Focus 4 Tier w/LVL January 2021 Formulary

PLEASE NOTE: Certain specialty medications may only be available through your plan’s preferred specialty pharmacy. Some medications may be subject to the Affordable Care Act (ACA) provisions or your plan's preventive benefit and covered by your plan at 100%. Individual plans may vary. For questions regarding plan-specific restrictions, coverage criteria, and cost sharing information, please log into your member portal and use the “What’s my Cost” feature or call the phone number printed on your member ID card.

Focus 4 Tier w/LVL January 2021 Formulary

Each medication may have specific coverage requirements not reflected in this document. The key below explains common coverage indicators present on this file. Drugs shown in lower-case are generically available and typically covered at the lowest member cost share.

This document provides an alphabetical listing of medications covered on the Focus 4 Tier w/LVL January 2021 formulary. Inclusion on this list does not guarantee coverage. Individual plans may vary and medications that do not appear on this abbreviated list may be covered. Agents listed are primarily oral, self-injected, inhaled or topical pharmaceutical formulations. Drugs requiring provider administration are generally covered under the medical benefit and may not appear on this list.

Tier 1 medication, typically generics or drugs available at lowest member cost share.T1

Tier 2 medication, typically preferred or formulary brand drugs.T2

Tier 3 medication, typically non-preferred or non-formulary drugs.T3

Tier 4 medication, typically specialty medications.T4

Drug requires prior authorization to confirm medical necessity prior to coverage.PA

Quantity limits may apply.QL

BP

SP

AABILIFY MAINTENA INJECTION

T4, PA, SP

ABIRATERONE TABLET T4, PA, SP

ABRAXANE SUSPENSION T4, PA, SP

acamprosate calcium dr tablet

T1

ACCU-CHEK FASTCLIX KIT T2

ACCU-CHEK FASTCLIX MISC T2

ACCU-CHEK SOFTCLIX MISC T2

acebutolol capsule T1

acetaminophen w/codeine tablet

T1

acetaminophen/codeine solution

T1

acetaminophen/codeine tablet

T1

acetazolamide er capsule T1

acetazolamide tablet T1

acetic acid solution T1

acetic acid/hydrocortisone solution

T1

ACTEMRA ACTPEN INJECTION

T4, PA, SP

ACTEMRA INJECTION T4, PA, SP

ACTEMRA SOLUTION T4, PA, SP

ACTHAR GEL T4, PA, SP

ACTHREL SOLUTION T4, PA, SP

ACTIMMUNE SOLUTION T4, PA, SP

acyclovir capsule T1

acyclovir ointment T1, QL

acyclovir suspension T1

acyclovir tablet T1

ACZONE GEL T3, BP

ADACEL SUSPENSION T2

ADAKVEO SOLUTION T4, PA, SP

adapalene cream T1

adapalene gel T1

adapalene-benzoyl peroxide gel

T1

ADCETRIS SOLUTION T4, PA, SP

ADDERALL XR 24 HOUR CAP T3, QL, BP

ADDYI TABLET T3, QL

ADEFOVIR DIPIVOXIL TABLET T4, PA, SP

ADEMPAS TABLET T4, PA, SP

ADRIAMYCIN SOLUTION T4, PA, SP

ADVAIR DISKUS AEROSOL T2, QL, BP

ADVAIR HFA AEROSOL T2, QL

ADVATE SOLUTION T4, PA, SP

ADYNOVATE SOLUTION T4, PA, SP

AEROCHAMBER MISC T2

AEROCHAMBER PLUS FLOW VU MISC

T2

AEROCHAMBER PLUS FLOW-VU MISC

T2

AFINITOR DISPERZ TABLET T4, PA, SP

AFINITOR TABLET T4, PA, SP, BP

AFLURIA QUAD 2020-2021 SUSPENSION

T2

AFLURIA QUAD 2020-21 (3YR UP) INJECTION

T2

AFSTYLA KIT T4, PA, SP

AIMOVIG INJECTION T2, PA

of 25www.MaxorPlus.comFor plan specific information, call (800) 687-0707 or log onto your member portal at:

Brand Penalty: Member may be responsible for the cost difference between brand and generic.

Specialty Medication: This drug may only be available at the plan's preferred specialty pharmacy.

SUBJECT TO CHANGE

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AJOVY INJECTION T2, PA

AKLIEF CREAM T3, PA

ALBUKED 25 SOLUTION T4, PA, SP

ALBUKED 5 SOLUTION T4, PA, SP

ALBUMIN HUMAN SOLUTION T4, PA, SP

ALBUMINEX SOLUTION T4, PA, SP

ALBURX SOLUTION T4, PA, SP

ALBUTEIN SOLUTION T4, PA, SP

albuterol sulfate hfa aerosol T1, QL

albuterol sulfate nebulized T1

albuterol sulfate syrup T1

ALDURAZYME SOLUTION T4, PA, SP

ALECENSA CAPSULE T4, PA, SP

alendronate sodium tablet T1, QL

ALFERON N SOLUTION T4, PA, SP

alfuzosin er 24 hr tab T1

ALIMTA SOLUTION T4, PA, SP

ALINIA TABLET T2

ALIQOPA SOLUTION T4, PA, SP

ALKERAN SOLUTION T4, PA, SP, BP

ALKERAN TABLET T4, PA, SP, BP

allopurinol tablet T1

ALOXI SOLUTION T4, PA, SP, BP

ALPHAGAN P SOLUTION T2, BP

ALPHANATE/VON WILLEBRAND SOLUTION

T4, PA, SP

ALPHANINE SD SOLUTION T4, PA, SP

alprazolam er 24 hr tab T1

alprazolam tablet T1

alprazolam xr 24 hr tab T1

ALPROLIX SOLUTION T4, PA, SP

ALREX SUSPENSION T3

altavera tablet T1

ALTRENO LOTION T3

ALUNBRIG TABLET T4, PA, SP

alyacen 1/35 tablet T1

AMBRISENTAN TABLET T4, PA, SP

amethia tablet T1

amiloride tablet T1

amiodarone tablet

AMITIZA CAPSULE

amitriptyline tablet

amlodipine besylate tablet T1

amlodipine besylate-benazepril capsule

T1

ammonium lactate lotion T1

amnesteem capsule T1, PA

amoxicillin capsule T1

amoxicillin chew tab T1

amoxicillin suspension T1

amoxicillin tablet T1

amoxicillin-clavulanate pot er 12 hr tab

T1

amoxicillin-clavulanate potass suspension

T1

amoxicillin-clavulanate potass tablet

T1

ampicillin capsule T1

ANASCORP SOLUTION T4, PA, SP

anastrozole tablet T1

ANDEXXA SOLUTION T4, PA, SP

ANGELIQ TABLET T3

ANNOVERA T3, QL

ANORO ELLIPTA AEROSOL T2, QL

APOKYN INJECTION T4, PA, SP

aprepitant capsule T1, QL, PA

apri tablet T1

APRISO 24 HOUR CAP T3, BP

ARALAST NP SOLUTION T4, PA, SP

ARCALYST SOLUTION T4, PA, SP

ARIKAYCE SUSPENSION T4, PA, SP

aripiprazole tablet T1

ARISTADA INITIO INJECTION T4, PA, SP

ARISTADA INJECTION T4, PA, SP

armodafinil tablet T1, QL

ARNUITY ELLIPTA AEROSOL T2, QL

ARRANON SOLUTION T4, PA, SP

ARSENIC TRIOXIDE SOLUTION

T4, PA, SP

ARZERRA T4, PA, SP

ASCENIV SOLUTION T4, PA, SP

ASCLERA SOLUTION T4, PA, SP

ashlyna tablet T1

ASPARLAS SOLUTION T4, PA, SP

aspirin adult low dose tablet T1

aspirin adult tablet T1

aspirin chew tab T1

aspirin e.c. tablet T1

aspirin ec tablet T1

aspirin low dose chew tab T1

aspirin low dose tablet T1

aspirin regular strength tablet

T1

atenolol tablet T1

atenolol/chlorthalidone tablet

T1

atomoxetine capsule T1

ATOPADERM CREAM T3

atorvastatin calcium tablet T1, QL

atovaquone/proguanil tablet T1

atropine sulfate solution T1

ATROVENT HFA AEROSOL T3, QL

AUBAGIO TABLET T4, PA, SP

aurovela fe 1.5/30 tablet T1

aurovela fe 1/20 tablet T1

AURYXIA TABLET T3

AUSTEDO TABLET T4, PA, SP

AVENOVA SOLUTION T3

aviane tablet T1

AVONEX INJECTION T4, PA, SP

AVONEX PEN INJECTION T4, PA, SP

AVSOLA SOLUTION T4, PA, SP

AYVAKIT TABLET T4, PA, SP

AZACITIDINE SUSPENSION T4, PA, SP

AZASITE SOLUTION T2

azathioprine tablet T1

AZEDRA DOSIMETRIC SOLUTION

T4, PA, SP

AZEDRA THERAPEUTIC SOLUTION

T4, PA, SP

azelaic acid gel T1

azelastine solution T1, QL

azelastine-fluticasone suspension

T1, QL

AZELEX CREAM T3

azithromycin packet T1

azithromycin suspension T1

azithromycin tablet T1

AZOPT SUSPENSION

azurette tablet T1

Bbacitracin ointment T1

bacitracin/polymyxin b ointment

T1

baclofen tablet T1

BAFIERTAM CAPSULE (DELAYED RELEASE)

