capsule 1acebutolol 400 mg capsule 1ALDACTAZIDE 25-25 TABLET 2 ECALDACTAZIDE 50-50 TABLET 2 ECaliskiren 150 mg tablet 1 QL 30/30aliskiren 300 mg tablet 1 QL 30/30ALTACE 1.25 MG CAPSULE 2 QL

60/30,ECALTACE 10 MG CAPSULE 2 QL

60/30,EC

15

Drug NameDrug Tier



Drug NameDrug Tier


ALTACE 2.5 MG CAPSULE 2 QL 60/30,EC

ALTACE 5 MG CAPSULE 2 QL 60/30,EC

amiloride hcl 5 mg tablet 1amiloride hcl-hctz 5-50 mg tab 1amlodipine besylate 10 mg tab 1amlodipine besylate 2.5 mg tab 1amlodipine besylate 5 mg tab 1amlodipine-benazepril 10-20 mg 1amlodipine-benazepril 10-40 mg 1amlodipine-benazepril 2.5-10 1amlodipine-benazepril 5-10 mg 1amlodipine-benazepril 5-20 mg 1amlodipine-benazepril 5-40 mg 1amlodipine-olmesartan 10-20 mg 1 QL 30/30amlodipine-olmesartan 10-40 mg 1 QL 30/30amlodipine-olmesartan 5-20 mg 1 QL 30/30amlodipine-olmesartan 5-40 mg 1 QL 30/30amlodipine-valsartan 10-160 mg 1amlodipine-valsartan 10-320 mg 1amlodipine-valsartan 5-160 mg 1amlodipine-valsartan 5-320 mg 1amlod-valsa-hctz 10-160-12.5mg 1amlod-valsa-hctz 10-160-25 mg 1amlod-valsa-hctz 10-320-25 mg 1amlod-valsa-hctz 5-160-12.5 mg 1amlod-valsa-hctz 5-160-25 mg 1ATACAND 16 MG TABLET 2 QL

60/30,ECATACAND 32 MG TABLET 2 QL



60/30,ECATACAND HCT 16-12.5 MG TAB 2 ECATACAND HCT 32-12.5 MG TAB 2 ECATACAND HCT 32-25 MG TABLET 2 ECatenolol 100 mg tablet 1atenolol 25 mg tablet 1

atenolol 50 mg tablet 1atenolol-chlorthalidone 100-25 1atenolol-chlorthalidone 50-25 1AVAPRO 150 MG TABLET 2 QL

60/30,ECAVAPRO 300 MG TABLET 2 QL

30/30,ECAVAPRO 75 MG TABLET 2 QL

60/30,ECAZOR 10-20 MG TABLET 2 QL

30/30,ST,EC

AZOR 10-40 MG TABLET 2 QL 30/30,ST,E

CAZOR 5-20 MG TABLET 2 QL

30/30,ST,EC

AZOR 5-40 MG TABLET 2 QL 30/30,ST,E

Cbenazepril hcl 10 mg tablet 1benazepril hcl 20 mg tablet 1benazepril hcl 40 mg tablet 1benazepril hcl 5 mg tablet 1benazepril-hctz 10-12.5 mg tab 1benazepril-hctz 20-12.5 mg tab 1benazepril-hctz 20-25 mg tab 1benazepril-hctz 5-6.25 mg tab 1betaxolol 10 mg tablet 1betaxolol 20 mg tablet 1BIDIL TABLET 2 QL 180/30bisoprolol fumarate 10 mg tab 1bisoprolol fumarate 5 mg tab 1bisoprolol-hctz 10-6.25 mg tab 1bisoprolol-hctz 2.5-6.25 mg tb 1bisoprolol-hctz 5-6.25 mg tab 1bumetanide 0.5 mg tablet 1bumetanide 1 mg tablet 1bumetanide 1 mg/4 ml vial 1bumetanide 2 mg tablet 1BYSTOLIC 10 MG TABLET 2

16

Drug NameDrug Tier



Drug NameDrug Tier


BYSTOLIC 2.5 MG TABLET 2BYSTOLIC 20 MG TABLET 2BYSTOLIC 5 MG TABLET 2CALAN SR 120 MG CAPLET 2 ECCALAN SR 180 MG CAPLET 2 ECCALAN SR 240 MG CAPLET 2 ECcandesartan cilexetil 16 mg tb 1 QL 60/30candesartan cilexetil 32 mg tb 1 QL 30/30candesartan cilexetil 4 mg tab 1 QL 60/30candesartan cilexetil 8 mg tab 1 QL 60/30candesartan-hctz 16-12.5 mg tb 1candesartan-hctz 32-12.5 mg tb 1candesartan-hctz 32-25 mg tab 1captopril 100 mg tablet 1captopril 12.5 mg tablet 1 QL 90/30captopril 25 mg tablet 1 QL 90/30captopril 50 mg tablet 1captopril-hctz 25-15 mg tablet 1captopril-hctz 25-25 mg tablet 1captopril-hctz 50-15 mg tablet 1captopril-hctz 50-25 mg tablet 1CARDIZEM LA 120 MG TABLET 2 ECCARDURA XL 4 MG TABLET 2 ECCARDURA XL 8 MG TABLET 2 ECCARTIA XT 120 MG CAPSULE 1CARTIA XT 180 MG CAPSULE 1CARTIA XT 240 MG CAPSULE 1CARTIA XT 300 MG CAPSULE 1carvedilol 12.5 mg tablet 1carvedilol 25 mg tablet 1carvedilol 3.125 mg tablet 1carvedilol 6.25 mg tablet 1carvedilol er 10 mg capsule 1carvedilol er 20 mg capsule 1carvedilol er 40 mg capsule 1carvedilol er 80 mg capsule 1CATAPRES-TTS 1 PATCH 2 QL 4/28,ECCATAPRES-TTS 2 PATCH 2 QL 4/28,ECCATAPRES-TTS 3 PATCH 2 QL 8/28,ECchlorothiazide 250 mg tablet 1

chlorothiazide 500 mg tablet 1chlorothiazide sod 500 mg vial 1chlorthalidone 25 mg tablet 1chlorthalidone 50 mg tablet 1clonidine 0.1 mg/day patch 1 QL 4/28clonidine 0.2 mg/day patch 1 QL 4/28clonidine 0.3 mg/day patch 1 QL 8/28clonidine hcl 0.1 mg tablet 1clonidine hcl 0.2 mg tablet 1clonidine hcl 0.3 mg tablet 1COREG 12.5 MG TABLET 2 ECCOREG 25 MG TABLET 2 ECCOREG 3.125 MG TABLET 2 ECCOREG 6.25 MG TABLET 2 ECCOZAAR 100 MG TABLET 2 QL

60/30,ECCOZAAR 25 MG TABLET 2 QL

60/30,ECCOZAAR 50 MG TABLET 2 QL

60/30,ECDEMSER 250 MG CAPSULE 4 PADILT XR 120 MG CAPSULE 1DILT XR 180 MG CAPSULE 1DILT XR 240 MG CAPSULE 1DILT-CD 180 MG CAPSULE 1DILT-CD 240 MG CAPSULE 1diltiazem 100 mg add-van vial 1diltiazem 120 mg tablet 1diltiazem 125 mg/25 ml vial 1diltiazem 12hr er 120 mg cap 1diltiazem 12hr er 60 mg cap 1diltiazem 12hr er 90 mg cap 1diltiazem 24h er(cd) 120 mg cp 1diltiazem 24h er(cd) 180 mg cp 1diltiazem 24h er(cd) 240 mg cp 1diltiazem 24h er(cd) 300 mg cp 1diltiazem 24h er(cd) 360 mg cp 1diltiazem 24h er(la) 180 mg tb 1diltiazem 24h er(la) 240 mg tb 1diltiazem 24h er(la) 300 mg tb 1diltiazem 24h er(la) 360 mg tb 1

17

Drug NameDrug Tier



Drug NameDrug Tier


diltiazem 24h er(la) 420 mg tb 1diltiazem 24h er(xr) 120 mg cp 1diltiazem 24h er(xr) 180 mg cp 1diltiazem 24h er(xr) 240 mg cp 1diltiazem 24hr cd 180 mg cap 1diltiazem 24hr er 120 mg cap 1diltiazem 24hr er 180 mg cap 1diltiazem 24hr er 240 mg cap 1diltiazem 24hr er 300 mg cap 1diltiazem 24hr er 360 mg cap 1diltiazem 24hr er 420 mg cap 1diltiazem 25 mg/5 ml vial 1diltiazem 30 mg tablet 1diltiazem 50 mg/10 ml vial 1diltiazem 60 mg tablet 1diltiazem 90 mg tablet 1DIOVAN 160 MG TABLET 2 QL

60/30,ECDIOVAN 320 MG TABLET 2 QL



60/30,ECDIOVAN HCT 160-12.5 MG TAB 2 QL

30/30,ECDIOVAN HCT 160-25 MG TABLET 2 QL

30/30,ECDIOVAN HCT 320-12.5 MG TAB 2 QL

30/30,ECDIOVAN HCT 320-25 MG TABLET 2 QL

30/30,ECDIOVAN HCT 80-12.5 MG TABLET 2 QL

30/30,ECDIURIL 250 MG/5 ML ORAL SUSP 3doxazosin mesylate 1 mg tab 1doxazosin mesylate 2 mg tab 1doxazosin mesylate 4 mg tab 1doxazosin mesylate 8 mg tab 1DYAZIDE 37.5-25 CAPSULE 2 ECDYRENIUM 100 MG CAPSULE 3

DYRENIUM 50 MG CAPSULE 3EDARBI 40 MG TABLET 2 ST,ECEDARBI 80 MG TABLET 2 ST,ECEDARBYCLOR 40-12.5 MG TABLET

2 ST,EC

EDARBYCLOR 40-25 MG TABLET 2 ST,ECenalapril maleate 10 mg tab 1enalapril maleate 2.5 mg tab 1enalapril maleate 20 mg tab 1enalapril maleate 5 mg tablet 1enalapril-hctz 10-25 mg tablet 1enalapril-hctz 5-12.5 mg tab 1eplerenone 25 mg tablet 1eplerenone 50 mg tablet 1eprosartan mesylate 600 mg tab 1 QL 30/30ethacrynate sodium 50 mg vial 1ethacrynic acid 25 mg tablet 1EXFORGE 10-160 MG TABLET 2 ST,ECEXFORGE 10-320 MG TABLET 2 ST,ECEXFORGE 5-160 MG TABLET 2 ST,ECEXFORGE 5-320 MG TABLET 2 ST,ECEXFORGE HCT 10-160-12.5 MG TAB

2 ST,EC

EXFORGE HCT 10-160-25 MG TAB

2 ST,EC

EXFORGE HCT 10-320-25 MG TAB

2 ST,EC

EXFORGE HCT 5-160-12.5 MG TAB

2 ST,EC

EXFORGE HCT 5-160-25 MG TAB 2 ST,ECfelodipine er 10 mg tablet 1felodipine er 2.5 mg tablet 1felodipine er 5 mg tablet 1fosinopril sodium 10 mg tab 1 QL 60/30fosinopril sodium 20 mg tab 1 QL 60/30fosinopril sodium 40 mg tab 1 QL 60/30fosinopril-hctz 10-12.5 mg tab 1 QL 120/30fosinopril-hctz 20-12.5 mg tab 1 QL 120/30furosemide 10 mg/ml solution 1furosemide 100 mg/10 ml vial 1furosemide 20 mg tablet 1

18

Drug NameDrug Tier



Drug NameDrug Tier


furosemide 40 mg tablet 1furosemide 40 mg/4 ml syringe 1furosemide 40 mg/5 ml soln 1furosemide 80 mg tablet 1guanfacine 1 mg tablet 1guanfacine 2 mg tablet 1hydralazine 10 mg tablet 1hydralazine 100 mg tablet 1hydralazine 20 mg/ml vial 1hydralazine 25 mg tablet 1hydralazine 50 mg tablet 1hydrochlorothiazide 12.5 mg cp 1hydrochlorothiazide 12.5 mg tb 1hydrochlorothiazide 25 mg tab 1hydrochlorothiazide 50 mg tab 1HYZAAR 100-12.5 TABLET 2 QL

30/30,ECHYZAAR 100-25 TABLET 2 QL

30/30,ECHYZAAR 50-12.5 TABLET 2 QL

60/30,ECindapamide 1.25 mg tablet 1indapamide 2.5 mg tablet 1INDERAL LA 120 MG CAPSULE 2 ECINDERAL LA 160 MG CAPSULE 2 ECINDERAL LA 60 MG CAPSULE 2 ECINDERAL LA 80 MG CAPSULE 2 ECirbesartan 150 mg tablet 1 QL 60/30irbesartan 300 mg tablet 1 QL 30/30irbesartan 75 mg tablet 1 QL 60/30irbesartan-hctz 150-12.5 mg tb 1 QL 30/30irbesartan-hctz 300-12.5 mg tb 1 QL 30/30isradipine 2.5 mg capsule 1isradipine 5 mg capsule 1labetalol hcl 100 mg tablet 1labetalol hcl 200 mg tablet 1labetalol hcl 300 mg tablet 1LASIX 20 MG TABLET 2 ECLASIX 40 MG TABLET 2 ECLASIX 80 MG TABLET 2 EClisinopril 10 mg tablet 1

lisinopril 2.5 mg tablet 1lisinopril 20 mg tablet 1lisinopril 30 mg tablet 1lisinopril 40 mg tablet 1lisinopril 5 mg tablet 1lisinopril-hctz 10-12.5 mg tab 1lisinopril-hctz 20-12.5 mg tab 1lisinopril-hctz 20-25 mg tab 1losartan potassium 100 mg tab 1 QL 60/30losartan potassium 25 mg tab 1 QL 60/30losartan potassium 50 mg tab 1 QL 60/30losartan-hctz 100-12.5 mg tab 1 QL 30/30losartan-hctz 100-25 mg tab 1 QL 30/30losartan-hctz 50-12.5 mg tab 1 QL 60/30LOTREL 10-20 MG CAPSULE 2 QL

30/30,ECLOTREL 10-40 MG CAPSULE 2 QL



60/30,ECMATZIM LA 180 MG TABLET 1MATZIM LA 240 MG TABLET 1MATZIM LA 300 MG TABLET 1MATZIM LA 360 MG TABLET 1MATZIM LA 420 MG TABLET 1methyclothiazide 5 mg tablet 1methyldopa 250 mg tablet 1 PA (HRM)methyldopa 500 mg tablet 1 PA (HRM)methyldopa-hctz 250-15 mg tab 1 PA (HRM)methyldopa-hctz 250-25 mg tab 1 PA (HRM)metolazone 10 mg tablet 1metolazone 2.5 mg tablet 1metolazone 5 mg tablet 1metoprolol succ er 100 mg tab 1metoprolol succ er 200 mg tab 1metoprolol succ er 25 mg tab 1metoprolol succ er 50 mg tab 1metoprolol tartrate 100 mg tab 1metoprolol tartrate 25 mg tab 1

19

Drug NameDrug Tier



Drug NameDrug Tier


metoprolol tartrate 37.5 mg tb 1metoprolol tartrate 50 mg tab 1metoprolol tartrate 75 mg tab 1metoprolol-hctz 100-25 mg tab 1metoprolol-hctz 100-50 mg tab 1metoprolol-hctz 50-25 mg tab 1MICARDIS 20 MG TABLET 2 QL

30/30,ECMICARDIS 40 MG TABLET 2 QL

30/30,ECMICARDIS 80 MG TABLET 2 QL

60/30,ECMICARDIS HCT 40-12.5 MG TABLET

2 QL 30/30,EC

MICARDIS HCT 80-12.5 MG TABLET

2 QL 60/30,EC

MICARDIS HCT 80-25 MG TABLET

2 QL 30/30,EC

minoxidil 10 mg tablet 1minoxidil 2.5 mg tablet 1moexipril hcl 15 mg tablet 1moexipril hcl 7.5 mg tablet 1nadolol 20 mg tablet 1nadolol 40 mg tablet 1nadolol 80 mg tablet 1nadolol-bendroflu 40-5 mg tab 1nicardipine 20 mg capsule 1nicardipine 25 mg/10 ml vial 1nicardipine 30 mg capsule 1nifedipine 10 mg capsule 1nifedipine 20 mg capsule 1nifedipine er 30 mg tablet 1 QL 60/30nifedipine er 60 mg tablet 1 QL 60/30nifedipine er 90 mg tablet 1 QL 60/30nimodipine 30 mg capsule 1nisoldipine er 17 mg tablet 1nisoldipine er 20 mg tablet 1nisoldipine er 25.5 mg tablet 1nisoldipine er 30 mg tablet 1nisoldipine er 34 mg tablet 1nisoldipine er 40 mg tablet 1

nisoldipine er 8.5 mg tablet 1NORVASC 10 MG TABLET 2 QL

30/30,ECNORVASC 2.5 MG TABLET 2 QL

120/30,ECNORVASC 5 MG TABLET 2 QL

60/30,EColmesartan medoxomil 20 mg tab 1olmesartan medoxomil 40 mg tab 1olmesartan medoxomil 5 mg tab 1olmesartan-hctz 20-12.5 mg tab 1olmesartan-hctz 40-12.5 mg tab 1olmesartan-hctz 40-25 mg tab 1olmsrtn-amldpn-hctz 20-5-12.5 1 QL 30/30olmsrtn-amldpn-hctz 40-10-12.5 1 QL 30/30olmsrtn-amldpn-hctz 40-10-25mg 1 QL 30/30olmsrtn-amldpn-hctz 40-5-12.5 1 QL 30/30olmsrtn-amldpn-hctz 40-5-25 mg 1 QL 30/30perindopril erbumine 2 mg tab 1perindopril erbumine 4 mg tab 1perindopril erbumine 8 mg tab 1phenoxybenzamine hcl 10 mg cap

4

pindolol 10 mg tablet 1pindolol 5 mg tablet 1prazosin 1 mg capsule 1prazosin 2 mg capsule 1prazosin 5 mg capsule 1propranolol 10 mg tablet 1propranolol 20 mg tablet 1propranolol 20 mg/5 ml soln 1propranolol 40 mg tablet 1propranolol 40 mg/5 ml soln 1propranolol 60 mg tablet 1propranolol 80 mg tablet 1propranolol er 120 mg capsule 1propranolol er 160 mg capsule 1propranolol er 60 mg capsule 1propranolol er 80 mg capsule 1propranolol-hctz 40-25 mg tab 1propranolol-hctz 80-25 mg tab 1

20

Drug NameDrug Tier



Drug NameDrug Tier


quinapril 10 mg tablet 1quinapril 20 mg tablet 1quinapril 40 mg tablet 1quinapril 5 mg tablet 1quinapril-hctz 10-12.5 mg tab 1quinapril-hctz 20-12.5 mg tab 1quinapril-hctz 20-25 mg tab 1ramipril 1.25 mg capsule 1ramipril 10 mg capsule 1ramipril 2.5 mg capsule 1ramipril 5 mg capsule 1REMODULIN 1 MG/ML VIAL 4 PA,B/DREMODULIN 10 MG/ML VIAL 4 PA,B/DREMODULIN 2.5 MG/ML VIAL 4 PA,B/DREMODULIN 5 MG/ML VIAL 4 PA,B/Dspironolactone 100 mg tablet 1spironolactone 25 mg tablet 1spironolactone 50 mg tablet 1spironolactone-hctz 25-25 tab 1TARKA ER 1-240 MG TABLET 2 QL

30/30,ECTARKA ER 2-180 MG TABLET 2 QL



60/30,ECTAZTIA XT 120 MG CAPSULE 1TAZTIA XT 180 MG CAPSULE 1TAZTIA XT 240 MG CAPSULE 1TAZTIA XT 300 MG CAPSULE 1TAZTIA XT 360 MG CAPSULE 1TEKTURNA 150 MG TABLET 3 QL

30/30,ECTEKTURNA 300 MG TABLET 3 QL

30/30,ECTEKTURNA HCT 150-12.5 MG TAB

3 QL 30/30,EC

TEKTURNA HCT 150-25 MG TABLET

3 QL 30/30,EC

TEKTURNA HCT 300-12.5 MG TAB

3 QL 30/30,EC

TEKTURNA HCT 300-25 MG TABLET

3 QL 30/30,EC

telmisartan 20 mg tablet 1 QL 30/30telmisartan 40 mg tablet 1 QL 30/30telmisartan 80 mg tablet 1 QL 60/30telmisartan-amlodipine 40-10 1 QL 30/30telmisartan-amlodipine 40-5 mg 1 QL 30/30telmisartan-amlodipine 80-10 1 QL 30/30telmisartan-amlodipine 80-5 mg 1 QL 30/30telmisartan-hctz 40-12.5 mg tb 1 QL 30/30telmisartan-hctz 80-12.5 mg tb 1 QL 60/30telmisartan-hctz 80-25 mg tab 1 QL 30/30TENORMIN 100 MG TABLET 2 ECTENORMIN 25 MG TABLET 2 ECTENORMIN 50 MG TABLET 2 ECterazosin 1 mg capsule 1terazosin 10 mg capsule 1terazosin 2 mg capsule 1terazosin 5 mg capsule 1timolol maleate 10 mg tablet 1timolol maleate 20 mg tablet 1timolol maleate 5 mg tablet 1TOPROL XL 100 MG TABLET 2 QL

60/30,ECTOPROL XL 200 MG TABLET 2 QL



60/30,ECtorsemide 10 mg tablet 1torsemide 100 mg tablet 1torsemide 20 mg tablet 1torsemide 5 mg tablet 1trandolapril 1 mg tablet 1trandolapril 2 mg tablet 1trandolapril 4 mg tablet 1trandolapr-verapam er 1-240 mg 1 QL 30/30trandolapr-verapam er 2-180 mg 1 QL 30/30

21

Drug NameDrug Tier



Drug NameDrug Tier


trandolapr-verapam er 2-240 mg 1 QL 30/30trandolapr-verapam er 4-240 mg 1 QL 60/30triamterene-hctz 37.5-25 mg cp 1triamterene-hctz 37.5-25 mg tb 1triamterene-hctz 75-50 mg tab 1TRIBENZOR 20-5-12.5 MG TABLET

2 QL 30/30,ST,E

CTRIBENZOR 40-10-12.5 MG TABLET

2 QL 30/30,ST,E

CTRIBENZOR 40-10-25 MG TABLET

2 QL 30/30,ST,E

CTRIBENZOR 40-5-12.5 MG TABLET

2 QL 30/30,ST,E

CTRIBENZOR 40-5-25 MG TABLET 2 QL

30/30,ST,EC

valsartan 160 mg tablet 1 QL 60/30valsartan 320 mg tablet 1 QL 30/30valsartan 40 mg tablet 1 QL 60/30valsartan 80 mg tablet 1 QL 60/30valsartan-hctz 160-12.5 mg tab 1 QL 30/30valsartan-hctz 160-25 mg tab 1 QL 30/30valsartan-hctz 320-12.5 mg tab 1 QL 30/30valsartan-hctz 320-25 mg tab 1 QL 30/30valsartan-hctz 80-12.5 mg tab 1 QL 30/30verapamil 10 mg/4 ml vial 1verapamil 120 mg tablet 1verapamil 360 mg cap pellet 1verapamil 40 mg tablet 1verapamil 5 mg/2 ml vial 1verapamil 80 mg tablet 1verapamil er 120 mg capsule 1verapamil er 120 mg tablet 1verapamil er 180 mg capsule 1verapamil er 180 mg tablet 1verapamil er 240 mg capsule 1verapamil er 240 mg tablet 1verapamil er pm 100 mg capsule 1

verapamil er pm 200 mg capsule 1verapamil er pm 300 mg capsule 1verapamil sr 120 mg capsule 1verapamil sr 180 mg capsule 1verapamil sr 240 mg capsule 1

ANTIMIGRAINE PREPARATIONSisomethept-caff-acetaminophen 1 +isomethept-dichloralp-acetamin 1 +nodolor capsule 1 +PRODRIN CAPLET 2 +

ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS

abiraterone acetate 250 mg tab 4 PA,QL 120/30

ABRAXANE 100 MG VIAL 4 PA,B/DAFINITOR 10 MG TABLET 4 PA,QL

28/28AFINITOR 2.5 MG TABLET 4 PA,QL

28/28AFINITOR 5 MG TABLET 4 PA,QL

28/28AFINITOR 7.5 MG TABLET 4 PA,QL

28/28AFINITOR DISPERZ 2 MG TABLET

4 PA,QL 56/28

AFINITOR DISPERZ 3 MG TABLET

4 PA,QL 56/28

AFINITOR DISPERZ 5 MG TABLET

4 PA,QL 56/28

ALECENSA 150 MG CAPSULE 4 PA,QL 240/30

ALIMTA 100 MG VIAL 4 PA,B/DALIMTA 500 MG VIAL 4 PA,B/DALIQOPA 60 MG VIAL 4 PA,B/DALUNBRIG 180 MG TABLET 4 PA,QL

30/30ALUNBRIG 30 MG TABLET 4 PA,QL

180/30ALUNBRIG 90 MG TABLET 4 PA,QL

30/30ALUNBRIG 90 MG-180 MG TAB PACK

4 PA,QL 60/365

22

Drug NameDrug Tier



Drug NameDrug Tier


anastrozole 1 mg tablet 1ARIMIDEX 1 MG TABLET 2 QL

30/30,ECAROMASIN 25 MG TABLET 2 QL

60/30,ECarsenic trioxide 10 mg/10ml vl 1 PA,B/DASTAGRAF XL 0.5 MG CAPSULE 3 PA,B/DASTAGRAF XL 1 MG CAPSULE 3 PA,B/DASTAGRAF XL 5 MG CAPSULE 3 PA,B/DAVASTIN 100 MG/4 ML VIAL 4 PA,B/DAVASTIN 400 MG/16 ML VIAL 4 PA,B/DAZASAN 100 MG TABLET 2 PA,B/DAZASAN 75 MG TABLET 2 PA,B/Dazathioprine 50 mg tablet 1 PA,B/Dazathioprine sod 100 mg vial 3 PA,B/DBALVERSA 3 MG TABLET 4 PA,QL

90/30BALVERSA 4 MG TABLET 4 PA,QL

60/30BALVERSA 5 MG TABLET 4 PA,QL

30/30BAVENCIO 200 MG/10 ML VIAL 4 PA,B/DBENDEKA 100 MG/4 ML VIAL 4 PA,QL

8/21,B/DBESPONSA 0.9 MG VIAL 4 PA,B/Dbexarotene 75 mg capsule 4 PAbicalutamide 50 mg tablet 1bortezomib 3.5 mg vial 4 PA,QL

14/21,B/DBOSULIF 100 MG TABLET 4 PABOSULIF 400 MG TABLET 4 PABOSULIF 500 MG TABLET 4 PABRAFTOVI 75 MG CAPSULE 4 PA,QL

180/30busulfan 60 mg/10 ml vial 4 PA,B/DBUSULFEX 60 MG/10 ML VIAL 4 PA,B/DCABOMETYX 20 MG TABLET 4 PA,QL

30/30CABOMETYX 40 MG TABLET 4 PA,QL

60/30CABOMETYX 60 MG TABLET 4 PA,QL

30/30

CALQUENCE 100 MG CAPSULE 4 PA,QL 60/30

CAPRELSA 100 MG TABLET 4 PA,QL 60/30

CAPRELSA 300 MG TABLET 4 PA,QL 30/30

CELLCEPT 200 MG/ML ORAL SUSP

4 PA,B/D

CELLCEPT 250 MG CAPSULE 3 PA,B/DCELLCEPT 500 MG TABLET 4 PA,B/DCOMETRIQ 100 MG DAILY-DOSE PK

4 PA,QL 56/28

COMETRIQ 140 MG DAILY-DOSE PK

4 PA,QL 112/28

COMETRIQ 60 MG DAILY-DOSE PACK

4 PA,QL 84/28

COPIKTRA 15 MG CAPSULE 4 PA,QL 60/30

COPIKTRA 25 MG CAPSULE 4 PA,QL 60/30

COSMEGEN 0.5 MG VIAL 4 PA,B/DCOTELLIC 20 MG TABLET 4 PA,QL

63/28cyclophosphamide 1 gm vial 4 PA,B/Dcyclophosphamide 2 gm vial 4 PA,B/Dcyclophosphamide 25 mg capsule

1 PA,B/D

cyclophosphamide 50 mg capsule

1 PA,B/D

cyclophosphamide 500 mg vial 4 PA,B/Dcyclosporine 100 mg capsule 1 PA,B/Dcyclosporine 25 mg capsule 1 PA,B/Dcyclosporine 50 mg/ml ampul 1 PA,B/Dcyclosporine modified 100 mg 1 PA,B/Dcyclosporine modified 100mg/ml 1 PA,B/Dcyclosporine modified 25 mg 1 PA,B/Dcyclosporine modified 50 mg 1 PA,B/DCYRAMZA 100 MG/10 ML VIAL 4 PA,B/DCYRAMZA 500 MG/50 ML VIAL 4 PA,B/Ddactinomycin 0.5 mg vial 4 PA,B/DDARZALEX 100 MG/5 ML VIAL 4 PA,B/DDARZALEX 400 MG/20 ML VIAL 4 PA,B/D

23

Drug NameDrug Tier



Drug NameDrug Tier


daunorubicin 20 mg/4 ml vial 3 PA,B/Ddaunorubicin 50 mg/10 ml vial 3 PA,B/DDAURISMO 100 MG TABLET 4 PA,QL

30/30DAURISMO 25 MG TABLET 4 PA,QL

60/30DROXIA 200 MG CAPSULE 2DROXIA 300 MG CAPSULE 2DROXIA 400 MG CAPSULE 2ELIGARD 22.5 MG SYRINGE KIT 3 PA,QL 1/90ELIGARD 30 MG SYRINGE KIT 3 PA,QL

1/120ELIGARD 45 MG SYRINGE KIT 3 PA,QL

1/180ELIGARD 7.5 MG SYRINGE KIT 3 PA,QL 1/30EMCYT 140 MG CAPSULE 3ENVARSUS XR 0.75 MG TABLET 3 PA,B/DENVARSUS XR 1 MG TABLET 3 PA,B/DENVARSUS XR 4 MG TABLET 4 PA,B/DERIVEDGE 150 MG CAPSULE 4 PA,QL

28/28ERLEADA 60 MG TABLET 4 PAerlotinib hcl 100 mg tablet 4 PA,QL

30/30erlotinib hcl 150 mg tablet 4 PA,QL

30/30erlotinib hcl 25 mg tablet 4 PA,QL

60/30etoposide 1,000 mg/50 ml vial 1 PA,B/Detoposide 100 mg/5 ml vial 1 PA,B/Detoposide 500 mg/25 ml vial 1 PA,B/DEVOMELA 50 MG VIAL 4 PA,B/Dexemestane 25 mg tablet 1 QL 60/30FARYDAK 10 MG CAPSULE 4 PA,QL 6/21FARYDAK 15 MG CAPSULE 4 PA,QL 6/21FARYDAK 20 MG CAPSULE 4 PA,QL 6/21FASLODEX 250 MG/5 ML SYRINGE

4 PA,QL 30/30,B/D

FEMARA 2.5 MG TABLET 2 QL 30/30,EC

FIRMAGON 2 X 120 MG KIT 4 PA,QL 4/365,B/D

FIRMAGON 80 MG KIT 3 PA,QL 1/28,B/D

fludarabine 50 mg vial 1 PA,B/Dfludarabine 50 mg/2 ml vial 1 PA,B/Dflutamide 125 mg capsule 1FOLOTYN 20 MG/ML VIAL 4 PA,B/DFOLOTYN 40 MG/2 ML VIAL 4 PA,B/Dfulvestrant 250 mg/5 ml syrng 4 PA,QL

30/30,B/DGAZYVA 1,000 MG/40 ML VIAL 4 PA,B/Dgemcitabine 1 gram/26.3 ml vl 1 PA,B/Dgemcitabine 2 gram/52.6 ml vl 1 PA,B/Dgemcitabine 200 mg/5.26 ml vl 1 PA,B/Dgemcitabine hcl 1 gram vial 1 PA,B/Dgemcitabine hcl 2 gram vial 1 PA,B/Dgemcitabine hcl 2 gram/20 ml 4 PA,B/Dgemcitabine hcl 200 mg vial 1 PA,B/Dgemcitabine hcl 200 mg/2 ml vl 4 PA,B/Dgengraf 100 mg capsule 1 PA,B/Dgengraf 100 mg/ml solution 1 PA,B/Dgengraf 25 mg capsule 1 PA,B/DGILOTRIF 20 MG TABLET 4 PA,QL

30/30GILOTRIF 30 MG TABLET 4 PA,QL

30/30GILOTRIF 40 MG TABLET 4 PA,QL

30/30GLEOSTINE 10 MG CAPSULE 2GLEOSTINE 100 MG CAPSULE 3GLEOSTINE 40 MG CAPSULE 2HALAVEN 1 MG/2 ML VIAL 4HERCEPTIN 150 MG VIAL 4 PA,B/DHERCEPTIN 440 MG VIAL 4 PA,B/DHERCEPTIN HYLECTA 600MG-10,000

4 PA,B/D

HYDREA 500 MG CAPSULE 2 EChydroxyurea 500 mg capsule 1IBRANCE 100 MG CAPSULE 4 PA,QL

21/28IBRANCE 125 MG CAPSULE 4 PA,QL

21/28

24

Drug NameDrug Tier



Drug NameDrug Tier


IBRANCE 75 MG CAPSULE 4 PA,QL 21/28

ICLUSIG 15 MG TABLET 4 PA,QL 60/30

ICLUSIG 45 MG TABLET 4 PA,QL 30/30

IDHIFA 100 MG TABLET 4 PAIDHIFA 50 MG TABLET 4 PAimatinib mesylate 100 mg tab 4 PA,QL

180/30imatinib mesylate 400 mg tab 4 PA,QL

60/30IMBRUVICA 140 MG CAPSULE 4 PA,QL

120/30IMBRUVICA 140 MG TABLET 4 PA,QL




30/30IMBRUVICA 70 MG CAPSULE 4 PA,QL

30/30IMFINZI 120 MG/2.4 ML VIAL 4 PA,B/DIMFINZI 500 MG/10 ML VIAL 4 PA,B/DINFUGEM 1,200 MG/120 ML BAG 4 PA,B/DINFUGEM 1,300 MG/130 ML BAG 4 PA,B/DINFUGEM 1,400 MG/140 ML BAG 4 PA,B/DINFUGEM 1,500 MG/150 ML BAG 4 PA,B/DINFUGEM 1,600 MG/160 ML BAG 4 PA,B/DINFUGEM 1,700 MG/170 ML BAG 4 PA,B/DINFUGEM 1,800 MG/180 ML BAG 4 PA,B/DINFUGEM 1,900 MG/190 ML BAG 4 PA,B/DINFUGEM 2,000 MG/200 ML BAG 4 PA,B/DINFUGEM 2,200 MG/220 ML BAG 4 PA,B/DINLYTA 1 MG TABLET 4 PA,QL

180/30INLYTA 5 MG TABLET 4 PA,QL

120/30IRESSA 250 MG TABLET 4 PA,QL

30/30

irinotecan hcl 100 mg/5 ml vl 1 PA,B/Dirinotecan hcl 40 mg/2 ml vial 1 PA,B/Dirinotecan hcl 500 mg/25 ml vl 1 PA,B/DISTODAX 10 MG KIT 4 PA,B/DJAKAFI 10 MG TABLET 4 PA,QL

60/30JAKAFI 15 MG TABLET 4 PA,QL




60/30KADCYLA 100 MG VIAL 4 PA,B/DKADCYLA 160 MG VIAL 4 PA,B/DKEYTRUDA 100 MG/4 ML VIAL 4 PA,B/DKISQALI 200 MG DAILY DOSE 4 PA,QL

63/28KISQALI 400 MG DAILY DOSE 4 PA,QL

63/28KISQALI 600 MG DAILY DOSE 4 PA,QL

63/28KISQALI FEMARA 200 MG CO-PACK

4 PA,QL 49/28

KISQALI FEMARA 400 MG CO-PACK

4 PA,QL 70/28

KISQALI FEMARA 600 MG CO-PACK

4 PA,QL 91/28

KYPROLIS 10 MG VIAL 4 PA,B/DKYPROLIS 30 MG VIAL 4 PA,B/DKYPROLIS 60 MG VIAL 4 PA,B/DLARTRUVO 190 MG/19 ML VIAL 4 PA,B/DLARTRUVO 500 MG/50 ML VIAL 4 PA,B/DLENVIMA 10 MG DAILY DOSE 4 PA,QL

30/30LENVIMA 12 MG DAILY DOSE 4 PA,QL



90/30

25

Drug NameDrug Tier



Drug NameDrug Tier


LENVIMA 20 MG DAILY DOSE 4 PA,QL 60/30


LENVIMA 4 MG CAPSULE 4 PA,QL 30/30


letrozole 2.5 mg tablet 1LEUKERAN 2 MG TABLET 2leuprolide 2wk 14 mg/2.8 ml kt 1 PALIBTAYO 350 MG/7 ML VIAL 4 PA,QL

7/21,B/DLONSURF 15 MG-6.14 MG TABLET

4 PA,QL 100/28

LONSURF 20 MG-8.19 MG TABLET

4 PA,QL 80/28

LORBRENA 100 MG TABLET 4 PA,QL 30/30

LORBRENA 25 MG TABLET 4 PA,QL 90/30

LUMOXITI 1 MG VIAL 4 PA,B/DLUPRON DEPOT 11.25 MG 3MO KIT

4 PA,QL 1/84

LUPRON DEPOT 22.5 MG 3MO KIT

4 PA,QL 1/84

LUPRON DEPOT 3.75 MG KIT 4 PA,QL 1/30LUPRON DEPOT 45 MG 6MO KIT 4 PA,QL

1/168LUPRON DEPOT 7.5 MG KIT 4 PA,QL 1/30LUPRON DEPOT-4 MONTH KIT 4 PA,QL

1/112LUPRON DEPOT-PED 11.25 MG 3MO

4 PA,QL 1/84

LUPRON DEPOT-PED 11.25 MG KIT

4 PA,QL 1/30

LUPRON DEPOT-PED 15 MG KIT 4 PA,QL 1/30LUPRON DEPOT-PED 30 MG 3MO KIT

4 PA,QL 1/84

LUPRON DEPOT-PED 7.5 MG KIT 4 PA,QL 1/30LYNPARZA 100 MG TABLET 4 PA,QL

120/30

LYNPARZA 150 MG TABLET 4 PA,QL 120/30

LYSODREN 500 MG TABLET 4MATULANE 50 MG CAPSULE 4megestrol 20 mg tablet 1 PA,DvEmegestrol 40 mg tablet 1 PA,DvEmegestrol 625 mg/5 ml susp 1 PA,DvEmegestrol acet 40 mg/ml susp 1 PA,DvEMEKINIST 0.5 MG TABLET 4 PA,QL

90/30MEKINIST 2 MG TABLET 4 PA,QL

30/30MEKTOVI 15 MG TABLET 4 PA,QL

180/30melphalan 50 mg vial w-diluent 4 PA,B/Dmercaptopurine 50 mg tablet 1methotrexate 1 gm vial 1methotrexate 1 gram/40 ml vial 1methotrexate 2.5 mg tablet 1methotrexate 250 mg/10 ml vial 1methotrexate 50 mg/2 ml vial 1mycophenolate 200 mg/ml susp 4 PA,B/Dmycophenolate 250 mg capsule 1 PA,B/Dmycophenolate 500 mg tablet 1 PA,B/Dmycophenolate 500 mg vial 1 PA,B/Dmycophenolic acid dr 180 mg tb 1 PA,B/Dmycophenolic acid dr 360 mg tb 1 PA,B/DMYFORTIC 180 MG TABLET 3 PA,B/DMYFORTIC 360 MG TABLET 3 PA,B/DMYLOTARG 4.5 MG VIAL 4 PA,B/DNEORAL 100 MG GELATIN CAPSULE

3 PA,B/D

NEORAL 100 MG/ML SOLUTION 3 PA,B/DNEORAL 25 MG GELATIN CAPSULE

3 PA,B/D

NERLYNX 40 MG TABLET 4 PA,QL 180/30

NEXAVAR 200 MG TABLET 4 PA,QL 120/30

nilutamide 150 mg tablet 4 QL 60/30NINLARO 2.3 MG CAPSULE 4 PA,QL 3/28

26

Drug NameDrug Tier



Drug NameDrug Tier


NINLARO 3 MG CAPSULE 4 PA,QL 3/28NINLARO 4 MG CAPSULE 4 PA,QL 3/28NULOJIX 250 MG VIAL 4 PA,QL

26/28,B/Doctreotide 1,000 mcg/ml vial 1 PAoctreotide acet 0.05 mg/ml vl 1 PAoctreotide acet 100 mcg/ml vl 1 PAoctreotide acet 200 mcg/ml vl 1 PAoctreotide acet 500 mcg/ml vl 3 PAODOMZO 200 MG CAPSULE 4 PA,QL

30/30OPDIVO 100 MG/10 ML VIAL 4 PA,QL

80/28,B/DOPDIVO 240 MG/24 ML VIAL 4 PA,QL

80/28,B/DOPDIVO 40 MG/4 ML VIAL 4 PA,QL

80/28,B/Dpaclitaxel 100 mg/16.7 ml vial 1 PA,B/Dpaclitaxel 150 mg/25 ml vial 1 PA,B/Dpaclitaxel 30 mg/5 ml vial 1 PA,B/Dpaclitaxel 300 mg/50 ml vial 1 PA,B/DPERJETA 420 MG/14 ML VIAL 4 PA,B/DPIQRAY 200 MG DAILY DOSE 4 PA,QL

28/28PIQRAY 250 MG DAILY DOSE 4 PA,QL

56/28PIQRAY 300 MG DAILY DOSE 4 PA,QL

56/28POMALYST 1 MG CAPSULE 4 PA,QL




21/28POTELIGEO 20 MG/5 ML VIAL 4 PA,B/DPROGRAF 0.2 MG GRANULE PACKET

3 PA,B/D

PROGRAF 0.5 MG CAPSULE 2 PA,B/DECPROGRAF 1 MG CAPSULE 2 PA,B/DEC

PROGRAF 1 MG GRANULE PACKET

3 PA,B/D

PROGRAF 5 MG CAPSULE 2 PA,B/DECPROGRAF 5 MG/ML AMPULE 3 PA,B/DPURIXAN 20 MG/ML ORAL SUSP 4 QL 300/30RAPAMUNE 0.5 MG TABLET 3 PA,B/DRAPAMUNE 1 MG TABLET 4 PA,B/DRAPAMUNE 1 MG/ML ORAL SOLN

4 PA,B/D

RAPAMUNE 2 MG TABLET 4 PA,B/DREVLIMID 10 MG CAPSULE 2 PA,QL

28/28,ECREVLIMID 15 MG CAPSULE 2 PA,QL

21/28,ECREVLIMID 2.5 MG CAPSULE 2 PA,QL




28/28,ECRITUXAN 100 MG/10 ML VIAL 4 PA,B/DRITUXAN 500 MG/50 ML VIAL 4 PA,B/DRITUXAN HYCELA 1,400 MG-23,400

4 PA,B/D

RITUXAN HYCELA 1,600 MG-26,800

4 PA,B/D

romidepsin 10 mg kit 4 PA,B/DRUBRACA 200 MG TABLET 4 PA,QL

120/30RUBRACA 250 MG TABLET 4 PA,QL

120/30RUBRACA 300 MG TABLET 4 PA,QL

120/30RYDAPT 25 MG CAPSULE 4 PA,QL

224/28SANDIMMUNE 100 MG/ML SOLN 3 PA,B/DSANDOSTATIN LAR DEPOT 10 MG KT

4 PA

SANDOSTATIN LAR DEPOT 20 MG KT

4 PA

27

Drug NameDrug Tier



Drug NameDrug Tier


SANDOSTATIN LAR DEPOT 30 MG KT

4 PA

SIGNIFOR 0.3 MG/ML AMPULE 4 PA,QL 60/30



SIMULECT 10 MG VIAL 4 PA,B/DSIMULECT 20 MG VIAL 4 PA,B/Dsirolimus 0.5 mg tablet 1 PA,B/Dsirolimus 1 mg tablet 1 PA,B/Dsirolimus 1 mg/ml solution 4 PA,B/Dsirolimus 2 mg tablet 1 PA,B/DSOLTAMOX 20 MG/10 ML SOLN 4SOMATULINE DEPOT 120 MG/0.5 ML

4 PA,QL 0.5/28

SOMATULINE DEPOT 60 MG/0.2 ML

4 PA,QL 0.2/28

SOMATULINE DEPOT 90 MG/0.3 ML

4 PA,QL 0.3/28

SPRYCEL 100 MG TABLET 4 PA,QL 30/30






STIVARGA 40 MG TABLET 4 PA,QL 120/28

SUTENT 12.5 MG CAPSULE 4 PA,QL 28/28

SUTENT 25 MG CAPSULE 4 PA,QL 28/28

SUTENT 37.5 MG CAPSULE 4 PA,QL 28/28

SUTENT 50 MG CAPSULE 4 PA,QL 28/28

SYNRIBO 3.5 MG/ML VIAL 4 PA,QL 28/28

TABLOID 40 MG TABLET 3tacrolimus 0.5 mg capsule 1 PA,B/Dtacrolimus 1 mg capsule 1 PA,B/Dtacrolimus 5 mg capsule 1 PA,B/DTAFINLAR 50 MG CAPSULE 4 PA,QL

120/30TAFINLAR 75 MG CAPSULE 4 PA,QL

120/30TAGRISSO 40 MG TABLET 4 PA,QL

30/30TAGRISSO 80 MG TABLET 4 PA,QL

30/30TALZENNA 0.25 MG CAPSULE 4 PA,QL

90/30TALZENNA 1 MG CAPSULE 4 PA,QL

90/30tamoxifen 10 mg tablet 1tamoxifen 20 mg tablet 1TARCEVA 100 MG TABLET 4 PA,QL

30/30TARCEVA 150 MG TABLET 4 PA,QL

30/30TARCEVA 25 MG TABLET 4 PA,QL

60/30TARGRETIN 1% GEL 4 PA,QL

60/30TASIGNA 150 MG CAPSULE 4 PA,QL



420/30TECENTRIQ 1,200 MG/20 ML VIAL

4 PA,QL 20/21,B/D

TECENTRIQ 840 MG/14 ML VIAL 4 PA,QL 28/28,B/D

temsirolimus 25 mg vial 4 PA,QL 4/28,B/D

THALOMID 100 MG CAPSULE 4 PA,QL 28/28

28

Drug NameDrug Tier



Drug NameDrug Tier





thiotepa 15 mg vial 1 PA,B/DTIBSOVO 250 MG TABLET 4 PA,QL

60/30TOPOSAR 1,000 MG/50 ML VIAL 1 PA,B/DTOPOSAR 100 MG/5 ML VIAL 1 PA,B/DTOPOSAR 500 MG/25 ML VIAL 1 PA,B/Dtopotecan hcl 4 mg vial 4toremifene citrate 60 mg tab 4 QL 30/30TORISEL 25 MG KIT 4 PA,QL

4/28,B/DTREANDA 100 MG VIAL 4 PA,B/DTREANDA 25 MG VIAL 4 PA,QL

8/21,B/DTRELSTAR 11.25 MG VIAL 4 PA,QL 1/84TRELSTAR 22.5 MG VIAL 4 PA,QL

1/168TRELSTAR 3.75 MG VIAL 4 PA,QL 1/28tretinoin 10 mg capsule 4TREXALL 10 MG TABLET 2 ECTREXALL 15 MG TABLET 2 ECTREXALL 5 MG TABLET 2 ECTREXALL 7.5 MG TABLET 2 ECTRIPTODUR 22.5 MG KIT 4 PA,QL

1/168TRISENOX 12 MG/6 ML VIAL 3 PA,B/DTYKERB 250 MG TABLET 4 PA,QL

180/30UNITUXIN 17.5 MG/ 5 ML VIAL 4 PA,B/DVECTIBIX 100 MG/5 ML VIAL 4 PA,B/DVECTIBIX 400 MG/20 ML VIAL 4 PA,B/DVELCADE 3.5 MG VIAL 4 PA,QL

14/21,B/DVENCLEXTA 10 MG TABLET 2 PA,QL

60/30VENCLEXTA 100 MG TABLET 4 PA,QL

120/30

VENCLEXTA 50 MG TABLET 2 PA,QL 30/30

VENCLEXTA STARTING PACK 4 PA,QL 84/365

VERZENIO 100 MG TABLET 4 PA,QL 60/30




VINCASAR PFS 1 MG/ML VIAL 1 PA,B/Dvincristine 1 mg/ml vial 1 PA,B/Dvinorelbine 10 mg/ml vial 1 PA,B/Dvinorelbine 50 mg/5 ml vial 1 PA,B/DVITRAKVI 100 MG CAPSULE 4 PA,QL

60/30VITRAKVI 20 MG/ML SOLUTION 4 PA,QL

300/30VITRAKVI 25 MG CAPSULE 4 PA,QL

180/30VIZIMPRO 15 MG TABLET 4 PA,QL



30/30VOTRIENT 200 MG TABLET 4 PA,QL

120/30VYXEOS 44 MG-100 MG VIAL 4 PA,B/DXALKORI 200 MG CAPSULE 4 PA,QL

60/30XALKORI 250 MG CAPSULE 4 PA,QL

60/30XATMEP 2.5 MG/ML ORAL SOLUTION

3 PA

XOSPATA 40 MG TABLET 4 PA,QL 90/30

XTANDI 40 MG CAPSULE 4 PAYERVOY 200 MG/40 ML VIAL 4 PA,QL

80/21,B/DYERVOY 50 MG/10 ML VIAL 4 PA,B/D

29

Drug NameDrug Tier



Drug NameDrug Tier


YONDELIS 1 MG VIAL 4 PA,B/DYONSA 125 MG TABLET 4 PA,QL

120/30ZEJULA 100 MG CAPSULE 4 PA,QL

90/30ZELBORAF 240 MG TABLET 4 PA,QL

240/30ZOLINZA 100 MG CAPSULE 4 QL 120/30ZORTRESS 0.25 MG TABLET 3 PA,QL

60/30,B/DZORTRESS 0.5 MG TABLET 4 PA,QL

120/30,B/DZORTRESS 0.75 MG TABLET 4 PA,QL

60/30,B/DZORTRESS 1 MG TABLET 4 PA,QL

60/30,B/DZYDELIG 100 MG TABLET 4 PA,QL

60/30ZYDELIG 150 MG TABLET 4 PA,QL

60/30ZYKADIA 150 MG CAPSULE 4 PA,QL

140/28ZYKADIA 150 MG TABLET 4 PA,QL

140/28ZYTIGA 250 MG TABLET 4 PAZYTIGA 500 MG TABLET 4 PA,QL

60/30

ANTIPARKINSONISM AGENTSAPOKYN 30 MG/3 ML CARTRIDGE

4 PA,QL 60/30

benztropine 2 mg/2 ml ampule 1benztropine mes 0.5 mg tab 1 PA (HRM)benztropine mes 1 mg tablet 1 PA (HRM)benztropine mes 2 mg tablet 1 PA (HRM)bromocriptine 2.5 mg tablet 1bromocriptine 5 mg capsule 1carbidopa 25 mg tablet 1carbidopa-levo 10-100 mg odt 1carbidopa-levo 25-100 mg odt 1carbidopa-levo 25-250 mg odt 1carbidopa-levo er 25-100 tab 1carbidopa-levo er 50-200 tab 1

carbidopa-levodopa 100 mg-enta 1carbidopa-levodopa 10-100 tab 1carbidopa-levodopa 125 mg-enta 1carbidopa-levodopa 150 mg-enta 1carbidopa-levodopa 200 mg-enta 1carbidopa-levodopa 25-100 tab 1carbidopa-levodopa 25-250 tab 1carbidopa-levodopa 50 mg-enta 1carbidopa-levodopa 75 mg-enta 1entacapone 200 mg tablet 1 QL 240/30MIRAPEX ER 0.375 MG TABLET 2 QL

90/30,ECMIRAPEX ER 0.75 MG TABLET 2 QL



30/30,ECMIRAPEX ER 3 MG TABLET 2 QL



30/30,ECNEUPRO 1 MG/24 HR PATCH 3NEUPRO 2 MG/24 HR PATCH 3NEUPRO 3 MG/24 HR PATCH 3NEUPRO 4 MG/24 HR PATCH 3NEUPRO 6 MG/24 HR PATCH 3NEUPRO 8 MG/24 HR PATCH 3pramipexole 0.125 mg tablet 1pramipexole 0.25 mg tablet 1pramipexole 0.5 mg tablet 1pramipexole 0.75 mg tablet 1pramipexole 1 mg tablet 1pramipexole 1.5 mg tablet 1pramipexole er 0.375 mg tablet 1 QL 90/30pramipexole er 0.75 mg tablet 1 QL 90/30pramipexole er 1.5 mg tablet 1 QL 90/30pramipexole er 2.25 mg tablet 1 QL 30/30pramipexole er 3 mg tablet 1 QL 30/30

30

Drug NameDrug Tier



Drug NameDrug Tier


pramipexole er 3.75 mg tablet 1 QL 30/30pramipexole er 4.5 mg tablet 1 QL 30/30rasagiline mesylate 0.5 mg tab 1rasagiline mesylate 1 mg tab 1ropinirole hcl 0.25 mg tablet 1ropinirole hcl 0.5 mg tablet 1ropinirole hcl 1 mg tablet 1ropinirole hcl 2 mg tablet 1ropinirole hcl 3 mg tablet 1ropinirole hcl 4 mg tablet 1ropinirole hcl 5 mg tablet 1ropinirole hcl er 12 mg tablet 1ropinirole hcl er 2 mg tablet 1ropinirole hcl er 4 mg tablet 1ropinirole hcl er 6 mg tablet 1ropinirole hcl er 8 mg tablet 1RYTARY ER 23.75 MG-95 MG CAP

3 ST

RYTARY ER 36.25 MG-145 MG CAP

3 ST


3 ST


3 ST

selegiline hcl 5 mg capsule 1selegiline hcl 5 mg tablet 1tolcapone 100 mg tablet 4trihexyphenidyl 2 mg tablet 1 PA (HRM)trihexyphenidyl 2 mg/5 ml elx 1 PA (HRM)trihexyphenidyl 5 mg tablet 1 PA (HRM)

ANTIPRURITICS,TOPICALLEVICYN ANTIPRURITIC GEL 2 +sp antipruritic gel 1 +

ANTIPSORIATIC / ANTISEBORRHEICacitretin 10 mg capsule 3acitretin 17.5 mg capsule 3acitretin 25 mg capsule 3calcipotriene 0.005% cream 1 QL 120/30calcipotriene 0.005% ointment 1 QL 120/30calcipotriene 0.005% solution 1CALCITRENE 0.005% OINTMENT 1 QL 120/30

calcitriol 3 mcg/g ointment 1EPIFOAM FOAM 2PRAMOSONE 1% LOTION 2PRAMOSONE 1%-1% CREAM 2PRAMOSONE 2.5%-1% LOTION 2selenium sulfide 2.5% lotion 1SKYRIZI 150 MG DOSE KIT-2 SYRN

4 PA,QL 2/28

STELARA 45 MG/0.5 ML SYRINGE

2 PA,QL 0.5/28,EC

STELARA 45 MG/0.5 ML VIAL 2 PA,QL 0.5/28,EC

STELARA 90 MG/ML SYRINGE 2 PA,QL 1/28,EC

ANTIPSORIATICS AGENTSZITHRANOL 1% SHAMPOO 2 +

ANTISEBORRHEIC AGENTSOVACE 10% WASH 2 +OVACE PLUS 10% CREAM 2 +OVACE PLUS 10% SHAMPOO 2 +OVACE PLUS 10% WASH 2 +OVACE PLUS 9.8% FOAM 2 +OVACE PLUS 9.8% LOTION 2 +OVACE PLUS WASH 10% CLNSNG GEL

2 +

PROMISEB TOPICAL CREAM 2 +seb-prev 10% wash 1 +selenium sulfide 2.25% shampoo 1 +selenium sulfide 2.3% shampoo 1 +SELRX 2.3% SHAMPOO 2 +sod sulfacetam 10% clnsng gel 1 +sod sulfacetamide 10% shampoo 1 +sodium sulfacetamide 10% wash 1 +TERSI 2.25% FOAM 2 +

ANTITHYROID AGENTSmethimazole 10 mg tablet 1methimazole 5 mg tablet 1propylthiouracil 50 mg tablet 1

ANTIVIRALSabacavir 20 mg/ml solution 1 QL 960/30abacavir 300 mg tablet 1 QL 60/30

31

Drug NameDrug Tier



Drug NameDrug Tier


abacavir-lamivudine 600-300 mg 1 QL 30/30abacavir-lamivudine-zidov tab 4 QL 60/30acyclovir 200 mg capsule 1acyclovir 200 mg/5 ml susp 1acyclovir 400 mg tablet 1acyclovir 500 mg/10 ml vial 1 PA,B/Dacyclovir 800 mg tablet 1adefovir dipivoxil 10 mg tab 4 QL 30/30amantadine 100 mg capsule 1amantadine 100 mg tablet 1amantadine 50 mg/5 ml solution 1APTIVUS 100 MG/ML SOLUTION 4 QL 285/28APTIVUS 250 MG CAPSULE 4 QL 120/30atazanavir sulfate 150 mg cap 1 QL 30/30atazanavir sulfate 200 mg cap 4 QL 60/30atazanavir sulfate 300 mg cap 4 QL 30/30ATRIPLA TABLET 4 QL 30/30BARACLUDE 0.05 MG/ML SOLUTION

3 QL 630/30

BIKTARVY 50-200-25 MG TABLET 4 QL 30/30CIMDUO 300-300 MG TABLET 4 QL 30/30COMPLERA TABLET 4 QL 30/30CRIXIVAN 200 MG CAPSULE 3 QL 270/30CRIXIVAN 400 MG CAPSULE 3 QL 180/30DELSTRIGO 100-300-300 MG TAB 4 QL 30/30DESCOVY 200-25 MG TABLET 4 QL 30/30didanosine dr 200 mg capsule 1 QL 30/30didanosine dr 250 mg capsule 1 QL 30/30didanosine dr 400 mg capsule 1 QL 30/30DOVATO 50-300 MG TABLET 4 QL 30/30EDURANT 25 MG TABLET 4 QL 30/30efavirenz 200 mg capsule 1 QL 120/30efavirenz 50 mg capsule 1 QL 180/30efavirenz 600 mg tablet 4 QL 30/30EMTRIVA 10 MG/ML SOLUTION 2 QL 680/28EMTRIVA 200 MG CAPSULE 2 QL 30/30entecavir 0.5 mg tablet 1 QL 30/30entecavir 1 mg tablet 1 QL 30/30EPCLUSA 400 MG-100 MG TABLET

4 PA,QL 28/28

EPIVIR HBV 25 MG/5 ML SOLN 2EVOTAZ 300 MG-150 MG TABLET 4 QL 30/30famciclovir 125 mg tablet 1 QL 60/30famciclovir 250 mg tablet 1 QL 60/30famciclovir 500 mg tablet 1 QL 60/30fosamprenavir 700 mg tablet 4 QL 120/30FUZEON 90 MG VIAL 4 QL 60/30GENVOYA TABLET 4 QL 30/30HARVONI 90-400 MG TABLET 4 PA,QL

28/28INTELENCE 100 MG TABLET 4 QL 60/30INTELENCE 200 MG TABLET 4 QL 60/30INTELENCE 25 MG TABLET 3 QL 120/30INVIRASE 500 MG TABLET 4 QL 120/30ISENTRESS 100 MG POWDER PACKET

3 QL 60/30

ISENTRESS 100 MG TABLET CHEW

4 QL 180/30

ISENTRESS 25 MG TABLET CHEW

2 QL 180/30

ISENTRESS 400 MG TABLET 4 QL 120/30ISENTRESS HD 600 MG TABLET 4 QL 60/30JULUCA 50-25 MG TABLET 4KALETRA 100-25 MG TABLET 3 QL 300/30KALETRA 200-50 MG TABLET 4 QL 120/30lamivudine 10 mg/ml oral soln 1 QL 900/30lamivudine 150 mg tablet 1 QL 60/30lamivudine 300 mg tablet 1 QL 30/30lamivudine hbv 100 mg tablet 1 QL 30/30lamivudine-zidovudine tablet 1 QL 60/30LEXIVA 50 MG/ML SUSPENSION 3 QL 1575/28lopinavir-ritonavir 80-20mg/ml 1 QL 480/30MAVYRET 100-40 MG TABLET 4 PA,QL

84/28nevirapine 200 mg tablet 1 QL 60/30nevirapine 50 mg/5 ml susp 1 QL 1200/30nevirapine er 100 mg tablet 1 QL 90/30nevirapine er 400 mg tablet 1 QL 30/30NORVIR 100 MG POWDER PACKET

3 QL 360/30

NORVIR 100 MG TABLET 3 QL 360/30

32

Drug NameDrug Tier



Drug NameDrug Tier


NORVIR 80 MG/ML SOLUTION 3 QL 480/30ODEFSEY TABLET 4 QL 30/30oseltamivir 6 mg/ml suspension 1oseltamivir phos 30 mg capsule 1oseltamivir phos 45 mg capsule 1oseltamivir phos 75 mg capsule 1PIFELTRO 100 MG TABLET 4 QL 30/30PREZCOBIX 800 MG-150 MG TABLET

4 QL 30/30

PREZISTA 100 MG/ML SUSPENSION

4 QL 400/30

PREZISTA 150 MG TABLET 3 QL 180/30PREZISTA 600 MG TABLET 4 QL 60/30PREZISTA 75 MG TABLET 2 QL 210/30PREZISTA 800 MG TABLET 4 QL 30/30RELENZA 5 MG DISKHALER 3 QL 120/365RESCRIPTOR 200 MG TABLET 3 QL 180/30RETROVIR 200 MG/20 ML VIAL 3REYATAZ 50 MG POWDER PACKET

4 QL 180/30

ribavirin 200 mg capsule 1 QL 168/28ribavirin 200 mg tablet 1rimantadine hcl 100 mg tablet 1ritonavir 100 mg tablet 1 QL 360/30SELZENTRY 150 MG TABLET 4 QL 60/30SELZENTRY 20 MG/ML ORAL SOLN

4 QL 1610/26

SELZENTRY 25 MG TABLET 3 QL 240/30SELZENTRY 300 MG TABLET 4 QL 120/30SELZENTRY 75 MG TABLET 4 QL 60/30stavudine 15 mg capsule 1 QL 60/30stavudine 20 mg capsule 1 QL 60/30stavudine 30 mg capsule 1 QL 60/30stavudine 40 mg capsule 1 QL 60/30STRIBILD TABLET 4 QL 30/30SYMFI 600-300-300 MG TABLET 4 QL 30/30SYMFI LO 400-300-300 MG TABLET

4 QL 30/30

SYMTUZA 800-150-200-10 MG TAB

4 QL 30/30

tenofovir disop fum 300 mg tb 1 QL 30/30

TIVICAY 10 MG TABLET 3 QL 60/30TIVICAY 25 MG TABLET 4 QL 60/30TIVICAY 50 MG TABLET 4 QL 60/30trifluridine 1% eye drops 1TRIUMEQ 600-50-300 MG 4 QL 30/30TROGARZO 200 MG/1.33 ML VIAL 4 PA,B/DTRUVADA 100 MG-150 MG TABLET

4 QL 30/30

TRUVADA 133 MG-200 MG TABLET

4 QL 30/30


4 QL 30/30


2 QL 30/30,EC

TYBOST 150 MG TABLET 2 QL 30/30valacyclovir hcl 1 gram tablet 1 QL 120/30valacyclovir hcl 500 mg tablet 1 QL 60/30valganciclovir 450 mg tablet 4valganciclovir hcl 50 mg/ml 4VALTREX 1 GM CAPLET 2 QL

