LIST OF COVERED DRUGS (FORMULARY) 2021 · 2020. 9. 28. · he drugs on the List of Covered Drugs...

Updated on 02/01/2021. For more recent information or other questions, please contact Cigna CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week, 8 a.m. to 8 p.m. Central Time, or visit careplantx.cigna.com. HPMS Approved Formulary File Submission ID 21125, Version Number 8H8423_21_86173b Approved © 2020 Cigna

Cigna CarePlan (Medicare-Medicaid Plan)

2021

LIST OF COVERED DRUGS (FORMULARY)

Member Services1-877-653-0327 (TTY: 7-1-1)7 days a week8 a.m. to 8 p.m. Central Time

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If you have questions, please call Cigna CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week, 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. 1 ?

Cigna CarePlan (Medicare-Medicaid Plan) | 2021 List of Covered Drugs (Formulary)

Introduction

This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter drugs and items are covered by Cigna CarePlan. The Drug List also tells you if there are any special rules or restrictions on any drugs covered by Cigna CarePlan. Key terms and their definitions appear in the last chapter of the Member Handbook.

Updated on 02/01/2021. For more recent information or other questions, contact us at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time or visit careplantx.cigna.com.

Table of Contents

A. Disclaimers ............................................................................................................................................ 3

B. Frequently Asked Questions (FAQ)...................................................................................................... 3

B1. What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the “Drug List” for short.) ................................................... 3

B2. Does the Drug List ever change?.................................................................................................. 4

B3. What happens when there is a change to the Drug List? ............................................................ 5

B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs? ................................................................................................................... 6

B5. How will you know if the drug you want has limits or if there are required actions to take to get the drug? ........................................................................................................................... 6

B6. What happens if we change our rules about some drugs (for example, prior authorization (approval), quantity limits, and/or step therapy restrictions)? ................................................... 6

B7. How can you find a drug on the Drug List? .................................................................................. 6

B8. What if the drug you want to take is not on the Drug List? .......................................................... 7

B9. What if you are a new Cigna CarePlan member and can’t find your drug on the Drug List or have a problem getting your drug? ........................................................................................ 7

B10. Can you ask for an exception to cover your drug?..................................................................... 8

B11. How can you ask for an exception? ............................................................................................ 8

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Table of Contents

A. Disclaimers ...................................................................................................................................... 3

B. Frequently Asked Questions (FAQ) ................................................................................................. 3

B1. What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the “Drug List” for short.) ........................................................................................................ 3

B2. Does the Drug List ever change? ............................................................................................. 4

B3. What happens when there is a change to the Drug List? ......................................................... 5

B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs? ........................................................................................................................ 6

B5. How will you know if the drug you want has limits or if there are required actions to take to get the drug? ................................................................................................................................ 6

B6. What happens if we change our rules about some drugs (for example, prior authorization (approval), quantity limits, and/or step therapy restrictions)? ................................................. 6

B7. How can you find a drug on the Drug List? ............................................................................... 6

B8. What if the drug you want to take is not on the Drug List?........................................................ 7


B10. Can you ask for an exception to cover your drug?.................................................................. 8

B11. How can you ask for an exception? ........................................................................................ 8



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B12. How long does it take to get an exception? ................................................................................ 8

B13. What are generic drugs? ............................................................................................................. 8

B14. What are OTC drugs? ................................................................................................................. 9

B15. Does Cigna CarePlan cover non-drug OTC products? ............................................................. 9

B16. What is your copay? .................................................................................................................... 9

B17. What are drug tiers? .................................................................................................................... 9

C. Overview of the List of Covered Drugs .............................................................................................. 10

C1. Drugs Grouped by Medical Condition ......................................................................................... 12

D. Index of Covered Drugs ................................................................................................................... 113



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A. Disclaimers

This is a list of drugs that Members can get in Cigna CarePlan.

v All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

v Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

v For information on Cigna CarePlan and other options for your health care, call MAXIMUS at 1-800-964-2777, Monday to Friday, 8 a.m. to 6 p.m. Central Time. TTY users should call 1-800-735-2989.

v For information on the coverage of mosquito repellent products for the prevention of Zika virus, and applicable restrictions, please visit careplantx.cigna.com.

v Express Scripts Pharmacy is a trademark of Express Scripts Strategic Development, Inc.

v ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-653-0327 (TTY: 7-1-1), los 7 días de la semana, de 8 a.m. a 8 p.m., hora del Centro. La llamada es gratuita.

v You can get this document for free in other formats, such as large print, braille, or audio. Call 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free.

v We will update your personal record and maintain your preferred language or format as a standing request. In the future, when you call Member Services, we will verify this information. You may ask us to update it at any time.

B. Frequently Asked Questions (FAQ)

Find answers here to questions you have about this List of Covered Drugs. You can read all of the FAQ to learn more, or look for a question and answer.

B1. What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the “Drug List” for short.)

The drugs on the List of Covered Drugs that starts on page 12 are the drugs covered by Cigna CarePlan. These drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies.”

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• Cigna CarePlan will cover all medically necessary drugs on the Drug List if:

o your doctor or other prescriber says you need them to get better or stay healthy, and

o you fill the prescription at a Cigna CarePlan network pharmacy.

• Cigna CarePlan may have additional steps to access certain drugs (see question B4 below).

You can also see an up-to-date list of drugs that we cover on our website at careplantx.cigna.com or call Member Services at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time.

B2. Does the Drug List ever change? Yes, and Cigna CarePlan must follow Medicare and Texas Medicaid rules when making changes. We may add or remove drugs on the Drug List during the year.

We may also change our rules about drugs. For example, we could:

• Decide to require or not require prior approval for a drug. (Prior approval is permission from Cigna CarePlan before you can get a drug.)

• Add or change the amount of a drug you can get (called quantity limits).

• Add or change step therapy restrictions on a drug. (Step therapy means you must try one drug before we will cover another drug.)

For more information on these drug rules, see question B4.

If you are taking a drug Medicare Part D drug that was covered at the beginning of the year, we will generally not remove or change coverage of that drug during the rest of the year unless:

• a new, cheaper drug comes on the market that works as well as a drug on the Drug list now, or

• we learn that a drug is not safe, or

• a drug is removed from the market.

Questions B3 and B6 below have more information on what happens when the Drug List changes.

• You can always check Cigna CarePlan’s up-to-date Drug List online at careplantx.cigna.com.

• You can also call Member Services to check the current Drug List at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time.



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B3. What happens when there is a change to the Drug List? Some changes to the Drug List will happen immediately. For example:

• A new generic drug becomes available. Sometimes, a new generic drug comes on the market that works as well as a brand name drug on the Drug List now. When that happens, we may remove the brand name drug and add the new generic drug, but your cost for the new drug will stay the same. When we add the new generic drug, we may also decide to keep the brand name drug on the list but change its coverage rules or limits.

o We may not tell you before we make this change, but we will send you information about the specific change we made once it happens.

o You or your provider can ask for an exception from these changes. We will send you a notice with the steps you can take to ask for an exception. Please see question B10 for more information on exceptions.

• A drug is taken off the market. If the Food and Drug Administration (FDA) says a drug you are taking is not safe or the drug’s manufacturer takes a drug off the market, we will take it off the Drug List. If you are taking the drug, we will let you know. If you are notified that your drug is being removed, you should contact your provider to get a new prescription.

We may make other changes that affect the drugs you take. We will tell you in advance about these other changes to the Drug List. These changes might happen if:

• The FDA provides new guidance or there are new clinical guidelines about a drug.

• We add a generic drug that is not new to the market and

o Replace a brand name drug currently on the Drug List or

o Change the coverage rules or limits for the brand name drug.

When these changes happen, we will:

• Tell you at least 30 days before we make the change to the Drug List or

• Let you know and give you a 30-day supply of the drug after you ask for a refill.

This will give you time to talk to your doctor or other prescriber. He or she can help you decide:

• If there is a similar drug on the Drug List you can take instead or

• Whether to ask for an exception from these changes. To learn more about exceptions, see question B10.

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B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs?

Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases, you or your doctor or other prescriber must do something before you can get the drug. For example:

• Prior approval (or prior authorization): For some drugs, you or your doctor or other prescriber must get approval from Cigna CarePlan before you fill your prescription. Cigna CarePlan may not cover the drug if you do not get approval.

• Quantity limits: Sometimes Cigna CarePlan limits the amount of a drug you can get.

• Step therapy: Sometimes Cigna CarePlan requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. If your doctor thinks the first drug doesn’t work for you, then we will cover the second.

• Indication-based coverage: If Cigna CarePlan covers a drug only for some medical conditions, we clearly identify it on the Drug List along with the specific medical conditions that are covered.

You can find out if your drug has any additional requirements or limits by looking in the tables on pages 12-112. You can also get more information by visiting our web site at careplantx.cigna.com. We have posted online documents that explain our prior authorization restriction and step therapy restrictions. You may also ask us to send you a copy.

You can ask for an exception from these limits. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception. Please see questions B10- B12 for more information about exceptions.

B5. How will you know if the drug you want has limits or if there are required actions to take to get the drug?

The List of Covered Drugs on page 12 has a column labeled “Necessary actions, restrictions, or limits on use.”

B6. What happens if we change our rules about some drugs (for example, prior authorization (approval), quantity limits, and/or step therapy restrictions)?

In some cases, we tell you in advance if we add or change prior approval, quantity limits, and/or step therapy restrictions on a drug. See question B3 for more information about this advance notice and situations where we may not be able to tell you in advance when our rules about drugs on the Drug List change.

B7. How can you find a drug on the Drug List? There are two ways to find a drug:



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• You can search alphabetically (if you know how to spell the drug), or

• You can search by medical condition.

To search alphabetically, go to the Index of Covered Drugs section. You can find it on page 113. This section has a list of all the drugs in this book. The drug names are in the first column of the list with the page number across from each name.

To search by medical condition, find the section labeled “List of drugs by medical condition” on page 12. The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular Agents. That is where you will find drugs that treat heart conditions.

B8. What if the drug you want to take is not on the Drug List? If you don’t see your drug on the Drug List, call Member Services at 1-877-653-0327 (TTY: 7-1-1) and ask about it. If you learn that Cigna CarePlan will not cover the drug, you can do one of these things:

• Ask Member Services for a list of drugs like the one you want to take. Then show the list to your doctor or other prescriber. He or she can prescribe a drug on the Drug List that is like the one you want to take. Or

• You can ask the health plan to make an exception to cover your drug. Please see questions B10-B12 for more information about exceptions.

B9. What if you are a new Cigna CarePlan member and can’t find your drug on the Drug List or have a problem getting your drug?

We can help. We may cover a temporary 30-day supply (or 31 days if you live in a long-term care facility) of your drug during the first 90 days you are a Member of Cigna CarePlan. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception.

If your prescription is written for fewer days, we will allow multiple refills to provide up to a maximum of 30 days of medication (or 31 days if you live in a long-term care facility).

We will cover a 30-day supply of your drug if:

• you are taking a drug that is not on our Drug List, or

• health plan rules do not let you get the amount ordered by your prescriber, or

• the drug requires prior approval by Cigna CarePlan, or

• you are taking a drug that is part of a step therapy restriction.

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If you are in a nursing home or other long-term care facility and need a drug that is not on the Drug List or if you cannot easily get the drug you need, we can help. If you have been in the plan for more than 90 days, live in a long-term care facility, and need a supply right away:

• We will cover one 31-day supply of the drug you need (unless you have a prescription for fewer days), whether or not you are a new Cigna CarePlan member.

• This is in addition to the temporary supply during the first 90 days you are a member of Cigna CarePlan.

We will cover a temporary 30-day supply of your drug if an unexpected move happens. For example, if you are released from the hospital to go home or to a nursing home and you are not able to get your medicine.

B10. Can you ask for an exception to cover your drug? Yes. You can ask Cigna CarePlan to make an exception to cover a drug that is not on the Drug List.

You can also ask us to change the rules on your drug.

• For example, Cigna CarePlan may limit the amount of a drug we will cover. If your drug has a limit, you can ask us to change the limit and cover more.

• Other examples: You can ask us to drop step therapy restrictions or prior approval requirements.

B11. How can you ask for an exception? To ask for an exception, call Member Services. A Member Services representative will work with you and your provider to help you ask for an exception. You can also read Chapter 9 of the Member Handbook to learn more about exceptions.

B12. How long does it take to get an exception? First, we must get a statement from your prescriber supporting your request for an exception. After we get the statement, we will give you a decision on your exception request within 72 hours.

If you or your prescriber think your health may be harmed if you have to wait 72 hours for a decision, you can ask for an expedited exception. This is a faster decision. If your prescriber supports your request, we will give you a decision within 24 hours of getting your prescriber’s supporting statement.

B13. What are generic drugs? Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration (FDA).

Cigna CarePlan covers both brand name drugs and generic drugs.



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B14. What are OTC drugs? OTC stands for “over-the-counter.” Cigna CarePlan covers some OTC drugs when they are written as prescriptions by your provider.

You can read the Cigna CarePlan Drug List to see what OTC drugs are covered.

B15. Does Cigna CarePlan cover non-drug OTC products? Cigna CarePlan covers some non-drug OTC products when they are written as prescriptions by your provider.

Examples of non-drug OTC products include aspirin, some vitamins and nicotine containing products such as nicotine patches, gum and lozenges to help stop smoking.

You can read the Cigna CarePlan Drug List to see what non-drug OTC products are covered.

B16. What is your copay? As a Cigna CarePlan member, you have no copays for prescription and OTC drugs as long as you follow Cigna CarePlan’s rules.

B17. What are drug tiers? Tiers are groups of drugs on our Drug List. All tiers have no copay.

• Tier 1 drugs are generic drugs.

• Tier 2 drugs are brand name drugs.

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C. Overview of the List of Covered Drugs

The following list of covered drugs gives you information about the drugs covered by Cigna CarePlan. If you have trouble finding your drug in the list, turn to the Index of Covered Drugs that begins on page 113. The index alphabetically lists all drugs covered by Cigna CarePlan.

The first column of the chart lists the name of the drug. 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 necessary actions, restrictions, or limits on use column tells you if Cigna CarePlan has any rules for covering your drug.

Abbreviation Explanation

LA (Limited Availability) This drug may be available only at certain pharmacies.

B/D (Part B/Part D) This drug might be covered under Medicare Part B instead of Medicare Part D. More information might be needed for Cigna CarePlan to decide which plan should cover it.

PA (Prior Authorization) This drug requires prior authorization.

QL (Quantity Limits) This drug has quantity limits.

ST (Step Therapy) This drug has step therapy requirements.

MC (Medicaid Covered) MC (Medicaid Covered) Non-Part D Drugs or OTC items that are covered by Texas Medicaid.

NDS (Non-Extended Day Supply) This drug is only available as a 30-day supply or less. For certain drugs, Cigna CarePlan limits the amount of the drug that Cigna CarePlan will cover to only a 30-day supply or less, at one time. For example, members 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. Members who have received a recent fill of an opioid pain medication (not opioid naïve), are limited to up to a month’s supply at one time.



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Note: The “MC” next to a drug means the drug is not a “Part D drug.” 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 getting Extra Help to pay for your prescriptions, you will not get any Extra Help to pay for these drugs. For more information on Extra Help, please see the call-out box below.

• These drugs also have different rules for appeals. An appeal is a formal way of asking us to review a coverage decision and to change it if you think we made a mistake. For example, we might decide that a drug that you want is not covered or is no longer covered by Medicare or Texas Medicaid.

• If you or your doctor disagrees with our decision, you can appeal. To ask for instructions on how to appeal, call Member Services at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. You can also read Chapter 9 of the Member Handbook to learn how to appeal a decision.

Extra Help is a Medicare program that helps people with limited incomes and resources reduce Medicare Part D prescription drug costs, such as premiums, deductibles, and copays. Extra Help is also called the “Low-Income Subsidy,” or “LIS.”

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C1. Drugs Grouped by Medical Condition The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular, Hypertension/Lipids. That is where you will find drugs that treat heart conditions.

Name of drug What the drug will cost you (tier level)

Necessary actions, restrictions, or limits on use

ANTI - INFECTIVES (DRUGS THAT TREAT INFECTIONS)ANTIFUNGAL AGENTSABELCET 0(Tier 2) PAAMBISOME 0(Tier 2) PA; NDSamphotericin b 0(Tier 1) PAcaspofungin 0(Tier 1) PA; NDSclotrimazole mucous membrane 0(Tier 1)CRESEMBA ORAL 0(Tier 2) NDSfluconazole 0(Tier 1)fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml

0(Tier 1) PA

flucytosine 0(Tier 1) NDSgriseofulvin microsize 0(Tier 1)griseofulvin ultramicrosize 0(Tier 1)itraconazole oral capsule 0(Tier 1) QL (120 EA per 30 days)itraconazole oral solution 0(Tier 1) NDSketoconazole oral 0(Tier 1)micafungin 0(Tier 1) NDSnystatin oral suspension 0(Tier 1)nystatin oral tablet 0(Tier 1)posaconazole oral tablet,delayed release (dr/ec) 0(Tier 1) QL (96 EA per 30 days); NDSterbinafine hcl oral 0(Tier 1)voriconazole intravenous 0(Tier 1) PA; NDSvoriconazole oral suspension for reconstitution 0(Tier 1) NDSvoriconazole oral tablet 200 mg 0(Tier 1) NDSvoriconazole oral tablet 50 mg 0(Tier 1)ANTIVIRALSabacavir oral solution 0(Tier 1) QL (960 ML per 30 days)abacavir oral tablet 0(Tier 1) QL (60 EA per 30 days)abacavir-lamivudine 0(Tier 1) QL (30 EA per 30 days)abacavir-lamivudine-zidovudine 0(Tier 1) QL (60 EA per 30 days); NDSacyclovir oral capsule 0(Tier 1)acyclovir oral suspension 200 mg/5 ml 0(Tier 1)acyclovir oral tablet 0(Tier 1)

Key: QL = Quantity Limits listed as (qty/days); PA = Prior Authorization may be required; ST = Step Therapy rules apply; B/D = Drug covered under Medicare Part B or Part D; NDS = Non-Extended Day Supply; MC = Non-Part D Drugs, or OTC items that are covered by Texas Medicaid; LA = Limited Availability (may only be available at certain pharmacies). 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.

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acyclovir sodium intravenous solution 0(Tier 1) B/D PAadefovir 0(Tier 1) NDSamantadine hcl 0(Tier 1)APTIVUS 0(Tier 2) QL (120 EA per 30 days); NDSAPTIVUS (WITH VITAMIN E) 0(Tier 2) QL (285 ML per 28 days); NDSatazanavir oral capsule 150 mg, 300 mg 0(Tier 1) QL (30 EA per 30 days)atazanavir oral capsule 200 mg 0(Tier 1) QL (60 EA per 30 days)ATRIPLA 0(Tier 2) QL (30 EA per 30 days); NDSBARACLUDE ORAL SOLUTION 0(Tier 2) QL (630 ML per 30 days)BIKTARVY 0(Tier 2) NDSCIMDUO 0(Tier 2) NDSCOMPLERA 0(Tier 2) QL (30 EA per 30 days); NDSCRIXIVAN ORAL CAPSULE 200 MG 0(Tier 2) QL (270 EA per 30 days)CRIXIVAN ORAL CAPSULE 400 MG 0(Tier 2) QL (180 EA per 30 days)DELSTRIGO 0(Tier 2) NDSDESCOVY 0(Tier 2) QL (30 EA per 30 days); NDSdidanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg

0(Tier 1) QL (30 EA per 30 days)

DOVATO 0(Tier 2) NDSEDURANT 0(Tier 2) QL (30 EA per 30 days); NDSefavirenz oral capsule 200 mg 0(Tier 1) QL (120 EA per 30 days); NDSefavirenz oral capsule 50 mg 0(Tier 1) QL (180 EA per 30 days)efavirenz oral tablet 0(Tier 1) QL (30 EA per 30 days); NDSefavirenz-emtricitabin-tenofov 0(Tier 1) QL (30 EA per 30 days); NDSefavirenz-lamivu-tenofov disop oral tablet 400-300-300 mg

0(Tier 1) QL (30 EA per 30 days); NDS

efavirenz-lamivu-tenofov disop oral tablet 600-300-300 mg

0(Tier 1) NDS

emtricitabine 0(Tier 1) QL (30 EA per 30 days)emtricitabine-tenofovir (tdf) 0(Tier 1) QL (30 EA per 30 days); NDSEMTRIVA ORAL CAPSULE 0(Tier 2) QL (30 EA per 30 days)EMTRIVA ORAL SOLUTION 0(Tier 2) QL (680 ML per 28 days)entecavir 0(Tier 1) QL (30 EA per 30 days)EPCLUSA 0(Tier 2) PA; QL (28 EA per 28 days); NDSEPIVIR HBV ORAL SOLUTION 0(Tier 2)EVOTAZ 0(Tier 2) QL (30 EA per 30 days); NDSfamciclovir 0(Tier 1) QL (60 EA per 30 days)fosamprenavir 0(Tier 1) QL (120 EA per 30 days); NDSFUZEON SUBCUTANEOUS RECON SOLN 0(Tier 2) QL (60 EA per 30 days); NDS


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GENVOYA 0(Tier 2) QL (30 EA per 30 days); NDSHARVONI ORAL PELLETS IN PACKET 33.75-150 MG

0(Tier 2) PA; QL (28 EA per 28 days); NDS

HARVONI ORAL PELLETS IN PACKET 45-200 MG


HARVONI ORAL TABLET 45-200 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSHARVONI ORAL TABLET 90-400 MG 0(Tier 2) PA; QL (28 EA per 28 days); NDSINTELENCE ORAL TABLET 100 MG, 200 MG 0(Tier 2) QL (60 EA per 30 days); NDSINTELENCE ORAL TABLET 25 MG 0(Tier 2) QL (120 EA per 30 days)INVIRASE ORAL TABLET 0(Tier 2) QL (120 EA per 30 days); NDSISENTRESS HD 0(Tier 2) NDSISENTRESS ORAL POWDER IN PACKET 0(Tier 2) QL (60 EA per 30 days)ISENTRESS ORAL TABLET 0(Tier 2) QL (120 EA per 30 days); NDSISENTRESS ORAL TABLET,CHEWABLE 100 MG


ISENTRESS ORAL TABLET,CHEWABLE 25 MG


JULUCA 0(Tier 2) NDSKALETRA ORAL TABLET 100-25 MG 0(Tier 2) QL (300 EA per 30 days)KALETRA ORAL TABLET 200-50 MG 0(Tier 2) QL (120 EA per 30 days); NDSlamivudine oral solution 0(Tier 1) QL (900 ML per 30 days)lamivudine oral tablet 100 mg, 300 mg 0(Tier 1) QL (30 EA per 30 days)lamivudine oral tablet 150 mg 0(Tier 1) QL (60 EA per 30 days)lamivudine-zidovudine 0(Tier 1) QL (60 EA per 30 days)LEXIVA ORAL SUSPENSION 0(Tier 2) QL (1575 ML per 28 days)lopinavir-ritonavir 0(Tier 1)MAVYRET 0(Tier 2) PA; QL (84 EA per 28 days); NDSnevirapine oral suspension 0(Tier 1) QL (1200 ML per 30 days)nevirapine oral tablet 0(Tier 1) QL (60 EA per 30 days)nevirapine oral tablet extended release 24 hr 100 mg


nevirapine oral tablet extended release 24 hr 400 mg


NORVIR ORAL POWDER IN PACKET 0(Tier 2)NORVIR ORAL SOLUTION 0(Tier 2) QL (480 ML per 30 days)ODEFSEY 0(Tier 2) QL (30 EA per 30 days); NDSoseltamivir 0(Tier 1)PIFELTRO 0(Tier 2) NDSPREVYMIS ORAL 0(Tier 2) QL (30 EA per 30 days); NDS


14



PREZCOBIX 0(Tier 2) QL (30 EA per 30 days); NDSPREZISTA ORAL SUSPENSION 0(Tier 2) QL (400 ML per 30 days); NDSPREZISTA ORAL TABLET 150 MG 0(Tier 2) QL (240 EA per 30 days)PREZISTA ORAL TABLET 600 MG 0(Tier 2) QL (60 EA per 30 days); NDSPREZISTA ORAL TABLET 75 MG 0(Tier 2) QL (480 EA per 30 days)PREZISTA ORAL TABLET 800 MG 0(Tier 2) QL (30 EA per 30 days); NDSRETROVIR INTRAVENOUS 0(Tier 2)REYATAZ ORAL POWDER IN PACKET 0(Tier 2) QL (240 EA per 30 days); NDSribavirin oral capsule 0(Tier 1)ribavirin oral tablet 200 mg 0(Tier 1)rimantadine 0(Tier 1)ritonavir 0(Tier 1) QL (360 EA per 30 days)RUKOBIA 0(Tier 2) NDSSELZENTRY ORAL SOLUTION 0(Tier 2) NDSSELZENTRY ORAL TABLET 150 MG, 75 MG 0(Tier 2) QL (60 EA per 30 days); NDSSELZENTRY ORAL TABLET 25 MG 0(Tier 2) QL (120 EA per 30 days)SELZENTRY ORAL TABLET 300 MG 0(Tier 2) QL (120 EA per 30 days); NDSstavudine oral capsule 0(Tier 1) QL (60 EA per 30 days)STRIBILD 0(Tier 2) QL (30 EA per 30 days); NDSSYMFI 0(Tier 2) NDSSYMFI LO 0(Tier 2) QL (30 EA per 30 days); NDSSYMTUZA 0(Tier 2) NDSTEMIXYS 0(Tier 2) NDStenofovir disoproxil fumarate 0(Tier 1) QL (30 EA per 30 days)TIVICAY ORAL TABLET 10 MG 0(Tier 2) QL (60 EA per 30 days)TIVICAY ORAL TABLET 25 MG, 50 MG 0(Tier 2) QL (60 EA per 30 days); NDSTIVICAY PD 0(Tier 2) QL (180 EA per 30 days); NDSTRIUMEQ 0(Tier 2) QL (30 EA per 30 days); NDSTROGARZO 0(Tier 2) NDSTRUVADA 0(Tier 2) QL (30 EA per 30 days); NDSTYBOST 0(Tier 2)valacyclovir oral tablet 1 gram 0(Tier 1) QL (120 EA per 30 days)valacyclovir oral tablet 500 mg 0(Tier 1) QL (60 EA per 30 days)valganciclovir 0(Tier 1) NDSVEMLIDY 0(Tier 2) NDSVIRACEPT ORAL TABLET 250 MG 0(Tier 2) QL (270 EA per 30 days); NDSVIRACEPT ORAL TABLET 625 MG 0(Tier 2) QL (120 EA per 30 days); NDSVIREAD ORAL POWDER 0(Tier 2) QL (240 GM per 30 days); NDS


15



VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG


VOSEVI 0(Tier 2) PA; QL (28 EA per 28 days); NDSXOFLUZA 0(Tier 2)zidovudine oral capsule 0(Tier 1) QL (180 EA per 30 days)zidovudine oral syrup 0(Tier 1) QL (1680 ML per 28 days)zidovudine oral tablet 0(Tier 1) QL (60 EA per 30 days)CEPHALOSPORINScefaclor oral capsule 0(Tier 1)cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml

0(Tier 1)

cefaclor oral tablet extended release 12 hr 0(Tier 1)cefadroxil oral capsule 0(Tier 1)cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

0(Tier 1)

cefadroxil oral tablet 0(Tier 1)cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml

0(Tier 1)

CEFAZOLIN IN DEXTROSE (ISO-OS) INTRAVENOUS PIGGYBACK 2 GRAM/100 ML

0(Tier 2)

cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/50 ml

0(Tier 2)

cefazolin injection recon soln 1 gram, 10 gram, 100 gram, 300 g, 500 mg

0(Tier 1)

cefazolin intravenous 0(Tier 1)cefdinir 0(Tier 1)CEFEPIME IN DEXTROSE 5% 0(Tier 1)cefepime in dextrose,iso-osm 0(Tier 1)cefepime injection 0(Tier 1)CEFEPIME INTRAVENOUS 0(Tier 1) PAcefixime 0(Tier 1)CEFOTETAN IN DEXTROSE, ISO-OSM 0(Tier 1) PAcefotetan injection 0(Tier 1) PAcefoxitin 0(Tier 1) PAcefoxitin in dextrose, iso-osm 0(Tier 1) PAcefpodoxime 0(Tier 1)cefprozil 0(Tier 1)ceftazidime 0(Tier 1) PACEFTAZIDIME IN D5W 0(Tier 1) PAceftriaxone in dextrose,iso-os 0(Tier 1)


16



ceftriaxone injection recon soln 1 gram, 10 gram, 2 gram, 250 mg, 500 mg

0(Tier 1)

CEFTRIAXONE INJECTION RECON SOLN 100 GRAM

0(Tier 1)

ceftriaxone intravenous 0(Tier 1)cefuroxime axetil oral tablet 0(Tier 1)cefuroxime sodium injection recon soln 750 mg 0(Tier 1) PAcefuroxime sodium intravenous 0(Tier 1) PAcephalexin oral capsule 250 mg, 500 mg 0(Tier 1)cephalexin oral suspension for reconstitution 0(Tier 1)SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 500 MG/5 ML

0(Tier 2)

tazicef 0(Tier 1) PATEFLARO 0(Tier 2) PA; NDSERYTHROMYCINS / OTHER MACROLIDESazithromycin intravenous 0(Tier 1) PAazithromycin oral 0(Tier 1)clarithromycin 0(Tier 1)DIFICID ORAL TABLET 0(Tier 2) PA; QL (20 EA per 10 days); NDSERYPED 400 0(Tier 2) NDSery-tab 0(Tier 1)erythrocin (as stearate) oral tablet 250 mg 0(Tier 1)erythrocin intravenous recon soln 500 mg 0(Tier 1) PAerythromycin ethylsuccinate oral suspension for reconstitution 200 mg/5 ml

0(Tier 1)

erythromycin ethylsuccinate oral suspension for reconstitution 400 mg/5 ml

0(Tier 1) NDS

erythromycin ethylsuccinate oral tablet 0(Tier 1)erythromycin oral tablet 0(Tier 1)erythromycin oral tablet,delayed release (dr/ec) 0(Tier 1)MISCELLANEOUS ANTIINFECTIVESalbendazole 0(Tier 1) NDSALINIA ORAL SUSPENSION FOR RECONSTITUTION

0(Tier 2) QL (360 ML per 30 days); NDS

ALINIA ORAL TABLET 0(Tier 2) QL (20 EA per 10 days); NDSamikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml

0(Tier 1) PA

ARIKAYCE 0(Tier 2) PA; LA; NDSatovaquone 0(Tier 1) NDSatovaquone-proguanil 0(Tier 1)


17



aztreonam 0(Tier 1) PAbacitracin intramuscular 0(Tier 1)CAPASTAT 0(Tier 2)CAYSTON 0(Tier 2) PA; LA; QL (84 ML per 28 days); NDSchloramphenicol sod succinate 0(Tier 1)chloroquine phosphate 0(Tier 1)clindamycin hcl 0(Tier 1)CLINDAMYCIN IN 0.9% SOD CHLOR 0(Tier 1) PAclindamycin in 5% dextrose 0(Tier 1) PAclindamycin pediatric 0(Tier 1)clindamycin phosphate injection 0(Tier 1) PAclindamycin phosphate intravenous solution 600 mg/4 ml

0(Tier 1) PA

COARTEM 0(Tier 2) QL (24 EA per 30 days)colistin (colistimethate na) 0(Tier 1) PA; NDSCYCLOSERINE 0(Tier 1)dapsone oral 0(Tier 1)daptomycin 0(Tier 1) NDSEMVERM 0(Tier 2) NDSertapenem 0(Tier 1)ethambutol 0(Tier 1)FIRVANQ ORAL RECON SOLN 25 MG/ML 0(Tier 2) QL (300 ML per 10 days)FIRVANQ ORAL RECON SOLN 50 MG/ML 0(Tier 2) QL (450 ML per 10 days)gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 60 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml

0(Tier 1) PA

GENTAMICIN IN NACL (ISO-OSM) INTRAVENOUS PIGGYBACK 100 MG/50 ML, 120 MG/100 ML

0(Tier 1) PA

gentamicin injection solution 40 mg/ml 0(Tier 1) PAgentamicin sulfate (ped) (pf) 0(Tier 1) PAhydroxychloroquine 0(Tier 1)imipenem-cilastatin 0(Tier 1)isoniazid oral 0(Tier 1)ivermectin oral 0(Tier 1)lincomycin 0(Tier 1) PAlinezolid in dextrose 5% 0(Tier 1) PAlinezolid oral suspension for reconstitution 0(Tier 1) QL (1800 ML per 30 days); NDSlinezolid oral tablet 0(Tier 1) QL (60 EA per 30 days)


18



linezolid-0.9% sodium chloride 0(Tier 1) PAmefloquine 0(Tier 1)meropenem 0(Tier 1)MEROPENEM-0.9% SODIUM CHLORIDE 0(Tier 1)metro i.v. 0(Tier 1) PAmetronidazole in nacl (iso-os) 0(Tier 1) PAmetronidazole oral tablet 0(Tier 1)neomycin 0(Tier 1)ORBACTIV 0(Tier 2) PA; QL (3 EA per 30 days); NDSparomomycin 0(Tier 1)PASER 0(Tier 2)PENTAM 0(Tier 2)pentamidine inhalation 0(Tier 1) B/D PA; QL (1 EA per 28 days)pentamidine injection 0(Tier 1)polymyxin b sulfate 0(Tier 1) PApraziquantel 0(Tier 1)PRIFTIN 0(Tier 2)PRIMAQUINE 0(Tier 2)pyrazinamide 0(Tier 1)pyrimethamine 0(Tier 1) PA; NDSquinine sulfate 0(Tier 1) PA; QL (42 EA per 7 days)rifabutin 0(Tier 1)rifampin 0(Tier 1)RIFATER 0(Tier 2)SIRTURO 0(Tier 2) PA; LASIVEXTRO INTRAVENOUS 0(Tier 2) PA; QL (6 EA per 28 days); NDSSIVEXTRO ORAL 0(Tier 2) QL (6 EA per 28 days); NDSstreptomycin 0(Tier 1) PA; NDSSYNERCID 0(Tier 2) PA; NDStigecycline 0(Tier 1) PA; NDSTOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE


tobramycin in 0.225% nacl 0(Tier 1) B/D PA; QL (280 ML per 28 days); NDStobramycin sulfate 0(Tier 1) PATRECATOR 0(Tier 2)VANCOMYCIN IN 0.9% SODIUM CHL INTRAVENOUS PIGGYBACK

0(Tier 1)

VANCOMYCIN IN DEXTROSE 5% INTRAVENOUS PIGGYBACK

0(Tier 1)


19



VANCOMYCIN INJECTION 0(Tier 1)vancomycin intravenous recon soln 1,000 mg, 10 gram, 250 mg, 5 gram, 500 mg, 750 mg

0(Tier 1)

VANCOMYCIN INTRAVENOUS RECON SOLN 1.25 GRAM, 1.5 GRAM

0(Tier 2)

vancomycin oral capsule 125 mg 0(Tier 1) PA; QL (40 EA per 10 days)vancomycin oral capsule 250 mg 0(Tier 1) PA; QL (80 EA per 10 days)vancomycin oral recon soln 0(Tier 1) QL (450 ML per 10 days)VANCOMYCIN-WATER INJECT (PEG) 0(Tier 2)XIFAXAN ORAL TABLET 550 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSPENICILLINSamoxicillin oral capsule 0(Tier 1)amoxicillin oral suspension for reconstitution 0(Tier 1)amoxicillin oral tablet 0(Tier 1)amoxicillin oral tablet,chewable 125 mg, 250 mg 0(Tier 1)amoxicillin-pot clavulanate 0(Tier 1)ampicillin oral capsule 500 mg 0(Tier 1)ampicillin sodium 0(Tier 1) PAampicillin-sulbactam 0(Tier 1) PABICILLIN L-A 0(Tier 2) PAdicloxacillin 0(Tier 1)nafcillin 0(Tier 1) PAnafcillin in dextrose iso-osm 0(Tier 1) PAoxacillin injection 0(Tier 1) PApenicillin g potassium 0(Tier 1) PApenicillin v potassium 0(Tier 1)pfizerpen-g 0(Tier 2) PAPIPERACILLIN-TAZOBACTAM INTRAVENOUS RECON SOLN 13.5 GRAM

0(Tier 1)

piperacillin-tazobactam intravenous recon soln 2.25 gram, 3.375 gram, 4.5 gram, 40.5 gram

0(Tier 1)

ZOSYN IN DEXTROSE (ISO-OSM) 0(Tier 2)QUINOLONESciprofloxacin hcl oral 0(Tier 1)ciprofloxacin in 5% dextrose 0(Tier 1) PAlevofloxacin in d5w 0(Tier 1) PAlevofloxacin intravenous 0(Tier 1) PAlevofloxacin oral 0(Tier 1)moxifloxacin oral 0(Tier 1)


20



MOXIFLOXACIN-SOD.ACE,SUL-WATER 0(Tier 1) PAmoxifloxacin-sod.chloride(iso) 0(Tier 1) PASULFAS / RELATED AGENTSsulfadiazine 0(Tier 1)sulfamethoxazole-trimethoprim intravenous 0(Tier 1) PAsulfamethoxazole-trimethoprim oral 0(Tier 1)TETRACYCLINESdemeclocycline 0(Tier 1)doxy-100 0(Tier 1) PAdoxycycline hyclate intravenous 0(Tier 1) PAdoxycycline hyclate oral capsule 0(Tier 1)doxycycline hyclate oral tablet 100 mg, 20 mg 0(Tier 1)doxycycline monohydrate oral capsule 100 mg, 50 mg

0(Tier 1)

DOXYCYCLINE MONOHYDRATE ORAL CAPSULE,IR - DELAY REL,BIPHASE

0(Tier 1)

doxycycline monohydrate oral suspension for reconstitution

0(Tier 1)

doxycycline monohydrate oral tablet 0(Tier 1)minocycline oral capsule 0(Tier 1)minocycline oral tablet 0(Tier 1)mondoxyne nl oral capsule 100 mg, 75 mg 0(Tier 1)morgidox oral capsule 100 mg 0(Tier 1)NUZYRA INTRAVENOUS 0(Tier 2) PA; NDSNUZYRA ORAL 0(Tier 2) NDStetracycline 0(Tier 1)URINARY TRACT AGENTSfosfomycin tromethamine 0(Tier 1)methenamine hippurate 0(Tier 1)MONUROL 0(Tier 2)nitrofurantoin 0(Tier 1)nitrofurantoin macrocrystal 0(Tier 1)nitrofurantoin monohyd/m-cryst 0(Tier 1)trimethoprim 0(Tier 1)ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS (DRUGS THAT TREAT CANCER)ADJUNCTIVE AGENTSleucovorin calcium 0(Tier 1)mesna 0(Tier 1) B/D PAMESNEX ORAL 0(Tier 2) NDS


21



XGEVA 0(Tier 2) PA; QL (1.7 ML per 28 days); NDSANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGSabiraterone oral tablet 250 mg 0(Tier 1) PA; QL (120 EA per 30 days); NDSabiraterone oral tablet 500 mg 0(Tier 1) PA; NDSABRAXANE 0(Tier 2) PA; NDSADCETRIS 0(Tier 2) PA; NDSadriamycin intravenous recon soln 10 mg 0(Tier 1) B/D PAADRIAMYCIN INTRAVENOUS RECON SOLN 50 MG

0(Tier 2) B/D PA

adriamycin intravenous solution 0(Tier 1) B/D PAadrucil intravenous solution 2.5 gram/50 ml 0(Tier 1) B/D PAAFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG


AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 3 MG, 5 MG


AFINITOR ORAL TABLET 10 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSALECENSA 0(Tier 2) PA; QL (240 EA per 30 days); NDSALIMTA 0(Tier 2) PA; NDSALIQOPA 0(Tier 2) PA; NDSALUNBRIG ORAL TABLET 180 MG, 90 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSALUNBRIG ORAL TABLET 30 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSALUNBRIG ORAL TABLETS,DOSE PACK 0(Tier 2) PA; QL (30 EA per 30 days); NDSanastrozole 0(Tier 1)ARRANON 0(Tier 2) B/D PAARSENIC TRIOXIDE INTRAVENOUS SOLUTION 1 MG/ML

0(Tier 1) B/D PA; NDS

arsenic trioxide intravenous solution 2 mg/ml 0(Tier 1) B/D PA; NDSARZERRA 0(Tier 2) B/D PA; NDSASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 0.5 MG, 1 MG

0(Tier 2) PA

ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 5 MG

0(Tier 2) PA; NDS

AYVAKIT 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSazacitidine 0(Tier 1) B/D PA; NDSAZASAN 0(Tier 2) PAazathioprine 0(Tier 1) PAazathioprine sodium 0(Tier 1) PABALVERSA 0(Tier 2) PA; LA; NDSBAVENCIO 0(Tier 2) PA; NDS


22



BELEODAQ 0(Tier 2) B/D PA; NDSBENDEKA 0(Tier 2) B/D PA; NDSBESPONSA 0(Tier 2) PA; NDSbexarotene 0(Tier 1) PA; NDSbicalutamide 0(Tier 1)BLENREP 0(Tier 2) PA; NDSbleomycin 0(Tier 1) B/D PABLINCYTO INTRAVENOUS KIT 0(Tier 2) B/D PA; NDSBORTEZOMIB 0(Tier 2) PA; NDSBOSULIF ORAL TABLET 100 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSBOSULIF ORAL TABLET 400 MG, 500 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSBRAFTOVI ORAL CAPSULE 75 MG 0(Tier 2) PA; LA; QL (180 EA per 30 days); NDSBRUKINSA 0(Tier 2) PA; LA; NDSbusulfan 0(Tier 1) B/D PA; NDSBUSULFEX 0(Tier 2) B/D PACABOMETYX ORAL TABLET 20 MG, 60 MG 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSCABOMETYX ORAL TABLET 40 MG 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSCALQUENCE 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSCAPRELSA ORAL TABLET 100 MG 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSCAPRELSA ORAL TABLET 300 MG 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDScarboplatin intravenous solution 0(Tier 1) B/D PAcarmustine 0(Tier 1) B/D PAcisplatin intravenous solution 0(Tier 1) B/D PAcladribine 0(Tier 1) B/D PAclofarabine 0(Tier 1) B/D PACOMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1-20 MG X1)


COMETRIQ ORAL CAPSULE 140 MG/DAY(80 MG X1-20 MG X3)


COMETRIQ ORAL CAPSULE 60 MG/DAY (20 MG X 3/DAY)


COPIKTRA 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSCOSMEGEN 0(Tier 2) B/D PA; NDSCOTELLIC 0(Tier 2) PA; LA; QL (63 EA per 28 days); NDScyclophosphamide intravenous recon soln 0(Tier 1) B/D PA; NDSCYCLOPHOSPHAMIDE INTRAVENOUS SOLUTION


cyclophosphamide oral capsule 0(Tier 1) B/D PAcyclosporine intravenous 0(Tier 1) PA


23



cyclosporine modified 0(Tier 1) PAcyclosporine oral capsule 0(Tier 1) PACYRAMZA 0(Tier 2) PA; NDScytarabine 0(Tier 1) B/D PAcytarabine (pf) injection solution 0(Tier 1) B/D PAdacarbazine 0(Tier 1) B/D PAdactinomycin 0(Tier 1) B/D PADARZALEX 0(Tier 2) PA; NDSDARZALEX FASPRO 0(Tier 2) PA; NDSdaunorubicin intravenous solution 0(Tier 1) B/D PADAURISMO ORAL TABLET 100 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSDAURISMO ORAL TABLET 25 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSdecitabine 0(Tier 1) B/D PA; NDSdocetaxel intravenous solution 160 mg/16 ml (10 mg/ml), 160 mg/8 ml (20 mg/ml), 20 mg/2 ml (10 mg/ml), 20 mg/ml (1 ml), 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml)

0(Tier 1) B/D PA

doxorubicin intravenous recon soln 50 mg 0(Tier 1) B/D PAdoxorubicin intravenous solution 0(Tier 1) B/D PAdoxorubicin, peg-liposomal 0(Tier 1) B/D PA; NDSDROXIA 0(Tier 2)ELIGARD 0(Tier 2) PAELIGARD (3 MONTH) 0(Tier 2) PAELIGARD (4 MONTH) 0(Tier 2) PAELIGARD (6 MONTH) 0(Tier 2) PAELLENCE 0(Tier 2) B/D PAELZONRIS 0(Tier 2) B/D PA; NDSEMCYT 0(Tier 2) NDSEMPLICITI 0(Tier 2) PAENHERTU 0(Tier 2) PA; NDSENVARSUS XR 0(Tier 2) PAepirubicin intravenous solution 0(Tier 1) B/D PAERBITUX 0(Tier 2) B/D PA; NDSERIVEDGE 0(Tier 2) PA; QL (30 EA per 30 days); NDSERLEADA 0(Tier 2) PA; QL (120 EA per 30 days); NDSerlotinib oral tablet 100 mg, 150 mg 0(Tier 1) PA; QL (30 EA per 30 days); NDSerlotinib oral tablet 25 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSERWINAZE 0(Tier 2) B/D PA; NDSETOPOPHOS 0(Tier 2) B/D PA


24



etoposide intravenous 0(Tier 1) B/D PAeverolimus (antineoplastic) 0(Tier 1) PA; QL (30 EA per 30 days); NDSeverolimus (immunosuppressive) oral tablet 0.25 mg, 0.75 mg


everolimus (immunosuppressive) oral tablet 0.5 mg


EVOMELA 0(Tier 2) PA; NDSexemestane 0(Tier 1)FARYDAK 0(Tier 2) PA; QL (6 EA per 21 days); NDSFIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG


FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG

0(Tier 2) B/D PA

floxuridine 0(Tier 1) B/D PAfludarabine 0(Tier 1) B/D PAfluorouracil intravenous 0(Tier 1) B/D PAflutamide 0(Tier 1)FOLOTYN 0(Tier 2) B/D PA; NDSfulvestrant 0(Tier 1) B/D PA; NDSGAVRETO 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSGAZYVA 0(Tier 2) PA; NDSgemcitabine intravenous recon soln 0(Tier 1) B/D PAgemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ml), 2 gram/52.6 ml (38 mg/ml), 200 mg/5.26 ml (38 mg/ml)

0(Tier 1) B/D PA

GEMCITABINE INTRAVENOUS SOLUTION 100 MG/ML


gengraf oral capsule 100 mg, 25 mg 0(Tier 1) PAgengraf oral solution 0(Tier 1) PAGILOTRIF 0(Tier 2) PA; QL (30 EA per 30 days); NDSHALAVEN 0(Tier 2) PA; NDSHERCEPTIN HYLECTA 0(Tier 2) PA; NDShydroxyurea 0(Tier 1)IBRANCE 0(Tier 2) PA; QL (21 EA per 28 days); NDSICLUSIG ORAL TABLET 15 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSICLUSIG ORAL TABLET 45 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSidarubicin 0(Tier 1) B/D PAIDHIFA 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSifosfamide 0(Tier 1) B/D PAimatinib oral tablet 100 mg 0(Tier 1) PA; QL (180 EA per 30 days); NDS


25



imatinib oral tablet 400 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSIMBRUVICA ORAL CAPSULE 140 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSIMBRUVICA ORAL CAPSULE 70 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSIMBRUVICA ORAL TABLET 0(Tier 2) PA; QL (30 EA per 30 days); NDSIMFINZI 0(Tier 2) PA; NDSINFUGEM 0(Tier 2) B/D PA; NDSINLYTA ORAL TABLET 1 MG 0(Tier 2) PA; QL (180 EA per 30 days); NDSINLYTA ORAL TABLET 5 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSINQOVI 0(Tier 2) PA; QL (5 EA per 28 days); NDSINREBIC 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSIRESSA 0(Tier 2) PA; QL (30 EA per 30 days); NDSirinotecan 0(Tier 1) B/D PAIXEMPRA 0(Tier 2) B/D PA; NDSJAKAFI 0(Tier 2) PA; QL (60 EA per 30 days); NDSJEVTANA 0(Tier 2) B/D PAKADCYLA 0(Tier 2) PA; NDSKANJINTI 0(Tier 2) PA; NDSKEYTRUDA INTRAVENOUS SOLUTION 0(Tier 2) PA; NDSKISQALI FEMARA CO-PACK ORAL TABLET 200 MG/DAY(200 MG X 1)-2.5 MG


KISQALI FEMARA CO-PACK ORAL TABLET 400 MG/DAY(200 MG X 2)-2.5 MG


KISQALI FEMARA CO-PACK ORAL TABLET 600 MG/DAY(200 MG X 3)-2.5 MG


KISQALI ORAL TABLET 200 MG/DAY (200 MG X 1)






KYPROLIS 0(Tier 2) B/D PA; NDSlapatinib 0(Tier 1) PA; QL (180 EA per 30 days); NDSLENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 4 MG


LENVIMA ORAL CAPSULE 12 MG/DAY (4 MG X 3), 18 MG/DAY (10 MG X 1-4 MG X2), 24 MG/DAY(10 MG X 2-4 MG X 1)


LENVIMA ORAL CAPSULE 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 8 MG/DAY (4 MG X 2)



26



letrozole 0(Tier 1)LEUKERAN 0(Tier 2)leuprolide subcutaneous kit 0(Tier 1) PA; NDSLIBTAYO 0(Tier 2) PA; NDSLONSURF ORAL TABLET 15-6.14 MG 0(Tier 2) PA; QL (100 EA per 28 days); NDSLONSURF ORAL TABLET 20-8.19 MG 0(Tier 2) PA; QL (80 EA per 28 days); NDSLORBRENA ORAL TABLET 100 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSLORBRENA ORAL TABLET 25 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSLUMOXITI 0(Tier 2) PA; NDSLUPRON DEPOT 0(Tier 2) PA; NDSLUPRON DEPOT (3 MONTH) 0(Tier 2) PA; NDSLUPRON DEPOT (4 MONTH) 0(Tier 2) PA; NDSLUPRON DEPOT (6 MONTH) 0(Tier 2) PA; NDSLUPRON DEPOT-PED 0(Tier 2) PA; NDSLUPRON DEPOT-PED (3 MONTH) 0(Tier 2) PA; NDSLYNPARZA ORAL TABLET 0(Tier 2) PA; QL (120 EA per 30 days); NDSLYSODREN 0(Tier 2) NDSMARQIBO 0(Tier 2) B/D PA; NDSMATULANE 0(Tier 2) NDSmegestrol oral suspension 400 mg/10 ml (10 ml), 400 mg/10 ml (40 mg/ml)

0(Tier 1) PA

megestrol oral tablet 0(Tier 1) PAMEKINIST ORAL TABLET 0.5 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSMEKINIST ORAL TABLET 2 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSMEKTOVI 0(Tier 2) PA; LA; QL (180 EA per 30 days); NDSmelphalan 0(Tier 1) B/D PAmelphalan hcl 0(Tier 1) B/D PA; NDSmercaptopurine 0(Tier 1)methotrexate sodium (pf) 0(Tier 1) B/D PAmethotrexate sodium injection 0(Tier 1) B/D PAmethotrexate sodium oral 0(Tier 1)mitomycin intravenous 0(Tier 1) B/D PAmitoxantrone 0(Tier 1) B/D PAMONJUVI 0(Tier 2) PA; NDSMVASI 0(Tier 2) PA; NDSmycophenolate mofetil (hcl) 0(Tier 1) PAmycophenolate mofetil oral capsule 0(Tier 1) PAmycophenolate mofetil oral suspension for reconstitution

0(Tier 1) PA; NDS


27



mycophenolate mofetil oral tablet 0(Tier 1) PAmycophenolate sodium 0(Tier 1) PAMYLOTARG 0(Tier 2) PA; NDSNERLYNX 0(Tier 2) PA; LA; NDSNEXAVAR 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSnilutamide 0(Tier 1) NDSNINLARO 0(Tier 2) PA; QL (3 EA per 28 days); NDSNIPENT 0(Tier 2) B/D PANUBEQA 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSNULOJIX 0(Tier 2) PA; QL (26 EA per 28 days); NDSoctreotide acetate injection solution 1,000 mcg/ml, 500 mcg/ml

0(Tier 1) PA; NDS

octreotide acetate injection solution 100 mcg/ml, 200 mcg/ml, 50 mcg/ml

0(Tier 1) PA

ODOMZO 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSOGIVRI 0(Tier 2) PA; NDSONCASPAR 0(Tier 2) B/D PA; NDSONIVYDE 0(Tier 2) PA; NDSOPDIVO 0(Tier 2) PA; QL (80 ML per 28 days); NDSoxaliplatin 0(Tier 1) B/D PApaclitaxel 0(Tier 1) B/D PAPADCEV 0(Tier 2) PA; NDSPEMAZYRE 0(Tier 2) PA; LA; QL (14 EA per 21 days); NDSPERJETA 0(Tier 2) PA; NDSPHESGO 0(Tier 2) PA; NDSPIQRAY 0(Tier 2) PA; NDSPOLIVY 0(Tier 2) PA; NDSPOMALYST 0(Tier 2) PA; LA; QL (21 EA per 28 days); NDSPORTRAZZA 0(Tier 2) B/D PAPOTELIGEO 0(Tier 2) PA; NDSPROGRAF INTRAVENOUS 0(Tier 2) PAPROGRAF ORAL GRANULES IN PACKET 0(Tier 2) PAPURIXAN 0(Tier 2) NDSQINLOCK 0(Tier 2) PA; LA; NDSRETEVMO 0(Tier 2) PA; LA; NDSREVLIMID 0(Tier 2) PA; LA; QL (28 EA per 28 days); NDSRITUXAN HYCELA 0(Tier 2) PA; NDSROMIDEPSIN INTRAVENOUS SOLUTION 0(Tier 2) PA; NDSROZLYTREK ORAL CAPSULE 100 MG 0(Tier 2) PA; QL (150 EA per 30 days); NDS


28



ROZLYTREK ORAL CAPSULE 200 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSRUBRACA 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSRUXIENCE 0(Tier 2) PA; NDSRYDAPT 0(Tier 2) PA; QL (240 EA per 30 days); NDSSANDIMMUNE ORAL SOLUTION 0(Tier 2) PASANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

0(Tier 2) PA; NDS

SARCLISA 0(Tier 2) PA; NDSSIGNIFOR 0(Tier 2) PA; NDSSIMULECT 0(Tier 2) B/D PA; NDSsirolimus oral solution 0(Tier 1) PA; NDSsirolimus oral tablet 0(Tier 1) PASOLTAMOX 0(Tier 2) NDSSOMATULINE DEPOT 0(Tier 2) PA; NDSSPRYCEL ORAL TABLET 100 MG, 140 MG, 50 MG, 80 MG


SPRYCEL ORAL TABLET 20 MG, 70 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSSTIVARGA 0(Tier 2) PA; QL (84 EA per 28 days); NDSSUTENT 0(Tier 2) PA; QL (30 EA per 30 days); NDSSYNRIBO 0(Tier 2) PA; NDSTABLOID 0(Tier 2)TABRECTA 0(Tier 2) PA; NDStacrolimus oral 0(Tier 1) PATAFINLAR 0(Tier 2) PA; QL (120 EA per 30 days); NDSTAGRISSO 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSTALZENNA ORAL CAPSULE 0.25 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSTALZENNA ORAL CAPSULE 1 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDStamoxifen 0(Tier 1)TARGRETIN TOPICAL 0(Tier 2) PA; NDSTASIGNA ORAL CAPSULE 150 MG, 200 MG 0(Tier 2) PA; QL (112 EA per 28 days); NDSTASIGNA ORAL CAPSULE 50 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSTAZVERIK 0(Tier 2) PA; LA; NDSTECENTRIQ 0(Tier 2) PA; NDSTEMODAR INTRAVENOUS 0(Tier 2) B/D PA; NDStemsirolimus 0(Tier 1) B/D PA; NDSTHALOMID ORAL CAPSULE 100 MG, 150 MG, 50 MG


THALOMID ORAL CAPSULE 200 MG 0(Tier 2) PA; QL (56 EA per 28 days); NDS


29



thiotepa 0(Tier 1) PATIBSOVO 0(Tier 2) PA; NDStoposar 0(Tier 1) B/D PAtopotecan intravenous recon soln 0(Tier 1) B/D PA; NDStopotecan intravenous solution 4 mg/4 ml (1 mg/ml)

0(Tier 1) B/D PA

toremifene 0(Tier 1) NDSTRAZIMERA 0(Tier 2) PA; NDSTREANDA INTRAVENOUS RECON SOLN 0(Tier 2) B/D PA; NDSTRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