T4, PA, SP

balsalazide disodium capsule T1

BALVERSA TABLET T4, PA, SP

balziva tablet T1

BANZEL TABLET T2, PA


T2

T1

T2, QL

T1

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BAQSIMI ONE PACK POWDER T2

BAQSIMI TWO PACK POWDER

T2

BARACLUDE SOLUTION T4, PA, SP

BAVENCIO SOLUTION T4, PA, SP

B-D INSULIN SYRINGE MISC T2

BELBUCA FILM T2, QL

BELEODAQ SOLUTION T4, PA, SP

BELRAPZO SOLUTION T4, PA, SP

BELSOMRA TABLET T2, QL

benazepril tablet T1

benazepril-hctz tablet T1

BENDEKA SOLUTION T4, PA, SP

BENEFIX KIT T4, PA, SP

BENLYSTA INJECTION T4, PA, SP

BENLYSTA SOLUTION T4, PA, SP

benzonatate capsule T1

benztropine mesylate tablet T1

BEOVU SOLUTION T4, PA, SP

BEPREVE SOLUTION T3

BESIVANCE SUSPENSION T3

BESPONSA SOLUTION T4, PA, SP

betamethasone dipropionate cream

T1

betamethasone dipropionate lotion

T1

betamethasone dipropionate ointment

T1

betamethasone valerate cream

T1

betamethasone valerate ointment

T1

BETASERON KIT T4, PA, SP

BETHKIS NEBULIZED T4, PA, SP

BETIMOL SOLUTION T3

BEVESPI AEROSPHERE AEROSOL

T2, QL

BEXAROTENE CAPSULE T4, PA, SP

BEXSERO INJECTION T2

BICNU SOLUTION T4, PA, SP, BP

BIKTARVY TABLET T2, QL

bisacodyl ec tablet T1

bisoprolol fumarate tablet T1

bisoprolol fumarate/hctz tablet

T1

BIVIGAM SOLUTION T4, PA, SP

BLEOMYCIN SOLUTION T4, PA, SP

BLEOMYCIN SULFATE SOLUTION

T4, PA, SP

BLINCYTO SOLUTION T4, PA, SP

blisovi 24 fe tablet T1

blisovi fe 1.5/30 tablet T1

blisovi fe 1/20 tablet T1

BONIVA SOLUTION T4, PA, SP, BP

BOOSTRIX SUSPENSION T2

BORTEZOMIB SOLUTION T4, PA, SP

BOSENTAN TABLET T4, PA, SP

BOSULIF TABLET T4, PA, SP

BOTOX SOLUTION T4, PA, SP

BRAFTOVI CAPSULE T4, PA, SP

BREO ELLIPTA AEROSOL T2, QL

BRILINTA TABLET T2

brimonidine tartrate solution T1

BRINEURA KIT T4, PA, SP

BRIVIACT TABLET T3

bromphen/pseudoephedrine syrup

T1

BROMSITE SOLUTION T3

BROVANA NEBULIZED T3

BRUKINSA CAPSULE T4, PA, SP

budesonide capsule T1

budesonide er 24 hr tab T1

budesonide suspension T1

bumetanide tablet T1

BUPHENYL POWDER T4, PA, SP, BP

BUPHENYL TABLET T4, PA, SP, BP

buprenorphine sl T1, QL

buprenorphine-naloxone film

T1, QL

buprenorphine-naloxone sl T1, QL

bupropion sr 12 hr tab T1

bupropion tablet T1

bupropion xl 24 hr tab T1, QL

buspirone tablet T1

BUSULFAN SOLUTION T4, PA, SP

BUSULFEX SOLUTION T4, PA, SP, BP

butalbital compound capsule T1

butalbital/apap/caffeine tablet

T1

butalbital/caff/apap/codeine capsule

T1

butalbital-asp-caffeine capsule

T1

BYNFEZIA PEN INJECTION T4, PA, SP

BYSTOLIC TABLET T2

C

cabergoline tablet T1

CABLIVI KIT T4, PA, SP

CABOMETYX TABLET T4, PA, SP

calcipotriene cream T1

calcipotriene ointment T1

calcipotriene solution T1

calcitonin-salmon solution T1

calcitriol capsule T1

camila tablet T1

CAMPTOSAR SOLUTION T4, PA, SP, BP

camrese lo tablet T1

camrese tablet T1

CANASA SUPPOSITORY T3, BP

candesartan cilexetil tablet T1

CAPECITABINE TABLET T4, PA, SP

CAPRELSA TABLET T4, PA, SP

CARAFATE SUSPENSION T3, BP

CARBAGLU TABLET T4, PA, SP

carbamazepine er 12 hr tab T1

carbamazepine tablet T1

carbidopa/levodopa er tablet T1

carbidopa/levodopa tablet T1

CARBOPLATIN SOLUTION T4, PA, SP

CARDIZEM LA 24 HR TAB T3, BP

CARIMUNE NANOFILTERED SOLUTION

T4, PA, SP

carisoprodol tablet T1

CARMUSTINE SOLUTION T4, PA, SP

cartia xt 24 hour cap T1

carvedilol tablet T1

CAYSTON SOLUTION T4, PA, SP

cefadroxil capsule T1

cefdinir capsule T1

cefdinir suspension T1

cefixime capsule T1

cefpodoxime proxetil tablet T1

cefprozil suspension T1

cefprozil tablet T1

cefuroxime axetil tablet T1

celecoxib capsule T1, QL

cephalexin capsule T1

cephalexin suspension T1

CEPHALEXIN TABLET T2

CEPROTIN SOLUTION T4, PA, SP

CEQUA SOLUTION T3, QL

CERDELGA CAPSULE T4, PA, SP

CEREZYME SOLUTION T4, PA, SP


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cetirizine solution T1

CETROTIDE KIT T2

cevimeline capsule T1

CHANTIX CONTINUING MONTH TABLET

T2

CHANTIX TABLET T2

CHENODAL TABLET T4, PA, SP

chlordiazepoxide capsule T1

chlorhexidine gluconate solution

T1

chlorthalidone tablet T1

chlorzoxazone tablet T1

CHOLBAM CAPSULE T4, PA, SP

cholestyramine light packet T1

cholestyramine packet T1

cholestyramine powder T1

ciclopirox nail lacquer solution

T1

ciclopirox olamine cream T1

ciclopirox shampoo T1

CIDOFOVIR SOLUTION T4, PA, SP

cilostazol tablet T1

cimetidine tablet T1

CINACALCET TABLET T4, PA, SP

CINRYZE SOLUTION T4, PA, SP

CINVANTI EMULSION T4, PA, SP, QL

CIPRO HC SUSPENSION T3

CIPRO SUSPENSION T3

CIPRODEX SUSPENSION T3, BP

ciprofloxacin solution T1

ciprofloxacin tablet T1

ciprofloxacin-dexamethasone suspension

T1

CISPLATIN SOLUTION T4, PA, SP

citalopram tablet T1

CLADRIBINE SOLUTION T4, PA, SP

claravis capsule T1, PA

CLARINEX-D 12 HOUR TAB T3

clarithromycin tablet T1

CLENPIQ SOLUTION T2

CLEOCIN SUPPOSITORY T3

CLEVER CHOICE COMFORT EZ MISC

T2

clindamycin capsule T1

clindamycin palmitate solution

T1

clindamycin pediatric solution

T1

clindamycin phosphate cream

T1

clindamycin phosphate gel T1

clindamycin phosphate lotion

T1

clindamycin phosphate solution

T1

clindamycin phosphate swab T1

clindamycin-benzoyl peroxide gel

T1

CLINDESSE CREAM T3

clobetasol solution T1

CLOFARABINE SOLUTION T4, PA, SP

CLOLAR SOLUTION T4, PA, SP, BP

clomiphene tablet T1

clonazepam odt tablet T1

clonazepam tablet T1

clonidine tablet T1

clopidogrel tablet T1

clotrimazole cream T1

clotrimazole lozenge T1

clotrimazole/betamethasone cream

T1

clotrimazole/betamethasone lotion

T1

CLOVIQUE CAPSULE T4, PA, SP

COAGADEX SOLUTION T4, PA, SP

colchicine tablet T1

COLCRYS TABLET T3, BP

colesevelam tablet T1

colestipol tablet T1

COMBIGAN SOLUTION T2

COMBIPATCH PATCH T2

COMBIVENT RESPIMAT AEROSOL

T2, QL

COMETRIQ KIT T4, PA, SP

COMPACT SPACE CHAMBER T2

COMP-AIR NEBULIZER COMPRESSOR MISC

T2

CONDYLOX GEL T3

CONTRAVE 12 HR TAB T3, PA

COPAXONE INJECTION T4, PA, SP, BP

COPIKTRA CAPSULE T4, PA, SP

CORIFACT KIT T4, PA, SP

CORLANOR TABLET T2, QL

CORTEF TABLET T3, BP

CORTISPORIN-TC SUSPENSION

T3

CORTROSYN SOLUTION T4, PA, SP, BP

COSMEGEN SOLUTION T4, PA, SP, BP

COSYNTROPIN SOLUTION T4, PA, SP

COTELLIC TABLET T4, PA, SP

CREON CAPSULE T2, PA

cromolyn sodium solution T1

cryselle-28 tablet T1

CRYSVITA SOLUTION T4, PA, SP

CUVITRU SOLUTION T4, PA, SP

CUVPOSA SOLUTION T3

cyanocobalamin solution T1

cyclobenzaprine tablet T1

cyclopentolate solution T1

cyclophosphamide solution T1, PA, SP

cyproheptadine syrup T1

cyproheptadine tablet T1

CYRAMZA SOLUTION T4, PA, SP

CYSTADANE POWDER T4, PA, SP

CYSTAGON CAPSULE T4, PA, SP

CYSTARAN SOLUTION T4, PA, SP

CYTARABINE SOLUTION T4, PA, SP

CYTOGAM INJECTION T4, PA, SP

DDACARBAZINE SOLUTION T4, PA, SP

DACOGEN SOLUTION T4, PA, SP, BP

DACTINOMYCIN SOLUTION T4, PA, SP

DALFAMPRIDINE ER 12 HR TAB

T4, PA, SP

DALIRESP TABLET T2

DALVANCE SOLUTION T4, PA, SP

dapsone gel T1

DARAPRIM TABLET T4, PA, SP, BP

DARZALEX FASPRO SOLUTION

T4, PA, SP

DARZALEX SOLUTION T4, PA, SP

dasetta 1/35 tablet T1

daunorubicin solution T1, PA, SP, BP

DAURISMO TABLET T4, PA, SP

daysee tablet T1

DAYTRANA PATCH T2, QL

deblitane tablet T1

DECITABINE SOLUTION T4, PA, SP

DEFERASIROX PACKET T4, PA, SP

DEFERASIROX TABLET T4, PA, SP

DEFERIPRONE TABLET T4, PA, SP

DEFEROXAMINE MESYLATE SOLUTION

T4, PA, SP


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DELESTROGEN OIL T3, BP

DEMSER CAPSULE T4, PA, SP, BP

DEPAKOTE ER 24 HR TAB T3, BP

DEPO-ESTRADIOL OIL T2

DEPO-SUBQ PROVERA 104 INJECTION

T3

DEPO-TESTOSTERONE SOLUTION

T3, BP

DESCOVY TABLET T2, QL

DESFERAL SOLUTION T4, PA, SP, BP

desloratadine tablet T1

desmopressin tablet T1

desogestr-eth estrad eth estra tablet

T1

desonide ointment T1

desvenlafaxine er 24 hr tab T1

dexamethasone elixir T1

DEXAMETHASONE INTENSOL

T2

dexamethasone sodium phosphate solution

T1, BP

dexamethasone solution T1

dexamethasone tablet T1

DEXCOM G4 MISC T2, PA

DEXCOM G5 MISC T2, PA

DEXCOM G6 RECEIVER T2, PA

DEXCOM G6 SENSOR MISC T2, PA

DEXCOM G6 TRANSMITTER MISC

T2, PA

dexmethylphenidate er 24 hour cap

T1, QL

dexmethylphenidate tablet T1

DEXRAZOXANE SOLUTION T4, PA, SP

dextroamphetamine sulfate er 24 hour cap

T1

dextroamphetamine sulfate tablet

T1

dextroamphetamine-amphet er 24 hour cap

T1, QL

dextroamphetamine-amphetamine tablet

T1

DIACOMIT CAPSULE T4, PA, SP

DIACOMIT PACKET T4, PA, SP

DIASTAT ACUDIAL GEL T3

DIAZEPAM RECTAL T2

diazepam tablet T1

DIBENZYLINE CAPSULE T4, PA, SP, BP

diclofenac potassium tablet T1

diclofenac sodium dr tablet T1

diclofenac sodium er 24 hr tab

T1

diclofenac sodium gel T1, PA

diclofenac sodium solution T1

diclofenac sodium-misoprostol tablet

T1

dicloxacillin sodium capsule T1

dicyclomine capsule T1

dicyclomine tablet T1

DIFICID TABLET T3, PA, QL

digoxin tablet T1

DILANTIN CAPSULE T2, BP

diltiazem 24hr er (cd) 24 hour cap

T1

diltiazem er 24 hour cap T1

diltiazem tablet T1

dilt-xr 24 hour cap T1

DIMETHYL FUMARATE CAPSULE (DELAYED RELEASE)

T4, PA, SP

DIMETHYL FUMARATE MISC T4, PA, SP

diphenoxylate w/atropine tablet

T1

diphenoxylate/atropine tablet

T1

DIPRIVAN EMULSION T4, PA, SP, BP

disulfiram tablet T1

divalproex sodium dr tablet T1

divalproex sodium er 24 hr tab

T1

DOCETAXEL T4, PA, SP, BP

DOCETAXEL SOLUTION T4, PA, SP, BP

DOJOLVI LIQUID T4, PA, SP

donepezil tablet T1

DOPTELET TABLET T4, PA, SP

dorzolamide solution T1

dorzolamide-timolol solution T1

dotti patch T1, QL

DOVATO TABLET T2, QL

doxazosin mesylate tablet T1

doxepin T1

doxepin capsule T1

DOXEPIN CREAM T2, QL

DOXIL INJECTION T4, PA, SP, BP

DOXORUBICIN LIPOSOMAL INJECTION

T4, PA, SP

DOXORUBICIN SOLUTION T4, PA, SP

doxycycline hyclate capsule T1

doxycycline hyclate dr tablet T1

doxycycline hyclate tablet T1

doxycycline monohydrate capsule

T1

doxycycline monohydrate tablet

T1

doxycycline suspension T1

drospirenone-ethinyl estradiol tablet

T1

DRYSOL SOLUTION T3

DUAVEE TABLET T2

duloxetine capsule T1

DUPIXENT INJECTION T4, PA, SP

DUREZOL EMULSION T2

dutasteride capsule

DYMISTA SUSPENSION

DYSPORT SOLUTION T4, PA, SP

EEASIVENT MISC T2

EASY TOUCH 32GX6MM MISC

T3

EASY TOUCH MISC T2

ec-naproxen tablet T1

econazole nitrate cream T1

EDARBI TABLET T2

EGRIFTA SV SOLUTION T4, PA, SP

ELAPRASE SOLUTION T4, PA, SP

eletriptan tablet T1, QL

ELFOLATE TABLET T2

ELIGARD KIT T4, PA, SP, QL

elinest tablet T1

ELIQUIS STARTER PACK TABLET

T2

ELIQUIS TABLET T2

ELITEK SOLUTION T4, PA, SP

ELLA TABLET T3

ELLENCE SOLUTION T4, PA, SP, BP

ELMIRON CAPSULE T2

ELOCTATE SOLUTION T4, PA, SP

eluryng T1, QL

ELZONRIS SOLUTION T4, PA, SP

EMCYT CAPSULE T4, PA, SP

EMEND SOLUTION T4, PA, SP, BP

EMGALITY INJECTION T2, PA

EMPLICITI SOLUTION T4, PA, SP

EMVERM CHEW TAB T2, PA

enalapril maleate tablet T1

enalapril maleate/hctz tablet T1

ENBREL INJECTION T4, PA, SP

ENBREL MINI INJECTION T4, PA, SP

ENBREL SOLUTION T4, PA, SP


T3, QL, BP

T1

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ENBREL SURECLICK INJECTION

T4, PA, SP

ENDARI PACKET T4, PA, SP

ENDOMETRIN T2

ENGERIX-B SUSPENSION T2

ENHERTU SOLUTION T4, PA, SP

enoxaparin sodium solution T1

enpresse-28 tablet T1

enskyce tablet T1

ENSPRYNG INJECTION T4, PA, SP

ENTECAVIR TABLET T4, PA, SP

ENTEREG CAPSULE T4, PA, SP

ENTRESTO TABLET T2, QL

ENTYVIO SOLUTION T4, PA, SP

EPCLUSA TABLET T4, PA, SP

EPICYN SOLUTION T3

EPIDIOLEX SOLUTION T4, PA, SP

EPIDUO FORTE GEL T2

epinephrine injection T1, QL

EPIPEN 2-PAK INJECTION T2, QL, BP

EPIPEN-JR 2-PAK INJECTION T2, QL, BP

EPIRUBICIN SOLUTION T4, PA, SP

EPIVIR HBV SOLUTION T4, PA, SP

EPIVIR HBV TABLET T4, PA, SP, BP

EPOPROSTENOL SODIUM SOLUTION

T4, PA, SP

ERBITUX SOLUTION T4, PA, SP

ERIVEDGE CAPSULE T4, PA, SP

ERLEADA TABLET T4, PA, SP

ERLOTINIB TABLET T4, PA, SP

errin tablet T1

ERWINAZE SOLUTION T4, PA, SP

erythromycin gel T1

erythromycin ointment T1

erythromycin solution T1

erythromycin-benzoyl peroxide gel

T1

ESBRIET CAPSULE T4, PA, SP

ESBRIET TABLET T4, PA, SP

escitalopram oxalate tablet T1

esomeprazole magnesium capsule (delayed release)