30/30,ECVALTREX 500 MG CAPLET 2 QL

30/30,ECVIDEX 2 GM PEDIATRIC SOLN 3 QL 1200/30VIDEX 4 GM PEDIATRIC SOLN 3 QL 1200/30VIDEX EC 125 MG CAPSULE 3VIRACEPT 250 MG TABLET 4 QL 270/30VIRACEPT 625 MG TABLET 4 QL 120/30VIREAD 150 MG TABLET 4 QL 30/30VIREAD 200 MG TABLET 4 QL 30/30VIREAD 250 MG TABLET 4 QL 30/30VIREAD POWDER 4 QL 240/30VOSEVI 400-100-100 MG TABLET 4 PA,QL

30/30XOFLUZA 20 MG TAB (40 MG DOSE)

3

XOFLUZA 40 MG TAB (80 MG DOSE)

3

zidovudine 100 mg capsule 1 QL 180/30zidovudine 300 mg tablet 1 QL 60/30zidovudine 50 mg/5 ml syrup 1 QL 1680/28

33

Drug NameDrug Tier



Drug NameDrug Tier


ZIRGAN 0.15% OPHTHALMIC GEL

2

BELLADONNA ALKALOIDSbelladonna-phenobarbital elixr 1 +belladonna-phenobarbital tab 1 +DONNATAL TABLET 2 +hyosyne 125 mcg/5 ml elixir 1 +LEVSIN 0.125 MG TABLET 2 +LEVSIN-SL 0.125 MG TABLET SL 2 +phenohytro elixir 1 +phenohytro tablet 1 +symax fastabs 0.125 mg tablet 1 +

BENIGN PROSTATIC HYPERPLASIA(BPH) THERAPY

alfuzosin hcl er 10 mg tablet 1 QL 30/30AVODART 0.5 MG SOFTGEL 2 QL

30/30,ECdutasteride 0.5 mg capsule 1 QL 30/30dutasteride-tamsulosin 0.5-0.4 1 QL 30/30finasteride 5 mg tablet 1 QL 30/30FLOMAX 0.4 MG CAPSULE 2 QL

60/30,ECJALYN 0.5-0.4 MG CAPSULE 2 QL

30/30,ECPROSCAR 5 MG TABLET 2 QL

30/30,ECRAPAFLO 4 MG CAPSULE 2 QL 30/30RAPAFLO 8 MG CAPSULE 2 QL 30/30silodosin 4 mg capsule 1 QL 30/30silodosin 8 mg capsule 1 QL 30/30tamsulosin hcl 0.4 mg capsule 1 QL 60/30UROXATRAL 10 MG TABLET 2 QL

30/30,EC

BETA-BLOCKERSbetaxolol hcl 0.5% eye drop 1BETIMOL 0.25% EYE DROPS 3BETIMOL 0.5% EYE DROPS 3BETOPTIC S 0.25% EYE DROPS 3carteolol hcl 1% eye drops 1ISTALOL 0.5% EYE DROPS 3levobunolol 0.5% eye drops 1

timolol 0.25% gfs gel-solution 1timolol 0.5% eye drop 1timolol 0.5% gfs gel-solution 1timolol maleate 0.25% eye drop 1timolol maleate 0.5% eye drops 1TIMOPTIC 0.25% OCUDOSE DROP

2 EC

TIMOPTIC 0.5% OCUDOSE DROP 2 EC

BIOTECHNOLOGY DRUGSACTIMMUNE 100 MCG/0.5 ML VIAL

4 PA

ARANESP 10 MCG/0.4 ML SYRINGE

3 PA,QL 1.6/28,B/D


4 PA,QL 2/28,B/D

ARANESP 100 MCG/ML VIAL 4 PA,QL 4/28,B/D


4 PA,QL 1.2/28,B/D


4 PA,QL 1.6/28,B/D


ARANESP 25 MCG/0.42 ML SYRING

3 PA,QL 1.68/28,B/D



4 PA,QL 2.4/28,B/D



3 PA,QL 1.6/28,B/D


ARANESP 500 MCG/1 ML SYRINGE

4 PA,QL 1/21,B/D


3 PA,QL 1.2/28,B/D


ARCALYST 220 MG INJECTION 4 PA,B/DAVONEX 30 MCG VIAL KIT 4 PA,QL 4/28

34

Drug NameDrug Tier



Drug NameDrug Tier


AVONEX PEN 30 MCG/0.5 ML KIT 4 PA,QL 1/28AVONEX PREFILLED SYR 30 MCG KT

4 PA,QL 1/28

BETASERON 0.3 MG KIT 4 PA,QL 14/28

EGRIFTA 1 MG VIAL 4 PA,QL 60/30

EPOGEN 2,000 UNITS/ML VIAL 3 PA,B/DEPOGEN 20,000 UNITS/2 ML VIAL 3 PA,B/DEPOGEN 20,000 UNITS/ML VIAL 3 PA,B/DEPOGEN 3,000 UNITS/ML VIAL 3 PA,B/DEPOGEN 4,000 UNITS/ML VIAL 3 PA,B/DEXTAVIA 0.3 MG KIT 4 PAGENOTROPIN 12 MG CARTRIDGE

4 PA

GENOTROPIN 5 MG CARTRIDGE 4 PAGENOTROPIN MINIQUICK 0.2 MG 3 PAGENOTROPIN MINIQUICK 0.4 MG 4 PAGENOTROPIN MINIQUICK 0.6 MG 4 PAGENOTROPIN MINIQUICK 0.8 MG 4 PAGENOTROPIN MINIQUICK 1 MG 4 PAGENOTROPIN MINIQUICK 1.2 MG 4 PAGENOTROPIN MINIQUICK 1.4 MG 4 PAGENOTROPIN MINIQUICK 1.6 MG 4 PAGENOTROPIN MINIQUICK 1.8 MG 4 PAGENOTROPIN MINIQUICK 2 MG 4 PAINTRON A 10 MILLION UNITS VIAL

4

INTRON A 18 MILLION UNIT/3 ML 3INTRON A 18 MILLION UNITS VIAL

4

INTRON A 25 MILLION UNIT/2.5ML

4

INTRON A 50 MILLION UNITS VIAL

4

LEUKINE 250 MCG VIAL 4MOZOBIL 24 MG/1.2 ML VIAL 4 QL 9.6/30PROCRIT 10,000 UNITS/ML VIAL 3 PA,QL

12/28,B/DPROCRIT 2,000 UNITS/ML VIAL 3 PA,QL

12/28,B/D

PROCRIT 20,000 UNITS/ML VIAL 4 PA,QL 12/28,B/D




REBIF 22 MCG/0.5 ML SYRINGE 4 PA,QL 6/28REBIF 44 MCG/0.5 ML SYRINGE 4 PA,QL 6/28REBIF REBIDOSE 22 MCG/0.5 ML 4 PA,QL 6/28REBIF REBIDOSE 44 MCG/0.5 ML 4 PA,QL 6/28REBIF REBIDOSE TITRATION PACK

4 PA,QL 8.4/365

REBIF TITRATION PACK 4 PA,QL 8.4/365

RETACRIT 10,000 UNIT/ML VIAL 3 PA,QL 12/28,B/D





SYLATRON 200 MCG KIT 4 PA,QL 4/28SYLATRON 300 MCG KIT 4 PA,QL 4/28SYLATRON 600 MCG KIT 4 PA,QL 4/28SYNAGIS 100 MG/1 ML VIAL 4 PASYNAGIS 50 MG/0.5 ML VIAL 4 PAZARXIO 300 MCG/0.5 ML SYRINGE

4

ZARXIO 480 MCG/0.8 ML SYRINGE

4

CEPHALOSPORINScefaclor 125 mg/5 ml susp 1cefaclor 250 mg capsule 1cefaclor 250 mg/5 ml susp 1cefaclor 375 mg/5 ml suspen 1cefaclor 500 mg capsule 1cefaclor er 500 mg tablet 1

35

Drug NameDrug Tier



Drug NameDrug Tier


cefadroxil 1 gm tablet 1cefadroxil 250 mg/5 ml susp 1cefadroxil 500 mg capsule 1cefadroxil 500 mg/5 ml susp 1cefazolin 1 g/50 ml-dextrose 1cefazolin 1 gm vial 1cefazolin 10 gm vial 1cefazolin 2 g/100 ml-dextrose 1cefazolin 2 g/50 ml-dextrose 1cefazolin 500 mg vial 1cefdinir 125 mg/5 ml susp 1cefdinir 250 mg/5 ml susp 1cefdinir 300 mg capsule 1cefepime 1 gm injection 1cefepime 2 gm injection 1cefepime hcl 1 gm vial 1cefepime hcl 2 gram vial 1cefepime-dextrose 1 gm/50 ml 1cefepime-dextrose 2 gm/50 ml 1cefixime 100 mg/5 ml susp 1cefixime 200 mg/5 ml susp 1cefixime 400 mg capsule 1 QL 30/30cefotaxime sodium 1 gm vial 1cefotaxime sodium 500 mg vial 1cefotetan 1 gm vial 1cefotetan 10 gm vial 1cefotetan 2 gm vial 1cefoxitin 1 gm vial 1cefoxitin 10 gm vial 1cefoxitin 2 gm vial 1cefpodoxime 100 mg tablet 1cefpodoxime 100 mg/5 ml susp 1cefpodoxime 200 mg tablet 1cefpodoxime 50 mg/5 ml susp 1cefprozil 125 mg/5 ml susp 1cefprozil 250 mg tablet 1cefprozil 250 mg/5 ml susp 1cefprozil 500 mg tablet 1ceftazidime 1 gm piggyback 1ceftazidime 1 gm vial 1

ceftazidime 2 gm piggyback 1ceftazidime 2 gm vial 1ceftazidime 6 gm vial 1ceftriaxone 1 gm piggyback 1ceftriaxone 1 gm vial 1ceftriaxone 10 gm vial 1ceftriaxone 2 gm add vial 1ceftriaxone 2 gm piggyback 1ceftriaxone 2 gm vial 1ceftriaxone 250 mg vial 1ceftriaxone 500 mg vial 1cefuroxime axetil 250 mg tab 1cefuroxime axetil 500 mg tab 1cefuroxime sod 1.5 gm vial 1cefuroxime sod 7.5 gm vial 1cefuroxime sod 750 mg vial 1cephalexin 125 mg/5 ml susp 1cephalexin 250 mg capsule 1cephalexin 250 mg tablet 1cephalexin 250 mg/5 ml susp 1cephalexin 500 mg capsule 1cephalexin 500 mg tablet 1cephalexin 750 mg capsule 1SUPRAX 500 MG/5 ML SUSPENSION

3

TAZICEF 1 GM ADD-VANTAGE VIAL

1

TAZICEF 1 GRAM VIAL 1TAZICEF 2 GM ADD-VANTAGE VIAL

1

TAZICEF 2 GRAM VIAL 1TAZICEF 6 GRAM VIAL 1TEFLARO 400 MG VIAL 4TEFLARO 600 MG VIAL 4

CHEMOTHERAPEUTICS, ANTIBACTERIAL, MISC.

hyophen tablet 1 +me-naphos-mb-hyo 1 tablet 1 +ur n-c tablet 1 +uretron d-s tablet 1 +URIBEL CAPSULE 2 +

36

Drug NameDrug Tier



Drug NameDrug Tier


urogesic-blue tablet 1 +uro-mp capsule 1 +uryl tablet 1 +UTA CAPSULE 2 +vilamit mb capsule 1 +vilevev mb tablet 1 +

COAGULATION THERAPYaminocaproic acid 1,000 mg tab 1aminocaproic acid 25% solution 1aminocaproic acid 500 mg tab 1aspirin-dipyridam er 25-200 mg 1 QL 60/30BRILINTA 60 MG TABLET 2 QL 60/30BRILINTA 90 MG TABLET 2 QL 60/30cilostazol 100 mg tablet 1cilostazol 50 mg tablet 1clopidogrel 300 mg tablet 1 QL 2/365clopidogrel 75 mg tablet 1COUMADIN 1 MG TABLET 3COUMADIN 10 MG TABLET 3COUMADIN 2 MG TABLET 3COUMADIN 2.5 MG TABLET 3COUMADIN 3 MG TABLET 3COUMADIN 4 MG TABLET 3COUMADIN 5 MG TABLET 3COUMADIN 6 MG TABLET 3COUMADIN 7.5 MG TABLET 3dipyridamole 25 mg tablet 1dipyridamole 50 mg tablet 1dipyridamole 75 mg tablet 1EFFIENT 10 MG TABLET 3 QL

30/30,ECEFFIENT 5 MG TABLET 3 QL

30/30,ECELIQUIS 2.5 MG TABLET 2ELIQUIS 5 MG STARTER PACK 2ELIQUIS 5 MG TABLET 2enoxaparin 100 mg/ml syringe 1enoxaparin 120 mg/0.8 ml syr 1enoxaparin 150 mg/ml syringe 3enoxaparin 30 mg/0.3 ml syr 1

enoxaparin 300 mg/3 ml vial 1enoxaparin 40 mg/0.4 ml syr 1enoxaparin 60 mg/0.6 ml syr 1enoxaparin 80 mg/0.8 ml syr 1fondaparinux 10 mg/0.8 ml syr 4fondaparinux 2.5 mg/0.5 ml syr 1fondaparinux 5 mg/0.4 ml syr 4fondaparinux 7.5 mg/0.6 ml syr 4heparin 20,000 unit/500 ml-d5w 1heparin 25,000 unit/250 ml-d5w 1heparin 25,000 unit/250-1/2 ns 1heparin 25,000 unit/500 ml-d5w 1heparin 25,000 unit/500-1/2 ns 1heparin 30,000 unit/30 ml vial 1heparin sod 10,000 unit/ml vl 1heparin sod 20,000 unit/ml vl 1heparin sod 5,000 unit/0.5 ml 1heparin sod 5,000 unit/ml vial 1heparin sodium/sodium chloride 1000unit/500ml; 0.9% soln

1

heparin-1/2ns 25,000 units/500 1heparin-d5w 25,000 unit/250 ml 1heparin-d5w 25,000 unit/500 ml 1heparin-ns 1,000 units/500 ml 1heparin-ns 2,000 unit/1,000 ml 1JANTOVEN 1 MG TABLET 1JANTOVEN 10 MG TABLET 1JANTOVEN 2 MG TABLET 1JANTOVEN 2.5 MG TABLET 1JANTOVEN 3 MG TABLET 1JANTOVEN 4 MG TABLET 1JANTOVEN 5 MG TABLET 1JANTOVEN 6 MG TABLET 1JANTOVEN 7.5 MG TABLET 1pentoxifylline er 400 mg tab 1PLAVIX 300 MG TABLET 2 QL

2/365,ECPLAVIX 75 MG TABLET 2 QL

30/30,ECPRADAXA 110 MG CAPSULE 3 QL 60/30PRADAXA 150 MG CAPSULE 3 QL 60/30

37

Drug NameDrug Tier



Drug NameDrug Tier


PRADAXA 75 MG CAPSULE 3 QL 60/30prasugrel 10 mg tablet 1 QL 30/30prasugrel 5 mg tablet 1 QL 30/30PROMACTA 12.5 MG SUSPEN PACKET

4 PA,QL 360/30

PROMACTA 12.5 MG TABLET 4 PA,QL 30/30

PROMACTA 25 MG TABLET 4 PA,QL 30/30



warfarin sodium 1 mg tablet 1warfarin sodium 10 mg tablet 1warfarin sodium 2 mg tablet 1warfarin sodium 2.5 mg tablet 1warfarin sodium 3 mg tablet 1warfarin sodium 4 mg tablet 1warfarin sodium 5 mg tablet 1warfarin sodium 6 mg tablet 1warfarin sodium 7.5 mg tablet 1XARELTO 10 MG TABLET 2 QL 30/30XARELTO 15 MG TABLET 2 QL 60/30XARELTO 2.5 MG TABLET 2 QL 60/30XARELTO 20 MG TABLET 2 QL 30/30XARELTO STARTER PACK 2 QL 102/365

Cough & Cold Supplementalbenzonatate capsules 1 +bromfed dm cough syrup 1 +bromphenir-pseudoephed-dm syr

1 +

CAPCOF LIQUID 2 +cheratussin ac syrup 1 +codeine-guaifen 10-100 mg/5 ml 1 +CODITUSSIN AC LIQUID 2 +CODITUSSIN DAC LIQUID 2 +g tussin ac liquid 1 +guaiatussin ac liquid 1 +GUAIFEN-CODEINE 100-10 MG/5 ML

2 +

guaifen-codeine 100-10 mg/5 ml 1 +GUAIFEN-CODEINE 200-20 MG/10ML

2 +

guaifenesin ac cough syrup 1 +guaifenesin dac oral solution 1 +guaifenesin-codeine syrup 1 +hydrocod-cpm-pseudoep 5-4-60/5

1 +

hydrocodone-chlorphen er susp 1 +HYDROCODONE-GUAIF 2.5-200 MG/5

2 +

hydrocodone-homatropine 5-1.5 1 +hydrocodone-homatropine soln 1 +hydrocodone-homatropine syrup 1 +HYDROCODONE-HOMATROPINE SYRUP

2 +

hydromet syrup 1 +lortuss ex liquid 1 +MAR-COF BP LIQUID 2 +MAR-COF CG LIQUID 2 +MAXI-TUSS CD LIQUID 2 +m-clear wc liquid 1 +M-END PE LIQUID 2 +OBREDON 2.5-200 MG/5 ML SOLN

2 +

pcm la tablet 1 +pe-guai drops 1 +POLY-TUSSIN AC LIQUID 2 +promethazine-codeine syrup 1 +promethazine-dm solution 1 +promethazine-dm syrup 1 +promethazine-pe-codeine syrup 1 +PRO-RED AC SYRUP 2 +RESPA A.R. TABLET SA 2 +robafen ac oral solution 1 +rydex liquid 1 +TESSALON PERLE 100 MG CAP 2 +tusnel c syrup 1 +TUSNEL PEDIATRIC LIQUID 2 +TUSSICAPS 10 MG-8 MG CAPSULE

2 +

38

Drug NameDrug Tier



Drug NameDrug Tier


TUSSICAPS 5 MG-4 MG CAPSULE

2 +

TUSSIONEX PENNKINETIC SUSP 2 +TUXARIN ER 8-54.3 MG TABLET 2 +TUZISTRA XR 14.7-2.8 MG/5 ML 2 +virtussin ac liquid 1 +virtussin dac liquid 1 +ZODRYL AC 25 SUSPENSION 2 +ZODRYL AC 30 SUSPENSION 2 +ZODRYL AC 35 SUSPENSION 2 +ZODRYL AC 40 SUSPENSION 2 +ZODRYL AC 50 SUSPENSION 2 +ZODRYL AC 60 SUSPENSION 2 +ZODRYL AC 80 SUSPENSION 2 +ZODRYL DAC 25 SUSPENSION 2 +ZODRYL DAC 30 SUSPENSION 2 +ZODRYL DAC 35 SUSPENSION 2 +ZODRYL DAC 40 SUSPENSION 2 +ZODRYL DAC 50 SUSPENSION 2 +ZODRYL DAC 60 SUSPENSION 2 +ZODRYL DAC 80 SUSPENSION 2 +ZODRYL DEC 25 SUSPENSION 2 +ZODRYL DEC 30 SUSPENSION 2 +ZODRYL DEC 35 SUSPENSION 2 +ZODRYL DEC 40 SUSPENSION 2 +ZODRYL DEC 50 SUSPENSION 2 +ZODRYL DEC 60 SUSPENSION 2 +ZODRYL DEC 80 SUSPENSION 2 +Z-TUSS AC 2 MG-9 MG/5 ML LIQ 2 +

CYCLOPLEGIC MYDRIATICSCYCLOMYDRIL EYE DROPS 2 +cyclopentolate 0.5% eye drops 1 +cyclopentolate 1% eye drops 1 +cyclopentolate hcl 2% drops 1 +

DIABETES THERAPYacarbose 100 mg tablet 1 QL 90/30acarbose 25 mg tablet 1 QL 90/30acarbose 50 mg tablet 1 QL 180/30ACTOPLUS MET 15 MG-500 MG TAB

2 QL 90/30,EC

ACTOPLUS MET 15 MG-850 MG TAB

2 QL 90/30,EC

ACTOPLUS MET XR 15-1,000 MG TB

2 EC

ACTOPLUS MET XR 30-1,000 MG TB

2 EC

ACTOS 15 MG TABLET 2 QL 30/30,EC



ALCOHOL 70% PREP PADS 1AMARYL 1 MG TABLET 2 QL

240/30,ECAMARYL 2 MG TABLET 2 QL

120/30,ECAMARYL 4 MG TABLET 2 QL

60/30,ECAPIDRA 100 UNITS/ML VIAL 3 QL

40/30,STAPIDRA SOLOSTAR 100 UNITS/ML

3 QL 40/30,ST

AVANDIA 2 MG TABLET 3 QL 60/30AVANDIA 4 MG TABLET 3 QL 60/30BD INS SYR UF 0.5ML 12.7MMX30G

1 QL 200/30

BD INSULIN SYR UF 1 ML 8MMX31G

1 QL 200/30

BD SAFETYGLD INS 1 ML 13MMX29G

1 QL 200/30

BD UF INS SYR 0.3 ML 31GX5/16" 1 QL 200/30BD UF MINI PEN NEEDLE 5MMX31G

1 QL 200/30

BD UF NANO PEN NEEDLE 4MMX32G

1 QL 200/30

BD UF ORIG PEN NDL 12.7MMX29G

1 QL 200/30

BYDUREON 2 MG PEN INJECT 3 QL 4/28BYDUREON BCISE 2 MG AUTOINJECT

3 QL 4/28

BYETTA 10 MCG DOSE PEN INJ 2 QL 2.4/30BYETTA 5 MCG DOSE PEN INJ 2 QL 1.2/30

39

Drug NameDrug Tier



Drug NameDrug Tier


chlorpropamide 100 mg tablet 1chlorpropamide 250 mg tablet 1CURAD GAUZE PADS 2" X 2" 1CYCLOSET 0.8 MG TABLET 2 ECFARXIGA 10 MG TABLET 2 QL 30/30FARXIGA 5 MG TABLET 2 QL 60/30FORTAMET ER 1,000 MG TABLET 2 QL

60/30,ECFORTAMET ER 500 MG TABLET 2 QL

150/30,ECglimepiride 1 mg tablet 1 QL 240/30glimepiride 2 mg tablet 1 QL 120/30glimepiride 4 mg tablet 1 QL 60/30glipizide 10 mg tablet 1 QL 120/30glipizide 5 mg tablet 1 QL 240/30glipizide er 10 mg tablet 1 QL 60/30glipizide er 2.5 mg tablet 1 QL 240/30glipizide er 5 mg tablet 1 QL 120/30glipizide xl 10 mg tablet 1 QL 60/30glipizide xl 2.5 mg tablet 1 QL 240/30glipizide xl 5 mg tablet 1 QL 120/30glipizide-metformin 2.5-250 mg 1 QL 240/30glipizide-metformin 2.5-500 mg 1 QL 120/30glipizide-metformin 5-500 mg 1 QL 120/30GLUCAGEN 1 MG HYPOKIT 2GLUCAGON 1 MG EMERGENCY KIT

2

GLUCOPHAGE 1,000 MG TABLET 2 QL 60/30,EC

GLUCOPHAGE 500 MG TABLET 2 QL 150/30,EC

GLUCOPHAGE 850 MG TABLET 2 QL 90/30,EC

GLUCOPHAGE XR 500 MG TAB 2 QL 120/30,EC

GLUCOPHAGE XR 750 MG TAB 2 QL 60/30,EC

GLUCOVANCE 2.5-500 MG TABLET

2 PA (HRM)EC

GLUCOVANCE 5-500 MG TABLET 2 PA (HRM)EC

GLUMETZA ER 1,000 MG TABLET 3 QL 60/30,ST,E

CGLUMETZA ER 500 MG TABLET 3 QL

120/30,ST,EC

glyburide 1.25 mg tablet 1 PA (HRM)glyburide 2.5 mg tablet 1 PA (HRM)glyburide 5 mg tablet 1 PA (HRM)glyburide micro 1.5 mg tab 1 PA (HRM)glyburide micro 3 mg tablet 1 PA (HRM)glyburide micro 6 mg tablet 1 PA (HRM)glyburide-metformin 2.5-500 mg 1 PA (HRM)glyburide-metformin 5-500 mg 1 PA (HRM)glyburid-metformin 1.25-250 mg 1 PA (HRM)GLYXAMBI 10 MG-5 MG TABLET 2 QL 30/30GLYXAMBI 25 MG-5 MG TABLET 2 QL 30/30HUMALOG 100 UNIT/ML VIAL 2HUMALOG 100 UNITS/ML CARTRIDGE

2

HUMALOG 100 UNITS/ML KWIKPEN

2

HUMALOG 200 UNITS/ML KWIKPEN

2

HUMALOG JR 100 UNIT/ML KWIKPEN

2

HUMALOG MIX 50-50 KWIKPEN 2HUMALOG MIX 50-50 VIAL 2HUMALOG MIX 75-25 KWIKPEN 2HUMALOG MIX 75-25 VIAL 2HUMULIN 70/30 KWIKPEN 2HUMULIN 70-30 VIAL 2HUMULIN N 100 UNIT/ML VIAL 2HUMULIN N 100 UNITS/ML KWIKPEN

2

HUMULIN R 100 UNIT/ML VIAL 2HUMULIN R 500 UNITS/ML KWIKPEN

2

HUMULIN R 500 UNITS/ML VIAL 2INVOKAMET 150-1,000 MG TABLET

3 QL 60/30

INVOKAMET 150-500 MG TABLET 3 QL 60/30

40

Drug NameDrug Tier



Drug NameDrug Tier


INVOKAMET 50-1,000 MG TABLET

3 QL 60/30

INVOKAMET 50-500 MG TABLET 3 QL 60/30INVOKAMET XR 150-1,000 MG TAB

3 QL 60/30

INVOKAMET XR 150-500 MG TABLET

3 QL 60/30

INVOKAMET XR 50-1,000 MG TAB 3 QL 60/30INVOKAMET XR 50-500 MG TABLET

3 QL 60/30

INVOKANA 100 MG TABLET 3 QL 30/30INVOKANA 300 MG TABLET 3 QL 30/30JANUMET 50-1,000 MG TABLET 2 QL 60/30JANUMET 50-500 MG TABLET 2 QL 60/30JANUMET XR 100-1,000 MG TABLET

2 QL 30/30

JANUMET XR 50-1,000 MG TABLET

2 QL 60/30

JANUMET XR 50-500 MG TABLET 2 QL 60/30JANUVIA 100 MG TABLET 2 QL 30/30JANUVIA 25 MG TABLET 2 QL 30/30JANUVIA 50 MG TABLET 2 QL 30/30JARDIANCE 10 MG TABLET 2 QL 30/30JARDIANCE 25 MG TABLET 2 QL 30/30JENTADUETO 2.5 MG-1000 MG TAB

2 QL 60/30

JENTADUETO 2.5 MG-500 MG TAB

2 QL 60/30

JENTADUETO 2.5 MG-850 MG TAB

2 QL 60/30

JENTADUETO XR 2.5 MG-1,000 MG

2 QL 60/30

JENTADUETO XR 5 MG-1,000 MG TB

2 QL 30/30

KOMBIGLYZE XR 2.5-1,000 MG TAB

2 QL 60/30,ST,E

CKOMBIGLYZE XR 5-1,000 MG TAB

2 QL 30/30,ST,E

CKOMBIGLYZE XR 5-500 MG TABLET

2 QL 30/30,ST,E

C

LANTUS 100 UNIT/ML VIAL 2LANTUS SOLOSTAR 100 UNIT/ML 2LEVEMIR 100 UNIT/ML VIAL 2LEVEMIR FLEXTOUCH 100 UNIT/ML

2

metformin er 1,000 mg gastr-tb (generic glumetza)

1 QL 60/30,ST

metformin er 1,000 mg osm-tab (generic fortamet)

1 QL 60/30

metformin er 500 mg gastrc-tb (generic glumetza)

1 QL 120/30,ST

metformin er 500 mg osmotic tb (generic fortamet)

1 QL 150/30

metformin hcl 1,000 mg tablet 1 QL 75/30metformin hcl 500 mg tablet 1 QL 150/30metformin hcl 850 mg tablet 1 QL 90/30metformin hcl er 500 mg tablet (generic glucophage)

1 QL 120/30

metformin hcl er 750 mg tab (generic glucophage)

1 QL 60/30

miglitol 100 mg tablet 1 QL 90/30miglitol 25 mg tablet 1 QL 90/30miglitol 50 mg tablet 1 QL 90/30nateglinide 120 mg tablet 1 QL 90/30nateglinide 60 mg tablet 1 QL 180/30NOVOFINE 32G NEEDLES 1 QL 200/30NOVOFINE AUTOCOVER 30G NEEDLE

1 QL 200/30

NOVOLIN 70-30 100 UNIT/ML VIAL

2 ST,EC

NOVOLIN 70-30 FLEXPEN 2 ST,ECNOVOLIN N 100 UNIT/ML VIAL 2 ST,ECNOVOLIN R 100 UNIT/ML VIAL 2 ST,ECNOVOLOG 100 UNIT/ML CARTRIDGE

2 ST,EC

NOVOLOG 100 UNIT/ML FLEXPEN

2 ST,EC

NOVOLOG 100 UNIT/ML VIAL 2 ST,ECNOVOLOG MIX 70-30 FLEXPEN SYRN

2 ST,EC

NOVOLOG MIX 70-30 VIAL 2 ST,ECNOVOTWIST NEEDLE 32G 5MM 1 QL 200/30

41

Drug NameDrug Tier



Drug NameDrug Tier


OMNIPOD 5 PACK POD 2 QL 30/30OMNIPOD DASH 5 PACK POD 2 QL 30/30OMNIPOD DASH PDM KIT 2 QL 1/365OMNIPOD STARTER KIT 2 QL 1/365ONGLYZA 2.5 MG TABLET 2 QL

30/30,ST,EC

ONGLYZA 5 MG TABLET 2 QL 30/30,ST,E

COZEMPIC 0.25-0.5 MG DOSE PEN 2 QL 3/28OZEMPIC 1 MG DOSE PEN 2 QL 3/28pioglitazone hcl 15 mg tablet 1 QL 90/30pioglitazone hcl 30 mg tablet 1 QL 30/30pioglitazone hcl 45 mg tablet 1 QL 30/30pioglitazone-glimepiride 30-2 1 QL 30/30pioglitazone-glimepiride 30-4 1 QL 30/30pioglitazone-metformin 15-500 1 QL 90/30pioglitazone-metformin 15-850 1 QL 90/30PRANDIN 1 MG TABLET 2 QL

120/30,ECPRANDIN 2 MG TABLET 2 QL

240/30,ECPROGLYCEM 50 MG/ML ORAL SUSP

3

RELION NOVOLIN 70-30 FLEXPEN

2 ST,EC

RELION NOVOLIN 70-30 VIAL 2 ST,ECRELION NOVOLIN N 100 UNIT/ML 2 ST,ECRELION NOVOLIN R 100 UNIT/ML 2 ST,ECrepaglinide 0.5 mg tablet 1 QL 120/30repaglinide 1 mg tablet 1 QL 120/30repaglinide 2 mg tablet 1 QL 240/30RIOMET 500 MG/5 ML SOLUTION 2 QL 750/30SOLIQUA 100 UNIT-33 MCG/ML PEN

2 QL 18/30,ST

SYMLINPEN 120 PEN INJECTOR 4 PA,QL 10.8/28

SYMLINPEN 60 PEN INJECTOR 4 PA,QL 6/30SYNJARDY 12.5-1,000 MG TABLET

2 QL 60/30

SYNJARDY 12.5-500 MG TABLET 2 QL 60/30

SYNJARDY 5-1,000 MG TABLET 2 QL 60/30SYNJARDY 5-500 MG TABLET 2 QL 60/30SYNJARDY XR 10-1,000 MG TABLET

2 QL 60/30

SYNJARDY XR 12.5-1,000 MG TAB

2 QL 60/30

SYNJARDY XR 25-1,000 MG TABLET

2 QL 30/30

SYNJARDY XR 5-1,000 MG TABLET

2 QL 60/30

TECHLITE PEN NEEDLE 31GX1/4"

1 QL 200/30


1 QL 200/30


1 QL 200/30


1 QL 200/30


1 QL 200/30

tolazamide 250 mg tablet 1tolazamide 500 mg tablet 1tolbutamide 500 mg tablet 1TOUJEO MAX SOLOSTAR 300UNIT/ML

2

TOUJEO SOLOSTAR 300 UNIT/ML

2

TRADJENTA 5 MG TABLET 2 QL 30/30TRESIBA 100 UNIT/ML VIAL 2TRESIBA FLEXTOUCH 100 UNIT/ML

2

TRESIBA FLEXTOUCH 200 UNIT/ML

2

TRULICITY 0.75 MG/0.5 ML PEN 2 QL 2/28TRULICITY 1.5 MG/0.5 ML PEN 2 QL 2/28V-GO 20 DISPOSABLE DEVICE 2V-GO 30 DISPOSABLE DEVICE 2V-GO 40 DISPOSABLE DEVICE 2VICTOZA 3-PAK 18 MG/3 ML PEN 2 QL 9/30XIGDUO XR 10 MG-1,000 MG TAB 2 QL 30/30XIGDUO XR 10 MG-500 MG TABLET

2 QL 30/30

42

Drug NameDrug Tier



Drug NameDrug Tier


XIGDUO XR 2.5 MG-1,000 MG TAB

2 QL 60/30

XIGDUO XR 5 MG-1,000 MG TABLET

2 QL 60/30

XIGDUO XR 5 MG-500 MG TABLET

2 QL 60/30

XULTOPHY 100 UNIT-3.6MG/ML PEN

2 QL 15/30,ST

EAR PREPARATIONS, MISC. ANTI-INFECTIVES

CORTANE-B LOTION 2 +

ELECTROLYTEScalcium acetate 667 mg gelcap 1calcium acetate 667 mg tablet 1d5%-1/2ns-kcl 10 meq/l iv sol 3 PA,B/Dd5%-1/2ns-kcl 30 meq/l iv sol 3 PA,B/Dd5%-1/2ns-kcl 40 meq/l iv sol 3 PA,B/Ddextrose 5%-electrolyte 48 3 PA,B/Ddextrose 5%-lr iv solution 3 PA,B/DEFFER-K 10 MEQ TABLET EFF 2EFFER-K 25 MEQ TABLET EFF 1K EFFERVESCENT 25 MEQ TABLET

1

kcl 20 meq in d5w solution 3 PA,B/Dkcl 20 meq in d5w-0.2% nacl 3 PA,B/Dkcl 20 meq in d5w-0.225% nacl 3 PA,B/Dkcl 20 meq in d5w-0.3% nacl 3 PA,B/Dkcl 20 meq in d5w-0.45% nacl 3 PA,B/Dkcl 20 meq in d5w-lact ringer 3 PA,B/Dkcl 20 meq in d5w-ns 3 PA,B/Dkcl 20 meq-ns 1,000 ml iv soln 3 PA,B/Dkcl 40 meq in d5w solution 3 PA,B/Dkcl 40 meq in d5w-lact ringer 3 PA,B/Dkcl 40 meq in d5w-nacl 0.9% 3 PA,B/Dkcl 40 meq-ns 1,000 ml iv soln 3 PA,B/DKLOR-CON 10 MEQ TABLET 2KLOR-CON 20 MEQ PACKET 1KLOR-CON 8 MEQ TABLET 2KLOR-CON M10 TABLET 1KLOR-CON M15 TABLET 1KLOR-CON M20 TABLET 1

KLOR-CON SPRINKLE ER 10 MEQ CP

1

KLOR-CON SPRINKLE ER 8 MEQ CAP

1

KLOR-CON-EF 25 MEQ TAB EFF 1K-PHOS NEUTRAL TABLET 1lactated ringers injection 3 PA,B/Dmagnesium sulf 1 g/100 ml-d5w 1 PA,B/Dmagnesium sulf 2 g/50 ml bag 1 PA,B/Dmagnesium sulf 20 g/500 ml bag 1 PA,B/Dmagnesium sulf 4 g/100 ml bag 1 PA,B/Dmagnesium sulf 4 g/50 ml bag 1 PA,B/Dmagnesium sulf 40 g/1,000 ml 1 PA,B/Dmagnesium sulfate 50% syringe 1 PA,B/Dmagnesium sulfate 50% vial 1 PA,B/DNORMOSOL-R IV SOLUTION 3 PA,B/DNORMOSOL-R-DEXTROSE 5% IV SOLN

3 PA,B/D

PHOSLYRA 667 MG/5 ML SOLUTION

3

potassium 25 meq tablet eff 1potassium cl 10 meq/100 ml sol 1 PA,B/Dpotassium cl 10% (20 meq/15ml) 1potassium cl 2 meq/ml vial 1 PA,B/Dpotassium cl 20 meq packet 1potassium cl 20 meq/100 ml sol 1 PA,B/Dpotassium cl 20 meq-0.45% nacl 3 PA,B/Dpotassium cl 20% (40 meq/15ml) 1potassium cl 25 meq tab eff 1potassium cl 40 meq/100 ml sol 1 PA,B/Dpotassium cl 40 meq/20 ml conc 1 PA,B/Dpotassium cl er 10 meq capsule 1potassium cl er 10 meq tablet 1potassium cl er 20 meq tablet 1potassium cl er 8 meq capsule 1potassium cl er 8 meq tablet 1ringer's iv solution 3 PA,B/Dsodium bicarb 4.2% abbjct 1 +sodium bicarb 7.5% abboject 1sodium bicarb 8.4% abboject 1sodium chloride 0.45% soln 1

43

Drug NameDrug Tier



Drug NameDrug Tier


sodium chloride 100 meq/40 ml 1sodium chloride 3% iv soln 1sodium chloride 5% iv soln 1sodium lactate 50 meq/10 ml vl 3 PA,B/DTPN ELECTROLYTES VIAL 3 PA,B/D

EMOLLIENTSATOPADERM CREAM 2 +ATOPICLAIR CREAM 2 +ATRAPRO HYDROGEL 2 +celacyn gel 1 +CERAMAX SKIN BARRIER CREAM

2 +

CERAMAX SKIN BARRIER LOTION

2 +

DEXERYL CREAM 2 +eletone cream 1 +eletone cream twin pack 1 +hpr emollient foam 1 +hpr plus cream 1 +hpr plus emollient foam 1 +HYLATOPIC EMOLLIENT FOAM 2 +HYLATOPICPLUS CREAM 2 +HYLATOPICPLUS EMOLLIENT FOAM

2 +

HYLATOPICPLUS LOTION 2 +LEVICYN ANTIPRURITIC SG GEL 2 +MIMYX CREAM 2 +NEOCERA ADVANCED CREAM 2 +NEOSALUS CP CREAM 2 +NEOSALUS CREAM 2 +NEOSALUS FOAM 2 +NEOSALUS LOTION 2 +nivatopic plus cream 1 +NUTRASEB FACIAL CREAM 2 +PRESERA FOAM 2 +pruclair nonsteroidal cream 1 +prumyx cream 1 +RESTIZAN GEL 2 +SEBUDERM GEL 2 +sp scar management gel 1 +

ERYTHROMYCINS / OTHER MACROLIDESazithromycin 1 gm pwd packet 1azithromycin 100 mg/5 ml susp 1azithromycin 200 mg/5 ml susp 1azithromycin 250 mg tablet 1azithromycin 500 mg tablet 1azithromycin 600 mg tablet 1 QL 60/30azithromycin i.v. 500 mg vial 1clarithromycin 125 mg/5 ml sus 1clarithromycin 250 mg tablet 1clarithromycin 250 mg/5 ml sus 1clarithromycin 500 mg tablet 1clarithromycin er 500 mg tab 1DIFICID 200 MG TABLET 4 PA,QL

20/10E.E.S. 400 FILMTAB 1ERYPED 400 MG/5 ML SUSPENSION

4

ERY-TAB DR 250 MG TABLET 1ERY-TAB DR 333 MG TABLET 1ERY-TAB DR 500 MG TABLET 1ERYTHROCIN 250 MG FILMTAB 1ERYTHROCIN 500 MG ADDVAN VIAL

3

erythromycin 200 mg/5 ml susp 1erythromycin 250 mg filmtab 1erythromycin 400 mg/5 ml susp 4erythromycin 500 mg filmtab 1erythromycin dr 250 mg cap 1erythromycin dr 250 mg tablet 1erythromycin dr 333 mg tablet 1erythromycin dr 500 mg tablet 1erythromycin es 400 mg tab 1

ESTROGEN/ANDROGEN COMBINATIONScovaryx h.s. tablet 1 +covaryx tablet 1 +eemt ds 1.25-2.5 mg tablet 1 +eemt hs 0.625-1.25 mg tablet 1 +estrogen-methyltestos f.s. tab 1 +estrogen-methyltestos h.s. tab 1 +

44

Drug NameDrug Tier



Drug NameDrug Tier


ESTROGENS / PROGESTINSALORA 0.025 MG PATCH 2 QL

8/28,PA (HRM)

ALORA 0.05 MG PATCH 2 QL 8/28,PA (HRM)



AMABELZ 0.5 MG-0.1 MG TABLET 1 PA (HRM)AMABELZ 1 MG-0.5 MG TABLET 1 PA (HRM)ANGELIQ 0.25 MG-0.5 MG TABLET

3

ANGELIQ 0.5 MG-1 MG TABLET 3CAMILA 0.35 MG TABLET 1CLIMARA 0.025 MG/DAY PATCH 2 QL

4/28,PA (HRM)EC

CLIMARA 0.0375 MG/DAY PATCH 2 QL 4/28,PA (HRM)EC





CLIMARA PRO PATCH 3 QL 4/28,PA (HRM)

COMBIPATCH 0.05-0.14 MG PTCH

3 PA (HRM)

COMBIPATCH 0.05-0.25 MG PTCH

3 PA (HRM)

CRINONE 8% GEL 2 PA,DvEDEBLITANE 0.35 MG TABLET 1DELESTROGEN 10 MG/ML VIAL 3DEPO-ESTRADIOL 5 MG/ML VIAL 3DEPO-PROVERA 400 MG/ML VIAL

3 QL 10/28

DIVIGEL 0.25 MG GEL PACKET 3DIVIGEL 0.5 MG GEL PACKET 3DIVIGEL 0.75 MG GEL PACKET 3DIVIGEL 1 MG GEL PACKET 3DOTTI 0.025 MG PATCH 1 QL

8/28,PA (HRM)

DOTTI 0.0375 MG PATCH 1 QL 8/28,PA (HRM)




DUAVEE 0.45-20 MG TABLET 3 PA,QL 30/30

ELESTRIN 0.06% GEL 2 ECERRIN 0.35 MG TABLET 1ESTRACE 0.01% CREAM 3estradiol 0.01% cream 1estradiol 0.025 mg patch 1 QL

8/28,PA (HRM)

estradiol 0.0375 mg patch 1 QL 8/28,PA (HRM)



45

Drug NameDrug Tier



Drug NameDrug Tier



estradiol 0.5 mg tablet 1 PA (HRM)estradiol 1 mg tablet 1 PA (HRM)estradiol 10 mcg vaginal insrt 1 QL 18/28estradiol 2 mg tablet 1 PA (HRM)estradiol tds 0.025 mg/day 1 QL

4/28,PA (HRM)

estradiol tds 0.0375 mg/day 1 QL 4/28,PA (HRM)





estradiol valerate 20 mg/ml vl 1estradiol valerate 40 mg/ml vl 1estradiol-noreth 0.5-0.1 mg tb 1 PA (HRM)estradiol-noreth 1-0.5 mg tab 1 PA (HRM)ESTRING 2 MG VAGINAL RING 2 QL 1/90ESTROGEL 0.06% GEL 2 +FEMHRT 0.5 MG-2.5 MCG TABLET

2 PA (HRM)EC

FEMRING 0.05 MG/DAY VAG RING

2 QL 1/90

FEMRING 0.10 MG/DAY VAG RING

2 QL 1/90

FYAVOLV 0.5 MG-2.5 MCG TABLET

1 PA (HRM)

FYAVOLV 1 MG-5 MCG TABLET 1 PA (HRM)HEATHER TABLET 1hydroxyprogesterone 1.25 g/5ml 4 PA,B/DINCASSIA 0.35 MG TABLET 1

JENCYCLA 0.35 MG TABLET 1JINTELI 1 MG-5 MCG TABLET 1 PA (HRM)JOLIVETTE TABLET 1LYZA 0.35 MG TABLET 1medroxyprogesterone 10 mg tab 1medroxyprogesterone 150 mg/ml 1medroxyprogesterone 2.5 mg tab 1medroxyprogesterone 5 mg tab 1MENEST 0.3 MG TABLET 2 PA (HRM)MENEST 0.625 MG TABLET 2 PA (HRM)MENEST 1.25 MG TABLET 2 PA (HRM)MENOSTAR 14 MCG/DAY PATCH 2 QL

4/28,PA (HRM)

MIMVEY 1-0.5 MG TABLET 1 PA (HRM)MIMVEY LO 0.5-0.1 MG TABLET 1 PA (HRM)MINIVELLE 0.025 MG PATCH 2 QL

8/28,PA (HRM)

MINIVELLE 0.0375 MG PATCH 2 QL 8/28,PA (HRM)




NORA-BE TABLET 1norethind-eth estrad 0.5-2.5 1 PA (HRM)norethindrone 0.35 mg tablet 1norethindrone 5 mg tablet 1norethin-eth estrad 1 mg-5 mcg 1 PA (HRM)NORLYROC 0.35 MG TABLET 1PREFEST TABLET 3 PA (HRM)PREMARIN 0.3 MG TABLET 2 PA (HRM)PREMARIN 0.45 MG TABLET 2 PA (HRM)PREMARIN 0.625 MG TABLET 2 PA (HRM)PREMARIN 0.9 MG TABLET 2 PA (HRM)

46

Drug NameDrug Tier



Drug NameDrug Tier


PREMARIN 1.25 MG TABLET 2 PA (HRM)PREMARIN 25 MG VIAL 3PREMARIN VAGINAL CREAM-APPL

2

PREMPHASE 0.625-5 MG TABLET 3 PA (HRM)PREMPRO 0.3 MG-1.5 MG TABLET

2 PA (HRM)EC

PREMPRO 0.45-1.5 MG TABLET 2 PA (HRM)EC

PREMPRO 0.625-2.5 MG TABLET 2 PA (HRM)EC

PREMPRO 0.625-5 MG TABLET 2 PA (HRM)EC

progesterone 100 mg capsule 1progesterone 200 mg capsule 1SHAROBEL 0.35 MG TABLET 1VIVELLE-DOT 0.025 MG PATCH 2 QL

8/28,PA (HRM)EC

VIVELLE-DOT 0.0375 MG PATCH 2 QL 8/28,PA (HRM)EC




YUVAFEM 10 MCG VAGINAL INSERT

1 QL 18/28

GASTROINTESTINAL RADIOPAQUE DIAGNOSTICS

E-Z DISK 700 MG TABLET 2 +E-Z-CAT DRY SUSPENSION 2 +E-Z-HD SUSPENSION 2 +E-Z-PAQUE BARIUM SULFATE SUSP

2 +

E-Z-PASTE 60% CREAM 2 +LIQUID E-Z PAQUE 60% SUSP 2 +LIQUID POLIBAR PLUS SUSP 2 +

READI-CAT 2 2% SUSPENSION 2 +TAGITOL V 40% SUSPENSION 2 +VARIBAR HONEY SUSPENSION 2 +VARIBAR NECTAR 40% SUSPENSION

2 +

VARIBAR PUDDING 40% PASTE 2 +VARIBAR THIN HONEY SUSPENSION

2 +

VARIBAR THIN LIQUID 40% SUSP 2 +VOLUMEN 0.1% SUSPENSION 2 +

GENERAL INHALATION AGENTSHYPER-SAL 3.5% VIAL 2 +HYPER-SAL 7% VIAL 2 +nebusal 3% vial 1 +NEBUSAL 6% VIAL 2 +pulmosal 7% vial 1 +sodium chloride 0.9% inhal vl 1 +sodium chloride 10% vial 1 +sodium chloride 3% vial 1 +sodium chloride 7% vial 1 +

GOUT THERAPYallopurinol 100 mg tablet 1allopurinol 300 mg tablet 1colchicine 0.6 mg capsule 1 QL 60/30colchicine 0.6 mg tablet 1 QL 120/30COLCRYS 0.6 MG TABLET 2 QL

120/30,ECfebuxostat 40 mg tablet 1 QL

30/30,STfebuxostat 80 mg tablet 1 QL

30/30,STMITIGARE 0.6 MG CAPSULE 2 QL 60/30probenecid 500 mg tablet 1probenecid-colchicine tablet 1ULORIC 40 MG TABLET 2 QL

30/30,ST,EC

ULORIC 80 MG TABLET 2 QL 30/30,ST,E

C

47

Drug NameDrug Tier



Drug NameDrug Tier


HEMORRHOID PREP,ANTI-INFLAM STEROID-LOCAL ANESTHET

ANA-LEX 2-2% KIT 2 +ANALPRAM HC 2.5%-1% CREAM 2 +ANALPRAM HC 2.5%-1% CRM SINGLE

2 +

hydrocort-pramoxine 2.5%-1% cm

1 +

lidocaine-hc 2.8-0.55% gel 1 +lidocaine-hc 3-2.5% gel kit 1 +pramcort 1% cream 1 +PROCORT 1.85%-1.15% CREAM 2 +

KERATOLYTICSBENSAL HP 3% OINTMENT 2 +BENZEFOAM 5.3% EMOLLIENT FOAM

2 +

BENZEFOAM ULTRA 9.8% FOAM 2 +benzepro 6% foaming cloths 1 +BENZEPRO 7% CREAMY WASH 2 +benzoyl peroxide 5.3% foam 1 +benzoyl peroxide 9.8% foam 1 +bpo 4% gel 1 +bpo 6% foaming cloths 1 +bpo 8% gel 1 +cem-urea 45% pre-filled appl 1 +HYDRO 35 FOAM 2 +HYDRO 40 FOAM 2 +KERAFOAM 30% FOAM 2 +KERAFOAM 42% FOAM 2 +KERALAC 47% CREAM 2 +KERALYT 6% GEL 2 +KERALYT SCALP COMPLETE KIT 2 +METOPIC 41% CREAM 2 +PACNEX 7% WASH 2 +PACNEX HP 7% CLEANSING PADS

2 +

PACNEX LP 4.25% CLEANSING PADS

2 +

RYNODERM 37.5% TOPICAL CREAM

2 +

SALEX 6% CREAM KIT 2 +

SALEX 6% LOTION KIT 2 +SALEX 6% SHAMPOO 2 +salicylic acid 26% liquid 1 +salicylic acid 27.5% liquid 1 +salicylic acid 6% cream 1 +salicylic acid 6% cream kit 1 +salicylic acid 6% foam 1 +salicylic acid 6% lotion 1 +salicylic acid er 28.5% soln 1 +salimez 6% cream 1 +SALIMEZ FORTE 10% CREAM 2 +salvax 6% foam 1 +SALVAX DUO PLUS COMBO PACK

2 +

silver nitrate applicator 1 +ULTRASAL-ER 28.5% SOLUTION 2 +umecta 40% mousse 1 +URAMAXIN 20% FOAM 2 +URAMAXIN 45% LOTION 2 +URAMAXIN 45% NAIL GEL 2 +URAMAXIN 45% UREA CREAM 2 +URAMAXIN GT 45% PRE-FILLED APP

2 +

urea 35% foam 1 +urea 39% cream 1 +urea 40% cream 1 +UREA 40% LOTION 2 +urea 41% cream 1 +urea 45% cream 1 +urea 45% lotion 1 +urea 45% nail gel 1 +urea 47% cream 1 +urea 50% cream 1 +urea 50% nail stick 1 +ure-k 50% cream 1 +UREVAZ 44% CREAM 2 +UTOPIC 41% CREAM 2 +VIRASAL ANTIVIRAL WART REMOVER

2 +

XALIX 28% SOLUTION 2 +

48

Drug NameDrug Tier



Drug NameDrug Tier


LIPID/CHOLESTEROL LOWERING AGENTSALTOPREV 20 MG TABLET 2 QL

30/30,ECALTOPREV 40 MG TABLET 2 QL

30/30,ECALTOPREV 60 MG TABLET 2 QL

30/30,ECamlodipine-atorvast 10-10 mg 1 QL 30/30amlodipine-atorvast 10-20 mg 1 QL 30/30amlodipine-atorvast 10-40 mg 1 QL 30/30amlodipine-atorvast 10-80 mg 1 QL 30/30amlodipine-atorvast 2.5-10 mg 1 QL 30/30amlodipine-atorvast 2.5-20 mg 1 QL 30/30amlodipine-atorvast 2.5-40 mg 1 QL 30/30amlodipine-atorvast 5-10 mg 1 QL 30/30amlodipine-atorvast 5-20 mg 1 QL 30/30amlodipine-atorvast 5-40 mg 1 QL 30/30amlodipine-atorvast 5-80 mg 1 QL 30/30ANTARA 30 MG CAPSULE 2 QL

30/30,ECANTARA 90 MG CAPSULE 2 QL

60/30,ECatorvastatin 10 mg tablet 1 QL 30/30atorvastatin 20 mg tablet 1 QL 30/30atorvastatin 40 mg tablet 1 QL 60/30atorvastatin 80 mg tablet 1 QL 30/30CADUET 10 MG-10 MG TABLET 2 QL

30/30,ECCADUET 10 MG-20 MG TABLET 2 QL







30/30,EC

cholestyramine light packet 1cholestyramine light powder 1cholestyramine packet 1cholestyramine powder 1colesevelam 625 mg tablet 1colesevelam hcl 3.75 g packet 1colestipol hcl granules 1colestipol hcl granules packet 1colestipol micronized 1 gm tab 1CRESTOR 10 MG TABLET 3 QL

30/30,ST,EC

CRESTOR 20 MG TABLET 3 QL 30/30,ST,E

CCRESTOR 40 MG TABLET 3 QL

30/30,ST,EC

CRESTOR 5 MG TABLET 3 QL 30/30,ST,E

Cezetimibe 10 mg tablet 1 QL 30/30ezetimibe-simvastatin 10-10 mg 1 QL 30/30ezetimibe-simvastatin 10-20 mg 1 QL 30/30ezetimibe-simvastatin 10-40 mg 1 QL 30/30ezetimibe-simvastatin 10-80 mg 1 QL 30/30fenofibrate 120 mg tablet 1 QL 30/30fenofibrate 130 mg capsule 1fenofibrate 134 mg capsule 1fenofibrate 145 mg tablet 1fenofibrate 150 mg capsule 1fenofibrate 160 mg tablet 1fenofibrate 200 mg capsule 1fenofibrate 40 mg tablet 1 QL 60/30fenofibrate 43 mg capsule 1fenofibrate 48 mg tablet 1fenofibrate 50 mg capsule 1fenofibrate 54 mg tablet 1fenofibrate 67 mg capsule 1fenofibric acid 105 mg tablet 1 QL 30/30fenofibric acid 35 mg tablet 1 QL 60/30

49

Drug NameDrug Tier



Drug NameDrug Tier


fenofibric acid dr 135 mg cap 1 QL 30/30fenofibric acid dr 45 mg cap 1 QL 60/30FENOGLIDE 120 MG TABLET 2 QL

30/30,ECFENOGLIDE 40 MG TABLET 2 QL

60/30,ECfluvastatin er 80 mg tablet 1 QL 30/30fluvastatin sodium 20 mg cap 1 QL 30/30fluvastatin sodium 40 mg cap 1 QL 60/30gemfibrozil 600 mg tablet 1LESCOL XL 80 MG TABLET 2 QL

30/30,ECLIPITOR 10 MG TABLET 2 QL




30/30,ECLIVALO 1 MG TABLET 2 QL 30/30LIVALO 2 MG TABLET 2 QL 30/30LIVALO 4 MG TABLET 2 QL 30/30lovastatin 10 mg tablet 1 QL 60/30lovastatin 20 mg tablet 1 QL 60/30lovastatin 40 mg tablet 1 QL 60/30LOVAZA 1 GM CAPSULE 2 QL

120/30,ECniacin 500 mg tablet 1niacin er 1,000 mg tablet 1niacin er 500 mg tablet 1niacin er 750 mg tablet 1NIACOR 500 MG TABLET 1omega-3 ethyl esters 1 gm cap 1 QL 120/30PRAVACHOL 20 MG TABLET 2 QL

30/30,ECPRAVACHOL 40 MG TABLET 2 QL

30/30,ECPRAVACHOL 80 MG TABLET 2 QL

30/30,ECpravastatin sodium 10 mg tab 1 QL 30/30pravastatin sodium 20 mg tab 1 QL 30/30

pravastatin sodium 40 mg tab 1 QL 60/30pravastatin sodium 80 mg tab 1 QL 30/30PREVALITE PACKET 1PREVALITE POWDER 1REPATHA 140 MG/ML SURECLICK

2 PA,QL 3/28

REPATHA 140 MG/ML SYRINGE 2 PA,QL 3/28REPATHA 420 MG/3.5ML PUSHTRONX

2 PA,QL 3.5/28

rosuvastatin calcium 10 mg tab 1 QL 30/30rosuvastatin calcium 20 mg tab 1 QL 30/30rosuvastatin calcium 40 mg tab 1 QL 30/30rosuvastatin calcium 5 mg tab 1 QL 30/30simvastatin 10 mg tablet 1 QL 30/30simvastatin 20 mg tablet 1 QL 30/30simvastatin 40 mg tablet 1 QL 30/30simvastatin 5 mg tablet 1 QL 30/30simvastatin 80 mg tablet 1 QL 30/30TRICOR 145 MG TABLET 2 QL

30/30,ECTRICOR 48 MG TABLET 2 QL

60/30,ECTRIGLIDE 160 MG TABLET 2 QL

30/30,ECTRILIPIX DR 135 MG CAPSULE 2 QL

30/30,ECTRILIPIX DR 45 MG CAPSULE 2 QL

60/30,ECVASCEPA 0.5 GM CAPSULE 2 QL 240/30VASCEPA 1 GM CAPSULE 2 QL 120/30WELCHOL 3.75G PACKET 3 ECWELCHOL 625 MG TABLET 3 ECZETIA 10 MG TABLET 3 QL

30/30,ST,EC

ZOCOR 10 MG TABLET 2 QL 30/30,EC



50

Drug NameDrug Tier



Drug NameDrug Tier




LOCAL ANESTHETICSLIDOCAINE 0.5MG INTRADERM SYST

2 +

LIDOCAINE 100 MG/5 ML (2%) SYR

2 +

lidocaine hcl 10 mg/ml syringe 1 +lidocaine hcl 100 mg/10 ml syr 1 +LIDOCAINE HCL 30 MG/3 ML SYR 2 +LIDOCAINE HCL 50 MG/5 ML SYRNG

2 +

MIGRAINE / CLUSTER HEADACHE THERAPYalmotriptan malate 12.5 mg tab 1 QL

12/30,STalmotriptan malate 6.25 mg tab 1 QL

18/30,STdihydroergotamine 4 mg/ml spry 1 QL 8/30eletriptan hbr 20 mg tablet 1 QL

12/30,STeletriptan hbr 40 mg tablet 1 QL 6/30,STergotamine-caffeine 1-100mg tb 1 QL 40/28FROVA 2.5 MG TABLET 2 QL

18/30,ST,EC

frovatriptan succ 2.5 mg tab 1 QL 18/30,ST

MIGERGOT SUPPOSITORY 4 QL 20/28naratriptan hcl 1 mg tablet 1 QL 18/28naratriptan hcl 2.5 mg tablet 1 QL 18/28rizatriptan 10 mg odt 1 QL 36/28rizatriptan 10 mg tablet 1 QL 36/28rizatriptan 5 mg odt 1 QL 36/28rizatriptan 5 mg tablet 1 QL 36/28sumatriptan 20 mg nasal spray 1 QL 18/28sumatriptan 4 mg/0.5 ml cart 1 QL 8/28sumatriptan 4 mg/0.5 ml inject 1 QL 8/28sumatriptan 5 mg nasal spray 1 QL 18/28sumatriptan 6 mg/0.5 ml inject 1 QL 8/28sumatriptan 6 mg/0.5 ml refill 1 QL 8/28

sumatriptan 6 mg/0.5 ml syrng 1 QL 8/28sumatriptan 6 mg/0.5 ml vial 1 QL 8/28sumatriptan succ 100 mg tablet 1 QL 18/28sumatriptan succ 25 mg tablet 1 QL 18/28sumatriptan succ 50 mg tablet 1 QL 18/28zolmitriptan 2.5 mg odt 1 QL 12/30zolmitriptan 2.5 mg tablet 1 QL 12/30zolmitriptan 5 mg odt 1 QL 6/30zolmitriptan 5 mg tablet 1 QL 6/30

MISCELLANEOUS AGENTSacamprosate calc dr 333 mg tab 1acetic acid 0.25% irrig soln 1ACTONEL 30 MG TABLET 2 QL

30/30,ECADAGEN 250 UNIT/ML VIAL 4 PAalendronate sodium 40 mg tab 1 QL 30/30anagrelide hcl 0.5 mg capsule 1anagrelide hcl 1 mg capsule 1ANTABUSE 250 MG TABLET 2 ECANTABUSE 500 MG TABLET 2 ECARALAST NP 1,000 MG VIAL 4 PA,B/DARALAST NP 500 MG VIAL 4 PA,B/DARESTIN 1 MG MICROSPHERE 3ASTEPRO 0.15% NASAL SPRAY 2 QL

30/25,ECAURYXIA 210 MG TABLET 3 PA,QL

360/30,DvEazelastine 0.1% (137 mcg) spry 1 QL 30/25azelastine 0.15% nasal spray 1 QL 30/25BACTROBAN NASAL 2% OINTMENT

2

CARBAGLU 200 MG DISPER TABLET

4 PA

CARNITOR 1 GM/5 ML VIAL 3 PA,B/Dcevimeline hcl 30 mg capsule 1CHEMET 100 MG CAPSULE 4chlorhexidine 0.12% rinse 1CLINIMIX 4.25%-5% SOLUTION 3 PA,B/DCLINIMIX E 2.75%-10% SOLUTION

3 PA,B/D

51

Drug NameDrug Tier



Drug NameDrug Tier


CLINPRO 5000 1.1% TOOTHPASTE

1

DENTA 5000 PLUS CREAM 1DENTAGEL 1.1% GEL 1dextrose 10%-0.2% nacl iv soln 3 PA,B/Ddextrose 10%-0.45% nacl iv sol 3 PA,B/Ddextrose 10%-water iv solution 1 PA,B/Ddextrose 2.5%-0.45% nacl iv 3 PA,B/Ddextrose 20%-water iv soln 1 PA,B/Ddextrose 25%-water syringe 1 PA,B/Ddextrose 30%-water iv soln 1 PA,B/Ddextrose 40%-water iv soln 1 PA,B/Ddextrose 5%-0.2% nacl iv soln 3dextrose 5%-0.225% nacl iv sol 3dextrose 5%-0.3% nacl iv soln 3dextrose 5%-0.33% nacl iv soln 3dextrose 5%-0.45% nacl iv soln 3dextrose 5%-0.9% nacl iv soln 3dextrose 5%-water iv soln 1dextrose 50%-water iv soln 1 PA,B/Ddextrose 50%-water syringe 1 PA,B/Ddextrose 70%-water iv soln 1disulfiram 250 mg tablet 1disulfiram 500 mg tablet 1etidronate disodium 200 mg tab 1 +etidronate disodium 400 mg tab 1EXJADE 125 MG TABLET 4 STEXJADE 250 MG TABLET 4 STEXJADE 500 MG TABLET 4 STFERRIPROX 100 MG/ML SOLUTION

4 PA

FERRIPROX 500 MG TABLET 4 PAFLUORIDEX DAILY DEFENSE 1FOSRENOL 1,000 MG POWDER PACK

4

FOSRENOL 750 MG POWDER PACKET

4

INCRELEX 40 MG/4 ML VIAL 3 PAipratropium 0.03% spray 1 QL 30/30ipratropium 0.06% spray 1 QL 45/30JADENU 180 MG TABLET 4