0(Tier 2) PA; NDS

tretinoin (antineoplastic) 0(Tier 1) NDSTRIPTODUR 0(Tier 2) PA; QL (1 EA per 168 days); NDSTRODELVY 0(Tier 2) PA; NDSTRUXIMA 0(Tier 2) PA; NDSTUKYSA ORAL TABLET 150 MG 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSTUKYSA ORAL TABLET 50 MG 0(Tier 2) PA; LA; QL (300 EA per 30 days); NDSTURALIO 0(Tier 2) PA; LA; NDSTYKERB 0(Tier 2) PA; LA; QL (180 EA per 30 days); NDSUNITUXIN 0(Tier 2) PA; NDSvalrubicin 0(Tier 1) B/D PAVECTIBIX 0(Tier 2) PA; NDSVELCADE 0(Tier 2) PA; NDSVENCLEXTA ORAL TABLET 10 MG 0(Tier 2) PA; LA; QL (60 EA per 30 days)VENCLEXTA ORAL TABLET 100 MG 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSVENCLEXTA ORAL TABLET 50 MG 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSVENCLEXTA STARTING PACK 0(Tier 2) PA; LA; QL (42 EA per 30 days); NDSVERZENIO 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSvinblastine intravenous solution 0(Tier 1) B/D PAvincasar pfs 0(Tier 1) B/D PAvincristine 0(Tier 1) B/D PAvinorelbine 0(Tier 1) B/D PAVITRAKVI ORAL CAPSULE 100 MG 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSVITRAKVI ORAL CAPSULE 25 MG 0(Tier 2) PA; LA; QL (180 EA per 30 days); NDSVITRAKVI ORAL SOLUTION 0(Tier 2) PA; LA; QL (300 ML per 30 days); NDSVIZIMPRO 0(Tier 2) PA; QL (30 EA per 30 days); NDSVOTRIENT 0(Tier 2) PA; QL (120 EA per 30 days); NDSVYXEOS 0(Tier 2) B/D PA; NDSXALKORI 0(Tier 2) PA; QL (60 EA per 30 days); NDS


30



XATMEP 0(Tier 2) PAXOSPATA 0(Tier 2) PA; LA; NDSXPOVIO 0(Tier 2) PA; LA; NDSXTANDI 0(Tier 2) PA; QL (120 EA per 30 days); NDSYERVOY 0(Tier 2) PA; NDSYONDELIS 0(Tier 2) PA; NDSZALTRAP 0(Tier 2) B/D PAZANOSAR 0(Tier 2) B/D PAZEJULA 0(Tier 2) PA; LA; QL (90 EA per 30 days); NDSZELBORAF 0(Tier 2) PA; QL (240 EA per 30 days); NDSZEPZELCA 0(Tier 2) PA; NDSZIRABEV 0(Tier 2) PA; NDSZOLADEX 0(Tier 2) B/D PAZOLINZA 0(Tier 2) PA; QL (120 EA per 30 days); NDSZORTRESS ORAL TABLET 1 MG 0(Tier 2) PA; NDSZYDELIG 0(Tier 2) PA; QL (60 EA per 30 days); NDSZYKADIA ORAL TABLET 0(Tier 2) PA; QL (90 EA per 30 days); NDSAUTONOMIC / CNS DRUGS, NEUROLOGY / PSYCH (DRUGS FOR THE NERVOUS SYSTEM)ANTICONVULSANTSAPTIOM ORAL TABLET 200 MG 0(Tier 2) QL (180 EA per 30 days); NDSAPTIOM ORAL TABLET 400 MG 0(Tier 2) QL (90 EA per 30 days); NDSAPTIOM ORAL TABLET 600 MG, 800 MG 0(Tier 2) QL (60 EA per 30 days); NDSBANZEL 0(Tier 2) PA; NDSBRIVIACT INTRAVENOUS 0(Tier 2) NDSBRIVIACT ORAL SOLUTION 0(Tier 2) QL (600 ML per 30 days); NDSBRIVIACT ORAL TABLET 0(Tier 2) QL (60 EA per 30 days); NDScarbamazepine oral capsule, er multiphase 12 hr

0(Tier 1)

carbamazepine oral suspension 100 mg/5 ml, 200 mg/10 ml

0(Tier 1)

carbamazepine oral tablet 0(Tier 1)carbamazepine oral tablet extended release 12 hr

0(Tier 1)

carbamazepine oral tablet,chewable 0(Tier 1)CELONTIN ORAL CAPSULE 300 MG 0(Tier 2)clobazam oral suspension 0(Tier 1) PA; QL (480 ML per 30 days)clobazam oral tablet 0(Tier 1) PA; QL (60 EA per 30 days)clonazepam oral tablet 0.5 mg, 1 mg 0(Tier 1) QL (90 EA per 30 days)clonazepam oral tablet 2 mg 0(Tier 1) QL (300 EA per 30 days)


31



clonazepam oral tablet,disintegrating 0.125 mg, 0.25 mg, 0.5 mg, 1 mg


clonazepam oral tablet,disintegrating 2 mg 0(Tier 1) QL (300 EA per 30 days)DIACOMIT ORAL CAPSULE 250 MG 0(Tier 2) PA; LA; QL (360 EA per 30 days)DIACOMIT ORAL CAPSULE 500 MG 0(Tier 2) PA; LA; QL (180 EA per 30 days)DIACOMIT ORAL POWDER IN PACKET 250 MG

0(Tier 2) PA; LA; QL (360 EA per 30 days)

DIACOMIT ORAL POWDER IN PACKET 500 MG

0(Tier 2) PA; LA; QL (180 EA per 30 days)

DIASTAT 0(Tier 2)DIASTAT ACUDIAL 0(Tier 2)diazepam rectal 0(Tier 1)dilantin 30 mg 0(Tier 1)divalproex 0(Tier 1)EPIDIOLEX 0(Tier 2) PA; LA; NDSepitol 0(Tier 1)ethosuximide 0(Tier 1)felbamate oral suspension 0(Tier 1) NDSfelbamate oral tablet 0(Tier 1)FINTEPLA 0(Tier 2) PA; LA; NDSfosphenytoin 0(Tier 1)FYCOMPA ORAL SUSPENSION 0(Tier 2) QL (720 ML per 30 days)FYCOMPA ORAL TABLET 10 MG, 12 MG, 8 MG


FYCOMPA ORAL TABLET 2 MG, 4 MG, 6 MG 0(Tier 2) QL (60 EA per 30 days)gabapentin oral capsule 100 mg, 400 mg 0(Tier 1) QL (270 EA per 30 days)gabapentin oral capsule 300 mg 0(Tier 1) QL (360 EA per 30 days)gabapentin oral solution 0(Tier 1) QL (2160 ML per 30 days)gabapentin oral tablet 600 mg 0(Tier 1) QL (180 EA per 30 days)gabapentin oral tablet 800 mg 0(Tier 1) QL (120 EA per 30 days)lamotrigine oral tablet 0(Tier 1)lamotrigine oral tablet extended release 24hr 0(Tier 1)lamotrigine oral tablet, chewable dispersible 0(Tier 1)lamotrigine oral tablet,disintegrating 0(Tier 1)levetiracetam 0(Tier 1)levetiracetam in nacl (iso-os) 0(Tier 1)LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 165 MG, 82.5 MG



32



LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 330 MG


NAYZILAM 0(Tier 2) PA; QL (10 EA per 30 days); NDSoxcarbazepine 0(Tier 1)PHENOBARBITAL ORAL ELIXIR 0(Tier 2) PA; QL (1500 ML per 30 days)PHENOBARBITAL ORAL TABLET 0(Tier 2) PA; QL (120 EA per 30 days)phenobarbital sodium injection solution 0(Tier 1)phenytoin oral suspension 0(Tier 1)phenytoin oral tablet,chewable 0(Tier 1)phenytoin sodium extended 0(Tier 1)phenytoin sodium intravenous solution 0(Tier 1)pregabalin oral capsule 100 mg, 150 mg, 200 mg, 25 mg, 50 mg, 75 mg


pregabalin oral capsule 225 mg, 300 mg 0(Tier 1) QL (60 EA per 30 days)pregabalin oral solution 0(Tier 1) QL (900 ML per 30 days)primidone 0(Tier 1)roweepra 0(Tier 1)rufinamide 0(Tier 1) PA; NDSSPRITAM 0(Tier 2)subvenite 0(Tier 1)subvenite starter (blue) kit 0(Tier 1)subvenite starter (green) kit 0(Tier 1)subvenite starter (orange) kit 0(Tier 1)SYMPAZAN 0(Tier 2) PA; QL (60 EA per 30 days); NDStiagabine 0(Tier 1)topiramate oral capsule, sprinkle 0(Tier 1) PAtopiramate oral tablet 0(Tier 1) PATROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 100 MG, 25 MG, 50 MG

0(Tier 2)

TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 200 MG

0(Tier 2) NDS

valproate sodium 0(Tier 1)valproic acid 0(Tier 1)valproic acid (as sodium salt) oral solution 0(Tier 1)VALTOCO 0(Tier 2) PA; QL (10 EA per 30 days); NDSvigabatrin 0(Tier 1) PA; LA; QL (180 EA per 30 days); NDSvigadrone 0(Tier 1) PA; LA; QL (180 EA per 30 days); NDSVIMPAT INTRAVENOUS 0(Tier 2) QL (1200 ML per 30 days); NDSVIMPAT ORAL SOLUTION 0(Tier 2) QL (1200 ML per 30 days); NDS


33



VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG


VIMPAT ORAL TABLET 50 MG 0(Tier 2) QL (120 EA per 30 days)XCOPRI 0(Tier 2) PA; NDSXCOPRI MAINTENANCE PACK 0(Tier 2) PA; NDSXCOPRI TITRATION PACK 0(Tier 2) PAzonisamide 0(Tier 1) PAANTIPARKINSONISM AGENTSAPOKYN 0(Tier 2) PA; LA; QL (60 ML per 30 days); NDSbenztropine injection 0(Tier 1)benztropine oral 0(Tier 1) PAbromocriptine 0(Tier 1)carbidopa 0(Tier 1)carbidopa-levodopa 0(Tier 1)carbidopa-levodopa-entacapone 0(Tier 1)entacapone 0(Tier 1)NEUPRO 0(Tier 2)pramipexole 0(Tier 1)rasagiline 0(Tier 1)ropinirole oral tablet 0(Tier 1)RYTARY 0(Tier 2) STselegiline hcl 0(Tier 1)tolcapone 0(Tier 1) NDStrihexyphenidyl 0(Tier 1) PAMIGRAINE / CLUSTER HEADACHE THERAPYAIMOVIG AUTOINJECTOR 0(Tier 2) PA; QL (1 ML per 30 days)dihydroergotamine nasal 0(Tier 1) PA; QL (8 ML per 28 days); NDSergotamine-caffeine 0(Tier 1)MIGERGOT 0(Tier 2) NDSnaratriptan 0(Tier 1) QL (18 EA per 28 days)rizatriptan 0(Tier 1) QL (36 EA per 28 days)sumatriptan nasal spray,non-aerosol 20 mg/actuation


sumatriptan nasal spray,non-aerosol 5 mg/actuation


sumatriptan succinate oral 0(Tier 1) QL (18 EA per 28 days)sumatriptan succinate subcutaneous cartridge 0(Tier 1) QL (8 ML per 28 days)sumatriptan succinate subcutaneous pen injector

0(Tier 1) QL (8 ML per 28 days)


34



sumatriptan succinate subcutaneous solution 0(Tier 1) QL (8 ML per 28 days)sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml


MISCELLANEOUS NEUROLOGICAL THERAPYAUSTEDO ORAL TABLET 12 MG, 9 MG 0(Tier 2) PA; LA; QL (120 EA per 30 days); NDSAUSTEDO ORAL TABLET 6 MG 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSCOPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML

0(Tier 2) PA; QL (30 ML per 30 days); NDS

COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML


dalfampridine 0(Tier 1) PA; QL (60 EA per 30 days)dimethyl fumarate oral capsule,delayed release(dr/ec) 120 mg


dimethyl fumarate oral capsule,delayed release(dr/ec) 120 mg (14)- 240 mg (46)


dimethyl fumarate oral capsule,delayed release(dr/ec) 240 mg


donepezil oral tablet 10 mg 0(Tier 1) QL (60 EA per 30 days)donepezil oral tablet 23 mg 0(Tier 1)donepezil oral tablet 5 mg 0(Tier 1) QL (30 EA per 30 days)donepezil oral tablet,disintegrating 10 mg 0(Tier 1) QL (60 EA per 30 days)donepezil oral tablet,disintegrating 5 mg 0(Tier 1) QL (30 EA per 30 days)FIRDAPSE 0(Tier 2) PA; LA; NDSgalantamine oral capsule,ext rel. pellets 24 hr 0(Tier 1) QL (30 EA per 30 days)galantamine oral solution 0(Tier 1) QL (200 ML per 30 days)galantamine oral tablet 0(Tier 1) QL (60 EA per 30 days)GILENYA ORAL CAPSULE 0.5 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSmemantine oral capsule,sprinkle,er 24hr 0(Tier 1) PAmemantine oral solution 0(Tier 1) PA; QL (300 ML per 30 days)memantine oral tablet 10 mg 0(Tier 1) PA; QL (60 EA per 30 days)memantine oral tablet 5 mg 0(Tier 1) PA; QL (90 EA per 30 days)MEMANTINE ORAL TABLETS,DOSE PACK 0(Tier 2) PA; QL (98 EA per 28 days)NAMZARIC 0(Tier 2) PANUEDEXTA 0(Tier 2) PA; NDSOCREVUS 0(Tier 2) PA; NDSrivastigmine 0(Tier 1)rivastigmine tartrate 0(Tier 1) QL (60 EA per 30 days)TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG

0(Tier 2) PA; LA; QL (14 EA per 30 days); NDS


35



TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46)


TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 240 MG


tetrabenazine oral tablet 12.5 mg 0(Tier 1) PA; QL (240 EA per 30 days); NDStetrabenazine oral tablet 25 mg 0(Tier 1) PA; QL (120 EA per 30 days); NDSTYSABRI 0(Tier 2) PA; NDSMUSCLE RELAXANTS / ANTISPASMODIC THERAPYbaclofen oral 0(Tier 1)cyclobenzaprine oral tablet 10 mg, 5 mg 0(Tier 1) PAdantrolene oral 0(Tier 1)methocarbamol oral 0(Tier 1) PApyridostigmine bromide oral syrup 0(Tier 1) NDSpyridostigmine bromide oral tablet 60 mg 0(Tier 1)pyridostigmine bromide oral tablet extended release

0(Tier 1)

regonol 0(Tier 2)tizanidine 0(Tier 1)NARCOTIC ANALGESICSacetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml


acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg


acetaminophen-codeine oral tablet 300-60 mg 0(Tier 1) QL (180 EA per 30 days); NDSbuprenorphine 0(Tier 1) QL (4 EA per 28 days); NDSbuprenorphine hcl injection 0(Tier 1) NDSbuprenorphine hcl sublingual 0(Tier 1) PAendocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg


fentanyl 0(Tier 1) QL (10 EA per 30 days); NDSfentanyl citrate (pf) injection solution 0(Tier 1) NDSfentanyl citrate (pf) intravenous syringe 100 mcg/2 ml (50 mcg/ml)

0(Tier 1) NDS

fentanyl citrate buccal lozenge on a handle 0(Tier 1) PA; QL (120 EA per 30 days); NDShydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml)

0(Tier 1) NDS

hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml



36



hydrocodone-acetaminophen oral tablet 10-300 mg, 7.5-300 mg


hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg


hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg


hydromorphone (pf) injection solution 2 mg/ml 0(Tier 1) NDShydromorphone injection syringe 1 mg/ml, 2 mg/ml

0(Tier 1) NDS

hydromorphone oral liquid 0(Tier 1) QL (2400 ML per 30 days); NDShydromorphone oral tablet 0(Tier 1) QL (180 EA per 30 days); NDSibuprofen-oxycodone 0(Tier 1) QL (28 EA per 30 days); NDSINFUMORPH P/F 0(Tier 1) B/D PA; NDSmethadone injection solution 0(Tier 2) NDSmethadone intensol 0(Tier 1) NDSmethadone oral concentrate 0(Tier 1) NDSmethadone oral solution 10 mg/5 ml 0(Tier 1) QL (600 ML per 30 days); NDSmethadone oral solution 5 mg/5 ml 0(Tier 1) QL (1200 ML per 30 days); NDSmethadone oral tablet 10 mg 0(Tier 1) QL (120 EA per 30 days); NDSmethadone oral tablet 5 mg 0(Tier 1) QL (240 EA per 30 days); NDSmorphine (pf) injection solution 0.5 mg/ml, 1 mg/ml

0(Tier 1) NDS

morphine concentrate oral solution 0(Tier 1) QL (900 ML per 30 days); NDSMORPHINE INJECTION SOLUTION 10 MG/ML, 2 MG/ML, 4 MG/ML, 5 MG/ML

0(Tier 2) NDS

morphine injection solution 8 mg/ml 0(Tier 2) NDSMORPHINE INJECTION SYRINGE 2 MG/ML 0(Tier 1) NDSmorphine injection syringe 4 mg/ml, 5 mg/ml 0(Tier 1) NDSmorphine intravenous solution 10 mg/ml 0(Tier 2) NDSMORPHINE INTRAVENOUS SOLUTION 4 MG/ML

0(Tier 2) NDS

MORPHINE INTRAVENOUS SYRINGE 10 MG/ML

0(Tier 1) NDS

morphine intravenous syringe 2 mg/ml, 4 mg/ml 0(Tier 2) NDSMORPHINE INTRAVENOUS SYRINGE 8 MG/ML

0(Tier 2) NDS

morphine oral solution 0(Tier 1) QL (900 ML per 30 days); NDSMORPHINE ORAL TABLET 0(Tier 2) QL (180 EA per 30 days); NDSmorphine oral tablet extended release 0(Tier 1) QL (120 EA per 30 days); NDSoxycodone oral concentrate 0(Tier 1) QL (180 ML per 30 days); NDS


37



oxycodone oral solution 0(Tier 1) QL (1200 ML per 30 days); NDSoxycodone oral tablet 10 mg, 15 mg, 20 mg, 30 mg


oxycodone oral tablet 5 mg 0(Tier 1) QL (360 EA per 30 days); NDSoxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg


oxycodone-aspirin 0(Tier 1) QL (360 EA per 30 days); NDSoxymorphone oral tablet extended release 12 hr 0(Tier 1) QL (90 EA per 30 days); NDSXTAMPZA ER 0(Tier 2) QL (90 EA per 30 days); NDSNON-NARCOTIC ANALGESICS8 hour pain reliever 0(Tier 1) MC8hr muscle aches-pain 0(Tier 1) MCacetaminophen oral tablet 325 mg 0(Tier 1) MCacetaminophen oral tablet extended release 0(Tier 1) MCacetaminophen rectal 0(Tier 1) MCadult aspirin regimen 0(Tier 1) MCall day pain relief 0(Tier 1) MCall day relief 0(Tier 1) MCaspirin oral tablet 0(Tier 1) MCaspirin oral tablet,chewable 0(Tier 1) MCaspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg

0(Tier 1) MC

buprenorphine-naloxone sublingual film 12-3 mg 0(Tier 1) QL (60 EA per 30 days)buprenorphine-naloxone sublingual film 2-0.5 mg


buprenorphine-naloxone sublingual film 4-1 mg, 8-2 mg


buprenorphine-naloxone sublingual tablet 2-0.5 mg


buprenorphine-naloxone sublingual tablet 8-2 mg


butorphanol nasal 0(Tier 1) QL (10 ML per 28 days); NDScelecoxib 0(Tier 1) QL (60 EA per 30 days)children’s ibuprofen 0(Tier 1) MCchildren’s mapap oral tablet,chewable 80 mg 0(Tier 1) MCdiclofenac potassium 0(Tier 1)diclofenac sodium oral 0(Tier 1)diclofenac sodium topical drops 0(Tier 1) QL (300 ML per 28 days)diclofenac sodium topical gel 1% 0(Tier 1) QL (1000 GM per 28 days)diflunisal 0(Tier 1)


38



ec-naproxen 0(Tier 1)ed-apap 0(Tier 1) MCefferves pain relief antacid 0(Tier 1) MCetodolac 0(Tier 1)flurbiprofen oral tablet 100 mg 0(Tier 1)ibu 0(Tier 1)ibu-200 0(Tier 1) MCibuprofen jr strength 0(Tier 1) MCibuprofen oral capsule 0(Tier 1) MCibuprofen oral suspension 0(Tier 1)ibuprofen oral tablet 200 mg 0(Tier 1) MCibuprofen oral tablet 400 mg, 600 mg, 800 mg 0(Tier 1)infant’s ibuprofen 0(Tier 1) MCmapap (acetaminophen) oral capsule 0(Tier 1) MCmapap (acetaminophen) oral liquid 500 mg/15 ml

0(Tier 1) MC

mapap (acetaminophen) oral tablet 0(Tier 1) MCmapap arthritis pain 0(Tier 1) MCmapap extra strength 0(Tier 1) MCmeloxicam oral tablet 15 mg 0(Tier 1)meloxicam oral tablet 7.5 mg 0(Tier 1) QL (60 EA per 30 days)migraine relief 0(Tier 1) MCm-pap 0(Tier 1) MCnabumetone 0(Tier 1)nalbuphine 0(Tier 1) NDSnaloxone injection solution 0(Tier 1)naloxone injection syringe 1 mg/ml 0(Tier 1)naltrexone 0(Tier 1)naproxen 0(Tier 1)naproxen sodium oral tablet 220 mg 0(Tier 1) MCnaproxen sodium oral tablet 275 mg, 550 mg 0(Tier 1)NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION

0(Tier 2)

non-aspirin pm 0(Tier 1) MCoxaprozin 0(Tier 1)salsalate 0(Tier 1)SUBOXONE SUBLINGUAL FILM 12-3 MG 0(Tier 2) QL (60 EA per 30 days)SUBOXONE SUBLINGUAL FILM 2-0.5 MG 0(Tier 2) QL (360 EA per 30 days)


39



SUBOXONE SUBLINGUAL FILM 4-1 MG, 8-2 MG


sulindac 0(Tier 1)tramadol oral tablet 50 mg 0(Tier 1) QL (240 EA per 30 days); NDStramadol-acetaminophen 0(Tier 1) QL (240 EA per 30 days); NDSVIVITROL 0(Tier 2) NDSZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 1.4-0.36 MG, 11.4-2.9 MG, 2.9-0.71 MG, 5.7-1.4 MG


ZUBSOLV SUBLINGUAL TABLET 8.6-2.1 MG 0(Tier 2) QL (60 EA per 30 days)PSYCHOTHERAPEUTIC DRUGSABILIFY MAINTENA 0(Tier 2) QL (1 EA per 28 days); NDSADASUVE 0(Tier 2)alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg 0(Tier 1) QL (120 EA per 30 days)alprazolam oral tablet 2 mg 0(Tier 1) QL (150 EA per 30 days)alprazolam oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg


alprazolam oral tablet,disintegrating 2 mg 0(Tier 1) QL (150 EA per 30 days)amitriptyline 0(Tier 1)amoxapine 0(Tier 1)aripiprazole oral solution 0(Tier 1)aripiprazole oral tablet 0(Tier 1) QL (30 EA per 30 days)aripiprazole oral tablet,disintegrating 0(Tier 1) QL (60 EA per 30 days); NDSARISTADA INITIO 0(Tier 2) NDSARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 1,064 MG/3.9 ML

0(Tier 2) QL (3.9 ML per 56 days); NDS

ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 441 MG/1.6 ML






armodafinil 0(Tier 1) PA; QL (30 EA per 30 days)atomoxetine oral capsule 10 mg, 18 mg, 25 mg, 40 mg


atomoxetine oral capsule 100 mg, 60 mg, 80 mg 0(Tier 1) QL (30 EA per 30 days)bupropion hcl oral tablet 100 mg 0(Tier 1) QL (120 EA per 30 days)bupropion hcl oral tablet 75 mg 0(Tier 1) QL (180 EA per 30 days)bupropion hcl oral tablet extended release 24 hr 150 mg



40



bupropion hcl oral tablet extended release 24 hr 300 mg


bupropion hcl oral tablet sustained-release 12 hr 0(Tier 1) QL (60 EA per 30 days)buspirone 0(Tier 1)CAPLYTA 0(Tier 2) PA; QL (30 EA per 30 days); NDSchlorpromazine 0(Tier 1)citalopram 0(Tier 1)clomipramine 0(Tier 1)clonidine hcl oral tablet extended release 12 hr 0(Tier 1)clorazepate dipotassium oral tablet 15 mg 0(Tier 1) QL (180 EA per 30 days)clorazepate dipotassium oral tablet 3.75 mg 0(Tier 1) QL (90 EA per 30 days)clorazepate dipotassium oral tablet 7.5 mg 0(Tier 1) QL (360 EA per 30 days)clozapine 0(Tier 1)desipramine 0(Tier 1)desvenlafaxine succinate 0(Tier 1) QL (30 EA per 30 days)dexmethylphenidate oral tablet 0(Tier 1)dextroamphetamine oral capsule, extended release

0(Tier 1)

dextroamphetamine oral solution 0(Tier 1) QL (1800 ML per 30 days)dextroamphetamine oral tablet 0(Tier 1)dextroamphetamine-amphetamine oral capsule,extended release 24hr


dextroamphetamine-amphetamine oral tablet 10 mg


dextroamphetamine-amphetamine oral tablet 12.5 mg, 30 mg, 7.5 mg








diazepam injection 0(Tier 1)diazepam intensol 0(Tier 1) QL (240 ML per 30 days)diazepam oral concentrate 0(Tier 1) QL (240 ML per 30 days)diazepam oral solution 5 mg/5 ml (1 mg/ml) 0(Tier 1) QL (1200 ML per 30 days)diazepam oral tablet 0(Tier 1) QL (120 EA per 30 days)doxepin oral capsule 0(Tier 1)doxepin oral concentrate 0(Tier 1)doxepin oral tablet 0(Tier 1) QL (30 EA per 30 days)


41



DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 20 MG, 30 MG, 60 MG


DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 40 MG


duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg


EMSAM 0(Tier 2) QL (30 EA per 30 days); NDSescitalopram oxalate oral solution 0(Tier 1) QL (600 ML per 30 days)escitalopram oxalate oral tablet 0(Tier 1)FANAPT ORAL TABLET 1 MG 0(Tier 2) PA; QL (60 EA per 30 days)FANAPT ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG


FANAPT ORAL TABLETS,DOSE PACK 0(Tier 2) PA; QL (8 EA per 28 days)FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK

0(Tier 2) ST; QL (28 EA per 28 days)

FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR


fluoxetine oral capsule 10 mg 0(Tier 1) QL (30 EA per 30 days)fluoxetine oral capsule 20 mg 0(Tier 1)fluoxetine oral capsule 40 mg 0(Tier 1) QL (60 EA per 30 days)fluoxetine oral capsule,delayed release(dr/ec) 0(Tier 1) QL (4 EA per 28 days)fluoxetine oral solution 0(Tier 1)fluoxetine oral tablet 10 mg 0(Tier 1) QL (30 EA per 30 days)fluoxetine oral tablet 20 mg 0(Tier 1)fluphenazine decanoate 0(Tier 1)fluphenazine hcl 0(Tier 1)fluvoxamine oral tablet 100 mg 0(Tier 1) QL (90 EA per 30 days)fluvoxamine oral tablet 25 mg 0(Tier 1) QL (30 EA per 30 days)fluvoxamine oral tablet 50 mg 0(Tier 1) QL (60 EA per 30 days)GUANIDINE 0(Tier 2)haloperidol 0(Tier 1)haloperidol decanoate 0(Tier 1)haloperidol lactate injection 0(Tier 1)haloperidol lactate oral 0(Tier 1)HETLIOZ 0(Tier 2) PA; QL (30 EA per 30 days); NDSimipramine hcl 0(Tier 1)INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML



42



INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML


INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 234 MG/1.5 ML



0(Tier 2) QL (0.25 ML per 28 days)



INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML








LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG


LATUDA ORAL TABLET 80 MG 0(Tier 2) QL (60 EA per 30 days); NDSlithium carbonate 0(Tier 1)lorazepam injection 0(Tier 1)lorazepam intensol 0(Tier 1) QL (150 ML per 30 days)lorazepam oral concentrate 0(Tier 1) QL (150 ML per 30 days)lorazepam oral tablet 0.5 mg, 1 mg 0(Tier 1) QL (90 EA per 30 days)lorazepam oral tablet 2 mg 0(Tier 1) QL (150 EA per 30 days)loxapine succinate 0(Tier 1)maprotiline 0(Tier 1)MARPLAN 0(Tier 2) QL (180 EA per 30 days)methylphenidate hcl oral tablet 0(Tier 1) QL (90 EA per 30 days)methylphenidate hcl oral tablet extended release

0(Tier 1)

methylphenidate hcl oral tablet extended release 24hr 18 mg, 18 mg (bx rating), 27 mg, 27 mg (bx rating), 36 mg, 36 mg (bx rating), 54 mg, 54 mg (bx rating)

0(Tier 1)

mirtazapine oral tablet 0(Tier 1)mirtazapine oral tablet,disintegrating 0(Tier 1) QL (30 EA per 30 days)molindone 0(Tier 1)nefazodone 0(Tier 1)nortriptyline 0(Tier 1)NUPLAZID ORAL CAPSULE 0(Tier 2) PA; QL (30 EA per 30 days); NDS


43



NUPLAZID ORAL TABLET 10 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSolanzapine intramuscular 0(Tier 1) QL (30 EA per 30 days)olanzapine oral tablet 0(Tier 1)olanzapine oral tablet,disintegrating 0(Tier 1) QL (30 EA per 30 days)olanzapine-fluoxetine 0(Tier 1)oxazepam 0(Tier 1) QL (120 EA per 30 days)paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 9 mg

0(Tier 1) PA; QL (30 EA per 30 days)

paliperidone oral tablet extended release 24hr 6 mg


paroxetine hcl oral tablet 0(Tier 1)paroxetine hcl oral tablet extended release 24 hr 0(Tier 1) QL (60 EA per 30 days)PAXIL ORAL SUSPENSION 0(Tier 2) ST; QL (900 ML per 30 days)perphenazine 0(Tier 1)perphenazine-amitriptyline 0(Tier 1)PERSERIS 0(Tier 2) QL (1 EA per 30 days); NDSphenelzine 0(Tier 1)pimozide 0(Tier 1)protriptyline 0(Tier 1)quetiapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg


quetiapine oral tablet 300 mg, 400 mg 0(Tier 1) QL (60 EA per 30 days)quetiapine oral tablet extended release 24 hr 150 mg, 200 mg


quetiapine oral tablet extended release 24 hr 300 mg, 400 mg, 50 mg


ramelteon 0(Tier 1) QL (30 EA per 30 days)REXULTI 0(Tier 2) QL (30 EA per 30 days); NDSRISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 12.5 MG/2 ML


RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML


risperidone oral solution 0(Tier 1)risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg


risperidone oral tablet 4 mg 0(Tier 1) QL (120 EA per 30 days)risperidone oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg



44



risperidone oral tablet,disintegrating 4 mg 0(Tier 1) QL (120 EA per 30 days)SAPHRIS 0(Tier 2) QL (60 EA per 30 days); NDSSECUADO 0(Tier 2) QL (30 EA per 30 days)sertraline 0(Tier 1)sleep aid (doxylamine) 0(Tier 1) MCtemazepam 0(Tier 1) QL (60 EA per 365 days)thioridazine 0(Tier 1)thiothixene 0(Tier 1)tranylcypromine 0(Tier 1)trazodone 0(Tier 1)trifluoperazine 0(Tier 1)trimipramine 0(Tier 1)TRINTELLIX 0(Tier 2) ST; QL (30 EA per 30 days)venlafaxine oral capsule,extended release 24hr 0(Tier 1)venlafaxine oral tablet 0(Tier 1) QL (90 EA per 30 days)VERSACLOZ 0(Tier 2) NDSVIIBRYD ORAL TABLET 0(Tier 2) ST; QL (30 EA per 30 days)VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)


VRAYLAR ORAL CAPSULE 0(Tier 2) PA; QL (30 EA per 30 days); NDSVRAYLAR ORAL CAPSULE,DOSE PACK 0(Tier 2) PA; QL (7 EA per 30 days)XYREM 0(Tier 2) PA; LA; QL (540 ML per 30 days); NDSzaleplon oral capsule 10 mg 0(Tier 1) QL (60 EA per 30 days)zaleplon oral capsule 5 mg 0(Tier 1) QL (30 EA per 30 days)ziprasidone hcl 0(Tier 1) QL (60 EA per 30 days)ziprasidone mesylate 0(Tier 1) QL (6 EA per 30 days)zolpidem oral tablet 0(Tier 1) QL (30 EA per 30 days)ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 300 MG, 405 MG

0(Tier 2) PA; NDS

CARDIOVASCULAR, HYPERTENSION / LIPIDS (DRUGS FOR THE HEART AND BLOOD VESSELS)ANTIARRHYTHMIC AGENTSamiodarone intravenous solution 0(Tier 1) B/D PAamiodarone oral 0(Tier 1)dofetilide 0(Tier 1)flecainide 0(Tier 1)


45



lidocaine (pf) intravenous syringe 0(Tier 1)mexiletine 0(Tier 1)pacerone oral tablet 100 mg, 200 mg, 400 mg 0(Tier 1)propafenone 0(Tier 1)quinidine sulfate oral tablet 0(Tier 1)sorine 0(Tier 1)sotalol af 0(Tier 1)sotalol oral 0(Tier 1)SOTYLIZE 0(Tier 2)ANTIHYPERTENSIVE THERAPYacebutolol 0(Tier 1)aliskiren 0(Tier 1)amiloride 0(Tier 1)amiloride-hydrochlorothiazide 0(Tier 1)amlodipine 0(Tier 1)amlodipine-benazepril 0(Tier 1)amlodipine-valsartan 0(Tier 1)amlodipine-valsartan-hcthiazid 0(Tier 1)atenolol 0(Tier 1)atenolol-chlorthalidone 0(Tier 1)benazepril 0(Tier 1)benazepril-hydrochlorothiazide 0(Tier 1)betaxolol oral 0(Tier 1)BIDIL 0(Tier 2)bisoprolol fumarate 0(Tier 1)bisoprolol-hydrochlorothiazide 0(Tier 1)bumetanide 0(Tier 1)BYSTOLIC 0(Tier 2)candesartan oral tablet 16 mg, 4 mg, 8 mg 0(Tier 1) QL (60 EA per 30 days)candesartan oral tablet 32 mg 0(Tier 1) QL (30 EA per 30 days)candesartan-hydrochlorothiazid 0(Tier 1)cartia xt 0(Tier 1)carvedilol 0(Tier 1)carvedilol phosphate 0(Tier 1)chlorothiazide sodium 0(Tier 1)chlorthalidone oral tablet 25 mg, 50 mg 0(Tier 1)clonidine 0(Tier 1) QL (4 EA per 28 days)clonidine hcl oral tablet 0(Tier 1)


46



DEMSER 0(Tier 2) PA; NDSdiltiazem hcl intravenous 0(Tier 1)diltiazem hcl oral capsule,ext.rel 24h degradable 0(Tier 1)diltiazem hcl oral capsule,extended release 12 hr

0(Tier 1)

diltiazem hcl oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 420 mg

0(Tier 1)

diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg

0(Tier 1)

diltiazem hcl oral tablet 0(Tier 1)diltiazem hcl oral tablet extended release 24 hr 0(Tier 1)dilt-xr 0(Tier 1)doxazosin oral tablet 1 mg, 2 mg, 4 mg 0(Tier 1) QL (30 EA per 30 days)doxazosin oral tablet 8 mg 0(Tier 1) QL (60 EA per 30 days)EDARBI 0(Tier 2)EDARBYCLOR 0(Tier 2)enalapril maleate 0(Tier 1)enalapril-hydrochlorothiazide 0(Tier 1)ethacrynate sodium 0(Tier 1)felodipine 0(Tier 1)fosinopril 0(Tier 1)fosinopril-hydrochlorothiazide 0(Tier 1)furosemide injection 0(Tier 1)furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)

0(Tier 1)

furosemide oral tablet 0(Tier 1)hydralazine 0(Tier 1)hydrochlorothiazide 0(Tier 1)indapamide 0(Tier 1)irbesartan 0(Tier 1) QL (30 EA per 30 days)irbesartan-hydrochlorothiazide 0(Tier 1) QL (30 EA per 30 days)isradipine 0(Tier 1)labetalol oral 0(Tier 1)lisinopril 0(Tier 1)lisinopril-hydrochlorothiazide 0(Tier 1)losartan 0(Tier 1) QL (60 EA per 30 days)losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg



47



losartan-hydrochlorothiazide oral tablet 50-12.5 mg


matzim la 0(Tier 1)methyldopa 0(Tier 1)metolazone 0(Tier 1)metoprolol succinate 0(Tier 1)metoprolol ta-hydrochlorothiaz 0(Tier 1)metoprolol tartrate oral 0(Tier 1)metyrosine 0(Tier 1) PA; NDSminoxidil oral 0(Tier 1)moexipril 0(Tier 1)nadolol 0(Tier 1)nadolol-bendroflumethiazide oral tablet 80-5 mg 0(Tier 1)nicardipine intravenous solution 0(Tier 1)nicardipine oral 0(Tier 1)nifedipine oral tablet extended release 0(Tier 1)nifedipine oral tablet extended release 24hr 0(Tier 1)nimodipine 0(Tier 1)nisoldipine 0(Tier 1)olmesartan 0(Tier 1)olmesartan-hydrochlorothiazide 0(Tier 1)perindopril erbumine 0(Tier 1)phenoxybenzamine 0(Tier 1) NDSpindolol 0(Tier 1)prazosin 0(Tier 1)propranolol oral 0(Tier 1)propranolol-hydrochlorothiazid 0(Tier 1)quinapril 0(Tier 1)quinapril-hydrochlorothiazide 0(Tier 1)ramipril 0(Tier 1)spironolactone 0(Tier 1)spironolacton-hydrochlorothiaz 0(Tier 1)taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg

0(Tier 1)

TEKTURNA HCT 0(Tier 2)telmisartan 0(Tier 1)telmisartan-amlodipine 0(Tier 1)telmisartan-hydrochlorothiazid 0(Tier 1)terazosin oral capsule 1 mg, 2 mg, 5 mg 0(Tier 1) QL (30 EA per 30 days)


48



terazosin oral capsule 10 mg 0(Tier 1) QL (60 EA per 30 days)tiadylt er 0(Tier 1)timolol maleate oral 0(Tier 1)torsemide oral 0(Tier 1)trandolapril 0(Tier 1)triamterene-hydrochlorothiazid oral capsule 37.5-25 mg

0(Tier 1)

triamterene-hydrochlorothiazid oral tablet 0(Tier 1)UPTRAVI 0(Tier 2) PA; LA; NDSvalsartan oral tablet 160 mg, 40 mg, 80 mg 0(Tier 1) QL (60 EA per 30 days)valsartan oral tablet 320 mg 0(Tier 1) QL (30 EA per 30 days)valsartan-hydrochlorothiazide 0(Tier 1) QL (30 EA per 30 days)verapamil intravenous solution 0(Tier 1)verapamil oral capsule, 24 hr er pellet ct 0(Tier 1)verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg

0(Tier 1)

VERAPAMIL ORAL CAPSULE,EXT REL. PELLETS 24 HR 360 MG

0(Tier 2)

verapamil oral tablet 0(Tier 1)verapamil oral tablet extended release 0(Tier 1)COAGULATION THERAPYaminocaproic acid oral 0(Tier 1)aspirin-dipyridamole 0(Tier 1)BRILINTA 0(Tier 2) QL (60 EA per 30 days)cilostazol 0(Tier 1)clopidogrel oral tablet 300 mg 0(Tier 1)clopidogrel oral tablet 75 mg 0(Tier 1) QL (30 EA per 30 days)dipyridamole oral 0(Tier 1)ELIQUIS 0(Tier 2)ELIQUIS DVT-PE TREAT 30D START 0(Tier 2)enoxaparin 0(Tier 1)fondaparinux subcutaneous syringe 10 mg/0.8 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml

0(Tier 1) NDS

fondaparinux subcutaneous syringe 2.5 mg/0.5 ml

0(Tier 1)

heparin (porcine) in 5% dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml), 25,000 unit/250 ml(100 unit/ml), 25,000 unit/500 ml (50 unit/ml)

0(Tier 1)

heparin (porcine) in nacl (pf) 0(Tier 1)


49



heparin (porcine) injection solution 0(Tier 1)heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml

0(Tier 1)

heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml

0(Tier 1)

HEPARIN, PORCINE (PF) INJECTION SYRINGE 5,000 UNIT/ML

0(Tier 1)

jantoven 0(Tier 1)MEPHYTON 0(Tier 1) MCpentoxifylline 0(Tier 1)phytonadione (vitamin k1) injection solution 0(Tier 1) MCphytonadione (vitamin k1) oral tablet 5 mg 0(Tier 1) MCPRADAXA 0(Tier 2)prasugrel 0(Tier 1)PROMACTA ORAL POWDER IN PACKET 12.5 MG


PROMACTA ORAL POWDER IN PACKET 25 MG


PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG


PROMACTA ORAL TABLET 75 MG 0(Tier 2) PA; LA; QL (60 EA per 30 days); NDSvitamin k1 injection 0(Tier 1) MCwarfarin 0(Tier 1)XARELTO 0(Tier 2)XARELTO DVT-PE TREAT 30D START 0(Tier 2)LIPID/CHOLESTEROL LOWERING AGENTSatorvastatin 0(Tier 1) QL (30 EA per 30 days)cholestyramine (with sugar) 0(Tier 1)cholestyramine light 0(Tier 1)colesevelam 0(Tier 1)colestipol 0(Tier 1)endur-acin oral tablet extended release 250 mg, 500 mg

0(Tier 1) MC

ezetimibe 0(Tier 1) QL (30 EA per 30 days)ezetimibe-simvastatin 0(Tier 1) QL (30 EA per 30 days)fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg

0(Tier 1)

fenofibrate nanocrystallized oral tablet 145 mg, 48 mg

0(Tier 1)


50



fenofibrate oral tablet 160 mg, 54 mg 0(Tier 1)fenofibric acid (choline) 0(Tier 1)gemfibrozil 0(Tier 1)LIVALO 0(Tier 2) QL (30 EA per 30 days)lovastatin oral tablet 10 mg 0(Tier 1) QL (30 EA per 30 days)lovastatin oral tablet 20 mg, 40 mg 0(Tier 1) QL (60 EA per 30 days)niacin oral capsule, extended release 250 mg 0(Tier 1) MCniacin oral tablet 100 mg, 50 mg, 500 mg 0(Tier 1) MCniacin oral tablet extended release 24 hr 0(Tier 1)niacin oral tablet extended release 250 mg, 500 mg

0(Tier 1) MC

niacor 0(Tier 1)omega-3 acid ethyl esters 0(Tier 1)pravastatin 0(Tier 1) QL (30 EA per 30 days)prevalite 0(Tier 1)REPATHA 0(Tier 2) PA; QL (3 ML per 28 days)REPATHA PUSHTRONEX 0(Tier 2) PA; QL (3.5 ML per 28 days)REPATHA SURECLICK 0(Tier 2) PA; QL (3 ML per 28 days)rosuvastatin 0(Tier 1) QL (30 EA per 30 days)simvastatin oral tablet 0(Tier 1) QL (30 EA per 30 days)SLO-NIACIN ORAL TABLET EXTENDED RELEASE 250 MG

0(Tier 1) MC

slo-niacin oral tablet extended release 500 mg 0(Tier 1) MCVASCEPA 0(Tier 2)MISCELLANEOUS CARDIOVASCULAR AGENTSCORLANOR ORAL TABLET 0(Tier 2) PAdigitek 0(Tier 1)digox 0(Tier 1)digoxin oral solution 50 mcg/ml (0.05 mg/ml) 0(Tier 1)digoxin oral tablet 0(Tier 1)ENTRESTO 0(Tier 2) QL (60 EA per 30 days)LANOXIN ORAL TABLET 62.5 MCG (0.0625 MG)

0(Tier 2)

ranolazine 0(Tier 1) QL (60 EA per 30 days)VYNDAQEL 0(Tier 2) PA; NDSNITRATESisosorbide dinitrate oral tablet 0(Tier 1)isosorbide mononitrate 0(Tier 1)minitran 0(Tier 1)


51



nitroglycerin intravenous 0(Tier 1) B/D PAnitroglycerin sublingual 0(Tier 1)nitroglycerin transdermal patch 24 hour 0(Tier 1)nitroglycerin translingual spray,non-aerosol 0(Tier 1)DERMATOLOGICALS/TOPICAL THERAPY (DRUGS USED FOR SKIN PROBLEMS)ANTIPSORIATIC / ANTISEBORRHEICacitretin 0(Tier 1) PAcalcipotriene scalp 0(Tier 1) QL (120 ML per 30 days)calcipotriene topical cream 0(Tier 1) QL (120 GM per 30 days)calcipotriene topical ointment 0(Tier 1) QL (120 GM per 30 days)calcitriol topical 0(Tier 1)selenium sulfide topical lotion 0(Tier 1)SKYRIZI SUBCUTANEOUS SYRINGE KIT 0(Tier 2) PA; QL (2 EA per 28 days); NDSSTELARA SUBCUTANEOUS SOLUTION 0(Tier 2) PA; QL (0.5 ML per 28 days); NDSSTELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML

0(Tier 2) PA; QL (0.5 ML per 28 days); NDS

STELARA SUBCUTANEOUS SYRINGE 90 MG/ML


TALTZ SYRINGE 0(Tier 2) PA; QL (4 ML per 28 days); NDSKERATOLYTICScallus removers 0(Tier 1) MCcorn-callus remover topical liquid 17% 0(Tier 1) MCMISCELLANEOUS DERMATOLOGICALSammonium lactate 0(Tier 1)astringent 0(Tier 1) MCblue gel 0(Tier 1) MCcalamine clear 0(Tier 1) MCcalamine plus (pramox-calamin) 0(Tier 1) MCcaldyphen clear topical lotion 1-0.1% 0(Tier 1) MCcapsaicin topical cream 0.025% 0(Tier 1) MCCHEST RUB TOPICAL OINTMENT 0(Tier 1) MCCOATS ALOE MOISTURIZING 0(Tier 1) MCCOATS ALOE TOPICAL CREAM 0(Tier 1) MCCOATS ALOE TOPICAL GEL 0(Tier 1) MCCOZIMA 0(Tier 1) MCCUTTER BACKWOODS 0(Tier 1) MCCUTTER BACKWOODS DRY 0(Tier 1) MCCUTTER LEMON EUCALYPTUS 0(Tier 1) MCdiaper rash topical ointment 0(Tier 1) MC


52



dibucaine 0(Tier 1) MCDR. SMITH’S DIAPER 0(Tier 1) MCDR. SMITH’S DIAPER RASH 0(Tier 1) MCDUPIXENT PEN 0(Tier 2) PA; QL (8 ML per 28 days); NDSDUPIXENT SYRINGE SUBCUTANEOUS SYRINGE 200 MG/1.14 ML


DUPIXENT SYRINGE SUBCUTANEOUS SYRINGE 300 MG/2 ML


FLUOROURACIL TOPICAL CREAM 0.5% 0(Tier 2) NDSfluorouracil topical cream 5% 0(Tier 1)fluorouracil topical solution 0(Tier 1)glydo 0(Tier 1) QL (60 ML per 30 days)HEMORRHOIDAL RELIEF 0(Tier 1) MCimiquimod topical cream in metered-dose pump 0(Tier 1) NDSimiquimod topical cream in packet 0(Tier 1)INSECT REPELLENT (PICARIDIN) 0(Tier 1) MClidocaine (pf) injection solution 0(Tier 1)lidocaine hcl injection solution 0(Tier 1)lidocaine hcl laryngotracheal 0(Tier 1)lidocaine hcl mucous membrane jelly 0(Tier 1) QL (60 ML per 30 days)lidocaine hcl mucous membrane jelly in applicator


lidocaine hcl mucous membrane solution 4% (40 mg/ml)

0(Tier 1)

lidocaine topical adhesive patch,medicated 5% 0(Tier 1) PA; QL (90 EA per 30 days)lidocaine topical ointment 0(Tier 1) QL (50 GM per 30 days)lidocaine viscous 0(Tier 1)lidocaine-prilocaine topical cream 0(Tier 1) QL (30 GM per 30 days)MEDI-PADS 0(Tier 1) MCmethoxsalen 0(Tier 1)MOISTUREL THERAPEUTIC 0(Tier 1) MCNATRAPEL 0(Tier 1) MCOFF DEEP WOODS 0(Tier 1) MCOFF DEEP WOODS DRY 0(Tier 1) MCOFF DEEP WOODS SPORTSMEN TOPICAL AEROSOL,SPRAY

0(Tier 1) MC

OFF DEEP WOODS SPORTSMEN TOPICAL SPRAY,NON-AEROSOL 25%

0(Tier 1) MC

PAIN RELIEVING (M-SALIC-MEN) 0(Tier 1) MC


53



PANRETIN 0(Tier 2) NDSPICATO 0(Tier 2) NDSpimecrolimus 0(Tier 1) QL (100 GM per 30 days)podofilox 0(Tier 1)REGRANEX 0(Tier 2) PA; NDSREPEL HUNTER’S 0(Tier 1) MCREPEL LEMON EUCALYPTUS 0(Tier 1) MCREPEL SPORTSMEN 0(Tier 1) MCREPEL SPORTSMEN DRY 0(Tier 1) MCREPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

0(Tier 1) MC

SANTYL 0(Tier 2)silver sulfadiazine 0(Tier 1)SSD 0(Tier 2)tacrolimus topical 0(Tier 1) PA; QL (100 GM per 30 days)ULTRATHON TOPICAL AEROSOL,SPRAY 0(Tier 1) MCVALCHLOR 0(Tier 2) PA; NDSvits a and d-white pet-lanolin topical ointment 0(Tier 1) MCwhite petrolatum topical ointment 0(Tier 1) MCZ-BUM 0(Tier 1) MCzinc oxide topical ointment 20%, 25% 0(Tier 1) MCZTLIDO 0(Tier 2) PA; QL (90 EA per 30 days)THERAPY FOR ACNEACNE MEDICATION TOPICAL GEL 10%, 5% 0(Tier 1) MCACNE MEDICATION TOPICAL LOTION 0(Tier 1) MCamnesteem 0(Tier 1)avita 0(Tier 1) PAbenzoyl peroxide topical cleanser 10%, 5% 0(Tier 1) MCbenzoyl peroxide topical gel 10%, 2.5%, 5% 0(Tier 1) MCclaravis 0(Tier 1)clindacin etz topical swab 0(Tier 1) QL (60 EA per 30 days)clindacin p 0(Tier 1) QL (60 EA per 30 days)clindamycin phosphate topical gel 0(Tier 1) QL (120 GM per 30 days)CLINDAMYCIN PHOSPHATE TOPICAL GEL, ONCE DAILY


clindamycin phosphate topical lotion 0(Tier 1) QL (120 ML per 30 days)clindamycin phosphate topical solution 0(Tier 1) QL (120 ML per 30 days)clindamycin phosphate topical swab 0(Tier 1) QL (60 EA per 30 days)ery pads 0(Tier 1)


54



erythromycin with ethanol topical gel 0(Tier 1)erythromycin with ethanol topical solution 0(Tier 1)erythromycin-benzoyl peroxide 0(Tier 1)isotretinoin 0(Tier 1)metronidazole topical 0(Tier 1)myorisan 0(Tier 1)rosadan topical cream 0(Tier 1)rosadan topical gel 0(Tier 1)tazarotene 0(Tier 1) PATAZORAC 0(Tier 2) PAtretinoin microspheres 0(Tier 1) PAtretinoin topical 0(Tier 1) PAzenatane 0(Tier 1)TOPICAL ANTIBACTERIALSbacitracin topical ointment 0(Tier 1) MCbacitracin zinc topical ointment 0(Tier 1) MCDOUBLE ANTIBIOTIC (B.TRACN ZN) TOPICAL OINTMENT

0(Tier 1) MC

gentamicin topical 0(Tier 1)mupirocin 0(Tier 1) QL (44 GM per 30 days)mupirocin calcium 0(Tier 1) QL (30 GM per 30 days)POLY BACITRACIN (ZINC) 0(Tier 1) MCpovidone-iodine topical ointment 0(Tier 1) MCpovidone-iodine topical solution 10% 0(Tier 1) MCsulfacetamide sodium (acne) 0(Tier 1)triple antibiotic plus 0(Tier 1) MCtriple antibiotic topical ointment 0(Tier 1) MCtriple antibiotic topical ointment in packet 0(Tier 1) MCTOPICAL ANTIFUNGALSantifungal 0(Tier 1) MCantifungal (clotrimazole) 0(Tier 1) MCantifungal (tolnaftate) topical cream 0(Tier 1) MCantifungal (tolnaftate) topical powder 0(Tier 1) MCanti-fungal topical powder 0(Tier 1) MCathlete’s foot topical aerosol powder 0(Tier 1) MCciclodan topical solution 0(Tier 1)ciclopirox topical cream 0(Tier 1) QL (90 GM per 28 days)ciclopirox topical shampoo 0(Tier 1) QL (120 ML per 28 days)


55



ciclopirox topical solution 0(Tier 1)ciclopirox topical suspension 0(Tier 1) QL (60 ML per 28 days)clotrimazole topical cream 0(Tier 1) QL (45 GM per 28 days)clotrimazole topical solution 0(Tier 1) QL (30 ML per 28 days)clotrimazole-betamethasone topical cream 0(Tier 1) QL (45 GM per 28 days)clotrimazole-betamethasone topical lotion 0(Tier 1) QL (60 ML per 28 days)econazole 0(Tier 1) QL (85 GM per 28 days)fungoid tincture topical tincture 0(Tier 1) MCketoconazole topical cream 0(Tier 1) QL (60 GM per 28 days)ketoconazole topical shampoo 0(Tier 1) QL (120 ML per 28 days)miconazole nitrate topical cream 0(Tier 1) MCnaftifine topical cream 0(Tier 1) QL (60 GM per 28 days)NAFTIN TOPICAL GEL 0(Tier 2) QL (60 GM per 28 days)nyamyc 0(Tier 1)nystatin topical cream 0(Tier 1) QL (30 GM per 28 days)nystatin topical ointment 0(Tier 1) QL (30 GM per 28 days)nystatin topical powder 0(Tier 1)nystatin-triamcinolone 0(Tier 1) QL (60 GM per 28 days)nystop 0(Tier 1)terbinafine hcl topical 0(Tier 1) MCtolnaftate topical cream 0(Tier 1) MCtolnaftate topical powder 0(Tier 1) MCTOPICAL ANTIVIRALSacyclovir topical ointment 0(Tier 1) QL (30 GM per 30 days)DENAVIR 0(Tier 2) NDSTOPICAL CORTICOSTEROIDSala-cort topical cream 1% 0(Tier 1)alclometasone 0(Tier 1)betamethasone dipropionate 0(Tier 1)betamethasone valerate 0(Tier 1)betamethasone, augmented 0(Tier 1)clobetasol scalp 0(Tier 1) QL (100 ML per 28 days)clobetasol topical cream 0(Tier 1) QL (120 GM per 28 days)clobetasol topical foam 0(Tier 1) QL (100 GM per 28 days)clobetasol topical gel 0(Tier 1) QL (120 GM per 28 days)clobetasol topical ointment 0(Tier 1) QL (120 GM per 28 days)clobetasol topical shampoo 0(Tier 1) QL (236 ML per 28 days)clobetasol-emollient topical cream 0(Tier 1) QL (120 GM per 28 days)


56



clobetasol-emollient topical foam 0(Tier 1) QL (100 GM per 28 days)clocortolone pivalate 0(Tier 1)clodan 0(Tier 1) QL (236 ML per 28 days)desonide topical cream 0(Tier 1)desonide topical lotion 0(Tier 1)desonide topical ointment 0(Tier 1)desoximetasone topical cream 0(Tier 1)desoximetasone topical gel 0(Tier 1)desoximetasone topical ointment 0(Tier 1)fluocinolone 0(Tier 1)fluocinolone and shower cap 0(Tier 1)fluocinonide topical cream 0.05% 0(Tier 1)fluocinonide topical cream 0.1% 0(Tier 1) QL (120 GM per 30 days)fluocinonide topical gel 0(Tier 1) QL (120 GM per 30 days)fluocinonide topical ointment 0(Tier 1) QL (120 GM per 30 days)fluocinonide topical solution 0(Tier 1) QL (120 ML per 30 days)fluticasone propionate topical cream 0(Tier 1)fluticasone propionate topical ointment 0(Tier 1)halobetasol propionate topical cream 0(Tier 1)halobetasol propionate topical ointment 0(Tier 1)hydrocortisone butyrate topical cream 0(Tier 1) QL (120 GM per 30 days)hydrocortisone butyrate topical ointment 0(Tier 1)hydrocortisone butyrate topical solution 0(Tier 1) QL (120 ML per 30 days)hydrocortisone butyr-emollient 0(Tier 1) QL (120 GM per 30 days)hydrocortisone topical cream 1%, 2.5% 0(Tier 1)hydrocortisone topical lotion 2.5% 0(Tier 1)hydrocortisone topical ointment 1%, 2.5% 0(Tier 1)hydrocortisone valerate 0(Tier 1)hydrocortisone-aloe vera topical cream 1% 0(Tier 1) MCmometasone topical 0(Tier 1)prednicarbate topical ointment 0(Tier 1)triamcinolone acetonide topical cream 0(Tier 1)triamcinolone acetonide topical lotion 0(Tier 1)triamcinolone acetonide topical ointment 0(Tier 1)triderm topical cream 0.1% 0(Tier 1)TOPICAL SCABICIDES / PEDICULICIDESlice killing 0(Tier 1) MClice treatment topical liquid 1% 0(Tier 1) MC