T1

ESPEROCT SOLUTION T4, PA, SP

estarylla tablet T1

estradiol cream T1

estradiol patch T1, QL

estradiol tablet T1

estradiol-norethindrone acetat tablet

T1

ESTRING T2, QL

eszopiclone tablet T1, QL

ETHACRYNATE SODIUM SOLUTION

T4, PA, SP

ethynodiol-ethinyl estradiol tablet

T1

ETHYOL SOLUTION T4, PA, SP

etodolac tablet T1

etonogestrelethinyl estradiol

T1, QL

ETOPOPHOS SOLUTION T4, PA, SP

ETOPOSIDE CAPSULE T4, PA, SP

ETOPOSIDE SOLUTION T4, PA, SP

EUCRISA OINTMENT T2

EUFLEXXA INJECTION T4, PA, SP

euthyrox tablet T1

everolimus tablet T1, PA, SP

EVOMELA SOLUTION T4, PA, SP

EVRYSDI SOLUTION T4, PA, SP

exemestane tablet T1

EYLEA INJECTION T4, PA, SP

EYLEA SOLUTION T4, PA, SP

ezetimibe tablet T1, QL

ezetimibe/simvastatin tablet T1, QL

FFABRAZYME SOLUTION T4, PA, SP

falmina tablet T1

famciclovir tablet T1

famotidine suspension T1

famotidine tablet T1

FARXIGA TABLET T2, QL

FARYDAK CAPSULE T4, PA, SP

FASENRA INJECTION T4, PA, SP

FASENRA PEN INJECTION T4, PA, SP

FASLODEX SOLUTION T4, PA, SP, BP

FC2 FEMALE CONDOM MISC T2

febuxostat tablet T1

FEIBA SOLUTION T4, PA, SP

felodipine er 24 hr tab T1

femynor tablet T1

fenofibrate capsule T1

fenofibrate micronized capsule

T1

fenofibrate tablet T1

fenofibric acid dr capsule (delayed release)