JADENU 360 MG TABLET 4JADENU 90 MG TABLET 4JADENU SPRINKLE 180 MG GRANULE

4

JADENU SPRINKLE 360 MG GRANULE

4

JADENU SPRINKLE 90 MG GRANULE

4

KIONEX 15 GM/60 ML SUSPENSION

1

lactated ringers irrigation 3lanthanum carb 1,000 mg tb chw 1lanthanum carb 500 mg tab chew 1lanthanum carb 750 mg tab chew 1levocarnitine 1 g/10 ml soln 1levocarnitine 330 mg tablet 1LITHOSTAT 250 MG TABLET 2LOKELMA 10 GRAM POWDER PACKET

2

LOKELMA 5 GRAM POWDER PACKET

2

midodrine hcl 10 mg tablet 1midodrine hcl 2.5 mg tablet 1midodrine hcl 5 mg tablet 1NORTHERA 100 MG CAPSULE 4 PA,QL

90/30NORTHERA 200 MG CAPSULE 4 PA,QL

180/30NORTHERA 300 MG CAPSULE 4 PA,QL

180/30ORALONE 0.1% PASTE 1ORFADIN 10 MG CAPSULE 4ORFADIN 2 MG CAPSULE 4ORFADIN 20 MG CAPSULE 4ORFADIN 4 MG/ML SUSPENSION 4ORFADIN 5 MG CAPSULE 4PAROEX 0.12% ORAL RINSE 1PHYSIOLYTE IRRIGATION SOLN 3PHYSIOSOL IRRIGATION SOLN 3pilocarpine hcl 5 mg tablet 1pilocarpine hcl 7.5 mg tablet 1

52

Drug NameDrug Tier



Drug NameDrug Tier


PREVIDENT 0.2% RINSE 2PREVIDENT 1.1% GEL 2PREVIDENT 5000 1.1% DRY MOUTH

2

PREVIDENT 5000 BOOSTER PLUS

2

PREVIDENT 5000 PLUS CREAM 2PREVIDENT DENTAL RINSE 2PROLASTIN C 1,000 MG VIAL 4 PA,B/DRAVICTI 1.1 GRAM/ML LIQUID 4RENAGEL 400 MG TABLET 2 ECRENAGEL 800 MG TABLET 2 ECRENVELA 0.8 GM POWDER PACKET

2 QL 180/30

RENVELA 2.4 GM POWDER PACKET

2 QL 180/30

RENVELA 800 MG TABLET 2 QL 540/30riluzole 50 mg tablet 1ringers irrigation solution 3sevelamer 0.8 gm powder packet 1 QL 180/30sevelamer 2.4 gm powder packet 1 QL 180/30sevelamer carbonate 800 mg tab 1 QL 540/30sevelamer hcl 400 mg tablet 1sevelamer hcl 800 mg tablet 1SF 1.1% GEL 1SF 5000 PLUS CREAM 1sodium chloride 0.9% irrig. 1sodium chloride 0.9% solution 1sodium chloride 0.9% vial 1 +sodium phenylbutyrate 500mg tb 4 PAsodium phenylbutyrate powder 4 PAsodium polystyrene sulf powder 1sps 15 gm/60 ml suspension 1sps 30 gm/120 ml enema 1sterile water for irrigation 1TIS-U-SOL PENTALYTE IRRIG SOLN

3

triamcinolone 0.1% paste 1trientine hcl 250 mg capsule 4VELPHORO 500 MG CHEWABLE TAB

3 QL 180/30

VELTASSA 16.8 GM POWDER PACKET

2


2


2

XIAFLEX 0.9 MG VIAL 4 PA,B/DZEMAIRA 1,000 MG VIAL 4 PA,B/Dzoledronic acid 5 mg/100 ml 1 PA,QL

100/365,B/D

MISCELLANEOUS ANTIINFECTIVESalbendazole 200 mg tablet 4ALINIA 100 MG/5 ML SUSPENSION

4 QL 180/30

ALINIA 500 MG TABLET 4 QL 20/10amikacin sulf 1 gram/4 ml vial 1amikacin sulf 500 mg/2 ml vial 1atovaquone 750 mg/5 ml susp 3atovaquone-proguanil 250-100 1atovaquone-proguanil 62.5-25 1aztreonam 1 gm vial 1aztreonam 2 gm vial 4BACIIM 50,000 UNIT VIAL 1bacitracin 50,000 unit vial 1CAPASTAT SULFATE 1 GM VIAL 3CAYSTON 75 MG INHAL SOLUTION

4 PA,QL 84/56

chloramphen na succ 1 gm vl 1chloroquine ph 250 mg tablet 1chloroquine ph 500 mg tablet 1clindamycin 300 mg/2 ml addvan 1clindamycin 300 mg/50 ml-ns 1clindamycin 600 mg/50 ml-ns 1clindamycin 900 mg/50 ml-ns 1clindamycin 900 mg/6 ml addvan 1clindamycin hcl 150 mg capsule 1clindamycin hcl 300 mg capsule 1clindamycin hcl 75 mg capsule 1clindamycin pediatr 75 mg/5 ml 1clindamycin ph 300 mg/2 ml vl 1

53

Drug NameDrug Tier



Drug NameDrug Tier


clindamycin ph 600 mg/4 ml vl 1clindamycin ph 9 g/60 ml vial 1clindamycin ph 900 mg/6 ml vl 1clindamycin-d5w 300 mg/50 ml 1clindamycin-d5w 600 mg/50 ml 1clindamycin-d5w 900 mg/50 ml 1COARTEM TABLETS 3 QL 24/30colistimethate 150 mg vial 1cycloserine 250 mg capsule 1dapsone 100 mg tablet 1dapsone 25 mg tablet 1daptomycin 350 mg vial 4 PA,B/Ddaptomycin 500 mg vial 4 PA,B/DDARAPRIM 25 MG TABLET 4 QL 90/30ertapenem 1 gram vial 1ethambutol hcl 100 mg tablet 1ethambutol hcl 400 mg tablet 1FIRVANQ 25 MG/ML SOLUTION 3FIRVANQ 50 MG/ML SOLUTION 3gentamicin 80 mg/2 ml vial 1gentamicin ped 20 mg/2 ml vial 1hydroxychloroquine 200 mg tab 1imipenem-cilastatin 250 mg vl 1imipenem-cilastatin 500 mg vl 1iso gentamicin 100 mg/100 ml 1isoniazid 100 mg tablet 1isoniazid 300 mg tablet 1isoniazid 50 mg/5 ml solution 1isoton gentamicin 100 mg/50 ml 1isoton gentamicin 60 mg/50 ml 1isoton gentamicin 80 mg/100 ml 1isoton gentamicin 80 mg/50 ml 1ivermectin 3 mg tablet 1lincomycin hcl 600 mg/2 ml vl 1linezolid 100 mg/5 ml susp 4 QL 1800/30linezolid 600 mg tablet 1 QL 60/30linezolid 600 mg/300 ml-d5w 1linezolid 600mg/300ml; 0.9% soln 1linezolid 600mg/300ml-0.9%nacl 1mefloquine hcl 250 mg tablet 1

meropenem iv 1 gm vial 1meropenem iv 500 mg vial 1meropenem-0.9% nacl 1 gram/50 1meropenem-0.9% nacl 500 mg/50 1metronidazole 250 mg tablet 1metronidazole 375 mg capsule 1metronidazole 500 mg tablet 1metronidazole 500 mg/100 ml 1NEBUPENT 300 MG INHAL POWDER

2 PA,QL 1/28,B/D

neomycin 500 mg tablet 1neomy-polymyxin b 40 mg/ml amp

1

ORBACTIV 400 MG VIAL 4 QL 3/30paromomycin 250 mg capsule 1PASER GRANULES 4 GM PACKET

3

PENTAM 300 VIAL 2pentamidine 300 mg vial 1PLAQUENIL 200 MG TABLET 2 ECpolymyxin b sulfate vial 1praziquantel 600 mg tablet 1PRIFTIN 150 MG TABLET 3primaquine 26.3 mg tablet 2pyrazinamide 500 mg tablet 1quinine sulfate 324 mg capsule 1 QL 42/7rifabutin 150 mg capsule 1rifampin 150 mg capsule 1rifampin 300 mg capsule 1rifampin iv 600 mg vial 1RIFATER TABLET 3SIRTURO 100 MG TABLET 3 PA,QL

188/365SIVEXTRO 200 MG TABLET 4 QL 6/28SIVEXTRO 200 MG VIAL 4 PA,QL

6/28,B/Dstreptomycin sulf 1 gm vial 1SYNERCID 500 MG VIAL 4tigecycline 50 mg vial 4tinidazole 250 mg tablet 1tinidazole 500 mg tablet 1

54

Drug NameDrug Tier



Drug NameDrug Tier


TOBI PODHALER 28 MG INHALE CAP

4 QL 1568/365

tobramycin 1.2 gm vial 1tobramycin 1.2 gram/30 ml vial 1tobramycin 10 mg/ml vial 1tobramycin 300 mg/5 ml ampule 4 PA,QL

280/28,B/Dtobramycin 40 mg/ml vial 1TRECATOR 250 MG TABLET 2vanco 500 mg/100 ml-0.9% nacl 1vanco 750 mg/150 ml-0.9% nacl 1vancomycin 1 g/200ml-0.9% nacl 1vancomycin 1 gm vial 1vancomycin 500 mg vial 1vancomycin 750 mg/150 ml bag 1vancomycin hcl 1.25 gram vial 1vancomycin hcl 1.5 gram vial 1vancomycin hcl 10 gm vial 1vancomycin hcl 125 mg capsule 3 QL 40/10vancomycin hcl 1g/200 ml bag 1vancomycin hcl 250 mg capsule 3 QL 80/10vancomycin hcl 250 mg vial 1vancomycin hcl 5 gm vial 1vancomycin hcl 750 mg vial 1vancomycin-d5w 500 mg/100 ml 1XIFAXAN 200 MG TABLET 2 PA,QL

9/30,ECXIFAXAN 550 MG TABLET 2 PA,QL

90/30,EC

MISCELLANEOUS CARDIOVASCULAR AGENTS

CORLANOR 5 MG TABLET 3 PA,QL 60/30

CORLANOR 7.5 MG TABLET 3 PA,QL 60/30

DIGITEK 125 MCG TABLET 1DIGITEK 250 MCG TABLET 1DIGOX 125 MCG TABLET 1DIGOX 250 MCG TABLET 1digoxin 0.05 mg/ml solution 1digoxin 125 mcg tablet 1

digoxin 250 mcg tablet 1digoxin 500 mcg/2 ml ampule 1ENTRESTO 24 MG-26 MG TABLET

2 QL 60/30

ENTRESTO 49 MG-51 MG TABLET

2 QL 60/30

ENTRESTO 97 MG-103 MG TABLET

2 QL 60/30

LANOXIN 125 MCG TABLET 3 QL 30/30LANOXIN 187.5 MCG TABLET 3LANOXIN 250 MCG TABLET 3LANOXIN 62.5 MCG TABLET 3LANOXIN PED 100 MCG/ML AMPUL

3

RANEXA ER 1,000 MG TABLET 2 QL 60/30,EC

RANEXA ER 500 MG TABLET 2 QL 60/30,EC

ranolazine er 1,000 mg tablet 1 QL 60/30ranolazine er 500 mg tablet 1 QL 60/30

MISCELLANEOUS DERMATOLOGICALSacyclovir 5% cream 1acyclovir 5% ointment 1 QL 30/30ammonium lactate 12% cream 1ammonium lactate 12% lotion 1CONDYLOX 0.5% GEL 3DENAVIR 1% CREAM 4doxepin 5% cream 1ELIDEL 1% CREAM 2 QL

100/90,ECfluorouracil 0.5% cream 4fluorouracil 2% topical soln 1fluorouracil 5% cream 1fluorouracil 5% topical soln 1GLYDO 2% JELLY SYRINGE 1 QL 60/30imiquimod 3.75% cream pump 4imiquimod 5% cream packet 1lidocaine 2% viscous soln 1lidocaine 5% ointment 1 QL 50/30lidocaine 5% patch 1 PA,QL

90/30,DvE

55

Drug NameDrug Tier



Drug NameDrug Tier


lidocaine hcl 0.5% vial 1lidocaine hcl 1% ampul 1lidocaine hcl 1% vial 1lidocaine hcl 1.5% ampul 1lidocaine hcl 2% 40 mg/2 ml vl 1lidocaine hcl 2% jelly 1 QL 60/30lidocaine hcl 2% jelly uro-jet 1 QL 60/30lidocaine hcl 2% vial 1lidocaine hcl 4% ampul 1lidocaine-prilocaine cream 1 QL 30/30lidocaine-prilocaine-cream base 2.5%; 2.5% crea

1

methoxsalen 10 mg softgel 3PANRETIN 0.1% GEL 4PICATO 0.015% GEL 3 QL 3/56PICATO 0.05% GEL 3 QL 2/56pimecrolimus 1% cream 1 QL 100/90PODOCON-25 LIQUID 2 +podofilox 0.5% topical soln 1REGRANEX 0.01% GEL 4 PAsalicylic acid 6% shampoo 1 +SANTYL OINTMENT 2silver sulfadiazine 1% cream 1SSD 1% CREAM 2tacrolimus 0.03% ointment 1 QL 100/90tacrolimus 0.1% ointment 1 QL 100/90TOLAK 4% CREAM 3VALCHLOR 0.016% GEL 4 QL 60/30VEREGEN 15% OINTMENT 3

MISCELLANEOUS GASTROINTESTINAL AGENTS

alosetron hcl 0.5 mg tablet 3 PA,QL 60/30

alosetron hcl 1 mg tablet 4 PA,QL 60/30

AMITIZA 24 MCG CAPSULES 2 QL 60/30AMITIZA 8 MCG CAPSULE 2 QL 60/30ANALPRAM HC 1% CREAM 2ANALPRAM HC 2.5%-1% LOTION 2aprepitant 125 mg capsule 1 PA,B/Daprepitant 125-80-80 mg pack 1 PA,B/D

aprepitant 40 mg capsule 1 PA,B/Daprepitant 80 mg capsule 1 PA,B/DAPRISO ER 0.375 GRAM CAPSULE

2 QL 120/30

ASACOL HD DR 800 MG TABLET 2 ST,ECbalsalazide disodium 750 mg cp 1budesonide ec 3 mg capsule 1CANASA 1,000 MG SUPPOSITORY

3

CHENODAL 250 MG TABLET 4CIMZIA 200 MG VIAL KIT 2 PA,ECCIMZIA 200 MG/ML STARTER KIT 2 PA,ECCIMZIA 200 MG/ML SYRINGE KIT 2 PA,ECCOLOCORT 100 MG ENEMA 1COMPRO 25 MG SUPPOSITORY 1CONSTULOSE 10 GM/15 ML SOLN

1

CORTIFOAM 10% AEROSOL 3CREON DR 12,000 UNITS CAPSULE

2

CREON DR 24,000 UNITS CAPSULE

2


2


2


2

cromolyn 100 mg/5 ml oral conc 1CYSTADANE 1 GRAM/1.7 ML POWDER

4

DELZICOL DR 400 MG CAPSULE 3DIPENTUM 250 MG CAPSULE 4 STdronabinol 10 mg capsule 1 PA,QL

60/30,B/Ddronabinol 2.5 mg capsule 1 PA,QL

60/30,B/Ddronabinol 5 mg capsule 1 PA,QL

60/30,B/DEMEND 125 MG POWDER PACKET

3 PA,B/D

56

Drug NameDrug Tier



Drug NameDrug Tier


ENULOSE 10 GM/15 ML SOLUTION

1

GATTEX 5 MG 30-VIAL KIT 4 PAGAVILYTE-C SOLUTION 1GAVILYTE-G SOLUTION 1GAVILYTE-N SOLUTION 1GENERLAC 10 GM/15 ML SOLUTION

1

GOLYTELY PACKET 2granisetron hcl 1 mg tablet 1 PA,QL

60/30,B/Dgranisetron hcl 1 mg/ml vial 1 PA,B/Dgranisetron hcl 4 mg/4 ml vial 1 PA,B/Dhydrocortisone 100 mg/60 ml 1hydrocort-pramoxine 1%-1% crm 1lactulose 10 gm packet 1lactulose 10 gm/15 ml solution 1LIALDA DR 1.2 GM TABLET 3 QL 120/30lidocaine-hc 2-2% cream kit 1 +lidocaine-hc 3-0.5% cream kit 1 +lidocaine-hc 3-1% cream kit 1 +LINZESS 145 MCG CAPSULE 2 QL 30/30LINZESS 290 MCG CAPSULE 2 QL 30/30LINZESS 72 MCG CAPSULE 2 QL 30/30MAGNEBIND 400 RX TABLET 2 +meclizine 12.5 mg tablet 1meclizine 25 mg tablet 1mesalamine 1,000 mg supp 1mesalamine 4 gm/60 ml enema 1mesalamine 4 gm/60 ml kit 1mesalamine 800 mg dr tablet 1mesalamine dr 1.2 gm tablet 1 QL 120/30mesalamine dr 400 mg capsule 1metoclopramide 10 mg tablet 1metoclopramide 10 mg/2 ml vial 1metoclopramide 5 mg tablet 1metoclopramide 5 mg/5 ml soln 1MOVIPREP POWDER PACKET 3ondansetron 4 mg/2 ml isecure 1ondansetron 4 mg/5 ml solution 1 PA,QL

450/30,B/D

ondansetron 40 mg/20 ml vial 1ondansetron hcl 24 mg tablet 1 PA,B/Dondansetron hcl 4 mg tablet 1 PA,B/Dondansetron hcl 4 mg/2 ml vial 1ondansetron hcl 8 mg tablet 1 PA,B/Dondansetron odt 4 mg tablet 1 PA,B/Dondansetron odt 8 mg tablet 1 PA,B/DOSMOPREP TABLET 3palonosetron 0.25 mg/5 ml vial 4 PA,B/DPANCREAZE DR 10,500 UNIT CAP

2 EC

PANCREAZE DR 16,800 UNIT CAP

2 EC

PANCREAZE DR 21,000 UNIT CAP

2 EC

PANCREAZE DR 4,200 UNIT CAP 2 ECpeg 3350 electrolyte soln 1peg 3350-electrolyte solution 1peg-3350 and electrolytes soln 1PENTASA 250 MG CAPSULE 3PENTASA 500 MG CAPSULE 3PERTZYE DR 16,000 UNIT CAPSULE

2 EC

PERTZYE DR 24,000 UNIT CAPSULE

2 EC


2 EC


2 EC

PLENVU POWDER PACKETS 3polyethylene glycol 3350 powd 1prochlorperazine 10 mg tab 1prochlorperazine 10 mg/2 ml vl 1prochlorperazine 25 mg supp 1prochlorperazine 5 mg tablet 1PROCTOFOAM-HC 1%-1% FOAM 2PROCTO-MED HC 2.5% CREAM 1PROCTO-PAK 1% CREAM 1PROCTOSOL-HC 2.5% CREAM 1PROCTOZONE-HC 2.5% CREAM 1RECTIV 0.4% OINTMENT 3

57

Drug NameDrug Tier



Drug NameDrug Tier


RELISTOR 12 MG/0.6 ML SYRINGE

4 PA

RELISTOR 12 MG/0.6 ML VIAL 4 PARELISTOR 8 MG/0.4 ML SYRINGE 4 PARENFLEXIS 100 MG VIAL 4 PA,B/DSANCUSO 3.1 MG/24 HR PATCH 3 QL 4/28scopolamine 1 mg/3 day patch 1 QL 10/30SUCRAID 8,500 UNITS/ML SOLN 4sulfasalazine 500 mg tablet 1sulfasalazine dr 500 mg tab 1SUPREP BOWEL PREP KIT 2TIGAN 100 MG/ML VIAL 3TRANSDERM-SCOP 1.5 MG (1MG/3D)

3 QL 10/30

TRILYTE WITH FLAVOR PACKETS

1

trimethobenzamide 300 mg cap 1TRULANCE 3 MG TABLET 3ursodiol 250 mg tablet 1ursodiol 300 mg capsule 1ursodiol 500 mg tablet 1VIBERZI 100 MG TABLET 3 PA,QL

60/30VIBERZI 75 MG TABLET 3 PA,QL

60/30ZENPEP DR 10,000 UNIT CAPSULE

2

ZENPEP DR 15,000 UNIT CAPSULE

2


2


2


2


2


2

MISCELLANEOUS HORMONESALDURAZYME 2.9 MG/5 ML VIAL 4 PAANADROL-50 TABLET 4 PA,DvE

ANDRODERM 2 MG/24HR PATCH 3 QL 90/30ANDRODERM 4 MG/24HR PATCH 3 QL 30/30ANDROGEL 1.62% GEL PUMP 2 QL 150/30ANDROGEL 1.62%(1.25G) GEL PCKT

2 QL 112.5/30

ANDROGEL 1.62%(2.5G) GEL PCKT

2 QL 150/30

cabergoline 0.5 mg tablet 1calcitonin-salmon 200 units sp 1calcitriol 0.25 mcg capsule 1calcitriol 0.5 mcg capsule 1calcitriol 1 mcg/ml ampul 1calcitriol 1 mcg/ml solution 1CEREZYME 400 UNITS VIAL 4 PA,B/Dchorionic gonad 10,000 unit vl 1 PA,DvEcinacalcet hcl 30 mg tablet 2 QL

60/30,ECcinacalcet hcl 60 mg tablet 2 QL

60/30,ECcinacalcet hcl 90 mg tablet 2 QL

120/30,ECclomiphene citrate 50 mg tab 2 PA,DvEdanazol 100 mg capsule 1danazol 200 mg capsule 1danazol 50 mg capsule 1DEPO-TESTOSTERONE 100 MG/ML VL

2 EC

DEPO-TESTOSTERONE 200 MG/ML

2 EC

desmopressin 0.01% solution 1desmopressin 10 mcg/0.1 ml spr 1desmopressin 40 mcg/10 ml vial 1desmopressin acetate 0.1 mg tb 1desmopressin acetate 0.2 mg tb 1doxercalciferol 0.5 mcg cap 1 QL 90/30doxercalciferol 1 mcg capsule 1 QL 240/30doxercalciferol 2.5 mcg cap 3 QL 120/30doxercalciferol 4 mcg/2 ml vl 1ELAPRASE 6 MG/3 ML VIAL 4 PAFABRAZYME 35 MG VIAL 4 PA,B/DFABRAZYME 5 MG VIAL 4 PA,B/D

58

Drug NameDrug Tier



Drug NameDrug Tier


KORLYM 300 MG TABLET 4 PA,QL 120/30

KUVAN 100 MG POWDER PACKET

4 PA

KUVAN 100 MG TABLET 4 PAKUVAN 500 MG POWDER PACKET

4 PA

LUMIZYME 50 MG VIAL 4 PA,B/DMETHITEST 10 MG TABLET 1MIACALCIN 400 UNIT/2 ML VIAL 4miglustat 100 mg capsule 4 QL 90/30NAGLAZYME 5 MG/5 ML VIAL 4 PANATPARA 100 MCG DOSE CARTRIDGE

4 PA,QL 2/28

NATPARA 25 MCG DOSE CARTRIDGE

4 PA,QL 2/28


4 PA,QL 2/28


4 PA,QL 2/28

NOVAREL 10,000 UNITS VIAL 2 PA,DvEoxandrolone 10 mg tablet 3 PA,QL

60/30,DvEoxandrolone 2.5 mg tablet 1 PA,QL

120/30,DvEpamidronate 30 mg/10 ml vial 1 PA,B/Dpamidronate 60 mg/10 ml vial 1 PA,B/Dpamidronate 90 mg/10 ml vial 1 PA,B/Dpamidronate disod 30 mg vial 1 PA,B/Dpamidronate disod 90 mg vial 1 PA,B/Dparicalcitol 1 mcg capsule 1paricalcitol 2 mcg capsule 1paricalcitol 4 mcg capsule 1PREGNYL 10,000 UNITS VIAL 2 PA,DvESAMSCA 15 MG TABLET 4 PA,QL

30/30SAMSCA 30 MG TABLET 4 PA,QL

60/30SENSIPAR 30 MG TABLET 2 QL

60/30,ECSENSIPAR 60 MG TABLET 2 QL

60/30,EC

SENSIPAR 90 MG TABLET 2 QL 120/30,EC

SOMAVERT 10 MG VIAL 4 PA,QL 30/30





STIMATE 1.5 MG/ML NASAL SPRAY

4

STRIANT 30 MG 3 QL 60/30SYNAREL 2 MG/ML NASAL SPRAY

4 PA

TESTIM 1% (50MG) GEL 2 QL 300/30,EC

testosteron cyp 1,000 mg/10 ml 1testosteron enan 1,000 mg/5 ml 1testosterone 1.62% (2.5 g) pkt 1 QL 150/30testosterone 1.62% gel pump 1 QL 150/30testosterone 1.62%(1.25 g) pkt 1 QL

112.5/30testosterone 12.5 mg/1.25 gram 1 QL 300/30testosterone 25 mg/2.5 gm pkt 1 QL 300/30testosterone 30 mg/1.5 ml pump 1testosterone 50 mg/5 gram pkt 1 QL 300/30testosterone cyp 200 mg/ml 1zoledronic acid 4 mg/5 ml vial 1 PA,QL

15/21,B/D

MISCELLANEOUS NEUROLOGICAL THERAPYAUBAGIO 14 MG TABLET 4 PA,QL

28/28AUBAGIO 7 MG TABLET 4 PA,QL

28/28AUSTEDO 12 MG TABLET 4 PA,QL



120/30

59

Drug NameDrug Tier



Drug NameDrug Tier


COPAXONE 20 MG/ML SYRINGE 4 PA,QL 30/30

COPAXONE 40 MG/ML SYRINGE 4 PA,QL 12/28

dalfampridine er 10 mg tablet 1 PA,QL 60/30

donepezil hcl 10 mg tablet 1 QL 60/30donepezil hcl 23 mg tablet 1 QL 30/30donepezil hcl 5 mg tablet 1 QL 30/30donepezil hcl odt 10 mg tablet 1 QL 60/30donepezil hcl odt 5 mg tablet 1 QL 30/30EXELON 13.3 MG/24HR PATCH 2 QL

30/30,ECEXELON 4.6 MG/24HR PATCH 2 QL

30/30,ECEXELON 9.5 MG/24HR PATCH 2 QL

30/30,ECFIRDAPSE 10 MG TABLET 4 PAgalantamine 4 mg/ml oral soln 1 QL 200/30galantamine er 16 mg capsule 1 QL 30/30galantamine er 24 mg capsule 1 QL 30/30galantamine er 8 mg capsule 1 QL 30/30galantamine hbr 12 mg tablet 1 QL 60/30galantamine hbr 4 mg tablet 1 QL 60/30galantamine hbr 8 mg tablet 1 QL 60/30GILENYA 0.5 MG CAPSULE 4 PA,QL

30/30HORIZANT ER 300 MG TABLET 3 ECHORIZANT ER 600 MG TABLET 3 ECmemantine 5-10 mg titration pk 1 PA if <27

yrs old,QL 98/365

memantine hcl 10 mg tablet 1 PA if <27 yrs old,QL

60/30memantine hcl 2 mg/ml solution 1 PA if <27

yrs old,QL 300/30

memantine hcl 5 mg tablet 1 PA if <27 yrs old,QL

90/30

memantine hcl er 14 mg capsule 1 PA if <27 yrs old,QL

30/30memantine hcl er 21 mg capsule 1 PA if <27

yrs old,QL 30/30

memantine hcl er 28 mg capsule 1 PA if <27 yrs old,QL

30/30memantine hcl er 7 mg capsule 1 PA if <27

yrs old,QL 30/30

NAMENDA 10 MG TABLET 2 PA if <27 yrs old,QL 60/30,EC

NAMENDA 2 MG/ML SOLUTION 2 PA if <27 yrs old,QL 360/30,EC

NAMENDA 5 MG TABLET 2 PA if <27 yrs old,QL 90/30,EC

NAMENDA 5-10 MG TITRATION PK

2 PA if <27 yrs old,QL 49/28,EC

NAMENDA XR 14 MG CAPSULE 3 PA if <27 yrs old,QL 30/30,EC




NAMENDA XR TITRATION PACK 3 PA if <27 yrs old,QL 56/365,EC

NAMZARIC 14 MG-10 MG CAPSULE

2 PA if <27 yrs old


2 PA if <27 yrs old


2 PA if <27 yrs old

60

Drug NameDrug Tier



Drug NameDrug Tier



2 PA if <27 yrs old

NAMZARIC TITRATION PACK 2 PA if <27 yrs old,QL

56/365NUEDEXTA 20-10 MG CAPSULE 2 PA,QL

60/30,DvErivastigmine 1.5 mg capsule 1 QL 60/30rivastigmine 13.3 mg/24hr ptch 1 QL 30/30rivastigmine 3 mg capsule 1 QL 60/30rivastigmine 4.5 mg capsule 1 QL 60/30rivastigmine 4.6 mg/24hr patch 1 QL 30/30rivastigmine 6 mg capsule 1 QL 60/30rivastigmine 9.5 mg/24hr patch 1 QL 30/30TECFIDERA DR 120 MG CAPSULE

2 PA,QL 14/30,EC

TECFIDERA DR 240 MG CAPSULE

2 PA,QL 60/30,EC

TECFIDERA STARTER PACK 2 PA,QL 120/365,EC

tetrabenazine 12.5 mg tablet 4 PA,QL 90/30

tetrabenazine 25 mg tablet 4 PA,QL 120/30

TYSABRI 300 MG/15 ML VIAL 4 PA,QL 15/28

MISCELLANEOUS NUTRITION PRODUCTSAMINOSYN 10% IV SOLUTION 3 PA,B/DAMINOSYN 7%-ELECTROLYTE SOL

3 PA,B/D

AMINOSYN 8.5% IV SOLUTION 3 PA,B/DAMINOSYN 8.5%-ELECTROLYTES SOL

3 PA,B/D

AMINOSYN II 10% IV SOLUTION 3 PA,B/DAMINOSYN II 15% IV SOLUTION 3 PA,B/DAMINOSYN II 8.5% IV SOLUTION 3 PA,B/DAMINOSYN II 8.5%-ELECTROLYTES

3 PA,B/D

AMINOSYN M 3.5% IV SOLUTION 3 PA,B/DAMINOSYN-HBC 7% IV SOLUTION

3 PA,B/D

AMINOSYN-PF 10% IV SOLUTION 3 PA,B/D

AMINOSYN-PF 7% IV SOLUTION 3 PA,B/DAMINOSYN-RF 5.2% IV SOLUTION

3 PA,B/D

CLINIMIX 4.25%-10% SOLUTION 3 PA,B/DCLINIMIX 4.25%-25% SOLUTION 3 PA,B/DCLINIMIX 5%-15% SOLUTION 3 PA,B/DCLINIMIX 5%-20% SOLUTION 3 PA,B/DCLINIMIX 5%-25% SOLUTION 3 PA,B/DCLINIMIX E 4.25%-10% SOLUTION

3 PA,B/D

CLINIMIX E 4.25%-25% SOLUTION

3 PA,B/D

CLINIMIX N14G30E 4.25%-D15W 3 PA,B/DCLINIMIX N9G15E 2.75%-D7.5W 3 PA,B/DCLINISOL 15% SOLUTION 3 PA,B/DFREAMINE HBC 6.9% IV SOLN 3 PA,B/DFREAMINE III 10% IV SOLN. 3 PA,B/DHEPATAMINE 8% IV SOLUTION 3 PA,B/DINTRALIPID 20% IV FAT EMUL 3 PA,B/DINTRALIPID 30% IV FAT EMUL 3 PA,B/DKABIVEN IV EMULSION 3 PA,B/DNEPHRAMINE 5.4% IV SOLUTION 3 PA,B/DNORMOSOL-M AND DEXTROSE 5%

3 PA,B/D

NORMOSOL-R PH 7.4 IV SOLUTION

3 PA,B/D

NUTRILIPID 20% IV FAT EMULSION

3 PA,B/D

PERIKABIVEN IV EMULSION 3 PA,B/DPLENAMINE 15% SOLUTION 3 PA,B/DPREMASOL 10% IV SOLUTION 3 PA,B/DPREMASOL 6% IV SOLUTION 3 PA,B/DPROCALAMINE IV SOLUTION 3 PA,B/DPROSOL 20% INJECTION 3 PA,B/DTRAVASOL 10% SOLN VIAFLEX 3 PA,B/DTROPHAMINE 10% IV SOLUTION 3 PA,B/DTROPHAMINE 6% IV SOLUTION 3 PA,B/D

MISCELLANEOUS OB/GYNAVC 15% CREAM 3CLEOCIN 100 MG VAGINAL OVULE

3

61

Drug NameDrug Tier



Drug NameDrug Tier


clindamycin 2% vaginal cream 1CLINDESSE 2% VAGINAL CREAM 3FEM PH VAGINAL JELLY 1 +GYNAZOLE 1 2% CREAM 3INTRAROSA 6.5 MG VAG INSERT 3 PA,QL

30/30,DvEmethylergonovine 0.2 mg tablet 1metronidazole vaginal 0.75% gl 1miconazole 3 200 mg vag supp 1naproxen sod er 375 mg tablet 1NUVARING VAGINAL RING 3OSPHENA 60 MG TABLET 3 PA,QL

30/30,DvEterconazole 0.4% cream 1terconazole 0.8% cream 1terconazole 80 mg suppository 1tranexamic acid 650 mg tablet 1VANDAZOLE VAGINAL 0.75% GEL

1

XULANE PATCH 1

MISCELLANEOUS OPHTHALMOLOGICSALOCRIL 2% EYE DROPS 3ALOMIDE 0.1% EYE DROPS 3atropine 1% eye drops 1azelastine hcl 0.05% drops 1BLEPHAMIDE EYE DROPS 2BLEPHAMIDE EYE OINTMENT 2cromolyn 4% eye drops 1CYSTARAN 0.44% EYE DROPS 4 PA,QL

60/28epinastine hcl 0.05% eye drops 1LACRISERT 5 MG EYE INSERT 2olopatadine hcl 0.1% eye drops 1olopatadine hcl 0.2% eye drop 1PATADAY 0.2% EYE DROPS 3 STPAZEO 0.7% EYE DROPS 2phenylephrine 10% eye drops 1 +PHOSPHOLINE IODIDE 0.125% 3pilocarpine 1% eye drops 1pilocarpine 2% eye drops 1pilocarpine 4% eye drops 1

proparacaine 0.5% eye drops 1 +RESTASIS 0.05% EYE EMULSION 2 QL 60/30sulfacetamide 10% eye drops 1sulfacetamide 10% eye ointment 1sulf-pred 10-0.23% eye drops 1tetracaine 0.5% eye drop 1 +tetracaine 0.5% steri-unit sol 1 +tetracaine hcl 0.5% eye soln 1 +TETRAVISC 0.5% EYE DROPS 2 +TETRAVISC FORTE 0.5% EYE DROPS

2 +

tropicamide 0.5% eye drops 1 +tropicamide 1% eye drops 1 +XIIDRA 5% EYE DROPS 2 QL 60/30

MISCELLANEOUS OTIC PREPARATIONSacetic acid 2% ear solution 1FLAC OTIC OIL 0.01% EAR DROP 1fluocinolone oil 0.01% ear drp 1hydrocortison-acetic acid soln 1

MISCELLANEOUS UROLOGICALSbethanechol 10 mg tablet 1bethanechol 25 mg tablet 1bethanechol 5 mg tablet 1bethanechol 50 mg tablet 1CIALIS 2.5 MG TABLET 2 PA,QL

30/30,DvECIALIS 5 MG TABLET 2 PA,QL

30/30,DvECYSTAGON 150 MG CAPSULE 3CYSTAGON 50 MG CAPSULE 3CYTRA-K CRYSTALS PACKET 1 +ELMIRON 100 MG CAPSULE 3K-PHOS #2 TABLET 2K-PHOS ORIGINAL TABLET 2phenazopyridine 100 mg tab 1 +phenazopyridine 200 mg tab 1 +PHOSPHASAL TABLET 1 +potassium cit-citric acid soln 1 +potassium citrate er 10 meq tb 1potassium citrate er 15 meq tb 1

62

Drug NameDrug Tier



Drug NameDrug Tier


potassium citrate er 5 meq tab 1sod citrate-citric acid soln 1 +tadalafil 2.5 mg tablet 1 PA,QL

30/30,DvEtadalafil 5 mg tablet 1 PA,QL

30/30,DvEURELLE TABLET 2 +URIN D.S. TABLET 1 +URO-458 TABLET 1 +USTELL CAPSULE 1 +UTIRA-C TABLET 1 +

MUSCLE RELAXANTS / ANTISPASMODIC THERAPY

AMRIX ER 15 MG CAPSULE 2 QL 30/30,EC

AMRIX ER 30 MG CAPSULE 2 QL 30/30,EC

baclofen 10 mg tablet 1baclofen 20 mg tablet 1baclofen 5 mg tablet 1carisoprodl-aspirin 200-325 mg 1 PA,DvEcarisoprodol 250 mg tablet 1 PA,DvEcarisoprodol 350 mg tablet 1 PA,DvEcarisoprodol-aspirin-codein tb 1 DvE*chlorzoxazone 500 mg tablet 1 PA (HRM)cyclobenzaprine 10 mg tablet 1 PA (HRM)cyclobenzaprine 5 mg tablet 1 PA (HRM)cyclobenzaprine 7.5 mg tablet 1 QL

90/30,PA (HRM)

cyclobenzaprine er 15 mg cap 1 QL 30/30cyclobenzaprine er 30 mg cap 1 QL 30/30dantrolene sodium 100 mg cap 1dantrolene sodium 25 mg cap 1dantrolene sodium 50 mg cap 1meprobamate 200 mg tablet 1meprobamate 400 mg tablet 1METAXALL 800 MG TABLET 1 PA (HRM)metaxalone 400 mg tablet 1 PA (HRM)metaxalone 800 mg tablet 1 PA (HRM)methocarbamol 500 mg tablet 1 PA (HRM)

methocarbamol 750 mg tablet 1 PA (HRM)orphenadrine er 100 mg tablet 1 QL

60/30,PA (HRM)

pyridostigmine 60 mg/5 ml soln 1pyridostigmine br 60 mg tablet 1pyridostigmine er 180 mg tab 1REGONOL 10 MG/2 ML AMPUL 3tizanidine hcl 2 mg capsule 1tizanidine hcl 2 mg tablet 1tizanidine hcl 4 mg capsule 1tizanidine hcl 4 mg tablet 1tizanidine hcl 6 mg capsule 1

MYDRIATICSMYDRIACYL 1% EYE DROPS 2 +tropicamide 0.5% eye drop 1 +tropicamide 1% eye drop 1 +

NARCOTIC ANALGESICSacetamin-caff-dihydrocod 320.5 1 QL

300/30,*acetaminop-codeine 120-12 mg/5 1 QL

2700/30,*acetaminophen-cod #2 tablet 1 QL



180/30,*ASCOMP WITH CODEINE CAPSULE

1 QL 180/30,PA

(HRM)*BUPAP 50 MG-300 MG TABLET 1 QL

180/30,PA (HRM)

buprenorphine 0.3 mg/ml crpjct 1 QL 150/30buprenorphine 0.3 mg/ml vial 1 QL 150/30buprenorphine 10 mcg/hr patch 1 QL 4/28,*buprenorphine 15 mcg/hr patch 1 QL 4/28,*buprenorphine 2 mg tablet sl 1 QL 90/30buprenorphine 20 mcg/hr patch 1 QL 4/28,*buprenorphine 5 mcg/hr patch 1 QL 4/28,*buprenorphine 7.5 mcg/hr patch 1 QL 4/28,*

63

Drug NameDrug Tier



Drug NameDrug Tier


buprenorphine 8 mg tablet sl 1 QL 90/30butalb-acetamin-caff 50-300-40 1 QL

180/30,PA (HRM)

butalb-acetamin-caff 50-325-40 1 QL 180/30,PA

(HRM)butalb-acetaminoph-caff-codein 1 QL

180/30,PA (HRM)*

butalb-caff-acetaminoph-codein 1 QL 180/30,PA

(HRM)*butalbital comp-codeine #3 cap 1 QL

180/30,PA (HRM)*

butalbital-acetaminophn 50-300 1 QL 180/30,PA

(HRM)butalbital-acetaminophn 50-325 1 QL

180/30,PA (HRM)

butalbital-asa-caffeine cap 1 QL 180/30,PA

(HRM)BUTRANS 10 MCG/HR PATCH 2 QL

4/28,EC *BUTRANS 15 MCG/HR PATCH 2 QL



4/28,EC *BUTRANS 7.5 MCG/HR PATCH 2 QL

4/28,EC *codeine sulfate 30 mg tablet 1 QL

360/30,*codeine sulfate 60 mg tablet 1 QL

180/30,*DURAMORPH 10 MG/10 ML AMPUL

3 PA,QL 180/30,B/D

*

DURAMORPH 5 MG/10 ML AMPUL

3 PA,QL 180/30,B/D

*EMBEDA ER 100-4 MG CAPSULE 2 QL 60/30,*EMBEDA ER 20-0.8 MG CAPSULE 2 QL 60/30,*EMBEDA ER 30-1.2 MG CAPSULE 2 QL 60/30,*EMBEDA ER 50-2 MG CAPSULE 2 QL 60/30,*EMBEDA ER 60-2.4 MG CAPSULE 2 QL 60/30,*EMBEDA ER 80-3.2 MG CAPSULE 2 QL 60/30,*ENDOCET 10-325 MG TABLET 1 QL

360/30,*ENDOCET 2.5-325 MG TABLET 1 QL

360/30,*ENDOCET 5-325 TABLET 1 QL

360/30,*ENDOCET 7.5-325 MG TABLET 1 QL

360/30,*ESGIC CAPSULE 2 QL

180/30,PA (HRM)

fentanyl 1,000 mcg/20 ml ampul 1 PA,B/D*fentanyl 100 mcg/2 ml carpujct 1 PA,B/D*fentanyl 100 mcg/hr patch 1 QL 20/30,*fentanyl 12 mcg/hr patch 1 QL 20/30,*fentanyl 2,500 mcg/50 ml vial 1 PA,B/D*fentanyl 25 mcg/hr patch 1 QL 20/30,*fentanyl 250 mcg/5 ml vial 1 PA,B/D*fentanyl 37.5 mcg/hr patch 1 QL 20/30,*fentanyl 50 mcg/hr patch 1 QL 20/30,*fentanyl 62.5 mcg/hr patch 1 QL 20/30,*fentanyl 75 mcg/hr patch 1 QL 20/30,*fentanyl 87.5 mcg/hr patch 1 QL 20/30,*fentanyl cit otfc 1,200 mcg 4 PA,QL

120/30,DvE*

fentanyl cit otfc 1,600 mcg 4 PA,QL 120/30,DvE

*fentanyl citrate otfc 200 mcg 1 PA,QL

120/30,DvE*

64

Drug NameDrug Tier



Drug NameDrug Tier


fentanyl citrate otfc 400 mcg 3 PA,QL 120/30,DvE

*fentanyl citrate otfc 600 mcg 3 PA,QL

120/30,DvE*

fentanyl citrate otfc 800 mcg 4 PA,QL 120/30,DvE

*hydrocodone-acetamin 10-300 mg

1 QL 180/30,*

hydrocodone-acetamin 10-325 mg

1 QL 180/30,*

hydrocodone-acetamin 10-325/15 1 QL 2700/30,*

hydrocodone-acetamin 2.5-325 1 QL 360/30,*

hydrocodone-acetamin 5-300 mg 1 QL 360/30,*

hydrocodone-acetamin 5-325 mg 1 QL 360/30,*



hydrocodone-acetamn 7.5-325/15 1 QL 2700/30,*

hydrocodone-ibuprofen 10-200 1 QL 180/30,*

hydrocodone-ibuprofen 5-200 mg 1 QL 180/30,*

hydrocodone-ibuprofen 7.5-200 1 QL 180/30,*

hydromorphone 1 mg/ml solution 1 QL 1200/30,*

hydromorphone 1 mg/ml syringe 1 *hydromorphone 10 mg/ml vial 1 *hydromorphone 2 mg tablet 1 QL

180/30,*hydromorphone 2 mg/ml isecure 1 *hydromorphone 2 mg/ml vial 1 *hydromorphone 3 mg suppos 1 * +

hydromorphone 4 mg tablet 1 QL 180/30,*

hydromorphone 4 mg/ml carpujct 1 *hydromorphone 50 mg/5 ml vial 1 *hydromorphone 8 mg tablet 1 QL

240/30,*HYSINGLA ER 100 MG TABLET 2 QL 30/30,*HYSINGLA ER 120 MG TABLET 2 QL 30/30,*HYSINGLA ER 20 MG TABLET 2 QL 30/30,*HYSINGLA ER 30 MG TABLET 2 QL 30/30,*HYSINGLA ER 40 MG TABLET 2 QL 30/30,*HYSINGLA ER 60 MG TABLET 2 QL 30/30,*HYSINGLA ER 80 MG TABLET 2 QL 30/30,*INFUMORPH 200 MG/20 ML AMPUL

3 QL 200/30,*

INFUMORPH 500 MG/20 ML AMPUL

3 QL 200/30,*

LORCET 5-325 MG TABLET 1 QL 360/30,*

LORCET HD 10-325 MG TABLET 1 QL 180/30,*

LORCET PLUS 7.5-325 MG TABLET

1 QL 180/30,*

meperidine 100 mg tablet 1 QL 180/30,*

meperidine 50 mg tablet 1 QL 180/30,*

meperidine 50 mg/5 ml solution 1 QL 900/30,*

methadone 10 mg/5 ml solution 1 QL 900/30,*

methadone 10 mg/ml oral conc 1 QL 500/30,*

methadone 5 mg/5 ml solution 1 QL 1800/30,*

methadone hcl 10 mg tablet 1 QL 180/30,*

methadone hcl 10 mg/ml vial 1 QL 150/30,*

methadone hcl 5 mg tablet 1 QL 180/30,*

METHADONE INTENSOL 10 MG/ML

1 QL 500/30,*

65

Drug NameDrug Tier



Drug NameDrug Tier


MITIGO 200 MG/20 ML VIAL 1 QL 200/30,*

MITIGO 500 MG/20 ML VIAL 1 QL 200/30,*

morphine 10 mg/10 ml vial 1 PA,QL 180/30,B/D

*morphine 10 mg/ml isecure syrg 1 PA,QL

240/30,B/D*

morphine 10 mg/ml syringe 1 PA,QL 240/30,B/D

*morphine 2 mg/ml isecure syr 1 PA,QL

1260/30,B/D*

morphine 2 mg/ml syringe 1 PA,QL 1260/30,B/

D*morphine 4 mg/ml isecure syr 1 PA,QL

630/30,B/D*


*morphine 5 mg/10 ml vial 1 PA,QL

180/30,B/D*

morphine 5 mg/ml syringe 1 PA,B/D*morphine 5 mg/ml vial 1 PA,B/D*morphine 8 mg/ml isecure syrng 1 PA,QL

250/30,B/D*


*morphine sulf 10 mg suppos 1 * +morphine sulf 10 mg/5 ml soln 1 QL

2700/30,*morphine sulf 100 mg/5 ml conc 1 QL

270/30,*morphine sulf 20 mg suppos 1 * +morphine sulf 20 mg/5 ml soln 1 QL

1350/30,*

morphine sulf 30 mg suppos 1 * +morphine sulf 5 mg suppos 1 * +morphine sulf er 100 mg tablet 1 QL

120/30,*morphine sulf er 15 mg tablet 1 QL




120/30,*morphine sulfate 1 mg/ml vial 1 PA,B/D*morphine sulfate 10 mg/ml vial 1 PA,QL

240/30,B/D*

morphine sulfate 4 mg/ml vial 1 PA,QL 480/30,B/D

*morphine sulfate 5 mg/ml vial 1 PA,QL

700/30,B/D*

morphine sulfate 8 mg/ml vial 1 PA,QL 250/30,B/D

*morphine sulfate er 10 mg cap 1 QL 60/30,*morphine sulfate er 100 mg cap 1 QL 60/30,*morphine sulfate er 120 mg cap 1 QL 60/30,*morphine sulfate er 20 mg cap 1 QL 60/30,*morphine sulfate er 30 mg cap 1 QL 60/30,*morphine sulfate er 45 mg cap 1 QL 60/30,*morphine sulfate er 50 mg cap 1 QL 60/30,*morphine sulfate er 60 mg cap 1 QL 60/30,*morphine sulfate er 75 mg cap 1 QL 60/30,*morphine sulfate er 80 mg cap 1 QL 60/30,*morphine sulfate er 90 mg cap 1 QL 60/30,*morphine sulfate ir 15 mg tab 1 QL

180/30,*morphine sulfate ir 30 mg tab 1 QL

180/30,*nalbuphine 100 mg/10 ml vial 1 QL

180/30,*nalbuphine 200 mg/10 ml vial 1 QL 90/30,*

66

Drug NameDrug Tier



Drug NameDrug Tier


opium tincture 10 mg/ml 1 *oxycodon-acetaminophen 2.5-325

1 QL 360/30,*

oxycodon-acetaminophen 7.5-325

1 QL 360/30,*

oxycodone hcl 10 mg tablet 1 QL 300/30,*

oxycodone hcl 100 mg/5 ml conc 1 QL 270/30,*




oxycodone hcl 5 mg capsule 1 QL 300/30,*


oxycodone hcl 5 mg/5 ml soln 1 QL 1200/30,*

oxycodone hcl er 10 mg tablet 1 QL 90/30,*oxycodone hcl er 15 mg tablet 1 QL 90/30,*oxycodone hcl er 20 mg tablet 1 QL 90/30,*oxycodone hcl er 30 mg tablet 1 QL 90/30,*oxycodone hcl er 40 mg tablet 1 QL 90/30,*oxycodone hcl er 60 mg tablet 1 QL 90/30,*oxycodone hcl er 80 mg tablet 1 QL

120/30,*oxycodone-acetaminophen 10-325

1 QL 360/30,*

oxycodone-acetaminophen 5-325 1 QL 360/30,*

oxycodone-aspirin 4.8355-325 1 QL 180/30,*

oxycodone-ibuprofen 5-400 tab 1 QL 120/30,*

oxymorphone hcl 10 mg tablet 1 QL 180/30,*

oxymorphone hcl 5 mg tablet 1 QL 180/30,*

oxymorphone hcl er 10 mg tab 1 QL 60/30,*oxymorphone hcl er 15 mg tab 1 QL 60/30,*

oxymorphone hcl er 20 mg tab 1 QL 60/30,*oxymorphone hcl er 30 mg tab 1 QL 60/30,*oxymorphone hcl er 40 mg tab 1 QL

120/30,*oxymorphone hcl er 5 mg tablet 1 QL 60/30,*oxymorphone hcl er 7.5 mg tab 1 QL 60/30,*pentazocine-naloxone tablet 1 QL

360/30,*TENCON 50-325 MG TABLET 1 QL

180/30,PA (HRM)

VICODIN 5-300 MG TABLET 1 QL 360/30,*

VICODIN ES 7.5-300 MG TABLET 1 QL 180/30,*

VICODIN HP 10-300 MG TABLET 1 QL 180/30,*

XTAMPZA ER 13.5 MG CAPSULE 2 QL 60/30,*XTAMPZA ER 18 MG CAPSULE 2 QL 60/30,*XTAMPZA ER 27 MG CAPSULE 2 QL 60/30,*XTAMPZA ER 36 MG CAPSULE 2 QL 60/30,*XTAMPZA ER 9 MG CAPSULE 2 QL 60/30,*ZEBUTAL 50-325-40 MG CAPSULE

2 QL 180/30,PA

(HRM)

NITRATESisosorbide dinitr er 40 mg tab 1isosorbide dinitrate 10 mg tab 1isosorbide dinitrate 20 mg tab 1isosorbide dinitrate 30 mg tab 1isosorbide dinitrate 5 mg tab 1isosorbide mononit 10 mg tab 1isosorbide mononit 20 mg tab 1isosorbide mononit er 120 mg 1isosorbide mononit er 30 mg tb 1isosorbide mononit er 60 mg tb 1MINITRAN 0.1 MG/HR PATCH 1MINITRAN 0.2 MG/HR PATCH 1MINITRAN 0.4 MG/HR PATCH 1MINITRAN 0.6 MG/HR PATCH 1NITRO-BID 2% OINTMENT 3

67

Drug NameDrug Tier



Drug NameDrug Tier


NITRO-DUR 0.3 MG/HR PATCH 3NITRO-DUR 0.8 MG/HR PATCH 3nitroglycerin 0.1 mg/hr patch 1nitroglycerin 0.2 mg/hr patch 1nitroglycerin 0.3 mg tablet sl 1nitroglycerin 0.4 mg tablet sl 1nitroglycerin 0.4 mg/hr patch 1nitroglycerin 0.6 mg tablet sl 1nitroglycerin 0.6 mg/hr patch 1nitroglycerin 5 mg/ml vial 1nitroglycerin lingual 0.4 mg 1NITROSTAT 0.3 MG TABLET SL 3NITROSTAT 0.4 MG TABLET SL 3NITROSTAT 0.6 MG TABLET SL 3

NON-NARCOTIC ANALGESICSbupreno-nalox 2-0.5 mg sl film 1 QL 90/30buprenor-nalox 12-3 mg sl film 1 QL 60/30buprenorphin-naloxon 8-2 mg sl 1 QL 90/30buprenorphn-naloxn 2-0.5 mg sl 1 QL 90/30buprenorp-nalox 4-1 mg sl film 1 QL 90/30buprenorp-nalox 8-2 mg sl film 1 QL 90/30butorphanol 1 mg/ml vial 1 QL

480/30,*butorphanol 10 mg/ml spray 1 QL 5/30,*butorphanol 2 mg/ml vial 1 QL

240/30,*CELEBREX 100 MG CAPSULE 2 QL

60/30,ECCELEBREX 200 MG CAPSULE 2 QL



60/30,ECcelecoxib 100 mg capsule 1 QL 60/30celecoxib 200 mg capsule 1 QL 60/30celecoxib 400 mg capsule 1 QL 60/30celecoxib 50 mg capsule 1 QL 60/30diclofenac 1.5% topical soln 3 QL 450/28diclofenac pot 50 mg tablet 1diclofenac sod ec 25 mg tab 1

diclofenac sod ec 50 mg tab 1diclofenac sod ec 75 mg tab 1diclofenac sod er 100 mg tab 1diclofenac sodium 1% gel 1 QL 1000/30diclofenac-misoprost 50-200 tb 1diclofenac-misoprost 75-200 tb 1diflunisal 500 mg tablet 1DUEXIS 800-26.6 MG TABLET 2 QL

90/30,ECetodolac 200 mg capsule 1etodolac 300 mg capsule 1etodolac 400 mg tablet 1etodolac 500 mg tablet 1etodolac er 400 mg tablet 1etodolac er 500 mg tablet 1etodolac er 600 mg tablet 1fenoprofen 400 mg capsule 1fenoprofen 600 mg tablet 1flurbiprofen 100 mg tablet 1flurbiprofen 50 mg tablet 1IBU 600 MG TABLET 1IBU 800 MG TABLET 1ibuprofen 100 mg/5 ml susp 1ibuprofen 400 mg tablet 1ibuprofen 600 mg tablet 1ibuprofen 800 mg tablet 1indomethacin 25 mg capsule 1indomethacin 50 mg capsule 1indomethacin er 75 mg capsule 1ketorolac 10 mg tablet 1 QL 20/30ketorolac 30 mg/ml vial 1ketorolac 60 mg/2 ml carpuject 1meclofenamate 100 mg capsule 1meclofenamate 50 mg capsule 1meloxicam 15 mg tablet 1meloxicam 7.5 mg tablet 1methotrexate 25 mg/1 ml vial 1nabumetone 500 mg tablet 1nabumetone 750 mg tablet 1naloxone 0.4 mg/ml vial 1

68

Drug NameDrug Tier



Drug NameDrug Tier


naloxone 2 mg/2 ml syringe 1naltrexone 50 mg tablet 1NAPRELAN CR 375 MG TABLET 2 ECNAPRELAN CR 500 MG TABLET 2 ECNAPRELAN CR 750 MG TABLET 2 ECnaproxen 125 mg/5 ml suspen 1naproxen 250 mg tablet 1naproxen 375 mg tablet 1naproxen 500 mg tablet 1naproxen dr 375 mg tablet 1naproxen dr 500 mg tablet 1naproxen sod cr 375 mg tablet 1naproxen sod cr 500 mg tablet 1naproxen sodium 275 mg tab 1naproxen sodium 550 mg tab 1NARCAN 4 MG NASAL SPRAY 2 QL 4/30oxaprozin 600 mg tablet 1piroxicam 10 mg capsule 1piroxicam 20 mg capsule 1salsalate 500 mg tablet 1salsalate 750 mg tablet 1SUBOXONE 12 MG-3 MG SL FILM 2 QL 60/30SUBOXONE 2 MG-0.5 MG SL FILM

2 QL 90/30

SUBOXONE 4 MG-1 MG SL FILM 2 QL 90/30SUBOXONE 8 MG-2 MG SL FILM 2 QL 90/30sulindac 150 mg tablet 1sulindac 200 mg tablet 1tolmetin sodium 200 mg tab 1tolmetin sodium 400 mg cap 1tolmetin sodium 600 mg tab 1tramadol er 100 mg tablet 1 QL 30/30,*tramadol er 200 mg tablet 1 QL 30/30,*tramadol er 300 mg tablet 1 QL 30/30,*tramadol hcl 50 mg tablet 1 QL

240/30,*tramadol hcl er 100 mg tablet 1 QL 30/30,*tramadol hcl er 200 mg tablet 1 QL 30/30,*tramadol hcl er 300 mg tablet 1 QL 30/30,*tramadol-acetaminophn 37.5-325 1 QL

240/30,*

VIVITROL 380 MG VIAL + DILUENT

4 PA

ZUBSOLV 0.7-0.18 MG TABLET SL

2 QL 30/30


2 QL 90/30


2 QL 30/30


2 QL 90/30

ZUBSOLV 5.7-1.4 MG TABLET SL 2 QL 90/30ZUBSOLV 8.6-2.1 MG TABLET SL 2 QL 90/30

NON-STEROIDAL ANTI-INFLAMMATORY AGENTS

ACUVAIL 0.45% OPHTH SOLUTION

2 EC

bromfenac sodium 0.09% eye drp 1diclofenac 0.1% eye drops 1flurbiprofen 0.03% eye drop 1ILEVRO 0.3% OPHTH DROPS 2ketorolac 0.4% ophth solution 1ketorolac 0.5% ophth solution 1NEVANAC 0.1% DROPTAINER 3PROLENSA 0.07% EYE DROPS 2

OINTMENT/CREAM BASESRADIAGEL 2 +

ORAL CONTRACEPTIVES / RELATED AGENTSALTAVERA-28 TABLET 1ALYACEN 1-35 28 TABLET 1ALYACEN 7-7-7-28 TABLET 1AMETHIA 0.15-0.03-0.01 MG TAB 1AMETHIA LO TABLET 1AMETHYST 90-20 MCG TABLET 1APRI 28 DAY TABLET 1ARANELLE 28 TABLET 1ASHLYNA 0.15-0.03-0.01 MG TAB 1AUBRA-28 TABLET 1AVIANE-28 TABLET 1AZURETTE 28 DAY TABLET 1BALZIVA 28 TABLET 1BEKYREE 28 DAY TABLET 1

69

Drug NameDrug Tier



Drug NameDrug Tier


BLISOVI 24 FE TABLET 1BLISOVI FE 1.5-30 TABLET 1BLISOVI FE 1-20 TABLET 1BRIELLYN TABLET 1CAMRESE 0.15-0.03-0.01 MG TAB 1CAMRESE LO TABLET 1CAZIANT 28 DAY TABLET 1CHATEAL-28 TABLET 1CRYSELLE-28 TABLET 1CYCLAFEM 1-35-28 TABLET 1CYCLAFEM 7-7-7-28 TABLET 1CYRED 28 DAY TABLET 1CYRED EQ 28 DAY TABLET 1DASETTA 1-35-28 TABLET 1DASETTA 7/7/7-28 TABLET 1DAYSEE 0.15-0.03-0.01 MG TAB 1DELYLA-28 TABLET 1desogest-eth estra 0.15-0.03mg 1desogestr-eth estrad eth estra 1drosp-ee-levomef 3-0.02-0.451 1drospirenone-ee 3-0.02 mg tab 1drospirenone-ee 3-0.03 mg tab 1ELINEST-28 TABLET 1ELLA 30 MG TABLET 2EMOQUETTE 28 DAY TABLET 1ENPRESSE-28 TABLET 1ENSKYCE 28 TABLET 1ESTARYLLA 0.25-0.035 MG TABLET

1

ethynodiol-eth estra 1mg-50mcg 1FALMINA-28 TABLET 1FEMYNOR 28 TABLET 1GIANVI 3 MG-0.02 MG TABLET 1GILDAGIA 0.4 MG-0.035 MG TAB 1HAILEY 24 FE 1 MG-20 MCG TAB 1INTROVALE 0.15-0.03 MG TABLET

1

ISIBLOOM 28 DAY TABLET 1JASMIEL 3 MG-0.02 MG TABLET 1JOLESSA 0.15 MG-0.03 MG TABLET

1

JULEBER 28 DAY TABLET 1JUNEL 1 MG-20 MCG TABLET 1JUNEL 1.5 MG-30 MCG TABLET 1JUNEL FE 1 MG-20 MCG TABLET 1JUNEL FE 1.5 MG-30 MCG TABLET

1

JUNEL FE 24 TABLET 1KAITLIB FE CHEWABLE TABLET 1KARIVA 28 DAY TABLET 1KELNOR 1-35 28 TABLET 1KELNOR 1-50 TABLET 1KURVELO TABLET 1LARIN 1.5 MG-30 MCG TABLET 1LARIN 21 1-20 TABLET 1LARIN 24 FE 1 MG-20 MCG TABLET

1

LARIN FE 1.5-30 TABLET 1LARIN FE 1-20 TABLET 1LARISSIA-28 TABLET 1LAYOLIS FE CHEWABLE TABLET 1LEENA 28 TABLET 1LESSINA-28 TABLET 1LEVONEST-28 TABLET 1levono-e estrad 0.10-0.02-0.01 1levono-e estrad 0.15-0.03-0.01 1levonor-eth estra 0.09-0.02 mg 1levonor-eth estrad 0.1-0.02 mg 1levonor-eth estrad 0.15-0.03 1levonor-eth estrad triphasic 1LEVORA-28 TABLET 1LOPREEZA 0.5 MG-0.1 MG TABLET

1 PA (HRM)

LOPREEZA 1 MG-0.5 MG TABLET 1LORYNA 3 MG-0.02 MG TABLET 1LOW-OGESTREL-28 TABLET 1LUTERA-28 TABLET 1MARLISSA-28 TABLET 1MELODETTA 24 FE CHEWABLE TAB

1

MIBELAS 24 FE CHEWABLE TABLET

1

70

Drug NameDrug Tier



Drug NameDrug Tier


MICROGESTIN 21 1.5-30 TAB 1MICROGESTIN 21 1-20 TABLET 1MICROGESTIN FE 1.5-30 TAB 1MICROGESTIN FE 1-20 TABLET 1MILI 0.25-0.035 MG TABLET 1MONO-LINYAH 28 TABLET 1MONONESSA 28 TABLET 1MYZILRA-28 TABLET 1NECON 0.5-35-28 TABLET 1NIKKI 3 MG-0.02 MG TABLET 1noret-estr-fe 0.4-0.035(21)-75 1noreth-estrad-fe 1-0.02(21)-75 1noreth-estrad-fe 1-0.02(24)-75 1norethind-eth estrad 1-0.02 mg 1norethin-estra-fe 0.8-0.025 mg 1norg-ee 0.18-0.215-0.25/0.025 1norg-ethin estra 0.25-0.035 mg 1NORTREL 0.5-35-28 TABLET 1NORTREL 1-35 21 TABLET 1NORTREL 1-35 28 TABLET 1NORTREL 7-7-7-28 TABLET 1OCELLA 3 MG-0.03 MG TABLET 1OGESTREL TABLET 1ORSYTHIA-28 TABLET 1PHILITH 0.4-0.035 MG TABLET 1PIMTREA 28 DAY TABLET 1PIRMELLA 1-35-28 TABLET 1PIRMELLA 7-7-7-28 TABLET 1PORTIA-28 TABLET 1PREVIFEM TABLET 1QUASENSE 0.15-0.03 MG TABLET