57



lindane topical shampoo 0(Tier 1)malathion 0(Tier 1)permethrin topical cream 0(Tier 1)VANALICE 0(Tier 1) MCDIAGNOSTICS / MISCELLANEOUS AGENTS (OTHER DRUGS/DRUGS TO HELP STOP SMOKING)IRRIGATING SOLUTIONSlactated ringers irrigation 0(Tier 2)neomycin-polymyxin b gu 0(Tier 1)ringer’s irrigation 0(Tier 2)tis-u-sol pentalyte 0(Tier 2)MISCELLANEOUS AGENTSacamprosate 0(Tier 1)anagrelide 0(Tier 1)ARALAST NP 0(Tier 2) LA; NDSAURYXIA 0(Tier 2) PA; QL (360 EA per 30 days); NDSCALCIUM WITH BORON 0(Tier 1) MCCARBAGLU 0(Tier 2) PA; LA; NDSCARNITOR INTRAVENOUS 0(Tier 2) B/D PA; NDSCHEMET 0(Tier 2) PACLINIMIX 4.25%/D5W SULFIT FREE 0(Tier 2) B/D PAD10%-0.45% SODIUM CHLORIDE 0(Tier 2)D2.5%-0.45% SODIUM CHLORIDE 0(Tier 2)D5% AND 0.9% SODIUM CHLORIDE 0(Tier 2)D5%-0.45% SODIUM CHLORIDE 0(Tier 2)deferasirox oral granules in packet 0(Tier 1) PA; NDSdeferasirox oral tablet 0(Tier 1) PA; NDSdeferiprone 0(Tier 1) PA; NDSDEXTROSE 10% AND 0.2% NACL 0(Tier 2)DEXTROSE 10% IN WATER (D10W) 0(Tier 2)dextrose 25% in water (d25w) 0(Tier 2)dextrose 30% in water (d30w) 0(Tier 2)dextrose 40% in water (d40w) 0(Tier 2)DEXTROSE 5% IN WATER (D5W) INTRAVENOUS PARENTERAL SOLUTION

0(Tier 2)

dextrose 5% in water (d5w) intravenous piggyback

0(Tier 2)

dextrose 5%-lactated ringers 0(Tier 2)DEXTROSE 5%-0.2% SOD CHLORIDE 0(Tier 2)dextrose 5%-0.3% sod.chloride 0(Tier 2)


58



dextrose 50% in water (d50w) intravenous parenteral solution

0(Tier 2)

dextrose 50% in water (d50w) intravenous syringe

0(Tier 1)

dextrose 70% in water (d70w) 0(Tier 2)disulfiram 0(Tier 1)FERRIPROX 0(Tier 2) PA; NDSFERRIPROX (2 TIMES A DAY) 0(Tier 2) PA; NDSINCRELEX 0(Tier 2) PA; LAkionex (with sorbitol) 0(Tier 1)levocarnitine (with sugar) 0(Tier 1)levocarnitine oral solution 100 mg/ml 0(Tier 1)levocarnitine oral tablet 0(Tier 1)LOKELMA 0(Tier 2)midodrine 0(Tier 1)nitisinone 0(Tier 1) NDSNORTHERA ORAL CAPSULE 100 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSNORTHERA ORAL CAPSULE 200 MG, 300 MG 0(Tier 2) PA; QL (180 EA per 30 days); NDSpilocarpine hcl oral 0(Tier 1)PROLASTIN-C 0(Tier 2) PA; LA; NDSriluzole 0(Tier 1)risedronate oral tablet 30 mg 0(Tier 1) QL (30 EA per 30 days)sevelamer carbonate oral powder in packet 0(Tier 1) NDSsevelamer carbonate oral tablet 0(Tier 1)SODIUM CHLORIDE 0.9% INTRAVENOUS PARENTERAL SOLUTION

0(Tier 2)

sodium chloride 0.9% intravenous piggyback 0(Tier 2)SODIUM CHLORIDE IRRIGATION 0(Tier 2)sodium phenylbutyrate 0(Tier 1) PA; NDSsodium polystyrene (sorb free) 0(Tier 1)sodium polystyrene sulfonate oral powder 0(Tier 1)sps (with sorbitol) 0(Tier 1)SUSPENDOL-S 0(Tier 1) MCtrientine 0(Tier 1) PA; QL (240 EA per 30 days); NDSVELTASSA 0(Tier 2)water for irrigation, sterile 0(Tier 1)XIAFLEX 0(Tier 2) PA; NDSZEMAIRA 0(Tier 2) LA; NDS


59



zoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml

0(Tier 1) B/D PA

NEUTRACEUTICALScomplete premium vitamin 0(Tier 1) MCcranberry urinary comfort 0(Tier 1) MCSMOKING DETERRENTSbupropion hcl (smoking deter) 0(Tier 1) QL (60 EA per 30 days)CHANTIX 0(Tier 2)CHANTIX CONTINUING MONTH BOX 0(Tier 2)CHANTIX STARTING MONTH BOX 0(Tier 2)nicotine (polacrilex) buccal gum 0(Tier 1) MCNICOTINE (POLACRILEX) BUCCAL LOZENGE 2 MG

0(Tier 1) MC

nicotine (polacrilex) buccal lozenge 4 mg 0(Tier 1) MCnicotine (polacrilex) buccal mini lozenge 2 mg 0(Tier 1) MCNICOTINE (POLACRILEX) BUCCAL MINI LOZENGE 4 MG

0(Tier 1) MC

nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr

0(Tier 1) MC

nicotine transdermal patch, td daily, sequential 0(Tier 1) MCNICOTROL 0(Tier 2)NICOTROL NS 0(Tier 2)EAR, NOSE / THROAT MEDICATIONS (DRUGS THAT RELIEVE EAR, NOSE/THROAT PROBLEMS)MISCELLANEOUS AGENTSazelastine nasal 0(Tier 1) QL (60 ML per 30 days)chlorhexidine gluconate mucous membrane 0(Tier 1)COUGH DROPS MUCOUS MEMBRANE LOZENGE 5.4 MG, 5.8 MG, 7.6 MG

0(Tier 1) MC

deep sea nasal 0(Tier 1) MCfluoride (sodium) dental paste 0(Tier 1)ipratropium bromide nasal 0(Tier 1) QL (30 ML per 30 days)nasal decongestant (oxymetazl) 0(Tier 1) MCnasal spray (oxymetazoline) 0(Tier 1) MCoralone 0(Tier 1)paroex oral rinse 0(Tier 1)sodium fluoride-pot nitrate 0(Tier 1)triamcinolone acetonide dental 0(Tier 1)MISCELLANEOUS OTIC PREPARATIONSacetic acid otic (ear) 0(Tier 1)


60



ear drops (carbamide peroxide) 0(Tier 1) MCear wax removal drops 0(Tier 1) MCear wax removal kit 0(Tier 1) MCflac otic oil 0(Tier 1)fluocinolone acetonide oil 0(Tier 1)hydrocortisone-acetic acid 0(Tier 1)ofloxacin otic (ear) 0(Tier 1)OTIC STEROID / ANTIBIOTICCIPRO HC 0(Tier 2)CIPRODEX 0(Tier 2)ciprofloxacin-dexamethasone 0(Tier 1)CORTISPORIN-TC 0(Tier 2)neomycin-polymyxin-hc otic (ear) 0(Tier 1)ENDOCRINE/DIABETES (DRUGS THAT CONTROL HORMONES/DRUGS THAT CONTROL BLOOD SUGAR)ADRENAL HORMONEScortisone 0(Tier 1)DEPO-MEDROL 0(Tier 2)dexamethasone intensol 0(Tier 1)dexamethasone oral elixir 0(Tier 1)dexamethasone oral solution 0(Tier 1)dexamethasone oral tablet 0(Tier 1)dexamethasone sodium phos (pf) injection solution

0(Tier 1)

dexamethasone sodium phosphate injection solution

0(Tier 1)

fludrocortisone 0(Tier 1)hydrocortisone oral 0(Tier 1)MEDROL ORAL TABLET 2 MG 0(Tier 2)methylprednisolone 0(Tier 1)methylprednisolone acetate 0(Tier 1)methylprednisolone sodium succ injection recon soln 125 mg, 40 mg

0(Tier 1)

methylprednisolone sodium succ intravenous 0(Tier 1)prednisolone oral solution 15 mg/5 ml 0(Tier 1)prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 15 mg/5 ml (5 ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)

0(Tier 1)

prednisone intensol 0(Tier 1)prednisone oral solution 0(Tier 1)


61



prednisone oral tablet 0(Tier 1) B/D PAprednisone oral tablets,dose pack 0(Tier 1)SOLU-CORTEF ACT-O-VIAL (PF) 0(Tier 2)triamcinolone acetonide injection suspension 40 mg/ml

0(Tier 1)

ANTITHYROID AGENTSIOSAT 0(Tier 1) MCmethimazole oral tablet 10 mg, 5 mg 0(Tier 1)propylthiouracil 0(Tier 1)THYROSAFE 0(Tier 1) MCDIABETES THERAPYacarbose oral tablet 100 mg 0(Tier 1) QL (90 EA per 30 days)acarbose oral tablet 25 mg 0(Tier 1) QL (360 EA per 30 days)acarbose oral tablet 50 mg 0(Tier 1) QL (180 EA per 30 days)ALCOHOL PADS 0(Tier 1)BAQSIMI 0(Tier 2)BD PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)BYDUREON BCISE 0(Tier 2) QL (4 ML per 28 days)BYDUREON SUBCUTANEOUS PEN INJECTOR


CYCLOSET 0(Tier 2) QL (180 EA per 30 days)diazoxide 0(Tier 1)FARXIGA ORAL TABLET 10 MG 0(Tier 2) QL (30 EA per 30 days)FARXIGA ORAL TABLET 5 MG 0(Tier 2) QL (60 EA per 30 days)GAUZE PADS 2 X 2 0(Tier 1)glimepiride oral tablet 1 mg 0(Tier 1) QL (240 EA per 30 days)glimepiride oral tablet 2 mg 0(Tier 1) QL (120 EA per 30 days)glimepiride oral tablet 4 mg 0(Tier 1) QL (60 EA per 30 days)glipizide oral tablet 10 mg 0(Tier 1) QL (120 EA per 30 days)glipizide oral tablet 5 mg 0(Tier 1) QL (240 EA per 30 days)glipizide oral tablet extended release 24hr 10 mg


glipizide oral tablet extended release 24hr 2.5 mg


glipizide oral tablet extended release 24hr 5 mg 0(Tier 1) QL (120 EA per 30 days)glipizide-metformin oral tablet 2.5-250 mg 0(Tier 1) QL (240 EA per 30 days)glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg


GLUCAGEN HYPOKIT 0(Tier 2)


62



GLUCAGON (HCL) EMERGENCY KIT 0(Tier 2)GLUCAGON EMERGENCY KIT (HUMAN) 0(Tier 2)GLYXAMBI 0(Tier 2) QL (30 EA per 30 days)GVOKE HYPOPEN 1-PACK 0(Tier 2)GVOKE HYPOPEN 2-PACK 0(Tier 2)GVOKE PFS 1-PACK SYRINGE 0(Tier 2)GVOKE PFS 2-PACK SYRINGE 0(Tier 2)HUMALOG JUNIOR KWIKPEN U-100 0(Tier 2)HUMALOG KWIKPEN INSULIN 0(Tier 2)HUMALOG MIX 50-50 INSULN U-100 0(Tier 2)HUMALOG MIX 50-50 KWIKPEN 0(Tier 2)HUMALOG MIX 75-25 KWIKPEN 0(Tier 2)HUMALOG MIX 75-25(U-100)INSULN 0(Tier 2)HUMALOG U-100 INSULIN 0(Tier 2)HUMULIN 70/30 U-100 INSULIN 0(Tier 2)HUMULIN 70/30 U-100 KWIKPEN 0(Tier 2)HUMULIN N NPH INSULIN KWIKPEN 0(Tier 2)HUMULIN N NPH U-100 INSULIN 0(Tier 2)HUMULIN R REGULAR U-100 INSULN 0(Tier 2)HUMULIN R U-500 (CONC) INSULIN 0(Tier 2) B/D PA; NDSHUMULIN R U-500 (CONC) KWIKPEN 0(Tier 2) NDSINSULIN PEN NEEDLE 0(Tier 1)INSULIN SYRINGE (DISP) U-100 0.3 ML, 1 ML, 1/2 ML


INVOKAMET 0(Tier 2) QL (60 EA per 30 days)INVOKAMET XR 0(Tier 2) QL (60 EA per 30 days)INVOKANA 0(Tier 2) QL (30 EA per 30 days)JANUMET 0(Tier 2) QL (60 EA per 30 days)JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG


JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG


JANUVIA 0(Tier 2) QL (30 EA per 30 days)JARDIANCE 0(Tier 2) QL (30 EA per 30 days)JENTADUETO 0(Tier 2) QL (60 EA per 30 days)JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG


JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 5-1,000 MG



63



LANTUS SOLOSTAR U-100 INSULIN 0(Tier 2)LANTUS U-100 INSULIN 0(Tier 2)LEVEMIR FLEXTOUCH U-100 INSULN 0(Tier 2)LEVEMIR U-100 INSULIN 0(Tier 2)LYUMJEV KWIKPEN U-100 INSULIN 0(Tier 2)LYUMJEV KWIKPEN U-200 INSULIN 0(Tier 2)LYUMJEV U-100 INSULIN 0(Tier 2)metformin oral solution 0(Tier 1) QL (750 ML per 30 days)metformin oral tablet 1,000 mg 0(Tier 1) QL (75 EA per 30 days)metformin oral tablet 500 mg 0(Tier 1) QL (150 EA per 30 days)metformin oral tablet 850 mg 0(Tier 1) QL (90 EA per 30 days)metformin oral tablet extended release 24 hr 500 mg (generic for Glucophage XR)


metformin oral tablet extended release 24 hr 750 mg (generic for Glucophage XR)


metformin oral tablet extended release 24hr 1,000 mg (generic for Fortamet)


metformin oral tablet extended release 24 hr 500 mg (generic for Fortamet)


miglitol oral tablet 100 mg 0(Tier 1) QL (90 EA per 30 days)miglitol oral tablet 25 mg 0(Tier 1) QL (360 EA per 30 days)miglitol oral tablet 50 mg 0(Tier 1) QL (180 EA per 30 days)nateglinide oral tablet 120 mg 0(Tier 1) QL (90 EA per 30 days)nateglinide oral tablet 60 mg 0(Tier 1) QL (180 EA per 30 days)NEEDLES, INSULIN DISP.,SAFETY 0(Tier 1) QL (200 EA per 30 days)NOVOFINE PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)NOVOTWIST PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)OMNIPOD 5 PACK 0(Tier 2) QL (30 EA per 30 days)OMNIPOD DASH 5 PACK 0(Tier 2) QL (30 EA per 30 days)OMNIPOD STARTER KIT 0(Tier 2) QL (1 EA per 365 days)OZEMPIC SUBCUTANEOUS PEN INJECTOR 0.25 MG OR 0.5 MG(2 MG/1.5 ML)

0(Tier 2) QL (1.5 ML per 28 days)

OZEMPIC SUBCUTANEOUS PEN INJECTOR 1 MG/DOSE (2 MG/1.5 ML)


pioglitazone 0(Tier 1) QL (30 EA per 30 days)pioglitazone-metformin 0(Tier 1) QL (90 EA per 30 days)PROGLYCEM 0(Tier 2) NDSrepaglinide oral tablet 0.5 mg 0(Tier 1) QL (960 EA per 30 days)repaglinide oral tablet 1 mg 0(Tier 1) QL (480 EA per 30 days)


64



repaglinide oral tablet 2 mg 0(Tier 1) QL (240 EA per 30 days)RIOMET 0(Tier 2) QL (765 ML per 30 days)RIOMET ER 0(Tier 2) QL (600 ML per 30 days)RYBELSUS 0(Tier 2) QL (30 EA per 30 days)SOLIQUA 100/33 0(Tier 2) QL (15 ML per 30 days)SYMLINPEN 120 0(Tier 2) PA; QL (10.8 ML per 30 days); NDSSYMLINPEN 60 0(Tier 2) PA; QL (6 ML per 30 days); NDSSYNJARDY 0(Tier 2) QL (60 EA per 30 days)SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 5-1,000 MG


SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 25-1,000 MG


TECHLITE PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)TOUJEO MAX U-300 SOLOSTAR 0(Tier 2)TOUJEO SOLOSTAR U-300 INSULIN 0(Tier 2)TRADJENTA 0(Tier 2) QL (30 EA per 30 days)TRESIBA FLEXTOUCH U-100 0(Tier 2)TRESIBA FLEXTOUCH U-200 0(Tier 2)TRESIBA U-100 INSULIN 0(Tier 2)TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-5-1,000 MG, 25-5-1,000 MG


TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 12.5-2.5-1,000 MG, 5-2.5-1,000 MG


TRULICITY 0(Tier 2) QL (2 ML per 28 days)V-GO 20 0(Tier 2)V-GO 30 0(Tier 2)V-GO 40 0(Tier 2)VICTOZA 2-PAK 0(Tier 2) QL (9 ML per 30 days)VICTOZA 3-PAK 0(Tier 2) QL (9 ML per 30 days)XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 10-500 MG


XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG, 5-500 MG


XULTOPHY 100/3.6 0(Tier 2) QL (15 ML per 30 days)MISCELLANEOUS HORMONESALDURAZYME 0(Tier 2) PA; NDSANADROL-50 0(Tier 2) PA; NDS


65



cabergoline 0(Tier 1)calcitonin (salmon) 0(Tier 1)calcitriol intravenous solution 1 mcg/ml 0(Tier 1)calcitriol oral 0(Tier 1)CEREZYME INTRAVENOUS RECON SOLN 400 UNIT

0(Tier 2) PA; NDS

CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR

0(Tier 2) PA

cinacalcet oral tablet 30 mg, 60 mg 0(Tier 1) QL (60 EA per 30 days)cinacalcet oral tablet 90 mg 0(Tier 1) QL (120 EA per 30 days)danazol 0(Tier 1)desmopressin injection 0(Tier 1) NDSdesmopressin nasal spray with pump 0(Tier 1)desmopressin nasal spray,non-aerosol 0(Tier 1)desmopressin oral 0(Tier 1)doxercalciferol 0(Tier 1)ELAPRASE 0(Tier 2) PA; NDSFABRAZYME 0(Tier 2) NDSKORLYM 0(Tier 2) PA; QL (120 EA per 30 days); NDSKUVAN 0(Tier 2) PA; NDSLUMIZYME 0(Tier 2) PA; NDSMIACALCIN INJECTION 0(Tier 2) NDSmiglustat 0(Tier 1) LA; NDSNAGLAZYME 0(Tier 2) PA; NDSNATPARA 0(Tier 2) PA; LA; QL (2 EA per 28 days); NDSoxandrolone oral tablet 10 mg 0(Tier 1) PA; QL (60 EA per 30 days)oxandrolone oral tablet 2.5 mg 0(Tier 1) PA; QL (120 EA per 30 days)pamidronate 0(Tier 1)paricalcitol oral 0(Tier 1)SAMSCA ORAL TABLET 15 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSSAMSCA ORAL TABLET 30 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSsapropterin 0(Tier 1) PA; NDSSOMAVERT 0(Tier 2) PA; QL (30 EA per 30 days); NDSSYNAREL 0(Tier 2) NDStestosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml, 200 mg/ml (1 ml)

0(Tier 1)

testosterone enanthate 0(Tier 1)testosterone transdermal gel 0(Tier 1) PA; QL (300 GM per 30 days)


66



testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1%)

0(Tier 1) PA; QL (300 GM per 30 days)

testosterone transdermal gel in packet 1% (25 mg/2.5gram), 1% (50 mg/5 gram)

0(Tier 1) PA; QL (300 GM per 30 days)

tolvaptan oral tablet 30 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSzoledronic acid intravenous solution 0(Tier 1) B/D PAzoledronic acid-mannitol-water intravenous piggyback 4 mg/100 ml

0(Tier 1) B/D PA

ZOLEDRONIC AC-MANNITOL-0.9NACL 0(Tier 2) B/D PATHYROID HORMONESEUTHYROX 0(Tier 2)LEVO-T 0(Tier 2)levothyroxine oral tablet 0(Tier 1)levoxyl oral tablet 100 mcg, 112 mcg, 175 mcg 0(Tier 1)LEVOXYL ORAL TABLET 125 MCG, 137 MCG, 150 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG

0(Tier 2)

liothyronine oral 0(Tier 1)SYNTHROID 0(Tier 2)UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

0(Tier 2)

unithroid oral tablet 137 mcg 0(Tier 2)GASTROENTEROLOGY (DRUGS THAT TREAT ISSUES OF THE STOMACH/BOWELS/GALLBLADDER)ANTIDIARRHEALS / ANTISPASMODICSanti-diarrheal (loperamide) oral capsule 0(Tier 1) MCanti-diarrheal (loperamide) oral liquid 1 mg/7.5 ml

0(Tier 1) MC

anti-diarrheal (loperamide) oral tablet 0(Tier 1) MCatropine injection solution 0.4 mg/ml 0(Tier 1)atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 0(Tier 1)bismatrol 0(Tier 1) MCdicyclomine oral capsule 0(Tier 1)dicyclomine oral solution 0(Tier 1)dicyclomine oral tablet 0(Tier 1)diphenoxylate-atropine 0(Tier 1)GLYCOPYRROLATE (PF) IN WATER INJECTION

0(Tier 1)


67



glycopyrrolate (pf) in water intravenous syringe 0.4 mg/2 ml (0.2 mg/ml)

0(Tier 1)

glycopyrrolate injection 0(Tier 1)glycopyrrolate oral 0(Tier 1)loperamide oral capsule 0(Tier 1)loperamide oral liquid 1 mg/7.5 ml 0(Tier 1) MCpeptic relief oral tablet,chewable 0(Tier 1) MCstomach relief oral suspension 0(Tier 1) MCstomach relief oral tablet,chewable 0(Tier 1) MCMISCELLANEOUS GASTROINTESTINAL AGENTSacid gone antacid 0(Tier 1) MCactidose/sorbitol oral suspension 50 gram/240 ml

0(Tier 1) MC

almacone-2 0(Tier 1) MCalosetron 0(Tier 1) PA; NDSaluminum hydroxide gel oral suspension 320 mg/5 ml

0(Tier 1) MC

antacid 0(Tier 1) MCantacid anti-gas 0(Tier 1) MCantacid exst (mag carb-al hyd) 0(Tier 1) MCantacid plus anti-gas oral suspension 200-200-20 mg/5 ml

0(Tier 1) MC

antacid regular strength 0(Tier 1) MCaprepitant 0(Tier 1) B/D PAAVSOLA 0(Tier 2) PA; NDSbalsalazide 0(Tier 1)bisacodyl 0(Tier 1) MCbudesonide oral capsule,delayed,extend.release 0(Tier 1)budesonide oral tablet,delayed and ext.release 0(Tier 1) NDSclearlax oral powder 0(Tier 1) MCcompro 0(Tier 1)constulose 0(Tier 1)CREON 0(Tier 2)cromolyn oral 0(Tier 1)CYSTADANE 0(Tier 2) NDSDOCUSOL KIDS 0(Tier 1) MCDOCUSOL PLUS 0(Tier 1) MCdok oral capsule 100 mg 0(Tier 1) MCdok oral tablet 0(Tier 1) MC


68



driminate 0(Tier 1) MCdronabinol 0(Tier 1) B/D PA; QL (60 EA per 30 days)EMEND ORAL SUSPENSION FOR RECONSTITUTION

0(Tier 2) B/D PA

enema rectal enema 19-7 gram/118 ml 0(Tier 1) MCENEMEEZ 0(Tier 1) MCENEMEEZ PLUS 0(Tier 1) MCenulose 0(Tier 1)fiber (calcium polycarbophil) 0(Tier 1) MCfiber-lax 0(Tier 1) MCFLEET PEDIATRIC 0(Tier 1) MCformula em 0(Tier 1) MCgas relief (simethicone) oral capsule 125 mg 0(Tier 1) MCgas relief (simethicone) oral drops,suspension 0(Tier 1) MCgas relief (simethicone) oral tablet,chewable 80 mg

0(Tier 1) MC

gas relief extra strength 0(Tier 1) MCGATTEX 30-VIAL 0(Tier 2) PA; NDSGATTEX ONE-VIAL 0(Tier 2) PA; NDSgavilyte-c 0(Tier 1)gavilyte-n 0(Tier 1)generlac 0(Tier 1)granisetron (pf) intravenous solution 1 mg/ml (1 ml)

0(Tier 1) B/D PA

granisetron hcl intravenous 0(Tier 1)granisetron hcl oral 0(Tier 1) B/D PA; QL (60 EA per 30 days)HEMORRHOIDAL (PHENYLEPH-COCOA) RECTAL SUPPOSITORY 0.25-88.44%

0(Tier 1) MC

HEMORRHOIDAL CREAM 0(Tier 1) MCHEMORRHOIDAL(PE-MIN OIL-PETRO) RECTAL OINTMENT 0.25-14-74.9%

0(Tier 1) MC

hydrocortisone rectal 0(Tier 1)hydrocortisone topical cream with perineal applicator

0(Tier 1)

infants gas relief 0(Tier 1) MClactulose oral solution 0(Tier 1)LINZESS 0(Tier 2) QL (30 EA per 30 days)MAGNESIUM L-LACTATE 0(Tier 1) MCmagnesium oral tablet 250 mg 0(Tier 1) MC


69



magnesium oxide oral tablet 400 mg (241.3 mg magnesium)

0(Tier 1) MC

MAGTAB 0(Tier 1) MCmeclizine oral tablet 12.5 mg, 25 mg 0(Tier 1)mesalamine oral capsule,extended release 24hr 0(Tier 1)mesalamine oral tablet,delayed release (dr/ec) 1.2 gram

0(Tier 1)

mesalamine rectal enema 0(Tier 1)mesalamine with cleansing wipe 0(Tier 1)metoclopramide hcl injection solution 0(Tier 1)metoclopramide hcl oral solution 0(Tier 1)metoclopramide hcl oral tablet 0(Tier 1)mi-acid gas relief(simethicon) 0(Tier 1) MCmi-acid oral suspension 200-200-20 mg/5 ml 0(Tier 1) MCmilk of magnesia 0(Tier 1) MCmintox maximum strength 0(Tier 1) MCmintox plus 0(Tier 1) MCmotion sickness relief 0(Tier 1) MCnatural fiber laxative (sugar) oral powder 3.4 gram/7 gram

0(Tier 1) MC

OCALIVA 0(Tier 2) PA; LA; QL (30 EA per 30 days); NDSondansetron 0(Tier 1) B/D PAondansetron hcl (pf) 0(Tier 1)ondansetron hcl intravenous 0(Tier 1)ondansetron hcl oral solution 0(Tier 1) B/D PA; QL (450 ML per 30 days)ondansetron hcl oral tablet 0(Tier 1) B/D PApalonosetron intravenous solution 0.25 mg/5 ml 0(Tier 1) NDSpeg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram

0(Tier 1)

peg-electrolyte 0(Tier 1)PENTASA 0(Tier 2) NDSPLENVU 0(Tier 2)polyethylene glycol 3350 0(Tier 1) MCprochlorperazine 0(Tier 1)prochlorperazine edisylate 0(Tier 1)prochlorperazine maleate oral 0(Tier 1)procto-med hc 0(Tier 1)procto-pak 0(Tier 1)proctosol hc topical 0(Tier 1)


70



proctozone-hc 0(Tier 1)RECTIV 0(Tier 2)RELISTOR SUBCUTANEOUS SOLUTION 0(Tier 2) PA; NDSRELISTOR SUBCUTANEOUS SYRINGE 0(Tier 2) PA; NDSRENFLEXIS 0(Tier 2) PASANCUSO 0(Tier 2) NDSscopolamine base 0(Tier 1) QL (10 EA per 30 days)senna lax 0(Tier 1) MCsenna oral tablet 0(Tier 1) MCsimethicone oral capsule 180 mg 0(Tier 1) MCsimethicone oral drops,suspension 0(Tier 1) MCsodium bicarbonate oral 0(Tier 1) MCstool softener (docusate cal) 0(Tier 1) MCstool softener oral capsule 100 mg 0(Tier 1) MCsulfasalazine 0(Tier 1)SUPREP BOWEL PREP KIT 0(Tier 2)travel sickness 0(Tier 1) MCtravel sickness (meclizine) 0(Tier 1) MCtrilyte with flavor packets 0(Tier 1)ursodiol 0(Tier 1)VIOKACE ORAL TABLET 10,440-39,150- 39,150 UNIT

0(Tier 2)

VIOKACE ORAL TABLET 20,880-78,300- 78,300 UNIT

0(Tier 2) NDS

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT

0(Tier 2)

ULCER THERAPYacid reducer (famotidine) 0(Tier 1) MCacid reducer (omeprazole) 0(Tier 1) MCacid reducer complete (famot) 0(Tier 1) MCesomeprazole magnesium oral capsule,delayed release(dr/ec)

0(Tier 1)

famotidine oral suspension 0(Tier 1)famotidine oral tablet 10 mg 0(Tier 1) MCfamotidine oral tablet 20 mg, 40 mg 0(Tier 1)


71



lansoprazole oral capsule,delayed release(dr/ec)

0(Tier 1)

misoprostol 0(Tier 1)nizatidine oral capsule 0(Tier 1)omeprazole magnesium oral capsule,delayed release(dr/ec)

0(Tier 1) MC

OMEPRAZOLE MAGNESIUM ORAL TABLET,DELAYED RELEASE (DR/EC)

0(Tier 1) MC

omeprazole oral capsule,delayed release(dr/ec) 0(Tier 1)omeprazole oral tablet,delayed release (dr/ec) 0(Tier 1) MCpantoprazole oral tablet,delayed release (dr/ec) 20 mg

0(Tier 1)

pantoprazole oral tablet,delayed release (dr/ec) 40 mg


sucralfate 0(Tier 1)IMMUNOLOGY, VACCINES / BIOTECHNOLOGY (DRUGS FOR PREVENTION OF DISEASE/INFECTION)BIOTECHNOLOGY DRUGSACTIMMUNE 0(Tier 2) PA; NDSARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML, 60 MCG/ML

0(Tier 2) PA; NDS

ARANESP (IN POLYSORBATE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ML

0(Tier 2) PA

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 25 MCG/0.42 ML, 40 MCG/0.4 ML

0(Tier 2) PA

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 300 MCG/0.6 ML, 500 MCG/ML, 60 MCG/0.3 ML

0(Tier 2) PA; NDS

ARCALYST 0(Tier 2) PA; NDSAVONEX INTRAMUSCULAR PEN INJECTOR KIT


AVONEX INTRAMUSCULAR SYRINGE KIT 0(Tier 2) PA; QL (1 EA per 28 days); NDSBETASERON SUBCUTANEOUS KIT 0(Tier 2) PA; QL (14 EA per 28 days); NDSGENOTROPIN 0(Tier 2) PA; NDSGENOTROPIN MINIQUICK 0(Tier 2) PA; NDSINTRON A INJECTION RECON SOLN 0(Tier 2) B/D PA; NDSINTRON A INJECTION SOLUTION 10 MILLION UNIT/ML



72



INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML

0(Tier 2) B/D PA

LEUKINE INJECTION RECON SOLN 0(Tier 2) PA; NDSMOZOBIL 0(Tier 2) B/D PA; NDSNIVESTYM 0(Tier 2) PA; NDSPROLEUKIN 0(Tier 2) B/D PAREBIF (WITH ALBUMIN) 0(Tier 2) PA; QL (6 ML per 28 days); NDSREBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML


REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.2ML-22 MCG/0.5ML (6)


REBIF TITRATION PACK 0(Tier 2) PA; QL (4.2 ML per 180 days); NDSRETACRIT 0(Tier 2) PAZARXIO 0(Tier 2) PA; NDSZIEXTENZO 0(Tier 2) PA; NDSVACCINES / MISCELLANEOUS IMMUNOLOGICALSACTHIB (PF) 0(Tier 2)ADACEL(TDAP ADOLESN/ADULT)(PF) 0(Tier 2)ATGAM 0(Tier 2) PABCG VACCINE, LIVE (PF) 0(Tier 2)BEXSERO 0(Tier 2)BOOSTRIX TDAP 0(Tier 2)BOTOX 0(Tier 2) PADAPTACEL (DTAP PEDIATRIC) (PF) 0(Tier 2)ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 0(Tier 2) B/D PAENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE

0(Tier 2) B/D PA

fomepizole 0(Tier 1) NDSGAMMAKED INJECTION SOLUTION 1 GRAM/10 ML (10%), 10 GRAM/100 ML (10%), 20 GRAM/200 ML (10%), 5 GRAM/50 ML (10%)


GAMUNEX-C 0(Tier 2) B/D PA; NDSGARDASIL 9 (PF) 0(Tier 2)HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML

0(Tier 2)

HAVRIX (PF) INTRAMUSCULAR SYRINGE 0(Tier 2)HIBERIX (PF) 0(Tier 2)HIZENTRA 0(Tier 2) B/D PA; NDSIMOVAX RABIES VACCINE (PF) 0(Tier 2)


73



INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION

0(Tier 2)

IPOL 0(Tier 2)IXIARO (PF) 0(Tier 2)KINRIX (PF) 0(Tier 2)MENACTRA (PF) INTRAMUSCULAR SOLUTION

0(Tier 2)

MENQUADFI (PF) 0(Tier 2)MENVEO A-C-Y-W-135-DIP (PF) 0(Tier 2)M-M-R II (PF) 0(Tier 2)PEDIARIX (PF) 0(Tier 2)PEDVAX HIB (PF) 0(Tier 2)PENTACEL (PF) INTRAMUSCULAR KIT 15LF-48MCG-62DU -10 MCG/0.5ML

0(Tier 2)

PROQUAD (PF) 0(Tier 2)QUADRACEL (PF) 0(Tier 2)RABAVERT (PF) 0(Tier 2)RECOMBIVAX HB (PF) 0(Tier 2) B/D PAROTARIX 0(Tier 2)ROTATEQ VACCINE 0(Tier 2)SHINGRIX (PF) 0(Tier 2) QL (2 EA per 999 days)STAMARIL (PF) 0(Tier 2)TDVAX 0(Tier 2)TENIVAC (PF) INTRAMUSCULAR SYRINGE 0(Tier 2)TETANUS,DIPHTHERIA TOX PED(PF) 0(Tier 2)TRUMENBA 0(Tier 2)TWINRIX (PF) INTRAMUSCULAR SYRINGE 0(Tier 2)TYPHIM VI 0(Tier 2)VAQTA (PF) 0(Tier 2)VARIVAX (PF) 0(Tier 2)VARIZIG INTRAMUSCULAR SOLUTION 0(Tier 2)YF-VAX (PF) 0(Tier 2)ZOSTAVAX (PF) 0(Tier 2)MUSCULOSKELETAL / RHEUMATOLOGY (DRUGS THAT TREAT ISSUES OF THE JOINTS/MUSCLES/BONES)GOUT THERAPYallopurinol 0(Tier 1)colchicine oral tablet 0(Tier 1) QL (120 EA per 30 days)febuxostat 0(Tier 1) STMITIGARE 0(Tier 2)


74



probenecid 0(Tier 1)probenecid-colchicine 0(Tier 1)OSTEOPOROSIS THERAPYalendronate oral tablet 10 mg, 5 mg 0(Tier 1) QL (30 EA per 30 days)alendronate oral tablet 35 mg, 70 mg 0(Tier 1) QL (4 EA per 28 days)BINOSTO 0(Tier 2) QL (4 EA per 28 days)ibandronate oral 0(Tier 1) QL (1 EA per 30 days)PROLIA 0(Tier 2) QL (1 ML per 180 days)raloxifene 0(Tier 1) QL (30 EA per 30 days)risedronate oral tablet 150 mg 0(Tier 1) QL (1 EA per 30 days)risedronate oral tablet 35 mg, 35 mg (12 pack), 35 mg (4 pack)


risedronate oral tablet 5 mg 0(Tier 1) QL (30 EA per 30 days)TERIPARATIDE 0(Tier 2) PA; QL (2.4 ML per 28 days); NDSTYMLOS 0(Tier 2) PA; QL (1.56 ML per 30 days); NDSOTHER RHEUMATOLOGICALSBENLYSTA 0(Tier 2) PA; NDSDEPEN TITRATABS 0(Tier 2) NDSENBREL MINI 0(Tier 2) PA; QL (8 ML per 28 days); NDSENBREL SUBCUTANEOUS RECON SOLN 0(Tier 2) PA; QL (16 EA per 28 days); NDSENBREL SUBCUTANEOUS SOLUTION 0(Tier 2) PA; QL (4 ML per 28 days); NDSENBREL SUBCUTANEOUS SYRINGE 0(Tier 2) PA; QL (8 ML per 28 days); NDSENBREL SURECLICK 0(Tier 2) PA; QL (8 ML per 28 days); NDSHUMIRA PEN 0(Tier 2) PA; QL (4 EA per 28 days); NDSHUMIRA PEN CROHNS-UC-HS START 0(Tier 2) PA; QL (6 EA per 180 days); NDSHUMIRA PEN PSOR-UVEITS-ADOL HS 0(Tier 2) PA; QL (4 EA per 180 days); NDSHUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML


HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML


HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML


HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML-40 MG/0.4 ML


HUMIRA(CF) PEN CROHNS-UC-HS 0(Tier 2) PA; QL (3 EA per 180 days); NDSHUMIRA(CF) PEN PSOR-UV-ADOL HS 0(Tier 2) PA; QL (3 EA per 180 days); NDSHUMIRA(CF) PEN SUBCUTANEOUS INJECTOR KIT 40 MG/0.4 ML



75



HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML


HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML


HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 40 MG/0.4 ML


leflunomide 0(Tier 1) QL (30 EA per 30 days)ORENCIA CLICKJECT 0(Tier 2) PA; QL (4 ML per 28 days); NDSORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML


ORENCIA SUBCUTANEOUS SYRINGE 50 MG/0.4 ML


ORENCIA SUBCUTANEOUS SYRINGE 87.5 MG/0.7 ML


penicillamine 0(Tier 1) NDSRIDAURA 0(Tier 2) NDSRINVOQ 0(Tier 2) PA; QL (30 EA per 30 days); NDSXELJANZ 0(Tier 2) PA; QL (60 EA per 30 days); NDSXELJANZ XR 0(Tier 2) PA; QL (30 EA per 30 days); NDSOBSTETRICS / GYNECOLOGY (DRUGS THAT CONTROL OR REPLACE SEX HORMONES)ESTROGENS / PROGESTINSALORA 0(Tier 2) QL (8 EA per 28 days)camila 0(Tier 1)deblitane 0(Tier 1)DELESTROGEN INTRAMUSCULAR OIL 10 MG/ML

0(Tier 2)

DEPO-ESTRADIOL 0(Tier 2)dotti 0(Tier 1) QL (8 EA per 28 days)DUAVEE 0(Tier 2) PAerrin 0(Tier 1)estradiol oral 0(Tier 1)estradiol transdermal patch semiweekly 0(Tier 1) QL (8 EA per 28 days)estradiol transdermal patch weekly 0(Tier 1) QL (4 EA per 28 days)estradiol vaginal 0(Tier 1)estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml

0(Tier 1)

ESTRING 0(Tier 2)fyavolv 0(Tier 1)heather 0(Tier 1)hydroxyprogesterone caproate 0(Tier 1) NDS


76



incassia 0(Tier 1)jencycla 0(Tier 1)lyza 0(Tier 1)medroxyprogesterone 0(Tier 1)MENEST 0(Tier 2)MENOSTAR 0(Tier 2) QL (4 EA per 28 days)nora-be 0(Tier 1)norethindrone (contraceptive) 0(Tier 1)norethindrone acetate 0(Tier 1)norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg

0(Tier 1)

PREMARIN 0(Tier 2)progesterone micronized 0(Tier 1)sharobel 0(Tier 1)yuvafem 0(Tier 1)MISCELLANEOUS OB/GYNclindamycin phosphate vaginal 0(Tier 1)clotrimazole vaginal cream 0(Tier 1) MCmetronidazole vaginal 0(Tier 1)miconazole 7 0(Tier 1) MCmiconazole nitrate vaginal cream 0(Tier 1) MCMICONAZOLE NITRATE VAGINAL KIT 1,200-2 MG-%

0(Tier 1) MC

miconazole-3 vaginal kit 0(Tier 1) MCterconazole 0(Tier 1)TIOCONAZOLE-1 0(Tier 1) MCtranexamic acid oral 0(Tier 1)vandazole 0(Tier 1)ORAL CONTRACEPTIVES / RELATED AGENTSafirmelle 0(Tier 1)altavera (28) 0(Tier 1)alyacen 1/35 (28) 0(Tier 1)alyacen 7/7/7 (28) 0(Tier 1)amethia 0(Tier 1)amethyst (28) 0(Tier 1)apri 0(Tier 1)aranelle (28) 0(Tier 1)ashlyna 0(Tier 1)aubra 0(Tier 1)


77



aubra eq 0(Tier 1)aurovela 1.5/30 (21) 0(Tier 1)aurovela 1/20 (21) 0(Tier 1)aurovela 24 fe 0(Tier 1)aurovela fe 1.5/30 (28) 0(Tier 1)aurovela fe 1-20 (28) 0(Tier 1)aviane 0(Tier 1)ayuna 0(Tier 1)azurette (28) 0(Tier 1)balziva (28) 0(Tier 1)bekyree (28) 0(Tier 1)blisovi 24 fe 0(Tier 1)blisovi fe 1.5/30 (28) 0(Tier 1)blisovi fe 1/20 (28) 0(Tier 1)briellyn 0(Tier 1)camrese 0(Tier 1)camrese lo 0(Tier 1)caziant (28) 0(Tier 1)charlotte 24 fe 0(Tier 1)chateal (28) 0(Tier 1)chateal eq (28) 0(Tier 1)cryselle (28) 0(Tier 1)cyclafem 1/35 (28) 0(Tier 1)cyclafem 7/7/7 (28) 0(Tier 1)cyred 0(Tier 1)cyred eq 0(Tier 1)dasetta 1/35 (28) 0(Tier 1)dasetta 7/7/7 (28) 0(Tier 1)daysee 0(Tier 1)desog-e.estradiol/e.estradiol 0(Tier 1)desogestrel-ethinyl estradiol 0(Tier 1)drospirenone-e.estradiol-lm.fa 0(Tier 1)drospirenone-ethinyl estradiol 0(Tier 1)econtra ez 0(Tier 1) MCelinest 0(Tier 1)ELLA 0(Tier 2)emoquette 0(Tier 1)enpresse 0(Tier 1)


78



enskyce 0(Tier 1)estarylla 0(Tier 1)ethynodiol diac-eth estradiol 0(Tier 1)falmina (28) 0(Tier 1)fayosim 0(Tier 1)femynor 0(Tier 1)gemmily 0(Tier 1)gianvi (28) 0(Tier 1)hailey 0(Tier 1)hailey 24 fe 0(Tier 1)hailey fe 1.5/30 (28) 0(Tier 1)hailey fe 1/20 (28) 0(Tier 1)iclevia 0(Tier 1)introvale 0(Tier 1)isibloom 0(Tier 1)jaimiess 0(Tier 1)jasmiel (28) 0(Tier 1)jolessa 0(Tier 1)juleber 0(Tier 1)junel 1.5/30 (21) 0(Tier 1)junel 1/20 (21) 0(Tier 1)junel fe 1.5/30 (28) 0(Tier 1)junel fe 1/20 (28) 0(Tier 1)junel fe 24 0(Tier 1)kaitlib fe 0(Tier 1)kalliga 0(Tier 1)kariva (28) 0(Tier 1)kelnor 1/35 (28) 0(Tier 1)kelnor 1-50 (28) 0(Tier 1)kurvelo (28) 0(Tier 1)l norgest/e.estradiol-e.estrad 0(Tier 1)larin 1.5/30 (21) 0(Tier 1)larin 1/20 (21) 0(Tier 1)larin 24 fe 0(Tier 1)larin fe 1.5/30 (28) 0(Tier 1)larin fe 1/20 (28) 0(Tier 1)larissia 0(Tier 1)layolis fe 0(Tier 1)


79



leena 28 0(Tier 1)lessina 0(Tier 1)levonest (28) 0(Tier 1)levonorgestrel oral tablet 1.5 mg 0(Tier 1) MClevonorgestrel-ethinyl estrad 0(Tier 1)levonorg-eth estrad triphasic 0(Tier 1)levora-28 0(Tier 1)lillow (28) 0(Tier 1)lojaimiess 0(Tier 1)loryna (28) 0(Tier 1)low-ogestrel (28) 0(Tier 1)lo-zumandimine (28) 0(Tier 1)lutera (28) 0(Tier 1)marlissa (28) 0(Tier 1)melodetta 24 fe 0(Tier 1)mibelas 24 fe 0(Tier 1)microgestin 1.5/30 (21) 0(Tier 1)microgestin 1/20 (21) 0(Tier 1)microgestin fe 1.5/30 (28) 0(Tier 1)microgestin fe 1/20 (28) 0(Tier 1)mili 0(Tier 1)mono-linyah 0(Tier 1)my way 0(Tier 1) MCnecon 0.5/35 (28) 0(Tier 1)new day 0(Tier 1) MCnikki (28) 0(Tier 1)noreth-ethinyl estradiol-iron 0(Tier 1)norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg

0(Tier 1)

norethindrone-e.estradiol-iron oral capsule 0(Tier 1)norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1.5 mg-30 mcg (21)/75 mg (7)

0(Tier 1)

norethindrone-e.estradiol-iron oral tablet,chewable

0(Tier 1)

norgestimate-ethinyl estradiol 0(Tier 1)nortrel 0.5/35 (28) 0(Tier 1)nortrel 1/35 (21) 0(Tier 1)nortrel 1/35 (28) 0(Tier 1)


80



nortrel 7/7/7 (28) 0(Tier 1)nylia 7/7/7 (28) 0(Tier 1)nymyo 0(Tier 1)ocella 0(Tier 1)opcicon one-step 0(Tier 1) MCorsythia 0(Tier 1)philith 0(Tier 1)pimtrea (28) 0(Tier 1)pirmella 0(Tier 1)portia 28 0(Tier 1)previfem 0(Tier 1)reclipsen (28) 0(Tier 1)rivelsa 0(Tier 1)setlakin 0(Tier 1)simliya (28) 0(Tier 1)simpesse 0(Tier 1)sprintec (28) 0(Tier 1)sronyx 0(Tier 1)syeda 0(Tier 1)tarina 24 fe 0(Tier 1)tarina fe 1/20 (28) 0(Tier 1)tarina fe 1-20 eq (28) 0(Tier 1)tilia fe 0(Tier 1)tri femynor 0(Tier 1)tri-estarylla 0(Tier 1)tri-legest fe 0(Tier 1)tri-linyah 0(Tier 1)tri-lo-estarylla 0(Tier 1)tri-lo-marzia 0(Tier 1)tri-lo-mili 0(Tier 1)tri-lo-sprintec 0(Tier 1)tri-mili 0(Tier 1)tri-nymyo 0(Tier 1)tri-previfem (28) 0(Tier 1)tri-sprintec (28) 0(Tier 1)trivora (28) 0(Tier 1)tri-vylibra 0(Tier 1)tri-vylibra lo 0(Tier 1)


81



TYBLUME 0(Tier 1)tydemy 0(Tier 1)velivet triphasic regimen (28) 0(Tier 1)vienva 0(Tier 1)viorele (28) 0(Tier 1)volnea (28) 0(Tier 1)vyfemla (28) 0(Tier 1)vylibra 0(Tier 1)wera (28) 0(Tier 1)wymzya fe 0(Tier 1)zarah 0(Tier 1)zovia 1/35e (28) 0(Tier 1)zovia 1-35 (28) 0(Tier 1)zumandimine (28) 0(Tier 1)OPHTHALMOLOGY (DRUGS THAT RELIEVE OR PREVENT EYE PROBLEMS)ANTIBIOTICSak-poly-bac 0(Tier 1)AZASITE 0(Tier 2)bacitracin ophthalmic (eye) 0(Tier 1)bacitracin-polymyxin b ophthalmic (eye) 0(Tier 1)BESIVANCE 0(Tier 2)CILOXAN OPHTHALMIC (EYE) OINTMENT 0(Tier 2)ciprofloxacin hcl ophthalmic (eye) 0(Tier 1)erythromycin ophthalmic (eye) 0(Tier 1)gentak ophthalmic (eye) ointment 0(Tier 1)gentamicin ophthalmic (eye) drops 0(Tier 1)moxifloxacin ophthalmic (eye) 0(Tier 1)NATACYN 0(Tier 2)neomycin-bacitracin-polymyxin 0(Tier 1)neomycin-polymyxin-gramicidin 0(Tier 1)neo-polycin 0(Tier 1)ofloxacin ophthalmic (eye) 0(Tier 1)polycin 0(Tier 1)polymyxin b sulf-trimethoprim 0(Tier 1)tobramycin ophthalmic (eye) 0(Tier 1)TOBREX OPHTHALMIC (EYE) OINTMENT 0(Tier 2)ANTIVIRALStrifluridine 0(Tier 1)


82



ZIRGAN 0(Tier 2)BETA-BLOCKERScarteolol 0(Tier 1)levobunolol ophthalmic (eye) drops 0.5% 0(Tier 1)timolol maleate ophthalmic (eye) drops 0(Tier 1)timolol maleate ophthalmic (eye) gel forming solution

0(Tier 1)

MISCELLANEOUS OPHTHALMOLOGICSartificial tears (petro/min) 0(Tier 1) MCartificial tears (polyvin alc) 0(Tier 1) MCATROPINE OPHTHALMIC (EYE) DROPS 0(Tier 2)azelastine ophthalmic (eye) 0(Tier 1)BLEPHAMIDE 0(Tier 2)BLEPHAMIDE S.O.P. 0(Tier 2)cromolyn ophthalmic (eye) 0(Tier 1)CYSTARAN 0(Tier 2) PA; NDSDRY EYE RELIEF 0(Tier 1) MCepinastine 0(Tier 1)EYLEA 0(Tier 2) PA; NDSISOPTO TEARS 0(Tier 1) MCLACRISERT 0(Tier 2)LUBRICANT EYE (PG-PEG 400) 0(Tier 1) MClubricant eye drops ophthalmic (eye) dropperette

0(Tier 1) MC

lubricating plus 0(Tier 1) MClubrifresh pm 0(Tier 1) MCMURO 128 OPHTHALMIC (EYE) DROPS 0(Tier 1) MColopatadine ophthalmic (eye) 0(Tier 1)OXERVATE 0(Tier 2) PA; QL (112 ML per 999 days); NDSPAZEO 0(Tier 2)PHOSPHOLINE IODIDE 0(Tier 2)pilocarpine hcl ophthalmic (eye) drops 1%, 2%, 4%

0(Tier 1)

REFRESH CELLUVISC 0(Tier 1) MCREFRESH LACRI-LUBE 0(Tier 1) MCREFRESH OPTIVE MEGA-3 (PF) 0(Tier 1) MCREFRESH PLUS 0(Tier 1) MCRESTASIS 0(Tier 2) QL (60 EA per 30 days)RESTASIS MULTIDOSE 0(Tier 2) QL (60 ML per 30 days)


83



sodium chloride ophthalmic (eye) 0(Tier 1) MCsulfacetamide sodium ophthalmic (eye) drops 0(Tier 1)sulfacetamide-prednisolone 0(Tier 1)ULTRA LUBRICANT EYE 0(Tier 1) MCXIIDRA 0(Tier 2) QL (60 EA per 30 days)NON-STEROIDAL ANTI-INFLAMMATORY AGENTSbromfenac 0(Tier 1)diclofenac sodium ophthalmic (eye) 0(Tier 1)flurbiprofen sodium 0(Tier 1)ketorolac ophthalmic (eye) 0(Tier 1)PROLENSA 0(Tier 2)ORAL DRUGS FOR GLAUCOMAacetazolamide 0(Tier 1)acetazolamide sodium 0(Tier 1)methazolamide 0(Tier 1)OTHER GLAUCOMA DRUGSAZOPT 0(Tier 2)bimatoprost ophthalmic (eye) 0(Tier 1)COMBIGAN 0(Tier 2)dorzolamide 0(Tier 1)dorzolamide-timolol 0(Tier 1)latanoprost 0(Tier 1)LUMIGAN OPHTHALMIC (EYE) DROPS 0.01% 0(Tier 2)RHOPRESSA 0(Tier 2) STROCKLATAN 0(Tier 2) STSIMBRINZA 0(Tier 2)travoprost 0(Tier 1)STEROID-ANTIBIOTIC COMBINATIONSneomycin-bacitracin-poly-hc 0(Tier 1)neomycin-polymyxin b-dexameth 0(Tier 1)neomycin-polymyxin-hc ophthalmic (eye) 0(Tier 1)neo-polycin hc 0(Tier 1)PRED-G 0(Tier 2)PRED-G S.O.P. 0(Tier 2)tobramycin-dexamethasone 0(Tier 1)ZYLET 0(Tier 2)STEROIDS


84



dexamethasone sodium phosphate ophthalmic (eye)

0(Tier 1)

DUREZOL 0(Tier 2)fluorometholone 0(Tier 1)INVELTYS 0(Tier 2)LOTEMAX 0(Tier 2)LOTEMAX SM 0(Tier 2)prednisolone acetate 0(Tier 1)prednisolone sodium phosphate ophthalmic (eye)

0(Tier 1)

SYMPATHOMIMETICSALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1%

0(Tier 2)

apraclonidine 0(Tier 1)brimonidine 0(Tier 1)VASOCONSTRICTOR DECONGESTANTSeye drops (tetrahydrozoline) 0(Tier 1) MCeye drops advanced relief 0(Tier 1) MCREDNESS RELIEF OPHTHALMIC (EYE) DROPS 0.012-0.25%

0(Tier 1) MC

RESPIRATORY AND ALLERGY (DRUGS USED FOR BREATHING PROBLEMS)ANTIHISTAMINE / ANTIALLERGENIC AGENTS12 hour nasal decongest (pse) 0(Tier 1) MC24hr allergy relief 0(Tier 1) MCACETAMINOPHEN CONGESTION-PAIN 0(Tier 1) MCALAHIST CF 0(Tier 1) MCALAHIST DM 0(Tier 1) MCala-hist ir 0(Tier 1) MCALAHIST PE 0(Tier 1) MCall day allergy (cetirizine) oral tablet 0(Tier 1) MCaller-chlor oral tablet 0(Tier 1) MCallergy (chlorpheniramine) 0(Tier 1) MCallergy (diphenhydramine) oral capsule 0(Tier 1) MCallergy multi-symptom 0(Tier 1) MCallergy relief (fexofenadine) oral tablet 180 mg 0(Tier 1) MCallergy relief (loratadine) oral solution 0(Tier 1) MCallergy relief (loratadine) oral tablet 0(Tier 1) MCallergy relief d12 0(Tier 1) MCallergy relief d-24hr 0(Tier 1) MC


85



allergy relief(chlorpheniramn) oral tablet 0(Tier 1) MCallergy relief(diphenhydramin) 0(Tier 1) MCallergy relief-d (cetirizine) 0(Tier 1) MCallergy-congest relief-d(fexo) 0(Tier 1) MCALL-NITE COLD-FLU 0(Tier 1) MCaprodine 0(Tier 1) MCbanophen oral capsule 0(Tier 1) MCbenzonatate 0(Tier 1) MCbrompheniramine-pseudoeph-dm oral syrup 0(Tier 1) MCbrotapp dm 0(Tier 1) MCcetirizine oral solution 1 mg/ml 0(Tier 1) MCcetirizine oral tablet 0(Tier 1) MCcetirizine-pseudoephedrine 0(Tier 1) MCchest congestion relief oral tablet 0(Tier 1) MCCHILD MUCINEX CHEST MINI-MELTS ORAL GRANULES IN PACKET 100 MG

0(Tier 1) MC

CHILD MUCINEX COUGH MINI-MELTS 0(Tier 1) MCCHILD MUCINEX M-S COLD DAY-NTE 0(Tier 1) MCchild mucus relief cough 0(Tier 1) MCchildren’s allergy (diphenhyd) oral liquid 0(Tier 1) MCchildren’s allergy relief(lor) oral solution 0(Tier 1) MCchildren’s cetirizine oral solution 0(Tier 1) MCCHILDREN’S CETIRIZINE ORAL TABLET,CHEWABLE 10 MG

0(Tier 1) MC

children’s cetirizine oral tablet,chewable 5 mg 0(Tier 1) MCchildren’s cold and cough (pe) 0(Tier 1) MCCHILDREN’S COUGH DM ER 0(Tier 1) MCCHILDREN’S DAYCLEAR ALLERGY 0(Tier 1) MCCHILDREN’S DELSYM COUGH 0(Tier 1) MCCHILDREN’S MUCINEX COLD-FEVER 0(Tier 1) MCCHILDREN’S MUCINEX MULTI-SYMP 0(Tier 1) MCCHILDREN’S MUCINEX NIGHT TIME 0(Tier 1) MCchildren’s silfedrine 0(Tier 1) MCchild’s all day allergy(cetir) 0(Tier 1) MCCHILD’S MUCUS RELIEF M-S COLD 0(Tier 1) MCCHLO TUSS 0(Tier 1) MCcodeine-guaifenesin 0(Tier 1) MCcomplete allergy medicine oral capsule 0(Tier 1) MCCOUGH AND SEVERE COLD 0(Tier 1) MC