T1

fentanyl patch T1, QL

FERAHEME SOLUTION T4, PA, SP

FERRIPROX SOLUTION T4, PA, SP

FERRIPROX TABLET T4, PA, SP

FERRIPROX TWICE-A-DAY TABLET

T4, PA, SP

FERRLECIT SOLUTION T4, PA, SP, BP

FETZIMA 24 HOUR CAP T2, QL

FIASP FLEXTOUCH INJECTION T2, QL

FIASP SOLUTION T2, QL

FIBRYGA SOLUTION T4, PA, SP

FINACEA FOAM T2

FINACEA GEL T3, BP

finasteride tablet T1

FIRMAGON SOLUTION T4, PA, SP

FIRST-LANSOPRAZOLE SUSPENSION

T3

FIRST-MOUTHWASH BLM SUSPENSION

T3

FIRST-OMEPRAZOLE SUSPENSION

T3

FLAREX SUSPENSION T3

FLEBOGAMMA DIF SOLUTION

T4, PA, SP

flecainide tablet T1

FLECTOR PATCH T2

FLEXBUMIN SOLUTION T4, PA, SP

FLOLAN SOLUTION T4, PA, SP, BP

FLOVENT DISKUS AEROSOL T2, QL

FLOVENT HFA AEROSOL T2, QL

FLOXURIDINE SOLUTION T4, PA, SP

FLUAD QUAD 2020-2021 INJECTION

T2

FLUARIX INJECTION T2

FLUBLOK QUAD 2020-2021 INJECTION

T2

FLUCELVAX QUAD 2020-2021 INJECTION

T2

FLUCELVAX QUAD 2020-2021 SUSPENSION

T2

fluconazole suspension T1

fluconazole tablet T1

FLUDARABINE PHOSPHATE SOLUTION

T4, PA, SP

fludrocortisone tablet T1

FLULAVAL INJECTION T2

FLUMIST QUADRIVALENT SUSPENSION

T3

fluocinolone acetonide oil T1


www.maxorplus.com

fluocinonide cream T1

fluocinonide ointment T1

fluocinonide solution T1

fluorometholone suspension T1

fluorouracil cream T1

fluorouracil solution T1, PA, SP

fluoxetine capsule T1

fluoxetine solution T1

fluoxetine tablet T1

flurbiprofen tablet T1

fluticasone cream T1

fluticasone suspension T1, QL

fluvoxamine maleate tablet T1

FLUZONE HIGH-DOSE QUAD 2020-21 INJECTION

T2

FLUZONE QUAD 2020-2021 INJECTION

T2

FLUZONE QUAD 2020-2021 SUSPENSION

T2

folbee tablet T1

folic acid tablet T1

FOLIVANE-PLUS CAPSULE T2

FOLOTYN SOLUTION T4, PA, SP

FORTEO INJECTION T4, PA, SP

FOSAPREPITANT DIMEGLUMINE SOLUTION

T4, PA, SP

FREESTYLE FREEDOM LITE KIT

T2, QL

FREESTYLE LIBRE READER T2, PA

FREESTYLE LIBRE SENSOR MISC

T2, PA

FREESTYLE LITE METER T2, QL

FREESTYLE LITE STRIPS T2, QL

FREESTYLE TEST STRIPS T2, QL

FULPHILA INJECTION T4, PA, SP

FULVESTRANT SOLUTION T4, PA, SP

furosemide tablet T1

FUSION PLUS CAPSULE T3

FUZEON SOLUTION T4, PA, SP

FYCOMPA TABLET T2

Ggabapentin capsule T1

gabapentin tablet T1

GALAFOLD CAPSULE T4, PA, SP

GAMASTAN INJECTION T4, PA, SP

GAMIFANT SOLUTION T4, PA, SP

GAMMAGARD LIQUID SOLUTION

T4, PA, SP

GAMMAGARD S-D SOLUTION T4, PA, SP

GAMMAPLEX SOLUTION T4, PA, SP

GAMUNEX-C SOLUTION T4, PA, SP

GANCICLOVIR SOLUTION T4, PA, SP

ganirelix injection T1

GARDASIL 9 INJECTION T2

GARDASIL 9 SUSPENSION T2

gatifloxacin solution T1

GATTEX KIT T4, PA, SP

gavilyte-c solution T1

gavilyte-g solution T1

gavilyte-n/flavor pack solution

T1

GAVRETO CAPSULE T4, PA, SP

GAZYVA SOLUTION T4, PA, SP

GEMCITABINE SOLUTION T4, PA, SP

gemfibrozil tablet T1

gentamicin sulfate solution T1

GENVOYA TABLET T2, QL

gianvi tablet T1

GILENYA CAPSULE T4, PA, SP

GILOTRIF TABLET T4, PA, SP

GIVLAARI SOLUTION T4, PA, SP

GLASSIA SOLUTION T4, PA, SP

GLATIRAMER INJECTION T4, PA, SP

GLATOPA INJECTION T4, PA, SP

GLEOSTINE CAPSULE T4, PA, SP

GLIADEL WAFER T4, PA, SP

glimepiride tablet T1

glipizide er 24 hr tab T1

glipizide tablet T1

glipizide xl 24 hr tab T1

glipizide-metformin tablet T1

GLUCAGEN HYPOKIT SOLUTION

T2

GLUCAGON EMERGENCY KIT T2

glyburide tablet T1

glyburide-metformin tablet T1

glycopyrrolate tablet T1

GLYXAMBI TABLET T2, QL

GOLYTELY SOLUTION T3, BP

GONAL-F RFF REDIJECT SOLUTION

T2, PA

GRANISETRON SOLUTION T4, PA, SP

griseofulvin microsize suspension

T1

griseofulvin microsize tablet T1

guanfacine 24 hr tab T1, QL

guanfacine er 24 hr tab T1, QL

guanfacine tablet T1

GUARDIAN SENSOR 3 MISC T3, PA

GVOKE HYPOPEN 2-PACK INJECTION

T2

GVOKE PFS INJECTION T2

GYNAZOLE-1 CREAM T3

HHAEGARDA SOLUTION T4, PA, SP

hailey 1.5/30 tablet T1

hailey 24 fe tablet T1

hailey fe 1/20 tablet T1

HALAVEN SOLUTION T4, PA, SP

HARVONI PACKET T4, PA, SP

HARVONI TABLET T4, PA, SP

HAVRIX SUSPENSION T2

heather tablet T1

HEMANGEOL SOLUTION T4, PA, SP

HEMLIBRA SOLUTION T4, PA, SP

HEMOFIL M SOLUTION T4, PA, SP

HEPAGAM B SOLUTION T4, PA, SP

HEPLISAV-B INJECTION T3

HEPSERA TABLET T4, PA, SP, BP

HETLIOZ CAPSULE T4, PA, SP

HPR PLUS CREAM T2

HUMALOG JUNIOR KWIKPEN INJECTION

T2, QL

HUMATE-P SOLUTION T4, PA, SP

HUMIRA INJECTION T4, PA, SP

HUMIRA PEDIATRIC INJECTION

T4, PA, SP

HUMIRA PEN INJECTION T4, PA, SP

HUMIRA PEN-PS/UV STARTER INJECTION

T4, PA, SP

HUMULIN R SOLUTION T2, QL

HUMULIN R U-500 KWIKPEN INJECTION

T2, QL

HYCAMTIN CAPSULE T4, PA, SP

HYCAMTIN SOLUTION T4, PA, SP, BP

hydralazine tablet T1

hydrochlorothiazide capsule T1

hydrochlorothiazide tablet T1

hydrocodone w/acetaminophen solution

T1

hydrocodone w/acetaminophen tablet

T1

hydrocodone/homatropine syrup

T1


www.maxorplus.com

hydrocodone/ibuprofen tablet

T1

hydrocodone-chlorpheniramine suspension

T1, QL

hydrocortisone cream T1

hydrocortisone lotion T1

hydrocortisone ointment T1

hydrocortisone tablet T1

hydromet syrup T1

hydromorphone tablet T1

hydroxychloroquine sulfate tablet

T1

HYDROXYPROGESTERONE CAPROATE OIL

T4, PA, SP

HYDROXYPROGESTERONE CAPROATE SOLUTION

T4, PA, SP

hydroxyurea capsule T1

hydroxyzine pamoate capsule

T1

hydroxyzine syrup T1

hydroxyzine tablet T1

HYLENEX SOLUTION T4, PA, SP

HYPERRHO S/D INJECTION T4, PA, SP

HYPERRHO S/D MINI-DOSE INJECTION

T4, PA, SP

HYQVIA KIT T4, PA, SP

IIBANDRONATE SODIUM SOLUTION

T4, PA, SP

ibandronate sodium tablet T1, QL

IBRANCE CAPSULE T4, PA, SP

IBRANCE TABLET T4, PA, SP

ibu tablet T1

ibuprofen suspension T1

ibuprofen tablet T1

ICATIBANT SOLUTION T4, PA, SP

ICLUSIG TABLET T4, PA, SP

IDAMYCIN PFS SOLUTION T4, PA, SP, BP

IDARUBICIN SOLUTION T4, PA, SP

IDELVION SOLUTION T4, PA, SP

IDHIFA TABLET T4, PA, SP

IFEX SOLUTION T4, PA, SP, BP

IFOSFAMIDE SOLUTION T4, PA, SP

ILARIS SOLUTION T4, PA, SP

ILUVIEN INJECTION T4, PA, SP

IMATINIB MESYLATE TABLET T4, PA, SP

IMBRUVICA CAPSULE T4, PA, SP

IMBRUVICA TABLET T4, PA, SP

IMFINZI SOLUTION T4, PA, SP

imiquimod cream T1

IMLYGIC SUSPENSION T4, PA, SP

IMVEXXY MAINTENANCE PACK

T3

IMVEXXY STARTER PACK T3

INBRIJA CAPSULE T4, PA, SP

incassia tablet T1

INCRELEX SOLUTION T4, PA, SP

indapamide tablet T1

indomethacin capsule T1

indomethacin er capsule T1

INFLECTRA SOLUTION T4, PA, SP

INFUGEM SOLUTION T4, PA, SP

INJECTAFER SOLUTION T4, PA, SP

INLYTA TABLET T4, PA, SP

INTEGRA F CAPSULE T3

INTEGRA PLUS CAPSULE T3

INTRON A SOLUTION T4, PA, SP

introvale tablet T1

INVEGA SUSTENNA INJECTION

T4, PA, SP

INVEGA TRINZA INJECTION T4, PA, SP

IODOSORB GEL T3

ipratropium bromide solution

T1, QL

ipratropium-albuterol solution

T1

irbesartan tablet T1

irbesartan-hydrochlorothiazide tablet

T1

IRESSA TABLET T4, PA, SP

IRINOTECAN SOLUTION T4, PA, SP

ISENTRESS TABLET T2

isibloom tablet T1

isoniazid tablet T1

ISOPTO ATROPINE SOLUTION T3

isosorbide mononitrate 24 hr tab

T1

isotretinoin capsule T1, PA

ISTODAX (OVERFILL) SOLUTION

T4, PA, SP

itraconazole capsule T1

ivermectin tablet T1

IXEMPRA KIT SOLUTION T4, PA, SP

IXINITY SOLUTION T4, PA, SP

JJAKAFI TABLET T4, PA, SP

JANUMET TABLET T2, QL

JANUMET XR 24 HR TAB T2, QL

JANUVIA TABLET T2, QL

JARDIANCE TABLET T2, QL

JELMYTO SOLUTION T4, PA, SP

jencycla tablet T1

JEVTANA SOLUTION T4, PA, SP

JIVI SOLUTION T4, PA, SP

jolessa tablet T1

juleber tablet T1

JULUCA TABLET T2

junel 1.5/30 tablet T1

junel 1/20 tablet T1

junel fe 1.5/30 tablet T1

junel fe 1/20 tablet T1

junel fe 24 tablet T1

JUXTAPID CAPSULE T4, PA, SP

JYNARQUE TABLET T4, PA, SP

KKADCYLA SOLUTION T4, PA, SP

KALBITOR SOLUTION T4, PA, SP

KALYDECO PACKET T4, PA, SP

KALYDECO TABLET T4, PA, SP

KANJINTI SOLUTION T4, PA, SP

KANUMA SOLUTION T4, PA, SP

KARBINAL ER SUSPENSION T3

kariva tablet T1

KCENTRA KIT T4, PA, SP

KEDBUMIN SOLUTION T4, PA, SP

kelnor 1/35 tablet T1

KENGREAL SOLUTION T4, PA, SP

KEPIVANCE SOLUTION T4, PA, SP

KESIMPTA INJECTION T4, PA, SP

ketoconazole cream T1

ketoconazole shampoo T1

ketoconazole tablet T1

KETONE STRIP T2, QL

ketorolac tromethamine solution

T1, SP

ketorolac tromethamine tablet

T1, QL

KETOSTIX STRIP T2, QL

KEVEYIS TABLET T4, PA, SP


T3INSULIN- SYRINGE MISC

www.maxorplus.com

KEYTRUDA SOLUTION T4, PA, SP

KHAPZORY SOLUTION T4, PA, SP

KISQALI FEMARA 200 DOSE TABLET

T4, PA, SP


T4, PA, SP


T4, PA, SP

KISQALI TABLET T4, PA, SP

KITABIS PAK NEBULIZED T4, PA, SP

klor-con 10 tablet T1

klor-con m10 tablet T1

klor-con m20 tablet T1

KOATE SOLUTION T4, PA, SP

KOATE-DVI SOLUTION T4, PA, SP

KOGENATE FS KIT T4, PA, SP

KOSELUGO CAPSULE T4, PA, SP

KOVALTRY SOLUTION T4, PA, SP

kristalose packet T1

KRYSTEXXA SOLUTION T4, PA, SP

kurvelo tablet T1

KUVAN PACKET T4, PA, SP, BP

KUVAN TABLET T4, PA, SP, BP

KYLEENA T2, QL

KYMRIAH SUSPENSION T4, PA, SP

KYNMOBI FILM T4, PA, SP

KYPROLIS SOLUTION T4, PA, SP

Llabetalol tablet T1

lactulose solution T1

lamivudine tablet T1, PA, SP

lamotrigine tablet T1

LANCET MISC T2

lansoprazole capsule (delayed release)

T1

LANTUS SOLOSTAR INJECTION

T2, QL

LANTUS SOLUTION T2, QL

LAPATINIB DITOSYLATE TABLET

T4, PA, SP

larin 1.5/30 tablet T1

larin 1/20 tablet T1

larin 24 fe tablet T1

larin fe 1.5/30 tablet T1

larin fe 1/20 tablet T1

larissia tablet T1

LARTRUVO SOLUTION T4, PA, SP

latanoprost solution T1

LATUDA TABLET T2, QL

leflunomide tablet T1

LEMTRADA SOLUTION T4, PA, SP

LENVIMA 10 MG DAILY DOSE CAPSULE

T4, PA, SP

LENVIMA 12MG DAILY DOSE CAPSULE

T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP

lessina tablet T1

letrozole tablet T1

LEUCOVORIN CALCIUM SOLUTION

T4, PA, SP

LEUKINE SOLUTION T4, PA, SP

LEUPROLIDE KIT T4, PA, SP

levalbuterol nebulized T1

LEVEMIR FLEXTOUCH INJECTION

T2, QL

LEVEMIR SOLUTION T2, QL

levetiracetam er 24 hr tab T1

levetiracetam solution T1, BP

levetiracetam tablet T1

levocetirizine dihydrochloride tablet

T1

levofloxacin tablet T1

LEVOLEUCOVORIN CALCIUM SOLUTION

T4, PA, SP

LEVOLEUCOVORIN SOLUTION

T4, PA, SP

levonorgestrel tablet T1

levonorgestrel-eth estradiol tablet

T1

levonorg-eth estrad eth estrad tablet

T1

levora 0.15/30-28 tablet T1

levothyroxine sodium tablet T1

LEVULAN KERASTICK SOLUTION

T4, PA, SP

LIBTAYO SOLUTION T4, PA, SP

lidocaine jelly gel T1

lidocaine ointment T1, QL

lidocaine patch T1

lidocaine viscous solution T1

lidocaine/prilocaine cream T1

LILETTA T4, PA, SP, QL

lillow tablet T1

linezolid tablet T1

LINZESS CAPSULE T2, QL

liothyronine sodium tablet T1

lisinopril tablet T1

lisinopril-hctz tablet T1

lithium carbonate capsule T1, BP

lithium carbonate er tablet T1

lithium carbonate tablet T1

l-methylfolate calcium tablet T1

l-methylfolate tablet T1

LO LOESTRIN FE TABLET T2

LOKELMA PACKET T2

LOMAIRA TABLET T3, PA

LONSURF TABLET T4, PA, SP

loperamide capsule T1

lorazepam tablet T1

LORBRENA TABLET T4, PA, SP

loryna tablet T1

losartan potassium tablet T1

losartan-hydrochlorothiazide tablet

T1

LOTEMAX GEL T2

LOTEMAX OINTMENT T2

LOTEMAX SM GEL T2

LOTEMAX SUSPENSION T3, BP

loteprednol etabonate suspension

T1

lovastatin tablet T1, QL

LOVAZA CAPSULE T3, QL, BP

low-ogestrel tablet T1

lo-zumandimine tablet T1

LUCENTIS INJECTION T4, PA, SP

LUCENTIS SOLUTION T4, PA, SP

LUMIZYME SOLUTION T4, PA, SP

LUMOXITI SOLUTION T4, PA, SP

LUPANETA PACK KIT T4, PA, SP

LUPRON DEPOT (1-MONTH) KIT

T4, PA, SP, QL


T4, PA, SP, QL


T4, PA, SP, QL


www.maxorplus.com


T4, PA, SP

LUPRON DEPOT-PED KIT T4, PA, SP, QL

LUTATHERA SOLUTION T4, PA, SP

lutera tablet T1

LUXTURNA SUSPENSION T4, PA, SP

LYNPARZA TABLET T4, PA, SP

LYSODREN TABLET T4, PA, SP

MMACRILEN PACKET T4, PA, SP

MAKENA INJECTION T4, PA, SP

MAKENA OIL T4, PA, SP, BP

marlissa tablet T1

MARQIBO SUSPENSION T4, PA, SP

MATULANE CAPSULE T4, PA, SP

MAVENCLAD TABLET T4, PA, SP

MAYZENT TABLET T4, PA, SP

meclizine tablet T1

MEDROL DOSEPAK TABLET T3, BP

medroxyprogesterone injection

T1

medroxyprogesterone suspension

T1

medroxyprogesterone tablet T1

mefloquine tablet T1, QL

megestrol tablet T1

MEKINIST TABLET T4, PA, SP

MEKTOVI TABLET T4, PA, SP

meloxicam tablet T1

MELPHALAN SOLUTION T4, PA, SP

MELPHALAN TABLET T4, PA, SP

memantine tablet T1

MENACTRA INJECTION T2

MENOPUR SOLUTION T2, PA

MENVEO SOLUTION T3

MEPSEVII SOLUTION T4, PA, SP

mercaptopurine tablet T1

mesalamine dr capsule (delayed release)

T1

mesalamine dr tablet T1

mesalamine enema T1

mesalamine er 24 hour cap T1

mesalamine suppository T1

MESNA SOLUTION T4, PA, SP

MESNEX SOLUTION T4, PA, SP, BP

MESNEX TABLET T4, PA, SP

METANX CAPSULE T3

metaxalone tablet T1

metformin er 24 hr tab T1

metformin tablet T1

methenamine hippurate tablet

T1

methimazole tablet T1

methocarbamol tablet T1

methotrexate sodium solution

T1

methotrexate sodium tablet T1

methotrexate solution T1

methotrexate tablet T1

methylphenidate cd capsule T1, QL

methylphenidate er 24 hour cap

T1, QL

methylphenidate er 24 hr tab

T1, QL

methylphenidate er tablet T1, QL

methylphenidate la 24 hour cap

T1, QL

methylphenidate tablet T1

methylprednisolone tablet T1

metoclopramide tablet T1

metolazone tablet T1

metoprolol er 24 hr tab T1

metoprolol tartrate tablet T1

METROGEL GEL T3, BP

metronidazole cream T1

metronidazole gel T1

metronidazole lotion T1

metronidazole tablet T1

metronidazole vaginal gel T1

METYROSINE CAPSULE T4, PA, SP

MICONAZOLE 3 SUPPOSITORY

T2

MICRHOGAM ULTRA-FILTERED INJECTION

T4, PA, SP

MICROCHAMBER MISC T2

microgestin 1.5/30 tablet T1

microgestin 1/20 tablet T1

microgestin fe 1.5/30 tablet T1

microgestin fe tablet T1

MICROLET NEXT MISC T2

MICROSPACER MISC T2

midodrine tablet T1

MIGLUSTAT CAPSULE T4, PA, SP

mili tablet T1

mimvey tablet T1

minocycline capsule T1

minocycline tablet T1

MIRENA T4, PA, SP, QL

mirtazapine tablet T1

MIRVASO GEL T2

misoprostol tablet T1

MITIGARE CAPSULE T3

MITOMYCIN SOLUTION T4, PA, SP

MITOXANTRONE T4, PA, SP

M-M-R II SOLUTION T2

modafinil tablet T1, QL

mometasone furoate cream T1

mometasone furoate ointment

T1

mometasone furoate solution

T1

mometasone furoate suspension

T1, QL

MONJUVI SOLUTION T4, PA, SP

MONOJECT INSULIN SYRINGE MISC

T3

mono-linyah tablet T1

MONONINE SOLUTION T4, PA, SP

MONOVISC INJECTION T4, PA, SP

montelukast sodium chew tab

T1

montelukast sodium packet T1

montelukast sodium tablet T1

MONUROL PACKET T3

morphine sulfate er tablet T1, QL

morphine sulfate tablet T1, BP

MOTEGRITY TABLET T3, PA

moxifloxacin solution T1

moxifloxacin tablet T1

MOZOBIL SOLUTION T4, PA, SP

MUGARD LIQUID T4, PA, SP

MULTAQ TABLET T3

multivitamin with fluoride solution

T1

MULTIVITAMIN/FLUORIDE CHEW TAB

T2

mupirocin cream T1

mupirocin ointment T1

MUTAMYCIN SOLUTION T4, PA, SP

MVASI SOLUTION T4, PA, SP

my way tablet T1

MYALEPT SOLUTION T4, PA, SP

MYCAPSSA CAPSULE (DELAYED RELEASE)