1

RECLIPSEN 28 DAY TABLET 1SETLAKIN 0.15 MG-0.03 MG TAB 1SPRINTEC 28 DAY TABLET 1SRONYX 0.10-0.02 MG TABLET 1SYEDA 28 TABLET 1TARINA 24 FE 1 MG-20 MCG TAB 1TARINA FE 1-20 TABLET 1TILIA FE 28 TABLET 1

TRI-ESTARYLLA TABLET 1TRI-LEGEST FE-28 DAY TABLET 1TRI-LINYAH TABLET 1TRI-LO-ESTARYLLA TABLET 1TRI-LO-MARZIA TABLET 1TRI-MILI 28 TABLET 1TRINESSA TABLET 1TRI-PREVIFEM TABLET 1TRI-SPRINTEC TABLET 1TRIVORA-28 TABLET 1TRI-VYLIBRA 28 TABLET 1TRI-VYLIBRA LO TABLET 1TYDEMY TABLET 1VELIVET 28 DAY TABLET 1VIENVA-28 TABLET 1VIORELE 28 DAY TABLET 1VYFEMLA 28 TABLET 1VYLIBRA 28 TABLET 1WERA 0.5/0.035 MG 28 TABLET 1WYMZYA FE CHEWABLE TABLET 1ZARAH TABLET 1ZOVIA 1-35E TABLET 1

ORAL DRUGS FOR GLAUCOMAacetazolamide 125 mg tablet 1acetazolamide 250 mg tablet 1acetazolamide er 500 mg cap 1methazolamide 25 mg tablet 1methazolamide 50 mg tablet 1

OSTEOPOROSIS THERAPYACTONEL 150 MG TABLET 2 QL 1/30,ECACTONEL 35 MG TABLET 2 QL 4/28,ECACTONEL 5 MG TABLET 2 QL

30/30,ECalendronate sod 70 mg/75 ml 1alendronate sodium 10 mg tab 1 QL 30/30alendronate sodium 35 mg tab 1 QL 4/28alendronate sodium 5 mg tablet 1 QL 30/30alendronate sodium 70 mg tab 1 QL 4/28BINOSTO 70 MG TABLET EFF 3BONIVA 150 MG TABLET 2 QL 1/28,EC

71

Drug NameDrug Tier



Drug NameDrug Tier


EVISTA 60 MG TABLET 2 QL 30/30,EC

FORTEO 600 MCG/2.4 ML PEN INJ

2 PA,QL 2.4/28,EC

FOSAMAX 70 MG TABLET 2 QL 4/28,ECFOSAMAX PLUS D 70 MG-2,800 IU

3 QL 4/28,ST

FOSAMAX PLUS D 70 MG-5,600 IU

3 QL 4/28,ST

ibandronate sodium 150 mg tab 1 QL 1/28PROLIA 60 MG/ML SYRINGE 3 QL 1/180raloxifene hcl 60 mg tablet 1 QL 30/30risedronate sod dr 35 mg tab 1risedronate sodium 150 mg tab 1 QL 1/30risedronate sodium 30 mg tab 1 QL 30/30risedronate sodium 35 mg tab 1 QL 4/28risedronate sodium 5 mg tablet 1 QL 30/30TYMLOS 80 MCG DOSE PEN INJECTR

4 PA,QL 1.56/30

OTHER GLAUCOMA DRUGSacetazolamide sod 500 mg vial 1AZOPT 1% EYE DROPS 2bimatoprost 0.03% eye drops 1 QL 5/30COMBIGAN 0.2%-0.5% EYE DROPS

2

COSOPT EYE DROPS 2 QL 10/30,EC

COSOPT PF EYE DROPS 2 QL 60/30,EC

dorzolamide hcl 2% eye drops 1dorzolamide-timolol 2%-0.5% 1 QL 60/30dorzolamide-timolol eye drops 1latanoprost 0.005% eye drops 1LUMIGAN 0.01% EYE DROPS 2SIMBRINZA 1%-0.2% EYE DROPS 2 ECTRAVATAN Z 0.004% EYE DROP 2XALATAN 0.005% EYE DROPS 2 QL 5/30,ECZIOPTAN 0.0015% EYE DROPS 3 QL 30/30

OTHER RHEUMATOLOGICALSBENLYSTA 120 MG VIAL 4 PA,QL

30/28,B/D

BENLYSTA 400 MG VIAL 4 PA,QL 9/28,B/D

CUPRIMINE 250 MG CAPSULE 4DEPEN 250 MG TITRATAB 4ENBREL 25 MG KIT 2 PA,QL

8/28,ECENBREL 25 MG/0.5 ML SYRINGE 2 PA,QL

4.08/28,ECENBREL 50 MG/ML MINI CARTRIDGE

2 PA,QL 8/28,EC

ENBREL 50 MG/ML SURECLICK SYR

2 PA,QL 8/28,EC

ENBREL 50 MG/ML SYRINGE 2 PA,QL 8/28,EC

HUMIRA 10 MG/0.2 ML SYRINGE 2 PA,QL 2/28,EC



HUMIRA PEDI CROHN 40 MG/0.8 ML

2 PA,QL 6/365,EC

HUMIRA PEN 40 MG/0.8 ML 2 PA,QL 4/28,EC

HUMIRA PEN CROHN-UC-HS 40 MG

2 PA,QL 12/365,EC

HUMIRA PEN PS-UV-ADOL HS 40 MG

2 PA,QL 8/365,EC

HUMIRA(CF) 10 MG/0.1 ML SYRING

2 PA,QL 2/28,EC


2 PA,QL 2/28,EC


2 PA,QL 4/28,EC

HUMIRA(CF) PEDI CROHN 80-40 MG

2 PA,QL 4/365,EC

HUMIRA(CF) PEDI CROHN 80MG/0.8

2 PA,QL 6/365,EC

HUMIRA(CF) PEN 40 MG/0.4 ML 2 PA,QL 4/28,EC

HUMIRA(CF) PEN CRHN-UC-HS 80MG

2 PA,QL 6/365,EC

72

Drug NameDrug Tier



Drug NameDrug Tier


HUMIRA(CF) PEN PS-UV-AHS 80-40

2 PA,QL 6/365,EC

KINERET 100 MG/0.67 ML SYRINGE

4 PA,QL 20.1/30

leflunomide 10 mg tablet 1leflunomide 20 mg tablet 1ORENCIA 125 MG/ML SYRINGE 2 PA,QL

4/28,ECORENCIA 50 MG/0.4 ML SYRINGE

2 PA,QL 4/28,EC

ORENCIA 87.5 MG/0.7 ML SYRINGE

2 PA,QL 4/28,EC

ORENCIA CLICKJECT 125 MG/ML 2 PA,QL 4/28,EC

penicillamine 250 mg capsule 4RIDAURA 3 MG CAPSULE 3SAVELLA 100 MG TABLET 2 QL 60/30SAVELLA 12.5 MG TABLET 2 QL 60/30SAVELLA 25 MG TABLET 2 QL 60/30SAVELLA 50 MG TABLET 2 QL 60/30SAVELLA TITRATION PACK 2 QL 55/30SIMPONI 100 MG/ML PEN INJECTOR

2 PA,QL 3/30,EC

SIMPONI 100 MG/ML SYRINGE 2 PA,QL 3/30,EC

SIMPONI 50 MG/0.5 ML PEN INJEC

2 PA,QL 0.5/30,EC

SIMPONI 50 MG/0.5 ML SYRINGE 2 PA,QL 30/30,EC

SIMPONI ARIA 50 MG/4 ML VIAL 2 PA,ECXELJANZ 10 MG TABLET 2 PA,QL

60/30,ECXELJANZ 5 MG TABLET 2 PA,QL

60/30,ECXELJANZ XR 11 MG TABLET 2 PA,QL

30/30,EC

OTIC STEROID / ANTIBIOTICCIPRO HC OTIC SUSPENSION 2CIPRODEX OTIC SUSPENSION 2COLY-MYCIN S OTIC SUSP DROP

2

neomycin-polymyxin-hc ear soln 1

neomycin-polymyxin-hc ear susp 1

PENICILLINSamox tr-k clv 200-28.5/5 susp 1amox-clav 200-28.5 mg tab chew 1amox-clav 200-28.5 mg/5 ml sus 1amox-clav 250-125 mg tablet 1amox-clav 250-62.5 mg/5 ml sus 1amox-clav 400-57 mg tab chew 1amox-clav 400-57 mg/5 ml susp 1amox-clav 500-125 mg tablet 1amox-clav 600-42.9 mg/5 ml sus 1amox-clav 875-125 mg tablet 1amox-clav er 1,000-62.5 mg tab 1amoxicillin 125 mg tab chew 1amoxicillin 125 mg/5 ml susp 1amoxicillin 200 mg/5 ml susp 1amoxicillin 250 mg capsule 1amoxicillin 250 mg tab chew 1amoxicillin 250 mg/5 ml susp 1amoxicillin 400 mg/5 ml susp 1amoxicillin 500 mg capsule 1amoxicillin 500 mg tablet 1amoxicillin 875 mg tablet 1ampicillin 1 gm add-vantage vl 1ampicillin 1 gm vial 1ampicillin 10 gm vial 1ampicillin 125 mg vial 1ampicillin 2 gm add-vantage vl 1ampicillin 2 gm vial 1ampicillin 250 mg vial 1ampicillin 500 mg capsule 1ampicillin 500 mg vial 1ampicillin-sulb 1.5 g add vial 1ampicillin-sulbactam 1.5 gm vl 1ampicillin-sulbactam 15 gm vl 1ampicillin-sulbactam 3 gm vial 1AUGMENTIN 125-31.25 MG/5 ML 3BICILLIN L-A 1,200,000 UNITS 3BICILLIN L-A 2,400,000 UNITS 3BICILLIN L-A 600,000 UNIT/ML 3

73

Drug NameDrug Tier



Drug NameDrug Tier


dicloxacillin 250 mg capsule 1dicloxacillin 500 mg capsule 1nafcillin 1 gm add-van vial 1nafcillin 1 gm vial 1nafcillin 10 gm bulk vial 1nafcillin 2 gm add-vant vial 1nafcillin 2 gm vial 1oxacillin 1 gm vial 1oxacillin 10 gm vial 1oxacillin 2 gm vial 1penicillin g k 5 million unit 1penicillin gk 20 million unit 1penicillin vk 125 mg/5 ml soln 1penicillin vk 250 mg tablet 1penicillin vk 250 mg/5 ml soln 1penicillin vk 500 mg tablet 1PFIZERPEN 20 MILLION UNIT VIAL

1

PFIZERPEN 5 MILLION UNIT VIAL 1piperacil-tazobact 13.5 gm vl 1piperacil-tazobact 2.25 gm vl 1piperacil-tazobact 3.375 gm vl 1piperacil-tazobact 4.5 gm vial 1piperacil-tazobact 40.5 gram 1ZOSYN 2.25 GM/50 ML GALAXY BAG

3

ZOSYN 3.375 GM/50 ML GALAXY 3ZOSYN 4.5 GM/100 ML GALAXY BAG

3

Prescription VitaminsAQUASOL A 50,000 UNITS/ML VIAL

2 +

ascorbic acid 500 mg/ml vial 1 +AZESCO TABLET 2 +B-12 COMPLIANCE INJ KIT 2 +BAL-CARE DHA COMBO PACK 2 +BAL-CARE DHA ESSENTIAL PACK

2 +

b-complex 100 injection 1 +CADEAU DHA SOFTGEL 2 +calcitriol 0.25 mcg capsule 1 +

calcitriol 0.5 mcg capsule 1 +calcitriol 1 mcg/ml ampul 1 +calcitriol 1 mcg/ml solution 1 +CONCEPT DHA CAPSULE 2 +cyanocobalamin 1,000 mcg/ml 1 +DRISDOL 1.25 MG (50,000 UNIT) 2 +DUET DHA 400 COMBO PACK 2 +DUET DHA BALANCED (25 MG IRON)

2 +

ENBRACE HR SOFTGEL 2 +EXTRA-VIRT PLUS DHA SOFTGEL

2 +

FERAHEME 510 MG/17 ML VIAL 2 +FERRLECIT 62.5 MG/5 ML VIAL 2 +FOLET ONE SOFTGEL 2 +folic acid 1 mg tablet 1 +folic acid 5 mg/ml vial 1 +hydroxocobalamin 1,000 mcg/ml 1 +INFUVITE ADULT VIAL 2 +INFUVITE PEDIATRIC VIAL 2 +INJECTAFER 750 MG/15 ML VIAL 2 +M.V.I. ADULT VIAL 2 +M.V.I.-12 VIAL 2 +MEPHYTON 5 MG TABLET 2 +NASCOBAL 500 MCG NASAL SPRAY

2 +

NATACHEW TABLET 2 +NEEVODHA CAPSULE 2 +NESTABS DHA COMBO PACK 2 +NESTABS ONE SOFTGEL 2 +NESTABS TABLET 2 +newgen tablet 1 +NEXA PLUS SOFTGEL 2 +PHYTONADIONE 1 MG/0.5 ML SYR

2 +

PHYTONADIONE 10 MG/ML AMPUL

2 +

PHYTONADIONE 5 MG TABLET 2 +POTABA 500 MG CAPSULE 2 +prenaissance capsule 1 +prenaissance plus softgel 1 +

74

Drug NameDrug Tier



Drug NameDrug Tier


PRIMACARE SOFTGEL 2 +PROVIDA DHA CAPSULE 2 +pyridoxine 100 mg/ml vial 1 +ROCALTROL 0.25 MCG CAPSULE 2 +ROCALTROL 0.5 MCG CAPSULE 2 +ROCALTROL 1 MCG/ML ORAL SOLN

2 +

sod fer gluc cplx 62.5 mg/5 ml 1 +taron-c dha capsule 1 +thiamine 200 mg/2 ml vial 1 +THRIVITE RX TABLET 2 +TRIFERIC 27.2 MG/5 ML AMPULE 2 +TRIFERIC 272 MG POWDER PACKET

2 +

TRISTART DHA SOFTGEL 2 +triveen-duo dha combo pack 1 +VENOFER 100 MG/5 ML VIAL 2 +VENOFER 200 MG/10 ML VIAL 2 +VENOFER 50 MG/2.5 ML VIAL 2 +virt-advance tablet 1 +virt-c dha softgel 1 +virtprex capsule 1 +virt-select capsule 1 +virt-vite gt tablet 1 +VITAFOL FE+ DOCUSATE COMBO PCK

2 +

VITAFOL GUMMIES 2 +VITAFOL NANO TABLET 2 +VITAMEDMD ONE RX SOFTGEL 2 +VITAMEDMD REDICHEW RX TAB CHEW

2 +

vitamin d2 1.25mg(50,000 unit) 1 +vitamin k-1 1 mg/0.5 ml ampul 1 +vitamin k-1 10 mg/ml ampul 1 +VITAPEARL SOFTGEL 2 +VITATRUE COMBO PACK 2 +vp-ch plus softgel 1 +zingiber tablet 1 +

PROTECTIVESBIONECT 0.2% CREAM 2 +BIONECT 0.2% FOAM 2 +

BIONECT 0.2% GEL 2 +TETRIX CREAM 2 +

PSYCHOTHERAPEUTIC DRUGSABILIFY 10 MG TABLET 2 QL

30/30,ECABILIFY 15 MG TABLET 2 QL





30/30,ECABILIFY MAINTENA ER 300 MG SYR

4 QL 1/28

ABILIFY MAINTENA ER 300 MG VL

4 QL 1/28

ABILIFY MAINTENA ER 400 MG SYR

4 QL 1/28

ABILIFY MAINTENA ER 400 MG VL

4 QL 1/28

ADDERALL XR 10 MG CAPSULE 2 QL 30/30,EC






alprazolam 0.25 mg tablet 1 QL 120/30alprazolam 0.5 mg tablet 1 QL 120/30alprazolam 1 mg tablet 1 QL 120/30alprazolam 2 mg tablet 1 QL 150/30alprazolam er 0.5 mg tablet 1 QL 90/30alprazolam er 1 mg tablet 1 QL 90/30alprazolam er 2 mg tablet 1 QL 90/30alprazolam er 3 mg tablet 1 QL 90/30

75

Drug NameDrug Tier



Drug NameDrug Tier


ALPRAZOLAM INTENSOL 1 MG/ML

1 QL 300/30

alprazolam odt 0.25 mg tab 1 QL 120/30alprazolam odt 0.5 mg tab 1 QL 120/30alprazolam odt 1 mg tab 1 QL 120/30alprazolam odt 2 mg tab 1 QL 150/30alprazolam xr 0.5 mg tablet 1 QL 90/30alprazolam xr 1 mg tablet 1 QL 90/30alprazolam xr 2 mg tablet 1 QL 90/30alprazolam xr 3 mg tablet 1 QL 90/30AMBIEN 10 MG TABLET 2 ECAMBIEN 5 MG TABLET 2 ECAMBIEN CR 12.5 MG TABLET 2 ECAMBIEN CR 6.25 MG TABLET 2 ECamitriptyline hcl 10 mg tab 1 PA (HRM)amitriptyline hcl 100 mg tab 1 PA (HRM)amitriptyline hcl 150 mg tab 1 PA (HRM)amitriptyline hcl 25 mg tab 1 PA (HRM)amitriptyline hcl 50 mg tab 1 PA (HRM)amitriptyline hcl 75 mg tab 1 PA (HRM)amoxapine 100 mg tablet 1amoxapine 150 mg tablet 1amoxapine 25 mg tablet 1amoxapine 50 mg tablet 1ANAFRANIL 25 MG CAPSULE 2 PA

(HRM)ECANAFRANIL 50 MG CAPSULE 2 PA

(HRM)ECANAFRANIL 75 MG CAPSULE 2 PA

(HRM)ECAPLENZIN ER 174 MG TABLET 2 QL

30/30,ECAPLENZIN ER 348 MG TABLET 2 QL

30/30,ECAPLENZIN ER 522 MG TABLET 2 QL

30/30,ECaripiprazole 1 mg/ml solution 1 QL 900/30aripiprazole 10 mg tablet 1 QL 30/30aripiprazole 15 mg tablet 1 QL 30/30aripiprazole 2 mg tablet 1 QL 30/30aripiprazole 20 mg tablet 1 QL 30/30

aripiprazole 30 mg tablet 1 QL 30/30aripiprazole 5 mg tablet 1 QL 30/30aripiprazole odt 10 mg tablet 4 QL 60/30aripiprazole odt 15 mg tablet 4 QL 60/30ARISTADA ER 1064 MG/3.9 ML SYR

4 QL 3.9/56

ARISTADA ER 441 MG/1.6 ML SYRN

4 QL 1.6/28


4 QL 2.4/28


4 QL 3.2/28

ARISTADA INITIO ER 675 MG/2.4 4 QL 4.8/365armodafinil 150 mg tablet 1 PA,QL

30/30,DvEarmodafinil 200 mg tablet 1 PA,QL



30/30,DvEatomoxetine hcl 10 mg capsule 1 QL 60/30atomoxetine hcl 100 mg capsule 1 QL 30/30atomoxetine hcl 18 mg capsule 1 QL 60/30atomoxetine hcl 25 mg capsule 1 QL 60/30atomoxetine hcl 40 mg capsule 1 QL 60/30atomoxetine hcl 60 mg capsule 1 QL 30/30atomoxetine hcl 80 mg capsule 1 QL 30/30BELSOMRA 10 MG TABLET 2 QL 30/30BELSOMRA 15 MG TABLET 2 QL 30/30BELSOMRA 20 MG TABLET 2 QL 30/30BELSOMRA 5 MG TABLET 2 QL 60/30bupropion hcl 100 mg tablet 1 QL 120/30bupropion hcl 75 mg tablet 1 QL 180/30bupropion hcl sr 100 mg tablet 1 QL 60/30bupropion hcl sr 150 mg tablet 1 QL 90/30bupropion hcl sr 200 mg tablet 1 QL 60/30bupropion hcl xl 150 mg tablet 1 QL 90/30bupropion hcl xl 300 mg tablet 1 QL 30/30buspirone hcl 10 mg tablet 1buspirone hcl 15 mg tablet 1

76

Drug NameDrug Tier



Drug NameDrug Tier


buspirone hcl 30 mg tablet 1buspirone hcl 5 mg tablet 1buspirone hcl 7.5 mg tablet 1BUTISOL SODIUM 30 MG TABLET 3CELEXA 10 MG TABLET 2 ECCELEXA 20 MG TABLET 2 QL

60/30,ECCELEXA 40 MG TABLET 2 QL

30/30,ECchlordiazepo-amitriptyl 5-12.5 1 PA (HRM)chlordiazepox-amitriptyl 10-25 1 PA (HRM)chlordiazepoxide 10 mg capsule 1 QL 120/30chlordiazepoxide 25 mg capsule 1 QL 360/30chlordiazepoxide 5 mg capsule 1 QL 120/30chlorpromazine 10 mg tablet 1chlorpromazine 100 mg tablet 1chlorpromazine 200 mg tablet 1chlorpromazine 25 mg tablet 1chlorpromazine 25 mg/ml amp 1chlorpromazine 50 mg tablet 1citalopram hbr 10 mg tablet 1 QL 120/30citalopram hbr 10 mg/5 ml soln 1 QL 600/30citalopram hbr 20 mg tablet 1 QL 60/30citalopram hbr 40 mg tablet 1 QL 90/30clomipramine 25 mg capsule 1 PA (HRM)clomipramine 50 mg capsule 1 PA (HRM)clomipramine 75 mg capsule 1 PA (HRM)clonidine hcl er 0.1 mg tablet 1 QL 120/30clorazepate 15 mg tablet 1 QL 180/30clorazepate 3.75 mg tablet 1 QL 180/30clorazepate 7.5 mg tablet 1 QL 360/30clozapine 100 mg tablet 1clozapine 200 mg tablet 1clozapine 25 mg tablet 1clozapine 50 mg tablet 1clozapine odt 100 mg tablet 1 QL 270/30clozapine odt 12.5 mg tablet 1clozapine odt 150 mg tablet 1 QL 180/30clozapine odt 200 mg tablet 4 QL 120/30clozapine odt 25 mg tablet 1

CONCERTA ER 18 MG TABLET 2 QL 120/30,EC




CYMBALTA 20 MG CAPSULE 2 QL 60/30,ST,E

CCYMBALTA 30 MG CAPSULE 2 QL

90/30,ST,EC

CYMBALTA 60 MG CAPSULE 2 QL 60/30,ST,E

Cdesipramine 10 mg tablet 1desipramine 100 mg tablet 1desipramine 150 mg tablet 1desipramine 25 mg tablet 1desipramine 50 mg tablet 1desipramine 75 mg tablet 1desvenlafaxine er 100 mg tab 1 QL 30/30desvenlafaxine er 50 mg tab 1 QL 30/30desvenlafaxine suc er 100 mg 1 QL 120/30desvenlafaxine suc er 25 mg tb 1 QL 30/30desvenlafaxine suc er 50 mg tb 1 QL 30/30dexmethylphenidate 10 mg tab 1 QL 60/30dexmethylphenidate 2.5 mg tab 1 QL 60/30dexmethylphenidate 5 mg tab 1 QL 120/30dexmethylphenidate er 10 mg cp 1 QL 30/30dexmethylphenidate er 15 mg cp 1 QL 30/30dexmethylphenidate er 20 mg cp 1 QL 30/30dexmethylphenidate er 25 mg cp 1 QL 30/30dexmethylphenidate er 30 mg cp 1 QL 30/30dexmethylphenidate er 35 mg cp 1 QL 30/30dexmethylphenidate er 40 mg cp 1 QL 30/30dexmethylphenidate er 5 mg cap 1 QL 30/30dextroamp-amphet er 10 mg cap 1 QL 60/30dextroamp-amphet er 15 mg cap 1 QL 60/30dextroamp-amphet er 20 mg cap 1 QL 60/30

77

Drug NameDrug Tier



Drug NameDrug Tier


dextroamp-amphet er 25 mg cap 1 QL 60/30dextroamp-amphet er 30 mg cap 1 QL 60/30dextroamp-amphet er 5 mg cap 1 QL 60/30dextroamp-amphetam 12.5 mg tab

1 QL 60/30

dextroamp-amphetam 7.5 mg tab 1 QL 60/30dextroamp-amphetamin 10 mg tab

1 QL 180/30

dextroamp-amphetamin 15 mg tab

1 QL 120/30


1 QL 90/30


1 QL 60/30

dextroamp-amphetamine 5 mg tab

1 QL 360/30

dextroamphetamine 10 mg tab 1 QL 180/30dextroamphetamine 5 mg tab 1 QL 180/30dextroamphetamine 5 mg/5 ml 1 QL 1800/30dextroamphetamine er 10 mg cap 1 QL 180/30dextroamphetamine er 15 mg cap 1 QL 120/30dextroamphetamine er 5 mg cap 1 QL 60/30diazepam 10 mg tablet 1 QL 120/30diazepam 10 mg/2 ml carpuject 1diazepam 2 mg tablet 1 QL 120/30diazepam 5 mg tablet 1 QL 120/30diazepam 5 mg/5 ml solution 1 QL 1200/30diazepam 5 mg/ml oral conc 1 QL 240/30diazepam 5 mg/ml vial 1doxepin 10 mg capsule 1 PA (HRM)doxepin 10 mg/ml oral conc 1 PA (HRM)doxepin 100 mg capsule 1 PA (HRM)doxepin 150 mg capsule 1 PA (HRM)doxepin 25 mg capsule 1 PA (HRM)doxepin 50 mg capsule 1 PA (HRM)doxepin 75 mg capsule 1 PA (HRM)duloxetine hcl dr 20 mg cap 1 QL 180/30duloxetine hcl dr 30 mg cap 1 QL 90/30duloxetine hcl dr 40 mg cap 1 QL 90/30duloxetine hcl dr 60 mg cap 1 QL 60/30

EFFEXOR XR 150 MG CAPSULE 2 QL 60/30,EC

EFFEXOR XR 37.5 MG CAPSULE 2 QL 30/30,EC

EFFEXOR XR 75 MG CAPSULE 2 QL 90/30,EC

EMSAM 12 MG/24 HOURS PATCH 4 QL 30/30EMSAM 6 MG/24 HOURS PATCH 4 QL 30/30EMSAM 9 MG/24 HOURS PATCH 4 QL 30/30ergoloid mesylates 1 mg tab 1 PA (HRM)escitalopram 10 mg tablet 1escitalopram 20 mg tablet 1escitalopram 5 mg tablet 1escitalopram oxalate 5 mg/5 ml 1 QL 600/30estazolam 1 mg tablet 1 QL 30/30estazolam 2 mg tablet 1 QL 30/30eszopiclone 1 mg tablet 1eszopiclone 2 mg tablet 1eszopiclone 3 mg tablet 1FANAPT 1 MG TABLET 3 QL

60/30,STFANAPT 10 MG TABLET 4 QL






60/30,STFANAPT TITRATION PACK 3 QL

16/365,STFETZIMA 20-40 MG TITRATION PAK

3 QL 56/365,ST

FETZIMA ER 120 MG CAPSULE 3 QL 30/30,ST


78

Drug NameDrug Tier



Drug NameDrug Tier




fluoxetine 20 mg/5 ml solution 1 QL 600/30fluoxetine dr 90 mg capsule 1 QL 4/28fluoxetine hcl 10 mg capsule 1fluoxetine hcl 10 mg tablet 1fluoxetine hcl 20 mg capsule 1fluoxetine hcl 20 mg tablet 1fluoxetine hcl 40 mg capsule 1fluoxetine hcl 60 mg tablet 1fluphenazine 1 mg tablet 1fluphenazine 10 mg tablet 1fluphenazine 2.5 mg tablet 1fluphenazine 2.5 mg/5 ml elix 1fluphenazine 2.5 mg/ml vial 1fluphenazine 5 mg tablet 1fluphenazine 5 mg/ml conc 1fluphenazine dec 125 mg/5 ml 1flurazepam 15 mg capsule 1flurazepam 30 mg capsule 1fluvoxamine er 100 mg capsule 1 QL 90/30fluvoxamine er 150 mg capsule 1 QL 60/30fluvoxamine maleate 100 mg tab 1fluvoxamine maleate 25 mg tab 1fluvoxamine maleate 50 mg tab 1FOCALIN 10 MG TABLET 2 QL

60/30,ECFOCALIN 2.5 MG TABLET 2 QL

60/30,ECFOCALIN 5 MG TABLET 2 QL

60/30,ECFOCALIN XR 10 MG CAPSULE 2 QL




30/30,EC

FOCALIN XR 30 MG CAPSULE 2 QL 30/30,EC




GEODON 20 MG CAPSULE 2 QL 60/30,EC

GEODON 20 MG/ML VIAL 3 QL 6/30GEODON 40 MG CAPSULE 2 QL

60/30,ECGEODON 60 MG CAPSULE 2 QL

60/30,ECGEODON 80 MG CAPSULE 2 QL

60/30,ECguanfacine hcl er 1 mg tablet 1 QL 30/30guanfacine hcl er 2 mg tablet 1 QL 30/30guanfacine hcl er 3 mg tablet 1 QL 30/30guanfacine hcl er 4 mg tablet 1 QL 30/30guanidine hcl 125 mg tablet 2haloperidol 0.5 mg tablet 1haloperidol 1 mg tablet 1haloperidol 10 mg tablet 1haloperidol 2 mg tablet 1haloperidol 20 mg tablet 1haloperidol 5 mg tablet 1haloperidol dec 100 mg/ml amp 1haloperidol dec 100 mg/ml vial 1haloperidol decan 50 mg/ml amp 1haloperidol lac 2 mg/ml conc 1haloperidol lac 5 mg/ml vial 1HETLIOZ 20 MG CAPSULE 4 PA,QL

30/30imipramine hcl 10 mg tablet 1 PA (HRM)imipramine hcl 25 mg tablet 1 PA (HRM)imipramine hcl 50 mg tablet 1 PA (HRM)imipramine pamoate 100 mg cap 1 PA (HRM)imipramine pamoate 125 mg cap 1 PA (HRM)imipramine pamoate 150 mg cap 1 PA (HRM)

79

Drug NameDrug Tier



Drug NameDrug Tier


imipramine pamoate 75 mg cap 1 PA (HRM)INVEGA SUSTENNA 117 MG/0.75 ML

4 QL 0.75/28

INVEGA SUSTENNA 156 MG/ML SYRG

4 QL 1/28

INVEGA SUSTENNA 234 MG/1.5 ML

4 QL 1.5/28


3 QL 0.25/28


4 QL 0.5/28

INVEGA TRINZA 273 MG/0.875 ML

4 QL 0.88/90

INVEGA TRINZA 410 MG/1.315 ML

4 QL 1.32/90

INVEGA TRINZA 546 MG/1.75 ML 4 QL 1.75/90INVEGA TRINZA 819 MG/2.625 ML

4 QL 2.63/90

LATUDA 120 MG TABLET 4 QL 30/30LATUDA 20 MG TABLET 4 QL 30/30LATUDA 40 MG TABLET 4 QL 30/30LATUDA 60 MG TABLET 4 QL 30/30LATUDA 80 MG TABLET 4 QL 60/30LEXAPRO 10 MG TABLET 2 QL

60/30,ECLEXAPRO 20 MG TABLET 2 QL

90/30,ECLEXAPRO 5 MG TABLET 2 QL

30/30,EClithium 8 meq/5 ml solution 1lithium carbonate 150 mg cap 1lithium carbonate 300 mg cap 1lithium carbonate 300 mg tab 1lithium carbonate 600 mg cap 1lithium carbonate er 300 mg tb 1lithium carbonate er 450 mg tb 1lorazepam 0.5 mg tablet 1 QL 120/30lorazepam 1 mg tablet 1 QL 120/30lorazepam 2 mg tablet 1 QL 150/30lorazepam 2 mg/ml carpuject 1lorazepam 2 mg/ml oral concent 1 QL 150/30lorazepam 20 mg/10 ml vial 1

lorazepam 4 mg/ml carpuject 1lorazepam 4 mg/ml vial 1LORAZEPAM INTENSOL 2 MG/ML 1 QL 150/30loxapine 10 mg capsule 1loxapine 25 mg capsule 1loxapine 5 mg capsule 1loxapine 50 mg capsule 1maprotiline 25 mg tablet 1maprotiline 50 mg tablet 1maprotiline 75 mg tablet 1MARPLAN 10 MG TABLET 3 QL 180/30METADATE CD 10 MG CAPSULE 2 QL

30/30,ECMETADATE CD 20 MG CAPSULE 2 QL





30/30,ECMETADATE ER 20 MG TABLET 1 QL 90/30methamphetamine 5 mg tablet 1 PA,DvEmethylphenidate 10 mg chew tab 1methylphenidate 10 mg tablet 1 QL 90/30methylphenidate 10 mg/5 ml sol 1methylphenidate 2.5 mg chew tb 1methylphenidate 20 mg tablet 1 QL 90/30methylphenidate 5 mg chew tab 1methylphenidate 5 mg tablet 1 QL 90/30methylphenidate 5 mg/5 ml soln 1methylphenidate cd 10 mg cap 1 QL 30/30methylphenidate cd 20 mg cap 1 QL 30/30methylphenidate cd 30 mg cap 1 QL 30/30methylphenidate cd 40 mg cap 1 QL 30/30methylphenidate cd 50 mg cap 1 QL 30/30methylphenidate cd 60 mg cap 1 QL 30/30methylphenidate er 10 mg tab 1 QL 90/30methylphenidate er 18 mg tab 1 QL 120/30

80

Drug NameDrug Tier



Drug NameDrug Tier


methylphenidate er 20 mg tab 1 QL 90/30methylphenidate er 27 mg tab 1 QL 30/30methylphenidate er 36 mg tab 1 QL 60/30methylphenidate er 54 mg tab 1 QL 30/30methylphenidate er(cd) 20mg cp 1 QL 30/30methylphenidate er(cd) 30mg cp 1 QL 30/30methylphenidate er(cd) 40mg cp 1 QL 30/30methylphenidate er(la) 10mg cp 1 QL 30/30methylphenidate er(la) 40mg cp 1 QL 30/30methylphenidate la 20 mg cap 1 QL 30/30methylphenidate la 30 mg cap 1 QL 30/30methylphenidate la 60 mg cap 1 QL 30/30midazolam hcl 2 mg/ml syrup 1mirtazapine 15 mg odt 1 QL 30/30mirtazapine 15 mg tablet 1mirtazapine 30 mg odt 1 QL 30/30mirtazapine 30 mg tablet 1mirtazapine 45 mg odt 1 QL 30/30mirtazapine 45 mg tablet 1mirtazapine 7.5 mg tablet 1modafinil 100 mg tablet 1 PA,QL

30/30,DvEmodafinil 200 mg tablet 1 PA,QL

60/30,DvEmolindone hcl 10 mg tablet 1molindone hcl 25 mg tablet 1molindone hcl 5 mg tablet 1nefazodone hcl 100 mg tablet 1nefazodone hcl 150 mg tablet 1nefazodone hcl 200 mg tablet 1nefazodone hcl 250 mg tablet 1nefazodone hcl 50 mg tablet 1nortriptyline 10 mg/5 ml soln 1nortriptyline hcl 10 mg cap 1nortriptyline hcl 25 mg cap 1nortriptyline hcl 50 mg cap 1nortriptyline hcl 75 mg cap 1NUPLAZID 10 MG TABLET 4 PA,QL

30/30NUPLAZID 17 MG TABLET 4 PA,QL

60/30

NUPLAZID 34 MG CAPSULE 4 PA,QL 30/30

olanzapine 10 mg tablet 1 QL 120/30olanzapine 10 mg vial 1 QL 30/30olanzapine 15 mg tablet 1 QL 60/30olanzapine 2.5 mg tablet 1 QL 120/30olanzapine 20 mg tablet 1 QL 60/30olanzapine 5 mg tablet 1 QL 120/30olanzapine 7.5 mg tablet 1 QL 30/30olanzapine odt 10 mg tablet 1 QL 30/30olanzapine odt 15 mg tablet 1 QL 30/30olanzapine odt 20 mg tablet 1 QL 30/30olanzapine odt 5 mg tablet 1 QL 30/30olanzapine-fluoxetine 12-25 mg 1 QL 30/30olanzapine-fluoxetine 12-50 mg 1 QL 30/30olanzapine-fluoxetine 3-25 mg 1 QL 30/30olanzapine-fluoxetine 6-25 mg 1 QL 30/30olanzapine-fluoxetine 6-50 mg 1 QL 30/30oxazepam 10 mg capsule 1 QL 120/30oxazepam 15 mg capsule 1 QL 120/30oxazepam 30 mg capsule 1 QL 120/30paliperidone er 1.5 mg tablet 1 QL 30/30paliperidone er 3 mg tablet 1 QL 30/30paliperidone er 6 mg tablet 1 QL 60/30paliperidone er 9 mg tablet 1 QL 30/30paroxetine er 12.5 mg tablet 1 QL 30/30paroxetine er 25 mg tablet 1 QL 90/30paroxetine er 37.5 mg tablet 1 QL 60/30paroxetine hcl 10 mg tablet 1 QL 60/30paroxetine hcl 20 mg tablet 1 QL 90/30paroxetine hcl 30 mg tablet 1 QL 60/30paroxetine hcl 40 mg tablet 1 QL 60/30PAXIL 10 MG TABLET 2 QL

30/30,ECPAXIL 10 MG/5 ML SUSPENSION 3 QL

900/30,STPAXIL 20 MG TABLET 2 QL

90/30,ECPAXIL 30 MG TABLET 2 QL

60/30,EC

81

Drug NameDrug Tier



Drug NameDrug Tier


PAXIL 40 MG TABLET 2 QL 60/30,EC

PAXIL CR 12.5 MG TABLET 2 QL 30/30,EC

PAXIL CR 25 MG TABLET 2 QL 90/30,EC

PAXIL CR 37.5 MG TABLET 2 QL 60/30,EC

perphen-amitrip 2 mg-10 mg tab 1 PA (HRM)perphen-amitrip 2 mg-25 mg tab 1 PA (HRM)perphen-amitrip 4 mg-10 mg tab 1 PA (HRM)perphen-amitrip 4 mg-25 mg tab 1 PA (HRM)perphen-amitrip 4 mg-50 mg tab 1 PA (HRM)perphenazine 16 mg tablet 1perphenazine 2 mg tablet 1perphenazine 4 mg tablet 1perphenazine 8 mg tablet 1PERSERIS ER 120 MG SYRINGE KIT

4 QL 1/30

PERSERIS ER 90 MG SYRINGE KIT

4 QL 1/30

phenelzine sulfate 15 mg tab 1pimozide 1 mg tablet 1pimozide 2 mg tablet 1PRISTIQ ER 100 MG TABLET 2 QL

30/30,ECPRISTIQ ER 25 MG TABLET 2 QL

30/30,ECPRISTIQ ER 50 MG TABLET 2 QL

30/30,ECprotriptyline hcl 10 mg tablet 1protriptyline hcl 5 mg tablet 1PROVIGIL 100 MG TABLET 2 PA,QL

30/30,DvEEC

PROVIGIL 200 MG TABLET 2 PA,QL 60/30,DvE

ECPROZAC 10 MG PULVULE 2 QL

30/30,ECPROZAC 20 MG PULVULE 2 QL

120/30,EC

PROZAC 40 MG PULVULE 2 QL 60/30,EC

PROZAC WEEKLY 90 MG CAPSULE

2 QL 4/28,EC

quetiapine er 150 mg tablet 1 QL 30/30quetiapine er 200 mg tablet 1 QL 30/30quetiapine er 300 mg tablet 1 QL 60/30quetiapine er 400 mg tablet 1 QL 60/30quetiapine er 50 mg tablet 1 QL 60/30quetiapine fumarate 100 mg tab 1 QL 90/30quetiapine fumarate 200 mg tab 1 QL 90/30quetiapine fumarate 25 mg tab 1 QL 90/30quetiapine fumarate 300 mg tab 1 QL 60/30quetiapine fumarate 400 mg tab 1 QL 60/30quetiapine fumarate 50 mg tab 1 QL 90/30QUILLIVANT XR 25 MG/5 ML SUSP

2 EC

REMERON 15 MG TABLET 2 QL 30/30,EC



REXULTI 0.25 MG TABLET 4 QL 30/30REXULTI 0.5 MG TABLET 4 QL 30/30REXULTI 1 MG TABLET 4 QL 30/30REXULTI 2 MG TABLET 4 QL 30/30REXULTI 3 MG TABLET 4 QL 30/30REXULTI 4 MG TABLET 4 QL 30/30RISPERDAL 0.25 MG TABLET 2 QL

60/30,ECRISPERDAL 0.5 MG TABLET 2 QL

60/30,ECRISPERDAL 1 MG TABLET 2 QL

60/30,ECRISPERDAL 1 MG/ML SOLUTION 2 QL



60/30,EC

82

Drug NameDrug Tier



Drug NameDrug Tier


RISPERDAL 4 MG TABLET 2 QL 120/30,EC

RISPERDAL CONSTA 12.5 MG SYR

3 QL 2/28

RISPERDAL CONSTA 25 MG SYR 3 QL 2/28RISPERDAL CONSTA 37.5 MG SYR

3 QL 2/28

RISPERDAL CONSTA 50 MG SYR 4 QL 2/28risperidone 0.25 mg odt 1 QL 60/30risperidone 0.25 mg tablet 1risperidone 0.5 mg odt 1 QL 120/30risperidone 0.5 mg tablet 1risperidone 1 mg odt 1 QL 60/30risperidone 1 mg tablet 1risperidone 1 mg/ml solution 1 QL 360/30risperidone 2 mg odt 1 QL 60/30risperidone 2 mg tablet 1risperidone 3 mg odt 1 QL 60/30risperidone 3 mg tablet 1risperidone 4 mg odt 1 QL 120/30risperidone 4 mg tablet 1RITALIN 10 MG TABLET 2 QL

90/30,ECRITALIN 20 MG TABLET 2 QL

90/30,ECRITALIN 5 MG TABLET 2 QL

90/30,ECRITALIN LA 10 MG CAPSULE 2 QL




30/30,ECROZEREM 8 MG TABLET 2 QL 30/30SAPHRIS 10 MG TAB SUBLINGUAL

2 QL 60/30

SAPHRIS 2.5 MG TAB SUBLINGUAL

2 QL 60/30

SAPHRIS 5 MG TAB SUBLINGUAL

2 QL 60/30

SEROQUEL 100 MG TABLET 2 QL 60/30,EC






SEROQUEL XR 150 MG TABLET 2 QL 30/30,EC





sertraline 20 mg/ml oral conc 1 QL 300/30sertraline hcl 100 mg tablet 1 QL 60/30sertraline hcl 25 mg tablet 1 QL 60/30sertraline hcl 50 mg tablet 1 QL 120/30SILENOR 3 MG TABLET 2 QL 30/30SILENOR 6 MG TABLET 2 QL 30/30temazepam 15 mg capsule 1temazepam 22.5 mg capsule 1temazepam 30 mg capsule 1temazepam 7.5 mg capsule 1thioridazine 10 mg tablet 1thioridazine 100 mg tablet 1thioridazine 25 mg tablet 1thioridazine 50 mg tablet 1thiothixene 1 mg capsule 1thiothixene 10 mg capsule 1thiothixene 2 mg capsule 1thiothixene 5 mg capsule 1tranylcypromine sulf 10 mg tab 1trazodone 100 mg tablet 1

83

Drug NameDrug Tier



Drug NameDrug Tier


trazodone 150 mg tablet 1trazodone 300 mg tablet 1trazodone 50 mg tablet 1triazolam 0.125 mg tablet 1triazolam 0.25 mg tablet 1trifluoperazine 1 mg tablet 1trifluoperazine 10 mg tablet 1trifluoperazine 2 mg tablet 1trifluoperazine 5 mg tablet 1trimipramine maleate 100 mg cp 1 PA (HRM)trimipramine maleate 25 mg cap 1 PA (HRM)trimipramine maleate 50 mg cap 1 PA (HRM)TRINTELLIX 10 MG TABLET 3 QL

30/30,STTRINTELLIX 20 MG TABLET 3 QL

30/30,STTRINTELLIX 5 MG TABLET 3 QL

30/30,STvenlafaxine hcl 100 mg tablet 1venlafaxine hcl 25 mg tablet 1venlafaxine hcl 37.5 mg tablet 1venlafaxine hcl 50 mg tablet 1venlafaxine hcl 75 mg tablet 1venlafaxine hcl er 150 mg cap 1 QL 60/30venlafaxine hcl er 150 mg tab 1 QL 60/30venlafaxine hcl er 225 mg tab 1 QL 30/30venlafaxine hcl er 37.5 mg cap 1 QL 60/30venlafaxine hcl er 37.5 mg tab 1 QL 30/30venlafaxine hcl er 75 mg cap 1 QL 90/30venlafaxine hcl er 75 mg tab 1 QL 30/30VERSACLOZ 50 MG/ML SUSPENSION

3 QL 540/30

VIIBRYD 10 MG TABLET 2 QL 30/30,ST

VIIBRYD 10-20 MG STARTER PACK

3 QL 60/365,ST



VRAYLAR 1.5 MG CAPSULE 4 QL 30/30,ST

VRAYLAR 1.5 MG-3 MG PACK 3 QL 14/365,ST

VRAYLAR 3 MG CAPSULE 4 QL 30/30,ST

VRAYLAR 4.5 MG CAPSULE 4 QL 30/30,ST

VRAYLAR 6 MG CAPSULE 4 QL 30/30,ST

VYVANSE 20 MG CAPSULE 2 QL 30/30,EC






WELLBUTRIN SR 100 MG TABLET

2 QL 60/30,EC


2 QL 60/30,EC


2 QL 60/30,EC

WELLBUTRIN XL 150 MG TABLET 2 QL 90/30,EC

WELLBUTRIN XL 300 MG TABLET 2 QL 30/30,EC

XYREM 500 MG/ML ORAL SOLUTION

4 PA,QL 540/30,DvE

zaleplon 10 mg capsule 1zaleplon 5 mg capsule 1ziprasidone hcl 20 mg capsule 1 QL 60/30ziprasidone hcl 40 mg capsule 1 QL 60/30ziprasidone hcl 60 mg capsule 1 QL 60/30ziprasidone hcl 80 mg capsule 1 QL 60/30ZOLOFT 100 MG TABLET 2 QL

60/30,EC

84

Drug NameDrug Tier



Drug NameDrug Tier


ZOLOFT 25 MG TABLET 2 QL 30/30,EC

ZOLOFT 50 MG TABLET 2 QL 120/30,EC

zolpidem tart er 12.5 mg tab 1zolpidem tart er 6.25 mg tab 1zolpidem tartrate 10 mg tablet 1zolpidem tartrate 5 mg tablet 1ZYPREXA 10 MG TABLET 2 QL

30/30,ECZYPREXA 15 MG TABLET 2 QL

30/30,ECZYPREXA 2.5 MG TABLET 2 QL



30/30,ECZYPREXA 7.5 MG TABLET 2 QL

30/30,ECZYPREXA RELPREVV 210 MG VL KIT

3 QL 2/28

ZYPREXA RELPREVV 300 MG VL KIT

4 QL 2/28

ZYPREXA RELPREVV 405 MG VL KIT

4 QL 1/28

PULMONARY AGENTSacetylcysteine 10% vial 1 PA,B/Dacetylcysteine 20% vial 1 PA,B/DADEMPAS 0.5 MG TABLET 4 PA,QL

90/30ADEMPAS 1 MG TABLET 4 PA,QL

90/30ADEMPAS 1.5 MG TABLET 4 PA,QL

90/30ADEMPAS 2 MG TABLET 4 PA,QL

90/30ADEMPAS 2.5 MG TABLET 4 PA,QL

90/30ADVAIR 100-50 DISKUS 2 QL 60/30ADVAIR 250-50 DISKUS 2 QL 60/30ADVAIR 500-50 DISKUS 2 QL 60/30

ADVAIR HFA 115-21 MCG INHALER

2 QL 12/30


2 QL 12/30


2 QL 12/30

albuterol 2.5 mg/0.5 ml sol 1 PA,B/Dalbuterol hfa 90 mcg inh (generic for proair hfa)

1 QL 17/30

albuterol hfa 90 mcg inhaler (generic for proventil hfa)

1 QL 13.4/30

albuterol hfa 90 mcg inhaler (generic for ventolin hfa)

1 QL 36/30

albuterol sul 0.63 mg/3 ml sol 1 PA,B/Dalbuterol sul 1.25 mg/3 ml sol 1 PA,B/Dalbuterol sul 2.5 mg/3 ml soln 1 PA,B/Dalbuterol sulf 2 mg/5 ml syrup 1albuterol sulfate 2 mg tab 1albuterol sulfate 4 mg tab 1albuterol sulfate er 4 mg tab 1albuterol sulfate er 8 mg tab 1ALVESCO 160 MCG INHALER 3 STALVESCO 80 MCG INHALER 3 STALYQ 20 MG TABLET 4 PA,QL

60/30,DvEambrisentan 10 mg tablet 4 PA,QL

30/30ambrisentan 5 mg tablet 4 PA,QL

30/30ANORO ELLIPTA 62.5-25 MCG INH

2 QL 60/30

ARNUITY ELLIPTA 100 MCG INH 2 QL 30/30ARNUITY ELLIPTA 200 MCG INH 2 QL 30/30ARNUITY ELLIPTA 50 MCG INH 2 QL 30/30ASMANEX HFA 100 MCG INHALER

3 ST

ASMANEX HFA 200 MCG INHALER

3 ST

ASMANEX TWISTHALER 110 MCG #30

3 ST


3 ST

85

Drug NameDrug Tier



Drug NameDrug Tier



3 ST


3 ST


3 ST

ASMANEX TWISTHALR 220 MCG #120

3 ST

ATROVENT 17 MCG HFA INHALER

2 QL 25.8/30

BECONASE AQ 0.042% SPRAY 2 ECbosentan 125 mg tablet 4 PA,QL

60/30bosentan 62.5 mg tablet 4 PA,QL

60/30BREO ELLIPTA 100-25 MCG INH 2 QL 60/30BREO ELLIPTA 200-25 MCG INH 2 QL 60/30BROVANA 15 MCG/2 ML SOLUTION

3 PA,B/D

budesonide 0.25 mg/2 ml susp 1 PA,B/Dbudesonide 0.5 mg/2 ml susp 1 PA,B/Dbudesonide 1 mg/2 ml inh susp 1 PA,B/DCINRYZE 500 UNIT VIAL 4 PA,QL

100/30,B/DCOMBIVENT RESPIMAT 20-100 MCG

2 QL 8/30

cromolyn 20 mg/2 ml neb soln 1 PA,QL 240/30,B/D

DALIRESP 250 MCG TABLET 3 QL 30/30DALIRESP 500 MCG TABLET 3 QL 30/30DULERA 100 MCG/5 MCG INHALER

3

DULERA 200 MCG/5 MCG INHALER

3

DYMISTA NASAL SPRAY 2ESBRIET 267 MG CAPSULE 4 PA,QL

270/30ESBRIET 267 MG TABLET 4 PA,QL

270/30ESBRIET 801 MG TABLET 4 PA,QL

90/30FIRAZYR 30 MG/3 ML SYRINGE 4 PA,QL

18/30

FLOVENT 100 MCG DISKUS 2 QL 60/30FLOVENT 250 MCG DISKUS 2 QL 240/30FLOVENT 50 MCG DISKUS 2 QL 60/30FLOVENT HFA 110 MCG INHALER

2 QL 12/30

FLOVENT HFA 220 MCG INHALER

2 QL 24/30

FLOVENT HFA 44 MCG INHALER 2 QL 10.6/30flunisolide 0.025% spray 1 QL 50/30fluticasone prop 50 mcg spray 1 QL 16/30ICATIBANT 30 MG/3 ML SYRINGE 4 PA,QL

18/30INCRUSE ELLIPTA 62.5 MCG INH 2 QL 30/30iprat-albut 0.5-3(2.5) mg/3 ml 1 PA,B/Dipratropium br 0.02% soln 1 PA,B/DKALYDECO 150 MG TABLET 4 PA,QL

60/30KALYDECO 25 MG GRANULES PACKET

4 PA,QL 60/30

KALYDECO 50 MG GRANULES PACKET

4 PA,QL 60/30

KALYDECO 75 MG GRANULES PACKET

4 PA,QL 60/30

levalbuterol 0.31 mg/3 ml sol 1 PA,B/Dlevalbuterol 0.63 mg/3 ml sol 1 PA,B/Dlevalbuterol 1.25 mg/3 ml sol 1 PA,B/Dlevalbuterol conc 1.25 mg/0.5 1 PA,B/Dlevalbuterol tar hfa 45mcg inh 1 QL 30/30metaproterenol 10 mg tablet 1metaproterenol 10 mg/5 ml syr 1metaproterenol 20 mg tablet 1mometasone furoate 50 mcg spry 1 QL 34/30montelukast sod 10 mg tablet 1 QL 30/30montelukast sod 4 mg granules 1 QL 30/30montelukast sod 4 mg tab chew 1 QL 30/30montelukast sod 5 mg tab chew 1 QL 30/30OFEV 100 MG CAPSULE 4 PA,QL

60/30OFEV 150 MG CAPSULE 4 PA,QL

60/30OPSUMIT 10 MG TABLET 4 PA,QL

30/30

86

Drug NameDrug Tier



Drug NameDrug Tier


ORKAMBI 100 MG-125 MG TABLET

4 PA,QL 120/30

ORKAMBI 100-125 MG GRANULE PKT

4 PA,QL 56/28

ORKAMBI 150-188 MG GRANULE PKT

4 PA,QL 56/28

ORKAMBI 200 MG-125 MG TABLET

4 PA,QL 120/30

PERFOROMIST 20 MCG/2 ML SOLN

2 PA,QL 120/30,B/D

PROAIR HFA 90 MCG INHALER 2 QL 17/30PROAIR RESPICLICK INHAL POWDER

2 QL 2/30

PROLASTIN C 1,000 MG/20 ML VL 4 PA,B/DPROVENTIL HFA 90 MCG INHALER

3 QL 13.4/30

PULMICORT 180 MCG FLEXHALER

2 QL 2/30,ST,EC

PULMICORT 90 MCG FLEXHALER

2 QL 1/30,ST,EC

PULMOZYME 1 MG/ML AMPUL 4 PA,QL 150/30,B/D

QVAR REDIHALER 40 MCG 3 STQVAR REDIHALER 80 MCG 3 STRUCONEST 2,100 UNIT VIAL 4 PA,QL 8/30SEREVENT DISKUS 50 MCG 2 QL 60/30sildenafil 20 mg tablet (generic for revatio)

1 PA,QL 90/30,DvE

SINGULAIR 10 MG TABLET 2 QL 30/30,EC

SINGULAIR 4 MG TABLET CHEW 2 QL 30/30,EC

SINGULAIR 5 MG TABLET CHEW 2 QL 30/30,EC

SPIRIVA 18 MCG CP-HANDIHALER

3

SPIRIVA RESPIMAT 1.25 MCG INH

3

SPIRIVA RESPIMAT 2.5 MCG INH 3STIOLTO RESPIMAT INHAL SPRAY

3

STRIVERDI RESPIMAT INHAL SPRAY

3

SYMBICORT 160-4.5 MCG INHALER

3

SYMBICORT 80-4.5 MCG INHALER

3

tadalafil 20 mg tablet (generic for adcirca)

4 PA,QL 60/30,DvE

terbutaline sulf 1 mg/ml vial 1terbutaline sulfate 2.5 mg tab 1terbutaline sulfate 5 mg tab 1THEO-24 ER 100 MG CAPSULE 2THEO-24 ER 200 MG CAPSULE 2THEO-24 ER 300 MG CAPSULE 2THEO-24 ER 400 MG CAPSULE 2THEOCHRON ER 100 MG TABLET

1 +

THEOCHRON ER 200 MG TABLET

1 +

THEOCHRON ER 300 MG TABLET

1 +

theophylline 80 mg/15 ml soln 1theophylline er 100 mg tablet 1theophylline er 200 mg tablet 1theophylline er 300 mg tab 1theophylline er 400 mg tablet 1theophylline er 450 mg tab 1theophylline er 600 mg tablet 1TRACLEER 125 MG TABLET 4 PA,QL

60/30TRACLEER 32 MG TABLET FOR SUSP

4 PA

TRACLEER 62.5 MG TABLET 4 PA,QL 60/30

TRELEGY ELLIPTA 100-62.5-25 2 QL 60/30TUDORZA PRESSAIR 400 MCG INHAL

2 QL 1/30,EC

TYVASO 1.74 MG/2.9 ML SOLUTION

4 PA,B/D

TYVASO INHALATION REFILL KIT 4 PA,B/DTYVASO INHALATION STARTER KIT

4 PA,B/D

VENTAVIS 10 MCG/1 ML SOLUTION

4 PA,QL 270/30,B/D

87

Drug NameDrug Tier



Drug NameDrug Tier


VENTAVIS 20 MCG/1 ML SOLUTION

4 PA,QL 270/30,B/D

VENTOLIN HFA 90 MCG INHALER 3 QL 36/30VERAMYST 27.5 MCG NASAL SPRAY

3 QL 10/30,ST

XHANCE 93 MCG NASAL SPRAY 3 QL 16/30,ST

XOLAIR 150 MG VIAL 4 PA,QL 6/28XOLAIR 150 MG/ML SYRINGE 4 PA,QL 5/28XOLAIR 75 MG/0.5 ML SYRINGE 4 PA,QL 5/28XOPENEX HFA 45 MCG INHALER 2 QL

30/30,ECzafirlukast 10 mg tablet 1 QL 60/30zafirlukast 20 mg tablet 1 QL 60/30zileuton er 600 mg tablet 1

QUINOLONESBAXDELA 300 MG VIAL 3 QL 28/14BAXDELA 450 MG TABLET 3 QL 28/14ciprofloxacin 500 mg/5 ml susp 1ciprofloxacin hcl 100 mg tab 1ciprofloxacin hcl 250 mg tab 1ciprofloxacin hcl 500 mg tab 1ciprofloxacin hcl 750 mg tab 1ciprofloxacn-d5w 200 mg/100 ml 1ciprofloxacn-d5w 400 mg/200 ml 1levofloxacin 25 mg/ml solution 1levofloxacin 250 mg tablet 1levofloxacin 250 mg/50 ml-d5w 1levofloxacin 500 mg tablet 1levofloxacin 500 mg/100 ml-d5w 1levofloxacin 500 mg/20 ml vial 1levofloxacin 750 mg tablet 1levofloxacin 750 mg/150 ml-d5w 1moxifloxacin 400 mg/250 ml bag 1moxifloxacin hcl 400 mg tablet 1ofloxacin 300 mg tablet 1ofloxacin 400 mg tablet 1

RECTAL PREPARATIONSanucort-hc 25 mg suppository 1 +ANUSOL-HC 25 MG SUPPOSITORY

2 +

hemmorex-hc 25 mg suppository 1 +hemmorex-hc 30 mg suppository 1 +hydrocortisone ac 25 mg supp 1 +hydrocortisone ac 30 mg supp 1 +PROCTOCORT 30 MG SUPPOSITORY

2 +

ROSACEA AGENTS, TOPICALROSADAN 0.75% CREAM KIT 2 +ROSADAN 0.75% GEL KIT 2 +

SALIVA SUBSTITUTE AGENTSAQUORAL SPRAY 2 +CAPHOSOL SOLUTION 2 +NUMOISYN LIQUID 2 +XEROSTOMIA RELIEF SPRAY 2 +

Sexual DysfunctionADDYI 2 QL 30/30,+CAVERJECT 2 QL 6/30,+CIALIS 10 MG 2 QL 8/30,+CIALIS 2.5 MG 2 PA,DvEQL

8/30,+CIALIS 20 MG 2 QL 8/30,+CIALIS 5 MG 2 PA,DvEQL

8/30,+EDEX 2 QL 6/30,+LEVITRA 2 QL 8/30,+MUSE 2 QL 6/30,+PAPEVERINE-ALPROSTADIL 2 +PAPEVERINE-PHENTOLAMINE 2 +PAPEVERINE-PHENTOLAMINE-ALPROSTADIL

2 +

sildenafil 100 mg 1 QL 8/30,+sildenafil 25 mg 1 QL 8/30,+sildenafil 50 mg (generic viagra) 1 QL 8/30,+STAXYN 2 QL 8/30,+STENDRA 2 QL 8/30,+tadalafil 10 mg 1 QL 8/30,+tadalafil 2.5 mg 1 PA,DvEQL

8/30,+tadalafil 20 mg (generic cialis) 1 QL 8/30,+tadalafil 5 mg 1 PA,DvEQL

8/30,+

88

Drug NameDrug Tier



Drug NameDrug Tier


vardenafil tab 10 mg 1 QL 8/30,+vardenafil tab 2.5 mg 1 QL 8/30,+vardenafil tab 20 mg 1 QL 8/30,+vardenafil tab 5 mg 1 QL 8/30,+VIAGRA 2 QL 8/30,+

SMOKING DETERRENTSbupropion sr 150 mg tablet 1 QL 60/30CHANTIX 0.5 MG TABLET 2CHANTIX 1 MG CONT MONTH BOX

2

CHANTIX 1 MG TABLET 2CHANTIX STARTING MONTH BOX

2

NICOTROL CARTRIDGE 3NICOTROL NS 10 MG/ML SPRAY 3 QL 30/30

STEROID-ANTIBIOTIC COMBINATIONSneo-bacit-poly-hc eye ointment 1neomycin-poly-hc eye drops 1neomyc-polym-dexamet eye ointm

1

neomyc-polym-dexameth eye drop

1

NEO-POLYCIN HC EYE OINTMENT

1

PRED-G 1% EYE DROPS 2PRED-G S.O.P. EYE OINTMENT 2TOBRADEX EYE OINTMENT 2TOBRADEX ST EYE DROPS 3tobramycin-dexameth ophth susp

1

ZYLET EYE DROPS 2

STEROIDSdexamethasone 0.1% eye drop 1DUREZOL 0.05% EYE DROPS 3 ECFLAREX 0.1% EYE DROPS 3fluorometholone 0.1% drops 1FML FORTE 0.25% EYE DROPS 3FML S.O.P. 0.1% OINTMENT 3INVELTYS 1% EYE DROP 3LOTEMAX 0.5% EYE DROPS 3LOTEMAX 0.5% EYE OINTMENT 3

LOTEMAX 0.5% OPHTHALMIC GEL

3

LOTEMAX SM 0.38% OPHTH GEL 3MAXIDEX 0.1% EYE DROPS 3PRED MILD 0.12% EYE DROPS 2prednisolone ac 1% eye drop 1prednisolone sod 1% eye drop 1

SULFA'S / RELATED AGENTSsulfadiazine 500 mg tablet 1sulfamethoxazole-tmp ds tablet 1sulfamethoxazole-tmp inj vial 1sulfamethoxazole-tmp ss tablet 1sulfamethoxazole-tmp susp 1SULFATRIM PEDIATRIC SUSPENSION

2

SYMPATHOMIMETICSALPHAGAN P 0.1% DROPS 2ALPHAGAN P 0.15% EYE DROPS 2 ECapraclonidine hcl 0.5% drops 1brimonidine 0.2% eye drop 1brimonidine tartrate 0.15% drp 1IOPIDINE 1% EYE DROPS 3