86



COUGH DM ER 0(Tier 1) MCcough syrup dm 0(Tier 1) MCCOUGH-COLD RELIEF HBP 0(Tier 1) MCDAYTIME COLD-FLU RELIEF (PE) 0(Tier 1) MCDECONEX DMX ORAL TABLET 10-17.5-385 MG, 10-17.5-400 MG

0(Tier 1) MC

DECONEX IR ORAL TABLET 10-385 MG 0(Tier 1) MCDELSYM 12 HOUR 0(Tier 1) MCdelsym cough-chest congest dm 0(Tier 1) MCdesloratadine oral tablet 0(Tier 1) QL (30 EA per 30 days)DEXBROMPHENIRAMINE-PHENYLEPH 0(Tier 1) MCdextromethorphan polistirex 0(Tier 1) MCdimaphen dm 0(Tier 1) MCdiphenhist oral capsule 0(Tier 1) MCdiphenhydramine hcl injection solution 50 mg/ml 0(Tier 1)diphenhydramine hcl oral capsule 0(Tier 1) MCDIPHENHYDRAMINE HCL ORAL DROPS 0(Tier 1) MCdiphenhydramine hcl oral liquid 0(Tier 1) MCdiphenhydramine hcl oral tablet 25 mg 0(Tier 1) MCDOXYLAMINE-PHENYLEPHRINE 0(Tier 1) MCDURAFLU ORAL TABLET 60-20-200-325 MG 0(Tier 1) MCed a-hist 0(Tier 1) MCed a-hist dm oral liquid 0(Tier 1) MCED A-HIST DM ORAL TABLET 0(Tier 1) MCed bron gp 0(Tier 1) MCed chlorped jr 0(Tier 1) MCendacof - dm 0(Tier 1) MCepinephrine injection auto-injector 0(Tier 1) QL (2 EA per 30 days)epinephrine injection solution 1 mg/ml 0(Tier 1)FEXOFENADINE ORAL SUSPENSION 0(Tier 1) MCfexofenadine oral tablet 180 mg, 60 mg 0(Tier 1) MCfexofenadine-pseudoephedrine 0(Tier 1) MCFLU-SEVERE COLD-COUGH DAYTIME 0(Tier 1) MCguaiatussin ac 0(Tier 1) MCHISTEX (TRIPROLIDINE) ORAL LIQUID 0(Tier 1) MCHISTEX DM 0(Tier 1) MCHISTEX PD 0(Tier 1) MCHISTEX PE 0(Tier 1) MC


87



hydrocodone-chlorpheniramine 0(Tier 1) MChydrocodone-homatropine oral syrup 5-1.5 mg/5 ml

0(Tier 1) MC

hydrocodone-homatropine oral tablet 0(Tier 1) MChydromet 0(Tier 1) MChydroxyzine hcl oral tablet 0(Tier 1) PAlevocetirizine oral solution 0(Tier 1)levocetirizine oral tablet 0(Tier 1) QL (30 EA per 30 days)lohist - d 0(Tier 1) MClohist-dm 0(Tier 1) MClorata-dine d 0(Tier 1) MCloratadine oral solution 0(Tier 1) MCloratadine oral tablet 0(Tier 1) MCloratadine-d 0(Tier 1) MCLORTUSS LQ 0(Tier 1) MCmapap cold formula 0(Tier 1) MCM-END DMX 0(Tier 1) MCMUCINEX COLD,FLU,SORE THROAT 0(Tier 1) MCmucinex d 0(Tier 1) MCmucinex d maximum strength 0(Tier 1) MCmucinex dm oral tablet extended release 12 hr 30-600 mg

0(Tier 1) MC

MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR 60-1,200 MG

0(Tier 1) MC

MUCINEX FAST-MAX COLD-SINUS 0(Tier 1) MCMUCINEX FAST-MAX CONGEST-COUGH ORAL TABLET

0(Tier 1) MC

MUCINEX FAST-MAX DAY-NITE CONG ORAL TABLETS, SEQUENTIAL 5 MG (DY)/25 MG -5 MG-325MG(NT)

0(Tier 1) MC

mucinex fast-max dm max 0(Tier 1) MCMUCINEX FAST-MAX NITE COLD-FLU ORAL LIQUID

0(Tier 1) MC

MUCINEX FAST-MAX SEVERE COLD ORAL LIQUID

0(Tier 1) MC

MUCINEX FST-MX DY-NT COLD(DPH) ORAL LIQUID, SEQUENTIAL

0(Tier 1) MC

MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG

0(Tier 1) MC


88



mucinex oral tablet extended release 12hr 600 mg

0(Tier 1) MC

mucus dm 0(Tier 1) MCmucus dm max er 0(Tier 1) MCmucus relief 0(Tier 1) MCmucus relief d (pseudoephed) oral tablet extended release 12 hr 60-600 mg

0(Tier 1) MC

mucus relief dm cough 0(Tier 1) MCMUCUS RELIEF ER ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG

0(Tier 1) MC

mucus relief er oral tablet extended release 12hr 600 mg

0(Tier 1) MC

mucus relief sinus 0(Tier 1) MCMUCUS-CHEST CONGESTION 0(Tier 1) MCnasal decongestant (pseudoeph) oral tablet 0(Tier 1) MCNASOPEN PE 0(Tier 1) MCNIGHTTIME COLD-FLU 0(Tier 1) MCNIGHTTIME COLD-FLU RELIEF 0(Tier 1) MCnighttime sleep aid (diphen) oral tablet 0(Tier 1) MCNINJACOF 0(Tier 1) MCNINJACOF-XG 0(Tier 1) MCnohist-dm 0(Tier 1) MCnohist-lq 0(Tier 1) MCPEDIACLEAR ALLERGY 0(Tier 1) MCPEDIACLEAR COUGH 0(Tier 1) MCPEDIACLEAR PD 0(Tier 1) MCPEDIACLEAR-8 0(Tier 1) MCpediatric cough and cold oral liquid 1-15-5 mg/5 ml

0(Tier 1) MC

PHENYLEPHRINE-DM-GUAIFENESIN ORAL LIQUID 10-18-200 MG/15 ML

0(Tier 1) MC

PHENYLEPHRINE-DM-GUAIFENESIN ORAL TABLET

0(Tier 1) MC

POLY HIST FORTE 0(Tier 1) MCPOLY HIST FORTE (DOXYLAMINE) 0(Tier 1) MCPOLY HIST PD 0(Tier 1) MCPOLY-HIST DM (THONZYLAMINE) 0(Tier 1) MCPOLYTUSSIN DM 0(Tier 1) MCPOLY-VENT DM ORAL TABLET 60-20-380 MG 0(Tier 1) MCPOLY-VENT IR ORAL TABLET 60-380 MG 0(Tier 1) MC


89



promethazine oral 0(Tier 1) PApromethazine rectal suppository 12.5 mg, 25 mg 0(Tier 1)promethazine-codeine 0(Tier 1) MCpromethazine-dm 0(Tier 1) MCpromethegan rectal suppository 25 mg, 50 mg 0(Tier 1)pseudoephedrine hcl oral tablet 0(Tier 1) MCpseudoephedrine hcl oral tablet extended release

0(Tier 1) MC

PSEUDOEPHEDRINE-GUAIFENESIN ORAL TABLET

0(Tier 1) MC

pseudoephedrine-guaifenesin oral tablet extended release 12 hr

0(Tier 1) MC

RESCON 0(Tier 1) MCRESCON-DM 0(Tier 1) MCrescon-gg 0(Tier 1) MCrobafen 0(Tier 1) MCrobafen cf (phenylephrine) 0(Tier 1) MCrobafen cough 0(Tier 1) MCrobafen dm cough 0(Tier 1) MCrobafen dm cough-chest congest 0(Tier 1) MCrobafen dm peak cold 0(Tier 1) MCRU-HIST D 0(Tier 1) MCRYMED (DEXCHLORPHENIRAMINE-PE) 0(Tier 1) MCrynex dm 0(Tier 1) MCrynex pe 0(Tier 1) MCrynex pse 0(Tier 1) MCSEVERE COLD AND FLU (PE) ORAL TABLET 0(Tier 1) MCSEVERE COLD AND FLU NIGHTTIME 0(Tier 1) MCsiladryl sa 0(Tier 1) MCsiltussin dm das 0(Tier 1) MCsiltussin sa 0(Tier 1) MCsiltussin-dm 0(Tier 1) MCSINUS CONGESTION AND PAIN 0(Tier 1) MCSINUS CONGESTION-PAIN(GUAIF) 0(Tier 1) MCSINUS PAIN-PRESSURE (PE) ORAL TABLET 5-325 MG

0(Tier 1) MC

SLEEP AID (DIPHENHYDRAMINE) ORAL CAPSULE 25 MG

0(Tier 1) MC

sleep aid (diphenhydramine) oral capsule 50 mg 0(Tier 1) MC


90



SLEEP AID (DIPHENHYDRAMINE) ORAL LIQUID

0(Tier 1) MC

sleep aid (diphenhydramine) oral tablet 0(Tier 1) MCSTAHIST AD ORAL TABLET 0(Tier 1) MCsudogest 0(Tier 1) MCsudogest 12-hour 0(Tier 1) MCsudogest pe 0(Tier 1) MCsudogest sinus and allergy 0(Tier 1) MCTRIPROLIDINE HCL 0(Tier 1) MCtussin cf (pe-dm-guaif) 0(Tier 1) MCtussin dm cough and chest oral liquid 5-100 mg/5 ml

0(Tier 1) MC

tussin dm oral liquid 0(Tier 1) MCtussin dm oral syrup 10-100 mg/5 ml 0(Tier 1) MCtussin mucus-chest congestion 0(Tier 1) MCVANACLEAR PD 0(Tier 1) MCVANACOF 0(Tier 1) MCVANACOF DM 0(Tier 1) MCVANACOF DMX 0(Tier 1) MCVANAMINE PD 0(Tier 1) MCVANATAB DM 0(Tier 1) MCvirtussin ac 0(Tier 1) MCvirtussin dac 0(Tier 1) MCPULMONARY AGENTSacetylcysteine 0(Tier 1) B/D PAADEMPAS 0(Tier 2) PA; LA; QL (90 EA per 30 days); NDSADVAIR HFA 0(Tier 2) QL (12 GM per 30 days)albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (generic for ProAir)

0(Tier 1) QL (17 GM per 30 days)

albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (generic for Proventil)

0(Tier 1) QL (13.4 GM per 30 days)

albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (generic for Ventolin)


albuterol sulfate inhalation solution for nebulization

0(Tier 1) B/D PA

albuterol sulfate oral 0(Tier 1)ALLERGY RELIEF (FLUTICASONE) 0(Tier 1) MCalyq 0(Tier 1) PA; QL (60 EA per 30 days); NDSambrisentan 0(Tier 1) PA; LA; QL (30 EA per 30 days); NDS


91



ANORO ELLIPTA 0(Tier 2) QL (60 EA per 30 days)ARNUITY ELLIPTA 0(Tier 2) QL (30 EA per 30 days)ATROVENT HFA 0(Tier 2) QL (25.8 GM per 30 days)bosentan 0(Tier 1) PA; LA; NDSBREO ELLIPTA 0(Tier 2) QL (60 EA per 30 days)BROVANA 0(Tier 2) B/D PAbudesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml

0(Tier 1) B/D PA; QL (120 ML per 30 days)

budesonide inhalation suspension for nebulization 1 mg/2 ml


budesonide nasal 0(Tier 1) MCCOMBIVENT RESPIMAT 0(Tier 2) QL (8 GM per 30 days)cromolyn inhalation 0(Tier 1) B/D PAcromolyn nasal 0(Tier 1) MCDALIRESP 0(Tier 2) PA; QL (30 EA per 30 days)ESBRIET ORAL CAPSULE 0(Tier 2) PA; QL (270 EA per 30 days); NDSESBRIET ORAL TABLET 267 MG 0(Tier 2) PA; QL (270 EA per 30 days); NDSESBRIET ORAL TABLET 801 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSFLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION


FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION


FLOVENT HFA AEROSOL INHALER 110 MCG/ACTUATION





0(Tier 2) QL (10.6 GM per 30 days)

flunisolide nasal spray,non-aerosol 25 mcg (0.025%)


fluticasone propionate nasal 0(Tier 1) QL (16 GM per 30 days)fluticasone propion-salmeterol inhalation blister with device


HAEGARDA 0(Tier 2) PA; LA; NDSicatibant 0(Tier 1) PA; QL (18 ML per 30 days); NDSINCRUSE ELLIPTA 0(Tier 2) QL (30 EA per 30 days)ipratropium bromide inhalation 0(Tier 1) B/D PAipratropium-albuterol 0(Tier 1) B/D PAKALYDECO ORAL GRANULES IN PACKET 0(Tier 2) PA; QL (56 EA per 28 days); NDS


92



KALYDECO ORAL TABLET 0(Tier 2) PA; QL (60 EA per 30 days); NDSlevalbuterol hcl 0(Tier 1) B/D PAmetaproterenol oral syrup 0(Tier 1)mometasone nasal 0(Tier 1) QL (34 GM per 30 days)montelukast 0(Tier 1) QL (30 EA per 30 days)NASAL ALLERGY 0(Tier 1) MCOFEV 0(Tier 2) PA; QL (60 EA per 30 days); NDSOPSUMIT 0(Tier 2) PA; LA; NDSORKAMBI ORAL GRANULES IN PACKET 0(Tier 2) PA; QL (56 EA per 28 days); NDSORKAMBI ORAL TABLET 0(Tier 2) PA; QL (112 EA per 28 days); NDSPERFOROMIST 0(Tier 2) B/D PA; QL (120 ML per 30 days)PULMICORT INHALATION SUSPENSION FOR NEBULIZATION 0.25 MG/2 ML, 0.5 MG/2 ML


PULMICORT INHALATION SUSPENSION FOR NEBULIZATION 1 MG/2 ML


PULMOZYME 0(Tier 2) B/D PA; QL (150 ML per 30 days); NDSS2 RACEPINEPHRINE 0(Tier 1) MCSEREVENT DISKUS 0(Tier 2) QL (60 EA per 30 days)sildenafil (pulmonary arterial hypertension) oral tablet


SYMDEKO 0(Tier 2) PA; QL (56 EA per 28 days); NDStadalafil (pulmonary arterial hypertension) oral tablet 20 mg


terbutaline 0(Tier 1)THEO-24 0(Tier 2)theophylline oral tablet extended release 12 hr 300 mg, 450 mg

0(Tier 1)

theophylline oral tablet extended release 24 hr 0(Tier 1)TRELEGY ELLIPTA 0(Tier 2) QL (60 EA per 30 days)triamcinolone acetonide nasal 0(Tier 1) MCTRIKAFTA 0(Tier 2) PA; NDSVENTAVIS 0(Tier 2) PA; NDSVENTOLIN HFA 0(Tier 2) QL (36 GM per 30 days)wixela inhub 0(Tier 1) QL (60 EA per 30 days)XHANCE 0(Tier 2) ST; QL (32 ML per 30 days)XOLAIR SUBCUTANEOUS RECON SOLN 0(Tier 2) PA; LA; QL (6 EA per 28 days); NDSXOLAIR SUBCUTANEOUS SYRINGE 150 MG/ML

0(Tier 2) PA; LA; QL (4 ML per 28 days); NDS

XOLAIR SUBCUTANEOUS SYRINGE 75 MG/0.5 ML

0(Tier 2) PA; LA; QL (1 ML per 28 days); NDS


93



XOPENEX 0(Tier 2) B/D PAXOPENEX CONCENTRATE 0(Tier 2) B/D PAYUPELRI 0(Tier 2) B/D PA; QL (90 ML per 30 days)zafirlukast 0(Tier 1) QL (60 EA per 30 days)UROLOGICALS (DRUGS THAT TREAT PROBLEMS OF THE URINARY TRACT)ANTICHOLINERGICS / ANTISPASMODICSdarifenacin 0(Tier 1)flavoxate 0(Tier 1)MYRBETRIQ 0(Tier 2)oxybutynin chloride oral syrup 0(Tier 1)oxybutynin chloride oral tablet 0(Tier 1)oxybutynin chloride oral tablet extended release 24hr


solifenacin 0(Tier 1)tolterodine 0(Tier 1)TOVIAZ 0(Tier 2) QL (30 EA per 30 days)BENIGN PROSTATIC HYPERPLASIA(BPH) THERAPYalfuzosin 0(Tier 1)dutasteride 0(Tier 1)dutasteride-tamsulosin 0(Tier 1)finasteride oral tablet 5 mg 0(Tier 1) QL (30 EA per 30 days)tamsulosin 0(Tier 1) QL (60 EA per 30 days)MISCELLANEOUS UROLOGICALSbethanechol chloride 0(Tier 1)CYSTAGON 0(Tier 2) LAELMIRON 0(Tier 2) NDSK-PHOS ORIGINAL 0(Tier 2)potassium citrate 0(Tier 1)potassium citrate-citric acid oral solution 0(Tier 1) MCRENACIDIN IRRIGATION SOLUTION 1980.6 MG-59.4 MG-980.4MG/30ML

0(Tier 2)

sodium citrate-citric acid 0(Tier 1) MCtricitrates 0(Tier 1) MCVITAMINS, HEMATINICS / ELECTROLYTES (DRUGS THAT REPLACE NUTRIENTS/ELECTROLYTES)ELECTROLYTESantacid (calcium carbonate) oral tablet,chewable 200 mg calcium (500 mg)

0(Tier 1) MC

antacid ext str (calcium carb) 0(Tier 1) MC


94



antacid ultra strength oral tablet,chewable 400 mg calcium (1,000 mg)

0(Tier 1) MC

calcitrate 0(Tier 1) MCcalcium 500 + d oral tablet 500 mg(1,250mg) -200 unit

0(Tier 1) MC

calcium 500 + d oral tablet,chewable 0(Tier 1) MCcalcium 500 with d 0(Tier 1) MCcalcium 600 0(Tier 1) MCcalcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit

0(Tier 1) MC

calcium 600 with vitamin d3 oral tablet,chewable 0(Tier 1) MCcalcium acetate(phosphat bind) 0(Tier 1)calcium antacid oral tablet,chewable 200 mg calcium (500 mg), 300 mg (750 mg)

0(Tier 1) MC

calcium carbonate oral suspension 0(Tier 1) MCcalcium carbonate oral tablet 260 mg calcium (648 mg), 500 mg calcium (1,250 mg), 600 mg calcium (1,500 mg)

0(Tier 1) MC

calcium carbonate oral tablet,chewable 500 mg calcium (1,250 mg)

0(Tier 1) MC

calcium carbonate-vitamin d3 oral capsule 600 mg(1,500mg) -400 unit

0(Tier 1) MC

CALCIUM CARBONATE-VITAMIN D3 ORAL TABLET 250-125 MG-UNIT, 500MG (1,250MG) -600 UNIT, 600 MG(1,500MG) -800 UNIT

0(Tier 1) MC

calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit, 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit

0(Tier 1) MC

calcium carbonate-vitamin d3 oral tablet,chewable 500 mg(1,250mg) -400 unit

0(Tier 1) MC

calcium citrate + d 0(Tier 1) MCcalcium citrate oral tablet 200 mg (950 mg) 0(Tier 1) MCcalcium citrate plus (vit b6) 0(Tier 1) MCcalcium citrate-vitamin d3 oral tablet 200 mg-3.125 mcg (125 unit), 315 mg-5 mcg (200 unit)

0(Tier 1) MC

CALCIUM CITRATE-VITAMIN D3 ORAL TABLET 315 MG-6.25 MCG (250 UNIT)

0(Tier 1) MC

calcium with vitamin d 0(Tier 1) MCCALCIUM-MAGNESIUM 0(Tier 1) MC


95



calcium-magnesium-zinc oral tablet 333-133-5 mg

0(Tier 1) MC

cal-gest antacid 0(Tier 1) MCCALTRATE 600 PLUS D 0(Tier 1) MCCALTRATE WITH VITAMIN D3 0(Tier 1) MCCITRACAL + D MAXIMUM 0(Tier 1) MCelectrolytes-dextrose 0(Tier 1) MCENFAMIL ENFALYTE 0(Tier 1) MChi-cal plus vit d 0(Tier 1) MCklor-con 0(Tier 1)KLOR-CON 10 0(Tier 2)KLOR-CON 8 0(Tier 2)klor-con m10 0(Tier 1)klor-con m20 0(Tier 1)k-phos-neutral 0(Tier 1) MClactated ringers intravenous 0(Tier 2)MAGNESIUM (OXIDE/AA CHELATE) 0(Tier 1) MCMAGNESIUM GLUCONATE ORAL TABLET 30 MG (550 MG)

0(Tier 1) MC

MAGNESIUM ORAL TABLET 30 MG 0(Tier 1) MCmagnesium oxide oral capsule 500 mg 0(Tier 1) MCmagnesium oxide oral tablet 420 mg 0(Tier 1) MCMAGNESIUM OXIDE ORAL TABLET 500 MG 0(Tier 1) MCMAGNESIUM SULFATE IN D5W INTRAVENOUS PIGGYBACK 1 GRAM/100 ML

0(Tier 1)

magnesium sulfate in water 0(Tier 1)magnesium sulfate injection 0(Tier 1)MG-PLUS-PROTEIN 0(Tier 1) MCMONOCAL 0(Tier 1) MCNORMOSOL-R 0(Tier 2)NU-MAG 0(Tier 1) MCoralyte 0(Tier 1) MCORAZINC 0(Tier 1) MCOS-CAL 500 + D3 0(Tier 1) MCoysco 500/d oral tablet 0(Tier 1) MCoyster shell + d3 0(Tier 1) MCoyster shell calcium 500 0(Tier 1) MCoyster shell calcium and mag 0(Tier 1) MC


96



OYSTER SHELL CALCIUM-VIT D3 ORAL TABLET 250-125 MG-UNIT

0(Tier 1) MC

oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit

0(Tier 1) MC

oystercal-d 0(Tier 1) MCPEDIALYTE ADVANCED CARE 0(Tier 1) MCpedialyte freezer pops 0(Tier 1) MCpedialyte oral solution 0(Tier 1) MCpedialyte singles 0(Tier 1) MCpediatric electrolyte oral solution 0(Tier 1) MCpediatric freezer pops 0(Tier 1) MCPHILLIPS 0(Tier 1) MCphospha 250 neutral 0(Tier 1) MCphosphorous 0(Tier 1) MCphospho-trin 250 neutral 0(Tier 1) MCPOTASSIUM CHLORID-D5-0.45%NACL INTRAVENOUS PARENTERAL SOLUTION 10 MEQ/L, 20 MEQ/L, 40 MEQ/L

0(Tier 2)

potassium chlorid-d5-0.45%nacl intravenous parenteral solution 30 meq/l

0(Tier 1)

potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l

0(Tier 1)

POTASSIUM CHLORIDE IN 5% DEX INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2)

potassium chloride in 5% dex intravenous parenteral solution 30 meq/l

0(Tier 2)

potassium chloride in 5% dex intravenous parenteral solution 40 meq/l

0(Tier 1)

POTASSIUM CHLORIDE IN LR-D5 INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2)

potassium chloride in water intravenous piggyback

0(Tier 1)

potassium chloride intravenous 0(Tier 1)potassium chloride oral capsule, extended release

0(Tier 1)

POTASSIUM CHLORIDE ORAL LIQUID 0(Tier 2)potassium chloride oral packet 0(Tier 1)potassium chloride oral tablet extended release 0(Tier 1)


97



potassium chloride oral tablet,er particles/crystals

0(Tier 1)

potassium chloride-0.45% nacl 0(Tier 1)POTASSIUM CHLORIDE-D5-0.2%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2)

potassium chloride-d5-0.2%nacl intravenous parenteral solution 30 meq/l, 40 meq/l

0(Tier 2)

POTASSIUM CHLORIDE-D5-0.9%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2)

potassium chloride-d5-0.9%nacl intravenous parenteral solution 40 meq/l

0(Tier 1)

ringer’s intravenous 0(Tier 2)selenium oral tablet 0(Tier 1) MCSLOW-MAG 0(Tier 1) MCsodium bicarbonate intravenous syringe 10 meq/10 ml (8.4%), 7.5% (0.9 meq/ml), 8.4% (1 meq/ml)

0(Tier 1)

SODIUM CHLORIDE 0.45% INTRAVENOUS PARENTERAL SOLUTION

0(Tier 2)

SODIUM CHLORIDE 3% 0(Tier 2)SODIUM CHLORIDE 5% 0(Tier 2)sodium chloride intravenous 0(Tier 1)super calcium 0(Tier 1) MCTPN ELECTROLYTES 0(Tier 2) B/D PAvirt-phos 250 neutral 0(Tier 1) MCzinc 0(Tier 1) MCZINC GLUCONATE ORAL LOZENGE 0(Tier 1) MCzinc gluconate oral tablet 0(Tier 1) MCzinc sulfate oral 0(Tier 1) MCZINC-15 0(Tier 1) MCzinc-220 0(Tier 1) MCMISCELLANEOUS NUTRITION PRODUCTSAMINOSYN II 15% 0(Tier 2) B/D PAAMINOSYN-PF 7% (SULFITE-FREE) 0(Tier 2) B/D PACALCIUM CITRATE MALATE-VIT D3 0(Tier 1) MCCLINIMIX 5%/D15W SULFITE FREE 0(Tier 2) B/D PACLINIMIX 4.25%/D10W SULF FREE 0(Tier 2) B/D PACLINIMIX 5%-D20W(SULFITE-FREE) 0(Tier 2) B/D PA


98



CLINIMIX 6%-D5W (SULFITE-FREE) 0(Tier 2) B/D PACLINIMIX 8%-D10W(SULFITE-FREE) 0(Tier 2) B/D PACLINIMIX 8%-D14W(SULFITE-FREE) 0(Tier 2) B/D PACLINIMIX E 4.25%/D10W SUL FREE 0(Tier 2) B/D PACLINISOL SF 15% 0(Tier 2) B/D PAelectrolyte-48 in d5w 0(Tier 1)FORTAVIT 0(Tier 1) MCfreamine iii 10% 0(Tier 2) B/D PAHEPATAMINE 8% 0(Tier 2) B/D PAINTRALIPID INTRAVENOUS EMULSION 20%, 30%

0(Tier 2) B/D PA

KABIVEN 0(Tier 2) B/D PANEPHRAMINE 5.4% 0(Tier 2) B/D PANORMOSOL-M IN 5% DEXTROSE 0(Tier 2)NORMOSOL-R PH 7.4 0(Tier 2)NUTRILIPID 0(Tier 2) B/D PAPERIKABIVEN 0(Tier 2) B/D PAPLENAMINE 0(Tier 2) B/D PAPREMASOL 10% 0(Tier 2) B/D PAPROCALAMINE 3% 0(Tier 2) B/D PAPROSOL 20% 0(Tier 2) B/D PATRAVASOL 10% 0(Tier 2) B/D PATROPHAMINE 10% 0(Tier 2) B/D PAVITAMINS / HEMATINICSa thru z 0(Tier 1) MCa thru z advanced formula 0(Tier 1) MCA THRU Z MEN’S ULTIMATE 0(Tier 1) MCa thru z select 50plus formula 0(Tier 1) MCa thru z select oral tablet 500-300-250 mcg 0(Tier 1) MCa thru z select women’s 0(Tier 1) MCABANEU-SL 0(Tier 1) MCabc plus 0(Tier 1) MCactical 0(Tier 1) MCadult one daily multivitamin 0(Tier 1) MCadults 50 plus 0(Tier 1) MCALBA-LYBE 0(Tier 1) MCanimal chews 0(Tier 1) MCapatate forte 0(Tier 1) MC


99



APETEX 0(Tier 1) MCAPETIGEN 0(Tier 1) MCapetigen plus oral liquid 0(Tier 1) MCAPETIGEN PLUS ORAL TABLET 0(Tier 1) MCAQUADEKS ORAL TABLET,CHEWABLE 0(Tier 1) MCAQUADEKS PEDIATRIC 0(Tier 1) MCascorbic acid (vitamin c) oral capsule, extended release

0(Tier 1) MC

ASCORBIC ACID (VITAMIN C) ORAL GRANULES

0(Tier 1) MC

ascorbic acid (vitamin c) oral syrup 0(Tier 1) MCascorbic acid (vitamin c) oral tablet 0(Tier 1) MCascorbic acid (vitamin c) oral tablet extended release 1,500 mg, 500 mg

0(Tier 1) MC

ASCORBIC ACID (VITAMIN C) ORAL TABLET,CHEWABLE 250 MG

0(Tier 1) MC

ascorbic acid (vitamin c) oral tablet,chewable 500 mg

0(Tier 1) MC

b complex 1 (with folic acid) 0(Tier 1) MCb complex 100 oral 0(Tier 1) MCB COMPLEX W-VIT C 0(Tier 1) MCb complex-vitamin b12 0(Tier 1) MCb-12 dots 0(Tier 1) MCBACMIN 0(Tier 1) MCbalance b-100 (folic acid) 0(Tier 1) MCbalance b-50 (with folic acid) 0(Tier 1) MCbalanced b-100 oral tablet 0.4 mg 0(Tier 1) MCbalanced b-50 oral tablet 0(Tier 1) MCb-complex with vitamin c oral capsule 0(Tier 1) MCb-complex with vitamin c oral tablet 0(Tier 1) MCb-complex with vitamin c oral tablet extended release

0(Tier 1) MC

beta carotene oral capsule 25,000 unit 0(Tier 1) MCBIOCAL 0(Tier 1) MCbiopetit 0(Tier 1) MCbiotin oral capsule 2,500 mcg, 5 mg 0(Tier 1) MCbiotin oral tablet 1 mg 0(Tier 1) MCC 1000-BIOFLAVONOIDS-ROSE HIPS 0(Tier 1) MCc complex 0(Tier 1) MC


100



c-1000 0(Tier 1) MCc-1000 with rose hips 0(Tier 1) MCc-500 0(Tier 1) MCca-d3-mag ox-zinc-cop-mang-bor oral tablet,chewable 600 mg calcium- 400 unit-40 mg

0(Tier 1) MC

CA-D3-MAG OX-ZINC-COP-MANG-BOR ORAL TABLET,CHEWABLE 600 MG CALCIUM- 800 UNIT-40 MG

0(Tier 1) MC

CALCET PETITES 0(Tier 1) MCcalcidol 0(Tier 1) MCcalcium 600 + minerals 0(Tier 1) MCcalcium carbonate-vit d3-min oral tablet 0(Tier 1) MCcalcium for women 0(Tier 1) MCcalcium soft chew oral tablet,chewable 500-200-40 mg-unit-mcg

0(Tier 1) MC

calcium-folic acid-vitamin d 0(Tier 1) MCcalcium-magnesium-copper-zinc 0(Tier 1) MCcalcium-vitamin d3-vitamin k oral tablet,chewable 500-200-40 mg-unit-mcg

0(Tier 1) MC

CALTRATE 600-D PLUS MINERALS ORAL TABLET

0(Tier 1) MC

centamin 0(Tier 1) MCCENTRAL-VITE WOMEN’S MATURE 0(Tier 1) MCCENTRAM-CARE 0(Tier 1) MCcentratex 0(Tier 1) MCcentravites 50 plus oral tablet 0.4-300-250 mg-mcg-mcg

0(Tier 1) MC

CENTRUM COMPLETE 0(Tier 1) MCCENTRUM MEN 0(Tier 1) MCCENTRUM ORAL LIQUID 9 MG IRON/15 ML 0(Tier 1) MCCENTRUM SILVER ORAL TABLET 0(Tier 1) MCCENTRUM SILVER WOMEN 0(Tier 1) MCCENTRUM SPECIALIST HEART 0(Tier 1) MCCENTRUM ULTRA MEN’S 0(Tier 1) MCcentrum women 0(Tier 1) MCcentury adults 50 plus 0(Tier 1) MCcentury cardio 0(Tier 1) MCcentury mature oral tablet 0.4-300-250 mg-mcg-mcg

0(Tier 1) MC


101



century oral tablet 18-400 mg-mcg 0(Tier 1) MCCENTURY ULTIMATE MEN’S ORAL TABLET 8 MG IRON- 200 MCG-600 MCG

0(Tier 1) MC

century ultimate women’s 0(Tier 1) MCCEREFOLIN 0(Tier 1) MCcerovite advanced formula 0(Tier 1) MCcerta plus 0(Tier 1) MCCERTAVITE SENIOR 0(Tier 1) MCCERTAVITE-ANTIOXIDANT 0(Tier 1) MCchildren’s chewable multivitmn 0(Tier 1) MCchildren’s chewable vitamin 0(Tier 1) MCchildren’s chewables 0(Tier 1) MCchildren’s chewables extra c 0(Tier 1) MCchildren’s iron 0(Tier 1) MCchild’s chewable vitamins/iron oral tablet,chewable

0(Tier 1) MC

childs/iron 0(Tier 1) MCCHOLECALCIFEROL (VITAMIN D3) ORAL DROPS 10 MCG/ML (400 UNIT/ML)

0(Tier 1) MC

complete 50 plus 0(Tier 1) MCCOMPLETE MEN 0(Tier 1) MCcomplete multi 0(Tier 1) MCcomplete multi 50+ 0(Tier 1) MCcomplete multivitamin-mineral oral tablet 0(Tier 1) MCcomplete mv adult 50 plus 0(Tier 1) MCcomplete oral tablet 18-500-300-250 mg-mcg-mcg-mcg

0(Tier 1) MC

complete senior oral tablet 0.4-300-250 mg-mcg-mcg

0(Tier 1) MC

complete women 0(Tier 1) MCcomplex b-100 oral tablet extended release 0(Tier 1) MCCORAL CALCIUM ORAL CAPSULE 185-50-100 MG-MG-UNIT

0(Tier 1) MC

corvita 0(Tier 1) MCCORVITE 0(Tier 1) MCCORVITE 150 ORAL TABLET 150 MG IRON- 1 MG

0(Tier 1) MC

CORVITE FE ORAL TABLET 150 MG IRON- 1 MG

0(Tier 1) MC


102



cyanocobalamin (vitamin b-12) oral tablet 1,000 mcg, 100 mcg, 500 mcg

0(Tier 1) MC

cyanocobalamin (vitamin b-12) oral tablet extended release

0(Tier 1) MC

daily multiple for men 0(Tier 1) MCDAILY MULTIPLE FOR WOMEN 0(Tier 1) MCdaily multiple oral tablet , 18-400 mg-mcg 0(Tier 1) MCDAILY MULTIPLE ORAL TABLET 400-120 MCG-MG

0(Tier 1) MC

daily multiple vitamins/iron 0(Tier 1) MCdaily multi-vitamin 0(Tier 1) MCdaily multivitamin with iron 0(Tier 1) MCdaily multivitamin-minerals 0(Tier 1) MCdaily value 0(Tier 1) MCdaily vitamin formula 0(Tier 1) MCdaily vitamin formula-iron 0(Tier 1) MCdaily vitamin formula-minerals 0(Tier 1) MCdaily vitamin with iron 0(Tier 1) MCdaily vites/iron 0(Tier 1) MCDAILY-VITE 0(Tier 1) MCDEKAS ESSENTIAL ORAL CAPSULE 0(Tier 1) MCDEKAS PLUS (FOLIC ACID) ORAL CAPSULE 0(Tier 1) MCDEKAS PLUS LIQUID 0(Tier 1) MCdialyvite 0(Tier 1) MCDIALYVITE 3000 0(Tier 1) MCDIALYVITE 5000 0(Tier 1) MCdialyvite 800 oral tablet 0(Tier 1) MCDIALYVITE 800 WITH IRON 0(Tier 1) MCDIALYVITE SUPREME D 0(Tier 1) MCduofer 0(Tier 1) MCd-vi-sol 0(Tier 1) MCELFOLATE PLUS 0(Tier 1) MCendur-c with rose hips 0(Tier 1) MCENLYTE 0(Tier 1) MCergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 unit)

0(Tier 1) MC

ergocalciferol (vitamin d2) oral drops 0(Tier 1) MCessentia 0(Tier 1) MCessential daily 0(Tier 1) MC


103



ezfe 200 0(Tier 1) MCfabb 0(Tier 1) MCfe c 0(Tier 1) MCFEOSOL BIFERA 0(Tier 1) MCfeosol oral tablet 325 mg (65 mg iron) 0(Tier 1) MCferate oral tablet 240 mg (27 mg iron) 0(Tier 1) MCFERGON ORAL TABLET 240 MG (27 MG IRON)

0(Tier 1) MC

FER-IN-SOL 0(Tier 1) MCFERIVA 21-7 0(Tier 1) MCFERIVA FA (WITH SUMALATE) 0(Tier 1) MCferosul oral tablet 0(Tier 1) MCFERRALET 90 DUAL-IRON DELIVERY 0(Tier 1) MCferraplus 90 0(Tier 1) MCferretts 0(Tier 1) MCFERRETTS IPS 0(Tier 1) MCferrex 150 0(Tier 1) MCferrex 150 forte 0(Tier 1) MCferric x-150 0(Tier 1) MCFERRIMIN 150 0(Tier 1) MCferrocite 0(Tier 1) MCferro-time 0(Tier 1) MCferrous fumarate oral tablet 324 mg (106 mg iron)

0(Tier 1) MC

ferrous gluconate oral tablet 236 mg (27 mg iron), 240 mg (27 mg iron), 256 mg (28 mg iron), 324 mg (37.5 mg iron), 324 mg (38 mg iron)

0(Tier 1) MC

ferrous sulfate oral drops 0(Tier 1) MCferrous sulfate oral liquid 0(Tier 1) MCferrous sulfate oral solution 0(Tier 1) MCferrous sulfate oral tablet 325 mg (65 mg iron) 0(Tier 1) MCferrous sulfate oral tablet,delayed release (dr/ec)

0(Tier 1) MC

FLINTSTONES COMPLETE (IRON) ORAL TABLET,CHEWABLE

0(Tier 1) MC

FLINTSTONES MULTIVITAMIN 0(Tier 1) MCFLINTSTONES/EXTRA C ORAL TABLET,CHEWABLE

0(Tier 1) MC

FLORIVA 0(Tier 1) MCFLORIVA (FLUORIDE-VITAMIN D3) 0(Tier 1) MC


104



FLORIVA PLUS 0(Tier 1) MCfluoride (sodium) oral drops 0(Tier 1) MCfluoride (sodium) oral tablet 0(Tier 1)fluoride (sodium) oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

0(Tier 1)

folbee 0(Tier 1) MCfolbee plus 0(Tier 1) MCfolbic 0(Tier 1) MCfolic acid injection 0(Tier 1) MCfolic acid oral tablet 1 mg 0(Tier 1) MCFOLIC ACID-VIT B6-VIT B12 ORAL TABLET 0.5-5-0.2 MG

0(Tier 1) MC

folitab 0(Tier 1) MCfolplex 2.2 0(Tier 1) MCfoltabs 800 0(Tier 1) MCfoltanx 0(Tier 1) MCFOLTRATE 0(Tier 1) MCfosfree 0(Tier 1) MCfruit c-500 0(Tier 1) MCfull spectrum b-vitamin c 0(Tier 1) MCFUSION 0(Tier 1) MCFUSION PLUS 0(Tier 1) MCgummi bear multivitamin 0(Tier 1) MCgummy dinos oral tablet,chewable 200 mcg 0(Tier 1) MChair vitamins 0(Tier 1) MChair,skin and nails oral tablet 0(Tier 1) MChalls defense 0(Tier 1) MCHARD NAILS 0(Tier 1) MCHEMOCYTE 0(Tier 1) MCHEMOCYTE-F 0(Tier 1) MCHEMOCYTE-PLUS 0(Tier 1) MChigh potency iron oral tablet 134 mg (27 mg iron)

0(Tier 1) MC

HIGH POTENCY IRON ORAL TABLET 27 MG IRON

0(Tier 1) MC

I.L.X. B-12 0(Tier 1) MCICAPS 0(Tier 1) MCICAPS AREDS ORAL TABLET,DELAYED RELEASE (DR/EC)

0(Tier 1) MC


105



ICAPS MV 0(Tier 1) MCICAR ORAL SUSPENSION 0(Tier 1) MCICAR-C 0(Tier 1) MCiferex 150 0(Tier 1) MCiferex 150 forte 0(Tier 1) MCINFED 0(Tier 1) MCINTEGRA 0(Tier 1) MCINTEGRA F 0(Tier 1) MCINTEGRA PLUS 0(Tier 1) MCiron (ferrous sulfate) 0(Tier 1) MCiron oral tablet 325 mg (65 mg iron) 0(Tier 1) MCiron oral tablet extended release 159 mg (45 mg iron)

0(Tier 1) MC

iron,carbonyl-vitamin c 0(Tier 1) MCIROSPAN 24/6 0(Tier 1) MCKIDS MULTIVITAMIN-MINERALS 0(Tier 1) MCkobee 0(Tier 1) MCLIQUID B-12 0(Tier 1) MClittle animals 0(Tier 1) MClittle animals-iron oral tablet,chewable 0(Tier 1) MCl-methyl-b6-b12 0(Tier 1) MCl-methyl-mc 0(Tier 1) MClysiplex plus oral liquid 0(Tier 1) MCMEDTYCHOLL-B COMPLEX-LIVER 0(Tier 1) MCmega multi for women 0(Tier 1) MCmega multiple/chelated mineral 0(Tier 1) MCmega multivitamin for men 0(Tier 1) MCmen’s one daily oral tablet 0(Tier 1) MCMERIBIN 0(Tier 1) MCmetafolbic 0(Tier 1) MCMTX SUPPORT 0(Tier 1) MCmulti complete with iron 0(Tier 1) MCmulti-day with iron 0(Tier 1) MCmulti-delyn with iron 0(Tier 1) MCmultiple vitamin-minerals 0(Tier 1) MCmultiple vitamins 0(Tier 1) MCmulti-vit with fluoride-iron 0(Tier 1) MCmulti-vitamin hp/minerals 0(Tier 1) MC


106



multivitamin oral tablet 0(Tier 1) MCmulti-vitamin with fluoride oral drops 0(Tier 1) MCmultivitamin with iron 0(Tier 1) MCmultivitamin with minerals 0(Tier 1) MCmultivitamin women 50 plus 0(Tier 1) MCmultivitamins with fluoride 0(Tier 1) MCMULTI-VITE 0(Tier 1) MCMVW COMPLETE FORMUL MULTIVIT 0(Tier 1) MCMVW COMPLETE FORMUL PEDIATRIC 0(Tier 1) MCMVW COMPLETE FORMULATION D3000 0(Tier 1) MCMVW COMPLETE FORMULATION D5000 0(Tier 1) MCmyferon 150 0(Tier 1) MCmyferon 150 forte 0(Tier 1) MCmynephrocaps 0(Tier 1) MCmynephron 0(Tier 1) MCmy-vitalife 0(Tier 1) MCnephplex rx 0(Tier 1) MCNEPHRON FA 0(Tier 1) MCnephronex 0(Tier 1) MCNEPHRO-VITE 0(Tier 1) MCnephro-vite rx 0(Tier 1) MCNEURIN-SL 0(Tier 1) MCNIVA-FOL 0(Tier 1) MCNU-IRON 0(Tier 1) MCNUTRIVIT 0(Tier 1) MCocutabs 0(Tier 1) MComnicap 0(Tier 1) MCONCOVITE 0(Tier 1) MCone daily calcium/iron 0(Tier 1) MCone daily complete 0(Tier 1) MCone daily energy oral tablet 0(Tier 1) MCone daily essential oral tablet , 0.4 mg 0(Tier 1) MCone daily for men 50+ advanced 0(Tier 1) MCone daily for women 0(Tier 1) MCone daily maximum 0(Tier 1) MCone daily men’s 50 plus memory 0(Tier 1) MCone daily multivitamin oral tablet 0(Tier 1) MCone daily multivit-iron(folic) 0(Tier 1) MC


107



one daily plus iron oral tablet 18-400 mg-mcg 0(Tier 1) MCone daily plus minerals 0(Tier 1) MCONE DAILY WOMEN 50 PLUS 0(Tier 1) MCone daily womens 50 plus 0(Tier 1) MCone daily women’s oral tablet 27-0.4 mg 0(Tier 1) MCone-a-day essential 0(Tier 1) MCONE-A-DAY MEN’S 50PLUS(GINKGO) 0(Tier 1) MCone-a-day teen advantage 0(Tier 1) MCONE-A-DAY WOMENS FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA

0(Tier 1) MC

PEDIA D-VITE ORAL DROPS 0(Tier 1) MCpedia iron 0(Tier 1) MCPEDIA TRI-VITE 0(Tier 1) MCPERIDIN-C 0(Tier 1) MCpoly-iron 0(Tier 1) MCpoly-iron 150 forte 0(Tier 1) MCpolysaccharide iron complex 0(Tier 1) MCPOLY-VI-FLOR 0(Tier 1) MCPOLY-VI-FLOR WITH IRON 0(Tier 1) MCPOLY-VI-SOL ORAL DROPS 0(Tier 1) MCPOLY-VI-SOL WITH IRON 0(Tier 1) MCPRENATAL VITAMIN ORAL TABLET 0(Tier 2)PREVENT 0(Tier 1) MCPRO FE 0(Tier 1) MCPROFERRIN ES 0(Tier 1) MCPROFERRIN-FORTE 0(Tier 1) MCPROTECT IRON 0(Tier 1) MCpyridoxine (vitamin b6) oral tablet 100 mg, 25 mg, 50 mg

0(Tier 1) MC

QUFLORA 0(Tier 1) MCQUFLORA FE 0(Tier 1) MCQUFLORA FE (FERROUS SULFATE) 0(Tier 1) MCQUFLORA PEDIATRIC 0(Tier 1) MCQUFLORA PEDIATRIC DROPS 0(Tier 1) MCquintabs-m iron free 0(Tier 1) MCrenal caps 0(Tier 1) MCRENAL VITAMIN 0(Tier 1) MCRENAL-VITE 0(Tier 1) MCrena-vite 0(Tier 1) MC


108



rena-vite rx 0(Tier 1) MCreno caps 0(Tier 1) MCriboflavin (vitamin b2) oral tablet 100 mg 0(Tier 1) MCrisacal-d 0(Tier 1) MCSCOOBY-DOO ONE A DAY 0(Tier 1) MCsenior tabs 0(Tier 1) MCsentry 0(Tier 1) MCsentry senior 0(Tier 1) MCse-tan plus 0(Tier 1) MCSIDEROL ORAL TABLET 0(Tier 1) MCSLOW FE 0(Tier 1) MCSLOW RELEASE IRON ORAL TABLET EXTENDED RELEASE 140 MG (45 MG IRON), 142 MG (45 MG IRON), 143 MG (45 MG IRON), 159 MG (45 MG IRON)

0(Tier 1) MC

SOLUVITA-E 0(Tier 1) MCsoothing pureway-c 0(Tier 1) MCspectravite adult 50 plus 0(Tier 1) MCspectravite advanced formula oral tablet 18-400 mg-mcg

0(Tier 1) MC

spectravite men’s 0(Tier 1) MCspectravite senior oral tablet 500-300-250 mcg 0(Tier 1) MCspectravite ultra women 0(Tier 1) MCspectravite ultra women’s sr 0(Tier 1) MCspectravite women 0(Tier 1) MCstress b with zinc 0(Tier 1) MCstress formula 0(Tier 1) MCstress formula 600 c 0(Tier 1) MCstress formula with iron 0(Tier 1) MCstress formula with iron(sulf) 0(Tier 1) MCSTRESS FORMULA WITH ZINC 0(Tier 1) MCSTROVITE FORTE 0(Tier 1) MCSTROVITE ONE 0(Tier 1) MCsuper b complex-vitamin c 0(Tier 1) MCsuper b maxi complex 0(Tier 1) MCsuper b/c 0(Tier 1) MCsuper b-50 complex 0(Tier 1) MCsuper multiple oral tablet 0(Tier 1) MCsuper multivitamin 0(Tier 1) MC


109



super quints 0(Tier 1) MCsuper thera vite m 0(Tier 1) MCSUPERVITE 0(Tier 1) MCsupport 0(Tier 1) MCSUPPORT-500 0(Tier 1) MCTAB-A-VITE MULTIVITAMIN W-IRON ORAL TABLET 18-400 MG-MCG

0(Tier 1) MC

tab-a-vite/iron 0(Tier 1) MCTANDEM DUAL ACTION 0(Tier 1) MCTANDEM PLUS 0(Tier 1) MCtaron forte 0(Tier 1) MCthera m plus (ferrous fumarat) 0(Tier 1) MCtheralogix companion 0(Tier 1) MCthera-m oral tablet 27-0.4 mg, 9 mg iron-400 mcg

0(Tier 1) MC

therapeutic liquid 0(Tier 1) MCtherapeutic-m oral tablet 9 mg iron-400 mcg 0(Tier 1) MCtherapeutic-m vitamin/minerals 0(Tier 1) MCthera-tabs 0(Tier 1) MCtheratrum complete 50 plus-lyc 0(Tier 1) MCtheratrum complete with lutein 0(Tier 1) MCtherems-m 0(Tier 1) MCthiamine hcl (vitamin b1) oral tablet 100 mg, 250 mg, 50 mg

0(Tier 1) MC

triphrocaps 0(Tier 1) MCTRI-VI-FLOR 0(Tier 1) MCtri-vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

0(Tier 1) MC

tri-vite with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

0(Tier 1) MC

ultimate women’s complete 50+ 0(Tier 1) MCunicomplex-m 0(Tier 1) MCv-c forte 0(Tier 1) MCvic-forte 0(Tier 1) MCVIRT-CAPS 0(Tier 1) MCvirt-gard 0(Tier 1) MCVIT A PALMITATE-VIT C-VIT D3 0(Tier 1) MCVIT C(ASCORB.CALCIUM)(MV-MINS) 0(Tier 1) MCVITAL-D RX 0(Tier 1) MC


110



vitalee 0(Tier 1) MCvitalets oral tablet,chewable 0(Tier 1) MCvitamin a oral capsule 10,000 unit, 8,000 unit 0(Tier 1) MCvitamin b complex 0(Tier 1) MCvitamin b complex-folic acid oral tablet 0(Tier 1) MCvitamin b-1 0(Tier 1) MCvitamin b-12 oral tablet 0(Tier 1) MCvitamin b-12 oral tablet extended release 1,000 mcg, 2,000 mcg

0(Tier 1) MC

vitamin b-12 sublingual tablet 2,500 mcg 0(Tier 1) MCvitamin b-2 0(Tier 1) MCvitamin b-6 oral tablet 100 mg, 25 mg, 50 mg 0(Tier 1) MCvitamin c drops 0(Tier 1) MCvitamin c oral capsule, extended release 0(Tier 1) MCvitamin c oral powder 0(Tier 1) MCvitamin c oral tablet 1,000 mg, 250 mg, 500 mg 0(Tier 1) MCvitamin c oral tablet extended release 0(Tier 1) MCvitamin c oral tablet,chewable 250 mg, 500 mg 0(Tier 1) MCvitamin c with rose hips 0(Tier 1) MCvitamin e (dl, acetate) oral capsule 100 unit, 400 unit, 450 mg (1,000 unit)

0(Tier 1) MC

VITAMIN E (DL, ACETATE) ORAL DROPS 22.5 MG (50 UNIT)/ML

0(Tier 1) MC

vitamin e acetate 0(Tier 1) MCVITAMIN E MIXED ORAL CAPSULE 1,000 UNIT

0(Tier 1) MC

vitamin e mixed oral capsule 400 unit 0(Tier 1) MCvitamin e oral capsule 0(Tier 1) MCVITAMIN E ORAL DROPS 0(Tier 1) MCvitamins a and d 0(Tier 1) MCvitamins a,c,d and fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

0(Tier 1) MC

vitamins and minerals 0(Tier 1) MCvitamins b complex oral capsule 0(Tier 1) MCvitamins b complex oral tablet 0(Tier 1) MCVITAMINS B COMPLEX ORAL TABLET 500 MG-400 MCG- 18 MG IRON

0(Tier 1) MC

vitamins for hair oral tablet 0(Tier 1) MCVITA-RESPA 0(Tier 1) MC


111



vitatrum 0(Tier 1) MCVITRUM SENIOR ORAL TABLET 500-300-250 MCG

0(Tier 1) MC

vp-vite rx 0(Tier 1) MCwee care 0(Tier 1) MCwestab max 0(Tier 1) MCwestab mini 0(Tier 1) MCwestab one 0(Tier 1) MCWEST-VITE WITH FOLIC ACID 0(Tier 1) MCWOMEN’S DAILY FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA

0(Tier 1) MC

women’s daily formula oral tablet 27-0.4 mg 0(Tier 1) MCWOMEN’S ONE DAILY 0(Tier 1) MCyelets 0(Tier 1) MCZINC (WITH A AND C) LOZENGES 0(Tier 1) MC


112

D. INDEX OF COVERED DRUGS

112 hour nasal decongest (pse) . . . 85

224hr allergy relief . . . . . . . . . . . . . . . . 85

88 hour pain reliever . . . . . . . . . . . . . . 388hr muscle aches-pain . . . . . . . . . . . 38

Aabacavir-lamivudine . . . . . . . . . . . . . 12abacavir-lamivudine-zidovudine . . 12abacavir oral solution . . . . . . . . . . . . 12abacavir oral tablet . . . . . . . . . . . . . . 12ABANEU-SL . . . . . . . . . . . . . . . . . . . . 99abc plus . . . . . . . . . . . . . . . . . . . . . . . . 99ABELCET . . . . . . . . . . . . . . . . . . . . . . . 12ABILIFY MAINTENA . . . . . . . . . . . . . 40abiraterone oral tablet 250 mg . . . . 22abiraterone oral tablet 500 mg . . . . 22ABRAXANE . . . . . . . . . . . . . . . . . . . . . 22acamprosate . . . . . . . . . . . . . . . . . . . . 58acarbose oral tablet 25 mg . . . . . . . 62acarbose oral tablet 50 mg . . . . . . . 62acarbose oral tablet 100 mg . . . . . . 62acebutolol . . . . . . . . . . . . . . . . . . . . . . . 46acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml . . . . . . . . . . 36acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg . . . . . 36acetaminophen-codeine oral tablet 300-60 mg . . . . . . . . . . . . . . . . 36ACETAMINOPHEN CONGESTION-PAIN . . . . . . . . . . . . 85acetaminophen oral tablet 325 mg . 38acetaminophen oral tablet extended release . . . . . . . . . . . . . . . . 38acetaminophen rectal . . . . . . . . . . . . 38acetazolamide . . . . . . . . . . . . . . . . . . . 84acetazolamide sodium . . . . . . . . . . . 84acetic acid otic (ear) . . . . . . . . . . . . . 60acetylcysteine . . . . . . . . . . . . . . . . . . . 91

acid gone antacid . . . . . . . . . . . . . . . . 68acid reducer complete (famot) . . . . 71acid reducer (famotidine) . . . . . . . . . 71acid reducer (omeprazole) . . . . . . . 71acitretin . . . . . . . . . . . . . . . . . . . . . . . . . 52ACNE MEDICATION TOPICAL GEL 10%, 5% . . . . . . . . . 54ACNE MEDICATION TOPICAL LOTION . . . . . . . . . . . . . . . 54ACTHIB (PF) . . . . . . . . . . . . . . . . . . . . 73actical . . . . . . . . . . . . . . . . . . . . . . . . . . 99actidose/sorbitol oral suspension 50 gram/240 ml . . . . . . 68ACTIMMUNE . . . . . . . . . . . . . . . . . . . 72acyclovir oral capsule . . . . . . . . . . . . 12acyclovir oral suspension 200 mg/5 ml . . . . . . . . . . . . . . . . . . . . . 12acyclovir oral tablet . . . . . . . . . . . . . . 12acyclovir sodium intravenous solution . . . . . . . . . . . . . 13acyclovir topical ointment . . . . . . . . 56ADACEL (TDAP ADOLESN/ADULT)(PF) . . . 73ADASUVE . . . . . . . . . . . . . . . . . . . . . . 40ADCETRIS . . . . . . . . . . . . . . . . . . . . . . 22adefovir . . . . . . . . . . . . . . . . . . . . . . . . . 13ADEMPAS . . . . . . . . . . . . . . . . . . . . . . 91adriamycin intravenous recon soln 10 mg . . . . . . . . . . . . . . . . 22ADRIAMYCIN INTRAVENOUS RECON SOLN 50 MG . . . . . . . . . . . 22adriamycin intravenous solution . . 22adrucil intravenous solution 2.5 gram/50 ml . . . . . . . . . . . . . . . . . . . . . . 22adult aspirin regimen . . . . . . . . . . . . 38adult one daily multivitamin . . . . . . . 99adults 50 plus . . . . . . . . . . . . . . . . . . . 99ADVAIR HFA . . . . . . . . . . . . . . . . . . . . 91AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG . . . . . . . 22AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 3 MG, 5 MG . . 22AFINITOR ORAL TABLET 10 MG . 22afirmelle . . . . . . . . . . . . . . . . . . . . . . . . 77AIMOVIG AUTOINJECTOR . . . . . . 34

ak-poly-bac . . . . . . . . . . . . . . . . . . . . . 82ala-cort topical cream 1% . . . . . . . . 56ALAHIST CF . . . . . . . . . . . . . . . . . . . . 85ALAHIST DM . . . . . . . . . . . . . . . . . . . . 85ala-hist ir . . . . . . . . . . . . . . . . . . . . . . . . 85ALAHIST PE . . . . . . . . . . . . . . . . . . . . 85ALBA-LYBE . . . . . . . . . . . . . . . . . . . . . 99albendazole . . . . . . . . . . . . . . . . . . . . . 17albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (generic for ProAir) . . . . . . . . . . . . . . 91albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (generic for Proventil) . . . . . . . . . . . . 91albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (generic for Ventolin) . . . . . . . . . . . . . 91albuterol sulfate inhalation solution for nebulization . . . . . . . . . . 91albuterol sulfate oral . . . . . . . . . . . . . 91alclometasone . . . . . . . . . . . . . . . . . . . 56ALCOHOL PADS . . . . . . . . . . . . . . . . 62ALDURAZYME . . . . . . . . . . . . . . . . . . 65ALECENSA . . . . . . . . . . . . . . . . . . . . . 22alendronate oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 75alendronate oral tablet 35 mg, 70 mg . . . . . . . . . . . . . . . . . . . 75alfuzosin . . . . . . . . . . . . . . . . . . . . . . . . 94ALIMTA . . . . . . . . . . . . . . . . . . . . . . . . . 22ALINIA ORAL SUSPENSION FOR RECONSTITUTION . . . . . . . . 17ALINIA ORAL TABLET . . . . . . . . . . . 17ALIQOPA . . . . . . . . . . . . . . . . . . . . . . . 22aliskiren . . . . . . . . . . . . . . . . . . . . . . . . . 46all day allergy (cetirizine) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 85all day pain relief . . . . . . . . . . . . . . . . 38all day relief . . . . . . . . . . . . . . . . . . . . . 38aller-chlor oral tablet . . . . . . . . . . . . . 85allergy (chlorpheniramine) . . . . . . . . 85allergy-congest relief-d(fexo) . . . . . 86allergy (diphenhydramine) oral capsule . . . . . . . . . . . . . . . . . . . . . 85allergy multi-symptom . . . . . . . . . . . . 85