T4, PA, SP


www.maxorplus.com

mycophenolate mofetil capsule

T1

mycophenolate mofetil tablet

T1

MYFORTIC TABLET T3, BP

MYLERAN TABLET T4, PA, SP

MYLOTARG SOLUTION T4, PA, SP

MYOBLOC SOLUTION T4, PA, SP

myorisan capsule T1, PA

MYRBETRIQ 24 HR TAB T2

Nnabumetone tablet T1

nadolol tablet T1

NAGLAZYME SOLUTION T4, PA, SP

naltrexone tablet T1

naproxen dr tablet T1

naproxen sodium tablet T1

naproxen tablet T1

naratriptan tablet T1, QL

NARCAN LIQUID T2

NATAZIA TABLET T3

NATPARA INJECTION T4, PA, SP

NATURE-THROID TABLET T2

NAVELBINE SOLUTION T4, PA, SP

NAYZILAM SOLUTION T2, QL

NEBUPENT SOLUTION T4, PA, SP, BP

neo/polymyxin/dexamethasone ointment

T1

neo/polymyxin/dexamethasone suspension

T1

neomycin sulfate tablet T1

neomycin/polymyxin/hc solution

T1

neomycin/polymyxin/hc suspension

T1

NERLYNX TABLET T4, PA, SP

NEUPRO PATCH T2

NEXAVAR TABLET T4, PA, SP

NEXPLANON INJECTION T4, PA, SP, QL

nicotine patch T1

nicotine polacrilex gum T1

NICOTROL INHALER T3

NICOTROL NS SOLUTION T3

nifedipine er 24 hr tab T1

nikki tablet T1

NILANDRON TABLET T4, PA, SP, BP

NILUTAMIDE TABLET T4, PA, SP

NINLARO CAPSULE T4, PA, SP

NIPENT SOLUTION T4, PA, SP

NITRO-BID OINTMENT T2

nitrofurantoin capsule T1

nitrofurantoin macrocrystal capsule

T1

nitroglycerin sl T1

NITYR TABLET T4, PA, SP

NIVA-PLUS TABLET T3

NIVESTYM INJECTION T4, PA, SP

NIVESTYM SOLUTION T4, PA, SP

nora-be tablet T1

NORDITROPIN FLEXPRO INJECTION

T4, PA, SP

norethindrone tablet T1

norethindrone-ethin estradiol tablet

T1

norethin-eth estra ferrous fum chew tab

T1

norethin-eth estra ferrous fum tablet

T1

norgestimate-ethinyl estradiol tablet

T1

norlyda tablet T1

NORTHERA CAPSULE T4, PA, SP

nortrel 0.5/35 (28) tablet T1

nortrel 1/35 tablet T1

nortrel 7/7/7 tablet T1

nortriptyline capsule T1

NOURIANZ TABLET T4, PA, SP

novarel solution T1

NOVOEIGHT SOLUTION T4, PA, SP

NOVOFINE 32GX6MM MISC T2

NOVOFINE AUTOCOVER MISC

T2

NOVOFINE PLUS 32GX4MM MISC

T2

NOVOLIN 70/30 FLEXPEN SUSPENSION

T2, QL

NOVOLIN 70/30 RELION SUSPENSION

T2, QL

NOVOLIN 70/30 SUSPENSION T2, QL

NOVOLIN N FLEXPEN SUSPENSION

T2, QL

NOVOLIN N RELION SUSPENSION

T2, QL

NOVOLIN N SUSPENSION T2, QL

NOVOLIN R RELION SOLUTION

T2, QL

NOVOLIN R SOLUTION T2, QL

NOVOLOG FLEXPEN INJECTION

T2, QL

NOVOLOG MIX 70/30 SUSPENSION

T2, QL

NOVOLOG MIX 70-30 SUSPENSION

T2, QL

NOVOLOG PENFILL INJECTION

T2, QL

NOVOLOG SOLUTION T2, QL

NOVOSEVEN RT SOLUTION T4, PA, SP

NOVOTWIST 32GX5MM MISC

T2

NPLATE SOLUTION T4, PA, SP

NUBEQA TABLET T4, PA, SP

NUCALA INJECTION T4, PA, SP

NUCALA SOLUTION T4, PA, SP

NUEDEXTA CAPSULE T2

NULYTELY/FLAVOR PACKS SOLUTION

T3, BP

NUPLAZID CAPSULE T4, PA, SP

NUPLAZID TABLET T4, PA, SP

NURTEC TABLET T2, PA, QL

NUVARING T3, QL, BP

NUZYRA SOLUTION T4, PA, SP

NUZYRA TABLET T4, PA, SP

nyamyc powder T1

nystatin cream T1

nystatin ointment T1

nystatin powder T1

nystatin suspension T1

nystatin tablet T1

nystatin/triamcinolone cream

T1

nystatin/triamcinolone ointment

T1

nystop powder T1

OOB COMPLETE ONE CAPSULE T3

OB COMPLETE PETITE CAPSULE

T3

OBIZUR SOLUTION T4, PA, SP

OCALIVA TABLET T4, PA, SP

ocella tablet T1

OCREVUS SOLUTION T4, PA, SP

OCTAGAM SOLUTION T4, PA, SP

OCTAPLAS BLOOD GROUP A SOLUTION

T4, PA, SP

OCTAPLAS BLOOD GROUP AB SOLUTION

T4, PA, SP


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OCTAPLAS BLOOD GROUP B SOLUTION

T4, PA, SP

OCTAPLAS BLOOD GROUP O SOLUTION

T4, PA, SP

OCTREOTIDE SOLUTION T4, PA, SP

ODEFSEY TABLET T2, QL

ODOMZO CAPSULE T4, PA, SP

OFEV CAPSULE T4, PA, SP

ofloxacin solution T1

olanzapine tablet T1

olmesartan medoxomil tablet

T1

olmesartan-amlodipine-hctz tablet

T1

olmesartan-hydrochlorothiazide tablet

T1

olopatadine solution T1, QL

omega-3 acid ethyl esters capsule

T1, QL

omeprazole capsule (delayed release)

T1

omeprazole dr capsule (delayed release)

T1

OMNIPOD 5 PACK MISC T2

OMNIPOD DASH 5 PACK MISC

T2

ONCASPAR SOLUTION T4, PA, SP

ondansetron odt tablet T1, QL

ondansetron solution T1

ondansetron tablet T1, QL

ONE TOUCH DELICA MISC T2

ONE TOUCH VERIO IQ KIT T2, QL

ONE TOUCH VERIO STRIP T2, QL

ONETOUCH DELICA PLUS LANC DEV MISC

T2

ONETOUCH ULTRA 2 KIT T2, QL

ONETOUCH ULTRA MINI KIT T2, QL

ONETOUCH ULTRA STRIP T2, QL

ONETOUCH VERIO FLEX KIT T2, QL

ONETOUCH VERIO KIT T2, QL

ONETOUCH VERIO REFLECT KIT

T2, QL

ONEXTON GEL T2

ONIVYDE INJECTION T4, PA, SP

ONUREG TABLET T4, PA, SP

OPDIVO SOLUTION T4, PA, SP

OPSUMIT TABLET T4, PA, SP

OPTICHAMBER DIAMOND T2

OPTICHAMBER DIAMOND MISC

T2

ORACEA CAPSULE (DELAYED RELEASE)

T3

ORALAIR SL T4, PA, SP

ORENITRAM TABLET T4, PA, SP

ORFADIN SUSPENSION T4, PA, SP

ORILISSA TABLET T2, PA

ORKAMBI PACKET T4, PA, SP

ORKAMBI TABLET T4, PA, SP

orphenadrine er 12 hr tab T1

ORTHOVISC INJECTION T4, PA, SP

oseltamivir phosphate capsule

T1, QL

oseltamivir phosphate suspension

T1

OSPHENA TABLET T3

OTEZLA TABLET T4, PA, SP

OVIDREL INJECTION T2

OXALIPLATIN SOLUTION T4, PA, SP

oxaprozin tablet T1

oxcarbazepine suspension T1

oxcarbazepine tablet T1

OXERVATE SOLUTION T4, PA, SP

OXTELLAR XR 24 HR TAB T2

oxybutynin chloride er 24 hr tab

T1

oxybutynin chloride tablet T1

oxycodone capsule T1

oxycodone solution T1

oxycodone tablet T1

oxycodone/acetaminophen tablet

T1

OXYCONTIN 12 HR TAB T2, QL

OZEMPIC INJECTION T2, QL

OZURDEX INJECTION T4, PA, SP

PPACLITAXEL T4, PA, SP

PADCEV SOLUTION T4, PA, SP

PALONOSETRON INJECTION T4, PA, SP

PALONOSETRON SOLUTION T4, PA, SP

PALYNZIQ INJECTION T4, PA, SP

PAMIDRONATE DISODIUM SOLUTION

T4, PA, SP

pantoprazole sodium tablet T1

PANZYGA SOLUTION T4, PA, SP

PARADIGM MISC T2

PARAGARD T 380A T3, QL

PARAPLATIN SOLUTION T4, PA, SP

paroex solution T1

paroxetine er 24 hr tab T1, QL

paroxetine tablet T1

PARSABIV SOLUTION T4, PA, SP

PCCA LIPODERM BASE CREAM

T2

peg 3350-electrolyte solution

T1

peg-3350/electrolytes solution

T1

peg3350-sod sul-nacl-kcl-asb-c solution

T1

PEGASYS PROCLICK SOLUTION

T4, PA, SP

PEGASYS SOLUTION T4, PA, SP

PEGINTRON KIT T4, PA, SP

PEMAZYRE TABLET T4, PA, SP

penicillin v potassium solution

T1

penicillin v potassium tablet T1

PENTAM 300 SOLUTION T4, PA, SP, BP

PENTAMIDINE ISETHIONATE SOLUTION

T4, PA, SP

PENTASA CAPSULE T2

PENTIPS 32GX4MM MISC T3

pentoxifylline er tablet T1

PERFOROMIST NEBULIZED T2

PERJETA SOLUTION T4, PA, SP

permethrin cream T1

PERSERIS INJECTION T4, PA, SP

PHENOXYBENZAMINE CAPSULE

T4, PA, SP

phentermine capsule T1

phentermine tablet T1

PHOTOFRIN SOLUTION T4, PA, SP

PICATO GEL T2

pilocarpine tablet T1

pimecrolimus cream T1

pimtrea tablet T1

pioglitazone tablet T1

pirmella 1/35 tablet T1

pirmella 7/7/7 tablet T1

piroxicam capsule T1

PLASBUMIN-25 SOLUTION T4, PA, SP

PLASBUMIN-5 SOLUTION T4, PA, SP

PLASMANATE SOLUTION T4, PA, SP

PLEGRIDY INJECTION T4, PA, SP


T1phenytoin sodium capsule

www.maxorplus.com

PLEGRIDY STARTER PACK INJECTION

T4, PA, SP

PLENVU SOLUTION T3

PNEUMOVAX 23 INJECTION T2

PNEUMOVAX 23/1 DOSE INJECTION

T2

PNV TABS 29-1 TABLET T2

PODIAPN CAPSULE T3

POLIVY SOLUTION T4, PA, SP

polyethylene glycol 3350 packet

T1

polyethylene glycol 3350 powder

T1

polymyxin b sul-trimethoprim solution

T1

POMALYST CAPSULE T4, PA, SP

portia-28 tablet T1

PORTRAZZA SOLUTION T4, PA, SP

potassium chloride cr tablet T1

potassium chloride er capsule

T1

potassium chloride er tablet T1

potassium er tablet T1

PRALUENT INJECTION T4, PA, SP

pramipexole di-hcl tablet T1

prasugrel tablet T1

pravastatin sodium tablet T1, QL

prazosin capsule T1

PRECISION XTRA STRIP T2, QL

PRED FORTE SUSPENSION T3

prednisolone sodium phosphate solution

T1

prednisolone solution T1

prednisolone suspension T1

PREDNISONE SOLUTION T2

prednisone tablet T1

pregabalin capsule T1, QL

PREMARIN CREAM T2

PREMARIN TABLET T2

PREMPRO TABLET T2

PRENA1 PEARL CAPSULE T2

PRENATABS RX TABLET T2

PRENATAL 19 CHEW TAB T2

PREPLUS TABLET T2

prevalite packet T1

previfem tablet T1

PREVNAR 13 SUSPENSION T2

PREVYMIS SOLUTION T4, PA, SP

PREVYMIS TABLET T4, PA, SP

PREZISTA TABLET T2

PRIALT SOLUTION T4, PA, SP

PRIFTIN TABLET T2

primidone tablet T1

PRIVIGEN SOLUTION T4, PA, SP

PROBUPHINE IMPLANT KIT INJECTION

T4, PA, SP

prochlorperazine maleate tablet

T1

PROCRIT SOLUTION T4, PA, SP

procto-med hc cream T1

proctosol hc cream T1

proctozone-hc cream T1

PROFILNINE SOLUTION T4, PA, SP

progesterone capsule T1

progesterone oil T1

PROGRAF CAPSULE T3, BP

PROLASTIN-C SOLUTION T4, PA, SP

PROLEUKIN SOLUTION T4, PA, SP

PROMACTA PACKET T4, PA, SP

PROMACTA TABLET T4, PA, SP

promethazine plain syrup T1

promethazine suppository T1

promethazine syrup T1

promethazine tablet T1

promethazine w/dm syrup T1

promethazine/codeine solution

T1

promethazine/codeine syrup T1

promethegan suppository T1

PROMISEB CREAM T3

PROPOFOL EMULSION T4, PA, SP

propranolol er 24 hour cap T1

propranolol solution T1

propranolol tablet T1

PROVENGE SUSPENSION T4, PA, SP

PULMICORT FLEXHALER AEROSOL

T2, QL

PULMOZYME SOLUTION T4, PA, SP

PURIFIED WATER LIQUID T2

PURIXAN SUSPENSION T4, PA, SP

pyridostigmine bromide tablet

T1

PYRIMETHAMINE TABLET T4, PA, SP

QQBREXZA PADS T3

QUADRAMET SOLUTION T4, PA, SP

quetiapine fumarate tablet T1

QUILLIVANT XR INJECTION T2, QL

quinapril tablet T1

QVAR REDIHALER INHALER T2, QL

Rrabeprazole sodium tablet T1

RADICAVA SOLUTION T4, PA, SP

raloxifene tablet T1

ramelteon tablet T1, QL

ramipril capsule T1

ranolazine er 12 hr tab T1

RAVICTI LIQUID T4, PA, SP

REBIF INJECTION T4, PA, SP

REBIF REBIDOSE INJECTION T4, PA, SP

REBIF REBIDOSE TITRATION INJECTION

T4, PA, SP

REBIF TITRATION PACK INJECTION

T4, PA, SP

REBINYN SOLUTION T4, PA, SP

REBLOZYL SOLUTION T4, PA, SP

RECLAST SOLUTION T4, PA, SP, BP

reclipsen tablet T1

RECTIV OINTMENT T2

RELISTOR SOLUTION T4, PA, SP

RELISTOR TABLET T4, PA, SP

RELIZORB T4, PA, SP

RELPAX TABLET T3, QL, BP

REMICADE SOLUTION T4, PA, SP

REMODULIN SOLUTION T4, PA, SP, BP

RENFLEXIS SOLUTION T4, PA, SP

REPATHA INJECTION T4, PA, SP

REPATHA PUSHTRONEX INJECTION

T4, PA, SP

REPATHA SURECLICK INJECTION

T4, PA, SP

RESTASIS EMULSION T2, QL

RESTASIS MULTIDOSE EMULSION

T2, QL

RETACRIT SOLUTION T4, PA, SP

RETEVMO CAPSULE T4, PA, SP

RETISERT INJECTION T4, PA, SP

REVCOVI SOLUTION T4, PA, SP

REVLIMID CAPSULE T4, PA, SP

REXULTI TABLET T3, QL

REYVOW TABLET T2, PA, QL

RHOFADE CREAM T3

RHOGAM PLUS INJECTION T4, PA, SP


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RHOPHYLAC INJECTION T4, PA, SP