TETRACYCLINE ANTIBIOTICSMORGIDOX 1X100 MG KIT 2 +MORGIDOX 1X50 MG KIT 2 +MORGIDOX 2X100 MG KIT 2 +

TETRACYCLINESdemeclocycline 150 mg tablet 1demeclocycline 300 mg tablet 1DOXY 100 VIAL 1doxycycline 25 mg/5 ml susp 1doxycycline hyc dr 100 mg tab 1doxycycline hyc dr 150 mg tab 1doxycycline hyc dr 75 mg tab 1doxycycline hyclate 100 mg cap 1doxycycline hyclate 100 mg tab 1doxycycline hyclate 100 mg vl 1doxycycline hyclate 20 mg tab 1doxycycline hyclate 50 mg cap 1doxycycline ir-dr 40 mg cap 1

89

Drug NameDrug Tier



Drug NameDrug Tier


doxycycline mono 100 mg cap 1doxycycline mono 100 mg tablet 1doxycycline mono 150 mg cap 1doxycycline mono 150 mg tablet 1doxycycline mono 50 mg cap 1doxycycline mono 50 mg tablet 1doxycycline mono 75 mg capsule 1 QL 60/30doxycycline mono 75 mg tablet 1minocycline 100 mg capsule 1minocycline 50 mg capsule 1minocycline 75 mg capsule 1minocycline hcl 100 mg tablet 1minocycline hcl 50 mg tablet 1minocycline hcl 75 mg tablet 1MONDOXYNE NL 100 MG CAPSULE

1

MONDOXYNE NL 50 MG CAPSULE

1

MONDOXYNE NL 75 MG CAPSULE

1

MORGIDOX 100 MG CAPSULE 1MORGIDOX 50 MG CAPSULE 1NUZYRA 100 MG VIAL 3 QL 15/14NUZYRA 150 MG TABLET 3 QL 30/14NUZYRA 150 MG TABLET-7 DAY 3 QL 30/14NUZYRA 150 MG-7 DAY WITH LOAD

3 QL 30/14

ORACEA 40 MG CAPSULE 2 ECSOLOXIDE DR 150 MG TABLET 1tetracycline 250 mg capsule 1tetracycline 500 mg capsule 1

THERAPY FOR ACNEadapalene 0.1% cream 1adapalene 0.1% gel 1adapalene 0.1% lotion 1 +adapalene 0.3% gel 1AMNESTEEM 10 MG CAPSULE 1AMNESTEEM 20 MG CAPSULE 1AMNESTEEM 40 MG CAPSULE 1AVITA 0.025% CREAM 2 PA,DvEAVITA 0.025% GEL 2 PA,DvE

azelaic acid 15% gel 1CLARAVIS 10 MG CAPSULE 1CLARAVIS 20 MG CAPSULE 1CLARAVIS 30 MG CAPSULE 1CLARAVIS 40 MG CAPSULE 1clind ph-benzoyl perox 1.2-5% 1CLINDACIN ETZ 1% PLEDGET 1CLINDACIN P 1% PLEDGETS 1clindamycin ph 1% gel 1clindamycin ph 1% solution 1clindamycin phos 1% pledget 1clindamycin phosp 1% lotion 1clindamycin phosphate 1% foam 1clindamycin-benzoyl perox 1-5% 1clinda-tretinoin 1.2%-0.025% 1ERY 2% PADS 1erythromycin 2% gel 1erythromycin 2% pledgets 1erythromycin 2% solution 1erythromycin-benzoyl gel 1FINACEA 15% FOAM 3FINACEA 15% GEL 3isotretinoin 10 mg capsule 1isotretinoin 20 mg capsule 1isotretinoin 30 mg capsule 1isotretinoin 40 mg capsule 1metronidazole 0.75% cream 1metronidazole 0.75% lotion 1metronidazole topical 0.75% gl 1metronidazole topical 1% gel 1MYORISAN 10 MG CAPSULE 1MYORISAN 20 MG CAPSULE 1MYORISAN 30 MG CAPSULE 1MYORISAN 40 MG CAPSULE 1NEUAC GEL 1ROSADAN 0.75% CREAM 1ROSADAN 0.75% GEL 1salicylic acid 6% gel 1 +tazarotene 0.1% cream 1TAZORAC 0.05% CREAM 3

90

Drug NameDrug Tier



Drug NameDrug Tier


TAZORAC 0.05% GEL 3 QL 100/30TAZORAC 0.1% CREAM 3TAZORAC 0.1% GEL 3 QL 100/30tretinoin 0.01% gel 1 PA,DvEtretinoin 0.025% cream 1 PA,DvEtretinoin 0.025% gel 1 PA,DvEtretinoin 0.05% cream 1 PA,DvEtretinoin 0.05% gel 1 PA,DvEtretinoin 0.1% cream 1 PA,DvEtretinoin gel micro 0.04% pump 1 PA,DvEtretinoin gel micro 0.04% tube 1 PA,DvEtretinoin gel micro 0.1% pump 1 PA,DvEtretinoin gel micro 0.1% tube 1 PA,DvEZENATANE 10 MG CAPSULE 1ZENATANE 20 MG CAPSULE 1ZENATANE 30 MG CAPSULE 1ZENATANE 40 MG CAPSULE 1

THYROID HORMONESARMOUR THYROID 120 MG TABLET

2

ARMOUR THYROID 15 MG TABLET

2


2


2


2


2


2


2

CYTOMEL 25 MCG TABLET 2 ECCYTOMEL 5 MCG TABLET 2 ECCYTOMEL 50 MCG TABLET 2 EClevothyroxine 100 mcg tablet 1levothyroxine 100 mcg/5 ml vl 1levothyroxine 112 mcg tablet 1levothyroxine 125 mcg tablet 1

levothyroxine 137 mcg tablet 1levothyroxine 150 mcg tablet 1levothyroxine 175 mcg tablet 1levothyroxine 200 mcg tablet 1levothyroxine 200 mcg/5 ml vl 1levothyroxine 25 mcg tablet 1levothyroxine 300 mcg tablet 1levothyroxine 50 mcg tablet 1levothyroxine 500 mcg/5 ml vl 1levothyroxine 75 mcg tablet 1levothyroxine 88 mcg tablet 1LEVOXYL 100 MCG TABLET 2LEVOXYL 112 MCG TABLET 2LEVOXYL 125 MCG TABLET 2LEVOXYL 137 MCG TABLET 2LEVOXYL 150 MCG TABLET 2LEVOXYL 175 MCG TABLET 2LEVOXYL 200 MCG TABLET 2LEVOXYL 25 MCG TABLET 2LEVOXYL 50 MCG TABLET 2LEVOXYL 75 MCG TABLET 2LEVOXYL 88 MCG TABLET 2liothyronine sod 25 mcg tab 1liothyronine sod 5 mcg tab 1liothyronine sod 50 mcg tab 1nature-throid 113.75 mg tablet 1 +nature-throid 130 mg tablet 1 +nature-throid 146.25 mg tablet 1 +nature-throid 16.25 mg tablet 1 +nature-throid 162.5 mg tablet 1 +nature-throid 195 mg tablet 1 +nature-throid 260 mg tablet 1 +nature-throid 32.5 mg tablet 1 +nature-throid 325 mg tablet 1 +nature-throid 48.75 mg tablet 1 +nature-throid 65 mg tablet 1 +nature-throid 81.25 mg tablet 1 +nature-throid 97.5 mg tablet 1 +NP THYROID 120 MG TABLET 1NP THYROID 15 MG TABLET 1

91

Drug NameDrug Tier



Drug NameDrug Tier


NP THYROID 30 MG TABLET 1NP THYROID 60 MG TABLET 1NP THYROID 90 MG TABLET 1SYNTHROID 100 MCG TABLET 2SYNTHROID 112 MCG TABLET 2SYNTHROID 125 MCG TABLET 2SYNTHROID 137 MCG TABLET 2SYNTHROID 150 MCG TABLET 2SYNTHROID 175 MCG TABLET 2SYNTHROID 200 MCG TABLET 2SYNTHROID 25 MCG TABLET 2SYNTHROID 300 MCG TABLET 2SYNTHROID 50 MCG TABLET 2SYNTHROID 75 MCG TABLET 2SYNTHROID 88 MCG TABLET 2thyroid 120 mg tablet 1thyroid 15 mg tablet 1THYROID 30 MG TABLET 1THYROID 60 MG TABLET 1THYROID 90 MG TABLET 1THYROLAR-1 STRENGTH TABLET

2

THYROLAR-1/2 STRENGTH TAB 2THYROLAR-1/4 STRENGTH TAB 2THYROLAR-2 STRENGTH TABLET

2

THYROLAR-3 STRENGTH TABLET

2

TIROSINT 100 MCG CAPSULE 2 ECTIROSINT 112 MCG CAPSULE 2 ECTIROSINT 125 MCG CAPSULE 2 ECTIROSINT 13 MCG CAPSULE 2 ECTIROSINT 137 MCG CAPSULE 2 ECTIROSINT 150 MCG CAPSULE 2 ECTIROSINT 175 MCG CAPSULE 2 ECTIROSINT 200 MCG CAPSULE 2 ECTIROSINT 25 MCG CAPSULE 2 ECTIROSINT 50 MCG CAPSULE 2 ECTIROSINT 75 MCG CAPSULE 2 ECTIROSINT 88 MCG CAPSULE 2 EC

TIROSINT-SOL 100 MCG/ML SOLN

2 EC


2 EC


2 EC

TIROSINT-SOL 13 MCG/ML SOLN 2 ECTIROSINT-SOL 137 MCG/ML SOLN

2 EC


2 EC


2 EC


2 EC

TIROSINT-SOL 25 MCG/ML SOLN 2 ECTIROSINT-SOL 50 MCG/ML SOLN 2 ECTIROSINT-SOL 75 MCG/ML SOLN 2 ECTIROSINT-SOL 88 MCG/ML SOLN 2 ECUNITHROID 100 MCG TABLET 2UNITHROID 112 MCG TABLET 2UNITHROID 125 MCG TABLET 2UNITHROID 137 MCG TABLET 2UNITHROID 150 MCG TABLET 2UNITHROID 175 MCG TABLET 2UNITHROID 200 MCG TABLET 2UNITHROID 25 MCG TABLET 2UNITHROID 300 MCG TABLET 2UNITHROID 50 MCG TABLET 2UNITHROID 75 MCG TABLET 2UNITHROID 88 MCG TABLET 2westhroid 130 mg tablet 1 +westhroid 195 mg tablet 1 +westhroid 32.5 mg tablet 1 +westhroid 65 mg tablet 1 +westhroid 97.5 mg tablet 1 +WP THYROID 113.75 MG TABLET 2 +WP THYROID 130 MG TABLET 2 +WP THYROID 16.25 MG TABLET 2 +WP THYROID 32.5 MG TABLET 2 +WP THYROID 48.75 MG TABLET 2 +

92

Drug NameDrug Tier



Drug NameDrug Tier


WP THYROID 65 MG TABLET 2 +WP THYROID 81.25 MG TABLET 2 +WP THYROID 97.5 MG TABLET 2 +

TOPICAL AGENTS,MISCELLANEOUSGORDON'S UREA 22% OINTMENT

2 +

TOPICAL ANESTHETICSlidocaine hcl 4% solution 1ZTLIDO 1.8% TOPICAL SYSTEM 2

TOPICAL ANTIBACTERIALSgentamicin 0.1% cream 1gentamicin 0.1% ointment 1KLARON 10% LOTION 2mafenide acetate 50 gm powd pk 1mupirocin 2% cream 1mupirocin 2% ointment 1sodium sulf-sulfur cleanser 1 +sulfacetamide sod 10% top susp 1

TOPICAL ANTIBIOTIC AND ANTI-INFLAMMATORY STEROID

NEO-SYNALAR 0.5-0.025% CRM KIT

2 +

TOPICAL ANTIFUNGALSCICLODAN 0.77% CREAM KIT 2 +CICLODAN 8% SOLUTION 1ciclopirox 0.77% cream 1 QL 90/28ciclopirox 0.77% gel 1ciclopirox 0.77% topical susp 1ciclopirox 1% shampoo 1 QL 120/28ciclopirox 8% solution 1clotrimazole 1% cream 1clotrimazole 1% solution 1 QL 30/28clotrimazole-betamethasone crm 1 QL 45/28clotrimazole-betamethasone lot 1 QL 60/28econazole nitrate 1% cream 1 QL 85/28ketoconazole 2% cream 1 QL 60/28ketoconazole 2% shampoo 1 QL 120/28LOPROX 0.77% CREAM KIT 2 +LOPROX 0.77% SUSPENSION KIT

2 +

naftifine hcl 1% cream 1 QL 60/28naftifine hcl 2% cream 1 QL 60/28NAFTIN 1% GEL 2NAFTIN 2% CREAM 3 ECNAFTIN 2% GEL 2NYAMYC 100,000 UNITS/GM POWDER

1

nystatin 100,000 unit/gm cream 1 QL 30/28nystatin 100,000 unit/gm oint 1 QL 30/28nystatin 100,000 unit/gm powd 1nystatin-triamcinolone cream 1 QL 60/28nystatin-triamcinolone ointm 1 QL 60/28NYSTOP 100,000 UNITS/GM POWDER

1

oxiconazole nitrate 1% cream 1

TOPICAL ANTI-INFLAMMATORY STEROIDALDERMASORB HC 2% COMPLETE KIT

2 +

DERMASORB TA 0.1% COMPLETE KIT

2 +

SCALACORT DK 2% KIT 2 +ULTRAVATE X CREAM COMBO PACK

2 +

ULTRAVATE X OINTMENT COMBO PAC

2 +

TOPICAL ANTI-INFLAMMATORY STEROID-LOCAL ANESTHETIC

MEZPAROX-HC 2.5%-1% CREAM 2 +NOVACORT 2%-1% GEL 2 +PRAMOSONE 1%-1% OINTMENT 2 +PRAMOSONE 2.5%-1% CREAM 2 +PRAMOSONE 2.5%-1% OINTMENT

2 +

TOPICAL CORTICOSTEROIDSALA-CORT 1% CREAM 1alclometasone dipr 0.05% oint 1alclometasone dipro 0.05% crm 1APEXICON E 0.05% CREAM 1betamethasone dp 0.05% crm 1betamethasone dp 0.05% lot 1betamethasone dp 0.05% oint 1

93

Drug NameDrug Tier



Drug NameDrug Tier


betamethasone dp aug 0.05% crm

1

betamethasone dp aug 0.05% gel 1betamethasone dp aug 0.05% lot 1betamethasone dp aug 0.05% oin 1betamethasone va 0.1% cream 1betamethasone va 0.1% lotion 1betamethasone valer 0.1% ointm 1betamethasone valer 0.12% foam 1clobetasol 0.05% cream 1 QL 120/28clobetasol 0.05% gel 1 QL 120/28clobetasol 0.05% ointment 1 QL 120/28clobetasol 0.05% shampoo 1 QL 236/28clobetasol 0.05% solution 1 QL 100/28clobetasol 0.05% topical lotn 1clobetasol emollient 0.05% crm 1 QL 120/28clobetasol emollnt 0.05% foam 1clobetasol emulsion 0.05% foam 1clobetasol prop 0.05% foam 1 QL 100/28clobetasol prop 0.05% spray 1clocortolone pivalate 0.1% crm 1CLODAN 0.05% SHAMPOO 1 QL 236/28desonide 0.05% cream 1desonide 0.05% lotion 1desonide 0.05% ointment 1desoximetasone 0.05% cream 1desoximetasone 0.05% gel 1desoximetasone 0.05% ointment 1desoximetasone 0.25% cream 1desoximetasone 0.25% ointment 1fluocinolone 0.01% body oil 1fluocinolone 0.01% cream 1fluocinolone 0.01% scalp oil 1fluocinolone 0.01% solution 1fluocinolone 0.025% cream 1fluocinolone 0.025% ointment 1fluocinonide 0.05% cream 1fluocinonide 0.05% gel 1 QL 120/30fluocinonide 0.05% ointment 1 QL 120/30fluocinonide 0.05% solution 1 QL 120/30

fluocinonide 0.1% cream 1fluocinonide-e 0.05% cream 1flurandrenolide 0.05% cream 1flurandrenolide 0.05% lotion 1flurandrenolide 0.05% ointment 1fluticasone prop 0.005% oint 1fluticasone prop 0.05% cream 1fluticasone prop 0.05% lotion 1halobetasol prop 0.05% cream 1halobetasol prop 0.05% ointmnt 1hydrocort buty 0.1% lipid crm 1hydrocort buty 0.1% lipo cream 1hydrocortisone 1% absorbase 1hydrocortisone 1% cream 1hydrocortisone 1% ointment 1hydrocortisone 2.5% cream 1hydrocortisone 2.5% lotion 1hydrocortisone 2.5% ointment 1hydrocortisone buty 0.1% cream 1hydrocortisone butyr 0.1% oint 1hydrocortisone butyr 0.1% soln 1hydrocortisone val 0.2% cream 1hydrocortisone val 0.2% ointmt 1mometasone furoate 0.1% cream 1mometasone furoate 0.1% oint 1mometasone furoate 0.1% soln 1PANDEL 0.1% CREAM 3prednicarbate 0.1% cream 1prednicarbate 0.1% ointment 1TEXACORT 2.5% SOLUTION 1triamcinolone 0.025% cream 1triamcinolone 0.025% lotion 1triamcinolone 0.025% oint 1triamcinolone 0.1% cream 1triamcinolone 0.1% lotion 1triamcinolone 0.1% ointment 1triamcinolone 0.147 mg/g spray 1triamcinolone 0.5% cream 1triamcinolone 0.5% ointment 1TRIANEX 0.05% OINTMENT 4

94

Drug NameDrug Tier



Drug NameDrug Tier


TRIDERM 0.1% CREAM 1

TOPICAL LOCAL ANESTHETICSANASTIA 2.75% LOTION 2 +ASTERO 4% GEL PUMP 2 +cidaleaze 3% cream 1 +ethyl chloride spray 1 +LDO PLUS 4% HYDROGEL PUMP 2 +lidocaine 3% cream 1 +lidocaine hcl 3% lotion 1 +LIDOCAINE HCL 3.88% CREAM 2 +LIDODERM 5% PATCH 2 +lido-k 3% lotion 1 +LIDOPAC 5% OINTMENT-DRESSING

2 +

lidopin 3% cream 1 +LIDOPIN 3.25% CREAM 2 +LIDORX 3% GEL 2 +LIDOTRAL 3.88% CREAM 2 +LIDOVEX 3.75% CREAM 2 +lidozion 3% lotion 1 +LIDTOPIC MAX 10% CREAM 2 +NUMBONEX 2.75% LOTION 2 +pre-attached lta kit 1 +TRANZAREL 4% GEL 2 +

TOPICAL PREPARATIONS,ANTIBACTERIALSALA-QUIN 3-0.5% CREAM 2 +ALCORTIN A GEL 2 +ALOQUIN 1.25%-1% GEL 2 +dermazene cream 1 +hydrocort-iodoquinol-aloe sach 1 +hydrocortisone-iodoquinol crm 1 +iodoquinol-hydrocort-aloe gel 1 +QUINJA 1.25%-1% GEL 2 +VYTONE CREAM PACKET 2 +

TOPICAL SCABICIDES / PEDICULICIDESCROTAN 10% LOTION 1EURAX 10% CREAM 3lindane 1% lotion 1lindane 1% shampoo 1malathion 0.5% lotion 1

permethrin 5% cream 1SKLICE 0.5% LOTION 3spinosad 0.9% topical susp 1 +

TOPICAL SULFONAMIDESAVAR 9.5%-5% FOAM 2 +AVAR 9.5-5% CLEANSING PADS 2 +avar cleanser 1 +AVAR LS 10%-2% FOAM 2 +AVAR LS 10-2% CLEANSING PADS

2 +

AVAR LS CLEANSER 2 +AVAR-E EMOLLIENT CREAM 2 +AVAR-E GREEN EMOLLIENT CREAM

2 +

AVAR-E LS CREAM 2 +bp 10-1 wash 1 +PLEXION 9.8-4.8% CLEANSER 2 +PLEXION 9.8-4.8% CLNSING CLOTH

2 +

PLEXION 9.8-4.8% CREAM 2 +PLEXION 9.8-4.8% LOTION 2 +ROSANIL CLEANSER LOTION 2 +ROSULA 10%-4.5% WASH 2 +rosula 10%-5% cloths 1 +sod sulface-sulf 9.8-4.8% clsr 1 +sod sulface-sulfur 9-4.5% kit 1 +sod sulface-sulfur 9-4.5% wash 1 +sod sulfacetamide-sulfur lotn 1 +sod sulfacetamide-sulfur susp 1 +sod sulfacet-sulfur 10-2% clsr 1 +sod sulfacet-sulfur 10-4% pad 1 +sod sulfacet-sulfur 10-5% clsr 1 +sod sulfac-sulfur 9.8-4.8% crm 1 +sod sulfac-sulfur 9.8-4.8% lot 1 +sodium sulfacet-sulfur wash 1 +sss 10-5 cream 1 +sss 10-5 foam 1 +sulfacet sod-sulfur 10-4% pad 1 +sulfacetamide-sulfur 10-2% crm 1 +sulfacetamide-sulfur 10-5% crm 1 +

95

Drug NameDrug Tier



Drug NameDrug Tier


sulfacetamide-sulfur 8-4% susp 1 +sulfacleanse 8-4 suspension 1 +SUMADAN 9%-4.5% WASH 2 +SUMADAN KIT 2 +SUMADAN XLT KIT 2 +SUMAXIN CLEANSING PADS 2 +SUMAXIN CP KIT 2 +SUMAXIN TS TOPICAL SUSPENSION

2 +

SUMAXIN WASH 2 +

ULCER THERAPYACIPHEX DR 20 MG TABLET 2 QL

60/30,ECCARAFATE 1 GM/10 ML SUSP 2 ECcimetidine 200 mg tablet 1cimetidine 300 mg tablet 1cimetidine 300 mg/5 ml soln 1cimetidine 400 mg tablet 1cimetidine 800 mg tablet 1DEXILANT DR 30 MG CAPSULE 2 QL

60/30,ECDEXILANT DR 60 MG CAPSULE 2 QL

60/30,ECesomeprazole mag dr 20 mg cap 1 QL 60/30esomeprazole mag dr 40 mg cap 1 QL 60/30famotidine 20 mg tablet 1famotidine 20 mg/2 ml vial 1famotidine 40 mg tablet 1famotidine 40 mg/5 ml susp 1lansoprazol-amoxicil-clarithro 1lansoprazole dr 15 mg capsule 1 QL 60/30lansoprazole dr 30 mg capsule 1 QL 60/30lansoprazole odt 15 mg tablet 1 QL 60/30lansoprazole odt 30 mg tablet 1 QL 60/30misoprostol 100 mcg tablet 1misoprostol 200 mcg tablet 1NEXIUM DR 10 MG PACKET 2 QL

60/30,ECNEXIUM DR 2.5 MG PACKET 2 QL

60/30,EC

NEXIUM DR 20 MG CAPSULE 2 QL 60/30,EC

NEXIUM DR 20 MG PACKET 2 QL 60/30,EC

NEXIUM DR 40 MG CAPSULE 2 QL 60/30,EC



nizatidine 150 mg capsule 1nizatidine 300 mg capsule 1omeprazole dr 10 mg capsule 1 QL 60/30omeprazole dr 20 mg capsule 1 QL 60/30omeprazole dr 40 mg capsule 1 QL 60/30omeprazole-bicarb 20-1,100 cap 3 QL 60/30omeprazole-bicarb 20-1,680 pkt 3 QL 60/30omeprazole-bicarb 40-1,100 cap 3 QL 60/30omeprazole-bicarb 40-1,680 pkt 3 QL 60/30pantoprazole sod dr 20 mg tab 1 QL 60/30pantoprazole sod dr 40 mg tab 1 QL 60/30PREVACID 15 MG SOLUTAB 2 QL

60/30,ECPREVACID 30 MG SOLUTAB 2 QL

60/30,ECPREVACID DR 30 MG CAPSULE 2 QL

60/30,ECPROTONIX 40 MG SUSPENSION 2 QL

60/30,ECPROTONIX DR 20 MG TABLET 2 QL

60/30,ECPROTONIX DR 40 MG TABLET 2 QL

60/30,ECrabeprazole sod dr 20 mg tab 1 QL 60/30ranitidine 15 mg/ml syrup 1ranitidine 150 mg capsule 1ranitidine 150 mg tablet 1ranitidine 300 mg capsule 1ranitidine 300 mg tablet 1ranitidine hcl 50 mg/2 ml vial 1sucralfate 1 gm tablet 1

96

Drug NameDrug Tier



Drug NameDrug Tier


URINARY PH MODIFIERScytra-2 oral solution 1 +cytra-3 syrup 1 +cytra-k oral solution 1 +ORACIT ORAL SOLUTION 2 +phospha 250 neutral tablet 1 +phosphorous 250 mg tablet 1 +phospho-trin 250 neutral tab 1 +pot citrate-citric acid packet 1 +potass cit-sod cit-citric soln 1 +SHOHL'S MODIFIED SOLUTION 2 +tricitrates oral solution 1 +virt-phos 250 neutral tablet 1 +virtrate-2 solution 1 +virtrate-3 solution 1 +virtrate-k solution 1 +

URINARY TRACT AGENTSmethenamine hipp 1 gm tablet 1methenamine md 1 gm tablet 1methenamine md 500 mg tablet 1MONUROL 3 GM SACHET 3nitrofurantoin 25 mg/5 ml susp 1nitrofurantoin mcr 100 mg cap 1nitrofurantoin mcr 25 mg cap 1nitrofurantoin mcr 50 mg cap 1nitrofurantoin mono-mcr 100 mg 1PRIMSOL 50 MG/5 ML ORAL SOLN

3

trimethoprim 100 mg tablet 1

URINARY TRACT ANESTHETIC/ANALGESIC AGNT (AZO-DYE)

PYRIDIUM 100 MG TABLET 2 +PYRIDIUM 200 MG TABLET 2 +

VACCINES / MISCELLANEOUS IMMUNOLOGICALS

ACTHIB VACCINE WITH DILUENT 2ADACEL TDAP SYRINGE 2 QL 0.5/365ADACEL TDAP VIAL 2 QL 0.5/365ATGAM 50 MG/ML AMPUL 3 PA,B/Dbcg vaccine (tice strain) vial 2

BEXSERO PREFILLED SYRINGE 2BIVIGAM LIQUID 10% VIAL 4 PA,B/DBOOSTRIX TDAP VACCINE SYRINGE

2 QL 0.5/365

BOOSTRIX TDAP VACCINE VIAL 2 QL 0.5/365BOTOX 100 UNIT VIAL 3 PA,DvEBOTOX 200 UNIT VIAL 3 PA,DvEDAPTACEL DTAP VACCINE 2diphtheria-tetanus toxoids-ped 2ENGERIX-B 20 MCG/ML SYRN 2 PA,QL

8/365,B/DENGERIX-B PEDI 10 MCG/0.5 SYRN

2 PA,QL 3/365,B/D

FLEBOGAMMA DIF 10% VIAL 4 PA,B/DFLEBOGAMMA DIF 5% VIAL 4 PA,B/Dfomepizole 1.5 gm/1.5 ml vial 4GAMASTAN S-D VIAL 3 PA,B/DGAMASTAN VIAL 3 PA,B/DGAMMAGARD LIQUID 10% VIAL 4 PA,B/DGAMMAGARD S-D 10 G (IGA<1) SOL

4 PA,B/D

GAMMAGARD S-D 5 G (IGA<1) SOLN

4 PA,B/D

GAMMAKED 1 GRAM/10 ML VIAL 4 PA,B/DGAMMAKED 10 GRAM/100 ML VIAL

4 PA,B/D

GAMMAKED 2.5 GRAM/25 ML VIAL

4 PA,B/D

GAMMAKED 20 GRAM/200 ML VIAL

4 PA,B/D

GAMMAKED 5 GRAM/50 ML VIAL 4 PA,B/DGAMMAPLEX 10 GRAM/200 ML VIAL

4 PA,B/D

GAMMAPLEX 5 GRAM/100 ML VIAL

4 PA,B/D

GAMUNEX-C 1 GRAM/10 ML VIAL 4 PA,B/DGAMUNEX-C 10 GRAM/100 ML VIAL

4 PA,B/D

GAMUNEX-C 2.5 GRAM/25 ML VIAL

4 PA,B/D

GAMUNEX-C 20 GRAM/200 ML VIAL

4 PA,B/D

97

Drug NameDrug Tier



Drug NameDrug Tier


GAMUNEX-C 40 GRAM/400 ML VIAL

4 PA,B/D

GAMUNEX-C 5 GRAM/50 ML VIAL 4 PA,B/DGARDASIL 9 SYRINGE 2 QL 1.5/365GARDASIL 9 VIAL 2 QL 1.5/365HAVRIX 1,440 UNITS/ML SYRINGE

2

HAVRIX 1,440 UNITS/ML VIAL 2HAVRIX 720 UNIT/0.5 ML SYRINGE

2

HAVRIX 720 UNITS/0.5 ML VIAL 2HIBERIX VACCINE WITH DILUENT

2

IMOVAX RABIES VACCINE+DILUENT

2 PA,B/D

INFANRIX DTAP VIAL 2IPOL VIAL 2IXIARO 6 MCG/0.5 ML SYRINGE 2KINRIX TIP-LOK SYRINGE 2KINRIX VIAL 2MENACTRA VIAL 2MENVEO A-C-Y-W-135-DIP VIAL KT

2

M-M-R II VACCINE WITH DILUENT

2 QL 2/365

OCTAGAM 10% VIAL 4 PA,B/DOCTAGAM 5% VIAL 4 PA,B/DPEDIARIX 0.5 ML SYRINGE 2PEDVAXHIB VACCINE VIAL 2PRIVIGEN 10% VIAL 4 PA,B/DPROQUAD VIAL 2 QL 2/365QUADRACEL DTAP-IPV VIAL 2RABAVERT RABIES VACC W-DILUENT

2 PA,B/D

RECOMBIVAX HB 10 MCG/ML SYR

2 PA,QL 3/365,B/D

RECOMBIVAX HB 10 MCG/ML VIAL

2 PA,QL 3/365,B/D

RECOMBIVAX HB 40 MCG/ML VIAL

2 PA,QL 3/365,B/D

RECOMBIVAX HB 5 MCG/0.5 ML SYR

2 PA,QL 3/365,B/D

ROTARIX VACCINE SUSPENSION

2

ROTATEQ VACCINE 2SHINGRIX VIAL KIT 2 QL 2/999STAMARIL VIAL 2 QL 1/999tdvax vial 2TENIVAC SYRINGE 2 QL 0.5/28TRUMENBA 120 MCG/0.5 ML VACCIN

2

TWINRIX VACCINE SYRINGE 2TYPHIM VI 25 MCG/0.5 ML SYRNG

2

TYPHIM VI 25 MCG/0.5 ML VIAL 2VAQTA 25 UNITS/0.5 ML SYRINGE

2

VAQTA 25 UNITS/0.5 ML VIAL 2VAQTA 50 UNITS/ML SYRINGE 2VAQTA 50 UNITS/ML VIAL 2VARIVAX VACCINE WITH DILUENT

2 QL 1/365

VARIZIG 125 UNIT/1.2 ML VIAL 3 QL 12/30YF-VAX 1 DOSE VIAL 2ZOSTAVAX VIAL 2 QL 1/999

VASOCONSTRICTOR DECONGESTANTSnaphazoline 0.1% eye drops 1phenylephrine 2.5% eye drop 1 +

VASODILATORS,CORONARYnitroglycerin er 2.5 mg cap 1 +nitroglycerin er 6.5 mg cap 1 +nitroglycerin er 9 mg capsule 1 +nitro-time er 2.5 mg capsule 1 +nitro-time er 6.5 mg capsule 1 +nitro-time er 9 mg capsule 1 +

VASODILATORS,PERIPHERALisoxsuprine 10 mg tablet 1 +isoxsuprine 20 mg tablet 1 +

VITAMIN B PREPARATIONSPOTABA 500 MG CAPSULE 2 +

VITAMINS / HEMATINICSfluoride 1 mg tablet chewable 1FLUORITAB 1 MG TABLET CHEW 1

98

Drug NameDrug Tier



Drug NameDrug Tier


LUDENT FLUORIDE 1 MG TAB CHEW

1

sodium fluoride 1 mg (2.2 mg) 1VP-PNV-DHA SOFTGEL 2

99

Index of Medications

31abacavir 20 mg/ml solution

31abacavir 300 mg tablet32abacavir-lamivudine

600-300 mg32abacavir-lamivudine-

zidov tab14ABELCET 100 MG/20

ML VIAL75ABILIFY 10 MG

TABLET75ABILIFY 15 MG

TABLET75ABILIFY 2 MG TABLET75ABILIFY 20 MG

TABLET75ABILIFY 30 MG

TABLET75ABILIFY 5 MG TABLET75ABILIFY MAINTENA

ER 300 MG SYR75ABILIFY MAINTENA

ER 300 MG VL75ABILIFY MAINTENA

ER 400 MG SYR75ABILIFY MAINTENA

ER 400 MG VL22abiraterone acetate 250

mg tab22ABRAXANE 100 MG

VIAL51acamprosate calc dr

333 mg tab39acarbose 100 mg tablet39acarbose 25 mg tablet39acarbose 50 mg tablet15acebutolol 200 mg

capsule15acebutolol 400 mg

capsule

63acetamin-caff-dihydrocod 320.5

63acetaminop-codeine 120-12 mg/5

63acetaminophen-cod #2 tablet



71acetazolamide 125 mg tablet

71acetazolamide 250 mg tablet

71acetazolamide er 500 mg cap

72acetazolamide sod 500 mg vial

51acetic acid 0.25% irrig soln

62acetic acid 2% ear solution

85acetylcysteine 10% vial85acetylcysteine 20% vial96ACIPHEX DR 20 MG

TABLET31acitretin 10 mg capsule31acitretin 17.5 mg

capsule31acitretin 25 mg capsule97ACTHIB VACCINE

WITH DILUENT34ACTIMMUNE 100

MCG/0.5 ML VIAL71ACTONEL 150 MG

TABLET51ACTONEL 30 MG

TABLET71ACTONEL 35 MG

TABLET

71ACTONEL 5 MG TABLET

39ACTOPLUS MET 15 MG-500 MG TAB

39ACTOPLUS MET 15 MG-850 MG TAB

39ACTOPLUS MET XR 15-1,000 MG TB

39ACTOPLUS MET XR 30-1,000 MG TB

39ACTOS 15 MG TABLET39ACTOS 30 MG TABLET39ACTOS 45 MG TABLET69ACUVAIL 0.45%

OPHTH SOLUTION32acyclovir 200 mg

capsule32acyclovir 200 mg/5 ml

susp32acyclovir 400 mg tablet55acyclovir 5% cream55acyclovir 5% ointment32acyclovir 500 mg/10 ml

vial32acyclovir 800 mg tablet97ADACEL TDAP

SYRINGE97ADACEL TDAP VIAL51ADAGEN 250 UNIT/ML

VIAL90adapalene 0.1% cream90adapalene 0.1% gel90adapalene 0.1% lotion90adapalene 0.3% gel75ADDERALL XR 10 MG

CAPSULE75ADDERALL XR 15 MG

CAPSULE

100Comprehensive Formulary 2020

75ADDERALL XR 20 MG CAPSULE




88ADDYI32adefovir dipivoxil 10 mg

tab85ADEMPAS 0.5 MG

TABLET85ADEMPAS 1 MG

TABLET85ADEMPAS 1.5 MG

TABLET85ADEMPAS 2 MG

TABLET85ADEMPAS 2.5 MG

TABLET85ADVAIR 100-50

DISKUS85ADVAIR 250-50

DISKUS85ADVAIR 500-50

DISKUS85ADVAIR HFA 115-21

MCG INHALER85ADVAIR HFA 230-21

MCG INHALER85ADVAIR HFA 45-21

MCG INHALER22AFINITOR 10 MG

TABLET22AFINITOR 2.5 MG

TABLET22AFINITOR 5 MG

TABLET22AFINITOR 7.5 MG

TABLET22AFINITOR DISPERZ 2

MG TABLET

22AFINITOR DISPERZ 3 MG TABLET

22AFINITOR DISPERZ 5 MG TABLET

10AK-POLY-BAC EYE OINTMENT

93ALA-CORT 1% CREAM95ALA-QUIN 3-0.5%

CREAM53albendazole 200 mg

tablet85albuterol 2.5 mg/0.5 ml

sol85albuterol hfa 90 mcg inh

(generic for proair hfa)85albuterol hfa 90 mcg

inhaler (generic for proventil hfa)

85albuterol hfa 90 mcg inhaler (generic for ventolin hfa)

85albuterol sul 0.63 mg/3 ml sol

85albuterol sul 1.25 mg/3 ml sol

85albuterol sul 2.5 mg/3 ml soln

85albuterol sulf 2 mg/5 ml syrup

85albuterol sulfate 2 mg tab

85albuterol sulfate 4 mg tab

85albuterol sulfate er 4 mg tab

85albuterol sulfate er 8 mg tab

93alclometasone dipr 0.05% oint

93alclometasone dipro 0.05% crm

39ALCOHOL 70% PREP PADS

95ALCORTIN A GEL15ALDACTAZIDE 25-25

TABLET15ALDACTAZIDE 50-50

TABLET58ALDURAZYME 2.9

MG/5 ML VIAL22ALECENSA 150 MG

CAPSULE71alendronate sod 70

mg/75 ml71alendronate sodium 10

mg tab71alendronate sodium 35



mg tablet71alendronate sodium 70

mg tab34alfuzosin hcl er 10 mg

tablet22ALIMTA 100 MG VIAL22ALIMTA 500 MG VIAL53ALINIA 100 MG/5 ML

SUSPENSION53ALINIA 500 MG

TABLET22ALIQOPA 60 MG VIAL15aliskiren 150 mg tablet15aliskiren 300 mg tablet47allopurinol 100 mg tablet47allopurinol 300 mg tablet51almotriptan malate 12.5

mg tab51almotriptan malate 6.25

mg tab62ALOCRIL 2% EYE

DROPS


62ALOMIDE 0.1% EYE DROPS

95ALOQUIN 1.25%-1% GEL

45ALORA 0.025 MG PATCH



45ALORA 0.1 MG PATCH56alosetron hcl 0.5 mg

tablet56alosetron hcl 1 mg tablet89ALPHAGAN P 0.1%

DROPS89ALPHAGAN P 0.15%

EYE DROPS75alprazolam 0.25 mg

tablet75alprazolam 0.5 mg tablet75alprazolam 1 mg tablet75alprazolam 2 mg tablet75alprazolam er 0.5 mg

tablet75alprazolam er 1 mg



tablet76ALPRAZOLAM

INTENSOL 1 MG/ML76alprazolam odt 0.25 mg

tab76alprazolam odt 0.5 mg

tab76alprazolam odt 1 mg tab76alprazolam odt 2 mg tab76alprazolam xr 0.5 mg

tablet

76alprazolam xr 1 mg tablet



15ALTACE 1.25 MG CAPSULE

15ALTACE 10 MG CAPSULE

16ALTACE 2.5 MG CAPSULE

16ALTACE 5 MG CAPSULE

69ALTAVERA-28 TABLET49ALTOPREV 20 MG

TABLET49ALTOPREV 40 MG

TABLET49ALTOPREV 60 MG

TABLET22ALUNBRIG 180 MG



TABLET22ALUNBRIG 90 MG-180

MG TAB PACK85ALVESCO 160 MCG

INHALER85ALVESCO 80 MCG

INHALER69ALYACEN 1-35 28

TABLET69ALYACEN 7-7-7-28

TABLET85ALYQ 20 MG TABLET45AMABELZ 0.5 MG-0.1

MG TABLET45AMABELZ 1 MG-0.5

MG TABLET

32amantadine 100 mg capsule

32amantadine 100 mg tablet

32amantadine 50 mg/5 ml solution

39AMARYL 1 MG TABLET39AMARYL 2 MG TABLET39AMARYL 4 MG TABLET76AMBIEN 10 MG

TABLET76AMBIEN 5 MG TABLET76AMBIEN CR 12.5 MG

TABLET76AMBIEN CR 6.25 MG

TABLET14AMBISOME 50 MG

VIAL85ambrisentan 10 mg

tablet85ambrisentan 5 mg tablet69AMETHIA 0.15-0.03-

0.01 MG TAB69AMETHIA LO TABLET69AMETHYST 90-20

MCG TABLET53amikacin sulf 1 gram/4

ml vial53amikacin sulf 500 mg/2

ml vial16amiloride hcl 5 mg tablet16amiloride hcl-hctz 5-50

mg tab37aminocaproic acid

1,000 mg tab37aminocaproic acid 25%

solution37aminocaproic acid 500

mg tab61AMINOSYN 10% IV

SOLUTION


61AMINOSYN 7%-ELECTROLYTE SOL

61AMINOSYN 8.5% IV SOLUTION

61AMINOSYN 8.5%-ELECTROLYTES SOL

61AMINOSYN II 10% IV SOLUTION

61AMINOSYN II 15% IV SOLUTION

61AMINOSYN II 8.5% IV SOLUTION

61AMINOSYN II 8.5%-ELECTROLYTES

61AMINOSYN M 3.5% IV SOLUTION

61AMINOSYN-HBC 7% IV SOLUTION

61AMINOSYN-PF 10% IV SOLUTION

61AMINOSYN-PF 7% IV SOLUTION

61AMINOSYN-RF 5.2% IV SOLUTION

9amiodarone 150 mg/3 ml vial



9amiodarone hcl 100 mg tablet



56AMITIZA 24 MCG CAPSULES

56AMITIZA 8 MCG CAPSULE

76amitriptyline hcl 10 mg tab






16amlodipine besylate 10 mg tab

16amlodipine besylate 2.5 mg tab

16amlodipine besylate 5 mg tab

49amlodipine-atorvast 10-10 mg




49amlodipine-atorvast 2.5-10 mg







16amlodipine-benazepril 10-20 mg


16amlodipine-benazepril 2.5-10




16amlodipine-olmesartan 10-20 mg




16amlodipine-valsartan 10-160 mg




16amlod-valsa-hctz 10-160-12.5mg

16amlod-valsa-hctz 10-160-25 mg


16amlod-valsa-hctz 5-160-12.5 mg


55ammonium lactate 12% cream

55ammonium lactate 12% lotion

90AMNESTEEM 10 MG CAPSULE




73amox tr-k clv 200-28.5/5 susp

76amoxapine 100 mg tablet

76amoxapine 150 mg tablet

76amoxapine 25 mg tablet76amoxapine 50 mg tablet73amox-clav 200-28.5 mg

tab chew73amox-clav 200-28.5

mg/5 ml sus73amox-clav 250-125 mg

tablet73amox-clav 250-62.5


tab chew73amox-clav 400-57 mg/5

ml susp73amox-clav 500-125 mg

tablet73amox-clav 600-42.9


tablet73amox-clav er 1,000-62.5

mg tab73amoxicillin 125 mg tab

chew73amoxicillin 125 mg/5 ml

susp73amoxicillin 200 mg/5 ml

susp73amoxicillin 250 mg

capsule73amoxicillin 250 mg tab

chew73amoxicillin 250 mg/5 ml

susp

73amoxicillin 400 mg/5 ml susp

73amoxicillin 500 mg capsule

73amoxicillin 500 mg tablet73amoxicillin 875 mg tablet14amphotericin b 50 mg

vial73ampicillin 1 gm add-

vantage vl73ampicillin 1 gm vial73ampicillin 10 gm vial73ampicillin 125 mg vial73ampicillin 2 gm add-

vantage vl73ampicillin 2 gm vial73ampicillin 250 mg vial73ampicillin 500 mg

capsule73ampicillin 500 mg vial73ampicillin-sulb 1.5 g add

vial73ampicillin-sulbactam 1.5

gm vl73ampicillin-sulbactam 15

gm vl73ampicillin-sulbactam 3

gm vial63AMRIX ER 15 MG

CAPSULE63AMRIX ER 30 MG

CAPSULE58ANADROL-50 TABLET76ANAFRANIL 25 MG

CAPSULE76ANAFRANIL 50 MG

CAPSULE76ANAFRANIL 75 MG

CAPSULE51anagrelide hcl 0.5 mg

capsule

51anagrelide hcl 1 mg capsule

48ANA-LEX 2-2% KIT56ANALPRAM HC 1%

CREAM48ANALPRAM HC 2.5%-

1% CREAM48ANALPRAM HC 2.5%-

1% CRM SINGLE56ANALPRAM HC 2.5%-

1% LOTION14ANASPAZ 0.125 MG

TABLET ODT95ANASTIA 2.75%

LOTION23anastrozole 1 mg tablet58ANDRODERM 2

MG/24HR PATCH58ANDRODERM 4

MG/24HR PATCH58ANDROGEL 1.62%

GEL PUMP58ANDROGEL

1.62%(1.25G) GEL PCKT

58ANDROGEL 1.62%(2.5G) GEL PCKT

45ANGELIQ 0.25 MG-0.5 MG TABLET

45ANGELIQ 0.5 MG-1 MG TABLET

85ANORO ELLIPTA 62.5-25 MCG INH

51ANTABUSE 250 MG TABLET

51ANTABUSE 500 MG TABLET

49ANTARA 30 MG CAPSULE

49ANTARA 90 MG CAPSULE

88anucort-hc 25 mg suppository


88ANUSOL-HC 25 MG SUPPOSITORY

93APEXICON E 0.05% CREAM

39APIDRA 100 UNITS/ML VIAL

39APIDRA SOLOSTAR 100 UNITS/ML

76APLENZIN ER 174 MG TABLET



30APOKYN 30 MG/3 ML CARTRIDGE

89apraclonidine hcl 0.5% drops

56aprepitant 125 mg capsule

56aprepitant 125-80-80 mg pack



69APRI 28 DAY TABLET56APRISO ER 0.375

GRAM CAPSULE10APTIOM 200 MG

TABLET10APTIOM 400 MG



TABLET32APTIVUS 100 MG/ML

SOLUTION32APTIVUS 250 MG

CAPSULE74AQUASOL A 50,000

UNITS/ML VIAL

88AQUORAL SPRAY51ARALAST NP 1,000

MG VIAL51ARALAST NP 500 MG

VIAL69ARANELLE 28 TABLET34ARANESP 10 MCG/0.4

ML SYRINGE34ARANESP 100

MCG/0.5 ML SYRINGE34ARANESP 100

MCG/ML VIAL34ARANESP 150



MCG/ML VIAL34ARANESP 25

MCG/0.42 ML SYRING34ARANESP 25 MCG/ML

VIAL34ARANESP 300


MCG/ML VIAL34ARANESP 40 MCG/0.4

ML SYRINGE34ARANESP 40 MCG/ML

VIAL34ARANESP 500 MCG/1

ML SYRINGE34ARANESP 60 MCG/0.3

ML SYRINGE34ARANESP 60 MCG/ML

VIAL34ARCALYST 220 MG

INJECTION51ARESTIN 1 MG

MICROSPHERE23ARIMIDEX 1 MG

TABLET

76aripiprazole 1 mg/ml solution

76aripiprazole 10 mg tablet76aripiprazole 15 mg tablet76aripiprazole 2 mg tablet76aripiprazole 20 mg tablet76aripiprazole 30 mg tablet76aripiprazole 5 mg tablet76aripiprazole odt 10 mg

tablet76aripiprazole odt 15 mg

tablet76ARISTADA ER 1064

MG/3.9 ML SYR76ARISTADA ER 441

MG/1.6 ML SYRN76ARISTADA ER 662

MG/2.4 ML SYRN76ARISTADA ER 882

MG/3.2 ML SYRN76ARISTADA INITIO ER

675 MG/2.476armodafinil 150 mg

tablet76armodafinil 200 mg

tablet76armodafinil 250 mg

tablet76armodafinil 50 mg tablet91ARMOUR THYROID

120 MG TABLET91ARMOUR THYROID 15

MG TABLET91ARMOUR THYROID

180 MG TABLET91ARMOUR THYROID

240 MG TABLET91ARMOUR THYROID 30

MG TABLET91ARMOUR THYROID

300 MG TABLET


91ARMOUR THYROID 60 MG TABLET

91ARMOUR THYROID 90 MG TABLET

85ARNUITY ELLIPTA 100 MCG INH



23AROMASIN 25 MG TABLET

23arsenic trioxide 10 mg/10ml vl

56ASACOL HD DR 800 MG TABLET

63ASCOMP WITH CODEINE CAPSULE

74ascorbic acid 500 mg/ml vial

69ASHLYNA 0.15-0.03-0.01 MG TAB

85ASMANEX HFA 100 MCG INHALER

85ASMANEX HFA 200 MCG INHALER

85ASMANEX TWISTHALER 110 MCG #30





86ASMANEX TWISTHALR 220 MCG #120

37aspirin-dipyridam er 25-200 mg

23ASTAGRAF XL 0.5 MG CAPSULE

23ASTAGRAF XL 1 MG CAPSULE

23ASTAGRAF XL 5 MG CAPSULE

51ASTEPRO 0.15% NASAL SPRAY

95ASTERO 4% GEL PUMP

16ATACAND 16 MG TABLET




16ATACAND HCT 16-12.5 MG TAB

16ATACAND HCT 32-12.5 MG TAB

16ATACAND HCT 32-25 MG TABLET

32atazanavir sulfate 150 mg cap



16atenolol 100 mg tablet16atenolol 25 mg tablet16atenolol 50 mg tablet16atenolol-chlorthalidone

100-2516atenolol-chlorthalidone

50-2597ATGAM 50 MG/ML

AMPUL

76atomoxetine hcl 10 mg capsule







44ATOPADERM CREAM44ATOPICLAIR CREAM49atorvastatin 10 mg tablet49atorvastatin 20 mg tablet49atorvastatin 40 mg tablet49atorvastatin 80 mg tablet53atovaquone 750 mg/5

ml susp53atovaquone-proguanil

250-10053atovaquone-proguanil

62.5-2544ATRAPRO HYDROGEL32ATRIPLA TABLET14atropine 1 mg/ml vial62atropine 1% eye drops14atropine 8 mg/20 ml vial86ATROVENT 17 MCG

HFA INHALER59AUBAGIO 14 MG

TABLET59AUBAGIO 7 MG

TABLET69AUBRA-28 TABLET73AUGMENTIN 125-

31.25 MG/5 ML


51AURYXIA 210 MG TABLET

59AUSTEDO 12 MG TABLET



39AVANDIA 2 MG TABLET

39AVANDIA 4 MG TABLET

16AVAPRO 150 MG TABLET



95AVAR 9.5%-5% FOAM95AVAR 9.5-5%

CLEANSING PADS95avar cleanser95AVAR LS 10%-2%

FOAM95AVAR LS 10-2%

CLEANSING PADS95AVAR LS CLEANSER95AVAR-E EMOLLIENT

CREAM95AVAR-E GREEN

EMOLLIENT CREAM95AVAR-E LS CREAM23AVASTIN 100 MG/4 ML

VIAL23AVASTIN 400 MG/16

ML VIAL61AVC 15% CREAM69AVIANE-28 TABLET90AVITA 0.025% CREAM90AVITA 0.025% GEL

34AVODART 0.5 MG SOFTGEL

34AVONEX 30 MCG VIAL KIT

35AVONEX PEN 30 MCG/0.5 ML KIT

35AVONEX PREFILLED SYR 30 MCG KT

23AZASAN 100 MG TABLET

23AZASAN 75 MG TABLET

10AZASITE 1% EYE DROPS

23azathioprine 50 mg tablet

23azathioprine sod 100 mg vial

90azelaic acid 15% gel51azelastine 0.1% (137

mcg) spry51azelastine 0.15% nasal

spray62azelastine hcl 0.05%

drops74AZESCO TABLET44azithromycin 1 gm pwd

packet44azithromycin 100 mg/5

ml susp44azithromycin 200 mg/5

ml susp44azithromycin 250 mg

tablet44azithromycin 500 mg

tablet44azithromycin 600 mg

tablet44azithromycin i.v. 500 mg

vial72AZOPT 1% EYE

DROPS

16AZOR 10-20 MG TABLET

16AZOR 10-40 MG TABLET

16AZOR 5-20 MG TABLET16AZOR 5-40 MG TABLET53aztreonam 1 gm vial53aztreonam 2 gm vial69AZURETTE 28 DAY

TABLET74B-12 COMPLIANCE INJ

KIT53BACIIM 50,000 UNIT

VIAL53bacitracin 50,000 unit

vial10bacitracin 500 unit/gm

ophth10bacitracin-polymyxin

eye oint63baclofen 10 mg tablet63baclofen 20 mg tablet63baclofen 5 mg tablet51BACTROBAN NASAL

2% OINTMENT74BAL-CARE DHA

COMBO PACK74BAL-CARE DHA

ESSENTIAL PACK56balsalazide disodium

750 mg cp23BALVERSA 3 MG

TABLET23BALVERSA 4 MG

TABLET23BALVERSA 5 MG

TABLET69BALZIVA 28 TABLET11BANZEL 200 MG

TABLET


11BANZEL 40 MG/ML SUSPENSION

11BANZEL 400 MG TABLET

32BARACLUDE 0.05 MG/ML SOLUTION

23BAVENCIO 200 MG/10 ML VIAL

88BAXDELA 300 MG VIAL88BAXDELA 450 MG

TABLET97bcg vaccine (tice strain)

vial74b-complex 100 injection39BD INS SYR UF 0.5ML

12.7MMX30G39BD INSULIN SYR UF 1

ML 8MMX31G39BD SAFETYGLD INS 1

ML 13MMX29G39BD UF INS SYR 0.3 ML

31GX5/16"39BD UF MINI PEN

NEEDLE 5MMX31G39BD UF NANO PEN

NEEDLE 4MMX32G39BD UF ORIG PEN NDL

12.7MMX29G86BECONASE AQ

0.042% SPRAY69BEKYREE 28 DAY

TABLET14belladonna-opium 16.2-

30 supp14belladonna-opium 16.2-

60 supp34belladonna-

phenobarbital elixr34belladonna-

phenobarbital tab76BELSOMRA 10 MG

TABLET

76BELSOMRA 15 MG TABLET



16benazepril hcl 10 mg tablet




16benazepril-hctz 10-12.5 mg tab


16benazepril-hctz 20-25 mg tab


23BENDEKA 100 MG/4 ML VIAL

72BENLYSTA 120 MG VIAL

72BENLYSTA 400 MG VIAL

48BENSAL HP 3% OINTMENT

48BENZEFOAM 5.3% EMOLLIENT FOAM

48BENZEFOAM ULTRA 9.8% FOAM

48benzepro 6% foaming cloths

48BENZEPRO 7% CREAMY WASH

38benzonatate capsules 48benzoyl peroxide 5.3%

foam48benzoyl peroxide 9.8%

foam

30benztropine 2 mg/2 ml ampule

30benztropine mes 0.5 mg tab

30benztropine mes 1 mg tablet

30benztropine mes 2 mg tablet

10BESIVANCE 0.6% SUSP

23BESPONSA 0.9 MG VIAL

93betamethasone dp 0.05% crm

93betamethasone dp 0.05% lot

93betamethasone dp 0.05% oint

94betamethasone dp aug 0.05% crm

94betamethasone dp aug 0.05% gel

94betamethasone dp aug 0.05% lot

94betamethasone dp aug 0.05% oin

94betamethasone va 0.1% cream

94betamethasone va 0.1% lotion

94betamethasone valer 0.1% ointm

94betamethasone valer 0.12% foam

35BETASERON 0.3 MG KIT

16betaxolol 10 mg tablet16betaxolol 20 mg tablet34betaxolol hcl 0.5% eye

drop62bethanechol 10 mg

tablet


62bethanechol 25 mg tablet

62bethanechol 5 mg tablet62bethanechol 50 mg

tablet34BETIMOL 0.25% EYE

DROPS34BETIMOL 0.5% EYE

DROPS34BETOPTIC S 0.25%

EYE DROPS23bexarotene 75 mg

capsule97BEXSERO PREFILLED

SYRINGE23bicalutamide 50 mg

tablet73BICILLIN L-A 1,200,000

UNITS73BICILLIN L-A 2,400,000

UNITS73BICILLIN L-A 600,000

UNIT/ML16BIDIL TABLET32BIKTARVY 50-200-25

MG TABLET72bimatoprost 0.03% eye

drops71BINOSTO 70 MG

TABLET EFF75BIONECT 0.2% CREAM75BIONECT 0.2% FOAM75BIONECT 0.2% GEL16bisoprolol fumarate 10

mg tab16bisoprolol fumarate 5

mg tab16bisoprolol-hctz 10-6.25

mg tab16bisoprolol-hctz 2.5-6.25

mg tb

16bisoprolol-hctz 5-6.25 mg tab

97BIVIGAM LIQUID 10% VIAL

62BLEPHAMIDE EYE DROPS

62BLEPHAMIDE EYE OINTMENT

70BLISOVI 24 FE TABLET70BLISOVI FE 1.5-30

TABLET70BLISOVI FE 1-20

TABLET71BONIVA 150 MG

TABLET97BOOSTRIX TDAP

VACCINE SYRINGE97BOOSTRIX TDAP

VACCINE VIAL23bortezomib 3.5 mg vial86bosentan 125 mg tablet86bosentan 62.5 mg tablet23BOSULIF 100 MG

TABLET23BOSULIF 400 MG

TABLET23BOSULIF 500 MG

TABLET97BOTOX 100 UNIT VIAL97BOTOX 200 UNIT VIAL95bp 10-1 wash48bpo 4% gel48bpo 6% foaming cloths48bpo 8% gel23BRAFTOVI 75 MG

CAPSULE86BREO ELLIPTA 100-25

MCG INH86BREO ELLIPTA 200-25

MCG INH70BRIELLYN TABLET

37BRILINTA 60 MG TABLET

37BRILINTA 90 MG TABLET

89brimonidine 0.2% eye drop

89brimonidine tartrate 0.15% drp

11BRIVIACT 10 MG TABLET

11BRIVIACT 10 MG/ML ORAL SOLN





38bromfed dm cough syrup

69bromfenac sodium 0.09% eye drp

30bromocriptine 2.5 mg tablet

30bromocriptine 5 mg capsule

38bromphenir-pseudoephed-dm syr

86BROVANA 15 MCG/2 ML SOLUTION

86budesonide 0.25 mg/2 ml susp

86budesonide 0.5 mg/2 ml susp

86budesonide 1 mg/2 ml inh susp

56budesonide ec 3 mg capsule

16bumetanide 0.5 mg tablet

16bumetanide 1 mg tablet


16bumetanide 1 mg/4 ml vial

16bumetanide 2 mg tablet63BUPAP 50 MG-300 MG

TABLET68bupreno-nalox 2-0.5 mg

sl film68buprenor-nalox 12-3 mg

sl film63buprenorphine 0.3

mg/ml crpjct63buprenorphine 0.3

mg/ml vial63buprenorphine 10

mcg/hr patch63buprenorphine 15

mcg/hr patch63buprenorphine 2 mg

tablet sl63buprenorphine 20

mcg/hr patch63buprenorphine 5 mcg/hr

patch63buprenorphine 7.5

mcg/hr patch64buprenorphine 8 mg

tablet sl68buprenorphin-naloxon 8-

2 mg sl68buprenorphn-naloxn 2-

0.5 mg sl68buprenorp-nalox 4-1 mg

sl film68buprenorp-nalox 8-2 mg

sl film76bupropion hcl 100 mg

tablet76bupropion hcl 75 mg

tablet76bupropion hcl sr 100 mg

tablet76bupropion hcl sr 150 mg

tablet

76bupropion hcl sr 200 mg tablet

76bupropion hcl xl 150 mg tablet

76bupropion hcl xl 300 mg tablet

89bupropion sr 150 mg tablet

76buspirone hcl 10 mg tablet




77buspirone hcl 7.5 mg tablet

23busulfan 60 mg/10 ml vial

23BUSULFEX 60 MG/10 ML VIAL

64butalb-acetamin-caff 50-300-40

64butalb-acetamin-caff 50-325-40

64butalb-acetaminoph-caff-codein

64butalb-caff-acetaminoph-codein

64butalbital comp-codeine #3 cap

64butalbital-acetaminophn 50-300

64butalbital-acetaminophn 50-325

64butalbital-asa-caffeine cap

77BUTISOL SODIUM 30 MG TABLET

68butorphanol 1 mg/ml vial68butorphanol 10 mg/ml

spray

68butorphanol 2 mg/ml vial64BUTRANS 10 MCG/HR

PATCH64BUTRANS 15 MCG/HR



PATCH64BUTRANS 7.5

MCG/HR PATCH39BYDUREON 2 MG PEN

INJECT39BYDUREON BCISE 2

MG AUTOINJECT39BYETTA 10 MCG

DOSE PEN INJ39BYETTA 5 MCG DOSE

PEN INJ16BYSTOLIC 10 MG

TABLET17BYSTOLIC 2.5 MG

TABLET17BYSTOLIC 20 MG

TABLET17BYSTOLIC 5 MG

TABLET58cabergoline 0.5 mg

tablet23CABOMETYX 20 MG

TABLET23CABOMETYX 40 MG

TABLET23CABOMETYX 60 MG

TABLET74CADEAU DHA

SOFTGEL49CADUET 10 MG-10 MG

TABLET49CADUET 10 MG-20 MG

TABLET49CADUET 10 MG-40 MG

TABLET


49CADUET 10 MG-80 MG TABLET





17CALAN SR 120 MG CAPLET



31calcipotriene 0.005% cream

31calcipotriene 0.005% ointment

31calcipotriene 0.005% solution

58calcitonin-salmon 200 units sp

31CALCITRENE 0.005% OINTMENT

58calcitriol 0.25 mcg capsule




58calcitriol 1 mcg/ml ampul74calcitriol 1 mcg/ml ampul58calcitriol 1 mcg/ml

solution74calcitriol 1 mcg/ml

solution31calcitriol 3 mcg/g

ointment

43calcium acetate 667 mg gelcap

43calcium acetate 667 mg tablet

23CALQUENCE 100 MG CAPSULE

45CAMILA 0.35 MG TABLET

70CAMRESE 0.15-0.03-0.01 MG TAB

70CAMRESE LO TABLET56CANASA 1,000 MG

SUPPOSITORY17candesartan cilexetil 16

mg tb17candesartan cilexetil 32

mg tb17candesartan cilexetil 4

mg tab17candesartan cilexetil 8

mg tab17candesartan-hctz 16-

12.5 mg tb17candesartan-hctz 32-

12.5 mg tb17candesartan-hctz 32-25

mg tab53CAPASTAT SULFATE

1 GM VIAL38CAPCOF LIQUID88CAPHOSOL SOLUTION23CAPRELSA 100 MG

TABLET23CAPRELSA 300 MG

TABLET17captopril 100 mg tablet17captopril 12.5 mg tablet17captopril 25 mg tablet17captopril 50 mg tablet17captopril-hctz 25-15 mg

tablet

17captopril-hctz 25-25 mg tablet



96CARAFATE 1 GM/10 ML SUSP

51CARBAGLU 200 MG DISPER TABLET

11carbamazepine 100 mg tab chew

11carbamazepine 100 mg/5 ml susp

11carbamazepine 200 mg tablet

11carbamazepine er 100 mg cap

11carbamazepine er 100 mg tablet





30carbidopa 25 mg tablet30carbidopa-levo 10-100

mg odt30carbidopa-levo 25-100

mg odt30carbidopa-levo 25-250

mg odt30carbidopa-levo er 25-

100 tab30carbidopa-levo er 50-

200 tab30carbidopa-levodopa 100

mg-enta30carbidopa-levodopa 10-

100 tab


30carbidopa-levodopa 125 mg-enta



30carbidopa-levodopa 25-100 tab

30carbidopa-levodopa 25-250 tab



15carbinoxamine 4 mg/5 ml liquid

15carbinoxamine maleate 4 mg tab

17CARDIZEM LA 120 MG TABLET

17CARDURA XL 4 MG TABLET

17CARDURA XL 8 MG TABLET

63carisoprodl-aspirin 200-325 mg

63carisoprodol 250 mg tablet

63carisoprodol 350 mg tablet

63carisoprodol-aspirin-codein tb

51CARNITOR 1 GM/5 ML VIAL

34carteolol hcl 1% eye drops

17CARTIA XT 120 MG CAPSULE




17carvedilol 12.5 mg tablet17carvedilol 25 mg tablet17carvedilol 3.125 mg

tablet17carvedilol 6.25 mg tablet17carvedilol er 10 mg

capsule17carvedilol er 20 mg



capsule14caspofungin acetate 50

mg vial14caspofungin acetate 70

mg vial17CATAPRES-TTS 1

PATCH17CATAPRES-TTS 2

PATCH17CATAPRES-TTS 3

PATCH88CAVERJECT53CAYSTON 75 MG

INHAL SOLUTION70CAZIANT 28 DAY

TABLET35cefaclor 125 mg/5 ml

susp35cefaclor 250 mg capsule35cefaclor 250 mg/5 ml

susp35cefaclor 375 mg/5 ml

suspen35cefaclor 500 mg capsule35cefaclor er 500 mg tablet36cefadroxil 1 gm tablet