113

anti-diarrheal (loperamide) oral capsule . . . . . . . . . . . . . . . . . . . . . 67anti-diarrheal (loperamide) oral liquid 1 mg/7.5 ml . . . . . . . . . . . 67anti-diarrheal (loperamide) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 67antifungal . . . . . . . . . . . . . . . . . . . . . . . 55antifungal (clotrimazole) . . . . . . . . . . 55antifungal (tolnaftate) topical cream . . . . . . . . . . . . . . . . . . . . 55antifungal (tolnaftate) topical powder . . . . . . . . . . . . . . . . . . . 55anti-fungal topical powder . . . . . . . . 55apatate forte . . . . . . . . . . . . . . . . . . . . 99APETEX . . . . . . . . . . . . . . . . . . . . . . . 100APETIGEN . . . . . . . . . . . . . . . . . . . . . 100apetigen plus oral liquid . . . . . . . . . 100APETIGEN PLUS ORAL TABLET . . . . . . . . . . . . . . . . . 100APOKYN . . . . . . . . . . . . . . . . . . . . . . . . 34apraclonidine . . . . . . . . . . . . . . . . . . . . 85aprepitant . . . . . . . . . . . . . . . . . . . . . . . 68apri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77aprodine . . . . . . . . . . . . . . . . . . . . . . . . 86APTIOM ORAL TABLET 200 MG . 31APTIOM ORAL TABLET 400 MG . 31APTIOM ORAL TABLET 600 MG, 800 MG . . . . . . . . . . . . . . . . 31APTIVUS . . . . . . . . . . . . . . . . . . . . . . . 13APTIVUS (WITH VITAMIN E). . . . . 13AQUADEKS ORAL TABLET,CHEWABLE . . . . . . . . . . . 100AQUADEKS PEDIATRIC . . . . . . . . 100ARALAST NP . . . . . . . . . . . . . . . . . . . 58aranelle (28) . . . . . . . . . . . . . . . . . . . . 77ARANESP (IN POLYSORBATE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ML . . . . . . . . 72ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML, 60 MCG/ML . . . . . . . 72ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 25 MCG/ 0.42 ML, 40 MCG/0.4 ML . . . . . . . . 72

amiloride . . . . . . . . . . . . . . . . . . . . . . . . 46amiloride-hydrochlorothiazide . . . . 46aminocaproic acid oral . . . . . . . . . . . 49AMINOSYN II 15% . . . . . . . . . . . . . . 98AMINOSYN-PF 7% (SULFITE-FREE) . . . . . . . . . . . . . . . . 98amiodarone intravenous solution . 45amiodarone oral . . . . . . . . . . . . . . . . . 45amitriptyline . . . . . . . . . . . . . . . . . . . . . 40amlodipine . . . . . . . . . . . . . . . . . . . . . . 46amlodipine-benazepril . . . . . . . . . . . 46amlodipine-valsartan . . . . . . . . . . . . . 46amlodipine-valsartan-hcthiazid . . . 46ammonium lactate . . . . . . . . . . . . . . . 52amnesteem . . . . . . . . . . . . . . . . . . . . . 54amoxapine . . . . . . . . . . . . . . . . . . . . . . 40amoxicillin oral capsule . . . . . . . . . . 20amoxicillin oral suspension for reconstitution . . . . . . . . . . . . . . . . . 20amoxicillin oral tablet . . . . . . . . . . . . 20amoxicillin oral tablet, chewable 125 mg, 250 mg . . . . . . . 20amoxicillin-pot clavulanate . . . . . . . 20amphotericin b . . . . . . . . . . . . . . . . . . 12ampicillin oral capsule 500 mg . . . . 20ampicillin sodium . . . . . . . . . . . . . . . . 20ampicillin-sulbactam . . . . . . . . . . . . . 20ANADROL-50 . . . . . . . . . . . . . . . . . . . 65anagrelide . . . . . . . . . . . . . . . . . . . . . . 58anastrozole . . . . . . . . . . . . . . . . . . . . . 22animal chews . . . . . . . . . . . . . . . . . . . 99ANORO ELLIPTA . . . . . . . . . . . . . . . . 92antacid . . . . . . . . . . . . . . . . . . . . . . . . . . 68antacid anti-gas . . . . . . . . . . . . . . . . . 68antacid (calcium carbonate) oral tablet,chewable 200 mg calcium (500 mg) . . . . . . . . . . . . . . . . 94antacid exst (mag carb-al hyd) . . . 68antacid ext str (calcium carb) . . . . . 94antacid plus anti-gas oral suspension 200-200-20 mg/5 ml . . 68antacid regular strength . . . . . . . . . . 68antacid ultra strength oral tablet,chewable 400 mg calcium (1,000 mg) . . . . . . . . . . . . . . 95

allergy relief(chlorpheniramn) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 86allergy relief d12 . . . . . . . . . . . . . . . . . 85allergy relief d-24hr . . . . . . . . . . . . . . 85allergy relief-d (cetirizine) . . . . . . . . 86allergy relief(diphenhydramin) . . . . 86allergy relief (fexofenadine) oral tablet 180 mg . . . . . . . . . . . . . . . 85ALLERGY RELIEF (FLUTICASONE) . . . . . . . . . . . . . . . . 91allergy relief (loratadine) oral solution . . . . . . . . . . . . . . . . . . . . . 85allergy relief (loratadine) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 85ALL-NITE COLD-FLU . . . . . . . . . . . . 86allopurinol . . . . . . . . . . . . . . . . . . . . . . . 74almacone-2 . . . . . . . . . . . . . . . . . . . . . 68ALORA . . . . . . . . . . . . . . . . . . . . . . . . . 76alosetron . . . . . . . . . . . . . . . . . . . . . . . . 68ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1% . . . . . . . . . . . . . 85alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg . . . . . . . . . . . 40alprazolam oral tablet 2 mg . . . . . . 40alprazolam oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg . . . . . . . . . . . 40alprazolam oral tablet, disintegrating 2 mg . . . . . . . . . . . . . . 40altavera (28) . . . . . . . . . . . . . . . . . . . . 77aluminum hydroxide gel oral suspension 320 mg/5 ml . . . . . . . . . 68ALUNBRIG ORAL TABLET 30 MG . 22ALUNBRIG ORAL TABLET 180 MG, 90 MG . . . . . . . . . 22ALUNBRIG ORAL TABLETS,DOSE PACK . . . . . . . . . . 22alyacen 1/35 (28) . . . . . . . . . . . . . . . . 77alyacen 7/7/7 (28) . . . . . . . . . . . . . . . 77alyq . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91amantadine hcl . . . . . . . . . . . . . . . . . . 13AMBISOME . . . . . . . . . . . . . . . . . . . . . 12ambrisentan . . . . . . . . . . . . . . . . . . . . . 91amethia . . . . . . . . . . . . . . . . . . . . . . . . . 77amethyst (28) . . . . . . . . . . . . . . . . . . . 77amikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml . . . . . . 17

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aubra . . . . . . . . . . . . . . . . . . . . . . . . . . . 77aubra eq . . . . . . . . . . . . . . . . . . . . . . . . 78aurovela 1.5/30 (21) . . . . . . . . . . . . . 78aurovela 1/20 (21) . . . . . . . . . . . . . . . 78aurovela 24 fe . . . . . . . . . . . . . . . . . . . 78aurovela fe 1.5/30 (28) . . . . . . . . . . . 78aurovela fe 1-20 (28) . . . . . . . . . . . . 78AURYXIA . . . . . . . . . . . . . . . . . . . . . . . 58AUSTEDO ORAL TABLET 6 MG . 35AUSTEDO ORAL TABLET 12 MG, 9 MG . . . . . . . . . . . . . . . . . . . . 35aviane . . . . . . . . . . . . . . . . . . . . . . . . . . 78avita . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54AVONEX INTRAMUSCULAR PEN INJECTOR KIT . . . . . . . . . . . . . 72AVONEX INTRAMUSCULAR SYRINGE KIT . . . . . . . . . . . . . . . . . . . 72AVSOLA . . . . . . . . . . . . . . . . . . . . . . . . 68ayuna . . . . . . . . . . . . . . . . . . . . . . . . . . . 78AYVAKIT . . . . . . . . . . . . . . . . . . . . . . . . 22azacitidine . . . . . . . . . . . . . . . . . . . . . . 22AZASAN . . . . . . . . . . . . . . . . . . . . . . . . 22AZASITE . . . . . . . . . . . . . . . . . . . . . . . . 82azathioprine . . . . . . . . . . . . . . . . . . . . . 22azathioprine sodium . . . . . . . . . . . . . 22azelastine nasal . . . . . . . . . . . . . . . . . 60azelastine ophthalmic (eye) . . . . . . 83azithromycin intravenous . . . . . . . . . 17azithromycin oral . . . . . . . . . . . . . . . . 17AZOPT . . . . . . . . . . . . . . . . . . . . . . . . . 84aztreonam . . . . . . . . . . . . . . . . . . . . . . 18azurette (28) . . . . . . . . . . . . . . . . . . . . 78

Bb-12 dots . . . . . . . . . . . . . . . . . . . . . . . 100bacitracin intramuscular . . . . . . . . . . 18bacitracin ophthalmic (eye) . . . . . . . 82bacitracin-polymyxin b ophthalmic (eye) . . . . . . . . . . . . . . . . . 82bacitracin topical ointment . . . . . . . . 55bacitracin zinc topical ointment . . . 55baclofen oral . . . . . . . . . . . . . . . . . . . . 36BACMIN . . . . . . . . . . . . . . . . . . . . . . . 100balance b-50 (with folic acid) . . . . 100

ascorbic acid (vitamin c) oral tablet extended release 1,500 mg, 500 mg . . . . . . . . . . . . . . 100ashlyna . . . . . . . . . . . . . . . . . . . . . . . . . 77aspirin-dipyridamole . . . . . . . . . . . . . 49aspirin oral tablet . . . . . . . . . . . . . . . . 38aspirin oral tablet,chewable . . . . . . 38aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg . . . . 38ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 0.5 MG, 1 MG . . 22ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 5 MG . . . . . . . . . . . 22astringent . . . . . . . . . . . . . . . . . . . . . . . 52atazanavir oral capsule 150 mg, 300 mg . . . . . . . . . . . . . . . . . 13atazanavir oral capsule 200 mg . . . 13atenolol . . . . . . . . . . . . . . . . . . . . . . . . . 46atenolol-chlorthalidone . . . . . . . . . . . 46ATGAM . . . . . . . . . . . . . . . . . . . . . . . . . 73athlete’s foot topical aerosol powder . . . . . . . . . . . . . . . . . . 55a thru z . . . . . . . . . . . . . . . . . . . . . . . . . 99a thru z advanced formula . . . . . . . . 99A THRU Z MEN’S ULTIMATE . . . . 99a thru z select 50plus formula . . . . 99a thru z select oral tablet 500-300-250 mcg . . . . . . . . . . . . . . . . 99a thru z select women’s . . . . . . . . . . 99atomoxetine oral capsule 10 mg, 18 mg, 25 mg, 40 mg . . . . . 40atomoxetine oral capsule 100 mg, 60 mg, 80 mg . . . . . . . . . . . 40atorvastatin . . . . . . . . . . . . . . . . . . . . . 50atovaquone . . . . . . . . . . . . . . . . . . . . . 17atovaquone-proguanil . . . . . . . . . . . . 17ATRIPLA . . . . . . . . . . . . . . . . . . . . . . . . 13atropine injection solution 0.4 mg/ml . . . . . . . . . . . . . . . . . . . . . . . 67atropine injection syringe 0.05 mg/ml, 0.1 mg/ml . . . . . . . . . . . 67ATROPINE OPHTHALMIC (EYE) DROPS . . . . . . . . . . . . . . . . . . 83ATROVENT HFA . . . . . . . . . . . . . . . . 92

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/ 0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 300 MCG/0.6 ML, 500 MCG/ML, 60 MCG/0.3 ML . . . 72ARCALYST . . . . . . . . . . . . . . . . . . . . . 72ARIKAYCE . . . . . . . . . . . . . . . . . . . . . . 17aripiprazole oral solution . . . . . . . . . 40aripiprazole oral tablet . . . . . . . . . . . 40aripiprazole oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 40ARISTADA INITIO . . . . . . . . . . . . . . . 40ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 1,064 MG/3.9 ML . . . . . . . 40ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 441 MG/1.6 ML . . . . . . . . . 40ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 662 MG/2.4 ML . . . . . . . . . 40ARISTADA INTRAMUSCULAR SUSPENSION, EXTENDED REL SYRING 882 MG/3.2 ML . . . . . . . . . 40armodafinil . . . . . . . . . . . . . . . . . . . . . . 40ARNUITY ELLIPTA . . . . . . . . . . . . . . 92ARRANON . . . . . . . . . . . . . . . . . . . . . . 22ARSENIC TRIOXIDE INTRAVENOUS SOLUTION 1 MG/ML . . . . . . . . . . . . 22arsenic trioxide intravenous solution 2 mg/ml . . . . . . . . . . . . . . . . . 22artificial tears (petro/min) . . . . . . . . . 83artificial tears (polyvin alc) . . . . . . . . 83ARZERRA . . . . . . . . . . . . . . . . . . . . . . 22ascorbic acid (vitamin c) oral capsule, extended release . . . . . . 100ASCORBIC ACID (VITAMIN C) ORAL GRANULES . . . . . . . . . . . . . 100ascorbic acid (vitamin c) oral syrup . . . . . . . . . . . . . . . . . . . . . . 100ascorbic acid (vitamin c) oral tablet . . . . . . . . . . . . . . . . . . . . . . 100ASCORBIC ACID (VITAMIN C) ORAL TABLET,CHEWABLE 250 MG . . . . . . . . . . . . . . . . . . . . . . . . 100ascorbic acid (vitamin c) oral tablet,chewable 500 mg . . . . . . . . . 100

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BRIVIACT ORAL SOLUTION . . . . . 31BRIVIACT ORAL TABLET . . . . . . . . 31bromfenac . . . . . . . . . . . . . . . . . . . . . . 84bromocriptine . . . . . . . . . . . . . . . . . . . 34brompheniramine- pseudoeph-dm oral syrup . . . . . . . . 86brotapp dm . . . . . . . . . . . . . . . . . . . . . . 86BROVANA . . . . . . . . . . . . . . . . . . . . . . 92BRUKINSA . . . . . . . . . . . . . . . . . . . . . 23budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml . . . . . . . . 92budesonide inhalation suspension for nebulization 1 mg/2 ml . . . . . . . . 92budesonide nasal . . . . . . . . . . . . . . . . 92budesonide oral capsule,delayed,extend.release . . 68budesonide oral tablet,delayed and ext.release . . . . . . . . . . . . . . . . . . 68bumetanide . . . . . . . . . . . . . . . . . . . . . 46buprenorphine . . . . . . . . . . . . . . . . . . . 36buprenorphine hcl injection . . . . . . . 36buprenorphine hcl sublingual . . . . . 36buprenorphine-naloxone sublingual film 2-0.5 mg . . . . . . . . . . 38buprenorphine-naloxone sublingual film 4-1 mg, 8-2 mg . . . . 38buprenorphine-naloxone sublingual film 12-3 mg . . . . . . . . . . 38buprenorphine-naloxone sublingual tablet 2-0.5 mg . . . . . . . . 38buprenorphine-naloxone sublingual tablet 8-2 mg . . . . . . . . . . 38bupropion hcl oral tablet 75 mg . . . 40bupropion hcl oral tablet 100 mg . . 40bupropion hcl oral tablet extended release 24 hr 150 mg . . . 40bupropion hcl oral tablet extended release 24 hr 300 mg . . . 41bupropion hcl oral tablet sustained-release 12 hr . . . . . . . . . . 41bupropion hcl (smoking deter) . . . . 60buspirone . . . . . . . . . . . . . . . . . . . . . . . 41busulfan . . . . . . . . . . . . . . . . . . . . . . . . 23BUSULFEX . . . . . . . . . . . . . . . . . . . . . 23butorphanol nasal . . . . . . . . . . . . . . . 38

BETASERON SUBCUTANEOUS KIT . . . . . . . . . . . 72betaxolol oral . . . . . . . . . . . . . . . . . . . . 46bethanechol chloride . . . . . . . . . . . . . 94bexarotene . . . . . . . . . . . . . . . . . . . . . . 23BEXSERO . . . . . . . . . . . . . . . . . . . . . . 73bicalutamide . . . . . . . . . . . . . . . . . . . . 23BICILLIN L-A . . . . . . . . . . . . . . . . . . . . 20BIDIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 46BIKTARVY . . . . . . . . . . . . . . . . . . . . . . 13bimatoprost ophthalmic (eye) . . . . . 84BINOSTO . . . . . . . . . . . . . . . . . . . . . . . 75BIOCAL . . . . . . . . . . . . . . . . . . . . . . . . 100biopetit . . . . . . . . . . . . . . . . . . . . . . . . . 100biotin oral capsule 2,500 mcg, 5 mg . . . . . . . . . . . . . . . 100biotin oral tablet 1 mg . . . . . . . . . . . 100bisacodyl . . . . . . . . . . . . . . . . . . . . . . . . 68bismatrol . . . . . . . . . . . . . . . . . . . . . . . . 67bisoprolol fumarate . . . . . . . . . . . . . . 46bisoprolol-hydrochlorothiazide . . . . 46BLENREP . . . . . . . . . . . . . . . . . . . . . . 23bleomycin . . . . . . . . . . . . . . . . . . . . . . . 23BLEPHAMIDE . . . . . . . . . . . . . . . . . . . 83BLEPHAMIDE S.O.P. . . . . . . . . . . . . 83BLINCYTO INTRAVENOUS KIT . . 23blisovi 24 fe . . . . . . . . . . . . . . . . . . . . . 78blisovi fe 1.5/30 (28) . . . . . . . . . . . . . 78blisovi fe 1/20 (28) . . . . . . . . . . . . . . . 78blue gel . . . . . . . . . . . . . . . . . . . . . . . . . 52BOOSTRIX TDAP . . . . . . . . . . . . . . . 73BORTEZOMIB . . . . . . . . . . . . . . . . . . 23bosentan . . . . . . . . . . . . . . . . . . . . . . . . 92BOSULIF ORAL TABLET 100 MG . 23BOSULIF ORAL TABLET 400 MG, 500 MG . . . . . . . . . . . . . . . . 23BOTOX . . . . . . . . . . . . . . . . . . . . . . . . . 73BRAFTOVI ORAL CAPSULE 75 MG . . . . . . . . . . . . . . . 23BREO ELLIPTA . . . . . . . . . . . . . . . . . 92briellyn . . . . . . . . . . . . . . . . . . . . . . . . . . 78BRILINTA . . . . . . . . . . . . . . . . . . . . . . . 49brimonidine . . . . . . . . . . . . . . . . . . . . . 85BRIVIACT INTRAVENOUS . . . . . . . 31

balance b-100 (folic acid) . . . . . . . 100balanced b-50 oral tablet . . . . . . . . 100balanced b-100 oral tablet 0.4 mg . . . . . . . . . . . . . . . . . . . . . . . . . 100balsalazide . . . . . . . . . . . . . . . . . . . . . . 68BALVERSA . . . . . . . . . . . . . . . . . . . . . 22balziva (28) . . . . . . . . . . . . . . . . . . . . . 78banophen oral capsule . . . . . . . . . . . 86BANZEL . . . . . . . . . . . . . . . . . . . . . . . . 31BAQSIMI . . . . . . . . . . . . . . . . . . . . . . . . 62BARACLUDE ORAL SOLUTION . 13BAVENCIO . . . . . . . . . . . . . . . . . . . . . . 22BCG VACCINE, LIVE (PF) . . . . . . . 73b complex 1 (with folic acid) . . . . . 100b complex 100 oral . . . . . . . . . . . . . 100b complex-vitamin b12 . . . . . . . . . . 100b-complex with vitamin c oral capsule . . . . . . . . . . . . . . . . . . . . 100b-complex with vitamin c oral tablet . . . . . . . . . . . . . . . . . . . . . . 100b-complex with vitamin c oral tablet extended release . . . . . 100B COMPLEX W-VIT C . . . . . . . . . . 100BD PEN NEEDLE . . . . . . . . . . . . . . . 62bekyree (28) . . . . . . . . . . . . . . . . . . . . 78BELEODAQ . . . . . . . . . . . . . . . . . . . . . 23benazepril . . . . . . . . . . . . . . . . . . . . . . . 46benazepril-hydrochlorothiazide . . . 46BENDEKA . . . . . . . . . . . . . . . . . . . . . . 23BENLYSTA . . . . . . . . . . . . . . . . . . . . . . 75benzonatate . . . . . . . . . . . . . . . . . . . . . 86benzoyl peroxide topical cleanser 10%, 5% . . . . . . . . . . . . . . . 54benzoyl peroxide topical gel 10%, 2.5%, 5% . . . . . . . . . . . . . . 54benztropine injection . . . . . . . . . . . . . 34benztropine oral . . . . . . . . . . . . . . . . . 34BESIVANCE . . . . . . . . . . . . . . . . . . . . 82BESPONSA . . . . . . . . . . . . . . . . . . . . . 23beta carotene oral capsule 25,000 unit . . . . . . . . . . . . . . . . . . . . . 100betamethasone, augmented . . . . . . 56betamethasone dipropionate . . . . . 56betamethasone valerate . . . . . . . . . 56

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calcium-magnesium-zinc oral tablet 333-133-5 mg . . . . . . . . . 96calcium soft chew oral tablet,chewable 500-200-40 mg-unit-mcg . . . . . . . . 101calcium-vitamin d3-vitamin k oral tablet,chewable 500-200-40 mg-unit-mcg . . . . . . . . 101CALCIUM WITH BORON . . . . . . . . 58calcium with vitamin d . . . . . . . . . . . . 95caldyphen clear topical lotion 1-0.1% . . . . . . . . . . . . . 52cal-gest antacid . . . . . . . . . . . . . . . . . 96callus removers . . . . . . . . . . . . . . . . . 52CALQUENCE . . . . . . . . . . . . . . . . . . . 23CALTRATE 600-D PLUS MINERALS ORAL TABLET . . . . . . 101CALTRATE 600 PLUS D . . . . . . . . . 96CALTRATE WITH VITAMIN D3 . . . 96camila . . . . . . . . . . . . . . . . . . . . . . . . . . 76camrese . . . . . . . . . . . . . . . . . . . . . . . . 78camrese lo . . . . . . . . . . . . . . . . . . . . . . 78candesartan-hydrochlorothiazid . . 46candesartan oral tablet 16 mg, 4 mg, 8 mg . . . . . . . . . . . . . . . 46candesartan oral tablet 32 mg . . . . 46CAPASTAT . . . . . . . . . . . . . . . . . . . . . . 18CAPLYTA . . . . . . . . . . . . . . . . . . . . . . . 41CAPRELSA ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 23CAPRELSA ORAL TABLET 300 MG . . . . . . . . . . . . . . . . 23capsaicin topical cream 0.025% . . 52CARBAGLU . . . . . . . . . . . . . . . . . . . . . 58carbamazepine oral capsule, er multiphase 12 hr . . . . . . . . . . . . . . 31carbamazepine oral suspension 100 mg/5 ml, 200 mg/10 ml . . . . . . 31carbamazepine oral tablet . . . . . . . . 31carbamazepine oral tablet, chewable . . . . . . . . . . . . . . . . . . . . . . . 31carbamazepine oral tablet extended release 12 hr . . . . . . . . . . 31carbidopa . . . . . . . . . . . . . . . . . . . . . . . 34carbidopa-levodopa . . . . . . . . . . . . . . 34carbidopa-levodopa-entacapone . . 34

calcium 600 with vitamin d3 oral tablet,chewable . . . . . . . . . . . . . 95calcium acetate(phosphat bind) . . . 95calcium antacid oral tablet, chewable 200 mg calcium (500 mg), 300 mg (750 mg) . . . . . . 95calcium carbonate oral suspension . . . . . . . . . . . . . . . . . 95calcium carbonate oral tablet 260 mg calcium (648 mg), 500 mg calcium (1,250 mg), 600 mg calcium (1,500 mg) . . . . . . 95calcium carbonate oral tablet,chewable 500 mg calcium (1,250 mg) . . . . . . . . . . . . . . 95calcium carbonate-vitamin d3 oral capsule 600 mg (1,500mg) -400 unit . . . . . . . . . . . . . . 95CALCIUM CARBONATE- VITAMIN D3 ORAL TABLET 250-125 MG-UNIT, 500MG (1,250MG) -600 UNIT, 600 MG(1,500MG) -800 UNIT . . . . 95calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit, 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit . . . . . . 95calcium carbonate-vitamin d3 oral tablet,chewable 500 mg(1,250mg) -400 unit . . . . . . 95calcium carbonate-vit d3-min oral tablet . . . . . . . . . . . . . . . . . . . . . . 101calcium citrate + d . . . . . . . . . . . . . . . 95CALCIUM CITRATE MALATE-VIT D3 . . . . . . . . . . . . . . . . . 98calcium citrate oral tablet 200 mg (950 mg) . . . . . . . . . . . . . . . . 95calcium citrate plus (vit b6) . . . . . . . 95calcium citrate-vitamin d3 oral tablet 200 mg-3.125 mcg (125 unit), 315 mg-5 mcg (200 unit) . . . . . . . . . 95CALCIUM CITRATE- VITAMIN D3 ORAL TABLET 315 MG-6.25 MCG (250 UNIT) . . . 95calcium-folic acid-vitamin d . . . . . . 101calcium for women . . . . . . . . . . . . . . 101CALCIUM-MAGNESIUM . . . . . . . . . 95calcium-magnesium-copper-zinc 101

BYDUREON BCISE . . . . . . . . . . . . . 62BYDUREON SUBCUTANEOUS PEN INJECTOR . . . . . . . . . . . . . . . . . 62BYSTOLIC . . . . . . . . . . . . . . . . . . . . . . 46

Cc-500 . . . . . . . . . . . . . . . . . . . . . . . . . . 101c-1000 . . . . . . . . . . . . . . . . . . . . . . . . . 101C 1000-BIOFLAVONOIDS- ROSE HIPS . . . . . . . . . . . . . . . . . . . . 100c-1000 with rose hips . . . . . . . . . . . 101cabergoline . . . . . . . . . . . . . . . . . . . . . 66CABOMETYX ORAL TABLET 20 MG, 60 MG . . . . . . . . . . 23CABOMETYX ORAL TABLET 40 MG . . . . . . . . . . . . . . . . . 23ca-d3-mag ox-zinc-cop-mang- bor oral tablet,chewable 600 mg calcium- 400 unit-40 mg . . . . . . . . 101CA-D3-MAG OX-ZINC- COP-MANG-BOR ORAL TABLET,CHEWABLE 600 MG CALCIUM- 800 UNIT-40 MG . . . . 101calamine clear . . . . . . . . . . . . . . . . . . . 52calamine plus (pramox-calamin) . . 52CALCET PETITES . . . . . . . . . . . . . 101calcidol . . . . . . . . . . . . . . . . . . . . . . . . 101calcipotriene scalp . . . . . . . . . . . . . . . 52calcipotriene topical cream . . . . . . . 52calcipotriene topical ointment . . . . . 52calcitonin (salmon) . . . . . . . . . . . . . . . 66calcitrate . . . . . . . . . . . . . . . . . . . . . . . . 95calcitriol intravenous solution 1 mcg/ml . . . . . . . . . . . . . . . . 66calcitriol oral . . . . . . . . . . . . . . . . . . . . . 66calcitriol topical . . . . . . . . . . . . . . . . . . 52calcium 500 + d oral tablet 500 mg(1,250mg) -200 unit . . . . . . 95calcium 500 + d oral tablet, chewable . . . . . . . . . . . . . . . . . . . . . . . 95calcium 500 with d . . . . . . . . . . . . . . . 95calcium 600 . . . . . . . . . . . . . . . . . . . . . 95calcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit . . . . . . 95calcium 600 + minerals . . . . . . . . . 101

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cephalexin oral capsule 250 mg, 500 mg . . . . . . . . . . . . . . . . . 17cephalexin oral suspension for reconstitution . . . . . . . . . . . . . . . . . 17CEREFOLIN . . . . . . . . . . . . . . . . . . . 102CEREZYME INTRAVENOUS RECON SOLN 400 UNIT . . . . . . . . 66cerovite advanced formula . . . . . . 102certa plus . . . . . . . . . . . . . . . . . . . . . . 102CERTAVITE-ANTIOXIDANT . . . . . 102CERTAVITE SENIOR . . . . . . . . . . . 102cetirizine oral solution 1 mg/ml . . . 86cetirizine oral tablet . . . . . . . . . . . . . . 86cetirizine-pseudoephedrine . . . . . . . 86CHANTIX . . . . . . . . . . . . . . . . . . . . . . . 60CHANTIX CONTINUING MONTH BOX . . . . . . . . . . . . . . . . . . . 60CHANTIX STARTING MONTH BOX . . . . . . . . . . . . . . . . . . . 60charlotte 24 fe . . . . . . . . . . . . . . . . . . . 78chateal (28) . . . . . . . . . . . . . . . . . . . . . 78chateal eq (28) . . . . . . . . . . . . . . . . . . 78CHEMET . . . . . . . . . . . . . . . . . . . . . . . 58chest congestion relief oral tablet . 86CHEST RUB TOPICAL OINTMENT . . . . . . . . . . . . . . . . . . . . . 52CHILD MUCINEX CHEST MINI-MELTS ORAL GRANULES IN PACKET 100 MG . . . . . . . . . . . . . 86CHILD MUCINEX COUGH MINI-MELTS . . . . . . . . . . . . . . . . . . . . 86CHILD MUCINEX M-S COLD DAY-NTE . . . . . . . . . . . . . . . . . 86child mucus relief cough . . . . . . . . . 86children’s allergy (diphenhyd) oral liquid . . . . . . . . . . . . . . . . . . . . . . . 86children’s allergy relief(lor) oral solution . . . . . . . . . . . . . . . . . . . . . 86children’s cetirizine oral solution . . 86children’s cetirizine oral tablet,chewable 5 mg . . . . . . . . . . . . 86CHILDREN’S CETIRIZINE ORAL TABLET,CHEWABLE 10 MG . . . . . 86children’s chewable multivitmn . . 102children’s chewables . . . . . . . . . . . . 102children’s chewables extra c . . . . . 102

cefpodoxime . . . . . . . . . . . . . . . . . . . . 16cefprozil . . . . . . . . . . . . . . . . . . . . . . . . 16ceftazidime . . . . . . . . . . . . . . . . . . . . . . 16CEFTAZIDIME IN D5W . . . . . . . . . . 16ceftriaxone in dextrose,iso-os . . . . 16ceftriaxone injection recon soln 1 gram, 10 gram, 2 gram, 250 mg, 500 mg . . . . . . . . . . . . . . . . . 17CEFTRIAXONE INJECTION RECON SOLN 100 GRAM . . . . . . . 17ceftriaxone intravenous . . . . . . . . . . 17cefuroxime axetil oral tablet . . . . . . 17cefuroxime sodium injection recon soln 750 mg . . . . . . . . . . . . . . . 17cefuroxime sodium intravenous . . . 17celecoxib . . . . . . . . . . . . . . . . . . . . . . . . 38CELONTIN ORAL CAPSULE 300 MG . . . . . . . . . . . . . . 31centamin . . . . . . . . . . . . . . . . . . . . . . . 101CENTRAL-VITE WOMEN’S MATURE . . . . . . . . . . . . 101CENTRAM-CARE . . . . . . . . . . . . . . 101centratex . . . . . . . . . . . . . . . . . . . . . . . 101centravites 50 plus oral tablet 0.4-300-250 mg-mcg-mcg . . . . . . . 101CENTRUM COMPLETE . . . . . . . . 101CENTRUM MEN . . . . . . . . . . . . . . . 101CENTRUM ORAL LIQUID 9 MG IRON/15 ML . . . . . . . . . . . . . . 101CENTRUM SILVER ORAL TABLET . . . . . . . . . . . . . . . . . 101CENTRUM SILVER WOMEN. . . . 101CENTRUM SPECIALIST HEART . 101CENTRUM ULTRA MEN’S . . . . . . 101centrum women . . . . . . . . . . . . . . . . 101century adults 50 plus . . . . . . . . . . . 101century cardio . . . . . . . . . . . . . . . . . . 101century mature oral tablet 0.4-300-250 mg-mcg-mcg . . . . . . . 101century oral tablet 18-400 mg-mcg . . . . . . . . . . . . . . . . 102CENTURY ULTIMATE MEN’S ORAL TABLET 8 MG IRON- 200 MCG-600 MCG . . . . . . 102century ultimate women’s . . . . . . . 102

carboplatin intravenous solution . . 23carmustine . . . . . . . . . . . . . . . . . . . . . . 23CARNITOR INTRAVENOUS . . . . . 58carteolol . . . . . . . . . . . . . . . . . . . . . . . . 83cartia xt . . . . . . . . . . . . . . . . . . . . . . . . . 46carvedilol . . . . . . . . . . . . . . . . . . . . . . . 46carvedilol phosphate . . . . . . . . . . . . . 46caspofungin . . . . . . . . . . . . . . . . . . . . . 12CAYSTON . . . . . . . . . . . . . . . . . . . . . . 18caziant (28) . . . . . . . . . . . . . . . . . . . . . 78c complex . . . . . . . . . . . . . . . . . . . . . . 100cefaclor oral capsule . . . . . . . . . . . . . 16cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml . . . . . . . . 16cefaclor oral tablet extended release 12 hr . . . . . . . . . . 16cefadroxil oral capsule . . . . . . . . . . . 16cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml . . . . . . . . . . . . . . . . . . . . . 16cefadroxil oral tablet . . . . . . . . . . . . . 16cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml . . . . . . . . . . . . . . . . . . . . 16cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/50 ml . . . . . . . . . . . . . . . . . . . . 16CEFAZOLIN IN DEXTROSE (ISO-OS) INTRAVENOUS PIGGYBACK 2 GRAM/100 ML . . . 16cefazolin injection recon soln 1 gram, 10 gram, 100 gram, 300 g, 500 mg . . . . . . . . 16cefazolin intravenous . . . . . . . . . . . . 16cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . . 16CEFEPIME IN DEXTROSE 5% . . . 16cefepime in dextrose,iso-osm . . . . 16cefepime injection . . . . . . . . . . . . . . . 16CEFEPIME INTRAVENOUS . . . . . 16cefixime . . . . . . . . . . . . . . . . . . . . . . . . . 16CEFOTETAN IN DEXTROSE, ISO-OSM . . . . . . . . . . . . . . . . . . . . . . . 16cefotetan injection . . . . . . . . . . . . . . . 16cefoxitin . . . . . . . . . . . . . . . . . . . . . . . . . 16cefoxitin in dextrose, iso-osm . . . . . 16

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CLINIMIX 5%-D20W (SULFITE-FREE) . . . . . . . . . . . . . . . . 98CLINIMIX 6%-D5W (SULFITE-FREE) . . . . . . . . . . . . . . . . 99CLINIMIX 8%-D10W (SULFITE-FREE) . . . . . . . . . . . . . . . . 99CLINIMIX 8%-D14W (SULFITE-FREE) . . . . . . . . . . . . . . . . 99CLINIMIX E 4.25%/D10W SUL FREE . . . . . . . . . . . . . . . . . . . . . . 99CLINISOL SF 15% . . . . . . . . . . . . . . 99clobazam oral suspension . . . . . . . . 31clobazam oral tablet . . . . . . . . . . . . . 31clobetasol-emollient topical cream . 56clobetasol-emollient topical foam . 57clobetasol scalp . . . . . . . . . . . . . . . . . 56clobetasol topical cream . . . . . . . . . 56clobetasol topical foam . . . . . . . . . . . 56clobetasol topical gel . . . . . . . . . . . . 56clobetasol topical ointment . . . . . . . 56clobetasol topical shampoo . . . . . . 56clocortolone pivalate . . . . . . . . . . . . . 57clodan . . . . . . . . . . . . . . . . . . . . . . . . . . 57clofarabine . . . . . . . . . . . . . . . . . . . . . . 23clomipramine . . . . . . . . . . . . . . . . . . . . 41clonazepam oral tablet 0.5 mg, 1 mg . . . . . . . . . . . . . . . . . . . . 31clonazepam oral tablet 2 mg . . . . . 31clonazepam oral tablet, disintegrating 0.125 mg, 0.25 mg, 0.5 mg, 1 mg . . . . . . . . . . . 32clonazepam oral tablet, disintegrating 2 mg . . . . . . . . . . . . . . 32clonidine . . . . . . . . . . . . . . . . . . . . . . . . 46clonidine hcl oral tablet . . . . . . . . . . . 46clonidine hcl oral tablet extended release 12 hr . . . . . . . . . . 41clopidogrel oral tablet 75 mg . . . . . 49clopidogrel oral tablet 300 mg . . . . 49clorazepate dipotassium oral tablet 3.75 mg . . . . . . . . . . . . . . . 41clorazepate dipotassium oral tablet 7.5 mg . . . . . . . . . . . . . . . . 41clorazepate dipotassium oral tablet 15 mg . . . . . . . . . . . . . . . . 41

CILOXAN OPHTHALMIC (EYE) OINTMENT . . . . . . . . . . . . . . . 82CIMDUO . . . . . . . . . . . . . . . . . . . . . . . . 13cinacalcet oral tablet 30 mg, 60 mg . . . . . . . . . . . . . . . . . . . 66cinacalcet oral tablet 90 mg . . . . . . 66CIPRODEX . . . . . . . . . . . . . . . . . . . . . 61ciprofloxacin-dexamethasone . . . . 61ciprofloxacin hcl ophthalmic (eye) . 82ciprofloxacin hcl oral . . . . . . . . . . . . . 20ciprofloxacin in 5% dextrose . . . . . . 20CIPRO HC . . . . . . . . . . . . . . . . . . . . . . 61cisplatin intravenous solution . . . . . 23citalopram . . . . . . . . . . . . . . . . . . . . . . . 41CITRACAL + D MAXIMUM . . . . . . . 96cladribine . . . . . . . . . . . . . . . . . . . . . . . 23claravis . . . . . . . . . . . . . . . . . . . . . . . . . 54clarithromycin . . . . . . . . . . . . . . . . . . . 17clearlax oral powder . . . . . . . . . . . . . 68clindacin etz topical swab . . . . . . . . 54clindacin p . . . . . . . . . . . . . . . . . . . . . . 54clindamycin hcl . . . . . . . . . . . . . . . . . . 18CLINDAMYCIN IN 0.9% SOD CHLOR . . . . . . . . . . . . . . 18clindamycin in 5% dextrose . . . . . . 18clindamycin pediatric . . . . . . . . . . . . 18clindamycin phosphate injection . . 18clindamycin phosphate intravenous solution 600 mg/4 ml . 18clindamycin phosphate topical gel . 54CLINDAMYCIN PHOSPHATE TOPICAL GEL, ONCE DAILY . . . . 54clindamycin phosphate topical lotion . . . . . . . . . . . . . . . . . . . . . 54clindamycin phosphate topical solution . . . . . . . . . . . . . . . . . . 54clindamycin phosphate topical swab . . . . . . . . . . . . . . . . . . . . . 54clindamycin phosphate vaginal . . . 77CLINIMIX 4.25%/D5W SULFIT FREE . . . . . . . . . . . . . . . . . . . 58CLINIMIX 4.25%/D10W SULF FREE . . . . . . . . . . . . . . . . . . . . . 98CLINIMIX 5%/D15W SULFITE FREE . . . . . . . . . . . . . . . . . 98

children’s chewable vitamin . . . . . 102children’s cold and cough (pe) . . . . 86CHILDREN’S COUGH DM ER . . . 86CHILDREN’S DAYCLEAR ALLERGY . . . . . . . . . . . 86CHILDREN’S DELSYM COUGH . 86children’s ibuprofen . . . . . . . . . . . . . . 38children’s iron . . . . . . . . . . . . . . . . . . 102children’s mapap oral tablet, chewable 80 mg . . . . . . . . . . . . . . . . . 38CHILDREN’S MUCINEX COLD-FEVER . . . . . . . . . . . . . . . . . . . 86CHILDREN’S MUCINEX MULTI-SYMP . . . . . . . . . . . . . . . . . . . 86CHILDREN’S MUCINEX NIGHT TIME . . . . . . . . . . . . . . . . . . . . 86children’s silfedrine . . . . . . . . . . . . . . 86child’s all day allergy(cetir) . . . . . . . 86child’s chewable vitamins/iron oral tablet,chewable . . . . . . . . . . . 102childs/iron . . . . . . . . . . . . . . . . . . . . . . 102CHILD’S MUCUS RELIEF M-S COLD . . . . . . . . . . . . . . 86chloramphenicol sod succinate . . . 18chlorhexidine gluconate mucous membrane . . . . . . . . . . . . . . 60chloroquine phosphate . . . . . . . . . . . 18chlorothiazide sodium . . . . . . . . . . . . 46chlorpromazine . . . . . . . . . . . . . . . . . . 41chlorthalidone oral tablet 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . 46CHLO TUSS . . . . . . . . . . . . . . . . . . . . 86CHOLECALCIFEROL (VITAMIN D3) ORAL DROPS 10 MCG/ML (400 UNIT/ML) . . . . . 102cholestyramine light . . . . . . . . . . . . . 50cholestyramine (with sugar) . . . . . . 50CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR . . . . . 66ciclodan topical solution . . . . . . . . . . 55ciclopirox topical cream . . . . . . . . . . 55ciclopirox topical shampoo . . . . . . . 55ciclopirox topical solution . . . . . . . . . 56ciclopirox topical suspension . . . . . 56cilostazol . . . . . . . . . . . . . . . . . . . . . . . . 49

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cyanocobalamin (vitamin b-12) oral tablet 1,000 mcg, 100 mcg, 500 mcg . . . . . . . . . . . . . . 103cyanocobalamin (vitamin b-12) oral tablet extended release . . . . . 103cyclafem 1/35 (28) . . . . . . . . . . . . . . . 78cyclafem 7/7/7 (28) . . . . . . . . . . . . . . 78cyclobenzaprine oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 36cyclophosphamide intravenous recon soln . . . . . . . . . . . 23CYCLOPHOSPHAMIDE INTRAVENOUS SOLUTION . . . . . 23cyclophosphamide oral capsule . . 23CYCLOSERINE . . . . . . . . . . . . . . . . . 18CYCLOSET . . . . . . . . . . . . . . . . . . . . . 62cyclosporine intravenous . . . . . . . . . 23cyclosporine modified . . . . . . . . . . . . 24cyclosporine oral capsule . . . . . . . . 24CYRAMZA . . . . . . . . . . . . . . . . . . . . . . 24cyred . . . . . . . . . . . . . . . . . . . . . . . . . . . 78cyred eq . . . . . . . . . . . . . . . . . . . . . . . . 78CYSTADANE . . . . . . . . . . . . . . . . . . . 68CYSTAGON . . . . . . . . . . . . . . . . . . . . . 94CYSTARAN . . . . . . . . . . . . . . . . . . . . . 83cytarabine . . . . . . . . . . . . . . . . . . . . . . . 24cytarabine (pf) injection solution . . 24

DD2.5%-0.45% SODIUM CHLORIDE . . . . . . . . . . . . 58D5%-0.45% SODIUM CHLORIDE 58D5% AND 0.9% SODIUM CHLORIDE . . . . . . . . . . . . . . . . . . . . . 58D10%-0.45% SODIUM CHLORIDE 58dacarbazine . . . . . . . . . . . . . . . . . . . . . 24dactinomycin . . . . . . . . . . . . . . . . . . . . 24daily multiple for men . . . . . . . . . . . 103DAILY MULTIPLE FOR WOMEN 103daily multiple oral tablet, 18-400 mg-mcg . . . . . . . . . . . . . . . . 103DAILY MULTIPLE ORAL TABLET 400-120 MCG-MG . . . . . 103daily multiple vitamins/iron . . . . . . 103daily multi-vitamin . . . . . . . . . . . . . . 103daily multivitamin-minerals . . . . . . 103

constulose . . . . . . . . . . . . . . . . . . . . . . 68COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML . . . . . . . . . . . . 35COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML . . . . . . . . . . . . 35COPIKTRA . . . . . . . . . . . . . . . . . . . . . 23CORAL CALCIUM ORAL CAPSULE 185-50-100 MG-MG-UNIT . . . . . . 102CORLANOR ORAL TABLET . . . . . 51corn-callus remover topical liquid 17% . . . . . . . . . . . . . . . . 52cortisone . . . . . . . . . . . . . . . . . . . . . . . . 61CORTISPORIN-TC . . . . . . . . . . . . . . 61corvita . . . . . . . . . . . . . . . . . . . . . . . . . 102CORVITE . . . . . . . . . . . . . . . . . . . . . . 102CORVITE 150 ORAL TABLET 150 MG IRON- 1 MG . . . . . . . . . . . 102CORVITE FE ORAL TABLET 150 MG IRON- 1 MG . . . . . . . . . . . 102COSMEGEN . . . . . . . . . . . . . . . . . . . . 23COTELLIC . . . . . . . . . . . . . . . . . . . . . . 23COUGH AND SEVERE COLD. . . . 86COUGH-COLD RELIEF HBP . . . . . 87COUGH DM ER . . . . . . . . . . . . . . . . . 87COUGH DROPS MUCOUS MEMBRANE LOZENGE 5.4 MG, 5.8 MG, 7.6 MG . . . . . . . . . 60cough syrup dm . . . . . . . . . . . . . . . . . 87COZIMA . . . . . . . . . . . . . . . . . . . . . . . . 52cranberry urinary comfort . . . . . . . . 60CREON . . . . . . . . . . . . . . . . . . . . . . . . . 68CRESEMBA ORAL . . . . . . . . . . . . . . 12CRIXIVAN ORAL CAPSULE 200 MG . . . . . . . . . . . . . . 13CRIXIVAN ORAL CAPSULE 400 MG . . . . . . . . . . . . . . 13cromolyn inhalation . . . . . . . . . . . . . . 92cromolyn nasal . . . . . . . . . . . . . . . . . . 92cromolyn ophthalmic (eye) . . . . . . . 83cromolyn oral . . . . . . . . . . . . . . . . . . . . 68cryselle (28) . . . . . . . . . . . . . . . . . . . . . 78CUTTER BACKWOODS . . . . . . . . . 52CUTTER BACKWOODS DRY . . . . 52CUTTER LEMON EUCALYPTUS . 52

clotrimazole-betamethasone topical cream . . . . . . . . . . . . . . . . . . . . 56clotrimazole-betamethasone topical lotion . . . . . . . . . . . . . . . . . . . . . 56clotrimazole mucous membrane . . 12clotrimazole topical cream . . . . . . . . 56clotrimazole topical solution . . . . . . 56clotrimazole vaginal cream . . . . . . . 77clozapine . . . . . . . . . . . . . . . . . . . . . . . 41COARTEM . . . . . . . . . . . . . . . . . . . . . . 18COATS ALOE MOISTURIZING . . . 52COATS ALOE TOPICAL CREAM . 52COATS ALOE TOPICAL GEL . . . . 52codeine-guaifenesin . . . . . . . . . . . . . 86colchicine oral tablet . . . . . . . . . . . . . 74colesevelam . . . . . . . . . . . . . . . . . . . . . 50colestipol . . . . . . . . . . . . . . . . . . . . . . . . 50colistin (colistimethate na) . . . . . . . . 18COMBIGAN . . . . . . . . . . . . . . . . . . . . . 84COMBIVENT RESPIMAT . . . . . . . . 92COMETRIQ ORAL CAPSULE 60 MG/DAY (20 MG X 3/DAY) . . . . 23COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1-20 MG X1) 23COMETRIQ ORAL CAPSULE 140 MG/DAY(80 MG X1-20 MG X3) 23COMPLERA . . . . . . . . . . . . . . . . . . . . 13complete 50 plus . . . . . . . . . . . . . . . 102complete allergy medicine oral capsule . . . . . . . . . . . . . . . . . . . . . 86COMPLETE MEN . . . . . . . . . . . . . . 102complete multi . . . . . . . . . . . . . . . . . . 102complete multi 50+ . . . . . . . . . . . . . 102complete multivitamin- mineral oral tablet . . . . . . . . . . . . . . 102complete mv adult 50 plus . . . . . . 102complete oral tablet 18-500- 300-250 mg-mcg-mcg-mcg . . . . . . 102complete premium vitamin . . . . . . . 60complete senior oral tablet 0.4-300-250 mg-mcg-mcg . . . . . . . 102complete women . . . . . . . . . . . . . . . 102complex b-100 oral tablet extended release . . . . . . . . . . . . . . 102compro . . . . . . . . . . . . . . . . . . . . . . . . . 68

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dextroamphetamine-amphetamine oral tablet 10 mg . . . . . . . . . . . . . . . . 41dextroamphetamine-amphetamine oral tablet 12.5 mg, 30 mg, 7.5 mg . 41dextroamphetamine-amphetamine oral tablet 15 mg . . . . . . . . . . . . . . . . 41dextroamphetamine-amphetamine oral tablet 20 mg . . . . . . . . . . . . . . . . 41dextroamphetamine oral capsule, extended release . . . . . . . 41dextroamphetamine oral solution . 41dextroamphetamine oral tablet . . . 41dextromethorphan polistirex . . . . . . 87DEXTROSE 5%- 0.2% SOD CHLORIDE . . . . . . . . . . . 58dextrose 5%-0.3% sod.chloride . . . 58DEXTROSE 5% IN WATER (D5W) INTRAVENOUS PARENTERAL SOLUTION . . . . . . . 58dextrose 5% in water (d5w) intravenous piggyback . . . . . . . . . . . 58dextrose 5%-lactated ringers . . . . . 58DEXTROSE 10% AND 0.2% NACL 58DEXTROSE 10% IN WATER (D10W) . . . . . . . . . . . . . . 58dextrose 25% in water (d25w) . . . . 58dextrose 30% in water (d30w) . . . . 58dextrose 40% in water (d40w) . . . . 58dextrose 50% in water (d50w) intravenous parenteral solution . . . 59dextrose 50% in water (d50w) intravenous syringe . . . . . . . . . . . . . . 59dextrose 70% in water (d70w) . . . . 59DIACOMIT ORAL CAPSULE 250 MG . . . . . . . . . . . . . . 32DIACOMIT ORAL CAPSULE 500 MG . . . . . . . . . . . . . . 32DIACOMIT ORAL POWDER IN PACKET 250 MG . . . . . . . . . . . . . 32DIACOMIT ORAL POWDER IN PACKET 500 MG . . . . . . . . . . . . . 32dialyvite . . . . . . . . . . . . . . . . . . . . . . . . 103dialyvite 800 oral tablet . . . . . . . . . 103DIALYVITE 800 WITH IRON . . . . 103DIALYVITE 3000 . . . . . . . . . . . . . . . 103DIALYVITE 5000 . . . . . . . . . . . . . . . 103

DELSTRIGO . . . . . . . . . . . . . . . . . . . . 13DELSYM 12 HOUR . . . . . . . . . . . . . . 87delsym cough-chest congest dm . . 87demeclocycline . . . . . . . . . . . . . . . . . . 21DEMSER . . . . . . . . . . . . . . . . . . . . . . . 47DENAVIR . . . . . . . . . . . . . . . . . . . . . . . 56DEPEN TITRATABS . . . . . . . . . . . . . 75DEPO-ESTRADIOL . . . . . . . . . . . . . 76DEPO-MEDROL . . . . . . . . . . . . . . . . 61DESCOVY . . . . . . . . . . . . . . . . . . . . . . 13desipramine . . . . . . . . . . . . . . . . . . . . . 41desloratadine oral tablet . . . . . . . . . 87desmopressin injection . . . . . . . . . . . 66desmopressin nasal spray, non-aerosol . . . . . . . . . . . . . . . . . . . . . 66desmopressin nasal spray with pump . . . . . . . . . . . . . . . . . . . . . . . 66desmopressin oral . . . . . . . . . . . . . . . 66desog-e.estradiol/e.estradiol . . . . . 78desogestrel-ethinyl estradiol . . . . . . 78desonide topical cream . . . . . . . . . . 57desonide topical lotion . . . . . . . . . . . 57desonide topical ointment . . . . . . . . 57desoximetasone topical cream . . . 57desoximetasone topical gel . . . . . . 57desoximetasone topical ointment . 57desvenlafaxine succinate . . . . . . . . 41dexamethasone intensol . . . . . . . . . 61dexamethasone oral elixir . . . . . . . . 61dexamethasone oral solution . . . . . 61dexamethasone oral tablet . . . . . . . 61dexamethasone sodium phos (pf) injection solution . . . . . . . 61dexamethasone sodium phosphate injection solution . . . . . . 61dexamethasone sodium phosphate ophthalmic (eye) . . . . . . 85DEXBROMPHENIRAMINE-PHENYLEPH . . . . . . . . . . . . . . . . . . . 87dexmethylphenidate oral tablet . . . 41dextroamphetamine-amphetamine oral capsule,extended release 24hr 41dextroamphetamine-amphetamine oral tablet 5 mg . . . . . . . . . . . . . . . . . . 41

daily multivitamin with iron . . . . . . 103daily value . . . . . . . . . . . . . . . . . . . . . 103daily vitamin formula . . . . . . . . . . . . 103daily vitamin formula-iron . . . . . . . . 103daily vitamin formula-minerals . . . 103daily vitamin with iron . . . . . . . . . . . 103DAILY-VITE . . . . . . . . . . . . . . . . . . . . 103daily vites/iron . . . . . . . . . . . . . . . . . . 103dalfampridine . . . . . . . . . . . . . . . . . . . . 35DALIRESP . . . . . . . . . . . . . . . . . . . . . . 92danazol . . . . . . . . . . . . . . . . . . . . . . . . . 66dantrolene oral . . . . . . . . . . . . . . . . . . 36dapsone oral . . . . . . . . . . . . . . . . . . . . 18DAPTACEL (DTAP PEDIATRIC) (PF) . . . . . . . . . 73daptomycin . . . . . . . . . . . . . . . . . . . . . 18darifenacin . . . . . . . . . . . . . . . . . . . . . . 94DARZALEX . . . . . . . . . . . . . . . . . . . . . 24DARZALEX FASPRO . . . . . . . . . . . . 24dasetta 1/35 (28) . . . . . . . . . . . . . . . . 78dasetta 7/7/7 (28) . . . . . . . . . . . . . . . . 78daunorubicin intravenous solution 24DAURISMO ORAL TABLET 25 MG 24DAURISMO ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 24daysee . . . . . . . . . . . . . . . . . . . . . . . . . . 78DAYTIME COLD-FLU RELIEF (PE) . . . . . . . . . . . . . . . . . . . . 87deblitane . . . . . . . . . . . . . . . . . . . . . . . . 76decitabine . . . . . . . . . . . . . . . . . . . . . . . 24DECONEX DMX ORAL TABLET 10-17.5-385 MG, 10-17.5-400 MG . 87DECONEX IR ORAL TABLET 10-385 MG . . . . . . . . . . . . . 87deep sea nasal . . . . . . . . . . . . . . . . . . 60deferasirox oral granules in packet 58deferasirox oral tablet . . . . . . . . . . . . 58deferiprone . . . . . . . . . . . . . . . . . . . . . . 58DEKAS ESSENTIAL ORAL CAPSULE . . . . . . . . . . . . . . . 103DEKAS PLUS (FOLIC ACID) ORAL CAPSULE . . . . . . . . . . . . . . . 103DEKAS PLUS LIQUID . . . . . . . . . . 103DELESTROGEN INTRAMUSCULAR OIL 10 MG/ML . 76