RHOPRESSA SOLUTION T2

RIASTAP SOLUTION T4, PA, SP

RIBAVIRIN CAPSULE T4, PA, SP

RIBAVIRIN SOLUTION T4, PA, SP

RIBAVIRIN TABLET T4, PA, SP

rifampin capsule T1

RINVOQ 24 HR TAB T4, PA, SP

risedronate sodium tablet T1, QL

RISPERDAL CONSTA INJECTION

T4, PA, SP

risperidone tablet T1

RIXUBIS SOLUTION T4, PA, SP

rizatriptan benzoate odt tablet

T1, QL

rizatriptan benzoate tablet T1, QL

ROCKLATAN SOLUTION T3

ROMIDEPSIN SOLUTION T4, PA, SP

ropinirole tablet T1

rosuvastatin calcium tablet T1, QL

ROZLYTREK CAPSULE T4, PA, SP

RUBRACA TABLET T4, PA, SP

RUCONEST SOLUTION T4, PA, SP

RUXIENCE SOLUTION T4, PA, SP

RUZURGI TABLET T4, PA, SP

RYBELSUS TABLET T2, QL

RYDAPT CAPSULE T4, PA, SP

SSABRIL PACKET T4, PA, SP, BP

SABRIL TABLET T4, PA, SP, BP

SALT STABLE LS ADVANCED CREAM

T2

SAMSCA TABLET T4, PA, SP, BP

SANCUSO PATCH T3, QL

SANDOSTATIN SOLUTION T4, PA, SP, BP

SANTYL OINTMENT T2, PA

SAPHRIS SL T2, QL

SAPROPTERIN DIHYDROCHLORIDE PACKET

T4, PA, SP

SAPROPTERIN DIHYDROCHLORIDE TABLET

T4, PA, SP

SARCLISA SOLUTION T4, PA, SP

SAVELLA TABLET T2

SAVELLA TITRATION PACK MISC

T2

SAXENDA INJECTION T2, PA

SCENESSE INJECTION T4, PA, SP

scopolamine patch T1

selenium sulfide lotion T1

SEREVENT DISKUS AEROSOL T2, QL

SEROSTIM SOLUTION T4, PA, SP

sertraline tablet T1

setlakin tablet T1

SEVENFACT SOLUTION T4, PA, SP

sharobel tablet T1

SHINGRIX SUSPENSION T2

SIGNIFOR SOLUTION T4, PA, SP

sildenafil tablet T1, QL, PA

SILENOR TABLET T3, BP

SILVADENE CREAM T3, BP

silver sulfadiazine cream T1

SIMBRINZA SUSPENSION T3

simvastatin tablet T1, QL

SIRTURO TABLET T4, PA, SP

SKYLA T4, PA, SP, QL

SKYRIZI INJECTION T4, PA, SP

SLYND TABLET T3

SOD FERRIC GLUCONATE COMPLEX SOLUTION

T4, PA, SP

sodium chloride nebulized T1

SODIUM EDECRIN SOLUTION T4, PA, SP, BP

sodium fluoride solution T1

SODIUM PHENYLBUTYRATE POWDER

T4, PA, SP

SODIUM PHENYLBUTYRATE TABLET

T4, PA, SP

sodium sulfacetamide lotion T1

sodium sulfacetamide solution

T1

SOLESTA GEL T4, PA, SP

solifenacin tablet T1

SOLIQUA 100/33 INJECTION T2, QL

SOLIRIS SOLUTION T4, PA, SP

SOLOSEC PACKET T2

SOLU-CORTEF SOLUTION T2

SOMATULINE DEPOT SOLUTION

T4, PA, SP

SOMAVERT SOLUTION T4, PA, SP

sotalol hydrocholride tablet T1

sotalol tablet T1

SOVALDI PACKET T4, PA, SP

SOVALDI TABLET T4, PA, SP

SPINOSAD SUSPENSION T2

SPINRAZA SOLUTION T4, PA, SP

SPIRIVA HANDIHALER CAPSULE

T2, QL

SPIRIVA RESPIMAT AEROSOL T2, QL

spironolactone tablet T1

spironolactone w/hctz tablet T1

sprintec 28 tablet T1

SPRYCEL TABLET T4, PA, SP

sronyx tablet T1

ssd cream T1

STELARA INJECTION T4, PA, SP

STELARA SOLUTION T4, PA, SP

STIMATE SOLUTION T4, PA, SP

STIOLTO RESPIMAT AEROSOL T2, QL

STIVARGA TABLET T4, PA, SP

STRENSIQ SOLUTION T4, PA, SP

SUBLOCADE INJECTION T4, PA, SP

SUBOXONE FILM T3, QL, BP

SUCRAID SOLUTION T4, PA, SP

sucralfate suspension T1

sucralfate tablet T1

sulfacetamide sodium lotion T1

sulfacetamide sodium solution

T1

sulfacetamide w/prednisolone solution

T1

sulfamethoxazole/trimethoprim suspension

T1

sulfamethoxazole/trimethoprim tablet

T1

sulfasalazine tablet T1

sulfatrim pediatric suspension

T1

sulindac tablet T1

sumatriptan injection T1, QL

sumatriptan solution T1, QL

sumatriptan tablet T1, QL

SUNOSI TABLET T2, PA, QL

SUPPRELIN LA KIT T4, PA, SP

SUPREP BOWEL PREP KIT SOLUTION

T2

SUTENT CAPSULE T4, PA, SP

syeda tablet T1

SYLVANT SOLUTION T4, PA, SP

SYMBICORT AEROSOL T2, QL

SYMDEKO TABLET T4, PA, SP

SYMPROIC TABLET T2, QL

SYMTUZA TABLET T2, QL

SYNAGIS SOLUTION T4, PA, SP

SYNAREL SOLUTION T4, PA, SP


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SYNJARDY TABLET T2, QL

SYNJARDY XR 24 HR TAB T2, QL

SYNRIBO SOLUTION T4, PA, SP

SYNTHROID TABLET T3, BP

SYPRINE CAPSULE T4, PA, SP, BP

TT:SLIM T:LOCK INSULIN CA MISC

T2

TABRECTA TABLET T4, PA, SP

tacrolimus capsule T1

tacrolimus ointment T1

tadalafil tablet T1, QL, PA

TAFINLAR CAPSULE T4, PA, SP

TAGRISSO TABLET T4, PA, SP

TAKHZYRO SOLUTION T4, PA, SP

TALZENNA CAPSULE T4, PA, SP

TAMIFLU CAPSULE T3, QL, BP

TAMIFLU SUSPENSION T3, BP

tamoxifen tablet T1

tamsulosin capsule T1

TARCEVA TABLET T4, PA, SP, BP

TARGRETIN GEL T4, PA, SP

tarina fe 1/20 eq tablet T1

TASIGNA CAPSULE T4, PA, SP

TAXOTERE T4, PA, SP, BP

tazarotene cream T1

TAZVERIK TABLET T4, PA, SP

TECARTUS SUSPENSION T4, PA, SP

TECENTRIQ SOLUTION T4, PA, SP

TEGRETOL TABLET T3, BP

TEGRETOL-XR 12 HR TAB T3, BP

TEGSEDI INJECTION T4, PA, SP

telmisartan tablet T1

telmisartan-hydrochlorothiazid tablet

T1

temazepam capsule T1

TEMODAR CAPSULE T4, PA, SP, BP

TEMODAR SOLUTION T4, PA, SP

TEMOZOLOMIDE CAPSULE T4, PA, SP

TEMSIROLIMUS SOLUTION T4, PA, SP

TENIPOSIDE SOLUTION T4, PA, SP

tenofovir disoproxil fumarate tablet

T1

TEPADINA SOLUTION T4, PA, SP, BP

TEPEZZA SOLUTION T4, PA, SP

terazosin capsule T1

terbinafine tablet T1

terconazole cream T1

terconazole suppository T1

TERIPARATIDE INJECTION T4, PA, SP

testosterone cypionate solution

T1

testosterone gel T1, QL

testosterone pump gel T1, QL

TETRABENAZINE TABLET T4, PA, SP

THALOMID CAPSULE T4, PA, SP

THIOLA EC TABLET T4, PA, SP

THIOLA TABLET T4, PA, SP

THIOTEPA SOLUTION T4, PA, SP

THROMBATE III SOLUTION T4, PA, SP

THYROGEN SOLUTION T4, PA, SP

TIBSOVO TABLET T4, PA, SP

TICE BCG SUSPENSION T4, PA, SP

timolol maleate solution T1

tinidazole tablet T1

TIVICAY TABLET T2

tizanidine capsule T1

tizanidine tablet T1

TOBI PODHALER CAPSULE T4, PA, SP

TOBRADEX OINTMENT T2

TOBRADEX ST SUSPENSION T2

TOBRAMYCIN NEBULIZED T4, PA, SP

tobramycin solution T1

tobramycin sulfate solution T1

tobramycin/dexamethasone suspension

T1

TOBREX OINTMENT T3

tolterodine tartrate er 24 hour cap

T1

tolterodine tartrate tablet T1

TOLVAPTAN TABLET T4, PA, SP

topiramate capsule T1

topiramate tablet T1

TOPOSAR SOLUTION T4, PA, SP

TOPOTECAN SOLUTION T4, PA, SP, BP

TORISEL SOLUTION T4, PA, SP, BP

torsemide tablet T1

TOTECT SOLUTION T4, PA, SP

TOUJEO MAX SOLOSTAR INJECTION

T2, QL

TOUJEO SOLOSTAR INJECTION

T2, QL

TOVIAZ 24 HR TAB T2

TRACLEER TABLET T4, PA, SP, BP

tramadol er 24 hr tab T1

tramadol tablet T1

tramadol-acetaminophen tablet

T1

tranexamic acid tablet T1

travoprost solution T1

TRAZIMERA SOLUTION T4, PA, SP

trazodone tablet T1

TREANDA SOLUTION T4, PA, SP

TRELEGY ELLIPTA AEROSOL T2, QL

TREMFYA INJECTION T4, PA, SP

TREPROSTINIL SOLUTION T4, PA, SP

TRESIBA FLEXTOUCH INJECTION

T2, QL

TRETINOIN CAPSULE T4, PA, SP

tretinoin cream T1

tretinoin gel T1

tretinoin microsphere gel T1

TRETTEN SOLUTION T4, PA, SP

tri femynor tablet T1

triamcinolone acetonide cream

T1

triamcinolone acetonide lotion

T1

triamcinolone acetonide ointment

T1

triamcinolone acetonide paste

T1

triamterene w/hctz capsule T1

triamterene w/hctz tablet T1

triazolam tablet T1

TRIENTINE CAPSULE T4, PA, SP

tri-estarylla tablet T1

TRIKAFTA TABLET T4, PA, SP

tri-legest fe tablet T1

tri-linyah tablet T1

tri-lo-estarylla tablet T1

tri-lo-marzia tablet T1

tri-lo-mili tablet T1

tri-lo-sprintec tablet T1

trimethoprim tablet T1

tri-mili tablet T1

TRINATAL RX 1 TABLET T2

TRINTELLIX TABLET T2, QL

tri-previfem tablet T1

TRIPTODUR INJECTION T4, PA, SP

TRISENOX SOLUTION T4, PA, SP, BP


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tri-sprintec tablet T1

TRIUMEQ TABLET T2, QL

TRODELVY SOLUTION T4, PA, SP

TROGARZO SOLUTION T4, PA, SP

trospium chloride er 24 hour cap

T1

trospium chloride tablet T1

TRUEPLUS INSULIN SYRINGE MISC

T3

TRULANCE TABLET

TRULICITY INJECTION T2, QL

TRUMENBA INJECTION T2

TRUVADA TABLET T2, QL, BP

TUKYSA TABLET T4, PA, SP

TURALIO CAPSULE T4, PA, SP

TWINRIX INJECTION T2

TYKERB TABLET T4, PA, SP

TYMLOS INJECTION T4, PA, SP

TYPHIM VI SOLUTION T2

TYSABRI T4, PA, SP

TYVASO REFILL SOLUTION T4, PA, SP

TYVASO SOLUTION T4, PA, SP

TYVASO STARTER SOLUTION T4, PA, SP

UUBRELVY TABLET T2, PA, QL

UCERIS FOAM T2

ULTICARE INSULIN SYRINGE MISC

T3

ULTICARE MISC T3

ULTOMIRIS SOLUTION T4, PA, SP

UNIFINE PENTIPS 31GX6MM MISC

T3


T3


T3

UNIFINE PENTIPS MISC T3

UNIFINE PENTIPS PLUS MISC T3

UNITUXIN SOLUTION T4, PA, SP

UPTRAVI TABLET T4, PA, SP

ursodiol capsule T1

Vvalacyclovir tablet T1

VALCHLOR GEL T4, PA, SP

valganciclovir tablet T1

VALRUBICIN SOLUTION T4, PA, SP

valsartan tablet T1

valsartan-hydrochlorothiazide tablet

T1

VALSTAR SOLUTION T4, PA, SP, BP

VALVED HOLDING CHAMBER T2

vancomycin capsule T1

vancomycin solution T1

vandazole gel T1

VANTAS KIT T4, PA, SP

VAQTA SUSPENSION T3

VARITHENA FOAM T4, PA, SP

VARIVAX INJECTION T2

VARUBI TABLET T4, PA, SP

VASCEPA CAPSULE T2, QL

VASOSTRICT SOLUTION T4, PA, SP

VECTIBIX SOLUTION T4, PA, SP

VELCADE SOLUTION T4, PA, SP

VELETRI SOLUTION T4, PA, SP

velivet tablet T1

VELPHORO CHEW TAB T2, PA

VEMLIDY TABLET T4, PA, SP

VENCLEXTA STARTING PACK TABLET

T4, PA, SP

VENCLEXTA TABLET T4, PA, SP

venlafaxine er 24 hour cap T1