36cefadroxil 250 mg/5 ml susp

36cefadroxil 500 mg capsule

36cefadroxil 500 mg/5 ml susp

36cefazolin 1 g/50 ml-dextrose

36cefazolin 1 gm vial36cefazolin 10 gm vial36cefazolin 2 g/100 ml-

dextrose36cefazolin 2 g/50 ml-

dextrose36cefazolin 500 mg vial36cefdinir 125 mg/5 ml

susp36cefdinir 250 mg/5 ml

susp36cefdinir 300 mg capsule36cefepime 1 gm injection36cefepime 2 gm injection36cefepime hcl 1 gm vial36cefepime hcl 2 gram vial36cefepime-dextrose 1

gm/50 ml36cefepime-dextrose 2

gm/50 ml36cefixime 100 mg/5 ml

susp36cefixime 200 mg/5 ml

susp36cefixime 400 mg capsule36cefotaxime sodium 1

gm vial36cefotaxime sodium 500

mg vial36cefotetan 1 gm vial36cefotetan 10 gm vial36cefotetan 2 gm vial


36cefoxitin 1 gm vial36cefoxitin 10 gm vial36cefoxitin 2 gm vial36cefpodoxime 100 mg

tablet36cefpodoxime 100 mg/5

ml susp36cefpodoxime 200 mg

tablet36cefpodoxime 50 mg/5

ml susp36cefprozil 125 mg/5 ml

susp36cefprozil 250 mg tablet36cefprozil 250 mg/5 ml

susp36cefprozil 500 mg tablet36ceftazidime 1 gm

piggyback36ceftazidime 1 gm vial36ceftazidime 2 gm

piggyback36ceftazidime 2 gm vial36ceftazidime 6 gm vial36ceftriaxone 1 gm

piggyback36ceftriaxone 1 gm vial36ceftriaxone 10 gm vial36ceftriaxone 2 gm add

vial36ceftriaxone 2 gm

piggyback36ceftriaxone 2 gm vial36ceftriaxone 250 mg vial36ceftriaxone 500 mg vial36cefuroxime axetil 250

mg tab36cefuroxime axetil 500

mg tab

36cefuroxime sod 1.5 gm vial

36cefuroxime sod 7.5 gm vial

36cefuroxime sod 750 mg vial

44celacyn gel68CELEBREX 100 MG

CAPSULE68CELEBREX 200 MG



CAPSULE68celecoxib 100 mg

capsule68celecoxib 200 mg

capsule68celecoxib 400 mg

capsule68celecoxib 50 mg capsule77CELEXA 10 MG

TABLET77CELEXA 20 MG

TABLET77CELEXA 40 MG

TABLET23CELLCEPT 200 MG/ML

ORAL SUSP23CELLCEPT 250 MG

CAPSULE23CELLCEPT 500 MG

TABLET11CELONTIN 300 MG

KAPSEAL48cem-urea 45% pre-filled

appl36cephalexin 125 mg/5 ml

susp36cephalexin 250 mg

capsule

36cephalexin 250 mg tablet

36cephalexin 250 mg/5 ml susp

36cephalexin 500 mg capsule

36cephalexin 500 mg tablet

36cephalexin 750 mg capsule

44CERAMAX SKIN BARRIER CREAM

44CERAMAX SKIN BARRIER LOTION

58CEREZYME 400 UNITS VIAL

51cevimeline hcl 30 mg capsule

89CHANTIX 0.5 MG TABLET

89CHANTIX 1 MG CONT MONTH BOX

89CHANTIX 1 MG TABLET

89CHANTIX STARTING MONTH BOX

70CHATEAL-28 TABLET51CHEMET 100 MG

CAPSULE56CHENODAL 250 MG

TABLET38cheratussin ac syrup53chloramphen na succ 1

gm vl77chlordiazepo-amitriptyl

5-12.577chlordiazepox-amitriptyl

10-2577chlordiazepoxide 10 mg

capsule77chlordiazepoxide 25 mg

capsule


77chlordiazepoxide 5 mg capsule

14chlordiazepoxide-clidinium cap

51chlorhexidine 0.12% rinse

53chloroquine ph 250 mg tablet

53chloroquine ph 500 mg tablet

17chlorothiazide 250 mg tablet

17chlorothiazide 500 mg tablet

17chlorothiazide sod 500 mg vial

77chlorpromazine 10 mg tablet




77chlorpromazine 25 mg/ml amp


40chlorpropamide 100 mg tablet

40chlorpropamide 250 mg tablet

17chlorthalidone 25 mg tablet

17chlorthalidone 50 mg tablet

63chlorzoxazone 500 mg tablet

49cholestyramine light packet

49cholestyramine light powder

49cholestyramine packet

49cholestyramine powder58chorionic gonad 10,000

unit vl88CIALIS 10 MG88CIALIS 2.5 MG62CIALIS 2.5 MG TABLET88CIALIS 20 MG88CIALIS 5 MG62CIALIS 5 MG TABLET93CICLODAN 0.77%

CREAM KIT93CICLODAN 8%

SOLUTION93ciclopirox 0.77% cream93ciclopirox 0.77% gel93ciclopirox 0.77% topical

susp93ciclopirox 1% shampoo93ciclopirox 8% solution95cidaleaze 3% cream37cilostazol 100 mg tablet37cilostazol 50 mg tablet10CILOXAN 0.3%

OINTMENT32CIMDUO 300-300 MG

TABLET96cimetidine 200 mg tablet96cimetidine 300 mg tablet96cimetidine 300 mg/5 ml

soln96cimetidine 400 mg tablet96cimetidine 800 mg tablet56CIMZIA 200 MG VIAL

KIT56CIMZIA 200 MG/ML

STARTER KIT56CIMZIA 200 MG/ML

SYRINGE KIT

58cinacalcet hcl 30 mg tablet



86CINRYZE 500 UNIT VIAL

73CIPRO HC OTIC SUSPENSION

73CIPRODEX OTIC SUSPENSION

10ciprofloxacin 0.3% eye drop

88ciprofloxacin 500 mg/5 ml susp

88ciprofloxacin hcl 100 mg tab




88ciprofloxacn-d5w 200 mg/100 ml

88ciprofloxacn-d5w 400 mg/200 ml

77citalopram hbr 10 mg tablet

77citalopram hbr 10 mg/5 ml soln



90CLARAVIS 10 MG CAPSULE





15CLARINEX 0.5 MG/ML (2.5 MG/5)

15CLARINEX 5 MG TABLET

15CLARINEX-D 12 HOUR TABLET

44clarithromycin 125 mg/5 ml sus

44clarithromycin 250 mg tablet

44clarithromycin 250 mg/5 ml sus

44clarithromycin 500 mg tablet

44clarithromycin er 500 mg tab

15clemastine fum 2.68 mg tab

61CLEOCIN 100 MG VAGINAL OVULE

45CLIMARA 0.025 MG/DAY PATCH






45CLIMARA PRO PATCH90clind ph-benzoyl perox

1.2-5%90CLINDACIN ETZ 1%

PLEDGET90CLINDACIN P 1%

PLEDGETS62clindamycin 2% vaginal

cream

53clindamycin 300 mg/2 ml addvan

53clindamycin 300 mg/50 ml-ns



53clindamycin 900 mg/6 ml addvan

53clindamycin hcl 150 mg capsule



53clindamycin pediatr 75 mg/5 ml

90clindamycin ph 1% gel90clindamycin ph 1%

solution53clindamycin ph 300

mg/2 ml vl54clindamycin ph 600

mg/4 ml vl54clindamycin ph 9 g/60

ml vial54clindamycin ph 900

mg/6 ml vl90clindamycin phos 1%

pledget90clindamycin phosp 1%

lotion90clindamycin phosphate

1% foam90clindamycin-benzoyl

perox 1-5%54clindamycin-d5w 300

mg/50 ml54clindamycin-d5w 600

mg/50 ml54clindamycin-d5w 900

mg/50 ml

90clinda-tretinoin 1.2%-0.025%

62CLINDESSE 2% VAGINAL CREAM

61CLINIMIX 4.25%-10% SOLUTION



61CLINIMIX 5%-15% SOLUTION



51CLINIMIX E 2.75%-10% SOLUTION



61CLINIMIX N14G30E 4.25%-D15W

61CLINIMIX N9G15E 2.75%-D7.5W

61CLINISOL 15% SOLUTION

52CLINPRO 5000 1.1% TOOTHPASTE

11clobazam 10 mg tablet11clobazam 2.5 mg/ml

suspension11clobazam 20 mg tablet94clobetasol 0.05% cream94clobetasol 0.05% gel94clobetasol 0.05%

ointment94clobetasol 0.05%

shampoo94clobetasol 0.05%

solution


94clobetasol 0.05% topical lotn

94clobetasol emollient 0.05% crm

94clobetasol emollnt 0.05% foam

94clobetasol emulsion 0.05% foam

94clobetasol prop 0.05% foam

94clobetasol prop 0.05% spray

94clocortolone pivalate 0.1% crm

94CLODAN 0.05% SHAMPOO

58clomiphene citrate 50 mg tab

77clomipramine 25 mg capsule



11clonazepam 0.125 mg dis tab

11clonazepam 0.25 mg odt11clonazepam 0.5 mg dis

tablet11clonazepam 0.5 mg

tablet11clonazepam 1 mg dis

tablet11clonazepam 1 mg tablet11clonazepam 2 mg odt11clonazepam 2 mg tablet17clonidine 0.1 mg/day

patch17clonidine 0.2 mg/day

patch17clonidine 0.3 mg/day

patch

17clonidine hcl 0.1 mg tablet



77clonidine hcl er 0.1 mg tablet

37clopidogrel 300 mg tablet

37clopidogrel 75 mg tablet77clorazepate 15 mg tablet77clorazepate 3.75 mg

tablet77clorazepate 7.5 mg

tablet93clotrimazole 1% cream93clotrimazole 1% solution14clotrimazole 10 mg

troche93clotrimazole-

betamethasone crm93clotrimazole-

betamethasone lot77clozapine 100 mg tablet77clozapine 200 mg tablet77clozapine 25 mg tablet77clozapine 50 mg tablet77clozapine odt 100 mg

tablet77clozapine odt 12.5 mg

tablet77clozapine odt 150 mg



tablet54COARTEM TABLETS64codeine sulfate 30 mg

tablet

64codeine sulfate 60 mg tablet

38codeine-guaifen 10-100 mg/5 ml

38CODITUSSIN AC LIQUID

38CODITUSSIN DAC LIQUID

47colchicine 0.6 mg capsule

47colchicine 0.6 mg tablet47COLCRYS 0.6 MG

TABLET49colesevelam 625 mg

tablet49colesevelam hcl 3.75 g

packet49colestipol hcl granules49colestipol hcl granules

packet49colestipol micronized 1

gm tab54colistimethate 150 mg

vial56COLOCORT 100 MG

ENEMA73COLY-MYCIN S OTIC

SUSP DROP72COMBIGAN 0.2%-0.5%

EYE DROPS45COMBIPATCH 0.05-

0.14 MG PTCH45COMBIPATCH 0.05-

0.25 MG PTCH86COMBIVENT

RESPIMAT 20-100 MCG

23COMETRIQ 100 MG DAILY-DOSE PK

23COMETRIQ 140 MG DAILY-DOSE PK

23COMETRIQ 60 MG DAILY-DOSE PACK


32COMPLERA TABLET56COMPRO 25 MG

SUPPOSITORY74CONCEPT DHA

CAPSULE77CONCERTA ER 18 MG

TABLET77CONCERTA ER 27 MG



TABLET55CONDYLOX 0.5% GEL56CONSTULOSE 10

GM/15 ML SOLN60COPAXONE 20 MG/ML

SYRINGE60COPAXONE 40 MG/ML

SYRINGE23COPIKTRA 15 MG

CAPSULE23COPIKTRA 25 MG

CAPSULE17COREG 12.5 MG

TABLET17COREG 25 MG TABLET17COREG 3.125 MG

TABLET17COREG 6.25 MG

TABLET55CORLANOR 5 MG

TABLET55CORLANOR 7.5 MG

TABLET43CORTANE-B LOTION

8CORTEF 10 MG TABLET

8CORTEF 20 MG TABLET

8CORTEF 5 MG TABLET

56CORTIFOAM 10% AEROSOL

8cortisone 25 mg tablet23COSMEGEN 0.5 MG

VIAL72COSOPT EYE DROPS72COSOPT PF EYE

DROPS23COTELLIC 20 MG

TABLET37COUMADIN 1 MG



TABLET37COUMADIN 2.5 MG





TABLET37COUMADIN 7.5 MG

TABLET44covaryx h.s. tablet44covaryx tablet17COZAAR 100 MG

TABLET17COZAAR 25 MG

TABLET17COZAAR 50 MG

TABLET56CREON DR 12,000

UNITS CAPSULE56CREON DR 24,000

UNITS CAPSULE56CREON DR 3,000

UNITS CAPSULE

56CREON DR 36,000 UNITS CAPSULE

56CREON DR 6,000 UNITS CAPSULE

49CRESTOR 10 MG TABLET




45CRINONE 8% GEL32CRIXIVAN 200 MG

CAPSULE32CRIXIVAN 400 MG

CAPSULE56cromolyn 100 mg/5 ml

oral conc86cromolyn 20 mg/2 ml

neb soln62cromolyn 4% eye drops95CROTAN 10% LOTION70CRYSELLE-28 TABLET72CUPRIMINE 250 MG

CAPSULE40CURAD GAUZE PADS

2" X 2"74cyanocobalamin 1,000

mcg/ml70CYCLAFEM 1-35-28

TABLET70CYCLAFEM 7-7-7-28

TABLET63cyclobenzaprine 10 mg

tablet63cyclobenzaprine 5 mg

tablet63cyclobenzaprine 7.5 mg

tablet63cyclobenzaprine er 15

mg cap


63cyclobenzaprine er 30 mg cap

39CYCLOMYDRIL EYE DROPS

39cyclopentolate 0.5% eye drops

39cyclopentolate 1% eye drops

39cyclopentolate hcl 2% drops

23cyclophosphamide 1 gm vial

23cyclophosphamide 2 gm vial

23cyclophosphamide 25 mg capsule

23cyclophosphamide 50 mg capsule

23cyclophosphamide 500 mg vial

54cycloserine 250 mg capsule

40CYCLOSET 0.8 MG TABLET

23cyclosporine 100 mg capsule

23cyclosporine 25 mg capsule

23cyclosporine 50 mg/ml ampul

23cyclosporine modified 100 mg

23cyclosporine modified 100mg/ml



77CYMBALTA 20 MG CAPSULE



15cyproheptadine 2 mg/5 ml syrup

15cyproheptadine 4 mg tablet

23CYRAMZA 100 MG/10 ML VIAL

23CYRAMZA 500 MG/50 ML VIAL

70CYRED 28 DAY TABLET

70CYRED EQ 28 DAY TABLET

56CYSTADANE 1 GRAM/1.7 ML POWDER

62CYSTAGON 150 MG CAPSULE

62CYSTAGON 50 MG CAPSULE

62CYSTARAN 0.44% EYE DROPS

91CYTOMEL 25 MCG TABLET



97cytra-2 oral solution97cytra-3 syrup62CYTRA-K CRYSTALS

PACKET97cytra-k oral solution43d5%-1/2ns-kcl 10 meq/l

iv sol43d5%-1/2ns-kcl 30 meq/l

iv sol43d5%-1/2ns-kcl 40 meq/l

iv sol23dactinomycin 0.5 mg vial

60dalfampridine er 10 mg tablet

86DALIRESP 250 MCG TABLET

86DALIRESP 500 MCG TABLET

58danazol 100 mg capsule58danazol 200 mg capsule58danazol 50 mg capsule63dantrolene sodium 100

mg cap63dantrolene sodium 25

mg cap63dantrolene sodium 50

mg cap54dapsone 100 mg tablet54dapsone 25 mg tablet97DAPTACEL DTAP

VACCINE54daptomycin 350 mg vial54daptomycin 500 mg vial54DARAPRIM 25 MG

TABLET10darifenacin er 15 mg

tablet10darifenacin er 7.5 mg

tablet23DARZALEX 100 MG/5

ML VIAL23DARZALEX 400 MG/20

ML VIAL70DASETTA 1-35-28

TABLET70DASETTA 7/7/7-28

TABLET24daunorubicin 20 mg/4

ml vial24daunorubicin 50 mg/10

ml vial24DAURISMO 100 MG

TABLET


24DAURISMO 25 MG TABLET

70DAYSEE 0.15-0.03-0.01 MG TAB

9DEBACTEROL SOLUTION

9DEBACTEROL SWABSTICK

45DEBLITANE 0.35 MG TABLET

45DELESTROGEN 10 MG/ML VIAL

32DELSTRIGO 100-300-300 MG TAB

70DELYLA-28 TABLET56DELZICOL DR 400 MG

CAPSULE89demeclocycline 150 mg

tablet89demeclocycline 300 mg

tablet17DEMSER 250 MG

CAPSULE55DENAVIR 1% CREAM52DENTA 5000 PLUS

CREAM52DENTAGEL 1.1% GEL11DEPAKOTE DR 125

MG SPRINKLE CP11DEPAKOTE DR 125

MG TABLET11DEPAKOTE DR 250

MG TABLET11DEPAKOTE DR 500

MG TABLET11DEPAKOTE ER 250

MG TABLET11DEPAKOTE ER 500

MG TABLET72DEPEN 250 MG

TITRATAB

45DEPO-ESTRADIOL 5 MG/ML VIAL

8DEPO-MEDROL 20 MG/ML VIAL

45DEPO-PROVERA 400 MG/ML VIAL

58DEPO-TESTOSTERONE 100 MG/ML VL

58DEPO-TESTOSTERONE 200 MG/ML

93DERMASORB HC 2% COMPLETE KIT

93DERMASORB TA 0.1% COMPLETE KIT

95dermazene cream32DESCOVY 200-25 MG

TABLET77desipramine 10 mg

tablet77desipramine 100 mg





tablet15desloratadine 5 mg

tablet58desmopressin 0.01%

solution58desmopressin 10

mcg/0.1 ml spr58desmopressin 40

mcg/10 ml vial58desmopressin acetate

0.1 mg tb58desmopressin acetate

0.2 mg tb

70desogest-eth estra 0.15-0.03mg

70desogestr-eth estrad eth estra

94desonide 0.05% cream94desonide 0.05% lotion94desonide 0.05%

ointment94desoximetasone 0.05%

cream94desoximetasone 0.05%

gel94desoximetasone 0.05%

ointment94desoximetasone 0.25%

cream94desoximetasone 0.25%

ointment77desvenlafaxine er 100

mg tab77desvenlafaxine er 50

mg tab77desvenlafaxine suc er

100 mg77desvenlafaxine suc er

25 mg tb77desvenlafaxine suc er

50 mg tb10DETROL LA 2 MG

CAPSULE10DETROL LA 4 MG

CAPSULE89dexamethasone 0.1%

eye drop8dexamethasone 0.5 mg

tablet8dexamethasone 0.5

mg/5 ml elx8dexamethasone 0.5

mg/5 ml liq8dexamethasone 0.75

mg tablet


8dexamethasone 1 mg tablet

8dexamethasone 1.5 mg tablet

8dexamethasone 10 mg/ml vial

8dexamethasone 100 mg/10 ml vl

8dexamethasone 120 mg/30 ml vl


9dexamethasone 20 mg/5 ml vial


9dexamethasone 4 mg/ml vial


9DEXAMETHASONE INTENSOL 1 MG/ML

44DEXERYL CREAM96DEXILANT DR 30 MG

CAPSULE96DEXILANT DR 60 MG

CAPSULE77dexmethylphenidate 10

mg tab77dexmethylphenidate 2.5

mg tab77dexmethylphenidate 5

mg tab77dexmethylphenidate er

10 mg cp77dexmethylphenidate er




30 mg cp

77dexmethylphenidate er 35 mg cp

77dexmethylphenidate er 40 mg cp

77dexmethylphenidate er 5 mg cap

77dextroamp-amphet er 10 mg cap






78dextroamp-amphetam 12.5 mg tab

78dextroamp-amphetam 7.5 mg tab

78dextroamp-amphetamin 10 mg tab




78dextroamp-amphetamine 5 mg tab

78dextroamphetamine 10 mg tab

78dextroamphetamine 5 mg tab

78dextroamphetamine 5 mg/5 ml

78dextroamphetamine er 10 mg cap



52dextrose 10%-0.2% nacl iv soln

52dextrose 10%-0.45% nacl iv sol

52dextrose 10%-water iv solution

52dextrose 2.5%-0.45% nacl iv

52dextrose 20%-water iv soln

52dextrose 25%-water syringe




52dextrose 5%-0.225% nacl iv sol





43dextrose 5%-electrolyte 48

43dextrose 5%-lr iv solution



52dextrose 50%-water syringe



11DIASTAT 2.5 MG PEDI SYSTEM

11DIASTAT ACUDIAL 12.5-15-20 MG

11DIASTAT ACUDIAL 5-7.5-10 MG KT

11diazepam 10 mg rectal gel syst

78diazepam 10 mg tablet78diazepam 10 mg/2 ml

carpuject78diazepam 2 mg tablet11diazepam 2.5 mg rectal

gel sys11diazepam 20 mg rectal

gel syst78diazepam 5 mg tablet78diazepam 5 mg/5 ml

solution78diazepam 5 mg/ml oral

conc78diazepam 5 mg/ml vial69diclofenac 0.1% eye

drops68diclofenac 1.5% topical

soln68diclofenac pot 50 mg

tablet68diclofenac sod ec 25

mg tab68diclofenac sod ec 50

mg tab68diclofenac sod ec 75

mg tab68diclofenac sod er 100

mg tab68diclofenac sodium 1%

gel68diclofenac-misoprost 50-

200 tb68diclofenac-misoprost 75-

200 tb

74dicloxacillin 250 mg capsule

74dicloxacillin 500 mg capsule

14dicyclomine 10 mg capsule

14dicyclomine 10 mg/5 ml soln

14dicyclomine 20 mg tablet32didanosine dr 200 mg

capsule32didanosine dr 250 mg

capsule32didanosine dr 400 mg

capsule44DIFICID 200 MG

TABLET68diflunisal 500 mg tablet55DIGITEK 125 MCG

TABLET55DIGITEK 250 MCG

TABLET55DIGOX 125 MCG

TABLET55DIGOX 250 MCG

TABLET55digoxin 0.05 mg/ml

solution55digoxin 125 mcg tablet55digoxin 250 mcg tablet55digoxin 500 mcg/2 ml

ampule51dihydroergotamine 4

mg/ml spry11DILANTIN 100 MG

CAPSULE11DILANTIN 30 MG

CAPSULE11DILANTIN 50 MG

INFATAB17DILT XR 120 MG

CAPSULE

17DILT XR 180 MG CAPSULE

17DILT XR 240 MG CAPSULE

17DILT-CD 180 MG CAPSULE

17DILT-CD 240 MG CAPSULE

17diltiazem 100 mg add-van vial

17diltiazem 120 mg tablet17diltiazem 125 mg/25 ml

vial17diltiazem 12hr er 120

mg cap17diltiazem 12hr er 60 mg

cap17diltiazem 12hr er 90 mg

cap17diltiazem 24h er(cd) 120

mg cp17diltiazem 24h er(cd) 180




mg cp17diltiazem 24h er(la) 180

mg tb17diltiazem 24h er(la) 240




mg tb18diltiazem 24h er(xr) 120

mg cp18diltiazem 24h er(xr) 180

mg cp


18diltiazem 24h er(xr) 240 mg cp

18diltiazem 24hr cd 180 mg cap

18diltiazem 24hr er 120 mg cap






18diltiazem 25 mg/5 ml vial18diltiazem 30 mg tablet18diltiazem 50 mg/10 ml

vial18diltiazem 60 mg tablet18diltiazem 90 mg tablet18DIOVAN 160 MG

TABLET18DIOVAN 320 MG



TABLET18DIOVAN HCT 160-12.5

MG TAB18DIOVAN HCT 160-25

MG TABLET18DIOVAN HCT 320-12.5

MG TAB18DIOVAN HCT 320-25

MG TABLET18DIOVAN HCT 80-12.5

MG TABLET56DIPENTUM 250 MG

CAPSULE

15diphenhydramine 50 mg/ml vial

14diphenoxylat-atrop 2.5-0.025/5

14diphenoxylate-atrop 2.5-0.025

97diphtheria-tetanus toxoids-ped

37dipyridamole 25 mg tablet



9disopyramide 100 mg capsule

9disopyramide 150 mg capsule

52disulfiram 250 mg tablet52disulfiram 500 mg tablet18DIURIL 250 MG/5 ML

ORAL SUSP11divalproex dr 125 mg

cap sprnk11divalproex sod dr 125

mg tab11divalproex sod dr 250

mg tab11divalproex sod dr 500

mg tab11divalproex sod er 250

mg tab11divalproex sod er 500

mg tab45DIVIGEL 0.25 MG GEL

PACKET45DIVIGEL 0.5 MG GEL

PACKET45DIVIGEL 0.75 MG GEL

PACKET45DIVIGEL 1 MG GEL

PACKET

9dofetilide 125 mcg capsule



60donepezil hcl 10 mg tablet

60donepezil hcl 23 mg tablet

60donepezil hcl 5 mg 60donepezil hcl odt 10 mg

tablet60donepezil hcl odt 5 mg

tablet34DONNATAL TABLET72dorzolamide hcl 2% eye

drops72dorzolamide-timolol 2%-

0.5%72dorzolamide-timolol eye

drops45DOTTI 0.025 MG

PATCH45DOTTI 0.0375 MG

PATCH45DOTTI 0.05 MG PATCH45DOTTI 0.075 MG

PATCH45DOTTI 0.1 MG PATCH32DOVATO 50-300 MG

TABLET18doxazosin mesylate 1

mg tab18doxazosin mesylate 2



mg tab78doxepin 10 mg capsule


78doxepin 10 mg/ml oral conc

78doxepin 100 mg capsule78doxepin 150 mg capsule78doxepin 25 mg capsule55doxepin 5% cream78doxepin 50 mg capsule78doxepin 75 mg capsule58doxercalciferol 0.5 mcg

cap58doxercalciferol 1 mcg

capsule58doxercalciferol 2.5 mcg

cap58doxercalciferol 4 mcg/2

ml vl89DOXY 100 VIAL89doxycycline 25 mg/5 ml

susp89doxycycline hyc dr 100

mg tab89doxycycline hyc dr 150

mg tab89doxycycline hyc dr 75

mg tab89doxycycline hyclate 100

mg cap89doxycycline hyclate 100


mg vl89doxycycline hyclate 20


mg cap89doxycycline ir-dr 40 mg

cap90doxycycline mono 100

mg cap90doxycycline mono 100

mg tablet

90doxycycline mono 150 mg cap

90doxycycline mono 150 mg tablet

90doxycycline mono 50 mg cap


90doxycycline mono 75 mg capsule


74DRISDOL 1.25 MG (50,000 UNIT)

56dronabinol 10 mg capsule

56dronabinol 2.5 mg capsule

56dronabinol 5 mg capsule70drosp-ee-levomef 3-

0.02-0.45170drospirenone-ee 3-0.02

mg tab70drospirenone-ee 3-0.03

mg tab24DROXIA 200 MG

CAPSULE24DROXIA 300 MG

CAPSULE24DROXIA 400 MG

CAPSULE45DUAVEE 0.45-20 MG

TABLET74DUET DHA 400

COMBO PACK74DUET DHA

BALANCED (25 MG IRON)

68DUEXIS 800-26.6 MG TABLET

86DULERA 100 MCG/5 MCG INHALER

86DULERA 200 MCG/5 MCG INHALER

78duloxetine hcl dr 20 mg cap




64DURAMORPH 10 MG/10 ML AMPUL

64DURAMORPH 5 MG/10 ML AMPUL

89DUREZOL 0.05% EYE DROPS

34dutasteride 0.5 mg capsule

34dutasteride-tamsulosin 0.5-0.4

18DYAZIDE 37.5-25 CAPSULE

86DYMISTA NASAL SPRAY

18DYRENIUM 100 MG CAPSULE

18DYRENIUM 50 MG CAPSULE

44E.E.S. 400 FILMTAB93econazole nitrate 1%

cream18EDARBI 40 MG

TABLET18EDARBI 80 MG

TABLET18EDARBYCLOR 40-12.5

MG TABLET18EDARBYCLOR 40-25

MG TABLET88EDEX14ED-SPAZ 0.125 MG

ODT


32EDURANT 25 MG TABLET

44eemt ds 1.25-2.5 mg tablet

44eemt hs 0.625-1.25 mg tablet

32efavirenz 200 mg capsule

32efavirenz 50 mg capsule32efavirenz 600 mg tablet43EFFER-K 10 MEQ

TABLET EFF43EFFER-K 25 MEQ

TABLET EFF78EFFEXOR XR 150 MG

CAPSULE78EFFEXOR XR 37.5 MG

CAPSULE78EFFEXOR XR 75 MG

CAPSULE37EFFIENT 10 MG

TABLET37EFFIENT 5 MG TABLET35EGRIFTA 1 MG VIAL58ELAPRASE 6 MG/3 ML

VIAL45ELESTRIN 0.06% GEL44eletone cream44eletone cream twin pack51eletriptan hbr 20 mg

tablet51eletriptan hbr 40 mg

tablet55ELIDEL 1% CREAM24ELIGARD 22.5 MG

SYRINGE KIT24ELIGARD 30 MG

SYRINGE KIT24ELIGARD 45 MG

SYRINGE KIT

24ELIGARD 7.5 MG SYRINGE KIT

70ELINEST-28 TABLET37ELIQUIS 2.5 MG

TABLET37ELIQUIS 5 MG

STARTER PACK37ELIQUIS 5 MG TABLET70ELLA 30 MG TABLET62ELMIRON 100 MG

CAPSULE64EMBEDA ER 100-4 MG

CAPSULE64EMBEDA ER 20-0.8

MG CAPSULE64EMBEDA ER 30-1.2

MG CAPSULE64EMBEDA ER 50-2 MG

CAPSULE64EMBEDA ER 60-2.4

MG CAPSULE64EMBEDA ER 80-3.2

MG CAPSULE24EMCYT 140 MG

CAPSULE56EMEND 125 MG

POWDER PACKET70EMOQUETTE 28 DAY

TABLET78EMSAM 12 MG/24

HOURS PATCH78EMSAM 6 MG/24

HOURS PATCH78EMSAM 9 MG/24

HOURS PATCH32EMTRIVA 10 MG/ML

SOLUTION32EMTRIVA 200 MG

CAPSULE18enalapril maleate 10 mg

tab

18enalapril maleate 2.5 mg tab

18enalapril maleate 20 mg tab

18enalapril maleate 5 mg tablet

18enalapril-hctz 10-25 mg tablet

18enalapril-hctz 5-12.5 mg tab

74ENBRACE HR SOFTGEL

72ENBREL 25 MG KIT72ENBREL 25 MG/0.5 ML

SYRINGE72ENBREL 50 MG/ML

MINI CARTRIDGE72ENBREL 50 MG/ML

SURECLICK SYR72ENBREL 50 MG/ML

SYRINGE64ENDOCET 10-325 MG

TABLET64ENDOCET 2.5-325 MG

TABLET64ENDOCET 5-325

TABLET64ENDOCET 7.5-325 MG

TABLET97ENGERIX-B 20

MCG/ML SYRN97ENGERIX-B PEDI 10

MCG/0.5 SYRN37enoxaparin 100 mg/ml

syringe37enoxaparin 120 mg/0.8

ml syr37enoxaparin 150 mg/ml

syringe37enoxaparin 30 mg/0.3

ml syr37enoxaparin 300 mg/3 ml

vial


37enoxaparin 40 mg/0.4 ml syr



70ENPRESSE-28 TABLET70ENSKYCE 28 TABLET30entacapone 200 mg

tablet32entecavir 0.5 mg tablet32entecavir 1 mg tablet55ENTRESTO 24 MG-26

MG TABLET55ENTRESTO 49 MG-51

MG TABLET55ENTRESTO 97 MG-103

MG TABLET57ENULOSE 10 GM/15

ML SOLUTION24ENVARSUS XR 0.75

MG TABLET24ENVARSUS XR 1 MG

TABLET24ENVARSUS XR 4 MG

TABLET32EPCLUSA 400 MG-100

MG TABLET11EPIDIOLEX 100 MG/ML

SOLUTION31EPIFOAM FOAM62epinastine hcl 0.05%

eye drops15epinephrine 0.1 mg/ml

syringe15epinephrine 0.15 mg

auto-injct15epinephrine 0.3 mg

auto-inject15epinephrine 1 mg/ml

ampul15epinephrine 1 mg/ml vial

15EPIPEN 2-PAK 0.3 MG AUTO-INJCT

15EPIPEN JR 2-PAK 0.15 MG INJCTR

11EPITOL 200 MG TABLET

32EPIVIR HBV 25 MG/5 ML SOLN

18eplerenone 25 mg tablet18eplerenone 50 mg tablet35EPOGEN 2,000

UNITS/ML VIAL35EPOGEN 20,000

UNITS/2 ML VIAL35EPOGEN 20,000



UNITS/ML VIAL18eprosartan mesylate

600 mg tab11EQUETRO 100 MG

CAPSULE11EQUETRO 200 MG

CAPSULE11EQUETRO 300 MG

CAPSULE78ergoloid mesylates 1

mg tab51ergotamine-caffeine 1-

100mg tb24ERIVEDGE 150 MG

CAPSULE24ERLEADA 60 MG

TABLET24erlotinib hcl 100 mg

tablet24erlotinib hcl 150 mg

tablet24erlotinib hcl 25 mg tablet

45ERRIN 0.35 MG TABLET

54ertapenem 1 gram vial90ERY 2% PADS44ERYPED 400 MG/5 ML

SUSPENSION44ERY-TAB DR 250 MG

TABLET44ERY-TAB DR 333 MG

TABLET44ERY-TAB DR 500 MG

TABLET44ERYTHROCIN 250 MG

FILMTAB44ERYTHROCIN 500 MG

ADDVAN VIAL10erythromycin 0.5% eye

ointment90erythromycin 2% gel90erythromycin 2%

pledgets90erythromycin 2%

solution44erythromycin 200 mg/5

ml susp44erythromycin 250 mg

filmtab44erythromycin 400 mg/5

ml susp44erythromycin 500 mg

filmtab44erythromycin dr 250 mg

cap44erythromycin dr 250 mg

tablet44erythromycin dr 333 mg

tablet44erythromycin dr 500 mg

tablet44erythromycin es 400 mg

tab


90erythromycin-benzoyl gel

86ESBRIET 267 MG CAPSULE

86ESBRIET 267 MG TABLET

86ESBRIET 801 MG TABLET

78escitalopram 10 mg tablet

78escitalopram 20 mg tablet

78escitalopram 5 mg tablet78escitalopram oxalate 5

mg/5 ml64ESGIC CAPSULE96esomeprazole mag dr

20 mg cap96esomeprazole mag dr

40 mg cap70ESTARYLLA 0.25-

0.035 MG TABLET78estazolam 1 mg tablet78estazolam 2 mg tablet45ESTRACE 0.01%

CREAM45estradiol 0.01% cream45estradiol 0.025 mg patch45estradiol 0.0375 mg

patch45estradiol 0.05 mg patch45estradiol 0.075 mg patch46estradiol 0.1 mg patch46estradiol 0.5 mg tablet46estradiol 1 mg tablet46estradiol 10 mcg vaginal

insrt46estradiol 2 mg tablet46estradiol tds 0.025

mg/day

46estradiol tds 0.0375 mg/day




46estradiol tds 0.1 mg/day46estradiol valerate 20

mg/ml vl46estradiol valerate 40

mg/ml vl46estradiol-noreth 0.5-0.1

mg tb46estradiol-noreth 1-0.5

mg tab46ESTRING 2 MG

VAGINAL RING46ESTROGEL 0.06% GEL44estrogen-methyltestos

f.s. tab44estrogen-methyltestos

h.s. tab78eszopiclone 1 mg tablet78eszopiclone 2 mg tablet78eszopiclone 3 mg tablet18ethacrynate sodium 50

mg vial18ethacrynic acid 25 mg

tablet54ethambutol hcl 100 mg

tablet54ethambutol hcl 400 mg

tablet11ethosuximide 250 mg

capsule11ethosuximide 250 mg/5

ml soln95ethyl chloride spray70ethynodiol-eth estra

1mg-50mcg

52etidronate disodium 200 mg tab

52etidronate disodium 400 mg tab

68etodolac 200 mg capsule

68etodolac 300 mg capsule

68etodolac 400 mg tablet68etodolac 500 mg tablet68etodolac er 400 mg

tablet68etodolac er 500 mg

tablet68etodolac er 600 mg

tablet24etoposide 1,000 mg/50

ml vial24etoposide 100 mg/5 ml

vial24etoposide 500 mg/25 ml

vial95EURAX 10% CREAM72EVISTA 60 MG TABLET24EVOMELA 50 MG VIAL32EVOTAZ 300 MG-150

MG TABLET60EXELON 13.3

MG/24HR PATCH60EXELON 4.6 MG/24HR

PATCH60EXELON 9.5 MG/24HR

PATCH24exemestane 25 mg

tablet18EXFORGE 10-160 MG

TABLET18EXFORGE 10-320 MG

TABLET18EXFORGE 5-160 MG

TABLET


18EXFORGE 5-320 MG TABLET

18EXFORGE HCT 10-160-12.5 MG TAB

18EXFORGE HCT 10-160-25 MG TAB


18EXFORGE HCT 5-160-12.5 MG TAB


52EXJADE 125 MG TABLET



35EXTAVIA 0.3 MG KIT74EXTRA-VIRT PLUS

DHA SOFTGEL47E-Z DISK 700 MG

TABLET47E-Z-CAT DRY

SUSPENSION49ezetimibe 10 mg tablet49ezetimibe-simvastatin

10-10 mg49ezetimibe-simvastatin



10-80 mg47E-Z-HD SUSPENSION47E-Z-PAQUE BARIUM

SULFATE SUSP47E-Z-PASTE 60%

CREAM58FABRAZYME 35 MG

VIAL

58FABRAZYME 5 MG VIAL

70FALMINA-28 TABLET32famciclovir 125 mg

tablet32famciclovir 250 mg

tablet32famciclovir 500 mg

tablet96famotidine 20 mg tablet96famotidine 20 mg/2 ml

vial96famotidine 40 mg tablet96famotidine 40 mg/5 ml

susp78FANAPT 1 MG TABLET78FANAPT 10 MG

TABLET78FANAPT 12 MG

TABLET78FANAPT 2 MG TABLET78FANAPT 4 MG TABLET78FANAPT 6 MG TABLET78FANAPT 8 MG TABLET78FANAPT TITRATION

PACK40FARXIGA 10 MG

TABLET40FARXIGA 5 MG

TABLET24FARYDAK 10 MG

CAPSULE24FARYDAK 15 MG

CAPSULE24FARYDAK 20 MG

CAPSULE24FASLODEX 250 MG/5

ML SYRINGE47febuxostat 40 mg tablet47febuxostat 80 mg tablet11felbamate 400 mg tablet

11felbamate 600 mg tablet11felbamate 600 mg/5 ml

susp18felodipine er 10 mg

tablet18felodipine er 2.5 mg

tablet18felodipine er 5 mg tablet62FEM PH VAGINAL

JELLY24FEMARA 2.5 MG

TABLET46FEMHRT 0.5 MG-2.5

MCG TABLET46FEMRING 0.05

MG/DAY VAG RING46FEMRING 0.10

MG/DAY VAG RING70FEMYNOR 28 TABLET49fenofibrate 120 mg

tablet49fenofibrate 130 mg

capsule49fenofibrate 134 mg





capsule49fenofibrate 40 mg tablet49fenofibrate 43 mg



capsule


49fenofibric acid 105 mg tablet

49fenofibric acid 35 mg tablet

50fenofibric acid dr 135 mg cap

50fenofibric acid dr 45 mg cap

50FENOGLIDE 120 MG TABLET

50FENOGLIDE 40 MG TABLET

68fenoprofen 400 mg capsule

68fenoprofen 600 mg tablet

64fentanyl 1,000 mcg/20 ml ampul

64fentanyl 100 mcg/2 ml carpujct

64fentanyl 100 mcg/hr patch

64fentanyl 12 mcg/hr patch64fentanyl 2,500 mcg/50

ml vial64fentanyl 25 mcg/hr patch64fentanyl 250 mcg/5 ml

vial64fentanyl 37.5 mcg/hr

patch64fentanyl 50 mcg/hr patch64fentanyl 62.5 mcg/hr

patch64fentanyl 75 mcg/hr patch64fentanyl 87.5 mcg/hr

patch64fentanyl cit otfc 1,200

mcg64fentanyl cit otfc 1,600

mcg64fentanyl citrate otfc 200

mcg

65fentanyl citrate otfc 400 mcg



74FERAHEME 510 MG/17 ML VIAL

52FERRIPROX 100 MG/ML SOLUTION

52FERRIPROX 500 MG TABLET

74FERRLECIT 62.5 MG/5 ML VIAL

78FETZIMA 20-40 MG TITRATION PAK

78FETZIMA ER 120 MG CAPSULE




90FINACEA 15% FOAM90FINACEA 15% GEL34finasteride 5 mg tablet86FIRAZYR 30 MG/3 ML

SYRINGE60FIRDAPSE 10 MG

TABLET24FIRMAGON 2 X 120

MG KIT24FIRMAGON 80 MG KIT54FIRVANQ 25 MG/ML

SOLUTION54FIRVANQ 50 MG/ML

SOLUTION62FLAC OTIC OIL 0.01%

EAR DROP89FLAREX 0.1% EYE

DROPS

10flavoxate hcl 100 mg tablet

97FLEBOGAMMA DIF 10% VIAL

97FLEBOGAMMA DIF 5% VIAL

9flecainide acetate 100 mg tab



34FLOMAX 0.4 MG CAPSULE

86FLOVENT 100 MCG DISKUS



86FLOVENT HFA 110 MCG INHALER



14fluconazole 10 mg/ml susp

14fluconazole 100 mg tablet



14fluconazole 40 mg/ml susp

14fluconazole 50 mg tablet14fluconazole-nacl 200

mg/100 ml14fluconazole-nacl 400

mg/200 ml14flucytosine 250 mg

capsule


14flucytosine 500 mg capsule

24fludarabine 50 mg vial24fludarabine 50 mg/2 ml

vial9fludrocortisone 0.1 mg

tablet86flunisolide 0.025% spray94fluocinolone 0.01%

body oil94fluocinolone 0.01%

cream94fluocinolone 0.01%

scalp oil94fluocinolone 0.01%

solution94fluocinolone 0.025%

cream94fluocinolone 0.025%

ointment62fluocinolone oil 0.01%

ear drp94fluocinonide 0.05%

cream94fluocinonide 0.05% gel94fluocinonide 0.05%

ointment94fluocinonide 0.05%

solution94fluocinonide 0.1% cream94fluocinonide-e 0.05%

cream98fluoride 1 mg tablet

chewable52FLUORIDEX DAILY

DEFENSE98FLUORITAB 1 MG

TABLET CHEW89fluorometholone 0.1%

drops55fluorouracil 0.5% cream

55fluorouracil 2% topical soln

55fluorouracil 5% cream55fluorouracil 5% topical

soln79fluoxetine 20 mg/5 ml

solution79fluoxetine dr 90 mg

capsule79fluoxetine hcl 10 mg


tablet79fluoxetine hcl 20 mg


tablet79fluoxetine hcl 40 mg


tablet79fluphenazine 1 mg tablet79fluphenazine 10 mg

tablet79fluphenazine 2.5 mg

tablet79fluphenazine 2.5 mg/5

ml elix79fluphenazine 2.5 mg/ml

vial79fluphenazine 5 mg tablet79fluphenazine 5 mg/ml

conc79fluphenazine dec 125

mg/5 ml94flurandrenolide 0.05%

cream94flurandrenolide 0.05%

lotion94flurandrenolide 0.05%

ointment

79flurazepam 15 mg capsule

79flurazepam 30 mg capsule

69flurbiprofen 0.03% eye drop

68flurbiprofen 100 mg tablet

68flurbiprofen 50 mg tablet24flutamide 125 mg

capsule94fluticasone prop 0.005%

oint94fluticasone prop 0.05%

cream94fluticasone prop 0.05%

lotion86fluticasone prop 50 mcg

spray50fluvastatin er 80 mg

tablet50fluvastatin sodium 20

mg cap50fluvastatin sodium 40

mg cap79fluvoxamine er 100 mg

capsule79fluvoxamine er 150 mg

capsule79fluvoxamine maleate

100 mg tab79fluvoxamine maleate 25

mg tab79fluvoxamine maleate 50

mg tab89FML FORTE 0.25%

EYE DROPS89FML S.O.P. 0.1%

OINTMENT79FOCALIN 10 MG

TABLET79FOCALIN 2.5 MG

TABLET


79FOCALIN 5 MG TABLET

79FOCALIN XR 10 MG CAPSULE








74FOLET ONE SOFTGEL74folic acid 1 mg tablet74folic acid 5 mg/ml vial24FOLOTYN 20 MG/ML

VIAL24FOLOTYN 40 MG/2 ML

VIAL97fomepizole 1.5 gm/1.5

ml vial37fondaparinux 10 mg/0.8

ml syr37fondaparinux 2.5

mg/0.5 ml syr37fondaparinux 5 mg/0.4

ml syr37fondaparinux 7.5

mg/0.6 ml syr40FORTAMET ER 1,000

MG TABLET40FORTAMET ER 500

MG TABLET72FORTEO 600 MCG/2.4

ML PEN INJ

72FOSAMAX 70 MG TABLET

72FOSAMAX PLUS D 70 MG-2,800 IU

72FOSAMAX PLUS D 70 MG-5,600 IU

32fosamprenavir 700 mg tablet

18fosinopril sodium 10 mg tab



18fosinopril-hctz 10-12.5 mg tab

18fosinopril-hctz 20-12.5 mg tab

52FOSRENOL 1,000 MG POWDER PACK

52FOSRENOL 750 MG POWDER PACKET

61FREAMINE HBC 6.9% IV SOLN

61FREAMINE III 10% IV SOLN.

51FROVA 2.5 MG TABLET

51frovatriptan succ 2.5 mg tab

24fulvestrant 250 mg/5 ml syrng

18furosemide 10 mg/ml solution

18furosemide 100 mg/10 ml vial

18furosemide 20 mg tablet19furosemide 40 mg tablet19furosemide 40 mg/4 ml

syringe19furosemide 40 mg/5 ml

soln

19furosemide 80 mg tablet32FUZEON 90 MG VIAL46FYAVOLV 0.5 MG-2.5

MCG TABLET46FYAVOLV 1 MG-5

MCG TABLET11FYCOMPA 0.5 MG/ML

ORAL SUSP11FYCOMPA 10 MG

TABLET11FYCOMPA 12 MG





TABLET38g tussin ac liquid11gabapentin 100 mg

capsule11gabapentin 250 mg/5 ml

soln11gabapentin 300 mg

capsule11gabapentin 400 mg

capsule11gabapentin 600 mg

tablet11gabapentin 800 mg

tablet11GABITRIL 2 MG

TABLET11GABITRIL 4 MG

TABLET60galantamine 4 mg/ml

oral soln60galantamine er 16 mg

capsule


60galantamine er 24 mg capsule

60galantamine er 8 mg capsule

60galantamine hbr 12 mg tablet



97GAMASTAN S-D VIAL97GAMASTAN VIAL97GAMMAGARD LIQUID

10% VIAL97GAMMAGARD S-D 10

G (IGA<1) SOL97GAMMAGARD S-D 5 G

(IGA<1) SOLN97GAMMAKED 1

GRAM/10 ML VIAL97GAMMAKED 10

GRAM/100 ML VIAL97GAMMAKED 2.5



GRAM/50 ML VIAL97GAMMAPLEX 10

GRAM/200 ML VIAL97GAMMAPLEX 5

GRAM/100 ML VIAL97GAMUNEX-C 1


GRAM/100 ML VIAL97GAMUNEX-C 2.5



GRAM/400 ML VIAL

98GAMUNEX-C 5 GRAM/50 ML VIAL

98GARDASIL 9 SYRINGE98GARDASIL 9 VIAL10gatifloxacin 0.5% eye

drops57GATTEX 5 MG 30-VIAL

KIT57GAVILYTE-C

SOLUTION57GAVILYTE-G

SOLUTION57GAVILYTE-N

SOLUTION24GAZYVA 1,000 MG/40

ML VIAL10GELNIQUE 10% GEL

PUMP24gemcitabine 1

gram/26.3 ml vl24gemcitabine 2

gram/52.6 ml vl24gemcitabine 200

mg/5.26 ml vl24gemcitabine hcl 1 gram

vial24gemcitabine hcl 2 gram

vial24gemcitabine hcl 2

gram/20 ml24gemcitabine hcl 200 mg

vial24gemcitabine hcl 200

mg/2 ml vl50gemfibrozil 600 mg

tablet57GENERLAC 10 GM/15

ML SOLUTION24gengraf 100 mg capsule24gengraf 100 mg/ml

solution24gengraf 25 mg capsule

35GENOTROPIN 12 MG CARTRIDGE

35GENOTROPIN 5 MG CARTRIDGE

35GENOTROPIN MINIQUICK 0.2 MG




35GENOTROPIN MINIQUICK 1 MG





35GENOTROPIN MINIQUICK 2 MG

10GENTAK 0.3 % EYE OINTMENT

93gentamicin 0.1% cream93gentamicin 0.1%

ointment10gentamicin 3 mg/ml eye

drop54gentamicin 80 mg/2 ml

vial54gentamicin ped 20 mg/2

ml vial32GENVOYA TABLET79GEODON 20 MG

CAPSULE79GEODON 20 MG/ML

VIAL79GEODON 40 MG

CAPSULE


79GEODON 60 MG CAPSULE

79GEODON 80 MG CAPSULE

70GIANVI 3 MG-0.02 MG TABLET

70GILDAGIA 0.4 MG-0.035 MG TAB

60GILENYA 0.5 MG CAPSULE

24GILOTRIF 20 MG TABLET



24GLEOSTINE 10 MG CAPSULE



40glimepiride 1 mg tablet40glimepiride 2 mg tablet40glimepiride 4 mg tablet40glipizide 10 mg tablet40glipizide 5 mg tablet40glipizide er 10 mg tablet40glipizide er 2.5 mg tablet40glipizide er 5 mg tablet40glipizide xl 10 mg tablet40glipizide xl 2.5 mg tablet40glipizide xl 5 mg tablet40glipizide-metformin 2.5-

250 mg40glipizide-metformin 2.5-

500 mg40glipizide-metformin 5-

500 mg40GLUCAGEN 1 MG

HYPOKIT

40GLUCAGON 1 MG EMERGENCY KIT

40GLUCOPHAGE 1,000 MG TABLET

40GLUCOPHAGE 500 MG TABLET

40GLUCOPHAGE 850 MG TABLET

40GLUCOPHAGE XR 500 MG TAB

40GLUCOPHAGE XR 750 MG TAB

40GLUCOVANCE 2.5-500 MG TABLET

40GLUCOVANCE 5-500 MG TABLET

40GLUMETZA ER 1,000 MG TABLET

40GLUMETZA ER 500 MG TABLET

40glyburide 1.25 mg tablet40glyburide 2.5 mg tablet40glyburide 5 mg tablet40glyburide micro 1.5 mg

tab40glyburide micro 3 mg

tablet40glyburide micro 6 mg

tablet40glyburide-metformin 2.5-

500 mg40glyburide-metformin 5-

500 mg40glyburid-metformin 1.25-

250 mg14glycopyrrolate 0.2

mg/ml syrng14glycopyrrolate 0.2

mg/ml vial14glycopyrrolate 0.4 mg/2

ml syr

14glycopyrrolate 1 mg tablet

14glycopyrrolate 2 mg tablet

14glycopyrrolate 4 mg/20 ml vial

55GLYDO 2% JELLY SYRINGE

40GLYXAMBI 10 MG-5 MG TABLET

40GLYXAMBI 25 MG-5 MG TABLET

57GOLYTELY PACKET93GORDON'S UREA 22%

OINTMENT12GRALISE 30-DAY

STARTER PACK12GRALISE ER 300 MG

TABLET12GRALISE ER 600 MG

TABLET57granisetron hcl 1 mg

tablet57granisetron hcl 1 mg/ml

vial57granisetron hcl 4 mg/4

ml vial14griseofulvin 125 mg/5

ml susp14griseofulvin micro 500

mg tab14griseofulvin ultra 125

mg tab14griseofulvin ultra 250

mg tab38guaiatussin ac liquid38guaifen-codeine 100-10

mg/5 ml38GUAIFEN-CODEINE

100-10 MG/5 ML38GUAIFEN-CODEINE

200-20 MG/10ML


38guaifenesin ac cough syrup

38guaifenesin dac oral solution

38guaifenesin-codeine syrup

19guanfacine 1 mg tablet19guanfacine 2 mg tablet79guanfacine hcl er 1 mg

tablet79guanfacine hcl er 2 mg



tablet79guanidine hcl 125 mg

tablet62GYNAZOLE 1 2%

CREAM70HAILEY 24 FE 1 MG-20

MCG TAB24HALAVEN 1 MG/2 ML

VIAL94halobetasol prop 0.05%

cream94halobetasol prop 0.05%

ointmnt79haloperidol 0.5 mg tablet79haloperidol 1 mg tablet79haloperidol 10 mg tablet79haloperidol 2 mg tablet79haloperidol 20 mg tablet79haloperidol 5 mg tablet79haloperidol dec 100

mg/ml amp79haloperidol dec 100

mg/ml vial79haloperidol decan 50

mg/ml amp

79haloperidol lac 2 mg/ml conc

79haloperidol lac 5 mg/ml vial

32HARVONI 90-400 MG TABLET

98HAVRIX 1,440 UNITS/ML SYRINGE

98HAVRIX 1,440 UNITS/ML VIAL

98HAVRIX 720 UNIT/0.5 ML SYRINGE

98HAVRIX 720 UNITS/0.5 ML VIAL

46HEATHER TABLET88hemmorex-hc 25 mg

suppository88hemmorex-hc 30 mg

suppository37heparin 20,000 unit/500

ml-d5w37heparin 25,000 unit/250

ml-d5w37heparin 25,000 unit/250-

1/2 ns37heparin 25,000 unit/500

ml-d5w37heparin 25,000 unit/500-

1/2 ns37heparin 30,000 unit/30

ml vial37heparin sod 10,000

unit/ml vl37heparin sod 20,000

unit/ml vl37heparin sod 5,000

unit/0.5 ml37heparin sod 5,000

unit/ml vial37heparin sodium/sodium

chloride 1000unit/500ml; 0.9% soln

37heparin-1/2ns 25,000 units/500

37heparin-d5w 25,000 unit/250 ml

37heparin-d5w 25,000 unit/500 ml

37heparin-ns 1,000 units/500 ml

37heparin-ns 2,000 unit/1,000 ml

61HEPATAMINE 8% IV SOLUTION

24HERCEPTIN 150 MG VIAL

24HERCEPTIN 440 MG VIAL

24HERCEPTIN HYLECTA 600MG-10,000

79HETLIOZ 20 MG CAPSULE

98HIBERIX VACCINE WITH DILUENT

60HORIZANT ER 300 MG TABLET

60HORIZANT ER 600 MG TABLET

9HP ACTHAR GEL 80 UNIT/ML VIAL

44hpr emollient foam44hpr plus cream44hpr plus emollient foam40HUMALOG 100

UNIT/ML VIAL40HUMALOG 100

UNITS/ML CARTRIDGE40HUMALOG 100

UNITS/ML KWIKPEN40HUMALOG 200

UNITS/ML KWIKPEN40HUMALOG JR 100

UNIT/ML KWIKPEN


40HUMALOG MIX 50-50 KWIKPEN

40HUMALOG MIX 50-50 VIAL

40HUMALOG MIX 75-25 KWIKPEN

40HUMALOG MIX 75-25 VIAL

72HUMIRA 10 MG/0.2 ML SYRINGE



72HUMIRA PEDI CROHN 40 MG/0.8 ML

72HUMIRA PEN 40 MG/0.8 ML

72HUMIRA PEN CROHN-UC-HS 40 MG

72HUMIRA PEN PS-UV-ADOL HS 40 MG

72HUMIRA(CF) 10 MG/0.1 ML SYRING



72HUMIRA(CF) PEDI CROHN 80-40 MG

72HUMIRA(CF) PEDI CROHN 80MG/0.8

72HUMIRA(CF) PEN 40 MG/0.4 ML

72HUMIRA(CF) PEN CRHN-UC-HS 80MG

73HUMIRA(CF) PEN PS-UV-AHS 80-40

40HUMULIN 70/30 KWIKPEN

40HUMULIN 70-30 VIAL40HUMULIN N 100

UNIT/ML VIAL

40HUMULIN N 100 UNITS/ML KWIKPEN

40HUMULIN R 100 UNIT/ML VIAL

40HUMULIN R 500 UNITS/ML KWIKPEN

40HUMULIN R 500 UNITS/ML VIAL

19hydralazine 10 mg tablet19hydralazine 100 mg

tablet19hydralazine 20 mg/ml

vial19hydralazine 25 mg tablet19hydralazine 50 mg tablet24HYDREA 500 MG

CAPSULE48HYDRO 35 FOAM48HYDRO 40 FOAM19hydrochlorothiazide

12.5 mg cp19hydrochlorothiazide

12.5 mg tb19hydrochlorothiazide 25

mg tab19hydrochlorothiazide 50

mg tab38hydrocod-cpm-

pseudoep 5-4-60/565hydrocodone-acetamin

10-300 mg65hydrocodone-acetamin


10-325/1565hydrocodone-acetamin

2.5-32565hydrocodone-acetamin


5-325 mg

65hydrocodone-acetamin 7.5-300

65hydrocodone-acetamin 7.5-325

65hydrocodone-acetamn 7.5-325/15

38hydrocodone-chlorphen er susp

38HYDROCODONE-GUAIF 2.5-200 MG/5

38hydrocodone-homatropine 5-1.5

38hydrocodone-homatropine soln

38hydrocodone-homatropine syrup

38HYDROCODONE-HOMATROPINE SYRUP

65hydrocodone-ibuprofen 10-200

65hydrocodone-ibuprofen 5-200 mg

65hydrocodone-ibuprofen 7.5-200

94hydrocort buty 0.1% lipid crm

94hydrocort buty 0.1% lipo cream

95hydrocort-iodoquinol-aloe sach

62hydrocortison-acetic acid soln

94hydrocortisone 1% absorbase

94hydrocortisone 1% cream

94hydrocortisone 1% ointment

9hydrocortisone 10 mg tablet

57hydrocortisone 100 mg/60 ml


94hydrocortisone 2.5% cream

94hydrocortisone 2.5% lotion

94hydrocortisone 2.5% ointment



88hydrocortisone ac 25 mg supp

88hydrocortisone ac 30 mg supp

94hydrocortisone buty 0.1% cream

94hydrocortisone butyr 0.1% oint

94hydrocortisone butyr 0.1% soln

94hydrocortisone val 0.2% cream

94hydrocortisone val 0.2% ointmt

95hydrocortisone-iodoquinol crm

57hydrocort-pramoxine 1%-1% crm

48hydrocort-pramoxine 2.5%-1% cm

38hydromet syrup65hydromorphone 1

mg/ml solution65hydromorphone 1

mg/ml syringe65hydromorphone 10

mg/ml vial65hydromorphone 2 mg

tablet65hydromorphone 2

mg/ml isecure65hydromorphone 2

mg/ml vial

65hydromorphone 3 mg suppos

65hydromorphone 4 mg tablet

65hydromorphone 4 mg/ml carpujct

65hydromorphone 50 mg/5 ml vial

65hydromorphone 8 mg tablet

74hydroxocobalamin 1,000 mcg/ml

54hydroxychloroquine 200 mg tab

46hydroxyprogesterone 1.25 g/5ml

24hydroxyurea 500 mg capsule

15hydroxyzine 10 mg/5 ml soln

15hydroxyzine 25 mg/ml vial

15hydroxyzine 50 mg/ml vial

15hydroxyzine hcl 10 mg tablet



15hydroxyzine pam 100 mg cap



44HYLATOPIC EMOLLIENT FOAM

44HYLATOPICPLUS CREAM

44HYLATOPICPLUS EMOLLIENT FOAM

44HYLATOPICPLUS LOTION

36hyophen tablet14hyoscyamine 0.125 mg

odt14hyoscyamine 0.125 mg

tab sl14hyoscyamine 0.125

mg/5 ml elix14hyoscyamine 0.125

mg/ml drop14hyoscyamine sr 0.375

mg tab14hyoscyamine sulf 0.125

mg tab34hyosyne 125 mcg/5 ml

elixir47HYPER-SAL 3.5% VIAL47HYPER-SAL 7% VIAL65HYSINGLA ER 100 MG

TABLET65HYSINGLA ER 120 MG






TABLET19HYZAAR 100-12.5

TABLET19HYZAAR 100-25

TABLET19HYZAAR 50-12.5

TABLET72ibandronate sodium 150

mg tab


24IBRANCE 100 MG CAPSULE



68IBU 600 MG TABLET68IBU 800 MG TABLET68ibuprofen 100 mg/5 ml

susp68ibuprofen 400 mg tablet68ibuprofen 600 mg tablet68ibuprofen 800 mg tablet86ICATIBANT 30 MG/3