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dorzolamide-timolol . . . . . . . . . . . . . . 84dotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76DOUBLE ANTIBIOTIC (B.TRACN ZN) TOPICAL OINTMENT . . . . . . . 55DOVATO . . . . . . . . . . . . . . . . . . . . . . . . 13doxazosin oral tablet 1 mg, 2 mg, 4 mg . . . . . . . . . . . . . . . . 47doxazosin oral tablet 8 mg . . . . . . . 47doxepin oral capsule . . . . . . . . . . . . . 41doxepin oral concentrate . . . . . . . . . 41doxepin oral tablet . . . . . . . . . . . . . . . 41doxercalciferol . . . . . . . . . . . . . . . . . . . 66doxorubicin intravenous recon soln 50 mg . . . . . . . . . . . . . . . . 24doxorubicin intravenous solution . . 24doxorubicin, peg-liposomal . . . . . . . 24doxy-100 . . . . . . . . . . . . . . . . . . . . . . . . 21doxycycline hyclate intravenous . . 21doxycycline hyclate oral capsule . . 21doxycycline hyclate oral tablet 100 mg, 20 mg . . . . . . . . . . . . . . . . . . 21doxycycline monohydrate oral capsule 100 mg, 50 mg . . . . . . 21DOXYCYCLINE MONOHYDRATE ORAL CAPSULE,IR - DELAY REL,BIPHASE . . . . . . . . . . . . . . . . . . 21doxycycline monohydrate oral suspension for reconstitution . . . . . 21doxycycline monohydrate oral tablet . . . . . . . . . . . . . . . . . . . . . . . 21DOXYLAMINE-PHENYLEPHRINE . 87driminate . . . . . . . . . . . . . . . . . . . . . . . . 69DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 20 MG, 30 MG, 60 MG . 42DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 40 MG . . . . . . . . . . . . . . . 42dronabinol . . . . . . . . . . . . . . . . . . . . . . 69drospirenone-e.estradiol-lm.fa . . . . 78drospirenone-ethinyl estradiol . . . . 78DROXIA . . . . . . . . . . . . . . . . . . . . . . . . 24DR. SMITH’S DIAPER . . . . . . . . . . . 53DR. SMITH’S DIAPER RASH . . . . 53DRY EYE RELIEF . . . . . . . . . . . . . . . 83DUAVEE . . . . . . . . . . . . . . . . . . . . . . . . 76

diltiazem hcl oral tablet . . . . . . . . . . . 47diltiazem hcl oral tablet extended release 24 hr . . . . . . . . . . 47dilt-xr . . . . . . . . . . . . . . . . . . . . . . . . . . . 47dimaphen dm . . . . . . . . . . . . . . . . . . . 87dimethyl fumarate oral capsule,delayed release(dr/ec) 120 mg . . . . . . . . . . . . . . . . . . . . . . . . . 35dimethyl fumarate oral capsule,delayed release(dr/ec) 120 mg (14)- 240 mg (46) . . . . . . . . 35dimethyl fumarate oral capsule,delayed release(dr/ec) 240 mg . . . . . . . . . . . . . . . . . . . . . . . . . 35diphenhist oral capsule . . . . . . . . . . 87diphenhydramine hcl injection solution 50 mg/ml . . . . . . . . . . . . . . . . 87diphenhydramine hcl oral capsule 87DIPHENHYDRAMINE HCL ORAL DROPS . . . . . . . . . . . . . . . . . . 87diphenhydramine hcl oral liquid . . . 87diphenhydramine hcl oral tablet 25 mg . . . . . . . . . . . . . . . . 87diphenoxylate-atropine . . . . . . . . . . . 67dipyridamole oral . . . . . . . . . . . . . . . . 49disulfiram . . . . . . . . . . . . . . . . . . . . . . . 59divalproex . . . . . . . . . . . . . . . . . . . . . . . 32docetaxel intravenous solution 160 mg/16 ml (10 mg/ml), 160 mg/ 8 ml (20 mg/ml), 20 mg/2 ml (10 mg/ml), 20 mg/ml (1 ml), 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml) . . . . . . . . . . . 24DOCUSOL KIDS . . . . . . . . . . . . . . . . 68DOCUSOL PLUS . . . . . . . . . . . . . . . . 68dofetilide . . . . . . . . . . . . . . . . . . . . . . . . 45dok oral capsule 100 mg . . . . . . . . . 68dok oral tablet . . . . . . . . . . . . . . . . . . . 68donepezil oral tablet 5 mg . . . . . . . . 35donepezil oral tablet 10 mg . . . . . . . 35donepezil oral tablet 23 mg . . . . . . . 35donepezil oral tablet, disintegrating 5 mg . . . . . . . . . . . . . . 35donepezil oral tablet, disintegrating 10 mg . . . . . . . . . . . . . 35dorzolamide . . . . . . . . . . . . . . . . . . . . . 84

DIALYVITE SUPREME D . . . . . . . 103diaper rash topical ointment . . . . . . 52DIASTAT . . . . . . . . . . . . . . . . . . . . . . . . 32DIASTAT ACUDIAL . . . . . . . . . . . . . . 32diazepam injection . . . . . . . . . . . . . . . 41diazepam intensol . . . . . . . . . . . . . . . 41diazepam oral concentrate . . . . . . . 41diazepam oral solution 5 mg/5 ml (1 mg/ml) . . . . . . . . . . . . . 41diazepam oral tablet . . . . . . . . . . . . . 41diazepam rectal . . . . . . . . . . . . . . . . . 32diazoxide . . . . . . . . . . . . . . . . . . . . . . . 62dibucaine . . . . . . . . . . . . . . . . . . . . . . . 53diclofenac potassium . . . . . . . . . . . . 38diclofenac sodium ophthalmic (eye) . . . . . . . . . . . . . . . . . 84diclofenac sodium oral . . . . . . . . . . . 38diclofenac sodium topical drops . . 38diclofenac sodium topical gel 1% . 38dicloxacillin . . . . . . . . . . . . . . . . . . . . . . 20dicyclomine oral capsule . . . . . . . . . 67dicyclomine oral solution . . . . . . . . . 67dicyclomine oral tablet . . . . . . . . . . . 67didanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg . . . 13DIFICID ORAL TABLET . . . . . . . . . . 17diflunisal . . . . . . . . . . . . . . . . . . . . . . . . 38digitek . . . . . . . . . . . . . . . . . . . . . . . . . . 51digox . . . . . . . . . . . . . . . . . . . . . . . . . . . 51digoxin oral solution 50 mcg/ml (0.05 mg/ml) . . . . . . . . . . 51digoxin oral tablet . . . . . . . . . . . . . . . . 51dihydroergotamine nasal . . . . . . . . . 34dilantin 30 mg . . . . . . . . . . . . . . . . . . . 32diltiazem hcl intravenous . . . . . . . . . 47diltiazem hcl oral capsule, extended release 12 hr . . . . . . . . . . 47diltiazem hcl oral capsule, extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg . . . . . . . . . 47diltiazem hcl oral capsule, extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 420 mg . 47diltiazem hcl oral capsule, ext.rel 24h degradable . . . . . . . . . . . 47

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ENFAMIL ENFALYTE . . . . . . . . . . . . 96ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE . . . . 73ENGERIX-B (PF) INTRAMUSCULAR SYRINGE . . . . 73ENHERTU . . . . . . . . . . . . . . . . . . . . . . 24ENLYTE . . . . . . . . . . . . . . . . . . . . . . . 103enoxaparin . . . . . . . . . . . . . . . . . . . . . . 49enpresse . . . . . . . . . . . . . . . . . . . . . . . . 78enskyce . . . . . . . . . . . . . . . . . . . . . . . . . 79entacapone . . . . . . . . . . . . . . . . . . . . . 34entecavir . . . . . . . . . . . . . . . . . . . . . . . . 13ENTRESTO . . . . . . . . . . . . . . . . . . . . . 51enulose . . . . . . . . . . . . . . . . . . . . . . . . . 69ENVARSUS XR . . . . . . . . . . . . . . . . . 24EPCLUSA . . . . . . . . . . . . . . . . . . . . . . 13EPIDIOLEX . . . . . . . . . . . . . . . . . . . . . 32epinastine . . . . . . . . . . . . . . . . . . . . . . . 83epinephrine injection auto-injector . 87epinephrine injection solution 1 mg/ml . . . . . . . . . . . . . . . . . 87epirubicin intravenous solution . . . 24epitol . . . . . . . . . . . . . . . . . . . . . . . . . . . 32EPIVIR HBV ORAL SOLUTION . . 13ERBITUX . . . . . . . . . . . . . . . . . . . . . . . 24ergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 unit) . 103ergocalciferol (vitamin d2) oral drops . . . . . . . . . . . . . . . . . . . . . . 103ergotamine-caffeine . . . . . . . . . . . . . 34ERIVEDGE . . . . . . . . . . . . . . . . . . . . . 24ERLEADA . . . . . . . . . . . . . . . . . . . . . . 24erlotinib oral tablet 25 mg . . . . . . . . 24erlotinib oral tablet 100 mg, 150 mg . . . . . . . . . . . . . . . . . 24errin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76ertapenem . . . . . . . . . . . . . . . . . . . . . . 18ERWINAZE . . . . . . . . . . . . . . . . . . . . . 24ery pads . . . . . . . . . . . . . . . . . . . . . . . . 54ERYPED 400 . . . . . . . . . . . . . . . . . . . 17ery-tab . . . . . . . . . . . . . . . . . . . . . . . . . . 17erythrocin (as stearate) oral tablet 250 mg . . . . . . . . . . . . . . . 17erythrocin intravenous recon soln 500 mg . . . . . . . . . . . . . . . 17

electrolytes-dextrose . . . . . . . . . . . . . 96ELFOLATE PLUS . . . . . . . . . . . . . . 103ELIGARD . . . . . . . . . . . . . . . . . . . . . . . 24ELIGARD (3 MONTH) . . . . . . . . . . . 24ELIGARD (4 MONTH) . . . . . . . . . . . 24ELIGARD (6 MONTH) . . . . . . . . . . . 24elinest . . . . . . . . . . . . . . . . . . . . . . . . . . 78ELIQUIS . . . . . . . . . . . . . . . . . . . . . . . . 49ELIQUIS DVT-PE TREAT 30D START . . . . . . . . . . . . . . 49ELLA . . . . . . . . . . . . . . . . . . . . . . . . . . . 78ELLENCE . . . . . . . . . . . . . . . . . . . . . . . 24ELMIRON . . . . . . . . . . . . . . . . . . . . . . . 94ELZONRIS . . . . . . . . . . . . . . . . . . . . . . 24EMCYT . . . . . . . . . . . . . . . . . . . . . . . . . 24EMEND ORAL SUSPENSION FOR RECONSTITUTION . . . . . . . . 69emoquette . . . . . . . . . . . . . . . . . . . . . . 78EMPLICITI . . . . . . . . . . . . . . . . . . . . . . 24EMSAM . . . . . . . . . . . . . . . . . . . . . . . . . 42emtricitabine . . . . . . . . . . . . . . . . . . . . 13emtricitabine-tenofovir (tdf) . . . . . . . 13EMTRIVA ORAL CAPSULE . . . . . . 13EMTRIVA ORAL SOLUTION . . . . . 13EMVERM . . . . . . . . . . . . . . . . . . . . . . . 18enalapril-hydrochlorothiazide . . . . . 47enalapril maleate . . . . . . . . . . . . . . . . 47ENBREL MINI . . . . . . . . . . . . . . . . . . . 75ENBREL SUBCUTANEOUS RECON SOLN . . . . . . . . . . . . . . . . . . 75ENBREL SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 75ENBREL SUBCUTANEOUS SYRINGE . . . . . . . . . . . . . . . . . . . . . . . 75ENBREL SURECLICK . . . . . . . . . . . 75endacof - dm . . . . . . . . . . . . . . . . . . . . 87endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg 36endur-acin oral tablet extended release 250 mg, 500 mg . . . . . . . . . 50endur-c with rose hips . . . . . . . . . . 103enema rectal enema 19-7 gram/118 ml . . . . . . . . . . . . . . . . 69ENEMEEZ . . . . . . . . . . . . . . . . . . . . . . 69ENEMEEZ PLUS . . . . . . . . . . . . . . . . 69

duloxetine oral capsule, delayed release(dr/ec) 20 mg, 30 mg, 60 mg . . . . . . . . . . . . 42duofer . . . . . . . . . . . . . . . . . . . . . . . . . 103DUPIXENT PEN . . . . . . . . . . . . . . . . . 53DUPIXENT SYRINGE SUBCUTANEOUS SYRINGE 200 MG/1.14 ML . . . . . . . . . . . . . . . . 53DUPIXENT SYRINGE SUBCUTANEOUS SYRINGE 300 MG/2 ML . . . . . . . . . . . . . . . . . . . 53DURAFLU ORAL TABLET 60-20-200-325 MG . . . . . . . . . . . . . . 87DUREZOL . . . . . . . . . . . . . . . . . . . . . . 85dutasteride . . . . . . . . . . . . . . . . . . . . . . 94dutasteride-tamsulosin . . . . . . . . . . . 94d-vi-sol . . . . . . . . . . . . . . . . . . . . . . . . . 103

Eear drops (carbamide peroxide) . . 61ear wax removal drops . . . . . . . . . . . 61ear wax removal kit . . . . . . . . . . . . . . 61ec-naproxen . . . . . . . . . . . . . . . . . . . . . 39econazole . . . . . . . . . . . . . . . . . . . . . . . 56econtra ez . . . . . . . . . . . . . . . . . . . . . . 78ed a-hist . . . . . . . . . . . . . . . . . . . . . . . . 87ed a-hist dm oral liquid . . . . . . . . . . . 87ED A-HIST DM ORAL TABLET . . . 87ed-apap . . . . . . . . . . . . . . . . . . . . . . . . . 39EDARBI . . . . . . . . . . . . . . . . . . . . . . . . 47EDARBYCLOR . . . . . . . . . . . . . . . . . . 47ed bron gp . . . . . . . . . . . . . . . . . . . . . . 87ed chlorped jr . . . . . . . . . . . . . . . . . . . 87EDURANT . . . . . . . . . . . . . . . . . . . . . . 13efavirenz-emtricitabin-tenofov . . . . 13efavirenz-lamivu-tenofov disop oral tablet 400-300-300 mg . . . . . . . 13efavirenz-lamivu-tenofov disop oral tablet 600-300-300 mg . . . . . . . 13efavirenz oral capsule 50 mg . . . . . 13efavirenz oral capsule 200 mg . . . . 13efavirenz oral tablet . . . . . . . . . . . . . . 13efferves pain relief antacid . . . . . . . 39ELAPRASE . . . . . . . . . . . . . . . . . . . . . 66electrolyte-48 in d5w . . . . . . . . . . . . . 99

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fentanyl . . . . . . . . . . . . . . . . . . . . . . . . . 36fentanyl citrate buccal lozenge on a handle . . . . . . . . . . . . . 36fentanyl citrate (pf) injection solution . . . . . . . . . . . . . . . . . 36fentanyl citrate (pf) intravenous syringe 100 mcg/2 ml (50 mcg/ml) . . . . . . . . 36FEOSOL BIFERA . . . . . . . . . . . . . . 104feosol oral tablet 325 mg (65 mg iron) . . . . . . . . . . . . 104ferate oral tablet 240 mg (27 mg iron) . . . . . . . . . . . . 104FERGON ORAL TABLET 240 MG (27 MG IRON) . . . . . . . . . 104FER-IN-SOL . . . . . . . . . . . . . . . . . . . 104FERIVA 21-7 . . . . . . . . . . . . . . . . . . . 104FERIVA FA (WITH SUMALATE) . 104ferosul oral tablet . . . . . . . . . . . . . . . 104FERRALET 90 DUAL- IRON DELIVERY . . . . . . . . . . . . . . . 104ferraplus 90 . . . . . . . . . . . . . . . . . . . . 104ferretts . . . . . . . . . . . . . . . . . . . . . . . . . 104FERRETTS IPS . . . . . . . . . . . . . . . . 104ferrex 150 . . . . . . . . . . . . . . . . . . . . . . 104ferrex 150 forte . . . . . . . . . . . . . . . . . 104ferric x-150 . . . . . . . . . . . . . . . . . . . . . 104FERRIMIN 150 . . . . . . . . . . . . . . . . . 104FERRIPROX . . . . . . . . . . . . . . . . . . . . 59FERRIPROX (2 TIMES A DAY) . . . 59ferrocite . . . . . . . . . . . . . . . . . . . . . . . . 104ferro-time . . . . . . . . . . . . . . . . . . . . . . 104ferrous fumarate oral tablet 324 mg (106 mg iron) . . . . . . . . . . . 104ferrous gluconate oral tablet 236 mg (27 mg iron), 240 mg (27 mg iron), 256 mg (28 mg iron), 324 mg (37.5 mg iron), 324 mg (38 mg iron) . . . . . . . . . . . . 104ferrous sulfate oral drops . . . . . . . . 104ferrous sulfate oral liquid . . . . . . . . 104ferrous sulfate oral solution . . . . . . 104ferrous sulfate oral tablet 325 mg (65 mg iron) . . . . . . . . . . . . 104ferrous sulfate oral tablet, delayed release (dr/ec) . . . . . . . . . 104

everolimus (immunosuppressive) oral tablet 0.5 mg . . . . . . . . . . . . . . . . 25everolimus (immunosuppressive) oral tablet 0.25 mg, 0.75 mg . . . . . . 25EVOMELA . . . . . . . . . . . . . . . . . . . . . . 25EVOTAZ . . . . . . . . . . . . . . . . . . . . . . . . 13exemestane . . . . . . . . . . . . . . . . . . . . . 25eye drops advanced relief . . . . . . . . 85eye drops (tetrahydrozoline) . . . . . . 85EYLEA . . . . . . . . . . . . . . . . . . . . . . . . . . 83ezetimibe . . . . . . . . . . . . . . . . . . . . . . . 50ezetimibe-simvastatin . . . . . . . . . . . . 50ezfe 200 . . . . . . . . . . . . . . . . . . . . . . . 104

Ffabb . . . . . . . . . . . . . . . . . . . . . . . . . . . 104FABRAZYME . . . . . . . . . . . . . . . . . . . 66falmina (28) . . . . . . . . . . . . . . . . . . . . . 79famciclovir . . . . . . . . . . . . . . . . . . . . . . 13famotidine oral suspension . . . . . . . 71famotidine oral tablet 10 mg . . . . . . 71famotidine oral tablet 20 mg, 40 mg . . . . . . . . . . . . . . . . . . . 71FANAPT ORAL TABLET 1 MG . . . 42FANAPT ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG . . 42FANAPT ORAL TABLETS, DOSE PACK . . . . . . . . . . . . . . . . . . . . 42FARXIGA ORAL TABLET 5 MG . . 62FARXIGA ORAL TABLET 10 MG . 62FARYDAK . . . . . . . . . . . . . . . . . . . . . . 25fayosim . . . . . . . . . . . . . . . . . . . . . . . . . 79febuxostat . . . . . . . . . . . . . . . . . . . . . . . 74fe c . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104felbamate oral suspension . . . . . . . 32felbamate oral tablet . . . . . . . . . . . . . 32felodipine . . . . . . . . . . . . . . . . . . . . . . . 47femynor . . . . . . . . . . . . . . . . . . . . . . . . . 79fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg . . 50fenofibrate nanocrystallized oral tablet 145 mg, 48 mg . . . . . . . . 50fenofibrate oral tablet 160 mg, 54 mg . . . . . . . . . . . . . . . . . . 51fenofibric acid (choline) . . . . . . . . . . 51

erythromycin-benzoyl peroxide . . . 55erythromycin ethylsuccinate oral suspension for reconstitution 200 mg/5 ml . . . . . . . . . . . . . . . . . . . . . 17erythromycin ethylsuccinate oral suspension for reconstitution 400 mg/5 ml . . . . . . . . . . . . . . . . . . . . . 17erythromycin ethylsuccinate oral tablet . . . . . . . . . . . . . . . . . . . . . . . 17erythromycin ophthalmic (eye) . . . . 82erythromycin oral tablet . . . . . . . . . . 17erythromycin oral tablet, delayed release (dr/ec) . . . . . . . . . . 17erythromycin with ethanol topical gel . . . . . . . . . . . . . . . . . . . . . . . 55erythromycin with ethanol topical solution . . . . . . . . . . . . . . . . . . 55ESBRIET ORAL CAPSULE . . . . . . 92ESBRIET ORAL TABLET 267 MG 92ESBRIET ORAL TABLET 801 MG 92escitalopram oxalate oral solution 42escitalopram oxalate oral tablet . . . 42esomeprazole magnesium oral capsule,delayed release(dr/ec) . . . 71essentia . . . . . . . . . . . . . . . . . . . . . . . 103essential daily . . . . . . . . . . . . . . . . . . 103estarylla . . . . . . . . . . . . . . . . . . . . . . . . 79estradiol oral . . . . . . . . . . . . . . . . . . . . 76estradiol transdermal patch semiweekly . . . . . . . . . . . . . . . 76estradiol transdermal patch weekly . . . . . . . . . . . . . . . . . . . . 76estradiol vaginal . . . . . . . . . . . . . . . . . 76estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml . . . . . . . . . . . 76ESTRING . . . . . . . . . . . . . . . . . . . . . . . 76ethacrynate sodium . . . . . . . . . . . . . . 47ethambutol . . . . . . . . . . . . . . . . . . . . . . 18ethosuximide . . . . . . . . . . . . . . . . . . . . 32ethynodiol diac-eth estradiol . . . . . . 79etodolac . . . . . . . . . . . . . . . . . . . . . . . . 39ETOPOPHOS . . . . . . . . . . . . . . . . . . . 24etoposide intravenous . . . . . . . . . . . 25EUTHYROX . . . . . . . . . . . . . . . . . . . . . 67everolimus (antineoplastic) . . . . . . . 25

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fluphenazine hcl . . . . . . . . . . . . . . . . . 42flurbiprofen oral tablet 100 mg . . . . 39flurbiprofen sodium . . . . . . . . . . . . . . 84FLU-SEVERE COLD- COUGH DAYTIME . . . . . . . . . . . . . . 87flutamide . . . . . . . . . . . . . . . . . . . . . . . . 25fluticasone propionate nasal . . . . . . 92fluticasone propionate topical cream . . . . . . . . . . . . . . . . . . . . 57fluticasone propionate topical ointment . . . . . . . . . . . . . . . . . 57fluticasone propion-salmeterol inhalation blister with device . . . . . . 92fluvoxamine oral tablet 25 mg . . . . 42fluvoxamine oral tablet 50 mg . . . . 42fluvoxamine oral tablet 100 mg . . . 42folbee . . . . . . . . . . . . . . . . . . . . . . . . . . 105folbee plus . . . . . . . . . . . . . . . . . . . . . 105folbic . . . . . . . . . . . . . . . . . . . . . . . . . . 105folic acid injection . . . . . . . . . . . . . . . 105folic acid oral tablet 1 mg . . . . . . . . 105FOLIC ACID-VIT B6-VIT B12 ORAL TABLET 0.5-5-0.2 MG . . . . 105folitab . . . . . . . . . . . . . . . . . . . . . . . . . . 105FOLOTYN . . . . . . . . . . . . . . . . . . . . . . 25folplex 2.2 . . . . . . . . . . . . . . . . . . . . . . 105foltabs 800 . . . . . . . . . . . . . . . . . . . . . 105foltanx . . . . . . . . . . . . . . . . . . . . . . . . . 105FOLTRATE . . . . . . . . . . . . . . . . . . . . . 105fomepizole . . . . . . . . . . . . . . . . . . . . . . 73fondaparinux subcutaneous syringe 2.5 mg/0.5 ml . . . . . . . . . . . . 49fondaparinux subcutaneous syringe 10 mg/0.8 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml . . . . . . . 49formula em . . . . . . . . . . . . . . . . . . . . . . 69FORTAVIT . . . . . . . . . . . . . . . . . . . . . . 99fosamprenavir . . . . . . . . . . . . . . . . . . . 13fosfomycin tromethamine . . . . . . . . 21fosfree . . . . . . . . . . . . . . . . . . . . . . . . . 105fosinopril . . . . . . . . . . . . . . . . . . . . . . . . 47fosinopril-hydrochlorothiazide . . . . 47fosphenytoin . . . . . . . . . . . . . . . . . . . . 32freamine iii 10% . . . . . . . . . . . . . . . . . 99fruit c-500 . . . . . . . . . . . . . . . . . . . . . . 105

FLOVENT HFA AEROSOL INHALER 44 MCG/ACTUATION . . 92FLOVENT HFA AEROSOL INHALER 110 MCG/ACTUATION . 92FLOVENT HFA AEROSOL INHALER 220 MCG/ACTUATION 92floxuridine . . . . . . . . . . . . . . . . . . . . . . . 25fluconazole . . . . . . . . . . . . . . . . . . . . . . 12fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml . . . 12flucytosine . . . . . . . . . . . . . . . . . . . . . . 12fludarabine . . . . . . . . . . . . . . . . . . . . . . 25fludrocortisone . . . . . . . . . . . . . . . . . . 61flunisolide nasal spray, non-aerosol 25 mcg (0.025%) . . . . 92fluocinolone . . . . . . . . . . . . . . . . . . . . . 57fluocinolone acetonide oil . . . . . . . . 61fluocinolone and shower cap . . . . . 57fluocinonide topical cream 0.1% . . 57fluocinonide topical cream 0.05% . 57fluocinonide topical gel . . . . . . . . . . . 57fluocinonide topical ointment . . . . . 57fluocinonide topical solution . . . . . . 57fluoride (sodium) dental paste . . . . 60fluoride (sodium) oral drops . . . . . 105fluoride (sodium) oral tablet . . . . . 105fluoride (sodium) oral tablet, chewable 1 mg (2.2 mg sod. fluoride) . . . . . . . . . . . 105fluorometholone . . . . . . . . . . . . . . . . . 85fluorouracil intravenous . . . . . . . . . . 25FLUOROURACIL TOPICAL CREAM 0.5% . . . . . . . . . 53fluorouracil topical cream 5% . . . . . 53fluorouracil topical solution . . . . . . . 53fluoxetine oral capsule 10 mg . . . . 42fluoxetine oral capsule 20 mg . . . . 42fluoxetine oral capsule 40 mg . . . . 42fluoxetine oral capsule, delayed release(dr/ec) . . . . . . . . . . . 42fluoxetine oral solution . . . . . . . . . . . 42fluoxetine oral tablet 10 mg . . . . . . . 42fluoxetine oral tablet 20 mg . . . . . . . 42fluphenazine decanoate . . . . . . . . . . 42

FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR . . . . . . . . . . . . . . . . 42FETZIMA ORAL CAPSULE, EXT REL 24HR DOSE PACK. . . . . 42FEXOFENADINE ORAL SUSPENSION . . . . . . . . . . . . 87fexofenadine oral tablet 180 mg, 60 mg . . . . . . . . . . . . . . . . . . 87fexofenadine-pseudoephedrine . . . 87fiber (calcium polycarbophil) . . . . . . 69fiber-lax . . . . . . . . . . . . . . . . . . . . . . . . . 69finasteride oral tablet 5 mg . . . . . . . 94FINTEPLA . . . . . . . . . . . . . . . . . . . . . . 32FIRDAPSE . . . . . . . . . . . . . . . . . . . . . . 35FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG . . . . . . . . . . . 25FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG . . . . . . . . . . 25FIRVANQ ORAL RECON SOLN 25 MG/ML . . . . . . . . 18FIRVANQ ORAL RECON SOLN 50 MG/ML . . . . . . . . 18flac otic oil . . . . . . . . . . . . . . . . . . . . . . 61flavoxate . . . . . . . . . . . . . . . . . . . . . . . . 94flecainide . . . . . . . . . . . . . . . . . . . . . . . 45FLEET PEDIATRIC . . . . . . . . . . . . . . 69FLINTSTONES COMPLETE (IRON) ORAL TABLET, CHEWABLE . . . . . . . . . . . . . . . . . . . 104FLINTSTONES/EXTRA C ORAL TABLET,CHEWABLE . . . . . 104FLINTSTONES MULTIVITAMIN . 104FLORIVA . . . . . . . . . . . . . . . . . . . . . . 104FLORIVA (FLUORIDE-VITAMIN D3). . . . . . . 104FLORIVA PLUS . . . . . . . . . . . . . . . . 105FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION . . . . . . . . . . . . 92FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION . . . . . . . . . . 92

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glipizide oral tablet 10 mg . . . . . . . . 62glipizide oral tablet extended release 24hr 2.5 mg . . . . 62glipizide oral tablet extended release 24hr 5 mg . . . . . . 62glipizide oral tablet extended release 24hr 10 mg . . . . 62GLUCAGEN HYPOKIT . . . . . . . . . . 62GLUCAGON EMERGENCY KIT (HUMAN) . . . . . . . . . . . . . . . . . . . 63GLUCAGON (HCL) EMERGENCY KIT . . . . . . . . . . . . . . . 63glycopyrrolate injection . . . . . . . . . . . 68glycopyrrolate oral . . . . . . . . . . . . . . . 68GLYCOPYRROLATE (PF) IN WATER INJECTION . . . . . . . . . . 67glycopyrrolate (pf) in water intravenous syringe 0.4 mg/2 ml (0.2 mg/ml) . . . . . . . . . . 68glydo . . . . . . . . . . . . . . . . . . . . . . . . . . . 53GLYXAMBI . . . . . . . . . . . . . . . . . . . . . . 63granisetron hcl intravenous . . . . . . . 69granisetron hcl oral . . . . . . . . . . . . . . 69granisetron (pf) intravenous solution 1 mg/ml (1 ml) . . . . . . . . . . . 69griseofulvin microsize . . . . . . . . . . . . 12griseofulvin ultramicrosize . . . . . . . . 12guaiatussin ac . . . . . . . . . . . . . . . . . . . 87GUANIDINE . . . . . . . . . . . . . . . . . . . . . 42gummi bear multivitamin . . . . . . . . 105gummy dinos oral tablet, chewable 200 mcg . . . . . . . . . . . . . . 105GVOKE HYPOPEN 1-PACK . . . . . 63GVOKE HYPOPEN 2-PACK . . . . . 63GVOKE PFS 1-PACK SYRINGE. . 63GVOKE PFS 2-PACK SYRINGE. . 63

HHAEGARDA . . . . . . . . . . . . . . . . . . . . 92hailey . . . . . . . . . . . . . . . . . . . . . . . . . . . 79hailey 24 fe . . . . . . . . . . . . . . . . . . . . . 79hailey fe 1.5/30 (28) . . . . . . . . . . . . . 79hailey fe 1/20 (28) . . . . . . . . . . . . . . . 79hair,skin and nails oral tablet . . . . 105hair vitamins . . . . . . . . . . . . . . . . . . . 105HALAVEN . . . . . . . . . . . . . . . . . . . . . . . 25

gavilyte-c . . . . . . . . . . . . . . . . . . . . . . . 69gavilyte-n . . . . . . . . . . . . . . . . . . . . . . . 69GAVRETO . . . . . . . . . . . . . . . . . . . . . . 25GAZYVA . . . . . . . . . . . . . . . . . . . . . . . . 25gemcitabine intravenous recon soln . . . . . . . . . . . . . . . . . . . . . . . 25gemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ml), 2 gram/52.6 ml (38 mg/ml), 200 mg/5.26 ml (38 mg/ml) . . . . . . . 25GEMCITABINE INTRAVENOUS SOLUTION 100 MG/ML . . . . . . . . . . 25gemfibrozil . . . . . . . . . . . . . . . . . . . . . . 51gemmily . . . . . . . . . . . . . . . . . . . . . . . . 79generlac . . . . . . . . . . . . . . . . . . . . . . . . 69gengraf oral capsule 100 mg, 25 mg . . . . . . . . . . . . . . . . . . 25gengraf oral solution . . . . . . . . . . . . . 25GENOTROPIN . . . . . . . . . . . . . . . . . . 72GENOTROPIN MINIQUICK . . . . . . 72gentak ophthalmic (eye) ointment . 82gentamicin injection solution 40 mg/ml . . . . . . . . . . . . . . . . 18GENTAMICIN IN NACL (ISO-OSM) INTRAVENOUS PIGGYBACK 100 MG/50 ML, 120 MG/100 ML . . 18gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 60 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml . . . . . . 18gentamicin ophthalmic (eye) drops 82gentamicin sulfate (ped) (pf) . . . . . . 18gentamicin topical . . . . . . . . . . . . . . . 55GENVOYA . . . . . . . . . . . . . . . . . . . . . . 14gianvi (28) . . . . . . . . . . . . . . . . . . . . . . 79GILENYA ORAL CAPSULE 0.5 MG . . . . . . . . . . . . . . . 35GILOTRIF . . . . . . . . . . . . . . . . . . . . . . . 25glimepiride oral tablet 1 mg . . . . . . . 62glimepiride oral tablet 2 mg . . . . . . . 62glimepiride oral tablet 4 mg . . . . . . . 62glipizide-metformin oral tablet 2.5-250 mg . . . . . . . . . . . . . . . . 62glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg . . . . . 62glipizide oral tablet 5 mg . . . . . . . . . 62

full spectrum b-vitamin c . . . . . . . . 105fulvestrant . . . . . . . . . . . . . . . . . . . . . . . 25fungoid tincture topical tincture . . . 56furosemide injection . . . . . . . . . . . . . 47furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) . . 47furosemide oral tablet . . . . . . . . . . . . 47FUSION . . . . . . . . . . . . . . . . . . . . . . . 105FUSION PLUS . . . . . . . . . . . . . . . . . 105FUZEON SUBCUTANEOUS RECON SOLN . . . . . . . . . . . . . . . . . . 13fyavolv . . . . . . . . . . . . . . . . . . . . . . . . . . 76FYCOMPA ORAL SUSPENSION . 32FYCOMPA ORAL TABLET 2 MG, 4 MG, 6 MG . . . . . . . . . . . . . . 32FYCOMPA ORAL TABLET 10 MG, 12 MG, 8 MG . . . . . . . . . . . . 32

Ggabapentin oral capsule 100 mg, 400 mg . . . . . . . . . . . . . . . . . 32gabapentin oral capsule 300 mg . . 32gabapentin oral solution . . . . . . . . . . 32gabapentin oral tablet 600 mg . . . . 32gabapentin oral tablet 800 mg . . . . 32galantamine oral capsule,ext rel. pellets 24 hr . . . . . . . . . . . . . . . . . . . . . 35galantamine oral solution . . . . . . . . . 35galantamine oral tablet . . . . . . . . . . . 35GAMMAKED INJECTION SOLUTION 1 GRAM/10 ML (10%), 10 GRAM/100 ML (10%), 20 GRAM/200 ML (10%), 5 GRAM/50 ML (10%) . . . . . . . . . . . 73GAMUNEX-C . . . . . . . . . . . . . . . . . . . 73GARDASIL 9 (PF) . . . . . . . . . . . . . . . 73gas relief extra strength . . . . . . . . . . 69gas relief (simethicone) oral capsule 125 mg . . . . . . . . . . . . . 69gas relief (simethicone) oral drops,suspension . . . . . . . . . . . 69gas relief (simethicone) oral tablet,chewable 80 mg . . . . . . . 69GATTEX 30-VIAL . . . . . . . . . . . . . . . . 69GATTEX ONE-VIAL . . . . . . . . . . . . . 69GAUZE PADS 2 X 2 . . . . . . . . . . . . . 62

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HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML . . . . . . . . . . . . . . . . . . . 76HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 40 MG/0.4 ML . . . . . 76HUMIRA PEN . . . . . . . . . . . . . . . . . . . 75HUMIRA PEN CROHNS- UC-HS START . . . . . . . . . . . . . . . . . . 75HUMIRA PEN PSOR- UVEITS-ADOL HS . . . . . . . . . . . . . . . 75HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML . . . . . . . . . . . . . . . . . . . 75HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML . . . . . 75HUMULIN 70/30 U-100 INSULIN . 63HUMULIN 70/30 U-100 KWIKPEN . . . . . . . . . . . . . . . . 63HUMULIN N NPHINSULIN KWIKPEN . . . . . . . . . . . . . 63HUMULIN N NPH U-100 INSULIN . 63HUMULIN R REGULARU-100 INSULN . . . . . . . . . . . . . . . . . . 63HUMULIN R U-500(CONC) INSULIN . . . . . . . . . . . . . . . . 63HUMULIN R U-500(CONC) KWIKPEN . . . . . . . . . . . . . . 63hydralazine . . . . . . . . . . . . . . . . . . . . . 47hydrochlorothiazide . . . . . . . . . . . . . . 47hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml . . . . . . . . 36hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml) . . 36hydrocodone-acetaminophen oral tablet 10-300 mg, 7.5-300 mg . . . . 37hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . . . . . . . . . . . . 37hydrocodone-chlorpheniramine . . . 88hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml . . . . . . . . . 88hydrocodone-homatropine oral tablet . . . . . . . . . . . . . . . . . . . . . . . 88hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg . 37hydrocortisone-acetic acid . . . . . . . 61hydrocortisone-aloe veratopical cream 1% . . . . . . . . . . . . . . . . 57

heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml . . . . . . . . . 50HEPARIN, PORCINE (PF) INJECTION SYRINGE 5,000 UNIT/ML . . . . . . . . . . . . . . . . . . 50HEPATAMINE 8% . . . . . . . . . . . . . . . 99HERCEPTIN HYLECTA . . . . . . . . . . 25HETLIOZ . . . . . . . . . . . . . . . . . . . . . . . 42HIBERIX (PF) . . . . . . . . . . . . . . . . . . . 73hi-cal plus vit d . . . . . . . . . . . . . . . . . . 96HIGH POTENCY IRON ORAL TABLET 27 MG IRON . . . . . . . . . . 105high potency iron oral tablet 134 mg (27 mg iron) . . . . . . . . . . . . 105HISTEX DM . . . . . . . . . . . . . . . . . . . . . 87HISTEX PD . . . . . . . . . . . . . . . . . . . . . 87HISTEX PE . . . . . . . . . . . . . . . . . . . . . 87HISTEX (TRIPROLIDINE) ORAL LIQUID . . . . . . . . . . . . . . . . . . . 87HIZENTRA . . . . . . . . . . . . . . . . . . . . . . 73HUMALOG JUNIOR KWIKPEN U-100 . . . . . . . . . . . . . . . . 63HUMALOG KWIKPEN INSULIN . . 63HUMALOG MIX 50-50 INSULN U-100 . . . . . . . . . . . . . . . . . . 63HUMALOG MIX 50-50 KWIKPEN 63HUMALOG MIX 75-25 KWIKPEN 63HUMALOG MIX 75-25 (U-100)INSULN . . . . . . . . . . . . . . . . . 63HUMALOG U-100 INSULIN . . . . . . 63HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML . . . . . 75HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML- 40 MG/0.4 ML . . . . . . . . . . . . . . . . . . . 75HUMIRA(CF) PEN CROHNS-UC-HS . . . . . . . . . . . . . . . . 75HUMIRA(CF) PEN PSOR-UV-ADOL HS . . . . . . . . . . . . . 75HUMIRA(CF) PEN SUBCUTANEOUS INJECTOR KIT 40 MG/0.4 ML . . . . . . . . . . . . . . . 75HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML . . . . 76

halls defense . . . . . . . . . . . . . . . . . . . 105halobetasol propionate topical cream . . . . . . . . . . . . . . . . . . . . 57halobetasol propionate topical ointment . . . . . . . . . . . . . . . . . 57haloperidol . . . . . . . . . . . . . . . . . . . . . . 42haloperidol decanoate . . . . . . . . . . . 42haloperidol lactate injection . . . . . . 42haloperidol lactate oral . . . . . . . . . . . 42HARD NAILS . . . . . . . . . . . . . . . . . . . 105HARVONI ORAL PELLETS IN PACKET 33.75-150 MG . . . . . . . 14HARVONI ORAL PELLETS IN PACKET 45-200 MG . . . . . . . . . . 14HARVONI ORAL TABLET 45-200 MG . . . . . . . . . . . . . . . . . . . . . . 14HARVONI ORAL TABLET 90-400 MG . . . . . . . . . . . . . . . . . . . . . . 14HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML . . . . . . . . . . . 73HAVRIX (PF) INTRAMUSCULAR SYRINGE . . . . 73heather . . . . . . . . . . . . . . . . . . . . . . . . . 76HEMOCYTE . . . . . . . . . . . . . . . . . . . 105HEMOCYTE-F . . . . . . . . . . . . . . . . . 105HEMOCYTE-PLUS . . . . . . . . . . . . . 105HEMORRHOIDAL CREAM . . . . . . . 69HEMORRHOIDAL (PE-MIN OIL-PETRO) RECTAL OINTMENT 0.25-14-74.9% . . . . . . . 69HEMORRHOIDAL (PHENYLEPH-COCOA) RECTAL SUPPOSITORY 0.25-88.44% . . . . 69HEMORRHOIDAL RELIEF . . . . . . . 53heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml . . . . . . . . . . . . . . . 50heparin (porcine) in 5% dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml), 25,000 unit/250 ml(100 unit/ml), 25,000 unit/500 ml (50 unit/ml) . . . 49heparin (porcine) injection solution . . . . . . . . . . . . . . . . . 50heparin (porcine) in nacl (pf) . . . . . . 49

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INSULIN SYRINGE (DISP) U-100 0.3 ML, 1 ML, 1/2 ML . . . . . . 63INTEGRA . . . . . . . . . . . . . . . . . . . . . . 106INTEGRA F . . . . . . . . . . . . . . . . . . . . 106INTEGRA PLUS . . . . . . . . . . . . . . . . 106INTELENCE ORAL TABLET 25 MG . . . . . . . . . . . . . . . . . 14INTELENCE ORAL TABLET 100 MG, 200 MG . . . . . . . 14INTRALIPID INTRAVENOUS EMULSION 20%, 30% . . . . . . . . . . . 99INTRON A INJECTION RECON SOLN . . . . . . . . . . . . . . . . . . 72INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML . 73INTRON A INJECTION SOLUTION 10 MILLION UNIT/ML 72introvale . . . . . . . . . . . . . . . . . . . . . . . . 79INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 39 MG/0.25 ML . . . . . . . . . . . . . . . . . . 43INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 78 MG/0.5 ML . . . . . . . . . . . . . . . . . . . 43INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML . . . . . . . . . . . . . . . . . 42INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML . . . . . . . . . . . . . . . . . . . . . 43INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 234 MG/1.5 ML . . . . . . . . . . . . . . . . . . 43INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML . . . . . 43INVEGA TRINZA INTRAMUSCULAR SYRINGE 410 MG/1.315 ML . . . . . 43INVEGA TRINZA INTRAMUSCULAR SYRINGE 546 MG/1.75 ML . . . . . . 43INVEGA TRINZA INTRAMUSCULAR SYRINGE 819 MG/2.625 ML . . . . . 43INVELTYS . . . . . . . . . . . . . . . . . . . . . . 85INVIRASE ORAL TABLET . . . . . . . 14INVOKAMET . . . . . . . . . . . . . . . . . . . . 63INVOKAMET XR . . . . . . . . . . . . . . . . 63INVOKANA . . . . . . . . . . . . . . . . . . . . . 63IOSAT . . . . . . . . . . . . . . . . . . . . . . . . . . 62

ICAR-C . . . . . . . . . . . . . . . . . . . . . . . . 106ICAR ORAL SUSPENSION . . . . . 106icatibant . . . . . . . . . . . . . . . . . . . . . . . . 92iclevia . . . . . . . . . . . . . . . . . . . . . . . . . . . 79ICLUSIG ORAL TABLET 15 MG . . 25ICLUSIG ORAL TABLET 45 MG . . 25idarubicin . . . . . . . . . . . . . . . . . . . . . . . 25IDHIFA . . . . . . . . . . . . . . . . . . . . . . . . . . 25iferex 150 . . . . . . . . . . . . . . . . . . . . . . 106iferex 150 forte . . . . . . . . . . . . . . . . . 106ifosfamide . . . . . . . . . . . . . . . . . . . . . . . 25I.L.X. B-12 . . . . . . . . . . . . . . . . . . . . . 105imatinib oral tablet 100 mg . . . . . . . 25imatinib oral tablet 400 mg . . . . . . . 26IMBRUVICA ORAL CAPSULE 70 MG . . . . . . . . . . . . . . . 26IMBRUVICA ORAL CAPSULE 140 MG . . . . . . . . . . . . . . 26IMBRUVICA ORAL TABLET . . . . . . 26IMFINZI . . . . . . . . . . . . . . . . . . . . . . . . . 26imipenem-cilastatin . . . . . . . . . . . . . . 18imipramine hcl . . . . . . . . . . . . . . . . . . . 42imiquimod topical cream in metered-dose pump . . . . . . . . . . . 53imiquimod topical cream in packet . 53IMOVAX RABIES VACCINE (PF) . 73incassia . . . . . . . . . . . . . . . . . . . . . . . . . 77INCRELEX . . . . . . . . . . . . . . . . . . . . . . 59INCRUSE ELLIPTA . . . . . . . . . . . . . . 92indapamide . . . . . . . . . . . . . . . . . . . . . 47INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 74infants gas relief . . . . . . . . . . . . . . . . . 69infant’s ibuprofen . . . . . . . . . . . . . . . . 39INFED . . . . . . . . . . . . . . . . . . . . . . . . . 106INFUGEM . . . . . . . . . . . . . . . . . . . . . . . 26INFUMORPH P/F. . . . . . . . . . . . . . . . 37INLYTA ORAL TABLET 1 MG . . . . . 26INLYTA ORAL TABLET 5 MG . . . . . 26INQOVI . . . . . . . . . . . . . . . . . . . . . . . . . 26INREBIC . . . . . . . . . . . . . . . . . . . . . . . . 26INSECT REPELLENT (PICARIDIN) . . . . . . . . . . . . . . . . . . . . 53INSULIN PEN NEEDLE . . . . . . . . . . 63

hydrocortisone butyrate topical cream . . . . . . . . . . . . . . . . . . . . 57hydrocortisone butyrate topical ointment . . . . . . . . . . . . . . . . . 57hydrocortisone butyrate topical solution . . . . . . . . . . . . . . . . . . 57hydrocortisone butyr-emollient . . . . 57hydrocortisone oral . . . . . . . . . . . . . . 61hydrocortisone rectal . . . . . . . . . . . . 69hydrocortisone topical cream 1%, 2.5% . . . . . . . . . . . . . . . . . . . . . . . 57hydrocortisone topical cream with perineal applicator . . . . . . . . . . 69hydrocortisone topical lotion 2.5% 57hydrocortisone topical ointment 1%, 2.5% . . . . . . . . . . . . . . 57hydrocortisone valerate . . . . . . . . . . 57hydromet . . . . . . . . . . . . . . . . . . . . . . . . 88hydromorphone injection syringe 1 mg/ml, 2 mg/ml . . . . . . . . 37hydromorphone oral liquid . . . . . . . . 37hydromorphone oral tablet . . . . . . . 37hydromorphone (pf) injection solution 2 mg/ml . . . . . . . . 37hydroxychloroquine . . . . . . . . . . . . . . 18hydroxyprogesterone caproate . . . 76hydroxyurea . . . . . . . . . . . . . . . . . . . . . 25hydroxyzine hcl oral tablet . . . . . . . . 88

Iibandronate oral . . . . . . . . . . . . . . . . . 75IBRANCE . . . . . . . . . . . . . . . . . . . . . . . 25ibu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39ibu-200 . . . . . . . . . . . . . . . . . . . . . . . . . 39ibuprofen jr strength . . . . . . . . . . . . . 39ibuprofen oral capsule . . . . . . . . . . . 39ibuprofen oral suspension . . . . . . . . 39ibuprofen oral tablet 200 mg . . . . . . 39ibuprofen oral tablet 400 mg, 600 mg, 800 mg . . . . . . . . . 39ibuprofen-oxycodone . . . . . . . . . . . . 37ICAPS . . . . . . . . . . . . . . . . . . . . . . . . . 105ICAPS AREDS ORAL TABLET,DELAYED RELEASE (DR/EC) . . . . . . . . . . . . . 105ICAPS MV . . . . . . . . . . . . . . . . . . . . . 106

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KIDS MULTIVITAMIN- MINERALS . . . . . . . . . . . . . . . . . . . . 106KINRIX (PF) . . . . . . . . . . . . . . . . . . . . . 74kionex (with sorbitol) . . . . . . . . . . . . . 59KISQALI FEMARA CO-PACK ORAL TABLET 200 MG/DAY (200 MG X 1)-2.5 MG . . . . . . . . . . . . 26KISQALI FEMARA CO-PACK ORAL TABLET 400 MG/DAY (200 MG X 2)-2.5 MG . . . . . . . . . . . . 26KISQALI FEMARA CO-PACK ORAL TABLET 600 MG/DAY (200 MG X 3)-2.5 MG . . . . . . . . . . . . 26KISQALI ORAL TABLET 200 MG/DAY (200 MG X 1) . . . . . . 26KISQALI ORAL TABLET 400 MG/DAY (200 MG X 2) . . . . . . 26KISQALI ORAL TABLET 600 MG/DAY (200 MG X 3) . . . . . . 26klor-con . . . . . . . . . . . . . . . . . . . . . . . . . 96KLOR-CON 8 . . . . . . . . . . . . . . . . . . . 96KLOR-CON 10 . . . . . . . . . . . . . . . . . . 96klor-con m10 . . . . . . . . . . . . . . . . . . . . 96klor-con m20 . . . . . . . . . . . . . . . . . . . . 96kobee . . . . . . . . . . . . . . . . . . . . . . . . . . 106KORLYM . . . . . . . . . . . . . . . . . . . . . . . . 66k-phos-neutral . . . . . . . . . . . . . . . . . . . 96K-PHOS ORIGINAL . . . . . . . . . . . . . 94kurvelo (28) . . . . . . . . . . . . . . . . . . . . . 79KUVAN . . . . . . . . . . . . . . . . . . . . . . . . . 66KYPROLIS . . . . . . . . . . . . . . . . . . . . . . 26

Llabetalol oral . . . . . . . . . . . . . . . . . . . . 47LACRISERT . . . . . . . . . . . . . . . . . . . . 83lactated ringers intravenous . . . . . . 96lactated ringers irrigation . . . . . . . . . 58lactulose oral solution . . . . . . . . . . . . 69lamivudine oral solution . . . . . . . . . . 14lamivudine oral tablet 100 mg, 300 mg . . . . . . . . . . . . . . . . . 14lamivudine oral tablet 150 mg . . . . 14lamivudine-zidovudine . . . . . . . . . . . 14lamotrigine oral tablet . . . . . . . . . . . . 32lamotrigine oral tablet, chewable dispersible . . . . . . . . . . . . 32

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG . . . . . . . . . . . . . . . . . . . 63JANUVIA . . . . . . . . . . . . . . . . . . . . . . . 63JARDIANCE . . . . . . . . . . . . . . . . . . . . 63jasmiel (28) . . . . . . . . . . . . . . . . . . . . . 79jencycla . . . . . . . . . . . . . . . . . . . . . . . . . 77JENTADUETO . . . . . . . . . . . . . . . . . . 63JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG . . . . . . . . . . . . . 63JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 5-1,000 MG . . . . . . . . . . . . . . . 63JEVTANA . . . . . . . . . . . . . . . . . . . . . . . 26jolessa . . . . . . . . . . . . . . . . . . . . . . . . . . 79juleber . . . . . . . . . . . . . . . . . . . . . . . . . . 79JULUCA . . . . . . . . . . . . . . . . . . . . . . . . 14junel 1.5/30 (21) . . . . . . . . . . . . . . . . . 79junel 1/20 (21) . . . . . . . . . . . . . . . . . . . 79junel fe 1.5/30 (28) . . . . . . . . . . . . . . . 79junel fe 1/20 (28) . . . . . . . . . . . . . . . . 79junel fe 24 . . . . . . . . . . . . . . . . . . . . . . . 79

KKABIVEN . . . . . . . . . . . . . . . . . . . . . . . 99KADCYLA . . . . . . . . . . . . . . . . . . . . . . 26kaitlib fe . . . . . . . . . . . . . . . . . . . . . . . . . 79KALETRA ORAL TABLET 100-25 MG . . . . . . . . . . . . . . . . . . . . . . 14KALETRA ORAL TABLET 200-50 MG . . . . . . . . . . . . . . . . . . . . . . 14kalliga . . . . . . . . . . . . . . . . . . . . . . . . . . 79KALYDECO ORAL GRANULES IN PACKET . . . . . . . . . 92KALYDECO ORAL TABLET . . . . . . 93KANJINTI . . . . . . . . . . . . . . . . . . . . . . . 26kariva (28) . . . . . . . . . . . . . . . . . . . . . . 79kelnor 1/35 (28) . . . . . . . . . . . . . . . . . 79kelnor 1-50 (28) . . . . . . . . . . . . . . . . . 79ketoconazole oral . . . . . . . . . . . . . . . . 12ketoconazole topical cream . . . . . . 56ketoconazole topical shampoo . . . 56ketorolac ophthalmic (eye) . . . . . . . 84KEYTRUDA INTRAVENOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 26

IPOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74ipratropium-albuterol . . . . . . . . . . . . . 92ipratropium bromide inhalation . . . 92ipratropium bromide nasal . . . . . . . . 60irbesartan . . . . . . . . . . . . . . . . . . . . . . . 47irbesartan-hydrochlorothiazide . . . 47IRESSA . . . . . . . . . . . . . . . . . . . . . . . . . 26irinotecan . . . . . . . . . . . . . . . . . . . . . . . 26iron,carbonyl-vitamin c . . . . . . . . . . 106iron (ferrous sulfate) . . . . . . . . . . . . 106iron oral tablet 325 mg (65 mg iron) . . . . . . . . . . . . . . . . . . . . 106iron oral tablet extended release 159 mg (45 mg iron) . . . . 106IROSPAN 24/6 . . . . . . . . . . . . . . . . . 106ISENTRESS HD . . . . . . . . . . . . . . . . . 14ISENTRESS ORAL POWDER IN PACKET . . . . . . . . . . . 14ISENTRESS ORAL TABLET . . . . . 14ISENTRESS ORAL TABLET,CHEWABLE 25 MG . . . . . 14ISENTRESS ORAL TABLET,CHEWABLE 100 MG . . . . 14isibloom . . . . . . . . . . . . . . . . . . . . . . . . . 79isoniazid oral . . . . . . . . . . . . . . . . . . . . 18ISOPTO TEARS . . . . . . . . . . . . . . . . . 83isosorbide dinitrate oral tablet . . . . 51isosorbide mononitrate . . . . . . . . . . . 51isotretinoin . . . . . . . . . . . . . . . . . . . . . . 55isradipine . . . . . . . . . . . . . . . . . . . . . . . 47itraconazole oral capsule . . . . . . . . . 12itraconazole oral solution . . . . . . . . . 12ivermectin oral . . . . . . . . . . . . . . . . . . 18IXEMPRA . . . . . . . . . . . . . . . . . . . . . . . 26IXIARO (PF) . . . . . . . . . . . . . . . . . . . . 74

Jjaimiess . . . . . . . . . . . . . . . . . . . . . . . . . 79JAKAFI . . . . . . . . . . . . . . . . . . . . . . . . . 26jantoven . . . . . . . . . . . . . . . . . . . . . . . . 50JANUMET . . . . . . . . . . . . . . . . . . . . . . 63JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG . . . . . . . . 63