venlafaxine tablet T1

VENOFER SOLUTION T4, PA, SP

VENTAVIS SOLUTION T4, PA, SP

verapamil er 24 hour cap T1

verapamil er tablet T1

verapamil sr 24 hour cap T1

verapamil tablet T1

VERZENIO TABLET T4, PA, SP

VIBATIV SOLUTION T4, PA, SP

VIBERZI TABLET T2, PA

VIBRAMYCIN SYRUP T3

VICTOZA INJECTION T2, QL

VIDAZA SUSPENSION T4, PA, SP, BP

vienva tablet T1

VIGABATRIN PACKET T4, PA, SP

VIGABATRIN TABLET T4, PA, SP

VIGADRONE PACKET T4, PA, SP

VIIBRYD STARTER PACK KIT T2, QL

VIIBRYD TABLET T2, QL

VIMIZIM SOLUTION T4, PA, SP

VIMPAT SOLUTION T2

VIMPAT TABLET T2

VINBLASTINE SULFATE SOLUTION

T4, PA, SP

VINCRISTINE SULFATE SOLUTION

T4, PA, SP

VINORELBINE TARTRATE SOLUTION

T4, PA, SP

viorele tablet T1

VIOS AEROSOL DELIVERY SYSTEM MISC

T2

VIRAZOLE SOLUTION T4, PA, SP, BP

VISTOGARD PACKET T4, PA, SP

VISUDYNE SOLUTION T4, PA, SP

VITAFOL GUMMIES CHEW TAB

T3

vitamin d capsule T1

VITAPEARL CAPSULE T3

VITRAKVI CAPSULE T4, PA, SP

VITRAKVI SOLUTION T4, PA, SP

VITRASE SOLUTION T4, PA, SP

VIVITROL SUSPENSION T4, PA, SP, QL

VIVOTIF CAPSULE (DELAYED RELEASE)

T2

VIZIMPRO TABLET T4, PA, SP

VOL-PLUS TABLET T2

VOLTAREN GEL T3, BP

VONVENDI SOLUTION T4, PA, SP

VORAXAZE SOLUTION T4, PA, SP

VOSEVI TABLET T4, PA, SP

VOTRIENT TABLET T4, PA, SP

VPRIV SOLUTION T4, PA, SP

VRAYLAR CAPSULE T3, QL

VUMERITY CAPSULE (DELAYED RELEASE)

T4, PA, SP

VYLEESI INJECTION T4, PA, SP

VYNDAMAX CAPSULE T4, PA, SP

VYNDAQEL CAPSULE T4, PA, SP

VYVANSE CAPSULE T2, QL

VYVANSE CHEW TAB T2, QL

VYXEOS SUSPENSION T4, PA, SP

VYZULTA SOLUTION T3

WWAKIX TABLET T4, PA, SP

warfarin sodium tablet T1

WELCHOL TABLET T3, BP

WILATE KIT T4, PA, SP

WINRHO SDF SOLUTION T4, PA, SP


T3, QL

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XXALKORI CAPSULE T4, PA, SP

XARELTO STARTER PACK TABLET

T2

XARELTO TABLET T2

XELJANZ TABLET T4, PA, SP

XELJANZ XR 24 HR TAB T4, PA, SP

XELODA TABLET T4, PA, SP, BP

XEMBIFY SOLUTION T4, PA, SP

XEOMIN SOLUTION T4, PA, SP

XERMELO TABLET T4, PA, SP

XGEVA SOLUTION T4, PA, SP

XHANCE T3, PA, QL

XIAFLEX SOLUTION T4, PA, SP

XIFAXAN TABLET T2, PA

XIGDUO XR 24 HR TAB T2, QL

XOFIGO SOLUTION T4, PA, SP

XOFLUZA TABLET T3, QL

XOLAIR INJECTION T4, PA, SP

XOLAIR SOLUTION T4, PA, SP

XOSPATA TABLET T4, PA, SP

XTANDI CAPSULE T4, PA, SP

xulane patch T1, QL

XULTOPHY 100/3.6 INJECTION

T2, QL

XURIDEN PACKET T4, PA, SP

XYREM SOLUTION T4, PA, SP

XYWAV SOLUTION T4, SP

YYAZ TABLET T3, BP

YERVOY SOLUTION T4, PA, SP

YESCARTA SUSPENSION T4, PA, SP

YONDELIS SOLUTION T4, PA, SP

YONSA TABLET T4, PA, SP

YUTIQ INJECTION T4, PA, SP

yuvafem tablet T1

Zzaleplon capsule T1, QL

ZALTRAP SOLUTION T4, PA, SP

ZANOSAR SOLUTION T4, PA, SP

ZARXIO INJECTION T4, PA, SP

ZEJULA CAPSULE T4, PA, SP

ZELBORAF TABLET T4, PA, SP

ZEMAIRA SOLUTION T4, PA, SP

zenatane capsule T1, PA

ZENPEP CAPSULE T2, PA

ZEPOSIA CAPSULE T4, PA, SP

ZEPOSIA STARTER KIT CAPSULE

T4, PA, SP

ZEPZELCA SOLUTION T4, PA, SP

ZEVALIN Y-90 KIT T4, PA, SP

ZIEXTENZO INJECTION T4, PA, SP

ZINPLAVA SOLUTION T4, PA, SP

ziprasidone capsule T1

ZIRABEV SOLUTION T4, PA, SP

ZIRGAN GEL T3

ZOLADEX INJECTION T4, PA, SP, QL

ZOLEDRONIC ACID T4, PA, SP

ZOLEDRONIC ACID SOLUTION T4, PA, SP

ZOLGENSMA 10.1-10.5 KG KIT

T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP


T4, PA, SP

ZOLGENSMA 2.6-3.0 KG KIT T4, PA, SP















ZOLINZA CAPSULE T4, PA, SP

zolmitriptan odt tablet T1, QL

zolmitriptan tablet T1, QL

zolpidem tartrate er tablet T1, QL

zolpidem tartrate tablet T1, QL

ZOMIG SOLUTION T2, QL

zonisamide capsule T1

ZORBTIVE SOLUTION T4, PA, SP

ZULRESSO SOLUTION T4, PA, SP

zumandimine tablet T1

ZYDELIG TABLET T4, PA, SP

ZYKADIA TABLET T4, PA, SP

ZYPREXA RELPREVV SUSPENSION

T4, PA, SP


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Medications Excluded from Coverage with Covered Alternatives

Alternative Covered OptionsExcluded Drug

ACCU-CHEK AVIVA PLUS Onetouch Ultra Meters/strips, Onetouch Verio Meters/strips

ACCU-CHEK GUIDE Onetouch Ultra Meters/strips, Onetouch Verio Meters/strips

ACCU-CHEK GUIDE ME Onetouch Ultra Meters/strips, Onetouch Verio Meters/strips

ACCU-CHEK SMARTVIEW Onetouch Ultra Meters/strips, Onetouch Verio Meters/strips

ADHANSIA XR Methylphenidate Er (generic For Concerta)

ADMELOG Novolog

ADMELOG SOLOSTAR Novolog

ADZENYS XR-ODT Amphetamine-dextroamphetamine Tablet (generic For Adderall Or Adderall Xr)

ALBUTEROL SULFATE HFA Albuterol Sulfate Hfa (generic For Proair By Cipla, Par, Perrigo, Proficient Rx, Or Teva)

ALOGLIPTIN Januvia

ALVESCO Arnuity Ellipta, Flovent Diskus/hfa, Pulmicort Flexhaler, Qvar Redihaler

AMBIEN Zolpidem (generic For Ambien)

AMBIEN CR Zolpidem Er (generic For Ambien Cr)

AMPYRA Dalfampridine Er (generic For Ampyra)

AMZEEQ Clindamycin (generic For Cleocin T)

ANDRODERM Testosterone 1%, 1.62% Transdermal Gel (generic For Androgel)

ANDROGEL PUMP Testosterone (generic For Androgel)

APIDRA Novolog

APIDRA SOLOSTAR Novolog

APTIOM Carbamazepine (generic For Tegretol)

ARANESP ALBUMIN FREE Procrit

ARESTIN Chlorhexidine Gluconate (generic For Peridex), Minocycline (generic For Minocin)

ASMANEX Flovent Hfa

ASMANEX HFA Flovent Hfa

ATRIPLA Biktarvy, Genvoya, Odefsey, Efavirenz-lamivudine-tenofovir Df (generic For Symfi/symfi Lo), Triumeq

AUVI-Q Epinephrine (generic For Adrenaclick), Epipen, Epipen Jr.

BALCOLTRA Junel Fe (generic For Microgestin 24 Fe)

BARACLUDE Entecavir (generic For Baraclude)

BASAGLAR KWIKPEN Lantus, Lantus Solostar, Levemir, Levemir Flextouch

BEYAZ Drosperinone-ethinyl Estradiol (generic For Yaz Or Yasmin), Gianvi, Nikki, Ocella, Zarah

BIJUVA

BONJESTA Doxylamine (generic For Unisom), Pyridoxine Hcl (generic For Hexa-betalin), Ondansetron (generic For Zofran)

BRYHALI Betamethasone Dipropionate Cream (generic For Diprolene)

BUDESONIDE-FORMOTEROL FUMARATE

Symbicort


Estradiol-norethindrone Acetate, Jinteli, Mimvey, Premphase, Prempro

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BUPROPION HCL XL Bupropion Hcl Xl (generic For Wellbutrin Xl)

BYDUREON BCISE Victoza, Ozempic, Trulicity

BYDUREON PEN Victoza, Ozempic, Trulicity

BYETTA Victoza, Ozempic, Trulicity

CALQUENCE

CAMBIA Sumatriptan Succinate (generic For Imitrex), Diclofenac Tablet (generic For Voltaren)

CELEBREX Celecoxib (generic For Celebrex)

CEPHALEXIN Cephalexin 250 Mg And 500 Mg Capsule (generic For Keflex)

CIALIS Tadalafil (generic For Cialis), Sildenafil (generic For Viagra)

CILOXAN Ciprofloxacin Hcl (generic For Ciloxan)

CIMZIA Humira, Enbrel, Skyrizi, Otezla, Xeljanz/xr

CIMZIA STARTER KIT Humira, Enbrel, Skyrizi, Otezla, Xeljanz/xr

CIPROFLOXACIN HCL-FLUOCINOLONE Ciprofloxacin/dexamethasone (generic For Ciprodex), Ciprofloxacin 0.2% Otic Solution (generic For Cetraxal)

CLIMARA PRO Combipatch

CLINDAMYCIN PHOSPHATE Clindamycin Phosphate 1% Solution (generic For Cleocin-t), Dapsone Gel (generic For Aczone)

CLOCORTOLONE PIVALATE Triamcinolone 0.025%, 0.1% Cream, Ointment, Lotion (generic For Kenalog)

CLODERM

COLCHICINE Colchicine Tablet (generic For Colcrys)

CONCERTA Methylphenidate Er (generic For Concerta)

CONTOUR One Touch Ultra Test Strips, One Touch Verio

CONTOUR NEXT One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync

CONTOUR NEXT EZ One Touch Ultra Test Strips, One Touch Verio

CONTOUR NEXT EZ One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync

CONTOUR NEXT ONE One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync

CORDRAN Mometasone (generic For Elocon), Triamcinolone (generic For Kenalog)

COTEMPLA XR-ODT Methylphenidate Er (generic For Concerta), Daytrana

CRESTOR Rosuvastatin Calcium (generic For Crestor)

CYTOMEL Liothyronine Sodium (generic For Cytomel)

DENAVIR Acyclovir (generic For Zovirax)

DESVENLAFAXINE ER Venlafaxine Er Capsule (generic For Effexor Xr)

DEXILANT Lansoprazole Capsule (generic For Prevacid)

DICLEGIS


Betamethasone Valerate Foam (generic For Luxiq)

(generic For Zofran)Doxylamine (generic For Unisom), Pyridoxine Hcl (generic For Hexa-betalin), Ondansetron

Imbruvica, Venclexta

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DICLOFENAC EPOLAMINE

DIVIGEL Estradiol Products (generic For Estrace, Climara, Or Depo-estradiol)

DORYX MPC Doxycycline 50 Mg Capsule, 75 Mg, 100 Mg, 150 Mg Capsule (generic For Vibramycin)

DOXYCYCLINE HYCLATE Doxycycline 50 Mg Capsule, 75 Mg, 100 Mg, 150 Mg Capsule (generic For Vibramycin)

DUEXIS Ibuprofen (generic For Motrin), Famotidine (generic For Pepcid Rx)

DULERA Advair Diskus, Advair Hfa, Breo Ellipta, Symbicort

DUROLANE Euflexxa, Orthovisc

DYANAVEL XR Amphetamine-dextroamphetamine Tablet (generic For Adderall Or Adderall Xr)

EDARBYCLOR Losartan (generic For Cozaar), Valsartan (generic For Diovan), Chlorthalidone Tablet (generic For Thalitone)

ELESTRIN Estradiol Products (generic For Estrace, Climara Or Depo-estradiol)

ELIDEL Pimecrolimus (generic For Elidel)