ML SYRINGE25ICLUSIG 15 MG

TABLET25ICLUSIG 45 MG

TABLET25IDHIFA 100 MG

TABLET25IDHIFA 50 MG TABLET69ILEVRO 0.3% OPHTH

DROPS25imatinib mesylate 100

mg tab25imatinib mesylate 400

mg tab25IMBRUVICA 140 MG

CAPSULE25IMBRUVICA 140 MG

TABLET25IMBRUVICA 280 MG




CAPSULE25IMFINZI 120 MG/2.4 ML

VIAL

25IMFINZI 500 MG/10 ML VIAL

54imipenem-cilastatin 250 mg vl

54imipenem-cilastatin 500 mg vl

79imipramine hcl 10 mg tablet



79imipramine pamoate 100 mg cap




55imiquimod 3.75% cream pump

55imiquimod 5% cream packet

98IMOVAX RABIES VACCINE+DILUENT

46INCASSIA 0.35 MG TABLET

52INCRELEX 40 MG/4 ML VIAL

86INCRUSE ELLIPTA 62.5 MCG INH

19indapamide 1.25 mg tablet

19indapamide 2.5 mg tablet

19INDERAL LA 120 MG CAPSULE




68indomethacin 25 mg capsule

68indomethacin 50 mg capsule

68indomethacin er 75 mg capsule

98INFANRIX DTAP VIAL25INFUGEM 1,200

MG/120 ML BAG25INFUGEM 1,300









MG/220 ML BAG65INFUMORPH 200

MG/20 ML AMPUL65INFUMORPH 500

MG/20 ML AMPUL74INFUVITE ADULT VIAL74INFUVITE PEDIATRIC

VIAL74INJECTAFER 750

MG/15 ML VIAL25INLYTA 1 MG TABLET25INLYTA 5 MG TABLET32INTELENCE 100 MG

TABLET


32INTELENCE 200 MG TABLET

32INTELENCE 25 MG TABLET

61INTRALIPID 20% IV FAT EMUL

61INTRALIPID 30% IV FAT EMUL

62INTRAROSA 6.5 MG VAG INSERT

35INTRON A 10 MILLION UNITS VIAL

35INTRON A 18 MILLION UNIT/3 ML


35INTRON A 25 MILLION UNIT/2.5ML


70INTROVALE 0.15-0.03 MG TABLET

80INVEGA SUSTENNA 117 MG/0.75 ML

80INVEGA SUSTENNA 156 MG/ML SYRG




80INVEGA TRINZA 273 MG/0.875 ML




89INVELTYS 1% EYE DROP

32INVIRASE 500 MG TABLET

40INVOKAMET 150-1,000 MG TABLET

40INVOKAMET 150-500 MG TABLET

41INVOKAMET 50-1,000 MG TABLET

41INVOKAMET 50-500 MG TABLET

41INVOKAMET XR 150-1,000 MG TAB

41INVOKAMET XR 150-500 MG TABLET

41INVOKAMET XR 50-1,000 MG TAB

41INVOKAMET XR 50-500 MG TABLET

41INVOKANA 100 MG TABLET

41INVOKANA 300 MG TABLET

95iodoquinol-hydrocort-aloe gel

89IOPIDINE 1% EYE DROPS

98IPOL VIAL86iprat-albut 0.5-3(2.5)

mg/3 ml52ipratropium 0.03% spray52ipratropium 0.06% spray86ipratropium br 0.02%

soln19irbesartan 150 mg tablet19irbesartan 300 mg tablet19irbesartan 75 mg tablet19irbesartan-hctz 150-

12.5 mg tb19irbesartan-hctz 300-

12.5 mg tb25IRESSA 250 MG

TABLET

25irinotecan hcl 100 mg/5 ml vl

25irinotecan hcl 40 mg/2 ml vial

25irinotecan hcl 500 mg/25 ml vl

32ISENTRESS 100 MG POWDER PACKET

32ISENTRESS 100 MG TABLET CHEW

32ISENTRESS 25 MG TABLET CHEW

32ISENTRESS 400 MG TABLET

32ISENTRESS HD 600 MG TABLET

70ISIBLOOM 28 DAY TABLET

54iso gentamicin 100 mg/100 ml

22isomethept-caff-acetaminophen

22isomethept-dichloralp-acetamin

54isoniazid 100 mg tablet54isoniazid 300 mg tablet54isoniazid 50 mg/5 ml

solution67isosorbide dinitr er 40

mg tab67isosorbide dinitrate 10




mg tab67isosorbide mononit 10

mg tab67isosorbide mononit 20

mg tab


67isosorbide mononit er 120 mg

67isosorbide mononit er 30 mg tb

67isosorbide mononit er 60 mg tb

54isoton gentamicin 100 mg/50 ml




90isotretinoin 10 mg capsule




98isoxsuprine 10 mg tablet98isoxsuprine 20 mg tablet19isradipine 2.5 mg

capsule19isradipine 5 mg capsule34ISTALOL 0.5% EYE

DROPS25ISTODAX 10 MG KIT14itraconazole 10 mg/ml

solution15itraconazole 100 mg

capsule54ivermectin 3 mg tablet98IXIARO 6 MCG/0.5 ML

SYRINGE52JADENU 180 MG

TABLET52JADENU 360 MG

TABLET

52JADENU 90 MG TABLET

52JADENU SPRINKLE 180 MG GRANULE



25JAKAFI 10 MG TABLET25JAKAFI 15 MG TABLET25JAKAFI 20 MG TABLET25JAKAFI 25 MG TABLET25JAKAFI 5 MG TABLET34JALYN 0.5-0.4 MG

CAPSULE37JANTOVEN 1 MG

TABLET37JANTOVEN 10 MG


TABLET37JANTOVEN 2.5 MG





TABLET37JANTOVEN 7.5 MG

TABLET41JANUMET 50-1,000

MG TABLET41JANUMET 50-500 MG

TABLET41JANUMET XR 100-

1,000 MG TABLET41JANUMET XR 50-1,000

MG TABLET

41JANUMET XR 50-500 MG TABLET

41JANUVIA 100 MG TABLET



41JARDIANCE 10 MG TABLET

41JARDIANCE 25 MG TABLET

70JASMIEL 3 MG-0.02 MG TABLET

46JENCYCLA 0.35 MG TABLET

41JENTADUETO 2.5 MG-1000 MG TAB



41JENTADUETO XR 2.5 MG-1,000 MG

41JENTADUETO XR 5 MG-1,000 MG TB

46JINTELI 1 MG-5 MCG TABLET

70JOLESSA 0.15 MG-0.03 MG TABLET

46JOLIVETTE TABLET70JULEBER 28 DAY

TABLET32JULUCA 50-25 MG

TABLET70JUNEL 1 MG-20 MCG

TABLET70JUNEL 1.5 MG-30 MCG

TABLET70JUNEL FE 1 MG-20

MCG TABLET70JUNEL FE 1.5 MG-30

MCG TABLET


70JUNEL FE 24 TABLET43K EFFERVESCENT 25

MEQ TABLET61KABIVEN IV

EMULSION25KADCYLA 100 MG VIAL25KADCYLA 160 MG VIAL70KAITLIB FE

CHEWABLE TABLET32KALETRA 100-25 MG

TABLET32KALETRA 200-50 MG

TABLET86KALYDECO 150 MG

TABLET86KALYDECO 25 MG

GRANULES PACKET86KALYDECO 50 MG

GRANULES PACKET86KALYDECO 75 MG

GRANULES PACKET70KARIVA 28 DAY

TABLET43kcl 20 meq in d5w

solution43kcl 20 meq in d5w-0.2%

nacl43kcl 20 meq in d5w-

0.225% nacl43kcl 20 meq in d5w-0.3%

nacl43kcl 20 meq in d5w-

0.45% nacl43kcl 20 meq in d5w-lact

ringer43kcl 20 meq in d5w-ns43kcl 20 meq-ns 1,000 ml

iv soln43kcl 40 meq in d5w

solution43kcl 40 meq in d5w-lact

ringer

43kcl 40 meq in d5w-nacl 0.9%

43kcl 40 meq-ns 1,000 ml iv soln

70KELNOR 1-35 28 TABLET

70KELNOR 1-50 TABLET9KENALOG-10 50 MG/5

ML VIAL12KEPPRA 1,000 MG

TABLET12KEPPRA 100 MG/ML

ORAL SOLN12KEPPRA 250 MG

TABLET12KEPPRA 500 MG

TABLET12KEPPRA 750 MG

TABLET12KEPPRA XR 500 MG

TABLET12KEPPRA XR 750 MG

TABLET48KERAFOAM 30% FOAM48KERAFOAM 42% FOAM48KERALAC 47% CREAM48KERALYT 6% GEL48KERALYT SCALP

COMPLETE KIT93ketoconazole 2% cream93ketoconazole 2%

shampoo15ketoconazole 200 mg

tablet69ketorolac 0.4% ophth

solution69ketorolac 0.5% ophth

solution68ketorolac 10 mg tablet68ketorolac 30 mg/ml vial

68ketorolac 60 mg/2 ml carpuject

25KEYTRUDA 100 MG/4 ML VIAL

73KINERET 100 MG/0.67 ML SYRINGE

98KINRIX TIP-LOK SYRINGE

98KINRIX VIAL52KIONEX 15 GM/60 ML

SUSPENSION25KISQALI 200 MG

DAILY DOSE25KISQALI 400 MG

DAILY DOSE25KISQALI 600 MG

DAILY DOSE25KISQALI FEMARA 200

MG CO-PACK25KISQALI FEMARA 400

MG CO-PACK25KISQALI FEMARA 600

MG CO-PACK93KLARON 10% LOTION43KLOR-CON 10 MEQ

TABLET43KLOR-CON 20 MEQ

PACKET43KLOR-CON 8 MEQ

TABLET43KLOR-CON M10



TABLET43KLOR-CON SPRINKLE

ER 10 MEQ CP43KLOR-CON SPRINKLE

ER 8 MEQ CAP43KLOR-CON-EF 25

MEQ TAB EFF


41KOMBIGLYZE XR 2.5-1,000 MG TAB

41KOMBIGLYZE XR 5-1,000 MG TAB

41KOMBIGLYZE XR 5-500 MG TABLET

59KORLYM 300 MG TABLET

62K-PHOS #2 TABLET43K-PHOS NEUTRAL

TABLET62K-PHOS ORIGINAL

TABLET70KURVELO TABLET59KUVAN 100 MG

POWDER PACKET59KUVAN 100 MG

TABLET59KUVAN 500 MG

POWDER PACKET25KYPROLIS 10 MG VIAL25KYPROLIS 30 MG VIAL25KYPROLIS 60 MG VIAL19labetalol hcl 100 mg

tablet19labetalol hcl 200 mg

tablet19labetalol hcl 300 mg

tablet62LACRISERT 5 MG EYE

INSERT43lactated ringers injection52lactated ringers irrigation57lactulose 10 gm packet57lactulose 10 gm/15 ml

solution12LAMICTAL 100 MG

TABLET12LAMICTAL 150 MG

TABLET

12LAMICTAL 200 MG TABLET

12LAMICTAL 25 MG DISPER TABLET

12LAMICTAL 25 MG TABLET

12LAMICTAL 5 MG DISPER TABLET

12LAMICTAL TAB START KIT (BLUE)

12LAMICTAL TAB START KIT (GREEN)

12LAMICTAL TB START KIT (ORANGE)

12LAMICTAL XR 100 MG TABLET






12LAMICTAL XR START KIT (BLUE)

12LAMICTAL XR START KIT (GREEN)

12LAMICTAL XR START KIT (ORANGE)

32lamivudine 10 mg/ml oral soln

32lamivudine 150 mg tablet

32lamivudine 300 mg tablet

32lamivudine hbv 100 mg tablet

32lamivudine-zidovudine tablet

12lamotrigine 100 mg tablet



12lamotrigine 25 mg disper tab

12lamotrigine 25 mg tablet12lamotrigine 5 mg disper

tablet12lamotrigine er 100 mg






tablet12lamotrigine odt 100 mg




tablet12lamotrigine tab start kit-

blue12lamotrigine tab start kt-

green12lamotrigine tab start kt-

orang55LANOXIN 125 MCG

TABLET55LANOXIN 187.5 MCG

TABLET55LANOXIN 250 MCG

TABLET


55LANOXIN 62.5 MCG TABLET

55LANOXIN PED 100 MCG/ML AMPUL

96lansoprazol-amoxicil-clarithro

96lansoprazole dr 15 mg capsule

96lansoprazole dr 30 mg capsule

96lansoprazole odt 15 mg tablet

96lansoprazole odt 30 mg tablet

52lanthanum carb 1,000 mg tb chw

52lanthanum carb 500 mg tab chew

52lanthanum carb 750 mg tab chew

41LANTUS 100 UNIT/ML VIAL

41LANTUS SOLOSTAR 100 UNIT/ML

70LARIN 1.5 MG-30 MCG TABLET

70LARIN 21 1-20 TABLET70LARIN 24 FE 1 MG-20

MCG TABLET70LARIN FE 1.5-30

TABLET70LARIN FE 1-20 TABLET70LARISSIA-28 TABLET25LARTRUVO 190 MG/19

ML VIAL25LARTRUVO 500 MG/50

ML VIAL19LASIX 20 MG TABLET19LASIX 40 MG TABLET19LASIX 80 MG TABLET72latanoprost 0.005% eye

drops

80LATUDA 120 MG TABLET





70LAYOLIS FE CHEWABLE TABLET

95LDO PLUS 4% HYDROGEL PUMP

70LEENA 28 TABLET73leflunomide 10 mg tablet73leflunomide 20 mg tablet25LENVIMA 10 MG

DAILY DOSE25LENVIMA 12 MG






CAPSULE26LENVIMA 8 MG DAILY

DOSE50LESCOL XL 80 MG

TABLET70LESSINA-28 TABLET26letrozole 2.5 mg tablet

8leucovorin cal 500 mg/50 ml vl

8leucovorin calcium 10 mg tab

8leucovorin calcium 100 mg vial






8leucovorin calcium 500 mg vl

26LEUKERAN 2 MG TABLET

35LEUKINE 250 MCG VIAL

26leuprolide 2wk 14 mg/2.8 ml kt

86levalbuterol 0.31 mg/3 ml sol



86levalbuterol conc 1.25 mg/0.5

86levalbuterol tar hfa 45mcg inh

41LEVEMIR 100 UNIT/ML VIAL

41LEVEMIR FLEXTOUCH 100 UNIT/ML

12levetiracetam 1,000 mg tablet

12levetiracetam 100 mg/ml soln

12levetiracetam 250 mg tablet



12levetiracetam 500 mg/5 ml vial


12levetiracetam er 500 mg tablet

12levetiracetam er 750 mg tablet

12levetiracetam-nacl 1,000mg/100

12levetiracetam-nacl 1,500mg/100

12levetiracetam-nacl 500 mg/100

31LEVICYN ANTIPRURITIC GEL

44LEVICYN ANTIPRURITIC SG GEL

88LEVITRA34levobunolol 0.5% eye

drops52levocarnitine 1 g/10 ml

soln52levocarnitine 330 mg

tablet15levocetirizine 2.5 mg/5

ml sol15levocetirizine 5 mg tablet10levofloxacin 0.5% eye

drops88levofloxacin 25 mg/ml

solution88levofloxacin 250 mg

tablet88levofloxacin 250 mg/50

ml-d5w88levofloxacin 500 mg

tablet88levofloxacin 500

mg/100 ml-d5w88levofloxacin 500 mg/20

ml vial

88levofloxacin 750 mg tablet

88levofloxacin 750 mg/150 ml-d5w

70LEVONEST-28 TABLET70levono-e estrad 0.10-

0.02-0.0170levono-e estrad 0.15-

0.03-0.0170levonor-eth estra 0.09-

0.02 mg70levonor-eth estrad 0.1-

0.02 mg70levonor-eth estrad 0.15-

0.0370levonor-eth estrad

triphasic70LEVORA-28 TABLET91levothyroxine 100 mcg

tablet91levothyroxine 100

mcg/5 ml vl91levothyroxine 112 mcg

tablet91levothyroxine 125 mcg





tablet91levothyroxine 200

mcg/5 ml vl91levothyroxine 25 mcg



tablet

91levothyroxine 500 mcg/5 ml vl

91levothyroxine 75 mcg tablet

91levothyroxine 88 mcg tablet

91LEVOXYL 100 MCG TABLET











34LEVSIN 0.125 MG TABLET

34LEVSIN-SL 0.125 MG TABLET SL

80LEXAPRO 10 MG TABLET



32LEXIVA 50 MG/ML SUSPENSION

57LIALDA DR 1.2 GM TABLET

14LIBRAX CAPSULE


26LIBTAYO 350 MG/7 ML VIAL

51LIDOCAINE 0.5MG INTRADERM SYST

51LIDOCAINE 100 MG/5 ML (2%) SYR

55lidocaine 2% viscous soln

95lidocaine 3% cream55lidocaine 5% ointment55lidocaine 5% patch56lidocaine hcl 0.5% vial

9lidocaine hcl 1% abboject

56lidocaine hcl 1% ampul56lidocaine hcl 1% vial56lidocaine hcl 1.5%

ampul51lidocaine hcl 10 mg/ml

syringe51lidocaine hcl 100 mg/10

ml syr56lidocaine hcl 2% 40

mg/2 ml vl56lidocaine hcl 2% jelly56lidocaine hcl 2% jelly

uro-jet9lidocaine hcl 2% luer-jet

56lidocaine hcl 2% vial95lidocaine hcl 3% lotion95LIDOCAINE HCL

3.88% CREAM51LIDOCAINE HCL 30

MG/3 ML SYR56lidocaine hcl 4% ampul93lidocaine hcl 4% solution51LIDOCAINE HCL 50

MG/5 ML SYRNG48lidocaine-hc 2.8-0.55%

gel

57lidocaine-hc 2-2% cream kit

57lidocaine-hc 3-0.5% cream kit

57lidocaine-hc 3-1% cream kit

48lidocaine-hc 3-2.5% gel kit

56lidocaine-prilocaine cream

56lidocaine-prilocaine-cream base 2.5%; 2.5% crea

95LIDODERM 5% PATCH95lido-k 3% lotion95LIDOPAC 5%

OINTMENT-DRESSING95lidopin 3% cream95LIDOPIN 3.25% CREAM95LIDORX 3% GEL95LIDOTRAL 3.88%

CREAM95LIDOVEX 3.75%

CREAM95lidozion 3% lotion95LIDTOPIC MAX 10%

CREAM54lincomycin hcl 600 mg/2

ml vl95lindane 1% lotion95lindane 1% shampoo54linezolid 100 mg/5 ml

susp54linezolid 600 mg tablet54linezolid 600 mg/300 ml-

d5w54linezolid 600mg/300ml;

0.9% soln54linezolid 600mg/300ml-

0.9%nacl

57LINZESS 145 MCG CAPSULE



91liothyronine sod 25 mcg tab



50LIPITOR 10 MG TABLET




47LIQUID E-Z PAQUE 60% SUSP

47LIQUID POLIBAR PLUS SUSP

19lisinopril 10 mg tablet19lisinopril 2.5 mg tablet19lisinopril 20 mg tablet19lisinopril 30 mg tablet19lisinopril 40 mg tablet19lisinopril 5 mg tablet19lisinopril-hctz 10-12.5

mg tab19lisinopril-hctz 20-12.5

mg tab19lisinopril-hctz 20-25 mg

tab80lithium 8 meq/5 ml

solution80lithium carbonate 150

mg cap80lithium carbonate 300

mg cap


80lithium carbonate 300 mg tab

80lithium carbonate 600 mg cap

80lithium carbonate er 300 mg tb

80lithium carbonate er 450 mg tb

52LITHOSTAT 250 MG TABLET

50LIVALO 1 MG TABLET50LIVALO 2 MG TABLET50LIVALO 4 MG TABLET52LOKELMA 10 GRAM

POWDER PACKET52LOKELMA 5 GRAM

POWDER PACKET26LONSURF 15 MG-6.14

MG TABLET26LONSURF 20 MG-8.19

MG TABLET14loperamide 2 mg

capsule32lopinavir-ritonavir 80-

20mg/ml70LOPREEZA 0.5 MG-0.1

MG TABLET70LOPREEZA 1 MG-0.5

MG TABLET93LOPROX 0.77%

CREAM KIT93LOPROX 0.77%

SUSPENSION KIT80lorazepam 0.5 mg tablet80lorazepam 1 mg tablet80lorazepam 2 mg tablet80lorazepam 2 mg/ml

carpuject80lorazepam 2 mg/ml oral

concent80lorazepam 20 mg/10 ml

vial

80lorazepam 4 mg/ml carpuject

80lorazepam 4 mg/ml vial80LORAZEPAM

INTENSOL 2 MG/ML26LORBRENA 100 MG

TABLET26LORBRENA 25 MG

TABLET65LORCET 5-325 MG

TABLET65LORCET HD 10-325

MG TABLET65LORCET PLUS 7.5-325

MG TABLET38lortuss ex liquid70LORYNA 3 MG-0.02

MG TABLET19losartan potassium 100

mg tab19losartan potassium 25

mg tab19losartan potassium 50

mg tab19losartan-hctz 100-12.5

mg tab19losartan-hctz 100-25 mg

tab19losartan-hctz 50-12.5

mg tab89LOTEMAX 0.5% EYE

DROPS89LOTEMAX 0.5% EYE

OINTMENT89LOTEMAX 0.5%

OPHTHALMIC GEL89LOTEMAX SM 0.38%

OPHTH GEL19LOTREL 10-20 MG

CAPSULE19LOTREL 10-40 MG

CAPSULE

19LOTREL 5-10 MG CAPSULE

19LOTREL 5-20 MG CAPSULE

50lovastatin 10 mg tablet50lovastatin 20 mg tablet50lovastatin 40 mg tablet50LOVAZA 1 GM

CAPSULE70LOW-OGESTREL-28

TABLET80loxapine 10 mg capsule80loxapine 25 mg capsule80loxapine 5 mg capsule80loxapine 50 mg capsule99LUDENT FLUORIDE 1

MG TAB CHEW72LUMIGAN 0.01% EYE

DROPS59LUMIZYME 50 MG VIAL26LUMOXITI 1 MG VIAL26LUPRON DEPOT 11.25

MG 3MO KIT26LUPRON DEPOT 22.5


MG KIT26LUPRON DEPOT 45


MG KIT26LUPRON DEPOT-4

MONTH KIT26LUPRON DEPOT-PED

11.25 MG 3MO26LUPRON DEPOT-PED

11.25 MG KIT26LUPRON DEPOT-PED

15 MG KIT26LUPRON DEPOT-PED

30 MG 3MO KIT


26LUPRON DEPOT-PED 7.5 MG KIT

70LUTERA-28 TABLET26LYNPARZA 100 MG

TABLET26LYNPARZA 150 MG

TABLET12LYRICA 100 MG

CAPSULE12LYRICA 150 MG

CAPSULE12LYRICA 20 MG/ML

ORAL SOLUTION12LYRICA 200 MG






CAPSULE12LYRICA CR 165 MG

TABLET12LYRICA CR 330 MG

TABLET12LYRICA CR 82.5 MG

TABLET26LYSODREN 500 MG

TABLET46LYZA 0.35 MG TABLET74M.V.I. ADULT VIAL74M.V.I.-12 VIAL93mafenide acetate 50 gm

powd pk57MAGNEBIND 400 RX

TABLET43magnesium sulf 1 g/100

ml-d5w

43magnesium sulf 2 g/50 ml bag




43magnesium sulf 40 g/1,000 ml

43magnesium sulfate 50% syringe

43magnesium sulfate 50% vial

95malathion 0.5% lotion80maprotiline 25 mg tablet80maprotiline 50 mg tablet80maprotiline 75 mg tablet38MAR-COF BP LIQUID38MAR-COF CG LIQUID70MARLISSA-28 TABLET80MARPLAN 10 MG

TABLET26MATULANE 50 MG

CAPSULE19MATZIM LA 180 MG

TABLET19MATZIM LA 240 MG




TABLET32MAVYRET 100-40 MG

TABLET89MAXIDEX 0.1% EYE

DROPS38MAXI-TUSS CD LIQUID38m-clear wc liquid

57meclizine 12.5 mg tablet57meclizine 25 mg tablet68meclofenamate 100 mg

capsule68meclofenamate 50 mg

capsule9MEDROL 2 MG

TABLET46medroxyprogesterone

10 mg tab46medroxyprogesterone

150 mg/ml46medroxyprogesterone

2.5 mg tab46medroxyprogesterone 5

mg tab54mefloquine hcl 250 mg

tablet26megestrol 20 mg tablet26megestrol 40 mg tablet26megestrol 625 mg/5 ml

susp26megestrol acet 40

mg/ml susp26MEKINIST 0.5 MG

TABLET26MEKINIST 2 MG

TABLET26MEKTOVI 15 MG

TABLET70MELODETTA 24 FE

CHEWABLE TAB68meloxicam 15 mg tablet68meloxicam 7.5 mg tablet26melphalan 50 mg vial w-

diluent60memantine 5-10 mg

titration pk60memantine hcl 10 mg

tablet60memantine hcl 2 mg/ml

solution


60memantine hcl 5 mg tablet

60memantine hcl er 14 mg capsule




98MENACTRA VIAL36me-naphos-mb-hyo 1

tablet38M-END PE LIQUID46MENEST 0.3 MG

TABLET46MENEST 0.625 MG

TABLET46MENEST 1.25 MG

TABLET46MENOSTAR 14

MCG/DAY PATCH98MENVEO A-C-Y-W-135-

DIP VIAL KT65meperidine 100 mg

tablet65meperidine 50 mg tablet65meperidine 50 mg/5 ml

solution74MEPHYTON 5 MG

TABLET63meprobamate 200 mg

tablet63meprobamate 400 mg

tablet26mercaptopurine 50 mg

tablet54meropenem iv 1 gm vial54meropenem iv 500 mg

vial54meropenem-0.9% nacl

1 gram/50

54meropenem-0.9% nacl 500 mg/50

57mesalamine 1,000 mg supp

57mesalamine 4 gm/60 ml enema

57mesalamine 4 gm/60 ml kit

57mesalamine 800 mg dr tablet

57mesalamine dr 1.2 gm tablet

57mesalamine dr 400 mg capsule

8mesna 1 gram/10 ml vial8MESNEX 400 MG

TABLET80METADATE CD 10 MG

CAPSULE80METADATE CD 20 MG





CAPSULE80METADATE ER 20 MG

TABLET86metaproterenol 10 mg

tablet86metaproterenol 10 mg/5

ml syr86metaproterenol 20 mg

tablet63METAXALL 800 MG

TABLET63metaxalone 400 mg

tablet63metaxalone 800 mg

tablet

41metformin er 1,000 mg gastr-tb (generic glumetza)

41metformin er 1,000 mg osm-tab (generic fortamet)

41metformin er 500 mg gastrc-tb (generic glumetza)

41metformin er 500 mg osmotic tb (generic fortamet)

41metformin hcl 1,000 mg tablet

41metformin hcl 500 mg tablet

41metformin hcl 850 mg tablet

41metformin hcl er 500 mg tablet (generic glucophage)

41metformin hcl er 750 mg tab (generic glucophage)

65methadone 10 mg/5 ml solution

65methadone 10 mg/ml oral conc

65methadone 5 mg/5 ml solution

65methadone hcl 10 mg tablet

65methadone hcl 10 mg/ml vial

65methadone hcl 5 mg tablet

65METHADONE INTENSOL 10 MG/ML

80methamphetamine 5 mg tablet

71methazolamide 25 mg tablet

71methazolamide 50 mg tablet


97methenamine hipp 1 gm tablet

97methenamine md 1 gm tablet

97methenamine md 500 mg tablet

31methimazole 10 mg tablet

31methimazole 5 mg tablet59METHITEST 10 MG

TABLET63methocarbamol 500 mg

tablet63methocarbamol 750 mg

tablet26methotrexate 1 gm vial26methotrexate 1 gram/40

ml vial26methotrexate 2.5 mg

tablet68methotrexate 25 mg/1

ml vial26methotrexate 250

mg/10 ml vial26methotrexate 50 mg/2

ml vial56methoxsalen 10 mg

softgel14methscopolamine brom

2.5 mg tb14methscopolamine brom

5 mg tab19methyclothiazide 5 mg

tablet19methyldopa 250 mg

tablet19methyldopa 500 mg

tablet19methyldopa-hctz 250-15

mg tab19methyldopa-hctz 250-25

mg tab

62methylergonovine 0.2 mg tablet

80methylphenidate 10 mg chew tab

80methylphenidate 10 mg tablet

80methylphenidate 10 mg/5 ml sol

80methylphenidate 2.5 mg chew tb


80methylphenidate 5 mg chew tab


80methylphenidate 5 mg/5 ml soln

80methylphenidate cd 10 mg cap






80methylphenidate er 10 mg tab






81methylphenidate er(cd) 20mg cp



81methylphenidate er(la) 10mg cp

81methylphenidate er(la) 40mg cp

81methylphenidate la 20 mg cap



9methylprednisolone 16 mg tab


9methylprednisolone 4 mg dosepk

9methylprednisolone 4 mg tablet

9methylprednisolone 40 mg/ml vl


9methylprednisolone 80 mg/ml vl

9methylprednisolone ss 125 mg

9methylprednisolone ss 40 mg vl

57metoclopramide 10 mg tablet

57metoclopramide 10 mg/2 ml vial

57metoclopramide 5 mg tablet

57metoclopramide 5 mg/5 ml soln

19metolazone 10 mg tablet


19metolazone 2.5 mg tablet

19metolazone 5 mg tablet48METOPIC 41% CREAM19metoprolol succ er 100

mg tab19metoprolol succ er 200



mg tab19metoprolol tartrate 100


mg tab20metoprolol tartrate 37.5

mg tb20metoprolol tartrate 50


mg tab20metoprolol-hctz 100-25



mg tab90metronidazole 0.75%

cream90metronidazole 0.75%

lotion54metronidazole 250 mg

tablet54metronidazole 375 mg

capsule54metronidazole 500 mg

tablet54metronidazole 500

mg/100 ml90metronidazole topical

0.75% gl

90metronidazole topical 1% gel

62metronidazole vaginal 0.75% gl

9mexiletine 150 mg capsule



93MEZPAROX-HC 2.5%-1% CREAM

59MIACALCIN 400 UNIT/2 ML VIAL

70MIBELAS 24 FE CHEWABLE TABLET

20MICARDIS 20 MG TABLET



20MICARDIS HCT 40-12.5 MG TABLET

20MICARDIS HCT 80-12.5 MG TABLET

20MICARDIS HCT 80-25 MG TABLET

62miconazole 3 200 mg vag supp

71MICROGESTIN 21 1.5-30 TAB

71MICROGESTIN 21 1-20 TABLET

71MICROGESTIN FE 1.5-30 TAB

71MICROGESTIN FE 1-20 TABLET

81midazolam hcl 2 mg/ml syrup

52midodrine hcl 10 mg tablet

52midodrine hcl 2.5 mg tablet

52midodrine hcl 5 mg tablet

51MIGERGOT SUPPOSITORY

41miglitol 100 mg tablet41miglitol 25 mg tablet41miglitol 50 mg tablet59miglustat 100 mg

capsule71MILI 0.25-0.035 MG

TABLET46MIMVEY 1-0.5 MG

TABLET46MIMVEY LO 0.5-0.1

MG TABLET44MIMYX CREAM67MINITRAN 0.1 MG/HR

PATCH67MINITRAN 0.2 MG/HR



PATCH46MINIVELLE 0.025 MG





PATCH90minocycline 100 mg

capsule90minocycline 50 mg

capsule90minocycline 75 mg

capsule


90minocycline hcl 100 mg tablet



20minoxidil 10 mg tablet20minoxidil 2.5 mg tablet30MIRAPEX ER 0.375

MG TABLET30MIRAPEX ER 0.75 MG

TABLET30MIRAPEX ER 1.5 MG


TABLET30MIRAPEX ER 3 MG



TABLET81mirtazapine 15 mg odt81mirtazapine 15 mg tablet81mirtazapine 30 mg odt81mirtazapine 30 mg tablet81mirtazapine 45 mg odt81mirtazapine 45 mg tablet81mirtazapine 7.5 mg

tablet96misoprostol 100 mcg

tablet96misoprostol 200 mcg

tablet47MITIGARE 0.6 MG

CAPSULE66MITIGO 200 MG/20 ML

VIAL66MITIGO 500 MG/20 ML

VIAL

98M-M-R II VACCINE WITH DILUENT

81modafinil 100 mg tablet81modafinil 200 mg tablet20moexipril hcl 15 mg

tablet20moexipril hcl 7.5 mg

tablet81molindone hcl 10 mg



tablet94mometasone furoate

0.1% cream94mometasone furoate

0.1% oint94mometasone furoate

0.1% soln86mometasone furoate 50

mcg spry90MONDOXYNE NL 100

MG CAPSULE90MONDOXYNE NL 50

MG CAPSULE90MONDOXYNE NL 75

MG CAPSULE71MONO-LINYAH 28

TABLET71MONONESSA 28

TABLET86montelukast sod 10 mg

tablet86montelukast sod 4 mg

granules86montelukast sod 4 mg

tab chew86montelukast sod 5 mg

tab chew97MONUROL 3 GM

SACHET

90MORGIDOX 100 MG CAPSULE

89MORGIDOX 1X100 MG KIT



90MORGIDOX 50 MG CAPSULE

66morphine 10 mg/10 ml vial

66morphine 10 mg/ml isecure syrg

66morphine 10 mg/ml syringe

66morphine 2 mg/ml isecure syr


66morphine 4 mg/ml isecure syr


66morphine 5 mg/10 ml vial


66morphine 5 mg/ml vial66morphine 8 mg/ml

isecure syrng66morphine 8 mg/ml

syringe66morphine sulf 10 mg

suppos66morphine sulf 10 mg/5

ml soln66morphine sulf 100 mg/5

ml conc66morphine sulf 20 mg

suppos66morphine sulf 20 mg/5

ml soln


66morphine sulf 30 mg suppos

66morphine sulf 5 mg suppos

66morphine sulf er 100 mg tablet





66morphine sulfate 1 mg/ml vial





66morphine sulfate er 10 mg cap











66morphine sulfate ir 15 mg tab

66morphine sulfate ir 30 mg tab

57MOVIPREP POWDER PACKET

10MOXEZA 0.5% EYE DROPS

10moxifloxacin 0.5% eye drops

88moxifloxacin 400 mg/250 ml bag

88moxifloxacin hcl 400 mg tablet

35MOZOBIL 24 MG/1.2 ML VIAL

9MULTAQ 400 MG TABLET

93mupirocin 2% cream93mupirocin 2% ointment88MUSE15MYCAMINE 100 MG

VIAL15MYCAMINE 50 MG

VIAL26mycophenolate 200

mg/ml susp26mycophenolate 250 mg

capsule26mycophenolate 500 mg

tablet26mycophenolate 500 mg

vial26mycophenolic acid dr

180 mg tb26mycophenolic acid dr

360 mg tb

63MYDRIACYL 1% EYE DROPS

26MYFORTIC 180 MG TABLET

26MYFORTIC 360 MG TABLET

26MYLOTARG 4.5 MG VIAL

90MYORISAN 10 MG CAPSULE




10MYRBETRIQ ER 25 MG TABLET

10MYRBETRIQ ER 50 MG TABLET

71MYZILRA-28 TABLET68nabumetone 500 mg

tablet68nabumetone 750 mg

tablet20nadolol 20 mg tablet20nadolol 40 mg tablet20nadolol 80 mg tablet20nadolol-bendroflu 40-5

mg tab74nafcillin 1 gm add-van

vial74nafcillin 1 gm vial74nafcillin 10 gm bulk vial74nafcillin 2 gm add-vant

vial74nafcillin 2 gm vial93naftifine hcl 1% cream93naftifine hcl 2% cream93NAFTIN 1% GEL93NAFTIN 2% CREAM


93NAFTIN 2% GEL59NAGLAZYME 5 MG/5

ML VIAL66nalbuphine 100 mg/10

ml vial66nalbuphine 200 mg/10

ml vial68naloxone 0.4 mg/ml vial69naloxone 2 mg/2 ml

syringe69naltrexone 50 mg tablet60NAMENDA 10 MG

TABLET60NAMENDA 2 MG/ML

SOLUTION60NAMENDA 5 MG

TABLET60NAMENDA 5-10 MG

TITRATION PK60NAMENDA XR 14 MG

CAPSULE60NAMENDA XR 21 MG



CAPSULE60NAMENDA XR

TITRATION PACK60NAMZARIC 14 MG-10

MG CAPSULE60NAMZARIC 21 MG-10



MG CAPSULE61NAMZARIC

TITRATION PACK98naphazoline 0.1% eye

drops

69NAPRELAN CR 375 MG TABLET



69naproxen 125 mg/5 ml suspen

69naproxen 250 mg tablet69naproxen 375 mg tablet69naproxen 500 mg tablet69naproxen dr 375 mg

tablet69naproxen dr 500 mg

tablet69naproxen sod cr 375

mg tablet69naproxen sod cr 500

mg tablet62naproxen sod er 375

mg tablet69naproxen sodium 275

mg tab69naproxen sodium 550

mg tab51naratriptan hcl 1 mg

tablet51naratriptan hcl 2.5 mg

tablet69NARCAN 4 MG NASAL

SPRAY74NASCOBAL 500 MCG

NASAL SPRAY74NATACHEW TABLET10NATACYN EYE DROPS41nateglinide 120 mg

tablet41nateglinide 60 mg tablet59NATPARA 100 MCG

DOSE CARTRIDGE59NATPARA 25 MCG

DOSE CARTRIDGE

59NATPARA 50 MCG DOSE CARTRIDGE

59NATPARA 75 MCG DOSE CARTRIDGE

91nature-throid 113.75 mg tablet

91nature-throid 130 mg tablet












54NEBUPENT 300 MG INHAL POWDER

47nebusal 3% vial47NEBUSAL 6% VIAL71NECON 0.5-35-28

TABLET74NEEVODHA CAPSULE81nefazodone hcl 100 mg

tablet81nefazodone hcl 150 mg

tablet


81nefazodone hcl 200 mg tablet



89neo-bacit-poly-hc eye ointment

44NEOCERA ADVANCED CREAM

10neomyc-bacit-polymix eye oint

54neomycin 500 mg tablet89neomycin-poly-hc eye

drops73neomycin-polymyxin-hc

ear soln73neomycin-polymyxin-hc

ear susp89neomyc-polym-dexamet

eye ointm89neomyc-polym-

dexameth eye drop10neomyc-polym-gramicid

eye drop54neomy-polymyxin b 40

mg/ml amp10NEO-POLYCIN EYE

OINTMENT89NEO-POLYCIN HC

EYE OINTMENT26NEORAL 100 MG

GELATIN CAPSULE26NEORAL 100 MG/ML

SOLUTION26NEORAL 25 MG

GELATIN CAPSULE44NEOSALUS CP CREAM44NEOSALUS CREAM44NEOSALUS FOAM44NEOSALUS LOTION

93NEO-SYNALAR 0.5-0.025% CRM KIT

61NEPHRAMINE 5.4% IV SOLUTION

26NERLYNX 40 MG TABLET

74NESTABS DHA COMBO PACK

74NESTABS ONE SOFTGEL

74NESTABS TABLET90NEUAC GEL30NEUPRO 1 MG/24 HR

PATCH30NEUPRO 2 MG/24 HR





PATCH13NEURONTIN 100 MG

CAPSULE13NEURONTIN 300 MG



TABLET13NEURONTIN 800 MG

TABLET69NEVANAC 0.1%

DROPTAINER32nevirapine 200 mg tablet32nevirapine 50 mg/5 ml

susp32nevirapine er 100 mg

tablet

32nevirapine er 400 mg tablet

74newgen tablet74NEXA PLUS SOFTGEL26NEXAVAR 200 MG

TABLET96NEXIUM DR 10 MG

PACKET96NEXIUM DR 2.5 MG

PACKET96NEXIUM DR 20 MG

CAPSULE96NEXIUM DR 20 MG


CAPSULE96NEXIUM DR 40 MG


PACKET50niacin 500 mg tablet50niacin er 1,000 mg tablet50niacin er 500 mg tablet50niacin er 750 mg tablet50NIACOR 500 MG

TABLET20nicardipine 20 mg

capsule20nicardipine 25 mg/10 ml

vial20nicardipine 30 mg

capsule89NICOTROL

CARTRIDGE INHALER89NICOTROL NS 10

MG/ML SPRAY20nifedipine 10 mg

capsule20nifedipine 20 mg

capsule20nifedipine er 30 mg

tablet


20nifedipine er 60 mg tablet

20nifedipine er 90 mg tablet

71NIKKI 3 MG-0.02 MG TABLET

26nilutamide 150 mg tablet20nimodipine 30 mg

capsule26NINLARO 2.3 MG

CAPSULE27NINLARO 3 MG

CAPSULE27NINLARO 4 MG

CAPSULE20nisoldipine er 17 mg

tablet20nisoldipine er 20 mg

tablet20nisoldipine er 25.5 mg




tablet20nisoldipine er 8.5 mg

tablet67NITRO-BID 2%

OINTMENT68NITRO-DUR 0.3

MG/HR PATCH68NITRO-DUR 0.8

MG/HR PATCH97nitrofurantoin 25 mg/5

ml susp97nitrofurantoin mcr 100

mg cap97nitrofurantoin mcr 25

mg cap97nitrofurantoin mcr 50

mg cap

97nitrofurantoin mono-mcr 100 mg

68nitroglycerin 0.1 mg/hr patch


68nitroglycerin 0.3 mg tablet sl





68nitroglycerin 5 mg/ml vial98nitroglycerin er 2.5 mg

cap98nitroglycerin er 6.5 mg

cap98nitroglycerin er 9 mg

capsule68nitroglycerin lingual 0.4

mg68NITROSTAT 0.3 MG

TABLET SL68NITROSTAT 0.4 MG

TABLET SL68NITROSTAT 0.6 MG

TABLET SL98nitro-time er 2.5 mg

capsule98nitro-time er 6.5 mg

capsule98nitro-time er 9 mg

capsule44nivatopic plus cream96nizatidine 150 mg

capsule96nizatidine 300 mg

capsule

22nodolor capsule46NORA-BE TABLET71noret-estr-fe 0.4-

0.035(21)-7571noreth-estrad-fe 1-

0.02(21)-7571noreth-estrad-fe 1-

0.02(24)-7546norethind-eth estrad 0.5-

2.571norethind-eth estrad 1-

0.02 mg46norethindrone 0.35 mg

tablet46norethindrone 5 mg

tablet71norethin-estra-fe 0.8-

0.025 mg46norethin-eth estrad 1

mg-5 mcg71norg-ee 0.18-0.215-

0.25/0.02571norg-ethin estra 0.25-

0.035 mg46NORLYROC 0.35 MG

TABLET61NORMOSOL-M AND

DEXTROSE 5%43NORMOSOL-R IV

SOLUTION61NORMOSOL-R PH 7.4

IV SOLUTION43NORMOSOL-R-

DEXTROSE 5% IV SOLN

9NORPACE CR 100 MG CAPSULE

9NORPACE CR 150 MG CAPSULE

52NORTHERA 100 MG CAPSULE




71NORTREL 0.5-35-28 TABLET

71NORTREL 1-35 21 TABLET

71NORTREL 1-35 28 TABLET

71NORTREL 7-7-7-28 TABLET

81nortriptyline 10 mg/5 ml soln

81nortriptyline hcl 10 mg cap




20NORVASC 10 MG TABLET

20NORVASC 2.5 MG TABLET

20NORVASC 5 MG TABLET

32NORVIR 100 MG POWDER PACKET

32NORVIR 100 MG TABLET

33NORVIR 80 MG/ML SOLUTION

93NOVACORT 2%-1% GEL

59NOVAREL 10,000 UNITS VIAL

41NOVOFINE 32G NEEDLES

41NOVOFINE AUTOCOVER 30G NEEDLE

41NOVOLIN 70-30 100 UNIT/ML VIAL

41NOVOLIN 70-30 FLEXPEN

41NOVOLIN N 100 UNIT/ML VIAL

41NOVOLIN R 100 UNIT/ML VIAL

41NOVOLOG 100 UNIT/ML CARTRIDGE

41NOVOLOG 100 UNIT/ML FLEXPEN

41NOVOLOG 100 UNIT/ML VIAL

41NOVOLOG MIX 70-30 FLEXPEN SYRN

41NOVOLOG MIX 70-30 VIAL

41NOVOTWIST NEEDLE 32G 5MM

15NOXAFIL 40 MG/ML SUSPENSION

15NOXAFIL DR 100 MG TABLET

91NP THYROID 120 MG TABLET





61NUEDEXTA 20-10 MG CAPSULE

14NULEV 0.125 MG CHEWABLE MELT

27NULOJIX 250 MG VIAL95NUMBONEX 2.75%

LOTION88NUMOISYN LIQUID81NUPLAZID 10 MG

TABLET

81NUPLAZID 17 MG TABLET

81NUPLAZID 34 MG CAPSULE

44NUTRASEB FACIAL CREAM

61NUTRILIPID 20% IV FAT EMULSION

62NUVARING VAGINAL RING

90NUZYRA 100 MG VIAL90NUZYRA 150 MG

TABLET90NUZYRA 150 MG

TABLET-7 DAY90NUZYRA 150 MG-7

DAY WITH LOAD93NYAMYC 100,000

UNITS/GM POWDER93nystatin 100,000

unit/gm cream93nystatin 100,000

unit/gm oint93nystatin 100,000

unit/gm powd15nystatin 100,000 unit/ml

susp15nystatin 500,000 unit

oral tab93nystatin-triamcinolone

cream93nystatin-triamcinolone

ointm93NYSTOP 100,000

UNITS/GM POWDER38OBREDON 2.5-200

MG/5 ML SOLN71OCELLA 3 MG-0.03

MG TABLET98OCTAGAM 10% VIAL98OCTAGAM 5% VIAL


27octreotide 1,000 mcg/ml vial

27octreotide acet 0.05 mg/ml vl

27octreotide acet 100 mcg/ml vl



33ODEFSEY TABLET27ODOMZO 200 MG

CAPSULE86OFEV 100 MG

CAPSULE86OFEV 150 MG

CAPSULE10ofloxacin 0.3% ear drops10ofloxacin 0.3% eye

drops88ofloxacin 300 mg tablet88ofloxacin 400 mg tablet71OGESTREL TABLET81olanzapine 10 mg tablet81olanzapine 10 mg vial81olanzapine 15 mg tablet81olanzapine 2.5 mg tablet81olanzapine 20 mg tablet81olanzapine 5 mg tablet81olanzapine 7.5 mg tablet81olanzapine odt 10 mg

tablet81olanzapine odt 15 mg



tablet81olanzapine-fluoxetine

12-25 mg

81olanzapine-fluoxetine 12-50 mg




20olmesartan medoxomil 20 mg tab



20olmesartan-hctz 20-12.5 mg tab

20olmesartan-hctz 40-12.5 mg tab

20olmesartan-hctz 40-25 mg tab

20olmsrtn-amldpn-hctz 20-5-12.5


20olmsrtn-amldpn-hctz 40-10-25mg


20olmsrtn-amldpn-hctz 40-5-25 mg

62olopatadine hcl 0.1% eye drops

62olopatadine hcl 0.2% eye drop

50omega-3 ethyl esters 1 gm cap

96omeprazole dr 10 mg capsule



96omeprazole-bicarb 20-1,100 cap

96omeprazole-bicarb 20-1,680 pkt

96omeprazole-bicarb 40-1,100 cap

96omeprazole-bicarb 40-1,680 pkt

42OMNIPOD 5 PACK 42OMNIPOD DASH 5

PACK POD42OMNIPOD DASH PDM

KIT42OMNIPOD STARTER

KIT57ondansetron 4 mg/2 ml

isecure57ondansetron 4 mg/5 ml

solution57ondansetron 40 mg/20

ml vial57ondansetron hcl 24 mg

tablet57ondansetron hcl 4 mg

tablet57ondansetron hcl 4 mg/2

ml vial57ondansetron hcl 8 mg

tablet57ondansetron odt 4 mg

tablet57ondansetron odt 8 mg

tablet42ONGLYZA 2.5 MG

TABLET42ONGLYZA 5 MG

TABLET27OPDIVO 100 MG/10

ML VIAL27OPDIVO 240 MG/24

ML VIAL27OPDIVO 40 MG/4 ML

VIAL


67opium tincture 10 mg/ml86OPSUMIT 10 MG

TABLET90ORACEA 40 MG

CAPSULE97ORACIT ORAL

SOLUTION52ORALONE 0.1% PASTE54ORBACTIV 400 MG

VIAL73ORENCIA 125 MG/ML

SYRINGE73ORENCIA 50 MG/0.4

ML SYRINGE73ORENCIA 87.5 MG/0.7

ML SYRINGE73ORENCIA CLICKJECT

125 MG/ML52ORFADIN 10 MG

CAPSULE52ORFADIN 2 MG

CAPSULE52ORFADIN 20 MG

CAPSULE52ORFADIN 4 MG/ML

SUSPENSION52ORFADIN 5 MG

CAPSULE87ORKAMBI 100 MG-125

MG TABLET87ORKAMBI 100-125 MG

GRANULE PKT87ORKAMBI 150-188 MG

GRANULE PKT87ORKAMBI 200 MG-125

MG TABLET63orphenadrine er 100 mg

tablet71ORSYTHIA-28 TABLET14OSCIMIN 0.125 MG

ODT

14OSCIMIN 0.125 MG TABLET

14OSCIMIN SL 0.125 MG TABLET

14OSCIMIN SR 0.375 MG TABLET

33oseltamivir 6 mg/ml suspension

33oseltamivir phos 30 mg capsule



57OSMOPREP TABLET62OSPHENA 60 MG

TABLET31OVACE 10% WASH31OVACE PLUS 10%

CREAM31OVACE PLUS 10%

SHAMPOO31OVACE PLUS 10%

WASH31OVACE PLUS 9.8%

FOAM31OVACE PLUS 9.8%

LOTION31OVACE PLUS WASH

10% CLNSNG GEL74oxacillin 1 gm vial74oxacillin 10 gm vial74oxacillin 2 gm vial59oxandrolone 10 mg

tablet59oxandrolone 2.5 mg

tablet69oxaprozin 600 mg tablet81oxazepam 10 mg

capsule81oxazepam 15 mg

capsule

81oxazepam 30 mg capsule

13oxcarbazepine 150 mg tablet


13oxcarbazepine 300 mg/5 ml susp


93oxiconazole nitrate 1% cream

13OXTELLAR XR 150 MG TABLET



10oxybutynin 5 mg tablet10oxybutynin 5 mg/5 ml

syrup10oxybutynin cl er 10 mg

tablet10oxybutynin cl er 15 mg

tablet10oxybutynin cl er 5 mg

tablet67oxycodon-

acetaminophen 2.5-32567oxycodon-

acetaminophen 7.5-32567oxycodone hcl 10 mg

tablet67oxycodone hcl 100

mg/5 ml conc67oxycodone hcl 15 mg

tablet67oxycodone hcl 20 mg



capsule


67oxycodone hcl 5 mg tablet

67oxycodone hcl 5 mg/5 ml soln

67oxycodone hcl er 10 mg tablet







67oxycodone-acetaminophen 10-325

67oxycodone-acetaminophen 5-325

67oxycodone-aspirin 4.8355-325

67oxycodone-ibuprofen 5-400 tab

67oxymorphone hcl 10 mg tablet

67oxymorphone hcl 5 mg tablet

67oxymorphone hcl er 10 mg tab





67oxymorphone hcl er 5 mg tablet

67oxymorphone hcl er 7.5 mg tab

42OZEMPIC 0.25-0.5 MG DOSE PEN

42OZEMPIC 1 MG DOSE PEN

9PACERONE 100 MG TABLET



27paclitaxel 100 mg/16.7 ml vial

27paclitaxel 150 mg/25 ml vial



48PACNEX 7% WASH48PACNEX HP 7%

CLEANSING PADS48PACNEX LP 4.25%

CLEANSING PADS81paliperidone er 1.5 mg

tablet81paliperidone er 3 mg



tablet57palonosetron 0.25 mg/5

ml vial59pamidronate 30 mg/10



ml vial59pamidronate disod 30

mg vial

59pamidronate disod 90 mg vial

57PANCREAZE DR 10,500 UNIT CAP




94PANDEL 0.1% CREAM56PANRETIN 0.1% GEL96pantoprazole sod dr 20

mg tab96pantoprazole sod dr 40

mg tab88PAPEVERINE-

ALPROSTADIL88PAPEVERINE-

PHENTOLAMINE 88PAPEVERINE-

PHENTOLAMINE-ALPROSTADIL

14paregoric liquid59paricalcitol 1 mcg

capsule59paricalcitol 2 mcg

capsule59paricalcitol 4 mcg

capsule52PAROEX 0.12% ORAL

RINSE54paromomycin 250 mg

capsule81paroxetine er 12.5 mg

tablet81paroxetine er 25 mg

tablet81paroxetine er 37.5 mg

tablet81paroxetine hcl 10 mg

tablet


81paroxetine hcl 20 mg tablet



54PASER GRANULES 4 GM PACKET

62PATADAY 0.2% EYE DROPS

81PAXIL 10 MG TABLET81PAXIL 10 MG/5 ML

SUSPENSION81PAXIL 20 MG TABLET81PAXIL 30 MG TABLET82PAXIL 40 MG TABLET82PAXIL CR 12.5 MG

TABLET82PAXIL CR 25 MG

TABLET82PAXIL CR 37.5 MG

TABLET62PAZEO 0.7% EYE

DROPS38pcm la tablet98PEDIARIX 0.5 ML

SYRINGE98PEDVAXHIB VACCINE

VIAL57peg 3350 electrolyte

soln57peg 3350-electrolyte

solution57peg-3350 and

electrolytes soln13PEGANONE 250 MG

TABLET38pe-guai drops73penicillamine 250 mg

capsule74penicillin g k 5 million

unit

74penicillin gk 20 million unit

74penicillin vk 125 mg/5 ml soln

74penicillin vk 250 mg tablet

74penicillin vk 250 mg/5 ml soln

74penicillin vk 500 mg tablet

54PENTAM 300 VIAL54pentamidine 300 mg vial57PENTASA 250 MG

CAPSULE57PENTASA 500 MG

CAPSULE67pentazocine-naloxone

tablet37pentoxifylline er 400 mg

tab87PERFOROMIST 20

MCG/2 ML SOLN61PERIKABIVEN IV

EMULSION20perindopril erbumine 2

mg tab20perindopril erbumine 4

mg tab20perindopril erbumine 8

mg tab27PERJETA 420 MG/14

ML VIAL95permethrin 5% cream82perphen-amitrip 2 mg-

10 mg tab82perphen-amitrip 2 mg-



25 mg tab

82perphen-amitrip 4 mg-50 mg tab

82perphenazine 16 mg tablet




82PERSERIS ER 120 MG SYRINGE KIT

82PERSERIS ER 90 MG SYRINGE KIT

57PERTZYE DR 16,000 UNIT CAPSULE




74PFIZERPEN 20 MILLION UNIT VIAL

74PFIZERPEN 5 MILLION UNIT VIAL

15PHENADOZ 12.5 MG SUPPOSITORY

15PHENADOZ 25 MG SUPPOSITORY

62phenazopyridine 100 mg tab

62phenazopyridine 200 mg tab

82phenelzine sulfate 15 mg tab

13phenobarbital 100 mg tablet


13phenobarbital 16.2 mg tablet


13phenobarbital 20 mg/5 ml elix






34phenohytro elixir34phenohytro tablet20phenoxybenzamine hcl

10 mg cap62phenylephrine 10% eye

drops98phenylephrine 2.5% eye

drop13PHENYTEK 200 MG

CAPSULE13PHENYTEK 300 MG

CAPSULE13phenytoin 125 mg/5 ml

susp13phenytoin 50 mg infatab13phenytoin 50 mg tablet

chew13phenytoin sod ext 100

mg cap13phenytoin sod ext 200

mg cap13phenytoin sod ext 300

mg cap71PHILITH 0.4-0.035 MG

TABLET43PHOSLYRA 667 MG/5

ML SOLUTION97phospha 250 neutral

tablet62PHOSPHASAL TABLET

62PHOSPHOLINE IODIDE 0.125%

97phosphorous 250 mg tablet

97phospho-trin 250 neutral tab

52PHYSIOLYTE IRRIGATION SOLN

52PHYSIOSOL IRRIGATION SOLN

74PHYTONADIONE 1 MG/0.5 ML SYR

74PHYTONADIONE 10 MG/ML AMPUL

74PHYTONADIONE 5 MG TABLET

56PICATO 0.015% GEL56PICATO 0.05% GEL33PIFELTRO 100 MG

TABLET62pilocarpine 1% eye

drops62pilocarpine 2% eye

drops62pilocarpine 4% eye

drops52pilocarpine hcl 5 mg

tablet52pilocarpine hcl 7.5 mg

tablet56pimecrolimus 1% cream82pimozide 1 mg tablet82pimozide 2 mg tablet71PIMTREA 28 DAY

TABLET20pindolol 10 mg tablet20pindolol 5 mg tablet42pioglitazone hcl 15 mg

tablet42pioglitazone hcl 30 mg

tablet

42pioglitazone hcl 45 mg tablet

42pioglitazone-glimepiride 30-2

42pioglitazone-glimepiride 30-4

42pioglitazone-metformin 15-500

42pioglitazone-metformin 15-850

74piperacil-tazobact 13.5 gm vl



74piperacil-tazobact 4.5 gm vial

74piperacil-tazobact 40.5 gram

27PIQRAY 200 MG DAILY DOSE



71PIRMELLA 1-35-28 TABLET

71PIRMELLA 7-7-7-28 TABLET

69piroxicam 10 mg 69piroxicam 20 mg 54PLAQUENIL 200 MG

TABLET37PLAVIX 300 MG

TABLET37PLAVIX 75 MG TABLET61PLENAMINE 15%

SOLUTION57PLENVU POWDER

PACKETS


95PLEXION 9.8-4.8% CLEANSER

95PLEXION 9.8-4.8% CLNSING CLOTH

95PLEXION 9.8-4.8% CREAM

95PLEXION 9.8-4.8% LOTION

56PODOCON-25 LIQUID56podofilox 0.5% topical

soln10POLYCIN EYE

OINTMENT57polyethylene glycol

3350 powd54polymyxin b sulfate vial10polymyxin b-tmp eye

drops38POLY-TUSSIN AC

LIQUID27POMALYST 1 MG

CAPSULE27POMALYST 2 MG



CAPSULE71PORTIA-28 TABLET97pot citrate-citric acid

packet74POTABA 500 MG

CAPSULE98POTABA 500 MG

CAPSULE97potass cit-sod cit-citric

soln43potassium 25 meq

tablet eff62potassium cit-citric acid

soln

62potassium citrate er 10 meq tb

62potassium citrate er 15 meq tb

63potassium citrate er 5 meq tab

43potassium cl 10 meq/100 ml sol

43potassium cl 10% (20 meq/15ml)

43potassium cl 2 meq/ml vial

43potassium cl 20 meq packet


43potassium cl 20 meq-0.45% nacl

43potassium cl 20% (40 meq/15ml)

43potassium cl 25 meq tab eff


43potassium cl 40 meq/20 ml conc

43potassium cl er 10 meq capsule

43potassium cl er 10 meq tablet


43potassium cl er 8 meq capsule


27POTELIGEO 20 MG/5 ML VIAL

37PRADAXA 110 MG CAPSULE



48pramcort 1% cream30pramipexole 0.125 mg

tablet30pramipexole 0.25 mg



tablet30pramipexole 1 mg tablet30pramipexole 1.5 mg

tablet30pramipexole er 0.375

mg tablet30pramipexole er 0.75 mg

tablet30pramipexole er 1.5 mg


tablet30pramipexole er 3 mg



tablet31PRAMOSONE 1%

LOTION31PRAMOSONE 1%-1%

CREAM93PRAMOSONE 1%-1%

OINTMENT93PRAMOSONE 2.5%-

1% CREAM31PRAMOSONE 2.5%-

1% LOTION93PRAMOSONE 2.5%-

1% OINTMENT42PRANDIN 1 MG

TABLET


42PRANDIN 2 MG TABLET

38prasugrel 10 mg tablet38prasugrel 5 mg tablet50PRAVACHOL 20 MG

TABLET50PRAVACHOL 40 MG

TABLET50PRAVACHOL 80 MG

TABLET50pravastatin sodium 10

mg tab50pravastatin sodium 20



mg tab54praziquantel 600 mg

tablet20prazosin 1 mg capsule20prazosin 2 mg capsule20prazosin 5 mg capsule95pre-attached lta kit89PRED MILD 0.12%

EYE DROPS89PRED-G 1% EYE

DROPS89PRED-G S.O.P. EYE

OINTMENT94prednicarbate 0.1%

cream94prednicarbate 0.1%

ointment9prednisolone 15 mg/5

ml soln9prednisolone 5 mg/5 ml

soln89prednisolone ac 1% eye

drop9prednisolone odt 10 mg

tablet

9prednisolone odt 15 mg tablet

9prednisolone odt 30 mg tablet

89prednisolone sod 1% eye drop

9prednisolone sod ph 25 mg/5 ml

9prednisone 1 mg tablet9prednisone 10 mg tab

dose pack9prednisone 10 mg tablet9prednisone 2.5 mg tablet9prednisone 20 mg tablet9prednisone 5 mg tab

dose pack9prednisone 5 mg tablet9prednisone 5 mg/5 ml

solution9prednisone 50 mg tablet9PREDNISONE

INTENSOL 5 MG/ML46PREFEST TABLET13pregabalin 100 mg

capsule13pregabalin 150 mg

capsule13pregabalin 20 mg/ml

solution13pregabalin 200 mg






capsule

59PREGNYL 10,000 UNITS VIAL

46PREMARIN 0.3 MG TABLET





47PREMARIN 25 MG VIAL47PREMARIN VAGINAL

CREAM-APPL61PREMASOL 10% IV

SOLUTION61PREMASOL 6% IV

SOLUTION47PREMPHASE 0.625-5

MG TABLET47PREMPRO 0.3 MG-1.5

MG TABLET47PREMPRO 0.45-1.5

MG TABLET47PREMPRO 0.625-2.5

MG TABLET47PREMPRO 0.625-5 MG

TABLET74prenaissance capsule74prenaissance plus

softgel44PRESERA FOAM96PREVACID 15 MG

SOLUTAB96PREVACID 30 MG

SOLUTAB96PREVACID DR 30 MG

CAPSULE50PREVALITE PACKET50PREVALITE POWDER


53PREVIDENT 0.2% RINSE

53PREVIDENT 1.1% GEL53PREVIDENT 5000

1.1% DRY MOUTH53PREVIDENT 5000

BOOSTER PLUS53PREVIDENT 5000

PLUS CREAM53PREVIDENT DENTAL

RINSE71PREVIFEM TABLET33PREZCOBIX 800 MG-

150 MG TABLET33PREZISTA 100 MG/ML

SUSPENSION33PREZISTA 150 MG

TABLET33PREZISTA 600 MG



TABLET54PRIFTIN 150 MG

TABLET75PRIMACARE SOFTGEL54primaquine 26.3 mg

tablet13primidone 250 mg tablet13primidone 50 mg tablet97PRIMSOL 50 MG/5 ML

ORAL SOLN82PRISTIQ ER 100 MG

TABLET82PRISTIQ ER 25 MG

TABLET82PRISTIQ ER 50 MG

TABLET98PRIVIGEN 10% VIAL87PROAIR HFA 90 MCG

INHALER

87PROAIR RESPICLICK INHAL POWDER

47probenecid 500 mg tablet

47probenecid-colchicine tablet

61PROCALAMINE IV SOLUTION

57prochlorperazine 10 mg tab

57prochlorperazine 10 mg/2 ml vl

57prochlorperazine 25 mg supp

57prochlorperazine 5 mg tablet

48PROCORT 1.85%-1.15% CREAM

35PROCRIT 10,000 UNITS/ML VIAL






88PROCTOCORT 30 MG SUPPOSITORY

57PROCTOFOAM-HC 1%-1% FOAM

57PROCTO-MED HC 2.5% CREAM

57PROCTO-PAK 1% CREAM

57PROCTOSOL-HC 2.5% CREAM

57PROCTOZONE-HC 2.5% CREAM

22PRODRIN CAPLET

47progesterone 100 mg capsule

47progesterone 200 mg capsule

42PROGLYCEM 50 MG/ML ORAL SUSP

27PROGRAF 0.2 MG GRANULE PACKET

27PROGRAF 0.5 MG CAPSULE

27PROGRAF 1 MG CAPSULE

27PROGRAF 1 MG GRANULE PACKET

27PROGRAF 5 MG CAPSULE

27PROGRAF 5 MG/ML AMPULE

53PROLASTIN C 1,000 MG VIAL

87PROLASTIN C 1,000 MG/20 ML VL

69PROLENSA 0.07% EYE DROPS

72PROLIA 60 MG/ML SYRINGE

38PROMACTA 12.5 MG SUSPEN PACKET

38PROMACTA 12.5 MG TABLET

38PROMACTA 25 MG TABLET



15promethazine 12.5 mg suppos

15promethazine 12.5 mg tablet

15promethazine 25 mg suppository


15promethazine 25 mg tablet

15promethazine 50 mg suppository

15promethazine 50 mg tablet

15promethazine 50 mg/ml ampul

15promethazine 6.25 mg/5 ml soln

15promethazine 6.25 mg/5 ml syrp

38promethazine-codeine syrup

38promethazine-dm solution

38promethazine-dm syrup38promethazine-pe-

codeine syrup15PROMETHEGAN 12.5

MG SUPPOS15PROMETHEGAN 25

MG SUPPOSITORY15PROMETHEGAN 50

MG SUPPOSITORY31PROMISEB TOPICAL

CREAM10propafenone hcl 150

mg tablet10propafenone hcl 225

mg tab10propafenone hcl 300

mg tab10propafenone hcl er 225

mg cap10propafenone hcl er 325

mg cap10propafenone hcl er 425

mg cap14propantheline 15 mg

tablet62proparacaine 0.5% eye

drops

20propranolol 10 mg tablet20propranolol 20 mg tablet20propranolol 20 mg/5 ml

soln20propranolol 40 mg tablet20propranolol 40 mg/5 ml

soln20propranolol 60 mg tablet20propranolol 80 mg tablet20propranolol er 120 mg

capsule20propranolol er 160 mg



capsule20propranolol-hctz 40-25

mg tab20propranolol-hctz 80-25

mg tab31propylthiouracil 50 mg

tablet98PROQUAD VIAL38PRO-RED AC SYRUP34PROSCAR 5 MG

TABLET61PROSOL 20%

INJECTION96PROTONIX 40 MG

SUSPENSION96PROTONIX DR 20 MG

TABLET96PROTONIX DR 40 MG

TABLET82protriptyline hcl 10 mg

tablet82protriptyline hcl 5 mg

tablet87PROVENTIL HFA 90

MCG INHALER

75PROVIDA DHA CAPSULE

82PROVIGIL 100 MG TABLET

82PROVIGIL 200 MG TABLET

82PROZAC 10 MG PULVULE



82PROZAC WEEKLY 90 MG CAPSULE

44pruclair nonsteroidal cream

44prumyx cream87PULMICORT 180 MCG

FLEXHALER87PULMICORT 90 MCG

FLEXHALER47pulmosal 7% vial87PULMOZYME 1 MG/ML

AMPUL27PURIXAN 20 MG/ML

ORAL SUSP54pyrazinamide 500 mg

tablet97PYRIDIUM 100 MG

TABLET97PYRIDIUM 200 MG

TABLET63pyridostigmine 60 mg/5

ml soln63pyridostigmine br 60 mg

tablet63pyridostigmine er 180

mg tab75pyridoxine 100 mg/ml

vial98QUADRACEL DTAP-

IPV VIAL


71QUASENSE 0.15-0.03 MG TABLET

82quetiapine er 150 mg tablet





82quetiapine fumarate 100 mg tab






82QUILLIVANT XR 25 MG/5 ML SUSP

21quinapril 10 mg tablet21quinapril 20 mg tablet21quinapril 40 mg tablet21quinapril 5 mg tablet21quinapril-hctz 10-12.5

mg tab21quinapril-hctz 20-12.5

mg tab21quinapril-hctz 20-25 mg

tab10quinidine gluc er 324

mg tab10quinidine sulfate 200

mg tab10quinidine sulfate 300

mg tab

54quinine sulfate 324 mg capsule

95QUINJA 1.25%-1% GEL87QVAR REDIHALER 40

MCG87QVAR REDIHALER 80

MCG98RABAVERT RABIES

VACC W-DILUENT96rabeprazole sod dr 20

mg tab69RADIAGEL72raloxifene hcl 60 mg

tablet21ramipril 1.25 mg capsule21ramipril 10 mg capsule21ramipril 2.5 mg capsule21ramipril 5 mg capsule55RANEXA ER 1,000 MG