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lillow (28) . . . . . . . . . . . . . . . . . . . . . . . 80lincomycin . . . . . . . . . . . . . . . . . . . . . . 18lindane topical shampoo . . . . . . . . . 58linezolid-0.9% sodium chloride . . . 19linezolid in dextrose 5% . . . . . . . . . . 18linezolid oral suspension for reconstitution . . . . . . . . . . . . . . . . . 18linezolid oral tablet . . . . . . . . . . . . . . . 18LINZESS . . . . . . . . . . . . . . . . . . . . . . . . 69liothyronine oral . . . . . . . . . . . . . . . . . 67LIQUID B-12 . . . . . . . . . . . . . . . . . . . 106lisinopril . . . . . . . . . . . . . . . . . . . . . . . . . 47lisinopril-hydrochlorothiazide . . . . . 47lithium carbonate . . . . . . . . . . . . . . . . 43little animals . . . . . . . . . . . . . . . . . . . . 106little animals-iron oral tablet,chewable . . . . . . . . . . . . . . . 106LIVALO . . . . . . . . . . . . . . . . . . . . . . . . . 51l-methyl-b6-b12 . . . . . . . . . . . . . . . . . 106l-methyl-mc . . . . . . . . . . . . . . . . . . . . 106l norgest/e.estradiol-e.estrad . . . . . 79lohist - d . . . . . . . . . . . . . . . . . . . . . . . . 88lohist-dm . . . . . . . . . . . . . . . . . . . . . . . . 88lojaimiess . . . . . . . . . . . . . . . . . . . . . . . 80LOKELMA . . . . . . . . . . . . . . . . . . . . . . 59LONSURF ORAL TABLET 15-6.14 MG . . . . . . . . . . . . . . . . . . . . . 27LONSURF ORAL TABLET 20-8.19 MG . . . . . . . . . . . . . . . . . . . . . 27loperamide oral capsule . . . . . . . . . . 68loperamide oral liquid 1 mg/7.5 ml . 68lopinavir-ritonavir . . . . . . . . . . . . . . . . 14lorata-dine d . . . . . . . . . . . . . . . . . . . . . 88loratadine-d . . . . . . . . . . . . . . . . . . . . . 88loratadine oral solution . . . . . . . . . . . 88loratadine oral tablet . . . . . . . . . . . . . 88lorazepam injection . . . . . . . . . . . . . . 43lorazepam intensol . . . . . . . . . . . . . . 43lorazepam oral concentrate . . . . . . 43lorazepam oral tablet 0.5 mg, 1 mg 43lorazepam oral tablet 2 mg . . . . . . . 43LORBRENA ORAL TABLET 25 MG 27LORBRENA ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 27

levetiracetam . . . . . . . . . . . . . . . . . . . . 32levetiracetam in nacl (iso-os) . . . . . 32levobunolol ophthalmic (eye) drops 0.5% . . . . . . . . . . . . . . . . 83levocarnitine oral solution 100 mg/ml . . . . . . . . . . . . . . 59levocarnitine oral tablet . . . . . . . . . . 59levocarnitine (with sugar) . . . . . . . . . 59levocetirizine oral solution . . . . . . . . 88levocetirizine oral tablet . . . . . . . . . . 88levofloxacin in d5w . . . . . . . . . . . . . . 20levofloxacin intravenous . . . . . . . . . 20levofloxacin oral . . . . . . . . . . . . . . . . . 20levonest (28) . . . . . . . . . . . . . . . . . . . . 80levonorgestrel-ethinyl estrad . . . . . 80levonorgestrel oral tablet 1.5 mg . . 80levonorg-eth estrad triphasic . . . . . 80levora-28 . . . . . . . . . . . . . . . . . . . . . . . . 80LEVO-T . . . . . . . . . . . . . . . . . . . . . . . . . 67levothyroxine oral tablet . . . . . . . . . . 67levoxyl oral tablet 100 mcg, 112 mcg, 175 mcg . . . . . 67LEVOXYL ORAL TABLET 125 MCG, 137 MCG, 150 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG . . . . . . . . . . . . . . . 67LEXIVA ORAL SUSPENSION . . . . 14LIBTAYO . . . . . . . . . . . . . . . . . . . . . . . . 27lice killing . . . . . . . . . . . . . . . . . . . . . . . 57lice treatment topical liquid 1% . . . 57lidocaine hcl injection solution . . . . 53lidocaine hcl laryngotracheal . . . . . 53lidocaine hcl mucous membrane jelly . . . . . . . . . . . . . . . . . . 53lidocaine hcl mucous membrane jelly in applicator . . . . . . 53lidocaine hcl mucous membrane solution 4% (40 mg/ml) . . . . . . . . . . 53lidocaine (pf) injection solution . . . . 53lidocaine (pf) intravenous syringe . 46lidocaine-prilocaine topical cream . 53lidocaine topical adhesive patch,medicated 5% . . . . . . . . . . . . . 53lidocaine topical ointment . . . . . . . . 53lidocaine viscous . . . . . . . . . . . . . . . . 53

lamotrigine oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 32lamotrigine oral tablet extended release 24hr . . . . . . . . . . . 32LANOXIN ORAL TABLET 62.5 MCG (0.0625 MG) . . . . . . . . . . 51lansoprazole oral capsule, delayed release(dr/ec) . . . . . . . . . . . 72LANTUS SOLOSTAR U-100 INSULIN . . . . . . . . . . . . . . . . . . 64LANTUS U-100 INSULIN . . . . . . . . 64lapatinib . . . . . . . . . . . . . . . . . . . . . . . . 26larin 1.5/30 (21) . . . . . . . . . . . . . . . . . 79larin 1/20 (21) . . . . . . . . . . . . . . . . . . . 79larin 24 fe . . . . . . . . . . . . . . . . . . . . . . . 79larin fe 1.5/30 (28) . . . . . . . . . . . . . . . 79larin fe 1/20 (28) . . . . . . . . . . . . . . . . . 79larissia . . . . . . . . . . . . . . . . . . . . . . . . . . 79latanoprost . . . . . . . . . . . . . . . . . . . . . . 84LATUDA ORAL TABLET 80 MG . . 43LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG . . 43layolis fe . . . . . . . . . . . . . . . . . . . . . . . . 79leena 28 . . . . . . . . . . . . . . . . . . . . . . . . 80leflunomide . . . . . . . . . . . . . . . . . . . . . 76LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 4 MG . . 26LENVIMA ORAL CAPSULE 12 MG/DAY (4 MG X 3), 18 MG/ DAY (10 MG X 1-4 MG X2), 24 MG/DAY(10 MG X 2-4 MG X 1) . . . . . . . 26LENVIMA ORAL CAPSULE 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 8 MG/DAY (4 MG X 2) . . . . . . . . . . . 26lessina . . . . . . . . . . . . . . . . . . . . . . . . . . 80letrozole . . . . . . . . . . . . . . . . . . . . . . . . 27leucovorin calcium . . . . . . . . . . . . . . . 21LEUKERAN . . . . . . . . . . . . . . . . . . . . . 27LEUKINE INJECTION RECON SOLN . . . . . . . . . . . . . . . . . . 73leuprolide subcutaneous kit . . . . . . 27levalbuterol hcl . . . . . . . . . . . . . . . . . . 93LEVEMIR FLEXTOUCH U-100 INSULN . . . . . . . . . . . . . . . . . . 64LEVEMIR U-100 INSULIN . . . . . . . 64

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MEDTYCHOLL- B COMPLEX-LIVER . . . . . . . . . . . . 106mefloquine . . . . . . . . . . . . . . . . . . . . . . 19mega multi for women . . . . . . . . . . 106mega multiple/chelated mineral . . 106mega multivitamin for men . . . . . . 106megestrol oral suspension 400 mg/10 ml (10 ml), 400 mg/10 ml (40 mg/ml) . . . . . . . . . 27megestrol oral tablet . . . . . . . . . . . . . 27MEKINIST ORAL TABLET 0.5 MG . 27MEKINIST ORAL TABLET 2 MG . . 27MEKTOVI . . . . . . . . . . . . . . . . . . . . . . . 27melodetta 24 fe . . . . . . . . . . . . . . . . . . 80meloxicam oral tablet 7.5 mg . . . . . 39meloxicam oral tablet 15 mg . . . . . . 39melphalan . . . . . . . . . . . . . . . . . . . . . . . 27melphalan hcl . . . . . . . . . . . . . . . . . . . 27memantine oral capsule, sprinkle,er 24hr . . . . . . . . . . . . . . . . . . 35memantine oral solution . . . . . . . . . . 35memantine oral tablet 5 mg . . . . . . 35memantine oral tablet 10 mg . . . . . 35MEMANTINE ORAL TABLETS,DOSE PACK . . . . . . . . . . 35MENACTRA (PF) INTRAMUSCULAR SOLUTION . . 74M-END DMX . . . . . . . . . . . . . . . . . . . . 88MENEST . . . . . . . . . . . . . . . . . . . . . . . . 77MENOSTAR . . . . . . . . . . . . . . . . . . . . 77MENQUADFI (PF) . . . . . . . . . . . . . . . 74men’s one daily oral tablet . . . . . 106MENVEO A-C-Y-W-135-DIP (PF) . 74MEPHYTON . . . . . . . . . . . . . . . . . . . . 50mercaptopurine . . . . . . . . . . . . . . . . . . 27MERIBIN . . . . . . . . . . . . . . . . . . . . . . . 106meropenem . . . . . . . . . . . . . . . . . . . . . 19MEROPENEM- 0.9% SODIUM CHLORIDE . . . . . . . 19mesalamine oral capsule, extended release 24hr . . . . . . . . . . . 70mesalamine oral tablet,delayed release (dr/ec) 1.2 gram . . . . . . . . . 70mesalamine rectal enema . . . . . . . . 70mesalamine with cleansing wipe . . 70

lyza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

MMAGNESIUM GLUCONATE ORAL TABLET 30 MG (550 MG) . 96MAGNESIUM L-LACTATE . . . . . . . 69MAGNESIUM ORAL TABLET 30 MG . . . . . . . . . . . . . . . . . 96magnesium oral tablet 250 mg . . . 69MAGNESIUM (OXIDE/AA CHELATE) . . . . . . . . . . . 96magnesium oxide oral capsule 500 mg . . . . . . . . . . . . . . . . . 96magnesium oxide oral tablet 400 mg (241.3 mg magnesium) . . . 70magnesium oxide oral tablet 420 mg . . . . . . . . . . . . . . . . . . . 96MAGNESIUM OXIDE ORAL TABLET 500 MG . . . . . . . . . . 96MAGNESIUM SULFATE IN D5W INTRAVENOUS PIGGYBACK 1 GRAM/100 ML . . . . . . . . . . . . . . . . 96magnesium sulfate injection . . . . . . 96magnesium sulfate in water . . . . . . 96MAGTAB . . . . . . . . . . . . . . . . . . . . . . . . 70malathion . . . . . . . . . . . . . . . . . . . . . . . 58mapap (acetaminophen) oral capsule . . . . . . . . . . . . . . . . . . . . . 39mapap (acetaminophen) oral liquid 500 mg/15 ml . . . . . . . . . . 39mapap (acetaminophen) oral tablet 39mapap arthritis pain . . . . . . . . . . . . . . 39mapap cold formula . . . . . . . . . . . . . . 88mapap extra strength . . . . . . . . . . . . 39maprotiline . . . . . . . . . . . . . . . . . . . . . . 43marlissa (28) . . . . . . . . . . . . . . . . . . . . 80MARPLAN . . . . . . . . . . . . . . . . . . . . . . 43MARQIBO . . . . . . . . . . . . . . . . . . . . . . 27MATULANE . . . . . . . . . . . . . . . . . . . . . 27matzim la . . . . . . . . . . . . . . . . . . . . . . . 48MAVYRET . . . . . . . . . . . . . . . . . . . . . . 14meclizine oral tablet 12.5 mg, 25 mg . . . . . . . . . . . . . . . . . . 70MEDI-PADS . . . . . . . . . . . . . . . . . . . . . 53MEDROL ORAL TABLET 2 MG . . . 61medroxyprogesterone . . . . . . . . . . . . 77

LORTUSS LQ . . . . . . . . . . . . . . . . . . . 88loryna (28) . . . . . . . . . . . . . . . . . . . . . . 80losartan . . . . . . . . . . . . . . . . . . . . . . . . . 47losartan-hydrochlorothiazide oral tablet 50-12.5 mg . . . . . . . . . . . . . . . . 48losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg . . . 47LOTEMAX . . . . . . . . . . . . . . . . . . . . . . 85LOTEMAX SM . . . . . . . . . . . . . . . . . . 85lovastatin oral tablet 10 mg . . . . . . . 51lovastatin oral tablet 20 mg, 40 mg 51low-ogestrel (28) . . . . . . . . . . . . . . . . 80loxapine succinate . . . . . . . . . . . . . . . 43lo-zumandimine (28) . . . . . . . . . . . . . 80lubricant eye drops ophthalmic (eye) dropperette . . . . . 83LUBRICANT EYE (PG-PEG 400) . 83lubricating plus . . . . . . . . . . . . . . . . . . 83lubrifresh pm . . . . . . . . . . . . . . . . . . . . 83LUMIGAN OPHTHALMIC (EYE) DROPS 0.01% . . . . . . . . . . . . 84LUMIZYME . . . . . . . . . . . . . . . . . . . . . 66LUMOXITI . . . . . . . . . . . . . . . . . . . . . . 27LUPRON DEPOT . . . . . . . . . . . . . . . 27LUPRON DEPOT (3 MONTH) . . . . 27LUPRON DEPOT (4 MONTH) . . . . 27LUPRON DEPOT (6 MONTH) . . . . 27LUPRON DEPOT-PED . . . . . . . . . . 27LUPRON DEPOT-PED (3 MONTH) . . . . . . . . . . . . . . . . . . . . . 27lutera (28) . . . . . . . . . . . . . . . . . . . . . . . 80LYNPARZA ORAL TABLET . . . . . . . 27LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 165 MG, 82.5 MG . . . . . . . . . 32LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 330 MG . . . . . . . . . . . . . . . . . . 33lysiplex plus oral liquid . . . . . . . . . . 106LYSODREN . . . . . . . . . . . . . . . . . . . . . 27LYUMJEV KWIKPEN U-100 INSULIN . . . . . . . . . . . . . . . . . . 64LYUMJEV KWIKPEN U-200 INSULIN . . . . . . . . . . . . . . . . . . 64LYUMJEV U-100 INSULIN . . . . . . . 64

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miglustat . . . . . . . . . . . . . . . . . . . . . . . . 66migraine relief . . . . . . . . . . . . . . . . . . . 39mili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80milk of magnesia . . . . . . . . . . . . . . . . 70minitran . . . . . . . . . . . . . . . . . . . . . . . . . 51minocycline oral capsule . . . . . . . . . 21minocycline oral tablet . . . . . . . . . . . 21minoxidil oral . . . . . . . . . . . . . . . . . . . . 48mintox maximum strength . . . . . . . . 70mintox plus . . . . . . . . . . . . . . . . . . . . . . 70mirtazapine oral tablet . . . . . . . . . . . 43mirtazapine oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 43misoprostol . . . . . . . . . . . . . . . . . . . . . 72MITIGARE . . . . . . . . . . . . . . . . . . . . . . 74mitomycin intravenous . . . . . . . . . . . 27mitoxantrone . . . . . . . . . . . . . . . . . . . . 27M-M-R II (PF) . . . . . . . . . . . . . . . . . . . 74moexipril . . . . . . . . . . . . . . . . . . . . . . . . 48MOISTUREL THERAPEUTIC . . . . 53molindone . . . . . . . . . . . . . . . . . . . . . . . 43mometasone nasal . . . . . . . . . . . . . . 93mometasone topical . . . . . . . . . . . . . 57mondoxyne nl oral capsule 100 mg, 75 mg . . . . . . . . . . . . . . . . . . 21MONJUVI . . . . . . . . . . . . . . . . . . . . . . . 27MONOCAL . . . . . . . . . . . . . . . . . . . . . . 96mono-linyah . . . . . . . . . . . . . . . . . . . . . 80montelukast . . . . . . . . . . . . . . . . . . . . . 93MONUROL . . . . . . . . . . . . . . . . . . . . . 21morgidox oral capsule 100 mg . . . . 21morphine concentrate oral solution 37morphine injection solution 8 mg/ml . . . . . . . . . . . . . . . . . . . . . . . . . 37MORPHINE INJECTION SOLUTION 10 MG/ML, 2 MG/ML, 4 MG/ML, 5 MG/ML . . . 37MORPHINE INJECTION SYRINGE 2 MG/ML . . . . . . . . . . . . . 37morphine injection syringe 4 mg/ml, 5 mg/ml . . . . . . . . . . . . . . . . 37MORPHINE INTRAVENOUS SOLUTION 4 MG/ML . . . . . . . . . . . . 37morphine intravenous solution 10 mg/ml . . . . . . . . . . . . . . . . 37

methylprednisolone . . . . . . . . . . . . . . 61methylprednisolone acetate . . . . . . 61methylprednisolone sodium succ injection recon soln 125 mg, 40 mg . . . . . . . . 61methylprednisolone sodium succ intravenous . . . . . . . . . 61metoclopramide hcl injection solution . . . . . . . . . . . . . . . . . 70metoclopramide hcl oral solution . . 70metoclopramide hcl oral tablet . . . . 70metolazone . . . . . . . . . . . . . . . . . . . . . 48metoprolol succinate . . . . . . . . . . . . . 48metoprolol ta-hydrochlorothiaz . . . 48metoprolol tartrate oral . . . . . . . . . . . 48metro i.v. . . . . . . . . . . . . . . . . . . . . . . . . 19metronidazole in nacl (iso-os) . . . . 19metronidazole oral tablet . . . . . . . . . 19metronidazole topical . . . . . . . . . . . . 55metronidazole vaginal . . . . . . . . . . . . 77metyrosine . . . . . . . . . . . . . . . . . . . . . . 48mexiletine . . . . . . . . . . . . . . . . . . . . . . . 46MG-PLUS-PROTEIN . . . . . . . . . . . . 96MIACALCIN INJECTION . . . . . . . . . 66mi-acid gas relief(simethicon) . . . . 70mi-acid oral suspension 200-200-20 mg/5 ml . . . . . . . . . . . . . 70mibelas 24 fe . . . . . . . . . . . . . . . . . . . . 80micafungin . . . . . . . . . . . . . . . . . . . . . . 12miconazole-3 vaginal kit . . . . . . . . . 77miconazole 7 . . . . . . . . . . . . . . . . . . . . 77miconazole nitrate topical cream . . 56miconazole nitrate vaginal cream . 77MICONAZOLE NITRATE VAGINAL KIT 1,200-2 MG-% . . . . . 77microgestin 1.5/30 (21) . . . . . . . . . . 80microgestin 1/20 (21) . . . . . . . . . . . . 80microgestin fe 1.5/30 (28) . . . . . . . . 80microgestin fe 1/20 (28) . . . . . . . . . . 80midodrine . . . . . . . . . . . . . . . . . . . . . . . 59MIGERGOT . . . . . . . . . . . . . . . . . . . . . 34miglitol oral tablet 25 mg . . . . . . . . . 64miglitol oral tablet 50 mg . . . . . . . . . 64miglitol oral tablet 100 mg . . . . . . . . 64

mesna . . . . . . . . . . . . . . . . . . . . . . . . . . 21MESNEX ORAL . . . . . . . . . . . . . . . . . 21metafolbic . . . . . . . . . . . . . . . . . . . . . . 106metaproterenol oral syrup . . . . . . . . 93metformin oral solution . . . . . . . . . . . 64metformin oral tablet 1,000 mg . . . 64metformin oral tablet 500 mg . . . . . 64metformin oral tablet 850 mg . . . . . 64metformin oral tablet extended release 24hr 1,000 mg (generic for Fortamet) . . . . . . . . . . . . 64metformin oral tablet extended release 24 hr 500 mg (generic for Fortamet) . . . . . . . . . . . . 64metformin oral tablet extended release 24 hr 500 mg (generic for Glucophage XR) . . . . . 64metformin oral tablet extended release 24 hr 750 mg (generic for Glucophage XR) . . . . . 64methadone injection solution . . . . . 37methadone intensol . . . . . . . . . . . . . . 37methadone oral concentrate . . . . . . 37methadone oral solution 5 mg/5 ml .37methadone oral solution 10 mg/5 ml . . . . . . . . . . . . . . 37methadone oral tablet 5 mg . . . . . . 37methadone oral tablet 10 mg . . . . . 37methazolamide . . . . . . . . . . . . . . . . . . 84methenamine hippurate . . . . . . . . . . 21methimazole oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 62methocarbamol oral . . . . . . . . . . . . . 36methotrexate sodium injection . . . . 27methotrexate sodium oral . . . . . . . . 27methotrexate sodium (pf) . . . . . . . . . 27methoxsalen . . . . . . . . . . . . . . . . . . . . 53methyldopa . . . . . . . . . . . . . . . . . . . . . 48methylphenidate hcl oral tablet . . . 43methylphenidate hcl oral tablet extended release . . . . . . . . . . . . . . . . 43methylphenidate hcl oral tablet extended release 24hr 18 mg, 18 mg (bx rating), 27 mg, 27 mg (bx rating), 36 mg, 36 mg (bx rating), 54 mg, 54 mg (bx rating) . . . . . . . . . 43

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MVW COMPLETE FORMUL PEDIATRIC . . . . . . . . . . . 107mycophenolate mofetil (hcl) . . . . . . 27mycophenolate mofetil oral capsule . . . . . . . . . . . . . . . . . . . . . 27mycophenolate mofetil oral suspension for reconstitution . . . . . 27mycophenolate mofetil oral tablet . 28mycophenolate sodium . . . . . . . . . . 28myferon 150 . . . . . . . . . . . . . . . . . . . . 107myferon 150 forte . . . . . . . . . . . . . . . 107MYLOTARG . . . . . . . . . . . . . . . . . . . . . 28mynephrocaps . . . . . . . . . . . . . . . . . 107mynephron . . . . . . . . . . . . . . . . . . . . . 107myorisan . . . . . . . . . . . . . . . . . . . . . . . . 55MYRBETRIQ . . . . . . . . . . . . . . . . . . . . 94my-vitalife . . . . . . . . . . . . . . . . . . . . . . 107my way . . . . . . . . . . . . . . . . . . . . . . . . . 80

Nnabumetone . . . . . . . . . . . . . . . . . . . . . 39nadolol . . . . . . . . . . . . . . . . . . . . . . . . . . 48nadolol-bendroflumethiazide oral tablet 80-5 mg . . . . . . . . . . . . . . . 48nafcillin . . . . . . . . . . . . . . . . . . . . . . . . . 20nafcillin in dextrose iso-osm . . . . . . 20naftifine topical cream . . . . . . . . . . . . 56NAFTIN TOPICAL GEL . . . . . . . . . . 56NAGLAZYME . . . . . . . . . . . . . . . . . . . 66nalbuphine . . . . . . . . . . . . . . . . . . . . . . 39naloxone injection solution . . . . . . . 39naloxone injection syringe 1 mg/ml . . . . . . . . . . . . . . . . . 39naltrexone . . . . . . . . . . . . . . . . . . . . . . 39NAMZARIC . . . . . . . . . . . . . . . . . . . . . 35naproxen . . . . . . . . . . . . . . . . . . . . . . . . 39naproxen sodium oral tablet 220 mg . . . . . . . . . . . . . . . 39naproxen sodium oral tablet 275 mg, 550 mg . . . . . . . 39naratriptan . . . . . . . . . . . . . . . . . . . . . . 34NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION . . . 39NASAL ALLERGY . . . . . . . . . . . . . . . 93nasal decongestant (oxymetazl) . . 60

MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG . . . . . . . . . . . . . . . . . 88mucinex oral tablet extended release 12hr 600 mg . . . . . . . . . . . . . 89MUCUS-CHEST CONGESTION. . 89mucus dm . . . . . . . . . . . . . . . . . . . . . . . 89mucus dm max er . . . . . . . . . . . . . . . 89mucus relief . . . . . . . . . . . . . . . . . . . . . 89mucus relief dm cough . . . . . . . . . . . 89mucus relief d (pseudoephed) oral tablet extended release 12 hr 60-600 mg . . . . . . . . . . . . . . . . . 89MUCUS RELIEF ER ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG . . . . . . 89mucus relief er oral tablet extended release 12hr 600 mg . . . 89mucus relief sinus . . . . . . . . . . . . . . . 89multi complete with iron . . . . . . . . . 106multi-day with iron . . . . . . . . . . . . . . 106multi-delyn with iron . . . . . . . . . . . . 106multiple vitamin-minerals . . . . . . . . 106multiple vitamins . . . . . . . . . . . . . . . . 106multi-vitamin hp/minerals . . . . . . . . 106multivitamin oral tablet . . . . . . . . . . 107multivitamins with fluoride . . . . . . . 107multi-vitamin with fluoride oral drops . . . . . . . . . . . . . . . . . . . . . . 107multivitamin with iron . . . . . . . . . . . 107multivitamin with minerals . . . . . . . 107multivitamin women 50 plus . . . . . 107MULTI-VITE . . . . . . . . . . . . . . . . . . . . 107multi-vit with fluoride-iron . . . . . . . . 106mupirocin . . . . . . . . . . . . . . . . . . . . . . . 55mupirocin calcium . . . . . . . . . . . . . . . 55MURO 128 OPHTHALMIC (EYE) DROPS . . . . . . . . . . . . . . . . . . 83MVASI . . . . . . . . . . . . . . . . . . . . . . . . . . 27MVW COMPLETE FORMULATION D3000 . . . . . . . . . 107MVW COMPLETE FORMULATION D5000 . . . . . . . . . 107MVW COMPLETE FORMUL MULTIVIT . . . . . . . . . . . . 107

morphine intravenous syringe 2 mg/ml, 4 mg/ml . . . . . . . . 37MORPHINE INTRAVENOUS SYRINGE 8 MG/ML . . . . . . . . . . . . . 37MORPHINE INTRAVENOUS SYRINGE 10 MG/ML . . . . . . . . . . . . 37morphine oral solution . . . . . . . . . . . 37MORPHINE ORAL TABLET . . . . . . 37morphine oral tablet extended release . . . . . . . . . . . . . . . . 37morphine (pf) injection solution 0.5 mg/ml, 1 mg/ml . . . . . . 37motion sickness relief . . . . . . . . . . . . 70moxifloxacin ophthalmic (eye) . . . . 82moxifloxacin oral . . . . . . . . . . . . . . . . 20MOXIFLOXACIN-SOD. ACE,SUL-WATER . . . . . . . . . . . . . . . 21moxifloxacin-sod.chloride(iso) . . . . 21MOZOBIL . . . . . . . . . . . . . . . . . . . . . . . 73m-pap . . . . . . . . . . . . . . . . . . . . . . . . . . 39MTX SUPPORT . . . . . . . . . . . . . . . . 106MUCINEX COLD, FLU,SORE THROAT . . . . . . . . . . . . 88mucinex d . . . . . . . . . . . . . . . . . . . . . . . 88mucinex d maximum strength . . . . 88mucinex dm oral tablet extended release 12 hr 30-600 mg . . . . . . . . . 88MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR 60-1,200 MG . . . . . . . . . . . . . 88MUCINEX FAST-MAX COLD-SINUS . . . . . . . . . . . . . . . . . . . 88MUCINEX FAST-MAX CONGEST-COUGH ORAL TABLET . . . . . . . . . . 88MUCINEX FAST-MAX DAY-NITE CONG ORAL TABLETS, SEQUENTIAL 5 MG (DY)/ 25 MG -5 MG-325MG(NT) . . . . . . . 88mucinex fast-max dm max . . . . . . . 88MUCINEX FAST-MAX NITE COLD-FLU ORAL LIQUID . . . . . . . . 88MUCINEX FAST-MAX SEVERE COLD ORAL LIQUID . . . 88MUCINEX FST-MX DY-NT COLD(DPH) ORAL LIQUID, SEQUENTIAL . . . . . . . . . . . . . . . . . . . 88

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nitrofurantoin monohyd/m-cryst . . . 21nitroglycerin intravenous . . . . . . . . . 52nitroglycerin sublingual . . . . . . . . . . . 52nitroglycerin transdermal patch 24 hour . . . . . . . . . . . . . . . . . . . 52nitroglycerin translingual spray,non-aerosol . . . . . . . . . . . . . . . 52NIVA-FOL . . . . . . . . . . . . . . . . . . . . . . 107NIVESTYM . . . . . . . . . . . . . . . . . . . . . 73nizatidine oral capsule . . . . . . . . . . . 72nohist-dm . . . . . . . . . . . . . . . . . . . . . . . 89nohist-lq . . . . . . . . . . . . . . . . . . . . . . . . 89non-aspirin pm . . . . . . . . . . . . . . . . . . 39nora-be . . . . . . . . . . . . . . . . . . . . . . . . . 77noreth-ethinyl estradiol-iron . . . . . . 80norethindrone acetate . . . . . . . . . . . . 77norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg . . . . . . . 77norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg . . . . . . . . . . . . . . . . . . 80norethindrone (contraceptive) . . . . 77norethindrone-e.estradiol-iron oral capsule . . . . . . . . . . . . . . . . . . . . . 80norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1.5 mg-30 mcg (21)/75 mg (7) . . . . 80norethindrone-e.estradiol-iron oral tablet,chewable . . . . . . . . . . . . . 80norgestimate-ethinyl estradiol . . . . 80NORMOSOL-M IN 5% DEXTROSE . . . . . . . . . . . . . . 99NORMOSOL-R . . . . . . . . . . . . . . . . . . 96NORMOSOL-R PH 7.4 . . . . . . . . . . 99NORTHERA ORAL CAPSULE 100 MG . . . . . . . . . . . . . . 59NORTHERA ORAL CAPSULE 200 MG, 300 MG . . . . . 59nortrel 0.5/35 (28) . . . . . . . . . . . . . . . 80nortrel 1/35 (21) . . . . . . . . . . . . . . . . . 80nortrel 1/35 (28) . . . . . . . . . . . . . . . . . 80nortrel 7/7/7 (28) . . . . . . . . . . . . . . . . . 81nortriptyline . . . . . . . . . . . . . . . . . . . . . 43NORVIR ORAL POWDER IN PACKET . . . . . . . . . . . . . . . . . . . . . 14NORVIR ORAL SOLUTION . . . . . . 14

niacin oral capsule, extended release 250 mg . . . . . . . . 51niacin oral tablet 100 mg, 50 mg, 500 mg . . . . . . . . . . 51niacin oral tablet extended release 24 hr . . . . . . . . . . . . . . . . . . . . 51niacin oral tablet extended release 250 mg, 500 mg . . . . . . . . . 51niacor . . . . . . . . . . . . . . . . . . . . . . . . . . . 51nicardipine intravenous solution . . 48nicardipine oral . . . . . . . . . . . . . . . . . . 48nicotine (polacrilex) buccal gum . . 60NICOTINE (POLACRILEX) BUCCAL LOZENGE 2 MG . . . . . . . 60nicotine (polacrilex) buccal lozenge 4 mg . . . . . . . . . . . . . . . . . . . . 60nicotine (polacrilex) buccal mini lozenge 2 mg . . . . . . . . . . . . . . . 60NICOTINE (POLACRILEX) BUCCAL MINI LOZENGE 4 MG . . 60nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr . . . . . . . . . . 60nicotine transdermal patch, td daily, sequential . . . . . . . . . . . . . . . 60NICOTROL . . . . . . . . . . . . . . . . . . . . . 60NICOTROL NS . . . . . . . . . . . . . . . . . . 60nifedipine oral tablet extended release . . . . . . . . . . . . . . . . 48nifedipine oral tablet extended release 24hr . . . . . . . . . . . 48NIGHTTIME COLD-FLU . . . . . . . . . 89NIGHTTIME COLD-FLU RELIEF . 89nighttime sleep aid (diphen) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 89nikki (28) . . . . . . . . . . . . . . . . . . . . . . . . 80nilutamide . . . . . . . . . . . . . . . . . . . . . . . 28nimodipine . . . . . . . . . . . . . . . . . . . . . . 48NINJACOF . . . . . . . . . . . . . . . . . . . . . . 89NINJACOF-XG . . . . . . . . . . . . . . . . . . 89NINLARO . . . . . . . . . . . . . . . . . . . . . . . 28NIPENT . . . . . . . . . . . . . . . . . . . . . . . . . 28nisoldipine . . . . . . . . . . . . . . . . . . . . . . 48nitisinone . . . . . . . . . . . . . . . . . . . . . . . 59nitrofurantoin . . . . . . . . . . . . . . . . . . . . 21nitrofurantoin macrocrystal . . . . . . . 21

nasal decongestant (pseudoeph) oral tablet . . . . . . . . . . 89nasal spray (oxymetazoline) . . . . . . 60NASOPEN PE . . . . . . . . . . . . . . . . . . 89NATACYN . . . . . . . . . . . . . . . . . . . . . . . 82nateglinide oral tablet 60 mg . . . . . 64nateglinide oral tablet 120 mg . . . . 64NATPARA . . . . . . . . . . . . . . . . . . . . . . . 66NATRAPEL . . . . . . . . . . . . . . . . . . . . . 53natural fiber laxative (sugar) oral powder 3.4 gram/7 gram . . . . . 70NAYZILAM . . . . . . . . . . . . . . . . . . . . . . 33necon 0.5/35 (28) . . . . . . . . . . . . . . . . 80NEEDLES, INSULIN DISP.,SAFETY . . . . . . . . . . . . . . . . . . 64nefazodone . . . . . . . . . . . . . . . . . . . . . 43neomycin . . . . . . . . . . . . . . . . . . . . . . . 19neomycin-bacitracin-poly-hc . . . . . . 84neomycin-bacitracin-polymyxin . . . 82neomycin-polymyxin b-dexameth . 84neomycin-polymyxin b gu . . . . . . . . 58neomycin-polymyxin-gramicidin . . 82neomycin-polymyxin-hc ophthalmic (eye) . . . . . . . . . . . . . . . . . 84neomycin-polymyxin-hc otic (ear) . 61neo-polycin . . . . . . . . . . . . . . . . . . . . . 82neo-polycin hc . . . . . . . . . . . . . . . . . . . 84nephplex rx . . . . . . . . . . . . . . . . . . . . 107NEPHRAMINE 5.4% . . . . . . . . . . . . . 99nephronex . . . . . . . . . . . . . . . . . . . . . 107NEPHRON FA . . . . . . . . . . . . . . . . . 107NEPHRO-VITE . . . . . . . . . . . . . . . . . 107nephro-vite rx . . . . . . . . . . . . . . . . . . 107NERLYNX . . . . . . . . . . . . . . . . . . . . . . 28NEUPRO . . . . . . . . . . . . . . . . . . . . . . . 34NEURIN-SL . . . . . . . . . . . . . . . . . . . . 107nevirapine oral suspension . . . . . . . 14nevirapine oral tablet . . . . . . . . . . . . 14nevirapine oral tablet extended release 24 hr 100 mg . . . . . . . . . . . . 14nevirapine oral tablet extended release 24 hr 400 mg . . . . . . . . . . . . 14new day . . . . . . . . . . . . . . . . . . . . . . . . 80NEXAVAR . . . . . . . . . . . . . . . . . . . . . . . 28

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one daily maximum . . . . . . . . . . . . . 107one daily men’s 50 plus memory . 107one daily multivitamin oral tablet 107one daily multivit-iron(folic) . . . . . . 107one daily plus iron oral tablet 18-400 mg-mcg . . . . . . . . . . . . . . . . 108one daily plus minerals . . . . . . . . . . 108ONE DAILY WOMEN 50 PLUS . . 108one daily womens 50 plus . . . . . . . 108one daily women’s oral tablet 27-0.4 mg . . . . . . . . . . . . 108ONIVYDE . . . . . . . . . . . . . . . . . . . . . . . 28opcicon one-step . . . . . . . . . . . . . . . . 81OPDIVO . . . . . . . . . . . . . . . . . . . . . . . . 28OPSUMIT . . . . . . . . . . . . . . . . . . . . . . . 93oralone . . . . . . . . . . . . . . . . . . . . . . . . . 60oralyte . . . . . . . . . . . . . . . . . . . . . . . . . . 96ORAZINC . . . . . . . . . . . . . . . . . . . . . . . 96ORBACTIV . . . . . . . . . . . . . . . . . . . . . 19ORENCIA CLICKJECT . . . . . . . . . . 76ORENCIA SUBCUTANEOUS SYRINGE 50 MG/0.4 ML . . . . . . . . . 76ORENCIA SUBCUTANEOUS SYRINGE 87.5 MG/0.7 ML . . . . . . . 76ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML . . . . . . . . . . . 76ORKAMBI ORAL GRANULES IN PACKET . . . . . . . . . . . . . . . . . . . . . 93ORKAMBI ORAL TABLET . . . . . . . . 93orsythia . . . . . . . . . . . . . . . . . . . . . . . . . 81OS-CAL 500 + D3 . . . . . . . . . . . . . . . 96oseltamivir . . . . . . . . . . . . . . . . . . . . . . 14oxacillin injection . . . . . . . . . . . . . . . . 20oxaliplatin . . . . . . . . . . . . . . . . . . . . . . . 28oxandrolone oral tablet 2.5 mg . . . 66oxandrolone oral tablet 10 mg . . . . 66oxaprozin . . . . . . . . . . . . . . . . . . . . . . . 39oxazepam . . . . . . . . . . . . . . . . . . . . . . . 44oxcarbazepine . . . . . . . . . . . . . . . . . . 33OXERVATE . . . . . . . . . . . . . . . . . . . . . 83oxybutynin chloride oral syrup . . . . 94oxybutynin chloride oral tablet . . . . 94oxybutynin chloride oral tablet extended release 24hr . . . . . . . . . . . 94

ofloxacin otic (ear) . . . . . . . . . . . . . . . 61OGIVRI . . . . . . . . . . . . . . . . . . . . . . . . . 28olanzapine-fluoxetine . . . . . . . . . . . . 44olanzapine intramuscular . . . . . . . . . 44olanzapine oral tablet . . . . . . . . . . . . 44olanzapine oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 44olmesartan . . . . . . . . . . . . . . . . . . . . . . 48olmesartan-hydrochlorothiazide . . 48olopatadine ophthalmic (eye) . . . . . 83omega-3 acid ethyl esters . . . . . . . . 51omeprazole magnesium oral capsule,delayed release(dr/ec) . . . 72OMEPRAZOLE MAGNESIUM ORAL TABLET,DELAYED RELEASE (DR/EC) . . . . . . . . . . . . . . 72omeprazole oral capsule, delayed release(dr/ec) . . . . . . . . . . . 72omeprazole oral tablet, delayed release (dr/ec) . . . . . . . . . . 72omnicap . . . . . . . . . . . . . . . . . . . . . . . 107OMNIPOD 5 PACK . . . . . . . . . . . . . . 64OMNIPOD DASH 5 PACK. . . . . . . . 64OMNIPOD STARTER KIT . . . . . . . . 64ONCASPAR . . . . . . . . . . . . . . . . . . . . . 28ONCOVITE . . . . . . . . . . . . . . . . . . . . 107ondansetron . . . . . . . . . . . . . . . . . . . . . 70ondansetron hcl intravenous . . . . . 70ondansetron hcl oral solution . . . . . 70ondansetron hcl oral tablet . . . . . . . 70ondansetron hcl (pf) . . . . . . . . . . . . . 70one-a-day essential . . . . . . . . . . . . . 108ONE-A-DAY MEN’S 50PLUS(GINKGO) . . . . . . . . . . . . . 108one-a-day teen advantage . . . . . . 108ONE-A-DAY WOMENS FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA . . . . 108one daily calcium/iron . . . . . . . . . . . 107one daily complete . . . . . . . . . . . . . . 107one daily energy oral tablet . . . . . . 107one daily essential oral tablet, 0.4 mg . . . . . . . . . . . . . . 107one daily for men 50+ advanced . 107one daily for women . . . . . . . . . . . . 107

NOVOFINE PEN NEEDLE . . . . . . . 64NOVOTWIST PEN NEEDLE . . . . . 64NUBEQA . . . . . . . . . . . . . . . . . . . . . . . 28NUEDEXTA . . . . . . . . . . . . . . . . . . . . . 35NU-IRON . . . . . . . . . . . . . . . . . . . . . . 107NULOJIX . . . . . . . . . . . . . . . . . . . . . . . 28NU-MAG . . . . . . . . . . . . . . . . . . . . . . . . 96NUPLAZID ORAL CAPSULE . . . . . 43NUPLAZID ORAL TABLET 10 MG . 44NUTRILIPID . . . . . . . . . . . . . . . . . . . . . 99NUTRIVIT . . . . . . . . . . . . . . . . . . . . . . 107NUZYRA INTRAVENOUS . . . . . . . . 21NUZYRA ORAL . . . . . . . . . . . . . . . . . 21nyamyc . . . . . . . . . . . . . . . . . . . . . . . . . 56nylia 7/7/7 (28) . . . . . . . . . . . . . . . . . . 81nymyo . . . . . . . . . . . . . . . . . . . . . . . . . . 81nystatin oral suspension . . . . . . . . . 12nystatin oral tablet . . . . . . . . . . . . . . . 12nystatin topical cream . . . . . . . . . . . . 56nystatin topical ointment . . . . . . . . . 56nystatin topical powder . . . . . . . . . . . 56nystatin-triamcinolone . . . . . . . . . . . . 56nystop . . . . . . . . . . . . . . . . . . . . . . . . . . 56

OOCALIVA . . . . . . . . . . . . . . . . . . . . . . . 70ocella . . . . . . . . . . . . . . . . . . . . . . . . . . . 81OCREVUS . . . . . . . . . . . . . . . . . . . . . . 35octreotide acetate injection solution 1,000 mcg/ml, 500 mcg/ml . . . . . . . 28octreotide acetate injection solution 100 mcg/ml, 200 mcg/ml, 50 mcg/ml . . . . . . . . . . 28ocutabs . . . . . . . . . . . . . . . . . . . . . . . . 107ODEFSEY . . . . . . . . . . . . . . . . . . . . . . 14ODOMZO . . . . . . . . . . . . . . . . . . . . . . . 28OFEV . . . . . . . . . . . . . . . . . . . . . . . . . . . 93OFF DEEP WOODS . . . . . . . . . . . . . 53OFF DEEP WOODS DRY . . . . . . . . 53OFF DEEP WOODS SPORTSMEN TOPICAL AEROSOL,SPRAY . . . . . 53OFF DEEP WOODS SPORTSMEN TOPICAL SPRAY,NON-AEROSOL 25% . . . . 53ofloxacin ophthalmic (eye) . . . . . . . 82

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perindopril erbumine . . . . . . . . . . . . . 48PERJETA . . . . . . . . . . . . . . . . . . . . . . . 28permethrin topical cream . . . . . . . . . 58perphenazine . . . . . . . . . . . . . . . . . . . 44perphenazine-amitriptyline . . . . . . . 44PERSERIS . . . . . . . . . . . . . . . . . . . . . . 44pfizerpen-g . . . . . . . . . . . . . . . . . . . . . . 20phenelzine . . . . . . . . . . . . . . . . . . . . . . 44PHENOBARBITAL ORAL ELIXIR . 33PHENOBARBITAL ORAL TABLET 33phenobarbital sodium injection solution . . . . . . . . . . . . . . . . . 33phenoxybenzamine . . . . . . . . . . . . . . 48PHENYLEPHRINE-DM-GUAIFENESIN ORAL LIQUID 10-18-200 MG/15 ML . . . . 89PHENYLEPHRINE-DM-GUAIFENESIN ORAL TABLET . . . 89phenytoin oral suspension . . . . . . . 33phenytoin oral tablet,chewable . . . 33phenytoin sodium extended . . . . . . 33phenytoin sodium intravenous solution . . . . . . . . . . . . . 33PHESGO . . . . . . . . . . . . . . . . . . . . . . . 28philith . . . . . . . . . . . . . . . . . . . . . . . . . . . 81PHILLIPS . . . . . . . . . . . . . . . . . . . . . . . 97phospha 250 neutral . . . . . . . . . . . . . 97PHOSPHOLINE IODIDE . . . . . . . . . 83phosphorous . . . . . . . . . . . . . . . . . . . . 97phospho-trin 250 neutral . . . . . . . . . 97phytonadione (vitamin k1) injection solution . . . . . . . . . . . . . . . . . 50phytonadione (vitamin k1) oral tablet 5 mg . . . . . . . . . . . . . . . . . . 50PICATO . . . . . . . . . . . . . . . . . . . . . . . . . 54PIFELTRO . . . . . . . . . . . . . . . . . . . . . . 14pilocarpine hcl ophthalmic (eye) drops 1%, 2%, 4% . . . . . . . . . 83pilocarpine hcl oral . . . . . . . . . . . . . . . 59pimecrolimus . . . . . . . . . . . . . . . . . . . . 54pimozide . . . . . . . . . . . . . . . . . . . . . . . . 44pimtrea (28) . . . . . . . . . . . . . . . . . . . . . 81pindolol . . . . . . . . . . . . . . . . . . . . . . . . . 48pioglitazone . . . . . . . . . . . . . . . . . . . . . 64pioglitazone-metformin . . . . . . . . . . . 64

paroex oral rinse . . . . . . . . . . . . . . . . 60paromomycin . . . . . . . . . . . . . . . . . . . . 19paroxetine hcl oral tablet . . . . . . . . . 44paroxetine hcl oral tablet extended release 24 hr . . . . . . . . . . 44PASER . . . . . . . . . . . . . . . . . . . . . . . . . 19PAXIL ORAL SUSPENSION . . . . . 44PAZEO . . . . . . . . . . . . . . . . . . . . . . . . . 83PEDIACLEAR-8 . . . . . . . . . . . . . . . . . 89PEDIACLEAR ALLERGY . . . . . . . . 89PEDIACLEAR COUGH . . . . . . . . . . 89PEDIACLEAR PD . . . . . . . . . . . . . . . 89PEDIA D-VITE ORAL DROPS . . . 108pedia iron . . . . . . . . . . . . . . . . . . . . . . 108PEDIALYTE ADVANCED CARE . . 97pedialyte freezer pops . . . . . . . . . . . 97pedialyte oral solution . . . . . . . . . . . . 97pedialyte singles . . . . . . . . . . . . . . . . . 97PEDIARIX (PF) . . . . . . . . . . . . . . . . . . 74pediatric cough and cold oral liquid 1-15-5 mg/5 ml . . . . . . . . 89pediatric electrolyte oral solution . . 97pediatric freezer pops . . . . . . . . . . . . 97PEDIA TRI-VITE . . . . . . . . . . . . . . . . 108PEDVAX HIB (PF) . . . . . . . . . . . . . . . 74peg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram . . 70peg-electrolyte . . . . . . . . . . . . . . . . . . 70PEMAZYRE . . . . . . . . . . . . . . . . . . . . . 28penicillamine . . . . . . . . . . . . . . . . . . . . 76penicillin g potassium . . . . . . . . . . . . 20penicillin v potassium . . . . . . . . . . . . 20PENTACEL (PF) INTRAMUSCULAR KIT 15LF- 48MCG-62DU -10 MCG/0.5ML . . . 74PENTAM . . . . . . . . . . . . . . . . . . . . . . . . 19pentamidine inhalation . . . . . . . . . . . 19pentamidine injection . . . . . . . . . . . . 19PENTASA . . . . . . . . . . . . . . . . . . . . . . . 70pentoxifylline . . . . . . . . . . . . . . . . . . . . 50peptic relief oral tablet,chewable . . 68PERFOROMIST . . . . . . . . . . . . . . . . . 93PERIDIN-C . . . . . . . . . . . . . . . . . . . . 108PERIKABIVEN . . . . . . . . . . . . . . . . . . 99

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg . . . . . . . . . . . 38oxycodone-aspirin . . . . . . . . . . . . . . . 38oxycodone oral concentrate . . . . . . 37oxycodone oral solution . . . . . . . . . . 38oxycodone oral tablet 5 mg . . . . . . . 38oxycodone oral tablet 10 mg, 15 mg, 20 mg, 30 mg . . . . . 38oxymorphone oral tablet extended release 12 hr . . . . . . . . . . 38oysco 500/d oral tablet . . . . . . . . . . . 96oystercal-d . . . . . . . . . . . . . . . . . . . . . . 97oyster shell + d3 . . . . . . . . . . . . . . . . . 96oyster shell calcium 500 . . . . . . . . . 96oyster shell calcium and mag . . . . . 96OYSTER SHELL CALCIUM-VIT D3 ORAL TABLET 250-125 MG-UNIT 97oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit . . . . . . 97OZEMPIC SUBCUTANEOUS PEN INJECTOR 0.25 MG OR 0.5 MG(2 MG/1.5 ML) . . . . . . . . 64OZEMPIC SUBCUTANEOUS PEN INJECTOR 1 MG/DOSE (2 MG/1.5 ML) . . . . . . . . . . . . . . . . . . . 64

Ppacerone oral tablet 100 mg, 200 mg, 400 mg . . . . . . . . . 46paclitaxel . . . . . . . . . . . . . . . . . . . . . . . . 28PADCEV . . . . . . . . . . . . . . . . . . . . . . . . 28PAIN RELIEVING (M-SALIC-MEN) . 53paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 9 mg . 44paliperidone oral tablet extended release 24hr 6 mg . . . . . . 44palonosetron intravenous solution 0.25 mg/5 ml . . . . . . . . . . . . 70pamidronate . . . . . . . . . . . . . . . . . . . . . 66PANRETIN . . . . . . . . . . . . . . . . . . . . . . 54pantoprazole oral tablet, delayed release (dr/ec) 20 mg . . . . 72pantoprazole oral tablet, delayed release (dr/ec) 40 mg . . . . 72paricalcitol oral . . . . . . . . . . . . . . . . . . 66

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POTELIGEO . . . . . . . . . . . . . . . . . . . . 28povidone-iodine topical ointment . . 55povidone-iodine topical solution 10% . . . . . . . . . . . . . 55PRADAXA . . . . . . . . . . . . . . . . . . . . . . 50pramipexole . . . . . . . . . . . . . . . . . . . . . 34prasugrel . . . . . . . . . . . . . . . . . . . . . . . . 50pravastatin . . . . . . . . . . . . . . . . . . . . . . 51praziquantel . . . . . . . . . . . . . . . . . . . . . 19prazosin . . . . . . . . . . . . . . . . . . . . . . . . 48PRED-G . . . . . . . . . . . . . . . . . . . . . . . . 84PRED-G S.O.P. . . . . . . . . . . . . . . . . . 84prednicarbate topical ointment . . . . 57prednisolone acetate . . . . . . . . . . . . 85prednisolone oral solution 15 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 61prednisolone sodium phosphate ophthalmic (eye) . . . . . . . . . . . . . . . . . 85prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 15 mg/5 ml (5 ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml) . . . . 61prednisone intensol . . . . . . . . . . . . . . 61prednisone oral solution . . . . . . . . . . 61prednisone oral tablet . . . . . . . . . . . . 62prednisone oral tablets,dose pack . 62pregabalin oral capsule 100 mg, 150 mg, 200 mg, 25 mg, 50 mg, 75 mg . . . . . . . . . . . . 33pregabalin oral capsule 225 mg, 300 mg . . . . . . . . . . . . . . . . . 33pregabalin oral solution . . . . . . . . . . 33PREMARIN . . . . . . . . . . . . . . . . . . . . . 77PREMASOL 10% . . . . . . . . . . . . . . . . 99PRENATAL VITAMIN ORAL TABLET . . . . . . . . . . . . . . . . . 108prevalite . . . . . . . . . . . . . . . . . . . . . . . . 51PREVENT . . . . . . . . . . . . . . . . . . . . . 108previfem . . . . . . . . . . . . . . . . . . . . . . . . 81PREVYMIS ORAL . . . . . . . . . . . . . . . 14PREZCOBIX . . . . . . . . . . . . . . . . . . . . 15PREZISTA ORAL SUSPENSION . 15PREZISTA ORAL TABLET 75 MG 15PREZISTA ORAL TABLET 150 MG 15

potassium chlorid-d5-0.45%nacl intravenous parenteral solution 30 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 97potassium chloride-0.45% nacl . . . 98POTASSIUM CHLORIDE-D5-0.2%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . . . . . . . . . . . . . 98potassium chloride-d5-0.2%nacl intravenous parenteral solution 30 meq/l, 40 meq/l . . . . . . . . . . . . . . . 98POTASSIUM CHLORIDE-D5-0.9%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . . . . . . . . . . . . . 98potassium chloride-d5-0.9%nacl intravenous parenteral solution 40 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 98potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l . . . . . . . . . . . . . . . 97POTASSIUM CHLORIDE IN 5% DEX INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . . . . . . . . . . . . . 97potassium chloride in 5% dex intravenous parenteral solution 30 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 97potassium chloride in 5% dex intravenous parenteral solution 40 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 97POTASSIUM CHLORIDE IN LR-D5 INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . 97potassium chloride intravenous . . . 97potassium chloride in water intravenous piggyback . . . . . . . . . . . 97potassium chloride oral capsule, extended release . . . . . . . . . . . . . . . . 97POTASSIUM CHLORIDE ORAL LIQUID . . . . . . . . . . . . . . . . . . . 97potassium chloride oral packet . . . 97potassium chloride oral tablet, er particles/crystals . . . . . . . . . . . . . . 98potassium chloride oral tablet extended release . . . . . . . . . . . . . . . . 97potassium citrate . . . . . . . . . . . . . . . . 94potassium citrate-citric acid oral solution . . . . . . . . . . . . . . . . . . . . . 94

piperacillin-tazobactam intravenous recon soln 2.25 gram, 3.375 gram, 4.5 gram, 40.5 gram . 20PIPERACILLIN-TAZOBACTAM INTRAVENOUS RECON SOLN 13.5 GRAM . . . . . . . . . . . . . . . . . . . . . 20PIQRAY . . . . . . . . . . . . . . . . . . . . . . . . . 28pirmella . . . . . . . . . . . . . . . . . . . . . . . . . 81PLENAMINE . . . . . . . . . . . . . . . . . . . . 99PLENVU . . . . . . . . . . . . . . . . . . . . . . . . 70podofilox . . . . . . . . . . . . . . . . . . . . . . . . 54POLIVY . . . . . . . . . . . . . . . . . . . . . . . . . 28POLY BACITRACIN (ZINC) . . . . . . 55polycin . . . . . . . . . . . . . . . . . . . . . . . . . . 82polyethylene glycol 3350 . . . . . . . . . 70POLY-HIST DM (THONZYLAMINE) . . . . . . . . . . . . . . 89POLY HIST FORTE . . . . . . . . . . . . . . 89POLY HIST FORTE (DOXYLAMINE) . . . . . . . . . . . . . . . . . 89POLY HIST PD . . . . . . . . . . . . . . . . . . 89poly-iron . . . . . . . . . . . . . . . . . . . . . . . 108poly-iron 150 forte . . . . . . . . . . . . . . 108polymyxin b sulfate . . . . . . . . . . . . . . 19polymyxin b sulf-trimethoprim . . . . 82polysaccharide iron complex . . . . 108POLYTUSSIN DM . . . . . . . . . . . . . . . 89POLY-VENT DM ORAL TABLET 60-20-380 MG . . . . . . . . . . 89POLY-VENT IR ORAL TABLET 60-380 MG . . . . . . . . . . . . . 89POLY-VI-FLOR . . . . . . . . . . . . . . . . . 108POLY-VI-FLOR WITH IRON . . . . . 108POLY-VI-SOL ORAL DROPS . . . . 108POLY-VI-SOL WITH IRON . . . . . . 108POMALYST . . . . . . . . . . . . . . . . . . . . . 28portia 28 . . . . . . . . . . . . . . . . . . . . . . . . 81PORTRAZZA . . . . . . . . . . . . . . . . . . . 28posaconazole oral tablet, delayed release (dr/ec) . . . . . . . . . . 12POTASSIUM CHLORID-D5-0.45%NACL INTRAVENOUS PARENTERAL SOLUTION 10 MEQ/L, 20 MEQ/L, 40 MEQ/L . 97

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QUFLORA FE (FERROUS SULFATE). . . . . . . . . . 108QUFLORA PEDIATRIC . . . . . . . . . 108QUFLORA PEDIATRIC DROPS . 108quinapril . . . . . . . . . . . . . . . . . . . . . . . . 48quinapril-hydrochlorothiazide . . . . . 48quinidine sulfate oral tablet . . . . . . . 46quinine sulfate . . . . . . . . . . . . . . . . . . . 19quintabs-m iron free . . . . . . . . . . . . 108

RRABAVERT (PF) . . . . . . . . . . . . . . . . 74raloxifene . . . . . . . . . . . . . . . . . . . . . . . 75ramelteon . . . . . . . . . . . . . . . . . . . . . . . 44ramipril . . . . . . . . . . . . . . . . . . . . . . . . . 48ranolazine . . . . . . . . . . . . . . . . . . . . . . . 51rasagiline . . . . . . . . . . . . . . . . . . . . . . . 34REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.2ML- 22 MCG/0.5ML (6) . . . . . . . . . . . . . . . 73REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML . . . . . . . . . . . . . . . . . 73REBIF TITRATION PACK . . . . . . . . 73REBIF (WITH ALBUMIN) . . . . . . . . . 73reclipsen (28) . . . . . . . . . . . . . . . . . . . 81RECOMBIVAX HB (PF) . . . . . . . . . . 74RECTIV . . . . . . . . . . . . . . . . . . . . . . . . . 71REDNESS RELIEF OPHTHALMIC (EYE) DROPS 0.012-0.25% . . . . . . 85REFRESH CELLUVISC . . . . . . . . . . 83REFRESH LACRI-LUBE . . . . . . . . . 83REFRESH OPTIVE MEGA-3 (PF) . 83REFRESH PLUS . . . . . . . . . . . . . . . . 83regonol . . . . . . . . . . . . . . . . . . . . . . . . . 36REGRANEX . . . . . . . . . . . . . . . . . . . . 54RELISTOR SUBCUTANEOUS SOLUTION . . . 71RELISTOR SUBCUTANEOUS SYRINGE . . . . 71RENACIDIN IRRIGATION SOLUTION 1980.6 MG- 59.4 MG-980.4MG/30ML . . . . . . . . . 94renal caps . . . . . . . . . . . . . . . . . . . . . . 108

propranolol oral . . . . . . . . . . . . . . . . . . 48propylthiouracil . . . . . . . . . . . . . . . . . . 62PROQUAD (PF) . . . . . . . . . . . . . . . . . 74PROSOL 20% . . . . . . . . . . . . . . . . . . . 99PROTECT IRON . . . . . . . . . . . . . . . 108protriptyline . . . . . . . . . . . . . . . . . . . . . 44PSEUDOEPHEDRINE-GUAIFENESIN ORAL TABLET . . . 90pseudoephedrine-guaifenesin oral tablet extended release 12 hr . . . . . 90pseudoephedrine hcl oral tablet . . 90pseudoephedrine hcl oral tablet extended release . . . . . . . . . . . . . . . . 90PULMICORT INHALATION SUSPENSION FOR NEBULIZATION 0.25 MG/2 ML, 0.5 MG/2 ML . . . . . 93PULMICORT INHALATION SUSPENSION FOR NEBULIZATION 1 MG/2 ML . . . . . . 93PULMOZYME . . . . . . . . . . . . . . . . . . . 93PURIXAN . . . . . . . . . . . . . . . . . . . . . . . 28pyrazinamide . . . . . . . . . . . . . . . . . . . . 19pyridostigmine bromide oral syrup 36pyridostigmine bromide oral tablet 60 mg . . . . . . . . . . . . . . . . 36pyridostigmine bromide oral tablet extended release . . . . . . 36pyridoxine (vitamin b6) oral tablet 100 mg, 25 mg, 50 mg . . . . 108pyrimethamine . . . . . . . . . . . . . . . . . . 19