EMFLAZA Prednisone (generic For Deltasone)

ENSTILAR Calcipotriene Cream/ointment/solution (generic For Dovonex), Betamethasone Dip 0.05% Cream (generic For Diprosone)

ENVARSUS XR Tacrolimus (generic For Prograf)

EPANED Enalapril (generic For Vasotec)

EPINEPHRINE Epinephrine (generic For Epipen) By Mylan, Epipen

EPOGEN Procrit

ESTROGEL Estradiol Products (generic For Estrace, Climara, Or Depo-estradiol)

EVAMIST Estradiol (generic For Estrace)

EVENITY Forteo

EXJADE Deferasirox (generic For Exjade)

FABIOR Tazarotene (generic For Tazorac)

FIRAZYR Icatibant Acetate (generic For Firazyr)

FIRDAPSE Ruzurgi

FIRVANQ Vancomycin Hcl (generic For Vancocin Hcl)

FLUOXETINE HYDROCHLORIDE Fluoxetine Capsule (generic For Prozac)

FOCALIN XR Dexmethylphenidate (generic For Focalin, Focalin Xr)

FREESTYLE PRECISION NEO One Touch Ultra Test Strips, One Touch Verio

GEL-ONE Euflexxa, Orthovisc

GELSYN-3 Euflexxa, Orthovisc

GENOTROPIN Norditropin

GENOTROPIN MINIQUICK Norditropin

GLEEVEC Imatinib Mesylate (generic For Gleevec)

GOCOVRI Amantadine Hcl (generic For Symmetrel)

GRALISE Gabapentin (generic For Neurontin)

GRANIX Nivestym, Zarxio


Flector Patch, Diclofenac Sodium (generic For Voltaren)

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HORIZANT Gabapentin (generic For Neurontin), Pregabalin (generic For Lyrica)

HUMALOG Novolog, Fiasp

HUMALOG KWIKPEN Novolog, Fiasp

HUMALOG MIX 75/25 Novolog, Fiasp

HUMALOG MIX 75-25 Novolog, Fiasp

HUMATROPE Norditropin

HUMULIN 70/30 Novolin

HUMULIN 70/30 KWIKPEN Novolin

HUMULIN N Novolin

HUMULIN N KWIKPEN Novolin

HUMULIN R Novolin

HYMOVIS Euflexxa, Orthovisc

ILEVRO Diclofenac Eye Drop (generic For Voltaren Ophtha), Ketorolac Eye Drop (generic For Acular)

IMPOYZ Augmented Betamethasone Dip 0.05% Ointment, Lotion, Cream (generic For Diprolene)

INCRUSE ELLIPTA Spiriva Respimat, Spiriva Handihaler

INGREZZA Tetrabenazine (generic For Xenazine), Austedo

INREBIC Jakafi

INSULIN ASPART Novolog

INSULIN ASPART FLEXPEN Novolog Flexpen

INSULIN LISPRO Novolog

INSULIN LISPRO KWIKPEN Novolog

INTRAROSA

INVELTYS Loteprednol (generic For Lotemax)

INVOKAMET

INVOKAMET XR

INVOKANA Farxiga, Jardiance

JADENU Deferasirox (generic For Exjade)

JENTADUETO Janumet

JENTADUETO XR Janumet Xr

JORNAY PM Methylphenidate Er (generic For Concerta)

JUBLIA Ciclopirox 8% Solution (generic For Penlac)

KEVZARA Actemra

KINERET Actemra, Enbrel, Humira, Remicade, Xeljanz, Xeljanz Xr

KOMBIGLYZE XR Janumet, Janumet Xr

KORLYM Ketoconazole (generic For Nizoral), Signifor

LAMICTAL Lamotrigine (generic For Lamictal)


Xigduo Xr, Synjardy, Synjardy Xr

Xigduo Xr, Synjardy, Synjardy Xr

estradiol products (generic For Climara, Estrace, or Depo-estradiol), Estring, Premarin

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LASTACAFT

LEDIPASVIR/SOFOSBUVIR

LETAIRIS

LEVALBUTEROL TARTRATE HFA Albuterol Sulfate Hfa (generic For Proair By Cipla, Par, Perrigo, Proficient Rx, Or Teva)

LEVITRA Tadalafil (generic For Cialis), Sildenafil (generic For Viagra)

LEXAPRO Escitalopram Oxalate (generic For Lexapro)

LEXETTE Betamethasone Dipropionaten Cream (generic For Diprolene)

LIALDA Mesalamine (generic For Lialda)

LIVALO Atorvastatin (generic For Lipitor), Rosuvastatin (generic For Crestor), Simvastatin (generic For Zocor)

LUMIGAN Travoprost (generic For Travatan-z)

LYRICA Pregabalin (generic For Lyrica)

MAVYRET Epclusa, Harvoni, Vosevi, Solvaldi

MOVIPREP Peg-electrolyte Solution (generic For Golytely), Clenpiq, Suprep

MOXEZA Ciprofloxacin (generic For Ciloxan),moxifloxacin (generic For Vigamox), Ofloxacin (generic For Ocuflox)

MULPLETA Doptelet

MYDAYIS Amphetamine-dextroamphetamine Tablet (generic For Adderall, Adderall Xr)

NAFTIN Ciclopirox (generic For Ciclodan), Ketoconazole (generic For Nizoral)

NASCOBAL Cyanocobalamin 1000 Mcg/ml Injection (generic For Vitamin B-12)

NATROBA Spinosad (generic For Natroba)

NEUPOGEN Zarxio

NEXIUM

NUTROPIN AQ NUSPIN 20 Norditropin


NUVESSA Metronidazole (generic For Metrogel), Clindamycin Phosphate (generic For Cleocin)

NUWIQ Advate, Afstyla, Kogenate Fs, Kovaltry, Novoeight

OLUMIANT Actemra, Enbrel, Humira, Xeljanz

OMNITROPE Norditropin

ONGLYZA Januvia

ORENCIA Actemra, Enbrel, Humira, Remicade, Xeljanz, Xeljanz Xr

ORENCIA CLICKJECT Actemra, Enbrel, Humira, Remicade, Xeljanz, Xeljanz Xr

OSMOPREP Polyethylene Glycol (generic For Golytely), Clenpiq, Prepopik

OTOVEL Ciprofloxacin 0.2% Otic Solution (generic For Cetraxal)


Ambrisentan (generic For Letairis)

Harvoni

For Alrex)Azelastine (generic For Optivar) Olopatadine (generic For Patanol), Loteprednol (generic

Esomeprazole (generic For Nexium Rx)


www.maxorplus.com


OXBRYTA Hydroxyurea (generic For Hydrea), Droxia

OXYCODONE HCL ER Morphine Sulfate Er (generic For Ms Contin), Oxymorphone Hcl Er (generic For Opana Er), Oxycontin

PENNSAID Diclofenac Sodium Topical (generic For Voltaren), Flector Patch

PIQRAY 200MG DAILY DOSE Ibrance



PRADAXA Eliquis, Xarelto

PRED MILD Fluorometholone (generic For Fml Liquifilm), Prednisolone Acetate (generic For Pred-forte)

PREZCOBIX Ritonavir (generic For Norvir), Kaletra Tablets, Prezista

PRODIGY NO CODING One Touch Ultra Test Strips, One Touch Verio

PROLENSA Bromfenac (generic For Bromday), Diclofenac (generic For Voltaren Ophtha), Ketorolac Tromethamine (generic For Acular)

PROLIA Ibandronate (generic For Boniva), Risedronate (generic For Actonel)

PROVENTIL HFA Albuterol Sulfate Hfa (generic For Proair By Cipla, Par, Perrigo, Proficient Rx, Or Teva)

PYLERA Omeprazole (generic For Prilosec), Amoxicillin(generic For Amoxil), Clarithromycin (generic For Biaxin), Talicia

QNASL Fluticasone (generic For Flonase), Triamcinolone(generic For Nasacort), Mometasone (generic For Nasonex)

QNASL CHILDRENS Fluticasone (generic For Flonase), Triamcinolone(generic For Nasacort), Mometasone (generic For Nasonex)

QSYMIA Benzphetamine Hcl (generic For Regimex), Phentermine Hcl (generic For Adipex-p)

QUDEXY XR Topiramate Capsule, Tablet (generic For Topamax)

QUILLICHEW ER Methylphenidate Er (generic For Concerta)

RANEXA Ranolazine (generic For Ranexa)

RASUVO Generic Methotrexate Injections

RECOMBINATE Advate, Adynovate, Afstyla, Helixate Fs, Kogenate Fs, Kovaltry, Novoeight

RELION PRIME One Touch Ultra Test Strips, One Touch Verio

RETIN-A MICRO Tretinoin Microsphere (generic For Retin-a Micro Pump)

RETIN-A MICRO PUMP Tretinoin Microsphere (generic For Retin-a Micro Pump)

RITUXAN Ruxience (biosimilar For Rituxan)

RYTARY Carbidopa-levodopa Er Tablet (generic For Sinemet Cr)

SANDOSTATIN LAR DEPOT Somatuline Depot

SENSIPAR Cinacalcet Hcl (generic For Sensipar)

SEYSARA Doxycycline 50 Mg Capsule, 75 Mg, 100 Mg, 150 Mg Capsule (generic For Vibramycin)

SILIQ Humira, Enbrel, Skyrizi, Otezla, Xeljanz/xr

SIMPONI Humira, Enbrel, Skyrizi, Otezla, Xeljanz/xr

SINUVA Mometasone Furoate (generic For Nasonex)


www.maxorplus.com


SOFOSBUVIR/VELPATASVIR Epclusa

SOOLANTRA Ivermectin (generic For Soolantra)

SORILUX Calcipotriene (generic For Dovonex)

SPRAVATO 56MG DOSE Olanzapine-fluoxetine (generic For Symbyax), Bupropion (generic For Wellbutrin)

SPRAVATO 84MG DOSE Olanzapine-fluoxetine (generic For Symbyax), Bupropion (generic For Wellbutrin)

SPRIX Diclofenac Sodium (generic For Voltaren)

STEGLATRO Farxiga

STEGLUJAN Glyxambi

STENDRA Tadalafil (generic For Cialis), Sildenafil (generic For Viagra)

STRIBILD Genvoya

SUPARTZ FX Euflexxa, Orthovisc

SYNVISC Euflexxa, Orthovisc

SYNVISC ONE Euflexxa, Orthovisc

TACLONEX

TARGADOX Doxycycline 50 Mg Capsule, 75 Mg, 100 Mg, 150 Mg Capsule (generic For Vibramycin)

TAVALISSE Doptelet, Promacta

TAYTULLA

TECFIDERA Dimethyl Fumarate (generic For Tecfidera)

TECFIDERA STARTER PACK Dimethyl Fumarate (generic For Tecfidera)

TESTOPEL Testosterone (generic For Androgel)

TIROSINT Levothyroxine Sodium (generic For Synthroid)

TOBI Tobramycin Sulfate (generic For Tobi)

TOPIRAMATE ER Topiramate (generic For Topamax)

TOPROL XL Metoprolol Succinate (generic For Toprol Xl)

TRADJENTA Januvia

TRANSDERM-SCOP Scopolamine (generic For Transderm-scop)

TRAVATAN Z Travoprost (generic For Travatan Z)

TROKENDI XR Topiramate Capsule, Tablet (generic For Topamax)

TRUE METRIX BLOOD GLUCOSE MTR One Touch Ultramini, One Touch Verio, Onetouch Verio Flex, One Touch Verio Iq, One Touch Verio Sync

TRUE METRIX GLUCOSE TEST STRIP One Touch Ultra Test Strips, One Touch Verio

TRUETRACK One Touch Ultra Test Strips, One Touch Verio

TUDORZA PRESSAIR Spiriva Respimat, Spiriva Handihaler

VELTASSA Lokelma

VIAGRA Sildenafil Citrate (generic For Viagra)

VIVELLE-DOT Estradiol (generic For Vivelle-dot)


Junel Fe, Blisovi Fe, Larin 24 Fe

0.05% Cream (generic For Diprosone)Calcipotriene Cream/ointment/solution (generic For Dovonex), Betamethasone Dip

www.maxorplus.com


WELLBUTRIN XL Bupropion Hcl Xl (generic For Wellbutrin Xl)

XANAX Alprazolam (generic For Xanax)

XIMINO Minocycline (generic For Minocin)

XOPENEX HFA Albuterol Sulfate Hfa (generic For Proair By Cipla, Par, Perrigo, Proficient Rx, Or Teva)

XPOVIO Revlimid

XPOVIO 60 MG ONCE WEEKLY Revlimid

XTAMPZA ER Oxycodone (generic For Roxicodone), Oxycontin

XYNTHA Advate, Adynovate, Afstyla, Helixate Fs, Kogenate Fs, Kovaltry, Novoeight

XYOSTED Testosterone Cypionate (generic For Depo-testosterone)

ZIOPTAN Bimatoprost (generic For Lumigan), Latanoprost (generic For Xalatan), Travoprost (generic For Travatan Z)

ZOLOFT Sertraline Hcl (generic For Zoloft)

ZOMACTON Norditropin

ZORVOLEX Diclofenac Sodium (generic For Voltaren)

ZTLIDO

ZUBSOLV Buprenorphine-naloxone (generic For Suboxone)

ZYLET Loteprednol (generic For Lotemax), Tobramycin Susp (generic For Tobrex)


Lidocaine Patch (generic For Lidoderm)

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Focus 4 Tier w/LVL January 2021 Formulary

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Transcript of Focus 4 Tier w/LVL January 2021 Formulary