TABLET55RANEXA ER 500 MG

TABLET96ranitidine 15 mg/ml

syrup96ranitidine 150 mg

capsule96ranitidine 150 mg tablet96ranitidine 300 mg

capsule96ranitidine 300 mg tablet96ranitidine hcl 50 mg/2

ml vial55ranolazine er 1,000 mg

tablet55ranolazine er 500 mg

tablet34RAPAFLO 4 MG

CAPSULE34RAPAFLO 8 MG

CAPSULE

27RAPAMUNE 0.5 MG TABLET

27RAPAMUNE 1 MG TABLET

27RAPAMUNE 1 MG/ML ORAL SOLN

27RAPAMUNE 2 MG TABLET

31rasagiline mesylate 0.5 mg tab

31rasagiline mesylate 1 mg tab

53RAVICTI 1.1 GRAM/ML LIQUID

47READI-CAT 2 2% SUSPENSION

35REBIF 22 MCG/0.5 ML SYRINGE

35REBIF 44 MCG/0.5 ML SYRINGE

35REBIF REBIDOSE 22 MCG/0.5 ML

35REBIF REBIDOSE 44 MCG/0.5 ML

35REBIF REBIDOSE TITRATION PACK

35REBIF TITRATION PACK

71RECLIPSEN 28 DAY TABLET

98RECOMBIVAX HB 10 MCG/ML SYR

98RECOMBIVAX HB 10 MCG/ML VIAL

98RECOMBIVAX HB 40 MCG/ML VIAL

98RECOMBIVAX HB 5 MCG/0.5 ML SYR

57RECTIV 0.4% OINTMENT

63REGONOL 10 MG/2 ML AMPUL

56REGRANEX 0.01% GEL


33RELENZA 5 MG DISKHALER

42RELION NOVOLIN 70-30 FLEXPEN

42RELION NOVOLIN 70-30 VIAL

42RELION NOVOLIN N 100 UNIT/ML

42RELION NOVOLIN R 100 UNIT/ML

58RELISTOR 12 MG/0.6 ML SYRINGE

58RELISTOR 12 MG/0.6 ML VIAL

58RELISTOR 8 MG/0.4 ML SYRINGE

82REMERON 15 MG TABLET



21REMODULIN 1 MG/ML VIAL


21REMODULIN 2.5 MG/ML VIAL


53RENAGEL 400 MG TABLET

53RENAGEL 800 MG TABLET

58RENFLEXIS 100 MG VIAL

53RENVELA 0.8 GM POWDER PACKET

53RENVELA 2.4 GM POWDER PACKET

53RENVELA 800 MG TABLET

42repaglinide 0.5 mg tablet

42repaglinide 1 mg tablet42repaglinide 2 mg tablet50REPATHA 140 MG/ML

SURECLICK50REPATHA 140 MG/ML

SYRINGE50REPATHA 420

MG/3.5ML PUSHTRONX

33RESCRIPTOR 200 MG TABLET

38RESPA A.R. TABLET SA

62RESTASIS 0.05% EYE EMULSION

44RESTIZAN GEL35RETACRIT 10,000

UNIT/ML VIAL35RETACRIT 2,000




UNIT/ML VIAL33RETROVIR 200 MG/20

ML VIAL27REVLIMID 10 MG

CAPSULE27REVLIMID 15 MG

CAPSULE27REVLIMID 2.5 MG




CAPSULE82REXULTI 0.25 MG

TABLET

82REXULTI 0.5 MG TABLET

82REXULTI 1 MG TABLET82REXULTI 2 MG TABLET82REXULTI 3 MG TABLET82REXULTI 4 MG TABLET33REYATAZ 50 MG

POWDER PACKET33ribavirin 200 mg capsule33ribavirin 200 mg tablet73RIDAURA 3 MG

CAPSULE54rifabutin 150 mg capsule54rifampin 150 mg capsule54rifampin 300 mg capsule54rifampin iv 600 mg vial54RIFATER TABLET53riluzole 50 mg tablet33rimantadine hcl 100 mg

tablet53ringers irrigation solution43ringer's iv solution42RIOMET 500 MG/5 ML

SOLUTION72risedronate sod dr 35

mg tab72risedronate sodium 150




mg tablet82RISPERDAL 0.25 MG

TABLET82RISPERDAL 0.5 MG

TABLET82RISPERDAL 1 MG

TABLET


82RISPERDAL 1 MG/ML SOLUTION

82RISPERDAL 2 MG TABLET



83RISPERDAL CONSTA 12.5 MG SYR

83RISPERDAL CONSTA 25 MG SYR

83RISPERDAL CONSTA 37.5 MG SYR

83RISPERDAL CONSTA 50 MG SYR

83risperidone 0.25 mg odt83risperidone 0.25 mg

tablet83risperidone 0.5 mg odt83risperidone 0.5 mg tablet83risperidone 1 mg odt83risperidone 1 mg tablet83risperidone 1 mg/ml

solution83risperidone 2 mg odt83risperidone 2 mg tablet83risperidone 3 mg odt83risperidone 3 mg tablet83risperidone 4 mg odt83risperidone 4 mg tablet83RITALIN 10 MG

TABLET83RITALIN 20 MG

TABLET83RITALIN 5 MG TABLET83RITALIN LA 10 MG

CAPSULE83RITALIN LA 20 MG

CAPSULE

83RITALIN LA 30 MG CAPSULE

83RITALIN LA 40 MG CAPSULE

33ritonavir 100 mg tablet27RITUXAN 100 MG/10

ML VIAL27RITUXAN 500 MG/50

ML VIAL27RITUXAN HYCELA

1,400 MG-23,40027RITUXAN HYCELA

1,600 MG-26,80061rivastigmine 1.5 mg

capsule61rivastigmine 13.3

mg/24hr ptch61rivastigmine 3 mg

capsule61rivastigmine 4.5 mg


mg/24hr patch61rivastigmine 6 mg


mg/24hr patch51rizatriptan 10 mg odt51rizatriptan 10 mg tablet51rizatriptan 5 mg odt51rizatriptan 5 mg tablet38robafen ac oral solution75ROCALTROL 0.25

MCG CAPSULE75ROCALTROL 0.5 MCG

CAPSULE75ROCALTROL 1

MCG/ML ORAL SOLN27romidepsin 10 mg kit31ropinirole hcl 0.25 mg

tablet

31ropinirole hcl 0.5 mg tablet

31ropinirole hcl 1 mg tablet31ropinirole hcl 2 mg tablet31ropinirole hcl 3 mg tablet31ropinirole hcl 4 mg tablet31ropinirole hcl 5 mg tablet31ropinirole hcl er 12 mg

tablet31ropinirole hcl er 2 mg




tablet90ROSADAN 0.75%

CREAM88ROSADAN 0.75%

CREAM KIT90ROSADAN 0.75% GEL88ROSADAN 0.75% GEL

KIT95ROSANIL CLEANSER

LOTION95ROSULA 10%-4.5%

WASH95rosula 10%-5% cloths50rosuvastatin calcium 10

mg tab50rosuvastatin calcium 20



mg tab98ROTARIX VACCINE

SUSPENSION98ROTATEQ VACCINE


13ROWEEPRA 1,000 MG TABLET

13ROWEEPRA 500 MG TABLET

13ROWEEPRA 750 MG TABLET

13ROWEEPRA XR 500 MG TABLET

13ROWEEPRA XR 750 MG TABLET

83ROZEREM 8 MG TABLET

27RUBRACA 200 MG TABLET



87RUCONEST 2,100 UNIT VIAL

27RYDAPT 25 MG CAPSULE

38rydex liquid48RYNODERM 37.5%

TOPICAL CREAM31RYTARY ER 23.75 MG-

95 MG CAP31RYTARY ER 36.25 MG-



245 MG CAP48SALEX 6% CREAM KIT48SALEX 6% LOTION KIT48SALEX 6% SHAMPOO48salicylic acid 26% liquid48salicylic acid 27.5%

liquid48salicylic acid 6% cream48salicylic acid 6% cream

kit

48salicylic acid 6% foam90salicylic acid 6% gel48salicylic acid 6% lotion56salicylic acid 6%

shampoo48salicylic acid er 28.5%

soln48salimez 6% cream48SALIMEZ FORTE 10%

CREAM69salsalate 500 mg tablet69salsalate 750 mg tablet48salvax 6% foam48SALVAX DUO PLUS

COMBO PACK59SAMSCA 15 MG

TABLET59SAMSCA 30 MG

TABLET58SANCUSO 3.1 MG/24

HR PATCH27SANDIMMUNE 100

MG/ML SOLN27SANDOSTATIN LAR

DEPOT 10 MG KT27SANDOSTATIN LAR

DEPOT 20 MG KT28SANDOSTATIN LAR

DEPOT 30 MG KT56SANTYL OINTMENT83SAPHRIS 10 MG TAB

SUBLINGUAL83SAPHRIS 2.5 MG TAB

SUBLINGUAL83SAPHRIS 5 MG TAB

SUBLINGUAL73SAVELLA 100 MG

TABLET73SAVELLA 12.5 MG

TABLET

73SAVELLA 25 MG TABLET

73SAVELLA 50 MG TABLET

73SAVELLA TITRATION PACK

93SCALACORT DK 2% KIT

58scopolamine 1 mg/3 day patch

31seb-prev 10% wash44SEBUDERM GEL31selegiline hcl 5 mg

capsule31selegiline hcl 5 mg tablet31selenium sulfide 2.25%

shampoo31selenium sulfide 2.3%

shampoo31selenium sulfide 2.5%

lotion31SELRX 2.3%

SHAMPOO33SELZENTRY 150 MG

TABLET33SELZENTRY 20

MG/ML ORAL SOLN33SELZENTRY 25 MG

TABLET33SELZENTRY 300 MG

TABLET33SELZENTRY 75 MG

TABLET15SEMPREX-D 8 MG-60

MG CAPSULE59SENSIPAR 30 MG

TABLET59SENSIPAR 60 MG

TABLET59SENSIPAR 90 MG

TABLET


87SEREVENT DISKUS 50 MCG

83SEROQUEL 100 MG TABLET






83SEROQUEL XR 150 MG TABLET





83sertraline 20 mg/ml oral conc

83sertraline hcl 100 mg tablet



71SETLAKIN 0.15 MG-0.03 MG TAB

53sevelamer 0.8 gm powder packet

53sevelamer 2.4 gm powder packet

53sevelamer carbonate 800 mg tab

53sevelamer hcl 400 mg tablet

53sevelamer hcl 800 mg tablet

53SF 1.1% GEL53SF 5000 PLUS CREAM47SHAROBEL 0.35 MG

TABLET98SHINGRIX VIAL KIT97SHOHL'S MODIFIED

SOLUTION28SIGNIFOR 0.3 MG/ML

AMPULE28SIGNIFOR 0.6 MG/ML

AMPULE28SIGNIFOR 0.9 MG/ML

AMPULE88sildenafil 100 mg87sildenafil 20 mg tablet

(generic for revatio)88sildenafil 25 mg88sildenafil 50 mg

(generic viagra)83SILENOR 3 MG

TABLET83SILENOR 6 MG

TABLET34silodosin 4 mg capsule34silodosin 8 mg capsule48silver nitrate applicator56silver sulfadiazine 1%

cream72SIMBRINZA 1%-0.2%

EYE DROPS73SIMPONI 100 MG/ML

PEN INJECTOR73SIMPONI 100 MG/ML

SYRINGE73SIMPONI 50 MG/0.5

ML PEN INJEC73SIMPONI 50 MG/0.5

ML SYRINGE

73SIMPONI ARIA 50 MG/4 ML VIAL

28SIMULECT 10 MG VIAL28SIMULECT 20 MG VIAL50simvastatin 10 mg tablet50simvastatin 20 mg tablet50simvastatin 40 mg tablet50simvastatin 5 mg tablet50simvastatin 80 mg tablet87SINGULAIR 10 MG

TABLET87SINGULAIR 4 MG

TABLET CHEW87SINGULAIR 5 MG

TABLET CHEW28sirolimus 0.5 mg tablet28sirolimus 1 mg tablet28sirolimus 1 mg/ml

solution28sirolimus 2 mg tablet54SIRTURO 100 MG

TABLET54SIVEXTRO 200 MG

TABLET54SIVEXTRO 200 MG

VIAL95SKLICE 0.5% LOTION31SKYRIZI 150 MG

DOSE KIT-2 SYRN63sod citrate-citric acid

soln75sod fer gluc cplx 62.5

mg/5 ml95sod sulface-sulf 9.8-

4.8% clsr95sod sulface-sulfur 9-

4.5% kit95sod sulface-sulfur 9-

4.5% wash31sod sulfacetam 10%

clnsng gel


31sod sulfacetamide 10% shampoo

95sod sulfacetamide-sulfur lotn

95sod sulfacetamide-sulfur susp

95sod sulfacet-sulfur 10-2% clsr

95sod sulfacet-sulfur 10-4% pad

95sod sulfacet-sulfur 10-5% clsr

95sod sulfac-sulfur 9.8-4.8% crm

95sod sulfac-sulfur 9.8-4.8% lot

43sodium bicarb 4.2% abbjct

43sodium bicarb 7.5% abboject

43sodium bicarb 8.4% abboject

43sodium chloride 0.45% soln

47sodium chloride 0.9% inhal vl

53sodium chloride 0.9% irrig.

53sodium chloride 0.9% solution

53sodium chloride 0.9% vial

47sodium chloride 10% 44sodium chloride 100

meq/40 ml44sodium chloride 3% iv

soln47sodium chloride 3% vial44sodium chloride 5% iv

soln47sodium chloride 7% vial

99sodium fluoride 1 mg (2.2 mg)

44sodium lactate 50 meq/10 ml vl

53sodium phenylbutyrate 500mg tb

53sodium phenylbutyrate powder

53sodium polystyrene sulf powder

31sodium sulfacetamide 10% wash

95sodium sulfacet-sulfur wash

93sodium sulf-sulfur cleanser

10solifenacin 10 mg tablet10solifenacin 5 mg tablet42SOLIQUA 100 UNIT-33

MCG/ML PEN90SOLOXIDE DR 150 MG

TABLET28SOLTAMOX 20 MG/10

ML SOLN9SOLU-CORTEF 1,000

MG ACT-O-VL9SOLU-CORTEF 100

MG ACT-O-VIAL9SOLU-CORTEF 250

MG ACT-O-VIAL9SOLU-CORTEF 500

MG ACT-O-VIAL28SOMATULINE DEPOT

120 MG/0.5 ML28SOMATULINE DEPOT

60 MG/0.2 ML28SOMATULINE DEPOT

90 MG/0.3 ML59SOMAVERT 10 MG

VIAL59SOMAVERT 15 MG

VIAL

59SOMAVERT 20 MG VIAL



10SORINE 120 MG TABLET




10sotalol 120 mg tablet10sotalol 160 mg tablet10sotalol 240 mg tablet10sotalol 80 mg tablet10sotalol af 120 mg tablet10sotalol af 160 mg tablet10sotalol af 80 mg tablet31sp antipruritic gel44sp scar management gel95spinosad 0.9% topical

susp87SPIRIVA 18 MCG CP-

HANDIHALER87SPIRIVA RESPIMAT

1.25 MCG INH87SPIRIVA RESPIMAT

2.5 MCG INH21spironolactone 100 mg

tablet21spironolactone 25 mg

tablet21spironolactone 50 mg

tablet21spironolactone-hctz 25-

25 tab71SPRINTEC 28 DAY

TABLET


13SPRITAM 1,000 MG TABLET

13SPRITAM 250 MG TABLET



28SPRYCEL 100 MG TABLET






53sps 15 gm/60 ml suspension

53sps 30 gm/120 ml enema

71SRONYX 0.10-0.02 MG TABLET

56SSD 1% CREAM95sss 10-5 cream95sss 10-5 foam98STAMARIL VIAL33stavudine 15 mg 33stavudine 20 mg 33stavudine 30 mg 33stavudine 40 mg 88STAXYN31STELARA 45 MG/0.5

ML SYRINGE31STELARA 45 MG/0.5

ML VIAL31STELARA 90 MG/ML

SYRINGE

88STENDRA53sterile water for irrigation59STIMATE 1.5 MG/ML

NASAL SPRAY87STIOLTO RESPIMAT

INHAL SPRAY28STIVARGA 40 MG

TABLET54streptomycin sulf 1 gm

vial59STRIANT 30 MG

MUCOADHESIVE33STRIBILD TABLET87STRIVERDI RESPIMAT

INHAL SPRAY69SUBOXONE 12 MG-3

MG SL FILM69SUBOXONE 2 MG-0.5

MG SL FILM69SUBOXONE 4 MG-1

MG SL FILM69SUBOXONE 8 MG-2

MG SL FILM58SUCRAID 8,500

UNITS/ML SOLN96sucralfate 1 gm tablet95sulfacet sod-sulfur 10-

4% pad62sulfacetamide 10% eye

drops62sulfacetamide 10% eye

ointment93sulfacetamide sod 10%

top susp95sulfacetamide-sulfur 10-

2% crm95sulfacetamide-sulfur 10-

5% crm96sulfacetamide-sulfur 8-

4% susp96sulfacleanse 8-4

suspension

89sulfadiazine 500 mg tablet

89sulfamethoxazole-tmp ds tablet

89sulfamethoxazole-tmp inj vial

89sulfamethoxazole-tmp ss tablet

89sulfamethoxazole-tmp susp

58sulfasalazine 500 mg tablet

58sulfasalazine dr 500 mg tab

89SULFATRIM PEDIATRIC SUSPENSION

62sulf-pred 10-0.23% eye drops

69sulindac 150 mg tablet69sulindac 200 mg tablet96SUMADAN 9%-4.5%

WASH96SUMADAN KIT96SUMADAN XLT KIT51sumatriptan 20 mg

nasal spray51sumatriptan 4 mg/0.5 ml

cart51sumatriptan 4 mg/0.5 ml

inject51sumatriptan 5 mg nasal

spray51sumatriptan 6 mg/0.5 ml

inject51sumatriptan 6 mg/0.5 ml

refill51sumatriptan 6 mg/0.5 ml

syrng51sumatriptan 6 mg/0.5 ml

vial


51sumatriptan succ 100 mg tablet



96SUMAXIN CLEANSING PADS

96SUMAXIN CP KIT96SUMAXIN TS TOPICAL

SUSPENSION96SUMAXIN WASH36SUPRAX 500 MG/5 ML

SUSPENSION58SUPREP BOWEL

PREP KIT28SUTENT 12.5 MG

CAPSULE28SUTENT 25 MG

CAPSULE28SUTENT 37.5 MG

CAPSULE28SUTENT 50 MG

CAPSULE71SYEDA 28 TABLET35SYLATRON 200 MCG

KIT35SYLATRON 300 MCG

KIT35SYLATRON 600 MCG

KIT34symax fastabs 0.125

mg tablet14SYMAX-SL 0.125 MG

TABLET SL14SYMAX-SR 0.375 MG

TABLET87SYMBICORT 160-4.5

MCG INHALER87SYMBICORT 80-4.5

MCG INHALER

33SYMFI 600-300-300 MG TABLET

33SYMFI LO 400-300-300 MG TABLET

42SYMLINPEN 120 PEN INJECTOR

42SYMLINPEN 60 PEN INJECTOR

13SYMPAZAN 10 MG FILM

13SYMPAZAN 20 MG FILM

13SYMPAZAN 5 MG FILM33SYMTUZA 800-150-200-

10 MG TAB35SYNAGIS 100 MG/1 ML

VIAL35SYNAGIS 50 MG/0.5

ML VIAL59SYNAREL 2 MG/ML

NASAL SPRAY54SYNERCID 500 MG

VIAL42SYNJARDY 12.5-1,000

MG TABLET42SYNJARDY 12.5-500

MG TABLET42SYNJARDY 5-1,000

MG TABLET42SYNJARDY 5-500 MG

TABLET42SYNJARDY XR 10-

1,000 MG TABLET42SYNJARDY XR 12.5-

1,000 MG TAB42SYNJARDY XR 25-

1,000 MG TABLET42SYNJARDY XR 5-1,000

MG TABLET28SYNRIBO 3.5 MG/ML

VIAL92SYNTHROID 100 MCG

TABLET

92SYNTHROID 112 MCG TABLET











28TABLOID 40 MG TABLET

56tacrolimus 0.03% ointment

56tacrolimus 0.1% ointment

28tacrolimus 0.5 mg capsule

28tacrolimus 1 mg capsule28tacrolimus 5 mg capsule88tadalafil 10 mg88tadalafil 2.5 mg63tadalafil 2.5 mg tablet88tadalafil 20 mg (generic

cialis)87tadalafil 20 mg tablet

(generic for adcirca)88tadalafil 5 mg63tadalafil 5 mg tablet


28TAFINLAR 50 MG CAPSULE

28TAFINLAR 75 MG CAPSULE

47TAGITOL V 40% SUSPENSION

28TAGRISSO 40 MG TABLET

28TAGRISSO 80 MG TABLET

28TALZENNA 0.25 MG CAPSULE

28TALZENNA 1 MG CAPSULE

28tamoxifen 10 mg tablet28tamoxifen 20 mg tablet34tamsulosin hcl 0.4 mg

capsule28TARCEVA 100 MG

TABLET28TARCEVA 150 MG

TABLET28TARCEVA 25 MG

TABLET28TARGRETIN 1% GEL71TARINA 24 FE 1 MG-

20 MCG TAB71TARINA FE 1-20

TABLET21TARKA ER 1-240 MG




TABLET75taron-c dha capsule28TASIGNA 150 MG

CAPSULE28TASIGNA 200 MG

CAPSULE

28TASIGNA 50 MG CAPSULE

90tazarotene 0.1% cream36TAZICEF 1 GM ADD-

VANTAGE VIAL36TAZICEF 1 GRAM VIAL36TAZICEF 2 GM ADD-

VANTAGE VIAL36TAZICEF 2 GRAM VIAL36TAZICEF 6 GRAM VIAL90TAZORAC 0.05%

CREAM91TAZORAC 0.05% GEL91TAZORAC 0.1%

CREAM91TAZORAC 0.1% GEL21TAZTIA XT 120 MG

CAPSULE21TAZTIA XT 180 MG




CAPSULE98tdvax vial28TECENTRIQ 1,200

MG/20 ML VIAL28TECENTRIQ 840

MG/14 ML VIAL61TECFIDERA DR 120

MG CAPSULE61TECFIDERA DR 240

MG CAPSULE61TECFIDERA STARTER

PACK42TECHLITE PEN

NEEDLE 31GX1/4"42TECHLITE PEN

NEEDLE 31GX5/16"

42TECHLITE PEN NEEDLE 32GX1/4"



36TEFLARO 400 MG VIAL36TEFLARO 600 MG VIAL13TEGRETOL XR 100

MG TABLET21TEKTURNA 150 MG

TABLET21TEKTURNA 300 MG

TABLET21TEKTURNA HCT 150-

12.5 MG TAB21TEKTURNA HCT 150-

25 MG TABLET21TEKTURNA HCT 300-

12.5 MG TAB21TEKTURNA HCT 300-

25 MG TABLET21telmisartan 20 mg tablet21telmisartan 40 mg tablet21telmisartan 80 mg tablet21telmisartan-amlodipine

40-1021telmisartan-amlodipine

40-5 mg21telmisartan-amlodipine

80-1021telmisartan-amlodipine

80-5 mg21telmisartan-hctz 40-12.5

mg tb21telmisartan-hctz 80-12.5

mg tb21telmisartan-hctz 80-25

mg tab83temazepam 15 mg

capsule


83temazepam 22.5 mg capsule

83temazepam 30 mg capsule

83temazepam 7.5 mg capsule

28temsirolimus 25 mg vial67TENCON 50-325 MG

TABLET98TENIVAC SYRINGE33tenofovir disop fum 300

mg tb21TENORMIN 100 MG

TABLET21TENORMIN 25 MG

TABLET21TENORMIN 50 MG

TABLET21terazosin 1 mg capsule21terazosin 10 mg capsule21terazosin 2 mg capsule21terazosin 5 mg capsule15terbinafine hcl 250 mg

tablet87terbutaline sulf 1 mg/ml

vial87terbutaline sulfate 2.5

mg tab87terbutaline sulfate 5 mg

tab62terconazole 0.4% cream62terconazole 0.8% cream62terconazole 80 mg

suppository31TERSI 2.25% FOAM38TESSALON PERLE

100 MG CAP59TESTIM 1% (50MG)

GEL59testosteron cyp 1,000

mg/10 ml

59testosteron enan 1,000 mg/5 ml

59testosterone 1.62% (2.5 g) pkt

59testosterone 1.62% gel pump

59testosterone 1.62%(1.25 g) pkt

59testosterone 12.5 mg/1.25 gram

59testosterone 25 mg/2.5 gm pkt

59testosterone 30 mg/1.5 ml pump

59testosterone 50 mg/5 gram pkt

59testosterone cyp 200 mg/ml

61tetrabenazine 12.5 mg tablet

61tetrabenazine 25 mg tablet

62tetracaine 0.5% eye drop

62tetracaine 0.5% steri-unit sol

62tetracaine hcl 0.5% eye soln

90tetracycline 250 mg capsule

90tetracycline 500 mg capsule

62TETRAVISC 0.5% EYE DROPS

62TETRAVISC FORTE 0.5% EYE DROPS

75TETRIX CREAM94TEXACORT 2.5%

SOLUTION28THALOMID 100 MG

CAPSULE29THALOMID 150 MG

CAPSULE

29THALOMID 200 MG CAPSULE

29THALOMID 50 MG CAPSULE

87THEO-24 ER 100 MG CAPSULE




87THEOCHRON ER 100 MG TABLET



87theophylline 80 mg/15 ml soln

87theophylline er 100 mg tablet


87theophylline er 300 mg tab


87theophylline er 450 mg tab


75thiamine 200 mg/2 ml vial

83thioridazine 10 mg tablet83thioridazine 100 mg

tablet83thioridazine 25 mg tablet83thioridazine 50 mg tablet29thiotepa 15 mg vial83thiothixene 1 mg


83thiothixene 10 mg capsule

83thiothixene 2 mg 83thiothixene 5 mg 75THRIVITE RX TABLET92thyroid 120 mg tablet92thyroid 15 mg tablet92THYROID 30 MG

TABLET92THYROID 60 MG

TABLET92THYROID 90 MG

TABLET92THYROLAR-1

STRENGTH TABLET92THYROLAR-1/2

STRENGTH TAB92THYROLAR-1/4

STRENGTH TAB92THYROLAR-2

STRENGTH TABLET92THYROLAR-3

STRENGTH TABLET13tiagabine hcl 12 mg

tablet13tiagabine hcl 16 mg

tablet13tiagabine hcl 2 mg tablet13tiagabine hcl 4 mg tablet29TIBSOVO 250 MG

TABLET58TIGAN 100 MG/ML VIAL54tigecycline 50 mg vial71TILIA FE 28 TABLET34timolol 0.25% gfs gel-

solution34timolol 0.5% eye drop34timolol 0.5% gfs gel-

solution34timolol maleate 0.25%

eye drop

34timolol maleate 0.5% eye drops

21timolol maleate 10 mg tablet



34TIMOPTIC 0.25% OCUDOSE DROP

34TIMOPTIC 0.5% OCUDOSE DROP

54tinidazole 250 mg tablet54tinidazole 500 mg tablet92TIROSINT 100 MCG

CAPSULE92TIROSINT 112 MCG











CAPSULE92TIROSINT-SOL 100

MCG/ML SOLN92TIROSINT-SOL 112

MCG/ML SOLN

92TIROSINT-SOL 125 MCG/ML SOLN










53TIS-U-SOL PENTALYTE IRRIG SOLN

33TIVICAY 10 MG TABLET



63tizanidine hcl 2 mg capsule

63tizanidine hcl 2 mg tablet63tizanidine hcl 4 mg

capsule63tizanidine hcl 4 mg tablet63tizanidine hcl 6 mg

capsule55TOBI PODHALER 28

MG INHALE CAP89TOBRADEX EYE

OINTMENT89TOBRADEX ST EYE

DROPS


10tobramycin 0.3% eye drop

55tobramycin 1.2 gm vial55tobramycin 1.2 gram/30

ml vial55tobramycin 10 mg/ml vial55tobramycin 300 mg/5 ml

ampule55tobramycin 40 mg/ml vial89tobramycin-dexameth

ophth susp10TOBREX 0.3% EYE

OINTMENT56TOLAK 4% CREAM42tolazamide 250 mg

tablet42tolazamide 500 mg

tablet42tolbutamide 500 mg

tablet31tolcapone 100 mg tablet69tolmetin sodium 200 mg

tab69tolmetin sodium 400 mg

cap69tolmetin sodium 600 mg

tab10tolterodine tart er 2 mg

cap10tolterodine tart er 4 mg

cap10tolterodine tartrate 1 mg

tab10tolterodine tartrate 2 mg

tab13TOPAMAX 100 MG

TABLET13TOPAMAX 15 MG

SPRINKLE CAP13TOPAMAX 200 MG

TABLET

13TOPAMAX 25 MG SPRINKLE CAP

13TOPAMAX 25 MG TABLET

13TOPAMAX 50 MG TABLET

13topiramate 100 mg tablet

13topiramate 15 mg sprinkle cap

13topiramate 200 mg tablet

13topiramate 25 mg sprinkle cap

13topiramate 25 mg tablet13topiramate 50 mg tablet29TOPOSAR 1,000

MG/50 ML VIAL29TOPOSAR 100 MG/5

ML VIAL29TOPOSAR 500 MG/25

ML VIAL29topotecan hcl 4 mg vial21TOPROL XL 100 MG

TABLET21TOPROL XL 200 MG



TABLET29toremifene citrate 60

mg tab29TORISEL 25 MG KIT21torsemide 10 mg tablet21torsemide 100 mg tablet21torsemide 20 mg tablet21torsemide 5 mg tablet42TOUJEO MAX

SOLOSTAR 300UNIT/ML

42TOUJEO SOLOSTAR 300 UNIT/ML

10TOVIAZ ER 4 MG TABLET

10TOVIAZ ER 8 MG TABLET

44TPN ELECTROLYTES VIAL

87TRACLEER 125 MG TABLET

87TRACLEER 32 MG TABLET FOR SUSP

87TRACLEER 62.5 MG TABLET

42TRADJENTA 5 MG TABLET

69tramadol er 100 mg tablet



69tramadol hcl 50 mg tablet

69tramadol hcl er 100 mg tablet



69tramadol-acetaminophn 37.5-325

21trandolapril 1 mg tablet21trandolapril 2 mg tablet21trandolapril 4 mg tablet21trandolapr-verapam er 1-

240 mg21trandolapr-verapam er 2-

180 mg22trandolapr-verapam er 2-

240 mg


22trandolapr-verapam er 4-240 mg

62tranexamic acid 650 mg tablet

58TRANSDERM-SCOP 1.5 MG (1MG/3D)

83tranylcypromine sulf 10 mg tab

95TRANZAREL 4% GEL61TRAVASOL 10% SOLN

VIAFLEX72TRAVATAN Z 0.004%

EYE DROP83trazodone 100 mg tablet84trazodone 150 mg tablet84trazodone 300 mg tablet84trazodone 50 mg tablet29TREANDA 100 MG

VIAL29TREANDA 25 MG VIAL55TRECATOR 250 MG

TABLET87TRELEGY ELLIPTA

100-62.5-2529TRELSTAR 11.25 MG

VIAL29TRELSTAR 22.5 MG

VIAL29TRELSTAR 3.75 MG

VIAL42TRESIBA 100 UNIT/ML

VIAL42TRESIBA FLEXTOUCH

100 UNIT/ML42TRESIBA FLEXTOUCH

200 UNIT/ML91tretinoin 0.01% gel91tretinoin 0.025% cream91tretinoin 0.025% gel91tretinoin 0.05% cream91tretinoin 0.05% gel

91tretinoin 0.1% cream29tretinoin 10 mg capsule91tretinoin gel micro

0.04% pump91tretinoin gel micro

0.04% tube91tretinoin gel micro 0.1%

pump91tretinoin gel micro 0.1%

tube29TREXALL 10 MG

TABLET29TREXALL 15 MG

TABLET29TREXALL 5 MG

TABLET29TREXALL 7.5 MG

TABLET94triamcinolone 0.025%

cream94triamcinolone 0.025%

lotion94triamcinolone 0.025%

oint94triamcinolone 0.1%


lotion94triamcinolone 0.1%

ointment53triamcinolone 0.1%

paste94triamcinolone 0.147

mg/g spray94triamcinolone 0.5%


ointment9triamcinolone acet 200

mg/5 ml9triamcinolone acet

40mg/ml vl

22triamterene-hctz 37.5-25 mg cp

22triamterene-hctz 37.5-25 mg tb

22triamterene-hctz 75-50 mg tab

94TRIANEX 0.05% OINTMENT

84triazolam 0.125 mg tablet

84triazolam 0.25 mg tablet22TRIBENZOR 20-5-12.5

MG TABLET22TRIBENZOR 40-10-

12.5 MG TABLET22TRIBENZOR 40-10-25

MG TABLET22TRIBENZOR 40-5-12.5

MG TABLET22TRIBENZOR 40-5-25

MG TABLET97tricitrates oral solution50TRICOR 145 MG

TABLET50TRICOR 48 MG

TABLET95TRIDERM 0.1% CREAM53trientine hcl 250 mg

capsule71TRI-ESTARYLLA

TABLET75TRIFERIC 27.2 MG/5

ML AMPULE75TRIFERIC 272 MG

POWDER PACKET84trifluoperazine 1 mg

tablet84trifluoperazine 10 mg

tablet84trifluoperazine 2 mg

tablet


84trifluoperazine 5 mg tablet

33trifluridine 1% eye drops50TRIGLIDE 160 MG

TABLET31trihexyphenidyl 2 mg

tablet31trihexyphenidyl 2 mg/5

ml elx31trihexyphenidyl 5 mg

tablet71TRI-LEGEST FE-28

DAY TABLET13TRILEPTAL 150 MG

TABLET13TRILEPTAL 300 MG

TABLET13TRILEPTAL 300 MG/5

ML SUSP13TRILEPTAL 600 MG

TABLET71TRI-LINYAH TABLET50TRILIPIX DR 135 MG

CAPSULE50TRILIPIX DR 45 MG

CAPSULE71TRI-LO-ESTARYLLA

TABLET71TRI-LO-MARZIA

TABLET58TRILYTE WITH

FLAVOR PACKETS58trimethobenzamide 300

mg cap97trimethoprim 100 mg

tablet71TRI-MILI 28 TABLET84trimipramine maleate

100 mg cp84trimipramine maleate 25

mg cap

84trimipramine maleate 50 mg cap

71TRINESSA TABLET84TRINTELLIX 10 MG

TABLET84TRINTELLIX 20 MG

TABLET84TRINTELLIX 5 MG

TABLET71TRI-PREVIFEM

TABLET29TRIPTODUR 22.5 MG

KIT29TRISENOX 12 MG/6

ML VIAL71TRI-SPRINTEC

TABLET75TRISTART DHA

SOFTGEL33TRIUMEQ 600-50-300

MG TABLET75triveen-duo dha combo

pack71TRIVORA-28 TABLET71TRI-VYLIBRA 28

TABLET71TRI-VYLIBRA LO

TABLET33TROGARZO 200

MG/1.33 ML VIAL13TROKENDI XR 100 MG

CAPSULE14TROKENDI XR 200 MG



CAPSULE61TROPHAMINE 10% IV

SOLUTION61TROPHAMINE 6% IV

SOLUTION

63tropicamide 0.5% eye drop

62tropicamide 0.5% eye drops

63tropicamide 1% eye 62tropicamide 1% eye

drops10trospium chloride 20 mg

tablet10trospium chloride er 60

mg cap58TRULANCE 3 MG

TABLET42TRULICITY 0.75

MG/0.5 ML PEN42TRULICITY 1.5 MG/0.5

ML PEN98TRUMENBA 120

MCG/0.5 ML VACCIN33TRUVADA 100 MG-150

MG TABLET33TRUVADA 133 MG-200



MG TABLET87TUDORZA PRESSAIR

400 MCG INHAL38tusnel c syrup38TUSNEL PEDIATRIC

LIQUID38TUSSICAPS 10 MG-8

MG CAPSULE39TUSSICAPS 5 MG-4

MG CAPSULE39TUSSIONEX

PENNKINETIC SUSP39TUXARIN ER 8-54.3

MG TABLET39TUZISTRA XR 14.7-2.8

MG/5 ML


98TWINRIX VACCINE SYRINGE

33TYBOST 150 MG TABLET

71TYDEMY TABLET29TYKERB 250 MG

TABLET72TYMLOS 80 MCG

DOSE PEN INJECTR98TYPHIM VI 25 MCG/0.5

ML SYRNG98TYPHIM VI 25 MCG/0.5

ML VIAL61TYSABRI 300 MG/15

ML VIAL87TYVASO 1.74 MG/2.9

ML SOLUTION87TYVASO INHALATION

REFILL KIT87TYVASO INHALATION

STARTER KIT47ULORIC 40 MG

TABLET47ULORIC 80 MG

TABLET48ULTRASAL-ER 28.5%

SOLUTION93ULTRAVATE X CREAM

COMBO PACK93ULTRAVATE X

OINTMENT COMBO PAC

48umecta 40% mousse92UNITHROID 100 MCG

TABLET92UNITHROID 112 MCG




TABLET

92UNITHROID 175 MCG TABLET







29UNITUXIN 17.5 MG/ 5 ML VIAL

36ur n-c tablet48URAMAXIN 20% FOAM48URAMAXIN 45%

LOTION48URAMAXIN 45% NAIL

GEL48URAMAXIN 45% UREA

CREAM48URAMAXIN GT 45%

PRE-FILLED APP48urea 35% foam48urea 39% cream48urea 40% cream48UREA 40% LOTION48urea 41% cream48urea 45% cream48urea 45% lotion48urea 45% nail gel48urea 47% cream48urea 50% cream48urea 50% nail stick48ure-k 50% cream63URELLE TABLET36uretron d-s tablet

48UREVAZ 44% CREAM36URIBEL CAPSULE63URIN D.S. TABLET63URO-458 TABLET37urogesic-blue tablet37uro-mp capsule34UROXATRAL 10 MG

TABLET58ursodiol 250 mg tablet58ursodiol 300 mg capsule58ursodiol 500 mg tablet37uryl tablet63USTELL CAPSULE37UTA CAPSULE63UTIRA-C TABLET48UTOPIC 41% CREAM33valacyclovir hcl 1 gram

tablet33valacyclovir hcl 500 mg

tablet56VALCHLOR 0.016%

GEL33valganciclovir 450 mg

tablet33valganciclovir hcl 50

mg/ml14valproic acid 250 mg

capsule14valproic acid 250 mg/5

ml soln22valsartan 160 mg tablet22valsartan 320 mg tablet22valsartan 40 mg tablet22valsartan 80 mg tablet22valsartan-hctz 160-12.5

mg tab22valsartan-hctz 160-25

mg tab


22valsartan-hctz 320-12.5 mg tab

22valsartan-hctz 320-25 mg tab

22valsartan-hctz 80-12.5 mg tab

33VALTREX 1 GM CAPLET

33VALTREX 500 MG CAPLET

55vanco 500 mg/100 ml-0.9% nacl

55vanco 750 mg/150 ml-0.9% nacl

55vancomycin 1 g/200ml-0.9% nacl

55vancomycin 1 gm vial55vancomycin 500 mg vial55vancomycin 750

mg/150 ml bag55vancomycin hcl 1.25

gram vial55vancomycin hcl 1.5

gram vial55vancomycin hcl 10 gm

vial55vancomycin hcl 125 mg

capsule55vancomycin hcl 1g/200

ml bag55vancomycin hcl 250 mg

capsule55vancomycin hcl 250 mg

vial55vancomycin hcl 5 gm

vial55vancomycin hcl 750 mg

vial55vancomycin-d5w 500

mg/100 ml62VANDAZOLE VAGINAL

0.75% GEL

98VAQTA 25 UNITS/0.5 ML SYRINGE

98VAQTA 25 UNITS/0.5 ML VIAL

98VAQTA 50 UNITS/ML SYRINGE

98VAQTA 50 UNITS/ML VIAL

89vardenafil tab 10 mg89vardenafil tab 2.5 mg89vardenafil tab 20 mg89vardenafil tab 5 mg47VARIBAR HONEY

SUSPENSION47VARIBAR NECTAR

40% SUSPENSION47VARIBAR PUDDING

40% PASTE47VARIBAR THIN

HONEY SUSPENSION47VARIBAR THIN LIQUID

40% SUSP98VARIVAX VACCINE

WITH DILUENT98VARIZIG 125 UNIT/1.2

ML VIAL50VASCEPA 0.5 GM

CAPSULE50VASCEPA 1 GM

CAPSULE29VECTIBIX 100 MG/5

ML VIAL29VECTIBIX 400 MG/20

ML VIAL29VELCADE 3.5 MG VIAL71VELIVET 28 DAY

TABLET53VELPHORO 500 MG

CHEWABLE TAB53VELTASSA 16.8 GM

POWDER PACKET

53VELTASSA 25.2 GM POWDER PACKET

53VELTASSA 8.4 GM POWDER PACKET

29VENCLEXTA 10 MG TABLET



29VENCLEXTA STARTING PACK

84venlafaxine hcl 100 mg tablet


84venlafaxine hcl 37.5 mg tablet



84venlafaxine hcl er 150 mg cap

84venlafaxine hcl er 150 mg tab


84venlafaxine hcl er 37.5 mg cap

84venlafaxine hcl er 37.5 mg tab

84venlafaxine hcl er 75 mg cap


75VENOFER 100 MG/5 ML VIAL

75VENOFER 200 MG/10 ML VIAL

75VENOFER 50 MG/2.5 ML VIAL


87VENTAVIS 10 MCG/1 ML SOLUTION

88VENTAVIS 20 MCG/1 ML SOLUTION

88VENTOLIN HFA 90 MCG INHALER

88VERAMYST 27.5 MCG NASAL SPRAY

22verapamil 10 mg/4 ml vial

22verapamil 120 mg tablet22verapamil 360 mg cap

pellet22verapamil 40 mg tablet22verapamil 5 mg/2 ml vial22verapamil 80 mg tablet22verapamil er 120 mg

capsule22verapamil er 120 mg

tablet22verapamil er 180 mg


tablet22verapamil er 240 mg


tablet22verapamil er pm 100

mg capsule22verapamil er pm 200

mg capsule22verapamil er pm 300

mg capsule22verapamil sr 120 mg

capsule22verapamil sr 180 mg

capsule22verapamil sr 240 mg

capsule56VEREGEN 15%

OINTMENT

84VERSACLOZ 50 MG/ML SUSPENSION

29VERZENIO 100 MG TABLET




10VESICARE 10 MG TABLET

10VESICARE 5 MG TABLET

42V-GO 20 DISPOSABLE DEVICE



89VIAGRA58VIBERZI 100 MG

TABLET58VIBERZI 75 MG

TABLET67VICODIN 5-300 MG

TABLET67VICODIN ES 7.5-300

MG TABLET67VICODIN HP 10-300

MG TABLET42VICTOZA 3-PAK 18

MG/3 ML PEN33VIDEX 2 GM

PEDIATRIC SOLN33VIDEX 4 GM

PEDIATRIC SOLN33VIDEX EC 125 MG

CAPSULE71VIENVA-28 TABLET14vigabatrin 500 mg

powder packt

14vigabatrin 500 mg tablet14VIGADRONE 500 MG

POWDER PACKET84VIIBRYD 10 MG

TABLET84VIIBRYD 10-20 MG

STARTER PACK84VIIBRYD 20 MG

TABLET84VIIBRYD 40 MG

TABLET37vilamit mb capsule37vilevev mb tablet14VIMPAT 10 MG/ML

SOLUTION14VIMPAT 100 MG

TABLET14VIMPAT 150 MG

TABLET14VIMPAT 200 MG

TABLET14VIMPAT 200 MG/20 ML

VIAL14VIMPAT 50 MG

TABLET29VINCASAR PFS 1

MG/ML VIAL29vincristine 1 mg/ml vial29vinorelbine 10 mg/ml vial29vinorelbine 50 mg/5 ml

vial71VIORELE 28 DAY

TABLET33VIRACEPT 250 MG

TABLET33VIRACEPT 625 MG

TABLET48VIRASAL ANTIVIRAL

WART REMOVER33VIREAD 150 MG

TABLET


33VIREAD 200 MG TABLET

33VIREAD 250 MG TABLET

33VIREAD POWDER75virt-advance tablet75virt-c dha softgel97virt-phos 250 neutral

tablet75virtprex capsule97virtrate-2 solution97virtrate-3 solution97virtrate-k solution75virt-select capsule39virtussin ac liquid39virtussin dac liquid75virt-vite gt tablet75VITAFOL FE+

DOCUSATE COMBO PCK

75VITAFOL GUMMIES75VITAFOL NANO

TABLET75VITAMEDMD ONE RX

SOFTGEL75VITAMEDMD

REDICHEW RX TAB CHEW

75vitamin d2 1.25mg(50,000 unit)

75vitamin k-1 1 mg/0.5 ml ampul

75vitamin k-1 10 mg/ml ampul

75VITAPEARL SOFTGEL75VITATRUE COMBO

PACK29VITRAKVI 100 MG

CAPSULE29VITRAKVI 20 MG/ML

SOLUTION

29VITRAKVI 25 MG CAPSULE

47VIVELLE-DOT 0.025 MG PATCH





69VIVITROL 380 MG VIAL + DILUENT

29VIZIMPRO 15 MG TABLET



47VOLUMEN 0.1% SUSPENSION

15voriconazole 200 mg tablet

15voriconazole 200 mg vial15voriconazole 40 mg/ml

susp15voriconazole 50 mg

tablet33VOSEVI 400-100-100

MG TABLET29VOTRIENT 200 MG

TABLET75vp-ch plus softgel99VP-PNV-DHA

SOFTGEL84VRAYLAR 1.5 MG

CAPSULE84VRAYLAR 1.5 MG-3

MG PACK84VRAYLAR 3 MG

CAPSULE

84VRAYLAR 4.5 MG CAPSULE

84VRAYLAR 6 MG CAPSULE

71VYFEMLA 28 TABLET71VYLIBRA 28 TABLET95VYTONE CREAM

PACKET84VYVANSE 20 MG

CAPSULE84VYVANSE 30 MG





CAPSULE29VYXEOS 44 MG-100

MG VIAL38warfarin sodium 1 mg

tablet38warfarin sodium 10 mg


tablet38warfarin sodium 2.5 mg





tablet38warfarin sodium 7.5 mg

tablet50WELCHOL 3.75G

PACKET


50WELCHOL 625 MG TABLET

84WELLBUTRIN SR 100 MG TABLET



84WELLBUTRIN XL 150 MG TABLET

84WELLBUTRIN XL 300 MG TABLET

71WERA 0.5/0.035 MG 28 TABLET

92westhroid 130 mg tablet92westhroid 195 mg tablet92westhroid 32.5 mg tablet92westhroid 65 mg tablet92westhroid 97.5 mg tablet92WP THYROID 113.75

MG TABLET92WP THYROID 130 MG

TABLET92WP THYROID 16.25

MG TABLET92WP THYROID 32.5 MG


MG TABLET93WP THYROID 65 MG


MG TABLET93WP THYROID 97.5 MG

TABLET71WYMZYA FE

CHEWABLE TABLET72XALATAN 0.005% EYE

DROPS48XALIX 28% SOLUTION29XALKORI 200 MG

CAPSULE

29XALKORI 250 MG CAPSULE

38XARELTO 10 MG TABLET


38XARELTO 2.5 MG TABLET


38XARELTO STARTER PACK

29XATMEP 2.5 MG/ML ORAL SOLUTION

73XELJANZ 10 MG TABLET

73XELJANZ 5 MG TABLET

73XELJANZ XR 11 MG TABLET

9XENICAL 120 MG CAPSULE

88XEROSTOMIA RELIEF SPRAY

8XGEVA 120 MG/1.7 ML VIAL

88XHANCE 93 MCG NASAL SPRAY

53XIAFLEX 0.9 MG VIAL55XIFAXAN 200 MG

TABLET55XIFAXAN 550 MG

TABLET42XIGDUO XR 10 MG-

1,000 MG TAB42XIGDUO XR 10 MG-

500 MG TABLET43XIGDUO XR 2.5 MG-

1,000 MG TAB43XIGDUO XR 5 MG-

1,000 MG TABLET43XIGDUO XR 5 MG-500

MG TABLET

62XIIDRA 5% EYE DROPS

33XOFLUZA 20 MG TAB (40 MG DOSE)

33XOFLUZA 40 MG TAB (80 MG DOSE)

88XOLAIR 150 MG VIAL88XOLAIR 150 MG/ML

SYRINGE88XOLAIR 75 MG/0.5 ML

SYRINGE88XOPENEX HFA 45

MCG INHALER29XOSPATA 40 MG

TABLET67XTAMPZA ER 13.5 MG

CAPSULE67XTAMPZA ER 18 MG




CAPSULE29XTANDI 40 MG

CAPSULE62XULANE PATCH43XULTOPHY 100 UNIT-

3.6MG/ML PEN84XYREM 500 MG/ML

ORAL SOLUTION29YERVOY 200 MG/40

ML VIAL29YERVOY 50 MG/10 ML

VIAL98YF-VAX 1 DOSE VIAL30YONDELIS 1 MG VIAL30YONSA 125 MG

TABLET47YUVAFEM 10 MCG

VAGINAL INSERT


88zafirlukast 10 mg tablet88zafirlukast 20 mg tablet84zaleplon 10 mg capsule84zaleplon 5 mg capsule71ZARAH TABLET35ZARXIO 300 MCG/0.5

ML SYRINGE35ZARXIO 480 MCG/0.8

ML SYRINGE67ZEBUTAL 50-325-40

MG CAPSULE30ZEJULA 100 MG

CAPSULE30ZELBORAF 240 MG

TABLET53ZEMAIRA 1,000 MG

VIAL91ZENATANE 10 MG

CAPSULE91ZENATANE 20 MG



CAPSULE58ZENPEP DR 10,000

UNIT CAPSULE58ZENPEP DR 15,000






UNIT CAPSULE50ZETIA 10 MG TABLET33zidovudine 100 mg

capsule

33zidovudine 300 mg tablet

33zidovudine 50 mg/5 ml syrup

88zileuton er 600 mg tablet75zingiber tablet72ZIOPTAN 0.0015%

EYE DROPS84ziprasidone hcl 20 mg

capsule84ziprasidone hcl 40 mg



capsule34ZIRGAN 0.15%

OPHTHALMIC GEL31ZITHRANOL 1%

SHAMPOO50ZOCOR 10 MG TABLET50ZOCOR 20 MG TABLET50ZOCOR 40 MG TABLET51ZOCOR 5 MG TABLET51ZOCOR 80 MG TABLET39ZODRYL AC 25

SUSPENSION39ZODRYL AC 30






SUSPENSION39ZODRYL DAC 25

SUSPENSION

39ZODRYL DAC 30 SUSPENSION






39ZODRYL DEC 25 SUSPENSION







59zoledronic acid 4 mg/5 ml vial

53zoledronic acid 5 mg/100 ml

30ZOLINZA 100 MG CAPSULE

51zolmitriptan 2.5 mg odt51zolmitriptan 2.5 mg

tablet51zolmitriptan 5 mg odt51zolmitriptan 5 mg tablet84ZOLOFT 100 MG

TABLET85ZOLOFT 25 MG

TABLET


85ZOLOFT 50 MG TABLET

85zolpidem tart er 12.5 mg tab

85zolpidem tart er 6.25 mg tab

85zolpidem tartrate 10 mg tablet

85zolpidem tartrate 5 mg tablet

14zonisamide 100 mg capsule



30ZORTRESS 0.25 MG TABLET



30ZORTRESS 1 MG TABLET

98ZOSTAVAX VIAL74ZOSYN 2.25 GM/50 ML

GALAXY BAG74ZOSYN 3.375 GM/50

ML GALAXY74ZOSYN 4.5 GM/100 ML

GALAXY BAG71ZOVIA 1-35E TABLET93ZTLIDO 1.8% TOPICAL

SYSTEM39Z-TUSS AC 2 MG-9

MG/5 ML LIQ69ZUBSOLV 0.7-0.18 MG

TABLET SL69ZUBSOLV 1.4-0.36 MG

TABLET SL69ZUBSOLV 11.4-2.9 MG

TABLET SL

69ZUBSOLV 2.9-0.71 MG TABLET SL



30ZYDELIG 100 MG TABLET

30ZYDELIG 150 MG TABLET

30ZYKADIA 150 MG CAPSULE

30ZYKADIA 150 MG TABLET

89ZYLET EYE DROPS85ZYPREXA 10 MG

TABLET85ZYPREXA 15 MG

TABLET85ZYPREXA 2.5 MG



TABLET85ZYPREXA 7.5 MG

TABLET85ZYPREXA RELPREVV

210 MG VL KIT85ZYPREXA RELPREVV

300 MG VL KIT85ZYPREXA RELPREVV

405 MG VL KIT30ZYTIGA 250 MG

TABLET30ZYTIGA 500 MG

TABLET


2020 Diabetes Standard Package Page 1 of 1

Preventive drugs are used to improve outcomes for diabetes. The list below contains the diabetes drugs and Part D covered diabetic supplies. If you have questions about which drugs are right for you, talk to your doctor.

You do not have to pay a copay or coinsurance for the preventive drugs on this list if filled at a pharmacy in the Cigna-HealthSpring Rx (PDP) network. All quantity limits, prior authorization and step therapy in the full drug list still apply.

Diabetes acarbose HUMALOG MX KWKPN LANTUS SOLOSTR RIOMET soln BYETTA HUMALOG MX VIAL LANTUS VIAL SOLIQUA PEN chlorpropamide tab HUMULIN 70/30 KWKPN LEVEMIR FLEXTCH SYNJARDY tab, XR FARXIGA HUMULIN 70-30 VIAL LEVEMIR VIAL tolazamide tab glimepiride tab HUMULIN N KWIKPEN metformin ER tab tolbutamide tab glipizide ER, XL, tab HUMULIN N VIAL metformin er osm tab TOUJEO SOLOSTR glipizide-metformin HUMULIN R KWIKPEN metformin tab TOUJEO MAX SOLOSTAR glyburide tab HUMULIN R VIAL miglitol tab TRADJENTA glyburide micro tab JANUMET nateglinide tab TRESIBA glyburide-metformin JANUMET XR OZEMPIC PEN TRESIBA FLEXTCH GLYXAMBI JANUVIA pioglitazone tab TRULICITY HUMALOG JR KWKPN JARDIANCE pioglitazone-glimepir VICTOZA PEN HUMALOG KWKPN JENTADUETO pioglitazone-metform XIGDUO XR HUMALOG VIAL JENTADUETO XR repaglinide tab XULTOPHY PEN

Diabetic Supplies

ALCOHOL SWABS INSULIN PEN NDLE OMNIPOD 5 pk OMNIPOD STARTER KIT GAUZE PADS 2 X 2 INSULIN SYRINGES OMNIPOD DASH VGO 20, 30, 40

If you have any questions about this pharmacy plan please call Customer Service Monday through Friday at 1-800-558-9562 (TTY 711) October 1–March 31, 7 days a week, 8:00 am–8:00 pm local time. From April 1–September 30, Monday–Friday, 8:00 am–8:00 pm local time (a voicemail system is available on weekends and holidays).

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring Rx (PDP) is a Medicare Prescription Drug Plan (PDP) with a Medicare contract. Enrollment in Cigna-HealthSpring depends on contract renewal.

2020 Generic Package Page 1 of 2

Preventive drugs are used to improve outcomes for high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, heart attack, stroke and prenatal vitamins. The list below contains the generic drugs sorted by each category. If you have questions about which drugs are right for you, talk to your doctor.

You do not have to pay a copay or coinsurance for the preventive drugs on this list if filled at a pharmacy in the Cigna-HealthSpring Rx (PDP) network. All quantity limits, prior authorization and step therapy in full drug list still apply.

Asthma albuterol syrup budesonide susp levalbuterol conc. metaproterenol syr theochron tab albuterol tab cromolyn neb soln levalbuterol soln montelukast oral theophylline ER, CR albuterol solution ipratropium brom levalbuterol HFA terbutaline tab zafirlukast tab albuterol HFA ipratropium-albut metaproterenol tab terbutaline vial zileuton er

Blood Pressure

acebutolol cap captopril tab guanfacine minoxidil tab SORINE acetazolamide, er captopril-hctz hydralazine tab moexipril tab sotalol af tab aliskiren CARTIA XT hydralazine inj nadolol tab sotalol tab amiloride tab carvedilol tab, er hydrochlorothiazide nadolol/bend tab spironolactone tab amiloride-hctz chlorothiazide indapamide tab nicardipine cap spironolactone-hctz amlodipine tab chlorthalidone tab irbesartan tab nicardipine inj TAZTIA XT amlodipine-atorv clonidine tab, patch irbesartan-hctz nifedipine cap telmisartan tab amlodipine benz DILT-XR isradipine cap nifedipine er tab telmisartan-amlod amlodipine-olmes diltiazem vial labetalol tab nimodipine cap telmisartan-hctz amlodipine-valsart. diltiazem tab lisinopril tab nisoldipine er tab terazosin cap amlodipine-val-hctz diltiazem er, cd lisinopril-hctz olmesartan timolol tab atenolol tab doxazosin tab losartan tab olm-aml-hctz torsemide tab atenolol-chlorthalid enalapril tab losartan-hctz olmesartan-hctz trandolapril tab benazepril tab enalapril-hctz MATZIM LA perindopril tab trandolapril-verap er benazepril-hctz eplerenone tab methazolamide tab pindolol tab triamterene-hctz betaxolol tab eprosartan tab methyclothiazide prazosin cap valsartan tab bisoprolol tab ethacrynate sod methyldopa tab propranolol,er valsartan-hctz bisoprolol-hctz ethacrynic acid methyldopa-hctz propranolol-hctz verapamil cap pellet bumetanide tab felodipine er metolazone tab quinapril tab verapamil er tab, cap bumetanide inj fosinopril tab metoprolol succ er quinapril-hctz verapamil sr cap candesartan tab fosinopril-hctz metoprolol tart tab ramipril cap verapamil tab, inj candesartan-hctz furosemide metoprolol-hctz

2020 Generic Package Page 2 of 2

Blood Thinners aspirin-dipyridam er clopidogrel tab JANTOVEN tab warfarin tab cilostazol tab dipyridamole tab prasugrel tab

Cholesterol

atorvastatin tab ezetimibe fenofibric acid tab niacin er (RX) prevalite packet cholestyramine, light ezetimbe-simvastatin fluvastatin cap, er tab NIACOR prevalite powder colesevelam pck,tab fenofibrate cap, tab gemfibrozil tab omega-3 ethyl (RX) rosuvastatin tab colestipol granules,tb fenofibric acid dr lovastatin tabs pravastatin tab simvastatin tab

Diabetes

acarbose glipizide-metformin metformin ER tab nateglinide tab repaglinide tab chlorpropamide tab glyburide tab metformin er osm tab pioglitazone tab tolazamide tab glimepiride tab glyburide micro tab metformin tab pioglitazone-glimepir tolbutamide tab glipizide ER, XL, tab glyburide-metformin miglitol tab pioglitazone-metform

Osteoporosis

alendronate etidronate disodium pamidronate inj risedronate tab zoledronic acid calcitonin-salmon ibandronate tab raloxifene tab risedronate dr tab

Prenatal Vitamins

All Generic Prescription Prenatal Vitamins If you have any questions about this pharmacy plan please call Customer Service Monday through Friday at 1-800-558-9562 (TTY 711) October 1–March 31, 7 days a week, 8:00 am–8:00 pm local time. From April 1–September 30, Monday–Friday, 8:00 am–8:00 pm local time (a voicemail system is available on weekends and holidays).

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring Rx (PDP) is a Medicare Prescription Drug Plan (PDP) with a Medicare contract. Enrollment in Cigna-HealthSpring depends on contract renewal

1-800-558-9562 (TTY 711) October 1 – March 31, 8 a.m. – 8 p.m. local time, 7 days a week. From April 1 – September 30, Monday – Friday, 8 a.m. – 8 p.m. local time. Messaging service used weekends, after hours, and on federal holidays. Customer service also has free language interpreter services available for non-English speakers.

CignaMedicare.com/group/PDPresources You can also visit us online at to find a pharmacy, view plan information, and more. This drug list was updated September 2019. For more recent information or other questions, please contact Cigna-HealthSpring Rx (PDP) Customer Service. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. ©2019 Cigna

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