QQINLOCK . . . . . . . . . . . . . . . . . . . . . . . 28QUADRACEL (PF) . . . . . . . . . . . . . . 74quetiapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg . . . 44quetiapine oral tablet 300 mg, 400 mg . . . . . . . . . . . . . . . . . 44quetiapine oral tablet extended release 24 hr 150 mg, 200 mg . . . . 44quetiapine oral tablet extended release 24 hr 300 mg, 400 mg, 50 mg . . . . . . . . . . . . . . . . . . 44QUFLORA . . . . . . . . . . . . . . . . . . . . . 108QUFLORA FE . . . . . . . . . . . . . . . . . . 108

PREZISTA ORAL TABLET 600 MG 15PREZISTA ORAL TABLET 800 MG 15PRIFTIN . . . . . . . . . . . . . . . . . . . . . . . . 19PRIMAQUINE . . . . . . . . . . . . . . . . . . . 19primidone . . . . . . . . . . . . . . . . . . . . . . . 33probenecid . . . . . . . . . . . . . . . . . . . . . . 75probenecid-colchicine . . . . . . . . . . . . 75PROCALAMINE 3% . . . . . . . . . . . . . 99prochlorperazine . . . . . . . . . . . . . . . . 70prochlorperazine edisylate . . . . . . . 70prochlorperazine maleate oral . . . . 70procto-med hc . . . . . . . . . . . . . . . . . . . 70procto-pak . . . . . . . . . . . . . . . . . . . . . . 70proctosol hc topical . . . . . . . . . . . . . . 70proctozone-hc . . . . . . . . . . . . . . . . . . . 71PRO FE . . . . . . . . . . . . . . . . . . . . . . . 108PROFERRIN ES . . . . . . . . . . . . . . . 108PROFERRIN-FORTE . . . . . . . . . . . 108progesterone micronized . . . . . . . . . 77PROGLYCEM . . . . . . . . . . . . . . . . . . . 64PROGRAF INTRAVENOUS . . . . . . 28PROGRAF ORAL GRANULES IN PACKET . . . . . . . . . . . . . . . . . . . . . 28PROLASTIN-C . . . . . . . . . . . . . . . . . . 59PROLENSA . . . . . . . . . . . . . . . . . . . . . 84PROLEUKIN . . . . . . . . . . . . . . . . . . . . 73PROLIA . . . . . . . . . . . . . . . . . . . . . . . . . 75PROMACTA ORAL POWDER IN PACKET 12.5 MG . . . . . . . . . . . . 50PROMACTA ORAL POWDER IN PACKET 25 MG . . . . . . . . . . . . . . 50PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG . . . . . . . . . 50PROMACTA ORAL TABLET 75 MG . . . . . . . . . . . . . . . . . . . . . . . . . . 50promethazine-codeine . . . . . . . . . . . 90promethazine-dm . . . . . . . . . . . . . . . . 90promethazine oral . . . . . . . . . . . . . . . 90promethazine rectal suppository 12.5 mg, 25 mg . . . . . . 90promethegan rectal suppository 25 mg, 50 mg . . . . . . . . 90propafenone . . . . . . . . . . . . . . . . . . . . 46propranolol-hydrochlorothiazid . . . 48

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ROTARIX . . . . . . . . . . . . . . . . . . . . . . . 74ROTATEQ VACCINE . . . . . . . . . . . . 74roweepra . . . . . . . . . . . . . . . . . . . . . . . . 33ROZLYTREK ORAL CAPSULE 100 MG . . . . . . . . . . . . . . 28ROZLYTREK ORAL CAPSULE 200 MG . . . . . . . . . . . . . . 29RUBRACA . . . . . . . . . . . . . . . . . . . . . . 29rufinamide . . . . . . . . . . . . . . . . . . . . . . 33RU-HIST D . . . . . . . . . . . . . . . . . . . . . . 90RUKOBIA . . . . . . . . . . . . . . . . . . . . . . . 15RUXIENCE . . . . . . . . . . . . . . . . . . . . . 29RYBELSUS . . . . . . . . . . . . . . . . . . . . . 65RYDAPT . . . . . . . . . . . . . . . . . . . . . . . . 29RYMED (DEXCHLORPHENIRAMINE-PE) 90rynex dm . . . . . . . . . . . . . . . . . . . . . . . . 90rynex pe . . . . . . . . . . . . . . . . . . . . . . . . 90rynex pse . . . . . . . . . . . . . . . . . . . . . . . 90RYTARY . . . . . . . . . . . . . . . . . . . . . . . . 34

SS2 RACEPINEPHRINE . . . . . . . . . . 93salsalate . . . . . . . . . . . . . . . . . . . . . . . . 39SAMSCA ORAL TABLET 15 MG . . 66SAMSCA ORAL TABLET 30 MG . . 66SANCUSO . . . . . . . . . . . . . . . . . . . . . . 71SANDIMMUNE ORAL SOLUTION . 29SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON . . . . . . . . . . . . . . . . . . . . 29SANTYL . . . . . . . . . . . . . . . . . . . . . . . . 54SAPHRIS . . . . . . . . . . . . . . . . . . . . . . . 45sapropterin . . . . . . . . . . . . . . . . . . . . . . 66SARCLISA . . . . . . . . . . . . . . . . . . . . . . 29SCOOBY-DOO ONE A DAY . . . . . 109scopolamine base . . . . . . . . . . . . . . . 71SECUADO . . . . . . . . . . . . . . . . . . . . . . 45selegiline hcl . . . . . . . . . . . . . . . . . . . . 34selenium oral tablet . . . . . . . . . . . . . . 98selenium sulfide topical lotion . . . . 52SELZENTRY ORAL SOLUTION . . 15SELZENTRY ORAL TABLET 25 MG . . . . . . . . . . . . . . . . . 15

RINVOQ . . . . . . . . . . . . . . . . . . . . . . . . 76RIOMET . . . . . . . . . . . . . . . . . . . . . . . . 65RIOMET ER . . . . . . . . . . . . . . . . . . . . . 65risacal-d . . . . . . . . . . . . . . . . . . . . . . . 109risedronate oral tablet 5 mg . . . . . . 75risedronate oral tablet 30 mg . . . . . 59risedronate oral tablet 35 mg, 35 mg (12 pack), 35 mg (4 pack) . 75risedronate oral tablet 150 mg . . . . 75RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 12.5 MG/2 ML . . . . . . 44RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML . . . . . . 44risperidone oral solution . . . . . . . . . . 44risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg . . . . . . . . 44risperidone oral tablet 4 mg . . . . . . 44risperidone oral tablet, disintegrating 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg . . . . . . . . 44risperidone oral tablet, disintegrating 4 mg . . . . . . . . . . . . . . 45ritonavir . . . . . . . . . . . . . . . . . . . . . . . . . 15RITUXAN HYCELA . . . . . . . . . . . . . . 28rivastigmine . . . . . . . . . . . . . . . . . . . . . 35rivastigmine tartrate . . . . . . . . . . . . . . 35rivelsa . . . . . . . . . . . . . . . . . . . . . . . . . . 81rizatriptan . . . . . . . . . . . . . . . . . . . . . . . 34robafen . . . . . . . . . . . . . . . . . . . . . . . . . 90robafen cf (phenylephrine) . . . . . . . 90robafen cough . . . . . . . . . . . . . . . . . . . 90robafen dm cough . . . . . . . . . . . . . . . 90robafen dm cough-chest congest . 90robafen dm peak cold . . . . . . . . . . . . 90ROCKLATAN . . . . . . . . . . . . . . . . . . . . 84ROMIDEPSIN INTRAVENOUS SOLUTION . . . . . 28ropinirole oral tablet . . . . . . . . . . . . . . 34rosadan topical cream . . . . . . . . . . . 55rosadan topical gel . . . . . . . . . . . . . . 55rosuvastatin . . . . . . . . . . . . . . . . . . . . . 51

RENAL VITAMIN . . . . . . . . . . . . . . . 108RENAL-VITE . . . . . . . . . . . . . . . . . . . 108rena-vite . . . . . . . . . . . . . . . . . . . . . . . 108rena-vite rx . . . . . . . . . . . . . . . . . . . . . 109RENFLEXIS . . . . . . . . . . . . . . . . . . . . . 71reno caps . . . . . . . . . . . . . . . . . . . . . . 109repaglinide oral tablet 0.5 mg . . . . . 64repaglinide oral tablet 1 mg . . . . . . 64repaglinide oral tablet 2 mg . . . . . . 65REPATHA . . . . . . . . . . . . . . . . . . . . . . . 51REPATHA PUSHTRONEX . . . . . . . 51REPATHA SURECLICK . . . . . . . . . . 51REPEL HUNTER’S . . . . . . . . . . . . . . 54REPEL LEMON EUCALYPTUS . . 54REPEL SPORTSMEN . . . . . . . . . . . 54REPEL SPORTSMEN DRY . . . . . . 54REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY . . . . . 54RESCON . . . . . . . . . . . . . . . . . . . . . . . 90RESCON-DM . . . . . . . . . . . . . . . . . . . 90rescon-gg . . . . . . . . . . . . . . . . . . . . . . . 90RESTASIS . . . . . . . . . . . . . . . . . . . . . . 83RESTASIS MULTIDOSE . . . . . . . . . 83RETACRIT . . . . . . . . . . . . . . . . . . . . . . 73RETEVMO . . . . . . . . . . . . . . . . . . . . . . 28RETROVIR INTRAVENOUS . . . . . 15REVLIMID . . . . . . . . . . . . . . . . . . . . . . 28REXULTI . . . . . . . . . . . . . . . . . . . . . . . . 44REYATAZ ORAL POWDER IN PACKET . . . . . . . . . . . . . . . . . . . . . 15RHOPRESSA . . . . . . . . . . . . . . . . . . . 84ribavirin oral capsule . . . . . . . . . . . . . 15ribavirin oral tablet 200 mg . . . . . . . 15riboflavin (vitamin b2) oral tablet 100 mg . . . . . . . . . . . . . . 109RIDAURA . . . . . . . . . . . . . . . . . . . . . . . 76rifabutin . . . . . . . . . . . . . . . . . . . . . . . . . 19rifampin . . . . . . . . . . . . . . . . . . . . . . . . . 19RIFATER . . . . . . . . . . . . . . . . . . . . . . . . 19riluzole . . . . . . . . . . . . . . . . . . . . . . . . . . 59rimantadine . . . . . . . . . . . . . . . . . . . . . 15ringer’s intravenous . . . . . . . . . . . . . . 98ringer’s irrigation . . . . . . . . . . . . . . . . . 58

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sodium polystyrene sulfonate oral powder . . . . . . . . . . . . 59solifenacin . . . . . . . . . . . . . . . . . . . . . . 94SOLIQUA 100/33 . . . . . . . . . . . . . . . . 65SOLTAMOX . . . . . . . . . . . . . . . . . . . . . 29SOLU-CORTEF ACT-O-VIAL (PF) . 62SOLUVITA-E . . . . . . . . . . . . . . . . . . . 109SOMATULINE DEPOT . . . . . . . . . . . 29SOMAVERT . . . . . . . . . . . . . . . . . . . . . 66soothing pureway-c . . . . . . . . . . . . . 109sorine . . . . . . . . . . . . . . . . . . . . . . . . . . . 46sotalol af . . . . . . . . . . . . . . . . . . . . . . . . 46sotalol oral . . . . . . . . . . . . . . . . . . . . . . 46SOTYLIZE . . . . . . . . . . . . . . . . . . . . . . 46spectravite adult 50 plus . . . . . . . . 109spectravite advanced formula oral tablet 18-400 mg-mcg . . . . . . 109spectravite men’s . . . . . . . . . . . . . . . 109spectravite senior oral tablet 500-300-250 mcg . . . . . . . . . . . . . . . 109spectravite ultra women . . . . . . . . . 109spectravite ultra women’s sr . . . . . 109spectravite women . . . . . . . . . . . . . . 109spironolactone . . . . . . . . . . . . . . . . . . 48spironolacton-hydrochlorothiaz . . . 48sprintec (28) . . . . . . . . . . . . . . . . . . . . . 81SPRITAM . . . . . . . . . . . . . . . . . . . . . . . 33SPRYCEL ORAL TABLET 20 MG, 70 MG . . . . . . . . . . . . . . . . . . 29SPRYCEL ORAL TABLET 100 MG, 140 MG, 50 MG, 80 MG . 29sps (with sorbitol) . . . . . . . . . . . . . . . . 59sronyx . . . . . . . . . . . . . . . . . . . . . . . . . . 81SSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54STAHIST AD ORAL TABLET . . . . . 91STAMARIL (PF) . . . . . . . . . . . . . . . . . 74stavudine oral capsule . . . . . . . . . . . 15STELARA SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 52STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML . . . . . . . . . 52STELARA SUBCUTANEOUS SYRINGE 90 MG/ML . . . . . . . . . . . . 52STIVARGA . . . . . . . . . . . . . . . . . . . . . . 29stomach relief oral suspension . . . 68

SIRTURO . . . . . . . . . . . . . . . . . . . . . . . 19SIVEXTRO INTRAVENOUS . . . . . . 19SIVEXTRO ORAL . . . . . . . . . . . . . . . 19SKYRIZI SUBCUTANEOUS SYRINGE KIT . . . . . . . . . . . . . . . . . . . 52SLEEP AID (DIPHENHYDRAMINE) ORAL CAPSULE 25 MG . . . . . . . . . 90sleep aid (diphenhydramine) oral capsule 50 mg . . . . . . . . . . . . . . 90SLEEP AID (DIPHENHYDRAMINE) ORAL LIQUID . . . . . . . . . . . . . . . . . . . 91sleep aid (diphenhydramine) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 91sleep aid (doxylamine) . . . . . . . . . . . 45SLO-NIACIN ORAL TABLET EXTENDED RELEASE 250 MG . . 51slo-niacin oral tablet extended release 500 mg . . . . . . . . 51SLOW FE . . . . . . . . . . . . . . . . . . . . . . 109SLOW-MAG . . . . . . . . . . . . . . . . . . . . . 98SLOW RELEASE IRON ORAL TABLET EXTENDED RELEASE 140 MG (45 MG IRON), 142 MG (45 MG IRON), 143 MG (45 MG IRON), 159 MG (45 MG IRON) . . 109sodium bicarbonate intravenous syringe 10 meq/10 ml (8.4%), 7.5% (0.9 meq/ml), 8.4% (1 meq/ml) . . . . . . . . . . . . . . . . . 98sodium bicarbonate oral . . . . . . . . . 71SODIUM CHLORIDE 0.9% INTRAVENOUS PARENTERAL SOLUTION . . . . . . . 59sodium chloride 0.9% intravenous piggyback . . . . . . . . . . . 59SODIUM CHLORIDE 0.45% INTRAVENOUS PARENTERAL SOLUTION . . . . . . . 98SODIUM CHLORIDE 3% . . . . . . . . 98SODIUM CHLORIDE 5% . . . . . . . . 98sodium chloride intravenous . . . . . . 98SODIUM CHLORIDE IRRIGATION 59sodium chloride ophthalmic (eye) . 84sodium citrate-citric acid . . . . . . . . . 94sodium fluoride-pot nitrate . . . . . . . . 60sodium phenylbutyrate . . . . . . . . . . . 59sodium polystyrene (sorb free) . . . 59

SELZENTRY ORAL TABLET 150 MG, 75 MG . . . . . . . . . 15SELZENTRY ORAL TABLET 300 MG . . . . . . . . . . . . . . . . 15senior tabs . . . . . . . . . . . . . . . . . . . . . 109senna lax . . . . . . . . . . . . . . . . . . . . . . . 71senna oral tablet . . . . . . . . . . . . . . . . . 71sentry . . . . . . . . . . . . . . . . . . . . . . . . . . 109sentry senior . . . . . . . . . . . . . . . . . . . 109SEREVENT DISKUS . . . . . . . . . . . . 93sertraline . . . . . . . . . . . . . . . . . . . . . . . . 45se-tan plus . . . . . . . . . . . . . . . . . . . . . 109setlakin . . . . . . . . . . . . . . . . . . . . . . . . . 81sevelamer carbonate oral powder in packet . . . . . . . . . . . . . . . . 59sevelamer carbonate oral tablet . . 59SEVERE COLD AND FLU NIGHTTIME . . . . . . . . . . . . . . . . . . . . . 90SEVERE COLD AND FLU (PE) ORAL TABLET . . . . . . . . . . . . . 90sharobel . . . . . . . . . . . . . . . . . . . . . . . . 77SHINGRIX (PF) . . . . . . . . . . . . . . . . . 74SIDEROL ORAL TABLET . . . . . . . 109SIGNIFOR . . . . . . . . . . . . . . . . . . . . . . 29siladryl sa . . . . . . . . . . . . . . . . . . . . . . . 90sildenafil (pulmonary arterial hypertension) oral tablet . . . . . . . . . 93siltussin-dm . . . . . . . . . . . . . . . . . . . . . 90siltussin dm das . . . . . . . . . . . . . . . . . 90siltussin sa . . . . . . . . . . . . . . . . . . . . . . 90silver sulfadiazine . . . . . . . . . . . . . . . 54SIMBRINZA . . . . . . . . . . . . . . . . . . . . . 84simethicone oral capsule 180 mg . 71simethicone oral drops,suspension 71simliya (28) . . . . . . . . . . . . . . . . . . . . . 81simpesse . . . . . . . . . . . . . . . . . . . . . . . 81SIMULECT . . . . . . . . . . . . . . . . . . . . . . 29simvastatin oral tablet . . . . . . . . . . . . 51SINUS CONGESTION AND PAIN 90SINUS CONGESTION-PAIN (GUAIF) . . . . . . . . . . . . . . . . . . . . . . . . 90SINUS PAIN-PRESSURE (PE) ORAL TABLET 5-325 MG . . . . . . . . 90sirolimus oral solution . . . . . . . . . . . . 29sirolimus oral tablet . . . . . . . . . . . . . . 29

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SYNTHROID . . . . . . . . . . . . . . . . . . . . 67

Ttab-a-vite/iron . . . . . . . . . . . . . . . . . . 110TAB-A-VITE MULTIVITAMIN W-IRON ORAL TABLET 18-400 MG-MCG . . . . . . . . . . . . . . . 110TABLOID . . . . . . . . . . . . . . . . . . . . . . . 29TABRECTA . . . . . . . . . . . . . . . . . . . . . 29tacrolimus oral . . . . . . . . . . . . . . . . . . 29tacrolimus topical . . . . . . . . . . . . . . . . 54tadalafil (pulmonary arterial hypertension) oral tablet 20 mg . . . 93TAFINLAR . . . . . . . . . . . . . . . . . . . . . . 29TAGRISSO . . . . . . . . . . . . . . . . . . . . . . 29TALTZ SYRINGE . . . . . . . . . . . . . . . . 52TALZENNA ORAL CAPSULE 0.25 MG . . . . . . . . . . . . . . 29TALZENNA ORAL CAPSULE 1 MG . . . . . . . . . . . . . . . . . 29tamoxifen . . . . . . . . . . . . . . . . . . . . . . . 29tamsulosin . . . . . . . . . . . . . . . . . . . . . . 94TANDEM DUAL ACTION . . . . . . . . 110TANDEM PLUS . . . . . . . . . . . . . . . . 110TARGRETIN TOPICAL . . . . . . . . . . 29tarina 24 fe . . . . . . . . . . . . . . . . . . . . . . 81tarina fe 1/20 (28) . . . . . . . . . . . . . . . 81tarina fe 1-20 eq (28) . . . . . . . . . . . . 81taron forte . . . . . . . . . . . . . . . . . . . . . . 110TASIGNA ORAL CAPSULE 50 MG . . . . . . . . . . . . . . . 29TASIGNA ORAL CAPSULE 150 MG, 200 MG . . . . . 29tazarotene . . . . . . . . . . . . . . . . . . . . . . 55tazicef . . . . . . . . . . . . . . . . . . . . . . . . . . 17TAZORAC . . . . . . . . . . . . . . . . . . . . . . 55taztia xt oral capsule, extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg . . . . . . . . . 48TAZVERIK . . . . . . . . . . . . . . . . . . . . . . 29TDVAX . . . . . . . . . . . . . . . . . . . . . . . . . 74TECENTRIQ . . . . . . . . . . . . . . . . . . . . 29TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG . . . . . . 35

sumatriptan succinate subcutaneous cartridge . . . . . . . . . . 34sumatriptan succinate subcutaneous pen injector . . . . . . . 34sumatriptan succinate subcutaneous solution . . . . . . . . . . . 35sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml 35super b-50 complex . . . . . . . . . . . . . 109super b/c . . . . . . . . . . . . . . . . . . . . . . . 109super b complex-vitamin c . . . . . . 109super b maxi complex . . . . . . . . . . . 109super calcium . . . . . . . . . . . . . . . . . . . 98super multiple oral tablet . . . . . . . . 109super multivitamin . . . . . . . . . . . . . . 109super quints . . . . . . . . . . . . . . . . . . . . 110super thera vite m . . . . . . . . . . . . . . 110SUPERVITE . . . . . . . . . . . . . . . . . . . 110support . . . . . . . . . . . . . . . . . . . . . . . . 110SUPPORT-500 . . . . . . . . . . . . . . . . . 110SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 500 MG/5 ML . . . . . . . . . . . . . . . . . . . 17SUPREP BOWEL PREP KIT . . . . . 71SUSPENDOL-S . . . . . . . . . . . . . . . . . 59SUTENT . . . . . . . . . . . . . . . . . . . . . . . . 29syeda . . . . . . . . . . . . . . . . . . . . . . . . . . . 81SYMDEKO . . . . . . . . . . . . . . . . . . . . . . 93SYMFI . . . . . . . . . . . . . . . . . . . . . . . . . . 15SYMFI LO . . . . . . . . . . . . . . . . . . . . . . 15SYMLINPEN 60 . . . . . . . . . . . . . . . . . 65SYMLINPEN 120 . . . . . . . . . . . . . . . . 65SYMPAZAN . . . . . . . . . . . . . . . . . . . . . 33SYMTUZA . . . . . . . . . . . . . . . . . . . . . . 15SYNAREL . . . . . . . . . . . . . . . . . . . . . . 66SYNERCID . . . . . . . . . . . . . . . . . . . . . 19SYNJARDY . . . . . . . . . . . . . . . . . . . . . 65SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 5-1,000 MG . . . . . . . . . . . . . . . . . . . . . 65SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 25-1,000 MG . . . . . . . . . . . . . . . . . . . . 65SYNRIBO . . . . . . . . . . . . . . . . . . . . . . . 29

stomach relief oral tablet, chewable . . . . . . . . . . . . . . . . . . . . . . . 68stool softener (docusate cal) . . . . . 71stool softener oral capsule 100 mg 71streptomycin . . . . . . . . . . . . . . . . . . . . 19stress b with zinc . . . . . . . . . . . . . . . 109stress formula . . . . . . . . . . . . . . . . . . 109stress formula 600 c . . . . . . . . . . . . 109stress formula with iron . . . . . . . . . 109stress formula with iron(sulf) . . . . . 109STRESS FORMULA WITH ZINC 109STRIBILD . . . . . . . . . . . . . . . . . . . . . . . 15STROVITE FORTE . . . . . . . . . . . . . 109STROVITE ONE . . . . . . . . . . . . . . . 109SUBOXONE SUBLINGUAL FILM 2-0.5 MG . . . . . . . . . . . . . . . . . . 39SUBOXONE SUBLINGUAL FILM 4-1 MG, 8-2 MG . . . . . . . . . . . 40SUBOXONE SUBLINGUAL FILM 12-3 MG . . . . . . . . . . . . . . . . . . . 39subvenite . . . . . . . . . . . . . . . . . . . . . . . 33subvenite starter (blue) kit . . . . . . . . 33subvenite starter (green) kit . . . . . . 33subvenite starter (orange) kit . . . . . 33sucralfate . . . . . . . . . . . . . . . . . . . . . . . 72sudogest . . . . . . . . . . . . . . . . . . . . . . . . 91sudogest 12-hour . . . . . . . . . . . . . . . . 91sudogest pe . . . . . . . . . . . . . . . . . . . . . 91sudogest sinus and allergy . . . . . . . 91sulfacetamide-prednisolone . . . . . . 84sulfacetamide sodium (acne) . . . . . 55sulfacetamide sodium ophthalmic (eye) drops . . . . . . . . . . . 84sulfadiazine . . . . . . . . . . . . . . . . . . . . . 21sulfamethoxazole-trimethoprim intravenous . . . . . . . . . . . . . . . . . . . . . 21sulfamethoxazole-trimethoprim oral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21sulfasalazine . . . . . . . . . . . . . . . . . . . . 71sulindac . . . . . . . . . . . . . . . . . . . . . . . . . 40sumatriptan nasal spray, non-aerosol 5 mg/actuation . . . . . . 34sumatriptan nasal spray, non-aerosol 20 mg/actuation . . . . . 34sumatriptan succinate oral . . . . . . . 34

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tobramycin-dexamethasone . . . . . . 84tobramycin in 0.225% nacl . . . . . . . 19tobramycin ophthalmic (eye) . . . . . 82tobramycin sulfate . . . . . . . . . . . . . . . 19TOBREX OPHTHALMIC (EYE) OINTMENT . . . . . . . . . . . . . . . 82tolcapone . . . . . . . . . . . . . . . . . . . . . . . 34tolnaftate topical cream . . . . . . . . . . 56tolnaftate topical powder . . . . . . . . . 56tolterodine . . . . . . . . . . . . . . . . . . . . . . 94tolvaptan oral tablet 30 mg . . . . . . . 67topiramate oral capsule, sprinkle . 33topiramate oral tablet . . . . . . . . . . . . 33toposar . . . . . . . . . . . . . . . . . . . . . . . . . 30topotecan intravenous recon soln . 30topotecan intravenous solution 4 mg/4 ml (1 mg/ml) . . . . . . . . . . . . . 30toremifene . . . . . . . . . . . . . . . . . . . . . . 30torsemide oral . . . . . . . . . . . . . . . . . . . 49TOUJEO MAX U-300 SOLOSTAR 65TOUJEO SOLOSTAR U-300 INSULIN . . . . . . . . . . . . . . . . . . 65TOVIAZ . . . . . . . . . . . . . . . . . . . . . . . . . 94TPN ELECTROLYTES . . . . . . . . . . . 98TRADJENTA . . . . . . . . . . . . . . . . . . . . 65tramadol-acetaminophen . . . . . . . . . 40tramadol oral tablet 50 mg . . . . . . . 40trandolapril . . . . . . . . . . . . . . . . . . . . . . 49tranexamic acid oral . . . . . . . . . . . . . 77tranylcypromine . . . . . . . . . . . . . . . . . 45TRAVASOL 10% . . . . . . . . . . . . . . . . 99travel sickness . . . . . . . . . . . . . . . . . . 71travel sickness (meclizine) . . . . . . . 71travoprost . . . . . . . . . . . . . . . . . . . . . . . 84TRAZIMERA . . . . . . . . . . . . . . . . . . . . 30trazodone . . . . . . . . . . . . . . . . . . . . . . . 45TREANDA INTRAVENOUS RECON SOLN . . . . . . . . . . . . . . . . . . 30TRECATOR . . . . . . . . . . . . . . . . . . . . . 19TRELEGY ELLIPTA . . . . . . . . . . . . . 93TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION . . . . . . . . . . . . . 30TRESIBA FLEXTOUCH U-100 . . . 65

THALOMID ORAL CAPSULE 200 MG . . . . . . . . . . . . . . 29THEO-24 . . . . . . . . . . . . . . . . . . . . . . . 93theophylline oral tablet extended release 12 hr 300 mg, 450 mg . . . . 93theophylline oral tablet extended release 24 hr . . . . . . . . . . 93theralogix companion . . . . . . . . . . . 110thera-m oral tablet 27-0.4 mg, 9 mg iron-400 mcg . . . 110thera m plus (ferrous fumarat) . . . 110therapeutic liquid . . . . . . . . . . . . . . . 110therapeutic-m oral tablet 9 mg iron-400 mcg . . . . . . . . . . . . . . 110therapeutic-m vitamin/minerals . . 110thera-tabs . . . . . . . . . . . . . . . . . . . . . . 110theratrum complete 50 plus-lyc . . 110theratrum complete with lutein . . . 110therems-m . . . . . . . . . . . . . . . . . . . . . 110thiamine hcl (vitamin b1) oral tablet 100 mg, 250 mg, 50 mg . . . 110thioridazine . . . . . . . . . . . . . . . . . . . . . 45thiotepa . . . . . . . . . . . . . . . . . . . . . . . . . 30thiothixene . . . . . . . . . . . . . . . . . . . . . . 45THYROSAFE . . . . . . . . . . . . . . . . . . . 62tiadylt er . . . . . . . . . . . . . . . . . . . . . . . . 49tiagabine . . . . . . . . . . . . . . . . . . . . . . . . 33TIBSOVO . . . . . . . . . . . . . . . . . . . . . . . 30tigecycline . . . . . . . . . . . . . . . . . . . . . . 19tilia fe . . . . . . . . . . . . . . . . . . . . . . . . . . . 81timolol maleate ophthalmic (eye) drops . . . . . . . . . . . . . . . . . . . . . . 83timolol maleate ophthalmic (eye) gel forming solution . . . . . . . . 83timolol maleate oral . . . . . . . . . . . . . . 49TIOCONAZOLE-1 . . . . . . . . . . . . . . . 77tis-u-sol pentalyte . . . . . . . . . . . . . . . . 58TIVICAY ORAL TABLET 10 MG . . 15TIVICAY ORAL TABLET 25 MG, 50 MG . . . . . . . . . . . . . . . . . . 15TIVICAY PD . . . . . . . . . . . . . . . . . . . . . 15tizanidine . . . . . . . . . . . . . . . . . . . . . . . 36TOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE . . . . . . . . 19

TECFIDERA ORAL CAPSULE, DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46) . . . . . . . 36TECFIDERA ORAL CAPSULE, DELAYED RELEASE(DR/EC) 240 MG . . . . . . . . . . . . . . . . . . . . . . . . . 36TECHLITE PEN NEEDLE . . . . . . . . 65TEFLARO . . . . . . . . . . . . . . . . . . . . . . . 17TEKTURNA HCT . . . . . . . . . . . . . . . . 48telmisartan . . . . . . . . . . . . . . . . . . . . . . 48telmisartan-amlodipine . . . . . . . . . . . 48telmisartan-hydrochlorothiazid . . . . 48temazepam . . . . . . . . . . . . . . . . . . . . . 45TEMIXYS . . . . . . . . . . . . . . . . . . . . . . . 15TEMODAR INTRAVENOUS . . . . . . 29temsirolimus . . . . . . . . . . . . . . . . . . . . 29TENIVAC (PF) INTRAMUSCULAR SYRINGE . . . . 74tenofovir disoproxil fumarate . . . . . 15terazosin oral capsule 1 mg, 2 mg, 5 mg . . . . . . . . . . . . . . . . 48terazosin oral capsule 10 mg . . . . . 49terbinafine hcl oral . . . . . . . . . . . . . . . 12terbinafine hcl topical . . . . . . . . . . . . 56terbutaline . . . . . . . . . . . . . . . . . . . . . . 93terconazole . . . . . . . . . . . . . . . . . . . . . 77TERIPARATIDE . . . . . . . . . . . . . . . . . 75testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml, 200 mg/ml (1 ml) . . . . . 66testosterone enanthate . . . . . . . . . . 66testosterone transdermal gel . . . . . 66testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1%) . . . . . . . . . 67testosterone transdermal gel in packet 1% (25 mg/2.5gram), 1% (50 mg/5 gram) . . . . . . . . . . . . . . 67TETANUS,DIPHTHERIA TOX PED(PF) . . . . . . . . . . . . . . . . . . . 74tetrabenazine oral tablet 12.5 mg . 36tetrabenazine oral tablet 25 mg . . . 36tetracycline . . . . . . . . . . . . . . . . . . . . . . 21THALOMID ORAL CAPSULE 100 MG, 150 MG, 50 MG . . . . . . . . 29

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TYBOST . . . . . . . . . . . . . . . . . . . . . . . . 15tydemy . . . . . . . . . . . . . . . . . . . . . . . . . . 82TYKERB . . . . . . . . . . . . . . . . . . . . . . . . 30TYMLOS . . . . . . . . . . . . . . . . . . . . . . . . 75TYPHIM VI . . . . . . . . . . . . . . . . . . . . . . 74TYSABRI . . . . . . . . . . . . . . . . . . . . . . . 36

Uultimate women’s complete 50+ . 110ULTRA LUBRICANT EYE . . . . . . . . 84ULTRATHON TOPICAL AEROSOL,SPRAY . . . . . . . . . . . . . . 54unicomplex-m . . . . . . . . . . . . . . . . . . 110UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG . . . . . . . . . . . . . . . 67unithroid oral tablet 137 mcg . . . . . 67UNITUXIN . . . . . . . . . . . . . . . . . . . . . . 30UPTRAVI . . . . . . . . . . . . . . . . . . . . . . . 49ursodiol . . . . . . . . . . . . . . . . . . . . . . . . . 71

Vvalacyclovir oral tablet 1 gram . . . . 15valacyclovir oral tablet 500 mg . . . 15VALCHLOR . . . . . . . . . . . . . . . . . . . . . 54valganciclovir . . . . . . . . . . . . . . . . . . . . 15valproate sodium . . . . . . . . . . . . . . . . 33valproic acid . . . . . . . . . . . . . . . . . . . . . 33valproic acid (as sodium salt) oral solution . . . . . . . . . . . . . . . . . . . . . 33valrubicin . . . . . . . . . . . . . . . . . . . . . . . 30valsartan-hydrochlorothiazide . . . . 49valsartan oral tablet 160 mg, 40 mg, 80 mg . . . . . . . . . . . 49valsartan oral tablet 320 mg . . . . . . 49VALTOCO . . . . . . . . . . . . . . . . . . . . . . . 33VANACLEAR PD . . . . . . . . . . . . . . . . 91VANACOF . . . . . . . . . . . . . . . . . . . . . . 91VANACOF DM . . . . . . . . . . . . . . . . . . 91VANACOF DMX . . . . . . . . . . . . . . . . . 91VANALICE . . . . . . . . . . . . . . . . . . . . . . 58VANAMINE PD . . . . . . . . . . . . . . . . . . 91VANATAB DM . . . . . . . . . . . . . . . . . . . 91

tri-nymyo . . . . . . . . . . . . . . . . . . . . . . . . 81triphrocaps . . . . . . . . . . . . . . . . . . . . . 110triple antibiotic plus . . . . . . . . . . . . . . 55triple antibiotic topical ointment . . . 55triple antibiotic topical ointment in packet . . . . . . . . . . . . . . . . . . . . . . . . 55tri-previfem (28) . . . . . . . . . . . . . . . . . 81TRIPROLIDINE HCL. . . . . . . . . . . . . 91TRIPTODUR . . . . . . . . . . . . . . . . . . . . 30tri-sprintec (28) . . . . . . . . . . . . . . . . . . 81TRIUMEQ . . . . . . . . . . . . . . . . . . . . . . . 15TRI-VI-FLOR . . . . . . . . . . . . . . . . . . . 110tri-vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml . . . . . . 110tri-vite with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml . . . . . . 110trivora (28) . . . . . . . . . . . . . . . . . . . . . . 81tri-vylibra . . . . . . . . . . . . . . . . . . . . . . . . 81tri-vylibra lo . . . . . . . . . . . . . . . . . . . . . 81TRODELVY . . . . . . . . . . . . . . . . . . . . . 30TROGARZO . . . . . . . . . . . . . . . . . . . . 15TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 100 MG, 25 MG, 50 MG . . . 33TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 200 MG . . . . . . . . 33TROPHAMINE 10% . . . . . . . . . . . . . 99TRULICITY . . . . . . . . . . . . . . . . . . . . . 65TRUMENBA . . . . . . . . . . . . . . . . . . . . 74TRUVADA . . . . . . . . . . . . . . . . . . . . . . 15TRUXIMA . . . . . . . . . . . . . . . . . . . . . . . 30TUKYSA ORAL TABLET 50 MG . . 30TUKYSA ORAL TABLET 150 MG . 30TURALIO . . . . . . . . . . . . . . . . . . . . . . . 30tussin cf (pe-dm-guaif) . . . . . . . . . . . 91tussin dm cough and chest oral liquid 5-100 mg/5 ml . . . . . . . . . 91tussin dm oral liquid . . . . . . . . . . . . . 91tussin dm oral syrup 10-100 mg/5 ml . . . . . . . . . . . . . . . . . . 91tussin mucus-chest congestion . . . 91TWINRIX (PF) INTRAMUSCULAR SYRINGE . . . . 74TYBLUME . . . . . . . . . . . . . . . . . . . . . . 82

TRESIBA FLEXTOUCH U-200 . . . 65TRESIBA U-100 INSULIN . . . . . . . . 65tretinoin (antineoplastic) . . . . . . . . . . 30tretinoin microspheres . . . . . . . . . . . 55tretinoin topical . . . . . . . . . . . . . . . . . . 55triamcinolone acetonide dental . . . 60triamcinolone acetonide injection suspension 40 mg/ml . . . . . . . . . . . . 62triamcinolone acetonide nasal . . . . 93triamcinolone acetonide topical cream . . . . . . . . . . . . . . . . . . . . 57triamcinolone acetonide topical lotion . . . . . . . . . . . . . . . . . . . . . 57triamcinolone acetonide topical ointment . . . . . . . . . . . . . . . . . 57triamterene-hydrochlorothiazid oral capsule 37.5-25 mg . . . . . . . . . 49triamterene-hydrochlorothiazid oral tablet . . . . . . . . . . . . . . . . . . . . . . . 49tricitrates . . . . . . . . . . . . . . . . . . . . . . . . 94triderm topical cream 0.1% . . . . . . . 57trientine . . . . . . . . . . . . . . . . . . . . . . . . . 59tri-estarylla . . . . . . . . . . . . . . . . . . . . . . 81tri femynor . . . . . . . . . . . . . . . . . . . . . . 81trifluoperazine . . . . . . . . . . . . . . . . . . . 45trifluridine . . . . . . . . . . . . . . . . . . . . . . . 82trihexyphenidyl . . . . . . . . . . . . . . . . . . 34TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-5- 1,000 MG, 25-5-1,000 MG . . . . . . . 65TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 12.5- 2.5-1,000 MG, 5-2.5-1,000 MG . . . 65TRIKAFTA . . . . . . . . . . . . . . . . . . . . . . 93tri-legest fe . . . . . . . . . . . . . . . . . . . . . . 81tri-linyah . . . . . . . . . . . . . . . . . . . . . . . . 81tri-lo-estarylla . . . . . . . . . . . . . . . . . . . . 81tri-lo-marzia . . . . . . . . . . . . . . . . . . . . . 81tri-lo-mili . . . . . . . . . . . . . . . . . . . . . . . . 81tri-lo-sprintec . . . . . . . . . . . . . . . . . . . . 81trilyte with flavor packets . . . . . . . . . 71trimethoprim . . . . . . . . . . . . . . . . . . . . . 21tri-mili . . . . . . . . . . . . . . . . . . . . . . . . . . . 81trimipramine . . . . . . . . . . . . . . . . . . . . . 45TRINTELLIX . . . . . . . . . . . . . . . . . . . . 45

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virt-phos 250 neutral . . . . . . . . . . . . . 98virtussin ac . . . . . . . . . . . . . . . . . . . . . . 91virtussin dac . . . . . . . . . . . . . . . . . . . . . 91VITAL-D RX . . . . . . . . . . . . . . . . . . . . 110vitalee . . . . . . . . . . . . . . . . . . . . . . . . . 111vitalets oral tablet,chewable . . . . . 111vitamin a oral capsule 10,000 unit, 8,000 unit . . . . . . . . . . 111vitamin b-1 . . . . . . . . . . . . . . . . . . . . . 111vitamin b-2 . . . . . . . . . . . . . . . . . . . . . 111vitamin b-6 oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . 111vitamin b-12 oral tablet . . . . . . . . . . 111vitamin b-12 oral tablet extended release 1,000 mcg, 2,000 mcg . . 111vitamin b-12 sublingual tablet 2,500 mcg . . . . . . . . . . . . . . . . . . . . . 111vitamin b complex . . . . . . . . . . . . . . 111vitamin b complex-folic acid oral tablet . . . . . . . . . . . . . . . . . . . . . . 111vitamin c drops . . . . . . . . . . . . . . . . . 111vitamin c oral capsule, extended release . . . . . . . . . . . . . . . 111vitamin c oral powder . . . . . . . . . . . 111vitamin c oral tablet 1,000 mg, 250 mg, 500 mg . . . . . . 111vitamin c oral tablet, chewable 250 mg, 500 mg . . . . . . 111vitamin c oral tablet extended release . . . . . . . . . . . . . . . 111vitamin c with rose hips . . . . . . . . . 111vitamin e acetate . . . . . . . . . . . . . . . 111vitamin e (dl, acetate) oral capsule 100 unit, 400 unit, 450 mg (1,000 unit) . . . . . . . . . . . . . 111VITAMIN E (DL, ACETATE) ORAL DROPS 22.5 MG (50 UNIT)/ML . 111VITAMIN E MIXED ORAL CAPSULE 1,000 UNIT . . . . . . . . . . 111vitamin e mixed oral capsule 400 unit . . . . . . . . . . . . . . . . 111vitamin e oral capsule . . . . . . . . . . . 111VITAMIN E ORAL DROPS . . . . . . 111vitamin k1 injection . . . . . . . . . . . . . . 50vitamins a and d . . . . . . . . . . . . . . . . 111

verapamil oral capsule, ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg . . . . . . . . . 49VERAPAMIL ORAL CAPSULE,EXT REL. PELLETS 24 HR 360 MG . . . 49verapamil oral tablet . . . . . . . . . . . . . 49verapamil oral tablet extended release . . . . . . . . . . . . . . . . 49VERSACLOZ . . . . . . . . . . . . . . . . . . . 45VERZENIO . . . . . . . . . . . . . . . . . . . . . 30V-GO 20 . . . . . . . . . . . . . . . . . . . . . . . . 65V-GO 30 . . . . . . . . . . . . . . . . . . . . . . . . 65V-GO 40 . . . . . . . . . . . . . . . . . . . . . . . . 65vic-forte . . . . . . . . . . . . . . . . . . . . . . . . 110VICTOZA 2-PAK . . . . . . . . . . . . . . . . . 65VICTOZA 3-PAK . . . . . . . . . . . . . . . . . 65vienva . . . . . . . . . . . . . . . . . . . . . . . . . . 82vigabatrin . . . . . . . . . . . . . . . . . . . . . . . 33vigadrone . . . . . . . . . . . . . . . . . . . . . . . 33VIIBRYD ORAL TABLET . . . . . . . . . 45VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23) . . . . 45VIMPAT INTRAVENOUS . . . . . . . . . 33VIMPAT ORAL SOLUTION . . . . . . . 33VIMPAT ORAL TABLET 50 MG . . . 34VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG . . . . . . . . . . . . . . . . . . . . 34vinblastine intravenous solution . . . 30vincasar pfs . . . . . . . . . . . . . . . . . . . . . 30vincristine . . . . . . . . . . . . . . . . . . . . . . . 30vinorelbine . . . . . . . . . . . . . . . . . . . . . . 30VIOKACE ORAL TABLET 10,440-39,150- 39,150 UNIT . . . . . 71VIOKACE ORAL TABLET 20,880-78,300- 78,300 UNIT . . . . . 71viorele (28) . . . . . . . . . . . . . . . . . . . . . . 82VIRACEPT ORAL TABLET 250 MG . . . . . . . . . . . . . . . . . . . . . . . . . 15VIRACEPT ORAL TABLET 625 MG . . . . . . . . . . . . . . . . . . . . . . . . . 15VIREAD ORAL POWDER . . . . . . . . 15VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG . . . . . . . 16VIRT-CAPS . . . . . . . . . . . . . . . . . . . . 110virt-gard . . . . . . . . . . . . . . . . . . . . . . . . 110

VANCOMYCIN IN 0.9% SODIUM CHL INTRAVENOUS PIGGYBACK . . . . 19VANCOMYCIN IN DEXTROSE 5% INTRAVENOUS PIGGYBACK 19VANCOMYCIN INJECTION . . . . . . 20vancomycin intravenous recon soln 1,000 mg, 10 gram, 250 mg, 5 gram, 500 mg, 750 mg . . . . . . . . . 20VANCOMYCIN INTRAVENOUS RECON SOLN 1.25 GRAM, 1.5 GRAM . . . . . . . . . . . . . . . . . . . . . . 20vancomycin oral capsule 125 mg . 20vancomycin oral capsule 250 mg . 20vancomycin oral recon soln . . . . . . 20VANCOMYCIN-WATER INJECT (PEG) . . . . . . . . . . . . . . . . . . 20vandazole . . . . . . . . . . . . . . . . . . . . . . . 77VAQTA (PF) . . . . . . . . . . . . . . . . . . . . . 74VARIVAX (PF) . . . . . . . . . . . . . . . . . . . 74VARIZIG INTRAMUSCULAR SOLUTION . . . . . . . . . . . . . . . . . . . . . 74VASCEPA . . . . . . . . . . . . . . . . . . . . . . . 51v-c forte . . . . . . . . . . . . . . . . . . . . . . . . 110VECTIBIX . . . . . . . . . . . . . . . . . . . . . . . 30VELCADE . . . . . . . . . . . . . . . . . . . . . . 30velivet triphasic regimen (28) . . . . . 82VELTASSA . . . . . . . . . . . . . . . . . . . . . . 59VEMLIDY . . . . . . . . . . . . . . . . . . . . . . . 15VENCLEXTA ORAL TABLET 10 MG . . . . . . . . . . . . . . . . . 30VENCLEXTA ORAL TABLET 50 MG . . . . . . . . . . . . . . . . . 30VENCLEXTA ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 30VENCLEXTA STARTING PACK . . 30venlafaxine oral capsule, extended release 24hr . . . . . . . . . . . 45venlafaxine oral tablet . . . . . . . . . . . . 45VENTAVIS . . . . . . . . . . . . . . . . . . . . . . 93VENTOLIN HFA . . . . . . . . . . . . . . . . . 93verapamil intravenous solution . . . 49verapamil oral capsule, 24 hr er pellet ct . . . . . . . . . . . . . . . . . 49

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XOPENEX CONCENTRATE . . . . . 94XOSPATA . . . . . . . . . . . . . . . . . . . . . . . 31XPOVIO . . . . . . . . . . . . . . . . . . . . . . . . 31XTAMPZA ER . . . . . . . . . . . . . . . . . . . 38XTANDI . . . . . . . . . . . . . . . . . . . . . . . . . 31XULTOPHY 100/3.6 . . . . . . . . . . . . . 65XYREM . . . . . . . . . . . . . . . . . . . . . . . . . 45

Yyelets . . . . . . . . . . . . . . . . . . . . . . . . . . 112YERVOY . . . . . . . . . . . . . . . . . . . . . . . . 31YF-VAX (PF) . . . . . . . . . . . . . . . . . . . . 74YONDELIS . . . . . . . . . . . . . . . . . . . . . . 31YUPELRI . . . . . . . . . . . . . . . . . . . . . . . 94yuvafem . . . . . . . . . . . . . . . . . . . . . . . . 77

Zzafirlukast . . . . . . . . . . . . . . . . . . . . . . . 94zaleplon oral capsule 5 mg . . . . . . . 45zaleplon oral capsule 10 mg . . . . . . 45ZALTRAP . . . . . . . . . . . . . . . . . . . . . . . 31ZANOSAR . . . . . . . . . . . . . . . . . . . . . . 31zarah . . . . . . . . . . . . . . . . . . . . . . . . . . . 82ZARXIO . . . . . . . . . . . . . . . . . . . . . . . . 73Z-BUM . . . . . . . . . . . . . . . . . . . . . . . . . . 54ZEJULA . . . . . . . . . . . . . . . . . . . . . . . . 31ZELBORAF . . . . . . . . . . . . . . . . . . . . . 31ZEMAIRA . . . . . . . . . . . . . . . . . . . . . . . 59zenatane . . . . . . . . . . . . . . . . . . . . . . . . 55ZENPEP ORAL CAPSULE, DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT . . . . . . 71ZEPZELCA . . . . . . . . . . . . . . . . . . . . . 31zidovudine oral capsule . . . . . . . . . . 16zidovudine oral syrup . . . . . . . . . . . . 16zidovudine oral tablet . . . . . . . . . . . . 16ZIEXTENZO . . . . . . . . . . . . . . . . . . . . 73zinc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98ZINC-15 . . . . . . . . . . . . . . . . . . . . . . . . 98zinc-220 . . . . . . . . . . . . . . . . . . . . . . . . 98

wera (28) . . . . . . . . . . . . . . . . . . . . . . . 82westab max . . . . . . . . . . . . . . . . . . . . 112westab mini . . . . . . . . . . . . . . . . . . . . 112westab one . . . . . . . . . . . . . . . . . . . . 112WEST-VITE WITH FOLIC ACID . 112white petrolatum topical ointment . 54wixela inhub . . . . . . . . . . . . . . . . . . . . . 93WOMEN’S DAILY FORMULA ORAL TABLET 18 MG IRON- 400 MCG-500 MG CA . . . . . . . . . . 112women’s daily formula oral tablet 27-0.4 mg . . . . . . . . . . . . 112WOMEN’S ONE DAILY . . . . . . . . . 112wymzya fe . . . . . . . . . . . . . . . . . . . . . . 82

XXALKORI . . . . . . . . . . . . . . . . . . . . . . . 30XARELTO . . . . . . . . . . . . . . . . . . . . . . . 50XARELTO DVT-PE TREAT 30D START . . . . . . . . . . . . . . 50XATMEP . . . . . . . . . . . . . . . . . . . . . . . . 31XCOPRI . . . . . . . . . . . . . . . . . . . . . . . . 34XCOPRI MAINTENANCE PACK . . 34XCOPRI TITRATION PACK . . . . . . 34XELJANZ . . . . . . . . . . . . . . . . . . . . . . . 76XELJANZ XR . . . . . . . . . . . . . . . . . . . 76XGEVA . . . . . . . . . . . . . . . . . . . . . . . . . 22XHANCE . . . . . . . . . . . . . . . . . . . . . . . . 93XIAFLEX . . . . . . . . . . . . . . . . . . . . . . . . 59XIFAXAN ORAL TABLET 550 MG . 20XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG, 5-500 MG . . . . . . . . . . . . . . . . . . . . . . . 65XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 10-500 MG . . . . . . . . 65XIIDRA . . . . . . . . . . . . . . . . . . . . . . . . . 84XOFLUZA . . . . . . . . . . . . . . . . . . . . . . . 16XOLAIR SUBCUTANEOUS RECON SOLN . . . . . . . . . . . . . . . . . . 93XOLAIR SUBCUTANEOUS SYRINGE 75 MG/0.5 ML . . . . . . . . . 93XOLAIR SUBCUTANEOUS SYRINGE 150 MG/ML . . . . . . . . . . . 93XOPENEX . . . . . . . . . . . . . . . . . . . . . . 94

vitamins a,c,d and fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml . 111vitamins and minerals . . . . . . . . . . . 111vitamins b complex oral capsule . 111vitamins b complex oral tablet . . . 111VITAMINS B COMPLEX ORAL TABLET 500 MG- 400 MCG- 18 MG IRON . . . . . . . . 111vitamins for hair oral tablet . . . . . . 111VIT A PALMITATE-VIT C-VIT D3 . 110VITA-RESPA . . . . . . . . . . . . . . . . . . . 111vitatrum . . . . . . . . . . . . . . . . . . . . . . . . 112VIT C(ASCORB.CALCIUM)(MV-MINS) . . . . . . . . . . . . . . . . . . . . . 110VITRAKVI ORAL CAPSULE 25 MG . . . . . . . . . . . . . . . 30VITRAKVI ORAL CAPSULE 100 MG . . . . . . . . . . . . . . 30VITRAKVI ORAL SOLUTION . . . . . 30VITRUM SENIOR ORAL TABLET 500-300-250 MCG . . . . . 112vits a and d-white pet-lanolin topical ointment . . . . . . . . . . . . . . . . . 54VIVITROL . . . . . . . . . . . . . . . . . . . . . . . 40VIZIMPRO . . . . . . . . . . . . . . . . . . . . . . 30volnea (28) . . . . . . . . . . . . . . . . . . . . . . 82voriconazole intravenous . . . . . . . . . 12voriconazole oral suspension for reconstitution . . . . . . . . . . . . . . . . . 12voriconazole oral tablet 50 mg . . . . 12voriconazole oral tablet 200 mg . . . 12VOSEVI . . . . . . . . . . . . . . . . . . . . . . . . 16VOTRIENT . . . . . . . . . . . . . . . . . . . . . . 30vp-vite rx . . . . . . . . . . . . . . . . . . . . . . . 112VRAYLAR ORAL CAPSULE . . . . . . 45VRAYLAR ORAL CAPSULE, DOSE PACK . . . . . . . . . . . . . . . . . . . . 45vyfemla (28) . . . . . . . . . . . . . . . . . . . . . 82vylibra . . . . . . . . . . . . . . . . . . . . . . . . . . 82VYNDAQEL . . . . . . . . . . . . . . . . . . . . . 51VYXEOS . . . . . . . . . . . . . . . . . . . . . . . . 30

Wwarfarin . . . . . . . . . . . . . . . . . . . . . . . . . 50water for irrigation, sterile . . . . . . . . 59wee care . . . . . . . . . . . . . . . . . . . . . . . 112

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ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG . . . . . . . . . . . . . . . . . . . . . . . . . 45ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 300 MG, 405 MG . . . . . . . . . . . . . . . . 45

ZINC GLUCONATE ORAL LOZENGE . . . . . . . . . . . . . . . . 98zinc gluconate oral tablet . . . . . . . . . 98zinc oxide topical ointment 20%, 25% . . . . . . . . . . . . . . . . . . . . . . . 54zinc sulfate oral . . . . . . . . . . . . . . . . . . 98ZINC (WITH A AND C) LOZENGES . . . . . . . . . . . . . . . . . . . . 112ziprasidone hcl . . . . . . . . . . . . . . . . . . 45ziprasidone mesylate . . . . . . . . . . . . 45ZIRABEV . . . . . . . . . . . . . . . . . . . . . . . 31ZIRGAN . . . . . . . . . . . . . . . . . . . . . . . . 83ZOLADEX . . . . . . . . . . . . . . . . . . . . . . 31zoledronic acid intravenous solution . . . . . . . . . . . . . 67zoledronic acid-mannitol-water intravenous piggyback 4 mg/100 ml . . . . . . . . . . . . . . . . . . . . . 67zoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml . . . . . . . . . . . . . . . . . . . . . 60ZOLEDRONIC AC- MANNITOL-0.9NACL . . . . . . . . . . . . 67ZOLINZA . . . . . . . . . . . . . . . . . . . . . . . 31zolpidem oral tablet . . . . . . . . . . . . . . 45zonisamide . . . . . . . . . . . . . . . . . . . . . . 34ZORTRESS ORAL TABLET 1 MG . . . . . . . . . . . . . . . . . . . 31ZOSTAVAX (PF) . . . . . . . . . . . . . . . . . 74ZOSYN IN DEXTROSE (ISO-OSM) . . . . . . . . . . . . . . . . . . . . . . 20zovia 1-35 (28) . . . . . . . . . . . . . . . . . . 82zovia 1/35e (28) . . . . . . . . . . . . . . . . . 82ZTLIDO . . . . . . . . . . . . . . . . . . . . . . . . . 54ZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 1.4-0.36 MG, 11.4-2.9 MG, 2.9-0.71 MG, 5.7-1.4 MG . . . . . . . . . 40ZUBSOLV SUBLINGUAL TABLET 8.6-2.1 MG . . . . . . . . . . . . . 40zumandimine (28) . . . . . . . . . . . . . . . 82ZYDELIG . . . . . . . . . . . . . . . . . . . . . . . 31ZYKADIA ORAL TABLET . . . . . . . . 31ZYLET . . . . . . . . . . . . . . . . . . . . . . . . . . 84

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Updated on 02/01/2021. For more information or other questions, please contact Cigna CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week, 8 a.m. to 8 p.m. Central Time, or visit careplantx.cigna.com.HPMS Approved Formulary File Submission ID 21125, Version Number 8 952036b

LIST OF COVERED DRUGS (FORMULARY) 2021 · 2020. 9. 28. · he drugs on the List of Covered Drugs...

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